Archives of Cardiovascular Diseases最新文献_第6页

Spontaneous coronary artery dissection vs atherosclerostic acute coronary syndrome: A propensity-matched study of long-term prognosis 自发性冠状动脉剥离vs动脉粥样硬化性急性冠状动脉综合征：长期预后的倾向匹配研究

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.2025.10.011

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。

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引用次数: 0

Surgical revascularization in acute coronary syndromes: Seven-years single center experience 急性冠脉综合征的外科血运重建术：7年单中心经验

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.2025.10.019

M. Laali , C. D’Alessandro , S. Manzo-Silberman , R. Choussat , D. Pichoy , C. Juvin , G. Lebreton , P. Leprince

Introduction

In Acute Coronary Syndromes (ACS) urgent Coronary Artery Bypass Grafting (CABG) is infrequently performed. Percutaneous Coronary Interventions (PCI) are the preferred option because they are more expeditious, while CABG is usually reserved for cases where PCI is not feasible or unsuccessful.

Objective

We reviewed our seven-year experience in patients undergoing CABG for ACS according to perioperative characteristics and urgency status.

Method

A single center retrospective analysis included 2076 patients undergoing CABG between 2018 and 2024. Patients were divided into three groups according to their EuroSCORE II Urgency Status: Elective (n = 1322), Urgent (n = 663), Emergency (n = 88).

Patients’ data and outcomes were extracted from the French Society of Thoracic and Cardiovascular Surgery database (EPICARD). Primary end-point was the occurrence of Major Adverse Cardiac Events (MACE), including coronary graft malfunction, perioperative myocardial infarction, cardiac arrest, the need for extra-corporeal membrane oxygenation (ECMO) or Intra-Aortic Balloon Pump (IABP) and in-hospital mortality.

Results

Preoperative characteristics, operative data and postoperative outcomes are resumed in Fig. 1a. Even if MACE occurrence was concordant with urgency status (2.9% in elective, 7.4% in urgent, 18% in emergency patients, P < 0.001), urgency status alone was not significantly associated with adverse events at multivariate analysis (Urgent vs Elective OR 1.59 [0.948; 2.66], P = 0.076; Emergency vs Elective OR 0.974 [0.339; 2.53], P = 0.96). Forestplot of independent predictive risk factors for MACE occurrence at multivariate analysis is shown in Fig. 1b: previous PCI (OR 1.79 [1.11; 2.85], P = 0.015), Left Main Disease (LMD) (OR 1.83 [1.15; 2.95], P = 0.012), critical preoperative status (OR 4.12 [1.40; 11.7], P < 0.01), EuroSCORE II, (OR 1.16 [1.08; 1.24], P < 0.001) and number of grafts (OR 0.766 [0.604; 0.969], P = 0.027).

Conclusion

In our recent experience, surgical revascularization for ACS can be performed in the emergency setting with satisfactory outcomes. The occurrence of MACE appears to depend more on the clinical presentation and risk profile of the patient than on the urgency status alone. On-pump total arterial revascularization can be performed safely and complete revascularization may protect against adverse events.

在急性冠状动脉综合征（ACS）中，紧急冠状动脉旁路移植术（CABG）很少被实施。经皮冠状动脉介入治疗（PCI）是首选的选择，因为它更迅速，而CABG通常保留在PCI不可行或不成功的情况下。目的根据ACS患者的围手术期特点和紧急情况，回顾我院7年冠脉搭桥治疗经验。方法采用单中心回顾性分析方法，纳入2018 - 2024年行冠脉搭桥术的2076例患者。根据患者的EuroSCORE II紧急状态将患者分为三组：择期（n = 1322）、紧急（n = 663）、紧急（n = 88）。患者数据和结果从法国胸心血管外科学会数据库（EPICARD）中提取。主要终点是主要心脏不良事件（MACE）的发生，包括冠状动脉移植物功能障碍、围手术期心肌梗死、心脏骤停、体外膜氧合（ECMO）或主动脉内球囊泵（IABP）的需要以及住院死亡率。结果术前特征、手术数据和术后结果见图1a。即使MACE的发生与紧急状态一致（择期患者为2.9%，紧急患者为7.4%，急诊患者为18%，P < 0.001），多因素分析显示，单独的紧急状态与不良事件没有显著相关性（紧急vs择期OR 1.59 [0.948; 2.66], P = 0.076；紧急vs择期OR 0.974 [0.339; 2.53], P = 0.96）。多因素分析中MACE发生的独立预测危险因素的森林图如图1b所示：既往PCI （OR 1.79 [1.11; 2.85], P = 0.015）、左主干疾病（LMD）（OR 1.83 [1.15; 2.95], P = 0.012）、关键术前状态（OR 4.12 [1.40; 11.7], P < 0.01）、EuroSCORE II （OR 1.16 [1.08; 1.24], P < 0.001）和移植物数量（OR 0.766 [0.604; 0.969], P = 0.027）。结论根据我们最近的经验，急性冠脉综合征的外科血运重建术可以在急诊进行，效果满意。MACE的发生似乎更多地取决于患者的临床表现和风险概况，而不仅仅是紧急状态。无泵全动脉血运重建术可以安全地进行，完全血运重建术可以防止不良事件的发生。

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引用次数: 0

Sex-based differences in phenotypic expression and prognosis of hereditary transthyretin cardiac amyloidosis associated with the Val122Ile mutation 与Val122Ile突变相关的遗传性转甲状腺素心脏淀粉样变性的表型表达和预后的性别差异

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.2025.10.088

A. Monfort , T. Damy , M. Kharoubi , P. Réant , P. Charron , F. Roubille , J.C. Eicher , A. Hagège , B. Funalot , O. Lairez , J. Inamo , A. Zaroui

Introduction

Transthyretin cardiac amyloidosis (ATTR-CA) is an under-recognized cause of heart failure with preserved ejection fraction (HFpEF), resulting from either the wild-type (ATTRwt) or hereditary form (ATTRv). In France, the valine-to-isoleucine substitution (Val122Ile) is the most common inherited variant.

Objective

Difference on gender differences in phenotype, prognosis, and the impact of tafamidis treatment in patients with Val122Ile-associated ATTR-CA remain limited.

Method

From the 5151 ATTR patients of the Healthcare European Amyloidosis Registry (HEAR,) 830 (16.1%) patients were ATTRv of whom and 513(9.9%) were patients with symptomatic ATTRv Val122Ile, the rest were ATTRv asymptomatic carriers (167 (3.2%)) and other type of ATTRv mutation. Gender differences in clinical presentation, echocardiographic parameters at diagnosis, and prognosis were assessed.

Results

150 (29.2%) were women and they were significantly older at diagnosis than men (83 [77–87] years vs. 77 [72–82] years; P < 0.001). Neuropathy symptoms, including carpal tunnel syndrome, were more frequent in women. Women also had lower septal wall thickness than men, even after adjusting for body mass index. Regarding left ventricular function, women exhibited higher LVEF and longitudinal strain (GLS) compared than men (LVEF: 54 [44–62] vs. 48 [38–56]; GLS: -10.6 [8.7–13.1 9.7] vs. −7.5–12.4]; P = 0.001 and P = 0.003, respectively). While NT-proBNP and troponinT HS levels were similar between genders, bilirubin levels were lower in women than men. The 48-month mortality rate did not differ significantly between women and men (74% vs. 63%; P = 0.07). Among the 430 (83.8) patients receiving treatment, the therapeutic benefit was consistent across genders. Women had significantly better 48-month survival than men (81% vs. 69%; P = 0.02). The adjusted 48-month mortality risk for women treated with Tafamidis was 0.452 [0.332–0.614] vs 0.767 [0.356–0.877] for men, P = 0.02.

Conclusion

ATTR Val122Ile women are underrepresented in this hereditary disease, are diagnosed at an older age and exhibit a different extracardiac phenotype, better cardiac function, and improved prognosis with or without treatment compared to men.

转甲状腺素型心脏淀粉样变性（atr - ca）是一种未被充分认识的导致保留射血分数（HFpEF）心力衰竭的原因，由野生型（ATTRwt）或遗传型（ATTRv）引起。在法国，缬氨酸-异亮氨酸取代（Val122Ile）是最常见的遗传变异。目的：性别差异在val122ile相关atr - ca患者的表型、预后和他非他汀治疗的影响方面的差异仍然有限。方法在欧洲淀粉样变性登记（HEAR）的5151例ATTR患者中，有830例（16.1%）为ATTRv，其中有症状的ATTRv Val122Ile患者513例（9.9%），其余为ATTRv无症状携带者（167例（3.2%））和其他类型的ATTRv突变。评估临床表现、诊断时超声心动图参数和预后的性别差异。结果150例（29.2%）为女性，确诊时年龄明显大于男性（83[77 - 87]岁vs. 77[72-82]岁；P < 0.001）。神经病变症状，包括腕管综合征，在女性中更为常见。女性的间隔壁厚度也比男性低，即使在调整了体重指数之后也是如此。在左心室功能方面，女性的LVEF和纵向应变（GLS）高于男性（LVEF: 54[44-62]比48 [38-56]；GLS: -10.6[8.7-13.1 9.7]比- 7.5-12.4];P = 0.001和P = 0.003）。虽然NT-proBNP和troponinT HS水平在性别之间相似，但女性的胆红素水平低于男性。48个月死亡率在男性和女性之间没有显著差异（74% vs. 63%; P = 0.07）。在接受治疗的430例（83.8例）患者中，治疗效果在性别上是一致的。女性的48个月生存率明显高于男性（81% vs. 69%; P = 0.02）。经校正后的48个月死亡风险，男性为0.767[0.356-0.877]，女性为0.452 [0.332-0.614],P = 0.02。结论：与男性相比，女性在这种遗传性疾病中的代表性不足，诊断年龄较大，表现出不同的心外表型，心功能更好，治疗或不治疗的预后更好。

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引用次数: 0

Predictive factors of cardiogenic shock in patients with Acute Coronary Syndrome (ACS) 急性冠脉综合征（ACS）患者心源性休克的预测因素

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.2025.10.042

Y. El Grini, H. Dahmani, A. Islam, L. Oukerraj, M. Cherti

Introduction

Cardiogenic shock is a serious and potentially fatal complication in patients with acute coronary syndrome, often developing unpredictably. This study aims to identify independent predictive factors of cardiogenic shock in patients with ACS.

Objective

Early diagnosis and rapid, appropriate management in high-risk patients in order to improve prognosis.

Method

This is a retrospective, analytical, and comparative study conducted in a single center. It includes 156 patients hospitalized for ACS between January 2024 and December 2024 in the cardiology department B of IBN SINA University Hospital. Patients presenting with cardiogenic shock at admission were excluded. The population was divided into two groups: the ‘shock’ group, consisting of patients who developed cardiogenic shock during hospitalization, and the ‘non-shock’ group, without cardiogenic shock. The clinical characteristics and outcomes of the two groups were compared.

Results

Among the 156 patients included, 12 (7.8%) developed cardiogenic shock. The main predictive factors identified were:.

•
the presence of acute heart failure at admission;
•
a GRACE score ≥ 140;
•
a left ventricular ejection fraction < 50%;
•
eccentric left ventricular hypertrophy;
•
right ventricular dysfunction;
•
patients in the ‘shock’ group had a higher rate of complications and increased mortality.

Conclusion

Cardiogenic shock occurring in the context of acute coronary syndrome is associated with a poor prognosis, marked by increased mortality. These findings highlight the importance of early diagnosis and rapid, appropriate management in high-risk patients in order to improve clinical outcomes.

心源性休克是急性冠状动脉综合征患者中一种严重且可能致命的并发症，其发展往往不可预测。本研究旨在确定ACS患者心源性休克的独立预测因素。目的对高危患者进行早期诊断和快速、合理的处理，以改善预后。方法采用单中心回顾性、分析性和比较性研究。该研究包括2024年1月至2024年12月在IBN SINA大学医院心内科B科因ACS住院的156例患者。排除入院时出现心源性休克的患者。人群被分为两组：“休克”组，由住院期间发生心源性休克的患者组成；“非休克”组，没有心源性休克。比较两组患者的临床特点及预后。结果156例患者中发生心源性休克12例（7.8%）。确定的主要预测因素有：•入院时出现急性心力衰竭；GRACE评分≥140分；•左心室射血分数<； 50%；•偏心左心室肥厚；•右心室功能障碍；•休克组的患者并发症发生率更高，死亡率也更高。结论急性冠状动脉综合征并发心源性休克预后差，死亡率增高。这些发现强调了对高危患者进行早期诊断和快速、适当管理以改善临床结果的重要性。

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引用次数: 0

Acknowledging our reviewers 感谢我们的审稿人

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.2026.01.005

引用次数: 0

Mental health as a predictor of cardiovascular outcomes in coronary artery disease 心理健康作为冠状动脉疾病心血管结局的预测因子

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.2025.10.029

Y. Ayadi , S. Charfeddine , A. Ghrab , M. Jabeur , T. Ellouze , R. Gargouri , Z. Triki , F. Triki , A. Bahloul , L. Abid

Introduction

Psychological distress—such as anxiety, depression, and stress—is common in coronary artery disease (CAD) and contributes to worse outcomes, yet it is often overlooked in standard cardiac care.

Objective

To assess the relationship between mental health disorders and clinical outcomes in CAD patients, and to compare findings between acute coronary syndrome (ACS) and chronic coronary syndrome (CCS) groups.

Method

This prospective study was conducted between Novembre 2023 and April 2025 at the Department of Cardiology in a tertiary care center. We included patients with CAD admitted for ACS, those undergoing coronary angiography (CAG) for CCS, and patients seen in routine follow-up. Stress, anxiety, and depression were assessed using the PSS, GAD-7, and PHQ-9 scales, respectively. We aim to compare the characteristics of the two groups: ACS and CCS. Patients were followed for a period ranging from 9 months to 1 year after inclusion. Major adverse cardiovascular events (MACE) were recorded. Psychological scores were monitored over the follow-up period.

Results

This study included 51 patients with a mean age of 57.86 years. No significant differences were found between the ACS and CCS groups regarding Cardiovscular Risk Factors. However, sedentarity was more prevalent in the CCS group (P = 0.03). Both anxiety (GAD-7 ≥ 9) (P = 0.024) and depression (PHQ-9 ≥ 9) (P = 0.020) were significantly more prevalent in the ACS group than in the CCS group, whereas stress levels (PSS ≥ 15), although higher in ACS, did not differ significantly (P = 0.44) (Fig. 1). Over the 9–12-month follow-up, the prevalence of depression, anxiety and stress declined. However, persistent depression was significantly associated with major adverse cardiovascular outcomes (ACVo) (P = 0.041) while anxiety and stress were not (P = 0.43 and 0.59, respectively). Treatment non-adherence tended to cluster with psychological distress—83%had at least one elevated score—but this trend did not reach statistical significance (P = 0.13).

Conclusion

CAD patients, particularly with ACS, face significant psychological challenges. Persistent depression predicts ACVo. Mental health integration in CAD care may improve overall prognosis, warranting further research.

心理困扰——如焦虑、抑郁和压力——在冠状动脉疾病（CAD）中很常见，并导致较差的结果，但在标准的心脏护理中经常被忽视。目的探讨冠心病患者心理健康障碍与临床转归的关系，并比较急性冠脉综合征（ACS）组与慢性冠脉综合征（CCS）组的差异。方法本前瞻性研究于2023年11月至2025年4月在某三级保健中心心内科进行。我们纳入了因ACS入院的CAD患者，因CCS接受冠状动脉造影（CAG）的患者，以及常规随访的患者。压力、焦虑和抑郁分别使用PSS、GAD-7和PHQ-9量表进行评估。我们的目的是比较两组的特点：ACS和CCS。纳入后对患者进行了9个月至1年的随访。记录主要不良心血管事件（MACE）。在随访期间监测心理得分。结果纳入51例患者，平均年龄57.86岁。在心血管危险因素方面，ACS组和CCS组之间没有发现显著差异。然而，在CCS组中，久坐不动更为普遍（P = 0.03）。焦虑（GAD-7≥9）（P = 0.024）和抑郁（PHQ-9≥9）（P = 0.020）在ACS组中明显高于CCS组，而应激水平（PSS≥15）虽然在ACS组中较高，但没有显著差异（P = 0.44）（图1）。在9 - 12个月的随访中，抑郁、焦虑和压力的患病率有所下降。然而，持续抑郁与主要不良心血管结局（ACVo）显著相关（P = 0.041），而焦虑和压力则无显著相关性（P分别= 0.43和0.59）。治疗不依从倾向于与心理困扰聚集在一起- 83%的患者至少有一次得分升高-但这种趋势没有达到统计学意义（P = 0.13）。结论cad患者，尤其是ACS患者，面临着巨大的心理挑战。持续抑郁预示着ACVo。将心理健康整合到CAD护理中可能改善整体预后，值得进一步研究。

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引用次数: 0

PHM Ratio < 0.82 predicts mortality after heart transplant: Evidence from the French CRISTAL Cohort PHM比值< 0.82预测心脏移植后死亡率：来自法国CRISTAL队列的证据

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.2025.10.056

A. Buschiazzo , G. Lebreton , R. Dorent , E. Flécher , A. Vincentelli , J.-C. Roussel , T. Senage , C.-H. David

Introduction

Predicted heart Mass (PHM) is recommended to assess donor-recipient size matching and predict mortality after heart transplant, based on the UNOS Cohort. UNOS and French cohort presents differences regarding donors and recipients. UNOS and French cohort presents differences regarding donors and recipients.

Objective

To ensure that PHM accurately predicts mortality following heart transplant in France, we assessed survival according to PHM ratio, compared to conventional metrics, in the French cohort.

Method

We analyzed data from the CRISTAL registry (2000–2018), including 5091 heart transplant recipients. For each matching metric, the cohort was divided into 11 equal strata. Survival was assessed at 1 month and 3 years using Kaplan-Meier estimators. Multivariate Cox models were used to compute hazard ratios.

Results

A PHM ratio < 0.825 was associated with significantly increased 1-month mortality (HR 1.45; 95% CI 1.09–2.03; P = 0.044) and 3-year mortality (HR 1.21; 95% CI 1.05–1.39; P = 0.001). No other size-matching metric showed increased risk at 1 month. At 3 years, undersized BSA ratio was also associated with higher mortality (HR 1.66; 95% CI 1.15–2.40; P = 0.034), while other metrics were not significant (Fig. 1).

Conclusion

The PHM ratio is a robust predictor of post-transplant mortality in the French population. We identified a lower threshold (< 0.82) than previously reported, which could enhance donor-recipient matching strategies in France.

基于UNOS队列，推荐使用预测心脏质量（PHM）来评估供体-受体大小匹配和预测心脏移植后的死亡率。UNOS和法国队列在捐赠者和接受者方面存在差异。UNOS和法国队列在捐赠者和接受者方面存在差异。目的：为了确保PHM准确预测法国心脏移植后的死亡率，与传统指标相比，我们根据PHM比率评估法国队列的生存率。方法：我们分析CRISTAL登记处（2000-2018）的数据，包括5091名心脏移植受者。对于每一个匹配的指标，队列被分成11个相等的阶层。使用Kaplan-Meier估计器评估1个月和3年的生存率。多变量Cox模型用于计算风险比。结果sa PHM比0.825与1个月死亡率（HR 1.45; 95% CI 1.09 ~ 2.03; P = 0.044）和3年死亡率（HR 1.21; 95% CI 1.05 ~ 1.39; P = 0.001）显著升高相关。没有其他尺寸匹配指标显示1个月时风险增加。在3年时，过低的BSA比率也与较高的死亡率相关（HR 1.66; 95% CI 1.15-2.40; P = 0.034），而其他指标则不显著（图1）。结论PHM比值是预测法国人群移植后死亡率的可靠指标。我们确定了比以前报道的更低的阈值（< 0.82），这可以增强法国的供体-受者匹配策略。

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引用次数: 0

Molecular diagnostic classification for heart allograft rejection: A validated and automated system 同种异体心脏移植排斥反应的分子诊断分类：一个经过验证的自动化系统

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.2025.10.058

G. Coutance , A. Giarraputo , J. Patel , M. Fedrigo , S. Varnous , J.-P. Duong , J. Dagobert , P. Rouvier , P. Leprince , P. Achouh , X. Jouven , P. Bruneval , A. Angelini , J. Kobashigawa , A. Loupy

Introduction

Endomyocardial biopsies (EMB) gene expression profiling is a promising companion tool for rejection diagnosis after heart transplantation. We developped and validated a tissular-based molecular diagnostic system of cardiac allograft rejection.

Objective

Our aim to design an automated report accessible for routine application in clinical practice to support diagnosis of rejection after heart transplantation.

Method

We performed a multicenter, retrospective study (NCT06436027), collecting 591 FFPE-EMBs between 2011 and 2021 representative of the landscape of rejection (antibody-mediated rejection-AMR, n = 188; acute cellular rejection-ACR, n = 289; non-rejection, n = 114). Tissue gene expression was analyzed using the consensus Banff Human Organ Transplant gene panel. Molecular classifiers for AMR and ACR were built using a supervised model, assessing thoroughly the performance. An automated molecular report was developed to provide a comprehensive visualization for clinical use.

Results

In the validation cohort (n = 116), the molecular classifiers demonstrated strong diagnostic performance: AMR detection achieved an accuracy of 81.89% (ROC-AUC = 0.831, Brier score = 0.143), while ACR detection achieved 77.58% accuracy (ROC-AUC = 0.812, Brier score = 0.176). The molecular report provided real-time assessment of molecular-based rejection scores, while allowing to contextualize a novel biopsy within the reference set rejection landscape (Fig. 1). In addition to delivering quantitative scores for AMR and ACR, clinical and biological information are recapitulated in each report, correlating the molecular findings with the pathophysiological insights from primary molecular pathways involved. This tool captured subtle molecular signals in cases of early or sub-clinical rejection, offering insights into potential risks even when histology was inconclusive. The automated nature of the report minimizes variability and considerably reduces turnaround time, seamlessly integrating into clinical workflows.

Conclusion

The molecular diagnostic system, validated and supported by an automated report, demonstrated high reproducibility and reliability in identifying cardiac rejection. This system can complement standard pathology, reduce diagnostic uncertainty, and serve as a practical companion tool in the clinical management of heart transplant patients, ensuring timely and accurate diagnosis.

心内膜肌活检（EMB）基因表达谱是心脏移植后排异反应诊断的一种很有前景的辅助工具。我们开发并验证了一种基于组织的心脏异体移植排斥反应分子诊断系统。目的设计一种可用于临床常规应用的心脏移植术后排斥反应诊断的自动报告。方法我们进行了一项多中心回顾性研究（NCT06436027），收集了2011年至2021年间591例具有排斥反应特征的FFPE-EMBs（抗体介导的排斥反应amr， n = 188；急性细胞排斥反应acr， n = 289；非排斥反应，n = 114）。组织基因表达分析使用共识班夫人类器官移植基因面板。AMR和ACR的分子分类器使用监督模型构建，全面评估性能。开发了一种自动分子报告，为临床使用提供全面的可视化。结果在验证队列（n = 116）中，分子分类器表现出较强的诊断效能：AMR检测准确率为81.89% (ROC-AUC = 0.831， Brier评分= 0.143)，ACR检测准确率为77.58% （ROC-AUC = 0.812， Brier评分= 0.176）。分子报告提供了基于分子的排斥评分的实时评估，同时允许在参考集排斥景观中进行新的活检（图1）。除了提供AMR和ACR的定量评分外，每份报告还概述了临床和生物学信息，将分子发现与所涉及的主要分子途径的病理生理学见解联系起来。该工具在早期或亚临床排斥的情况下捕捉到微妙的分子信号，即使在组织学不确定的情况下，也能提供对潜在风险的见解。报告的自动化特性最大限度地减少了可变性，大大减少了周转时间，无缝地集成到临床工作流程中。结论分子诊断系统在识别心脏排斥反应方面具有较高的重复性和可靠性，并得到了自动报告的验证和支持。该系统可作为标准病理的补充，减少诊断的不确定性，可作为心脏移植患者临床管理的实用配套工具，确保诊断的及时准确。

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引用次数: 0

Early introduction of SGLT2 inhibitors in patients with Heart Failure reduced ejection fraction hospitalized for acute heart failure: Results from Real-world observations 心衰患者早期引入SGLT2抑制剂可降低急性心衰住院患者的射血分数：来自现实世界观察的结果

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.2025.10.080

A. Bouchlarhem, Z. Bazid, N. Ismaili, E.O. Noha

Introduction

The early introduction of SGLT2 inhibitors during acute heart failure was studied in the empulse trial with positive results, but limited reel-world data are currently available.

Objective

Assessing the efficacy of early introducing of ISGLT2 during the acute heart failure.

Method

We prospectively analyzed patients admitted for acute heart failure with an ejection fraction of less than 40%. We excluded patients with glomerular filtration rate (GFR) < 20 ml/min, cardiogenic shock, and ejection fraction > 40%. We studied all-cause mortality as the primary outcome, and as secondary outcomes the duration of decongestion and pro-BNP levels at discharge.

Results

We included 516 patients who met the inclusion criteria. Early introduction of ISGLT2 was adopted in 270 patients (52.8%). No differences were observed in mean age (ISGLT vs. standard car;65.89 vs 65.58 years; P = 0.129), female gender (38.9% vs. 38.2%; P = 0.473), diabetes (48.1% vs. 51.6%; P = 0.242) and hypertension (44.4% vs. 45.5%; P = 0.437). At admission, Ejection fraction was higher in the ISGLT2 group (34% vs. 32%; P = 0.033), and systolic pulmonary pressure was lower (37.4mmhg vs. 41.5mmhg; P < 0.001).GFR was higher in the ISGLT2 group (72 vs 64 ml/min; P = 0.005), with lower Pro-BNP levels in this group but without significant difference (7635 vs 9839 ng/ml; P = 0.063).

Over a mean follow-up of 22 months, the primary endpoint was observed in 95 patients (18.4%), with significantly higher mortality in the standard group (28.5% vs. 9.3%; P < 0.001). After multivariate adjusted Cox proportional hazards analysis, early introduction of ISGLT2 was independently associated with a 23% reduction in all-cause mortality with (HR: 0. 862; 95%CI; 0.444–0.902; P = 0.039), as well as a significant difference on Kaplein meirer survival analysis (Log-rank test P < 0.001) (Fig. 1). For the secondary endpoints, the introduction of ISGLT2 significantly reduced the duration of decongestion (6.25 days in vs. 7.37 days; P = 0.017; with a mean reduction of 1.17 days). ISGLT2 also significantly reduced Pro-BNP levels at discharge (3986 vs. 7029 ng/ml; P = 0.001).

Conclusion

The results of our study support the hypothesis that SGLT2 should not only be introduced in HFrEF patients, but should also be rapidly introduced even during acute heart failure.

在搏动试验中研究了急性心力衰竭期间早期引入SGLT2抑制剂的积极结果，但目前可获得的数据有限。目的评价急性心力衰竭早期引入ISGLT2的疗效。方法前瞻性分析射血分数小于40%的急性心力衰竭患者。我们排除了肾小球滤过率(GFR)≤20ml /min、心源性休克和射血分数≤40%的患者。我们研究了全因死亡率作为主要结局，次要结局是去充血持续时间和出院时的亲bnp水平。结果纳入516例符合纳入标准的患者。270例患者（52.8%）采用早期引入ISGLT2。在平均年龄（ISGLT vs.标准组；65.89 vs. 65.58岁；P = 0.129）、女性（38.9% vs. 38.2%; P = 0.473）、糖尿病（48.1% vs. 51.6%; P = 0.242）和高血压（44.4% vs. 45.5%; P = 0.437）方面均无差异。入院时，ISGLT2组的射血分数较高（34% vs. 32%; P = 0.033），收缩压较低（37.4mmhg vs. 41.5mmhg; P < 0.001）。ISGLT2组GFR较高（72 vs 64 ml/min; P = 0.005），该组Pro-BNP水平较低，但无显著差异（7635 vs 9839 ng/ml; P = 0.063）。在平均22个月的随访中，95例患者（18.4%）观察到主要终点，标准组的死亡率明显更高（28.5%比9.3%;P < 0.001）。经过多因素调整Cox比例风险分析，早期引入ISGLT2与全因死亡率降低23% （HR: 0）独立相关。862年;95%可信区间;0.444 - -0.902;P = 0.039)，在Kaplein meier生存分析中差异有统计学意义（Log-rank检验P <； 0.001）（图1）。对于次要终点，引入ISGLT2显著减少了缓解充血的持续时间（6.25天vs. 7.37天；P = 0.017；平均减少1.17天）。ISGLT2还显著降低了放电时Pro-BNP水平（3986 vs 7029 ng/ml; P = 0.001）。结论我们的研究结果支持SGLT2不仅应该在HFrEF患者中引入，甚至在急性心力衰竭时也应该快速引入的假设。

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引用次数: 0

Cardiac amyloidosis and heart failure phenotypes: A prognostic study of systolic function markers 心脏淀粉样变性和心力衰竭表型：收缩功能标志物的预后研究

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.2025.10.086

A. Zaroui , S. Belaid , M. Kharoubi , S. Oghina , S. Odouard , E. Teiger , T. Damy

Introduction

Cardiac amyloidosis (CA), including light chain (AL), hereditary transthyretin (ATTRv), and wild-type transthyretin (ATTRwt), leads to heart failure (HF). Cardiologists use the ESC guidelines to classify patients with HF tailoring HF treatment accordingly. CA is commonly associated with HFpEF, with a smaller proportion presenting with HFmrEF and HFrEF.

Objective

This study aimed to assess the distribution of HF types in CA and their relationship with other left ventricular (LV) systolic function parameters such as global longitudinal strain (GLS) and cardiac index (CI) across amyloidosis subtypes.

Method

We retrospectively included symptomatic AL, ATTRv, and ATTRwt CA patients from our French referral center. LVEF was classified per ESC guidelines and compared to GLS and CI. Survival was assessed using Kaplan-Meier analyses and Cox regression. A decision tree incorporating LVEF, GLS, and CI was used to stratify patients into prognostic groups.

Results

Among 2244 patients, 557 AL, 392 ATTRv, 1137A TTRwt. Of these, 61.4% presented with HFpEF, 19.0% with HFmrEF, and 19.6% with HFrEF. In AL, 13.6%, 18%, and 68.4% were classified as HFrEF, HFmrEF, and HFpEF, respectively. In ATTRv, 28.3%, 15.3%, and 56.4% were HFrEF, HFmrEF, and HFpEF, respectively. In ATTRwt, 20.2%, 21.2%, and 58.6% were HFrEF, HFmrEF, and HFpEF, respectively. LVEF correlated moderately with GLS (r = 0.673), with stronger correlations in ATTRv (r = 0.776) compared to AL (r = 0.650) and ATTRwt (r = 0.644). LVEF correlated weakly with CI (r = 0.392). Median survival was 7 months [3–31] for AL, 28 months [12–54] for ATTRv, and 23 months [10–38] for ATTRwt. Survival differed by HF type: 30 months [18–41] for HFrEF, 40 months [20–42] for HFmrEF, and 51% survival at 48 months for HFpEF. A CI ≤ 1.96 L/min/m² was associated with a median survival of 29 months [17–37], with better outcomes in higher CI quartiles. A decision tree identified four prognostic groups, with hazard ratios for 4-year mortality ranging from 1.63 (LVEF ≥ 50%, GLS ≤ 11%) to 3.68 (LVEF ≤ 49%, CI ≤ 1.96 L/min/m²), reaching 12.34 in AL amyloidosis for the most severe group.

Conclusion

In CA, about 40% of patients present with reduced LVEF. Cardiologists should be aware that CA is not exclusively associated with HFpEF and that patients with reduced LVEF have worse prognosis. LV systolic function, assessed via LVEF, GLS, and CI, is a critical predictor of survival in CA, with distinct patterns across AL, ATTRv, and ATTRwt subtypes.

心脏淀粉样变性（CA），包括轻链（AL）、遗传性甲状腺转素（ATTRv）和野生型甲状腺转素（ATTRwt），可导致心力衰竭（HF）。心脏病专家使用ESC指南对心衰患者进行分类，相应地调整心衰治疗。CA通常与HFpEF相关，以HFmrEF和HFrEF为表现的比例较小。目的探讨不同淀粉样变性亚型CA中HF类型的分布及其与其他左心室收缩功能参数（如全局纵应变（GLS）和心脏指数（CI））的关系。方法回顾性研究来自法国转诊中心的有症状的AL、ATTRv和attrt CA患者。根据ESC指南对LVEF进行分类，并与GLS和CI进行比较。生存率采用Kaplan-Meier分析和Cox回归进行评估。采用结合LVEF、GLS和CI的决策树将患者分为预后组。结果2244例患者中，AL 557例，ATTRv 392例，TTRwt 1137A。其中，61.4%为HFpEF， 19.0%为HFmrEF， 19.6%为HFrEF。AL中，HFrEF、HFmrEF和HFpEF分别占13.6%、18%和68.4%。在ATTRv中，HFrEF、HFmrEF和HFpEF分别占28.3%、15.3%和56.4%。在ATTRwt中，HFrEF、HFmrEF和HFpEF分别占20.2%、21.2%和58.6%。LVEF与GLS有中度相关性（r = 0.673），与AL （r = 0.650）和ATTRwt （r = 0.644）相比，ATTRv的相关性更强（r = 0.776）。LVEF与CI呈弱相关（r = 0.392）。AL的中位生存期为7个月[3-31]，ATTRv为28个月[12-54]，attrt为23个月[10-38]。不同HF类型的生存期不同：HFrEF为30个月[18-41]，HFmrEF为40个月[20-42]，HFpEF为48个月时51%的生存期。CI≤1.96 L/min/m2与中位生存期为29个月相关[17-37]，CI越高，预后越好。决策树确定了4个预后组，4年死亡率的风险比从1.63 （LVEF≥50%,GLS≤11%）到3.68 (LVEF≤49%,CI≤1.96 L/min/m2)，最严重组AL淀粉样变性达到12.34。结论在CA中，约40%的患者表现为LVEF降低。心脏病专家应该意识到CA并不仅仅与HFpEF相关，LVEF降低的患者预后更差。通过LVEF、GLS和CI评估的左室收缩功能是CA患者生存的关键预测因子，在AL、ATTRv和ATTRwt亚型中具有不同的模式。

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引用次数: 0