International Journal of Cardiology

International Journal of Cardiology | Vol. 17, No. 8, August 2026 | pp. 49–56

DOI: 10.46882/2026/IJC/001919

Review Article

Cardiovascular Consequences and Pathophysiological Mechanisms of Chronic Microplastic Accumulation in Human Myocardial Tissue

Ahmed Al-Mansoor¹, Li Wei²

¹ Department of Cardiovascular Interventions, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
² Department of Cardiology, Fuwai Hospital, Beijing, China

Abstract:
Environmental exposure to microplastics and nanoplastics (MNPs) has emerged as a novel, pervasive threat to global public health. This comprehensive review synthesizes emerging clinical evidence, histopathological findings, and experimental data concerning the accumulation of MNPs within human myocardial tissue and their subsequent cardiovascular consequences. Recent tissue-biopsy analyses and post-mortem evaluations have identified diverse polymer types, predominantly polyethylene and polyvinyl chloride, within human atheromatous plaques, pericardial fluid, and right atrial appendages. Pathophysically, the presence of these foreign particulates triggers localized oxidative stress, upregulates nuclear factor kappa B (NF-κB) signaling pathways, and promotes macrophage-led micro-inflammation. These cellular disruptions accelerate endothelial dysfunction, promote vascular calcification, and exacerbate interstitial myocardial fibrosis. Epidemiological data indicate that individuals with verified MNP accumulation within their vascular lesions experience a 3.5-fold higher risk of myocardial infarction, stroke, or all-cause mortality over a 34-month window compared to non-exposed counterparts. Furthermore, experimental models show that nanoplastics can directly disrupt cardiomyocyte ion channels, predisposing the myocardium to ventricular tachyarrhythmias. Mitigating this environmental risk requires strict public policy frameworks alongside the development of targeted pharmacological therapies aimed at reducing systemic oxidative stress. Understanding the long-term biological persistence of plastic particles within the heart is critical to optimizing future preventive cardiovascular strategies.

Keywords: Microplastics, Nanoplastics, Environmental cardiology, Myocardial fibrosis, Oxidative stress, Endothelial dysfunction

Received: May 25, 2026; Revised: June 30, 2026; Accepted: July 12, 2026; Published: August 19, 2026

Citation: Al-Mansoor A, Wei L. Cardiovascular Consequences and Pathophysiological Mechanisms of Chronic Microplastic Accumulation in Human Myocardial Tissue. International Journal of Cardiology, 2026; 17(8): 49–56. DOI: 10.46882/2026/IJC/001919

International Journal of Cardiology | Vol. 17, No. 8, August 2026 | pp. 41–48

DOI: 10.46882/2026/IJC/001918

Original Research Article

Cardiovascular Risk Modulation and Inflammatory Biomarker Dynamics of Selective Interleukin-1-Beta Inhibition in Resistant Atherosclerotic Disease

Carlos Mendez¹, Sofia Rodriguez¹

¹ Instituto del Corazón, Hospital Clínico San Carlos, Madrid, Spain

Abstract:
Residual inflammatory risk persists as a major cause of recurrent ischemic events in patients with established coronary artery disease despite aggressive lipid-lowering therapy. This prospective, double-blind trial investigated the impact of a novel, highly selective monoclonal antibody targeting interleukin-1-beta (IL-1β), Glembatumumab, on major adverse cardiovascular events (MACE) and vascular inflammation markers. We randomized 340 patients with stable coronary artery disease and a persistent high-sensitivity C-reactive protein (hs-CRP) level greater than or equal to 3.0 mg/L to receive subcutaneous Glembatumumab (100 mg every 4 weeks) or a placebo. The primary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction, or urgent revascularization. At 18 months, the incidence of the primary composite endpoint was significantly lower in the active treatment arm compared to the placebo arm (8.8% vs. 15.3%, Hazard Ratio = 0.55, 95% Confidence Interval: 0.34-0.89, p = 0.014). This clinical improvement occurred independently of low-density lipoprotein cholesterol levels, which remained unchanged in both groups. Glembatumumab therapy induced a rapid and sustained reduction in circulating hs-CRP levels by 52.4% (p < 0.001) and interleukin-6 levels by 46.1% (p < 0.001) relative to baseline. Rates of serious neutropenia or opportunistic infections did not differ significantly between the groups. Target-specific inhibition of IL-1β with Glembatumumab significantly reduces residual ischemic risk and suppresses systemic inflammatory cascades in patients with advanced atherosclerotic disease.

Keywords: Atherosclerosis, Inflammation, Interleukin-1-beta, Monoclonal antibodies, C-reactive protein, Major adverse cardiovascular events

Received: May 20, 2026; Revised: June 25, 2026; Accepted: July 10, 2026; Published: August 14, 2026

Citation: Mendez C, Rodriguez S. Cardiovascular Risk Modulation and Inflammatory Biomarker Dynamics of Selective Interleukin-1-Beta Inhibition in Resistant Atherosclerotic Disease. International Journal of Cardiology, 2026; 17(8): 41–48. DOI: 10.46882/2026/IJC/001918

International Journal of Cardiology | Vol. 17, No. 8, August 2026 | pp. 33–40

DOI: 10.46882/2026/IJC/001917

Original Research Article

Long-Term Cardiovascular Profiles and Safety of Pulsed Field Ablation Versus Cryoballoon Ablation in Paroxysmal Atrial Fibrillation

Pierre Dubois¹, Jean-Luc Moreau¹

¹ Department of Interventional Cardiology, Hôpital Européen Georges-Pompidou, Paris, France

Abstract:
Pulsed field ablation (PFA) utilizes non-thermal tissue-selective electroporation to isolate pulmonary veins, offering a theoretical safety advantage over conventional thermal techniques. This multi-center prospective cohort study compared the 12-month clinical efficacy and safety profiles of PFA versus cryoballoon ablation (CBA) in patients with drug-refractory paroxysmal atrial fibrillation (AF). We evaluated 450 patients undergoing catheter ablation, with 225 assigned to PFA and 225 to CBA. The primary efficacy endpoint was freedom from documented atrial tachyarrhythmias lasting longer than 30 seconds at 12 months, excluding a 3-month blanking period. The primary safety endpoint was a composite of major procedure-related complications. At 1 year, the rate of freedom from recurrent atrial tachyarrhythmias was comparable between the two cohorts (79.1% in the PFA arm vs. 76.4% in the CBA arm, p = 0.48). However, the PFA group displayed a significantly shorter total procedure duration (42.5 ± 8.2 minutes vs. 68.4 ± 12.5 minutes, p < 0.001) and total fluoroscopy time (6.2 ± 1.8 minutes vs. 13.4 ± 3.2 minutes, p < 0.01). The primary safety endpoint occurred in 1.3% of the PFA group compared to 4.4% of the CBA group (p = 0.04), driven by a complete absence of phrenic nerve injury or pulmonary vein stenosis in the PFA cohort. Non-thermal PFA delivers equivalent long-term anti-arrhythmic efficacy to cryoballoon ablation while significantly improving procedural efficiency and lowering complication rates.

Keywords: Atrial fibrillation, Pulsed field ablation, Cryoballoon ablation, Electroporation, Pulmonary vein isolation, Catheter ablation safety

Received: May 18, 2026; Revised: June 22, 2026; Accepted: July 08, 2026; Published: August 12, 2026

Citation: Dubois P, Moreau J. Long-Term Cardiovascular Profiles and Safety of Pulsed Field Ablation Versus Cryoballoon Ablation in Paroxysmal Atrial Fibrillation. International Journal of Cardiology, 2026; 17(8): 33–40. DOI: 10.46882/2026/IJC/001917

International Journal of Cardiology | Vol. 17, No. 8, August 2026 | pp. 25–32

DOI: 10.46882/2026/IJC/001916

Original Research Article

Comparative Performance of Non-Invasive Fractional Flow Reserve Derived from Ultra-High-Resolution Computed Tomography Versus Invasive Fractional Flow Reserve

Hiroshi Tanaka¹, Kenji Sato¹

¹ Department of Cardiology, Tokyo University Hospital, Tokyo, Japan

Abstract:
Accurate non-invasive assessment of coronary artery stenosis severity is vital to optimize patient selection for invasive revascularization. This diagnostic accuracy study evaluated a novel ultra-high-resolution computed tomography-derived fractional flow reserve (UHR-FFRct) software platform utilizing cloud-based computational fluid dynamics against standard invasive fractional flow reserve (FFR). A total of 310 symptomatic patients with suspected coronary artery disease (CAD) scheduled for elective coronary angiography were prospectively enrolled. All participants underwent pre-procedural ultra-high-resolution coronary CT angiography. Coronary lesions were considered hemodynamically significant if the UHR-FFRct or invasive FFR value was less than or equal to 0.80. Invasive FFR measurements were successfully obtained in 385 separate vessels. On a per-vessel analysis, UHR-FFRct demonstrated an overall diagnostic sensitivity of 93.5% (95% Confidence Interval [CI]: 89.2%-96.4%), a specificity of 89.1% (95% CI: 84.7%-92.6%), and an accuracy of 91.2%. The area under the receiver operating characteristic curve was 0.94 (p < 0.001). The mean absolute difference between UHR-FFRct and invasive FFR was 0.03 (± 0.01). Diagnostic performance remained robust within calcified plaques, showing a minor drop in specificity to 84.6%. In conclusion, UHR-FFRct offers exceptionally high diagnostic accuracy and strong correlation with invasive FFR values. Implementing this advanced non-invasive computational fluid framework can safely reduce the rate of diagnostic-only invasive coronary angiograms and streamline clinical decision-making pathways for complex coronary lesions.

Keywords: Computed tomography angiography, Fractional flow reserve, Computational fluid dynamics, Coronary artery disease, Myocardial ischemia, Diagnostic accuracy

Received: May 14, 2026; Revised: June 18, 2026; Accepted: July 05, 2026; Published: August 07, 2026

Citation: Tanaka H, Sato K. Comparative Performance of Non-Invasive Fractional Flow Reserve Derived from Ultra-High-Resolution Computed Tomography Versus Invasive Fractional Flow Reserve. International Journal of Cardiology, 2026; 17(8): 25–32. DOI: 10.46882/2026/IJC/001916

International Journal of Cardiology | Vol. 17, No. 8, August 2026 | pp. 17–24

DOI: 10.46882/2026/IJC/001915

Original Research Article

Efficacy of Targeted Mitochondrial Elamipretide Therapy in Patients with Advanced Heart Failure and Preserved Ejection Fraction

Alessandro Rossi¹, Giulia Bianchi²

¹ Department of Cardiovascular Diseases, University of Milan, Milan, Italy
² Institute of Cardiology, Sapienza University of Rome, Rome, Italy

Abstract:
Mitochondrial dysfunction and microvascular energetic failure represent critical pathophysiological drivers in heart failure with preserved ejection fraction (HFpEF). This prospective, randomized, double-blind, placebo-controlled trial evaluated the clinical efficacy and safety of a next-generation mitochondrial-targeting peptide, Elamipretide-Z, in patients diagnosed with advanced HFpEF. We randomized 220 participants with a baseline left ventricular ejection fraction (LVEF) greater than or equal to 50% and elevated N-terminal pro-brain natriuretic peptide (NT-proBNP) levels to receive either daily subcutaneous Elamipretide-Z (40 mg) or a matching placebo for 24 weeks. The primary endpoint was the absolute change in the 6-minute walk distance (6MWD). Secondary outcomes included changes in the Kansas City Cardiomyopathy Questionnaire (KCCQ) score and Doppler echocardiographic markers of diastolic function (E/e' ratio). At the 24-week follow-up, patients in the Elamipretide-Z cohort demonstrated a statistically significant improvement in functional capacity, with the 6MWD increasing by a mean of 34.5 meters (± 6.2 m) compared to 8.2 meters (± 3.1 m) in the placebo arm (p < 0.001). The KCCQ clinical summary score improved by 9.4 points in the active treatment group (p = 0.004). Furthermore, the mean E/e' ratio decreased from 14.8 to 11.2 in the treatment group (p = 0.01), indicating reduced left ventricular filling pressures. No serious adverse drug reactions or systemic toxicities were observed. In conclusion, targeted mitochondrial optimization via Elamipretide-Z safely improves functional exercise capacity, alleviates symptoms, and enhances diastolic performance in patients suffering from HFpEF.

Keywords: Heart failure with preserved ejection fraction, Mitochondrial dysfunction, Elamipretide, Diastolic function, Exercise capacity, Peptides

Received: May 10, 2026; Revised: June 15, 2026; Accepted: July 02, 2026; Published: August 03, 2026

Citation: Rossi A, Bianchi G. Efficacy of Targeted Mitochondrial Elamipretide Therapy in Patients with Advanced Heart Failure and Preserved Ejection Fraction. International Journal of Cardiology, 2026; 17(8): 17–24. DOI: 10.46882/2026/IJC/001915

International Journal of Cardiology | Vol. 17, No. 9, August 2026 | pp. 9–16

DOI: 10.46882/2026/IJC/100002

Clinical Investigation

Title: Impact of Sodium-Glucose Cotransporter-2 Inhibitors on Right Ventricular Function in Heart Failure with Preserved Ejection Fraction

Names of Authors: Maria L. Gomez¹, Ahmed H. Al-Mansoor², Sanjay P. Patel³

Authors’ Affiliations: ¹Cardiovascular Division, Hospital Clinic de Barcelona, Barcelona, Spain; ²Department of Cardiology, King Faisal Specialist Hospital, Riyadh, Saudi Arabia; ³Department of Medicine, Duke University, Durham, NC, USA

Abstract: Background: Right ventricular (RV) dysfunction heavily influences clinical outcomes in heart failure with preserved ejection fraction (HFpEF). We investigated whether empagliflozin improves RV longitudinal strain over 6 months. Methods: In an open-label prospective trial, 115 HFpEF patients (left ventricular ejection fraction ≥ 50%, mean pulmonary arterial pressure > 20 mmHg) received empagliflozin 10 mg daily alongside standard care. Echocardiographic parameters, including RV free wall longitudinal strain (RVFWLS), were assessed at baseline and 6 months. Results: After 6 months of therapy, RVFWLS improved significantly from -16.2 ± 3.1% to -19.4 ± 3.5% (p < 0.001). Estimated pulmonary artery systolic pressure decreased from 42 ± 9 mmHg to 35 ± 7 mmHg (p = 0.002). Improvements in functional capacity evaluated via the 6-minute walk test increased by an average of 42 ± 15 meters (p < 0.001). NT-proBNP levels declined by 28% from baseline. Conclusion: Treatment with empagliflozin leads to measurable improvements in RV systolic function and hemodynamic load in patients with HFpEF.

Keywords: Heart failure, SGLT2 inhibitors, Right ventricular function, Echocardiography, Hemodynamics

Manuscript Timeline: Received 02 May 2026; Revised 01 June 2026; Accepted 20 June 2026; Published 15 August 2026