Background: Early graft failure within 90 postoperative days is the leading cause of mortality after heart transplantation. Existing risk scores, based on linear regression, often struggle to capture the complex, multifactorial biological interactions necessary for personalised donor-recipient matching. This study utilised explainable machine learning (ML) to identify robust predictors of 90-day graft failure and developed a clinically interpretable, ML-informed nomogram designed specifically for cross-population generalisability.
Methods: Using the UNOS registry (2008-2020; n=25 200), XGBoost/Random Forest models identified 90-day graft failure predictors from 32 donor-recipient variables. Explainable AI (SHapley Additive exPlanations) analysis revealed key predictors and their non-linear interactions, which were translated into a clinically applicable nomogram. External validation was performed on a large, single-centre Chinese cohort (Wuhan Union Hospital ; 2018-2023; n=563), assessing performance via area under the curve (AUC), calibration and decision curve analysis (DCA).
Findings: The final model incorporated eight predictors: recipient factors (prior cardiac surgery, age, bilirubin, body mass index (BMI)), donor factors (age, gender, BMI) and cold ischaemia time. The XGBoost-derived nomogram demonstrated consistent discrimination (AUC 0.67, 95% CI 0.64 to 0.70) and calibration. Patients stratified into the high-risk group (top quantile by nomogram score) had a 2.4-fold increased hazard of graft failure (HR 2.42, 95% CI 2.11 to 2.78). DCA confirmed the model's clinical utility across a wide range of risk thresholds (0.0-0.4). External validation in the Chinese cohort affirmed its generalisability (AUC 0.67).
Conclusion: This study introduces an ML-informed nomogram for 90-day graft failure, validated across USA and Chinese populations. By translating ML insights into a clinically interpretable tool using routinely available pretransplant variables, it bridges a key translational gap in transplant risk prediction. This tool can aid in optimising donor-recipient matching and personalising post-transplant management, with the potential to help address geographic disparities in heart transplant outcomes.
背景:术后90天内早期移植物衰竭是心脏移植术后死亡的主要原因。现有的基于线性回归的风险评分往往难以捕捉到个性化供体-受体匹配所必需的复杂的、多因素的生物相互作用。本研究利用可解释的机器学习(ML)来确定90天移植物衰竭的可靠预测因素,并开发了一个临床可解释的、ML信息的nomogram,专门设计用于跨人群的通用性。方法:使用UNOS注册表(2008-2020;n=25 200), XGBoost/Random Forest模型从32个供体-受体变量中确定90天移植物衰竭预测因子。可解释的AI (SHapley Additive exPlanations)分析揭示了关键预测因子及其非线性相互作用,并将其转化为临床适用的nomogram。在大型单中心中国队列(武汉协和医院;2018-2023;n=563)中进行外部验证,通过曲线下面积(AUC)、校准和决策曲线分析(DCA)评估疗效。结果:最终模型纳入了八个预测因素:受体因素(既往心脏手术、年龄、胆红素、体重指数(BMI))、供体因素(年龄、性别、BMI)和冷缺血时间。xgboost衍生的nomogram显示出一致的鉴别(AUC 0.67, 95% CI 0.64至0.70)和校准。高危组(nomogram评分最高的分位数)患者的移植物衰竭风险增加2.4倍(HR 2.42, 95% CI 2.11 ~ 2.78)。DCA证实了该模型在广泛的风险阈值(0.0-0.4)范围内的临床实用性。中国队列的外部验证证实了其普遍性(AUC为0.67)。结论:本研究引入了一种基于ml的90天移植物衰竭图,在美国和中国人群中得到了验证。通过使用常规可用的移植前变量将ML见解转化为临床可解释的工具,它弥合了移植风险预测中的关键翻译差距。该工具可以帮助优化供体-受体匹配和个性化移植后管理,有可能帮助解决心脏移植结果的地域差异。
{"title":"Bridging machine learning and clinical practice: a multicentre nomogram for 90-day graft failure risk stratification in heart transplantation.","authors":"Wai Yen Yim, Yating Li, Jincheng Hou, Yuqi Chen, Tixiusi Xiong, Chenghao Li, Junlin Lai, Yongbu Peng, Bingchuan Geng, Yunlong Wu, Fuqiang Tong, Yixuan Wang, Nianguo Dong","doi":"10.1136/openhrt-2025-003790","DOIUrl":"10.1136/openhrt-2025-003790","url":null,"abstract":"<p><strong>Background: </strong>Early graft failure within 90 postoperative days is the leading cause of mortality after heart transplantation. Existing risk scores, based on linear regression, often struggle to capture the complex, multifactorial biological interactions necessary for personalised donor-recipient matching. This study utilised explainable machine learning (ML) to identify robust predictors of 90-day graft failure and developed a clinically interpretable, ML-informed nomogram designed specifically for cross-population generalisability.</p><p><strong>Methods: </strong>Using the UNOS registry (2008-2020; n=25 200), XGBoost/Random Forest models identified 90-day graft failure predictors from 32 donor-recipient variables. Explainable AI (SHapley Additive exPlanations) analysis revealed key predictors and their non-linear interactions, which were translated into a clinically applicable nomogram. External validation was performed on a large, single-centre Chinese cohort (Wuhan Union Hospital ; 2018-2023; n=563), assessing performance via area under the curve (AUC), calibration and decision curve analysis (DCA).</p><p><strong>Findings: </strong>The final model incorporated eight predictors: recipient factors (prior cardiac surgery, age, bilirubin, body mass index (BMI)), donor factors (age, gender, BMI) and cold ischaemia time. The XGBoost-derived nomogram demonstrated consistent discrimination (AUC 0.67, 95% CI 0.64 to 0.70) and calibration. Patients stratified into the high-risk group (top quantile by nomogram score) had a 2.4-fold increased hazard of graft failure (HR 2.42, 95% CI 2.11 to 2.78). DCA confirmed the model's clinical utility across a wide range of risk thresholds (0.0-0.4). External validation in the Chinese cohort affirmed its generalisability (AUC 0.67).</p><p><strong>Conclusion: </strong>This study introduces an ML-informed nomogram for 90-day graft failure, validated across USA and Chinese populations. By translating ML insights into a clinically interpretable tool using routinely available pretransplant variables, it bridges a key translational gap in transplant risk prediction. This tool can aid in optimising donor-recipient matching and personalising post-transplant management, with the potential to help address geographic disparities in heart transplant outcomes.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"13 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12878189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146106476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-30DOI: 10.1136/openhrt-2025-003839
Zhao Ren, Yichao Shi, Jingwei Zou, Chun Hao, Yulin Li, Lichaoyue Sun, Dongxiao Wang, Hua Liu, Shuo Liang, Bin Zhu, Chunxing Li
Background: To compare the efficacy and safety of off-label low-dose versus standard-dose antiplatelet agents in coronary heart disease (CHD) patients, focusing on the evidence gap in comparisons of low-dose versus standard-dose ticagrelor and prasugrel.
Methods: PubMed, Embase, the Cochrane Library, ClinicalTrials.gov, China National Knowledge Infrastructure and Wanfang databases were searched up to 11 May 2025 for randomised controlled trials. Study quality was assessed using the Cochrane Risk of Bias 2.0 tool. A meta-analysis was performed, with relative risk (RR) and 95% CI as the effect estimates. Subgroup analyses were performed stratified by antiplatelet agent type, ethnic region, treatment duration and CHD subtype.
Results: A total of 22 randomised controlled trials, involving 7486 patients, met the study criteria. Among them, 92.09% were Asian, and 63.63% of the included studies exclusively enrolled acute coronary syndrome patients. All patients received the dual antiplatelet therapy (aspirin combined with a low or standard dose of P2Y12 receptor antagonist), mainly with low-dose prasugrel and ticagrelor. Off-label low-dose antiplatelet agents significantly reduced myocardial infarction (MI) (RR 0.75, 95% CI 0.58 to 0.97) and minimal bleeding risks (RR 0.64, 95% CI 0.50 to 0.82) compared with standard doses, with comparable risks for other ischaemic and bleeding events. Compared with standard-dose clopidogrel, they significantly reduced MI risk (RR 0.71, 95% CI 0.54 to 0.93) but increased overall (RR 1.40, 95% CI 1.11 to 1.77) and minor bleeding risks (RR 1.86, 95% CI 1.02 to 3.38). Compared with standard-dose prasugrel or ticagrelor, they demonstrated comparable ischaemic risks and significantly reduced overall and minimal bleeding risks. All other subgroup analyses were consistent with the overall findings.
Conclusion: Off-label low-dose antiplatelet therapy reduces the risks of MI and minimal bleeding. It surpassed standard-dose clopidogrel and offered lower bleeding risks than prasugrel or ticagrelor, thus representing an effective secondary prevention strategy for Asian CHD.
Prospero registration number: CRD42023438376.
背景:比较超说明书低剂量与标准剂量抗血小板药物治疗冠心病(CHD)患者的疗效和安全性,重点关注低剂量替格瑞洛和普拉格雷与标准剂量替格瑞洛和普拉格雷比较的证据缺口。方法:检索截至2025年5月11日的PubMed、Embase、Cochrane图书馆、ClinicalTrials.gov、中国国家知识基础设施和万方数据库,检索随机对照试验。使用Cochrane风险偏倚2.0工具评估研究质量。进行荟萃分析,以相对危险度(RR)和95% CI作为效果估计。按抗血小板药物类型、民族地区、治疗时间和冠心病亚型进行亚组分析。结果:共有22项随机对照试验,涉及7486例患者,符合研究标准。其中92.09%为亚洲人,63.63%的纳入研究只纳入急性冠状动脉综合征患者。所有患者均接受双抗血小板治疗(阿司匹林联合低剂量或标准剂量的P2Y12受体拮抗剂),主要是低剂量的普拉格雷和替格瑞洛。与标准剂量相比,标签外低剂量抗血小板药物显著降低心肌梗死(MI) (RR 0.75, 95% CI 0.58至0.97)和最小出血风险(RR 0.64, 95% CI 0.50至0.82),其他缺血和出血事件的风险相当。与标准剂量氯吡格雷相比,它们显著降低了心肌梗死风险(RR 0.71, 95% CI 0.54 ~ 0.93),但总体上增加了(RR 1.40, 95% CI 1.11 ~ 1.77)和轻微出血风险(RR 1.86, 95% CI 1.02 ~ 3.38)。与标准剂量的普拉格雷或替格瑞相比,它们显示出相当的缺血风险,并显着降低了总体和最小出血风险。所有其他亚组分析与总体结果一致。结论:说明书外低剂量抗血小板治疗可降低心肌梗死风险和少量出血。它超过了标准剂量的氯吡格雷,并提供比普拉格雷或替格瑞更低的出血风险,因此代表了亚洲冠心病的有效二级预防策略。普洛斯彼罗注册号:CRD42023438376。
{"title":"Efficacy and safety of off-label low-dose compared with standard-dose antiplatelet agents in patients with coronary heart disease: a meta-analysis.","authors":"Zhao Ren, Yichao Shi, Jingwei Zou, Chun Hao, Yulin Li, Lichaoyue Sun, Dongxiao Wang, Hua Liu, Shuo Liang, Bin Zhu, Chunxing Li","doi":"10.1136/openhrt-2025-003839","DOIUrl":"10.1136/openhrt-2025-003839","url":null,"abstract":"<p><strong>Background: </strong>To compare the efficacy and safety of off-label low-dose versus standard-dose antiplatelet agents in coronary heart disease (CHD) patients, focusing on the evidence gap in comparisons of low-dose versus standard-dose ticagrelor and prasugrel.</p><p><strong>Methods: </strong>PubMed, Embase, the Cochrane Library, ClinicalTrials.gov, China National Knowledge Infrastructure and Wanfang databases were searched up to 11 May 2025 for randomised controlled trials. Study quality was assessed using the Cochrane Risk of Bias 2.0 tool. A meta-analysis was performed, with relative risk (RR) and 95% CI as the effect estimates. Subgroup analyses were performed stratified by antiplatelet agent type, ethnic region, treatment duration and CHD subtype.</p><p><strong>Results: </strong>A total of 22 randomised controlled trials, involving 7486 patients, met the study criteria. Among them, 92.09% were Asian, and 63.63% of the included studies exclusively enrolled acute coronary syndrome patients. All patients received the dual antiplatelet therapy (aspirin combined with a low or standard dose of P2Y12 receptor antagonist), mainly with low-dose prasugrel and ticagrelor. Off-label low-dose antiplatelet agents significantly reduced myocardial infarction (MI) (RR 0.75, 95% CI 0.58 to 0.97) and minimal bleeding risks (RR 0.64, 95% CI 0.50 to 0.82) compared with standard doses, with comparable risks for other ischaemic and bleeding events. Compared with standard-dose clopidogrel, they significantly reduced MI risk (RR 0.71, 95% CI 0.54 to 0.93) but increased overall (RR 1.40, 95% CI 1.11 to 1.77) and minor bleeding risks (RR 1.86, 95% CI 1.02 to 3.38). Compared with standard-dose prasugrel or ticagrelor, they demonstrated comparable ischaemic risks and significantly reduced overall and minimal bleeding risks. All other subgroup analyses were consistent with the overall findings.</p><p><strong>Conclusion: </strong>Off-label low-dose antiplatelet therapy reduces the risks of MI and minimal bleeding. It surpassed standard-dose clopidogrel and offered lower bleeding risks than prasugrel or ticagrelor, thus representing an effective secondary prevention strategy for Asian CHD.</p><p><strong>Prospero registration number: </strong>CRD42023438376.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"13 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12863327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-30DOI: 10.1136/openhrt-2025-003865
Åsmund Olaf Bratholm, Håkon Ihle-Hansen, Thea Vigen, Magnus Nakrem Lyngbakken, Torbjorn Omland, Helge Røsjø, Inger Ariansen, Trygve Berge, Arnljot Tveit, Peter Selmer Rønningen
Background: Low socioeconomic status (SES) is linked to increased cardiovascular risk, but its association with carotid atherosclerosis in the general population is less well studied. We examined associations between individual-level and area-level SES and carotid plaque burden and explored potential sex differences.
Methods: In this cross-sectional analysis from the Akershus Cardiac Examination 1950 Study, individual-level SES was defined by educational attainment, and area-level SES by urban versus rural residence and median household income of municipality. Carotid ultrasound was used to quantify plaque burden with a plaque score (0-3 per segment; maximum 24), where >3 indicates elevated cardiovascular risk. Associations between SES and plaque score were estimated using Poisson regression in crude and adjusted models.
Results: We included 3673 participants (48.8% women; mean age 63.9 years). The prevalence of elevated plaque score (>3) was 23.3% in tertiary, 28.2% in secondary and 31.4% in primary education groups (p for trend <0.001). Women and men with primary education had 32% and 24% higher plaque scores than those with tertiary education (p<0.001). After adjustment for cardiovascular risk factors, excess atherosclerotic burden remained 22% in women and 12% in men (p<0.001). No significant associations were observed for area-level SES, and no sex interactions were detected.
Conclusion: Lower educational attainment is associated with higher carotid atherosclerotic burden in both sexes, independent of cardiovascular risk factors, while area-level SES shows no clear association. These findings suggest that educational disparities contribute to atherosclerotic disease burden and merit further investigation in longitudinal studies.
{"title":"Association between socioeconomic variables and carotid plaque in middle-aged adults: data from the Akershus Cardiac Examination (ACE) 1950 Study.","authors":"Åsmund Olaf Bratholm, Håkon Ihle-Hansen, Thea Vigen, Magnus Nakrem Lyngbakken, Torbjorn Omland, Helge Røsjø, Inger Ariansen, Trygve Berge, Arnljot Tveit, Peter Selmer Rønningen","doi":"10.1136/openhrt-2025-003865","DOIUrl":"10.1136/openhrt-2025-003865","url":null,"abstract":"<p><strong>Background: </strong>Low socioeconomic status (SES) is linked to increased cardiovascular risk, but its association with carotid atherosclerosis in the general population is less well studied. We examined associations between individual-level and area-level SES and carotid plaque burden and explored potential sex differences.</p><p><strong>Methods: </strong>In this cross-sectional analysis from the Akershus Cardiac Examination 1950 Study, individual-level SES was defined by educational attainment, and area-level SES by urban versus rural residence and median household income of municipality. Carotid ultrasound was used to quantify plaque burden with a plaque score (0-3 per segment; maximum 24), where >3 indicates elevated cardiovascular risk. Associations between SES and plaque score were estimated using Poisson regression in crude and adjusted models.</p><p><strong>Results: </strong>We included 3673 participants (48.8% women; mean age 63.9 years). The prevalence of elevated plaque score (>3) was 23.3% in tertiary, 28.2% in secondary and 31.4% in primary education groups (p for trend <0.001). Women and men with primary education had 32% and 24% higher plaque scores than those with tertiary education (p<0.001). After adjustment for cardiovascular risk factors, excess atherosclerotic burden remained 22% in women and 12% in men (p<0.001). No significant associations were observed for area-level SES, and no sex interactions were detected.</p><p><strong>Conclusion: </strong>Lower educational attainment is associated with higher carotid atherosclerotic burden in both sexes, independent of cardiovascular risk factors, while area-level SES shows no clear association. These findings suggest that educational disparities contribute to atherosclerotic disease burden and merit further investigation in longitudinal studies.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"13 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12863333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Persistent atrial fibrillation (PersAF) presents a significant clinical and economic burden and is associated with poorer outcomes after catheter ablation compared with paroxysmal atrial fibrillation (AF). Pulsed field ablation (PFA) has emerged as a new form of energy modality for AF treatment. Sphere-9 is a novel dual-energy large-focal lattice tip (LFLT) catheter that is also capable of high-density mapping. The study aims to evaluate the cost-effectiveness of Sphere-9 catheter versus conventional radiofrequency (RF ablation for the treatment of PersAF in the English National Health Service (NHS) setting.
Methods: Individual patient data from the SPHERE Per-AF randomised controlled trial were used to estimate efficacy, safety and resource utilisation parameters in symptomatic PersAF patients. The cost-effectiveness model consisted of a hybrid decision tree (1-year time horizon) and a Markov model with 3-month cycle length (lifetime time horizon, 40 years) and was developed from the perspective of the English NHS. Unit costs were derived from the National Institute for Health and Care Excellence (NICE) clinical guideline for AF diagnosis and management (NG196) and NHS national cost collection data. Health benefits were expressed in quality-adjusted life years (QALYs), and all benefits and costs were discounted at 3.5% per year in line with NICE requirements.
Results: LFLT ablation was found to be dominant compared with RF, since it was less costly and it produced greater health outcomes. LFLT was associated with an average cost of £15 433 and 8.26 QALYs per patient, compared with £20 861 and 8.20 QALYs for RF ablation. Results remained robust across all sensitivity and scenario analyses.
Discussion: The Sphere-9 catheter is a cost-saving strategy for treating patients with PersAF compared with conventional RF ablation. Given the growing burden of AF and limited healthcare resources, Sphere-9 presents a valuable option for improving patient outcomes while optimising NHS resource allocation.
{"title":"Economic evaluation of a novel dual-energy, large focal lattice-tip catheter versus conventional contact-force sensing radiofrequency catheter, for persistent atrial fibrillation ablation, from the English National Health Service perspective.","authors":"Greg Mellor, Vivek Reddy, Prapa Kanagaratnam, Rowan Iskandar, Eleni Ismyrloglou, Waruiru Mburu, Maxim Souter, Elad Anter","doi":"10.1136/openhrt-2025-003770","DOIUrl":"10.1136/openhrt-2025-003770","url":null,"abstract":"<p><strong>Introduction: </strong>Persistent atrial fibrillation (PersAF) presents a significant clinical and economic burden and is associated with poorer outcomes after catheter ablation compared with paroxysmal atrial fibrillation (AF). Pulsed field ablation (PFA) has emerged as a new form of energy modality for AF treatment. Sphere-9 is a novel dual-energy large-focal lattice tip (LFLT) catheter that is also capable of high-density mapping. The study aims to evaluate the cost-effectiveness of Sphere-9 catheter versus conventional radiofrequency (RF ablation for the treatment of PersAF in the English National Health Service (NHS) setting.</p><p><strong>Methods: </strong>Individual patient data from the SPHERE Per-AF randomised controlled trial were used to estimate efficacy, safety and resource utilisation parameters in symptomatic PersAF patients. The cost-effectiveness model consisted of a hybrid decision tree (1-year time horizon) and a Markov model with 3-month cycle length (lifetime time horizon, 40 years) and was developed from the perspective of the English NHS. Unit costs were derived from the National Institute for Health and Care Excellence (NICE) clinical guideline for AF diagnosis and management (NG196) and NHS national cost collection data. Health benefits were expressed in quality-adjusted life years (QALYs), and all benefits and costs were discounted at 3.5% per year in line with NICE requirements.</p><p><strong>Results: </strong>LFLT ablation was found to be dominant compared with RF, since it was less costly and it produced greater health outcomes. LFLT was associated with an average cost of £15 433 and 8.26 QALYs per patient, compared with £20 861 and 8.20 QALYs for RF ablation. Results remained robust across all sensitivity and scenario analyses.</p><p><strong>Discussion: </strong>The Sphere-9 catheter is a cost-saving strategy for treating patients with PersAF compared with conventional RF ablation. Given the growing burden of AF and limited healthcare resources, Sphere-9 presents a valuable option for improving patient outcomes while optimising NHS resource allocation.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"13 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12863331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-29DOI: 10.1136/openhrt-2025-003816
Rui Zhang, Qian-Ji Che, Peng-Cheng Yao, Mu Chen, Qun-Shan Wang, Jian Sun, Wei Li, Peng-Pai Zhang, Bo Liu, Yi-Gang Li
Background: Mechanical compression from the ascending aorta on the left atrial anterior wall (LAAW) can cause low voltage areas (LVAs), which are associated with a higher risk of atrial fibrillation (AF) recurrence after catheter ablation. This study investigates the AF recurrence rate post-LAAW complex fractionated atrial electrograms (CFAE) ablation or LAAW linear ablation in AF patients with aortic encroachment.
Methods: We retrospectively analysed AF patients who underwent first-time ablation between 2019 and 2023 in our department and had preablation cardiac CT scans. The impact of LAAW-LVAs and different LAAW ablation strategies on AF recurrence within 1-year postprocedure was evaluated.
Results: In total, 267 patients had both aortic encroachment and LAAW-LVAs. In the absence of LAAW ablation, patients with aortic encroachment had a significantly higher risk of AF recurrence compared with those without (adjusted HR (aHR): 2.29, 95% CI: 1.27 to 4.15, p=0.006). Patients receiving LAAW CFAE ablation had a higher recurrence rate than those receiving LAAW linear ablation (aHR: 3.29, 95% CI 1.42 to 7.63, p=0.006). Multivariable analysis identified that LAAW linear ablation was a strong independent predictor of reduced AF recurrence (HR: 0.13, 95% CI 0.06 to 0.28, p<0.001).
Conclusions: Aortic encroachment is a common and significant risk factor for AF recurrence after ablation. When LAAW-LVAs are present, performing LAAW linear ablation might be a highly effective strategy to reduce postablation AF recurrence.
{"title":"Left atrial anterior wall ablation reduces the recurrence of atrial fibrillation in patients with aortic encroachment.","authors":"Rui Zhang, Qian-Ji Che, Peng-Cheng Yao, Mu Chen, Qun-Shan Wang, Jian Sun, Wei Li, Peng-Pai Zhang, Bo Liu, Yi-Gang Li","doi":"10.1136/openhrt-2025-003816","DOIUrl":"10.1136/openhrt-2025-003816","url":null,"abstract":"<p><strong>Background: </strong>Mechanical compression from the ascending aorta on the left atrial anterior wall (LAAW) can cause low voltage areas (LVAs), which are associated with a higher risk of atrial fibrillation (AF) recurrence after catheter ablation. This study investigates the AF recurrence rate post-LAAW complex fractionated atrial electrograms (CFAE) ablation or LAAW linear ablation in AF patients with aortic encroachment.</p><p><strong>Methods: </strong>We retrospectively analysed AF patients who underwent first-time ablation between 2019 and 2023 in our department and had preablation cardiac CT scans. The impact of LAAW-LVAs and different LAAW ablation strategies on AF recurrence within 1-year postprocedure was evaluated.</p><p><strong>Results: </strong>In total, 267 patients had both aortic encroachment and LAAW-LVAs. In the absence of LAAW ablation, patients with aortic encroachment had a significantly higher risk of AF recurrence compared with those without (adjusted HR (aHR): 2.29, 95% CI: 1.27 to 4.15, p=0.006). Patients receiving LAAW CFAE ablation had a higher recurrence rate than those receiving LAAW linear ablation (aHR: 3.29, 95% CI 1.42 to 7.63, p=0.006). Multivariable analysis identified that LAAW linear ablation was a strong independent predictor of reduced AF recurrence (HR: 0.13, 95% CI 0.06 to 0.28, p<0.001).</p><p><strong>Conclusions: </strong>Aortic encroachment is a common and significant risk factor for AF recurrence after ablation. When LAAW-LVAs are present, performing LAAW linear ablation might be a highly effective strategy to reduce postablation AF recurrence.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"13 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12878463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146086765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-29DOI: 10.1136/openhrt-2025-003872
Jane Manning, Louis J Koizia, Melanie Dani, Iqbal Malik, Matteo Di Giovannantonio, Benjamin H L Harris, Michael B Fertleman
Objective: Multidisciplinary team (MDT) meetings are central to treatment decisions in aortic stenosis (AS), particularly for borderline or high-risk patients. This study evaluates long-term, real-world outcomes according to MDT-selected management strategy within routine clinical practice in this clinically important patient group.
Methods: We conducted a retrospective cohort study of all patients with severe AS discussed at a transcatheter aortic valve implantation (TAVI) MDT at a tertiary UK centre between January 2014 and December 2016. Patients were categorised as TAVI or non-TAVI (conservatively managed). Demographic, clinical and frailty data were collected, including Charlson Comorbidity Index, Clinical Frailty Scale (CFS) and number of prescribed medications. Survival was analysed using Kaplan-Meier estimates and Cox proportional hazards modelling adjusted for age, sex, frailty, comorbidity burden and medication count.
Results: A total of 373 patients were included (TAVI=178; non-TAVI=195). Patients undergoing TAVI were younger (81.3 years vs 83.5 years; p=0.01) and less frail (CFS 3.9 vs 4.9; p<0.01). Survival at 1 year, 2 years and 5 years was significantly higher following TAVI (87.6%, 74.7%, 44.9%) compared with conservative management (60.8%, 44.2%, 12.1%; p<0.001). Median survival was 53 months after TAVI versus 20 months without intervention. On multivariable analysis, TAVI was independently associated with reduced mortality (HR 0.38, 95% CI 0.28 to 0.50; p<0.001).
Conclusions: In patients with severe AS discussed at MDT, TAVI was associated with a substantial and durable survival advantage compared with conservative management. These findings highlight the poor prognosis of untreated severe AS and support systematic inclusion of conservatively managed patients in interventional registries to better inform MDT deliberation and shared decision-making.
目的:多学科团队(MDT)会议是主动脉瓣狭窄(AS)治疗决策的核心,特别是对于边缘或高危患者。本研究在这一临床重要患者组的常规临床实践中,根据mdt选择的管理策略评估长期的、真实的结果。方法:我们对2014年1月至2016年12月在英国三级中心经导管主动脉瓣植入术(TAVI) MDT中讨论的所有严重AS患者进行了回顾性队列研究。患者分为TAVI和非TAVI(保守治疗)。收集人口学、临床和衰弱数据,包括Charlson合并症指数、临床衰弱量表(CFS)和处方药物数量。生存率分析采用Kaplan-Meier估计和Cox比例风险模型,对年龄、性别、虚弱、合并症负担和用药计数进行调整。结果:共纳入373例患者(TAVI=178例,非TAVI=195例)。接受TAVI的患者更年轻(81.3岁vs 83.5岁;p=0.01),体弱程度更低(CFS 3.9 vs 4.9)。结论:在MDT讨论的严重AS患者中,与保守治疗相比,TAVI具有显著和持久的生存优势。这些发现强调了未经治疗的严重AS预后不良,并支持系统地将保守管理的患者纳入介入登记,以更好地为MDT审议和共同决策提供信息。
{"title":"Multidisciplinary team-guided management of severe aortic stenosis: 5-year outcomes following TAVI versus conservative treatment.","authors":"Jane Manning, Louis J Koizia, Melanie Dani, Iqbal Malik, Matteo Di Giovannantonio, Benjamin H L Harris, Michael B Fertleman","doi":"10.1136/openhrt-2025-003872","DOIUrl":"10.1136/openhrt-2025-003872","url":null,"abstract":"<p><strong>Objective: </strong>Multidisciplinary team (MDT) meetings are central to treatment decisions in aortic stenosis (AS), particularly for borderline or high-risk patients. This study evaluates long-term, real-world outcomes according to MDT-selected management strategy within routine clinical practice in this clinically important patient group.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of all patients with severe AS discussed at a transcatheter aortic valve implantation (TAVI) MDT at a tertiary UK centre between January 2014 and December 2016. Patients were categorised as TAVI or non-TAVI (conservatively managed). Demographic, clinical and frailty data were collected, including Charlson Comorbidity Index, Clinical Frailty Scale (CFS) and number of prescribed medications. Survival was analysed using Kaplan-Meier estimates and Cox proportional hazards modelling adjusted for age, sex, frailty, comorbidity burden and medication count.</p><p><strong>Results: </strong>A total of 373 patients were included (TAVI=178; non-TAVI=195). Patients undergoing TAVI were younger (81.3 years vs 83.5 years; p=0.01) and less frail (CFS 3.9 vs 4.9; p<0.01). Survival at 1 year, 2 years and 5 years was significantly higher following TAVI (87.6%, 74.7%, 44.9%) compared with conservative management (60.8%, 44.2%, 12.1%; p<0.001). Median survival was 53 months after TAVI versus 20 months without intervention. On multivariable analysis, TAVI was independently associated with reduced mortality (HR 0.38, 95% CI 0.28 to 0.50; p<0.001).</p><p><strong>Conclusions: </strong>In patients with severe AS discussed at MDT, TAVI was associated with a substantial and durable survival advantage compared with conservative management. These findings highlight the poor prognosis of untreated severe AS and support systematic inclusion of conservatively managed patients in interventional registries to better inform MDT deliberation and shared decision-making.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"13 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12863368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146086777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-29DOI: 10.1136/openhrt-2025-003851
Barbara Stähli, Victor Schweiger, Victoria Lucia Cammann, Matthias Schindler, Konrad A Szawan, David Niederseer, Michael Würdinger, Alexander Schönberger, Maximilian Schönberger, Iva Koleva, Julien C Mercier, Vanya Petkova, Maurus Steigmeier, Rodolfo Citro, Eduardo Bossone, Thomas F Lüscher, Jelena-Rima Templin-Ghadri, Davide Di Vece, Christian Templin
Aims: The obesity paradox has been described in different cardiovascular conditions. Data on the association between obesity and outcomes in patients with Takotsubo syndrome (TTS) are lacking. The aim of this study was to determine the relationship between body weight and mortality in TTS patients.
Methods: Patients enrolled in the International Takotsubo Registry from January 2011 to July 2021 and with available data on body mass index (BMI) were included in the analysis. Patients were stratified according to BMI (underweight, <18.5 kg/m2; normal weight, 18.5-24.9 kg/m2; overweight, 25.0-29.9 kg/m2; obese, 30.0-34.9 kg/m2; and very obese, ≥35.0 kg/m2). The primary endpoint was mortality at 1 year.
Results: Of the 2707 patients, 222 (8.2%) were underweight, 1340 (49.5%) of normal weight, 759 (28.0%) overweight, 268 (9.9%) obese and 118 (4.4%) very obese (p=0.02). Rates of mortality at 1 year were 11.3%, 6.9%, 5.5%, 4.9% and 9.3% in underweight, normal weight, overweight, obese and very obese patients (p=0.02). Being overweight or obese was significantly associated with a lower mortality rate at 1 year (HR 0.70, 95% CI 0.51 to 0.96, p=0.03), and this association remained significant after multivariable adjustments (adjusted HR 0.67, 95% CI 0.46 to 0.97, p=0.03).
Conclusion: A U-shaped mortality curve across BMI categories was observed in TTS patients, with the highest mortality rates observed in underweight and the lowest rates observed in obese patients. These observations provide the first evidence for the existence of the obesity paradox in TTS.
Trial registration number: NCT01947621.
目的:肥胖悖论已经在不同的心血管疾病中得到了描述。关于肥胖与Takotsubo综合征(TTS)患者预后之间关系的数据缺乏。本研究的目的是确定TTS患者体重与死亡率之间的关系。方法:纳入2011年1月至2021年7月在国际Takotsubo登记处登记并具有体重指数(BMI)数据的患者。根据BMI对患者进行分层(体重过轻,2;正常体重,18.5-24.9 kg/m2;超重,25.0-29.9 kg/m2;肥胖,30.0-34.9 kg/m2;非常肥胖,≥35.0 kg/m2)。主要终点是1年时的死亡率。结果:2707例患者中体重过轻222例(8.2%),正常体重1340例(49.5%),超重759例(28.0%),肥胖268例(9.9%),非常肥胖118例(4.4%)(p=0.02)。体重不足、正常体重、超重、肥胖和非常肥胖患者1年死亡率分别为11.3%、6.9%、5.5%、4.9%和9.3% (p=0.02)。超重或肥胖与1年时较低的死亡率显著相关(HR 0.70, 95% CI 0.51 ~ 0.96, p=0.03),并且在多变量调整后这种关联仍然显著(调整后HR 0.67, 95% CI 0.46 ~ 0.97, p=0.03)。结论:TTS患者死亡率呈u型曲线,体重过轻患者死亡率最高,肥胖患者死亡率最低。这些观察结果为TTS中肥胖悖论的存在提供了第一个证据。试验注册号:NCT01947621。
{"title":"Body weight and mortality in Takotsubo syndrome: insights from the International Takotsubo (InterTAK) Registry.","authors":"Barbara Stähli, Victor Schweiger, Victoria Lucia Cammann, Matthias Schindler, Konrad A Szawan, David Niederseer, Michael Würdinger, Alexander Schönberger, Maximilian Schönberger, Iva Koleva, Julien C Mercier, Vanya Petkova, Maurus Steigmeier, Rodolfo Citro, Eduardo Bossone, Thomas F Lüscher, Jelena-Rima Templin-Ghadri, Davide Di Vece, Christian Templin","doi":"10.1136/openhrt-2025-003851","DOIUrl":"10.1136/openhrt-2025-003851","url":null,"abstract":"<p><strong>Aims: </strong>The obesity paradox has been described in different cardiovascular conditions. Data on the association between obesity and outcomes in patients with Takotsubo syndrome (TTS) are lacking. The aim of this study was to determine the relationship between body weight and mortality in TTS patients.</p><p><strong>Methods: </strong>Patients enrolled in the International Takotsubo Registry from January 2011 to July 2021 and with available data on body mass index (BMI) were included in the analysis. Patients were stratified according to BMI (underweight, <18.5 kg/m<sup>2</sup>; normal weight, 18.5-24.9 kg/m<sup>2</sup>; overweight, 25.0-29.9 kg/m<sup>2</sup>; obese, 30.0-34.9 kg/m<sup>2</sup>; and very obese, ≥35.0 kg/m<sup>2</sup>). The primary endpoint was mortality at 1 year.</p><p><strong>Results: </strong>Of the 2707 patients, 222 (8.2%) were underweight, 1340 (49.5%) of normal weight, 759 (28.0%) overweight, 268 (9.9%) obese and 118 (4.4%) very obese (p=0.02). Rates of mortality at 1 year were 11.3%, 6.9%, 5.5%, 4.9% and 9.3% in underweight, normal weight, overweight, obese and very obese patients (p=0.02). Being overweight or obese was significantly associated with a lower mortality rate at 1 year (HR 0.70, 95% CI 0.51 to 0.96, p=0.03), and this association remained significant after multivariable adjustments (adjusted HR 0.67, 95% CI 0.46 to 0.97, p=0.03).</p><p><strong>Conclusion: </strong>A U-shaped mortality curve across BMI categories was observed in TTS patients, with the highest mortality rates observed in underweight and the lowest rates observed in obese patients. These observations provide the first evidence for the existence of the obesity paradox in TTS.</p><p><strong>Trial registration number: </strong>NCT01947621.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"13 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12878250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146086587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-29DOI: 10.1136/openhrt-2025-003506
Eleonora Hamilton, Tomas Jernberg, Joakim Alfredsson, Christina Christersson, David Erlinge, Krister Lindmark, Elmir Omerovic, Liyew Desta, Christian Reitan
Background: There is a lack of contemporary data describing patients with left ventricular (LV) systolic dysfunction post myocardial infarction (MI) in terms of symptom burden and secondary prevention measures. The aim of this study was to describe patients with various degrees of LV systolic dysfunction after a first MI, their symptom burden, quality of life and adherence to recommended secondary prevention measures in a nationwide patient material.
Methods: Patients (n=49 564) registered in the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease registry between 2011 and 2018, diagnosed with a first acute MI, discharged alive and with no previous heart failure, were stratified by degree of LV systolic dysfunction.
Results: Compared with patients with normal ejection fraction (EF≥50%), patients with a reduced EF (<30%) more often experienced shortness of breath (32.3% vs 5.6%, adjusted OR (95% CI): 7.45 (6.22 to 8.92)), had more often been readmitted (48.1% vs 31.2%, 1.87 (1.61 to 2.19)) and were more often on sick leave (26.6% vs 9.5%, 3.35 (2.45 to 4.58)), whereas there were no significant differences regarding chest pain and quality of life at the follow-up visit after 11-13 months. Patients with EF <30% had participated in education programme (44.9% vs 55.5%, 0.70 (0.60 to 0.81)) and physical therapy (11.3% vs 14.9%, 0.68 (0.58 to 0.79)) and have been physically active at least 30 min per day for at least 5 days per week (35.5% vs 40.2%, 0.86 (0.73 to 1.01)) to a lesser extent.
Conclusion: Contemporary representative data show that LV systolic dysfunction after MI is associated with a very high symptom burden and worse secondary prevention after 11-13 months.
{"title":"Symptom burden and secondary prevention in patients with left ventricular systolic dysfunction after acute myocardial infarction: a nationwide register-based study in Sweden.","authors":"Eleonora Hamilton, Tomas Jernberg, Joakim Alfredsson, Christina Christersson, David Erlinge, Krister Lindmark, Elmir Omerovic, Liyew Desta, Christian Reitan","doi":"10.1136/openhrt-2025-003506","DOIUrl":"10.1136/openhrt-2025-003506","url":null,"abstract":"<p><strong>Background: </strong>There is a lack of contemporary data describing patients with left ventricular (LV) systolic dysfunction post myocardial infarction (MI) in terms of symptom burden and secondary prevention measures. The aim of this study was to describe patients with various degrees of LV systolic dysfunction after a first MI, their symptom burden, quality of life and adherence to recommended secondary prevention measures in a nationwide patient material.</p><p><strong>Methods: </strong>Patients (n=49 564) registered in the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease registry between 2011 and 2018, diagnosed with a first acute MI, discharged alive and with no previous heart failure, were stratified by degree of LV systolic dysfunction.</p><p><strong>Results: </strong>Compared with patients with normal ejection fraction (EF≥50%), patients with a reduced EF (<30%) more often experienced shortness of breath (32.3% vs 5.6%, adjusted OR (95% CI): 7.45 (6.22 to 8.92)), had more often been readmitted (48.1% vs 31.2%, 1.87 (1.61 to 2.19)) and were more often on sick leave (26.6% vs 9.5%, 3.35 (2.45 to 4.58)), whereas there were no significant differences regarding chest pain and quality of life at the follow-up visit after 11-13 months. Patients with EF <30% had participated in education programme (44.9% vs 55.5%, 0.70 (0.60 to 0.81)) and physical therapy (11.3% vs 14.9%, 0.68 (0.58 to 0.79)) and have been physically active at least 30 min per day for at least 5 days per week (35.5% vs 40.2%, 0.86 (0.73 to 1.01)) to a lesser extent.</p><p><strong>Conclusion: </strong>Contemporary representative data show that LV systolic dysfunction after MI is associated with a very high symptom burden and worse secondary prevention after 11-13 months.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"13 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12863359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146086747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-28DOI: 10.1136/openhrt-2025-003812
Kathrine Stjernholm, Helene Støttrup Andersen, Anders Elkær Jensen, Jesper Bo Nielsen
Objectives: To evaluate if an intervention to improve health literacy, using the risk communication tool 'Your Heart Forecast' and informative e-mails, can lower patients' blood pressure (BP) and total cholesterol to high-density lipoprotein ratio (TC/HDL).
Design: A cluster randomised controlled trial.
Setting: The intervention took place in 17 Danish general practice clinics randomised to either control or intervention at clinic level after invitation of each 25 hypertensive patients by birthdate.
Participants: Men and women were eligible for inclusion if 35-75 years old, without prior cardiovascular disease (CVD). The final population consisted of 255 patients, 142 intervention and 113 control. The 146 men and 109 women were included between April 2019 and May 2021. The trial ended in March 2022.
Intervention: The intervention consisted of the CVD-risk communication tool 'Your Heart Forecast' at the annual BP consultations plus 1 monthly educational e-mail on lifestyle for 12 months. The control group received the usual care, defined as the annual CVD risk management consultation.Main outcome measures, BP and TC/HDL, were measured at baseline and follow-up after 10-18 months. Patients were divided into groups based on baseline levels and a paired t-test was performed on a pseudorandomised dataset by a blinded statistician.
Results: Both groups' most dysregulated patients decreased their BP (p<0.0001, p=0.0002), and the BP decrease in the intervention group was larger. Additionally, the intervention patients with moderately raised BP also decreased their BP significantly (p=0.0133). Both groups saw an increase in BP in the most well-regulated patients. TC/HDL decreased only for the intervention patients with the highest baseline levels (p<0.0001) and increased for all with the lowest ratio (p<0.0001).
Conclusion: The intervention lowered BP and TC/HDL in comparison to usual care for patients with dysregulated BP and/or TC/HDL above 4.
Trial registration number: NCT04058847; Clinicaltrials.gov, registered on 16 August 2019.
{"title":"Danish evaluation of Your Heart Forecast: a cluster randomised controlled trial aimed at improving modifiable risk factors of CVD.","authors":"Kathrine Stjernholm, Helene Støttrup Andersen, Anders Elkær Jensen, Jesper Bo Nielsen","doi":"10.1136/openhrt-2025-003812","DOIUrl":"https://doi.org/10.1136/openhrt-2025-003812","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate if an intervention to improve health literacy, using the risk communication tool 'Your Heart Forecast' and informative e-mails, can lower patients' blood pressure (BP) and total cholesterol to high-density lipoprotein ratio (TC/HDL).</p><p><strong>Design: </strong>A cluster randomised controlled trial.</p><p><strong>Setting: </strong>The intervention took place in 17 Danish general practice clinics randomised to either control or intervention at clinic level after invitation of each 25 hypertensive patients by birthdate.</p><p><strong>Participants: </strong>Men and women were eligible for inclusion if 35-75 years old, without prior cardiovascular disease (CVD). The final population consisted of 255 patients, 142 intervention and 113 control. The 146 men and 109 women were included between April 2019 and May 2021. The trial ended in March 2022.</p><p><strong>Intervention: </strong>The intervention consisted of the CVD-risk communication tool 'Your Heart Forecast' at the annual BP consultations plus 1 monthly educational e-mail on lifestyle for 12 months. The control group received the usual care, defined as the annual CVD risk management consultation.Main outcome measures, BP and TC/HDL, were measured at baseline and follow-up after 10-18 months. Patients were divided into groups based on baseline levels and a paired t-test was performed on a pseudorandomised dataset by a blinded statistician.</p><p><strong>Results: </strong>Both groups' most dysregulated patients decreased their BP (p<0.0001, p=0.0002), and the BP decrease in the intervention group was larger. Additionally, the intervention patients with moderately raised BP also decreased their BP significantly (p=0.0133). Both groups saw an increase in BP in the most well-regulated patients. TC/HDL decreased only for the intervention patients with the highest baseline levels (p<0.0001) and increased for all with the lowest ratio (p<0.0001).</p><p><strong>Conclusion: </strong>The intervention lowered BP and TC/HDL in comparison to usual care for patients with dysregulated BP and/or TC/HDL above 4.</p><p><strong>Trial registration number: </strong>NCT04058847; Clinicaltrials.gov, registered on 16 August 2019.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"13 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12853480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-27DOI: 10.1136/openhrt-2025-003612
Felipe Abatti Spadini, Kathize Betti Lira, Renan Senandes Delvaux, Luciane Kopittke, Fernando Anschau, Rafael Oliveira Ceron, Juarez Rode, Rafael Antonio Widholzer Rey, Adriana Silveira Almeida
Background: The benefits of minimally invasive mitral valve surgery (MIMVS) compared with conventional approaches (CMVS, conventional mitral valve surgery) remain controversial. We conducted a systematic review and meta-analysis to evaluate the short-term benefits between these approaches.
Objective: To evaluate the short-term benefits of MIMVS versus CMVS in adults.
Methods: We searched PubMed/MEDLINE, EMBASE, Cochrane Library, LILACS, SciELO, clinical trial registries and grey literature using MeSH terms, without date or language restrictions. Randomised clinical trials (RCTs) comparing MIMVS and CMVS in adults (≥18 years) were included. Robotic, endovascular and redo procedures were excluded. Two reviewers independently extracted data following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Risk of bias was assessed with the Cochrane tool, and certainty of evidence with Grading of Recommendations, Assessment, Development and Evaluation. Meta-analyses used random-effects models. Primary outcomes were mortality, acute kidney injury (AKI) and wound infection.
Results: Nine studies (1248 patients) from eight RCTs were included (686 CMVS, 562 MIMVS). MIMVS showed no significant difference in mortality or AKI compared with CMVS. There was a trend towards fewer wound infections (risk ratio=0.47; 95% CI=0.22 to 1.00) and shorter intensive care unit (ICU) stay (mean difference=-0.71 days; 95% CI=-1.47 to 0.04). MIMVS reduced reoperation for bleeding (RR=0.24; 95% CI=0.06 to 0.92) and hospital stay (mean difference=-1.83 days; 95% CI=-3.03 to -0.64). Operative times were longer with MIMVS, but without clinical impact. Stroke, myocardial infarction, mechanical ventilation time and transfusion rates were similar. Most studies had low risk of bias, with moderate to high certainty of evidence. No heterogeneity was detected for primary outcomes.
Conclusion: MIMVS enhances postoperative recovery through shorter hospital stays, fewer reoperations for bleeding and a trend towards fewer wound infections and shorter ICU stays compared with CMVS. Despite longer operative times, key safety is comparable between techniques. The overall certainty of evidence is high for most outcomes, supporting strong clinical recommendations in favour of MIMVS.
{"title":"Minimally invasive versus conventional mitral valve surgery: a systematic review and meta-analysis of randomised clinical trials.","authors":"Felipe Abatti Spadini, Kathize Betti Lira, Renan Senandes Delvaux, Luciane Kopittke, Fernando Anschau, Rafael Oliveira Ceron, Juarez Rode, Rafael Antonio Widholzer Rey, Adriana Silveira Almeida","doi":"10.1136/openhrt-2025-003612","DOIUrl":"10.1136/openhrt-2025-003612","url":null,"abstract":"<p><strong>Background: </strong>The benefits of minimally invasive mitral valve surgery (MIMVS) compared with conventional approaches (CMVS, conventional mitral valve surgery) remain controversial. We conducted a systematic review and meta-analysis to evaluate the short-term benefits between these approaches.</p><p><strong>Objective: </strong>To evaluate the short-term benefits of MIMVS versus CMVS in adults.</p><p><strong>Methods: </strong>We searched PubMed/MEDLINE, EMBASE, Cochrane Library, LILACS, SciELO, clinical trial registries and grey literature using MeSH terms, without date or language restrictions. Randomised clinical trials (RCTs) comparing MIMVS and CMVS in adults (≥18 years) were included. Robotic, endovascular and redo procedures were excluded. Two reviewers independently extracted data following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Risk of bias was assessed with the Cochrane tool, and certainty of evidence with Grading of Recommendations, Assessment, Development and Evaluation. Meta-analyses used random-effects models. Primary outcomes were mortality, acute kidney injury (AKI) and wound infection.</p><p><strong>Results: </strong>Nine studies (1248 patients) from eight RCTs were included (686 CMVS, 562 MIMVS). MIMVS showed no significant difference in mortality or AKI compared with CMVS. There was a trend towards fewer wound infections (risk ratio=0.47; 95% CI=0.22 to 1.00) and shorter intensive care unit (ICU) stay (mean difference=-0.71 days; 95% CI=-1.47 to 0.04). MIMVS reduced reoperation for bleeding (RR=0.24; 95% CI=0.06 to 0.92) and hospital stay (mean difference=-1.83 days; 95% CI=-3.03 to -0.64). Operative times were longer with MIMVS, but without clinical impact. Stroke, myocardial infarction, mechanical ventilation time and transfusion rates were similar. Most studies had low risk of bias, with moderate to high certainty of evidence. No heterogeneity was detected for primary outcomes.</p><p><strong>Conclusion: </strong>MIMVS enhances postoperative recovery through shorter hospital stays, fewer reoperations for bleeding and a trend towards fewer wound infections and shorter ICU stays compared with CMVS. Despite longer operative times, key safety is comparable between techniques. The overall certainty of evidence is high for most outcomes, supporting strong clinical recommendations in favour of MIMVS.</p><p><strong>Prospero registration number: </strong>CRD42022321939.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"13 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12853523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146065656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}