International journal of cardiology最新文献

{"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}

{"title":"Novel insights into myocardial synchrony: A CMR-based approach for improving the detection of coronary artery disease at rest","authors":"Minghui Hua ,&nbsp;Rong Liang ,&nbsp;Weizhi Nie ,&nbsp;Li Zhou ,&nbsp;Yimeng Zhang ,&nbsp;Ziyu Yan ,&nbsp;Keyi Cui ,&nbsp;Yufan Gao ,&nbsp;Boxin Li ,&nbsp;Jiwei Sun ,&nbsp;Wenjiao Wang ,&nbsp;Anhong Yu ,&nbsp;Yafang Zheng ,&nbsp;Xi Liu ,&nbsp;Feng Wang ,&nbsp;Zhen Xing ,&nbsp;Shuo Liang ,&nbsp;Jun Lv ,&nbsp;Yanhe Ma ,&nbsp;Ximing Li ,&nbsp;Hong Zhang","doi":"10.1016/j.ijcard.2026.134221","DOIUrl":"10.1016/j.ijcard.2026.134221","url":null,"abstract":"<div><h3>Background</h3><div>We aimed to develop a novel cardiac magnetic resonance (CMR)-based method for quantifying myocardial synchrony and evaluate its diagnostic value in detecting myocardial dysfunction of coronary artery disease (CAD).</div></div><div><h3>Methods</h3><div>Consecutive participants with anatomically/angiographically obstructive CAD (<em>n</em> = 112) and healthy participants (<em>n</em> = 87) undergoing CMR imaging were prospectively enrolled. Myocardial strain was analyzed using feature-tracking, and myocardial synchrony was quantified via Pearson correlation coefficients of segmental strain time series across the cardiac cycle. Machine learning models (strain-only, synchrony-only, combined) were developed and validated in an independent external cohort.</div></div><div><h3>Results</h3><div>Healthy participants exhibited high left ventricular myocardial synchrony (radial: 0.91 [IQR: 0.88, 0.93]; circumferential: 0.90 ± 0.04; longitudinal: 0.97 ± 0.02), significantly reduced in participants with CAD (radial: 0.84 [IQR: 0.75, 0.89]; circumferential: 0.81 ± 0.12; longitudinal: 0.90 ± 0.08), including those with preserved left ventricular ejection fraction (LVEF ≥50%) (radial: 0.86 [IQR: 0.82, 0.90]; circumferential: 0.86 ± 0.07; longitudinal: 0.91 ± 0.07), all <em>p</em> &lt; 0.001. In model analysis, the combined model significantly outperformed individual models (AUC: 0.94 [95% CI: 0.89–1.00] vs. 0.84 [0.75–0.94] for strain model, <em>p</em> = 0.037; vs. 0.79 [0.68–0.90] for synchrony model, <em>p</em> = 0.001). Superiority persisted in CAD with preserved LVEF (AUC: 0.91 [95% CI: 0.83–1.00]) and external validation (AUC: 0.93 [95% CI: 0.84–1.00]).</div></div><div><h3>Conclusions</h3><div>This CMR-derived approach demonstrated the high degree of left ventricular synchrony in healthy populations and significant dyssynchrony in CAD, even in those with preserved LVEF. Integrating myocardial synchrony with strain significantly enhanced CAD myocardial dysfunction detection relative to strain alone, with robust diagnostic performance maintained in CAD with preserved LVEF.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"450 ","pages":"Article 134221"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131624","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":"Phase III cardiac rehabilitation improves left ventricular ejection fraction in patients with coronary artery disease and mildly reduced ejection fraction after percutaneous coronary intervention","authors":"Mei-Lian Cai ,&nbsp;Wu-Xiang Shi ,&nbsp;Jing Li ,&nbsp;Tao Li ,&nbsp;Wei Zhang ,&nbsp;Chuang-Biao Lin ,&nbsp;Xin-Yun Wang ,&nbsp;Yu-Ting Huang ,&nbsp;Xin-Min Qing","doi":"10.1016/j.ijcard.2026.134219","DOIUrl":"10.1016/j.ijcard.2026.134219","url":null,"abstract":"<div><h3>Background</h3><div>Exercise-based cardiac rehabilitation (ExCR) is standard for secondary prevention in coronary artery disease (CAD), yet its efficacy in patients with heart failure with mildly reduced ejection fraction (HFmrEF) after percutaneous coronary intervention (PCI) remains unclear.</div></div><div><h3>Methods</h3><div>In this single-center RCT, 120 stable CAD patients with HFmrEF (LVEF 40–49%) post-PCI were randomized 1:1 to receive either guideline-directed medical therapy (GDMT) plus a 52-week structured ExCR program (intervention) or GDMT alone (control). Primary outcomes—LDL-C, TG, LVEF, and LVEDD—were assessed at 4, 12, 24, and 52 weeks. Linear Mixed Models analyzed longitudinal intervention effects.</div></div><div><h3>Results</h3><div>A significant Group × Time interaction was observed for LVEF (<em>p</em> = .032), indicating superior recovery in the ExCR group. At 52 weeks, the ExCR group showed greater improvement in LVEF (+5.0% vs. +4.0%, <em>p</em> = .023) and greater reduction in LDL-C (−1.43 mmol/L vs. –1.04 mmol/L, <em>p</em> = .030) versus control. No between-group differences were found in TG or LVEDD.</div></div><div><h3>Conclusions</h3><div>A 52-week structured ExCR program significantly enhances cardiac recovery and lipid control in HFmrEF patients post-PCI, providing incremental benefits beyond GDMT alone. Sustained ExCR should be considered essential in comprehensive management for this population.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"450 ","pages":"Article 134219"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146149648","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":"Systemic inflammatory indices, cardiac conduction disorders, and atrial fibrillation: Phenotype-specific associations and incremental discrimination in the China National Health Survey (CNHS)","authors":"Zichao Wang ,&nbsp;Yaoda Hu ,&nbsp;Huijing He ,&nbsp;Ji Tu ,&nbsp;Zhiming Lu ,&nbsp;Weihao Wang ,&nbsp;Haibo Huang ,&nbsp;Zhili Chen ,&nbsp;Da Xu ,&nbsp;Qing Wang ,&nbsp;Zhujie Ran ,&nbsp;Mengwei Zhang ,&nbsp;Guangliang Shan","doi":"10.1016/j.ijcard.2026.134224","DOIUrl":"10.1016/j.ijcard.2026.134224","url":null,"abstract":"<div><h3>Background</h3><div>Systemic inflammation may influence cardiac electrophysiology, but evidence on phenotype-specific links with ECG-defined conduction disorders and atrial fibrillation (AF) in China is limited.</div></div><div><h3>Methods</h3><div>We performed a cross-sectional analysis of 10,303 adults in the China National Health Survey. Nine inflammatory markers (neutrophils, lymphocytes, monocytes, platelets, hsCRP, NLR, SII, SIRI and PIV; log-transformed and standardized) were related to ECG-defined right bundle branch block (RBBB), intraventricular conduction delay (IVCD), left bundle branch block (LBBB), left anterior fascicular block (LAFB), atrioventricular block (AVB) and AF. Associations were estimated with Firth-penalised logistic regression with multivariable adjustment and false discovery rate control. Incremental discrimination beyond covariates was assessed by 10-fold cross-validated area under the curve (AUC).</div></div><div><h3>Results</h3><div>LBBB showed the strongest pattern: lymphocytes were inversely associated (odds ratio [OR] 0.65, 95% CI 0.50–0.84), while neutrophils (OR 5.39, 4.05–7.29), SIRI (OR 4.24, 3.34–5.44), and SII (OR 6.93, 5.17–9.52) were positively associated. LAFB and AF displayed similar signals (LAFB: lymphocytes OR 0.68, 0.55–0.86; NLR OR 1.66, 1.34–2.05; AF: monocytes OR 2.30, 1.79–2.94; SIRI OR 2.42, 1.92–3.03). RBBB showed modest links (NLR OR 1.15, 1.03–1.27); IVCD and AVB were largely null. Composite indices improved discrimination beyond covariates: SIRI yielded ΔAUC +0.163 for LBBB (final AUC 0.923), +0.098 for AF, and +0.041 for LAFB; gains for RBBB/IVCD/AVB were negligible. Sex interactions were significant: neutrophil and SIRI effects were stronger in men with LBBB (P-interaction 0.032/0.038), while lymphocytes were more protective in women with AF (OR 0.51, 0.36–0.73; P-interaction 0.001).</div></div><div><h3>Conclusions</h3><div>Systemic inflammation showed phenotype-specific associations with ECG-defined conduction disorders and atrial fibrillation. Low-cost composite indices—especially SIRI—substantially improved discrimination of prevalent LBBB, LAFB, and AF beyond clinical covariates; prospective studies are needed to clarify temporality, validate thresholds, and assess clinical utility.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"450 ","pages":"Article 134224"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146172264","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}