Open Heart最新文献

Background: Transcatheter aortic valve replacement (TAVR) has already been recommended for some high-risk patients with aortic valve regurgitation, but there is still a lack of evidence regarding its early-term and medium-term safety and effectiveness compared with surgical aortic valve replacement (SAVR).

Methods: This retrospective study included patients who underwent bioprosthetic aortic valve replacement for severe aortic regurgitation (AR) at a single centre between January 2018 and December 2023. All patients in the TAVR group received the J-Valve system via transapical (TA) approach. Propensity score matching (PSM) was used to balance the groups. The primary endpoint was 2-year all-cause mortality. Secondary endpoints included other clinical events, left ventricular (LV) function recovery and prosthesis haemodynamics, assessed by transthoracic echocardiography.

Results: A total of 369 patients (median age 68 years, 26.6% female) were enrolled. Of these, 256 underwent TA-TAVR and 113 underwent SAVR. After 1:1 PSM, 76 matched pairs were included. There were no statistical differences between the groups in all-cause mortality, cardiovascular mortality, stroke, heart failure rehospitalisation, permanent pacemaker implantation or moderate to severe paravalvular leakage at 30 days or 2 years. Before PSM, left ventricular ejection fraction (LVEF) improved in the TAVR group (57% (IQR: 45-63%) vs 61% (IQR: 55-65%), p<0.001), with no significant change in the SAVR group (61% (IQR: 55-65%) vs 62% (IQR: 59-66%), p>0.05). After PSM, LVEF improvement was comparable between groups (+4.0% (IQR: -1.5 to 10.0) vs +2.0% (IQR: -3.0 to 9.5), p=0.430). Haemodynamics was superior in the TAVR group (p<0.001), while regression of LV dimensions was greater in the SAVR group.

Conclusion: In patients with severe AR, using the J-Valve for TA-TAVR showed comparable outcomes to SAVR regarding mortality and other clinical events. TAVR provided superior valve haemodynamics and was an effective treatment that significantly improved LV function, especially in high-risk patients.

Background: Iron deficiency (ID) is common in patients with heart failure (HF). Current guidelines define ID based on serum ferritin and transferrin saturation (TSAT) rather than soluble transferrin receptor (STFR) or ratios such as iron/STFR or TSAT/STFR. We investigated the associations between these biomarkers and prognosis in patients with new-onset HF with reduced ejection fraction (HFrEF).

Methods: All patients hospitalised in 2016-2020 at Sahlgrenska University Hospital with new-onset HFrEF who had iron biomarkers measured within 6 months of discharge were included, with follow-up from the date of the iron biomarker test until 31 December 2021. The primary composite event of interest was first re-hospitalisation for HF (HHF) or all-cause mortality. The associations between ID biomarkers and endpoints were analysed using Cox regression adjusted for age, sex, previous HF, left ventricular ejection fraction, HF medications and comorbidity. Bonferroni-Holm correction was applied for multiple testing.

Results: Of 325 patients included (median age 68 (57-76) years, 70.2% men), 168 (52%) had ID using current guideline criteria and STFR was available for 224 (69%) patients. Median follow-up was 2.2 years. In the prespecified analysis plan, biomarkers of ID were not statistically significantly associated with the primary composite endpoint, although each SD increase in TSAT was associated with 56% lower risk of HHF (0.44 [0.27-0.71]) as were increased ratios of iron/STFR (0.58 [0.40-0.86]) and TSAT/STFR (0.55 [0.37-0.83]). However, in a post hoc sensitivity analysis in which patients with extreme values were excluded, each increase in SD of TSAT was associated with 47% lower risk of the primary composite endpoint (0.53 [0.35-0.79]).

Conclusions: Lower TSAT is associated with a greater risk of clinical events in patients with new-onset HF, as were the ratios of iron/STFR and TSAT/STFR. However, neither ratio appeared to offer a substantial advantage compared with TSAT alone.

Thoracic aortic dissection is often approached as an acute and localised event, and pathological examination has traditionally focused on the dissected segment. In daily practice, however, most clinicians recognise that the dissection itself is rarely the starting point of disease. Structural abnormalities of the aortic wall are frequently present long before rupture occurs and may extend well beyond the site of failure.At the same time, the diagnostic landscape of thoracic aortic disease is changing rapidly. Advances in genetic and molecular techniques have increased the detection of potentially disease-causing variants, but their clinical interpretation remains challenging. In this setting, histopathological examination of the aortic wall provides essential phenotypic context and continues to play a key role in recognising and interpreting genetic disease. The value of pathology, however, depends strongly on the representativeness of the sampled tissue.In this Brief Communication, we discuss why routine reliance on dissected aortic tissue may be insufficient to characterise the underlying disease process. We argue for a more deliberate approach to tissue selection, with attention to macroscopically intact aortic segments, and highlight the importance of standardised reporting and appropriate biobanking infrastructure. Despite ongoing advances in genomic medicine, careful pathological examination of the aorta remains a cornerstone in understanding thoracic aortopathy.

Background: Pericardium is considered electrically inert, but diffuse ST-elevation is an electrocardiographic marker of acute pericarditis. We hypothesised that ST-elevation in acute pericarditis may reflect underlying myocardial involvement. Accordingly, this study aimed to assess the association between ST-elevation and myocardial involvement in pericarditis patients and to further characterise the clinical features and long-term outcomes of myopericarditis compared with isolated pericarditis.

Methods: This longitudinal multicentre study included 351 pericarditis patients (328 recurrent; 180 females), 70/351 with myopericarditis, defined by troponin elevation and/or suggestive cardiac MRI.

Results: 121 patients had ST-elevation (34.5%); they were younger: 38 years (23-53) vs 47 (31-58) (median (IQR)) (p<0.001), more often male: 63.6% (77/121) vs 40.9% (94/230) (p<0.001) and had higher C reactive protein values: 92.0 (35-170) vs 58.4 mg/L (15.8-137.5) (median (IQR)) (p=0.002) and less frequent pericardial effusions: 71.1% (86/121) vs 83.5% (192/230) (p=0.004).Myocardial involvement was diagnosed in 70/351 (19.9%) patients, occurring more frequently among those with ST-elevation: 26.4% (32/121), compared with those without: 16.5% (38/230) (p=0.035). ST-elevation predicted myocardial involvement with an OR of 1.82 (95% CI 1.07 to 3.10). Compared with isolated pericarditis, patients with myopericarditis were more frequently male: 61.4% (43/70) vs 45.6% (128/281) (p=0.023) and had a higher prevalence of transient systolic dysfunction: 13.5% (7/52) vs 2.1% (3/141) (p=0.004). During follow-up, myopericarditis patients had a lower remission rate: 18.5% (12/65) vs 31.2% (82/263) (p=0.047) and a higher annual hospitalisation rate (median 0.5 vs 0.4/year, p=0.010), while recurrence rates and disease duration were similar. Treatment strategies, including use of corticosteroids and interleukin 1 blockers, were also comparable.

Conclusions: ST-segment elevation in acute pericarditis was associated with myocardial involvement, supporting the concept that the pericardium is electrically inert. Myopericarditis was associated with lower remission rates and slightly higher hospitalisation needs compared to isolated pericarditis, despite otherwise comparable recurrence rates and treatment strategies.

Objective: To analyse comorbidity measures in relation to cardiovascular disease risk, using data from Swedish healthcare registries. The aim was to evaluate the performance of different indices in predicting incidences of four outcomes: coronary heart disease (CHD), myocardial infarction (MI), heart failure (HF) and stroke.

Methods: Study population: All individuals in Sweden born between 1936 and 1975, with a look-back for diagnosis data 2010-2014 and followed-up for outcomes from 2024 to 2019, n=4 454 895 individuals. Two age groups: 40-64 and 65-79 years old were studied. We used the area under the receiver operating characteristic curves (AUROC) of age-and-sex, the Nordic Multimorbidity Index (NMI), a set of five cardiovascular risk factors as indicator variables (CV-IV) and explored measures based on inpatient care and numbers of filled prescriptions.

Results: In the age group 40-64 years, the AUROCs for age-and-sex alone were higher than those for the indices alone in all analyses: CHD (0.739); MI (0.736); HF (0.730) and stroke (0.685). CV-IV alone showed a higher AUROC for HF (0.694; 95% CI 0.690 to 0.697) than that for NMI (0.643; 95% CI 0.639 to 0.647), and for numbers of filled prescriptions (0.671; 95% CI 0.667 to 0.675).Highest AUROC was observed for HF, when taking age-and-sex into account, for CV-IV (0.781; 95% CI 0.778 to 0.784) followed by numbers of filled prescriptions (0.776; 95% CI 0.773 to 0.780) and NMI (0.771; 95% CI 0.768 to 0.774). Furthermore, AUROC was higher for CV-IV, when taking age-and-sex into account, than that of age-and-sex alone for all outcomes in both age groups.

Conclusion: AUROC for age-and-sex alone was higher than that for any other single measure alone for all outcomes. The highest AUROC observed was for CV-IV adjusted for age-and-sex for HF. Thus, simple indicators measuring a few well-established cardiovascular risk factors outperformed a complex index such as the NMI. Similar results were obtained for numbers of filled prescriptions implying possible use as a proxy measure for comorbidity.

Cinematic rendering (CR) is a three-dimensional visualisation technique that applies physically based lighting to standard volumetric CT and MRI datasets, producing images with enhanced depth and spatial realism. Although often regarded as primarily aesthetic, we believe CR offers practical clinical value in selected cardiac and vascular imaging scenarios. It can provide continuity of volumetric visualisation of structures leading to improved understanding of complex anatomy, enhance multidisciplinary communication, for example, in multidisciplinary conferences, and support procedural planning. This viewpoint discusses where CR adds meaningful insight into cardiovascular care and argues that its potential remains underused. Rather than replacing conventional imaging techniques, CR should be viewed as a complementary tool that enhances interpretation when spatial relationships are critical. As cardiovascular imaging becomes increasingly central to complex interventions and team-based decision-making, CR may play an important supporting role.

Background: Metabolic-associated steatotic liver disease (MASLD) is a prevalent chronic liver disease affecting approximately a third of the global population. Early identification is critical for timely intervention, yet effective screening tools remain limited. The American Heart Association's Life's Simple 7 (LS7), originally developed to assess cardiovascular health, captures several metabolic domains that overlap with the diagnostic criteria of MASLD. Consequently, observed associations between LS7 and MASLD are expected to partly reflect shared metabolic components rather than independent risk prediction.

Methods: We analysed data from 3204 participants undergoing screening colonoscopy in the Salzburg Colon Cancer Prevention Initiative (Sakkopi). LS7 was derived from seven modifiable lifestyle factors (smoking, body mass index, blood pressure, cholesterol, fasting glucose, physical activity and diet). MASLD was assessed using abdominal ultrasonography, while liver fibrosis was evaluated through non-invasive markers (Aspartate Aminotransferase to Platelet Ratio Index and transient elastography). Poisson regression with robust SEs was used to estimate risk ratios (RRs) for MASLD and liver fibrosis across LS7 categories (poor: 0-4, intermediate: 5-9, ideal: 10-14), adjusting for age, sex and socioeconomic status.

Results: MASLD prevalence was highest in individuals with poor LS7 (82%) compared with those with intermediate (47%) and ideal (16%) scores. Higher LS7 was significantly associated with a lower risk of MASLD (RR 0.80; 95% CI 0.79 to 0.82; p<0.001) and liver fibrosis after adjustment for confounders.

Conclusion: LS7 showed a strong association with MASLD and hepatic steatosis, while associations with non-invasive fibrosis markers were weaker and marker-dependent, underscoring the close interplay between cardiometabolic health and liver disease. Future studies should evaluate whether changes in LS7 over time are associated with longitudinal changes in hepatic steatosis and fibrosis-related outcomes.

Background: Preprocedural risk prediction of 30-day all-cause mortality after percutaneous coronary intervention (PCI) aids in clinical decision-making and benchmarking hospital performance. This study aimed to identify preprocedural factors to predict the risk of 30-day all-cause mortality post-PCI using machine learning (ML) approaches.

Methods: The study analysed 93 055 consecutive PCI procedures recorded in the Victorian Cardiac Outcomes Registry in Australia. The Boruta feature selection method was used to identify key predictive variables. Seven ML algorithms were employed for models' development and validation. Models' performance was assessed using standard metrics for validation data set. SHapley Additive exPlanations method was used to explain leading predictive variables.

Results: Among the seven ML algorithms, the Extreme Gradient Boosting (XGB) model had the better performance across most metrics, such as accuracy (86.7%), root mean square error (36.5%), specificity (82.5%), precision (54.0%), F1 score (52.7%) and Brier score (13.3%). The XGB model also demonstrated strong discriminatory power, achieving a receiver operating characteristics-area under the curve of 85.5% (95% CI 83.5% to 87.4%). The XGB model identified left ventricular ejection fraction, acute coronary syndrome, estimated glomerular filtration rate, age and complex lesions as the five leading factors associated with 30-day mortality post-PCI. Other factors, in order, were cardiogenic shock, body mass index, intubated out-of-hospital cardiac arrest, lesion location, mechanical ventricular support, gender and peripheral vascular disease.

Conclusion: The XGB model demonstrated the best performance in predicting 30-day all-cause mortality post-PCI, identified most influential predictors such as severely reduced ejection fraction, ST-elevation myocardial infarction presentation, severe renal impairment, age 80 years and older and complex lesion. These factors from the XGB model could support individualised risk assessment, informed clinical decision-making, improved patient care or efficient resource utilisation for an Australian population. Further external validation is essential to confirm the model's generalisability across different populations.

Introduction: The PRECISE study demonstrated that the Prospective multicentre imaging study for evaluation of chest pain (PROMISE) Minimal risk score (PMRS) can identify patients with recent onset stable chest pain who could safely be reassured and discharged without further testing. Despite this observation, the PMRS is not in widespread use. The aim of this analysis was therefore to retrospectively evaluate the performance of the PMRS had it been applied as a decision tool in a real-world population.

Methods: We performed a retrospective cohort analysis of all stable chest pain referrals from 03 April 2023 to 30 August 2024. All elements of the PMRS were measured, along with key patient outcomes including subsequent investigations and cardiovascular events (myocardial infarction (MI) and all-cause mortality). Statistical analyses were conducted in accordance with the data type and distribution. The cohort was split into the minimal risk cohort (PMRS >0.46) and the remainder of the cohort (PMRS ≤0.46). A Kaplan-Meier curve, with log rank analysis, was created to compare the incidence of death/MI between the minimal risk and the remainder of the cohort.

Results: This analysis included 3983 patients with a median age of 64 years (IQR 55-75 years) and 49.5% female. The median PMRS was 0.102 (IQR 0.041-0.257) with 10.9% (436) categorised as minimal risk (PMRS >0.46). In the minimal risk group, there were three CT coronary angiographies (0.7%) that demonstrated obstructive coronary disease. At a median follow-up of 306 days (IQR 177-428) there were no MI or deaths recorded in the minimal risk group.

Conclusion: These data demonstrate that a PMRS >0.46 is associated with a very low frequency of significant coronary artery disease and MI or death. This proof of concept suggests that PMRS could be safely instituted into clinical practice to defer those patients at minimal risk from further investigations which would result in significant resource savings for healthcare services.

Background: Japanese guidelines recommend a corticosteroid maintenance dose of 5-10 mg/day for cardiac sarcoidosis (CS); however, the optimal dose remains unclear. This study aimed to evaluate the impact of maintenance dose and corticosteroid re-escalation on prognosis in patients with CS.

Methods: This multicentre retrospective cohort study used data from a Japanese nationwide CS registry. A total of 352 patients diagnosed according to the Japanese Circulation Society 2016 guideline and treated with oral corticosteroids were included. Patients were grouped by maintenance dose: low (<5.0 mg/day), recommended (5.0-10.0 mg/day) and high (>10.0 mg/day). Clinical outcomes were analysed. The main outcome was all-cause mortality.

Results: The low-dose, recommended-dose and high-dose groups comprised 11% (n=40), 78% (n=276) and 10% (n=36) of patients, with mean maintenance doses of 2.2 mg/day, 6.7 mg/day and 16.2 mg/day, respectively. During a median follow-up of 5.12 years, 39 patients (11%) died. Kaplan-Meier survival analysis showed statistically better survival in the recommended dose group, with the high-dose group showing statistically significantly worse outcomes (log-rank p=0.012). Corticosteroid re-escalation occurred in 19% of patients (9% before and 11% after achieving maintenance dose). All-cause mortality was 8% in the recommended-dose group versus 25% in the low-dose and 17% in the high-dose groups. In univariable analyses, re-escalation after achieving maintenance was associated with mortality in the high-dose group (HR 4.34, 95% CI 1.24 to 98.3), whereas re-escalation before achieving maintenance was associated with mortality in the low-dose group (HR 19.41, 95% CI 2.71 to 138.5).

Conclusions: A recommended maintenance dose of corticosteroids was associated with better prognosis in patients with CS. Achieving and maintaining this dose appears critically important in clinical management.