Clinical Research in Cardiology最新文献

{"title":"Post-pulmonary embolism cardiac impairment and chronic thromboembolic pulmonary hypertension after ultrasound-assisted catheter-directed thrombolysis for acute pulmonary embolism.","authors":"Riccardo M Fumagalli, Stephanie Zbinden, Silvia Cardi, Aline Fürbringer-Schwarz, Olivier A Gyolay, Davide Voci, Frederikus A Klok, Stavros V Konstantinides, Conrad Von Stempel, Nils Kucher, Stefano Barco","doi":"10.1007/s00392-026-02894-7","DOIUrl":"https://doi.org/10.1007/s00392-026-02894-7","url":null,"abstract":"<p><strong>Background: </strong>Sparse data are available on the long-term course of acute pulmonary embolism (PE) after ultrasound-assisted catheter-directed thrombolysis (USAT).</p><p><strong>Methods: </strong>We included consecutive patients with intermediate-high or high-risk acute PE treated with USAT (alteplase 20 mg over 15 h) and therapeutic anticoagulation at a tertiary center, who underwent a structured post-interventional follow-up. The following outcomes were analyzed for patients with at least 3 months of follow-up: all-cause death, persistent dyspnea, symptomatic post-PE cardiac impairment, chronic thromboembolic pulmonary hypertension (CTEPH) or chronic thromboembolic pulmonary disease (CTEPD). Symptomatic post-PE cardiac impairment was defined as residual respiratory symptoms with at least one echocardiographic parameter of right ventricular dysfunction.</p><p><strong>Results: </strong>Among 300 patients (41% women, median age 65 [52-74] years), 254 (85%) had intermediate-high and 46 (15%) had high-risk PE. Follow-up data beyond the first 3 months (median 6.1 [3.6-12] months) were available for 260 (88%) survivors. At follow-up, 45 (17%) patients reported persistent respiratory symptoms and 18 (6.9%) met the criteria for post-PE cardiac impairment. CTEPH was diagnosed in 7 (2.7%) patients, deemed pre-existing in all cases based on radiological reassessment of index imaging. CTEPD was confirmed in 2 (0.8%) patients. The 1-year death rate was 2.9% after intermediate-high risk and 21% after high-risk PE.</p><p><strong>Conclusions: </strong>After a median of 6 months after acute PE, almost one in five patients treated with USAT had persistent respiratory symptoms, although post-PE cardiac impairment was rare. CTEPH was diagnosed in 2.7% of patients and deemed pre-existing in all cases.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147572694","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":"STEMI caused by spontaneous coronary artery dissection: prevalence, patient characteristics and outcomes.","authors":"Stefan Malleier, Luise Gaede, Susanne Jung, Mohamed Marwan, Stephan Achenbach, Monique Tröbs","doi":"10.1007/s00392-026-02900-y","DOIUrl":"https://doi.org/10.1007/s00392-026-02900-y","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous coronary artery dissection (SCAD) is a rare, but increasingly recognised cause of myocardial infarction. Our aim was to provide comprehensive real-world data on the prevalence of SCAD among patients who present with ST-segment elevation myocardial infarction (STEMI).</p><p><strong>Methods: </strong>Retrospective analysis of medical records and review of coronary angiograms allowed identification of all SCAD cases in a cohort of consecutive patients with STEMI, and review of clinical data provided further characterisation.</p><p><strong>Results: </strong>Among 2707 consecutive STEMI patients, the prevalence of SCAD was 0.9% (n = 24). In 9 cases, the diagnosis of SCAD diagnosis had been missed during clinical routine (37.5%). Compared to non-SCAD-STEMI, SCAD patients were younger (median age 53.5 vs. 66.0 years, p = 0.001) and more likely to be female (75.0% vs. 29.7%, p < 0.001). The most common symptom was typical angina (chest pain limited to the thorax, 75%). Importantly, six patients (25%) experienced cardiac arrest, either as the presenting symptom before (n = 2) or after first medical contact (n = 3), or during hospitalisation (n = 1). The most common angiographic pattern was SCAD type 4 (complete vessel occlusion, 37.5%), followed by type 2a (29.2%) and 2b (25%). Intravascular imaging was used in 25% (n = 6). 58.3% of patients with SCAD-STEMI underwent percutaneous coronary intervention (PCI). Complications occurred in 50% of PCI, mostly due to propagation of intramural hematoma. All patients survived to hospital discharge. Long-term follow-up was available in 50% of patients. While event rate was low, recurrence of SCAD did occur, in some cases after several years.</p><p><strong>Conclusion: </strong>In a Western European cohort of STEMI patients, SCAD was the underlying cause in approximately 1% of all cases. The true incidence may be higher since cardiac arrest occurred in one quarter of all patients within the cohort. Interventional treatment, while often required in SCAD-STEMI, is fraught by a high complication rate.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510166","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":"Correction: Critical insights on association of aortic root diameter and vascular function with an exaggerated blood pressure response to exercise among elite athletes.","authors":"Muhammad Ibrahim, Fathimathul Henna, Brijesh Sathian, Javed Iqbal","doi":"10.1007/s00392-026-02897-4","DOIUrl":"10.1007/s00392-026-02897-4","url":null,"abstract":"","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510090","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":"The weekend effect in atrial fibrillation hospitalizations: a nationwide analysis of outcomes and interventions.","authors":"Allen Fooks, Sameer Jamal, Joseph Heaton","doi":"10.1007/s00392-026-02888-5","DOIUrl":"https://doi.org/10.1007/s00392-026-02888-5","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have suggested that patients admitted on the weekend may experience worse outcomes compared to weekday admissions, a phenomenon known as the \"weekend effect.\" Atrial fibrillation (AF) management has evolved substantially in recent years, prompting a re-evaluation of whether the weekend effect persists in this population using more recently updated national data.</p><p><strong>Methods: </strong>We conducted a retrospective review using the 2022 National Inpatient Sample (NIS), analyzing adult hospitalizations with a primary diagnosis of atrial fibrillation. Weekday admissions were compared to weekend admissions. The primary outcome was receipt of cardioversion. Secondary outcomes included mortality, length of stay (LOS), and total hospital charges. Multivariate linear and logistic regression models were used to adjust for demographic, clinical, and hospital-level confounders.</p><p><strong>Results: </strong>Among 277,440 hospitalizations for atrial fibrillation, 61,305 (22.1%) occurred on weekends. Weekend admissions were less likely to undergo cardioversion (19.0% vs 22.0%; aOR 0.83, 95% CI 0.79-0.88; p < 0.001). In-hospital mortality was similar in weekend admissions (1.0%) compared to weekdays (0.8%) with an adjusted odds ratio (aOR) of 1.21 (95% CI 0.97-1.52; p = 0.090). Hospital charges were lower among weekend admissions ($48,478 vs $50,588; p = 0.022). There were no significant differences in length of stay (3.59 vs 3.58 days; p = 0.545) between groups.</p><p><strong>Conclusions: </strong>Weekend admissions for atrial fibrillation are less likely to undergo cardioversion. There was no significant difference in in-hospital mortality or length of stay. This pattern may reflect differences in care delivery or patient selection by day of admission, although the underlying mechanism cannot be determined using administrative data.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510141","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":"Myocardial strain shows modest diagnostic yield but may aid identification of patients with a low likelihood of ischemia during vasodilator stress cardiac magnetic resonance.","authors":"Julia M Treiber, J Sebastian Wolter, Sören J Backhaus, Petra Freiberger, Claudia Unbehaun, Steffen Kriechbaum, Andreas Rieth, Maren Weferling, Till Keller, Samuel Sossalla, Andreas Rolf","doi":"10.1007/s00392-026-02878-7","DOIUrl":"https://doi.org/10.1007/s00392-026-02878-7","url":null,"abstract":"<p><strong>Background and aim: </strong>Left ventricular dysfunction occurs early in the ischemic cascade. Strain parameters such as global longitudinal strain (GLS) and global circumferential strain (GCS) detect subtle contractile changes, but strain reduction may be observed in situations not related to ischemia. This study assessed whether GLS and GCS may support the identification of a low likelihood of myocardial ischemia in the absence of scarring.</p><p><strong>Methods: </strong>Patients were selected from an all-comers registry who underwent vasodilator-perfusion cardiac magnetic resonance imaging (CMR) and showed no evidence of ischemic late gadolinium enhancement. Patients with perfusion deficits were compared with a control group without ischemia and with normal morphological and functional volumetric parameters. GLS and GCS were quantified, and their ability to differentiate ischemic from non-ischemic patients was evaluated using receiver operating characteristic analysis.</p><p><strong>Results: </strong>Among 1434 patients with perfusion analysis, 451 had normal findings and 112 demonstrated a perfusion defect without LGE. GLS and GCS were significantly reduced in ischemic patients (- 16.66 ± 4.6% vs. - 18.5 ± 3.7%, p < 0.001). GLS and GCS showed only modest discriminatory ability in identifying myocardial ischemia, with AUCs of 0.627 and 0.674, respectively. Optimal cut-off values identified using the Youden index were -18.25% for GLS and -18.85% for GCS. At these thresholds, GLS yielded a sensitivity of 71% and specificity of 52%, and GCS a sensitivity of 65% and specificity of 63%, resulting in high negative predictive values (GLS, 88%; GCS, 88%) but limited overall accuracy.</p><p><strong>Conclusion: </strong>Strain analysis may provide supportive information indicating a low likelihood of ischemia in patients without LGE. Although sensitivity and specificity were only moderate, the consistently high NPV suggests a potential complementary role for strain as part of a multimodal diagnostic work-up, while limited sensitivity precludes its use as a standalone diagnostic marker.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510114","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":"Revisiting the obesity paradox in patients with heart failure with reduced ejection fraction in the light of contemporary guideline-directed medical therapy.","authors":"Tamás G Gergely, Zsolt Forrai, Ádám Kazay, Pál Péter Schäffer, Máté Vámos, Dávid Pilecky, Tamás Péter Füzesi, Laura Fanni Hanuska, Noémi Nyolczas, Miklós Dékány, Péter Andréka, Zsolt Piróth, Fanni Bánfi-Bacsárdi, Balázs Muk","doi":"10.1007/s00392-026-02865-y","DOIUrl":"https://doi.org/10.1007/s00392-026-02865-y","url":null,"abstract":"<p><strong>Background: </strong>The presence of higher body mass index (BMI) accompanied by better outcomes in patients with heart failure with reduced ejection fraction (HFrEF) is described as the obesity paradox. However, recent evidence has questioned the existence of this phenomenon by adjusting for better prognostic factors and using superior anthropometric measures of obesity. Nevertheless, data regarding the association between BMI and mortality in HFrEF patients with the use of contemporary guideline-directed medical therapy (GDMT), including SGLT2is, is scarce.</p><p><strong>Aim: </strong>To assess the association between BMI and mortality in patients with HFrEF treated with modern GDMT across a wide BMI spectrum.</p><p><strong>Patients and methods: </strong>The data of 420 consecutive patients (male sex: 75%, age: 62 [51-71] years, NT-proBNP at admission: 5678 [2647-10501] pg/mL, LVEF: 24 [20-30] %, coronary artery disease: 44%, atrial fibrillation: 45%, normal weight: 33% [group 1: BMI < 25 kg/m²], overweight: 31% [group 2: BMI: 25-29.9 kg/m²], obese: 36% [group 3: BMI ≥ 30 kg/m²], type 2 diabetes [T2D]: 35%, eGFR < 60 mL/min/1.73m²: 55%) hospitalised for HFrEF in 2021-2024 with available BMI were analysed retrospectively. The application of GDMT at hospital discharge was compared between three groups of patients (group 1, 2, and 3). All-cause mortality (ACM) was assessed using Kaplan-Meier curves and the log-rank test. Predictors of ACM were estimated with uni- and multivariate Cox proportional hazards regression. In a sensitivity analysis, BMI groups were propensity score-matched (PSM) at a 1:1:1 ratio, adjusting for possible confounders.</p><p><strong>Results: </strong>At hospital discharge, triple therapy (TT: RASi + βB + MRA) was applied in 82% (RASi: 92%, βB: 85%, MRA: 95%), while quadruple therapy (QT: TT + SGLT2i) was implemented in 58% of the total cohort (SGLT2i use: 64%). At discharge, higher BMI category was significantly (p < 0.05) associated with increased use of MRA (group 1, 2, 3: 93%, 92%, and 100%), SGLT2i medications (group 1, 2, 3: 58%, 61%, and 71%), and QT (group 1, 2, 3: 51%, 56%, and 65%). During a median follow-up of 534 days, ACM was lower with increasing BMI subgroup category (p = 0.021). In the multivariate analysis, BMI subgroup category was not associated with ACM, whereas age, T2D, peripheral artery disease, NT-proBNP at discharge, and use of QT at discharge were independent predictors of ACM. In the sensitivity analysis, no significant differences were seen in the ACM of each BMI category after PSM.</p><p><strong>Conclusions: </strong>In a consecutive cohort of patients hospitalised due to HFrEF with high rates of modern GDMT use across a wide BMI spectrum, higher BMI subgroup category was not associated with better survival after adjustment for comorbidities and prognostic factors.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510134","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":"Outcomes of transcatheter edge-to-edge repair versus transcatheter valve replacement with the cardiovalve system for tricuspid regurgitation.","authors":"Christoph Marquetand, Vanessa Soltau, Buntaro Fujita, Florian Genske, Thomas Stiermaier, Ingo Eitel, Christian Frerker, Tobias Schmidt","doi":"10.1007/s00392-026-02867-w","DOIUrl":"https://doi.org/10.1007/s00392-026-02867-w","url":null,"abstract":"<p><strong>Background: </strong>Tricuspid regurgitation (TR) is associated with increased morbidity and mortality. Since surgical treatment of tricuspid regurgitation in elderly, multimorbid patients is associated with high risk, less invasive therapies such as tricuspid transcatheter edge-to-edge repair (T-TEER) and transcatheter tricuspid valve replacement (TTVR) have been developed.</p><p><strong>Objectives: </strong>This study aimed to compare 30-day clinical and echocardiographic outcomes of T-TEER and TTVR in high-risk patients with severe TR.</p><p><strong>Methods: </strong>T-TEER was performed in 104 patients and TTVR in 10 patients based on anatomical suitability. All procedures were guided by transesophageal echocardiography and fluoroscopy. Primary endpoints included TR reduction, NYHA functional class, and safety events according to TVARC criteria.</p><p><strong>Results: </strong>At 30 days, TR reduction to grade 0/I was achieved in 44.9% of T-TEER and 80% of TTVR patients (p < 0.001). NYHA class I/II was present in 63.2% after T-TEER and 70% following TTVR (p = 0.69). Major bleeding occurred more frequently in the TTVR group (20%) than in the T-TEER group (1.96%; p = 0.041). One patient in the TTVR group required a new pacemaker. No deaths, strokes, or surgical conversions occurred in either group.</p><p><strong>Conclusions: </strong>T-TEER and TTVR are effective for treating severe TR in high-risk patients. TTVR achieved greater TR reduction but was associated with more access site bleeding. T-TEER demonstrated a favorable safety profile. Careful patient selection remains essential to optimize outcomes.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147503294","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":"Modulation of oxidation-related immune markers by lipid-lowering medications in individuals with elevated lipoprotein(a).","authors":"Amalia Despoina Koutsogianni, Fotios Barkas, Constantinos Tellis, Alexandros Tselepis, George Liamis, Sotirios Tsimikas, Evangelos Liberopoulos","doi":"10.1007/s00392-026-02896-5","DOIUrl":"https://doi.org/10.1007/s00392-026-02896-5","url":null,"abstract":"<p><strong>Background: </strong>Oxidative modification of apolipoprotein B-100 (apoB) containing particles and subsequent immune responses contribute to the pathogenesis of atherosclerosis. Circulating IgG and IgM apoB-containing immune complexes (apoB-IC) and autoantibodies to a malondialdehyde mimotope (anti-MDA-mimotope) serve as biomarkers of oxidative stress and immune activation in atherosclerotic cardiovascular disease. Elevated lipoprotein(a) [Lp(a)] is associated with increased oxidative burden and immune activation.</p><p><strong>Purpose: </strong>To investigate the effect of lipid-lowering medications on IgG and IgM apoB-IC and IgG and IgM autoantibodies to an MDA-mimotope in individuals with elevated lipoprotein(a) [Lp(a)] concentrations.</p><p><strong>Methods: </strong>In this prospective study, patients (n = 70) with Lp(a) levels ≥ 75 nmol/L were assigned to 3 treatment regimens according to current guidelines: high-intensity statin monotherapy (n = 28), ezetimibe added to high-intensity statin (n = 31) and proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) added to high-intensity statin plus ezetimibe (n = 11). IgG and IgM apoB-IC and IgG and IgM anti-MDA-mimotope were measured at baseline and 3 months after treatment initiation.</p><p><strong>Results: </strong>Patients had a mean age of 51 ± 15 years and 40% were male. Significant reductions in IgG apoB-IC levels were observed following treatment with high-intensity statins, add-on ezetimibe and add-on PCSK9i (by 18.3%, 17.5% and 25.5%, respectively, all p < 0.05). No significant changes in IgM apoB-IC, or IgG and IgM anti-MDA-mimotope levels were observed in any treatment group.</p><p><strong>Conclusions: </strong>In individuals with Lp(a) levels ≥ 75 nmol/L, high-intensity statins, add-on ezetimibe and add-on PCSK9i reduced IgG apoB-IC but did not affect IgM apoB-IC, or IgG and IgM anti-MDA-mimotope levels. The clinical significance of these findings warrants further investigation.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147503247","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":"Short-term lesion-level impact of extensive LDL-C reduction with statins and PCSK9 inhibitors: a pre-specified subgroup analysis of the randomized FITTER trial.","authors":"Jonathan Los, Frans B Mensink, Mohamed M Reda Morsy, Kensuke Nishimiya, Rohit M Oemrawsingh, Alexander J J IJsselmuiden, Martijn Meuwissen, Jin M Cheng, Himanshu Rai, Tim J F Ten Cate, Cyril Camaro, Peter Damman, Lokien X van Nunen, Aukelien C Dimitriu-Leen, Marleen H van Wely, Aysun Cetinyurek-Yavuz, Robert A Byrne, Niels van Royen, Robert-Jan M van Geuns","doi":"10.1007/s00392-026-02869-8","DOIUrl":"https://doi.org/10.1007/s00392-026-02869-8","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to evaluate the short-term potential of very-high-intensity lipid-lowering therapy on lesion-level atheroma burden.</p><p><strong>Methods: </strong>The investigator-initiated, double-blind, placebo-controlled FITTER trial (enrollment November 2020 to August 2023) randomized patients presenting with acute coronary syndrome (ACS) and relevant non-culprit coronary artery disease (fractional flow reserve: 0.67-0.85) to receive either evolocumab or placebo for 12 weeks in addition to high-intensity statin therapy to evaluate the short-term potential of lipid-lowering therapy on non-culprit plaque features. Present lesion-level analysis assessed the effects on coronary segments with advanced atherosclerotic plaque characteristics with increased cardiovascular risk and includes all patients who underwent successful serial intravascular ultrasound-near-infrared spectroscopy (IVUS-NIRS) imaging and with presence of IVUS-derived atherosclerotic lesions.</p><p><strong>Results: </strong>A total of 126 lesions were identified in 85 patients (mean age 65.1 ± 8.3, 18.8% female), of which 65 lesions were found in the evolocumab group (44 patients) and 61 in the placebo group (41 patients). Compared to placebo, patients treated with evolocumab did not demonstrate significant reductions in maximum lipid core index within any 4 mm segment (maxLCBI_4mm, between-group difference, -9.6 [95% CI, -52.8 to 33.6]; p = 0.7) or percent atheroma volume (PAV, between-group difference, 1.0% [95% CI, -1.3 to 3.2]; p = 0.4). However, an overall reduction in maxLCBI_4mm (overall change, -54.2 [95% CI, -89.6 to -18.7]; p = 0.003) and PAV (overall change, -2.0% [95% CI, -3.9 to -0.1]; p = 0.04) was observed.</p><p><strong>Conclusions: </strong>Compared with placebo, the addition of evolocumab did not yield incremental improvements in lesion-level atheroma burden in the first 12 weeks after ACS. However, in the pooled analysis, significant short-term reductions in atheroma volume and plaque lipid content were observed.</p><p><strong>Trial registration number: </strong>clinicaltrials.gov NCT04141579.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147503303","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":"Pressure gradient vs. flow relationships in patients with symptomatic valvular aortic stenosis - PREFLOW.","authors":"Henrik Vase, Ashkan Eftekhari, Steen H Poulsen, Christian J Terkelsen, Evald H Christiansen, Nils P Johnson, Mads J Andersen","doi":"10.1007/s00392-026-02890-x","DOIUrl":"10.1007/s00392-026-02890-x","url":null,"abstract":"<p><strong>Introduction: </strong>Management of aortic stenosis, particularly with preserved left ventricular ejection fraction (LVEF) and discordant or borderline echocardiographic findings, remains challenging, both in assessing the true severity of stenosis and in isolating the valvular contribution to symptoms amidst comorbid conditions. This study evaluates the feasibility and physiological insight obtained from invasive pressure measurements across the aortic valve at rest and during exercise in symptomatic patients with aortic stenosis (AS).</p><p><strong>Methods: </strong>This prospective cross-sectional study included patients with symptomatic high-gradient severe, low-gradient severe, and moderate aortic stenosis. They underwent invasive pressure gradient measurements across the aortic valve (pressure catheters in the left ventricle and ascending aorta) with concurrent right heart catheterization at rest and during peak supine bicycle exercise.</p><p><strong>Results: </strong>Of 28 patients included, invasive measurements during exercise were feasible in 25 patients. Overall, exercise induced increases in aortic valve gradient, flow, and opening area, but there was considerable heterogeneity in individual hemodynamic responses. Notably, of the 14 patients in the low-gradient severe group based on echocardiography, nine demonstrated divergent physiological responses consistent with either moderate or high-gradient severe during exercise. All patients - irrespective of stenosis severity - had differential causes of symptoms during exercise with at least one of the following: chronotropic incompetence, abnormal increase in pulmonary artery or left ventricular end-diastolic pressures, or peripheral impairment of oxygen extraction or utilization.</p><p><strong>Conclusion: </strong>These findings demonstrate the safety and feasibility of invasive hemodynamic exercise testing in patients with aortic stenosis and highlight heterogeneity in pressure-flow responses during exercise. Invasive hemodynamic assessment during exercise may help elucidate alternative contributing mechanisms to exertional dyspnea, particularly in patients with aortic stenosis and discordant symptoms and findings.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147472831","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}