Pub Date : 2026-01-01DOI: 10.1016/j.acvd.2025.10.090
P. Lemiere , J. Quilici , A.-S. Canu , L. Querion , E. Saunier , A. Vaudron
Introduction
Heart failure (HF) remains a leading cause of hospitalization and mortality worldwide. Remote monitoring programs (RMP) are increasingly implemented to optimize care, yet their real-world impact on hospitalized patient characteristics remains underexplored.
Objective
This study aimed to assess changes in the clinical profiles and outcomes of patients hospitalized for acute heart failure (AHF) before and after the implementation of a RMP in a rural cardiology department.
Method
We conducted a retrospective, single-center, study focusing HF-related hospitalizations (HFRH) in two periods: 2018–2019 with standard care; and 2023–2024 post RMP implementation, combining non-invasive remote weight monitoring, therapeutic education, and early home-based intervention by a mobile HF team. Data were extracted using ICD-10 codes.
Results
Among 4092 admissions, we selected 1364 HFRH (610 in 2018–2019 vs. 754 in 2023–2024), patients in the post RMP period showed higher severity (High GHM levels 51.5% vs. 45.6%, P = 0.031; mean IGS2 score: 37.7 vs. 35.1, P < 0.0001), longer hospital stays (mean 9.5 vs. 8.9 days, P < 0.001), more emergency admissions (66.6% vs. 39.4%, P < 0.0001), non-significant increased mortality (6.1% vs 3.9%, P 0.07). However, rehospitalizations decreased (13.4% vs. 18.1%, P = 0.03), and discharges to home increased (61.0% vs. 49.3%, P < 0.0001) (Fig. 1).
Conclusion
The implementation of the RMP improved post-discharge outcomes and was associated with a shift toward hospitalization of more severe heart failure patients, likely reflecting earlier outpatient management of milder cases. These findings support telemonitoring as an effective tool in real-world heart failure management and underscore its role in the ongoing digital transformation of care pathways.
{"title":"Effect of telemonitoring implementation on heart failure hospitalization profiles: A real-world analysis","authors":"P. Lemiere , J. Quilici , A.-S. Canu , L. Querion , E. Saunier , A. Vaudron","doi":"10.1016/j.acvd.2025.10.090","DOIUrl":"10.1016/j.acvd.2025.10.090","url":null,"abstract":"<div><h3>Introduction</h3><div>Heart failure (HF) remains a leading cause of hospitalization and mortality worldwide. Remote monitoring programs (RMP) are increasingly implemented to optimize care, yet their real-world impact on hospitalized patient characteristics remains underexplored.</div></div><div><h3>Objective</h3><div>This study aimed to assess changes in the clinical profiles and outcomes of patients hospitalized for acute heart failure (AHF) before and after the implementation of a RMP in a rural cardiology department.</div></div><div><h3>Method</h3><div>We conducted a retrospective, single-center, study focusing HF-related hospitalizations (HFRH) in two periods: 2018–2019 with standard care; and 2023–2024 post RMP implementation, combining non-invasive remote weight monitoring, therapeutic education, and early home-based intervention by a mobile HF team. Data were extracted using ICD-10 codes.</div></div><div><h3>Results</h3><div>Among 4092 admissions, we selected 1364 HFRH (610 in 2018–2019 vs. 754 in 2023–2024), patients in the post RMP period showed higher severity (High GHM levels 51.5% vs. 45.6%, <em>P</em> <!-->=<!--> <!-->0.031; mean IGS2 score: 37.7 vs. 35.1, <em>P</em> <!--><<!--> <!-->0.0001), longer hospital stays (mean 9.5 vs. 8.9 days, <em>P</em> <!--><<!--> <!-->0.001), more emergency admissions (66.6% vs. 39.4%, <em>P</em> <!--><<!--> <!-->0.0001), non-significant increased mortality (6.1% vs 3.9%, <em>P</em> 0.07). However, rehospitalizations decreased (13.4% vs. 18.1%, <em>P</em> <!-->=<!--> <!-->0.03), and discharges to home increased (61.0% vs. 49.3%, <em>P</em> <!--><<!--> <!-->0.0001) (<span><span>Fig. 1</span></span>).</div></div><div><h3>Conclusion</h3><div>The implementation of the RMP improved post-discharge outcomes and was associated with a shift toward hospitalization of more severe heart failure patients, likely reflecting earlier outpatient management of milder cases. These findings support telemonitoring as an effective tool in real-world heart failure management and underscore its role in the ongoing digital transformation of care pathways.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S51"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.acvd.2025.10.006
M.C. Vu , A. Trimaille , A. Granier , A. Carmona , A. Elidrissi , M. Kibler , L. Jesel , P. Olhmann , L. Sattler , O. Morel
Introduction
Unfractionated heparin (UFH) remains the standard anticoagulant during percutaneous coronary intervention (PCI), with guidelines recommending a target activated clotting time (ACT) ≥ 250 seconds. However, despite receiving a standardized bolus dose, many patients fail to achieve this target.
Objective
To evaluate the effectiveness of standard UFH bolus dosing in achieving target ACT and to identify patient-related factors associated with suboptimal anticoagulant response.
Method
This single-center, prospective, observational study included 171 adult patients undergoing PCI between October 2024 and April 2025. All patients received a 100-IU/kg intravenous UFH bolus immediately prior to PCI. ACT was measured 5 minutes post-administration, additional 50 IU/kg boluses were given as needed to achieve the target ACT ≥ 250 seconds. The primary endpoint was the percentage of patients achieving this target. The secondary endpoint was the identification of factors associated with suboptimal anticoagulation.
Results
Among 171 patients (mean age, 68 ± 12 years; 26.3% women), the target ACT was achieved in 35.7% (n = 61), while 64.3% (n = 110) did not (Table 1). Active smoking was independently associated with failure to reach the target ACT (adjusted OR, 6.06; 95% CI, 1.41 to 43.8; P = 0.032) (Fig. 1). Despite similar initial UFH dosing and timing to ACT measurement, smokers had significantly lower ACT values (P < 0.001) and required higher cumulative UFH dose during PCI (P = 0.043) (Fig. 2). Propensity score matching confirmed this independent association (P = 0.004) (Fig. 3).
Conclusion
Nearly two-thirds of patients failed to achieve the recommended target ACT following a standard UFH bolus during PCI, in which active smoking was independently associated with a more than sixfold reduction in the likelihood of reaching therapeutic anticoagulation.
{"title":"Variability in ACT response to standard UFH bolus during PCI: A prospective study on determinants of subtherapeutic anticoagulation","authors":"M.C. Vu , A. Trimaille , A. Granier , A. Carmona , A. Elidrissi , M. Kibler , L. Jesel , P. Olhmann , L. Sattler , O. Morel","doi":"10.1016/j.acvd.2025.10.006","DOIUrl":"10.1016/j.acvd.2025.10.006","url":null,"abstract":"<div><h3>Introduction</h3><div>Unfractionated heparin (UFH) remains the standard anticoagulant during percutaneous coronary intervention (PCI), with guidelines recommending a target activated clotting time (ACT)<!--> <!-->≥<!--> <!-->250<!--> <!-->seconds. However, despite receiving a standardized bolus dose, many patients fail to achieve this target.</div></div><div><h3>Objective</h3><div>To evaluate the effectiveness of standard UFH bolus dosing in achieving target ACT and to identify patient-related factors associated with suboptimal anticoagulant response.</div></div><div><h3>Method</h3><div>This single-center, prospective, observational study included 171 adult patients undergoing PCI between October 2024 and April 2025. All patients received a 100-IU/kg intravenous UFH bolus immediately prior to PCI. ACT was measured 5<!--> <!-->minutes post-administration, additional 50<!--> <!-->IU/kg boluses were given as needed to achieve the target ACT<!--> <!-->≥<!--> <!-->250<!--> <!-->seconds. The primary endpoint was the percentage of patients achieving this target. The secondary endpoint was the identification of factors associated with suboptimal anticoagulation.</div></div><div><h3>Results</h3><div>Among 171 patients (mean age, 68<!--> <!-->±<!--> <!-->12 years; 26.3% women), the target ACT was achieved in 35.7% (<em>n</em> <!-->=<!--> <!-->61), while 64.3% (<em>n</em> <!-->=<!--> <!-->110) did not (<span><span>Table 1</span></span>). Active smoking was independently associated with failure to reach the target ACT (adjusted OR, 6.06; 95% CI, 1.41 to 43.8; <em>P</em> <!-->=<!--> <!-->0.032) (<span><span>Fig. 1</span></span>). Despite similar initial UFH dosing and timing to ACT measurement, smokers had significantly lower ACT values (<em>P</em> <!--><<!--> <!-->0.001) and required higher cumulative UFH dose during PCI (<em>P</em> <!-->=<!--> <!-->0.043) (<span><span>Fig. 2</span></span>). Propensity score matching confirmed this independent association (<em>P</em> <!-->=<!--> <!-->0.004) (<span><span>Fig. 3</span></span>).</div></div><div><h3>Conclusion</h3><div>Nearly two-thirds of patients failed to achieve the recommended target ACT following a standard UFH bolus during PCI, in which active smoking was independently associated with a more than sixfold reduction in the likelihood of reaching therapeutic anticoagulation.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Pages S7-S8"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.acvd.2025.10.007
C. Thuaire, F. Bahri, A. Benjemaa, C.A.B. Samb, R. Hakim, G. Rangé, F. Albert
Introduction
Coronary computed tomography angiography (CCTA) has become a first-line imaging modality for the diagnosis of coronary atherosclerosis in patients with chronic coronary syndrome (CCS). It is primarily considered a means to reduce unnecessary invasive procedures, particularly normal or non-significant coronary angiographies.
Objective
To evaluate the impact of the implementation of a daily CCTA activity on the rate and diagnostic yield of invasive coronary angiographies performed for CCS at Chartres Hospital.
Method
In February 2024, daily CCTA was introduced at Chartres Hospital using a Canon Aquilion One® wide-detector CT scanner (16 cm coverage). Each scan was systematically coupled with a cardiology consultation at the time of result delivery, including treatment prescription and patient orientation based on CAD-RADS classification. A total of 2490 CCTAs were performed over the year, representing a 2.9-fold increase in imaging activity compared to previous years.
Using data from the France PCI registry, we assessed the impact of this implementation on coronary angiographies performed for stable angina and/or silent ischemia by comparing the rates of normal angiograms, lesions < 50%, and lesions > 50% from February 2024 to April 2025 against the mean of the three previous years (February 2021 to January 2024).
Results
Although total annual coronary angiography volume did not significantly increase (adjusted total for 2024–2025: 846 patients vs. 701 in previous years; P = 0.13), we observed a significant rise in the number of angiographies with lesions < 50% (248 vs. 181; P = 0.029), but more importantly a highly significant increase in angiographies showing lesions > 50%: monovessel (245 vs. 155; P = 0.0017), bivessel (197 vs. 113; P = 0.0009), and trivessel disease (169 vs. 119; P = 0.045).
Conclusion
Compared to the average of the three previous years, daily CCTA implementation did not significantly change the overall volume of coronary angiography in CCS patients in our center, nor did it significantly reduce the rate of normal angiograms. However, it was associated with a moderate but significant increase in < 50% lesions, and most importantly a marked and highly significant increase in angiographies with > 50% stenosis.
Daily CCTA combined with structured cardiology consultation improves patient selection and substantially enhances the diagnostic yield of invasive coronary angiography.
冠状动脉ct血管造影（CCTA）已成为慢性冠状动脉综合征（CCS）患者冠状动脉粥样硬化诊断的一线成像方式。它主要被认为是一种减少不必要的侵入性手术的手段，特别是正常或不重要的冠状动脉造影。目的评价每日CCTA活动对Chartres医院有创冠状动脉造影诊断率和诊断率的影响。方法2024年2月，Chartres医院开始使用Canon Aquilion One®宽探测器CT扫描仪（16 cm覆盖范围）进行每日CCTA。每次扫描在结果发布时系统地与心脏病学咨询相结合，包括基于CAD-RADS分类的治疗处方和患者定位。全年共进行了2490次ccta，与前几年相比，成像活动增加了2.9倍。使用来自法国PCI登记处的数据，我们通过比较2024年2月至2025年4月正常血管造影、病变<； 50%和病变>； 50%与前三年（2021年2月至2024年1月）的平均值，评估了该实施对稳定性心绞痛和/或无症状缺血进行冠状动脉造影的影响。ResultsAlthough年度冠状动脉造影总量没有显著增加(2024 - 2025年调整后的总:846名患者和701名在前几年;P = 0.13),我们观察到显著上升的数量与病变血管摄影& lt; 50% (248 vs 181; P = 0.029),但更重要的是一个高度显著增加血管造影显示病变在50%:monovessel (245 vs 155; P = 0.0017), bivessel (197 vs 113; P = 0.0009),和trivessel疾病(169 vs 119; P = 0.045)。结论与前三年的平均值相比，每日CCTA的实施并没有显著改变我中心CCS患者冠状动脉造影总容积，也没有显著降低正常血管造影率。然而，它与中度但显著增加50%病变相关，最重要的是，血管造影显示50%狭窄的显著且高度显著增加。每日CCTA结合结构化的心脏病学会诊，改善了患者的选择，大大提高了有创冠状动脉造影的诊断率。
{"title":"Impact of daily coronary CT angiography implementation on invasive coronary angiography in chronic coronary syndrome: A single-center experience","authors":"C. Thuaire, F. Bahri, A. Benjemaa, C.A.B. Samb, R. Hakim, G. Rangé, F. Albert","doi":"10.1016/j.acvd.2025.10.007","DOIUrl":"10.1016/j.acvd.2025.10.007","url":null,"abstract":"<div><h3>Introduction</h3><div>Coronary computed tomography angiography (CCTA) has become a first-line imaging modality for the diagnosis of coronary atherosclerosis in patients with chronic coronary syndrome (CCS). It is primarily considered a means to reduce unnecessary invasive procedures, particularly normal or non-significant coronary angiographies.</div></div><div><h3>Objective</h3><div>To evaluate the impact of the implementation of a daily CCTA activity on the rate and diagnostic yield of invasive coronary angiographies performed for CCS at Chartres Hospital.</div></div><div><h3>Method</h3><div>In February 2024, daily CCTA was introduced at Chartres Hospital using a Canon Aquilion One® wide-detector CT scanner (16<!--> <!-->cm coverage). Each scan was systematically coupled with a cardiology consultation at the time of result delivery, including treatment prescription and patient orientation based on CAD-RADS classification. A total of 2490 CCTAs were performed over the year, representing a 2.9-fold increase in imaging activity compared to previous years.</div><div>Using data from the France PCI registry, we assessed the impact of this implementation on coronary angiographies performed for stable angina and/or silent ischemia by comparing the rates of normal angiograms, lesions<!--> <!--><<!--> <!-->50%, and lesions<!--> <!-->><!--> <!-->50% from February 2024 to April 2025 against the mean of the three previous years (February 2021 to January 2024).</div></div><div><h3>Results</h3><div>Although total annual coronary angiography volume did not significantly increase (adjusted total for 2024–2025: 846 patients vs. 701 in previous years; <em>P</em> <!-->=<!--> <!-->0.13), we observed a significant rise in the number of angiographies with lesions<!--> <!--><<!--> <!-->50% (248 vs. 181; <em>P</em> <!-->=<!--> <!-->0.029), but more importantly a highly significant increase in angiographies showing lesions<!--> <!-->><!--> <!-->50%: monovessel (245 vs. 155; <em>P</em> <!-->=<!--> <!-->0.0017), bivessel (197 vs. 113; <em>P</em> <!-->=<!--> <!-->0.0009), and trivessel disease (169 vs. 119; <em>P</em> <!-->=<!--> <!-->0.045).</div></div><div><h3>Conclusion</h3><div>Compared to the average of the three previous years, daily CCTA implementation did not significantly change the overall volume of coronary angiography in CCS patients in our center, nor did it significantly reduce the rate of normal angiograms. However, it was associated with a moderate but significant increase in<!--> <!--><<!--> <!-->50% lesions, and most importantly a marked and highly significant increase in angiographies with<!--> <!-->><!--> <!-->50% stenosis.</div><div>Daily CCTA combined with structured cardiology consultation improves patient selection and substantially enhances the diagnostic yield of invasive coronary angiography.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Pages S8-S9"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.acvd.2025.10.072
O. Simon , A. Quessard , N. Labaste , P.-G. Guinot , N. Nesseler , A. Beurton , P. Gaudard , A. Ouattara
Introduction
Among patients treated by temporary mechanical circulatory support (tMCS) for refractory cardiogenic shock, some of them suffer from persistent cardiac dysfunction incompatible with a successful weaning. In eligible patients, the heart transplantation is still the gold standard therapy. However, due to the shortage of grafts and/or contraindications, some patients will not be transplanted. In these patients, for whom the Left ventricular Assist Device (LVAD) represents an alternative therapy, the best approach of tMCS as a bridge to durable LVAD remains to be clarified.
Objective
We tested the hypothesis that the use of IMPELLA® as bridge to LVAD should improve early postoperative outcomes by offering the opportunité of active rehabilitation under tMCS.
Method
The ECI-BLAD trial was a multicentre retrospective study including adults, supported with IMPELLA® or ECLS as a bridge to LVAD between January 2012 and December 2020 in 5 French cardiac intensive care units. The IMPELLA® group included patients assisted by an IMPELLA® alone at least five days prior the implantation of the LVAD while the ECLS group included patients treated by a ECLS with or without IMPELLA®. The primary endpoint was the proportion of patients alive with a John Hopkins Highest Level of Mobility score = 8, discharged from the critical care unit and not perfused at 30 days after LVAD implantation. Secondary endpoints included rehabilitation under tMCS (tracheal extubation, mobilization to chair, walking and cyclo-ergometer), 6-month survival rate after the LVAD implantation. This study was approved by our ethics committee and registered on Clinical trials (NCT04480151).
Results
From 388 consecutive patients implanted by LVAD, 92 patients treated as bridge to LVAD have been included in our study (ECLS group n = 42/IMPELLA group n = 50). Most of patients of IMPELLA group (72%) were implanted through an axillary approach. Early mobilization on tMCS was more frequently achieved in IMPELLA group (seating 50% vs 2%, P < 0.001 and walking 18% vs 0%, P < 0.01). A larger proportion of patients in IMPELLA group reached the primary endpoint (52% vs 26%, P = 0.018). The 6-month survival rate after LVAD implantation was significantly better in IMPELLA group (Fig. 1).
Conclusion
Implantation of IMPELLA through axillary approach as bridge to LVAD by allowing active and early rehabilitation might be associated with better outcomes.
在接受临时机械循环支持（tMCS）治疗难治性心源性休克的患者中，一些患者患有持续性心功能障碍，与成功脱机不相容。在符合条件的患者中，心脏移植仍然是金标准治疗。然而，由于移植物短缺和/或禁忌症，一些患者不会进行移植。在这些患者中，左心室辅助装置（LVAD）是一种替代疗法，tMCS作为持久左心室辅助装置的桥梁的最佳方法仍有待明确。目的：通过提供tMCS下主动康复的机会，我们验证了使用IMPELLA®作为LVAD桥应改善早期术后预后的假设。ECI-BLAD试验是一项多中心回顾性研究，包括成人，在2012年1月至2020年12月期间，在5个法国心脏重症监护病房中使用IMPELLA®或ECLS作为LVAD的桥梁。IMPELLA®组包括在LVAD植入前至少5天单独使用IMPELLA®辅助的患者，而ECLS组包括使用或不使用IMPELLA®的ECLS治疗的患者。主要终点是在LVAD植入后30天，John Hopkins最高活动水平评分= 8、从重症监护病房出院且未进行灌注的存活患者比例。次要终点包括tMCS下的康复（气管拔管，椅子活动，步行和循环计劳器），LVAD植入后6个月的生存率。本研究经伦理委员会批准，注册临床试验（NCT04480151）。结果在连续388例LVAD植入患者中，92例作为LVAD桥接患者纳入我们的研究（ECLS组42例/IMPELLA组50例）。IMPELLA组大部分患者（72%）采用腋窝入路植入术。IMPELLA组在tMCS上的早期活动更频繁（坐下50%对2%，P < 0.001，步行18%对0%，P < 0.01）。IMPELLA组达到主要终点的患者比例较大（52% vs 26%, P = 0.018）。IMPELLA组LVAD植入后6个月生存率明显优于IMPELLA组（图1）。结论经腋窝入路植入IMPELLA作为LVAD的桥梁，早期主动康复治疗效果较好。
{"title":"ExtraCorporeal life support versus IMPELLA® pump as Bridge to Left ventricular Assist Device (ECI-BLAD trial)","authors":"O. Simon , A. Quessard , N. Labaste , P.-G. Guinot , N. Nesseler , A. Beurton , P. Gaudard , A. Ouattara","doi":"10.1016/j.acvd.2025.10.072","DOIUrl":"10.1016/j.acvd.2025.10.072","url":null,"abstract":"<div><h3>Introduction</h3><div>Among patients treated by temporary mechanical circulatory support (tMCS) for refractory cardiogenic shock, some of them suffer from persistent cardiac dysfunction incompatible with a successful weaning. In eligible patients, the heart transplantation is still the gold standard therapy. However, due to the shortage of grafts and/or contraindications, some patients will not be transplanted. In these patients, for whom the Left ventricular Assist Device (LVAD) represents an alternative therapy, the best approach of tMCS as a bridge to durable LVAD remains to be clarified.</div></div><div><h3>Objective</h3><div>We tested the hypothesis that the use of IMPELLA® as bridge to LVAD should improve early postoperative outcomes by offering the opportunité of active rehabilitation under tMCS.</div></div><div><h3>Method</h3><div>The ECI-BLAD trial was a multicentre retrospective study including adults, supported with IMPELLA® or ECLS as a bridge to LVAD between January 2012 and December 2020 in 5 French cardiac intensive care units. The IMPELLA® group included patients assisted by an IMPELLA® alone at least five days prior the implantation of the LVAD while the ECLS group included patients treated by a ECLS with or without IMPELLA®. The primary endpoint was the proportion of patients alive with a John Hopkins Highest Level of Mobility score<!--> <!-->=<!--> <!-->8, discharged from the critical care unit and not perfused at 30 days after LVAD implantation. Secondary endpoints included rehabilitation under tMCS (tracheal extubation, mobilization to chair, walking and cyclo-ergometer), 6-month survival rate after the LVAD implantation. This study was approved by our ethics committee and registered on Clinical trials (<span><span>NCT04480151</span><svg><path></path></svg></span>).</div></div><div><h3>Results</h3><div>From 388 consecutive patients implanted by LVAD, 92 patients treated as bridge to LVAD have been included in our study (ECLS group <em>n</em> <!-->=<!--> <!-->42/IMPELLA group <em>n</em> <!-->=<!--> <!-->50). Most of patients of IMPELLA group (72%) were implanted through an axillary approach. Early mobilization on tMCS was more frequently achieved in IMPELLA group (seating 50% vs 2%, <em>P</em> <!--><<!--> <!-->0.001 and walking 18% vs 0%, <em>P</em> <!--><<!--> <!-->0.01). A larger proportion of patients in IMPELLA group reached the primary endpoint (52% vs 26%, <em>P</em> <!-->=<!--> <!-->0.018). The 6-month survival rate after LVAD implantation was significantly better in IMPELLA group (<span><span>Fig. 1</span></span>).</div></div><div><h3>Conclusion</h3><div>Implantation of IMPELLA through axillary approach as bridge to LVAD by allowing active and early rehabilitation might be associated with better outcomes.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S41"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.acvd.2025.10.013
A. Hassimi, Y. Outifa, A. Ech-Chenbouli, B. El Boussaadani, Z. Raissouni
Introduction
Perivascular retinal ischemic lesions (RIPL) may represent an ophthalmological marker of the severity of coronary artery disease.
Objective
Evaluate the correlation between the presence of RIPL and the severity of coronary lesions detected by coronary angiography in patients with acute coronary syndrome (ACS).
Method
This study included 200 patients who had presented with acute coronary syndrome (ACS) and significant coronary lesions (≥50% stenosis). All patients underwent a systematic ophthalmological evaluation to screen for perivascular retinal ischemic lesions (RIPL). To minimize bias related to diabetic retinopathy, diabetic patients were excluded from the study. The mean age of the patients was 61.4 years (±12.3), with a sex distribution of 41.1% male and 57.9% female. The most prevalent cardiovascular risk factors included hypertension (49.6%) and smoking (34.9%). The mean SYNTAX score was 14.3 (±5.0), reflecting varying degrees of coronary lesion complexity. Regarding the extent of coronary involvement, 16.4% of patients had single-vessel disease, 11.6% had two-vessel disease, and 9.6% had three-vessel disease. The most commonly affected arteries were the left anterior descending artery (75.7%), the circumflex artery (52.0%), and the right coronary artery (50.9%). In terms of treatment approach, 41.2% of patients underwent percutaneous coronary intervention (PCI) with stenting, while 14.6% required coronary artery bypass grafting (CABG) due to the complexity of their coronary disease.
Results
The results were satisfactory, highlighting an association between the presence of RIPL and the severity of coronary lesions. The presence of RIPL was significantly associated with multivessel disease (≥2 vessels) and bifurcation lesions. Furthermore, patients who underwent coronary artery bypass grafting or complex percutaneous intervention had an increased frequency of RIPL.
Conclusion
These findings suggest that the presence of RIPL could serve as a non-invasive ophthalmological marker to identify patients at high risk of developing ACS (STEMI, NSTEMI). A multidisciplinary approach integrating ophthalmology into cardiovascular risk assessment could improve coronary risk stratification. Long-term follow-up of patients with RIPL is necessary to confirm their prognostic value and refine their role in early diagnostic strategies.
{"title":"Correlation between perivascular retinal ischemic lesions (RIPL) and the severity of coronary lesions in patients with acute coronary syndrome","authors":"A. Hassimi, Y. Outifa, A. Ech-Chenbouli, B. El Boussaadani, Z. Raissouni","doi":"10.1016/j.acvd.2025.10.013","DOIUrl":"10.1016/j.acvd.2025.10.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Perivascular retinal ischemic lesions (RIPL) may represent an ophthalmological marker of the severity of coronary artery disease.</div></div><div><h3>Objective</h3><div>Evaluate the correlation between the presence of RIPL and the severity of coronary lesions detected by coronary angiography in patients with acute coronary syndrome (ACS).</div></div><div><h3>Method</h3><div>This study included 200 patients who had presented with acute coronary syndrome (ACS) and significant coronary lesions (≥50% stenosis). All patients underwent a systematic ophthalmological evaluation to screen for perivascular retinal ischemic lesions (RIPL). To minimize bias related to diabetic retinopathy, diabetic patients were excluded from the study. The mean age of the patients was 61.4 years (±12.3), with a sex distribution of 41.1% male and 57.9% female. The most prevalent cardiovascular risk factors included hypertension (49.6%) and smoking (34.9%). The mean SYNTAX score was 14.3 (±5.0), reflecting varying degrees of coronary lesion complexity. Regarding the extent of coronary involvement, 16.4% of patients had single-vessel disease, 11.6% had two-vessel disease, and 9.6% had three-vessel disease. The most commonly affected arteries were the left anterior descending artery (75.7%), the circumflex artery (52.0%), and the right coronary artery (50.9%). In terms of treatment approach, 41.2% of patients underwent percutaneous coronary intervention (PCI) with stenting, while 14.6% required coronary artery bypass grafting (CABG) due to the complexity of their coronary disease.</div></div><div><h3>Results</h3><div>The results were satisfactory, highlighting an association between the presence of RIPL and the severity of coronary lesions. The presence of RIPL was significantly associated with multivessel disease (≥2 vessels) and bifurcation lesions. Furthermore, patients who underwent coronary artery bypass grafting or complex percutaneous intervention had an increased frequency of RIPL.</div></div><div><h3>Conclusion</h3><div>These findings suggest that the presence of RIPL could serve as a non-invasive ophthalmological marker to identify patients at high risk of developing ACS (STEMI, NSTEMI). A multidisciplinary approach integrating ophthalmology into cardiovascular risk assessment could improve coronary risk stratification. Long-term follow-up of patients with RIPL is necessary to confirm their prognostic value and refine their role in early diagnostic strategies.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Pages S11-S12"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.acvd.2025.10.094
D.-D. Batouche , D. Boumendil , D. Batouche , Z.Z. Addou , H. Saddok , A. Bouguerra , F. Bounoua , F. Latreche , N.-F. Benatta , R. Okbani
Introduction
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.
Objective
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.
Method
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.
Results
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.
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.
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.
Conclusion
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.
{"title":"Catecholaminergic strom and cardiac failure in children: Insights from severe scorpion envenomation cases","authors":"D.-D. Batouche , D. Boumendil , D. Batouche , Z.Z. Addou , H. Saddok , A. Bouguerra , F. Bounoua , F. Latreche , N.-F. Benatta , 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 SpO<sub>2</sub>: 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}
Pub Date : 2026-01-01DOI: 10.1016/j.acvd.2025.10.095
S. Abid, T. Ellouze, M. Jabeur, A. Bahloul, L. Abid
Introduction
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.
Objective
To identify predictors of improving Left ventricular contractility after myocardial infarction.
Method
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 < 40%, and improvement was defined as LVEF > 40%. Revascularization indications followed international guidelines.
Results
A total of 342 patients with STEMI were included. The prevalence of LV dysfunction was 28.65%, with 98 patients having an initial LVEF < 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 (> 40%). Multivariate analysis identified three independent predictors of improved LVEF: optimal heart failure treatment including the four recommended drug classes (P < 0.001; OR = 2.46), female sex (P = 0.001; OR = 4.61), and good adherence to therapy (P = 0.019; OR = 2.27). Smoking was less common among patients with improved LVEF but was not an independent predictor.
Conclusion
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.
随着现代药物治疗和先进介入策略的出现，人们对重新评估心脏功能恢复能力的兴趣越来越大。了解心肌损伤、治疗干预和潜在可逆性之间的相互作用对于优化缺血性心力衰竭患者的长期预后至关重要。目的探讨心肌梗死后左室收缩力改善的预测因素。方法回顾性研究，纳入2022年4月1日至2023年3月31日在Hedi Chaker大学附属医院心内科诊断为st段抬高型心肌梗死（STEMI）的所有患者。收集并分析临床、超声心动图和血管造影资料。由经验丰富的操作人员评估左室射血分数（LVEF）。左心室功能不全定义为LVEF <； 40%，改善定义为LVEF >； 40%。血运重建指征遵循国际指南。结果共纳入342例STEMI患者。左室功能障碍的患病率为28.65%，其中98例患者入院时初始LVEF为40%。其中，仅有25例（25.5%）患者在stemi后40天接受了随访超声心动图检查，其中17例患者LVEF改善（40%）。多变量分析确定了改善LVEF的三个独立预测因素：最佳心力衰竭治疗包括四种推荐的药物类别（P < 0.001; OR = 2.46），女性（P = 0.001; OR = 4.61），以及良好的治疗依从性（P = 0.019; OR = 2.27）。吸烟在LVEF改善的患者中较少见，但不是一个独立的预测因子。结论：在我们的研究中，我们评估了心肌梗死后心力衰竭患者射血分数改善的发生情况。女性、坚持治疗和出院时使用最佳心力衰竭药物与LVEF改善相关。这些发现支持在适当条件下收缩功能恢复的潜力。
{"title":"Improved heart failure after myocardial infarction: Myth or reality?","authors":"S. Abid, T. Ellouze, M. Jabeur, A. Bahloul, 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<!--> <!--><<!--> <!-->40%, and improvement was defined as LVEF<!--> <!-->><!--> <!-->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<!--> <!--><<!--> <!-->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 (><!--> <!-->40%). Multivariate analysis identified three independent predictors of improved LVEF: optimal heart failure treatment including the four recommended drug classes (<em>P</em> <!--><<!--> <!-->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}
Pub Date : 2026-01-01DOI: 10.1016/j.acvd.2025.10.100
S. Toupin , J. Amar , J. Garot , S. Duhamel , A. Myriam , T. Hovasse , A. Neylon , S. Champagne , T. Unterseeh , A. Unger , T. Goncalves , J. Florence , S. Houssany-Pissot , E. Gall , J.-G. Dillinger , V. Bousson , F. Sanguineti , P. Garot , T. Pezel
Introduction
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.
Objective
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.
Method
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.
Results
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 (Figure 1). 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 versus 0.86 for the GLM, and PRAUC was 0.97 versus 0.78 (all p < 0.001) in the internal validation cohort. In the external validation cohort, the RF model achieved an AUROC of 0.92 versus 0.74 for the GLM, and a PRAUC of 0.84 versus 0.58 (all p < 0.001). SHAP analysis confirmed the interpretability of the model and the individual contribution of each variable (Figure 2).
Conclusion
A ML model combining stress cardiac MRI and clinical data significantly outperformed traditional methods in predicting MACE in asymptomatic patients with obstructive CAD.
{"title":"Artificial intelligence-enhanced cardiovascular magnetic resonance for cardiovascular risk prediction in asymptomatic CAD patients","authors":"S. Toupin , J. Amar , J. Garot , S. Duhamel , A. Myriam , T. Hovasse , A. Neylon , S. Champagne , T. Unterseeh , A. Unger , T. Goncalves , J. Florence , S. Houssany-Pissot , E. Gall , J.-G. Dillinger , V. Bousson , F. Sanguineti , P. Garot , 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> <!--><<!--> <!-->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> <!--><<!--> <!-->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}
Pub Date : 2026-01-01DOI: 10.1016/j.acvd.2025.10.025
Y. Ayadi, S. Charfeddine, A. Ghrab, A. Bahloul, R. Gargouri, Z. Triki, M. Jabeur, T. Ellouze, F. Triki, S. Mallek, L. Abid
Introduction
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.
Objective
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.
Method
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).
Results
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 < 1) in 9 patients, moderate dysfunction (1 ≤ EQI < 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 (P = 0.028, r = –0.38) (Fig. 1).
Conclusion
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.
{"title":"PSS Stress Scale: A novel indicator of endothelial dysfunction in coronary artery disease","authors":"Y. Ayadi, S. Charfeddine, A. Ghrab, A. Bahloul, R. Gargouri, Z. Triki, M. Jabeur, T. Ellouze, F. Triki, S. Mallek, 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<!--> <!--><<!--> <!-->1) in 9 patients, moderate dysfunction (1<!--> <!-->≤<!--> <!-->EQI<!--> <!--><<!--> <!-->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}
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