International journal of cardiology最新文献

{"title":"Machine learning risk-prediction model for in-hospital mortality in Takotsubo cardiomyopathy","authors":"Ankit Agrawal,&nbsp;Umesh Bhagat,&nbsp;Aro Daniela Arockiam,&nbsp;Elio Haroun,&nbsp;Michael Faulx,&nbsp;Milind Y. Desai,&nbsp;Wael Jaber,&nbsp;Venu Menon,&nbsp;Brian Griffin,&nbsp;Tom Kai Ming Wang","doi":"10.1016/j.ijcard.2025.133181","DOIUrl":"10.1016/j.ijcard.2025.133181","url":null,"abstract":"<div><h3>Background</h3><div>Takotsubo cardiomyopathy (TC) is an acute heart failure syndrome characterized by transient left ventricular dysfunction, often triggered by stress. Data on risk scores predicting mortality in TC is sparse. We developed a machine-learning risk score model to predict in-hospital mortality in patients with TC.</div></div><div><h3>Methods</h3><div>The National Inpatient Sample (NIS) database 2016–2020 was queried to identify adult patients (≥18 years) with TC using ICD-10 code I51.81. The primary outcome was in-hospital mortality. The dataset was randomly split into training (70 %), validation (20 %), and testing (10 %) dataset. Model performance was assessed using the area under the curve (AUC) with 95 % confidence intervals (95 % CI).</div></div><div><h3>Results</h3><div>Amongst 38,662 TC patients identified [mean age 67.15 ± 14.17 years, female 32,089 (83 %)], 2499 (6.5 %) died. A novel risk score (0–127) was developed on age, race, Elixhauser comorbidity burden, history of hypertension, history of cardiac arrhythmia, presentation of cardiac arrest, cardiogenic shock, and acute kidney injury. Model AUCs (95 % CI) in the training, validation, and testing datasets were 0.809 (0.781–0.838), 0.809 (0.780–0.837), and 0.838 (0.820–0.856), respectively.</div></div><div><h3>Conclusion</h3><div>TC carries high morbidity and mortality. Our novel machine learning-based risk score is an important tool for risk stratification. External validation is needed to confirm these findings.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"430 ","pages":"Article 133181"},"PeriodicalIF":3.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathophysiology of heart failure with preserved ejection fraction in overweight and obesity - Clinical and treatment implications","authors":"Mariana M. Rodrigues ,&nbsp;L. Menezes Falcão","doi":"10.1016/j.ijcard.2025.133182","DOIUrl":"10.1016/j.ijcard.2025.133182","url":null,"abstract":"<div><div>Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome with vast prevalence worldwide. Despite recent advances in understanding its pathophysiology, HFpEF remains under-diagnosed in clinical practice. Obesity-related HFpEF is a distinct and frequent phenotype with an additionally challenging diagnosis. We address the importance of overweight and obesity in HFpEF, focusing on the influence of adipose tissue in inflammation and neurohormonal activity. We also discuss atrial and ventricular remodelling in obesity-related HFpEF and potential clinical implications.</div><div>Obesity is an independent risk factor for HFpEF. Adipose tissue synthesizes aldosterone, causing lower levels of natriuretic peptide. Adipocytes dysfunction promotes a pro-inflammatory state and leads to extracellular matrix remodelling and consequently stiffening of the heart and vessels. Thus, the quantity, distribution and quality of the excess fat influences cardiovascular risk. Visceral and epicardial adipose tissue are often associated with an increased likelihood of developing HFpEF. Obesity-related HFpEF presents higher risk of left ventricular concentric remodelling and inadequate accommodation of the expanded volume due to the obesity, resulting in higher left ventricular filling pressure. Nevertheless, microvascular endothelium inflammation modifies cardiomyocyte elasticity and increases collagen deposition, which enhances myocardial fibrosis and results in HFpEF. Furthermore, neurohormonal activation may also contribute to cardiac remodelling by inducing plasma volume expansion. In turn, leptin also stimulates aldosterone synthesis and enhances renin–angiotensin–aldosterone system.</div><div>Obesity-related HFpEF presents worse overall prognosis, with increased risk of heart failure hospitalization and all-cause mortality. Intentional weight loss through caloric restriction, physical activity, pharmacological intervention and/or bariatric surgery are promising strategies.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"430 ","pages":"Article 133182"},"PeriodicalIF":3.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691973","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 challenge of interpreting t-wave inversion in athletes","authors":"Alessandro Zorzi,&nbsp;Francesca Graziano,&nbsp;Domenico Corrado","doi":"10.1016/j.ijcard.2025.133169","DOIUrl":"10.1016/j.ijcard.2025.133169","url":null,"abstract":"","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"430 ","pages":"Article 133169"},"PeriodicalIF":3.2,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673785","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":"Cumulative plaque burden analysis for phenotyping epicardial coronary artery disease","authors":"Tsung-Ying Tsai ,&nbsp;Pruthvi C. Revaiah ,&nbsp;Ali Aldujeli ,&nbsp;Kotaro Miyashita ,&nbsp;Akihiro Tobe ,&nbsp;Takashi Muramatsu ,&nbsp;Ken Kozuma ,&nbsp;Hideyuki Kawashima ,&nbsp;Yuki Ishibashi ,&nbsp;Gaku Nakazawa ,&nbsp;Kuniaki Takahashi ,&nbsp;Takayuki Okamura ,&nbsp;Yosuke Miyazaki ,&nbsp;Masato Nakamura ,&nbsp;Norihiro Kogame ,&nbsp;Taku Asano ,&nbsp;Yuki Katagiri ,&nbsp;Scot Garg ,&nbsp;Christos Bourantas ,&nbsp;Patrick W. Serruys ,&nbsp;Yoshinobu Onuma","doi":"10.1016/j.ijcard.2025.133173","DOIUrl":"10.1016/j.ijcard.2025.133173","url":null,"abstract":"<div><h3>Background</h3><div>Intravascular ultrasound (IVUS) reveals the location and burden of coronary artery disease (CAD) but is traditionally limited to segment-level analysis. We introduced the cumulative plaque burden index (CPBi), derived from AI-powered quantitative IVUS analysis, to characterize CAD morphological patterns across the entire vessel.</div></div><div><h3>Methods</h3><div>In this ASET JAPAN sub-study, pre- and post-percutaneous coronary intervention (PCI) IVUS and angiography were analyzed. Plaque burden was quantified per millimeter on the pre-PCI IVUS. After filtering out plaque burden &lt;40 %, CPB curves were generated to visualize morphological patterns. CPBi, a continuous metric derived from the CPB curves, was calculated to represent morphological patterns, with lower values indicating diffuse disease. Physiological CAD patterns were characterized by Murray law-based quantitative flow ratio (μFR)-derived pullback pressure gradient (PPG). Percentage reclassification was analyzed by comparing CPBi-derived CAD patterns with those derived from visual assessment and μFR-derived PPG.</div></div><div><h3>Results</h3><div>CPB analysis was feasible in 130 out of 138 vessels, quantifying 8101 mm of plaque burden. The Median CPB index (CPBi) was 0.45[0.32–0.58], significantly correlating with μFR-derived PPG (<em>r</em> = 0.35, <em>p</em> &lt; 0.001). Diffuse morphological pattern (low CPBi tertile) was associated with higher percent atheroma volume, longer segments with ≥40 % plaque burden, and longer stents. CPBi reclassified 55.4 % of visually assessed and 46.2 % of μFR-derived CAD patterns.</div></div><div><h3>Conclusions</h3><div>AI enables quantitative plaque burden analysis of the entire IVUS pullback, allowing visualization of morphological patterns via CPB curves and quantification with CPBi, which is associated with atherosclerosis severity and hemodynamics. Future studies need to validate the clinical implications of CPB analysis.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"430 ","pages":"Article 133173"},"PeriodicalIF":3.2,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673781","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":"Mortality after left main coronary artery bifurcation intervention; is it treatment or disease related?","authors":"Mohamed Salah Abdelbasit","doi":"10.1016/j.ijcard.2025.133178","DOIUrl":"10.1016/j.ijcard.2025.133178","url":null,"abstract":"","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"429 ","pages":"Article 133178"},"PeriodicalIF":3.2,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673783","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":"DNA hypermethylation of MED1 and MED23 as early diagnostic biomarkers for unsolved issues in atrial fibrillation","authors":"Concetta Schiano ,&nbsp;Teresa Infante ,&nbsp;Giuditta Benincasa ,&nbsp;Jacopo Burrello ,&nbsp;Antonio Ruocco ,&nbsp;Ciro Mauro ,&nbsp;Mark E. Pepin ,&nbsp;Francesco Donatelli ,&nbsp;Ciro Maiello ,&nbsp;Enrico Coscioni ,&nbsp;Claudio Napoli","doi":"10.1016/j.ijcard.2025.133179","DOIUrl":"10.1016/j.ijcard.2025.133179","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide. Much effort was spent to identify biomarkers useful to stratify AF patients. Mediator complex (MED) is an ancestral regulator of transcriptional mechanisms. Here, we investigated the role of methyl DNA-MED regulatory networks in AF patients.</div></div><div><h3>Methods</h3><div>We analyzed the methylome of circulating CD4⁺T lymphocytes isolated from patients at the time of first AF diagnosis vs. healthy subjects for identifying epigenetic dysregulation of MED-related genes.</div></div><div><h3>Results</h3><div>We identified 10 differentially methylated regions (DMRs) which were hypermethylated and annotated to 10 genes encoding for MED complex subunits in CD4⁺T lymphocytes of AF patients vs. healthy subjects (HS). Network-oriented analysis prioritized 6 subunits including MED1, MED13, MED15, MED17, MED23 and MED30, which enriched significantly lipid metabolism pathways and cardiopathy onset. ROC curve analysis showed that elevated methylation levels of MED1 and MED23 discriminated AF patients with an area under the curve (AUC) of 92.7 % (<em>p</em> &lt; 0.001) and an AUC = 100 % (p &lt; 0.001), respectively. Methylation levels of MED23 correlated with the presence of mitral valve disease (<em>p</em> &lt; 0.05) and NT-proBNP (p &lt; 0.05); moreover, MED23 had a not inferior diagnostic value than circulating levels of NT-proBNP (AUC = 0.923, <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>For the first time, we showed that DNA methylation changes are associated with regulation of MED complex subunits in early diagnosis of AF patients. Clinically, MED1 and MED23 hypermethylation showed a diagnostic value not inferior to circulating levels of NT-proBNP suggesting early diagnostic biomarker pathogenic molecular routes underlying disease onset.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"429 ","pages":"Article 133179"},"PeriodicalIF":3.2,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of radiofrequency versus cryoballoon ablation on left atrial calcification after atrial fibrillation ablation: A propensity score-matched comparison","authors":"Yusuke Hayashi,&nbsp;Miyako Igarashi,&nbsp;Hiro Yamasaki,&nbsp;Yuto Iioka,&nbsp;Tabito Kino,&nbsp;Yuichi Hanaki,&nbsp;Akira Kimata,&nbsp;Kojiro Ogawa,&nbsp;Yuki Komatsu,&nbsp;Tomoko Ishizu","doi":"10.1016/j.ijcard.2025.133177","DOIUrl":"10.1016/j.ijcard.2025.133177","url":null,"abstract":"<div><h3>Introduction</h3><div>Left atrial calcification (LAC) following atrial fibrillation (AF) ablation is associated with major adverse cardiovascular events, with prior reports focusing on radiofrequency catheter ablation (RFCA) rather than cryoballoon ablation (CBA). The aim of this study was to investigate the frequency of LAC and stiff LA physiology (SLAP) in patients undergoing CBA as the initial therapy for AF, compared with those undergoing RFCA, using a propensity score-matched (PSM) population.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study involving 2680 consecutive patients who underwent AF ablation with RFCA or CBA. Patients with rheumatic valve disease or mitral valve replacement, those undergoing dialysis, and those without postoperative computed tomography (CT) imaging were excluded. CT images acquired ≥1 year after the initial procedure were used to evaluate the LAC.</div></div><div><h3>Results</h3><div>In total, 473 eligible patients were identified. PSM created 125 pairs. After a median follow-up of 4.7 years, 9 (4 %) of 250 patients presented with LAC. Those who underwent CBA had a significantly lower incidence of LAC and SLAP compared to those who underwent RFCA (LAC: 1 % vs. 6 %, <em>P</em> = 0.03; SLAP: 1 % vs. 9 %, <em>P</em> = 0.005). Right ventricular systolic pressure significantly increased in the RFCA group (pre-ablation: 23 ± 8 vs. post-ablation: 26 ± 8, <em>P</em> = 0.01), but remained unchanged in the CBA group (pre-ablation: 23 ± 7 vs. post-ablation: 23 ± 8, <em>P</em> = 0.88).</div></div><div><h3>Conclusions</h3><div>The use of CBA as the initial ablation seems to have clinical benefits in preventing LAC and SLAP compared to RFCA.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"429 ","pages":"Article 133177"},"PeriodicalIF":3.2,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669825","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 mitral valve reoperation and first-time surgery for mitral regurgitation: A nationwide study","authors":"Sofie Truong ,&nbsp;Jeppe Petersen ,&nbsp;Eva Havers-Borgersen ,&nbsp;Liv Borum Schöps ,&nbsp;Morten Smerup ,&nbsp;Lars Køber ,&nbsp;Emil Fosbøl ,&nbsp;Lauge Østergaard","doi":"10.1016/j.ijcard.2025.133175","DOIUrl":"10.1016/j.ijcard.2025.133175","url":null,"abstract":"<div><h3>Background</h3><div>While mitral reoperation has been assumed to carry higher surgical risk than first-time mitral surgery, outcomes of this procedure remain uncertain.</div></div><div><h3>Aims</h3><div>To examine characteristics and outcomes associated with mitral valve reoperation and first-time surgery for mitral regurgitation.</div></div><div><h3>Methods</h3><div>Patients undergoing surgery for mitral regurgitation were identified using Danish nationwide registries. The population was categorized into 1) patients undergoing first-time mitral surgery, 2) patients undergoing mitral reoperation. Mortality rates were examined during 180-day follow-up using Reverse Kaplan-Meier and Multivariable Cox-analysis.</div></div><div><h3>Results</h3><div>In total, 7734 patients underwent surgery for mitral regurgitation. Of these, 428 patients also underwent mitral reoperation. Compared to first-time surgery, reoperated patients were younger (median 64.9 and 66.7 years) and had more cardiovascular comorbidities including atrial fibrillation (61.6 % and 38.8 %) and heart failure (48.7 % and 29.9 %). Median time to reoperation was 2.3 years. Prosthetic replacement was performed in 34.0 % of first-time surgeries and 78.7 % of reoperations. Mortality was 7.1 % following first-time surgery and 10.1 % following reoperation. Following first-time surgery, factors associated with increased mortality rate was prior myocardial infarction (HR = 1.98, 95 %CI 1.62–2.41), heart failure (HR = 1.59, 95 %CI 1.33–1.90), concomitant aortic valve surgery (HR = 1.61–1.27, 95 % CI 1.27–2.02) and bypass grafting (HR = 1.58, 95 %CI 1.31–1.91). Following reoperation, heart failure was associated with increased mortality rate (HR = 2.23, 95 %CI 1.17–4.60).</div></div><div><h3>Conclusions</h3><div>Patients undergoing mitral reoperation are young but have developed high burden of comorbidities at the time of reoperation. In spite of this, outcomes of mitral reoperation were acceptable, reflecting that this procedure can be performed safely in selected patients.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"430 ","pages":"Article 133175"},"PeriodicalIF":3.2,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation between workload-indexed blood pressure response to exercise (SBP/MET slope) and clinical and echocardiographic parameters among normotensive Olympic athletes","authors":"Giuseppe Di Gioia ,&nbsp;Armando Ferrera ,&nbsp;Viviana Maestrini ,&nbsp;Sara Monosilio ,&nbsp;Andrea Serdoz ,&nbsp;Antonio Nenna ,&nbsp;Federica Mango ,&nbsp;Maria Rosaria Squeo ,&nbsp;Antonio Pelliccia","doi":"10.1016/j.ijcard.2025.133171","DOIUrl":"10.1016/j.ijcard.2025.133171","url":null,"abstract":"<div><h3>Introduction</h3><div>The workload-indexed systolic blood pressure response to exercise (SBP/MET slope) has been proposed as a novel parameter for evaluating abnormal blood pressure response to exercise (ABPR) and its potential risks.</div><div>Aim of our study was to assess the association between SBP/MET slope and clinical and cardiac dimensional parameters in normotensive athletes.</div></div><div><h3>Methods</h3><div>A cohort of 292 normotensive Olympic athletes (155 male, 53.1 %) underwent a pre-participation evaluation that included clinical, echocardiographic, and exercise-stress test parameters. The SBP/MET slope was calculated as the increase in systolic blood pressure indexed to metabolic equivalents achieved during maximal exercise. Athletes were stratified into quartiles based on their SBP/MET slope, and comparisons across quartiles were made.</div></div><div><h3>Results</h3><div>Athletes in the highest SBP/MET slope quartile exhibited increased left ventricular wall thickness, i.e., interventricular septum (IVS) compared to those in lower quartiles (10.3 ± 0.9 vs. 9.5 ± 1.1, <em>p</em> = 0.014). Male athletes predominated in higher quartiles (<em>p</em> = 0.047), and endurance athletes were absent in the higher groups (<em>p</em> = 0.006). No differences were observed for systolic or diastolic function across quartiles. At multivariate analysis, SBP/MET slope was indipendently correlated to IVS (<em>p</em> = 0.040; R² = 0.566, standardized beta coefficient = 0.368) and inversely correlated to W/Kg (<em>p</em> = 0.014; R² = 0.566, standardized beta coefficient = −0.507). After a follow-up of 10.3 ± 2.6 years, 13.6 % of athletes in the highest quartile developed hypertension.</div></div><div><h3>Conclusion</h3><div>Athletes with higher SBP/MET slope exhibited increased wall thickness and lower exercise capacity and showed higher risk for late-onset hypertension.</div><div>Long-term follow-up studies are warranted to further elucidate its prognostic implications.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"429 ","pages":"Article 133171"},"PeriodicalIF":3.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143643919","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 prognostic role of Fibrosis-4 score in heart failure with reduced ejection fraction","authors":"Abdullahi A. Mohamed ,&nbsp;Daniel M. Christensen ,&nbsp;Milan Mohammad ,&nbsp;Lise L. Gluud ,&nbsp;Filip K. Knop ,&nbsp;Tor Biering-Sørensen ,&nbsp;Christian Torp-Pedersen ,&nbsp;Charlotte Andersson ,&nbsp;Morten Schou ,&nbsp;Gunnar Gislason","doi":"10.1016/j.ijcard.2025.133174","DOIUrl":"10.1016/j.ijcard.2025.133174","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure with reduced ejection fraction (HFrEF) and metabolic dysfunction-associated steatotic liver disease (MASLD) are both associated with liver fibrosis. HFrEF patients may develop liver fibrosis due to hepatic congestion, MASLD, or a combination of both. The Fibrosis-4 (FIB-4) score calculated using age, aspartate aminotransferase, alanine aminotransferase, and platelet count, serves as a screening tool for advanced liver fibrosis. This study examines the association between the FIB-4 score and all-cause mortality, cardiovascular mortality, and major adverse liver outcomes (MALO) in patients with HFrEF.</div></div><div><h3>Method and results</h3><div>This study included 4523 HFrEF patients from the Danish Heart Failure Registry. Based on FIB-4 score, 25.5 % were low-risk, 45.7 % were indeterminate-risk, and 28.8 % were high-risk for advanced liver fibrosis. After five years, the cumulative incidence of all-cause mortality was 43 % for the high-risk group, 36 % for the indeterminate-risk group, and 23 % for the low-risk group. The indeterminate-risk and high-risk group had an increased hazard ratio (HR) for all-cause mortality (HR 1.33, 95 % confidence interval [CI] 1.16–1.52; HR 1.51, 95 % CI 1.31–1.74) compared to the low-risk group. Similarly, HRs were elevated for cardiovascular mortality (HR 1.61, 95 % CI 1.27–2.05; HR 2.14, 95 % CI 1.67–2.74) and MALO (HR 1.77, 95 % CI 1.01–3.31; HR 2.54, 95 % CI 1.43–4.52).</div></div><div><h3>Conclusion</h3><div>A high FIB-4 score in patients with HFrEF is associated with increased mortality and MALO.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"429 ","pages":"Article 133174"},"PeriodicalIF":3.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}