International journal of cardiology最新文献

{"title":"ELSO-score: A practical pre-ECMO risk model for predicting in-hospital mortality in patients receiving VA-ECMO.","authors":"Mohammad Alarfaj, Mohamad Alhoda Mohamad Alahmad, William J Wallisch, Brigid C Flynn, Aniket S Rali, Joseph E Tonna, Zubair Shah","doi":"10.1016/j.ijcard.2026.134542","DOIUrl":"https://doi.org/10.1016/j.ijcard.2026.134542","url":null,"abstract":"<p><strong>Background: </strong>Despite advancements in management strategies, patients with refractory cardiogenic shock (CS) have high mortality. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly utilized as temporary mechanical support in these patients. Current predictive models for mortality suffer from practical limitations, including complexity and the extensive variables required.</p><p><strong>Objectives: </strong>We aimed to develop a simplified, practical predictive model, the Extracorporeal Life Support Outcome score (ELSO-Score), using readily available pre-ECMO variables to predict in-hospital mortality among VA-ECMO patients.</p><p><strong>Methods: </strong>This retrospective study utilized data from 8495 VA-ECMO patients collected by the Extracorporeal Life Support Organization (ELSO) registry between January 2017 and December 2022. We developed a simple neural predictive model, validated on training, validation, and test cohorts.</p><p><strong>Results: </strong>The training cohort comprised 6029 analyzed cases, with an overall in-hospital mortality rate of 55.5%. Significant predictors of mortality were elevated lactate levels, age, bilirubinemia, acute kidney injury, and the requirement for renal replacement therapy at the time of ECMO cannulation. The predictive model demonstrated moderate discriminatory performance, achieving area under the ROC curve values of 0.70, 0.69, and 0.68, 95% CI [0.63-0.73], in the training, validation, and test cohorts, respectively.</p><p><strong>Conclusions: </strong>Our study demonstrates that the ELSO-Score may be a practical and effective predictive tool facilitating informed clinical decision-making and resource allocation for patients considered for VA-ECMO therapy.</p>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":" ","pages":"134542"},"PeriodicalIF":3.2,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837367","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":"Central venous pressure, rather than cardiac output, is associated with peripheral chemoreceptor sensitivity in heart failure patients with left ventricular assist device","authors":"Maksym Jura ,&nbsp;Roman Przybylski ,&nbsp;Piotr Niewiński ,&nbsp;Mateusz Sokolski ,&nbsp;Rafał Seredyński ,&nbsp;Michał Zakliczyński ,&nbsp;Piotr Ponikowski ,&nbsp;Jan Biegus ,&nbsp;Bartłomiej Paleczny","doi":"10.1016/j.ijcard.2026.134228","DOIUrl":"10.1016/j.ijcard.2026.134228","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure (HF) patients experience elevated sympathetic tone and abnormal peripheral chemoreceptor (PChR) function (elevated sensitivity [PChS] and tonicity [PChT]), which can be attributed to a reduction in cardiac output (CO) and resultant hypoperfusion of the carotid bodies. Left ventricular assist devices (LVADs) are known to increase CO, and can be used as a unique model to examine the impact of acute hemodynamic changes on PChR.</div></div><div><h3>Methods and results</h3><div>Fourteen HF patients with LVADs underwent assessment of PChS (using the transient hypoxia test) and PChT (using low-dose dopamine infusion) under different LVAD flow parameters, previously determined using right heart catheterization to achieve significantly distinct CO levels. PChS did not differ between the low- vs high-flow conditions (0.61 [0.49;0.74] vs. 0.67 [0.33;0.9] L/min/SpO2%, <em>p</em> = 0.36) as well as PChT (0.97 [−0.36;1.96] vs. 0.81 [−1.67;2.2] L/min-1, <em>p</em> = 0.81).). In 9 patients, central venous pressure (CVP) decreased in response to higher pump speeds. In this group, PChS more frequently increased and was significantly higher than in the remaining patients. ΔCVP was also inversely related to ΔHVR (<em>R</em> = 0.75, <em>p</em> = 0.002).</div></div><div><h3>Conclusions</h3><div>Acute changes in CO, as well as pulse pressure, did not affect PChS or PChT. Surprisingly, we observed a strong correlation between a decrease in CVP in response to higher LVAD speed and an increase in PChS, which can be explained by the function of low-pressure baroreceptors. These findings provide unique data on PChR function under different hemodynamic conditions in the LVAD population.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"450 ","pages":"Article 134228"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142365","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":"Assessment of cardiovascular disease risk prediction using combination of TyG and ACEF in an elderly population","authors":"Shengjun Xiong ,&nbsp;Xiaotong Cui ,&nbsp;Yingmei Zhang ,&nbsp;Junbo Ge ,&nbsp;Miyesaier Abudureyimu ,&nbsp;Jun Ren","doi":"10.1016/j.ijcard.2026.134218","DOIUrl":"10.1016/j.ijcard.2026.134218","url":null,"abstract":"<div><h3>Purpose</h3><div>To explore the predictive value of TyG index and ACEF score for the risk of cardiovascular disease (CVD) in an elderly population.</div></div><div><h3>Methods</h3><div>A total of 2047 participants without history of CVD were enrolled in the follow-up. The endpoint was CVD incidence which was defined as stroke or coronary heart disease (CHD) during the follow-up period. Cox regression analyses was used to calculate hazard ratios. Kaplan-Meier curve was used to show the probability of CVD in different quartiles of TyG and ACEF. Restricted cubic spline further explored whether the relationship was linear. Finally, we assessed the discriminatory ability of TyG and ACEF for CVD using C-statistics, net reclassification index (NRI), and integrated discrimination improvement (IDI).</div></div><div><h3>Results</h3><div>During a median follow-up time of 4.66 years, 100 participants had CVD. Kaplan-Meier curve showed that TyG and ACEF were associated with CVD and participants with high TyG and ACEF were significantly more likely to have CVD. In the multivariate Cox regression analysis, the adjusted hazard ratios (HR) for TyG and ACEF were 1.21 (1.02–1.43) in TyG and 1.63 (1.25–2.17) in ACEF. In addition, multivariable adjusted HRs of TyG and ACEF still increased for CVD when stratified by various factors in subgroup analysis. Moreover, after adding TyG and ACEF to original risk prediction model, new model has higher C statistics of CVD (C-statistics = 0.733 than the original model (C-statistics = 0.656). Meanwhile, the results of NRI = 0.450 and IDI = 0.009 indicate that TyG and ACEF had enhancing effect on the prediction of CVD.</div></div><div><h3>Conclusions</h3><div>Our study showed that TyG and ACEF were associated with CVD in elderly populations in eastern China. Furthermore, it suggests that TyG could be a new tool for identifying potential patients at high risk of primary CVD in elderly population.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"450 ","pages":"Article 134218"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116534","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":"Diagnostic performance of aortic valve calcium scoring for severe aortic stenosis in patients with chronic kidney disease","authors":"Hesham Sheashaa ,&nbsp;Juan M. Farina ,&nbsp;Isabel G. Scalia ,&nbsp;Kamal Awad ,&nbsp;Mohammed Tiseer Abbas ,&nbsp;Milagros Pereyra ,&nbsp;Sherif Ahmed ,&nbsp;Fatmaelzahraa Abdelfattah ,&nbsp;Mahshad Razaghi ,&nbsp;Abdelrahman Hafez ,&nbsp;Ramzi Ibrahim ,&nbsp;Said Alsidawi ,&nbsp;Steven J. Lester ,&nbsp;David Fortuin ,&nbsp;John Sweeney ,&nbsp;Kristen Sell-Dottin ,&nbsp;Chadi Ayoub ,&nbsp;Reza Arsanjani","doi":"10.1016/j.ijcard.2026.134217","DOIUrl":"10.1016/j.ijcard.2026.134217","url":null,"abstract":"<div><h3>Background</h3><div>Aortic valve calcium scoring (AVCS) via noncontrast Computed Tomography (CT) has emerged as a valuable adjunct to echocardiography in diagnosing aortic stenosis (AS). However, its diagnostic accuracy in patients with chronic kidney disease (CKD) -a population characterized by extensive extra-valvular calcification- remains unclear.</div></div><div><h3>Methods</h3><div>This retrospective multicenter study included 2909 adults who underwent AVCS and echocardiography between 2015 and 2025 across Mayo Clinic sites. Patients were stratified by glomerular filtration rate (eGFR) to assess AVCS diagnostic performance for severe AS in CKD vs non-CKD cohorts. Receiver operating characteristic (ROC) curves, stratified by sex and eGFR categories, were used to evaluate diagnostic accuracy. Optimal thresholds were derived using Youden's index and compared with guideline-recommended cutoffs.</div></div><div><h3>Results</h3><div>AVCS demonstrated high diagnostic accuracy in patients with preserved renal function (AUC 0.861), but performance declined with worsening CKD. AUC dropped to 0.791 (eGFR &lt;60), 0.727 (eGFR &lt;45), and 0.691 (eGFR &lt;30). Specificity declined significantly across worsening eGFR, despite stable sensitivity. Sex-stratified analysis revealed similar results.</div></div><div><h3>Conclusion</h3><div>AVCS remains a reliable tool to rule out severe AS in patients with CKD, but declining specificity with worsening kidney function -likely due to nonvalvular calcification- highlights the risk of false positives. In CKD populations, AVCS thresholds should be interpreted cautiously and integrated with multimodal evaluation and clinical data.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"450 ","pages":"Article 134217"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124778","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":"Multisite derivation of a machine learning algorithm using high sensitivity troponin to predict major adverse cardiac events in the emergency department","authors":"Daniel Swedien ,&nbsp;Joseph Miller ,&nbsp;Jeffrey Nielson ,&nbsp;Rui Hu ,&nbsp;Maxim Shatsky ,&nbsp;Sean Roberts ,&nbsp;Girish Simon ,&nbsp;Riley Zambrano ,&nbsp;Tobin Efferen ,&nbsp;Eili Klein ,&nbsp;Scott Levin ,&nbsp;Jeremiah S. Hinson","doi":"10.1016/j.ijcard.2026.134215","DOIUrl":"10.1016/j.ijcard.2026.134215","url":null,"abstract":"<div><h3>Objective</h3><div>To develop a machine learning (ML) algorithm to stratify risk for major adverse cardiac events (MACE) within 30 days in emergency department (ED) patients undergoing troponin testing.</div></div><div><h3>Design</h3><div>Retrospective cohort analysis using extreme gradient boosting (XGBoost), a tree-based ensemble machine learning algorithm.</div></div><div><h3>Setting</h3><div>Twenty U.S. hospitals.</div></div><div><h3>Participants</h3><div>Patients aged ≥22 years who underwent high-sensitivity troponin-I (Beckman Coulter Access high-sensitivity troponin-I, hs-cTnI) testing between October 2019 and December 2020.</div></div><div><h3>Main outcomes</h3><div>We evaluated ML model performance for predicting 30-day MACE using negative predictive value (NPV), sensitivity, and specificity. The model used only objective EHR data.</div></div><div><h3>Results</h3><div>Out of 95,093 ED visits, 91,278 met inclusion criteria. The ML model generated predictions at three clinical timepoints based on troponin availability: initial (all patients), second (subset with serial testing), and final (patient's last result<strong>,</strong> with an area under the receiver operating characteristic curve (AUROC) of 0.90 (95% CI 0.89–0.90) for the initial prediction and 0.91 (95% CI 0.90–0.91) at the final troponin result. It identified 53.2% of patients as low risk with an NPV of 99.35% (95% CI 99.17% to 99.49%). The model showed strong calibration and discrimination, particularly in its ability to safely increase the proportion of patients classified as low risk for discharge.</div></div><div><h3>Conclusions</h3><div>This study demonstrates feasibility of automated machine learning using objective EHR data to predict 30-day MACE among ED patients undergoing troponin testing. This approach minimizes subjective interpretations and warrants prospective validation to assess potential for improving ED efficiency and patient safety<strong>.</strong></div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"450 ","pages":"Article 134215"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105381","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":"Neighbourhood socioeconomic disadvantage from childhood to midlife and carotid atherosclerosis.","authors":"Olli Raitakari ,&nbsp;Jaana Pentti ,&nbsp;Juhani S. Koskinen ,&nbsp;Juha Mykkänen ,&nbsp;Suvi Rovio ,&nbsp;Katja Pahkala ,&nbsp;Markus Juonala ,&nbsp;Terho Lehtimäki ,&nbsp;Mika Kähönen ,&nbsp;Ichiro Kawachi ,&nbsp;Mika Kivimäki ,&nbsp;Jorma Viikari ,&nbsp;Jussi Vahtera","doi":"10.1016/j.ijcard.2026.134216","DOIUrl":"10.1016/j.ijcard.2026.134216","url":null,"abstract":"<div><h3>Background</h3><div>Neighbourhood socioeconomic disadvantage correlates with cardiovascular disease risk. However, its relationship with subclinical atherosclerosis from childhood to midlife is not well-defined. We examined whether cumulative neighbourhood disadvantage is associated with carotid artery plaques, a measure of subclinical atherosclerosis.</div></div><div><h3>Methods</h3><div>We analysed data from 1998 participants in the Cardiovascular Risk in Young Finns Study, a cohort followed from childhood (mean age 10.7 years in 1980) to adulthood (mean age 48.6 years in 2018–2020). Neighbourhood disadvantage was derived from national grid-based socioeconomic data and computed cumulatively across the life course. The number of carotid artery plaques (mean plaque count) was assessed by standardized ultrasound imaging. Multivariable Poisson regression models were used to evaluate the associations. Mediation analyses were used to assessed the role of ideal cardiovascular health (CVH) metrics.</div></div><div><h3>Results</h3><div>Higher cumulative neighbourhood disadvantage from childhood to mid-adulthood was associated with a 1.24-fold increase in mean plaque count for every 1 standard deviation increase in cumulative disadvantage. This relationship persisted after controlling for parental carotid artery plaques, polygenic coronary artery disease risk score, and Framingham risk score. The association was partially explained by ideal CVH metrics, particularly smoking and blood pressure, which collectively accounted for almost half of the association.</div></div><div><h3>Conclusions</h3><div>Long-term exposure to neighbourhood socioeconomic disadvantage beginning in childhood is associated with subclinical atherosclerosis in midlife, independently of achieved socioeconomic position. These findings highlight the importance of cumulative socioeconomic environments across the life course and suggest that behavioural risk factors may partly explain observed neighbourhood-level associations with atherosclerosis.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"450 ","pages":"Article 134216"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116535","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":"Atrial fibrillation among master athletes: A complex relationship","authors":"L. Sciarra ,&nbsp;F. D'Ascenzi ,&nbsp;A. Borrelli ,&nbsp;M. Santarelli ,&nbsp;M. Fusari ,&nbsp;D. Scognamiglio ,&nbsp;F. Zanin ,&nbsp;L. Pignalosa ,&nbsp;G. Spiriti ,&nbsp;M. Petrungaro ,&nbsp;L. Buzzelli ,&nbsp;F. Sciarra ,&nbsp;G. De Masi De Luca ,&nbsp;S. Romano ,&nbsp;A. Scarà","doi":"10.1016/j.ijcard.2026.134212","DOIUrl":"10.1016/j.ijcard.2026.134212","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) is the most common sustained arrhythmia with a notable impact on morbidity and mortality. While moderate physical activity is generally protective against cardiovascular disease, the relationship between endurance sports and AF, especially in master athletes (aged ≥45), remains unclear. Some evidence suggests a U-shaped association between exercise intensity and AF risk.</div></div><div><h3>Objective</h3><div>To investigate the association between endurance sport participation and AF occurrence among master athletes, and to identify potential risk factors or predisposing conditions.</div></div><div><h3>Methods</h3><div>This observational case-control study enrolled 140 endurance athletes aged ≥45 years, divided into 70 with documented AF (cases) and 70 age- and activity-matched athletes without AF (controls). Data collected included demographic, anthropometric, sports participation, cardiovascular and extracardiac comorbidities, 24-h Holter ECG and echocardiographic parameters. Statistical comparisons were performed to identify differences between groups.</div></div><div><h3>Results</h3><div>Groups were comparable in age, sex and BMI. Both groups had similar patterns of endurance sport participation. Athletes with AF had a significantly higher burden of cardiovascular risk factors, notably hypertension (73% vs. 21%) and dyslipidaemia (54% vs. 14%), and more extracardiac comorbidities. Echocardiography revealed larger left atrial size and more frequent mitral and tricuspid regurgitation in the AF group. Most AF cases were paroxysmal, with palpitations reported in over 80%.</div></div><div><h3>Conclusions</h3><div>The main findings of our study suggest that endurance athletes experiencing AF show a higher prevalence of traditional cardiovascular risk factors, particularly hypertension and dyslipidaemia. These findings highlight the need for individualized cardiovascular assessment and risk management in this population. Further longitudinal studies are needed to clarify the causal role of sustained high-intensity exercise in the development of AF.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"450 ","pages":"Article 134212"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124798","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":"Redefining risk in diastolic function: mortality-based thresholds along a physiologic continuum","authors":"Mattia Alberti","doi":"10.1016/j.ijcard.2026.134201","DOIUrl":"10.1016/j.ijcard.2026.134201","url":null,"abstract":"","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"450 ","pages":"Article 134201"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131651","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":"Association of common risk factors with major adverse cardiac events and mortality in patients with MINOCA: A systematic review and meta-analysis","authors":"Sotirios Chiotis ,&nbsp;Georgios Giannopoulos ,&nbsp;Aristi Boulmpou ,&nbsp;Aikaterini Zgouridou ,&nbsp;Leonidas Koliastasis ,&nbsp;Ioannis Efthymiou ,&nbsp;Aikaterini Vassilikou ,&nbsp;Prokopios Mamolis ,&nbsp;Dimitrios Vrachatis ,&nbsp;Efstathios Pagkourelias ,&nbsp;Stergios Tzikas ,&nbsp;Ioannis Doundoulakis ,&nbsp;Christodoulos Papadopoulos ,&nbsp;Vassileios P. Vassilikos","doi":"10.1016/j.ijcard.2026.134225","DOIUrl":"10.1016/j.ijcard.2026.134225","url":null,"abstract":"<div><h3>Background</h3><div>Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous condition with variable outcomes. The prognostic value of common clinical risk factors for major adverse cardiac events (MACEs) and all-cause mortality remains unclear. This study systematically evaluates associations between traditional risk factors and adverse outcomes in MINOCA.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis was conducted to assess pooled hazard ratios (HRs) for clinical variables associated with MACEs and all-cause mortality. Eligible studies reporting HRs with at least 6 months of follow-up were included. Random-effects models were used to derive pooled estimates.</div></div><div><h3>Results</h3><div>Eleven studies including 12,081 patients were analyzed. Over a mean follow-up of 49.2 months, pooled MACEs incidence was 17% (95% CI: 11–26%) and all-cause mortality was 10% (95% CI: 8–14%). Older age increased the risk of MACEs (HR: 1.02; 95% CI: 1.01–1.04), while higher BMI was protective (HR: 0.92; 95% CI: 0.86–0.99). For all-cause mortality, significant predictors included age (HR: 1.04 per year), diabetes (HR: 1.33; 95% CI: 1.07–1.64), creatinine (HR: 1.01; 95% CI: 1.0009–1.02), and STEMI-pattern presentation (HR: 2.85; 95% CI: 1.09–7.44). Higher BMI (HR: 0.89; 95% CI: 0.82–0.98) and dyslipidemia (HR: 0.83; 95% CI: 0.76–0.90) were associated with lower mortality.</div></div><div><h3>Conclusion</h3><div>Only select clinical variables predict outcomes in MINOCA, while many traditional MI risk factors do not. These findings highlight the need for MINOCA-specific risk models and targeted management strategies.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"450 ","pages":"Article 134225"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142316","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":"Coronary inflammation: Identification, clinical impact and possible therapeutical solutions","authors":"Francesco Prati ,&nbsp;Flavio Giuseppe Biccirè ,&nbsp;Maria Teresa Mallus ,&nbsp;Flavio Mastroianni ,&nbsp;Laura Gatto ,&nbsp;Michela Ferrari ,&nbsp;Eloisa Arbustini","doi":"10.1016/j.ijcard.2026.134229","DOIUrl":"10.1016/j.ijcard.2026.134229","url":null,"abstract":"<div><div>Coronary inflammation is now widely recognized as a key driver of atherosclerotic plaque initiation, progression, and destabilization. Histopathological studies and advanced imaging have demonstrated the central role of local inflammation, including extensive macrophage infiltration, cytokine activation, and perivascular adipose tissue, in promoting plaque vulnerability and acute coronary syndromes. Among systemic biomarkers, high-sensitivity C-reactive protein remains the most widely used, although its limited specificity underscores the need for more targeted inflammatory markers such as interleukin-6. Invasive intracoronary imaging with optical coherence tomography can visualize macrophage accumulation and quantify local inflammatory burden. Hybrid molecular imaging with OCT-NIRF, novel PET tracers and peri-coronary adipose tissue attenuation can provide emerging opportunities to further characterize vascular inflammation and residual risk. Anti-inflammatory therapies represent a major opportunity to improve outcomes beyond lipid lowering. Among patients with coronary artery disease, the use of colchicine has demonstrated significant risk reduction in adverse events, though with mixed results. Important randomized trials are underway to investigate the efficacy of novel monoclonal antibodies targeting interleukin pathways. In addition, GLP-1 receptor agonists, SGLT2 inhibitors, and PCSK9 inhibitors have been described to exhibit favourable vascular anti-inflammatory effects in experimental and in-vivo studies. In this comprehensive review, we provide an updated reappraisal of the available evidence unravelling how accurate identification of high-risk patients through multimodal imaging and biomarker profiling, combined with selective anti-inflammatory therapy, can represent a promising strategy for further reducing residual cardiovascular risk.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"450 ","pages":"Article 134229"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146149680","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}