{"title":"Efficacy of sodium-glucose cotransporter 2 inhibitors for super-aged heart failure population.","authors":"Jun-Ichi Noiri, Hidekazu Tanaka, Susumu Odajima, Wataru Fujimoto, Hiroshi Okamoto, Chihiro Fujii, Hiroshi Tsunamoto, Yu Nishihara, Shun Nagai, Koya Uemura, Terunobu Fukuda, Eriko Hisamatsu, Hiromasa Otake","doi":"10.1016/j.ijcard.2025.133647","DOIUrl":"https://doi.org/10.1016/j.ijcard.2025.133647","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose cotransporter 2 (SGLT2) inhibitors are indicated for patients with all phenotypes of heart failure (HF). Despite the current unprecedented super-aged society in real-world settings, the efficacy of SGLT2 inhibitors in super-aged HF patients, especially those of ≥80 years, remains unknown.</p><p><strong>Methos: </strong>This study was conducted across three hospitals in Japan, including 238 HF patients ≥80 years (mean 84.2 ± 3.3 years), who were treated with SGLT2 inhibitors (dapagliflozin or empagliflozin). SGLT2 inhibitors were used for HF, with preserved ejection fraction in 131 patients (55.0 %), mildly-reduced ejection fraction in 54 patients (22.7 %), and reduced ejection fraction in 53 patients (22.3 %). Among 238 patients, 191 (80.3 %) continued SGLT2 inhibitors, while 47 (19.7 %) discontinued SGLT2 inhibitors (for any reason) during follow-up. The primary outcome was a composite of cardiovascular death or worsening HF, with a median follow-up duration of 2.73 (2.08-3.52) years.</p><p><strong>Results: </strong>Cumulative incidence curves modified by the Simon-Makuch method with a time-varying Cox regression analysis showed that HF patients with continued SGLT2 inhibitor treatment had significantly favorable outcomes, which remained consistent after adjustment for baseline characteristics by propensity score matching, and discontinuation of SGLT2 inhibitors was the strongest contributing factor to the outcome by a multivariable analysis. Moreover, the multivariable analysis identified a higher clinical frailty scale score as an independent factor associated with discontinuation of SGLT2 inhibitors.</p><p><strong>Conclusions: </strong>This study provides real-world evidence supporting the use of SGLT2 inhibitors in super-aged patients with HF, emphasizing the importance of appropriately assessing the continuation of SGLT2 inhibitors.</p>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":" ","pages":"133647"},"PeriodicalIF":3.2,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682594","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":"From prediction to translation: Key limitations of current machine learning models for CAD.","authors":"Sheng Huang, Jiawei Ma","doi":"10.1016/j.ijcard.2025.133632","DOIUrl":"https://doi.org/10.1016/j.ijcard.2025.133632","url":null,"abstract":"","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":" ","pages":"133632"},"PeriodicalIF":3.2,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682595","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}
Jun-Won Lee, Han-Young Jin, Hyun Cho, Sung Eun Kim, Joon-Hyung Doh, Yongcheol Kim, Bong-Ki Lee, Sang-Yong Yoo, Sang Yeub Lee, Chan Joon Kim, Jin Sup Park, Jung Ho Heo, Do Hoi Kim, Jin Bae Lee, Dong-Kie Kim, Jun Ho Bae, Sung-Yun Lee, Seung-Hwan Lee, Sung Woo Cho
{"title":"Distal radial access in elderly patients aged 70 years and older for coronary procedures: Lessons from the KODRA registry.","authors":"Jun-Won Lee, Han-Young Jin, Hyun Cho, Sung Eun Kim, Joon-Hyung Doh, Yongcheol Kim, Bong-Ki Lee, Sang-Yong Yoo, Sang Yeub Lee, Chan Joon Kim, Jin Sup Park, Jung Ho Heo, Do Hoi Kim, Jin Bae Lee, Dong-Kie Kim, Jun Ho Bae, Sung-Yun Lee, Seung-Hwan Lee, Sung Woo Cho","doi":"10.1016/j.ijcard.2025.133645","DOIUrl":"https://doi.org/10.1016/j.ijcard.2025.133645","url":null,"abstract":"<p><strong>Background: </strong>While distal radial access (DRA) is increasingly adopted for coronary procedures, evidence supporting its use in elderly patients remains limited. This study evaluated the feasibility and safety of DRA in elderly patients using data from the KODRA registry.</p><p><strong>Methods: </strong>A total of 4941 patients were divided into elderly (≥70 years; n = 2091) and non-elderly (<70 years; n = 2850) groups. The efficacy endpoint was successful coronary angiography completion without access-site crossover, while the safety endpoint comprised a composite of DRA-related bleeding and access-site complications. Multivariable logistic regression analysis assessed associations between age ≥ 70 years and the efficacy and safety endpoints.</p><p><strong>Results: </strong>The mean age was 77.5 ± 5.2 years in the elderly group. The cohort was 67.4 % male, with higher obesity rates and comorbidities in the elderly group. Puncture success was higher in the elderly (95.2 % vs. 93.8 %, p = 0.033), while the elderly experienced more frequent access-site crossover after successful puncture (1.6 % vs. 0.7 %, p = 0.002). The efficacy endpoint was comparable (93.5 % vs. 93.1 %, p = 0.496), whereas the safety endpoint occurred more frequently in the elderly (8.0 % vs. 6.1 %, p = 0.010). After adjustment for confounding variables, age ≥ 70 years was not associated with efficacy (odds ratio 1.054, 95 % confidence interval 0.831-1.337, p = 0.662) or safety endpoints (odds ratio 1.105, 95 % confidence interval 0.856-1.425, p = 0.445).</p><p><strong>Conclusions: </strong>DRA in elderly patients aged ≥70 years revealed a comparable efficacy endpoint but a higher incidence of the composite outcome of DRA-related bleeding and access-site complications. Older age (≥70 years) itself was not significantly associated with either efficacy or safety endpoints.</p>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":" ","pages":"133645"},"PeriodicalIF":3.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674701","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}
Stephen J Hankinson, Sylvain L Carre, Shelby S Laychak, Jon M Hainer, Akshay S Desai, Garrick C Stewart, Neal K Lakdawala, Michael M Givertz, Usha B Tedrow, William H Sauer, Ron Blankstein, Marcelo F Di Carli, Sanjay Divakaran
{"title":"Diagnoses and outcomes of patients referred for FDG PET/CT for suspected cardiac sarcoidosis.","authors":"Stephen J Hankinson, Sylvain L Carre, Shelby S Laychak, Jon M Hainer, Akshay S Desai, Garrick C Stewart, Neal K Lakdawala, Michael M Givertz, Usha B Tedrow, William H Sauer, Ron Blankstein, Marcelo F Di Carli, Sanjay Divakaran","doi":"10.1016/j.ijcard.2025.133643","DOIUrl":"https://doi.org/10.1016/j.ijcard.2025.133643","url":null,"abstract":"<p><strong>Background: </strong>Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) imaging is commonly used to facilitate diagnosis in suspected cardiac sarcoidosis (CS). However, there is a gap in evidence regarding the diagnoses and outcomes of patients who undergo FDG PET/CT.</p><p><strong>Objectives: </strong>Evaluate the diagnoses and outcomes of patients referred for FDG PET/CT imaging for suspected CS.</p><p><strong>Methods: </strong>We studied all consecutive patients referred to our center for FDG PET/CT for suspected CS from June 2006 to November 2023. Patients were characterized by their final clinical diagnosis and followed to a composite outcome of left ventricular assist device placement, heart transplant, or death.</p><p><strong>Results: </strong>A total of 1646 patients (mean age 58.4 ± 12.4 years; 66 % male) met inclusion criteria: 285 (17.3 %) with Heart Rhythm Society (HRS) criteria positive CS, 83 (5.0 %) with probable CS, 237 (14.4 %) with sarcoidosis but without HRS criteria for CS, and 1041 (63.2 %) with other diagnoses. 227 patients (13.8 %) underwent genetic testing, of whom 32 (14.1 %) were found to have a pathogenic/likely pathogenic variant. Over a median follow up of 4.4 years, 327 patients (19.9 %) met the primary outcome. There was no significant difference in outcomes by diagnosis (log-rank p = 0.4936).</p><p><strong>Conclusions: </strong>Most patients referred for FDG PET/CT for suspected CS were not found to have CS in follow up. However, they are at similar risk for the need for advanced therapies and many are found to have genetic CMP. These data highlight the importance of advanced heart disease consultation and referral for genetic testing in this population.</p>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":" ","pages":"133643"},"PeriodicalIF":3.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674700","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":"Reply to comments on “impact of PCSK9 inhibitors on bleeding and adverse outcomes in post-PCI patients undergoing antiplatelet therapy: A real-world cohort study”","authors":"Jia-Yi Ren, Hao Zhang, Tong Liu, Kang-Yin Chen","doi":"10.1016/j.ijcard.2025.133617","DOIUrl":"10.1016/j.ijcard.2025.133617","url":null,"abstract":"","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"439 ","pages":"Article 133617"},"PeriodicalIF":3.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667586","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":"Reply to Comment on “Association between device-detected subclinical atrial fibrillation and diabetes in patients with implantable cardioverter defibrillators: A propensity score-matched analysis”","authors":"Giovanni Malanchini , Eduardo Celentano","doi":"10.1016/j.ijcard.2025.133619","DOIUrl":"10.1016/j.ijcard.2025.133619","url":null,"abstract":"","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"439 ","pages":"Article 133619"},"PeriodicalIF":3.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144662765","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}
Xiaolin Su , Miaohan Qiu , Haiwei Liu , Kai Xu , Xiaozeng Wang , Jing Li , Yi Li , Yaling Han
{"title":"Prolonged dual antiplatelet therapy strategy in acute coronary syndrome patients post-standard therapy and adverse event-free: An analysis based on OPT-CAD risk score stratification","authors":"Xiaolin Su , Miaohan Qiu , Haiwei Liu , Kai Xu , Xiaozeng Wang , Jing Li , Yi Li , Yaling Han","doi":"10.1016/j.ijcard.2025.133636","DOIUrl":"10.1016/j.ijcard.2025.133636","url":null,"abstract":"<div><h3>Background</h3><div>The optimal antiplatelet strategy for patients with acute coronary syndrome (ACS) after the standard 12-month dual antiplatelet therapy (DAPT) is still a matter of concern. We aimed to apply the OPT-CAD score for risk stratification and to identify those who would derive benefit from prolonged DAPT beyond 12 months.</div></div><div><h3>Methods</h3><div>In this post hoc analysis of OPT-CAD study, 7154 patients with ACS, who completed 12-month DAPT without any adverse events, were divided into low-risk (<em>n</em> = 4171) and medium-to-high-risk (<em>n</em> = 2983) groups based on the OPT-CAD risk score. The primary endpoint was ischemic events, defined as the composite of cardiac death, myocardial infarction (MI) or stroke occurring between 12 and 24 months. The secondary endpoints included all-cause death and Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding.</div></div><div><h3>Results</h3><div>After propensity score matching, in low-risk patients, ischemic events, all-cause death and BARC type 3 or 5 bleeding were comparable between prolonged DAPT and single antiplatelet therapy (SAPT) regimens. However, among the medium-to-high-risk patients, prolonged DAPT was associated with a reduction in ischemic events (hazard ratio [HR] 0.48, 95 % confidence intervals [CI] 0.29–0.81, <em>P</em> = 0.0062) and all-cause death (HR 0.44, 95 %CI 0.21–0.89, <em>P</em> = 0.0220) without apparently increasing the risk of BARC type 3 or 5 bleeding (HR 1.49, 95 %CI 0.25–8.92, <em>P</em> = 0.6622).</div></div><div><h3>Conclusions</h3><div>The OPT-CAD risk score demonstrated moderate ability to predict long-term ischemic events and all-cause mortality in patients with ACS who completed the standard 12-month DAPT without adverse events, and might help identify those more likely to derive benefit from prolonged DAPT.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"439 ","pages":"Article 133636"},"PeriodicalIF":3.2,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667584","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}
Xiao Xu , Zihan Liu , Zhihao Liu , Zeyan Li , Yuyang Zhou , Huixin Zhou , Wuping Tan , Chen Peng , Siyi Cheng , Yueyi Wang , Liping Zhou , Xiaoya Zhou , Hong Jiang
{"title":"Increased sympathetic outflow induced by ventromedial hypothalamic nucleus activation aggravates cardiac electrophysiology disturbance after myocardial ischemia–reperfusion injury","authors":"Xiao Xu , Zihan Liu , Zhihao Liu , Zeyan Li , Yuyang Zhou , Huixin Zhou , Wuping Tan , Chen Peng , Siyi Cheng , Yueyi Wang , Liping Zhou , Xiaoya Zhou , Hong Jiang","doi":"10.1016/j.ijcard.2025.133634","DOIUrl":"10.1016/j.ijcard.2025.133634","url":null,"abstract":"<div><h3>Background and aims</h3><div>The ventromedial hypothalamus (VMH) is the key brain region related to emotional stress and sympathetic activity, which can exacerbate myocardial ischemia–reperfusion (I/R) injury and induce severe ventricular arrhythmia (VA). We aim to investigate the role of increased sympathetic outflow induced by VMH activation after myocardial I/R injury, especially the changes of cardiac electrical activity.</div></div><div><h3>Methods</h3><div>Sprague-Dawley rats were divided randomly into the Sham, I/R, hM3d(Gq) and hM4d(Gi) groups, with VMH specifically activated or inhibited using Designer Receptors Exclusively Activated Designer Drugs (DREADDs) technology. I/R model was inducted by ligation of the left coronary artery for 45 min. After 24 h of reperfusion, electrocardiogram and cardiac electrophysiological studies were conducted. Then the samples were collected for histopathological and molecular analyses.</div></div><div><h3>Results</h3><div>VMH was chemogenetically manipulated using DREADDs. The activation of VMH significantly increased systemic and local cardiac sympathetic activity, aggravating I/R injury, which reduced following VMH inhibition. The ventricular electrophysiology disturbance exacerbated following VMH activation and ameliorated following VMH inhibition. The expression of myocardial potassium channel including the rapid delayed rectifier potassium channel (Kcnd3), the inward rectifier potassium channel (Kcnj2) and the slow delayed rectifier potassium channel (Kcnq1) was markedly suppressed following VMH activation, which may represent a key mechanism underlying repolarization abnormalities and increased VA susceptibility.</div></div><div><h3>Conclusions</h3><div>VMH activation exacerbated cardiac electrophysiology disturbance and increased the susceptibility of VA after I/R injury via increased sympathetic outflow, a process closely linked to repolarization impairment caused by potassium channel dysfunction.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"439 ","pages":"Article 133634"},"PeriodicalIF":3.2,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144665498","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}