European Journal of Clinical Investigation最新文献

{"title":"Lipidomic profiling unveils sex differences in diabetes risk: Implications for precision medicine.","authors":"Ana F Pina, Maria João Meneses, Fabrizia Carli, Rogério T Ribeiro, Luís Gardete-Correia, José M Boavida, João F Raposo, Amalia Gastaldelli, M Paula Macedo","doi":"10.1111/eci.70137","DOIUrl":"https://doi.org/10.1111/eci.70137","url":null,"abstract":"<p><strong>Aims/hypothesis: </strong>Type 2 diabetes is a multifactorial condition whose greatest impact comes from its complications. We hypothesized that distinct insulin-derived mechanisms and lipid profiles discriminate sex differences and can be used to identify subjects at higher risk to develop diabetes-related complications.</p><p><strong>Methods: </strong>The PREVADIAB2 study evaluated metabolic alterations after 5 years in individuals initially free of Type 2 Diabetes (PREVADIAB1). In this analysis, 953 participants were stratified into clusters using hierarchical clustering based on insulinogenic index (IGI), fasting insulin secretion rate, HOMA-IR, and fasting insulin clearance. A subset of participants (n = 488) had their lipidome assessed using LC/MS-QTOF.</p><p><strong>Results: </strong>Four clusters were identified: Liver Sensitive (LS), Pancreas Glucose Sensitive (PGS), Insulin Deficient (ID), and Insulin Resistant (IR), each with distinct dysglycemia risk. While metabolic features were similar across sexes, the parameter thresholds differed, resulting in sex-specific lipidomic profiles. Women exhibited higher levels of circulating dihydroceramides (5.3 ± 1.9 vs. 4.7 ± 1.8, p < .001), associated with de novo ceramide synthesis, and elevated sphingomyelins (SM), suggesting altered lipid metabolism. Conversely, the ceramide-to-SM ratio was higher in men (1.04 ± .21 vs. .90 ± .18, p < .001). Except for the LS cluster, all other clusters exhibit distinct lipid signatures associated with metabolic dysfunction, further accentuated by specific lipid profile sex differences.</p><p><strong>Conclusions: </strong>Distinct insulin-related metabolic features and sex identify different phenotypes with distinct lipidome profiles, highlighting the need to place prediabetes in a broader context of metabolism beyond glucose.</p>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":" ","pages":"e70137"},"PeriodicalIF":3.6,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145354216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revisiting tricuspid regurgitation: Historical insights and emerging research perspectives.","authors":"Claudia Gonzalez-Cucharero, Gemma Vilahur, Marta Saura, Rocío Hinojar, Jose L Zamorano, Carlos Zaragoza","doi":"10.1111/eci.70138","DOIUrl":"https://doi.org/10.1111/eci.70138","url":null,"abstract":"<p><strong>Background: </strong>Tricuspid regurgitation (TR), defined as the failure of proper leaflet coaptation during systole, is a common but often underrecognized valvular disorder. TR continues to rise, primarily due to population aging and the broader application of advanced diagnostic imaging techniques. Recent studies have established a clear association between TR and increased morbidity and mortality, thereby challenging its historical perception as a benign condition.</p><p><strong>Methods: </strong>The development of novel interventional therapies, combined with enhanced insight into the pathophysiology of right-sided heart failure, has prompted a shift towards earlier diagnosis and more proactive clinical management.</p><p><strong>Aim: </strong>Several gaps between novel scientific advancements and clinical translation still make this disease deserving of further attention.</p><p><strong>Discussion and conclusion: </strong>In this review, we examine the most recent advances in understanding TR, which have enabled improved segmentation of affected patient populations. This progress has made it possible to identify key prognostic markers-particularly those related to disease progression-allowing for more accurate risk stratification and significantly more personalized treatment approaches.</p>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":" ","pages":"e70138"},"PeriodicalIF":3.6,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145354217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GLP-1 receptor agonists in patients with MGUS: A real-world propensity-matched study.","authors":"Anastasios Tentolouris, Ioannis Ntanasis-Stathopoulos, Charalampos Filippatos, Evangelos Terpos, Efstathios Kastritis, Ernesto Ruiz Duque, Meletios-Athanasios Dimopoulos, Maria Gavriatopoulou, Alexandros Briasoulis","doi":"10.1111/eci.70140","DOIUrl":"https://doi.org/10.1111/eci.70140","url":null,"abstract":"<p><strong>Background: </strong>Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant plasma cell disorder with potential progression to multiple myeloma (MM). Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated potential anti-neoplastic properties. This study evaluated the association between GLP-1 RA use and clinical outcomes in individuals with MGUS and concurrent DM, overweight or obesity.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using the TriNetX global health research network. Adults with MGUS and either DM or overweight/obesity were identified. Propensity score matching (1:1) was performed, resulting in two balanced cohorts. The primary outcome was progression-free survival (PFS). Secondary outcomes included overall survival (OS), time to progression to multiple myeloma (MM) and major cardiovascular events, including myocardial infarction (MI), ischemic stroke, ischemic heart disease and heart failure (HF).</p><p><strong>Results: </strong>Among 30,034 matched patients, 823 patients in the GLP-1 RA group and 2317 in the control group progressed to symptomatic MM or died. GLP-1 RA use was associated with significantly improved PFS [HR (95% CI): .63 (.58-.68)] and OS [HR (95% CI): .61 (.56-.66)]. A reduced risk of progression to symptomatic MM was also observed [HR (95% CI): .82 (.69-.98)]. GLP-1 RA users had lower cumulative incidence of MI, HF, ischemic heart disease, and stroke; however, these differences were not confirmed in time-to-event analyses.</p><p><strong>Conclusions: </strong>GLP-1 RA therapy was associated with significantly improved PFS and OS in MGUS patients with metabolic comorbidities. While fewer cardiovascular events were observed, these findings were not statistically confirmed over time.</p>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":" ","pages":"e70140"},"PeriodicalIF":3.6,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A matter arising: When should inflammatory and autoimmune rheumatic diseases be considered 'early'?","authors":"Elvis Hysa, Emanuele Gotelli, Carmen Pizzorni, Sabrina Paolino, Alberto Sulli, Vanessa Smith, Rosanna Campitiello, Maurizio Cutolo","doi":"10.1111/eci.70136","DOIUrl":"https://doi.org/10.1111/eci.70136","url":null,"abstract":"<p><strong>Background: </strong>Early diagnosis is pivotal for guiding the intensity of clinical monitoring, optimizing therapeutic strategies and preventing organ damage in inflammatory and autoimmune rheumatic diseases (IARDs). This review summarizes current evidence on early diagnostic and therapeutic approaches of some IARDs, including rheumatoid arthritis (RA), systemic sclerosis (SSc) and detection of large-vessel vasculitis (LVV) in polymyalgia rheumatica (PMR), representing distinct pathophysiological mechanisms of joint synovitis, tissue fibrosis and vasculitis, respectively.</p><p><strong>Methods: </strong>A comprehensive narrative literature review was conducted focusing on early recognition strategies, searching PubMed and Scopus databases with emphasis on studies from the past 5 years and recent EULAR/ACR conference abstracts (2023-2025).</p><p><strong>Results: </strong>In RA, clinically suspect arthralgia with seropositivity for rheumatoid factor and anti-citrullinated peptide antibodies significantly increases progression risk to definite RA. Musculoskeletal ultrasound detects subclinical synovitis in 44%-51% of high-risk individuals, while MRI identifies bone marrow edema predicting erosive progression. Abatacept significantly reduces RA development in seropositive individuals at high risk of RA. In SSc, Raynaud's phenomenon combined with SSc-specific autoantibodies and abnormal nailfold capillaroscopy predicts progression to definite disease, with 79.5% developing SSc within 4.6 years. LeRoy's criteria, validated by Koenig, enables early identification, though evidence for disease-modifying interventions in preclinical stages remains limited. For PMR, imaging reveals subclinical LVV in 16%-23% of patients without cranial symptoms. Subclinical LVV associates with higher relapse rates in retrospective studies, though optimal management approaches require prospective validation.</p><p><strong>Conclusions: </strong>Advances in early IARD recognition through refined clinical criteria, enhanced biomarkers and imaging enable risk stratification and personalized management. While intervention strategies show promise, particularly in RA, optimal patient selection and treatment protocols require further research.</p>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":" ","pages":"e70136"},"PeriodicalIF":3.6,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic dysfunction-associated steatotic liver disease, insulin resistance and hepatocellular carcinoma: A deadly triad.","authors":"Alfredo Caturano, Enes Erul, Roberto Nilo, Davide Nilo, Vincenzo Russo, Luca Rinaldi, Carlo Acierno, Erman Akkus, Katerina Koudelkova, Federica Cerini, Alessandro Rizzo, Ferdinando Carlo Sasso, Leonilde Bonfrate, Antonio Giordano, Hatime Arzu Yaşar, Caterina Conte","doi":"10.1111/eci.70132","DOIUrl":"https://doi.org/10.1111/eci.70132","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) has become a leading cause of chronic liver disease worldwide, driven by the increasing prevalence of obesity and insulin resistance (IR). IR, a central feature of the metabolic syndrome, promotes hepatic lipid accumulation, inflammation and mitochondrial dysfunction, fostering the transition from steatosis to advanced liver injury and hepatocellular carcinoma (HCC). This review summarizes current evidence on the molecular mechanisms linking MASLD, IR and HCC, highlighting the role of insulin resistance in liver carcinogenesis and disease progression.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted to identify experimental, clinical and epidemiological studies addressing the interplay between MASLD, IR and HCC. Key molecular pathways and risk profiles were synthesised and compared across etiologies.</p><p><strong>Results: </strong>IR contributes to hepatic lipid deposition, oxidative stress and chronic inflammation through activation of PI3K/Akt and mTOR signalling. The coexistence of MASLD and IR enhances pro-inflammatory and pro-fibrotic pathways, accelerating the evolution to HCC. Patients with MASLD-associated HCC exhibit distinct metabolic and molecular characteristics compared with those with viral or alcohol-related HCC. Novel biomarkers and advanced imaging modalities show promise for identifying high-risk individuals at earlier disease stages.</p><p><strong>Conclusions: </strong>Although substantial progress has been made in understanding the MASLD-IR-HCC axis, critical gaps remain regarding genetic, environmental and metabolic determinants. A multidisciplinary approach integrating metabolic, molecular and oncologic research is essential for improving early detection, risk stratification and the development of targeted therapies against metabolic liver cancer.</p>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":" ","pages":"e70132"},"PeriodicalIF":3.6,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular biomarkers and preeclampsia: A narrative review.","authors":"Johana Ullmo, Madalina Nicoleta Nan, Mónica Cruz-Lemini, Carmen Garrido-Gimenez, Judit Platero, Álvaro García-Osuna, Pablo García-Manau, Marcel Twickler, Elisa Llurba","doi":"10.1111/eci.70123","DOIUrl":"https://doi.org/10.1111/eci.70123","url":null,"abstract":"<p><strong>Background: </strong>Preeclampsia is a disorder with complex pathophysiology, which underscores the need to study various biomarkers for its early prediction, accurate diagnosis, better understanding of underlying mechanisms and potential links to other diseases. A growing body of research has explored the potential of established and emerging cardiovascular biomarkers in the context of preeclampsia. The overlap in risk factors between preeclampsia and cardiovascular disease, along with findings from numerous epidemiological studies, suggests that cardiovascular biomarkers may play a key role in predicting preeclampsia, assessing its severity and determining the long-term risk of cardiovascular disease.</p><p><strong>Aim: </strong>To explore the role of cardiovascular biomarkers in the prediction, diagnosis and management of preeclampsia, while investigating their ability to improve insights into disease mechanisms and their connection to long-term cardiovascular risk.</p><p><strong>Methods and discussion: </strong>This review summarizes findings from existing research on cardiovascular biomarkers in preeclampsia, including studies examining their predictive and diagnostic capabilities, their role in elucidating disease pathophysiology, and their relevance for long-term cardiovascular risk assessment. Furthermore, it highlights emerging cardiovascular biomarkers, outlining their technical limitations and the need for further studies to clarify their utility in routine clinical practice.</p><p><strong>Conclusion: </strong>Cardiovascular biomarkers are becoming essential for diagnosing, monitoring and predicting outcomes in preeclampsia, enabling early detection and treatment. While some are already in clinical use, emerging biomarkers show promise for more precise and individualized care. Advancing research in this area offers significant potential to improve maternal and fetal outcomes.</p>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":" ","pages":"e70123"},"PeriodicalIF":3.6,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The biology of lipoprotein(a): From genetics to molecular mechanisms.","authors":"Mark Atallah, Nadim Nasrallah, Tarek Harb, Gary Gerstenblith, Thorsten M Leucker","doi":"10.1111/eci.70133","DOIUrl":"https://doi.org/10.1111/eci.70133","url":null,"abstract":"<p><strong>Background: </strong>Lipoprotein(a) [Lp(a)] is a primarily genetically determined, low-density lipoprotein-like particle that plays an important role in atherosclerotic cardiovascular disease (ASCVD) and calcific aortic valve disease (CAVD). Despite optimal control of traditional lipid levels, elevated lipoprotein(a) [Lp(a)] remains a significant contributor to residual cardiovascular risk, affecting up to 20% of the global population.</p><p><strong>Methods: </strong>We performed a literature search of PubMed/Medline and Google Scholar until July 2025 to provide a comprehensive overview of the genetics, structure, metabolism, and molecular mechanisms underlying Lp(a)'s pathogenicity.</p><p><strong>Results: </strong>Structurally, Lp(a) consists of an LDL-like core covalently bound to apolipoprotein(a) [apo(a)], a polymorphic glycoprotein characterized by kringle IV type 2 (KIV-2) repeat variability. This copy number variation is the primary determinant of apo(a) isoform size and plasma Lp(a) levels. Small isoforms are produced more efficiently, resulting in higher concentrations. Lp(a) is synthesized in hepatocytes, and its plasma levels are predominantly governed by production rather than clearance. It carries a high burden of oxidized phospholipids (OxPLs), which confer pro-inflammatory and pro-atherogenic properties. Lp(a) promotes arterial inflammation, endothelial dysfunction, monocyte activation and impaired fibrinolysis via competition with plasminogen. It also plays a direct pathogenic role in valvular calcification by delivering OxPLs and autotaxin to valve interstitial cells, triggering osteogenic signaling cascades.</p><p><strong>Conclusion: </strong>While environmental factors such as inflammation and hormonal status can transiently modulate levels, genetic variation overwhelmingly dictates lifelong Lp(a) burden. As novel agents targeting Lp(a) enter late-stage clinical trials, mechanistic insights into Lp(a) biology will be essential to risk stratification and future clinical management.</p>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":" ","pages":"e70133"},"PeriodicalIF":3.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lipoprotein(a) in clinical practice: Risk stratification and therapeutic strategies.","authors":"Nadim Nasrallah, Mark Atallah, Tarek Harb, Gary Gerstenblith, Thorsten M Leucker","doi":"10.1111/eci.70127","DOIUrl":"https://doi.org/10.1111/eci.70127","url":null,"abstract":"<p><strong>Background: </strong>Lipoprotein(a) [Lp(a)] is a primarily genetically determined, causal and independent risk factor for atherosclerotic cardiovascular disease (ASCVD). Lp(a) levels are stable, unaffected by lifestyle, and best measured using isoform-insensitive, molar-based assays. Current guidelines from the European Atherosclerosis Society and U.S. National Lipid Association recommend a one-time Lp(a) measurement in all adults. Cascade testing is advised in affected families.</p><p><strong>Results: </strong>Elevated Lp(a) levels are associated with increased risk of coronary artery disease, myocardial infarction incidence and recurrence, and aortic stenosis onset and progression. In cerebrovascular disease, high Lp(a) is linked to large artery ischemic stroke incidence and recurrence, as well as poor functional outcomes. Associations with venous thromboembolism are limited to prothrombotic states and extreme Lp(a) concentrations. Elevated levels (≥50 mg/dL or ≥125 nmol/L) should prompt intensified risk factor modification.</p><p><strong>Conclusion: </strong>There are no currently approved lipid-lowering therapies that substantially reduce Lp(a) levels. Novel agents to lower Lp(a) include antisense oligonucleotides, small interfering ribonucleic acid and small molecules, all of which have shown promising results in phase 2 trials. Ongoing phase 3 trials will evaluate the causal relationship between Lp(a) and ASCVD, and whether lowering Lp(a) reduces cardiovascular outcomes.</p>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":" ","pages":"e70127"},"PeriodicalIF":3.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine learning prediction of moderate-to-severe acute kidney injury after ICU admission and cardiac surgery with urine trace elements.","authors":"Yang Chen, Ying Gue, Gregory Y H Lip, David S Gardner, Mark A J Devonald","doi":"10.1111/eci.70131","DOIUrl":"https://doi.org/10.1111/eci.70131","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is common and linked to poor outcomes, but early detection remains challenging. Previous research identified urinary trace elements (TE) as early AKI biomarkers in intensive care unit (ICU) or cardiac surgery patients. We aimed to explore whether urinary TE enhance machine learning (ML) models for AKI prediction.</p><p><strong>Methods: </strong>We constructed ML models using the ICU cohort. We filtered the variables and optimized hyperparameters before predicting Kidney Disease: Improving Global Outcomes stage 2-3 AKI using eight ML classifiers: light gradient boosting machine (LightGBM), random forest (RF), ML logistic regression, support vector machine, multilayer perceptron, eXtreme gradient boosting (XGBoost), Gaussian Naive Bayes and k-nearest neighbors. External validation was performed in the cardiac surgery cohort.</p><p><strong>Results: </strong>Among 149 ICU patients (median age 56.0 [interquartile range (IQR): 43.5-67.0], 63.1% male), 25 developed stage 2-3 AKI; among 144 cardiac surgery patients (median age 70.0 [IQR: 62.0-76.0], 72.9% male), 12 developed stage 2-3 AKI. Each ML in the internal validation had area under the curve (AUC) above .7, with XGBoost having the highest (.813); LightGBM had the second highest AUC (.799), highest G-mean (.567) and F1-score (.545). In external validation, RF had the highest AUC (.740), XGBoost had the highest G-mean (.289) and F1-score (.286). Age, strontium and boron were consistently ranked among the top five most important features in LightGBM, RF and XGBoost.</p><p><strong>Conclusion: </strong>ML models primarily based on urinary TE can identify AKI risk in both clinical groups (ICU and cardiac surgery), with LightGBM, RF and XGBoost serving as high-performance models for early prediction of stage 2-3 AKI.</p>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":" ","pages":"e70131"},"PeriodicalIF":3.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of transcatheter edge-to-edge repair in patients with functional mitral regurgitation and pulmonary hypertension.","authors":"Mandurino-Mirizzi Alessandro, Raone Luca, Munafò Andrea Raffaele, Gazzoli Fabrizio, Mussardo Marco, Montalto Claudio, Germinal Francesco, Ferlini Marco, Porto Italo, Colonna Giuseppe, Oreglia Jacopo, Crimi Gabriele","doi":"10.1111/eci.70130","DOIUrl":"https://doi.org/10.1111/eci.70130","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary hypertension (PH) is frequently observed in patients with functional mitral regurgitation (FMR) and heart failure with reduced ejection fraction (HFrEF) and adversely impacts prognosis. However, limited data exist on the outcomes of transcatheter edge-to-edge mitral valve repair (M-TEER) in patients with PH, particularly regarding hemodynamic subtypes.</p><p><strong>Methods: </strong>This multicenter, retrospective analysis included 144 HFrEF patients with moderate-to-severe or severe FMR who underwent M-TEER across four Italian centers. Baseline hemodynamic assessment was performed using right heart catheterization (RHC) in conscious patients. Procedural outcomes and clinical follow-up were evaluated at 1 year. The endpoints studied included death from any cause, heart failure hospitalization and a composite endpoint of both.</p><p><strong>Results: </strong>Among the 144 patients, 84% had PH (64% combined post- and pre-capillary-PH (Cpc-PH), 20% isolated post-capillary-PH (Ipc-PH)). Procedural success was achieved in 92%, with significant improvements in New York Heart Association (NYHA) functional class (p < .001) and echocardiographic parameters. At 1 year, the composite endpoint occurred in 30% of patients, with higher rates in PH patients compared to no PH group (34% vs. 9%, respectively, p = .039). Among PH patients, Cpc-PH patients demonstrated the worst outcomes (for the composite endpoint at 1 year Cpc-PH 37% vs. Ipc-PH 24% vs. no-PH 9%, p = .031). Multivariate analysis confirmed Cpc-PH as a significant predictor of adverse outcomes at 1 year.</p><p><strong>Conclusions: </strong>M-TEER is an effective therapeutic option for patients with HFrEF and FMR, providing significant procedural success and clinical improvements. However, patients with PH, particularly those with Cpc-PH, exhibit worse long-term clinical outcomes.</p>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":" ","pages":"e70130"},"PeriodicalIF":3.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}