Cardiology最新文献

{"title":"Causal Associations and Potential Mediating Factors between Sarcopenia-Related Traits and Heart Failure Risk: A Mendelian Randomization Study.","authors":"Yaping Zhang, Han Xu, Xinkai Qu, Kailei Shi, Chengqi Kong","doi":"10.1159/000553480","DOIUrl":"10.1159/000553480","url":null,"abstract":"<p><strong>Introduction: </strong>In this two-sample, two-step Mendelian randomization (MR) study, we aimed to elucidate the causal associations between sarcopenia-related characteristics and heart failure (HF) risk, and to identify the factors mediating these associations, with a particular focus on the mediating roles of obesity and sedentary habits.</p><p><strong>Methods: </strong>Genetic instruments for appendicular lean mass (ALM), hand grip strength (HGS), walking pace (WP), and potential mediators were extracted from genome-wide association studies. Inverse-variance weighting (IVW) was used as the primary analytical method, supplemented by MR-Egger regression, weighted median, and weighted mode analyses. Sensitivity analyses including Cochran's Q test and MR-Egger intercept method were performed to assess heterogeneity and pleiotropy. Bidirectional MR was conducted to exclude reverse causation.</p><p><strong>Results: </strong>IVW revealed that a faster genetically predicted WP was associated with lower HF risk (odds ratio [OR] 0.44, 95% confidence interval [CI] 0.33-0.60, p = 5.806 × 10-7). The mediation analysis indicated that body mass index (BMI) accounted for 32% of this effect, while time spent watching television accounted for 14%. Elevated ALM showed a slight but significant positive association with HF risk (OR 1.06, 95% CI 1.03-1.09, p = 5.437 × 10-4). However, multivariable MR adjusting for BMI completely attenuated this association (p = 0.693), suggesting ALM reflects overall body composition rather than isolated muscle mass. No significant associations were found between HGS and HF. Bidirectional MR showed no robust reverse effects.</p><p><strong>Conclusions: </strong>These findings suggest that genetically predicted increased WP exerts beneficial effects against HF, partially mediated by obesity and sedentary habits. Targeting weight management and anti-sedentary interventions may mitigate HF risk in individuals with sarcopenia-related characteristics.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-12"},"PeriodicalIF":1.9,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrocardiographic-Based Assessment in Acute Heart Failure with Left Bundle Branch Block: Insights from a Retrospective Cohort.","authors":"Cuma Suleymanoğlu, Fuat Polat, Rıdvan Yurt, İskan Zengin, Veysi Can","doi":"10.1159/000553619","DOIUrl":"10.1159/000553619","url":null,"abstract":"<p><strong>Introduction: </strong>Left bundle branch block (LBBB) complicates electrocardiographic interpretation in acute heart failure (AHF). This study aimed to evaluate the relationship between electrocardiographic parameters, including QRS duration, QRS morphology, and the Selvester QRS score (SQS), and echocardiographic findings in patients with AHF presenting with LBBB across different heart failure phenotypes.</p><p><strong>Methods: </strong>In this retrospective cohort, 275 patients hospitalized with AHF and LBBB were analyzed. Patients were classified as heart failure with reduced ejection fraction (HFrEF, left ventricular ejection fraction [LVEF] <40%), heart failure with mildly reduced ejection fraction (HFmrEF, LVEF 40-49%), or heart failure with preserved ejection fraction (HFpEF, LVEF ≥50%). Associations between electrocardiographic (ECG) and echocardiographic parameters were evaluated using Spearman correlation and multivariable regression. Discriminatory performance for reduced systolic function was assessed by receiver operating characteristic (ROC) analysis.</p><p><strong>Results: </strong>Mean age was 61.7 ± 13.8 years and 70.5% were male; median LVEF was 40% (IQR: 27-48%). HFrEF was present in 49.8%. Among ECG indices, only SQS correlated significantly with echocardiographic measures: LVEF (r = -0.447), left ventricular end-diastolic diameter (LVEDD, r = 0.346), left ventricular end-systolic diameter (LVESD, r = 0.373), and LV mass index (r = 0.205) (all p < 0.001). In multivariable analysis, SQS (OR = 1.373, 95% CI: 1.255-1.501, p < 0.001) and LV mass index independently predicted HFrEF. The Hosmer-Lemeshow test confirmed adequate calibration (p = 0.49). ROC analysis showed SQS had moderate discriminatory ability (area under the curve [AUC] 0.768, 95% CI: 0.711-0.825), with an optimal cutoff >43 yielding 74.5% sensitivity and 69.6% specificity. QRS duration and morphology demonstrated no meaningful predictive value (AUC ≈ 0.49).</p><p><strong>Conclusion: </strong>In AHF patients with LBBB, SQS outperforms conventional QRS metrics in identifying reduced LV systolic function. An SQS >43 provides moderate diagnostic accuracy and may support early risk stratification when echocardiography is not immediately available.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-11"},"PeriodicalIF":1.9,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimodality Imaging of Pulmonary Regurgitation and Right Ventricular Remodeling in Adults with Repaired Tetralogy of Fallot: A Descriptive Single-Center Case Series.","authors":"Jamilah AlRahimi","doi":"10.1159/000553580","DOIUrl":"10.1159/000553580","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic pulmonary regurgitation (PR) is a common late sequela after repair of Tetralogy of Fallot (TOF) and contributes to progressive right ventricular (RV) dilation, dysfunction, and adverse clinical outcomes. Multimodality imaging plays a central role in longitudinal assessment and in informing the timing of pulmonary valve replacement (PVR).</p><p><strong>Methods: </strong>We report a single-center, retrospective case series of seven adults with surgically repaired TOF followed at a tertiary care center. Each patient underwent serial transthoracic echocardiography (TTE) and at least two cardiac magnetic resonance (CMR) examinations over follow-up periods ranging from 5 to more than 15 years. PR severity was classified using CMR-derived regurgitant fraction according to established thresholds. RV size, systolic function, right ventricular outflow tract (RVOT) morphology, and clinical outcomes including PVR were recorded. Analyses were descriptive given the small sample size and heterogeneous nature of the cohort.</p><p><strong>Results: </strong>All seven patients (4 female, 3 male) survived to the most recent follow-up in 2025. PR was present in every patient, with CMR regurgitant fractions ranging from 21% to 57% at latest follow-up. Greater PR severity was associated with larger RV end-diastolic volume index (RVEDVi) and lower RV ejection fraction (RVEF) on serial imaging. RVEDVi ranged from 77 to 163 mL/m2 and RVEF from 37% to 61%. Qualitative concordance between TTE and CMR for RV remodeling was observed in 6 of 7 patients (86%). Several RVOT morphologic patterns were observed: patch-augmented RVOT with dilation, subpulmonic narrowing with turbulent flow acceleration, asymmetric branch pulmonary artery anatomy, and prosthetic pulmonary valve degeneration. Three patients underwent PVR during follow-up for severe PR, RVEDVi ≥150 mL/m2, declining RVEF, or symptomatic deterioration, and demonstrated post-procedural stabilization of RV size and improved functional status.</p><p><strong>Conclusions: </strong>In this single-center case series, integrated TTE and CMR provided complementary structural and functional information across a heterogeneous spectrum of post-repair RVOT anatomy, with CMR offering superior quantitative resolution of RV volumes and regurgitant fraction. The observed phenotypic variability illustrates the importance of multimodality, individualized surveillance in adults with repaired TOF, and reinforces the role of imaging integrated with clinical assessment in PVR decision-making.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-8"},"PeriodicalIF":1.9,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13485282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bending Oxygen Saturation Index and Risk of Major Cardiac Adverse Events in Patients with Pulmonary Arterial Hypertension.","authors":"Dursun Akaslan, Emre Aslanger, Burcu Aggül, Mehmet Narli, Elif Yaren Yurtman, Halil Ataş, Bülent Mutlu","doi":"10.1159/000553478","DOIUrl":"10.1159/000553478","url":null,"abstract":"<p><strong>Introduction: </strong>Shortness of breath while bending and its more objective version, bending oxygen saturation index (BOSI), are the latest additions to pulmonary arterial hypertension (PAH) symptom and signs armamentarium. In this study, we aimed to evaluate the association between BOSI and clinical outcomes in patients with PAH and to explore its potential to complement current risk estimation schemes.</p><p><strong>Methods: </strong>In this single-center, prospective, observational study, we enrolled patients with PAH who are under stable treatment. Baseline mortality risk was estimated using established risk schemes. Primary endpoint was defined as the combination of all-cause hospitalization and all-cause mortality at 1 year. The discriminative performance of BOSI was evaluated using ROC curve analysis.</p><p><strong>Results: </strong>A total of 102 patients were enrolled into the study. BOSI was equal to or more than 3 in 33 patients (32.4%). Primary endpoint occurred in 20 (60.6%) in BOSI ≥3 group and 16 (23.2%) in BOSI <3 group (p < 0.001). ROC analysis showed that BOSI had a significant discriminative ability (AUC 0.687, p = 0.002). Cox regression analysis showed that a BOSI ≥3 was significantly associated with adverse events, even after adjustment for baseline risk estimated by the four most used risk schemes (REVEAL, REVEAL Lite, COMPERA, and European Society of Cardiology/European Respiratory Society risk scores).</p><p><strong>Conclusion: </strong>BOSI is independently associated with adverse events in patients with PAH and its addition to current risk scores may improve baseline risk estimation.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-11"},"PeriodicalIF":1.9,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148435161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Predictors of 30-Day Readmission after Heart Failure Hospitalization in a Low- and Middle-Income Country.","authors":"Kabir Jitender, Zainab Batool, Sher M Sethi, Abdullah Umer, Farhala Baloch, Ainan Arshad","doi":"10.1159/000553526","DOIUrl":"10.1159/000553526","url":null,"abstract":"<p><strong>Introduction: </strong>Early hospital readmission after heart failure (HF) hospitalization is a major determinant of morbidity, mortality, and healthcare utilization. Most evidence informing readmission risk prediction originates from high-income countries, with limited data from low- and middle-income countries (LMICs), where healthcare delivery and post-discharge care differ substantially. We aimed to determine the rate and clinical predictors of 30-day readmission following HF hospitalization in an LMIC setting.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adult patients hospitalized with a primary diagnosis of HF between January 2020 and December 2022 at a tertiary care center in Pakistan. The primary outcome was unplanned all-cause readmission within 30 days of discharge. Baseline demographic, clinical, and laboratory variables were extracted from electronic health records. Multivariable logistic regression was performed using clinically informed, parsimonious modeling with continuous variables retained. Model discrimination and calibration were assessed using the C-statistic and Hosmer-Lemeshow test, respectively.</p><p><strong>Results: </strong>Among 557 patients hospitalized with HF, 172 (30.9%) experienced 30-day readmission. In multivariable analysis, a prior history of HF hospitalization was independently associated with increased readmission risk (adjusted odds ratio 1.9, 95% confidence interval 1.0-3.8; p = 0.04). Age, sex, HF phenotype, diabetes mellitus, renal function, and natriuretic peptide levels were not independently associated with readmission after adjustment. The model demonstrated acceptable calibration (Hosmer-Lemeshow p = 0.25) and modest discrimination (C-statistic 0.62).</p><p><strong>Conclusion: </strong>Nearly, one-third of patients hospitalized with HF in this LMIC cohort experienced 30-day readmission. Prior HF hospitalization was the only variable independently associated with early readmission, while inpatient clinical markers alone demonstrated limited predictive utility. These findings support the need for transitional care strategies and incorporation of socioeconomic and outpatient care factors into future readmission models in resource-limited settings.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-8"},"PeriodicalIF":1.9,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One-Hour Troponin Using a High-Sensitivity Point-of-Care Assay in Emergency Primary Care: The OUT-Point-of-Care Pilot Study.","authors":"Çağrı Zorlu","doi":"10.1159/000553108","DOIUrl":"10.1159/000553108","url":null,"abstract":"","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-2"},"PeriodicalIF":1.9,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation of Lactate Dehydrogenase Levels with Arrhythmia in Classic Severe Heatstroke.","authors":"Fujing Liu, Jing Shi, Fang Jin, Lingling Zhang, Ludan Yan, Yun Tang, Lijun Liu","doi":"10.1159/000553437","DOIUrl":"10.1159/000553437","url":null,"abstract":"<p><strong>Introduction: </strong>The incidence and risk factors for arrhythmia in patients with classic severe heatstroke remain poorly understood. This study aimed to investigate the relationship between lactate dehydrogenase (LDH) levels and arrhythmia in these patients.</p><p><strong>Methods: </strong>A retrospective multicenter cohort study was conducted across six hospitals involving patients with classic severe heatstroke. LDH levels were transformed using the natural logarithm, and modified Poisson regression was applied to assess the association between Ln(LDH) and arrhythmia. Receiver operating characteristic (ROC) curve analysis evaluated the predictive performance of LDH alone and in combination with the Sequential Organ Failure Assessment (SOFA) score for arrhythmia incidence. Mediation analysis was used to determine if LDH mediated the relationship between temperature and arrhythmia.</p><p><strong>Results: </strong>Among 261 eligible patients, 80 (30.7%) developed arrhythmia during hospitalization. After adjusting for confounders, modified Poisson regression revealed that higher Ln(LDH) was significantly associated with arrhythmia (adjusted relative risk [aRR] = 1.672, 95% CI = 1.162-2.407). ROC analysis demonstrated favorable predictive performance (AUC = 0.721; 95% CI: 0.657-0.785). The combination of LDH and the SOFA score significantly enhanced predictive accuracy (AUC = 0.789; 95% CI: 0.734-0.845). Mediation analysis showed that LDH partially mediated the relationship between temperature and arrhythmia, explaining 30.5% (95% CI: 15.1%-62.0%) of the association.</p><p><strong>Conclusion: </strong>Elevated LDH is significantly linked to an increased risk of arrhythmia in classic severe heatstroke and demonstrates strong predictive value.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-10"},"PeriodicalIF":1.9,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148419036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Letter.","authors":"Richard Z Lin, Rosanna Tavella, Sepehr Shakib, John F Beltrame","doi":"10.1159/000553412","DOIUrl":"10.1159/000553412","url":null,"abstract":"","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-2"},"PeriodicalIF":1.9,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aortic Valve Sclerosis: More than an Incidental Echocardiographic Finding.","authors":"Kenneth Caidahl, Sahrai Saeed","doi":"10.1159/000553214","DOIUrl":"10.1159/000553214","url":null,"abstract":"","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-4"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13466437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Resting Segmental Strain Identify Obstructive Coronary Artery Disease in Chronic Coronary Syndrome Patients Referred to Coronary Artery Bypass Grafting?","authors":"Assami Rösner, Didrik Kjønås, Marie Leiros Sandberg, Håvard Dalen, Henrik Schirmer","doi":"10.1159/000553322","DOIUrl":"10.1159/000553322","url":null,"abstract":"<p><strong>Introduction: </strong>Noninvasive identification of patients with chronic coronary syndrome (CCS) with obstructive coronary artery disease (CAD) remains a clinical challenge. Strain imaging enables detection of subtle myocardial dysfunction at rest and may serve as a sensitive marker of multivessel or left main CAD. This study aimed to assess whether segmental systolic strain at rest can identify patients with obstructive CAD referred for coronary artery bypass grafting (CABG) and to compare diagnostic performance of tissue Doppler imaging strain with two-dimensional speckle-tracking echocardiography in a retrospective analysis of a selected CABG-referred cohort.</p><p><strong>Methods: </strong>This retrospective study included 61 patients with CCS and obstructive CAD referred for CABG and 61 age- and sex-matched healthy controls from the population-based Nord-Trøndelag Health Study. All participants underwent echocardiography with both tissue Doppler and speckle-tracking strain analysis. The number of hypokinetic segments within one heart was counted, determined at different segmental peak longitudinal strain thresholds of -8% to -16%. The area under curve (AUC) using receiver operating characteristic analysis was used to evaluate diagnostic performance. Late gadolinium enhancement (LGE) cardiac magnetic resonance imaging (MRI) was used to assess myocardial scarring.</p><p><strong>Results: </strong>LGE MRI confirmed that 78% of patients had no visible myocardial scar and that overall scar burden was low (2.8%). At a hypokinetic strain threshold of -8%, tissue Doppler strain demonstrated excellent diagnostic accuracy for identifying myocardial dysfunction in CABG-referred patients (AUC 0.95, 95% confidence interval [CI]: 0.91-1.00), performing at least as well as speckle-tracking strain (AUC: 0.79, 95% CI: 0.70-0.87). Tissue Doppler strain identified obstructive CAD with 95% sensitivity and 86% specificity. Comparable AUCs were found in a subgroup of 20 patients without coronary occlusion or myocardial scarring, indicating that regional hypokinesia was equally detectable in patients with normal EF and no LGE-defined scars.</p><p><strong>Conclusion: </strong>Segmental strain imaging at rest - by both tissue Doppler and speckle tracking - can detect subclinical regional dysfunction in CABG-referred patients with obstructive CAD, even in patients with preserved global left ventricular function and no evidence of myocardial scarring. Tissue Doppler strain showed at least as high diagnostic accuracy as speckle-tracking strain. These findings underscore the clinical potential of resting segmental strain analysis as a sensitive, noninvasive tool for identifying obstructive CAD in this selected CABG-referred population.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-12"},"PeriodicalIF":1.9,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13485286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148350692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}