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/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}
Pub Date : 2026-02-05DOI: 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}
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}
Pub Date : 2026-02-05DOI: 10.1093/eurheartj/ehaf784.396
A Borrow, C Chen, V Caso, R Smolnik, J Antonio Gordillo De Souza, R De Caterina, M Unverdorben
Introduction Clinical practice guidelines are intended to improve patients’ outcomes by helping clinicians make the best evidence-based decisions in a time-efficient manner. The ESC Clinical Practice Guidelines for the management of atrial fibrillation (AF), revised in 2024, provide updated recommendations for the diagnosis and management of AF. Purpose To assess physicians’ reactions to and adoption of the 2024 guidelines for the management of AF and to identify remaining unanswered practical, clinical questions. Methods A 4-question poll was conducted between 4 November–4 December 2024 on the social media news feed of registered users of a closed, physician-only, social media platform. Registered platform users from 10 European and 4 Asian countries who were cardiologists, neurologists, or primary care physicians (PCPs) were asked about the importance of the new ESC guidelines for their own clinical practice, guideline topics of greatest interest, remaining uncertainties/unanswered clinical questions about AF and direct oral anticoagulant (DOAC) management, and preferred sources for clinical decision-making. Poll participation was voluntary and no financial compensation was provided to respondents. Descriptive analyses of responses were performed by speciality and by country, and responses to questions permitting multiple answers were rank ordered by proportion of respondents. Results A total of 433 physicians responded to the poll (26% cardiologists, 7% neurologists, 67% PCPs). Respondents were from Spain (33%), Germany (23%), Italy (18%), France (14%), and China (6%). Nearly all respondents (91%; N=417) considered the guidelines as very important or important for their clinical practice (very important: 76% cardiologists, 48% neurologists, 57% PCPs; important: 19% cardiologists, 45% neurologists, 32% PCPs). The 3 specialties (N=344) were largely aligned in their topics of interest, with greatest interest in comorbidity/risk factor management (Figure 1a). By specialty, cardiologists were most interested in CHA2DS2-VASc vs CHA2DS2-VA, neurologists in recommended DOAC dosing, and PCPs in rate vs rhythm control. Across specialties (N=262), the most common remaining uncertainties/unanswered clinical questions were for patients who were very elderly and/or frail, have chronic kidney disease/renal impairment, or have cancer (Figure 1b). Clinical guidelines (European and local), review articles, and congress-based information (both from congress and symposia attendance) were the most useful sources of information for clinical decision-making (N=268; Figure 2). Conclusions The 2024 ESC Clinical Practice Guidelines for AF management were considered important and useful for clinical practice by almost all respondents. Of particular interest were topics related to risk factor management, symptom control, and DOAC dosing. Additional guidance would be welcome on the management of patients with AF in high-risk groups.
{"title":"The 2024 ESC Guidelines for the Management of Atrial Fibrillation serve physicians well but leave a few questions unanswered: a social media-based poll of 433 European and Asian physicians","authors":"A Borrow, C Chen, V Caso, R Smolnik, J Antonio Gordillo De Souza, R De Caterina, M Unverdorben","doi":"10.1093/eurheartj/ehaf784.396","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.396","url":null,"abstract":"Introduction Clinical practice guidelines are intended to improve patients’ outcomes by helping clinicians make the best evidence-based decisions in a time-efficient manner. The ESC Clinical Practice Guidelines for the management of atrial fibrillation (AF), revised in 2024, provide updated recommendations for the diagnosis and management of AF. Purpose To assess physicians’ reactions to and adoption of the 2024 guidelines for the management of AF and to identify remaining unanswered practical, clinical questions. Methods A 4-question poll was conducted between 4 November–4 December 2024 on the social media news feed of registered users of a closed, physician-only, social media platform. Registered platform users from 10 European and 4 Asian countries who were cardiologists, neurologists, or primary care physicians (PCPs) were asked about the importance of the new ESC guidelines for their own clinical practice, guideline topics of greatest interest, remaining uncertainties/unanswered clinical questions about AF and direct oral anticoagulant (DOAC) management, and preferred sources for clinical decision-making. Poll participation was voluntary and no financial compensation was provided to respondents. Descriptive analyses of responses were performed by speciality and by country, and responses to questions permitting multiple answers were rank ordered by proportion of respondents. Results A total of 433 physicians responded to the poll (26% cardiologists, 7% neurologists, 67% PCPs). Respondents were from Spain (33%), Germany (23%), Italy (18%), France (14%), and China (6%). Nearly all respondents (91%; N=417) considered the guidelines as very important or important for their clinical practice (very important: 76% cardiologists, 48% neurologists, 57% PCPs; important: 19% cardiologists, 45% neurologists, 32% PCPs). The 3 specialties (N=344) were largely aligned in their topics of interest, with greatest interest in comorbidity/risk factor management (Figure 1a). By specialty, cardiologists were most interested in CHA2DS2-VASc vs CHA2DS2-VA, neurologists in recommended DOAC dosing, and PCPs in rate vs rhythm control. Across specialties (N=262), the most common remaining uncertainties/unanswered clinical questions were for patients who were very elderly and/or frail, have chronic kidney disease/renal impairment, or have cancer (Figure 1b). Clinical guidelines (European and local), review articles, and congress-based information (both from congress and symposia attendance) were the most useful sources of information for clinical decision-making (N=268; Figure 2). Conclusions The 2024 ESC Clinical Practice Guidelines for AF management were considered important and useful for clinical practice by almost all respondents. Of particular interest were topics related to risk factor management, symptom control, and DOAC dosing. Additional guidance would be welcome on the management of patients with AF in high-risk groups.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"24 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122063","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/ehaf784.2924
Y Kim, J Lim, S Bang, H Shin, J Yang, I Kang, J Song, H Kim, D Kim, S Chang
Background The role of prostacyclin is critical in pulmonary arterial hypertension (PAH) and parenteral prostacyclin is an essential treatment option for high-risk patients. However, its real-world utilization remains limited due to physician unfamiliarity and high costs. Comprehensive analysis of real-world treprostinil use has been scarce. Purpose This study aimed to investigate the treatment patterns and clinical response to treprostinil in real-world practice. Methods Patients prescribed treprostinil for PAH from 2011 to 2024 at two tertiary referral centers were identified. Clinical characteristics, treatment response and survival outcomes were analyzed. We categorized the study populations into three groups based on the timing of treprostinil initiation: optimal sequential combination therapy (when the patient reached intermediate to high risk), early triple combination (in high-risk patients), and delayed sequential combination therapy (delayed initiation of treprostinil in already diagnosed PAH when they reached the functional class IV or definite indication for lung transplantation). Results A total of 94 patients were identified, with 35 (37.2%) in optimal sequential combination therapy group, 12 (12.8%) in early triple combination therapy group, and 47 (50.0%) in delayed sequential combination therapy group. Hemodynamic characteristics and risk profiles for PAH were similar among the study groups except for functional class. The cumulative 1-year mortality rate in the overall population was 35.1%. 1-year mortality was significantly higher in delayed sequential combination therapy group (53.2%) compared to optimal sequential combination therapy group (20.0%) and early triple combination therapy group (8.3%) (p<0.001). Optimal sequential combination and early triple combination therapy over delayed sequential combination therapy were identified as independent predictor for death at 1 year (adjusted HR 0.239, 95% CI 0.096-0.599, p=0.002; adjusted HR 0.107, 95% CI 0.014-0.811, p=0.031). The treatment response to treprostinil was significantly lower in the delayed sequential combination therapy group (40.4%) compared to the optimal sequential combination (85.7%) and early triple combination therapy group (75.0%) (p<0.001). Optimal sequential combination and early triple combination therapy were associated with higher rates of successful transition to oral maintenance therapy (40.0% and 91.7%, respectively), whereas 8.5% of patients in the delayed sequential combination therapy group maintained therapy (p<0.001). Conclusions Although the guideline recommends the optimal timing for intervention with parenteral prostacyclin, it is frequently delayed in real-world clinics. Treatment outcomes show dramatic differences based on the timing—early, optimal, and delayed. Furthermore, a transition to an oral IP3 receptor agonist was even possible for some patients who survived due to early intervention with parenteral prostacyclin
背景：前列环素在肺动脉高压（PAH）中的作用至关重要，对于高危患者，肠外注射前列环素是必不可少的治疗选择。然而，由于医生的不熟悉和高昂的成本，其在现实世界中的应用仍然有限。对真实世界曲前列汀使用情况的综合分析很少。目的本研究旨在探讨现实世界中曲前列氨酯的治疗模式和临床反应。方法对2011 - 2024年在两家三级转诊中心使用曲前列替尼治疗PAH的患者进行分析。分析两组患者的临床特点、治疗效果及生存结局。我们根据曲前列替尼起始时间将研究人群分为三组：最佳序贯联合治疗（当患者达到中高风险时）、早期三联治疗（高危患者）和延迟序贯联合治疗（当已诊断为PAH的患者达到功能级IV或明确的肺移植指证时延迟曲前列替尼起始治疗）。结果94例患者中，最佳顺序联合治疗组35例（37.2%），早期三联治疗组12例（12.8%），延迟顺序联合治疗组47例（50.0%）。除功能组别外，各研究组的血流动力学特征和多环芳烃风险概况相似。总体人群1年累计死亡率为35.1%。延迟顺序联合治疗组的1年死亡率（53.2%）明显高于最佳顺序联合治疗组（20.0%）和早期三联治疗组（8.3%）（p<0.001）。最佳序贯组合和早期三联治疗优于延迟序贯组合治疗是1年死亡的独立预测因子（调整后HR 0.239, 95% CI 0.096 ~ 0.599, p=0.002；调整后HR 0.107, 95% CI 0.014 ~ 0.811, p=0.031）。延迟顺序联合治疗组对曲前列地尼的治疗反应（40.4%）明显低于最佳顺序联合治疗组（85.7%）和早期三联治疗组（75.0%）（p<0.001）。最佳顺序联合治疗和早期三联治疗与较高的成功过渡到口服维持治疗的比例相关（分别为40.0%和91.7%），而延迟顺序联合治疗组的患者维持治疗的比例为8.5% （p<0.001）。结论：尽管指南建议肠外注射前列环素干预的最佳时机，但在现实世界的临床中，它经常被推迟。治疗结果根据治疗时间的不同表现出显著差异——早期、最佳和延迟。此外，对于一些由于早期肠外注射前列环素干预而存活的患者，甚至可能过渡到口服IP3受体激动剂。
{"title":"Dramatic differences resulting from treatment timing of treprostinil in high-risk patients: a real-world data analysis","authors":"Y Kim, J Lim, S Bang, H Shin, J Yang, I Kang, J Song, H Kim, D Kim, S Chang","doi":"10.1093/eurheartj/ehaf784.2924","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.2924","url":null,"abstract":"Background The role of prostacyclin is critical in pulmonary arterial hypertension (PAH) and parenteral prostacyclin is an essential treatment option for high-risk patients. However, its real-world utilization remains limited due to physician unfamiliarity and high costs. Comprehensive analysis of real-world treprostinil use has been scarce. Purpose This study aimed to investigate the treatment patterns and clinical response to treprostinil in real-world practice. Methods Patients prescribed treprostinil for PAH from 2011 to 2024 at two tertiary referral centers were identified. Clinical characteristics, treatment response and survival outcomes were analyzed. We categorized the study populations into three groups based on the timing of treprostinil initiation: optimal sequential combination therapy (when the patient reached intermediate to high risk), early triple combination (in high-risk patients), and delayed sequential combination therapy (delayed initiation of treprostinil in already diagnosed PAH when they reached the functional class IV or definite indication for lung transplantation). Results A total of 94 patients were identified, with 35 (37.2%) in optimal sequential combination therapy group, 12 (12.8%) in early triple combination therapy group, and 47 (50.0%) in delayed sequential combination therapy group. Hemodynamic characteristics and risk profiles for PAH were similar among the study groups except for functional class. The cumulative 1-year mortality rate in the overall population was 35.1%. 1-year mortality was significantly higher in delayed sequential combination therapy group (53.2%) compared to optimal sequential combination therapy group (20.0%) and early triple combination therapy group (8.3%) (p&lt;0.001). Optimal sequential combination and early triple combination therapy over delayed sequential combination therapy were identified as independent predictor for death at 1 year (adjusted HR 0.239, 95% CI 0.096-0.599, p=0.002; adjusted HR 0.107, 95% CI 0.014-0.811, p=0.031). The treatment response to treprostinil was significantly lower in the delayed sequential combination therapy group (40.4%) compared to the optimal sequential combination (85.7%) and early triple combination therapy group (75.0%) (p&lt;0.001). Optimal sequential combination and early triple combination therapy were associated with higher rates of successful transition to oral maintenance therapy (40.0% and 91.7%, respectively), whereas 8.5% of patients in the delayed sequential combination therapy group maintained therapy (p&lt;0.001). Conclusions Although the guideline recommends the optimal timing for intervention with parenteral prostacyclin, it is frequently delayed in real-world clinics. Treatment outcomes show dramatic differences based on the timing—early, optimal, and delayed. Furthermore, a transition to an oral IP3 receptor agonist was even possible for some patients who survived due to early intervention with parenteral prostacyclin","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"30 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122065","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/ehaf784.4035
M Sandini, A Mauro, E Bizzi, R Mascolo, V Collini, L Bernardo, M Imazio, A Brucato
Background Current guidelines for diagnosis and treatment of recurrent pericarditis are based on adult populations. Aims Due to limited pediatric data, this study aims to highlight clinical, laboratory, and therapeutic differences between idiopathic recurrent pericarditis in children and adults to optimize pediatric disease management. Methods and Results This retrospective multicentric cohort study analyzed data from patients with recurrent pericarditis (idiopathic or post-cardiac injury). Clinical, laboratory, and outcome data were compared between pediatric (<18 years) and adult (>18 years) patients. A total of 61 children and 289 adults were included. Follow-up was significantly longer in children (8 vs. 4 years, p < 0.001). Males were predominantly affected in pediatric patient’s cohort (30.3% female vs 69.7% male), while gender distribution was similar in adults (51.6% female vs. 48.4% male). Children were hospitalized more frequently than adult (81.8% vs. 58.5%, p < 0.05). From the clinical point of view, chest pain was the most common symptom in both group (100% vs. 57.1%), whereas dyspnea was exclusive to adults (31.5%, p < 0.05). Pericardial effusion was less common in children (63.6% vs. 80.6%, p < 0.05) and no pediatric patients developed constrictive pericarditis requiring pericardiectomy. Pediatric patient’s cohort had a higher incidence of ST-segment elevation on ECG (64.7% vs. 32.4%, p < 0.01) and a higher relative lymphocyte count (p < 0.05) with a lower neutrophil-to-lymphocyte ratio (3.65 vs. 4.71, p < 0.05). Although the difference is not statistically significant, the troponin levels were found to be lower in children compared with adults (29 ng/L vs 72.6 ng/L, p=0.294). Recurrence of pericarditis was more frequent in adults (9.59 vs. 4.4 episodes/10 years, p < 0.001), but children had significantly longer relapse-free periods (68.31 vs. 31.72 months, p < 0.001). There were no significant differences observed in the treatment between the two groups. A total of 48 children (78.8%) and 237 adults (82.0%) were treated with NSAIDs. Colchicine was prescribed to 22 children (36.4%) and 136 adults (47.1%), while 15 children (24.2%) and 73 adults (25.3%) received Anakinra. The only notable difference was in the dosage of prednisone, with children receiving significantly higher doses compared to adults (37.25 mg vs. 25 mg, p = 0.023). Conclusions Recurrent pericarditis in children follows a different course than in adults, with fewer recurrences, prolonged symptom-free periods, and typical ECG abnormalities. The higher corticosteroid use in children raises some concerns because of its potential side effects, including growth impairment and osteoporosis. IL-1 inhibitors should be considered to minimize corticosteroid administration. These findings emphasize the importance of developing a pediatric age-specific guideline.
背景：目前复发性心包炎的诊断和治疗指南是基于成人人群的。由于儿科数据有限，本研究旨在突出儿童和成人特发性复发性心包炎的临床、实验室和治疗差异，以优化儿科疾病管理。方法和结果本回顾性多中心队列研究分析了复发性心包炎（特发性或心脏后损伤）患者的数据。比较儿科（18岁）和成人（18岁）患者的临床、实验室和结局数据。共有61名儿童和289名成人被纳入研究。儿童的随访时间明显更长（8年vs. 4年，p < 0.001）。在儿科患者队列中，男性主要受影响（女性占30.3%，男性占69.7%），而成人患者的性别分布相似（女性占51.6%，男性占48.4%）。儿童住院率高于成人（81.8%比58.5%,p < 0.05）。从临床角度来看，胸痛是两组患者最常见的症状（100% vs. 57.1%），而呼吸困难是成人所特有的（31.5%,p < 0.05）。心包积液在儿童中较少见（63.6%对80.6%,p < 0.05），没有儿童患者发生缩窄性心包炎需要心包切除术。儿童患者队列心电图st段抬高发生率较高（64.7% vs. 32.4%, p < 0.01），相对淋巴细胞计数较高（p < 0.05），中性粒细胞与淋巴细胞比值较低（3.65 vs. 4.71, p < 0.05）。虽然差异无统计学意义，但发现儿童肌钙蛋白水平低于成人（29 ng/L vs 72.6 ng/L, p=0.294）。心包炎的复发在成人中更为常见（9.59 vs 4.4次/10年，p < 0.001），但儿童的无复发期明显更长（68.31 vs 31.72个月，p < 0.001）。两组治疗效果无明显差异。共有48名儿童（78.8%）和237名成人（82.0%）接受了非甾体抗炎药治疗。22名儿童（36.4%）和136名成人（47.1%）使用秋水仙碱，15名儿童（24.2%）和73名成人（25.3%）使用阿那白。唯一的显著差异是泼尼松的剂量，儿童接受的剂量明显高于成人（37.25 mg vs. 25 mg, p = 0.023）。结论：儿童心包炎复发的病程与成人不同，复发较少，无症状期延长，心电图异常典型。儿童使用较多的皮质类固醇引起了一些担忧，因为它可能产生副作用，包括生长障碍和骨质疏松症。应考虑使用IL-1抑制剂来减少皮质类固醇的使用。这些发现强调了制定针对儿童年龄的指南的重要性。
{"title":"Idiopathic recurrent pericarditis in children and adults:clinical and diagnostic differences","authors":"M Sandini, A Mauro, E Bizzi, R Mascolo, V Collini, L Bernardo, M Imazio, A Brucato","doi":"10.1093/eurheartj/ehaf784.4035","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.4035","url":null,"abstract":"Background Current guidelines for diagnosis and treatment of recurrent pericarditis are based on adult populations. Aims Due to limited pediatric data, this study aims to highlight clinical, laboratory, and therapeutic differences between idiopathic recurrent pericarditis in children and adults to optimize pediatric disease management. Methods and Results This retrospective multicentric cohort study analyzed data from patients with recurrent pericarditis (idiopathic or post-cardiac injury). Clinical, laboratory, and outcome data were compared between pediatric (&lt;18 years) and adult (&gt;18 years) patients. A total of 61 children and 289 adults were included. Follow-up was significantly longer in children (8 vs. 4 years, p &lt; 0.001). Males were predominantly affected in pediatric patient’s cohort (30.3% female vs 69.7% male), while gender distribution was similar in adults (51.6% female vs. 48.4% male). Children were hospitalized more frequently than adult (81.8% vs. 58.5%, p &lt; 0.05). From the clinical point of view, chest pain was the most common symptom in both group (100% vs. 57.1%), whereas dyspnea was exclusive to adults (31.5%, p &lt; 0.05). Pericardial effusion was less common in children (63.6% vs. 80.6%, p &lt; 0.05) and no pediatric patients developed constrictive pericarditis requiring pericardiectomy. Pediatric patient’s cohort had a higher incidence of ST-segment elevation on ECG (64.7% vs. 32.4%, p &lt; 0.01) and a higher relative lymphocyte count (p &lt; 0.05) with a lower neutrophil-to-lymphocyte ratio (3.65 vs. 4.71, p &lt; 0.05). Although the difference is not statistically significant, the troponin levels were found to be lower in children compared with adults (29 ng/L vs 72.6 ng/L, p=0.294). Recurrence of pericarditis was more frequent in adults (9.59 vs. 4.4 episodes/10 years, p &lt; 0.001), but children had significantly longer relapse-free periods (68.31 vs. 31.72 months, p &lt; 0.001). There were no significant differences observed in the treatment between the two groups. A total of 48 children (78.8%) and 237 adults (82.0%) were treated with NSAIDs. Colchicine was prescribed to 22 children (36.4%) and 136 adults (47.1%), while 15 children (24.2%) and 73 adults (25.3%) received Anakinra. The only notable difference was in the dosage of prednisone, with children receiving significantly higher doses compared to adults (37.25 mg vs. 25 mg, p = 0.023). Conclusions Recurrent pericarditis in children follows a different course than in adults, with fewer recurrences, prolonged symptom-free periods, and typical ECG abnormalities. The higher corticosteroid use in children raises some concerns because of its potential side effects, including growth impairment and osteoporosis. IL-1 inhibitors should be considered to minimize corticosteroid administration. These findings emphasize the importance of developing a pediatric age-specific guideline.","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":"146122136","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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