Pub Date : 2026-02-05DOI: 10.1093/eurheartj/ehaf784.3610
B Pashaee, N Nasibi, A Mueller, V Namdarizandi, T Zamani, T Char, E Argulian, J Leipsic, J Narula, A Ahmadi
Introduction Patients with rheumatological conditions have an increased risk of cardiovascular disease, yet traditional risk stratification tools may underestimate their atherosclerotic burden. Imaging modalities such as coronary computed tomography angiography (CCTA), coronary artery calcium (CAC) scoring, and carotid ultrasound may improve risk assessment and optimize lipid-lowering therapy (LLT). Purpose This study evaluates the role of imaging-guided lipid-lowering therapy (LLT) in rheumatology-referred patients, aiming to determine its impact on risk stratification, treatment modification, and clinical outcomes. Methods A retrospective cohort analysis was conducted on 121 patients referred by rheumatologists for cardiovascular risk assessment. Cardiovascular risk factors, lipid profiles, and ASCVD risk estimates were obtained. Patients underwent imaging based on an age- and symptom-stratified protocol: CCTA, CAC scoring, or carotid ultrasound. LLT was initiated or adjusted based on imaging findings, targeting an LDL goal of ≤70 mg/dL for patients with atherosclerosis and ≤130 mg/dL for those without. The primary endpoint was LDL reduction, and secondary outcomes included reclassification rates and cardiovascular event occurrence. Results Atherosclerosis was detected in 85 patients (70%), despite only 69 (57%) having an ASCVD risk ≥5% per standard calculators. Imaging led to reclassification in 25.6% of patients, resulting in LLT intensification in 42.4% of patients not indicated for treatment per AHA guidelines and de-escalation in 19.3% of those previously indicated for treatment. Post-treatment, LDL reduction was 35.9% in atherosclerotic patients, compared to 17.9% in non-atherosclerotic patients. Over a mean follow-up of 4.8 ± 1.4 years, no major cardiovascular events (myocardial infarction [MI], cerebrovascular accident [CVA], or unplanned revascularization) were observed, despite an expected event rate of 3.4%–7.6% based on five different risk estimation models. Conclusion Incorporating atherosclerosis imaging into routine evaluation for individuals with rheumatological conditions enhances risk stratification, allows for personalized treatment strategies, and was associated with a lower rate of cardiovascular events compared with what was predicted by traditional risk-based approaches.
{"title":"Imaging-guided lipid-lowering therapy in rheumatology patients at cardiovascular risk","authors":"B Pashaee, N Nasibi, A Mueller, V Namdarizandi, T Zamani, T Char, E Argulian, J Leipsic, J Narula, A Ahmadi","doi":"10.1093/eurheartj/ehaf784.3610","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.3610","url":null,"abstract":"Introduction Patients with rheumatological conditions have an increased risk of cardiovascular disease, yet traditional risk stratification tools may underestimate their atherosclerotic burden. Imaging modalities such as coronary computed tomography angiography (CCTA), coronary artery calcium (CAC) scoring, and carotid ultrasound may improve risk assessment and optimize lipid-lowering therapy (LLT). Purpose This study evaluates the role of imaging-guided lipid-lowering therapy (LLT) in rheumatology-referred patients, aiming to determine its impact on risk stratification, treatment modification, and clinical outcomes. Methods A retrospective cohort analysis was conducted on 121 patients referred by rheumatologists for cardiovascular risk assessment. Cardiovascular risk factors, lipid profiles, and ASCVD risk estimates were obtained. Patients underwent imaging based on an age- and symptom-stratified protocol: CCTA, CAC scoring, or carotid ultrasound. LLT was initiated or adjusted based on imaging findings, targeting an LDL goal of ≤70 mg/dL for patients with atherosclerosis and ≤130 mg/dL for those without. The primary endpoint was LDL reduction, and secondary outcomes included reclassification rates and cardiovascular event occurrence. Results Atherosclerosis was detected in 85 patients (70%), despite only 69 (57%) having an ASCVD risk ≥5% per standard calculators. Imaging led to reclassification in 25.6% of patients, resulting in LLT intensification in 42.4% of patients not indicated for treatment per AHA guidelines and de-escalation in 19.3% of those previously indicated for treatment. Post-treatment, LDL reduction was 35.9% in atherosclerotic patients, compared to 17.9% in non-atherosclerotic patients. Over a mean follow-up of 4.8 ± 1.4 years, no major cardiovascular events (myocardial infarction [MI], cerebrovascular accident [CVA], or unplanned revascularization) were observed, despite an expected event rate of 3.4%–7.6% based on five different risk estimation models. Conclusion Incorporating atherosclerosis imaging into routine evaluation for individuals with rheumatological conditions enhances risk stratification, allows for personalized treatment strategies, and was associated with a lower rate of cardiovascular events compared with what was predicted by traditional risk-based approaches.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"57 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/eurheartj/ehaf784.259
C Perez Garcia, V Fuster, G Garcia-Marti, A Moreno-Arciniegas, S Gomez-Talavera, G Pizarro, A Devesa, B Oliva, R Vazirani, A Navarro-Guzman, J Sanchez-Gonzalez, H Bueno, B Ibanez, I Garcia-Lunar, A Garcia-Alvarez
Background Right ventricular (RV) dysfunction is a relevant prognostic factor in different cardiovascular conditions, but its early determinants remain unclear. Purpose This study aimed to identify the main determinants of RV performance through CMR in a large cohort of asymptomatic middle-aged individuals. Methods A subgroup of asymptomatic middle-aged participants from the PESA cardiovascular cohort underwent RV assessment by CMR-strain and a comprehensive screening of all possible factors that may influence RV performance (including demographics, cardiometabolic risk factors, physical activity objectively measured by accelerometry, and laboratory parameters). To further understand the mechanism through which RV performance may be affected, subjects additionally underwent stress CMR to assess myocardial perfusion reserve and tissue characterization; 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) to quantify bone marrow metabolic activity, and non-contrast cardiac computed tomography (CT) to measure epicardial adiposity. RV free wall longitudinal strain was calculated through myocardial tagging, and participants were divided into tertiles based on strain values. Age and sex-adjusted trend analyses were conducted, followed by multivariate lineal regression to identify independent predictors of RV strain. Subsequently, mediators of the association between obesity and RV strain were investigated. Results 609 individuals (mean age 52.7 years; 82.8% male) were included with a median RV ejection fraction of 59.4% [56.2–62.8] and RV strain -21.3% [-23.5 to -18.3]. After adjusting for age and sex, RV strain positively correlated with body mass index (BMI), waist circumference, non-alcoholic fatty liver disease, fasting glucose, and glycated hemoglobin (HbA1c) and negatively with left ventricular (LV) ejection fraction. Interestingly, bone marrow uptake (surrogate of increased hematopoietic activity) showed a significant positive linear association with RV strain (Table). In multivariable analysis, male sex, BMI, and lower LVEF remained independent predictors of RV strain (Figure). To further understand the association between obesity and RV performance, individuals were recategorized based on BMI tertiles. Higher BMI tertiles were linked to increased bone marrow FDG uptake, lower T1 values, larger epicardial adipose tissue volume, and reduced septal myocardial perfusion reserve, suggesting exacerbated hematopoiesis, myocardial adipose infiltration, epicardial compression and coronary microvascular dysfunction as intermediate mechanisms (Figure). Conclusions In asymptomatic middle-aged individuals, obesity emerged as a key determinant of subclinical RV dysfunction, alongside with male sex and LVEF. Increased hematopoietic activity, myocardial adipose infiltration, epicardial compression and coronary microvascular dysfunction were identified as intermediate mechanisms of this association. Figure
{"title":"Obesity determines right ventricular subclinical dysfunction in middle-aged individuals","authors":"C Perez Garcia, V Fuster, G Garcia-Marti, A Moreno-Arciniegas, S Gomez-Talavera, G Pizarro, A Devesa, B Oliva, R Vazirani, A Navarro-Guzman, J Sanchez-Gonzalez, H Bueno, B Ibanez, I Garcia-Lunar, A Garcia-Alvarez","doi":"10.1093/eurheartj/ehaf784.259","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.259","url":null,"abstract":"Background Right ventricular (RV) dysfunction is a relevant prognostic factor in different cardiovascular conditions, but its early determinants remain unclear. Purpose This study aimed to identify the main determinants of RV performance through CMR in a large cohort of asymptomatic middle-aged individuals. Methods A subgroup of asymptomatic middle-aged participants from the PESA cardiovascular cohort underwent RV assessment by CMR-strain and a comprehensive screening of all possible factors that may influence RV performance (including demographics, cardiometabolic risk factors, physical activity objectively measured by accelerometry, and laboratory parameters). To further understand the mechanism through which RV performance may be affected, subjects additionally underwent stress CMR to assess myocardial perfusion reserve and tissue characterization; 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) to quantify bone marrow metabolic activity, and non-contrast cardiac computed tomography (CT) to measure epicardial adiposity. RV free wall longitudinal strain was calculated through myocardial tagging, and participants were divided into tertiles based on strain values. Age and sex-adjusted trend analyses were conducted, followed by multivariate lineal regression to identify independent predictors of RV strain. Subsequently, mediators of the association between obesity and RV strain were investigated. Results 609 individuals (mean age 52.7 years; 82.8% male) were included with a median RV ejection fraction of 59.4% [56.2–62.8] and RV strain -21.3% [-23.5 to -18.3]. After adjusting for age and sex, RV strain positively correlated with body mass index (BMI), waist circumference, non-alcoholic fatty liver disease, fasting glucose, and glycated hemoglobin (HbA1c) and negatively with left ventricular (LV) ejection fraction. Interestingly, bone marrow uptake (surrogate of increased hematopoietic activity) showed a significant positive linear association with RV strain (Table). In multivariable analysis, male sex, BMI, and lower LVEF remained independent predictors of RV strain (Figure). To further understand the association between obesity and RV performance, individuals were recategorized based on BMI tertiles. Higher BMI tertiles were linked to increased bone marrow FDG uptake, lower T1 values, larger epicardial adipose tissue volume, and reduced septal myocardial perfusion reserve, suggesting exacerbated hematopoiesis, myocardial adipose infiltration, epicardial compression and coronary microvascular dysfunction as intermediate mechanisms (Figure). Conclusions In asymptomatic middle-aged individuals, obesity emerged as a key determinant of subclinical RV dysfunction, alongside with male sex and LVEF. Increased hematopoietic activity, myocardial adipose infiltration, epicardial compression and coronary microvascular dysfunction were identified as intermediate mechanisms of this association. Figure","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"29 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/eurheartj/ehaf784.2540
S Moscatelli, G Norrish, E Field, L Luedke, L Thorogood, A Barnes, J P Kaski
Background Arrhythmogenic cardiomyopathy is an umbrella term that encompasses various cardiomyopathy phenotypes, including dilated cardiomyopathy(DCM), nondilated left ventricular cardiomyopathy(NDLVC), and arrhythmogenic right ventricular cardiomyopathy(ARVC). Data on these conditions in the paediatric population remain limited. This study describes the clinical characteristics of children with genetic and gene-elusive NDLVC, ARVC, DCM. Methods Data on clinical presentation; genetic background; resting, signal-averaged and ambulatory electrocardiogram (ECG); exercise test (ETT); cardiac magnetic resonance (CMR); and outcomes from patients aged≤18 y evaluated in a single tertiary referral centre were collected. Results A total of 183 patients [mean age 16.4±4.6 y; 107 (58%) female] were included. 78 (42.6%) carried a desmosomal gene variant, 25 (13.7%)LMNA, 11 (6.0%)FLNC, 3 (1.6%)RBM20, 2 (1.1%)PLN, 2 (1.1%) SCN5A, 2 (1.1%)DES, 1 (0.5%)EDM, and 59 (32.2%) had no disease-causing gene variant identified. 71 individuals (38.8%) had no phenotypic features, 42 (23%) had non-diagnostic ‘early’ phenotypic features, and 70 (38.3%) fulfilled conventional diagnostic criteria, including: 34 (48.6%) DCM, 26 (37.1%) ARVC [10 (14.3%) definite, 10 (14.3%) borderline, 6 (8.6%) possible] and 10 (14.3%) NDLVC. Among affected patients, arrhythmias were observed in 34 (48.6%): ventricular arrythmias in 28 (40%) [non-sustained ventricular tachycardia (NSVT) 17 (24.3%), ventricular tachycardia (VT) 9 (12.9%), ventricular fibrillation (VF) 2 (2.9%)] and atrial tachycardia in 7 (10%). Frequent ventricular ectopy (VE) was found on ambulatory ECG monitoring in 26 cases (37.1%) and ETT-induced VE in 19 (27.1%). SAECG was positive in 17 (24.3%); resting ECG abnormalities were present in 38 (54.3%), and CMR structural abnormalities in 46 (65.7%). 17 patients (24.3%) underwent implantable cardioverter defibrillator (ICD) insertion (including 2 for secondary prevention), 9 (12.9%) underwent heart transplantation and 2 (2.9%) died (1 on the transplant list and 1 following transplantation). Among those with ‘early’ phenotype expression, arrhythmias were present in 23 (54%): NSVT 9 (39%), sustained VT 2 (9%), supraventricular tachycardia 6 (26%), and 1st-degree AV block 4 (17%). Frequent VE was found in 11 cases (26%) and ETT-induced VE in 6 (14%). SAECG was positive in 7 cases (16%), and resting ECG abnormalities were seen in 14 (33%). CMR abnormalities were found in 13 (29%). 2 patients (4.8%) underwent primary prevention ICD implantation. Conclusion This study shows a high burden of arrhythmic and structural disease and early phenotypic expression in children with arrhythmogenic cardiomyopathy phenotypes. These findings suggest that current diagnostic criteria may not adequately detect disease features in the paediatric population; future studies to determine paediatric and gene-specific diagnostic criteria for arrhythmogenic cardiomyopathy phenotypes are required.
{"title":"Clinical characteristics of genetic and gene-elusive arrhythmogenic cardiomyopathy phenotypes in children","authors":"S Moscatelli, G Norrish, E Field, L Luedke, L Thorogood, A Barnes, J P Kaski","doi":"10.1093/eurheartj/ehaf784.2540","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.2540","url":null,"abstract":"Background Arrhythmogenic cardiomyopathy is an umbrella term that encompasses various cardiomyopathy phenotypes, including dilated cardiomyopathy(DCM), nondilated left ventricular cardiomyopathy(NDLVC), and arrhythmogenic right ventricular cardiomyopathy(ARVC). Data on these conditions in the paediatric population remain limited. This study describes the clinical characteristics of children with genetic and gene-elusive NDLVC, ARVC, DCM. Methods Data on clinical presentation; genetic background; resting, signal-averaged and ambulatory electrocardiogram (ECG); exercise test (ETT); cardiac magnetic resonance (CMR); and outcomes from patients aged≤18 y evaluated in a single tertiary referral centre were collected. Results A total of 183 patients [mean age 16.4±4.6 y; 107 (58%) female] were included. 78 (42.6%) carried a desmosomal gene variant, 25 (13.7%)LMNA, 11 (6.0%)FLNC, 3 (1.6%)RBM20, 2 (1.1%)PLN, 2 (1.1%) SCN5A, 2 (1.1%)DES, 1 (0.5%)EDM, and 59 (32.2%) had no disease-causing gene variant identified. 71 individuals (38.8%) had no phenotypic features, 42 (23%) had non-diagnostic ‘early’ phenotypic features, and 70 (38.3%) fulfilled conventional diagnostic criteria, including: 34 (48.6%) DCM, 26 (37.1%) ARVC [10 (14.3%) definite, 10 (14.3%) borderline, 6 (8.6%) possible] and 10 (14.3%) NDLVC. Among affected patients, arrhythmias were observed in 34 (48.6%): ventricular arrythmias in 28 (40%) [non-sustained ventricular tachycardia (NSVT) 17 (24.3%), ventricular tachycardia (VT) 9 (12.9%), ventricular fibrillation (VF) 2 (2.9%)] and atrial tachycardia in 7 (10%). Frequent ventricular ectopy (VE) was found on ambulatory ECG monitoring in 26 cases (37.1%) and ETT-induced VE in 19 (27.1%). SAECG was positive in 17 (24.3%); resting ECG abnormalities were present in 38 (54.3%), and CMR structural abnormalities in 46 (65.7%). 17 patients (24.3%) underwent implantable cardioverter defibrillator (ICD) insertion (including 2 for secondary prevention), 9 (12.9%) underwent heart transplantation and 2 (2.9%) died (1 on the transplant list and 1 following transplantation). Among those with ‘early’ phenotype expression, arrhythmias were present in 23 (54%): NSVT 9 (39%), sustained VT 2 (9%), supraventricular tachycardia 6 (26%), and 1st-degree AV block 4 (17%). Frequent VE was found in 11 cases (26%) and ETT-induced VE in 6 (14%). SAECG was positive in 7 cases (16%), and resting ECG abnormalities were seen in 14 (33%). CMR abnormalities were found in 13 (29%). 2 patients (4.8%) underwent primary prevention ICD implantation. Conclusion This study shows a high burden of arrhythmic and structural disease and early phenotypic expression in children with arrhythmogenic cardiomyopathy phenotypes. These findings suggest that current diagnostic criteria may not adequately detect disease features in the paediatric population; future studies to determine paediatric and gene-specific diagnostic criteria for arrhythmogenic cardiomyopathy phenotypes are required.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"91 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/eurheartj/ehaf784.4314
Z Yin, X N Liu, Z F Li, S Zhang, X Li, W J Zhang, M Y Lu, Y L Xu, H T Zhang, H Qiu, J L Zhao, J J Li, K F Dou, N Q Wu
Background Coronary heart disease (CHD) is a leading cause of death among patients with glucose metabolism disorders. Previous studies have demonstrated that sodium-dependent glucose transporter 2 inhibitors (SGLT2i) offer cardiovascular benefits in diabetes patients at high cardiovascular risk. However, the effect of SGLT2i on triglyceride-derived indices among them remains unclear. Methods This prospective study analyzed data from 550 CHD patients from August 2020 to August 2021. Among those patients, 223 received SGLT2i, and 327 did not. Patients were categorized into three groups by diabetes control status based on fasting blood glucose (FBG) levels during hospitalization: well-controlled diabetes (FBG < 6.1 mmol/L), moderately controlled diabetes (FBG between 6.1 mmol/L to 7.0 mmol/L) and poorly controlled diabetes (FBG > 7.0 mmol/L). Baseline demographic data and biochemical indices, including plasma lipid profiles and remnant cholesterol and triglyceride (TG)-derived metabolic indicators were collected. The TG-derived metabolic indicators includes the atherogenic index of plasma (AIP) and the triglyceride-glucose (TyG) index. The AIP and TyG were calculated via the following formulas: AIP: Lg [TG (mg/dl)/HDL (mg/dl)], TyG: Ln [TG (mg/dL) × FPG (mg/dL)/2]. Multiple linear regression, logistic regression, subgroup analysis and sensitivity analysis were adopted to reveal the associations among biochemical indicators, SGLT2i and diabetes control status. Results The study included 550 CHD patients with an average age of 60.2 years, 21.8% of whom were female. Multiple linear regression indicated a significant positive effect of SGLT2i on changing AIP (β=-0.052, 95% CI, -0.096 to -0.009, P=0.018) and TG levels (β=-0.089, 95% CI, -0.177 to -0.004, P=0.039). The interaction between SGLT2i use and diabetes control status was statistically significant for AIP changes (P for interaction = 0.041), with greater benefits observed in patients with poorly controlled diabetes (β=-0.080, 95% CI, -0.138 to -0.023, P=0.007). Logistic regression revealed higher SGLT2i prescription rates linked to significant AIP reduction (Q1 vs Q4: odds ratio, 1.887, 95% CI, 1.149 to 3.100, P=0.012; P for trend = 0.035). Sensitivity analysis confirmed these findings in patients with hypertension and high BMI. Conclusions SGLT2i improved the AIP and TG levels in CHD patients with diabetes, regardless of background hypoglycemic and lipid-lowering drugs. Moreover, patients with poorly controlled diabetes might benefit more from SGLT2i treatment.Figure 1-6 Table 1&2
{"title":"Effects of SGLT2 inhibitors on triglyceride-derived indices among coronary heart disease patients with varying diabetes control status: a prospective cohort study","authors":"Z Yin, X N Liu, Z F Li, S Zhang, X Li, W J Zhang, M Y Lu, Y L Xu, H T Zhang, H Qiu, J L Zhao, J J Li, K F Dou, N Q Wu","doi":"10.1093/eurheartj/ehaf784.4314","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.4314","url":null,"abstract":"Background Coronary heart disease (CHD) is a leading cause of death among patients with glucose metabolism disorders. Previous studies have demonstrated that sodium-dependent glucose transporter 2 inhibitors (SGLT2i) offer cardiovascular benefits in diabetes patients at high cardiovascular risk. However, the effect of SGLT2i on triglyceride-derived indices among them remains unclear. Methods This prospective study analyzed data from 550 CHD patients from August 2020 to August 2021. Among those patients, 223 received SGLT2i, and 327 did not. Patients were categorized into three groups by diabetes control status based on fasting blood glucose (FBG) levels during hospitalization: well-controlled diabetes (FBG &lt; 6.1 mmol/L), moderately controlled diabetes (FBG between 6.1 mmol/L to 7.0 mmol/L) and poorly controlled diabetes (FBG &gt; 7.0 mmol/L). Baseline demographic data and biochemical indices, including plasma lipid profiles and remnant cholesterol and triglyceride (TG)-derived metabolic indicators were collected. The TG-derived metabolic indicators includes the atherogenic index of plasma (AIP) and the triglyceride-glucose (TyG) index. The AIP and TyG were calculated via the following formulas: AIP: Lg [TG (mg/dl)/HDL (mg/dl)], TyG: Ln [TG (mg/dL) × FPG (mg/dL)/2]. Multiple linear regression, logistic regression, subgroup analysis and sensitivity analysis were adopted to reveal the associations among biochemical indicators, SGLT2i and diabetes control status. Results The study included 550 CHD patients with an average age of 60.2 years, 21.8% of whom were female. Multiple linear regression indicated a significant positive effect of SGLT2i on changing AIP (β=-0.052, 95% CI, -0.096 to -0.009, P=0.018) and TG levels (β=-0.089, 95% CI, -0.177 to -0.004, P=0.039). The interaction between SGLT2i use and diabetes control status was statistically significant for AIP changes (P for interaction = 0.041), with greater benefits observed in patients with poorly controlled diabetes (β=-0.080, 95% CI, -0.138 to -0.023, P=0.007). Logistic regression revealed higher SGLT2i prescription rates linked to significant AIP reduction (Q1 vs Q4: odds ratio, 1.887, 95% CI, 1.149 to 3.100, P=0.012; P for trend = 0.035). Sensitivity analysis confirmed these findings in patients with hypertension and high BMI. Conclusions SGLT2i improved the AIP and TG levels in CHD patients with diabetes, regardless of background hypoglycemic and lipid-lowering drugs. Moreover, patients with poorly controlled diabetes might benefit more from SGLT2i treatment.Figure 1-6 Table 1&2","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"48 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/eurheartj/ehaf784.306
Y Kadoya, E Silva, N Heiji, L Altakroni, K Boczar, B Chow, R Dekemp, R Terrence, R Beanlands, G Small
Background In patients with prior coronary artery bypass grafting (CABG), the utility of quantitative positron emission tomography (PET) perfusion parameters remains unestablished. While quantitative PET overcomes the limitations of relative perfusion imaging in multivessel coronary artery disease by assessing myocardial blood flow (MBF), its prognostic relevance is less well explored. Purpose We sought to evaluate the prognostic value of PET-derived myocardial flow reserve (MFR) to assess epicardial coronary disease and coronary vascular resistance (CVR) for microvascular disease in CABG patients. Methods This retrospective study included consecutive patients undergoing Rubidium-82 PET myocardial perfusion imaging between May 2017 and November 2023. MFR was defined as stress/rest MBF, with a cut-off of 2.0 for impaired MFR. CVR was calculated as mean arterial pressure divided by stress MBF, with an optimal cut-off of 60 mmHg·min·g/mL determined by area under the curve analysis. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of all-cause mortality and nonfatal myocardial infarction. Associations were assessed using multivariable Cox proportional hazards models after adjusting for clinical variables and PET parameters. Results A total of 556 patients (median age 72 years, 79% male) were included. Over a median follow-up of 676 (482–1077) days, 71 patients (12.8%) experienced MACE. Patients with impaired MFR or CVR had significantly higher MACE rates (both p<0.001) (Figure 1). Stratifying by preserved or impaired MFR and CVR revealed significant differences in MACE incidence across the four combination groups (p<0.001) (Figure 2). Both MFR (<2.0) and CVR (≥60) independently predicted MACE, with adjusted hazard ratios of 3.204 (95% CI, 1.777–5.777; p<0.001) and 2.350 (95% CI, 1.308–4.223; p=0.004), respectively. Conclusions PET-derived MFR and CVR provide independent and incremental prognostic value, enhancing risk stratification beyond conventional perfusion and function parameters in CABG patients.Figure 1 Figure 2
{"title":"Prognostic utility of quantitative positron emission tomography in patients with prior coronary artery bypass grafting: incremental value of myocardial flow reserve and coronary vascular resistance","authors":"Y Kadoya, E Silva, N Heiji, L Altakroni, K Boczar, B Chow, R Dekemp, R Terrence, R Beanlands, G Small","doi":"10.1093/eurheartj/ehaf784.306","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.306","url":null,"abstract":"Background In patients with prior coronary artery bypass grafting (CABG), the utility of quantitative positron emission tomography (PET) perfusion parameters remains unestablished. While quantitative PET overcomes the limitations of relative perfusion imaging in multivessel coronary artery disease by assessing myocardial blood flow (MBF), its prognostic relevance is less well explored. Purpose We sought to evaluate the prognostic value of PET-derived myocardial flow reserve (MFR) to assess epicardial coronary disease and coronary vascular resistance (CVR) for microvascular disease in CABG patients. Methods This retrospective study included consecutive patients undergoing Rubidium-82 PET myocardial perfusion imaging between May 2017 and November 2023. MFR was defined as stress/rest MBF, with a cut-off of 2.0 for impaired MFR. CVR was calculated as mean arterial pressure divided by stress MBF, with an optimal cut-off of 60 mmHg·min·g/mL determined by area under the curve analysis. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of all-cause mortality and nonfatal myocardial infarction. Associations were assessed using multivariable Cox proportional hazards models after adjusting for clinical variables and PET parameters. Results A total of 556 patients (median age 72 years, 79% male) were included. Over a median follow-up of 676 (482–1077) days, 71 patients (12.8%) experienced MACE. Patients with impaired MFR or CVR had significantly higher MACE rates (both p&lt;0.001) (Figure 1). Stratifying by preserved or impaired MFR and CVR revealed significant differences in MACE incidence across the four combination groups (p&lt;0.001) (Figure 2). Both MFR (&lt;2.0) and CVR (≥60) independently predicted MACE, with adjusted hazard ratios of 3.204 (95% CI, 1.777–5.777; p&lt;0.001) and 2.350 (95% CI, 1.308–4.223; p=0.004), respectively. Conclusions PET-derived MFR and CVR provide independent and incremental prognostic value, enhancing risk stratification beyond conventional perfusion and function parameters in CABG patients.Figure 1 Figure 2","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"34 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/eurheartj/ehaf784.4398
A Morales-Galan, P Lopez-Gutierrez, J Garrido-Oliver, L Dux-Santoy, H Majul, L Rivas-Catoni, S Martin-Grieve, M Bragulat-Arevalo, M Ferrer-Cornet, A Catala-Santarrufina, G Teixido-Tura, L Galian-Gay, I Ferreira-Gonzalez, J Rodriguez-Palomares, A Guala
Background Left-ventricular (LV) size and ejection fraction (LVEF) play a crucial role in the diagnosis and risk stratification of several cardiovascular diseases. Their current assessment on echocardiography images has substantial inter-observer variability, possibly impacting patients management. Full-automatization by artificial intelligence (AI) models may improve LV size and LVEF reproducibility and permit their quantification by non-experts. Purpose To develop AI models for the identification of relevant echocardiography views, segment the LV in 2, 3 and 4-chamber views and compute LVEF. Methods Fifteen thousand echocardiography studies obtained during patients care were retrospectively identified, retrieved and anonymized. Via commercial clinical software, 619 videos (14082 frames) of 2-, 3- and 4-chamber views were annotated for LV internal and external borders, creating three regions of interest (LV cavity, LV wall and overall LV), and divided into independent training (465 videos) and testing (154) sets. LV volumes on 4-chamber views were used to assess LVEF, which was validated against clinical report data in an internal cohort of 488 patients and in an external cohort of 500 patients from the CAMUS open dataset. Results Demographic and clinical characteristics of the 488 internal cohort patients are included in Table 1. View detection was obtained with 93% accuracy. The segmentation of LV cavity, overall LV and LV wall were good in 2-chamber (Dice score of 0,86[0,79;0,90], 0,91[0,86;0,93], 0,79[0,74;0,83], respectively), 3-chamber (0,88[0,84;0,91], 0,91[0,90;0,93], 0,81[0,77;0,83]) and 4-chamber (0,90[0,86;0,93], 0,92[0,88;0,94], 0,82[0,79;0,85]) views. Error analysis revealed that segmentation performance was lower in images with low quality and in patients with atrial fibrillation, with no differences between sexes. Similarly, performance of these segmentation tasks was good in the external validation cohort, with Dice score of 0,91[0,87;0,94] and 0,80[0,73;0,84] for whole LV and LV cavity in 2 and 4-chamber views, respectively. LVEF predictions showed an acceptable linear association (p<0.001) but substantial underestimation (mean error = 12%) in the internal validation set, and a good linear association (p<0.001) and minimal underestimation (mean error = 2.2%) in the external validation set. Conclusions AI models perform well in echocardiography views identification and LV segmentation, resulting in LVEF predictions with errors in the order of inter-observer variability. Biases may be present in patients with atrial fibrillation or in videos of limited image quality.Table 1.Demographic and clinical data
{"title":"Automatic left-ventricular view detection and ejection fraction assessment by artificial intelligence models in echocardiography","authors":"A Morales-Galan, P Lopez-Gutierrez, J Garrido-Oliver, L Dux-Santoy, H Majul, L Rivas-Catoni, S Martin-Grieve, M Bragulat-Arevalo, M Ferrer-Cornet, A Catala-Santarrufina, G Teixido-Tura, L Galian-Gay, I Ferreira-Gonzalez, J Rodriguez-Palomares, A Guala","doi":"10.1093/eurheartj/ehaf784.4398","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.4398","url":null,"abstract":"Background Left-ventricular (LV) size and ejection fraction (LVEF) play a crucial role in the diagnosis and risk stratification of several cardiovascular diseases. Their current assessment on echocardiography images has substantial inter-observer variability, possibly impacting patients management. Full-automatization by artificial intelligence (AI) models may improve LV size and LVEF reproducibility and permit their quantification by non-experts. Purpose To develop AI models for the identification of relevant echocardiography views, segment the LV in 2, 3 and 4-chamber views and compute LVEF. Methods Fifteen thousand echocardiography studies obtained during patients care were retrospectively identified, retrieved and anonymized. Via commercial clinical software, 619 videos (14082 frames) of 2-, 3- and 4-chamber views were annotated for LV internal and external borders, creating three regions of interest (LV cavity, LV wall and overall LV), and divided into independent training (465 videos) and testing (154) sets. LV volumes on 4-chamber views were used to assess LVEF, which was validated against clinical report data in an internal cohort of 488 patients and in an external cohort of 500 patients from the CAMUS open dataset. Results Demographic and clinical characteristics of the 488 internal cohort patients are included in Table 1. View detection was obtained with 93% accuracy. The segmentation of LV cavity, overall LV and LV wall were good in 2-chamber (Dice score of 0,86[0,79;0,90], 0,91[0,86;0,93], 0,79[0,74;0,83], respectively), 3-chamber (0,88[0,84;0,91], 0,91[0,90;0,93], 0,81[0,77;0,83]) and 4-chamber (0,90[0,86;0,93], 0,92[0,88;0,94], 0,82[0,79;0,85]) views. Error analysis revealed that segmentation performance was lower in images with low quality and in patients with atrial fibrillation, with no differences between sexes. Similarly, performance of these segmentation tasks was good in the external validation cohort, with Dice score of 0,91[0,87;0,94] and 0,80[0,73;0,84] for whole LV and LV cavity in 2 and 4-chamber views, respectively. LVEF predictions showed an acceptable linear association (p&lt;0.001) but substantial underestimation (mean error = 12%) in the internal validation set, and a good linear association (p&lt;0.001) and minimal underestimation (mean error = 2.2%) in the external validation set. Conclusions AI models perform well in echocardiography views identification and LV segmentation, resulting in LVEF predictions with errors in the order of inter-observer variability. Biases may be present in patients with atrial fibrillation or in videos of limited image quality.Table 1.Demographic and clinical data","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"301 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/eurheartj/ehaf784.3579
I Shehata, M Gouda, A Ammar
Background Reactive oxygen species (ROS) play a crucial role in cellular functions and contribute to the development of atherosclerosis, particularly in individuals with risk factors such as hypercholesterolemia, diabetes, and smoking. This study explores the correlation between salivary hydrogen peroxide levels and the severity of coronary artery disease, offering insights into the combined effects of these risk factors on disease progression. Purpose To examine the potential of hydrogen peroxide (H₂O₂) as a biomarker for diagnosing and preventing vascular diseases, with a focus on coronary artery disease (CAD). Methods This study involved 84 patients experiencing typical chest pain, primarily male, with an average age of 55.65 ± 8.98 years. Patients were categorized based on risk factors such as diabetes mellitus (DM) and smoking and further divided into four subgroups. A comprehensive assessment included demographic data collection, medical history review, clinical examinations, and laboratory investigations. Results Salivary hydrogen peroxide levels were significantly higher in diabetic smokers compared to other patient groups. A strong positive correlation was observed between salivary hydrogen peroxide levels and the severity of atherosclerotic coronary artery disease (CAD) in diabetic smokers. Additionally, salivary hydrogen peroxide demonstrated high diagnostic accuracy in identifying CAD in this patient subgroup. Conclusion The findings support incorporating salivary hydrogen peroxide assessment into clinical practice, particularly for CAD patients with a history of diabetes and smoking. However, limitations include the widespread use of statins among patients and the reliance on data from a single medical center. Further research in molecular cardiology and pharmacogenetics is necessary to optimize antioxidant interventions for this specific patient group.
{"title":"Salivary hydrogen peroxide as a predictor of atherosclerotic coronary artery disease in diabetic patients, smokers, and diabetic smokers","authors":"I Shehata, M Gouda, A Ammar","doi":"10.1093/eurheartj/ehaf784.3579","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.3579","url":null,"abstract":"Background Reactive oxygen species (ROS) play a crucial role in cellular functions and contribute to the development of atherosclerosis, particularly in individuals with risk factors such as hypercholesterolemia, diabetes, and smoking. This study explores the correlation between salivary hydrogen peroxide levels and the severity of coronary artery disease, offering insights into the combined effects of these risk factors on disease progression. Purpose To examine the potential of hydrogen peroxide (H₂O₂) as a biomarker for diagnosing and preventing vascular diseases, with a focus on coronary artery disease (CAD). Methods This study involved 84 patients experiencing typical chest pain, primarily male, with an average age of 55.65 ± 8.98 years. Patients were categorized based on risk factors such as diabetes mellitus (DM) and smoking and further divided into four subgroups. A comprehensive assessment included demographic data collection, medical history review, clinical examinations, and laboratory investigations. Results Salivary hydrogen peroxide levels were significantly higher in diabetic smokers compared to other patient groups. A strong positive correlation was observed between salivary hydrogen peroxide levels and the severity of atherosclerotic coronary artery disease (CAD) in diabetic smokers. Additionally, salivary hydrogen peroxide demonstrated high diagnostic accuracy in identifying CAD in this patient subgroup. Conclusion The findings support incorporating salivary hydrogen peroxide assessment into clinical practice, particularly for CAD patients with a history of diabetes and smoking. However, limitations include the widespread use of statins among patients and the reliance on data from a single medical center. Further research in molecular cardiology and pharmacogenetics is necessary to optimize antioxidant interventions for this specific patient group.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"40 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/eurheartj/ehaf784.1932
S Lalani, M Yordanova, M D'angelo, N Bottega
Background Worldwide, cardiovascular disease remains a primary cause of death, with notable differences between sexes. While sex differences in Type 1 myocardial infarction (T1MI) are well recognized, those in Type 2 myocardial infarction (T2MI) are less understood and may influence clinical practice and provide valuable prognostic insights. Purpose We aimed to provide a comprehensive overview of sex-based differences in incidence, comorbidities, clinical management, and outcomes of T2MI. Methods A systematic-scoping review of retrospective and prospective studies examining the differences in T2MI by sex was conducted by three-independent reviewers. Six databases were included in the search strategy (Web of Science, OVID, SCOPUS, EMBASE, CINAHL, PUBMED), and were last searched on November 29, 2024. Pooled odds ratios (OR) with 95% confidence interval (CI) of T2MI gender differences were calculated using aggregated meta-analyses in Stata. Results The search strategy resulted in 1388 articles and 28 studies were included after the full-text screening (Figure 1). Thirteen of these were included in the meta-analysis on the likelihood of T2MI by gender, with 3,292,727 participants in total (618,535 T2MI, of which 47.5% were female). Meta-analysis displayed that men were significantly less likely than women to have T2MI (OR 0.69; 95% CI, 0.63-0.74; P<0.001) (Figure 2). Women with T2MI were generally older and had a higher prevalence of hypertension than men (n=5). While some studies found higher diabetes rates in men (n=2), others reported a greater history of prior PCI or CABG in this group (n=4). Coronary artery disease (CAD) was less frequently observed on angiography in women (n=3) compared to men. Mortality, both short- and long-term, was higher in men (n=4), though one study contradicted this finding (n=1). Although data on treatment differences were limited, some evidence suggested greater ASA use in men (n=2). Conclusion This is the first comprehensive overview of sex-based differences in T2MI. Our study demonstrated that T2MIs are more prevalent in females, highlighting key differences among genders. In sum, data is limited, and further research is needed on gender-specific factors in T2MI to improve diagnosis, management, and mortality rates.Figure 1:PRISMA Diagram Figure 2:Forest plot of unadjusted odd
在世界范围内，心血管疾病仍然是死亡的主要原因，性别之间存在显著差异。虽然1型心肌梗死（T1MI）的性别差异是公认的，但2型心肌梗死（T2MI）的性别差异知之甚少，可能影响临床实践并提供有价值的预后见解。目的：我们旨在全面概述T2MI在发病率、合并症、临床管理和结局方面的性别差异。方法由三名独立评论者对T2MI的性别差异进行回顾性和前瞻性研究的系统综述。6个数据库被纳入检索策略（Web of Science、OVID、SCOPUS、EMBASE、CINAHL、PUBMED），最后一次检索时间为2024年11月29日。使用Stata的汇总meta分析计算T2MI性别差异的合并优势比（OR）和95%置信区间（CI）。全文筛选后，共纳入1388篇文献，其中28篇研究（图1）。其中13人被纳入了按性别划分的T2MI可能性的荟萃分析，共有3292727名参与者（618535名T2MI患者，其中47.5%为女性）。荟萃分析显示，男性患T2MI的可能性明显低于女性（OR 0.69; 95% CI, 0.63-0.74; P<0.001）（图2）。女性T2MI患者一般年龄较大，高血压患病率高于男性（n=5）。虽然一些研究发现男性糖尿病发病率较高（n=2），但其他研究报告了该组患者既往PCI或CABG病史较高（n=4）。与男性相比，冠状动脉疾病（CAD）在女性血管造影中较少被观察到（n=3）。男性的短期和长期死亡率都较高（n=4），尽管一项研究与此发现相矛盾（n=1）。虽然关于治疗差异的数据有限，但一些证据表明，男性使用ASA更多（n=2）。结论：本文首次对T2MI的性别差异进行了全面综述。我们的研究表明，t2mi在女性中更为普遍，突出了性别之间的关键差异。总之，数据有限，需要进一步研究T2MI的性别因素，以改善诊断、管理和死亡率。图1:PRISMA图2：未调整奇数的森林样地
{"title":"A systematic-scoping review on sex-based differences in type-2 myocardial infarction (T2MI)","authors":"S Lalani, M Yordanova, M D'angelo, N Bottega","doi":"10.1093/eurheartj/ehaf784.1932","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.1932","url":null,"abstract":"Background Worldwide, cardiovascular disease remains a primary cause of death, with notable differences between sexes. While sex differences in Type 1 myocardial infarction (T1MI) are well recognized, those in Type 2 myocardial infarction (T2MI) are less understood and may influence clinical practice and provide valuable prognostic insights. Purpose We aimed to provide a comprehensive overview of sex-based differences in incidence, comorbidities, clinical management, and outcomes of T2MI. Methods A systematic-scoping review of retrospective and prospective studies examining the differences in T2MI by sex was conducted by three-independent reviewers. Six databases were included in the search strategy (Web of Science, OVID, SCOPUS, EMBASE, CINAHL, PUBMED), and were last searched on November 29, 2024. Pooled odds ratios (OR) with 95% confidence interval (CI) of T2MI gender differences were calculated using aggregated meta-analyses in Stata. Results The search strategy resulted in 1388 articles and 28 studies were included after the full-text screening (Figure 1). Thirteen of these were included in the meta-analysis on the likelihood of T2MI by gender, with 3,292,727 participants in total (618,535 T2MI, of which 47.5% were female). Meta-analysis displayed that men were significantly less likely than women to have T2MI (OR 0.69; 95% CI, 0.63-0.74; P&lt;0.001) (Figure 2). Women with T2MI were generally older and had a higher prevalence of hypertension than men (n=5). While some studies found higher diabetes rates in men (n=2), others reported a greater history of prior PCI or CABG in this group (n=4). Coronary artery disease (CAD) was less frequently observed on angiography in women (n=3) compared to men. Mortality, both short- and long-term, was higher in men (n=4), though one study contradicted this finding (n=1). Although data on treatment differences were limited, some evidence suggested greater ASA use in men (n=2). Conclusion This is the first comprehensive overview of sex-based differences in T2MI. Our study demonstrated that T2MIs are more prevalent in females, highlighting key differences among genders. In sum, data is limited, and further research is needed on gender-specific factors in T2MI to improve diagnosis, management, and mortality rates.Figure 1:PRISMA Diagram Figure 2:Forest plot of unadjusted odd","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"89 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/eurheartj/ehaf784.4452
D Hu, K Liu, K E Mangold, T Wagner, S Awasthi, J C Cruz, M K Ranganathan, A J Deshmukh, F Lopez-Jimenez, P A Friedman, P A Noseworthy, Z I Attia
Background Artificial intelligence (AI) models trained on 12-lead ECGs effectively detect left ventricular systolic dysfunction (LVSD; left ventricular ejection fraction [LVEF] <=40%). Continuous ECG monitoring via Holter recordings provides an opportunity for opportunistic screening for structural heart disease beyond rhythm disorders. We hypothesized that a lead-invariant version of the 12-lead AI model would enable a Holter monitor to screen for both arrhythmias and ventricular dysfunction. Methods We retrospectively analyzed continuous Holter ECGs from 17,665 patients who underwent a Holter and transthoracic echocardiogram (TTE) within 30 days of each other at Mayo Clinic. From each Holter, a random 20-minute of valid (non-flatline/lead disconnect) ECG segment was extracted and analyzed for LVSD detection using the adapted lead-invariant AI model. To evaluate stability, we examined model performance across different time points of the day, presenting results as area under the receiver operating characteristic curve (AUC) over time. Moreover, we illustrated the model’s robustness to noisy data by comparing its performance on raw ECG signals with that on bandpass-filtered inputs. Results Among 17,665 patients (mean age 59 years, 48.57% female), 4.96% had an LVEF <=40%. The AI model demonstrated strong predictive performance (20-minute segment AUC 0.90, mean prediction of 24-hour AUC 0.92). Analysis of results over time (Figure) revealed temporal patterns in predictive accuracy, with specific time periods showing greater stability. Despite modest variability, model performance remained consistently high throughout the day, confirming robustness across different physiological states. The predictions remained robust with noisy input. We did not observe performance improvement when the baseline wander and high frequency noise are removed by the bandpass filter. Conclusion Applying a 12-lead AI ECG model with a lead-invariant framework to a continuous Holter ECG enables effective screening for left ventricular dysfunction. This suggests that AI-based analysis of Holter-monitors can facilitate opportunistic screening of ventricular dysfunction and may enable assessment of an arrhythmia’s impact on LVEF, as well as the relationship between arrhythmia burden and LVEF.Figure 1.Mean prediction AUC of the day Figure 2.AUC for different time point
{"title":"Adapting AI for 24/7 ECG monitoring: Holter-based detection of LV dysfunction","authors":"D Hu, K Liu, K E Mangold, T Wagner, S Awasthi, J C Cruz, M K Ranganathan, A J Deshmukh, F Lopez-Jimenez, P A Friedman, P A Noseworthy, Z I Attia","doi":"10.1093/eurheartj/ehaf784.4452","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.4452","url":null,"abstract":"Background Artificial intelligence (AI) models trained on 12-lead ECGs effectively detect left ventricular systolic dysfunction (LVSD; left ventricular ejection fraction [LVEF] &lt;=40%). Continuous ECG monitoring via Holter recordings provides an opportunity for opportunistic screening for structural heart disease beyond rhythm disorders. We hypothesized that a lead-invariant version of the 12-lead AI model would enable a Holter monitor to screen for both arrhythmias and ventricular dysfunction. Methods We retrospectively analyzed continuous Holter ECGs from 17,665 patients who underwent a Holter and transthoracic echocardiogram (TTE) within 30 days of each other at Mayo Clinic. From each Holter, a random 20-minute of valid (non-flatline/lead disconnect) ECG segment was extracted and analyzed for LVSD detection using the adapted lead-invariant AI model. To evaluate stability, we examined model performance across different time points of the day, presenting results as area under the receiver operating characteristic curve (AUC) over time. Moreover, we illustrated the model’s robustness to noisy data by comparing its performance on raw ECG signals with that on bandpass-filtered inputs. Results Among 17,665 patients (mean age 59 years, 48.57% female), 4.96% had an LVEF &lt;=40%. The AI model demonstrated strong predictive performance (20-minute segment AUC 0.90, mean prediction of 24-hour AUC 0.92). Analysis of results over time (Figure) revealed temporal patterns in predictive accuracy, with specific time periods showing greater stability. Despite modest variability, model performance remained consistently high throughout the day, confirming robustness across different physiological states. The predictions remained robust with noisy input. We did not observe performance improvement when the baseline wander and high frequency noise are removed by the bandpass filter. Conclusion Applying a 12-lead AI ECG model with a lead-invariant framework to a continuous Holter ECG enables effective screening for left ventricular dysfunction. This suggests that AI-based analysis of Holter-monitors can facilitate opportunistic screening of ventricular dysfunction and may enable assessment of an arrhythmia’s impact on LVEF, as well as the relationship between arrhythmia burden and LVEF.Figure 1.Mean prediction AUC of the day Figure 2.AUC for different time point","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"87 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/eurheartj/ehaf784.1547
A Bielka, M Kalinowski, R Antonczyk, M Herdynska-Was, T Hrapkowicz, P Przybylowski
Introduction Owing to increasing numbers of heart failure (HF) patients (pts) the need for left ventricular assist device (LVAD) expands. Although this therapy improves survival in severe HF pts it is not free from limitations. Background The purpose of this study was to analyze outcomes of fully magnetically levitated LVAD implantations in our institution. Methods We retrospectively analyzed data of all consecutive 113 HeartMate3 LVAD pts (90% male; mean age-56 y; mean BMI- 28.1; median INTERMACS profile -3.1, other patient characteristics depicted in Table 1) implanted in our institution within years 2016-2024. The mean time of LVAD support was 833 days (median 619, range 1-2837). The probability of survival (Kaplan-Meier) was 0.88; 0.77; 0.69; 0.54; 0.4; 0.31 and 0.23 for 1,6,12,24,36,48, 60 months respectively (Figure 1). Patients were followed to death, heart transplantation, LVAD explantation or to the end of observation in our institution. 26 pts (23%) were transplanted, 52(46%) died during LVAD support and no pumps were explanted or de-activated. Results Early right ventricular failure (RVF) occurred in 32 (28% ) of pts, while late RVF only in 9 (8%). Right ventricular assist device (RVAD) was used in 10 pts(9%); concomitant valvular surgery was performed in 16 pts(14%). Drive-line infection (DLI), defined as at least one positive wound culture, was found in 47 pts(42%), while recurrent DLI in 36 pts( 32%). At least one positive blood culture during LVAD support occurred in 34 pts(30%). Ischemic stroke (IS) affected 11 pts(10%), hemorrhagic stroke (HS) – 7 pts(6%), gastrointestinal bleeding (GIB) - 13 pts(11%), pump thrombosis - 1 patient, outflow graft obstruction (OGO) - 3 pts(2.6% ). Mean time to death was 484 days (median 202, range 1-2446), while time to first positive drive-line wound culture - 571 (median 452, range 11-2043), time to first positive blood culture- 362 (median 41, range 5-2504), to IS- 82 (median 1 day, range 0-830); HS- 693 (median 449, range 5-2444), GIB- 297 (median 49, range 3-1227). We found statistically significant correlations (by use of log-rank test) between death during LVAD support and ischemic HF, HS, GIB, early and late RVF, RVAD use, DLI or recurrent DLI ( p respectively: 0.012, 0.019, 0.044, 0.006, 0.009, <0.001, 0.033, 0.01). No statistically significant relations were found between death and non-ischemic HF, IS, positive blood culture during LVAD support and concomitant valvular procedure at LVAD implantation ( p respectively: 0.72, 0.57, 0.49, 0.074). Conclusions Despite evident progress of LVAD support outcomes and significant reduction of hemocompatibility related events with fully magnetically levitated pumps, DLI and early RVF still remain major complications while hemorrhagic adverse events have a negative impact on survival of LVAD recipients. Further research is needed to achieve improvement in this area including establishment of optimal antithrombotic therapy and device innovations.
{"title":"Real-world long-term one-centre experience with the use of 113 fully magnetically levitated continuous flow left ventricular assist devices","authors":"A Bielka, M Kalinowski, R Antonczyk, M Herdynska-Was, T Hrapkowicz, P Przybylowski","doi":"10.1093/eurheartj/ehaf784.1547","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.1547","url":null,"abstract":"Introduction Owing to increasing numbers of heart failure (HF) patients (pts) the need for left ventricular assist device (LVAD) expands. Although this therapy improves survival in severe HF pts it is not free from limitations. Background The purpose of this study was to analyze outcomes of fully magnetically levitated LVAD implantations in our institution. Methods We retrospectively analyzed data of all consecutive 113 HeartMate3 LVAD pts (90% male; mean age-56 y; mean BMI- 28.1; median INTERMACS profile -3.1, other patient characteristics depicted in Table 1) implanted in our institution within years 2016-2024. The mean time of LVAD support was 833 days (median 619, range 1-2837). The probability of survival (Kaplan-Meier) was 0.88; 0.77; 0.69; 0.54; 0.4; 0.31 and 0.23 for 1,6,12,24,36,48, 60 months respectively (Figure 1). Patients were followed to death, heart transplantation, LVAD explantation or to the end of observation in our institution. 26 pts (23%) were transplanted, 52(46%) died during LVAD support and no pumps were explanted or de-activated. Results Early right ventricular failure (RVF) occurred in 32 (28% ) of pts, while late RVF only in 9 (8%). Right ventricular assist device (RVAD) was used in 10 pts(9%); concomitant valvular surgery was performed in 16 pts(14%). Drive-line infection (DLI), defined as at least one positive wound culture, was found in 47 pts(42%), while recurrent DLI in 36 pts( 32%). At least one positive blood culture during LVAD support occurred in 34 pts(30%). Ischemic stroke (IS) affected 11 pts(10%), hemorrhagic stroke (HS) – 7 pts(6%), gastrointestinal bleeding (GIB) - 13 pts(11%), pump thrombosis - 1 patient, outflow graft obstruction (OGO) - 3 pts(2.6% ). Mean time to death was 484 days (median 202, range 1-2446), while time to first positive drive-line wound culture - 571 (median 452, range 11-2043), time to first positive blood culture- 362 (median 41, range 5-2504), to IS- 82 (median 1 day, range 0-830); HS- 693 (median 449, range 5-2444), GIB- 297 (median 49, range 3-1227). We found statistically significant correlations (by use of log-rank test) between death during LVAD support and ischemic HF, HS, GIB, early and late RVF, RVAD use, DLI or recurrent DLI ( p respectively: 0.012, 0.019, 0.044, 0.006, 0.009, &lt;0.001, 0.033, 0.01). No statistically significant relations were found between death and non-ischemic HF, IS, positive blood culture during LVAD support and concomitant valvular procedure at LVAD implantation ( p respectively: 0.72, 0.57, 0.49, 0.074). Conclusions Despite evident progress of LVAD support outcomes and significant reduction of hemocompatibility related events with fully magnetically levitated pumps, DLI and early RVF still remain major complications while hemorrhagic adverse events have a negative impact on survival of LVAD recipients. Further research is needed to achieve improvement in this area including establishment of optimal antithrombotic therapy and device innovations.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"17 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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