Clinical Research in Cardiology最新文献

{"title":"Sex-related presentation, outcome, and treatment in CICU: the SPOTlight STUDY.","authors":"Alessia d'Aiello, Mattia Brecciaroli, Simone Filomia, Daniela Pedicino, Marco Giuseppe Del Buono, Gianluigi Saponara, Rocco Antonio Montone, Gaetano Pinnacchio, Lorenzo Genuardi, Laura Antenucci, Jacopo Lenkowicz, Giovanna Liuzzo, Carlo Trani, Francesco Burzotta, Tommaso Sanna","doi":"10.1007/s00392-025-02816-z","DOIUrl":"10.1007/s00392-025-02816-z","url":null,"abstract":"<p><strong>Key points: </strong>WHAT IS ALREADY KNOWN: • Sex-related differences in cardiovascular disease presentation, management, and outcomes have been increasingly recognized in recent years. • Women with acute cardiovascular conditions often receive less aggressive diagnostic and therapeutic interventions compared to men, particularly in the setting of acute coronary syndromes.</p><p><strong>What this study adds: </strong>• This study provides a comprehensive evaluation of sex-related differences in a contemporary cohort of patients admitted to the Cardiac Intensive Care Unit (CICU), highlighting distinct admission patterns and management disparities. • Women with cardiovascular disease tend to be older at presentation, exhibit different risk factor profiles, and show distinct clinical manifestations compared to men. • It identifies higher mortality rates for women with STEMI and pulmonary embolism, emphasizing the need for improved recognition and tailored management of sex-specific differences in acute cardiovascular care.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1930-1943"},"PeriodicalIF":3.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145699830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shock index and modified shock index at discharge as predictors of long-term mortality after myocardial infarction: results from the Augsburg Myocardial Infarction Registry.","authors":"Constantin Rödl, Christa Meisinger, Bernhard Kuch, Philip Raake, Jakob Linseisen, Timo Schmitz","doi":"10.1007/s00392-026-02929-z","DOIUrl":"10.1007/s00392-026-02929-z","url":null,"abstract":"<p><strong>Background: </strong>Shock index (SI) and modified shock index (mSI), measured at hospital admission, have been shown to be predictive for mid- and long-term outcomes after acute myocardial infarction (AMI). Whether these associations also hold when indices are measured at discharge is unclear, so this study's aim was to analyze the association between SI and mSI at discharge and long-term mortality after AMI.</p><p><strong>Material and methods: </strong>This analysis included 11,676 AMI cases registered by the population-based Myocardial Infarction Registry Augsburg. The follow-up time was restricted to a maximum of 5 years. Patients were categorized into low and high SI or mSI groups through separation at 75th percentiles for STEMI and NSTEMI, respectively. Analysis of survival included Kaplan-Meier curves with log-rank tests and multivariable-adjusted Cox-regression models.</p><p><strong>Results: </strong>Cut-off values were 0.6667 (STEMI) and 0.6545 (NSTEMI) for SI and 0.9231 (STEMI) and 0.9120 (NSTEMI) for mSI. Kaplan-Meier analysis showed significantly higher mortality for high SI and mSI groups in STEMI and NSTEMI patients. In STEMI cases, multivariable-adjusted Cox-regression analyses revealed significantly higher mortality for the high SI group (hazard ratio (HR): 1.25 (1.02-1.53), p value: 0.030), while mSI was non-significantly associated with long-term mortality (HR: 1.21 (0.99-1.48), p value: 0.060). Neither SI nor mSI was independently associated with mortality in NSTEMI.</p><p><strong>Conclusion: </strong>SI and mSI at discharge represent valuable tools for long-term post-infarction risk stratification especially in STEMI cases and can support decision-making regarding individualized ambulatory care.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1973-1982"},"PeriodicalIF":3.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to return of spontaneous circulation and associations with early neurological outcome at hospital discharge after out-of-hospital cardiac arrest.","authors":"Ulrik Rose, Marie Wulf, Morten Steen Kvistholm Jensen, Emma Riis Meyer, John Bro-Jeppesen","doi":"10.1007/s00392-026-02940-4","DOIUrl":"10.1007/s00392-026-02940-4","url":null,"abstract":"<p><strong>Aim: </strong>To assess the impact of time to return of spontaneous circulation (ROSC) on early in-hospital neurological function and long-term survival in survivors after out-of-hospital cardiac arrest (OHCA).</p><p><strong>Methods: </strong>This retrospective cohort study included survivors of OHCA admitted to the cardiology ward at Aarhus University Hospital. Patients were included from June 2020 to February 2024 and data were collected through review of medical records. Primary outcome was neurological function, and patients were stratified by modified Rankin Scale (mRS) at hospital discharge: good neurological outcome (mRS 0-2) and poor neurological outcome (mRS 3-6). Secondary outcomes were cognitive function assessed with Montreal Cognitive Assessment (MoCA) at hospital discharge and 180-day survival.</p><p><strong>Results: </strong>In total, 321 patients were included, of which 232 (72%) had good neurological outcome and 89 (28%) had poor neurological outcome. Every 5-min increase in time to ROSC was associated with decreased odds of good neurological outcome (OR 0.88, 95% CI 0.81-0.95, p < 0.0001). This association remained significant after adjusting for age and primary rhythm (OR_adjusted 0.86, 95% CI 0.78-0.95, p = 0.004). Patients with good neurological outcome had significantly higher MoCA scores (median 23 vs. 18, p < 0.001). In-hospital mortality was 6% and time to ROSC was not significantly associated with 180-day mortality.</p><p><strong>Conclusion: </strong>In initial OHCA survivors transferred to the cardiology ward, increased time to ROSC was independently associated with decreased odds of good neurological function at hospital discharge, even after adjusting for age and primary rhythm. The majority of patients had good neurological function at hospital discharge. In this population time to ROSC was not associated with mortality.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1993-2004"},"PeriodicalIF":3.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148148632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex disparities in revascularization strategies and mortality in infarct-related cardiogenic shock.","authors":"Tobias Heer, Matthias Hochadel, Holger Thiele, Sebastian Kerber, Julinda Mehilli, Bernward Lauer, Ralf Zahn, Uwe Zeymer","doi":"10.1007/s00392-026-02988-2","DOIUrl":"10.1007/s00392-026-02988-2","url":null,"abstract":"<p><strong>Background: </strong>Cardiogenic shock (CS) remains the leading cause of death in acute myocardial infarction (AMI). Sex-related disparities in AMI-CS have been reported, but findings vary across cohorts.</p><p><strong>Objectives: </strong>The authors examined the clinical characteristics and in-hospital outcomes of consecutive women and men with AMI-CS.</p><p><strong>Methods: </strong>The ALKK coronary angiography (CAG) registry prospectively enrolled consecutive CAG and percutaneous coronary interventions (PCI) across 51 participating hospitals in Germany.</p><p><strong>Results: </strong>Between January 2009 and December 2020, a total of 4204 patients undergoing CAG for suspected AMI-CS were included. Women (30.5%, n = 1281) were on average 6 years older (74.3 vs. 68.0 years, P < .001) and had more comorbidities. They less frequently had significant coronary artery disease (CAD), 82.3% vs. 90.3%, P < .001. No significant sex differences in the recommendation for revascularization (PCI or CABG) among patients with significant CAD after adjustment for age (92.4% vs. 91.3%, adjusted OR: 1.3; 95% CI: 0.99-1.72) were observed. There were no sex differences in hospital mortality after adjustment for age, particularly in the PCI group, age-adjusted OR: 1.06; 95% CI: 0.90-1.25, multivariable adjusted OR: 1.09; 95% CI: 0.92-1.28.</p><p><strong>Conclusions: </strong>In this large, contemporary registry, women with early CAG for AMI-CS were older than men and had more comorbidities. Significant CAD was less frequently diagnosed in women with suspected AMI-CS. After adjustment for age, there were neither sex differences in revascularization strategies nor in hospital mortality after PCI for AMI-CS. These results question previous reports about undertreatment and higher mortality of AMI-CS in women.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"2048-2061"},"PeriodicalIF":3.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of natriuresis-guided diuretic therapy in men and women with acute heart failure: insights from PUSH-AHF.","authors":"Hailun Qin, Lara E E C Zonneveld, Adriaan A Voors, Iris E Beldhuis, Alice Ravera, Dirk J van Veldhuisen, Jenifer E Coster, Wybe Nieuwland, Jan A Krikken, Peter van der Meer, Kevin Damman, Jozine M Ter Maaten","doi":"10.1007/s00392-026-03030-1","DOIUrl":"10.1007/s00392-026-03030-1","url":null,"abstract":"<p><strong>Aim: </strong>Natriuresis-guided therapy has been proposed as a personalized approach for decongestion in acute heart failure (HF). Given the evidence of sex-related differences in response to decongestive therapy, we performed a sex-specific analysis on the treatment effect of natriuresis-guided therapy in the PUSH-AHF trial.</p><p><strong>Methods: </strong>The PUSH-AHF trial randomized 310 patients (45% women) to natriuresis-guided therapy or standard of care (SOC). The endpoints of PUSH-AHF were compared between men and women. The 24-h natriuretic response was calculated as 24-h natriuresis divided by the total 24-h loop diuretic dose (mg of bumetanide equivalents).</p><p><strong>Results: </strong>In men, mean total 24-h natriuresis was greater with natriuresis-guided therapy compared to SOC (443 vs. 354 mmol, p = 0.004), whereas in women, this was similar between the groups (357 vs. 336 mmol, p = 0.533, adjusted p-interaction = 0.276). The median 24-h natriuretic response was lower in women receiving natriuresis-guided therapy (23 vs. 52 mmol urinary sodium/mg bumetanide, p = 0.001) when compared to SOC, whereas in men, there was no significant difference between treatment arms (38 vs. 45 mmol respectively, p = 0.337, adjusted p-interaction = 0.009). Natriuresis-guided therapy was associated with a lower risk of 180-day HF rehospitalization or all-cause mortality in men (adjusted HR 0.51 (95% CI, 0.30-0.86; p = 0.011), but not in women (adjusted HR 1.40 (95% CI, 0.67-2.91; p = 0.368), adjusted p-interaction = 0.026).</p><p><strong>Conclusion: </strong>Natriuresis-guided therapy was associated with greater natriuresis and a lower risk of 180-day all-cause mortality or HF rehospitalization in men but not in women. These exploratory sex-specific patterns warrant further investigation and confirmation.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"2062-2076"},"PeriodicalIF":3.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of lactate in patients with cardiogenic shock with and without cardiac arrest.","authors":"Uwe Zeymer, Anne Freund, Taoufik Ouarrak, Steffen Schneider, Ibrahim Akin, Daniel Duerschmidt, Steffen Desch, Holger Thiele, Janine Pöss","doi":"10.1007/s00392-025-02762-w","DOIUrl":"10.1007/s00392-025-02762-w","url":null,"abstract":"<p><strong>Background: </strong>Arterial lactate on admission is a well-established marker of shock severity and prognosis in infarct-related cardiogenic shock (CS). However, it remains unclear whether its prognostic value differs between patients with and without pre-hospital cardiac arrest (CA).</p><p><strong>Methods: </strong>We performed a pooled analysis of three randomized clinical trials on CS (IABP-SHOCK II, CULPRIT-SHOCK, and ECLS-SHOCK). Patients were stratified based on the presence or absence of pre-hospital CA. Admission arterial lactate levels were categorized into tertiles: < 3.6, 3.6-7.1, and > 7.1 mmol/L. The primary endpoint was 1-year all-cause mortality.</p><p><strong>Results: </strong>A total of 1401 patients (804 with CA and 597 without CA) were included. Higher admission lactate levels were associated with a linear increase in 1-year mortality. The prognostic performance of arterial lactate, assessed by the area under the curve (AUC), was 0.65 (95% CI 0.63-0.67). Patients with CA were more frequently represented in the highest lactate tertile compared to those without CA (31.6% vs. 8.8%). Across all tertiles, lactate levels were significantly associated with 1-year mortality, irrespective of CA status: 39.8% vs. 41.4% in the lowest tertile (p = 0.73), 48.6% vs. 50.8% in the intermediate tertile (p = 0.61), and 66.7% vs. 81.8% in the highest tertile (p = 0.0023), for CA and no-CA patients, respectively.</p><p><strong>Conclusions: </strong>Admission arterial lactate is associated with 1-year mortality in infarct-related CS, regardless of pre-hospital CA. Although patients without CA generally had lower lactate levels, those in the highest lactate tertile experienced the highest mortality risk.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1921-1929"},"PeriodicalIF":3.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment selection and long-term survival in patients aged 50 to < 75 years undergoing valve reintervention for failed surgical aortic bioprostheses: insights from the Netherlands Heart Registration.","authors":"Antigone Kostea, Jenna van Niekerk, Lucas Uchoa de Assis, Rik Adrichem, Marijke J C Timmermans, Pim A L Tonino, Michiel Voskuil, Arend de Weger, Fabiano Porta, Isabella Kardys, Nicolas M Van Mieghem, Rutger-Jan Nuis","doi":"10.1007/s00392-026-03045-8","DOIUrl":"https://doi.org/10.1007/s00392-026-03045-8","url":null,"abstract":"<p><strong>Objectives: </strong>To describe real-world treatment allocation and observed long-term survival in patients aged 50 to < 75 years with failed surgical aortic bioprostheses who underwent reintervention through valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) or redo surgical aortic valve replacement (redo-SAVR) in the Netherlands.</p><p><strong>Methods: </strong>Patients aged 50 to < 75 years who underwent ViV-TAVI or redo-SAVR for a failing surgical bioprosthesis between 2015 and 2020 were identified from the Netherlands Heart Registration. Baseline characteristics and Dutch surgical-risk categories were compared by treatment strategy. Multivariable logistic regression was used to identify factors associated with ViV-TAVI selection. Kaplan-Meier analysis described survival, and treatment-specific Cox models explored factors associated with all-cause mortality.</p><p><strong>Results: </strong>Of 345 patients, 41% underwent ViV-TAVI and 59% redo-SAVR. Patients selected for ViV-TAVI were older (median 71 vs. 67 years, p < 0.001), had higher surgical risk (EuroSCORE II: 6.2% vs. 4.6%, p = 0.014), and had a greater comorbidity burden than redo-SAVR patients. Despite these baseline risk differences, estimated survival within the ViV-TAVI cohort was 94.2% at 30 days, 89.6% at 2 years, and 74.4% at 4 years; corresponding redo-SAVR estimates were 96.1%, 89.8%, and 88.4%. Left ventricular ejection fraction ≤ 30% and chronic lung disease were associated both with ViV-TAVI selection (OR: 8.04, 95% CI: 2.16-29.92 and OR: 3.25, 95% CI: 1.53-6.92, respectively) and with all-cause mortality after redo-SAVR (HR: 15.70, 95% CI: 2.49-67.14 and HR: 4.23, 95% CI: 1.53-13.14, respectively).</p><p><strong>Conclusion: </strong>In this Dutch observational registry, ViV-TAVI was predominantly selected for patients with a higher-risk clinical phenotype, while redo-SAVR was more often used in lower-risk reintervention candidates and showed higher observed long-term survival. These data describe contemporary treatment selection and prognosis but do not establish comparative superiority of either strategy.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New insights into takotsubo syndrome: results from a multicenter cohort.","authors":"Hugo Lanz, Endrit Cekaj, Lucas Bacmeister, Christian Jung, Samuel Muli, Sabine Hoffmann, Matthias Schmid, Marcelo Galdos-Bejar, Daniel Hoyer, Lisa Crusius, Norman Mangner, Lisa Reinhardt, Loubna Yahsaly, Lars Michel, Victoria Pfeiffer, Mostafa Salem, Rafael Henrique Rangel, Johannes Terporten, Fabian Heindl, Marcus Brugger, Sebastian Zimmer, Tienush Rassaf, David Leistner, Dirk Westermann, Benjamin Meder, Malte Kelm, Stephan Baldus, Christian Schulze, Georg Nickenig, Franz Haertel, Enzo Lüsebrink","doi":"10.1007/s00392-026-03037-8","DOIUrl":"https://doi.org/10.1007/s00392-026-03037-8","url":null,"abstract":"<p><strong>Background: </strong>Takotsubo syndrome has long been deemed a benign condition following sudden emotional stress. While current mechanisms explaining the acute cardiac dysfunction are not fully understood, current evidence suggests certain takotsubo populations are at higher risk of adverse course. Acute neurologic emergencies commonly precede the takotsubo syndrome and new insights into the role of the brain-heart axis and central autonomic regions driving excess sympathetic activation have come about.</p><p><strong>Methods and results: </strong>This multicenter analysis included 595 patients admitted between January 2013 and December 2024 with takotsubo syndrome across 13 German tertiary care centers. The aim of this study was to (I) assess whether acute brain pathology influences severity of cardiac dysfunction differently in comparison to other nonneurologic forms of physical or emotional stress, (II) investigate short-term recovery of cardiac function, and (III) improve identification of vulnerable patients susceptible to critical in-hospital course. Marginal odds ratios were estimated for cardiac complications of takotsubo syndrome across trigger groups using generalized estimating equations. Multivariable mixed-effects logistic regression models were fit to analyze the association between prespecified variables for short-term recovery of wall motion and systolic abnormalities as well as critical in-hospital course. Acute neurologic emergencies (47.5%) and common physical triggers (37.9%) were associated with higher risk of cardiac complications in takotsubo syndrome compared to emotional triggers (12.5%). Nonapical forms of takotsubo syndrome showed improved recovery of wall motion abnormalities (OR 2.70, 95% CI 1.34-5.45), while older patients had worse recovery of systolic function to discharge (OR 0.67, 95% CI 0.48-0.93). Conversely, younger male patients in which disease was triggered by neurologic emergencies or physical triggers presented with higher odds of critical in-hospital course.</p><p><strong>Conclusion: </strong>Results of this study challenge the assumption of uniform reversibility of cardiac dysfunction and emphasize the need for early risk stratification and awareness of high-risk features as well as varying clinical presentations.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Echocardiography-derived Left Atrial Volumetric-Mechanical Coupling Index predicts early new-onset atrial fibrillation after embolic stroke/transient ischemic attack of undetermined source.","authors":"Chiara Giordano, Giacomo Gamberini, Andrea Faggiano, Laura Garau, Giulia Conti, Paolo Fabio D'Andria, Francesco Moda, Giulio Mallardi, Massimo Saviano, Sara Bonato, Isabella Ghione, Silvia Lanfranconi, Elisa Gherbesi, Gloria Santangelo, Massimiliano Ruscica, Francesca Bursi, Stefano Carugo","doi":"10.1007/s00392-026-03041-y","DOIUrl":"https://doi.org/10.1007/s00392-026-03041-y","url":null,"abstract":"<p><strong>Aim: </strong>In patients with embolic stroke or transient ischemic attack of undetermined source (ESUS/TIA), occult atrial fibrillation (AF) is a frequent underlying mechanism with critical therapeutic implications, yet selecting patients who warrant intensified rhythm monitoring remains challenging. The Left Atrioventricular Coupling Index (LACI = LA end-diastolic volume/LV end-diastolic volume) captures atrioventricular uncoupling, whereas the Left Atrial Volumetric-Mechanical Coupling Index (LACI-VM = LAVi/a') integrates atrial size with mechanical performance; both may capture complementary domains of atrial remodelling relevant to subclinical AF. We aimed to investigate the association of LACI-VM and LACI with incident AF in ESUS/TIA.</p><p><strong>Methods and results: </strong>In this retrospective single-center cohort, 285 consecutive patients with ESUS/TIA of undetermined source underwent transthoracic echocardiography at index hospitalization, including measurement of LACI-VM and LACI. The primary endpoint was new-onset AF during follow-up. Median age was 71 years and 43% were women. Over a median follow-up of 10.9 months, AF occurred in 24 patients (8.4%), with 62% of events occurring within the first year. LACI-VM was higher in patients who developed AF and remained independently associated with incident AF after multivariable adjustment (HR 6.64, CI 1.34-59.88; p = 0.041). LACI showed a non-significant association overall (HR 2.28, CI 0.74-7.01; p = 0.09), with predictive value confined to events within 12 months. A combined assessment of LACI-VM and LV filling pressures further refined risk stratification: patients with preserved LACI-VM (< 2.5) and normal filling pressures (E/e' ≤ 10) had a very low AF incidence (~ 2%), identifying a truly low-risk subgroup; conversely, when both LACI-VM (≥ 2.5) and filling pressures (E/e' > 10) were impaired, AF risk was ~ tenfold higher (~ 20%).</p><p><strong>Conclusion: </strong>In ESUS/TIA, echocardiography-derived LACI-VM independently predicts incident AF and identifies patients at genuinely low risk. As a simple echocardiographic metric, its integration with LV filling pressures may support a more personalized use of rhythm monitoring.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal cytokine trajectories during microaxial flow pump support identify a high-risk inflammatory phenotype in cardiogenic shock.","authors":"Julian Kreutz, Joshua Amoah, Klevis Mihali, Lukas Harbaum, Georgios Chatzis, Nikolaos Patsalis, Styliani Syntila, Bernhard Schieffer, Birgit Markus","doi":"10.1007/s00392-026-03040-z","DOIUrl":"https://doi.org/10.1007/s00392-026-03040-z","url":null,"abstract":"<p><strong>Background: </strong>Despite advances in temporary mechanical circulatory support, the mortality rate for patients with cardiogenic shock (CS) remains high. Current shock frameworks rely on hemodynamic parameters and fail to capture ongoing biological injury. Our study aimed to investigate cytokine trajectories during support and their association with clinical outcomes.</p><p><strong>Methods: </strong>This single-center retrospective cohort study analyzed 113 patients with CS in SCAI stage ≥ C who were treated with microaxial flow pump (mAFP). Serial cytokine levels were measured from the time of mAFP implantation until day 7 afterwards. Time-point-specific multivariable logistic regression was used to identify independent predictors of 30-day mortality. The incremental prognostic value of cytokine levels was evaluated in relation to age, lactate, and vasoactive-inotropic score (VIS), with interaction analyses conducted in relation to hemodynamic severity and blood culture positivity.</p><p><strong>Results: </strong>The overall 30-day mortality rate in the study cohort was 26.5%. IL-6 trajectories diverged progressively between survivors and non-survivors during mAFP support, with the greatest separation at 72 h. At this time point, log-transformed IL-6 was independently associated with 30-day mortality. ROC analysis at 72 h showed moderate discriminatory performance (AUC 0.745) and identified an optimal cut-off of 164.5 pg/mL (sensitivity 68.0%; specificity 82.1%). Patients with IL-6 levels ≥ 164.5 pg/mL presented with lower 30-day survival in exploratory landmark-type Kaplan-Meier analysis (log-rank p < 0.001). This association was not modified by blood culture positivity, although infection, culture-negative inflammatory complications, and vasoplegic/distributive physiology cannot be excluded as contributors to IL-6 elevation.</p><p><strong>Conclusions: </strong>In patients with CS supported by mAFP, persistent IL-6 elevation at 72 h was associated with increased 30-day mortality and provided additional prognostic information alongside established clinical severity markers. These findings suggest that ongoing inflammatory activity may provide additional prognostic information and support further evaluation of serial IL-6 measurements for risk stratification.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}