Cardiovascular diagnosis and therapy最新文献

{"title":"Simulation of calcium blooming artifacts in coronary CT angiography from digital phantoms.","authors":"Xiaoling Wang, Guanyu Li, Shiteng Suo, Sant Kumar, Jiayue Huang, Jianhua Ma, Yongbo Wang, Xuhui Zhou, Yiqiang Yang, Shengxian Tu","doi":"10.21037/cdt-2026-0156","DOIUrl":"10.21037/cdt-2026-0156","url":null,"abstract":"<p><strong>Background: </strong>Calcium blooming artifacts, predominantly caused by the partial volume effect, may limit the accuracy of coronary stenosis assessment on coronary computed tomography angiography (CTA). Existing comparative tests or physical phantoms to evaluate de-blooming methods are costly, time-consuming, and limited in geometry and materials. This study developed a computational method to simulate CTA images incorporating calcified plaques from digital phantoms to help understand the characteristics of blooming artifacts.</p><p><strong>Methods: </strong>Digital vascular phantoms with different plaque geometries and stenosis severities were created and imaged by computed tomography (CT) simulation. To assess the accuracy of simulation, CT images of three-dimensional (3D)-printed physical phantoms were acquired by CT scanners. To investigate the consistency of the impacts of tube voltage and reconstruction kernel on calcium blooming artifacts, both simulated and acquired CT images were quantitatively analyzed.</p><p><strong>Results: </strong>The average structural similarity index measure (SSIM) of simulated and acquired images was 0.94±0.04. CT number, image noise and calcified area comparison between the simulated and corresponding acquired images showed good agreement. Normalized calcified area was 1.12±0.13, 1.05±0.12, 0.99±0.11 (P<0.001), for 80, 100 and 120 kV, respectively, across the simulated and acquired images. Normalized calcified area was 0.93±0.04, 0.96±0.06, 1.02±0.05, and 1.07±0.16, for reconstruction kernels from sharp to soft (P<0.001) for simulated images; result was 0.99±0.17 (sharp) <i>vs.</i> 1.09±0.13 (soft) for acquired images (P<0.001). Linear regression analysis indicated that measured calcified area increased as tube voltage decreased or reconstruction kernel became softer (r²>0.98) both for simulated and acquired images.</p><p><strong>Conclusions: </strong>Simulated CT images from digital phantoms resembled the acquired images by CT scanners. Tube voltages and reconstruction kernels significantly affected the extent of calcium blooming artifacts both for simulated and acquired images. The proposed framework for calcium blooming artifacts may provide an <i>in silico</i> testbed for improving coronary CTA interpretation.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 4","pages":"65"},"PeriodicalIF":2.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal timing of surgery and analysis of prognostic factors for myocardial infarction complicated by ventricular septal rupture.","authors":"Lisong Wu, Wei Fu, Ran Dong, Jubing Zheng","doi":"10.21037/cdt-2026-1-0080","DOIUrl":"10.21037/cdt-2026-1-0080","url":null,"abstract":"<p><strong>Background: </strong>The optimal surgical timing for ventricular septal rupture (VSR) complicating acute myocardial infarction (MI) remains controversial, and evidence on safe bridging strategies to delay surgery is limited. This study sought to investigate the optimal timing for surgical treatment and to identify factors influencing postoperative mortality.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on the clinical data of 138 patients who underwent surgical repair for post-MI VSR at Beijing Anzhen Hospital between January 2008 and June 2025. The study aimed to determine the optimal surgical timing and to identify the factors associated with postoperative mortality using least absolute shrinkage and selection operator (LASSO) regression.</p><p><strong>Results: </strong>We included 138 patients (87 men; mean age 64.8±9.4 years). Perioperative mortality was 17.3% (24/138). Surgery performed on or after day 8 following VSR was associated with lower perioperative mortality. LASSO and multivariable logistic regression identified opened IRA and VSR-to-surgery ≥8 days as independent protective factors. A LASSO regression analysis of the preoperative variables identified preoperative opened by percutaneous infarct-related artery (IRA) and a VSR-to-surgery interval of ≥8 days as independent factors associated with postoperative mortality. Further analysis revealed that an opened IRA was associated with a significantly increased likelihood of survival to ≥8 days (P=0.046). Regardless of whether opened IRA was performed before or after VSR, most patients survived to undergo surgery beyond day 8 (72.5% <i>vs.</i> 86.5%, P=0.13), and the opened IRA timing (pre- or post-VSR) was not associated with perioperative mortality. With a median follow-up of 6.5 years (range, 0.1-16.5 years), the cumulative survival rates at 2, 5, 8, and 10 years were 83.5%, 78.5%, 70%, and 67.5%, respectively.</p><p><strong>Conclusions: </strong>A VSR-to-surgery interval of ≥8 days and preoperative opened IRA are critical factors influencing postoperative mortality. Surgery performed on or after day 8 following VSR was associated with lower mortality, and preoperative opened IRA may facilitate patient survival until the optimal surgical window.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 4","pages":"61"},"PeriodicalIF":2.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical predictors and prognostic implications of HFpEF following STEMI based on HFA-PEFF score: a multicenter cohort analysis.","authors":"Yun-Ho Cho, Jeong Yoon Jang, Jae Myoung Lee, Yujin Shin, Gain Yu, Jae Seok Bae, Choong Hwan Kwak, Yong-Lee Kim, Hangyul Kim, Min Gyu Kang, Kye-Hwan Kim, Jeong Rang Park, Jin-Yong Hwang, Jong-Hwa Ahn","doi":"10.21037/cdt-2026-1-0020","DOIUrl":"10.21037/cdt-2026-1-0020","url":null,"abstract":"<p><strong>Background: </strong>ST-segment elevation myocardial infarction (STEMI) is usually associated with impaired systolic function, but heart failure with preserved ejection fraction (HFpEF) may also occur and remains under-recognized in this setting. We aimed to investigate the prevalence, clinical predictors, and outcomes of HFpEF in STEMI patients with preserved left ventricular ejection fraction (LVEF).</p><p><strong>Methods: </strong>We retrospectively analyzed 421 STEMI patients who underwent successful percutaneous coronary intervention (PCI). Among them, 280 patients with LVEF ≥50% on 1-month follow-up echocardiography were included. Patients were classified as HFpEF or non-HFpEF according to the Heart Failure Association Pre-test assessment, Echocardiography and natriuretic peptide, Functional testing, Final etiology (HFA-PEFF) score, with scores ≥5 defining HFpEF. The primary endpoint was a composite of cardiovascular (CV) death or hospitalization for heart failure (HF).</p><p><strong>Results: </strong>Eighty-eight patients (31.4%) were classified as HFpEF. Compared with the non-HFpEF group, these patients were older (mean age 70 years), more frequently female (46.6% <i>vs</i>. 16.1%), and less likely to be current smokers (31.8% <i>vs.</i> 51.0%). During a median follow-up of 3 years, 2 patients (0.7%) died from CV causes and 29 (10.4%) were hospitalized for HF. The incidence of HF hospitalization was significantly higher in the HFpEF group (17.0% <i>vs</i>. 7.3%). In multivariable Cox regression, HFpEF was independently associated with the composite outcome [hazard ratio (HR) 2.45; 95% confidence interval (CI): 1.10-5.44].</p><p><strong>Conclusions: </strong>In STEMI patients with preserved LVEF, a substantial proportion developed HFpEF, which was associated with increased risks of HF hospitalization and mortality. The HFA-PEFF score provides incremental prognostic value in this population and may help identify high-risk patients for closer monitoring and tailored management.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 3","pages":"42"},"PeriodicalIF":2.2,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13345782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood flow patterns in patients with bicuspid aortic valve undergoing different type of aortic valve replacement-computational fluid dynamics analyses and case reports.","authors":"Kang An, Kun Zhu, Sheng Liu","doi":"10.21037/cdt-2025-1-643","DOIUrl":"10.21037/cdt-2025-1-643","url":null,"abstract":"<p><strong>Background: </strong>Computation fluid dynamics is useful for assessment of hemodynamic abnormalities. It allows visualization of the blood flow streamline and provides information regarding the pressure and the wall shear stress (WSS). Although previous studies have shown that blood flow patterns might be associated with ascending aortic dilation and adverse aortic events, studies regarding the comparison of different types of aortic prostheses are limited. This study aimed to compare the hemodynamics in the dilated ascending aorta in patient with bicuspid aortic valve (BAV) who underwent different type of aortic valve replacement (AVR).</p><p><strong>Case description: </strong>Computational fluid dynamics analyses were performed in three BAV patients with dilated ascending aorta who underwent mechanical, bioprosthetic, and transcatheter AVR. Before the AVR, all patients had abnormal blood flow in the ascending aorta. The pressure and the WSS were elevated in the great outer curvature. After the AVR, the abnormal flow patterns improved and the pressure and the WSS decreased (mechanical valve: pressure from 19,806 to 16,718 Pa, WSS from 89 to 17 Pa; transcatheter heart valve: pressure from 19,557 to 15,672 Pa, WSS from 68 to 21 Pa). However, the bioprosthetic valve still had remnant helical flow and relatively high residual pressure and WSS (pressure from 16,253 to 15,724 Pa, WSS from 76 to 40 Pa).</p><p><strong>Conclusions: </strong>Abnormal aortic flow patterns appeared to improve after AVR in patients with BAV. The type of aortic prostheses might be an influence on the hemodynamics, which requires further studies.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 3","pages":"55"},"PeriodicalIF":2.2,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13345783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Device innovation or systemic risk management?-rethinking priorities in diabetic percutaneous coronary intervention.","authors":"Ricardo Ortiz-Lozada, Pablo Salinas","doi":"10.21037/cdt-2026-0183","DOIUrl":"10.21037/cdt-2026-0183","url":null,"abstract":"","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 3","pages":"38"},"PeriodicalIF":2.2,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13345802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic, cardiac imaging, and management considerations in fungal infective endocarditis: a contemporary narrative review.","authors":"Jan K Kalinski, Bo Xu","doi":"10.21037/cdt-2026-1-0091","DOIUrl":"10.21037/cdt-2026-1-0091","url":null,"abstract":"<p><strong>Background and objective: </strong>Fungal infective endocarditis (FIE) is a rare but clinically important cause of endocarditis that poses unique challenges to diagnosis and treatment. As clinicians are faced with an aging population, increasing utilization of prosthetic valves and implantable cardiac devices, as well as increasing use of immunosuppressive therapies, which are known risk factors, familiarity with FIE is increasingly relevant. This narrative review presents the current state of knowledge concerning laboratory diagnosis, imaging tools, and treatment of FIE.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted using PubMed between January 2000 and September 2025. Original research, reviews, meta-analyses, guideline documents, and consensus statements were considered. Individual case reports and non-English publications were excluded.</p><p><strong>Key content and findings: </strong>FIE is caused by a wide range of pathogens, with the most common etiological organisms being <i>Candida spp.</i> followed by <i>Aspergillus spp.</i> and <i>Histoplasma spp.</i> Laboratory diagnostic methods are wide-ranging and specific to different genera of fungi. Blood cultures yield negative results in the case of various fungal infections, and for this reason, molecular diagnostic methods such as circulating cell-free DNA (cfDNA) and real-time polymerase chain reaction (PCR) are increasingly being used. Cardiac imaging, particularly echocardiography, remains a cornerstone of diagnosis, though increasingly cardiac computed tomography (CT) and 18-fluorine fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET) are being recommended to improve sensitivity of the current diagnostic criteria of infective endocarditis (IE). Treatment often requires definitive cardiac surgery and systemic antifungal therapy.</p><p><strong>Conclusions: </strong>The prognosis of FIE continues to be poor, likely owing to difficulties that exist in both diagnosis and treatment. Broader awareness of the risk factors, nuanced diagnostic options and management considerations may serve to improve patient outcomes.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 3","pages":"51"},"PeriodicalIF":2.2,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13345793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug-coated balloons (DCB) for symptomatic intracranial atherosclerotic stenosis: a systematic review and meta-analysis.","authors":"Chien-Hung Chang, Ching-Chang Chen, Chun-Ting Chen, Mun-Chun Yeap, Shuo-Chi Chien, Yi-Ming Wu, Zhuo-Hao Liu","doi":"10.21037/cdt-2025-410","DOIUrl":"10.21037/cdt-2025-410","url":null,"abstract":"<p><strong>Background: </strong>Intracranial atherosclerosis is a major cause of ischemic stroke, with high restenosis rates following angioplasty and stenting. Drug-coated balloons (DCBs) offer a potential alternative by delivering antiproliferative drugs to reduce restenosis. This systematic review and meta-analysis aimed to evaluate the restenosis rate and effectiveness of DCBs in treating intracranial atherosclerosis.</p><p><strong>Methods: </strong>PubMed, EMBASE, and Cochrane CENTRAL were searched from inception to April 13, 2025 (date of search). Eligible studies included randomized trials, and prospective and retrospective cohort studies evaluating DCBs in patients with symptomatic intracranial atherosclerosis. The primary outcomes were restenosis rate and degree of stenosis post-DCB treatment. Pooled proportions and odds ratios (ORs) with 95% confidence interval (CI) were calculated. Heterogeneity was assessed using the I² statistic, and risk of bias with the Newcastle-Ottawa Scale.</p><p><strong>Results: </strong>Twenty-six studies involving 1,489 patients were included. The pooled restenosis rate after DCB treatment was 11% (95% CI: 9-13%; I²=26.8%). The pooled mean degree of stenosis after treatment was 34.34% (95% CI: 29.85-38.84%; I²=93.9%). In comparative studies, DCB was associated with a significantly lower restenosis rate than non-DCB treatment (OR =0.26; 95% CI: 0.16-0.44; P<0.001; I²=0%). No significant difference was observed in post-treatment stenosis between groups (mean difference =14.58; 95% CI: -5.98 to 35.14; P=0.17; I²=92.5%).</p><p><strong>Conclusions: </strong>Restenosis rates following DCB treatment appear low and may be lower than those observed with non-DCB treatments in comparative studies. However, given the substantial heterogeneity in stenosis-related outcomes and the predominance of retrospective cohort studies, these findings should be interpreted cautiously. High-quality prospective studies, ideally randomized controlled trials, are warranted to better establish the long-term efficacy of DCB treatment.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 3","pages":"45"},"PeriodicalIF":2.2,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13345781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aortic remodeling after zone 0 simplified delivery frozen elephant trunk (SD-FET) technique in acute aortic dissection: one-year clinical and morphological results in a single centre.","authors":"Antoine Buschiazzo, Guillaume Guimbretiere, Tom Le Corvec, Beatrice Guyomarch, Karim Lakhal, Thomas Senage, Jean Christian Roussel, Blandine Maurel","doi":"10.21037/cdt-2025-aw-600","DOIUrl":"10.21037/cdt-2025-aw-600","url":null,"abstract":"<p><strong>Background: </strong>The simplified delivery frozen elephant trunk (SD-FET) technique enables a one-step repair of type A acute aortic dissection (AAD) with stent proximalisation and very short normothermic circulatory arrest. This study reports early and 1-year clinical outcomes together with aortic remodelling in the residual dissected aorta.</p><p><strong>Methods: </strong>Thirty consecutive patients underwent SD-FET for AAD between 2018 and 2023. Preoperative, postoperative, 1-year follow-up computed tomography scans were analyzed. True lumen (TL), false lumen (FL), and total aortic diameters were measured in four segments (proximal descending, distal descending, coeliac trunk, infra-renal) using the centerline method. Aortic remodelling was classified as positive, stable, or negative. Early and mid-term outcomes were assessed, including mortality, neurologic complications, and aortic reinterventions.</p><p><strong>Results: </strong>Four patients (13%) died in-hospital, and four (13%) sustained postoperative stroke; no spinal cord injury occurred. During follow-up, one patient died of an aortic event and two required secondary reinterventions for downstream enlargement, yielding an overall 1-year freedom from reintervention of 92.5% [95% confidence interval (CI): 83-100%]. At the proximal descending aorta, TL increased and FL decreased significantly at 3 months and 1 year (P<0.001), with 92% of patients showing positive or stable remodelling. At the distal descending aorta and coeliac level, positive/stable remodelling was observed in 53% and 63% of cases, respectively, whereas infra-renal changes were limited.</p><p><strong>Conclusions: </strong>SD-FET simplifies total arch repair for AAD, reduces circulatory arrest under normothermia, and achieves acceptable early results. One-year clinical outcomes and remodelling are comparable to conventional FET, may supports its safety and efficacy, though larger cohorts and longer follow-up remain warranted.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 3","pages":"39"},"PeriodicalIF":2.2,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13345807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148419197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond borderline physiology: determinants of treatment choice and phenotypes of outcome in QFR grey-zone lesions.","authors":"Abdulrahman AlQazzaz, Yanfeng Lu, Jasmine Yimeng Bao, Gary S Mintz, Jiahao Feng, Yong Zhang, Shanshan Gao, Qiang Song, Feifei Ning, Hytham H Al-Samawi, Mohsen Al-Manj, Mohammed Al-Asadi, Xin Huang, Ning Guo","doi":"10.21037/cdt-2026-1-0045","DOIUrl":"10.21037/cdt-2026-1-0045","url":null,"abstract":"<p><strong>Background: </strong>The management of coronary lesions with quantitative flow ratio (QFR) values in the grey zone (0.75-0.85) remains a common clinical dilemma, with uncertain outcomes and unclear determinants guiding treatment selection in real-world practice. This study aimed to identify the clinical and angiographic factors influencing real-world treatment selection and compare clinical outcomes of percutaneous coronary intervention (PCI) versus medical therapy in the QFR grey zone.</p><p><strong>Methods: </strong>This retrospective study analyzed 297 coronary lesions with borderline QFR values (0.75-0.85). Patients were stratified by treatment (PCI <i>vs.</i> medication-only), with target vessel failure [TVF: cardiac death, target vessel myocardial infarction (MI), or ischemia-driven revascularization] as the primary endpoint. Baseline characteristics were compared using appropriate statistical tests. Time-to-event analysis used Kaplan-Meier curves and Cox proportional hazards models adjusted for clinical risk factors. To identify predictors of TVF within the grey zone, lesions were further stratified into QFR 0.75-0.80 and 0.81-0.85 subgroups, with interaction testing for variables significantly associated with TVF in the primary analysis.</p><p><strong>Results: </strong>Among 297 patients with coronary lesions in the QFR grey-zone (0.75-0.85), PCI (n=101) was performed for lesions with greater anatomic severity (smaller MLD, higher DS% and AS%, all P<0.001), while medical therapy (n=196) was favored for patients with higher HbA1c and proBNP (P=0.006 and P=0.02, respectively) and for lesions with length >20 mm (74.5% <i>vs.</i> 63.4%, P=0.046). At a mean follow-up of 526 days, the rate of TVF was not significantly different between treatment strategies (P=0.95). In multivariable analysis, only HbA1c (HR 2.04, 95% CI: 1.10-3.76, P=0.02) and left ventricular ejection fraction (LVEF) ≤45% independently predicted TVF (LVEF >45% HR 0.06, 95% CI: 0.01-0.55, P=0.01). A significant interaction was found between LVEF and QFR (Pinteraction=0.040), with impaired LVEF conferring a significantly higher risk of TVF under medical management, particularly in the lower QFR sub-range (≤0.80).</p><p><strong>Conclusions: </strong>In patients with QFR grey-zone lesions, treatment selection balanced anatomic severity against clinical complexity. While overall outcomes were similar between strategies, impaired LVEF (≤45%) identified a high-risk phenotype for whom medical therapy was associated with worse outcomes, and poor glycemic control independently predicted TVF across the entire cohort. These findings suggest that a personalized approach-potentially including a lower threshold for revascularization in patients with reduced LVEF and intensified risk factor management in those with poor glycemic control-merits further investigation in prospective studies.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 3","pages":"41"},"PeriodicalIF":2.2,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13345805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of endothelial glycocalyx degradation with post-PCI slow flow phenomenon in STEMI patients: a prospective observational study.","authors":"Yufei Niu, Han Zhu, Yunong Zhao, Paijiao Zhang, Chunrong Jin","doi":"10.21037/cdt-2025-1-642","DOIUrl":"10.21037/cdt-2025-1-642","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The coronary slow flow (CSF) phenomenon following primary percutaneous coronary intervention (PPCI) for acute ST-segment elevation myocardial infarction (STEMI) represents a severe complication associated with adverse clinical outcomes. The endothelial glycocalyx (EG) serves as a pivotal barrier maintaining microvascular integrity; however, the kinetics of its degradation and its specific association with CSF remain incompletely understood. Therefore, this study aims to investigate the correlation between serum markers of EG shedding and the incidence of CSF in patients with STEMI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this prospective observational study, we consecutively enrolled 82 patients with STEMI who underwent emergent percutaneous coronary intervention (PCI) between August and November 2025. CSF was defined as a post-procedural corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC) &gt;27 frames. Post-procedural TIMI flow grade was recorded concurrently, and no-reflow was defined as TIMI flow grade &lt;3. Serum syndecan-1 (SDC-1) and hyaluronic acid (HA) were measured pre-procedure, immediately after PCI, and 24 hours after PCI. Multivariable logistic regression was used to evaluate the association between pre-procedural biomarkers and CSF, with continuous variables standardized as z-scores. As sensitivity analyses, we performed linear regression using CTFC as a continuous outcome and Firth's penalized logistic regression for no-reflow. Discriminative performance was assessed using receiver operating characteristic (ROC) curves.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Compared with the normal flow group, the CSF group had higher pre-procedural levels of SDC-1 and HA. Longitudinal analyses showed a more pronounced immediate post-PCI increase in HA in the CSF group, which remained elevated at 24 hours. Both SDC-1 and HA also remained higher at 24 hours in the CSF group. After adjustment for age, symptom-to-treatment time, total stent length, and admission diastolic blood pressure, higher pre-procedural SDC-1 [odds ratio (OR) =5.03; 95% confidence interval (CI): 2.39-10.60; P&lt;0.001] and HA (OR =3.56; 95% CI: 1.92-6.60; P&lt;0.001) were independently associated with CSF. These associations were directionally consistent in sensitivity analyses using CTFC as a continuous outcome and no-reflow as an endpoint. ROC analysis showed that pre-procedural SDC-1 had higher discriminative ability [area under the curve (AUC) =0.88] than HA (AUC =0.84).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Severe degradation of the EG, characterized by elevated serum levels of SDC-1 and HA, is independently associated with the post-procedural CSF phenomenon in patients with STEMI. Pre-procedural SDC-1 appeared to have a stronger association with CSF and numerically higher discriminative performance than HA. These findings suggest that therapeutic strategies aimed at preserving the glycocalyx may offer novel avenues for ameliorating coronary m","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 3","pages":"48"},"PeriodicalIF":2.2,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13345804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}