Archives of Cardiovascular Diseases最新文献_第7页

Incidence, risk factors, and impact of coronary artery disease events after kidney transplantation 肾移植后冠状动脉疾病的发生率、危险因素及影响

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.2025.10.012

T. Beaudrey , D. Bedo , S. Caillard , N. Florens

Introduction

Coronary artery disease (CAD) is a significant cause of morbidity and mortality among kidney transplant recipients. The epidemiology and impact of coronary events after transplantation remain poorly understood in France. We investigated these aspects using data from 17 French centers, sourced from the Astre and Divat cohorts.

Objective

We aimed to describe the epidemiology of coronary artery disease, and its risk factors and impact on graft and patient outcomes.

Method

We included adult kidney allograft recipients transplanted between 2008 and 2022, with follow-up until 03/31/2023. The primary outcome was the incidence of coronary events post-transplantation, defined as the need for coronary angiography with percutaneous transluminal angioplasty. We also studied risk factors and the impact of early events on patient and graft survival (<1 month post-transplantation) using univariate and then multivariate Cox models.

Results

Among the 19,837 kidney transplant recipients included, 764 experienced a coronary event (3.9%) with a mortality rate of 7.1%. The cumulative incidence was 1.03% at 1 month, 1.86% at 1 year, 3.77% at 5 years, and 6.60% at 10 years (Fig. 1A and B). Previously known coronary artery disease was the most prominent risk factor, but the majority of events (n = 505, 66.1%) occurred in patients without history of CAD. In multivariate analysis, the other risk factors for post-transplant CAD included age, male sex, cardiovascular history, diabetes, smoking, depleting induction therapy, dialysis duration, and delayed graft function. Early coronary events were associated with all-cause mortality (Hazard ratio 1.77, 95% Confidence Interval 1.34–2.33) and a graft failure (Hazard ratio 1.51, 95% CI 1.01–2.25).

Conclusion

Post-transplant coronary events are frequent, particularly in the first month, and can occur in patients without history of coronary artery disease, despite pretransplant screening. They are a significant cause of morbidity and mortality and are associated with decline in graft function.

冠状动脉疾病（CAD）是肾移植受者发病和死亡的重要原因。在法国，对移植后冠状动脉事件的流行病学和影响仍然知之甚少。我们使用来自法国17个中心的数据调查了这些方面，这些数据来自Astre和Divat队列。目的了解冠状动脉疾病的流行病学、危险因素及其对移植物和患者预后的影响。方法纳入2008 - 2022年间移植的成人同种异体肾受体，随访至2023年3月31日。主要结果是移植后冠状动脉事件的发生率，定义为冠状动脉造影和经皮腔内血管成形术的需要。我们还使用单变量和多变量Cox模型研究了危险因素和早期事件对患者和移植物存活（移植后1个月）的影响。结果在纳入的19,837例肾移植受者中，764例发生冠状动脉事件（3.9%），死亡率为7.1%。累积发病率为1个月时1.03%，1年时1.86%，5年时3.77%，10年时6.60%（图1A和B）。先前已知的冠状动脉疾病是最突出的危险因素，但大多数事件（n = 505, 66.1%）发生在没有CAD病史的患者中。在多因素分析中，移植后CAD的其他危险因素包括年龄、男性、心血管病史、糖尿病、吸烟、耗尽性诱导治疗、透析持续时间和移植后功能延迟。早期冠状动脉事件与全因死亡率（风险比1.77,95%可信区间1.34-2.33）和移植失败（风险比1.51,95%可信区间1.01-2.25）相关。结论移植后冠状动脉事件频发，尤其是在移植后的第一个月，尽管进行了移植前筛查，但无冠状动脉疾病史的患者也可能发生冠状动脉事件。它们是发病率和死亡率的重要原因，并与移植物功能下降有关。

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引用次数: 0

From Coronary Contrast to Renal Injury: The Emerging Role of Endothelial Dysfunction 从冠状动脉造影到肾损伤：内皮功能障碍的新作用

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.2025.10.009

M. Fakhfakh , F. Nouri , T. Lassoued , S. Ferjani , S. Milouchi

Introduction

Contrast-induced acute kidney injury (CIAKI) is a common and serious complication of coronary angiography, caused by iodinated contrast agents. It significantly worsens cardiovascular prognosis and increases in-hospital morbidity and mortality.

Objective

This study aimed to uncover predictive factors of CIAKI and to investigate the contribution of pre-existing endothelial dysfunction to its onset following percutaneous coronary interventions (PCI). Preventive strategies with potential clinical relevance were concurrently evaluated.

Method

This was a prospective observational longitudinal study in which we enrolled 187 patients with an indication for coronary angiography. Patients underwent an assessment of renal function: (basal creatinine, 24 h, 48–72 h and 1month after administration of contrast medium), we focused then on the evaluation of endothelial quality index (EQI) by finger thermal monitoring with E4 diagnosis Polymath (Fig. 1).

Results

187 patients (134 males), mean age 61.1 ± 11.8 years, were enrolled; 56.7% were type 2 diabetics. CIAKI occurred in 60 patients (33.7%). Mean EQI was 0.86 ± 0.61. A vast majority (95.2%) had endothelial dysfunction (EQI < 2), and 75.9% had severe dysfunction (EQI < 1). CIAKI was significantly associated with severe endothelial dysfunction (P = 0.007), rescue PCI (P = 0.002), contrast volume > 100 ml (P = 0.015), and two-vessel coronary artery disease (P = 0.008). Multivariate analysis confirmed severe endothelial dysfunction, rescue PCI, and contrast volume ≥ 140 ml as independent risk factors. CIAKI was significantly less frequent in patients receiving pre-/post-hydration with isotonic saline or those under baseline statin therapy (P = 0.007 and P = 0.008, respectively).

Conclusion

This study demonstrates a significant association between severe endothelial dysfunction assessed non-invasively by FTM and the risk of CIAKI. These findings highlight the potential of EQI as a novel, low-cost, reproducible predictor of CIAKI, with promising implications for cardiovascular risk stratification and prevention in interventional cardiology.

造影剂引起的急性肾损伤（CIAKI）是冠状动脉造影中一种常见且严重的并发症，由碘造影剂引起。它显著恶化心血管预后，增加住院发病率和死亡率。目的本研究旨在揭示CIAKI的预测因素，并探讨经皮冠状动脉介入治疗（PCI）后存在的内皮功能障碍对其发生的影响。同时评估具有潜在临床意义的预防策略。方法这是一项前瞻性观察性纵向研究，我们纳入了187例有冠状动脉造影指征的患者。对患者进行肾功能评估（对比剂给药后24小时、48-72小时和1个月的基础肌酐），然后我们重点通过手指热监测和E4诊断Polymath评估内皮质量指数（EQI）（图1）。结果共纳入187例患者，其中男性134例，平均年龄61.1±11.8岁；56.7%为2型糖尿病。CIAKI发生60例（33.7%）。平均EQI为0.86±0.61。绝大多数（95.2%）存在内皮功能障碍（EQI < 2）， 75.9%存在严重功能障碍（EQI < 1）。CIAKI与严重内皮功能障碍（P = 0.007）、PCI急救（P = 0.002）、造影剂量100 ml （P = 0.015）和双支冠状动脉疾病（P = 0.008）显著相关。多因素分析证实严重内皮功能障碍、抢救PCI、造影剂体积≥140 ml为独立危险因素。CIAKI在接受等渗盐水补水前/后或基线他汀类药物治疗的患者中发生率显著降低（P = 0.007和P = 0.008）。结论：本研究表明，非侵入性FTM评估的严重内皮功能障碍与CIAKI风险之间存在显著关联。这些发现强调了EQI作为CIAKI的一种新颖、低成本、可重复的预测指标的潜力，在心血管风险分层和介入心脏病学预防方面具有重要意义。

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引用次数: 0

Cardiovascular magnetic resonance late gadolinium enhancement risk score for mortality in hypertrophic cardiomyopathy: The HCM-LGE risk score 心血管磁共振晚期钆增强对肥厚性心肌病死亡率的风险评分：HCM-LGE风险评分

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.2025.10.099

J. Florence , J. Garot , P. Garot , F. Sanguineti , S. Duhamel , T. Goncalves , A. Unger , E. Ballout , J. Hudelo , J.-G. Dillinger , P. Henry , V. Bousson , Y. Bohbot , S. Toupin , T. Pezel

Introduction

Prognostic stratification is the cornerstone of the management of patients with hypertrophic cardiomyopathy (HCM). Our working group has developed the concept of “late gadolinium enhancement (LGE) granularity” using cardiovascular magnetic resonance (CMR) with an incremental prognostic value in HCM patients.

Objective

To develop a readily interpretable score based on the CMR-LGE granularity concept to predict all-cause mortality in HCM patients.

Method

Between 2008 and 2021, all patients referred for HCM assessment using CMR, without history of cardiovascular disease were prospectively recruited in two French centers. We selected patients with CMR-LGE. The outcome was all-cause death using the French National Registry of Death. Using the variables of the “LGE granularity” model (LGE extent, septal location and subepicardial associated midwall pattern), the HCM-LGE score, was derived from coefficients of the Cox regression (Figure 1). The first center (N = 723) was split into training set (N = 586) designated for score development, and testing set (N = 137) for performances assessment. The second center (N = 139) was used as the external validation cohort. Score categories were identified using a survival conditional inference tree analysis on the training set, aiming to optimize the log-rank. Performances of the score were assessed using Kaplan-Meier curves analysis and Cox regression on the overall population.

Results

Overall, 862 patients (52 ± 7 years, 54% males) with HCM and CMR-LGE were included. After a median (IQR) follow-up of 9 (7–11) years, 283 (33%) patients died. The proportion of mortality rate for each score points is presented in Figure 1A. In the overall population (N = 862), intermediate and high-risk categories were strongly associated with all-cause mortality (hazard ratio (HR) 8.61, 95% CI: 5.96–12.45, p < 0.001; HR 19.31, 95% CI: 13.95–26.73, p < 0.001 respectively) (Figure 1B). Based on our HCM-LGE score, we identified a low-risk population (CMR-LGE score below 4) and a high-risk population (CMR-LGE above 5), validated using survival curves in the overall population.

Conclusion

Our HCM-LGE score based on the concept of LGE granularity showed an excellent performance to stratify patient risk in HCM patients.

预后分层是肥厚性心肌病（HCM）患者治疗的基石。我们的工作小组提出了“晚期钆增强（LGE）粒度”的概念，使用心血管磁共振（CMR）对HCM患者的预后具有增量价值。目的建立一种基于CMR-LGE粒度概念的易于解释的评分方法，以预测HCM患者的全因死亡率。方法在2008年至2021年期间，在两个法国中心前瞻性招募所有无心血管疾病史的患者进行HCM评估。我们选择了CMR-LGE患者。结果是使用法国国家死亡登记处的全因死亡。利用“LGE粒度”模型的变量（LGE程度、间隔位置和心外膜下相关的中壁模式），根据Cox回归系数得出HCM-LGE评分（图1）。第一个中心（N = 723）分为用于分数制定的训练集（N = 586）和用于性能评估的测试集（N = 137）。第二个中心（N = 139）作为外部验证队列。在训练集上使用生存条件推理树分析来识别得分类别，旨在优化log-rank。采用Kaplan-Meier曲线分析和Cox回归对总体进行评分。结果共纳入HCM合并CMR-LGE患者862例（52±7岁，男性54%）。中位（IQR）随访9年（7-11年）后，283例（33%）患者死亡。每个评分点的死亡率比例如图1A所示。在总体人群中（N = 862），中等和高危类别与全因死亡率密切相关(危险比（HR） 8.61, 95% CI: 5.96-12.45, p < 0.001；HR 19.31, 95% CI: 13.95-26.73, p < 0.001)（图1B）。根据我们的HCM-LGE评分，我们确定了低危人群（CMR-LGE评分低于4）和高危人群（CMR-LGE评分高于5），并使用总体人群的生存曲线进行了验证。结论基于LGE粒度概念的HCM-LGE评分在HCM患者风险分层方面表现出色。

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引用次数: 0

Challenges in the Diagnosis and Management of Non-ST Elevation Acute Coronary Syndromes in Dakar 达喀尔非st段抬高急性冠状动脉综合征诊断和治疗的挑战

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.2025.10.026

A.A. Ngaide , P.G. Ndiaye , J.S. Mingou , S. Abdoulgabar , M. Dioum , C.M. Mouhamed , A. Kane

Introduction

Non-ST elevation acute coronary syndrome (NSTE-ACS) is the most common form of acute coronary syndrome (ACS). Its diagnosis and management remain controversial, particularly in resource-limited settings like Africa, where logistical and financial constraints often complicate optimal care.

Objective

This study aimed to assess the overall management of patients hospitalized for NSTE-ACS in Dakar.

Method

We conducted a prospective, multicenter, descriptive, and analytical study over a 12-month period across three cardiology departments in Dakar. All patients admitted with a diagnosis of NSTE-ACS were included. Clinical, biological, echocardiographic, and angiographic data were collected and analyzed.

Results

Out of 2329 patients admitted during the study period, 131 were diagnosed with NSTE-ACS, representing a hospital prevalence of 5.63% and accounting for 26.3% of all hospitalized ACS cases. Based on troponin levels, 86.7% had positive troponin (NSTEMI), while 13.3% had negative troponin (unstable angina). The cohort had a female predominance (56.0%), with a mean age of 61.1 years (range 40–91). The most frequent cardiovascular risk factors were physical inactivity (75.6%), hypertension (64.9%), and diabetes mellitus (36.7%). Chest pain was the leading symptom (81.7%), and physical examination was normal in 75% of cases. Echocardiography revealed segmental wall motion abnormalities in 45% and left ventricular dysfunction in 38.6% of patients. Nearly half of the patients (46.6%) were classified as high ischemic risk.

Coronary angiography was performed in 64.8% of patients, and coronary artery disease was identified in 82.4% of them, predominantly triple-vessel disease (46.7%). Among those with confirmed coronary disease, only 35.7% underwent percutaneous coronary intervention (PCI). The clinical outcome was generally favorable.

Conclusion

The diagnosis and management of NSTE-ACS remain major challenges in sub-Saharan Africa, particularly due to limited access to coronary angiography and revascularization procedures. Strengthening diagnostic infrastructure and improving access to interventional cardiology are essential for optimizing care and outcomes in this high-risk population.

非st段抬高急性冠脉综合征（NSTE-ACS）是最常见的急性冠脉综合征（ACS）。其诊断和管理仍然存在争议，特别是在非洲等资源有限的环境中，后勤和财政限制往往使最佳护理复杂化。目的本研究旨在评估达喀尔NSTE-ACS住院患者的整体管理情况。方法我们在达喀尔的三个心脏病科进行了一项为期12个月的前瞻性、多中心、描述性和分析性研究。所有确诊为NSTE-ACS的患者均纳入研究。收集并分析临床、生物学、超声心动图和血管造影资料。结果研究期间入院的2329例患者中，131例诊断为NSTE-ACS，医院患病率为5.63%，占所有住院ACS病例的26.3%。基于肌钙蛋白水平，86.7%为肌钙蛋白阳性（NSTEMI）， 13.3%为肌钙蛋白阴性（不稳定型心绞痛）。该队列以女性为主（56.0%），平均年龄61.1岁（40-91岁）。最常见的心血管危险因素是缺乏运动（75.6%）、高血压（64.9%）和糖尿病（36.7%）。胸痛是主要症状（81.7%），75%的病例体检正常。超声心动图显示45%的患者有节段性壁运动异常，38.6%的患者有左心室功能障碍。近一半（46.6%）的患者被归为高缺血性风险。64.8%的患者行冠状动脉造影，其中82.4%的患者发现冠状动脉病变，以三支血管病变为主（46.7%）。在确诊冠心病的患者中，只有35.7%接受了经皮冠状动脉介入治疗（PCI）。临床结果总体良好。结论NSTE-ACS的诊断和治疗仍然是撒哈拉以南非洲地区的主要挑战，特别是由于冠状动脉造影和血运重建术的机会有限。加强诊断基础设施和改善介入心脏病学的可及性对于优化这一高危人群的护理和结果至关重要。

{"title":"Challenges in the Diagnosis and Management of Non-ST Elevation Acute Coronary Syndromes in Dakar","authors":"A.A. Ngaide , P.G. Ndiaye , J.S. Mingou , S. Abdoulgabar , M. Dioum , C.M. Mouhamed , A. Kane","doi":"10.1016/j.acvd.2025.10.026","DOIUrl":"10.1016/j.acvd.2025.10.026","url":null,"abstract":"<div><h3>Introduction</h3><div>Non-ST elevation acute coronary syndrome (NSTE-ACS) is the most common form of acute coronary syndrome (ACS). Its diagnosis and management remain controversial, particularly in resource-limited settings like Africa, where logistical and financial constraints often complicate optimal care.</div></div><div><h3>Objective</h3><div>This study aimed to assess the overall management of patients hospitalized for NSTE-ACS in Dakar.</div></div><div><h3>Method</h3><div>We conducted a prospective, multicenter, descriptive, and analytical study over a 12-month period across three cardiology departments in Dakar. All patients admitted with a diagnosis of NSTE-ACS were included. Clinical, biological, echocardiographic, and angiographic data were collected and analyzed.</div></div><div><h3>Results</h3><div>Out of 2329 patients admitted during the study period, 131 were diagnosed with NSTE-ACS, representing a hospital prevalence of 5.63% and accounting for 26.3% of all hospitalized ACS cases. Based on troponin levels, 86.7% had positive troponin (NSTEMI), while 13.3% had negative troponin (unstable angina). The cohort had a female predominance (56.0%), with a mean age of 61.1 years (range 40–91). The most frequent cardiovascular risk factors were physical inactivity (75.6%), hypertension (64.9%), and diabetes mellitus (36.7%). Chest pain was the leading symptom (81.7%), and physical examination was normal in 75% of cases. Echocardiography revealed segmental wall motion abnormalities in 45% and left ventricular dysfunction in 38.6% of patients. Nearly half of the patients (46.6%) were classified as high ischemic risk.</div><div>Coronary angiography was performed in 64.8% of patients, and coronary artery disease was identified in 82.4% of them, predominantly triple-vessel disease (46.7%). Among those with confirmed coronary disease, only 35.7% underwent percutaneous coronary intervention (PCI). The clinical outcome was generally favorable.</div></div><div><h3>Conclusion</h3><div>The diagnosis and management of NSTE-ACS remain major challenges in sub-Saharan Africa, particularly due to limited access to coronary angiography and revascularization procedures. Strengthening diagnostic infrastructure and improving access to interventional cardiology are essential for optimizing care and outcomes in this high-risk population.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Pages S17-S18"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparison of return to work at one year after stenting or coronary artery bypass surgery 支架置入术和冠状动脉搭桥术一年后重返工作岗位的比较

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.2025.10.035

L. Boulares , J. Hsinet , S. Saidane , A. Chakroun , K. Mzoughi

Introduction

Coronary heart disease can cause premature disability, resulting in socioeconomic issues. A better understanding of return to work (RTW) and quality of life after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) may help inform patients better, and could provide metrics for patients and physicians to understand longer term social outcomes.

Objective

The aim of this study was to determine return to work (RTW) rates, long-term employment (>12 months postprocedure), time taken to RTW, and to evaluate the predictive factors of return to work, for the subgroup of professionally active patients aged less than 60 years, treated either with (PCI) or coronary bypass graft surgery (CABG).

Method

A descriptive cross-sectional study of active patients aged less than 60 years, followed for acute coronary syndrome in a cardiology department between 2021 and 2024 and who underwent PCI or CABG. The medical data were collected from the hospitalization records. In addition, socio-demographic and occupational characteristics were collected using a questionnaire addressed to patients either during a consultation or by a telephone contact.

Results

78 patients were employed preprocedure: 64 patients (82%) underwent PCI and 14 patients (18%) underwent CABG. The median age was 52.39 ± 54.04 years. The return to work rate was 69.4% with an average delay of 53.5 ± 40 days. Of these 44 (56.4%) PCI and 10 (12.8%) CABG, there was no significant difference between PCI and CABG patients in RTW nor in long term employment. The median time taken to RTW was 4 weeks after PCI and 12 weeks after CABG (P = 0.001).

Return to work was associated with age under 50 years (P = 0.013) and work in the public sector (P = 0.017). In addition, physical workload (P = 0.003), shift work (P = 0.018) and the existence of complications including heart failure (P = 0.001) and rhythm disorders (P = 0.007) were strongly associated with no return to the professional activity.

Conclusion

In this study comparing RTW after PCI or CABG indicates that RTW, is similar for PCI or CABG, albeit the number of matched pairs was small. There are differences, however, in delay in RTW.

Return to work after percutaneous coronary intervention or coronary bypass graft surgery depends essentially on socio-professional factors and heart complications.

冠心病可导致过早残疾，导致社会经济问题。更好地了解经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）后的恢复工作（RTW）和生活质量可能有助于更好地告知患者，并为患者和医生了解长期社会结果提供指标。目的：本研究的目的是确定年龄小于60岁、接受PCI或冠状动脉搭桥手术（CABG）的职业活跃患者亚组的重返工作（RTW）率、长期就业（术后12个月）、重返工作所需时间，并评估重返工作的预测因素。方法一项描述性横断面研究，对2021年至2024年间在心内科接受PCI或CABG治疗的年龄小于60岁的急性冠状动脉综合征患者进行随访。医疗数据是从住院记录中收集的。此外，在会诊期间或通过电话联系向患者发送问卷，收集社会人口统计学和职业特征。结果78例患者术前行PCI治疗64例（82%），CABG治疗14例（18%）。中位年龄为52.39±54.04岁。复工率为69.4%，平均延迟53.5±40天。在这44例（56.4%）PCI和10例（12.8%）CABG患者中，PCI和CABG患者在RTW和长期就业方面没有显著差异。到RTW的中位时间为PCI术后4周，CABG术后12周（P = 0.001）。重返工作岗位与年龄在50岁以下（P = 0.013）和在公共部门工作（P = 0.017）有关。此外，体力负荷（P = 0.003）、轮班工作（P = 0.018）以及包括心力衰竭（P = 0.001）和节律障碍（P = 0.007）在内的并发症的存在与无法重返专业活动密切相关。结论本研究比较PCI和CABG术后RTW，发现PCI和CABG术后RTW相似，只是配对对较少。然而，在RTW的延迟方面存在差异。经皮冠状动脉介入治疗或冠状动脉搭桥手术后重返工作岗位主要取决于社会专业因素和心脏并发症。

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引用次数: 0

New onset atrial fibrillation in acute coronary syndrome: Prevalence, risk factors, and long-term outcomes in a Tunisian population 急性冠状动脉综合征新发心房颤动：突尼斯人群的患病率、危险因素和长期预后

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.2025.10.038

M. Ben Halima, Z. Jebbari, K. Ezzaouia, W. Yaakoubi, S. Ouali, F. Meghaieth, A. Farhati, R. Ben Rejeb, N. Larbi, S. Boudiche, M.S. Mourali

Introduction

New-onset AF atrial fibrillation (NOAF) frequently complicates acute coronary syndromes (ACS) leading to adverse outcomes in the short and long term. The reported incidence ranges from 2 to 37% according to recent studies and a number of factors have consistently been shown to be associated with this arrhythmia.

Objective

The aim of the study was to determine the prevalence of NOAF in a population of patients admitted for ACS and to identify its predictive factors and study their prognosis.

Method

We carried out a prospective, descriptive and comparative observational study during a period of 10 months from January 2023 to November 2023 in the Cardiology department of the Rabta hospital. We included in our study consecutively hospitalized patients with acute coronary syndrome (ACS) who did not have a previous diagnosis of AF.

Results

In our study, we included 404 patients hospitalized for ACS. The prevalence of NOAF was 10%. In the multivariate analytical study, we found that age greater than 62 years (P = 0.04; adjusted OR = 4.83; CI95%: 1.07–21.77), chronic renal failure (P = 0.043; adjusted OR = 6.61; CI95%: 1.06–35.80), history of stroke (P = 0.002; adjusted OR = 44.51; CI95%: 3.97–498.10) and uricemia ≥ 62 mg/l (P = 0.04; adjusted OR = 4.4; CI95%: 1.06–18.15) were independent predictive factors of NOAF. NOAF was associated with a higher in-hospital mortality (5% vs. 0.5% in the group without AF; P = 0.04) as well as a higher incidence of in-hospital major cardiovascular events (69% versus 24%; P = 0.009). For the 183 patients followed over a mean period of 12 months, the NOAF was associated with a higher extra-hospital mortality (13% vs 6% in the group without AF; P = 0.03) but there was not significant difference between patients with and without AF for major cardiovascular events.

Conclusion

The prevalence of NOAF in patients with ACS was 10%. Its systematic screening in these patients appears to be a relevant approach because of the strong association between the two pathologies in this population, and the pejorative impact on the prognosis of this arrythmia.

新发房颤（NOAF）经常并发急性冠状动脉综合征（ACS），导致短期和长期的不良后果。根据最近的研究，报道的发病率从2%到37%不等，许多因素一直被证明与这种心律失常有关。目的本研究的目的是确定急性冠脉综合征（ACS）住院患者中NOAF的患病率，确定其预测因素并研究其预后。方法我们于2023年1月至2023年11月在Rabta医院心内科进行了为期10个月的前瞻性、描述性和比较观察性研究。我们的研究纳入了既往无af诊断的急性冠脉综合征（ACS）住院患者。结果在我们的研究中，我们纳入了404例ACS住院患者。NOAF患病率为10%。在多因素分析研究中，我们发现年龄大于62岁（P = 0.04，调整后OR = 4.83, CI95%: 1.07-21.77）、慢性肾功能衰竭（P = 0.043，调整后OR = 6.61, CI95%: 1.06-35.80）、卒中史（P = 0.002，调整后OR = 44.51, CI95%: 3.97-498.10）和尿毒症≥62 mg/l （P = 0.04，调整后OR = 4.4, CI95%: 1.06-18.15）是NOAF的独立预测因素。NOAF与较高的院内死亡率（5% vs.无AF组的0.5%,P = 0.04）以及较高的院内主要心血管事件发生率（69% vs. 24%, P = 0.009）相关。在平均随访12个月的183例患者中，NOAF与较高的院外死亡率相关（13% vs无房颤组的6%；P = 0.03），但在主要心血管事件方面，有房颤和无房颤患者之间没有显著差异。结论ACS患者NOAF发生率为10%。在这些患者中进行系统筛查似乎是一种相关的方法，因为这两种疾病在这一人群中具有很强的相关性，并且对这种心律失常的预后有不利的影响。

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引用次数: 0

Impact of gender and diabetes on the outcome of patients undergoing percutaneous coronary intervention with rotational atherectomy 性别和糖尿病对经皮冠状动脉介入治疗伴旋转动脉粥样硬化切除术患者预后的影响

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.2025.10.040

P. Chenard, A.M. Boutaleb, V. Coussens, A. Cianci, L. Lebivic, V. Aboyans, M. Boukhris

Introduction

The complexity of coronary lesions treated by percutaneous coronary intervention (PCI) has gradually increased with high prevalence of calcified lesions. The use of rotational atherectomy (RA) has become more common. However, the outcome of such a debulking device in specific patient subsets remains not well understood.

Objective

This study aimed to investigate the combined impact of gender and diabetes on the management and outcomes of patients undergoing PCI with RA.

Method

We conducted a retrospective single-center study of patients who underwent PCI with RA between January 2019 and December 2022. The primary outcome was the occurrence of major adverse cardiovascular events (MACE), including myocardial infarction (MI), cardiovascular (CV) death, and target vessel failure (TVF). Secondary outcomes included individual occurrences of MI, CV death, and TVF, along with data on technical success and safety outcomes, such as per-procedural and in-hospital complications.

Results

A total of 238 patients (mean age 77.2 ± 9.2 years; 74.8% male; diabetes prevalence 36.1%) were included: men with diabetes (n = 66, 27.7%), women with diabetes (n = 20, 8.4%), men without diabetes (n = 112, 47.1%), and women without diabetes (n = 40, 16.8%).

No in-hospital death was observed in patients without diabetes. In presence of diabetes, in-hospital death was significantly higher in women as compared with men (7.5% vs. 0.9%; P = 0.025).

The mean follow-up was 2.40 ± 1.41 years. Men with diabetes had a higher incidence of MACE than men without diabetes (P = 0.037) (Fig. 1), mainly due to more MI (P < 0.01). No significant difference was found in CV death (P = 0.995) or TVF (P = 0.285). After adjustment, diabetes was an independent predictor of MACE in men [hazard ratio (HR) = 1.97; 95% CI: 1.04–3.71; P = 0.037], but not in women.

Conclusion

In patients who underwent PCI with RA, women were more prone to have in-hospital complications, while long-term outcomes were worse in men, especially those with diabetes.

经皮冠状动脉介入治疗（PCI）治疗冠状动脉病变的复杂性逐渐增加，钙化病变的发生率很高。旋转动脉粥样硬化切除术（RA）的应用越来越普遍。然而，这种减容装置在特定患者亚群中的效果仍不清楚。目的探讨性别和糖尿病对RA患者行PCI治疗和预后的综合影响。方法我们对2019年1月至2022年12月期间接受RA PCI治疗的患者进行了回顾性单中心研究。主要结局是主要不良心血管事件（MACE）的发生，包括心肌梗死（MI）、心血管（CV）死亡和靶血管衰竭（TVF）。次要结局包括个体心肌梗死发生率、心血管死亡和TVF，以及技术成功和安全结局的数据，如手术前和院内并发症。结果共纳入238例患者（平均年龄77.2±9.2岁，男性74.8%，糖尿病患病率36.1%）：男性糖尿病患者（n = 66, 27.7%）、女性糖尿病患者（n = 20, 8.4%）、男性非糖尿病患者（n = 112, 47.1%）、女性非糖尿病患者（n = 40, 16.8%）。无糖尿病患者无院内死亡。患有糖尿病的女性住院死亡率明显高于男性（7.5% vs. 0.9%; P = 0.025）。平均随访时间为2.40±1.41年。糖尿病男性的MACE发生率高于非糖尿病男性（P = 0.037）（图1），主要原因是心肌梗死发生率更高（P < 0.01）。CV死亡率（P = 0.995）和TVF （P = 0.285）无显著差异。调整后，糖尿病是男性MACE的独立预测因子[危险比(HR) = 1.97；95% ci: 1.04-3.71；P = 0.037]，但女性没有。结论在接受PCI合并RA的患者中，女性更容易出现院内并发症，而男性的长期预后更差，尤其是糖尿病患者。

{"title":"Impact of gender and diabetes on the outcome of patients undergoing percutaneous coronary intervention with rotational atherectomy","authors":"P. Chenard, A.M. Boutaleb, V. Coussens, A. Cianci, L. Lebivic, V. Aboyans, M. Boukhris","doi":"10.1016/j.acvd.2025.10.040","DOIUrl":"10.1016/j.acvd.2025.10.040","url":null,"abstract":"<div><h3>Introduction</h3><div>The complexity of coronary lesions treated by percutaneous coronary intervention (PCI) has gradually increased with high prevalence of calcified lesions. The use of rotational atherectomy (RA) has become more common. However, the outcome of such a debulking device in specific patient subsets remains not well understood.</div></div><div><h3>Objective</h3><div>This study aimed to investigate the combined impact of gender and diabetes on the management and outcomes of patients undergoing PCI with RA.</div></div><div><h3>Method</h3><div>We conducted a retrospective single-center study of patients who underwent PCI with RA between January 2019 and December 2022. The primary outcome was the occurrence of major adverse cardiovascular events (MACE), including myocardial infarction (MI), cardiovascular (CV) death, and target vessel failure (TVF). Secondary outcomes included individual occurrences of MI, CV death, and TVF, along with data on technical success and safety outcomes, such as per-procedural and in-hospital complications.</div></div><div><h3>Results</h3><div>A total of 238 patients (mean age 77.2±9.2 years; 74.8% male; diabetes prevalence 36.1%) were included: men with diabetes (<em>n</em>  =20, 8.4%), men without diabetes (<em>n</em>  =40, 16.8%).</div><div>No in-hospital death was observed in patients without diabetes. In presence of diabetes, in-hospital death was significantly higher in women as compared with men (7.5% vs. 0.9%; <em>P</em>    =0.037) (<span><span>Fig. 1</span></span>), mainly due to more MI (<em>P</em>  =0.995) or TVF (<em>P</em>    =0.037], but not in women.</div></div><div><h3>Conclusion</h3><div>In patients who underwent PCI with RA, women were more prone to have in-hospital complications, while long-term outcomes were worse in men, especially those with diabetes.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S24"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cardiovascular health: Prevent, innovate, share 心血管健康：预防、创新、分享

IF 2.2 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2026-01-01 DOI: 10.1016/j.acvd.2025.12.004

Pr Victor Aboyans (Scientific Secretary of JESFC), Pr Anne Bernard (Deputy Scientific Secretary, in charge of the Simulation Village), Pr Stéphane Lafitte (in charge of CME and the Digital Village), Pr Hélène Eltchaninoff (President-Elect of the SFC), Pr Christophe Leclercq (Past President of the SFC), Pr Bernard Iung (President of the SFC)

引用次数: 0

Outcomes of the HELIOS-B monotherapy population: A post hoc analysis censoring data following tafamidis initiation HELIOS-B单药治疗人群的结果：一项对他法非地起始治疗后数据的事后分析

IF 2.2 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2026-01-01 DOI: 10.1016/j.acvd.2025.10.069

R. Witteles , A. Kristen , G. Habib , O. Azevedo , D. Rodriguez-Duque , E. Aldinc , S. Eraly , J. González-Costello

Introduction

In HELIOS-B, vutrisiran significantly reduced the risk of the primary endpoint composite of all-cause mortality (ACM) and recurrent cardiovascular (CV) events, and met all secondary endpoints (including ACM at 42 months), vs placebo in patients with transthyretin amyloidosis with cardiomyopathy (ATTR-CM) in both the overall and monotherapy (patients not receiving tafamidis at baseline) populations. In the monotherapy population, 21.5% of patients initiated tafamidis after randomization during the double-blind period.

Objective

To evaluate the efficacy of vutrisiran versus placebo in the monotherapy population of HELIOS-B.

Method

Patients were randomized 1:1 to receive vutrisiran 25 mg or placebo every 12 weeks for up to 36 months. Patients who were not receiving tafamidis at baseline (monotherapy population) could initiate tafamidis after enrollment depending on the investigator's decision and the availability of tafamidis. This analysis censored patient observations in the monotherapy population post-tafamidis initiation, and then repeated the primary analyses of the HELIOS-B study.

Results

A total of 395 patients in HELIOS-B were in the vutrisiran monotherapy population and were included in this analysis. Of these, 85 (21.5%) initiated tafamidis post randomization (vutrisiran n = 44; placebo n = 41) during the double-blind period. The results from this post hoc analysis are consistent with the results of the original primary analysis of the monotherapy population, and demonstrate the efficacy of vutrisiran vs placebo, when observations post-tafamidis initiation were censored. The hazard ratios for vutrisiran vs placebo were 0.67 and 0.71 for the composite primary endpoint of ACM and recurrent CV events and 0.66 and 0.67 for the secondary endpoint of ACM before and after censoring, respectively. The results were also consistent for other secondary endpoints (Table 1).

Conclusion

The efficacy of vutrisiran vs placebo is consistent after the observations following tafamidis initiation in the monotherapy population of HELIOS-B were censored. This provides further evidence supporting the efficacy of vutrisiran as monotherapy in patients with ATTR-CM.

在helos - b中，与安慰剂相比，在甲状腺素淀粉样变性合并心肌病（atr - cm）患者中，无论是整体治疗还是单药治疗（基线时未接受他法非地的患者），vutrisiran均显著降低了全因死亡率（ACM）和复发性心血管（CV）事件的主要终点复合风险，并达到了所有次要终点（包括42个月时的ACM）。在单药治疗人群中，21.5%的患者在双盲期随机分组后开始使用他法他胺。目的评价乌曲西兰与安慰剂在HELIOS-B单药治疗人群中的疗效。方法将患者按1:1随机分组，每12周接受vutrisiran 25 mg或安慰剂治疗，疗程长达36个月。基线时未接受他法非的患者（单药治疗人群）可以在入组后根据研究者的决定和他法非的可用性开始使用他法非。该分析审查了在他法非地开始单药治疗人群中的患者观察，然后重复了HELIOS-B研究的主要分析。结果共有395例HELIOS-B患者属于乌特里西兰单药治疗人群，并被纳入本分析。其中，85例（21.5%）在双盲期随机分组后开始使用他法他胺（vutrisiran n = 44; placebo n = 41）。这项事后分析的结果与最初对单药人群的初步分析结果一致，并证明了在他法非底斯开始治疗后观察到的vutrisiran与安慰剂的疗效。在筛选前后，vtrisiran与安慰剂的综合主要终点ACM和复发性CV事件的风险比分别为0.67和0.71，次要终点ACM的风险比分别为0.66和0.67。其他次要终点的结果也一致（表1）。结论在他非他地在HELIOS-B单药治疗人群中开始观察后，乌崔西兰与安慰剂的疗效是一致的。这进一步证明了vutrisiran单药治疗atr - cm患者的有效性。

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引用次数: 0

Clinical Characteristics of Heart Failure Patients According to QRS Morphology 心衰患者QRS形态学特征分析

IF 2.2 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2026-01-01 DOI: 10.1016/j.acvd.2025.10.085

F. Yahia , F. Mansour , N. Elyes , E. Allouche , S. Ouali

Introduction

QRS morphology reflects underlying conduction system abnormalities and myocardial disease, potentially influencing prognosis in heart failure (HF) patients.

Objective

To compare clinical, echocardiographic, and therapeutic profiles of HF patients stratified by QRS morphology: left bundle branch block (LBBB), right bundle branch block (RBBB), intra-ventricular conduction delay (IVCD), left anterior fascicular block (LAFB), and narrow QRS complexes.

Method

A retrospective study of HF patients with LVEF < 50% was conducted and baseline characteristics, therapies, and echocardiographic data were analyzed.

Results

Patients with LBBB (24%) showed more severe left ventricular dilation (mean DTD = 65.7 mm, P = 0.018) and depressed LVEF (mean 29.5%, P = 0.047) (Table 1). RBBB patients (7.5%) exhibited higher prevalence of right ventricular dysfunction and signs of systemic congestion. IVCD patients displayed intermediate clinical and echocardiographic profiles between LBBB and RBBB. LAFB (10.5%) was associated with higher coronary artery disease prevalence (P = 0.029) but milder clinical presentation. Narrow QRS patients (43.5%) had better preserved ventricular function and fewer signs of congestion. Therapeutic strategies, including device therapies, varied significantly across groups, notably a higher rate of CRT in LBBB patients.

Conclusion

QRS morphology is a powerful indicator of clinical and echocardiographic heterogeneity among HF patients. Recognition of specific conduction patterns can guide tailored management and improve risk stratification in HF with reduced or mid-range LVEF.

qrs形态学反映了潜在的传导系统异常和心肌疾病，可能影响心力衰竭（HF）患者的预后。目的比较QRS形态学分层：左束支传导阻滞（LBBB）、右束支传导阻滞（RBBB）、室内传导延迟（IVCD）、左前束传导阻滞（LAFB）和狭窄QRS复合体的HF患者的临床、超声心动图和治疗概况。方法对LVEF < 50%的HF患者进行回顾性研究，分析基线特征、治疗方法和超声心动图资料。结果LBBB患者（24%）表现出更严重的左室扩张（平均DTD = 65.7 mm, P = 0.018）和LVEF下降（平均29.5%,P = 0.047）（表1）。RBBB患者（7.5%）表现出更高的右心室功能障碍和全身充血症状。IVCD患者的临床和超声心动图表现介于LBBB和RBBB之间。LAFB（10.5%）与较高的冠状动脉疾病患病率相关（P = 0.029），但临床表现较轻。窄QRS患者（43.5%）的心室功能保存较好，充血症状较少。治疗策略，包括器械治疗，在各组间差异显著，特别是在LBBB患者中CRT的比例更高。结论qrs形态学是心衰患者临床和超声心动图异质性的重要指标。识别特定的传导模式可以指导有针对性的管理，并改善LVEF降低或中等范围的HF的风险分层。

{"title":"Clinical Characteristics of Heart Failure Patients According to QRS Morphology","authors":"F. Yahia , F. Mansour , N. Elyes , E. Allouche , S. Ouali","doi":"10.1016/j.acvd.2025.10.085","DOIUrl":"10.1016/j.acvd.2025.10.085","url":null,"abstract":"<div><h3>Introduction</h3><div>QRS morphology reflects underlying conduction system abnormalities and myocardial disease, potentially influencing prognosis in heart failure (HF) patients.</div></div><div><h3>Objective</h3><div>To compare clinical, echocardiographic, and therapeutic profiles of HF patients stratified by QRS morphology: left bundle branch block (LBBB), right bundle branch block (RBBB), intra-ventricular conduction delay (IVCD), left anterior fascicular block (LAFB), and narrow QRS complexes.</div></div><div><h3>Method</h3><div>A retrospective study of HF patients with LVEF<50% was conducted and baseline characteristics, therapies, and echocardiographic data were analyzed.</div></div><div><h3>Results</h3><div>Patients with LBBB (24%) showed more severe left ventricular dilation (mean DTD=65.7mm, <em>P</em>  =0.047) (<span><span>Table 1</span></span>). RBBB patients (7.5%) exhibited higher prevalence of right ventricular dysfunction and signs of systemic congestion. IVCD patients displayed intermediate clinical and echocardiographic profiles between LBBB and RBBB. LAFB (10.5%) was associated with higher coronary artery disease prevalence (<em>P</em>  <!-->0.029) but milder clinical presentation. Narrow QRS patients (43.5%) had better preserved ventricular function and fewer signs of congestion. Therapeutic strategies, including device therapies, varied significantly across groups, notably a higher rate of CRT in LBBB patients.</div></div><div><h3>Conclusion</h3><div>QRS morphology is a powerful indicator of clinical and echocardiographic heterogeneity among HF patients. Recognition of specific conduction patterns can guide tailored management and improve risk stratification in HF with reduced or mid-range LVEF.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Pages S48-S49"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0