International journal of cardiology最新文献

{"title":"SOX17 variants contribute to pulmonary arterial hypertension and congenital heart disease","authors":"Yi-Zhe Bian , Yang Lv , Chen-Xi Yang , Gao-Feng Zhang , Yi-Qing Yang","doi":"10.1016/j.ijcard.2026.134180","DOIUrl":"10.1016/j.ijcard.2026.134180","url":null,"abstract":"","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"449 ","pages":"Article 134180"},"PeriodicalIF":3.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145989029","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":"Deciphering the role of circulating inflammatory proteins in myocarditis: Novel strategies for targeted therapy","authors":"Zhiyu Zhang ,&nbsp;Zeye Liu ,&nbsp;Ke Li ,&nbsp;Haiyang Xie ,&nbsp;Hailu Wang ,&nbsp;Qi Li ,&nbsp;Fajar Prasetya ,&nbsp;Xi Chen ,&nbsp;Yifan Chen ,&nbsp;Yiyin Zhang","doi":"10.1016/j.ijcard.2026.134198","DOIUrl":"10.1016/j.ijcard.2026.134198","url":null,"abstract":"<div><h3>Aims</h3><div>Myocarditis is closely linked to immune dysregulation, yet the causal roles of circulating inflammatory proteins in its development remain incompletely understood. This study aimed to explore whether specific inflammatory proteins are causally associated with myocarditis and to assess their potential translational relevance.</div></div><div><h3>Methods</h3><div>We applied a two-sample Mendelian randomization (MR) using genome-wide association studies (GWAS) summary statistics for 91 circulating inflammatory proteins and myocarditis to identify causal associations. Candidate targets were refined through differential gene expression analysis of GEO datasets, followed by enrichment and protein–protein interaction (PPI) analyses. Cell-type–specific expression was confirmed using single-cell RNA sequencing (scRNA-seq) of myocarditis tissue. Drug prediction and molecular docking analyses were performed for the key target.</div></div><div><h3>Results</h3><div>MR identified interleukin-10 receptor subunit beta (IL10RB) and leukemia inhibitory factor (LIF) as potential causal proteins for myocarditis. LIF was prioritized as a key candidate target via transcriptomics, enrichment, and PPI analysis. scRNA-seq showed high LIF expression in dendritic cells, mural cells, and fibroblasts. Drug prediction and docking evaluated its therapeutic potential.</div></div><div><h3>Conclusions</h3><div>Elevated circulating LIF levels may be causally linked to increased myocarditis risk, supporting its potential as both a predictive biomarker and a therapeutic target. These results provide a rationale for further experimental studies to clarify the context-dependent roles of LIF in myocardial inflammation and to evaluate LIF-directed interventions.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"449 ","pages":"Article 134198"},"PeriodicalIF":3.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105365","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":"Cardiac remodeling and arterial stiffness progression in wild-type vs hereditary transthyretin amyloidosis in Crete","authors":"Dafni Korela ,&nbsp;Emmanouil Foukarakis ,&nbsp;Ioannis Zaganas ,&nbsp;Minas Drakos ,&nbsp;Anthοula Plevritaki ,&nbsp;Spyros Maragkoudakis ,&nbsp;Alexandros Patrianakos ,&nbsp;Nikolaos Kapsoritakis ,&nbsp;Sophia Koukouraki ,&nbsp;Olga Bourogianni ,&nbsp;Charalampos Pontikoglou ,&nbsp;Maria Psillaki ,&nbsp;Helen A. Padadaki ,&nbsp;Dimitris Samonakis ,&nbsp;Efstathios Detorakis ,&nbsp;Ioannis Petrakis ,&nbsp;Kostas Stylianou ,&nbsp;Gregory Chlouverakis ,&nbsp;Emmanouil Giannakoudakis ,&nbsp;Aneta Aleksova ,&nbsp;Maria Marketou","doi":"10.1016/j.ijcard.2025.134145","DOIUrl":"10.1016/j.ijcard.2025.134145","url":null,"abstract":"<div><h3>Background</h3><div>Hereditary transthyretin amyloidosis (hATTR) and wild-type transthyretin amyloidosis (ATTRwt) are two distinct forms of cardiac amyloidosis (CA) differing in genetics, clinical progression, and cardiac remodeling patterns. Understanding these differences is critical for accurate diagnosis and personalized management. This study compared cardiac remodeling progression and arterial stiffness in patients with wild-type and hereditary transthyretin CA in a well-characterized Cretan cohort.</div></div><div><h3>Methods</h3><div>We prospectively enrolled 39 CA patients who underwent TTR genotyping and comprehensive clinical, echocardiographic, and vascular assessments, including pulse wave velocity (PWV). Functional capacity and quality of life were evaluated at baseline and six months after tafamidis initiation.</div></div><div><h3>Results</h3><div>Pathogenic TTR variants were identified in 56 %, mainly pVal114Ala (38.5 %) and pVal50Met (18 %). Mutation carriers were younger (60.8 versus 79.1 years, <em>p</em> &lt; 0.001) and had better functional capacity (6-min walk test, 439 ± 121 m vs. 351 ± 103 m, <em>p</em> = 0.021) and superior myocardial strain (global longitudinal strain) than ATTRwt-CA patients. hATTR-CA showed less left ventricular hypertrophy and atrial dilation. Arterial stiffness (carotid-radial PWV) was higher in hATTR both at baseline and follow-up (<em>p</em> &lt; 0.05), with a trend toward improvement post-treatment. Quality of life favored hATTR after six months. ATTRwt patients showed a trend toward left ventricular hypertrophy regression absent in hATTR.</div></div><div><h3>Conclusions</h3><div>TTR genotype influences cardiac remodeling, vascular involvement, and function in CA. hATTR patients with pVal50Met and pVal114Ala variants are younger with better myocardial function but increased arterial stiffness compared to ATTRwt. Our findings indicate the need for genotype-specific assessment and management.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"449 ","pages":"Article 134145"},"PeriodicalIF":3.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145959210","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 using the 2024 ESC guideline-recommended method to estimate the likelihood of obstructive coronary disease - a cardiac CT study","authors":"Rita Barbosa Sousa ,&nbsp;Maria Rita Lima ,&nbsp;Pedro M. Lopes ,&nbsp;Pedro Freitas ,&nbsp;Francisco Gama ,&nbsp;Cláudia Silva ,&nbsp;Sara Guerreiro ,&nbsp;João Abecasis ,&nbsp;Ana Coutinho Santos ,&nbsp;Carla Saraiva ,&nbsp;Pedro Adragão ,&nbsp;António M. Ferreira","doi":"10.1016/j.ijcard.2026.134209","DOIUrl":"10.1016/j.ijcard.2026.134209","url":null,"abstract":"<div><h3>Introduction</h3><div>The 2024 ESC guidelines on chronic coronary syndromes integrated cardiovascular risk factors to estimate the pre-test probability (PTP) of obstructive coronary artery disease (CAD). Additionally, coronary artery calcium score (CACS) was proposed to reclassify patients with low PTP. We aimed to assess the impact of these new recommendations.</div></div><div><h3>Methods</h3><div>Single-center cross-sectional study including 1595 patients undergoing coronary computed tomography angiography (CCTA) for suspected CAD. Obstructive CAD was defined as ≥50% stenosis on CCTA, with reclassification based on downstream invasive or non-invasive test results when available. Discrimination, calibration, and reclassification were evaluated.</div></div><div><h3>Results</h3><div>Obstructive CAD prevalence was 14.0% (<em>n</em> = 223). Compared to the 2019 ESC-PTP, 2024 ESC-PTP showed improved discrimination [C-statistics of 0.76 (95%CI: 0.74–0.78) vs 0.74 (95%CI: 0.72–0.77), <em>p</em> = 0.042]. Regarding calibration, the 2019 ESC-PTP overestimated the likelihood of CAD (intercept −0.23, 95%CI: −0.38 to −0.09), while the 2024 ESC-PTP underestimated it (intercept 0.26, 95%CI: 0.11 to 0.41). The 2024 ESC-PTP reclassified 47.3% (<em>n</em> = 755) of patients, with 97.2% (<em>n</em> = 734) moving to a lower PTP category. Using CACS in patients with low PTP by the 2024 ESC-PTP (<em>n</em> = 617) would reclassify 41.3% (<em>n</em> = 255) to very low PTP. Of these, 1.6% (<em>n</em> = 4) had obstructive CAD.</div></div><div><h3>Conclusions</h3><div>The 2024 ESC-PTP model, calibrated to obstructive CAD defined by invasive coronary angiography, demonstrates slightly improved discrimination, but appears to underestimate the likelihood of CAD when evaluated against CCTA-defined disease. These guideline recommendations could obviate further testing in approximately half of the population, at the cost of 2% missed diagnoses.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"449 ","pages":"Article 134209"},"PeriodicalIF":3.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of left ventricular mechanical synchrony and intraventricular blood flow energy in ischemic heart disease using a hybrid positron emission tomography-magnetic resonance system","authors":"Ayano Ikeda ,&nbsp;Kenji Fukushima ,&nbsp;Sachika Ishii ,&nbsp;Keiichiro Endo ,&nbsp;Masataka Katahira ,&nbsp;Naoyuki Ukon ,&nbsp;Ryo Yamakuni ,&nbsp;Takatoyo Kiko ,&nbsp;Takeshi Shimizu ,&nbsp;Shiro Ishii ,&nbsp;Masayoshi Oikawa ,&nbsp;Hiroshi Ito ,&nbsp;Yasuchika Takeishi","doi":"10.1016/j.ijcard.2026.134200","DOIUrl":"10.1016/j.ijcard.2026.134200","url":null,"abstract":"<div><h3>Backgrounds</h3><div>We aimed to simultaneously investigate the relationship between left ventricular (LV) mechanical synchrony and intra-LV blood flow energy in patients with ischemic heart disease (IHD) using hybrid PET/MR.</div></div><div><h3>Methods</h3><div>Sixty-six patients (mean age 67 years, male 54) who underwent rest-pharmacological stress ¹³N ammonia PET and 4D flow MR were included. Left ventricular ejection fraction (LVEF), phase analysis (PA) parameters including histogram bandwidth (BW), phase standard deviation (PSD), and entropy were obtained from gated PET. Perfusion defect was assessed as summed defect score from static PET images. Intra-LV 4D flow MR acquisition was simultaneously performed for rest and stress. Intra-LV blood flow kinetic energy (KE mJ) was obtained from dynamic flow curve, and indexed with end-diastolic volume (KEi mJ/mL).</div></div><div><h3>Results</h3><div>A significant positive correlation was observed between LVEF and KEi at rest and stress (<em>r</em> = 0.30, <em>p</em> = 0.014; <em>r</em> = 0.42, <em>p</em> &lt; 0.0001 for rest and stress, respectively). In contrast, summed defect score did not show a significant correlation to KEi. All PA parameters demonstrated a weak inverse correlation with KEi at rest (BW: <em>r</em> = −0.26, <em>p</em> = 0.019; PSD <em>r</em> = −0.27, <em>p</em> = 0.026; entropy r = −0.27, <em>p</em> = 0.031) and stress (BW: <em>r</em> = −0.29, <em>p</em> = 0.016; PSD <em>r</em> = −0.37, <em>p</em> = 0.0021; entropy <em>r</em> = −0.33, <em>p</em> = 0.0062).</div></div><div><h3>Conclusion</h3><div>PET derived PA was associated with intra-LV blood flow energy, suggesting impaired LV mechanical synchrony is linked to intra-LV blood flow insufficiency. These findings highlight the novel assessment of PA in clinical practice for IHD.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"449 ","pages":"Article 134200"},"PeriodicalIF":3.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100193","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":"Caveolin-3 serves as a therapeutic target for myocardial ischemia-reperfusion injury in cardiac surgery patients","authors":"Shiyun Jin ,&nbsp;Weijun Liu ,&nbsp;Xinyu Chen ,&nbsp;Wenya Guo ,&nbsp;Qijing Xing ,&nbsp;Juan Wu ,&nbsp;Ye Zhang","doi":"10.1016/j.ijcard.2026.134179","DOIUrl":"10.1016/j.ijcard.2026.134179","url":null,"abstract":"<div><h3>Background</h3><div>Caveolin-3 (Cav3) has been reported to protect both normal and failing hearts against myocardial ischemia/reperfusion (I/R) injury in rodent models. However, there is currently no evidence demonstrating its cardioprotective effects in human hearts. In this study, we investigate whether Cav3 is involved in myocardial I/R injury during cardiac surgery and the underlying mechanisms.</div></div><div><h3>Methods</h3><div>Human atrial tissues were collected from cardiac surgery patients before myocardial ischemia and 30 min after reperfusion. The tissue samples were analyzed by western blot to assess the expression levels of Cav3, pro-survival kinases, and apoptosis-related proteins. Immunofluorescence assessed Cav3 distribution, and apoptosis staining evaluated cardiomyocyte death. Cardiac enzymes, lactate levels, and hospitalization data were also recorded.</div></div><div><h3>Results</h3><div>The expression levels of cardiac Cav3 protein exhibit around 60% reduction following myocardial I/R injury in the human heart. The reduction of Cav3 showed a strong negative correlation with cardiac injury. Similarly, the phosphorylation of ERK1/2, Akt, STAT3, and GSK3β, is markedly downregulated in cardiac tissue following I/R injury. Furthermore, the pro-apoptotic protein Bax and caspase-3 shows substantial upregulation, while the anti-apoptotic protein Bcl-2 is significantly downregulated. Importantly, a strong positive correlation was observed between decreased Cav3 expression and reduced phosphorylation of survival kinases, while a negative correlation was found with cardiomyocyte apoptosis.</div></div><div><h3>Conclusion</h3><div>Our data suggest that the downregulation of Cav3 is associated with increased cardiac injury in the human heart. Targeting Cav3 may represent a promising therapeutic strategy for mitigating myocardial I/R injury in patients undergoing cardiac surgery.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"449 ","pages":"Article 134179"},"PeriodicalIF":3.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994168","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":"Spontaneous coronary artery dissection: Why early treatment choices matter","authors":"Giuseppe Ciliberti ,&nbsp;Giandomenico Bisaccia ,&nbsp;Maria Luana Rizzuto ,&nbsp;Sabina Gallina ,&nbsp;Federico Fortuni ,&nbsp;Filippo Zilio ,&nbsp;Fabrizio Ricci","doi":"10.1016/j.ijcard.2026.134182","DOIUrl":"10.1016/j.ijcard.2026.134182","url":null,"abstract":"","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"449 ","pages":"Article 134182"},"PeriodicalIF":3.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145998040","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":"Prevalence and prognostic value of elevated soluble urokinase plasminogen activator receptor (suPAR) in patients admitted with acute heart failure","authors":"Aginsha Kandiah ,&nbsp;Ida Arentz Taraldsen ,&nbsp;Mohammed El-Sheikh ,&nbsp;Nora Olsen El Caidi ,&nbsp;Frederik Dencker Wisborg ,&nbsp;Sandra Henriette Tonning ,&nbsp;Jens Dahlgaard Hove ,&nbsp;Ove Andersen ,&nbsp;Johannes Grand","doi":"10.1016/j.ijcard.2026.134199","DOIUrl":"10.1016/j.ijcard.2026.134199","url":null,"abstract":"<div><h3>Background</h3><div>The inflammatory biomarker, soluble urokinase plasminogen activator receptor (suPAR), has emerged as a promising prognostic biomarker in cardiovascular diseases. However, little is known about suPAR levels in patients admitted with acute heart failure (AHF).</div><div>This study investigates the prevalence and prognostic value of elevated suPAR in patients hospitalized with AHF.</div></div><div><h3>Methods</h3><div>This cohort study included patients presenting with cardiopulmonary symptoms at the Medical Emergency Department of University Hospital Amager-Hvidovre, Denmark, between March 10, 2020, and March 31, 2022. SuPAR was measured upon admission, with the median time from admission to measurement of two hours (IQR 3.9 - 6.9). A cardiologist adjudicated whether the patients had AHF. Patients were stratified according to validated cut-off values of suPAR &lt;6 ng/ml and ≥ 6 ng/ml. Kaplan-Meier survival analysis and Cox regression were used to assess the association between suPAR levels and one-year mortality.</div></div><div><h3>Results</h3><div>A total of 386 (3.8%) AHF patients, from a total population of 10,027, were included. The mean suPAR value was significantly higher among AHF patients compared to non-AHF patients: 6.2 ng/ml (standard deviation [SD] = 4.8 ng/ml) vs 4.4 ng/ml (SD = 2.9 ng/ml), <em>p</em> &lt; 0.001.</div><div>A suPAR level ≥ 6 ng/ml was significantly associated with mortality, log-rank-<em>p</em>-value &lt;0.0001. Furthermore, Cox regression analysis demonstrated that elevated suPAR levels were independently associated with increased risk of mortality with a hazard ratio (HR): 1.06 (95% CI: 1.03–1.1, p &lt; 0.001) after adjusting for potential confounders.</div></div><div><h3>Conclusion</h3><div>SuPAR levels measured at hospital admission in AHF patients correlate significantly with one-year mortality and outperform C-reactive protein, supporting their potential role in early prognostication to identify high-risk patients.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"449 ","pages":"Article 134199"},"PeriodicalIF":3.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146097050","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":"Ten clinically important subgroups of myocardial infarction survivors: Identification by latent class analysis","authors":"Benedikte Irene von Osmanski ,&nbsp;Mikkel Zöllner Ankarfeldt ,&nbsp;Niels Thue Olsen ,&nbsp;Mette Rauhe Mouridsen ,&nbsp;Marius Mølsted Flege ,&nbsp;Andreas Høiberg Bentsen ,&nbsp;Espen Jimenez-Solem ,&nbsp;Janne Petersen","doi":"10.1016/j.ijcard.2025.134139","DOIUrl":"10.1016/j.ijcard.2025.134139","url":null,"abstract":"<div><h3>Background</h3><div>Given the substantial heterogeneity among patients with myocardial infarction (MI), stratification of this population may support improvements in clinical management and patient outcomes. Therefore, we aimed to identify homogenous subgroups among MI survivors using latent class analysis (LCA) and, secondarily, to demonstrate the clinical relevance of the subgroups by comparing their prognoses measured by risk of death and recurrent MI (RMI).</div></div><div><h3>Methods</h3><div>Patients surviving a hospitalization with a first-time MI from 2016 to 2018 were identified from nationwide Danish registries. We included 30 patient characteristics in the LCA and selected the best model based on statistical fit, clinical relevance, and reproducibility across data samples. The five-year mortality and risk of RMI were quantified by cumulative incidence functions and proportional hazard models.</div></div><div><h3>Results</h3><div>In total, 17,018 patients were included, and 10 latent classes were identified. The classes expressed distinct patterns of characteristics, but clusters with similarities were identified: three classes were characterized by high probabilities of ST-elevation MI, two classes by other MI-specific characteristics, and five classes by comorbidity and/or healthcare utilization patterns. The five-year cumulative incidences ranged from 3.2 % to 60.5 % (death) and 4.4 % to 13.5 % (RMI). Using the class with the best prognosis as reference group, the age- and sex-adjusted hazard ratios ranged from 1.67 to 12.94 (death) and 1.28 to 4.39 (RMI).</div></div><div><h3>Conclusion</h3><div>Ten clinically distinct subgroups were identified in a population of first-time MI survivors by using LCA. The subgroups showed markedly differing prognoses in terms of five-year mortality and risk of RMI.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"448 ","pages":"Article 134139"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933220","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":"Nationwide survey on the current clinical practice of the first atrial fibrillation episode","authors":"Pasquale Vergara ,&nbsp;Federico Migliore ,&nbsp;Martina Nesti ,&nbsp;Carlo Pignalberi ,&nbsp;Manuel Antonio Conti ,&nbsp;Francesco Borrello ,&nbsp;Amir Kol ,&nbsp;Pietro Rossi ,&nbsp;Pasquale Visconti ,&nbsp;Benedetta Brescia ,&nbsp;Giovanni Esposito ,&nbsp;Raimondo Calvanese","doi":"10.1016/j.ijcard.2025.134148","DOIUrl":"10.1016/j.ijcard.2025.134148","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) is a prevalent arrhythmia associated with increased risk of stroke, hospitalization, and progression to chronic forms. Early management of a first AF episode is essential to prevent recurrences and complications.</div></div><div><h3>Objective</h3><div>To evaluate real-world practices among Italian cardiologists in the management of the first documented AF episode.</div></div><div><h3>Methods</h3><div>Between January and October 2023, 706 cardiologists completed a nationwide online survey promoted by the ANMCO Arrhythmia Study Group. The questionnaire explored demographics, thromboembolic risk management, rhythm control strategies, and follow-up approaches. Descriptive and inferential analyses were performed.</div></div><div><h3>Results</h3><div>Most respondents worked in public hospitals (437/706, 61.9%). Transthoracic echocardiography was the most frequently prescribed examination after a first AF episode (627/706, 88.9%), followed by electrical cardioversion (414/706, 58.6%) and TEE (178/706, 25.2%). For paroxysmal AF, anticoagulation guided by CHA₂DS₂-VASc ≥1 was prescribed by 575 cardiologists (81.4%), while 47 (6.7%) anticoagulated all patients and 84 (11.9%) did not prescribe any OAC. DOACs were preferred in 542 cases (76.8%).</div><div>For persistent AF, anticoagulation was guided by CHA₂DS₂-VASc ≥1 in 354 (50.1%), whereas 321 (45.5%) prescribed OAC to all patients. DOACs were chosen in 636 cases (90.1%).</div><div>Pharmacological cardioversion was the preferred initial strategy for paroxysmal AF (455/706, 64.4%), while electrical cardioversion was more frequently used as first-line treatment in persistent AF (300/706, 42.5%). Catheter ablation was rarely proposed after the first AF episode: only 53 respondents (7.5%) recommended it routinely, and 154 (21.8%) considered it only in patients with heart failure. Regarding the EAST-AFNET 4 trial, 268 cardiologists (38.0%) reported adopting an early rhythm-control strategy, whereas 220 (31.2%) were unaware of the study.</div></div><div><h3>Conclusions</h3><div>Management of the first AF episode in Italy is highly heterogeneous. While CHA₂DS₂-VASc-based anticoagulation and evidence-based rhythm control are generally applied, notable variability persists across healthcare settings, particularly concerning cardioversion strategies and limited adoption of early catheter ablation. Greater dissemination and implementation of guideline-based practices may improve uniformity of care.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"448 ","pages":"Article 134148"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145959222","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}