Clinical Research in Cardiology最新文献

{"title":"Effects of the 2019 guideline update on lipid-lowering therapy in patients with acute coronary syndromes.","authors":"Lukas Galli, Johannes Bernhard, Lore Schrutka, Patrick Haider, Klaus Distelmaier, Christian Hengstenberg, Konstantin A Krychtiuk, Walter S Speidl","doi":"10.1007/s00392-025-02716-2","DOIUrl":"https://doi.org/10.1007/s00392-025-02716-2","url":null,"abstract":"<p><strong>Background: </strong>The European Society of Cardiology regularly updates its clinical practice guidelines. However, it is not well established whether guideline changes have significant effects on actual clinical practice. Therefore, we retrospectively analyzed lipid-lowering therapy at discharge after acute coronary syndrome (ACS) in a 1-year period before and a 1-year period after publication of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias, respectively.</p><p><strong>Methods and results: </strong>In total, we included 691 patients who were discharged alive after AMI. A total of 354 patients were treated in the period before, and 337 after the guideline change. After the guideline change, the proportion of patients discharged on high-dose statin was higher (89.3% vs 80.5%; p = 0.001) and ezetimibe was prescribed more often (31.2% vs 5.9%; p < 0.00001) resulting in more patients being discharged on high-intensity treatment (92.9% vs. 81.6%; p < 0.0001). Median on-treatment LDL-cholesterol was significantly higher in the period before (65 [IQR 47 to 90] mg/dL) than after the publication of the 2019 guidelines (48 [IQR 35 to 69] mg/dL; p < 0.0001). The LDL-C goal of < 55 mg/dL would have been reached by 37.5% patients in the earlier period and was reached by 62.9% in the later period (p < 0.0001).</p><p><strong>Conclusions: </strong>The update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias was associated with a significant improvement in the prescription of high-dose statin and ezetimibe in patients after ACS. The change of the guidelines rapidly translated into clinical practice resulting in improved risk factor control in patients at very high risk.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728447","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":"Prognostic impact of body mass index in acute myocardial infarction complicated by cardiogenic Shock: an ECLS-SHOCK subanalysis.","authors":"Tobias Schupp, Holger Thiele, Tienush Rassaf, Amir Abbas Mahabadi, Ralf Lehmann, Ingo Eitel, Carsten Skurk, Peter Clemmensen, Marcus Hennersdorf, Ingo Voigt, Axel Linke, Eike Tigges, Peter Nordbeck, Christian Jung, Philipp Lauten, Hans-Josef Feistritzer, Maria Buske, Janine Pöss, Taoufik Ouarrak, Steffen Schneider, Michael Behnes, Daniel Duerschmied, Steffen Desch, Anne Freund, Uwe Zeymer, Ibrahim Akin","doi":"10.1007/s00392-025-02717-1","DOIUrl":"https://doi.org/10.1007/s00392-025-02717-1","url":null,"abstract":"<p><strong>Background: </strong>The prognostic impact of overweight and obesity in patients with cardiogenic shock (CS) following acute myocardial infarction (AMI) is still a matter of debate. The present subanalysis of the ECLS-SHOCK trial sought to investigate the association between body mass index (BMI) and outcomes in patients with AMI-CS.</p><p><strong>Methods: </strong>Patients with AMI-CS enrolled in the multicenter, randomized ECLS-SHOCK trial between 2019 and 2022 were included. The prognostic impact of BMI was investigated stratified by BMI 18.5-24.9 kg/m², 25.0-29.9 kg/m² and ≥ 30.0 kg/m² with regard to the primary endpoint 30-day all-cause mortality.</p><p><strong>Results: </strong>Overall, 407 patients with AMI-CS were included with a median BMI of 27.7 kg/m² (interquartile range 24.8-30.8 kg/m²). Patients with a BMI ≥ 30.0 kg/m² (n = 115) were less likely males, had a higher burden of cardiovascular risk factors and higher rates of TIMI flow 0 before revascularization than patients with lower BMI values. The primary endpoint of all-cause mortality at 30 days occurred in 53.9%, 45.3% and 47.7% of patients with BMI ≥ 30.0 kg/m², 25.0-29.9 kg/m² and 18.5-24.9 kg/m², respectively. Using patients with a BMI 18.5-24.9 kg/m² as a reference, neither a BMI ≥ 30.0 kg/m² (OR = 1.28; 95% CI 0.76-2.16; p = 0.35) nor a BMI of 25.0-29.9 kg/m² (OR = 0.91; 95% CI 0.56-1.46; p = 0.68) were associated with an increased risk of all-cause mortality. Similar results were obtained regardless of allocation to extracorporeal life support (ECLS) or medical treatment only for all BMI groups. Safety endpoints did not differ across the different BMI groups.</p><p><strong>Conclusion: </strong>In this well-defined cohort of patients with AMI-CS, BMI was not associated with the risk of all-cause mortality, nor were we able to identify BMI subgroups who derived more benefit or less harm from ECLS therapy.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728448","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":"Comparing the efficacy and safety of direct oral anticoagulants with vitamin K antagonists in dialysis patients with nonvalvular atrial fibrillation: a systematic review and meta-analysis.","authors":"Tian Li, Tong Li, Yujun Xu, Diona Gjermeni, Lukas Heger, Dirk Westermann, Christoph B Olivier","doi":"10.1007/s00392-025-02711-7","DOIUrl":"https://doi.org/10.1007/s00392-025-02711-7","url":null,"abstract":"<p><strong>Aims: </strong>For patients with atrial fibrillation (AF) and preserved renal function, direct oral anticoagulants (DOACs) are superior to vitamin K antagonists (VKAs) for stroke prevention. However, the evidence in patients with end-stage kidney disease (ESKD) on dialysis remains inconclusive. In this systematic review and meta-analysis, we aim to compare the efficacy and safety of DOACs and VKAs in dialysis patients with nonvalvular AF.</p><p><strong>Methods and results: </strong>We conducted a systematic literature review of publications comparing DOACs and VKAs in dialysis patients with nonvalvular AF. Data of RCTs and cohort studies were synthesized separately. Outcomes were reported as risk ratios with 95% confidence intervals. Heterogeneity was assessed using I² statistics. Ten studies were included in this meta-analysis: 4 RCTs (DOACs, 269 patients; VKAs, 217) and 6 cohort studies (DOACs, 7039 patients; VKAs, 22,983). In RCTs, the risk for major bleeding was significantly lower with DOACs compared with VKAs (RR 0.64, 95% CI 0.42-0.99, I² = 0%). In cohort studies, DOAC was associated with a lower risk for all-cause death compared with VKAs; however, with high heterogeneity (RR 0.78, 95% CI 0.62-0.98, I² = 80%). No significant differences were found regarding ischemic stroke or systemic embolism and gastrointestinal bleeding.</p><p><strong>Conclusion: </strong>In dialysis patients with nonvalvular AF, DOACs were associated with significantly reduced risk for major bleeding in RCTs and significantly reduced risk for all-cause death in cohort studies. These findings suggest that DOACs may provide a higher net clinical benefit compared with VKAs in dialysis patients.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728446","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":"Pre-interventional transesophageal echocardiography as a reliable predictor of residual shunt following patent foramen ovale closure.","authors":"Tobias Harm, Monika Zdanyte, Andreas Goldschmied, Álvaro Petersen Uribe, Marc Reinert, Juergen Schreieck, Parwez Aidery, Dominik Rath, Tobias Geisler, Meinrad Paul Gawaz, Michal Droppa","doi":"10.1007/s00392-025-02713-5","DOIUrl":"https://doi.org/10.1007/s00392-025-02713-5","url":null,"abstract":"<p><strong>Background: </strong>Closure of a patent foramen ovale (PFO) is an effective strategy in the prevention of recurrent stroke after cryptogenic stroke. Residual shunt (RS) is a common issue following PFO closure and may affect safety and efficacy. Transesophageal echocardiography (TEE) is the key diagnostic tool, but standardized assessment of morphological parameters to prevent RS remains challenging.</p><p><strong>Aims: </strong>In this study, we investigate the diagnostic value of different anatomical parameters assessed by TEE to predict RS after PFO closure.</p><p><strong>Methods: </strong>We consecutively enrolled five-hundred and twenty-seven (n = 527) patients undergoing PFO closure. We performed pre-interventional TEE, and after PFO closure, we then screened for RS by TEE at 6-month follow-up.</p><p><strong>Results: </strong>Pre-interventional TEE measures of PFO morphology revealed significant differences in patients with RS in comparison to those with closed PFO. Incidence of RS was significantly more frequent in patients with atrial septum aneurysm (p = 0.022) and increasing PFO size (p = 0.025). In patients with RS, we found significantly increased length (p = 0.005) of septum primum and PFO tunnel (p = 0.036) as well as excursion (p = 0.005) of septum primum. By training machine learning models on TEE parameters, stratification of PFO morphology resulted in high diagnostic accuracy to predict RS after PFO closure.</p><p><strong>Conclusions: </strong>Our study elucidates that a baseline characterization of PFO morphology using TEE improves diagnostic precision to identify patients with RS after PFO closure. A standardized approach might thus enhance the efficacy and safety of transcatheter PFO closure. Prediction of complete closure might reduce complications and allow for a more refined patient selection and treatment.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697812","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":"EASIX as a predictor of 3-year mortality in aortic stenosis patients undergoing TAVR.","authors":"Mustafa Mousa Basha, Baravan Al-Kassou, Christopher Gestrich, Marcel Weber, Thomas Beiert, Sebastian Zimmer, Farhad Bakhtiary, Georg Nickenig, Jasmin Shamekhi","doi":"10.1007/s00392-025-02715-3","DOIUrl":"https://doi.org/10.1007/s00392-025-02715-3","url":null,"abstract":"<p><strong>Background: </strong>Endothelial dysfunction plays a crucial role in the progression of aortic stenosis (AS), and the Endothelial Activation and Stress Index (EASIX) has been proposed as a biomarker for predicting mortality in various clinical settings.</p><p><strong>Aims: </strong>Evaluating the predictive value of the EASIX for 3-year all-cause mortality in patients undergoing transcatheter aortic valve replacement (TAVR).</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 1084 patients with severe AS, who underwent TAVR between 2013 and 2021 at the Heart Center Bonn. The EASIX was measured pre-procedural. The optimal cut-off (EASIX ≥ 1.65) was determined using the Youden index. Its association with 3-year mortality was assessed using Kaplan-Meier survival analysis and Cox regression models. The primary endpoint was 3-year all-cause mortality.</p><p><strong>Results: </strong>Patients with an EASIX ≥ 1.65 had significantly higher 3-year mortality compared to those with lower EASIX (45.8% vs. 27.7%, p < 0.001). In multivariate analysis, EASIX remained an independent predictor of mortality (HR = 1.4, 95% CI: 1.1-1.8, p = 0.010). ROC analysis revealed an area under the curve (AUC) of 63.0% for the EASIX; its predictive ability was inferior to the well-established cardiac biomarkers such as NT-proBNP (AUC = 70.2%) and troponin T (AUC = 69.8%).</p><p><strong>Conclusion: </strong>The EASIX is a significant predictor of 3-year all-cause mortality in patients undergoing TAVR. However, its predictive performance is lower than NT-proBNP and troponin T. Integrating EASIX with traditional cardiac biomarkers may enhance risk stratification in TAVR patients and improve personalized care.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689074","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":"Impact of GLP-1 receptor agonists on cardiovascular outcomes in heart failure with preserved ejection fraction (HFpEF): systematic review and meta-analysis.","authors":"Antony Gonzales-Uribe, Renato Ruiz-Cortez, Nicole Collantes-Silva, Lorenzo Olivero, Raksheeth Agarwal, Sebastian Arambulo-Castillo, Alonso Garcia-Geng, Xiajie Lyu, Daniel Mendoza-Quispe, Victor Becerra-Gonzales, Hoda Butrous","doi":"10.1007/s00392-025-02710-8","DOIUrl":"https://doi.org/10.1007/s00392-025-02710-8","url":null,"abstract":"<p><strong>Background: </strong>Pharmacologic therapies for heart failure with preserved ejection fraction (HFpEF) have shown limited efficacy, and the impact of GLP-1 receptor agonists (GLP-1 RAs) remains unclear. This meta-analysis evaluates their effects on mortality and hospitalization in HFpEF.</p><p><strong>Methods: </strong>We obtained the data from PubMed, Scopus, Embase, and Web of Science for all eligible studies, including clinical trials (RCT) and cohorts comparing GLP-1 RAs to placebo or other hypoglycemic agents in patients with HFpEF published until December 31st, 2024. The Grade and Risk of Bias (ROB) tool assessment was used to evaluate the quality of the evidence. Data on the primary outcome, the composite of all-cause mortality and HF-related hospitalization, was pooled using a random effect meta-analysis with additional subgroup analyses. Risk ratios (RR), hazard ratios (HR), or mean differences with 95% confidence intervals (CI) are presented accordingly.</p><p><strong>Results: </strong>Six studies (five RCTs, one cohort) including 4043 patients were analyzed. Five studies evaluated semaglutide and one tirzepatide. GLP-1 RAs reduced the composite outcome of all-cause mortality and HF hospitalization by 27% (HR 0.73; 95% CI: 0.60-0.90; I² = 0%). Subgroup analyses revealed greater benefits in patients with atrial fibrillation. GLP-1 RAs also reduced HF hospitalizations alone (HR 0.57; 95% CI: 0.32-1.00), though no significant effect was found on all-cause mortality (HR 0.81; 95% CI: 0.58-1.14). RCTs showed a low risk of bias.</p><p><strong>Conclusion: </strong>GLP-1 RAs may significantly lower the combined risk of mortality and hospitalization in patients with HFpEF.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599650","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":"Patient risk evaluation for transcatheter aortic valve replacement (PRE-TAVR) - identification of real-time predictors of short- and long-term mortality.","authors":"Julian Kreutz, Philipp Lauten, Georgios Chatzis, Marie Nabrotzki, Nikolaos Patsalis, Styliani Syntila, Harald Lapp, Bernhard Schieffer, Birgit Markus","doi":"10.1007/s00392-025-02704-6","DOIUrl":"https://doi.org/10.1007/s00392-025-02704-6","url":null,"abstract":"<p><strong>Background: </strong>The steadily increasing number of transcatheter aortic valve replacement (TAVR) procedures being performed on a heterogeneous patient population highlights the need for robust risk assessment. While EuroSCORE II is well established for surgical risks, it is less effective for TAVR, and the newer STS/ACC TAVR score has so far been validated mainly for in-hospital and 30-day mortality.</p><p><strong>Aims: </strong>This study aims to improve risk stratification for TAVR patients by identifying real-time predictors of 30-day and 1-year mortality that incorporate comprehensive, procedure-specific factors.</p><p><strong>Methods: </strong>Five-year data from 2256 transfemoral TAVR procedures performed at two German Heart Centers (2017-2022) were retrospectively analyzed. Predictors of 1-year and 30-day mortality were assessed using multivariable logistic and LASSO regression, considering a broad spectrum of patient demographics, comorbidities, and peri-procedural factors.</p><p><strong>Results: </strong>The analyses revealed a predictor model (PRE-TAVR predictors) for 1-year mortality (AUC 0.770; 95% CI 0.731-0.809), including age (> 81.5 years), NYHA stage IV, COPD (GOLD ≥ 2), atrial fibrillation, previous stroke or malignancy, elevated C-reactive protein (≥ 9.5 mg/L), aortic valve ΔP mean ≥ 48.5 mmHg, peripheral arterial disease (> stage 2) and low platelet count (≤ 228.5 g/L). The accuracy of the model exceeded the EuroSCORE II (AUC 0.645; 95% CI 0.599-0.691) and the STS/ACC TAVR score (AUC 0.714; 95% CI 0.670-0.758). For 30-day mortality, NYHA class IV was the only significant predictor in the bivariate analyses. However, additional LASSO analyses identified pre-existing renal insufficiency (KDIGO stage ≥ 3) and pre-TAVR sodium levels as further significant predictors. The AUC was 0.699 (95% CI 0.611-0.788) compared to an AUC of 0.680 (95% CI 0.604-0.756) for EuroSCORE II and 0.7129 (95% CI 0.633-0.793) for the STS/ACC TAVR score.</p><p><strong>Conclusion: </strong>The PRE-TAVR study developed a robust model, particularly for predicting 1-year mortality. This model outperformed the EuroSCORE II and STS/ACC TAVR scores, despite requiring fewer variables. It provides a solid basis for future risk scores and enables more precise patient selection.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574955","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":"Predicting MRI-diagnosed microvascular obstruction and its long-term impact after acute myocardial infarction.","authors":"Johannes Brado, Ramona Schmitt, Manuel Hein, Christian Valina, Collin Steinhauer, Martin Soschynski, Christopher Schuppert, Christopher L Schlett, Franz-Josef Neumann, Dirk Westermann, Philipp Ruile, Philipp Breitbart","doi":"10.1007/s00392-025-02709-1","DOIUrl":"https://doi.org/10.1007/s00392-025-02709-1","url":null,"abstract":"<p><strong>Background: </strong>Microvascular obstruction (MVO) at cardiac magnetic resonance imaging (CMR) is a well-described risk factor for cardiac events after acute myocardial infarction (MI).</p><p><strong>Objective: </strong>Predicting MVO using cardiac biomarkers and performing risk stratification according to extent of MVO.</p><p><strong>Methods: </strong>We conducted a retrospective study including all patients with an acute MI and a subsequent CMR during the same hospital stay between October 2008 and August 2023. Patients were grouped according to the presence of any MVO and of relevant MVO (defined as > 1.55% of LV myocardial mass). The prediction of MVO based on peak high sensitivity cardiac troponin T (hs-cTnT) levels was analyzed. Survival according to MVO status was assessed in the entire study population.</p><p><strong>Results: </strong>We evaluated 597 patients with CMR 3 days [interquartile range 2-4 days] after myocardial infarction. MVO was present in 163 patients (27.3%) and relevant MVO in 100 patients (16.8%). Patients with MVO had significantly higher peak hs-cTnT levels compared to those without (p < 0.001). An hs-cTnT cut-off value of > 2455.0 ng/L predicted present MVO (area under the curve (AUC) 0.824), while a cut-off value of 3975.0 ng/L predicted relevant MVO (AUC 0.837). Relevant MVO was a predictor of all-cause mortality in the entire study population (hazard ratio (HR) 3.89 (1.50-10.09)), with an even stronger association in patients with an LVEF > 35% (HR 5.91 (1.79-19.56)).</p><p><strong>Conclusion: </strong>Higher peak hs-cTnT levels are strong predictors of MVO. Described cut-off values could serve as a screening tool. Relevant MVO is a significant predictor of all-cause mortality following acute MI, especially in patients with LVEF > 35%.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574956","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":"QTc interval prolongation as a marker of disease stage in transthyretin cardiac amyloidosis.","authors":"Theodoros Tsampras, Alexios S Antonopoulos, Freideriki-Eleni Kourti, Konstantinos Tsioufis, Charalambos Vlachopoulos","doi":"10.1007/s00392-025-02680-x","DOIUrl":"https://doi.org/10.1007/s00392-025-02680-x","url":null,"abstract":"<p><p>Transthyretin amyloidosis is a significant cause of heart failure with an unfavorable prognosis. In recent years, diagnosing the disease has become easier, with most patients now diagnosed non-invasively, and tissue biopsy being required only in a minority of cases. Although various laboratory findings have been reported as transthyretin amyloidosis red flags, the diagnostic and prognostic value of various electrocardiogram parameters remain largely unknown. In this study, the significance of QTc interval prolongation in transthyretin cardiac amyloidosis patients was investigated. We retrospectively analyzed electrocardiogram data from n = 58 patients with transthyretin amyloid cardiomyopathy and compared them with distinct cohorts of patients diagnosed with other forms of heart muscle disease, i.e., hypertrophic cardiomyopathy and dilated cardiomyopathy. QTc prolongation was found to be a unique feature of transthyretin cardiac amyloidosis, not shared by other cardiomyopathy types. Increased QTc interval in transthyretin amyloidosis patients correlates with disease severity markers, including NYHA class, NAC stage, NT-proBNP, and troponin I levels, suggesting its potential as a unique biomarker for monitoring disease progression.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144552457","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":"Intraprocedural 3D-vena contracta area predicts survival after transcatheter edge-to-edge repair: results from MITRA-PRO registry.","authors":"Dennis Rottländer, Jörg Hausleiter, Thomas Schmitz, Alexander Bufe, Melchior Seyfarth, Ralph Stephan von Bardeleben, Harald Beucher, Taoufik Ouarrak, Steffen Schneider, Peter Boekstegers","doi":"10.1007/s00392-024-02580-6","DOIUrl":"10.1007/s00392-024-02580-6","url":null,"abstract":"<p><strong>Background: </strong>The MITRA-PRO registry revealed residual mitral regurgitation (MR) to be an important predictor of survival following transcatheter edge-to-edge repair (TEER). Intraprocedural MR assessment using 3D-Vena Contracta Area (VCA) might be a feasible tool to guide mitral TEER procedures. The study aimed to assess the impact of residual MR assessed by 3D-VCA on 1-year mortality.</p><p><strong>Methods: </strong>823 patients with residual MR quantification using 3D-VCA in the MITRA-PRO registry, were included in this study. 1-year mortality, NYHA classification and major adverse events were assessed 1-year after mitral TEER.</p><p><strong>Results: </strong>Patients with trace residual MR after mitral TEER were allocated to the 3D-VCA < 0.1 cm² group (27.8%), while a 3D-VCA ≥ 0.1 < 0.3 cm² (55.4%) was considered as mild and a 3D-VCA ≥ 0.3 cm² (16.8%) as relevant residual MR. One-year mortality was significantly lower in patients with non-relevant residual MR (3D-VCA < 0.1 cm²: 10.5%; ≥ 0.1 < 0.3 cm²: 16.0%; ≥ 0.3: 24.8%, p = 0.003). An increasing 3D-VCA post mitral TEER was associated with a higher 1-year mortality. At a 3D-VCA of 0.07 cm² mortality increased significantly (1-year mortality 3D-VCA post mitral TEER ≥ 0.07 cm²: 16.5% vs. < 0.07 cm²: 7.8%; p = 0.005) indicating a 3D-VCA of 0.07 cm² to be a cut-off value for survival in daily practice.</p><p><strong>Conclusions: </strong>Residual MR assessed by 3D-VCA after TEER is associated with 1-year mortality. Therefore, 3D-VCA is a valuable echocardiographic tool for intraprocedural MR assessment during mitral TEER and achieving a lower 3D-VCA improve patient survival. (German Clinical Trials Register: DRKS00012288).</p><p><strong>Trial registration number: </strong>DRKS00012288.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"867-877"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799400","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}