The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology最新文献

{"title":"Intravascular lithotripsy versus rotational atherectomy for coronary atherosclerosis calcification: a systematic review and meta-analysis.","authors":"Pirel Aulia Baravia, Faqrizal Ria Qhabibi, Isman Firdaus","doi":"10.1186/s43044-026-00747-2","DOIUrl":"10.1186/s43044-026-00747-2","url":null,"abstract":"<p><strong>Background: </strong>Intravascular lithotripsy (IVL) is a novel calcium modification strategy with little evidence of efficacy compared to widely used rotational atherectomy (RA).</p><p><strong>Aims: </strong>We sought to compare the efficacy and safety level between IVL and RA in moderate-to-severe coronary artery calcification (CAC).</p><p><strong>Methods: </strong>We searched three databases until March 2025 for eligible observational studies and randomized controlled trials. The primary endpoint was major adverse cardiac event (MACE) while secondary endpoints were clinical outcomes, periprocedural complication, and procedural outcomes. Mantel-Haenszel risk ratio (RR) was used for dichotomous endpoints, and inverse variance mean difference (MD) for continuous variables, both with 95% confidence interval (CI).</p><p><strong>Results: </strong>Seven observational studies and two randomized clinical trials (RCT) with 968 patients were included; 418 IVL-treated patients and 550 RA-treated patients. IVL is associated with lower risk of MACE (IVL 1.5% vs. RA 5.3%; RR: 0.34 CI: 0.13-0.87) and all-cause mortality (IVL 1.6% vs. RA 5.4%; RR: 0.35 CI: 0.15-0.81) in in-hospital outcome. However, assessed with longer follow-up, IVL developed comparable risk of MACE (IVL 4.3% vs. RA 7.7%; RR 0.70 CI: 0.42-1.18) compared to RA while all-cause mortality remained lower in IVL (2.5% vs. 7.0%; RR: 0.41 CI: 0.22-0.78). No significant differences were observed in the risk of myocardial infarction (p = 0.58), nor in the risk of dissection (p = 0.52), perforation (p = 0.22), or slow/no-reflow (p = 0.07). IVL likewise demonstrated comparable procedural performance, including procedural success, angiographic success, fluoroscopy duration, and procedural time.</p><p><strong>Conclusion: </strong>IVL has similar outcomes to RA in terms of procedure outcomes and periprocedural complications. However, IVL is associated with lower all-cause mortality and MACE specifically in short term outcomes.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13194918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147984625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aneurysmal systemic-to-pulmonary arterial connection mimicking MAPCA in a structurally normal adult: computed tomography angiography diagnosis and endovascular exclusion.","authors":"Saubhagya Dhakal, Nikahat Yasmine, Nevzat Karabulut","doi":"10.1186/s43044-026-00749-0","DOIUrl":"10.1186/s43044-026-00749-0","url":null,"abstract":"<p><strong>Background: </strong>Major aortopulmonary collateral arteries (MAPCAs) are anomalous systemic-to-pulmonary vessels classically associated with complex congenital heart disease. In adults with structurally normal hearts, however, anomalous systemic-to-pulmonary arterial connections represent a broader diagnostic spectrum that includes MAPCA-like vessels, bronchial or non-bronchial systemic arterial collaterals, and isolated systemic arterial supply to normal lung (ISSNL). Aneurysmal degeneration in this setting is uncommon and clinically important because of the risk of rupture or hemorrhage.</p><p><strong>Case presentation: </strong>We report a 48-year-old man presenting with acute non-exertional chest pain. Computed tomography angiography (CTA) demonstrated a 2.6-cm saccular aneurysm arising from a tortuous systemic artery originating from the proximal descending thoracic aorta and extending toward the left lower lobe pulmonary arterial circulation. CTA delineated the vascular origin, course, aneurysmal morphology, and absence of associated congenital cardiac abnormalities. Digital subtraction angiography confirmed a single systemic-to-pulmonary arterial communication. The patient underwent thoracic endovascular aortic repair with adjunctive coil embolization, resulting in complete aneurysm exclusion and symptom resolution.</p><p><strong>Conclusions: </strong>This case highlights an aneurysmal systemic-to-pulmonary arterial connection with MAPCA-like features in a structurally normal adult. The case emphasizes the importance of CTA in differentiating MAPCA-like vessels from bronchial artery aneurysm, non-bronchial systemic collaterals, and ISSNL, and demonstrates the effectiveness of endovascular therapy in excluding a potentially high-risk aneurysmal vascular lesion.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13194822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147984622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and CT angiographic evaluation of coronary artery anomalies in 20,243 consecutive patients: a retrospective study.","authors":"Seenu Prasanth Adimoulame, Rohan Krishna C R, Rangaraj Ramalingam, Ashita Barthur, Madhav Hegde, Anushree Kumbhalkar, Sruthi Sankar","doi":"10.1186/s43044-026-00744-5","DOIUrl":"10.1186/s43044-026-00744-5","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery anomalies (CAAs) are rare congenital abnormalities involving the origin, course, or structure of coronary arteries. While often incidental, some variants have clinical and procedural implications. With the increasing use of computed tomography coronary angiography (CTCA), more anomalies are being detected, yet large-scale data from India remain limited.</p><p><strong>Objectives: </strong>To evaluate the prevalence, anatomical patterns, and clinical relevance of CAAs over a 12-year period using CTCA at a high-volume tertiary cardiac center in India.</p><p><strong>Methods: </strong>In this retrospective study, 20,243 consecutive patients undergoing multidetector CTCA between January 2011 and October 2023 were analyzed. Coronary anomalies were categorized into myocardial bridging (MB) and non-MB types based on Angelini's classification. Each scan was independently reviewed by both a radiologist and a cardiologist.</p><p><strong>Results: </strong>Coronary artery anomalies (CAAs) were identified in 1513 patients (overall prevalence 7.5%), largely driven by myocardial bridging (MB). When MB was excluded, the prevalence of non-bridging anomalies was 0.9% (n = 183), including both isolated and combined cases. Isolated myocardial bridging was the most common finding, identified in 1330 patients (87.9%), predominantly involving the mid-segment of the left anterior descending artery. Isolated non-bridging anomalies were observed in 171 patients, while 12 patients had combined MB and non-MB anomalies. Among non-bridging anomalies, the most frequent included anomalous right coronary artery origin from the left sinus with an interarterial course (26.9%), retroaortic left circumflex artery (9.9%), separate origins of the LAD and LCX (8.8%), and high take-off anomalies (7.6%). Most anomalies were classified according to Angelini's framework, with a small subset remaining unclassified due to atypical anatomical presentations.</p><p><strong>Conclusions: </strong>This 12-year retrospective cross-sectional study represents one of the largest single-center CTCA-based datasets on coronary artery anomalies (CAAs) globally. The findings highlight the utility of CTCA in detecting and characterizing both benign and potentially significant anomalies. The anatomical insights derived from this cohort have direct clinical relevance, aiding interventional cardiologists in procedural planning and risk stratification. Future multicenter studies are warranted to further refine diagnostic algorithms and management strategies across diverse populations.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13187100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polygenic risk scores for cardiovascular disease: clinical utility and limitations.","authors":"Faith Adedayo Adejumo, Oluwayimika Oluwatobi Obielodan, Emmanuela Ojoagefu Egwu, Temitomi Jane Oyedele, Ebunoluwa Hannah Fasanye, Emmanuel Niyi-Oriolowo, Oluwadara Favour Odejayi, Olorundemilade Dunmade David, Temilade Adejumo, Fiyinfoluwa Adetoye, Nicholas Aderinto","doi":"10.1186/s43044-026-00746-3","DOIUrl":"10.1186/s43044-026-00746-3","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide, highlighting the need for improved risk prediction and prevention strategies. Polygenic Risk Scores (PRS), derived from genome-wide association studies (GWAS), offer a novel approach to estimating an individual's genetic predisposition to conditions such as coronary artery disease (CAD), atrial fibrillation (AF), and heart failure (HF).</p><p><strong>Main text: </strong>PRS can improve early risk stratification, particularly among individuals with high genetic susceptibility who may not yet present traditional risk factors. Evidence suggests that PRS enhances risk prediction in younger populations and may inform targeted prevention efforts. However, several limitations constrain their clinical utility. These include limited predictive power relative to conventional risk models, a lack of diverse population representation in GWAS, and challenges in incorporating PRS into routine clinical workflows.</p><p><strong>Conclusions: </strong>While PRS holds promise for advancing personalized cardiovascular care, its clinical implementation requires overcoming key limitations. Increasing diversity in genetic research and integrating PRS with established clinical risk tools are critical steps toward realizing their full potential in CVD prevention and management.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13184024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147965916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individualized dynamic ablation strategy for persistent atrial fibrillation based on ibutilide response.","authors":"Jing Hu, Yu Xia, Yu Tao, Le Li, Xu Meng, Min Lin, Yin Liu, Hengli Lai, Ligang Ding, Yan Yao","doi":"10.1186/s43044-026-00745-4","DOIUrl":"10.1186/s43044-026-00745-4","url":null,"abstract":"<p><strong>Background: </strong>Persistent atrial fibrillation (PsAF) ablation faces a dilemma between insufficient pulmonary vein isolation (PVI) leading to high recurrence and excessive ablation increasing complications without clear benefit. Ibutilide may help identify critical ablation targets by modifying the arrhythmia substrate.</p><p><strong>Methods: </strong>This retrospective single-center study analyzed 367 PsAF patients undergoing ibutilide-guided ablation. After PVI, patients converting directly to sinus rhythm (SR) (PVI group, n = 86) received no further ablation. Non-responders (PVI+Linear group, n = 281) underwent linear ablation and were categorized by acute termination pattern: Directly to SR (n = 109), AFL to SR (n = 87), DC to SR (n = 75), or Failure (n = 10). Subgroups based on low-voltage areas (LVZs) and AF duration were analyzed. AF recurrence (> 30s post 3-month blanking period) was assessed.</p><p><strong>Results: </strong>Over a mean follow-up, AF-free survival rate was non-significantly higher in the PVI group vs. PVI+Linear group ((73.9% vs. 60.7%, P = 0.070). In the PVI+Linear group, success rates differed significantly by acute termination pattern (Direct to SR:67.8%, AFL to SR:72.6%, DC to SR:26.4%, Failure to SR:30.0%, P < 0.001), LVZs presence (Absent:63.8% vs. Present:55.8%, P < 0.001), and AF duration (≤ 1 year:73.9%, 1-5 year:55.3%, ≥ 5 year:44.6%, P < 0.001). Female, larger LA diameter, longer AF duration, and DC/Failure termination patterns independently predicted recurrence.</p><p><strong>Conclusion: </strong>The use of ibutilide may help identify \"PVI‑sensitive\" atrial fibrillation, reducing the extent of ablation without compromising efficacy.Female sex, LA enlargement, prolonged AF duration, and requiring DC/failing to terminate acutely predict recurrence.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13172120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147935886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of thrombocytopenia on bleeding and cardiovascular outcomes in patients undergoing percutaneous coronary intervention with dual-antiplatelet therapy.","authors":"Vishnu Sharma, Rajat Pachori, Vansh Bagrodia, Abhinav Agarwal, Arpita Digwal, Yajat Raisinghani, Naman Modi, Vansh Gupta, Toshit Vijayvergia, Abhishek Jhajharia, Harshvarshan Sharma, Prinshu Garg, Suhani Mittal","doi":"10.1186/s43044-026-00739-2","DOIUrl":"10.1186/s43044-026-00739-2","url":null,"abstract":"<p><strong>Background: </strong>Patients with thrombocytopenia undergoing percutaneous coronary intervention (PCI) are at an elevated risk of bleeding and adverse cardiovascular events due to dual-antiplatelet therapy (DAPT). Limited data exist on the safety of DAPT in this subset of patients.</p><p><strong>Methods: </strong>This single-centre prospective cohort study was conducted at SMS Medical College, Jaipur, India, over 12 months (March 2024-March 2025). A total of 368 patients with baseline (pre-PCI) thrombocytopenia who underwent elective or emergency PCI while on DAPT were enrolled. DAPT comprised aspirin plus a P2Y12 inhibitor: clopidogrel in 317 patients (86.1%), ticagrelor in 48 (13.0%), and prasugrel in 3 (0.8%), with the choice based on clinician discretion; the distribution did not differ significantly across thrombocytopenia grades (p = 0.204). DAPT was generally maintained for 6-12 months per institutional protocol, without a standardized de-escalation strategy. Thrombocytopenia was classified based on pre-procedural platelet counts as mild (100,000-150,000/mm³; n = 237, 64.4%), moderate (50,000-100,000/mm³; n = 104, 28.2%), or severe (30,000-50,000/mm³; n = 27, 7.3%). The primary outcomes were major adverse cardiovascular events (MACE), defined as a composite of total death, myocardial infarction (MI), coronary revascularization, stroke, and hospitalization due to heart failure; and bleeding events assessed using Bleeding Academic Research Consortium (BARC) criteria. Secondary outcomes included in-hospital mortality, stent thrombosis, target vessel revascularization, and post-PCI MI. Follow-up was conducted at 1, 2, and 6 months post-PCI. Multivariate logistic regression was used to adjust for confounders across three sequential models (demographics; clinical variables; procedural outcomes).</p><p><strong>Results: </strong>Severe thrombocytopenia independently predicted higher risks for MACE (HR: 2.30, CI: 1.89-2.81) and bleeding (HR: 2.88, CI: 2.37-3.49) across all models. Mild thrombocytopenia showed no significant risk after adjustment for confounders. Patients with moderate thrombocytopenia demonstrated consistent risks for both outcomes. Smoking and history of PCI/MI significantly correlated with thrombocytopenia severity (p < 0.01).</p><p><strong>Conclusion: </strong>Moderate and severe thrombocytopenia are independently associated with increased risks of bleeding and cardiovascular events in patients on DAPT post-PCI. These observational findings support the incorporation of thrombocytopenia severity into existing risk stratification frameworks; however, as this study did not evaluate alternative management strategies, prospective randomized trials are needed to determine whether modified antiplatelet regimens can improve outcomes in this high-risk population.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147870949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical management of a free-floating thrombus in the ascending aorta presenting with recurrent systemic embolism: a case report.","authors":"Hironari No, Hiroki Kato, Masaki Kitazawa","doi":"10.1186/s43044-026-00743-6","DOIUrl":"10.1186/s43044-026-00743-6","url":null,"abstract":"<p><strong>Background: </strong>A free-floating thrombus in the ascending aorta is a rare but clinically significant condition that can cause cerebral and peripheral arterial embolism. Preoperative differentiation from primary aortic tumors, particularly intimal sarcoma, remains challenging even with positron emission tomography-computed tomography (PET-CT). Optimal treatment strategies have not been established.</p><p><strong>Case presentation: </strong>A 49-year-old man presented to our emergency department with acute right lower extremity ischemia. Contrast-enhanced computed tomography revealed acute occlusion of the right common femoral artery, and emergent thrombectomy was performed on the same day. He had experienced a cryptogenic cerebral infarction two months earlier; although echocardiography had shown no intracardiac thrombus, he had been managed with anticoagulation alone. To identify the source of recurrent embolism, contrast-enhanced computed tomography from the neck to the pelvis was performed, revealing a pedunculated mass in the ascending aorta. PET-CT showed no abnormal uptake. On hospital day 10, ascending aortic replacement with a prosthetic graft was performed. Intraoperative epi-aortic echocardiography was used to identify the thrombus location and determine a safe cross-clamp site, thereby avoiding deep hypothermic circulatory arrest. The mass was resected together with a ring-shaped segment of the aortic wall at its attachment site to prevent local recurrence. Pathological examination confirmed an organizing thrombus without neoplastic features. The postoperative course was uneventful, and the patient was discharged on postoperative day 13. At 5-year follow-up, no recurrent embolic events or new thrombus formation has been observed.</p><p><strong>Conclusions: </strong>In patients with a pedunculated free-floating thrombus in the ascending aorta presenting with recurrent systemic embolism, early surgical intervention, including graft replacement, is a reasonable therapeutic option. Graft replacement enables complete excision of the attachment site for recurrence prevention and provides a definitive histopathological diagnosis. However, further accumulation of cases is needed to establish optimal management strategies for this rare condition.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13156391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Construction and verification of a diagnostic nomogram for heart failure in hypertrophic cardiomyopathy based on conventional clinical indicators: a case-control study.","authors":"Yu Li, Ziqi Duan, Jinlei Li, Bingxin Cheng, Fen Ai, Zhen Chen","doi":"10.1186/s43044-026-00742-7","DOIUrl":"10.1186/s43044-026-00742-7","url":null,"abstract":"<p><p>Heart failure (HF) manifests variably in patients with hypertrophic cardiomyopathy (HCM). This study developed and validated a diagnostic nomogram that uses routine clinical indicators to identify HF in individuals with HCM. Independent diagnostic indicators of HF in patients with HCM included B-type natriuretic peptide (BNP) (OR = 1.003, P < 0.001), diuretics (OR = 3.69, P = 0.014), and myocardial ischemia (OR = 4.99, P = 0.002). The diagnostic model demonstrated robust performance in both the training set and the validation set, yielding AUCs of 0.917 (95% CI: 0.879-0.955) and 0.929 (95% CI: 0.873-0.984), respectively. At an optimal threshold of 0.157, the training set exhibited sensitivity and specificity of 89.1% and 79.9%, respectively, while the validation set showed sensitivity and specificity of 90.9% and 82.9%, respectively. The calibration curve indicated a good fit, and DCA revealed that the model provided a net clinical benefit. In this study, the developed nomogram model accurately identifies HF in patients with HCM, aiding in diagnostic stratification and personalized management.Clinical Trial Registration This study was registered retrospectively at the Chinese Clinical Trial Registry ( http://www.chictr.org.cn/ ), registration number ChiCTR2500106648 (Registration Date: 2025-07-28).</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13156373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aortic response to cancer therapy: a narrative review of the radiotherapy paradox and clinical implications.","authors":"Bibin Joseph, P Ajay Chand","doi":"10.1186/s43044-026-00740-9","DOIUrl":"10.1186/s43044-026-00740-9","url":null,"abstract":"<p><strong>Background: </strong>Cancer treatments such as chemotherapy and radiotherapy significantly impact the cardiovascular system. While cardiac toxicity is well characterized, the effects on the aorta, the body's largest artery, remain less understood. Given that aortic weakening may lead to life-threatening conditions such as aneurysm formation and rupture, understanding these effects is crucial for improving long-term vascular health in cancer survivors.</p><p><strong>Methods: </strong>This narrative review synthesizes findings from six selected studies comprising clinical investigations and reviews. It examines the impact of radiotherapy, chemotherapy, cancer-related systemic factors, and incidental aortic findings from radiotherapy planning computed tomography scans, analysing their roles in aortic pathology progression or stabilization.</p><p><strong>Results: </strong>In this narrative review of six selected studies, radiotherapy was consistently associated with slower aneurysm expansion (~ 1.1 mm/year vs. 2.7 mm/year), suggesting a paradox wherein radiation-induced fibrosis and modulation of inflammatory processes may stabilize the aortic wall. Chemotherapy showed no significant effect on aneurysm growth, with rates comparable between treated patients and controls (~ 2.3 vs. 2.4 mm/year). Cancer-induced sarcopenia and inflammation contributed to adverse aortic remodelling within one year. Additionally, a high prevalence (9.3%) of thoracic aortic dilatation was identified via opportunistic screening on radiotherapy planning CTs, emphasizing an opportunity for earlier detection and intervention.</p><p><strong>Conclusions: </strong>The complex interplay between cancer therapies and aortic biology reveals a potentially counterintuitive stabilization of aortic pathology following radiotherapy, in contrast to the neutral effects of chemotherapy and the deleterious influence of cancer-related systemic changes. Radiotherapy planning CT offers an underutilized avenue for vascular screening. Future prospective studies are essential to disentangle these paradoxes and translate mechanistic insights into strategies that protect vascular integrity while optimizing cancer treatment outcomes.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13129122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anemia and long-term outcomes after second-generation drug-eluting stent implantation: a retrospective cohort study of mortality and clinical restenosis.","authors":"Mani Ghorbanzadeh-Aghdam, Samaneh Sardari, Mahsa Nikkhoo, Seyedhesamoddin Khatami, Amirali Zarrin, Mobina Riahi, Mojtaba Salarifar","doi":"10.1186/s43044-026-00725-8","DOIUrl":"10.1186/s43044-026-00725-8","url":null,"abstract":"<p><strong>Background: </strong>Anemia is common in patients undergoing percutaneous coronary intervention (PCI) and is a well-established predictor of bleeding and mortality. However, whether anemia contributes to clinically relevant in-stent restenosis (ISR) in the era of second-generation drug-eluting stents (DES) and competing long-term risks remains uncertain.</p><p><strong>Methods: </strong>We retrospectively analyzed 4,117 consecutive adults treated with PCI using second-generation DES at Tehran Heart Center. Anemia was defined as hemoglobin <13 g/dL in men and < 12 g/dL in women. The prespecified primary endpoint was clinically driven target lesion revascularization (TLR) within 5 years, used as a pragmatic proxy for clinical ISR and requiring ischemic symptoms or objective ischemia attributable to the index lesion. Secondary endpoints included all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE). Associations between anemia and outcomes were estimated using Cox proportional hazards models with inverse probability weighting (IPW) based on baseline covariates; Fine-Gray competing-risk models treating death as a competing event were prespecified sensitivity analyses for TLR.</p><p><strong>Results: </strong>Anemia was present in 369/4,117 (9.0%) patients. Cumulative TLR occurred in 73 (1.9%) patients, with only 3 events in the anemic group. Given this low event rate, statistical power to detect a difference in TLR was limited. TLR rates did not differ significantly between groups (IPW-adjusted HR 0.27, 95% CI 0.07 to 1.01; p = 0.051), a finding that was consistent in competing-risk analyses. In contrast, mortality was significantly higher in anemic patients (11.5% vs. 4.6%; IPW-adjusted HR 1.87, 95% CI 1.22 to 2.87; p = 0.004).</p><p><strong>Conclusions: </strong>In an all-comers cohort undergoing PCI with second-generation DES, baseline anemia was not associated with an increased risk of clinically driven TLR, but it remained a strong independent predictor of long-term mortality. These findings suggest that in contemporary practice, the dominant prognostic impact of anemia is on mortality. However, given the low TLR event rate, the relationship between anemia and clinically manifest restenosis requires further investigation in larger, adequately powered studies.</p>","PeriodicalId":74993,"journal":{"name":"The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}