International journal of cardiology最新文献

{"title":"Impaired atrioventricular time interaction contributes to tachycardia-induced hemodynamic deterioration: In vivo and in silico hybrid approach","authors":"Takuya Nishikawa ,&nbsp;Hiroki Matsushita ,&nbsp;Masahiro Otake ,&nbsp;Shohei Yokota ,&nbsp;Midori Kakuuchi ,&nbsp;Kei Sato ,&nbsp;Hidetaka Morita ,&nbsp;Nana Hiraki ,&nbsp;Kenta Ohba ,&nbsp;Yuki Yoshida ,&nbsp;Masafumi Fukumitsu ,&nbsp;Kazunori Uemura ,&nbsp;Toru Kawada ,&nbsp;Kengo Kusano ,&nbsp;Keita Saku","doi":"10.1016/j.ijcard.2026.134192","DOIUrl":"10.1016/j.ijcard.2026.134192","url":null,"abstract":"<div><h3>Background</h3><div>Heart rate (HR) is a major determinant of cardiac output (CO). During tachycardia, adequate left ventricular (LV) filling becomes important; however, excessive tachycardia reduces CO by shortening filling time. The impact of HR on hemodynamics differs according to the underlying cardiac pathological conditions, making HR management challenging. The atrioventricular (AV) time interaction, which represents the temporal coordination between atrial and ventricular functions for optimal LV filling, is key to effective HR management during tachycardia. This study aimed to elucidate tachycardia-induced hemodynamic deterioration by focusing on AV time interaction.</div></div><div><h3>Methods</h3><div>A hybrid approach combining animal experiments and computer simulations was employed. In animal experiments, hemodynamics and mitral valve (MV) flow at HR of 90–180 bpm were recorded in eight beagles. The relationship among LV end-diastolic pressure (LVEDP), left atrial pressure (LAP), and changes in MV E–A waves were evaluated. In simulation experiments, hemodynamics at HR of 50–150 bpm were analyzed using a cardiovascular mathematical model across five pathological conditions.</div></div><div><h3>Results</h3><div>In animal experiments, CO peaked at HR of 130–140 bpm, coinciding with MV E–A wave fusion and a decreased LVEDP/LAP ratio. Simulation studies showed effective tachycardic compensation in systolic and diastolic dysfunction. However, prolonged relaxation time and prolonged AV delay led to decreased CO at high HR.</div></div><div><h3>Conclusions</h3><div>AV time interaction manifests as E–A wave fusion and decreased LVEDP/LAP ratio. Simulation studies suggest that conditions directly affecting filling time significantly impair AV time interaction and lead to circulatory deterioration during tachycardia. These findings highlight the importance of individualized HR management.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"449 ","pages":"Article 134192"},"PeriodicalIF":3.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046580","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":"Predicting functional results of percutaneous coronary intervention using machine learning modelling","authors":"Simone Fezzi ,&nbsp;Yueyun Zhu ,&nbsp;Norma Bargary ,&nbsp;Daixin Ding ,&nbsp;Roberto Scarsini ,&nbsp;Mattia Lunardi ,&nbsp;Antonio Maria Leone ,&nbsp;Concetta Mammone ,&nbsp;Max Wagener ,&nbsp;Angela McInerney ,&nbsp;Gabor G. Toth ,&nbsp;Gabriele Pesarini ,&nbsp;David Connolly ,&nbsp;Carlo Trani ,&nbsp;Shengxian Tu ,&nbsp;Francesco Burzotta ,&nbsp;Flavio Ribichini ,&nbsp;Andrew J. Simpkin ,&nbsp;William Wijns","doi":"10.1016/j.ijcard.2026.134183","DOIUrl":"10.1016/j.ijcard.2026.134183","url":null,"abstract":"<div><h3>Background</h3><div>Post-percutaneous coronary intervention (PCI) Murray's law-based quantitative flow ratio (μFR) is associated with long-term clinical outcomes. A tool capable of accurately predicting post-PCI μFR <em>before</em> intervention could support procedural planning, reduce the risk of suboptimal physiological results, and improve prognosis.</div></div><div><h3>Objectives</h3><div>To develop and validate machine-learning models that predict continuous post-PCI μFR using only pre-procedural angiographic, physiological and clinical data, and to assess their ability to classify PCI outcomes as optimal (μFR ≥ 0.91) or sub-optimal (μFR &lt; 0.91).</div></div><div><h3>Methods</h3><div>Four machine learning models were trained using pre-PCI variables. Internal bootstrap validation (1000 iterations) identified the best-performing model based on lowest root mean square error (RMSE) for continuous prediction. Predicted μFR values were subsequently used to classify PCI outcomes.</div></div><div><h3>Results</h3><div>In 343 vessels (291 patients), machine learning achieved high accuracy for continuous post-PCI μFR prediction (RMSE 0.036; 95% CI: 0.033–0.040; mean absolute error 0.030; 95% CI: 0.027–0.032; mean absolute percentage error 3.2%; 95% CI: 2.9–3.5), indicating reliable estimation of post-PCI μFR using only pre-procedural data. When the predicted μFR was used to classify PCI outcomes, performance remained clinically meaningful, with accuracy 0.72 (95% CI: 0.70–0.75), area under the curve 0.72 (95% CI: 0.69–0.74), sensitivity 0.90 (95% CI: 0.88–0.93), and specificity 0.29 (95% CI: 0.23–0.34). The high sensitivity ensures reliable upfront identification of vessels likely to achieve optimal physiology.</div></div><div><h3>Conclusions</h3><div>Machine-learning models accurately predict post-PCI μFR and reliably distinguish optimal from sub-optimal outcomes <em>before</em> intervention. This approach supports personalized PCI planning and improves strategy selection.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"449 ","pages":"Article 134183"},"PeriodicalIF":3.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146003435","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":"Fast cardiac magnetic resonance (CMR) protocol for biventricular functional assessment and tissue characterisation","authors":"Andrea Baggiano ,&nbsp;Federica Rocca ,&nbsp;Andrea Daniele Annoni ,&nbsp;Francesco Cannata ,&nbsp;Maria Ludovica Carerj ,&nbsp;Fabrizio Celeste ,&nbsp;Nicola Cosentino ,&nbsp;Alberico Del Torto ,&nbsp;Fabio Fazzari ,&nbsp;Alberto Formenti ,&nbsp;Antonio Frappampina ,&nbsp;Laura Fusini ,&nbsp;Sarah Ghulam Ali ,&nbsp;Paola Gripari ,&nbsp;Daniele Junod ,&nbsp;Margherita Celeste Licastro ,&nbsp;Anna Maltagliati ,&nbsp;Maria Elisabetta Mancini ,&nbsp;Valentina Mantegazza ,&nbsp;Riccardo Maragna ,&nbsp;Gianluca Pontone","doi":"10.1016/j.ijcard.2026.134197","DOIUrl":"10.1016/j.ijcard.2026.134197","url":null,"abstract":"<div><h3>Background</h3><div>Clinical use of cardiovascular magnetic resonance (CMR), reference tool for cardiac function and myocardial tissue assessment, is frequently limited by long acquisition times. This study aimed to compare conventional “standard protocol” (ASSET bSSFP cine plus 2D single-segment PSIR LGE) with novel “fast protocol” incorporating deep-learning reconstruction (Sonic DL bSSFP cine and 2D multisegment PSIR LGE with AIR Recon DL), focusing on image quality, functional measurements, myocardial characterisation, and overall scan duration.</div></div><div><h3>Methods and results</h3><div>One-hundred consecutive patients with known or suspected myocardial disease underwent both protocols. Participants were predominantly male (78%), mean age 52 ± 16 years, mean BMI 25.0 ± 4.3 kg/m². Clinical indications included arrhythmias (26%), hypertrophic cardiomyopathy (19%), and coronary artery disease (13%). Cine image quality was comparable between ASSET bSSFP and Sonic DL bSSFP (Likert score 4.59 vs 4.56, <em>p</em> = 0.682), with no differences in ventricular size, function, or left ventricle mass. However, Sonic DL cine markedly shortened acquisition time for long-axis and short-axis stacks (38 vs 61 s and 125 vs 227 s respectively, both <em>p</em> &lt; 0.001). Similarly, 2D-MS PS LGE preserved diagnostic quality (Likert score 4.60 vs 4.51) while reducing acquisition time for long-axis and short-axis stacks (25 vs 77 s and 78 vs 302 s respectively, both p &lt; 0.001). The “fast” protocol reduced total scan time by nearly 60%, enabling comprehensive CMR completion in under 10 min.</div></div><div><h3>Conclusions</h3><div>A deep learning-based “fast” CMR protocol significantly reduces scan time without compromising volumetric accuracy or image quality, resulting a feasible option for routine clinical practice.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"449 ","pages":"Article 134197"},"PeriodicalIF":3.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113099","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":"Effects beyond prognosis: Do SGLT2 inhibitors prevent electrical dyssynchrony in HFpEF?","authors":"Omar Hajji,&nbsp;Mohammad Abumayyaleh,&nbsp;Ibrahim Akin,&nbsp;Tobias Schupp","doi":"10.1016/j.ijcard.2026.134213","DOIUrl":"10.1016/j.ijcard.2026.134213","url":null,"abstract":"","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"449 ","pages":"Article 134213"},"PeriodicalIF":3.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105422","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":"Impact of G protein-coupled receptor autoantibodies on clinical outcomes in patients with ST-segment elevation myocardial infarction","authors":"Xiaosong Ding ,&nbsp;Wenxi Dang ,&nbsp;Weiping Li ,&nbsp;Man Wang ,&nbsp;Yue Zhang ,&nbsp;Hui Chen ,&nbsp;Shun Li ,&nbsp;Ning Cao","doi":"10.1016/j.ijcard.2026.134185","DOIUrl":"10.1016/j.ijcard.2026.134185","url":null,"abstract":"<div><h3>Background</h3><div>G protein-coupled receptor autoantibodies (GPCR-AAs) have been implicated in various cardiovascular disorders. However, their prognostic value for major adverse cardiovascular events (MACEs) in patients with ST-segment elevation myocardial infarction (STEMI) remains unclear.</div></div><div><h3>Methods</h3><div>In this prospective cohort study, 436 STEMI patients undergoing primary percutaneous coronary intervention (PPCI) completed a one-year follow-up. Serum levels of five GPCR-AAs (β₁-, β₂-, α₁-, AT₁-, and M₂-AAs) were measured at admission using ELISA. Patients were grouped based on the occurrence of MACEs, and associations of GPCR- AAs with MACEs were evaluated using multivariate Cox regression.</div></div><div><h3>Results</h3><div>Compared with the non-MACEs group, the optical density (OD) values and positivity rates of the β₁-AA levels (69.6% vs 19.6%) and M₂-AA levels (82.6% vs 60.2%) in patients with STEMI were significantly higher in the MACEs group. Multivariate Cox regression analysis revealed that β₁-AA [HR (95% CI) 1.11 (1.06–1.16), <em>p</em> &lt; 0.001] and M₂-AA [HR (95%CI) 1.14 (1.05–1.23), <em>p</em> = 0.001] were regarded as predictors for the incidence of MACEs in patients with STEMI after PPCI. The combination of β₁-AA and M₂-AA has the highest predictive performance for MACEs. The area under the curve (AUC) of the integrated 2-marker panel was 0.807 (95% CI, 0.75–0.86, <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Elevated β₁- and M₂-Autoantibody levels at admission are independent predictors of one-year MACEs in STEMI patients undergoing PPCI. Their combined assessment enhances early risk stratification for guiding post-infarction management.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"449 ","pages":"Article 134185"},"PeriodicalIF":3.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146010165","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":"Trends in immune checkpoint inhibitor related myocarditis: A decade of insights","authors":"Milagros Pereyra Pietri ,&nbsp;Juan M. Farina ,&nbsp;Isabel G. Scalia ,&nbsp;Ahmed K. Mahmoud ,&nbsp;Mohammed Tiseer Abbas ,&nbsp;Kamal Awad ,&nbsp;Cecilia Tagle-Cornell ,&nbsp;Joerg Herrmann ,&nbsp;Reza Arsanjani ,&nbsp;Chadi Ayoub","doi":"10.1016/j.ijcard.2026.134189","DOIUrl":"10.1016/j.ijcard.2026.134189","url":null,"abstract":"<div><h3>Background</h3><div>Immune checkpoint inhibitors (ICIs) have transformed cancer treatment, yet their use carries the risk of ICI-related myocarditis (ICIrM), a rare but potentially fatal adverse event. Although the overall incidence of ICIrM has been described, recent trends and diagnostic shifts remain poorly characterized.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 11,602 patients treated with ICIs at a multi-center institution from 2011 to 2024. ICIrM cases were identified through manual chart review, and baseline characteristics, cardiovascular events, and outcomes were assessed. The study was designed as a descriptive analysis of temporal trends in ICI therapy use and ICIrM.</div></div><div><h3>Results</h3><div>ICIrM occurred in 127 patients (1.1%), with a mean age of 66.7 ± 12.7 years and 56.5% male. Median time to onset was 45 days (IQR 106). ICI use increased steadily over the past decade, with a marked rise in ICIrM diagnoses in 2023–2024, accounting for 47.2% of all cases. Diagnostic prevalence rose from 0.5% before 2020 to 1.3% after 2020, likely reflecting enhanced recognition due to the implementation of guideline-based diagnostic criteria (Bonaca et al. and ESC-ICOS). Seasonal variation in ICIrM incidence was not observed.</div></div><div><h3>Conclusions</h3><div>The increasing incidence of ICIrM likely reflects improved clinical awareness and diagnostic practices. Continued efforts to optimize surveillance, early detection, and mitigation strategies are essential as ICI use expands globally.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"449 ","pages":"Article 134189"},"PeriodicalIF":3.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018448","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":"Neurite orientation dispersion and density imaging (NODDI) and DTI-ALPS index reveal white matter microstructural abnormalities and glymphatic-like dysfunction linked to cognitive impairment in non-stroke atrial fibrillation patients","authors":"Songhong Yue ,&nbsp;Na Han ,&nbsp;Yurong Ma ,&nbsp;Jiahao Yan ,&nbsp;Jiachen Li ,&nbsp;Mingsong Tang ,&nbsp;Dan Yang ,&nbsp;Jing Zhang ,&nbsp;Laiyang Ma","doi":"10.1016/j.ijcard.2026.134157","DOIUrl":"10.1016/j.ijcard.2026.134157","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;While associations between silent white matter hyperintensities, diffuse microstructural damage, and cognitive impairment in atrial fibrillation (AF) patients without stroke have been reported, the precise underlying pathophysiological mechanisms remain to be fully elucidated. This study aimed to characterize white matter microstructure and glymphatic function in such patients using neurite orientation dispersion and density imaging (NODDI) and the diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) index. This study aimed to investigate alterations in white matter microstructure and glymphatic function in AF patients without stroke using NODDI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A total of 43 stroke-free AF patients and 53 healthy controls were enrolled. All participants underwent brain MRI on a 3.0 T scanner. Whole-brain white matter damage was assessed using diffusion metrics, while glymphatic function was evaluated via the DTI-ALPS index. Group differences in DTI and NODDI metrics were examined using two-sample &lt;em&gt;t&lt;/em&gt;-tests. The associations between imaging measures and cognitive performance were analyzed using ordinal logistic regression and negative binomial regression, according to the data types of the respective cognitive tests. All models were adjusted for age, sex, and years of education.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;No significant differences were observed in age (&lt;em&gt;P&lt;/em&gt; = 0.869), sex (&lt;em&gt;P&lt;/em&gt; = 0.054), or education level (&lt;em&gt;P&lt;/em&gt; = 0.626) between the two groups. Significant alterations in DTI and NODDI metrics were identified in stroke-free AF patients. Compared with controls, AF patients exhibited significantly lower fractional anisotropy (FA) (&lt;em&gt;P&lt;/em&gt; &lt;sub&gt;FWE&lt;/sub&gt; &lt; 0.05), neurite density index (NDI) (&lt;em&gt;P&lt;/em&gt; &lt;sub&gt;FWE&lt;/sub&gt; &lt; 0.001), and orientation dispersion index (ODI) (&lt;em&gt;P&lt;/em&gt; &lt;sub&gt;FWE&lt;/sub&gt; &lt; 0.001), alongside higher mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) (all &lt;em&gt;P&lt;/em&gt; &lt;sub&gt;FWE&lt;/sub&gt; &lt; 0.001). Furthermore, the DTI-ALPS index was significantly lower in the AF group than in the control group (mean: 1.41 vs. 1.58, &lt;em&gt;P&lt;/em&gt; &lt;sub&gt;FDR&lt;/sub&gt; = 0.007). Multivariate regression analysis revealed that the NODDI-derived NDI and ODI were significantly associated with performance across all cognitive domains (all &lt;em&gt;P&lt;/em&gt; &lt; 0.01), establishing them as the most consistent predictors of cognitive function. In contrast, although the DTI-ALPS index was significantly reduced in the AF group (&lt;em&gt;P&lt;/em&gt; &lt; 0.05), it did not show a significant correlation with cognitive test scores.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;This study confirms that white matter neurite microstructural damage is closely associated with decline across multiple cognitive domains in stroke-free AF patients, whereas glymphatic system dysfunction appears to play a more limited role in cognitive impairment in this population. The","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"449 ","pages":"Article 134157"},"PeriodicalIF":3.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145989089","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":"Does the heart remember childhood? Oral health trajectories as early-life markers of cardiovascular risk","authors":"Adriana Barbosa Ribeiro","doi":"10.1016/j.ijcard.2026.134169","DOIUrl":"10.1016/j.ijcard.2026.134169","url":null,"abstract":"","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"449 ","pages":"Article 134169"},"PeriodicalIF":3.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145989109","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":"Beyond the valve: The long shadow of transthyretin amyloidosis in aortic stenosis","authors":"Anna Cantone ,&nbsp;Matteo Serenelli ,&nbsp;Aldostefano Porcari","doi":"10.1016/j.ijcard.2026.134196","DOIUrl":"10.1016/j.ijcard.2026.134196","url":null,"abstract":"","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"449 ","pages":"Article 134196"},"PeriodicalIF":3.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100100","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":"Left ventricular global longitudinal strain impairment during long-term hydroxychloroquine exposure","authors":"Romain Didier ,&nbsp;Charles Guenancia ,&nbsp;Sabine Berthier ,&nbsp;Géraldine Muller ,&nbsp;Jean-Francis Maillefert ,&nbsp;Evelyne Collet ,&nbsp;Martin Nivet ,&nbsp;Bernard Bonnotte ,&nbsp;Gabriel Laurent ,&nbsp;Jean Christophe Eicher","doi":"10.1016/j.ijcard.2026.134191","DOIUrl":"10.1016/j.ijcard.2026.134191","url":null,"abstract":"<div><h3>Aims</h3><div>Antimalarial-induced cardiomyopathy (AMIC) is a rare but severe and under-recognized condition. Although screening for ocular toxicity is recommended, this is not the case for cardiac damage. After observing three successive cases of AMIC, we aimed to study the association of chronic hydroxychloroquine (HCQ) intake on echocardiographic parameters in asymptomatic patients.</div></div><div><h3>Methods and results</h3><div>After analyzing the characteristics of the 3 patients diagnosed with AMIC, we systematically investigated patients treated with HCQ and referred for routine transthoracic echocardiography between September 2017 and April 2025. Patients with known heart disease or decreased left ventricular ejection fraction (LVEF) were excluded. Patients were divided into tertiles of HCQ-exposure duration (ED).</div><div>Eighty-two patients were included with a median HCQ-ED of 132 months (72–204) and a cumulative HCQ dose of 1414 g (864–2358). Global longitudinal strain (GLS) was significantly different among the three tertiles of HCQ-ED (<em>p</em> = 0.048) whereas there was no difference in LVEF, left ventricular mass or diastolic function. GLS values were significantly correlated with HCQ-ED (<em>r</em> = 0.395, <em>p</em> &lt; 0.001) and HCQ cumulative dose (<em>r</em> = 0.402, p &lt; 0.001). GLS remained significantly associated in multivariate linear regression analysis adjusted for age, female sex, creatinine and hypertension. A threshold of 1994 g had 78.6% sensitivity and 76.5% specificity for impaired GLS (&gt; − 18%).</div></div><div><h3>Conclusion</h3><div>This is the first study highlighting the association between long-term HCQ-ED and systolic dysfunction assessed by GLS in asymptomatic patients. Because of its poor prognosis, early detection of AMIC is necessary, and GLS could be an interesting tool in the screening strategy for the detection of pre-clinical alterations.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"449 ","pages":"Article 134191"},"PeriodicalIF":3.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146043784","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}