Progress in cardiovascular diseases最新文献

{"title":"Artificial intelligence for risk prediction in atherosclerotic cardiovascular disease: A narrative review of advances, validation challenges, and clinical translation (2020-2026).","authors":"Ruifeng Liu, Ross Arena, Vlad C Vasile, Adelaide M Arruda-Olson, Dejana Popovic","doi":"10.1016/j.pcad.2026.08.012","DOIUrl":"10.1016/j.pcad.2026.08.012","url":null,"abstract":"<p><p>Since 2020, artificial intelligence (AI) has been increasingly applied to atherosclerotic cardiovascular disease (ASCVD) risk prediction. This structured narrative review with systematic evidence mapping summarizes literature (2020-2026) examining study design, data sources, model architectures, multimodal fusion, model development and validation, performance evaluation, subgroup applications, and implementation barriers. Overall, 126 studies informed the review; 93 provided sufficient information for structured extraction, including prevention setting, exact input variables, comparator scores, validation strategies, discrimination, calibration, dominant model architecture, endpoint category, foundation-model or pretrained-model status, regulatory status, and implementation features. AI-based models may offer modest but clinically meaningful gains over conventional risk equations, especially with multimodal or longitudinal data. Among the 93 studies, traditional machine learning accounted for 83 (89%), deep learning for 7 (8%), and multimodal fusion for 3 (3%). Endpoint definitions were heterogeneous (23% ASCVD-specific; 63% expanded MACE composites). Among these studies, no large language model or federated learning was used for risk prediction. Appropriate comparators should now include contemporary equations such as PREVENT, rather than only legacy tools. Major barriers remain, including limited external validation, performance attenuation, data and algorithmic bias, limited interpretability, inconsistent reporting of calibration, fairness, and clinical utility, unclear regulatory status, and limited prospective evidence. Future work should prioritize calibration, robustness, transportability, fairness, interpretability, regulatory clarity, workflow integration, and prospective evidence of decision impact or post-deployment benefit. The central question is not only whether AI can detect complex patterns, but whether such models can be trusted, implemented, and shown to advance preventive cardiology in real-world settings.</p>","PeriodicalId":94178,"journal":{"name":"Progress in cardiovascular diseases","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835197","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":"Aficamten is associated with improvements in cardiac mechanics in obstructive hypertrophic cardiomyopathy: Results from FOREST-HCM.","authors":"Mei-Ling Chen, James Hodovan, Ahmad Masri, Victoria Liu, Mi-Ok Kim, Chiara Melloni, Daniel L Jacoby, Stephen B Heitner, Theodore P Abraham","doi":"10.1016/j.pcad.2026.08.013","DOIUrl":"10.1016/j.pcad.2026.08.013","url":null,"abstract":"<p><strong>Background: </strong>Aficamten is a next-in-class, selective cardiac myosin inhibitor (CMI) that relieves left ventricular outflow tract (LVOT) obstruction in obstructive hypertrophic cardiomyopathy (oHCM) by addressing underlying myocardial hypercontractility. The long-term impact of aficamten on myocardial mechanics as measured by global longitudinal strain (GLS) is unknown.</p><p><strong>Methods: </strong>FOREST-HCM (NCT04219826) is an ongoing open-label extension trial for eligible patients with HCM who completed a parent study of aficamten. Here we report echocardiographic parameters (LVOT gradient and myocardial GLS) obtained from baseline up to week 48 from oHCM patients (N = 27) included in the FOREST-HCM study.</p><p><strong>Results: </strong>From baseline to 38 ± 4.8 weeks, aficamten reduced LVOT gradients at rest (mean difference - 32.7 ± 24 mmHg, p < 0.0001 vs. baseline) and with Valsalva (mean difference - 62.44 ± 34.5 mmHg, p < 0.0001 vs. baseline). Compared to baseline, strain analysis revealed similar GLS at week 12 (-13.9 ± 3.2 vs. -14.3 ± 3.0, p = 0.316) but a significant improvement at weeks 36-48 (-13.9 ± 3.2 vs. -15.1 ± 2.7, p = 0.0093). These improvements were only seen in patients who achieved a hemodynamic response (resting LVOT-G < 30 mmHg, n = 24, p = 0.0009; or complete response with rest <30 mmHg and Valsalva <50 mmHg, n = 21, p = 0.0023).</p><p><strong>Conclusions: </strong>Aficamten therapy improves myocardial mechanics after long-term treatment, which may indicate functional myocardial improvement incremental to relief of outflow obstruction. The potential mechanisms underlying this improvement warrant further investigation.</p><p><strong>Registration: </strong>https://clinicaltrials.gov/study/NCT04848506; Clinical trial identifier: NCT04848506.</p>","PeriodicalId":94178,"journal":{"name":"Progress in cardiovascular diseases","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820816","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":"Coronary CT angiography as an initial diagnostic strategy in low- to intermediate-risk NSTE-ACS: A real-world cohort study.","authors":"Ian N Chapman, Paola Kuschnir, Agustina Sciancalepore, Mariana Corneli, Juan F Furmento, Pablo Elissamburu, Marcos Viruel, Marcelo Trivi, Juan P Costabel","doi":"10.1016/j.pcad.2026.08.010","DOIUrl":"10.1016/j.pcad.2026.08.010","url":null,"abstract":"","PeriodicalId":94178,"journal":{"name":"Progress in cardiovascular diseases","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820810","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":"Beyond diet quality for cardiovascular prevention socioeconomic context and unequal cardiovascular risk.","authors":"Luis E Maldonado, Robert J Ostfeld, Carlos J Rodriguez","doi":"10.1016/j.pcad.2026.08.009","DOIUrl":"10.1016/j.pcad.2026.08.009","url":null,"abstract":"","PeriodicalId":94178,"journal":{"name":"Progress in cardiovascular diseases","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148809496","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":"Impact of cardiac rehabilitation on cardiovascular disease risk factor management at 1 and 3-year follow-up.","authors":"Carlos L Alejos Aguero, Jacob T Caldwell, Akhila S Cherukuri, Amanda R Bonikowske, Anna Svatikova, Joshua R Smith","doi":"10.1016/j.pcad.2026.08.007","DOIUrl":"10.1016/j.pcad.2026.08.007","url":null,"abstract":"","PeriodicalId":94178,"journal":{"name":"Progress in cardiovascular diseases","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148804034","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":"Joint associations of Interleukin-6 and apolipoprotein B with major adverse cardiovascular events in the UK biobank.","authors":"Patrick Cheon, James T McParland, Sean Doherty, Rishi R Rikhi, Bradley J Petek, Shahzeb Khan, Nicholas Chew, Garima Sharma, Jared Spitz, Dinesh Kalra, Michael D Shapiro","doi":"10.1016/j.pcad.2026.08.008","DOIUrl":"https://doi.org/10.1016/j.pcad.2026.08.008","url":null,"abstract":"<p><strong>Aims: </strong>The relative contributions of inflammatory and atherogenic lipoprotein pathways to residual cardiovascular risk remain unclear. We examined the joint and independent associations of interleukin-6 (IL-6) and apolipoprotein B (ApoB) with major adverse cardiovascular events (MACE) and mortality.</p><p><strong>Methods: </strong>Among 34,064 UK Biobank participants free of prevalent atherosclerotic cardiovascular disease with Olink proteomics, multivariable Cox models estimated hazard ratios (HRs) for MACE (myocardial infarction (MI), stroke, or cardiovascular death), MACE components, and all-cause mortality. Models adjusted for demographics, HDL cholesterol, triglycerides, lipid-lowering therapy, hypertension, diabetes, smoking, eGFR, BMI, and high sensitivity C-reactive protein. Participants were additionally classified into four groups by median IL-6 and an ApoB threshold of 90 mg/dL.</p><p><strong>Results: </strong>Over a median 13.6 years, 2551 (7.5%) MACE events occurred. In continuous models, IL-6 and ApoB were each independently associated with MACE (IL-6 HR 1.11 per SD, 95% CI 1.07-1.16; ApoB HR 1.12 per SD, 95% CI 1.07-1.17), and a simultaneous 1-SD increase in both biomarkers conferred 22% higher MACE risk. Associations were endpoint-specific: ApoB was strongest for MI (HR 1.20, 1.14-1.27), IL-6 for cardiovascular death (HR 1.20, 1.12-1.29) and all-cause mortality (HR 1.17, 1.14-1.20). In categorical analyses, MACE risk rose stepwise relative to the Low IL-6, Low ApoB reference: HR 1.22 (95% CI 1.05-1.41) for high ApoB alone, 1.33 (95% CI 1.15-1.55) for high IL-6 alone, and 1.55 (95% CI 1.34-1.78) for both.</p><p><strong>Conclusion: </strong>IL-6 and ApoB were independently associated with cardiovascular events, with atherogenic lipoprotein burden predominating for MI and inflammatory signaling for cardiovascular and all-cause death.</p>","PeriodicalId":94178,"journal":{"name":"Progress in cardiovascular diseases","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148804097","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":"The case for primordial cardiometabolic prevention.","authors":"Ahmed Sayed, Sana Sheikh, Salim S Virani","doi":"10.1016/j.pcad.2026.08.005","DOIUrl":"10.1016/j.pcad.2026.08.005","url":null,"abstract":"","PeriodicalId":94178,"journal":{"name":"Progress in cardiovascular diseases","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148804087","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":"Obesity, lipids, inflammation, and healthy aging.","authors":"Rishi Rikhi, Michael D Shapiro","doi":"10.1016/j.pcad.2026.08.006","DOIUrl":"10.1016/j.pcad.2026.08.006","url":null,"abstract":"<p><p>Cardiovascular disease (CVD) is the leading cause of death and disability globally. Thus, prevention efforts aimed at reducing CVD events allow for greater functional independence and wellbeing over the course of life. Low-density lipoprotein-cholesterol is causally associated with atherosclerosis and is the primary target for atherosclerotic CVD (ASCVD) prevention. More recently, low-grade systemic inflammation has been recognized for its role in atherosclerotic disease initiation and progression. Additionally, there is compelling evidence for combined assessments of lipid and inflammatory biomarkers to predict long-term CVD events and guide prevention efforts early in life. In the context of CVD prevention, there have also been population shifts in CVD risk factor prevalence. Obesity prevalence has increased drastically over the last three decades, contributing to disability, lower life expectancy, and higher risk of CVD through multiple mechanisms. Specifically, obesity leads to a more atherogenic lipid profile and higher levels of systemic inflammation. The purpose of this review is to synthesize available literature on the interplay between obesity, dyslipidemia, and inflammation with CVD and how optimization of these risk factors is critical for healthy aging and longevity.</p>","PeriodicalId":94178,"journal":{"name":"Progress in cardiovascular diseases","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148804126","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":"Conduction system pacing as a primary strategy for cardiac resynchronization therapy in reduced ejection fraction: An updated systematic review and meta-analysis of randomized controlled trials.","authors":"Shunsuke Kuroda, Yui Okamura, Iwanari Kawamura, Tadao Aikawa, Alexandros Briasoulis, Toshiki Kuno","doi":"10.1016/j.pcad.2026.08.004","DOIUrl":"10.1016/j.pcad.2026.08.004","url":null,"abstract":"<p><strong>Background: </strong>Biventricular pacing (BVP) is the standard for cardiac resynchronization therapy (CRT), particularly in left bundle branch block (LBBB). However, conduction system pacing (CSP) may offer superior outcomes as a physiological alternative. We evaluated the clinical efficacy of CSP compared with BVP as a primary strategy for patients with heart failure indicated for CRT.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was conducted using MEDLINE and the Cochrane Library databases. We included randomized controlled trials (RCTs) comparing CSP with BVP in patients with heart failure and a left ventricular ejection fraction below 50%. Pooled estimates were determined using a random-effects model for all outcomes.</p><p><strong>Results: </strong>Twelve RCTs involving 1223 patients were included. CSP significantly improved the echocardiographic response compared with BVP in the overall cohort (odds ratio [OR]: 1.73; 95% confidence interval [CI]: 1.19-2.52) and the LBBB subgroup (OR: 1.74; 95% CI: 1.15-2.62). CSP revealed significant improvements in NYHA functional class (standardized mean difference: -0.27; 95% CI: -0.46 to -0.08) and 6-min walk distance (mean difference: 21.6 m; 95% CI: 8.07 to 35.14). While composite endpoints (OR: 0.59; 95% CI: 0.33 to 1.08) and mortality (OR: 0.90; 95% CI: 0.39 to 2.11) showed trends favoring CSP, neither reached statistical significance. There was no significant difference in procedural crossovers between the groups (OR: 1.24; 95% CI: 0.54 to 2.87).</p><p><strong>Conclusion: </strong>Compared with BVP, CSP improved echocardiographic and functional response in patients requiring CRT. CSP as a primary strategy may be considered in selected patients, but large RCTs with hard clinical endpoints are needed.</p>","PeriodicalId":94178,"journal":{"name":"Progress in cardiovascular diseases","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763992","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":"Revascularization options for managing patients with multi-vessel coronary artery disease.","authors":"Arnar B Ingason, Alexander C Gregg, Bjorn Redfors, Mario Gaudino","doi":"10.1016/j.pcad.2026.08.003","DOIUrl":"10.1016/j.pcad.2026.08.003","url":null,"abstract":"<p><p>Coronary revascularization can be achieved via coronary artery bypass (CABG) or percutaneous coronary intervention (PCI). CABG is associated with higher peri-procedural complications and longer recovery periods but greater long-term reduction in recurrent cardiac events compared to PCI. The preferred revascularization modality depends on various clinical and anatomic factors. In general, CABG is preferable for patients with complex coronary artery disease, especially in cases of concomitant diabetes or reduced left ventricular ejection fraction. Meanwhile, PCI is preferred in patients with less extensive disease or those at high surgical risk. However, patient preference should be a key part of the treatment decision. The majority of randomized evidence is based on primarily White, non-elderly male populations from high-income countries. More robust evidence is urgently needed for patients that are female, older, non-White, and from low- or middle-income countries. In this review, we summarize the current evidence for CABG and PCI, discuss the optimal revascularization strategies for different patient populations, and highlight future directions and knowledge gaps in the field of coronary revascularization.</p>","PeriodicalId":94178,"journal":{"name":"Progress in cardiovascular diseases","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148727350","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}