Journal of Cardiovascular Medicine最新文献

{"title":"Eligibility for dual pathway inhibition in patients with peripheral artery disease undergoing revascularization.","authors":"Antonio Greco, Claudio Laudani, Marco Spagnolo, Matteo Cavallo, Antonio Bulla, Alessia Giaquinta, Gaetano Isola, Eugenio Pedullà, Rocco De Pasquale, Maurizio Giacinto Uva, Antonio Di Cataldo, Piera Capranzano, Valeria Calvi, Pierfrancesco Veroux, Corrado Tamburino, Davide Capodanno","doi":"10.2459/JCM.0000000000001862","DOIUrl":"10.2459/JCM.0000000000001862","url":null,"abstract":"<p><strong>Background: </strong>Dual pathway inhibition (DPI) with low-dose rivaroxaban and aspirin offers superior ischemic protection compared with single-agent therapy in patients with peripheral artery disease (PAD). However, its real-world adoption remains limited. We aimed to determine the proportion of revascularized PAD patients eligible for DPI, and to explore reasons for ineligibility and associated clinical outcomes.</p><p><strong>Methods: </strong>Consecutive patients undergoing lower limb revascularization for PAD between May 2021 and May 2023 were prospectively enrolled in the RAPID (RivAroxaban for PerIpheral artery Disease) registry and followed up for a median time of 283 (interquartile range 142-445) days. VOYAGER PAD eligibility criteria were applied. The primary outcome was eligibility for DPI. Exploratory clinical outcomes included major adverse limb events (MALE) - defined as the composite of cardiovascular death, acute limb ischemia, or repeat limb revascularization - and major bleeding.</p><p><strong>Results: </strong>A total of 196 patients were enrolled during the study period. Among them, 98 (50.0%) met DPI eligibility criteria; however, DPI was administered only to 4.1% of eligible patients. The most frequent exclusion factors were high bleeding risk (99.0%), low hemoglobin (48.8%), and age at least 75 years (36.7%). MALE occurred in 35 patients (28%), driven by recurrent revascularization (20%), while major bleeding occurred in nine patients (5%). DPI eligibility was associated with a lower risk of MALE (hazard ratio 0.42; 95% confidence interval 0.20-0.85), but this association faded out after statistical adjustment. Major bleeding did not differ between eligible and noneligible patients.</p><p><strong>Conclusion: </strong>In a contemporary population of PAD patients undergoing revascularization, only half met the VOYAGER PAD eligibility criteria. Bleeding-related exclusions prevailed, highlighting the need for systematic anemia correction and bleeding avoidance strategies to broaden eligibility for DPI and improve clinical outcomes.</p>","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"27 4","pages":"306-317"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Watching the woods to prevent falling trees: do we need routine coronary computed tomography angiography surveillance after left main percutaneous coronary intervention?","authors":"Ovidio De Filippo, Enrico Cerrato, Gianluca Campo, Fabrizio D'Ascenzo, Gregg Stone","doi":"10.2459/JCM.0000000000001861","DOIUrl":"10.2459/JCM.0000000000001861","url":null,"abstract":"","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"27 4","pages":"336-339"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coping with recurrent pericarditis: bridging guidelines and clinical practice.","authors":"Massimo Imazio, Mariacristina Tomat, Francesco Venturelli, Giorgia Spollero, Valentino Collini","doi":"10.2459/JCM.0000000000001869","DOIUrl":"10.2459/JCM.0000000000001869","url":null,"abstract":"","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":" ","pages":"340-344"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147592226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved endothelial function in heart failure outpatients with reduced ejection fraction after vericiguat therapy.","authors":"Michele Correale, Federica Santagata, Damiano D'Alessandro, Raffaele Capasso, Martina Tesse, Massimo Barile, Andrea Furore, Michelangelo Carbonara, Pietro Mazzeo, Giuseppe Dattilo, Savina Nodari, Eugenio Stabile, Massimo Iacoviello, Natale Daniele Brunetti","doi":"10.2459/JCM.0000000000001858","DOIUrl":"10.2459/JCM.0000000000001858","url":null,"abstract":"<p><strong>Background: </strong>Vericiguat, a soluble guanylate cyclase stimulator, has been shown to be effective in improving the prognosis of patients with heart failure with reduced ejection fraction (HFrEF) and worsening heart failure. We sought to evaluate possible changes in endothelial function assessed by flow-mediated dilation (FMD) in patients with HFrEF treated with vericiguat.</p><p><strong>Results: </strong>Improved FMD values were found after 3 months of therapy with vericiguat (19 ± 11 vs. 15 ± 10% FMD, P  = 0.04). FMD variation at follow-up was inversely related to baseline FMD values ( r  = -0.52, P  = 0.001).</p><p><strong>Major findings: </strong>Three months of therapy with vericiguat in patients with HFrEF and worsening heart failure were associated with improved endothelial function assessed by FMD.</p>","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":" ","pages":"291-295"},"PeriodicalIF":2.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147503728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnancy in the broad phenotype and genotype spectrum of disease-causing desmosomal variant-positive women.","authors":"Silvia Castelletti, Annina S Vischer, Rachel Bastiaenen, Elijah R Behr, William J McKenna, Antonios Pantazis, Lia Crotti, Marika Martini, Kalliopi Pilichou, Cinzia Radesich, Marco Merlo, Emanuele Monda, Giuseppe Limongelli, Barbara Bauce","doi":"10.2459/JCM.0000000000001870","DOIUrl":"10.2459/JCM.0000000000001870","url":null,"abstract":"<p><strong>Background: </strong>Pregnancy is generally well tolerated in patients with arrhythmogenic cardiomyopathy (AC), but there are limited data comparing right-dominant AC (ARVC) and left-dominant AC (ALVC), as well as gene-positive but phenotype-negative (G+/P-) individuals. Recent guidelines have also introduced the non-dilated left ventricular cardiomyopathy (NDLVC).</p><p><strong>Objective: </strong>This study examines disease expression in pregnant women with AC and family members with pathogenic genetic variants but a negative phenotype (G+/P-). We also included those with NDLVC.</p><p><strong>Methods: </strong>We reviewed data from 22 patients diagnosed with definite AC and 9 G+/P- patients. Four patients meeting criteria for NDLVC were also analyzed. Each underwent at least one cardiovascular evaluation during pregnancy, which included a 12-lead ECG, echocardiography, and 24-h ambulatory monitoring. Events were defined as new or worsening arrhythmias, heart failure, or thromboembolic events.</p><p><strong>Results: </strong>All AC patients, including those with ARVC and ALVC, tolerated pregnancy well. None of the G+/P- patients was diagnosed with AC during pregnancy. One G+/P- patient had ECG changes, while three with PKP2 mutations experienced mild left ventricular dysfunction but fully recovered postdelivery. Among the four NDLVC patients, only one developed left ventricular dysfunction. There was no increase in arrhythmias, and 31% of the cases required caesarean sections. All pregnancies resulted in live births, and no major maternal complications were reported.</p><p><strong>Conclusions: </strong>Pregnancy is typically safe for women with AC and G+/P- individuals, provided that they are hemodynamically stable. Patients with NDLVC also manage pregnancy well. However, careful monitoring during and after pregnancy is essential, even without obvious clinical signs of the disease.</p>","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"27 4","pages":"318-325"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Snare-assisted transcatheter aortic valve implantation: balancing success with risk-a case series.","authors":"Francesca Maria Di Muro, Andrea Grasso Granchietti, Francesco Meucci, Miroslava Stolcova, Emanuele Cecchi","doi":"10.2459/JCM.0000000000001823","DOIUrl":"10.2459/JCM.0000000000001823","url":null,"abstract":"<p><p>Snare-assisted transcatheter aortic valve implantation (TAVI) has emerged as a bailout technique to facilitate valve delivery in patients with hostile anatomies when standard maneuvers fail. However, while it can increase procedural success, this strategy may also carry significant risks. We present two cases of transfemoral TAVI in patients with severely calcified and tortuous aortic anatomies. In the first case, an 88-year-old woman with severe aortic stenosis and highly tortuous aortic arch underwent successful valve implantation after snare-assisted advancement of the delivery system, achieving optimal hemodynamic and clinical results. In the second case, a 67-year-old woman with porcelain aorta and extensive calcification required snare-assisted delivery of a self-expanding valve after failed conventional maneuvers. Despite successful implantation, the patient developed extensive cerebral embolization with catastrophic neurological sequelae, ultimately leading to death. These cases highlight the double-edged nature of snare-assisted TAVI. While the technique can facilitate valve delivery in anatomically challenging settings, repeated and prolonged device manipulation across a calcified arch may increase the risk of cerebral embolization and other complications. Careful patient selection, use of cerebral embolic protection, and consideration of alternative devices or access routes are crucial to minimize risks.</p>","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"27 3","pages":"253-258"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147491047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inclisiran safety and efficacy in real-world clinical practice: results of a retrospective observational investigation.","authors":"Stefania Angela Di Fusco, Andrea Matteucci, Alessandro Aiello, Stefano Aquilani, Silvio Fedele, Federico Nardi, Furio Colivicchi","doi":"10.2459/JCM.0000000000001852","DOIUrl":"10.2459/JCM.0000000000001852","url":null,"abstract":"<p><strong>Background: </strong>Real-world data on inclisiran are limited. We report a single-centre investigation on inclisiran safety and efficacy based on concurrent lipid-lowering treatments.</p><p><strong>Results: </strong>At 15 months, the mean low-density lipoprotein cholesterol (LDL-C) levels decreased by 59.5% in patients receiving statin ± ezetimibe and by 56% in those treated without statin ± ezetimibe (P < 0.001). Inclisiran with statin ± ezetimibe led to a higher likelihood of achieving LDL-C less than 55  mg/dl. Adverse effects (5.8%) were mild.</p><p><strong>Major findings: </strong>This real-world study confirms inclisiran as a well tolerated and potent LDL-C-lowering treatment, with a greater efficacy when used in association with statins ± ezetimibe.</p>","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"27 3","pages":"249-252"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147490941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GRACE score for risk stratification and completeness of revascularization in older patients with myocardial infarction.","authors":"Luigi Spadafora, Marco Bernardi, Giuseppe Biondi-Zoccai, Iginio Colaiori, Vincenzo Guiducci, Javier Escaned, Raul Moreno, Gianni Casella, Caterina Cavazza, Giuseppe Vadalà, Matteo Tebaldi, Alberto Sarti, Stefano Clò, Federico Marchini, Serena Caglioni, Marta Cocco, Gianluca Campo, Simone Biscaglia, Francesco Versaci","doi":"10.2459/JCM.0000000000001853","DOIUrl":"10.2459/JCM.0000000000001853","url":null,"abstract":"<p><strong>Background: </strong>The GRACE score is a well established tool for predicting mortality outcomes in patients with myocardial infarction (MI). However, its prognostic role and interaction with revascularization strategies in older patients with MI remain unclear. This study aimed to assess whether the GRACE score was predictive of adverse events in the FIRE trial cohort and whether the benefits of complete revascularization were consistent across the spectrum of the GRACE score.</p><p><strong>Methods: </strong>The FIRE trial randomized 1445 patients aged 75 years or older with MI and multivessel coronary artery disease to receive either culprit-only or complete revascularization. In this subanalysis, patients were stratified according to GRACE score tertiles: the first tertile (GRACE 92.6-128.0), the second tertile (GRACE 128.1-146.5), and the third tertile (GRACE 146.6-236.0). The primary endpoint was all-cause mortality at 1 year. Other key endpoints included cardiovascular death and a composite of cardiovascular death or MI at 1 year.</p><p><strong>Results: </strong>According to GRACE score tertiles, 487 patients were in the first tertile (33.7%), 477 in the second tertile (33.0%), and 481 in the third tertile (33.3%). Patients in the third tertile were more compromised in terms of cardiovascular risk factors and comorbidities. At 1 year, all-cause mortality was significantly higher in the third tertile (P < 0.0001), as well as cardiovascular death (P < 0.0001) and the composite of cardiovascular death or MI (P < 0.0001). However, the effect of physiology-guided revascularization did not differ across GRACE score tertiles (P for interaction > 0.05 for all the outcomes of interest). Survival analysis confirmed that the GRACE score was significantly associated with increased all-cause mortality [hazard ratio 1.027, 95% confidence interval (95% CI) 1.021-1.033, P < 0.001], cardiovascular death (hazard ratio 1.031, 95% CI 1.023-1.039, P < 0.001), and the composite of cardiovascular death or MI (hazard ratio 1.020, 95% CI 1.013-1.026, P < 0.001). Again, no interaction was found between revascularization strategy and GRACE score (all P for interaction > 0.05). The best discriminative value of the GRACE score for all-cause mortality at 1 year was 137.</p><p><strong>Conclusion: </strong>The GRACE score was confirmed to be predictive of adverse outcomes even in older MI patients. Physiology-guided complete revascularization was associated with benefit across the GRACE spectrum, suggesting that the GRACE score alone should not preclude this strategy in older patients with MI.</p>","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"27 3","pages":"182-191"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147490923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: Beyond the ischemic horizon - redefining risk and revascularization in the aging patient.","authors":"Mustafa Aytek Simsek, Muzaffer Degertekin","doi":"10.2459/JCM.0000000000001855","DOIUrl":"10.2459/JCM.0000000000001855","url":null,"abstract":"","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"27 3","pages":"192-193"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147490988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes after catheter-directed therapies for pulmonary embolism in a regional hub-and-spoke system: lessons learned from a real-world experience.","authors":"Carlo Alberto Caruzzo, Sarina Leupp Simone Sarzilla, Antonio Landi, Marco Valgimigli, Andrea Milzi","doi":"10.2459/JCM.0000000000001848","DOIUrl":"10.2459/JCM.0000000000001848","url":null,"abstract":"<p><strong>Background and aims: </strong>Pulmonary embolism (PE) is a potentially life-threatening condition requiring timely intervention. This study sought to investigate the short-term outcomes and complications of pharmacomechanical interventions in a regional hub-and-spoke system.</p><p><strong>Methods: </strong>We retrospectively analyzed the first 90 intermediate-high or high-risk PE patients treated with ultrasound-assisted catheter-directed thrombolysis (USAT) and large-bore mechanical thrombectomy (LBMT) following the introduction of a centralized PE response team in our hub-and-spoke regional network.</p><p><strong>Results: </strong>Of the 90 included patients, 71 (78.9%) underwent USAT, 17 (18.9%) LBMT, and 2 (2.2%) both interventional strategies. Median age was 72.0 (60.8-78.2) years and 52.2% were female patients. Echocardiography and lab values revealed signs of right-ventricular impairment, with a baseline right-ventricular/left-ventricular (RV/LV) ratio of 1.2 ± 0.2 and elevated median high-sensitive troponin T [63.0 (37.0-120.0) ng/l] and NT-pro-BNP [2054.5 (538.2-5936.0) pg/ml] pg/ml. The RV/LV ratio was normalized (≤1.0) in 58.2% of cases before hospital discharge. In-hospital mortality occurred in 5 patients (5.6%), while 12 patients (13.5%) experienced bleeding complications, including one fatal intracranial hemorrhage.</p><p><strong>Conclusion: </strong>Our initial experience with pharmacomechanical interventions for intermediate-high/high-risk PE in a regional hub-and-spoke system shows favorable hemodynamic improvements with a nonnegligible complication rate. Optimization of technical aspects and patient selection is necessary.</p>","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"27 3","pages":"194-203"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147490996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}