Archives of Cardiovascular Diseases最新文献

{"title":"Catecholaminergic strom and cardiac failure in children: Insights from severe scorpion envenomation cases","authors":"D.-D. Batouche ,&nbsp;D. Boumendil ,&nbsp;D. Batouche ,&nbsp;Z.Z. Addou ,&nbsp;H. Saddok ,&nbsp;A. Bouguerra ,&nbsp;F. Bounoua ,&nbsp;F. Latreche ,&nbsp;N.-F. Benatta ,&nbsp;R. Okbani","doi":"10.1016/j.acvd.2025.10.094","DOIUrl":"10.1016/j.acvd.2025.10.094","url":null,"abstract":"<div><h3>Introduction</h3><div>Scorpion envenomation is a common pediatric emergency in endemic regions. In its severe form, it may trigger a catecholaminergic storm leading to acute fulminant myocarditis. This cardiac involvement is a major prognostic factor but potentially reversible with intensive care management.</div></div><div><h3>Objective</h3><div>To describe the clinical, therapeutic, and prognostic features of severe scorpion envenomation (SE) in children, with a focus on cardiac involvement related to catecholaminergic myocarditis.</div></div><div><h3>Method</h3><div>We conducted prospective descriptive study involving 10 children admitted to pediatric intensive care for stage III scorpion envenomation between 2016 and 2024. Clinical, biological, echocardiographic, and outcome data were analyzed from medical records.</div></div><div><h3>Results</h3><div>The cohort included 8 boys and 2 girls, aged between 4 and 15 years. The average delay between the sting and admission was 8.5<!--> <!-->±<!--> <!-->1.2<!--> <!-->hours.</div><div>All patients presented with respiratory distress: tachypnea, severe hypoxemia (average SpO₂: 70%), and crackles on auscultation. Neurological signs included agitation (7 cases), stage II coma (2 cases), fasciculations (7 cases), and myoclonus (4 cases). Hemodynamically, all children exhibited cardiovascular collapse with a mean heart rate of 132 bpm. Chest imaging revealed fluffy pulmonary opacities consistent with acute pulmonary edema. Echocardiography showed marked left ventricular depression with global hypokinesia, apical ballooning, and significantly reduced ejection fraction (average 12%). Biological findings included elevated CPK and troponin levels, hyperglycemia in 2 cases, and acute kidney injury classified as stage R of the pediatric RIFLE score in 2 patients.</div><div>All children required mechanical ventilation, vasopressor support, cautious fluid resuscitation guided by echocardiographic preload assessment, and diuretics in 2 cases. Clinical outcomes were favorable in 9 patients, with one fatal case.</div></div><div><h3>Conclusion</h3><div>Catecholaminergic myocarditis represents the cornerstone of clinical severity in pediatric severe scorpion envenomation. Although dramatic, it is potentially reversible with appropriate and timely intensive care management.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S53"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904120","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}

{"title":"Improved heart failure after myocardial infarction: Myth or reality?","authors":"S. Abid,&nbsp;T. Ellouze,&nbsp;M. Jabeur,&nbsp;A. Bahloul,&nbsp;L. Abid","doi":"10.1016/j.acvd.2025.10.095","DOIUrl":"10.1016/j.acvd.2025.10.095","url":null,"abstract":"<div><h3>Introduction</h3><div>With the advent of modern pharmacological therapies and advanced interventional strategies, there is growing interest in reassessing the heart's capacity for functional recovery. Understanding the interplay between myocardial damage, therapeutic intervention, and potential reversibility is essential for optimizing long-term outcomes in patients with ischemic heart failure.</div></div><div><h3>Objective</h3><div>To identify predictors of improving Left ventricular contractility after myocardial infarction.</div></div><div><h3>Method</h3><div>We conducted a retrospective study including all patients admitted to the Cardiology Department at Hedi Chaker University Hospital between April 1, 2022, and March 31, 2023, with a diagnosis of ST-elevation myocardial infarction (STEMI). Clinical, echocardiographic, and angiographic data were collected and analyzed. Left ventricular ejection fraction (LVEF) was assessed by experienced operators. Left ventricular dysfunction was defined as LVEF<!--> <!-->&lt;<!--> <!-->40%, and improvement was defined as LVEF<!--> <!-->&gt;<!--> <!-->40%. Revascularization indications followed international guidelines.</div></div><div><h3>Results</h3><div>A total of 342 patients with STEMI were included. The prevalence of LV dysfunction was 28.65%, with 98 patients having an initial LVEF<!--> <!-->&lt;<!--> <!-->40% on admission. Among them, only 25 patients (25.5%) underwent a follow-up echocardiography at 40 days post-STEMI, and 17 of those showed improved LVEF (&gt;<!--> <!-->40%). Multivariate analysis identified three independent predictors of improved LVEF: optimal heart failure treatment including the four recommended drug classes (<em>P</em> <!-->&lt;<!--> <!-->0.001; OR<!--> <!-->=<!--> <!-->2.46), female sex (<em>P</em> <!-->=<!--> <!-->0.001; OR<!--> <!-->=<!--> <!-->4.61), and good adherence to therapy (<em>P</em> <!-->=<!--> <!-->0.019; OR<!--> <!-->=<!--> <!-->2.27). Smoking was less common among patients with improved LVEF but was not an independent predictor.</div></div><div><h3>Conclusion</h3><div>In our study, we evaluated the occurrence of improved ejection fraction in patients who developed heart failure following myocardial infarction. Female sex, adherence to therapy, and being discharged on optimal heart failure medication were associated with improved LVEF. These findings support the potential for recovery of systolic function under appropriate conditions.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S54"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904121","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}

{"title":"Artificial intelligence-enhanced cardiovascular magnetic resonance for cardiovascular risk prediction in asymptomatic CAD patients","authors":"S. Toupin ,&nbsp;J. Amar ,&nbsp;J. Garot ,&nbsp;S. Duhamel ,&nbsp;A. Myriam ,&nbsp;T. Hovasse ,&nbsp;A. Neylon ,&nbsp;S. Champagne ,&nbsp;T. Unterseeh ,&nbsp;A. Unger ,&nbsp;T. Goncalves ,&nbsp;J. Florence ,&nbsp;S. Houssany-Pissot ,&nbsp;E. Gall ,&nbsp;J.-G. Dillinger ,&nbsp;V. Bousson ,&nbsp;F. Sanguineti ,&nbsp;P. Garot ,&nbsp;T. Pezel","doi":"10.1016/j.acvd.2025.10.100","DOIUrl":"10.1016/j.acvd.2025.10.100","url":null,"abstract":"<div><h3>Introduction</h3><div>Risk stratification in patients with known coronary artery disease (CAD) remains a clinical challenge, especially in asymptomatic individuals. While stress cardiac magnetic resonance imaging (MRI) has strong prognostic value, current models do not fully exploit the richness of available clinical and imaging data. Machine learning (ML) offers an opportunity to optimize prediction by capturing complex patterns in high-dimensional datasets.</div></div><div><h3>Objective</h3><div>To assess the performance of a supervised ML model combining clinical and stress cardiac MRI data for predicting 10-year major adverse cardiovascular events (MACE) in asymptomatic patients with obstructive CAD, compared to logistic regression models.</div></div><div><h3>Method</h3><div>A total of 966 asymptomatic patients with obstructive CAD who underwent vasodilator stress cardiac MRI between 2009 and 2011 in two centres were retrospectively included. The first centre (n<!--> <!-->=<!--> <!-->742) provided a derivation cohort (n<!--> <!-->=<!--> <!-->603) and an internal validation cohort (n<!--> <!-->=<!--> <!-->139), while the second centre (n<!--> <!-->=<!--> <!-->224) served as an external validation cohort. Feature selection was performed using LASSO, XGBoost, Random Forest (RF), and Boruta. A final RF model was trained using five selected variables and compared to a generalized logistic regression model (GLM) using AUROC and PRAUC metrics.</div></div><div><h3>Results</h3><div>Five key variables were selected: number of ischemic segments, number of late gadolinium enhancement (LGE) segments, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter indexed, and age (<span><span>Figure 1</span></span>). Over the 10-year follow-up period, MACE occurred in 28% of patients in the derivation cohort, 30% in the internal validation cohort, and 24% in the external test cohort. The RF model demonstrated the best predictive performance in the derivation cohort (AUROC: 0.99, PRAUC: 0.98). Consistently, the AUROC was 0.98 <em>versus</em> 0.86 for the GLM, and PRAUC was 0.97 <em>versus</em> 0.78 (all <em>p</em> <!-->&lt;<!--> <!-->0.001) in the internal validation cohort. In the external validation cohort, the RF model achieved an AUROC of 0.92 <em>versus</em> 0.74 for the GLM, and a PRAUC of 0.84 <em>versus</em> 0.58 (all <em>p</em> <!-->&lt;<!--> <!-->0.001). SHAP analysis confirmed the interpretability of the model and the individual contribution of each variable (<span><span>Figure 2</span></span>).</div></div><div><h3>Conclusion</h3><div>A ML model combining stress cardiac MRI and clinical data significantly outperformed traditional methods in predicting MACE in asymptomatic patients with obstructive CAD.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Pages S57-S58"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904152","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}

{"title":"PSS Stress Scale: A novel indicator of endothelial dysfunction in coronary artery disease","authors":"Y. Ayadi,&nbsp;S. Charfeddine,&nbsp;A. Ghrab,&nbsp;A. Bahloul,&nbsp;R. Gargouri,&nbsp;Z. Triki,&nbsp;M. Jabeur,&nbsp;T. Ellouze,&nbsp;F. Triki,&nbsp;S. Mallek,&nbsp;L. Abid","doi":"10.1016/j.acvd.2025.10.025","DOIUrl":"10.1016/j.acvd.2025.10.025","url":null,"abstract":"<div><h3>Introduction</h3><div>Endothelial dysfunction is an early marker of vascular injury in CAD. While traditional risk factors are known, psychological stress—measured by the Perceived Stress Scale (PSS)—may also impact vascular health, though its role in predicting endothelial dysfunction is not well studied.</div></div><div><h3>Objective</h3><div>This study explores whether PSS stress scores are linked to endothelial function, assessing perceived stress as a potential early marker of vascular impairment in CAD patients.</div></div><div><h3>Method</h3><div>This observational study (Jan–Apr 2025) included Chronic Coronary Syndrome patients in follow-up. Stress was measured using the PSS, and endothelial function was evaluated via the Endothelium Quality Index (EQI).</div></div><div><h3>Results</h3><div>Among 51 CAD patients (mean age 57.86 years; 43 men, 8 women), the prevalence of hypertension, diabetes, and dyslipidemia was 66.6%, 60.78%, and 25.49%, respectively. Endothelial function, assessed by the Endothelial Quality Index (EQI), revealed severe dysfunction (EQI<!--> <!-->&lt;<!--> <!-->1) in 9 patients, moderate dysfunction (1<!--> <!-->≤<!--> <!-->EQI<!--> <!-->&lt;<!--> <!-->2) in 21, and normal function (EQI<!--> <!-->≥<!--> <!-->2) in 21. Poorly controlled hypertension and diabetes were present in 15% and 23% of patients, respectively. No significant association was found between endothelial dysfunction and traditional risk factors, but higher PSS scores were significantly correlated with worse endothelial function (<em>P</em> <!-->=<!--> <!-->0.028, <em>r</em> <!-->=<!--> <!-->–0.38) (<span><span>Fig. 1</span></span>).</div></div><div><h3>Conclusion</h3><div>In chronic coronary syndrome patients, traditional risk factors were not significantly linked to endothelial dysfunction, likely due to well-controlled comorbidities. However, higher perceived stress levels were significantly associated with poorer endothelial function, suggesting that psychological stress could be an early marker of vascular impairment. Incorporating stress assessment into routine cardiovascular evaluations may improve early detection and prevention.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S17"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904170","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}

{"title":"Drug-coated balloon angioplasty for in-stent restenosis: A single-center cohort study","authors":"A. Noamen,&nbsp;G. Tlili,&nbsp;A. Besseghaier,&nbsp;H. Amamou,&nbsp;N. Hajlaoui,&nbsp;W. Fehri","doi":"10.1016/j.acvd.2025.10.045","DOIUrl":"10.1016/j.acvd.2025.10.045","url":null,"abstract":"<div><h3>Introduction</h3><div>In the third generation DES era, percutaneous coronary intervention now targets increasingly complex lesions, generating an expanding pool of instent restenosis (ISR). Its ideal treatment is debated. Drug-coated balloons (DCB) deliver metal free anti-proliferative therapy and represent a promising option, yet outcome data from Tunisia, remain scarce.</div></div><div><h3>Objective</h3><div>To assess immediate procedural success and long term clinical outcomes of DCB angioplasty for coronary IRS, and to identify independent predictors of MACE in an observational cohort of consecutive Tunisian patients treated for ISR lesions.</div></div><div><h3>Method</h3><div>We performed a retrospective single centre cohort at the Military Hospital of Tunis was reviewed over seven years (June 2014–July 2021). Eligible were all angiographically proven instent restenosis (ISR) lesions treated with paclitaxel drug-coated balloons (DCB). Two interventional cardiologists reinterpreted all images. Lesion preparation, DCB size and inflation were chosen after heart team discussion, except in ad hoc cases. Procedural success required residual stenosis<!--> <!-->≤<!--> <!-->30%, TIMI3 flow and no in hospital complications. Patients attended follow-up at 1, 3 and 6 months, then biannually; survival, major adverse cardiac events (MACE) and target lesion revascularisation (TLR) were captured. The primary endpoint was MACE at 12 and 36 months, defined by ARC criteria.</div></div><div><h3>Results</h3><div>Among 68 consecutive patients treated with paclitaxelcoated drug-coated balloons (DCB) for coronary instent restenosis (ISR), mean age was 63<!--> <!-->±<!--> <!-->0<!--> <!-->years and 69% were diabetic. ACS presentation was common (63%). Immediate procedural success reached 91.2%, with a postdilatation minimal luminal diameter of 2.73<!--> <!-->±<!--> <!-->0.4<!--> <!-->mm and a median residual stenosis of 6.5%. Per-procedural complications were infrequent—two dissections (2.9%) and one slow flow episode. All lesions were predilated. Cumulative MACE occurred in 8.8% at 12 months and 23.1% at 36 months. TLR accounted for 13.2% of patients, whereas only one cardiovascular death and two definite/probable stent thromboses were recorded. On multivariable analysis, nonfocal ISR independently predicted TLR (hazard ratio 6.24, 95%CI 1.19–32.5; <em>P</em> <!-->=<!--> <!-->0.03), while diabetes, vessel calibre, and procedural parameters were not significant.</div></div><div><h3>Conclusion</h3><div>Drug-coated balloon angioplasty achieved high procedural success and acceptable long-term safety. These results support DCB as a viable, metal-free strategy.</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":"145903912","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}

{"title":"Pronostic value of initial TIMI flow after ischemic Out-of-Hospital Cardiac Arrest","authors":"E. Lasik,&nbsp;F. Picard,&nbsp;O. Varenne,&nbsp;P. Brami,&nbsp;V. Pham","doi":"10.1016/j.acvd.2025.10.050","DOIUrl":"10.1016/j.acvd.2025.10.050","url":null,"abstract":"<div><h3>Introduction</h3><div>Out-of-hospital cardiac arrest (OHCA) remains a major cause of mortality and morbidity, with ischemic heart disease identified as its leading etiology. Early coronary angiography (CAG) is often performed in these patients, yet the prognostic value of initial coronary flow remains poorly explored.</div></div><div><h3>Objective</h3><div>To evaluate the prognostic impact of preprocedural TIMI flow in OHCA survivors and identify predictors of reduced flow.</div></div><div><h3>Method</h3><div>We conducted a retrospective single-center study using the PROCAT registry. We included 330 patients admitted to the ICU at Cochin Hospital between 2016 and 2022 who underwent early CAG after successful resuscitation from OHCA of presumed cardiac origin. Patients were classified into non-ischemic OHCA and ischemic OHCA, the latter further stratified by TIMI flow: preserved (TIMI flow 2–3) vs. reduced (TIMI flow 0–1). The primary endpoint was 1-year mortality.</div></div><div><h3>Results</h3><div>One-year mortality was significantly higher in non-ischemic OHCA (66.7%) versus ischemic OHCA groups (34.5% for TIMI 2–3 and 36.7% for TIMI 0–1). Neurological outcomes were similarly poorer in non-ischemic OHCA. Among ischemic OHCA, reduced TIMI flow was associated with younger age, ST elevation, obesity, and elevated troponin. In multivariate analysis, reduced TIMI flow was independently associated with 1-year mortality (alongside age, low-flow duration, and non-shockable rhythm).</div></div><div><h3>Conclusion</h3><div>In ischemic OHCA, reduced initial coronary flow prior to PCI is an independent predictor of mortality at one year. These findings support early coronary evaluation and revascularization when appropriate, and call for larger prospective studies to refine risk stratification and management strategies.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S28"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903917","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}

{"title":"Clonal hematopoiesis of indeterminate potential in patients undergoing angio-coronarography: Result from a 24-year retrospective follow-up in a cohort of 2050 patients","authors":"A. Dupont ,&nbsp;C. Carbonneau ,&nbsp;N. Duployez ,&nbsp;F. Vincent ,&nbsp;L. Fenwarth ,&nbsp;G. Faivre-Dupaigre ,&nbsp;S. Bakhtari ,&nbsp;M. Rosa ,&nbsp;B. Staels ,&nbsp;C. Preudhomme ,&nbsp;S. Susen ,&nbsp;E. Van Belle","doi":"10.1016/j.acvd.2025.10.014","DOIUrl":"10.1016/j.acvd.2025.10.014","url":null,"abstract":"<div><h3>Introduction</h3><div>Cardiovascular disease (CVD) is highly prevalent and remains a cause of great morbi-mortality worldwide. Growing evidence suggests clonal hematopoiesis of indeterminate potential (CHIP) as an independent cardiovascular risk factor worsening overall survival (OS). However, actual data either comes from large population databases with heterogeneous and/or poorly defined CVD or from smaller better-defined populations but with limited follow-up.</div></div><div><h3>Objective</h3><div>We aimed to thoroughly characterize the extent and severity of coronary artery disease (CAD) and OS in CHIP-positive patients using the COROL (COROonary disease clinico-biological determinants study) cohort which included patients undergoing coronarography and for which we now have up to 24 years of follow-up. We also evaluated if OS in CHIP-positive patients was similar depending on CAD treatment.</div></div><div><h3>Method</h3><div>We retrospectively analyzed data from the 2050 COROL patients included between 2000–2001 at CHU de Lille in France (Mean age: 61 years<!--> <!-->±<!--> <!-->12). Our primary focus was CAD lesions (% of stenosis) by coronarography, treatment (medical, angioplasty or surgery), CHIP (variant allele frequency (VAF)<!--> <!-->≥<!--> <!-->2%, determined using a 70-gene NGS panel) and OS. Patients with no significant coronary lesion (&lt;50%) served as controls. Statistical analysis included log-rank and Student analysis.</div></div><div><h3>Results</h3><div>Of the 1976/2050 patients that met inclusion criteria, CHIP was found in 28.5% (<em>n</em> <!-->=<!--> <!-->478). <em>DNMT3a</em>, <em>TET2</em> and <em>ASXL1</em> accounted for two-third of the mutated genes. Preliminary results in 1466/1976 patients showed reduced median OS in CHIP-negative patients with<!--> <!-->≥<!--> <!-->50% lesions compared to those with<!--> <!-->&lt;<!--> <!-->50% lesions. Median OS was worse in both CHIP-positive groups with no difference according to CAD status (<span><span>Table 1</span></span>). Moreover, no CAD treatment could reverse CHIP effect (<span><span>Fig. 1</span></span>).</div></div><div><h3>Conclusion</h3><div>Our study is the first to provide detailed information on CAD extent and treatment in CHIP-positive patients while offering more 20 years of follow-up. It shows an independent negative effect of CHIP on OS, which raises concerns about CHIP identification and CAD patients management.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S12"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904041","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}

{"title":"Aspirin twice a day and acute coronary syndrome: The ANADAMN trial","authors":"J.-G. Dillinger ,&nbsp;T. Pezel ,&nbsp;L. Batias ,&nbsp;D. Angoulvant ,&nbsp;M. Goralski ,&nbsp;E. Ferrari ,&nbsp;G. Cayla ,&nbsp;J. Silvain ,&nbsp;M. Gilard ,&nbsp;G. Lemesle ,&nbsp;G. Souteyrand ,&nbsp;P. Lim ,&nbsp;C. Roubille ,&nbsp;M. Elbaz ,&nbsp;E. Puymirat ,&nbsp;S. Toupin ,&nbsp;G. Montalescot ,&nbsp;L. Drouet ,&nbsp;E. Vicaut ,&nbsp;P. Henry","doi":"10.1016/j.acvd.2025.10.004","DOIUrl":"10.1016/j.acvd.2025.10.004","url":null,"abstract":"<div><h3>Introduction</h3><div>After acute coronary syndrome (ACS), recurrence of ischemic events remains higher in patients with diabetes mellitus (DM) or aspirin resistance despite optimal antithrombotic treatment. Once-daily aspirin may not provide stable inhibition of platelet aggregation in patients with DM or aspirin resistance, leading to the recovery of platelet cyclooxygenase activity before the next dose. Aspirin twice a day (b. i.d.) offers a better cyclooxygenase-1 inhibition during 24<!--> <!-->hours.</div></div><div><h3>Objective</h3><div>To determine if aspirin b.i.d. decreases major adverse cardiovascular events (MACE) compared to aspirin once a day in patients with DM or aspirin resistance after ACS.</div></div><div><h3>Method</h3><div>In this prospective multicenter trial, patients with ACS and DM or aspirin resistance defined as: (i) index event occurring under aspirin; (ii) body mass index<!--> <!-->≥<!--> <!-->27<!--> <!-->kg/m²); (iii) increased waist circumference were randomly assigned to aspirin once daily (100<!--> <!-->mg) or b.i.d (100<!--> <!-->mg morning and 100<!--> <!-->mg evening). The primary objective was to demonstrate the superiority of aspirin b.i.d to reduce MACE (death, myocardial infarction, stroke, urgent coronary revascularization, acute arterial thrombotic event) after a follow-up of 18 months. The main secondary objective was the occurrence of BARC type 3 to 5 bleeding (<span><span>Fig. 1</span></span>).</div></div><div><h3>Results</h3><div>We enrolled 2485 participants in the study (mean age 62<!--> <!-->±<!--> <!-->11 years, 77.2% of DM, 55.5% of ST-elevation segment myocardial infarction). A total of 2260 patients (90.9%) were treated with more potent P2Y12 inhibitors (i.e. ticagrelor; 73.7% or prasugrel; 17,2%) at the time of randomization and 94.4% of the population underwent coronary revascularization. Follow-up at 18 months for all patients and data monitoring in all centers are completed. A blinded adjudication of the primary endpoint and the safety endpoint has been performed. We anticipate a primary endpoint incidence of 22.5% among patients treated by aspirin once a day and 17.7% among patients treated by aspirin once daily with a significant reduction of MACE after a median follow-up of 18 months. No significant difference in BARC type 3 to 5 bleeding is expected between the two groups. Results will be expected at th end of the year 2025.</div></div><div><h3>Conclusion</h3><div>The ANDAMAN trial will fill this gap by evaluating whether the improved antiplatelet effect of aspirin b.i.d. translates into better clinical outcomes for patients with diabetes mellitus or aspirin resistance after acute coronary syndrome.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Pages S6-S7"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904078","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}

{"title":"Long-term follow-up after percutaneous coronary interventions for chronic total occlusions","authors":"R. Arnold ,&nbsp;R. Gervasoni ,&nbsp;B. Ledermann ,&nbsp;L. Moulis ,&nbsp;S. Soltani ,&nbsp;B. Lattuca ,&nbsp;P. Robert ,&nbsp;F. Leclercq","doi":"10.1016/j.acvd.2025.10.005","DOIUrl":"10.1016/j.acvd.2025.10.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Percutaneous coronary interventions (PCI) for chronic total occlusions (CTO) remain challenging procedures with controversial long-term clinical benefits.</div></div><div><h3>Objective</h3><div>We aimed to describe clinical outcomes in a retrospective cohort of patients who have undergone PCI, and evaluate the impact of a successful CTO-PCI on long-term major cardiovascular events (MACE), survival, rehospitalizations, symptoms, LVEF and myocardial ischemia up-to-8-years follow-up.</div></div><div><h3>Method</h3><div>We conducted an observational monocentric study including consecutive patients who underwent PCI for CTO by experienced operators in a French University hospital between January 2015 and December 2022. All patients had symptoms and/or proved myocardial ischemia. Patients were divided into two groups based on PCI success or failure. The primary endpoint was the occurrence of MACE, defined as the composite of cardiac death, non-fatal myocardial infarction, and target vessel revascularization up to 8 years follow-up.</div></div><div><h3>Results</h3><div>Of the 448 patients who underwent a CTO-PCI, 401 (89.5%) had a successful procedure, while 47 (10.5%) experienced a failed intervention. During a mean follow-up of 3.7 years, MACE occurred in 71 patients (15.8%), including 12 patients (25.5%) in the failed group and 59 patients (14.7%) in the successful group (HR 2.68 [1.42; 5.06]; <em>P</em> <!-->&lt;<!--> <!-->0.01) (<span><span>Fig. 1</span></span>). While both groups had similar baseline clinical risk profiles, the successful CTO-PCI group had higher overall survival rate (88.8% vs. 74.5%; HR 2.23 [1.17; 4.27]; <em>P</em> <!-->=<!--> <!-->0.02) and significant improvements in left ventricular ejection fraction (LVEF) (<em>P</em> <!-->&lt;<!--> <!-->0.01) and NYHA class (<em>P</em> <!-->&lt;<!--> <!-->0.01). The J-CTO score was the only predictor of procedural failure (1.96 [1.44; 2.67]; <em>P</em> <!-->&lt;<!--> <!-->0.01).</div></div><div><h3>Conclusion</h3><div>Successful CTO-PCI, achieved in nearly 90% of patients in experienced hands, was associated with significant long-term benefits, including reduced MACE, improved survival, LVEF, and NYHA class, supporting the pursuit of this procedure in selected cases.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S7"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904079","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}

{"title":"Fragmented QRS complexes as an independent predictor of all-cause mortality in patients with systolic heart failure: A retrospective cohort study","authors":"F. Yahia ,&nbsp;S. Ben Farhat ,&nbsp;H. Ghardallou ,&nbsp;N. Elyes ,&nbsp;E. Allouche ,&nbsp;S. Ouali","doi":"10.1016/j.acvd.2025.10.079","DOIUrl":"10.1016/j.acvd.2025.10.079","url":null,"abstract":"<div><h3>Introduction</h3><div>Fragmented QRS complexes (fQRS), electrocardiographic markers of myocardial scarring/conduction abnormalities, are under investigation for prognostic value in heart failure (HF) with reduced left ventricular ejection fraction (LVEF).</div></div><div><h3>Objective</h3><div>To assess the association of fQRS with clinical outcomes in systolic HF (LVEF<!--> <!-->&lt;<!--> <!-->50%).</div></div><div><h3>Method</h3><div>Retrospective analysis of HF patients (LVEF<!--> <!-->&lt;<!--> <!-->50%). fQRS was defined by notching in R/S waves (≥<!--> <!-->2 contiguous leads; narrow/wide QRS criteria). Outcomes were analyzed using Cox models adjusted for clinical covariates.</div></div><div><h3>Results</h3><div>A total of 187 patients were enrolled, those with fQRS (34.8%) exhibited higher all-cause mortality vs. non-fQRS (unadjusted HR: 2.855, 95% CI 1.641–4.966, <em>P</em> <!-->=<!--> <!-->0.0001; adjusted HR: 4.130, 95% CI 2.109–8.088, <em>P</em> <!-->=<!--> <!-->0.0001) (<span><span>Table 1</span></span>). No significant associations with heart failure-related readmissions (HR: 1.084, <em>P</em> <!-->=<!--> <!-->0.755), all-cause rehospitalizations (HR: 1.237, <em>P</em> <!-->=<!--> <!-->0.357), or arrhythmic events (HR: 1.527, <em>P</em> <!-->=<!--> <!-->0.717) were observed.</div></div><div><h3>Conclusion</h3><div>fQRS independently predicts mortality but not readmissions or arrhythmias in systolic HF, supporting its role in risk stratification.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Pages S45-S46"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904089","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}