Cardiology最新文献

{"title":"Mortality Impact of Stroke and Major Bleeding across the Ejection Fraction Spectrum in Patients Hospitalized for Acute Heart Failure with Prevalent Atrial Fibrillation.","authors":"Jumpei Yamamoto, Keijiro Nakamura, Hiromasa Hayama, Yoshinari Enomoto, Masaya Yamamoto, Hidehiko Hara, Hisao Hara, Yukio Hiroi","doi":"10.1159/000553289","DOIUrl":"10.1159/000553289","url":null,"abstract":"<p><strong>Introduction: </strong>Whether the mortality impact of ischemic stroke and major bleeding differs across left ventricular ejection fraction (LVEF) categories in patients hospitalized for acute heart failure (AHF) with atrial fibrillation (AF) remains uncertain.</p><p><strong>Methods: </strong>We retrospectively analyzed 716 patients hospitalized for AHF with prevalent AF (mean age: 79 ± 11 years; 49% female). During up to 3 years of follow-up (median: 1.4 years), 53 patients developed stroke and 89 developed major bleeding. Time-dependent Cox models were used to evaluate associations between poststroke and post-major bleeding states and all-cause and cardiovascular mortality, stratified by LVEF category: heart failure with reduced ejection fraction, mildly reduced ejection fraction, and preserved ejection fraction.</p><p><strong>Results: </strong>There were 160 deaths, including 106 cardiovascular deaths. As first qualifying events, 34 were stroke-first, and 74 were bleeding-first, with the remaining patients experiencing death-first or being censored. In time-dependent Cox models, post-major bleeding status was associated with higher all-cause mortality, whereas the poststroke association was imprecise (hazard ratio [HR] 2.00, 95% confidence interval [CI] 1.22-3.28 vs. HR 1.35 [95% CI 0.67-2.70]). For cardiovascular death, neither exposure reached conventional statistical significance (HR 1.97 [95% CI 0.93-4.17] after stroke and 1.69 [0.88-3.26] after bleeding). LVEF-stratified estimates were imprecise, and interaction tests did not support definitive effect modification.</p><p><strong>Conclusion: </strong>In patients hospitalized for AHF with prevalent AF, transition into a post-major bleeding state was associated with higher subsequent all-cause mortality, whereas the poststroke association was imprecise. LVEF-stratified findings were exploratory because interaction tests were not significant and event counts were limited. Bleeding-risk mitigation should accompany continued stroke prevention, not replace it.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-11"},"PeriodicalIF":1.9,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148337850","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":"Impact of Inflammatory Disorders on Outcomes in Acute Heart Failure: A Nationwide Analysis.","authors":"Alon L Roguin, Ofer M Kobo, Ohad Stoler, Arieh Fox, Supriya Shore, Edo Y Birati","doi":"10.1159/000552936","DOIUrl":"10.1159/000552936","url":null,"abstract":"<p><strong>Introduction: </strong>Acute heart failure (AHF) is characterized by rapid symptom deterioration and high mortality. This study evaluates how eight inflammatory disorders, driven by systemic inflammation, immune dysfunction, and antirheumatic cardiotoxicity, impact in-hospital mortality, complications, and length of stay during AHF admissions.</p><p><strong>Methods: </strong>We included patients hospitalized with AHF between 2015 and 18 from the National Inpatient Sample (NIS). The population was compared based on inflammatory disease status. The primary endpoint was in-hospital mortality, with additional endpoints: length of stay and in-hospital complications.</p><p><strong>Results: </strong>A total of 1,042,218 AHF admissions were included in our analysis, of whom 39,485 were diagnosed with CID. Patients with CID were older (72 vs. 71 years, p < 0.001) and more likely to be female (67.8% vs. 47.0%, p < 0.001). In the adjusted multivariable model, CIDs as a whole were not associated with increased in-hospital mortality (OR: 1.05, 95% CI: 0.98-1.12, p = 0.183) or MACE (OR: 1.00, 95% CI: 0.97-1.05, p = 0.765). However, disease-specific analysis revealed that SLE (OR: 1.56, 95% CI: 1.33-1.85, p < 0.001) and SSc (OR: 1.47, 95% CI: 1.14-1.89, p = 0.003) were independently associated with significantly higher mortality. Additionally, MCTD (9.06 days), SSc (6.50 days), and SLE (6.27 days) patients had significantly longer hospitalizations compared to non-CID patients (5.36 days, p < 0.001). Conversely, a significantly lower risk of major bleeding was observed in Ulcerative Colitis (OR: 0.40, 95% CI: 0.24-0.67, p = 0.001), and Sjögren's (OR: 0.43, 95% CI: 0.26-0.72, p = 0.001) cohorts.</p><p><strong>Conclusion: </strong>While CIDs as a whole were not found to impact acute heart failure mortality, specific systemic autoimmune rheumatic diseases, namely SLE and SSc, carry a significantly higher risk for in-hospital death. The substantially longer lengths of stay observed in SLE, SSc, and MCTD patients likely reflect severe multi-organ vulnerability and higher resource intensity rather than isolated acute cardiovascular events. Furthermore, the observed reduction in major bleeding risk among specific subgroups suggests that CIDs should not be managed as a monolithic group. Clinicians should remain aware of disease-specific risks when managing AHF in patients with systemic autoimmune conditions.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-13"},"PeriodicalIF":1.9,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13446872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148327133","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":"Predictors and Clinical Impact of Tricuspid Regurgitation after Pericardiectomy for Constrictive Pericarditis.","authors":"So-Min Lim, Ga Yun Kim, Sung-Ho Jung, Sahmin Lee, Byung Joo Sun, Dae-Hee Kim, Duk-Hyun Kang, Jong-Min Song","doi":"10.1159/000551607","DOIUrl":"10.1159/000551607","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative progression of tricuspid regurgitation (TR) is an adverse consequence after pericardiectomy in patients with constrictive pericarditis (CP). We aimed to identify predictors, as well as the clinical significance, of TR development following pericardiectomy in CP patients.</p><p><strong>Methods: </strong>A total of 132 CP patients with mild or less TR before pericardiectomy, performed between March 1991 and March 2023, were enrolled. Patients were divided into two groups based on TR severity on pre-discharge echocardiography. Patients who maintained mild or less TR were assigned into the no-TR group, whereas those who showed significant (moderate or greater) TR were assigned into the TR group. The primary endpoint was all-cause death.</p><p><strong>Results: </strong>Among the 132 patients, 110 patients (83.3%) were classified into the no-TR group and 22 patients (16.7%) into the TR group. The median follow-up period was 4.65 years. A low body surface area, presence of diabetes mellitus, large mitral valve (MV) annulus diameter, and left atrial volume index (LAVI) were predictors of significant TR after pericardiectomy. The optimal cutoff values for MV annulus diameter and LAVI were 30.51 mm and 31.65 mL/m2, respectively. All-cause mortality was significantly higher in the TR group than in the no-TR group (hazard ratio 2.26; 95% confidence interval 1.09-4.70; log-rank p = 0.018).</p><p><strong>Conclusion: </strong>An enlarged left atrium is a risk factor for postoperative significant TR resulting in poor survival after pericardiectomy in CP patients. These results may help to identify patients who may benefit from combined tricuspid valve surgery.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-13"},"PeriodicalIF":1.9,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148293435","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":"Time for Holistic Care following Hospital Discharge after Takotsubo Syndrome.","authors":"Birkan Tugrul, Wolfgang Dichtl","doi":"10.1159/000552042","DOIUrl":"https://doi.org/10.1159/000552042","url":null,"abstract":"","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-3"},"PeriodicalIF":1.9,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283313","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":"Timing Is Everything: From Static to Dynamic Risk Prediction in Cardiogenic Shock.","authors":"Jorge A Ortega-Hernández, Gabriela Rojas-Cruz","doi":"10.1159/000552083","DOIUrl":"https://doi.org/10.1159/000552083","url":null,"abstract":"","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-3"},"PeriodicalIF":1.9,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283362","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":"Effects of Pharmacologic, Non-Pharmacologic, and Exercise-Based Interventions on Coronary Collateral Circulation: A Scoping Review.","authors":"Shraddha Shah, Lakshman Iyer, Sanjay Ganapathi, Ramachandran Padmakumar, Abraham Samuel Babu, Barry A Franklin","doi":"10.1159/000553146","DOIUrl":"10.1159/000553146","url":null,"abstract":"<p><strong>Introduction: </strong>Coronary collaterals are vascular connections that bridge epicardial arteries and supply blood to the oxygen-deprived myocardium in patients with coronary artery disease (CAD). This comprehensive review aimed to identify and evaluate potential interventions that may enhance the growth of coronary collateral vessels.</p><p><strong>Methods: </strong>We conducted a scoping review of five databases to identify relevant studies that focused on interventions that may promote coronary collateral circulation in patients with CAD.</p><p><strong>Results: </strong>Our search identified 23 studies that met our inclusion criteria. Studies (n = 7) using pharmacologic agents (i.e., angiotensin-converting enzyme inhibitors, granulocyte macrophage colony stimulating factor, statins, human recombinant basic fibroblast growth factor, and granulocyte macrophage colony stimulating factor) were found to improve collateralization, as did the non-pharmacologic studies (n = 13) (i.e., exercise training, electrical stimulation, and enhanced external counterpulsation), which formed most of the studies. Three studies found benefits of a combination of exercise and heparin. Improvements were seen in collateralization as measured by the coronary flow index and Rentrop scores across all interventions. Effect sizes from randomized trials with pharmacologic, non-pharmacologic, and exercise-based interventions ranged between 0.4 and 0.7.</p><p><strong>Conclusion: </strong>This review provides a comprehensive overview and update of the existing literature on interventions that may promote coronary collateralization (CC). In summary, we observed a few pharmacological and non-pharmacological (exercise, electrical stimulation, and enhanced external counterpulsation) interventions that have shown a positive effect on CC. These data provide a framework for more robust trials regarding the proliferation and clinical significance of enhanced CC in cardiovascular outcomes in patients with known or occult CAD.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-18"},"PeriodicalIF":1.9,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13441269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283341","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":"Utilization of Guideline-Directed Medical Therapies and Transcatheter-Edge-to-Edge Repair in Patients with Significant Secondary Mitral Regurgitation.","authors":"Varun Bhasin, Azin Vakilpour, Krishna Ravindra, Daniel Koropeckyj-Cox, Srinivas Denduluri, Paul Fiorilli, Aditya Parikh, Ray Hu, Marielle Scherrer-Crosbie","doi":"10.1159/000551963","DOIUrl":"https://doi.org/10.1159/000551963","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with heart failure with reduced ejection fraction and significant secondary mitral regurgitation (MR) benefit from optimal guideline-directed medical therapies (GDMTs). In those who remain symptomatic despite optimal GDMT, transcatheter edge-to-edge repair (TEER) has been shown to reduce rates of heart failure hospitalization and all-cause mortality. The objective of this study was to evaluate the utilization of GDMT and TEER in patients with significant secondary MR and reduced left ventricular ejection fraction (LVEF) and determine gaps in care delivery.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of all patients in a tertiary care center who had newly diagnosed moderate to severe or severe secondary MR and a LVEF of <50% on echocardiography. Use of medical therapy was evaluated at 3 months after the initial echocardiogram in surviving patients. Optimal GDMT was defined as treatment with 3 or more heart failure therapies. Both univariable and multivariable logistic regression analyses were conducted after excluding patients who experienced early mortality within 3 months.</p><p><strong>Results: </strong>508 patients were identified from a retrospective chart query. 101 patients (20%) died (median time to death of 56 days) with 63 of these patients experiencing early mortality within 90 days. The remaining 445 patients (age 68 ± 15 years, 55% male, LVEF 29 ± 11%) were analyzed, including 324 with moderate to severe MR and 121 with severe MR. 237 patients (53%) were on optimal GDMT at 3 months after the initial echo. Older patients (OR 0.97, 95% CI 0.95-0.99), patients with coronary artery disease (OR 0.66, 95% CI 0.45-0.96, p = 0.03), cancer (OR 0.55, 95% CI 0.35-0.85, p = 0.01), and chronic kidney disease (CKD) (OR 0.60, 95% CI 0.41-0.87, p = 0.01) were less likely to be on optimal GDMT at 3 months. Age and CKD remained significant variables in the multi-variable analysis. Nine patients (1.8%) underwent TEER with a median time to TEER of 140 days.</p><p><strong>Conclusion: </strong>Patients with significant secondary MR and reduced LVEF have a high mortality. Implementation of optimal GDMT was imperfect, and TEER was rarely utilized. Older patients and those with CKD were less likely to be on optimal GDMT at 3 months. Further study is needed to understand gaps in GDMT implementation and the effective utilization of TEER.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-6"},"PeriodicalIF":1.9,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283311","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":"Coffee Consumption and Atrial Fibrillation: An In-Depth Interpretation behind the Evidence.","authors":"Weina Ren, Huijun Zheng, Hao Liu","doi":"10.1159/000553110","DOIUrl":"10.1159/000553110","url":null,"abstract":"","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-2"},"PeriodicalIF":1.9,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148263457","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":"Systematic Review Certainty of Evidence and Procedural Durability of Septal Reduction Therapies in Obstructive Hypertrophic Cardiomyopathy: An Umbrella Review of Meta-Analyses.","authors":"Arthur Cordeiro Simão, Marcos Benito Gonçalves de Oliveira, Antônio da Silva Menezes Junior","doi":"10.1159/000552974","DOIUrl":"10.1159/000552974","url":null,"abstract":"<p><strong>Introduction: </strong>This umbrella review aimed to evaluate the certainty and consistency of the available evidence rather than to provide a new procedural comparison. We synthesized systematic reviews comparing surgical septal myectomy (SM) versus alcohol septal ablation (ASA) for symptomatic obstructive hypertrophic cardiomyopathy (oHCM) to critically assess the certainty of findings.</p><p><strong>Methods: </strong>An umbrella review of meta-analyses was conducted following Cochrane and PRISMA guidelines. A systematic search of four databases was performed. Methodological quality, risk of bias, and study overlap were assessed. Quantitative synthesis was performed using a random-effects model, and the certainty of evidence was classified using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.</p><p><strong>Results: </strong>Six meta-analyses comprising 31 unique primary studies and 12,860 patients were included, demonstrating very high study overlap. ASA was associated with a significantly higher risk of reoperation compared to SM, supported by high-certainty evidence. Conversely, for all other outcomes, including mortality and permanent pacemaker implantation, the certainty of evidence was consistently classified as very low due to inconsistency and imprecision.</p><p><strong>Conclusion: </strong>High-certainty evidence supports SM as the more durable intervention for oHCM, demonstrated by a reduced need for reoperations. Notably, the evidence for mortality outcomes is of very low certainty, precluding definitive conclusions regarding clinical equivalence or technique superiority. This review identifies current knowledge gaps regarding survival benefits to inform clinical practice and future research.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-10"},"PeriodicalIF":1.9,"publicationDate":"2026-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249247","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":"Unravelling the Link between Inflammatory Biomarkers and Coronary Artery Ectasia Severity: A Systematic Review and Meta-Analysis.","authors":"Hang Zhang, Xin Chen","doi":"10.1159/000552688","DOIUrl":"10.1159/000552688","url":null,"abstract":"<p><strong>Introduction: </strong>Coronary artery ectasia (CAE), with increasing detection, and the role of inflammation remain controversial. This meta-analysis explored correlations between multiple inflammatory markers and the occurrence and severity of CAE.</p><p><strong>Methods: </strong>PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to July 2025 for relevant studies. Literature screening, data extraction, and quality assessment were performed. Meta-analysis was conducted using Review Manager 5.3, with fixed- or random-effects models based on heterogeneity; mean difference (MD), odds ratio (OR), bias risk, and sensitivity analyses were computed.</p><p><strong>Results: </strong>Fifty-three studies involving 9,168 subjects were included. Compared with the control group, patients with CAE had higher levels of high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α). The ratio of white blood cells (WBCs) to neutrophils in CAE patients was higher than that in coronary artery disease (CAD) and non-coronary artery (NCA) populations. Lymphocytes showed a gradient distribution of \"NCA > CAE > CAD\". The level of monocytes in CAE patients was higher than that in CAD patients, but similar to that in NCA patients. There was no significant correlation between the neutrophil-to-lymphocyte ratio levels of CAE patients and those of CAD patients. The levels of hs-CRP and lymphocytes in CAE patients were positively correlated with the severity of CAE. Multivariate analysis showed that hs-CRP (OR = 1.78) and WBC (OR = 1.00) were the factors related to CAE.</p><p><strong>Conclusion: </strong>Hs-CRP, IL-6, TNF-α, and various inflammatory cells are related to the occurrence of CAE. Hs-CRP and lymphocytes can indicate the severity of CAE.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-21"},"PeriodicalIF":1.9,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148238847","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}