Background Drug-coated balloons (DCBs) are currently used for de novo coronary artery lesions. However, the natural course of the dissection after percutaneous coronary intervention (PCI) at an early stage remains unclear. Aims We sought to examine post-PCI dissection healing in de novo coronary lesions treated with DCBs by serial optical coherence tomography (OCT) imaging. Methods Of 94 de novo coronary lesions treated with DCB, OCT imaging at the pre-, post-PCI, and early follow-up period (< 12 months) were performed, and morphological findings, including residual dissection, were assessed. Results The median follow-up period was 231 (interquartile range, 112–314) days (< 3 months; 16 lesions [17.0%], 3–6 months; 23 lesions [24.5%]), and 84.0% of post-PCI dissection was not observed at follow-up. In persistent dissection lesions, more diabetes patients (66.7% vs. 29.1%, P = 0.008), more dual antiplatelet therapy continuation at follow-up (80.0% vs. 46.8%, P = 0.024), and shorter follow-up duration (median 44 days vs 258 days, P < 0.001) were found than in non-persistent dissection lesions. Residual dissection was significantly more common in lesions <3 months post-follow-up, compared to those with 3–6 months and 6–12 months (68.8% vs 8.7% vs 3.6%, P < 0.001). Conclusion The present study suggests that residual dissection was substantially less frequent beyond 3 months, suggesting progressive healing during the first several months after DCB treatment.
Background Atrial fibrillation is common in transthyretin cardiac amyloid cardiomyopathy (ATTR-CM), but its association with objective physical performance across atrial fibrillation status groups remains unclear. We investigated the association between atrial fibrillation status and functional capacity in ATTR-CM, using six-minute walk distance (6MWD) as the primary endpoint. Methods Consecutive adults with confirmed ATTR-CM evaluated between June 2018 and October 2025 were included and categorized as no atrial fibrillation, paroxysmal atrial fibrillation, or permanent atrial fibrillation. The primary endpoint was six-minute walk distance for submaximal functional capacity assessment. Secondary exploratory endpoints included cardiopulmonary exercise testing (CPET) parameters and NT-proBNP. Multivariable linear regression adjusted for age, sex, body mass index, and NYHA functional class; sensitivity analyses additionally considered beta-blocker use, rhythm-device status, ATTR subtype, left ventricular ejection fraction, and log-transformed NT-proBNP. Results Among 156 patients, 82 had no atrial fibrillation, 24 had paroxysmal atrial fibrillation, and 50 had permanent atrial fibrillation. Six-minute walk distance was available in 136 patients and differed across atrial fibrillation status groups: 432.9 ± 122.4 m, 309.2 ± 111.0 m, and 378.8 ± 108.7 m, respectively. After adjustment, AF status remained associated with 6MWD (overall p = 0.031), driven by lower adjusted values in paroxysmal versus no AF. Significant CPET-derived differences were present in unadjusted analyses but attenuated after adjustment for clinical parameters. Conclusions In ATTR-CM, atrial fibrillation status is associated with functional capacity, with six-minute walk distance providing the most robust parameter. Submaximal functional assessment may capture clinically relevant rhythm-related physical impairment in ATTR-CM.
Background The 2026 AHA/ACC/ADA/ASN guideline defines cardiovascular-kidney-metabolic (CKM) stage 1 by excess or dysfunctional adiposity. Whether adiposity and glycemic patterns distinguish subsequent risk is uncertain. Methods Adults aged 45–79 years meeting measured stage 1 criteria were studied in CHARLS and CHNS. Four patterns combined body mass index (BMI), waist circumference, and prediabetes. Modified Poisson models estimated risk ratios (RRs). Progression and hypertension models used censoring weights; cumulative self-reported cardiovascular disease (CVD) models used baseline-covariate imputation. The nonglycemic composite was a key secondary outcome. NHANES assessed reclassification with ancestry-appropriate thresholds and age–sex standardization. Chinese cohorts lacked albuminuria and subclinical CVD assessment. Results In CHARLS (model n = 965), adiposity plus prediabetes was associated with metabolic progression versus prediabetes only (RR, 1.38; 95% CI, 1.18–1.61). Corresponding RRs were 1.45 (1.21–1.74) for nonglycemic progression and 1.55 (1.21–1.98) for CHNS hypertension. Among 1824 participants, concordant BMI and waist adiposity was associated with cumulative reported CVD through 2020 (RR, 1.83; 95% CI, 1.23–2.71). CVD associations attenuated in complete-case models and after additional adjustment for metabolic measures. Standardized NHANES reclassification ranged from 0.8% to 9.0%. Conclusions Adiposity and glycemic patterns identified prognostic heterogeneity among adults meeting measured CKM stage 1 criteria, supporting joint assessment of these features.
Background Frailty predicts adverse health outcomes, but its relationship with cardiovascular disease (CVD) requires further validation across diverse populations. The value of a circulating protein signature for cardiovascular risk assessment remains uncertain. Methods We examined frailty–CVD associations in the XiDu2017 cohort (n = 4323) and UK Biobank (UKB; n = 84,276) using logistic and Cox regression, respectively. XiDu longitudinal analyses included 844 participants without baseline CVD. In the UKB proteomic subset, a 20-protein frailty (PF) score was compared with clinical frailty and a model of conventional cardiovascular risk factors. Results Each higher frailty category was associated with prevalent CVD in XiDu (adjusted odds ratio, 1.120; 95% confidence interval [CI], 1.004–1.251). In UKB, frail participants had a higher CVD hazard than robust participants (adjusted hazard ratio, 1.38; 95% CI, 1.28–1.48). For heart failure, the 5-year area under the curve (AUC) was 0.756 for PF and 0.595 for clinical frailty. Adding PF to conventional risk factors increased the optimism-corrected heart failure AUC by 0.113 (95% CI, 0.077–0.142). Conclusions Clinical frailty was associated with cardiovascular outcomes in both cohorts. PF showed incremental discrimination for selected outcomes, particularly heart failure. External validation and evaluation of clinical utility are needed before clinical application.
