Clinical Research in Cardiology最新文献

{"title":"Frailty, periinterventional complications and outcome in patients undergoing percutaneous mitral and tricuspid valve repair.","authors":"Matthieu Schäfer, Hannah Nöth, Clemens Metze, Christos Iliadis, Maria Isabel Körber, Marcel Halbach, Stephan Baldus, Roman Pfister","doi":"10.1007/s00392-024-02397-3","DOIUrl":"10.1007/s00392-024-02397-3","url":null,"abstract":"<p><strong>Background: </strong>Frailty is common in elderly and multimorbid patients and associated with increased vulnerability to stressors.</p><p><strong>Methods: </strong>In a single centre study frailty according to Fried criteria was assessed in consecutive patients before transcatheter mitral and tricuspid valve repair. Postprocedural infections, blood transfusion and bleeding and renal failure were retrospectively assessed from records. Median follow-up time for survival was 560 days (IQR: 363 to 730 days).</p><p><strong>Results: </strong>90% of 626 patients underwent mitral valve repair, 5% tricuspid valve repair, and 5% simultaneous mitral and tricuspid valve repair. 47% were classified as frail. Frailty was associated with a significantly increased frequency of bleeding (16 vs 10%; p = 0.016), blood transfusions (9 vs 3%; p =  < 0.001) and infections (18 vs 10%; p = 0.006), but not with acute kidney injury (20 vs 20%; p = 1.00). Bleeding and infections were associated with longer hospital stays, with a more pronounced effect in frail patients (interaction test p < 0.05, additional 3.2 and 4.1 days in frail patients, respectively). Adjustment for the occurrence of complications did not attenuate the increased risk of mortality associated with frailty (HR 2.24 [95% CI 1.62-3.10]; p < 0.001).</p><p><strong>Conclusions: </strong>Bleeding complications and infections were more frequent in frail patients undergoing transcatheter mitral and tricuspid valve repair and partly explained the longer hospital stay. Albeit some of the complications were associated with higher long-term mortality, this did not explain the strong association between frailty and mortality. Further research is warranted to explore interventions targeting periprocedural complications to improve outcomes in this vulnerable population.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"827-835"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139734593","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":"Favorable safety profile of NOAC therapy in patients after tricuspid transcatheter edge-to-edge repair.","authors":"Isabel A Hoerbrand, Martin J Kraus, Martin Gruber, Nicolas A Geis, Philipp Schlegel, Norbert Frey, Mathias H Konstandin","doi":"10.1007/s00392-024-02517-z","DOIUrl":"10.1007/s00392-024-02517-z","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter edge-to-edge repair for severe tricuspid regurgitation (TR) is a new treatment option (t-TEER). Data on optimal antithrombotic therapy after t-TEER in patients with an indication for anticoagulation are scarce and evidence-based guideline recommendations are lacking. We sought to investigate efficacy and safety of novel oral anticoagulation (NOAC) and vitamin-K-antagonists (VKA) in patients undergoing t-TEER.</p><p><strong>Methods: </strong>Among 78 consecutive patients with t-TEER of severe TR, 69 patients were identified with concomitant indication for oral anticoagulation. Outcomes of these patients treated with NOAC or VKA were compared over a median follow-up period of 327 (177-460) days.</p><p><strong>Results: </strong>Despite elevated thromboembolic and bleeding risk scores (CHA₂DS₂-VASc 4.2 ± 1.1, HEMORR₂HAGES 3.0 ± 1.0 and HAS-BLED 2.1 ± 0.8), only one major bleeding incidence occurred under NOAC therapy. The risk for overall (NOAC 8% vs. VKA group 26%, p = 0.044) and major bleeding events (NOAC 2% vs. VKA 21%, p = 0.010) was significantly lower in the NOAC compared to the VKA group. No significant difference was found between NOAC and VKA treatment in terms of mortality (NOAC 18% vs. VKA 16%, p = 0.865) or the combined endpoint of death, heart failure hospitalization, stroke, embolism, thrombosis, myocardial infarction, and severe bleeding (NOAC 48% vs. VKA 42%, p = 0.801). A comparison between apixaban (n = 27) and rivaroxaban (n = 16) treated patients revealed no significant differences between NOAC substances (all bleeding events apixaban 7% vs. rivaroxaban 13%, p = 0.638).</p><p><strong>Conclusion: </strong>Results of this study indicate that NOACs may offer a favorable risk-benefit profile for patients with concomitant indication for anticoagulation therapy following t-TEER.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"846-855"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999543","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":"Valve unit instead of intensive or intermediate care unit admission following transcatheter edge-to-edge mitral valve repair is safe and reduces postprocedural complications.","authors":"Matthias Gröger, Dominik Felbel, Michael Paukovitsch, Leonhard Moritz Schneider, Sinisa Markovic, Wolfgang Rottbauer, Mirjam Keßler","doi":"10.1007/s00392-024-02384-8","DOIUrl":"10.1007/s00392-024-02384-8","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter edge-to-edge mitral valve repair (M-TEER) is often performed in general anesthesia, and postprocedural monitoring is usually warranted on an intensive or intermediate care unit (ICU/IMC). We evaluated the implications of a dedicated valve unit (VU) instead of an ICU/IMC for monitoring after M-TEER.</p><p><strong>Methods and results: </strong>In total, 624 patients were retrospectively analyzed. A total of 312 patients were primarily transferred to either ICU or IMC following M-TEER, and 312 patients were scheduled for the VU in the absence of indications for ICU/IMC treatment. Hospital stay was significantly shorter in VU patients (median 6.0 days (interquartile range (IQR) 5.0 - 8.0) vs. 7.0 days (IQR 6.0 - 10.0), p < 0.001) and their risk for infections (2.9 vs. 7.7%, p = 0.008) and delirium (0.6 vs. 2.6%, p = 0.056) was substantially lower compared to ICU/IMC patients. In-hospital mortality was similar in both groups (0.6% vs. 1.3%, p = 0.41). Fifty patients (16.0%) in the VU group had to cross over to unplanned ICU/IMC admission. The most frequent indication was prolonged need for catecholamines (52.0%). Patients with ICU/IMC crossover had more advanced stages of heart failure (LV-EF < 30% in 36.0 vs. 16.0%, p = 0.001; severe concomitant tricuspid regurgitation in 48.0 vs. 27.8%, p = 0.005) and an LV-EF < 30% was independently associated with unplanned ICU/IMC admission.</p><p><strong>Conclusions: </strong>Following M-TEER postprocedural monitoring on a VU instead of an ICU/IMC is safe, reduces complications, and spares ICU capacities. Patients with advanced heart failure have a higher risk for unplanned ICU/IMC treatment after M-TEER.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"818-826"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139729173","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 impact of disease-related complications in asymptomatic mitral regurgitation: a health insurance claims analysis.","authors":"L Acar, C A Behrendt, S Baldus, V Falk, N Smetak, M Mboulla Nzomo, U Marschall, E Girdauskas","doi":"10.1007/s00392-024-02532-0","DOIUrl":"10.1007/s00392-024-02532-0","url":null,"abstract":"<p><strong>Background and aims: </strong>The impact of mitral regurgitation (MR) in asymptomatic patients is not well defined. We aimed to determine the prevalence of MR-related complications and their association with 10-year survival in a large unselected asymptomatic MR cohort.</p><p><strong>Methods: </strong>Health insurance claims data from Germany's second largest health insurance fund, BARMER, which maintains longitudinal data on 8.7 million German residents, were retrospectively analyzed. All patients with an outpatient diagnosis of MR in a minimum of two quarters during a calendar year and first recorded diagnosis between 2008 and 2011 were included. Patients with any complication attributable to MR or mitral valve intervention at index were excluded. Outcomes were compared between study group and age- and sex-matched controls (i.e., without known cardiac disease). MR-related complications of interest were new congestive heart failure, new-onset atrial fibrillation, pulmonary hypertension, or cardiac decompensation.</p><p><strong>Results: </strong>A total of 56,577 individuals (median age 68 years, 67% female) with asymptomatic MR were identified. At 10 years, MR-related complications were more frequent in the study group vs. control group (46.5% vs. 20.8%, OR 3.31, P < 0.0001). Furthermore, MR-related complications were more common in male vs. female patients with an asymptomatic MR (OR 2.65, P < 0.0001). The occurrence of at least one MR-related complication was associated with a reduced 10-year survival (OR 1.80, P < 0.0001).</p><p><strong>Conclusions: </strong>Almost half of patients with asymptomatic MR experience complications during a 10 year follow-up which result in impaired survival. These results imply the necessity of long-term disease management program. Furthermore, decision-making process and timing for mitral valve intervention in asymptomatic patients should be reevaluated.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"856-866"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142079513","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":"Letter to the editor: \"Cardiovascular magnetic resonance reveals myocardial involvement in patients with active stage of inflammatory bowel disease\".","authors":"Syeda Rabika, Syeda Sidra Mudassir, Muhammad Maaz, Syed Hussain","doi":"10.1007/s00392-025-02605-8","DOIUrl":"10.1007/s00392-025-02605-8","url":null,"abstract":"","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"943-944"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188548","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":"C-reactive protein-to-albumin ratio is associated with mortality after transcatheter tricuspid valve repair.","authors":"Karl Finke, Laura Marx, Jan Althoff, Thorsten Gietzen, Matthieu Schäfer, Jan Wrobel, Philipp von Stein, Jennifer von Stein, Maria Isabel Körber, Stephan Baldus, Roman Pfister, Christos Iliadis","doi":"10.1007/s00392-025-02641-4","DOIUrl":"10.1007/s00392-025-02641-4","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter tricuspid valve repair (TTVr) is a treatment option for tricuspid regurgitation (TR) in patients with high surgical risk. Given the heterogeneity in clinical benefit, there is a need for markers to assess mortality risk in patients undergoing TTVr. The C-reactive protein (CRP)/albumin ratio (CAR) is a marker of systemic inflammation and reduced nutritional status, which can both occur in TR.</p><p><strong>Methods: </strong>Consecutive patients undergoing TTVr at a tertiary care center were retrospectively analyzed. Serum CRP and albumin were collected at baseline. Intraprocedural success (IS) was defined according to TVARC criteria. The primary outcome of all-cause mortality was assessed up to 2 years after TTVr.</p><p><strong>Results: </strong>A total of 215 patients (69% females, median age 80 years) were identified. IS was achieved in 61% of patients. AUC of CAR for 2-year mortality was 0.695, with an optimal threshold of 1.2945 (Youden index) dividing patients in high CAR (n = 93) and low CAR (n = 122) groups. In the high CAR group, the primary endpoint occurred more frequently (43% vs 15%, p < 0.001) and significantly higher right atrial pressure, worse renal function, and less IS during TTVr were observed. High CAR was independently associated with an increased mortality risk even when adjusted for renal and liver function, right-ventricular function, and procedural failure (HR 2.188; 95%CI 1.2-3.9; p = 0.011).</p><p><strong>Conclusion: </strong>Higher CAR reflects patients with advanced right-heart failure and extracardiac organ damage and is associated with mortality after TTVr. CAR is derived from readily available parameters and may be useful additive to established risk scores.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"892-903"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962502","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":"Etiology of tricuspid regurgitation and mortality: a multicenter cohort study.","authors":"Jorge Rodríguez-Capitán, Paloma Márquez-Camas, Jesús Carmona-Carmona, Diego Félix Arroyo Moñino, Marinela Chaparro-Muñoz, Matías Soler-González, Manuel García Del Río, Teodora Egido de la Iglesia, Jorge Segovia-Reyes, Mora Murri, José Raúl López Salguero, David Couto-Mallón, Miguel Romero-Cuevas, Francisco Javier Pavón-Morón, Mario Gutiérrez-Bedmar, Manuel Jiménez-Navarro","doi":"10.1007/s00392-025-02662-z","DOIUrl":"10.1007/s00392-025-02662-z","url":null,"abstract":"<p><strong>Background: </strong>Significant tricuspid regurgitation (TR) encompasses a wide range of etiologies, complicating a comprehensive understanding of disease progression and prognostic factors. This study aimed to assess mortality associated with significant TR, focusing on the role of valvular disease etiology and other predictive factors.</p><p><strong>Methods: </strong>This is a retrospective, multicenter, cohort observational study, including all consecutive patients with moderate-to-severe or greater TR. The patients were classified into five etiological groups: organic TR, TR secondary to left valvulopathy, TR secondary to left or right ventricular dysfunction, TR secondary to pulmonary hypertension, and atrial TR. The long-term mortality was assessed (median follow-up: 39.8 months).</p><p><strong>Results: </strong>757 patients were included. The overall mortality incidence rate was 162.5 deaths per 1000 patient-years. Compared to atrial TR, all other etiologies presented a higher mortality risk: organic TR adjusted hazard ratio (aHR) = 2.344 (95% confidence interval [CI]: 1.138-4.829), left valvulopathy-related TR aHR = 1.901 (95% CI: 1.011-3.574), ventricular dysfunction-related TR aHR = 3.683 (95% CI: 1.627-8.338), and pulmonary hypertension-related TR aHR = 2.446 (95% CI: 1.215-4.927). In addition to known factors, male sex was associated with a higher mortality risk (aHR = 1.608, 1.175-2.201), while beta-blocker use was linked to a lower risk (aHR = 0.674, 0.502-0.904).</p><p><strong>Conclusions: </strong>In a large cohort of patients with significant TR, and after adjusting for clinical and echocardiographic variables, all etiological groups exhibited a higher mortality risk compared to atrial TR. Additionally, male patients with TR had a higher mortality risk, while beta-blocker therapy emerged as a protective factor.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"915-926"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977346","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":"Transcatheter edge-to-edge repair in anatomically complex degenerative mitral regurgitation: 3-year outcomes from a real-world registry.","authors":"Nicoleta Nita, Michael Paukovitsch, Dominik Felbel, Matthias Gröger, Dominik Buckert, Mirjam Keßler, Wolfgang Rottbauer","doi":"10.1007/s00392-025-02644-1","DOIUrl":"10.1007/s00392-025-02644-1","url":null,"abstract":"<p><strong>Background: </strong>Recent developments in transcatheter mitral valve repair (M-TEER) have expanded the indication for the procedure beyond conventional criteria to include patients with anatomically complex degenerative mitral regurgitation (DMR), but long-term outcomes are not well known.</p><p><strong>Aims: </strong>To investigate outcomes by specific anatomical criteria in patients with severe DMR and complex valve anatomy enrolled in the prospective MitraUlm registry.</p><p><strong>Methods: </strong>Clinical and echocardiographic 3-year outcomes of 304 patients with DMR and complex mitral valve anatomy, defined according to the CLASP IID registry criteria, were investigated. Outcomes were analysed separately for specific anatomical complexities.</p><p><strong>Results: </strong>33.5% of patients had ≥ independent significant jets, 12% multisegmental prolapse, 12.3% mitral valve orifice area < 4 cm², 10.9% commissural lesions with wide/multiple jets, and 10.1% large flail. Mitral regurgitation (MR) reduction ≤ 2 was achieved in 93.8% of patients at discharge and in 85.9% at 3-year follow-up. Patients with multisegmental prolapse and commissural lesions with multiple/wide jets had the lowest MR reduction at discharge. Compared to patients treated with MitraClip Generation 1-3, patients treated with MitraClip Generation 4 had significantly better post-procedural MR reduction (MR ≤ 1 in 74.3% vs 50.7%, P < 0.001) and higher 3-year survival rates (80.2% vs 61.6%, Log Rank P = 0.002). Postprocedural MR reduction to MR ≤ 1 was the strongest independent predictor of 3-year survival, whereas the presence of at least two anatomical complexities and elevated post-procedural left atrial pressure predicted 3-year all-cause mortality.</p><p><strong>Conclusions: </strong>In patients with anatomically complex DMR, advances in procedural techniques for M-TEER have allowed successful treatment with sustained MR reduction and improved long-term survival.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"904-914"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955198","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":"Predictability of post-delivery mitral regurgitation with a new generation transcatheter edge-to-edge device.","authors":"Katharina Hellhammer, Florian Schindhelm, Tobias Geisler, Isabela Kast, Andreas Goldschmied, Muhammed Gerçek, Felix Rudolph, Volker Rudolph, Matthias Totzeck, Peter Luedike, Tienush Rassaf, Amir A Mahabadi","doi":"10.1007/s00392-025-02705-5","DOIUrl":"https://doi.org/10.1007/s00392-025-02705-5","url":null,"abstract":"<p><strong>Background: </strong>Ensuring stable MR reduction post-device release is critical for procedural success, as applying a second device may not always be feasible. Incidence of change in residual MR and influencing factors using the PASCAL Precision system have not been evaluated. This study evaluates the intraprocedural incidence of changes in residual mitral regurgitation (MR) after device release during transcatheter edge-to-edge repair (TEER) and potential factors influencing changes in residual MR using the PASCAL Precision system.</p><p><strong>Methods: </strong>In this multicenter, retrospective analysis of 251 patients (mean age: 77.2 ± 10.8 years, 58.2% male), we assessed the predictability of intraprocedural post-release residual MR. MR grading before and after release as well as MR etiology and presence of complexity characteristics were evaluated in a central core lab in a blinded manner. MR changes were classified as \"unchanged,\" \"improved,\" or \"deteriorated\" based on pre- to post-release observations.</p><p><strong>Results: </strong>Procedural success was achieved in 97.2% of cases. Baseline MR was severe (4 +) in 75.7% and moderate to severe (3 +) in 24.3%. After release of the device from the implant catheter, residual MR improved in 13.5% of cases, remained unchanged in 78.5%, and worsened in 8%. Mitral valve mean pressure gradients were stable pre- and post-release (3.0 ± 1.2 vs. 2.9 ± 1.2 mmHg, p = 0.183). MR etiology or presence of complexity criteria did not differ among groups.</p><p><strong>Conclusions: </strong>M-TEER using the PASCAL Precision system demonstrates stable intraprocedural MR outcomes, with over 90% of cases showing no deterioration from pre- to post-release, irrespective of valve complexity or etiology.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526718","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":"Characteristics and outcomes of acute pulmonary embolism among patients with polyvascular, single-vascular or no atherosclerotic disease: insights from RIETE.","authors":"Silvia Cardi, Stefano Barco, Simon Wolf, Pablo Demelo-Rodríguez, Montserrat Pérez-Pinar, Andris Skride, Zoubida Tazi-Mezalek, Juan Bosco López-Sáez, Pablo Javier Marchena, Manuel Monreal","doi":"10.1007/s00392-025-02706-4","DOIUrl":"https://doi.org/10.1007/s00392-025-02706-4","url":null,"abstract":"<p><strong>Background: </strong>The role of atherosclerosis in pulmonary embolism (PE) prognosis remains uncertain. Our study assesses characteristics and outcomes of acute PE patients according to the presence and extent of atherosclerotic disease.</p><p><strong>Methods: </strong>Using data from the RIETE registry, acute PE patients were classified into three groups based on personal history: (1) polyvascular atherosclerosis, (2) single vascular atherosclerosis, and (3) no symptomatic atherosclerosis. Primary outcomes included recurrent PE and venous thromboembolism (VTE), arterial events, major bleeding, and all-cause death. Hazard ratios (HR) and Kaplan-Meier curves for clinical outcomes were estimated using Cox regression models.</p><p><strong>Results: </strong>Among 47,578 acute PE patients, 1,040 had polyvascular, 6,191 single-vascular, and 40,347 no atherosclerosis. During a median follow-up of 331 days, Adverse outcomes were more frequent in patients with atherosclerosis (vs. no atherosclerosis), rising with the number of affected vascular territories. Recurrent PE rates were 2.8, 1.6, and 1.2 per 100 patient-years in the polyvascular, single-vascular, and no atherosclerosis groups. Multivariable analysis showed a dose-dependent relationship between atherosclerosis and recurrent PE risk, with HRs of 3.2 (95% CI 1.7-5.9) and 1.6 (95% CI 1.1-2.3) for polyvascular and single-vascular disease (vs. no atherosclerosis). The risk of all-cause death followed a similar trend, with HRs of 1.3 (95% CI 1.1-1.6) and 1.2 (95% CI 1.1-1.4), respectively. Major bleeding appeared to be influenced by overall health status and antithrombotic therapy intensity.</p><p><strong>Conclusion: </strong>Atherosclerosis in acute PE patients may serve as a marker of disease severity and lead independently to adverse outcomes, highlighting the importance of cardiovascular risk stratification.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526716","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}