Progress in cardiovascular diseases最新文献

{"title":"Percutaneous approach to aortic disease: EVAR, TEVAR and newer techniques for more proximal disease.","authors":"Ottavia Borghese, Teresa Lodico, Giulia Felice, Yamume Tshomba","doi":"10.1016/j.pcad.2026.10.005","DOIUrl":"https://doi.org/10.1016/j.pcad.2026.10.005","url":null,"abstract":"<p><p>Advances in device design, imaging and vascular-closure technology have driven a progressive shift from surgical femoral exposure to totally percutaneous strategies for endovascular aortic repair. This narrative review summarises contemporary evidence and practical considerations for percutaneous access across the spectrum of aortic disease, from infrarenal endovascular aneurysm repair (EVAR) to thoracic endovascular aortic repair (TEVAR), fenestrated/branched repair and endovascular treatment of the aortic arch. Percutaneous femoral access is now supported by randomized evidence, large registries and administrative cohorts showing high technical success, fewer wound complications, shorter operative times and shorter hospital stay compared with routine surgical cutdown, and real-time ultrasound-guided puncture has become a guideline-endorsed standard of care. Major contemporary developments include computed tomography-based access planning centred on calcification burden and sheath-to-artery ratio; an individualised, anatomy-driven choice between suture- and plug-based closure devices; endovascular preparation of hostile iliofemoral anatomy with pave-and-crack, endoconduits and intravascular lithotripsy; low-profile endografts that have widened transfemoral eligibility; and percutaneous axillary and carotid routes that enable complex TEVAR, fenestrated/branched and selected arch repairs in experienced centres, although evidence for these latter applications remains largely observational. Looking ahead, further reductions in delivery-system profile, dedicated large-bore closure technologies, image-fusion guidance and off-the-shelf branched devices are expected to extend fully percutaneous repair to increasingly complex anatomy, while prospective, aortic-specific and device-level comparisons with standardized anatomical metrics and long-term follow-up are needed to refine patient selection and confirm durable limb and target-vessel patency.</p>","PeriodicalId":94178,"journal":{"name":"Progress in cardiovascular diseases","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epicardial fat inflammation: bridging adipose tissue biology and cardiovascular medicine.","authors":"Gianluca Iacobellis","doi":"10.1016/j.pcad.2026.10.008","DOIUrl":"10.1016/j.pcad.2026.10.008","url":null,"abstract":"","PeriodicalId":94178,"journal":{"name":"Progress in cardiovascular diseases","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Living longer but not healthier: Global differences in longevity and cardiometabolic health.","authors":"Ali Bin Abdul Jabbar, Shahnoor Ahmed, Ali Hyder, Sana Sheikh, Salil Deo, Sabha Bhatti, Dinesh Kalra, Amirhossein Sahebkar, Zainab Samad, Shiva Raj Mishra, Salim S Virani","doi":"10.1016/j.pcad.2026.10.007","DOIUrl":"https://doi.org/10.1016/j.pcad.2026.10.007","url":null,"abstract":"<p><p>Global life expectancy has increased dramatically from 1950 to 2023, rising by 25 years for females and 24 years for males, driven mostly by advances in nutrition, sanitation, and infectious disease control, and in part by declining cardiovascular disease (CVD) mortality. Although age-standardized CVD mortality has declined in many settings, absolute cardiometabolic burden has increased because of population growth, aging, and rising exposure to metabolic risks. In 2023, CVD alone accounted for 437 million DALYs and 19.2 million deaths. While overall life expectancy did increase by 8.1 years globally between 1990 and 2019, healthy life expectancy increased by only 6.6 years, corresponding to a widening health span-lifespan gap. This divergence is indicative of prolonged years that are lived with disability, with cardiometabolic diseases among the modifiable drivers. Regional patterns reveal significant heterogeneity, with low- and middle-income countries facing a double burden of communicable diseases and rapidly rising cardiometabolic diseases that are primarily driven by urbanization, nutritional transitions, and inadequate primary care infrastructure. High-income countries, on the other hand, are witnessing a rising health span - life span gap due to near-stagnant growth in LE but expanding cardiometabolic morbidity. Understanding the relationship between changes in longevity and cardiometabolic health is essential for addressing the growing global burden of years lived with disability. This narrative review examines global and regional patterns of life expectancy and healthy life expectancy, with a focus on cardiometabolic disease, and highlights disparities across developmental levels, regions, and demographics to inform targeted prevention and intervention strategies.</p>","PeriodicalId":94178,"journal":{"name":"Progress in cardiovascular diseases","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lifetime management of valvular heart disease in younger and low risk patients.","authors":"Laura Novelli, Nerea Fernández Ortiz, Guillem Murillo Varona, José Luis Diez Gil, Jorge Sanz Sanchez","doi":"10.1016/j.pcad.2026.10.006","DOIUrl":"https://doi.org/10.1016/j.pcad.2026.10.006","url":null,"abstract":"<p><p>Valvular heart disease in younger and low-risk patients presents unique therapeutic challenges because treatment decisions must account not only for immediate procedural success but also for the durability of the index intervention, the feasibility of future reinterventions, and the preservation of subsequent treatment options. Consequently, lifetime management has emerged as a longitudinal treatment paradigm in which every intervention influences the sequence, complexity, and outcomes of future procedures. Over the past decade, transcatheter valve therapies have expanded rapidly from a treatment reserved for elderly and high-surgical-risk patients to an increasingly adopted option in younger and lower-risk populations. Although contemporary evidence has demonstrated excellent procedural safety and mid-term outcomes, important uncertainties remain regarding long-term durability and the optimal management of structural valve deterioration and repeat interventions. These considerations highlight the importance of approaching each intervention not as an isolated procedure, but as a step within a predefined lifetime therapeutic strategy. In this context, structured Heart Team discussion and shared decision-making are fundamental to develop an individualized treatment plan that optimizes outcomes while preserving future surgical and transcatheter options across decades of patient care. This review aims to provide a practical framework for the lifetime management of aortic, mitral, and tricuspid valve disease in younger and low-risk patients.</p>","PeriodicalId":94178,"journal":{"name":"Progress in cardiovascular diseases","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epicardial adipose tissue phenotyping by cardiac CT in heart failure.","authors":"G Mendieta, D Viladés, R Leta","doi":"10.1016/j.pcad.2026.10.002","DOIUrl":"10.1016/j.pcad.2026.10.002","url":null,"abstract":"","PeriodicalId":94178,"journal":{"name":"Progress in cardiovascular diseases","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypertension and clinical outcomes following thoracic radiotherapy.","authors":"Megan McCrohan, Prem Patel, Tyren Busby, Sanam Ghazi, Adia Holtman, Anna Siefker, Elizabeth Wade, Akash Goyal, Eric McLaughlin, Ning Jin, Robert E Merritt, Dayssy Diaz, Mussammat Ferdousi, Patrick Ruz, Sohil Reddy, Trudy Wu, Dominic DiCostanzo, Austin M Faught, Jonathan Brammer, Evans Osuji, Onaopepo Kola-Kehinde, Terence M Williams, Meng Welliver, Eric D Miller, Daniel Addison","doi":"10.1016/j.pcad.2026.10.003","DOIUrl":"10.1016/j.pcad.2026.10.003","url":null,"abstract":"<p><strong>Background: </strong>Radiation therapy (RT) is highly efficacious in treating thoracic malignancies. However, RT has been linked to potential cardiotoxicity. Yet, the long-term incidence, severity, and implications of HTN-development post-RT are unknown.</p><p><strong>Methods: </strong>Leveraging a large US-based Comprehensive-Cancer-Center-cohort of patients treated with thoracic-RT from 2007 to 2019, we included patients ≥18 years old with histologically confirmed esophageal or lung cancers. The primary outcome was incidence of incident/new or worsened HTN [systolic-blood-pressure-(SBP) ≥130 mmHg] after RT-initiation. The secondary outcomes were major-adverse-cardiac-events (MACE- heart-failure, myocardial-infarction, arrhythmia, stroke, and sudden-death), disease-progression, and overall-survival, by HTN-status. Differences in outcomes by HTN-status were also evaluated via landmark-analysis, excluding those with undiagnosed HTN. Observed new HTN rates were compared to Framingham-predicted-rates, and absolute-excess-risks were estimated. Multivariate regression was used to define the relation between clinical and RT measures and both new or worsened HTN-development and survival-outcomes.</p><p><strong>Results: </strong>Overall, 439 RT-treated patients (238 esophageal; 201 lung; 66.7% male; mean age 63.6 years; 65% baseline HTN) were identified. Over a median follow-up of 23 months, 255 (58.1%) developed new or worsened HTN; median SBP increase of 7 mmHg. In landmark-analysis, the cumulative incidence of new or worsened HTN by 1-year was 48.0% and 63.4%, respectively. Using the JNC-8 cutoff of ≥140/90 mmHg, the new HTN rate was 21.6% at 1-year, translating to a 3.4-fold higher rate than the Framingham-predicted-rate (RR 3.37, P < 0.001). In multivariate regression, RT-dose was consistently associated with new or worsened HTN-development (P < 0.05); those with RT-induced-HTN saw improved progression-free-survival and overall-survival (HR 0.67 and 0.54, P < 0.01, respectively). Beyond traditional factors, only RT-dose is consistently associated with MACE (P < 0.05). No specific antihypertensive class prevented RT-related HTN.</p><p><strong>Conclusions: </strong>These data suggest that thoracic-RT increases early HTN risk.</p>","PeriodicalId":94178,"journal":{"name":"Progress in cardiovascular diseases","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A nonexercise equation to predict VO₂ peak in chronic heart failure: Integrating clinical variables for prognostic assessment.","authors":"Audrey Borghi-Silva, Aldair Darlan Santos-de-Araújo, Samuel Montalvo, Jeffrey W Christle, Jonathan Myers","doi":"10.1016/j.pcad.2026.10.001","DOIUrl":"10.1016/j.pcad.2026.10.001","url":null,"abstract":"<p><strong>Background: </strong>Peak oxygen consumption (pVO2) has been widely recognized to identify potential pathophysiological mechanisms of exercise intolerance and to stratify risk in patients with heart failure (HF).</p><p><strong>Aims: </strong>To develop a non-exercise equation to estimate pVO2 (esVO2) and to determine its association with all-cause mortality.</p><p><strong>Methods: </strong>A total of 5176 HF patients (age 48 ± 17 years) who underwent a CPET for clinical reasons, and were followed between May 2011, and December 1, 2023. Clinical and historical variables and forced expiratory volume in 1-s (FEV₁) were used in a stepwise multivariate regression analysis to predict pVO2 measured from CPET. Kaplan-Meier curves and Cox proportional hazards analyses were used to determine the association between esVO2 and all-cause mortality.</p><p><strong>Results: </strong>The first esVO2 model was significantly associated with pVO2 (multiple R = 0.73, P < 0.001). Two other models considered gender separately (male: multiple R = 0.72, P < 0.001 and female (multiple R = 0.70, P < 0.001). A fourth model was proposed when spirometry is not available (age, BMI, resting SBP, HR and gender (multiple R = 0.69, P < 0.001)). The fifth proposed model included history of atrial fibrillation and previous stroke (multiple R = 0.70, P < 0.001). Kaplan-Meier survival curves differentiated patients according to esVO2 and pVO2 ≤ and > 14 mL/kg^-1 per min^-1. Univariate Cox proportional hazard analyses indicated significant prognostic value when esVO2 and pVO2 were ≤ 14 mL/kg^-1 per min^-1 (P = 0.001).</p><p><strong>Conclusions: </strong>Multivariable nonexercise models combining spirometry and/or clinical variables commonly obtained during a clinical assessment predict pVO2 reasonably accurately in HF.</p>","PeriodicalId":94178,"journal":{"name":"Progress in cardiovascular diseases","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors affecting serum neurofilament light chain in transthyretin amyloid cardiomyopathy.","authors":"Bryton Davis, Yuanzi Zhao, Israt Jahan, Hailey Volk, Nizar Chahin, Ahmad Masri","doi":"10.1016/j.pcad.2026.10.004","DOIUrl":"10.1016/j.pcad.2026.10.004","url":null,"abstract":"<p><strong>Background: </strong>While serum neurofilament light chain (sNfL) has shown promise as a biomarker for the development of peripheral neuropathy (PN) in hereditary transthyretin (TTR) amyloidosis (vATTR), its role in all-comers with ATTR cardiomyopathy (ATTR-CM) is less well-defined, and it is unknown how CM severity and TTR stabilizer therapy affect sNfL in ATTR-CM.</p><p><strong>Methods: </strong>Study participants included those with ATTR-CM not on gene-silencer therapy referred to Oregon Health & Science University. The association between sNfL and baseline patient characteristics, including age, sex, body mass index (BMI), presence of PN, ATTR subtype, N-terminal pro b-type natriuretic peptide (NT-proBNP), estimated glomerular filtration rate (eGFR) and tafamidis treatment, were evaluated utilizing linear regression.</p><p><strong>Results: </strong>66 patients (age: 78.5 ± 6.9 years, 6.1% female, 16.7% with diabetes mellitus, 10.6% vATTR-CM, 43.9% with PN symptoms, 30.3% receiving tafamidis at baseline) were included. There was no difference in sNfL levels when stratified by ATTR subtype (p = 0.168), PN symptoms (p = 0.881), or tafamidis treatment measured categorically (p = 0.418). In 17 patients (17.6% vATTR-CM) with available paired pre-tafamidis and on-tafamidis samples, there was no difference in sNfL level. In our univariable and multivariable analysis, NT-proBNP and eGFR were associated with sNfL.</p><p><strong>Conclusions: </strong>In ATTR-CM, cardiomyopathy severity and renal dysfunction impact sNfL more than presence of PN or other clinical factors.</p>","PeriodicalId":94178,"journal":{"name":"Progress in cardiovascular diseases","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardio-metabolic biomarkers including circulating ketone bodies and risk of incident atrial fibrillation in the multi-ethnic study of atherosclerosis (MESA).","authors":"Parag Anilkumar Chevli, James McParland, Soroush Masrouri, Kaushik Gokul, Margery A Connelly, Christopher R DeFilippi, Natalie Bradford, Anvi Raina, Susan R Heckbert, Moyses Szklo, Takeki Suzuki, Michael D Shapiro, Prashant D Bhave","doi":"10.1016/j.pcad.2026.09.010","DOIUrl":"10.1016/j.pcad.2026.09.010","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) reflects systemic cardio-metabolic dysfunction. While myocardial stress and injury biomarkers are associated with incident AF, the role of ketone bodies (KB) remains incompletely defined.</p><p><strong>Objectives: </strong>To evaluate a multi-biomarker risk score integrating KB with NT-proBNP and hs-cTnT for incident AF prediction and its incremental value beyond established clinical models.</p><p><strong>Methods: </strong>We studied 6429 MESA participants free of AF and clinical CVD at baseline. A multi-biomarker risk score using total KB >252 μmol/L, NT-proBNP ≥125 pg/mL, and hs-cTnT ≥14 ng/L was categorized as Very Low Risk Score = 0, Low Risk Score = 1-3, Intermediate Risk Score = 4-5, and High Risk Score > 5. Associations with incident AF were evaluated using Cox proportional hazards and Fine-Gray competing risk models.</p><p><strong>Results: </strong>Over 16.4 years, 1269 participants developed AF before death. Higher risk score categories were associated with a strong, graded increase in AF risk independent of demographic, socioeconomic, and clinical covariates. High Risk Score > 5 had nearly threefold greater AF risk versus Very Low Risk Score = 0 (HR 2.72; 95% CI, 2.11-3.49; P < 0.001). At 5 years, AUC was 0.768 for CHARGE-AF, 0.784 after adding NT-proBNP, and 0.787 after adding hs-cTnT. Adding KB after NT-proBNP and hs-cTnT did not materially change the AUC; 10-year findings were similar. Decision curves showed no clear additional net benefit.</p><p><strong>Conclusions: </strong>A multi-biomarker risk score integrating KB with NT-proBNP and hs-cTnT was strongly associated with incident AF and provided modest incremental predictive value beyond CHARGE-AF. External validation is warranted before clinical application.</p>","PeriodicalId":94178,"journal":{"name":"Progress in cardiovascular diseases","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early aortic valve replacement for asymptomatic severe aortic stenosis: an updated systematic review and meta-analysis.","authors":"Francesco Cannata, Alberico Del Torto, Kamil Stankowski, Fabio Fazzari, Valentina Mantegazza, Luigi Tassetti, Nicola Cosentino, Saima Mushtaq, Andrea Baggiano, Manuela Muratori, Gianluca Pontone","doi":"10.1016/j.pcad.2026.09.005","DOIUrl":"10.1016/j.pcad.2026.09.005","url":null,"abstract":"<p><strong>Background: </strong>The optimal timing of intervention in asymptomatic severe aortic stenosis remains debated. This updated meta-analysis evaluates the comparative effects of early surgical or transcatheter aortic valve replacement (AVR) versus conservative management by incorporating recent long-term randomized evidence.</p><p><strong>Methods: </strong>We performed a systematic review and meta-analysis of randomized trials comparing early AVR with conservative management in asymptomatic severe AS. Hazard ratios and 95% confidence intervals were pooled using a random-effects model, and exploratory meta-regression analyses were conducted to identify potential treatment-effect modifiers.</p><p><strong>Results: </strong>Across the included randomized trials, an early intervention strategy was associated with significant reductions in cardiovascular hospitalizations, heart failure hospitalizations, and stroke. Reductions in all-cause and cardiovascular mortality favored early intervention but did not achieve statistical significance. Treatment benefits varied according to clinical and hemodynamic profiles: greater baseline valve severity was associated with larger therapeutic effects, whereas increasing comorbidity burden (such as diabetes) tended to result in inferior clinical outcomes.</p><p><strong>Conclusions: </strong>In asymptomatic severe AS, an early AVR strategy consistently reduces cardiovascular and heart failure hospitalizations and stroke compared with conservative surveillance, despite neutral effects on overall and cardiovascular mortality. These findings support a contemporary shift toward an individualized, phenotype-driven approach rather than universal early intervention. Integrating hemodynamic severity and comorbidity burden can help identify patients most likely to derive net clinical benefit from early valve replacement.</p>","PeriodicalId":94178,"journal":{"name":"Progress in cardiovascular diseases","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}