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Clinical characteristics of genetic and gene-elusive arrhythmogenic cardiomyopathy phenotypes in children 儿童遗传性和基因难以捉摸的心律失常性心肌病表型的临床特征
IF 39.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-05 DOI: 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.
背景:致心律失常性心肌病是一个涵盖各种心肌病表型的总称,包括扩张型心肌病(DCM)、非扩张型左室心肌病(NDLVC)和致心律失常性右室心肌病(ARVC)。在儿科人群中关于这些情况的数据仍然有限。本研究描述了遗传性和基因难以捉摸的NDLVC、ARVC、DCM患儿的临床特征。方法临床表现资料;遗传背景;静息、信号平均和动态心电图(ECG);运动试验(ETT);心脏磁共振(CMR);收集了在单一三级转诊中心评估的年龄≤18岁患者的结果。结果共183例患者[平均年龄16.4±4.6 y;纳入107例(58%)女性。78例(42.6%)携带桥粒体基因变异,25例(13.7%)LMNA, 11例(6.0%)FLNC, 3例(1.6%)RBM20, 2例(1.1%)PLN, 2例(1.1%)SCN5A, 2例(1.1%)DES, 1例(0.5%)EDM, 59例(32.2%)未发现致病基因变异。71例(38.8%)无表型特征,42例(23%)有非诊断性“早期”表型特征,70例(38.3%)符合常规诊断标准,其中:DCM 34例(48.6%),ARVC 26例(37.1%)[10例(14.3%)明确,10例(14.3%)边缘性,6例(8.6%)可能],NDLVC 10例(14.3%)。在受影响的患者中,34例(48.6%)出现心律失常:室性心律失常28例(40%)[非持续性室性心动过速(NSVT) 17例(24.3%),室性心动过速(VT) 9例(12.9%),心室颤动(VF) 2例(2.9%)],房性心动过速7例(10%)]。动态心电图监测发现频繁室性异位26例(37.1%),ett诱发的室性异位19例(27.1%)。SAECG阳性17例(24.3%);静息心电图异常38例(54.3%),CMR结构异常46例(65.7%)。17例(24.3%)患者接受了植入式心律转复除颤器(ICD)插入(包括2例二级预防),9例(12.9%)患者接受了心脏移植,2例(2.9%)患者死亡(移植名单上1例,移植后1例)。在“早期”表型表达的患者中,有23例(54%)存在心律失常:非svt 9(39%),持续VT 2(9%),室上性心动过速6(26%)和1度房室传导阻滞4(17%)。多发VE 11例(26%),et诱发VE 6例(14%)。SAECG阳性7例(16%),静息心电图异常14例(33%)。CMR异常13例(29%)。2例(4.8%)行一级预防ICD植入术。结论心律失常性心肌病患儿具有较高的心律失常和结构性疾病负担及早期表型表达。这些发现表明,目前的诊断标准可能无法充分检测儿科人群的疾病特征;未来的研究需要确定致心律失常心肌病表型的儿科和基因特异性诊断标准。
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引用次数: 0
Effects of SGLT2 inhibitors on triglyceride-derived indices among coronary heart disease patients with varying diabetes control status: a prospective cohort study SGLT2抑制剂对不同糖尿病控制状态冠心病患者甘油三酯衍生指标的影响:一项前瞻性队列研究
IF 39.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-05 DOI: 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
背景:冠心病(CHD)是糖代谢障碍患者死亡的主要原因。先前的研究表明,钠依赖性葡萄糖转运蛋白2抑制剂(SGLT2i)对心血管风险高的糖尿病患者有心血管益处。然而,SGLT2i对其中甘油三酯衍生指标的影响尚不清楚。方法本前瞻性研究分析了2020年8月至2021年8月期间550例冠心病患者的数据。在这些患者中,223人接受了SGLT2i治疗,327人没有接受SGLT2i治疗。根据住院期间空腹血糖(FBG)水平,将糖尿病控制情况分为3组:控制良好的糖尿病(FBG≤6.1 mmol/L)、中度控制的糖尿病(FBG≤6.1 mmol/L ~ 7.0 mmol/L)和控制不良的糖尿病(FBG≤7.0 mmol/L)。收集基线人口统计学数据和生化指标,包括血浆脂质谱、残余胆固醇和甘油三酯(TG)衍生代谢指标。tg衍生代谢指标包括血浆动脉粥样硬化指数(AIP)和甘油三酯-葡萄糖(TyG)指数。AIP和TyG的计算公式为:AIP: Lg [TG (mg/dl)/HDL (mg/dl)], TyG: Ln [TG (mg/dl) × FPG (mg/dl)/ 2]。采用多元线性回归、logistic回归、亚组分析和敏感性分析揭示生化指标、SGLT2i与糖尿病控制状况的相关性。结果纳入550例冠心病患者,平均年龄60.2岁,女性占21.8%。多元线性回归表明,SGLT2i对AIP (β=-0.052, 95% CI, -0.096 ~ -0.009, P=0.018)和TG水平(β=-0.089, 95% CI, -0.177 ~ -0.004, P=0.039)有显著的正向影响。使用SGLT2i与糖尿病控制状态之间的相互作用在AIP变化方面具有统计学意义(相互作用P= 0.041),在糖尿病控制不良的患者中观察到更大的益处(β=-0.080, 95% CI, -0.138至-0.023,P=0.007)。Logistic回归显示SGLT2i处方率较高与AIP显著降低相关(第一季度vs第四季度:优势比1.887,95% CI 1.149 ~ 3.100, P=0.012;趋势P= 0.035)。敏感性分析在高血压和高BMI患者中证实了这些发现。结论SGLT2i可改善冠心病合并糖尿病患者的AIP和TG水平,与背景使用降糖降脂药物无关。此外,控制不良的糖尿病患者可能从SGLT2i治疗中获益更多。图1-6表1
{"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 < 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","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}
引用次数: 0
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 定量正电子发射断层扫描在冠状动脉旁路移植术患者中的预后价值:心肌血流储备和冠状动脉血管阻力的增量值
IF 39.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-05 DOI: 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
背景:在接受过冠状动脉旁路移植术(CABG)的患者中,定量正电子发射断层扫描(PET)灌注参数的应用尚不明确。虽然定量PET通过评估心肌血流量(MBF)克服了多支冠状动脉疾病相对灌注成像的局限性,但其与预后的相关性尚未得到很好的探讨。目的探讨pet衍生心肌血流储备(MFR)对冠脉搭桥患者心外膜冠状动脉病变及微血管病变冠脉血管阻力(CVR)的预后价值。方法回顾性研究纳入2017年5月至2023年11月连续接受铷-82 PET心肌灌注显像的患者。MFR被定义为应激/休息MBF, MFR受损的临界值为2.0。CVR以平均动脉压除以应力MBF计算,曲线下面积分析确定最佳截止值为60 mmHg·min·g/mL。主要终点是主要不良心血管事件(MACE),定义为全因死亡率和非致死性心肌梗死的综合指标。在调整临床变量和PET参数后,使用多变量Cox比例风险模型评估相关性。结果共纳入556例患者,中位年龄72岁,男性79%。在676(482-1077)天的中位随访中,71例患者(12.8%)经历了MACE。MFR受损或CVR受损的患者MACE率明显更高(均为p&;lt;0.001)(图1)。通过MFR和CVR保存或受损的分层显示,四个联合组的MACE发生率存在显著差异(p<0.001)(图2)。MFR (<2.0)和CVR(≥60)独立预测MACE,调整后的风险比分别为3.204 (95% CI, 1.777-5.777; p<0.001)和2.350 (95% CI, 1.308-4.223; p=0.004)。结论pet衍生的MFR和CVR在CABG患者中具有独立的、递增的预后价值,在常规灌注和功能参数之外增强了风险分层。图1图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&amp;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&amp;lt;0.001) (Figure 2). Both MFR (&amp;lt;2.0) and CVR (≥60) independently predicted MACE, with adjusted hazard ratios of 3.204 (95% CI, 1.777–5.777; p&amp;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}
引用次数: 0
Automatic left-ventricular view detection and ejection fraction assessment by artificial intelligence models in echocardiography 超声心动图中人工智能模型的左心室图像自动检测和射血分数评估
IF 39.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-05 DOI: 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&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
背景左心室(LV)大小和射血分数(LVEF)在几种心血管疾病的诊断和危险分层中起着至关重要的作用。他们目前对超声心动图图像的评估有很大的观察者之间的差异,可能影响患者的管理。人工智能(AI)模型的完全自动化可以提高LV大小和LVEF的可重复性,并允许非专家对其进行量化。目的建立人工智能模型,识别相关超声心动图,在2、3、4室视图中分割LV并计算LVEF。方法对患者护理期间获得的1.5万份超声心动图进行回顾性分析、检索和匿名化处理。通过商业临床软件,对2室、3室和4室视图的619个视频(14082帧)进行左室内外边界注释,创建三个感兴趣的区域(左室腔、左室壁和整个左室),并分为独立训练集(465个视频)和测试集(154个)。使用4室视图上的左室容积来评估LVEF,并根据来自CAMUS开放数据集的488名患者的内部队列和500名患者的外部队列的临床报告数据进行验证。结果488例内部队列患者的人口学和临床特征见表1。视觉检测的准确率为93%。双腔(Dice评分分别为0,86[0,79;0,90]、0,91[0,86;0,93]、0,79[0,74;0,83])、三腔(0,88[0,84;0,91]、0,91[0,90;0,93]、0,81[0,77;0,83])和四腔(0,90[0,86;0,93]、0,92[0,88;0,94]、0,82[0,79;0,85])的左室腔、整体左室和左室壁分割良好。误差分析显示,在质量较低的图像和房颤患者中,分割性能较低,性别之间没有差异。同样,这些分割任务在外部验证队列中的表现也很好,Dice得分为0,91[0,87;[0,94]和[0,80][0,73;在2室和4室视图中,左室全腔和左室腔分别为0,84]。LVEF预测显示出可接受的线性关联(p<0.001),但在内部验证集中存在严重的低估(平均误差= 12%),在外部验证集中存在良好的线性关联(p<0.001)和最小的低估(平均误差= 2.2%)。结论人工智能模型在超声心动图视图识别和左室分割方面表现良好,导致LVEF预测误差在观察者间变异性的量级上。偏倚可能存在于房颤患者或图像质量有限的视频中。表1。人口统计和临床资料
{"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&amp;lt;0.001) but substantial underestimation (mean error = 12%) in the internal validation set, and a good linear association (p&amp;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}
引用次数: 0
Salivary hydrogen peroxide as a predictor of atherosclerotic coronary artery disease in diabetic patients, smokers, and diabetic smokers 唾液过氧化氢作为糖尿病患者、吸烟者和糖尿病吸烟者动脉粥样硬化性冠状动脉疾病的预测因子
IF 39.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-05 DOI: 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.
活性氧(ROS)在细胞功能中起着至关重要的作用,并有助于动脉粥样硬化的发展,特别是在具有高胆固醇血症、糖尿病和吸烟等危险因素的个体中。本研究探讨了唾液过氧化氢水平与冠状动脉疾病严重程度之间的相关性,为这些危险因素对疾病进展的综合影响提供了见解。目的探讨过氧化氢(h2o2)作为诊断和预防血管疾病的生物标志物的潜力,重点是冠状动脉疾病(CAD)。方法84例典型胸痛患者,主要为男性,平均年龄55.65±8.98岁。根据糖尿病(DM)、吸烟等危险因素对患者进行分类,并进一步分为4个亚组。综合评估包括人口统计数据收集、病史回顾、临床检查和实验室调查。结果糖尿病吸烟者唾液过氧化氢水平明显高于其他患者组。在糖尿病吸烟者中,唾液过氧化氢水平与动脉粥样硬化性冠状动脉疾病(CAD)的严重程度之间存在很强的正相关。此外,唾液过氧化氢在鉴别该患者亚组的CAD方面表现出很高的诊断准确性。结论:研究结果支持将唾液过氧化氢评估纳入临床实践,特别是对于有糖尿病和吸烟史的CAD患者。然而,局限性包括他汀类药物在患者中的广泛使用以及对单一医疗中心数据的依赖。进一步的分子心脏病学和药物遗传学研究是优化抗氧化干预这一特定患者群体的必要条件。
{"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}
引用次数: 0
Heart failure in the Portuguese population aged ≥50 years: prevalence and phenotypes in the PORTHOS study. 葡萄牙≥50岁人群的心力衰竭:PORTHOS研究中的患病率和表型
IF 35.6 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-05 DOI: 10.1093/eurheartj/ehag030
Rui Baptista, Ana Maria Rodrigues, Filipa Bernardo, Lígia Lopes Mendes, Fátima Franco, Joana Pimenta, Sara Gonçalves, Ana Rita Henriques, Jorge M Mendes, Ana Teresa Timóteo, Aurora Andrade, Brenda Moura, Cândida Fonseca, Carlos Aguiar, Dulce Brito, Jorge Ferreira, Marisa Peres, Paulo Santos, Pedro Moraes Sarmento, Rui Cernadas, Mário Santos, Ricardo Fontes-Carvalho, Marisa Pardal, Adalberto Campos Fernandes, Hugo Martinho, José R González-Juanatey, Luís Filipe Pereira, Cláudia Raquel Marques, Luís Filipe Azevedo, Helena Canhão, José Silva-Cardoso, Victor Machado Gil, Gianluigi Savarese, Cristina Gavina

Background and aims: Heart failure (HF) is a major global health burden, yet its true prevalence remains uncertain due to heterogeneous study designs and evolving diagnostic criteria. The Portuguese Heart Failure Prevalence Observational Study (PORTHOS) aimed to estimate the prevalence and phenotypic distribution of HF in community-dwelling adults aged ≥50 years in mainland Portugal.

Methods: PORTHOS was a cross-sectional, population-based study with a two-stage design. Stage 1 randomly selected community-dwelling individuals aged ≥50 years via structured interviews and point-of-care N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing. Individuals with NT-proBNP ≥125 pg/mL and/or a self-reported HF diagnosis, plus a random 5% of screen-negatives, proceeded to stage 2. This confirmatory stage included clinical assessment, electrocardiogram, and echocardiography. HF diagnosis required the presence of symptoms, NT-proBNP ≥125 pg/mL, and echocardiographic criteria. HF was defined as per the 2021 ESC and HFA-PEFF guidelines.

Results: Of 6189 participants, 2249 screened positive and 1136 were diagnosed with HF. The estimated HF prevalence was 16.54%, increasing with age (from 4.01% in 50-59 years old to 30.68% in those ≥70) and higher in females than males (21.00% vs 10.47%). Notably, 93.4% had HF with preserved ejection fraction (HFpEF), and 90% were previously undiagnosed. HFpEF was independently associated with older age, female sex, type 2 diabetes, atrial fibrillation, and dyslipidaemia.

Conclusions: HF affects approximately one in six Portuguese adults aged ≥50 years, with HFpEF accounting for over 90% of cases, most previously undiagnosed. These findings support NT-proBNP-based screening combined with echocardiographic evaluation to improve early HF detection in ageing populations.

背景和目的:心力衰竭(HF)是一个主要的全球健康负担,但其真正的患病率仍不确定,由于异质的研究设计和不断发展的诊断标准。葡萄牙心力衰竭患病率观察研究(PORTHOS)旨在估计葡萄牙大陆≥50岁社区居民HF的患病率和表型分布。方法:PORTHOS是一项横断面、以人群为基础的两阶段设计研究。第一阶段通过结构化访谈和现场n端前b型利钠肽(NT-proBNP)检测随机选择年龄≥50岁的社区居民。NT-proBNP≥125 pg/mL和/或自我报告HF诊断的个体,加上随机5%的筛查阴性,进入第二阶段。这一确认阶段包括临床评估、心电图和超声心动图。HF诊断需要出现症状、NT-proBNP≥125 pg/mL和超声心动图标准。HF是根据2021年ESC和HFA-PEFF指南定义的。结果:在6189名参与者中,2249名筛查阳性,1136名诊断为HF。估计HF患病率为16.54%,随年龄增长而增加(从50-59岁的4.01%增加到≥70岁的30.68%),女性高于男性(21.00% vs 10.47%)。值得注意的是,93.4%的患者患有HF并保留射血分数(HFpEF), 90%的患者以前未被诊断。HFpEF与老年、女性、2型糖尿病、心房颤动和血脂异常独立相关。结论:HF影响大约六分之一的葡萄牙≥50岁的成年人,HFpEF占90%以上的病例,大多数以前未被诊断。这些发现支持以nt - probnp为基础的筛查结合超声心动图评估来改善老年人群早期心衰的检测。
{"title":"Heart failure in the Portuguese population aged ≥50 years: prevalence and phenotypes in the PORTHOS study.","authors":"Rui Baptista, Ana Maria Rodrigues, Filipa Bernardo, Lígia Lopes Mendes, Fátima Franco, Joana Pimenta, Sara Gonçalves, Ana Rita Henriques, Jorge M Mendes, Ana Teresa Timóteo, Aurora Andrade, Brenda Moura, Cândida Fonseca, Carlos Aguiar, Dulce Brito, Jorge Ferreira, Marisa Peres, Paulo Santos, Pedro Moraes Sarmento, Rui Cernadas, Mário Santos, Ricardo Fontes-Carvalho, Marisa Pardal, Adalberto Campos Fernandes, Hugo Martinho, José R González-Juanatey, Luís Filipe Pereira, Cláudia Raquel Marques, Luís Filipe Azevedo, Helena Canhão, José Silva-Cardoso, Victor Machado Gil, Gianluigi Savarese, Cristina Gavina","doi":"10.1093/eurheartj/ehag030","DOIUrl":"https://doi.org/10.1093/eurheartj/ehag030","url":null,"abstract":"<p><strong>Background and aims: </strong>Heart failure (HF) is a major global health burden, yet its true prevalence remains uncertain due to heterogeneous study designs and evolving diagnostic criteria. The Portuguese Heart Failure Prevalence Observational Study (PORTHOS) aimed to estimate the prevalence and phenotypic distribution of HF in community-dwelling adults aged ≥50 years in mainland Portugal.</p><p><strong>Methods: </strong>PORTHOS was a cross-sectional, population-based study with a two-stage design. Stage 1 randomly selected community-dwelling individuals aged ≥50 years via structured interviews and point-of-care N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing. Individuals with NT-proBNP ≥125 pg/mL and/or a self-reported HF diagnosis, plus a random 5% of screen-negatives, proceeded to stage 2. This confirmatory stage included clinical assessment, electrocardiogram, and echocardiography. HF diagnosis required the presence of symptoms, NT-proBNP ≥125 pg/mL, and echocardiographic criteria. HF was defined as per the 2021 ESC and HFA-PEFF guidelines.</p><p><strong>Results: </strong>Of 6189 participants, 2249 screened positive and 1136 were diagnosed with HF. The estimated HF prevalence was 16.54%, increasing with age (from 4.01% in 50-59 years old to 30.68% in those ≥70) and higher in females than males (21.00% vs 10.47%). Notably, 93.4% had HF with preserved ejection fraction (HFpEF), and 90% were previously undiagnosed. HFpEF was independently associated with older age, female sex, type 2 diabetes, atrial fibrillation, and dyslipidaemia.</p><p><strong>Conclusions: </strong>HF affects approximately one in six Portuguese adults aged ≥50 years, with HFpEF accounting for over 90% of cases, most previously undiagnosed. These findings support NT-proBNP-based screening combined with echocardiographic evaluation to improve early HF detection in ageing populations.</p>","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":" ","pages":""},"PeriodicalIF":35.6,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146117906","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}
引用次数: 0
Predictors of atrial fibrillation recurrence after radiofrequency pulmonary vein isolation: metabolic syndrome, epicardial fat thickness, what else? 射频肺静脉隔离后房颤复发的预测因素:代谢综合征、心外膜脂肪厚度,还有什么?
IF 39.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-05 DOI: 10.1093/eurheartj/ehaf784.357
K Smirnov, E L Zaslavskaia, V A Ionin
Aim To establish association of metabolic syndrome (MS), epicardial fat thickness (EFT), concentration of galectin-3 and transforming growth factor-beta1 (TGF-b1) in blood serum with atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). Materials and methods Ninety five (n = 95) of 258 examined patients with AF underwent PVI due to ineffectiveness of the antiarrhythmic therapy. Average patient age was 54.2 ± 8.2 years. MS was diagnosed according to International Diabetes Federation (IDF) criteria. EFT was detected by means of transthoracic echocardiography. Galectin-3 and TGF-b1 serum levels were determined by enzyme-linked immunosorbent assay (ELISA). Results After one year of prospective post-PVI observation all patients were divided into 2 groups: Group I included 59 patients (62.1%) without arrhythmia recurrence, and Group II comprised 36 patients (37.9%) with AF recurrence. MS prevalence reached 80.6% among patients with AF relapse and only 33.9% – in patients without AFrecurrence. EFT in patients with AF recurrence was greater than in patients without AF recurrence (5.8 ± 1.8 mm and 4.9 ± 1.9 mm, p = 0.0187). Galectin-3 concentration in patients with AF recurrence was higher than in patients without AF recurrence (0.85 [0.68; 0.96] ng / ml and 0.72 [0.62; 0.85] ng / ml, p = 0.01). The concentration of TGF-b1 did not significantly differ in patients with and without AF recurrence (3586.9 [1841.0; 5545.8] pg/ml and 2581.3 [1896.4; 3177.4] pg/ml, p = 0.21). Logistic regression method allowed us to establish that the risk of AF recurrence after PVI was 8-hold higher in patients with MS (OS = 8.08, 95% CI 3.01-21.65; p = 0.001). According to the ROC analysis, the EFT threshold value of 4.5 mm or more (AUC = 0.653 ± 0.059, p = 0.014) increases the likelihood of AF recurrence after PVI by 1.32-fold (OR = 1.316 95% CI 1.053-1.645; p = 0.016 ); galectin-3 concentration level 0.77 ng/ml or more (AUC = 0.646 ± 0.060, p = 0.019) increases the risk of AF recurrence after PVI by 5.65-fold (OR = 5.65, 95% CI 1.153-27.762 ; p = 0.033). The change in TGF-b1 concentration did not affect AF recurrence. Conclusion Metabolic syndrome presence, high epicardial fat thickness and elevated level of galectin-3 serum concentration are independent predictors of ineffectiveness of radiofrequency pulmonary vein isolation in patients with paroxysmal atrial fibrillation.
目的探讨肺静脉分离(PVI)后心房颤动(AF)复发与代谢综合征(MS)、心外膜脂肪厚度(EFT)、血清半凝集素-3和转化生长因子- β 1 (TGF-b1)浓度的关系。材料与方法258例房颤患者中95例(n = 95)因抗心律失常治疗无效而发生PVI。患者平均年龄54.2±8.2岁。根据国际糖尿病联合会(IDF)的标准诊断多发性硬化症。经胸超声心动图检测EFT。采用酶联免疫吸附试验(ELISA)检测血清半乳糖凝集素-3和TGF-b1水平。结果经1年pvi术后前瞻性观察,所有患者分为2组:I组无心律失常复发59例(62.1%),II组房颤复发36例(37.9%)。在房颤复发患者中,MS患病率为80.6%,而在非房颤复发患者中,MS患病率仅为33.9%。房颤复发患者的EFT大于未复发患者(5.8±1.8 mm和4.9±1.9 mm, p = 0.0187)。AF复发患者的半凝集素-3浓度高于未复发患者(分别为0.85 [0.68;0.96]ng / ml和0.72 [0.62;0.85]ng / ml, p = 0.01)。TGF-b1浓度在AF复发患者和非AF复发患者中无显著差异(3586.9 [1841.0;5545.8]pg/ml和2581.3 [1896.4;3177.4]pg/ml, p = 0.21)。Logistic回归方法证实,MS患者PVI后房颤复发的风险比MS患者高8% (OS = 8.08, 95% CI 3.01-21.65; p = 0.001)。根据ROC分析,EFT阈值≥4.5 mm (AUC = 0.653±0.059,p = 0.014)使PVI后AF复发的可能性增加1.32倍(or = 1.316, 95% CI 1.053 ~ 1.645; p = 0.016);半凝集素-3浓度≥0.77 ng/ml (AUC = 0.646±0.060,p = 0.019)使PVI术后AF复发风险增加5.65倍(or = 5.65, 95% CI 1.153 ~ 27.762; p = 0.033)。TGF-b1浓度变化对房颤复发无影响。结论存在代谢综合征、心外膜脂肪厚度高、血清半乳糖凝集素-3水平升高是肺静脉射频隔离治疗无效的独立预测因素。
{"title":"Predictors of atrial fibrillation recurrence after radiofrequency pulmonary vein isolation: metabolic syndrome, epicardial fat thickness, what else?","authors":"K Smirnov, E L Zaslavskaia, V A Ionin","doi":"10.1093/eurheartj/ehaf784.357","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.357","url":null,"abstract":"Aim To establish association of metabolic syndrome (MS), epicardial fat thickness (EFT), concentration of galectin-3 and transforming growth factor-beta1 (TGF-b1) in blood serum with atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). Materials and methods Ninety five (n = 95) of 258 examined patients with AF underwent PVI due to ineffectiveness of the antiarrhythmic therapy. Average patient age was 54.2 ± 8.2 years. MS was diagnosed according to International Diabetes Federation (IDF) criteria. EFT was detected by means of transthoracic echocardiography. Galectin-3 and TGF-b1 serum levels were determined by enzyme-linked immunosorbent assay (ELISA). Results After one year of prospective post-PVI observation all patients were divided into 2 groups: Group I included 59 patients (62.1%) without arrhythmia recurrence, and Group II comprised 36 patients (37.9%) with AF recurrence. MS prevalence reached 80.6% among patients with AF relapse and only 33.9% – in patients without AFrecurrence. EFT in patients with AF recurrence was greater than in patients without AF recurrence (5.8 ± 1.8 mm and 4.9 ± 1.9 mm, p = 0.0187). Galectin-3 concentration in patients with AF recurrence was higher than in patients without AF recurrence (0.85 [0.68; 0.96] ng / ml and 0.72 [0.62; 0.85] ng / ml, p = 0.01). The concentration of TGF-b1 did not significantly differ in patients with and without AF recurrence (3586.9 [1841.0; 5545.8] pg/ml and 2581.3 [1896.4; 3177.4] pg/ml, p = 0.21). Logistic regression method allowed us to establish that the risk of AF recurrence after PVI was 8-hold higher in patients with MS (OS = 8.08, 95% CI 3.01-21.65; p = 0.001). According to the ROC analysis, the EFT threshold value of 4.5 mm or more (AUC = 0.653 ± 0.059, p = 0.014) increases the likelihood of AF recurrence after PVI by 1.32-fold (OR = 1.316 95% CI 1.053-1.645; p = 0.016 ); galectin-3 concentration level 0.77 ng/ml or more (AUC = 0.646 ± 0.060, p = 0.019) increases the risk of AF recurrence after PVI by 5.65-fold (OR = 5.65, 95% CI 1.153-27.762 ; p = 0.033). The change in TGF-b1 concentration did not affect AF recurrence. Conclusion Metabolic syndrome presence, high epicardial fat thickness and elevated level of galectin-3 serum concentration are independent predictors of ineffectiveness of radiofrequency pulmonary vein isolation in patients with paroxysmal atrial fibrillation.","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":"146122014","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}
引用次数: 0
A systematic-scoping review on sex-based differences in type-2 myocardial infarction (T2MI) 2型心肌梗死(T2MI)性别差异的系统综述
IF 39.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-05 DOI: 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&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
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&amp;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}
引用次数: 0
Adapting AI for 24/7 ECG monitoring: Holter-based detection of LV dysfunction 将人工智能应用于24/7心电图监测:基于霍尔特的左室功能障碍检测
IF 39.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-05 DOI: 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] &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
经过12导联心电图训练的人工智能(AI)模型可以有效检测左心室收缩功能障碍(LVSD;左心室射血分数[LVEF] &;lt;=40%)。通过动态心电图记录进行连续心电图监测,为节律障碍以外的结构性心脏病提供了机会性筛查。我们假设12导联AI模型的导联不变版本将使霍尔特监测器能够筛查心律失常和心室功能障碍。方法回顾性分析了17665例患者的动态心电图,这些患者在梅奥诊所接受了动态心电图和经胸超声心动图(TTE)检查,时间间隔为30天。从每个动态心电图中,随机提取20分钟有效(非平坦线/导联断开)心电图片段,并使用自适应导联不变人工智能模型进行LVSD检测分析。为了评估稳定性,我们检查了一天中不同时间点的模型性能,并将结果显示为接受者工作特征曲线(AUC)下的面积随时间变化。此外,我们通过比较该模型在原始心电信号和带通滤波输入上的性能,说明了该模型对噪声数据的鲁棒性。结果17665例患者(平均年龄59岁,女性48.57%)中,4.96%的患者LVEF =40%。AI模型表现出较强的预测性能(20分钟分段AUC 0.90,平均预测24小时AUC 0.92)。随时间变化的结果分析(图)揭示了预测准确性的时间模式,特定时间段显示出更大的稳定性。尽管有适度的变化,但模型的表现在一天中始终保持高水平,证实了不同生理状态下的稳健性。在有噪声输入的情况下,预测仍然是稳健的。当基线漂移和高频噪声被带通滤波器去除时,我们没有观察到性能的改善。结论将导联不变框架的12导联AI心电图模型应用于连续动态心电图可有效筛查左心室功能障碍。这表明基于人工智能的Holter-monitors分析可以促进心室功能障碍的机会筛选,并可以评估心律失常对LVEF的影响,以及心律失常负担与LVEF之间的关系。图1所示。当日平均预测AUC图2。不同时间点的AUC
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引用次数: 0
Real-world long-term one-centre experience with the use of 113 fully magnetically levitated continuous flow left ventricular assist devices 真实世界的长期单中心经验与使用113全磁悬浮连续流左心室辅助装置
IF 39.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-05 DOI: 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, &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.
由于心力衰竭(HF)患者(pts)数量的增加,对左心室辅助装置(LVAD)的需求扩大。虽然这种疗法可以提高严重心衰患者的生存率,但它也有局限性。本研究的目的是分析我院全磁悬浮LVAD植入术的效果。方法回顾性分析2016-2024年间在我院连续植入的113例HeartMate3 LVAD患者(90%为男性,平均年龄56岁,平均BMI- 28.1,中位INTERMACS谱-3.1,其他患者特征见表1)的数据。LVAD支持的平均时间为833天(中位数为619天,范围1-2837)。生存概率(Kaplan-Meier)为0.88;0.77;0.69;0.54;0.4;1、6、12、24、36、48、60个月分别为0.31和0.23(图1)。患者在我院随访至死亡、心脏移植、左心室辅助器移植或观察结束。26名患者(23%)被移植,52名患者(46%)在LVAD支持期间死亡,没有泵被移植或停用。结果32例(28%)患者发生早期右心室衰竭(RVF), 9例(8%)患者发生晚期右心室衰竭。10名患者(9%)使用右心室辅助装置(RVAD);合并瓣膜手术16例(14%)。驱动线感染(DLI),定义为至少一个阳性伤口培养,47例(42%)被发现,36例(32%)被发现复发性DLI。34名患者(30%)在LVAD支持期间至少有一次血培养阳性。缺血性卒中(IS) 11例(10%),出血性卒中(HS) 7例(6%),胃肠道出血(GIB) 13例(11%),泵血栓形成1例,移植物流出梗阻(OGO) 3例(2.6%)。平均死亡时间为484天(中位数202天,范围1-2446),而首次驱动线伤口培养阳性时间为571天(中位数452天,范围11-2043),首次血液培养阳性时间为362天(中位数41天,范围5-2504),至IS- 82天(中位数1天,范围0-830);HS- 693(中位数449,范围5-2444),GIB- 297(中位数49,范围3-1227)。我们发现(通过log-rank检验)LVAD支持期间死亡与缺血性HF、HS、GIB、裂谷热早期和晚期、RVAD使用、DLI或复发性DLI之间存在统计学显著相关性(p分别为0.012、0.019、0.044、0.006、0.009,<0.001、0.033、0.01)。非缺血性HF、IS、LVAD支持期间血培养阳性及LVAD植入时合并瓣膜手术与死亡无统计学意义(p分别为0.72、0.57、0.49、0.074)。结论:尽管全磁悬浮泵对LVAD支持效果有明显改善,血液相容性相关事件显著减少,但DLI和早期裂谷热仍然是LVAD受者的主要并发症,出血不良事件对LVAD受者的生存有负面影响。需要进一步的研究来实现这一领域的改进,包括建立最佳的抗血栓治疗和设备创新。图1表1
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European Heart Journal
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