Pub Date : 2026-01-09DOI: 10.1016/j.ahjo.2026.100717
Lauren Southwick , Neil K.R. Sehgal , Dena Torrente , Veronica Murgulescu , Devon Schroeder , David A. Asch , Lyle Ungar , Nandita Mitra , Peter Groenveld , Stephen E. Kimmel , Gary E. Weissman , Sharath Chandra Guntuku , Raina M. Merchant
A retrospective, exploratory cross-sectional analysis exploring whether social media data is associated with cardiovascular disease (CVD) risk beyond traditional clinical models. While social media data may capture behavioral and social markers relevant to CVD, their associations with CVD risk remains uncertain.
{"title":"Digital phenotyping and ASCVD risk: An exploratory cross-sectional analysis using online behavioral data","authors":"Lauren Southwick , Neil K.R. Sehgal , Dena Torrente , Veronica Murgulescu , Devon Schroeder , David A. Asch , Lyle Ungar , Nandita Mitra , Peter Groenveld , Stephen E. Kimmel , Gary E. Weissman , Sharath Chandra Guntuku , Raina M. Merchant","doi":"10.1016/j.ahjo.2026.100717","DOIUrl":"10.1016/j.ahjo.2026.100717","url":null,"abstract":"<div><div>A retrospective, exploratory cross-sectional analysis exploring whether social media data is associated with cardiovascular disease (CVD) risk beyond traditional clinical models. While social media data may capture behavioral and social markers relevant to CVD, their associations with CVD risk remains uncertain.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"62 ","pages":"Article 100717"},"PeriodicalIF":1.8,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To examine the relationship between coronary microvascular dysfunction (CMD) indices and chest pain presentation in patients with non-obstructive coronary artery disease (NOCA).
Design and setting
Retrospective, single-center observational study.
Participants
Patients with angiographically intermediate left anterior descending artery (LAD) stenosis and preserved epicardial physiology (fraction flow reserve, FFR >0.80), with no significant stenosis in vessels other than the LAD.
Interventions
Invasive CMD assessment using coronary flow reserve (CFR), index of microcirculatory resistance (IMR), and myocardial resistance reserve (MRR).
Main outcome measures
Associations between symptom phenotypes and physiological indices, and the diagnostic performance of symptom-based assessment for detecting CMD.
Results
Among 59 patients (mean age 69.2 years; 71 % male), CFR and MRR differed significantly across symptom phenotypes (both p < 0.001), whereas IMR did not. Patients with typical angina exhibited the lowest CFR and MRR, indicating impaired microvascular vasodilatory reserve despite preserved epicardial physiology. Conversely, patients with atypical symptoms had the highest CFR and MRR, whereas asymptomatic patients had intermediate values. FFR was comparable across groups (median 0.89, p = 0.21). In age-adjusted analyses, symptom severity was inversely associated with CFR (β = −1.085, p = 0.004) and MRR (β = −1.062, p = 0.003), but not with IMR. Symptom-based assessment showed higher specificity than sensitivity across CMD definitions and performed best for impaired MRR (sensitivity 60.9 %, specificity 80.6 %). Functional CMD was observed even in asymptomatic patients.
Conclusion
In patients with NOCA, coronary microvascular vasodilatory reserve varies according to symptom phenotype, highlighting the limited reliability of symptom assessment alone and underscoring the importance of objective physiological evaluation for characterizing CMD.
研究目的探讨非阻塞性冠状动脉疾病（NOCA）患者冠状动脉微血管功能障碍（CMD）指数与胸痛表现的关系。设计与背景回顾性、单中心观察性研究。参与者：血管造影显示为左前降支（LAD）中度狭窄，心外膜生理保存（血流储备分数，FFR >0.80），除LAD外其他血管无明显狭窄的患者。介入方法：冠脉血流储备（CFR）、微循环阻力指数（IMR）和心肌阻力储备（MRR）评估有创CMD。主要结局指标：症状表型与生理指标的关系，以及基于症状的评估对CMD的诊断效果。结果在59例患者（平均年龄69.2岁，71%为男性）中，不同症状表型的CFR和MRR差异显著（p < 0.001），而IMR无显著差异。典型心绞痛患者表现出最低的CFR和MRR，表明尽管心外膜生理保持，微血管血管舒张储备受损。相反，非典型症状患者的CFR和MRR最高，而无症状患者的CFR和MRR为中间值。各组间FFR具有可比性（中位数0.89,p = 0.21）。在年龄校正分析中，症状严重程度与CFR （β = - 1.085, p = 0.004）和MRR （β = - 1.062, p = 0.003）呈负相关，但与IMR无关。基于症状的评估在CMD定义中特异性高于敏感性，并且对受损的MRR效果最好（敏感性60.9%，特异性80.6%）。即使在无症状的患者中也观察到功能性CMD。结论在NOCA患者中，冠状动脉微血管血管舒张储备随症状表型的变化而变化，强调了单纯症状评估的可靠性有限，强调了客观生理评估对表征CMD的重要性。
{"title":"Symptom phenotypes and coronary microvascular function in non-obstructive coronary artery disease: Insights beyond epicardial ischemia","authors":"Kotaro Matsumoto , Kenichiro Otsuka , Shunsuke Kagawa , Hiroki Yamaura , Tsubasa Miura , Kazuya Sugioka , Wataru Saitoh , Akihiro Okamoto , Go Kajio , Naoki Fujisawa , Tomohiro Yamaguchi , Takenobu Shimada , Yusuke Hayashi , Atsushi Shibata , Asahiro Ito , Takanori Yamazaki , Daiju Fukuda","doi":"10.1016/j.ahjo.2026.100714","DOIUrl":"10.1016/j.ahjo.2026.100714","url":null,"abstract":"<div><h3>Study objective</h3><div>To examine the relationship between coronary microvascular dysfunction (CMD) indices and chest pain presentation in patients with non-obstructive coronary artery disease (NOCA).</div></div><div><h3>Design and setting</h3><div>Retrospective, single-center observational study.</div></div><div><h3>Participants</h3><div>Patients with angiographically intermediate left anterior descending artery (LAD) stenosis and preserved epicardial physiology (fraction flow reserve, FFR >0.80), with no significant stenosis in vessels other than the LAD.</div></div><div><h3>Interventions</h3><div>Invasive CMD assessment using coronary flow reserve (CFR), index of microcirculatory resistance (IMR), and myocardial resistance reserve (MRR).</div></div><div><h3>Main outcome measures</h3><div>Associations between symptom phenotypes and physiological indices, and the diagnostic performance of symptom-based assessment for detecting CMD.</div></div><div><h3>Results</h3><div>Among 59 patients (mean age 69.2 years; 71 % male), CFR and MRR differed significantly across symptom phenotypes (both <em>p</em> < 0.001), whereas IMR did not. Patients with typical angina exhibited the lowest CFR and MRR, indicating impaired microvascular vasodilatory reserve despite preserved epicardial physiology. Conversely, patients with atypical symptoms had the highest CFR and MRR, whereas asymptomatic patients had intermediate values. FFR was comparable across groups (median 0.89, <em>p</em> = 0.21). In age-adjusted analyses, symptom severity was inversely associated with CFR (β = −1.085, <em>p</em> = 0.004) and MRR (β = −1.062, <em>p</em> = 0.003), but not with IMR. Symptom-based assessment showed higher specificity than sensitivity across CMD definitions and performed best for impaired MRR (sensitivity 60.9 %, specificity 80.6 %). Functional CMD was observed even in asymptomatic patients.</div></div><div><h3>Conclusion</h3><div>In patients with NOCA, coronary microvascular vasodilatory reserve varies according to symptom phenotype, highlighting the limited reliability of symptom assessment alone and underscoring the importance of objective physiological evaluation for characterizing CMD.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"62 ","pages":"Article 100714"},"PeriodicalIF":1.8,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145929171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-07DOI: 10.1016/j.ahjo.2026.100715
Erik J. Offerman , Joseph Phan , Sarah Harirforoosh , Wenjun Fan , Nathan D. Wong , David M. Donaldson
Background
Machine learning (ML) may improve prediction of atrial fibrillation (AF), but its value compared with traditional models such as Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE-AF) in patients with diabetes remains unclear.
Methods
Among 9,307 patients in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) with type 2 diabetes and no prior AF, a random forest (RF) classifier using clinical and metabolic variables was compared with a CHARGE-AF Cox model. Discrimination was assessed by five-fold cross-validated area under receiver operating curve (AUC).
Results
Over 6.26 years, 175 patients developed AF. The RF model (AUC = 0.731) performed comparably to CHARGE-AF (AUC = 0.756; p = 0.18). Age, waist circumference, race, total cholesterol, and estimated glomerular filtration rate were the top predictors.
Conclusion
ML matched CHARGE-AF performance and revealed distinct predictors supporting personalized AF risk prevention.
机器学习（ML）可以提高对房颤（AF）的预测，但与传统模型（如基因组流行病学心脏与衰老研究队列（CHARGE-AF））相比，其在糖尿病患者中的价值尚不清楚。方法对9307例2型糖尿病患者进行临床和代谢变量随机森林（RF）分类，并与CHARGE-AF Cox模型进行比较。用5倍交叉验证的受试者工作曲线下面积（AUC）评估鉴别性。结果在6.26年的时间里，175例患者发生了房颤。RF模型（AUC = 0.731）与CHARGE-AF模型（AUC = 0.756; p = 0.18）的表现相当。年龄、腰围、种族、总胆固醇和估计的肾小球滤过率是最重要的预测因素。结论ml与CHARGE-AF表现相匹配，并显示出支持个性化房颤风险预防的独特预测因子。
{"title":"A risk model to predict atrial fibrillation in diabetes using machine learning: The ACCORD study","authors":"Erik J. Offerman , Joseph Phan , Sarah Harirforoosh , Wenjun Fan , Nathan D. Wong , David M. Donaldson","doi":"10.1016/j.ahjo.2026.100715","DOIUrl":"10.1016/j.ahjo.2026.100715","url":null,"abstract":"<div><h3>Background</h3><div>Machine learning (ML) may improve prediction of atrial fibrillation (AF), but its value compared with traditional models such as Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE-AF) in patients with diabetes remains unclear.</div></div><div><h3>Methods</h3><div>Among 9,307 patients in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) with type 2 diabetes and no prior AF, a random forest (RF) classifier using clinical and metabolic variables was compared with a CHARGE-AF Cox model. Discrimination was assessed by five-fold cross-validated area under receiver operating curve (AUC).</div></div><div><h3>Results</h3><div>Over 6.26 years, 175 patients developed AF. The RF model (AUC = 0.731) performed comparably to CHARGE-AF (AUC = 0.756; <em>p</em> = 0.18). Age, waist circumference, race, total cholesterol, and estimated glomerular filtration rate were the top predictors.</div></div><div><h3>Conclusion</h3><div>ML matched CHARGE-AF performance and revealed distinct predictors supporting personalized AF risk prevention.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"62 ","pages":"Article 100715"},"PeriodicalIF":1.8,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145929172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-02DOI: 10.1016/j.ahjo.2025.100712
Alaaeddine El Ghazawi , Akl C. Fahed , Nour Fawaz , Yeva Fakih , Samir Alam , Marwan Refaat
Cardiovascular diseases, and most notably coronary artery disease (CAD), carry a large burden of mortality and morbidity, highlighting the need for better risk prediction and prevention. Several risk scoring tools for CAD have been developed to improve early detection, reduce the risk of acute cardiac events, and ensure adequate monitoring and follow-up of high-risk individuals. One that seized attention, especially with the groundbreaking advancements in disease's genetic buildup, was the polygenic risk score (PRS) for CAD. It was developed for potentially improving risk prediction at an early age, with individualized patient care. Our review aims to review the latest advances in this field of polygenic risk prediction, highlighting background information about PRS, current evidence supporting the utility of PRS for CAD, challenges associated with its implementation, and its complementary role with the coronary artery calcium score (CAC). Our review demonstrates that PRS could be a strong predictive indicator of CAD, especially when combined with other clinical factors. However, concerns remain regarding its applicability to genetically diverse populations, the ethical and psychological challenges, and practical feasibility. Lastly, PRS can augment and predict CAC in terms of risk discrimination and reclassification. In conclusion, PRS is a valuable tool that is upscaling with wider adoption. This requires a proper handling of its associated challenges to better shape the future of individualized care.
{"title":"Unraveling the genetic blueprint of coronary artery disease: The role of polygenic risk scores in risk prediction","authors":"Alaaeddine El Ghazawi , Akl C. Fahed , Nour Fawaz , Yeva Fakih , Samir Alam , Marwan Refaat","doi":"10.1016/j.ahjo.2025.100712","DOIUrl":"10.1016/j.ahjo.2025.100712","url":null,"abstract":"<div><div>Cardiovascular diseases, and most notably coronary artery disease (CAD), carry a large burden of mortality and morbidity, highlighting the need for better risk prediction and prevention. Several risk scoring tools for CAD have been developed to improve early detection, reduce the risk of acute cardiac events, and ensure adequate monitoring and follow-up of high-risk individuals. One that seized attention, especially with the groundbreaking advancements in disease's genetic buildup, was the polygenic risk score (PRS) for CAD. It was developed for potentially improving risk prediction at an early age, with individualized patient care. Our review aims to review the latest advances in this field of polygenic risk prediction, highlighting background information about PRS, current evidence supporting the utility of PRS for CAD, challenges associated with its implementation, and its complementary role with the coronary artery calcium score (CAC). Our review demonstrates that PRS could be a strong predictive indicator of CAD, especially when combined with other clinical factors. However, concerns remain regarding its applicability to genetically diverse populations, the ethical and psychological challenges, and practical feasibility. Lastly, PRS can augment and predict CAC in terms of risk discrimination and reclassification. In conclusion, PRS is a valuable tool that is upscaling with wider adoption. This requires a proper handling of its associated challenges to better shape the future of individualized care.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"62 ","pages":"Article 100712"},"PeriodicalIF":1.8,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145898131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","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.ahjo.2025.100700
Katelyn J. Cullen , Mathew Mercuri , Hassan Mir , Karen Mosleh , Rafi Setrak , Sanjit S. Jolly , Michael Tsang , Renu Syal , James Nkurunziza , Michelle Welsford , JD Schwalm , Madhu K. Natarajan
Background
ST-Elevation Myocardial Infarction (STEMI) is a critical emergency. Managing care requires accurate diagnosis, shared communication between decision-makers, and timely transport and reperfusion at a hospital with capacity for such interventions. This study examines the implementation of a smartphone application (SMART AMI-ACS App) to facilitate real-time ECG sharing, enhancing communication and decision-making in STEMI management.
Methods
This multi-centre study evaluated the implementation, acceptability and uptake of the App among interventional cardiologists and emergency medicine (EM) physicians managing suspected STEMI patients between April 1st 2022 and March 31st 2023. Guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, STEMI registry data and post-implementation surveys from a large regional cardiac centre and its 13 partner emergency departments in Ontario, Canada, were used to assess App uptake and effectiveness.
Results
During the 12-month evaluation 254 (84 %) of the eligible 300 regional EM physicians downloaded the App, with > 1400 ECG images sent from 724 patients. Users reported the App helped in communication and timing of care. No degradation of ECG images was observed. App use was associated with lower door-in-door-out (DIDO) times 48 min (IQR 31–67) vs 55 min (IQR 39–77) and lower proportion of non-STEMI cases accepted to interventional cardiology (22 % vs 39 %, p < 0.0001).
Conclusion
Uptake of the SMART AMI-ACS App was positive and may be associated with lower non-STEMI cases and lower DIDO times. The App provided a secure channel for communication of information and point-of-care transfer of images across healthcare providers. Uptake of the App has expanded to other regions.
{"title":"Improving the management of acute myocardial infarctions: There's an App for that","authors":"Katelyn J. Cullen , Mathew Mercuri , Hassan Mir , Karen Mosleh , Rafi Setrak , Sanjit S. Jolly , Michael Tsang , Renu Syal , James Nkurunziza , Michelle Welsford , JD Schwalm , Madhu K. Natarajan","doi":"10.1016/j.ahjo.2025.100700","DOIUrl":"10.1016/j.ahjo.2025.100700","url":null,"abstract":"<div><h3>Background</h3><div>ST-Elevation Myocardial Infarction (STEMI) is a critical emergency. Managing care requires accurate diagnosis, shared communication between decision-makers, and timely transport and reperfusion at a hospital with capacity for such interventions. This study examines the implementation of a smartphone application (SMART AMI-ACS App) to facilitate real-time ECG sharing, enhancing communication and decision-making in STEMI management.</div></div><div><h3>Methods</h3><div>This multi-centre study evaluated the implementation, acceptability and uptake of the App among interventional cardiologists and emergency medicine (EM) physicians managing suspected STEMI patients between April 1st 2022 and March 31st 2023. Guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, STEMI registry data and post-implementation surveys from a large regional cardiac centre and its 13 partner emergency departments in Ontario, Canada, were used to assess App uptake and effectiveness.</div></div><div><h3>Results</h3><div>During the 12-month evaluation 254 (84 %) of the eligible 300 regional EM physicians downloaded the App, with > 1400 ECG images sent from 724 patients. Users reported the App helped in communication and timing of care. No degradation of ECG images was observed. App use was associated with lower door-in-door-out (DIDO) times 48 min (IQR 31–67) vs 55 min (IQR 39–77) and lower proportion of non-STEMI cases accepted to interventional cardiology (22 % vs 39 %, <em>p</em> < 0.0001).</div></div><div><h3>Conclusion</h3><div>Uptake of the SMART AMI-ACS App was positive and may be associated with lower non-STEMI cases and lower DIDO times. The App provided a secure channel for communication of information and point-of-care transfer of images across healthcare providers. Uptake of the App has expanded to other regions.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"61 ","pages":"Article 100700"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","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.ahjo.2025.100702
Nicole Charbel , Karl Aramouni , Sam Sater , Firas Kreidieh
As cancer survival improves, cardiovascular health has become an increasingly important concern, particularly given the elevated risk of coronary artery disease (CAD) in patients with cancer. This review examines the complex relationship between cancer and CAD, focusing on shared epidemiological trends, overlapping risk factors, converging pathophysiological mechanisms, and cancer treatment–related cardiovascular toxicities. Cancer and CAD share modifiable risk factors, including obesity, diabetes, hypertension, hyperlipidemia, smoking, alcohol use, physical inactivity, and poor diet, that may act synergistically to promote both conditions. In addition, biological processes such as chronic inflammation, oxidative stress, platelet activation, and clonal hematopoiesis of indeterminate potential further contribute to disease progression. Several cancer therapies, including antimetabolites, platinum-based agents, immune checkpoint inhibitors, tyrosine kinase inhibitors, and radiotherapy, have been implicated in vascular injury, plaque destabilization, and accelerated atherosclerosis, increasing the risk of CAD. Understanding these shared mechanisms is essential for reducing cardiovascular complications in patients with cancer. This review outlines the epidemiology, risk factors, and biological mechanisms linking CAD and cancer, and evaluates the cardiotoxic effects of commonly used cancer therapies.
{"title":"Coronary artery disease and cancer: Shared risk factors, pathogenesis, and treatment effects","authors":"Nicole Charbel , Karl Aramouni , Sam Sater , Firas Kreidieh","doi":"10.1016/j.ahjo.2025.100702","DOIUrl":"10.1016/j.ahjo.2025.100702","url":null,"abstract":"<div><div>As cancer survival improves, cardiovascular health has become an increasingly important concern, particularly given the elevated risk of coronary artery disease (CAD) in patients with cancer. This review examines the complex relationship between cancer and CAD, focusing on shared epidemiological trends, overlapping risk factors, converging pathophysiological mechanisms, and cancer treatment–related cardiovascular toxicities. Cancer and CAD share modifiable risk factors, including obesity, diabetes, hypertension, hyperlipidemia, smoking, alcohol use, physical inactivity, and poor diet, that may act synergistically to promote both conditions. In addition, biological processes such as chronic inflammation, oxidative stress, platelet activation, and clonal hematopoiesis of indeterminate potential further contribute to disease progression. Several cancer therapies, including antimetabolites, platinum-based agents, immune checkpoint inhibitors, tyrosine kinase inhibitors, and radiotherapy, have been implicated in vascular injury, plaque destabilization, and accelerated atherosclerosis, increasing the risk of CAD. Understanding these shared mechanisms is essential for reducing cardiovascular complications in patients with cancer. This review outlines the epidemiology, risk factors, and biological mechanisms linking CAD and cancer, and evaluates the cardiotoxic effects of commonly used cancer therapies.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"61 ","pages":"Article 100702"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This focused systematic review examines the role of the gut microbiota in cardiovascular disease (CVD). The review explores mechanisms linking gut dysbiosis with CVD via microbial metabolites such as trimethylamine-N-oxide (TMAO) and short-chain fatty acids (SCFAs), which affect inflammation, endothelial function, and lipid metabolism. Interventions including dietary modifications, probiotics, prebiotics, fecal microbiota transplantation, and pharmacological agents such as statins, rifaximin, and empagliflozin are evaluated for their impact on microbial composition and cardiovascular outcomes. Probiotic strains and fiber-rich diets demonstrated modest improvements in blood pressure, lipid profiles, and inflammatory markers. Studies revealed that gut microbiome alterations influence drug metabolism and bleeding risk in patients taking oral anticoagulants. Limited evidence suggests that modulation of the microbiota may reduce chemotherapy-induced cardiotoxicity. However, only nine eligible studies met the inclusion criteria, reflecting the early and heterogeneous nature of this research area. Consequently, these findings should be interpreted as exploratory and hypothesis-generating. The focused review emphasizes the need for large-scale trials to validate microbiome-targeted strategies in CVD prevention and management. This focused systematic review is registered with PROSPERO (ID: CRD420251022190).
这篇集中的系统综述探讨了肠道微生物群在心血管疾病（CVD）中的作用。本综述通过微生物代谢物如三甲胺- n -氧化物（TMAO）和短链脂肪酸（SCFAs）探讨了肠道生态失调与心血管疾病之间的联系机制，这些代谢物影响炎症、内皮功能和脂质代谢。干预措施包括饮食调整、益生菌、益生元、粪便微生物群移植和他汀类药物、利福昔明和恩格列净等药物对微生物组成和心血管结局的影响进行了评估。益生菌菌株和富含纤维的饮食在血压、血脂和炎症标志物方面表现出适度的改善。研究表明，肠道微生物组的改变会影响口服抗凝药物患者的药物代谢和出血风险。有限的证据表明，微生物群的调节可能会减少化疗引起的心脏毒性。然而，只有9项符合纳入标准的研究，反映了该研究领域的早期和异质性。因此，这些发现应该被解释为探索性和假设生成。重点综述强调需要大规模试验来验证心血管疾病预防和管理中的微生物组靶向策略。该重点系统评价已在PROSPERO注册（ID: CRD420251022190）。
{"title":"The gut-heart axis: Exploring the role of the gut microbiome in cardiovascular health – A focused systematic review","authors":"Yahya Makkieh , Haider Hussain Shah , Sakan Binte Imran , Shadman Mahmood Khan Pathan , Anagha Chirayath Saju , Mounica Majooju , Aastha Garg , Tarun Naag , Rabeeul Islam , Cheeranthodika Fahima , Ramsha Ali","doi":"10.1016/j.ahjo.2025.100687","DOIUrl":"10.1016/j.ahjo.2025.100687","url":null,"abstract":"<div><div>This focused systematic review examines the role of the gut microbiota in cardiovascular disease (CVD). The review explores mechanisms linking gut dysbiosis with CVD via microbial metabolites such as trimethylamine-N-oxide (TMAO) and short-chain fatty acids (SCFAs), which affect inflammation, endothelial function, and lipid metabolism. Interventions including dietary modifications, probiotics, prebiotics, fecal microbiota transplantation, and pharmacological agents such as statins, rifaximin, and empagliflozin are evaluated for their impact on microbial composition and cardiovascular outcomes. Probiotic strains and fiber-rich diets demonstrated modest improvements in blood pressure, lipid profiles, and inflammatory markers. Studies revealed that gut microbiome alterations influence drug metabolism and bleeding risk in patients taking oral anticoagulants. Limited evidence suggests that modulation of the microbiota may reduce chemotherapy-induced cardiotoxicity. However, only nine eligible studies met the inclusion criteria, reflecting the early and heterogeneous nature of this research area. Consequently, these findings should be interpreted as exploratory and hypothesis-generating. The focused review emphasizes the need for large-scale trials to validate microbiome-targeted strategies in CVD prevention and management. This focused systematic review is registered with PROSPERO (ID: CRD420251022190).</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"61 ","pages":"Article 100687"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","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.ahjo.2025.100701
Ramin Khameneh Bagheri , Ali Eshraghi , Hasan Amirsoleimani , Faeze Keihanian
Background
The pleiotropic effects of statins may benefit patients with acute coronary syndromes. This study compared the impact of pre-procedural atorvastatin versus rosuvastatin on hematologic and inflammatory indexes in the hyper-acute setting of ST-elevation myocardial infarction (STEMI).
Methods
In this pre-specified, multi-centric, triple-blind trial, STEMI patients were randomized to receive either 80-mg atorvastatin (n = 98) or 40-mg rosuvastatin (n = 102) before primary percutaneous coronary intervention (PPCI). Key hematologic indexes—neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and platelet distribution width (PDW)—were measured at baseline, 24, and 48 h post-PPCI. Contrast-induced nephropathy (CIN) incidence was also assessed.
Results
The incidence of CIN was similarly low in both groups (atorvastatin 3.0 % vs. rosuvastatin 3.5 %, p = 0.99). However, hematologic markers showed significant differences. The atorvastatin group had a significantly lower NLR at 48 h compared to the rosuvastatin group (Median [IQR]: 5.1 [3.2–8.1] vs. 7.8 [4.9–10.2], p = 0.003). Conversely, the rosuvastatin group demonstrated a significantly higher PDW at 24 h (15.6 ± 1.5 vs. 14.7 ± 1.5, p < 0.001). No significant inter-group difference was found in the 48-h PLR.
Conclusion
While both high-intensity statins provided similar nephroprotection, they exhibited distinct modulatory effects. Atorvastatin was associated with a more pronounced anti-inflammatory effect (lower NLR), whereas rosuvastatin was linked to increased platelet activity (higher PDW). These findings suggest differential pleiotropic properties that warrant further investigation for their impact on clinical outcomes.
{"title":"Differential effects of pre-procedural atorvastatin versus rosuvastatin on hematologic and inflammatory markers in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: A randomized controlled trial","authors":"Ramin Khameneh Bagheri , Ali Eshraghi , Hasan Amirsoleimani , Faeze Keihanian","doi":"10.1016/j.ahjo.2025.100701","DOIUrl":"10.1016/j.ahjo.2025.100701","url":null,"abstract":"<div><h3>Background</h3><div>The pleiotropic effects of statins may benefit patients with acute coronary syndromes. This study compared the impact of pre-procedural atorvastatin versus rosuvastatin on hematologic and inflammatory indexes in the hyper-acute setting of ST-elevation myocardial infarction (STEMI).</div></div><div><h3>Methods</h3><div>In this pre-specified, multi-centric, triple-blind trial, STEMI patients were randomized to receive either 80-mg atorvastatin (<em>n</em> = 98) or 40-mg rosuvastatin (<em>n</em> = 102) before primary percutaneous coronary intervention (PPCI). Key hematologic indexes—neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and platelet distribution width (PDW)—were measured at baseline, 24, and 48 h post-PPCI. Contrast-induced nephropathy (CIN) incidence was also assessed.</div></div><div><h3>Results</h3><div>The incidence of CIN was similarly low in both groups (atorvastatin 3.0 % vs. rosuvastatin 3.5 %, <em>p</em> = 0.99). However, hematologic markers showed significant differences. The atorvastatin group had a significantly lower NLR at 48 h compared to the rosuvastatin group (Median [IQR]: 5.1 [3.2–8.1] vs. 7.8 [4.9–10.2], <em>p</em> = 0.003). Conversely, the rosuvastatin group demonstrated a significantly higher PDW at 24 h (15.6 ± 1.5 vs. 14.7 ± 1.5, <em>p</em> < 0.001). No significant inter-group difference was found in the 48-h PLR.</div></div><div><h3>Conclusion</h3><div>While both high-intensity statins provided similar nephroprotection, they exhibited distinct modulatory effects. Atorvastatin was associated with a more pronounced anti-inflammatory effect (lower NLR), whereas rosuvastatin was linked to increased platelet activity (higher PDW). These findings suggest differential pleiotropic properties that warrant further investigation for their impact on clinical outcomes.</div><div>Registry Accessibility: <span><span>http://irct.ir/trial/27377</span><svg><path></path></svg></span></div><div>Trial registration code: IRCT2017101236737N1.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"61 ","pages":"Article 100701"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","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.ahjo.2025.100708
Chloe Kharsa , Gal Sella , Yasser Sammour , Rody G. Bou Chaaya , Mangesh Kritya , Jerrin Philip , Muhammad Hassan Masood Virk , Muhammad Haisum Maqsood , Neal S. Kleiman , Alpesh R. Shah
Background
Anemia is a common comorbidity in patients undergoing percutaneous coronary intervention (PCI) and may signal worse post-procedural outcomes. Its prognostic impact in the context of chronic total occlusion (CTO) PCI remains underexplored.
Objectives
To evaluate procedural and clinical outcomes following CTO PCI in patients with and without anemia using real-world data from a high-volume tertiary care center.
Methods
We conducted a retrospective observational study using data from 504 patients who underwent CTO PCI between January 2018 and December 2023 at Houston Methodist. Patients were stratified by anemia status, defined using World Health Organization hemoglobin thresholds. Primary endpoints included procedural success, one-year all-cause mortality, and target lesion revascularization (TLR). Secondary endpoints included target lesion failure (TLF) and in-hospital complications.
Results
Of the cohort, 163 patients (32.3 %) had anemia. Patients with anemia were older, more often female, and had a greater burden of comorbidities, including CKD and heart failure. Despite similar lesion complexity and procedural success rates (80.4 % vs. 81.5 %; p = 0.79), patients with anemia had higher rates of in-hospital complications and one-year mortality (18.1 % vs. 5.0 %; HR = 4.0, p < 0.001)one-year target lesion failure (HR = 1.9; 95 % CI [1.2–2.9]; p = 0.005). Multivariate analysis identified age, heart failure, anemia and multivessel PCI as independent predictors of mortality at one-year, while CKD, and ISR lesion were predictors of TLF at one-year. The severity of anemia was not independently associated with all-cause mortality.
Conclusion
Pre-procedural anemia is associated with markedly worse in-hospital and long-term outcomes in patients undergoing CTO PCI, despite comparable technical success. These findings highlight anemia as a marker of systemic vulnerability and underscore the need for comprehensive risk stratification and multidisciplinary care in this high-risk population.
背景：在接受经皮冠状动脉介入治疗（PCI）的患者中，贫血是一种常见的合并症，可能预示着更糟糕的术后结果。其在慢性全闭塞（CTO） PCI背景下的预后影响仍未得到充分探讨。目的利用来自高容量三级医疗中心的真实世界数据，评估有或无贫血患者CTO PCI治疗的程序和临床结果。方法：我们对2018年1月至2023年12月在休斯顿卫理公会医院接受CTO PCI治疗的504例患者的数据进行了回顾性观察研究。根据世界卫生组织血红蛋白阈值定义的贫血状态对患者进行分层。主要终点包括手术成功、一年全因死亡率和靶病变血运重建术（TLR）。次要终点包括靶病变失败（TLF）和院内并发症。结果163例（32.3%）患者有贫血。贫血患者年龄较大，多为女性，并且有更大的合并症负担，包括CKD和心力衰竭。尽管病变复杂性和手术成功率相似（80.4% vs. 81.5%; p = 0.79），但贫血患者的住院并发症和一年内死亡率更高（18.1% vs. 5.0%; HR = 4.0, p < 0.001），一年内目标病变失败（HR = 1.9; 95% CI [1.2-2.9]; p = 0.005）。多因素分析发现，年龄、心力衰竭、贫血和多血管PCI是1年死亡率的独立预测因素，而CKD和ISR病变是1年TLF的预测因素。贫血的严重程度与全因死亡率没有独立的相关性。结论CTO PCI患者术前贫血与较差的住院和长期预后相关，尽管技术上取得了相当的成功。这些发现强调了贫血是系统性易感性的标志，并强调了在这一高危人群中进行全面风险分层和多学科护理的必要性。
{"title":"Impact of baseline anemia on outcomes following chronic total occlusion percutaneous coronary intervention","authors":"Chloe Kharsa , Gal Sella , Yasser Sammour , Rody G. Bou Chaaya , Mangesh Kritya , Jerrin Philip , Muhammad Hassan Masood Virk , Muhammad Haisum Maqsood , Neal S. Kleiman , Alpesh R. Shah","doi":"10.1016/j.ahjo.2025.100708","DOIUrl":"10.1016/j.ahjo.2025.100708","url":null,"abstract":"<div><h3>Background</h3><div>Anemia is a common comorbidity in patients undergoing percutaneous coronary intervention (PCI) and may signal worse post-procedural outcomes. Its prognostic impact in the context of chronic total occlusion (CTO) PCI remains underexplored.</div></div><div><h3>Objectives</h3><div>To evaluate procedural and clinical outcomes following CTO PCI in patients with and without anemia using real-world data from a high-volume tertiary care center.</div></div><div><h3>Methods</h3><div>We conducted a retrospective observational study using data from 504 patients who underwent CTO PCI between January 2018 and December 2023 at Houston Methodist. Patients were stratified by anemia status, defined using World Health Organization hemoglobin thresholds. Primary endpoints included procedural success, one-year all-cause mortality, and target lesion revascularization (TLR). Secondary endpoints included target lesion failure (TLF) and in-hospital complications.</div></div><div><h3>Results</h3><div>Of the cohort, 163 patients (32.3 %) had anemia. Patients with anemia were older, more often female, and had a greater burden of comorbidities, including CKD and heart failure. Despite similar lesion complexity and procedural success rates (80.4 % vs. 81.5 %; <em>p</em> = 0.79), patients with anemia had higher rates of in-hospital complications and one-year mortality (18.1 % vs. 5.0 %; HR = 4.0, <em>p</em> < 0.001)one-year target lesion failure (HR = 1.9; 95 % CI [1.2–2.9]; <em>p</em> = 0.005). Multivariate analysis identified age, heart failure, anemia and multivessel PCI as independent predictors of mortality at one-year, while CKD, and ISR lesion were predictors of TLF at one-year. The severity of anemia was not independently associated with all-cause mortality.</div></div><div><h3>Conclusion</h3><div>Pre-procedural anemia is associated with markedly worse in-hospital and long-term outcomes in patients undergoing CTO PCI, despite comparable technical success. These findings highlight anemia as a marker of systemic vulnerability and underscore the need for comprehensive risk stratification and multidisciplinary care in this high-risk population.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"61 ","pages":"Article 100708"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","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.ahjo.2025.100692
Christelle Lteif , Paula Wachs , Ravindra K. Sharma , Julio D. Duarte
Objective
To investigate the role of Id genes in the development of pulmonary hypertension (PH) in heart failure (HF) and evaluate genetic variants of the ID genes associated with HF-PH.
Design
Experimental study using an AKR/J mouse model of HF-PH and a genetic association study using the UK Biobank cohort.
Setting
Laboratory animal study and population-based cohort study.
Participants
AKR/J mice with HF-PH and participants with HF from the UK Biobank cohort.
Interventions
Administration of tacrolimus (Id signaling inducer) in the mouse model.
Main outcome measures
Tissue-specific gene expression of Id1, Id2, and Id3 in HF-PH mice; severity of HF-PH after tacrolimus treatment; associations of single nucleotide polymorphisms of ID1, ID2, and ID3 with PH development and mortality in participants with HF.
Results
Id1 was upregulated in the left ventricle (Fold Change (FC) = 1.65; P = 3.0 × 10−4) of HF-PH mice. In adipose tissue, Id1 and Id3 were downregulated (FC = 0.33; P = 5.2 × 10−3 and FC = 0.50; P = 0.01, respectively), while Id2 was upregulated (FC = 1.78; P = 7 × 10−4). Tacrolimus worsened PH and diastolic dysfunction, upregulating only Id2 in adipose tissue. In the clinical cohort, rs7425561 and rs10174593 (expression quantitative loci for ID2) trended toward reduced risk of PH in HF and all-cause mortality in participants with HF-PH.
Conclusion
The results suggest ID1, ID2, and ID3 are involved in HF-PH pathogenesis, but more research is needed to characterize their exact role.
{"title":"The role of Id genes on pulmonary hypertension development in left heart failure","authors":"Christelle Lteif , Paula Wachs , Ravindra K. Sharma , Julio D. Duarte","doi":"10.1016/j.ahjo.2025.100692","DOIUrl":"10.1016/j.ahjo.2025.100692","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the role of <em>Id</em> genes in the development of pulmonary hypertension (PH) in heart failure (HF) and evaluate genetic variants of the <em>ID</em> genes associated with HF-PH.</div></div><div><h3>Design</h3><div>Experimental study using an AKR/J mouse model of HF-PH and a genetic association study using the UK Biobank cohort.</div></div><div><h3>Setting</h3><div>Laboratory animal study and population-based cohort study.</div></div><div><h3>Participants</h3><div>AKR/J mice with HF-PH and participants with HF from the UK Biobank cohort.</div></div><div><h3>Interventions</h3><div>Administration of tacrolimus (Id signaling inducer) in the mouse model.</div></div><div><h3>Main outcome measures</h3><div>Tissue-specific gene expression of <em>Id1</em>, <em>Id2</em>, and <em>Id3</em> in HF-PH mice; severity of HF-PH after tacrolimus treatment; associations of single nucleotide polymorphisms of <em>ID1</em>, <em>ID2</em>, and <em>ID3</em> with PH development and mortality in participants with HF.</div></div><div><h3>Results</h3><div><em>Id1</em> was upregulated in the left ventricle (Fold Change (FC) = 1.65; <em>P</em> = 3.0 × 10<sup>−4</sup>) of HF-PH mice. In adipose tissue, <em>Id1</em> and <em>Id3</em> were downregulated (FC = 0.33; <em>P</em> = 5.2 × 10<sup>−3</sup> and FC = 0.50; <em>P</em> = 0.01, respectively), while <em>Id2</em> was upregulated (FC = 1.78; <em>P</em> = 7 × 10<sup>−4</sup>). Tacrolimus worsened PH and diastolic dysfunction, upregulating only <em>Id2</em> in adipose tissue. In the clinical cohort, rs7425561 and rs10174593 (expression quantitative loci for <em>ID2</em>) trended toward reduced risk of PH in HF and all-cause mortality in participants with HF-PH.</div></div><div><h3>Conclusion</h3><div>The results suggest <em>ID1</em>, <em>ID2</em>, and <em>ID3</em> are involved in HF-PH pathogenesis, but more research is needed to characterize their exact role.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"61 ","pages":"Article 100692"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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