Journal of atherosclerosis and thrombosis最新文献

{"title":"Association of Multimodal Intracoronary Imaging-Derived Plaque Morphology with the Pathophysiological Disease Patterns Assessed by the Quantitative Flow Ratio-Pullback Pressure Gradient.","authors":"Eisuke Usui, Yoshihisa Kanaji, Masahiro Hada, Tatsuhiro Nagamine, Hiroki Ueno, Kodai Sayama, Takumi Watanabe, Takahiro Watanabe, Hikaru Shimosato, Takashi Mineo, Riko Murakami, Kaisei Hosokawa, Taishi Yonetsu, Tetsuo Sasano, Tsunekazu Kakuta","doi":"10.5551/jat.66164","DOIUrl":"https://doi.org/10.5551/jat.66164","url":null,"abstract":"<p><strong>Aims: </strong>The quantitative flow ratio (QFR)-derived pullback pressure gradient (PPG) characterizes the pathophysiological patterns of coronary atherosclerosis. This study investigated the plaque morphologies associated with these disease patterns.</p><p><strong>Methods: </strong>This study used the institutional QFR-PPG database registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000056097). Patients who underwent elective stenting with pre-procedural optical coherence tomography and near-infrared spectroscopy intravascular ultrasound were included. Offline QFR and QFR-PPG analyses were performed, and the lesions were stratified into tertiles.</p><p><strong>Results: </strong>A total of 168 de novo lesions were analyzed in this study. The QFR tertiles were defined as severe (＜0.61), moderate (0.61-0.71), and mild (＞0.71); the QFR-PPG tertiles were defined as diffuse (＜0.66), intermediate (0.66-0.79), and focal (＞0.79). The Severe QFR tertiles exhibited a smaller minimum lumen area (MLA) and higher frequencies of thin-cap fibroatheroma (TCFA) and layered plaque. In contrast, across the QFR-PPG tertiles, MLA and TCFA frequencies were similar, whereas the diffuse group exhibited more layered plaques and larger calcium angles. The maximum lipid-core burden index did not vary across the QFR-PPG tertiles. A multivariable analysis identified MLA and TCFA as independent predictors of QFR, while layered plaque and calcium angle independently predicted QFR-PPG. However, the lipidic features were not independent predictors of QFR.</p><p><strong>Conclusion: </strong>Multimodal intracoronary imaging demonstrated that QFR reflects luminal narrowing and the features of vulnerable plaques. Conversely, QFR-PPG reflects disease diffuseness, characterized by layered plaques and calcium burden rather than lipid-rich features.</p>","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345350","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":"C-reactive Protein-to-Albumin Ratio for Evaluating Patients with Chronic Limb-Threatening Ischemia Following Endovascular Therapy.","authors":"Akinori Satake, Takahiro Tokuda, Hiroaki Sawada, Masahiro Shimoda, Hirofumi Ohashi, Akihiro Suzuki, Yusuke Nakano, Hiroshi Takahashi, Akio Kodama, Makoto Narita, Tetsuya Amano","doi":"10.5551/jat.66108","DOIUrl":"https://doi.org/10.5551/jat.66108","url":null,"abstract":"<p><strong>Aim: </strong>Chronic limb-threatening ischemia (CLTI), the most advanced stage of lower-extremity artery disease, is associated with high mortality and major amputation rates, even after revascularization. Thus, identifying patients with CLTI at a particularly high risk of poor outcomes is crucial for shared decision making. Recently, the C-reactive protein-to-albumin ratio (CAR) has emerged as a novel composite biomarker that reflects both the inflammatory and nutritional status. Nonetheless, the prognostic significance of CAR in patients with CLTI undergoing endovascular therapy (EVT) remains unclear.</p><p><strong>Methods: </strong>Of 159 patients who underwent EVT for the first time between April 2010 and December 2023, 79 were included in this study. The patients were categorized into two groups using a CAR value of 0.17: the high-CAR group (CAR ≥ 0.17) and the low-CAR group (CAR ＜0.17). The primary endpoint was 1-year amputation-free survival (AFS) after EVT.</p><p><strong>Results: </strong>The median follow-up period was 23 months (95% confidence interval [CI], 11-34). During the follow-up period, 56 patients (71%) died and 11 (14%) underwent major amputation. AFS was significantly reduced in the high-CAR group (log-rank P＜0.01). The CAR (hazard ratio: 1.43 per one-unit increase, 95% CI: 1.20-1.70, P＜0.01) was an independent predictor of reduced AFS following EVT.</p><p><strong>Conclusions: </strong>elevated preprocedural CAR was independently associated with reduced AFS after EVT in patients with CLTI. The CAR may serve as a valuable tool for evaluating patients with CLTI before EVT.</p>","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295241","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":"Distribution of Lipoprotein(a) Levels Among Children with Elevated Low-Density Lipoprotein Cholesterol Identified Through Universal Pediatric Lipid Screening.","authors":"Ryosuke Tani, Keiji Matsunaga, Keita Tanimoto, Tomoko Inoue, Katsufumi Nishioka, Sonoko Kondo, Takashi Iwase, Takashi Kusaka, Hai Ying Fu, Hayato Tada, Masayuki Takamura, Tetsuo Minamino","doi":"10.5551/jat.66114","DOIUrl":"https://doi.org/10.5551/jat.66114","url":null,"abstract":"<p><strong>Aim: </strong>Children with elevated low-density lipoprotein cholesterol (LDL-C) levels, suspected familial hypercholesterolemia (FH), and elevated lipoprotein(a) (Lp(a)) levels are considered to have a particularly high lifetime risk of atherosclerotic cardiovascular disease. Nevertheless, the distribution of Lp(a) levels among children with elevated LDL-C levels remains unclear. This study aimed to clarify the distribution of Lp(a) levels and their association with pathogenic FH variants in children with elevated LDL-C levels.</p><p><strong>Methods: </strong>A total of 97 children with LDL-C levels ≥ 140 mg/dL suspected of having FH who underwent genetic testing at Kagawa University Hospital between January 2018 and May 2025 were analyzed. Lp(a) levels were measured using the Lp(a) Latex \"DAIICHI\" assay and converted from mass units (mg/dL) to molar units (nmol/L) using the calibration-based conversion formula. Clinical and lipid parameters were compared according to Lp(a) levels (≥ 105 vs. ＜105 nmol/L) and the presence of pathogenic FH variants.</p><p><strong>Results: </strong>Lp(a) levels exhibited a right-skewed distribution, with a median of 57.6 nmol/L (15.9 mg/dL) and an interquartile range of 24.0-93.4 nmol/L (7.0-25.4 mg/dL), and 21.6% of children had levels ≥ 105 nmol/L. Pathogenic FH variants were identified in 44 children. No significant differences were observed in either clinical or lipid parameters according to Lp(a) levels (≥ 105 vs. ＜105 nmol/L) or the presence of pathogenic FH variants (P = 0.672).</p><p><strong>Conclusion: </strong>Regardless of the presence of pathogenic FH variants, approximately 20% of the children had Lp(a) levels ≥ 105 nmol/L. These findings emphasize the importance of early lipid management and suggest that Lp(a) measurement may contribute to future cardiovascular risk stratification.</p>","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148217137","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":"Cardiovascular Risk of Alcohol Consumption due to Renal Impairment: A 10-Year Prospective Study in a Community-Dwelling Japanese Population.","authors":"Aya Hirata, Sei Harada, Miho Iida, Minako Matsumoto, Naoko Miyagawa, Ryota Toki, Shun Edagawa, Takuma Shibuki, Kazuyo Kuwabara, Shun Kohsaka, Yoshikane Izawa, Mitsuaki Sawano, Tsubasa Takizawa, Satoshi Shoji, Masahiro Katsumata, Daisuke Sugiyama, Tomonori Okamura, Toru Takebayashi","doi":"10.5551/jat.65989","DOIUrl":"10.5551/jat.65989","url":null,"abstract":"<p><strong>Aims: </strong>The association between alcohol consumption and the risk of cardiovascular disease (CVD) varies according to the presence of underlying cardiovascular risk factors. Incorporating such risk factors may be important to effectively reduce harmful alcohol use through health guidance. However, whether the risk of alcohol consumption is affected due to renal impairment remains unclear.</p><p><strong>Methods: </strong>A total of 10,583 community-dwelling Japanese adults (mean age 59.4 (SD 10.1) years; 46% men) were followed for 10 years. Alcohol consumption was categorized into five groups for men: never drinkers, former drinkers, light drinkers (＜20 g/day), moderate drinkers (20-39 g/day), and heavy drinkers (≥ 40 g/day), and four groups for women with moderate and heavy combined. Cox proportional hazards models estimated hazard ratios for incident CVD stratified by the presence or absence of reduced estimated glomerular filtration rate (eGFR) (＜60 mL/min/1.73m²) and proteinuria, with adjustment for confounders.</p><p><strong>Results: </strong>Among men with proteinuria, alcohol consumption was associated with a higher risk of atherosclerotic CVD, whereas an inverse association was observed in men without proteinuria [hazard ratio (95% confidence interval): moderate drinkers without proteinuria, 0.58 (0.34-0.97); moderate drinkers with proteinuria, 3.49 (1.15-10.56)]. Moderate to heavy drinking increased the risk of intracerebral hemorrhage irrespective of the renal status. In women, moderate to heavy drinking was associated with an increased CVD risk only when proteinuria was present. In contrast, a reduced eGFR did not clearly affect the association in either sex.</p><p><strong>Conclusions: </strong>The CVD risk associated with alcohol consumption may differ according to the renal status, particularly depending on the presence or absence of proteinuria.</p>","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":"775-797"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147354796","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":"Beyond Conventional Imaging: From Time-Based to Data-Driven Decision-Making in Acute Ischemic Stroke.","authors":"Ichiro Deguchi, Junya Aoki","doi":"10.5551/jat.RV22050","DOIUrl":"10.5551/jat.RV22050","url":null,"abstract":"<p><p>Reperfusion therapy has profoundly transformed acute ischemic stroke (AIS) care. Initially, treatment decisions relied primarily on time from symptom onset. However, growing evidence has shown that the extent of irreversibly injured tissue and the presence of salvageable brain tissue determine the efficacy and safety of reperfusion therapy. This caused a paradigm shift from time-based selection toward tissue-based assessment, placing neuroimaging at the center of clinical decision-making. This narrative review traces the evolution of imaging-based stroke assessment in the reperfusion era. We review the development and clinical impact of the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) and diffusion-weighted imaging (DWI)-ASPECTS, which translated the pathophysiological concept of the ischemic core into a practical, reproducible, routine clinical tool. We discuss the emergence of imaging and clinical mismatch concepts, including perfusion-based ischemic core-penumbra mismatch, as well as clinical-diffusion, MRA-diffusion, and DWI-FLAIR mismatches, which address the limitations of strict time-based criteria and expand treatment opportunities, particularly in patients with unknown onset time. Finally, we examine the growing role of artificial intelligence (AI)-driven automated imaging platforms in acute stroke care, enabling rapid, standardized, and quantitative assessment of ischemic core, penumbra, and vascular pathology. These tools support clinical decision-making under severe time constraints and reduce inter-reader and inter-institutional variability. This iterative process of trial and refinement has shaped the current framework of tissue-based, data-driven stroke care. We discuss how integrating established imaging concepts with emerging AI technologies may further advance precision reperfusion therapy and improve equity and outcomes in AIS treatment.</p>","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":"665-674"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147622878","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":"Prognostic impact of Lesion Subset with or without below the Knee Lesion in Chronic Limb-Threatening Ischemia following Endovascular Revascularization.","authors":"Yusuke Watanabe, Toru Naganuma, Satoshi Matsuoka, Koji Hozawa","doi":"10.5551/jat.66002","DOIUrl":"10.5551/jat.66002","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study is to evaluate the impact of each level atherosclerotic lesion subset on clinical outcomes following EVT in CLTI patients.</p><p><strong>Methods: </strong>We identified 705 consecutive CLTI patients undergone successful EVT between January 2010 and December 2019 at our hospital in Japan. The technical success was defined as the acquisition of one straight line flow to the ulcerated or gangrenous region. We excluded 15 patients with follow up ＜30days. The primary endpoint was major adverse limb event (MALE) at 2 years after EVT. MALE was defined as composite of all cause death and major amputation (MA). MA was defined as an above-the-ankle amputation.</p><p><strong>Results: </strong>The median follow-up duration was 24.4 months. MALE rate was significantly higher in BK group (adjusted HR 1.48, 95% CI, 1.04-2.10 p = 0.028). Cardiovascular mortality was significantly higher in BK group (adjusted HR 1.94, 95% CI, 1.06-3.56 p = 0.031). Isolated BK lesions were identified an independent predictor of MA (adjusted HR 2.12, 95% CI, 1.01-4.48 p = 0.048).</p><p><strong>Conclusion: </strong>In CLTI patients who received EVT, those with BK lesions were associated with poorer clinical outcomes after EVT than those without BK lesion, mainly due to increased cardiovascular death. Additionally, isolated BK lesion was associated with higher MA rate after EVT than both FP and BK lesions or isolated FP lesions in our study population.</p>","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":"798-808"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326006","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":"A Single-Cell Analysis Reveals Macrophage Heterogeneity Driving Plaque Vulnerability in Coronary and Carotid Arteries.","authors":"Takeshi Yoshida, Takuo Emoto, Hiroyuki Yamamoto, Tomofumi Takaya, Takahiro Sawada, Sarah Louise Murphy, Mitsuhiko Shoda, Keisuke Nakamura, Masayuki Taniguchi, Naoto Sasaki, Yuta Fukuishi, Takayoshi Toba, Takenao Ohkawa, Tomoyuki Furuyashiki, Hiroya Kawai, Ken-Ichi Hirata, Hiromasa Otake, Tomoya Yamashita","doi":"10.5551/jat.65991","DOIUrl":"10.5551/jat.65991","url":null,"abstract":"<p><strong>Aim: </strong>Acute coronary syndrome (ACS) and ischemic stroke are major life-threatening conditions caused by atherosclerosis. Although the mechanisms of atherosclerosis appear to be broadly similar across different vascular beds, growing evidence suggests that there are morphological and histological differences between coronary and carotid atherosclerosis. To identify disease-specific therapeutic strategies, we aimed to compare ACS and chronic coronary syndrome (CCS) in coronary artery disease, and symptomatic and asymptomatic carotid artery disease.</p><p><strong>Methods: </strong>We analyzed our own single-cell RNA sequencing dataset for coronary artery disease (GSE184073) and a publicly available dataset for carotid artery disease (GSE253903). Myeloid cells were extracted from these datasets and comparative analyses were performed using metabolic profiling and an RNA velocity analysis.</p><p><strong>Results: </strong>By integrating multiple velocity-inference approaches, including the original and dynamic RNA velocity models, TFvelo using transcription factor regulatory information, and CellRank, we consistently identified a differentiation trajectory toward interleukin-1B (IL1B)^＋ inflammatory macrophages marked by high expression of matrix metalloproteinase 19 (MMP19). This trajectory was accompanied by the activation of the glycolytic and glycosaminoglycan degradation pathways. A similar directional flow toward IL1B^＋ inflammatory macrophages was also observed in symptomatic carotid artery plaques. However, unlike coronary lesions, carotid lesions activated the glycolytic pathway in SPP1^＋ foamy macrophages expressing MMP19.</p><p><strong>Conclusions: </strong>Our findings revealed a shared differentiation trajectory into IL1B^＋ inflammatory macrophages in carotid and coronary artery diseases, which is associated with plaque vulnerability. Notably, the distinct activation of the glycolytic pathway in a separate macrophage subset suggests that tailored therapeutic strategies may be necessary to effectively address plaque vulnerability in each vascular bed.</p>","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":"809-834"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147480835","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":"P2Y₁₂ Inhibitor Response By Patient Background Factors: An Exploratory Post Hoc Subgroup Analysis of the ACUTE-PRAS Study.","authors":"Shigeru Fujimoto, Yasuyuki Iguchi, Hiroshi Yamagami, Masatoshi Koga, Ryo Itabashi, Yusuke Yakushiji, Kazuma Kowata, Naoto Kimura, Yuka Terasawa, Takahiro Shimizu, Yuichi Miyazaki, Koichi Oki, Osamu Masuo, Hideki Matsuoka, Shuji Arakawa, Toshihiro Ueda, Ryota Tanaka, Wataru Hashimoto, Satoru Abe, Go Kato, Taketoshi Furugori, Kazumi Kimura","doi":"10.5551/jat.66056","DOIUrl":"10.5551/jat.66056","url":null,"abstract":"<p><strong>Aim: </strong>To explore whether the antiplatelet effects of prasugrel and clopidogrel vary according to patient background factors in the ACUTE-PRAS study.</p><p><strong>Methods: </strong>This was a post hoc, hypothesis-generating, exploratory analysis of the multicenter, open-label, randomized controlled ACUTE-PRAS study, in which 176 patients with acute atherothrombotic stroke or high-risk TIA received prasugrel or clopidogrel within 48 h of symptom onset. High platelet reactivity (HPR; platelet reaction units [PRU] ＞208) and absolute PRU were assessed on Day 5 in subgroups stratified by ABCD-GENE score, age, body mass index (BMI), chronic kidney disease (CKD), diabetes mellitus (DM), hypertension, dyslipidemia, time from stroke onset to treatment, National Institutes of Health Stroke Scale (NIHSS) score, and prior ischemic stroke.</p><p><strong>Results: </strong>Patients with prasugrel had numerically lower rates of HPR than those with clopidogrel in the high-risk stratum of ABCD-GENE score ≥ 10 (OR 2.73, p = 0.076), and favorable trends in prasugrel were also observed for CKD (8.06, p = 0.012), age ＞75 years (5.02, p = 0.025), BMI ＜25 kg/m² (4.61, p = 0.012), dyslipidemia (4.73, p = 0.009), DM (3.86, p = 0.038), treatment initiation ≤ 24 h (3.31, p = 0.010), and NIHSS ≤ 3 (2.77, p = 0.036) or ≥ 4 (9.00, p = 0.025). Prasugrel also reduced PRU numerically more than clopidogrel across most subgroups, except in patients with BMI ≥ 25 kg/m², treatment initiation ＞24 hours, or prior ischemic stroke, where only numerical differences were observed.</p><p><strong>Conclusions: </strong>Prasugrel provided favorable early platelet inhibition, particularly in subgroups characterized by advanced age, CKD, low BMI, metabolic comorbidities, or very early treatment start.</p>","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":"703-716"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147354725","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":"An Inverted U-shaped Relationship between Glycemic Variability and Mortality in Patients with Severe Pulmonary Embolism: A Retrospective Study.","authors":"Huihui Tan, Zihao Tang, Renyi Wu","doi":"10.5551/jat.66093","DOIUrl":"10.5551/jat.66093","url":null,"abstract":"<p><strong>Aims: </strong>Hyperglycemia and glycemic variability (GV) are predictors of adverse outcomes in critically ill patients; however, their roles in pulmonary embolism (PE) remain unclear. This study investigated the association between the mean blood glucose (MBG), GV, and mortality in patients with PE.</p><p><strong>Methods: </strong>A retrospective cohort study of patients with PE was conducted using the MIMIC-IV 3.0. GV was quantified using the coefficient of variation (CV). Patients were stratified according to tertiles of MBG and CV. Multivariable logistic regression, restricted cubic splines (RCS), and ROC curves were used to evaluate the associations with ICU and in-hospital mortality, supplemented by the threshold effect, sensitivity, and subgroup analyses.</p><p><strong>Results: </strong>Among the 1,493 PE patients, the ICU and in-hospital mortality rates were 12.99% and 20.90%, respectively. A higher MBG or CV was significantly associated with an increased risk of ICU mortality and in-hospital mortality. RCS revealed a linear association between MBG and mortality, whereas CV exhibited an inverted U-shaped relationship with inflection points at 38.523% (ICU) and 37.038% (in-hospital). For every 1% increase in CV to the left of the inflection point, the relative risks of ICU and in-hospital mortality increased by 0.035. The combined model (MBG + CV + ERS (European Respiratory Society)) achieved AUCs of 0.735 (ICU) and 0.693 (in-hospital) for mortality prediction.</p><p><strong>Conclusions: </strong>MBG and CV are independent predictors of mortality in critically ill patients with PE, suggesting that optimal glycemic control may benefit this population.</p>","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":"849-870"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147377595","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":"The Blockade of Delta-Like Ligand 1 Inhibits Atherosclerotic Lesion Formation and Attenuates Plaque Vulnerability.","authors":"Nasanbadrakh Orkhonselenge, Jun-Ichiro Koga, Daiki Kakumori, Yuki Kondo, Keisuke Hidaka, Tomohiro Shirouzu, Hiromichi Ueno, Hideo Yagita, Yosuke Nishimura, Masaharu Kataoka","doi":"10.5551/jat.65825","DOIUrl":"10.5551/jat.65825","url":null,"abstract":"<p><strong>Aim: </strong>Notch signaling is a fundamental signal that regulates morphogenesis and cell differentiation during the embryonic period, and it plays a crucial role in macrophage differentiation. Macrophage-mediated inflammation promotes atherosclerosis from the initial lesion formation to acute thrombotic complications in advanced plaques. However, their role in atherosclerosis remains unclear. We herein focused on the Notch ligand Delta-like ligand 1 (Dll1), and examined its role in the pathobiology of atherosclerosis.</p><p><strong>Methods: </strong>In Apoe^-/- mice, a blocking antibody against Dll1 (Dll1 Ab) was administered for 12 weeks from 8 weeks (early phase) or 20 weeks (late phase) of age.</p><p><strong>Results: </strong>Dll1 blockade suppressed both initial lesion development and plaque vulnerability compared with lesions in mice treated with non-immune IgG. Dll1 Ab decreased lipid accumulation in advanced lesions and increased the collagen content. In ex vivo cultured macrophages, the blockade of Dll1-Notch signaling by Dll1 blocking antibodies suppressed the mRNA expression of Tnf and the release of activated matrix metalloproteinase 9, which increased plaque vulnerability. In contrast, the stimulation of Dll1-Notch by recombinant Dll1 induced Il1b, Il6, and Tnf expression in macrophages, as well as NF-κB activation. An exploratory transcriptome analysis of atherosclerotic arteries suggested that Dll1-Notch signaling regulates the expression of genes associated with inflammation and mitosis.</p><p><strong>Conclusions: </strong>These results indicate that Dll1 promotes the pathobiology of atherosclerosis from the initial lesion development to plaque destabilization in advanced atherosclerotic lesions.</p>","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":"681-702"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145959475","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}