Open Heart最新文献

Objective: To develop diagnostic models to predict initial heart failure (HF) hospitalisation in patients with unstable angina (UA) and prognostic models to predict rehospitalisation for recurrent or new-onset HF after discharge, aiming to enhance early identification and patient care strategies.

Methods: We retrospectively analysed data from 12 857 acute coronary syndrome patients (January 2015 to March 2023). After screening, 7092 UA patients were included and randomly divided into a training cohort (4964) and a validation cohort (2128). Logistic regression and least absolute shrinkage and selection operator (LASSO) regression identified risk factors. Diagnostic models were developed and evaluated using receiver operating characteristic curves. Using the same predictors, prognostic models predicted rehospitalisation at 1, 2 and 6 months postdischarge.

Results: The lambda.1se criterion in LASSO regression identified three key risk factors: left ventricular diameter, N-terminal pro-B-type natriuretic peptide and ischaemic cardiomyopathy. The diagnostic model's area under the curve (AUC) was 0.938 (95% CI 0.909 to 0.955) in the training cohort and 0.931 (95% CI 0.901 to 0.956) in the validation cohort, showing consistent and reliable performance. Prognostic models for 1, 2 and 6 months postdischarge had AUC values of 0.770, 0.794 and 0.751, respectively, supporting their utility in prognostic evaluations.

Conclusion: The UA diagnostic and prognostic HF model was developed and validated. These models can quickly identify high-risk patients, enabling prompt and tailored interventions.

Objective: To evaluate sex differences in perioperative characteristics, in-hospital outcomes and long-term survival following coronary artery bypass grafting (CABG).

Methods: Prospective data were collected for all patients undergoing isolated CABG at a single centre during 2001-2021. Baseline characteristics were adjusted between females and males using 1:1 propensity score matching (nearest-neighbour, without replacement). Kaplan-Meier analysis assessed long-term survival. A predefined sub-analysis assessed risk mitigation associated with using off-pump CABG (OPCABG) in females in the matched cohort.

Results: Prematching, 11 563 males and 2573 females were included. Females were older with higher prevalences of class III-IV angina, hypertension and diabetes. After matching, 2573 patients per group were analysed, with standardised mean differences <0.1 for all covariates. Females had fewer left internal mammary artery (LIMA) grafts (84% vs 88%, p<0.001), fewer total grafts (median 2 vs 3, p<0.001), higher in-hospital mortality (2.2% vs 1.3%, OR 1.74, 95% CI 1.14 to 2.71, p=0.011) and longer hospital stays (median 7 days vs 6 days, beta 0.51, 95% CI 0.12 to 0.90, p=0.01). Long-term survival was similar (stratified log-rank p=0.79). OPCABG mitigated the risk of in-hospital mortality in females (1.1% males vs 1.6% females, OR 0.69, 95% CI 0.33 to 1.43, p=0.32; 1.6% OPCABG females vs 3.0% on-pump females, OR 0.53, 95% CI 0.31 to 0.91, p=0.021).

Conclusions: Females suffer higher in-hospital mortality and receive fewer LIMA and total number of grafts than males; however, 20-year survival is similar. OPCABG protects females from in-hospital mortality. A new female-tailored peri-operative care approach is warranted for females undergoing CABG.

Background: Cardiovascular disease (CVD) is the leading cause of mortality worldwide, while depression is highly prevalent in this patient population and has long been regarded as an independent risk factor for increased mortality. However, recent evidence suggests that this association may be influenced by symptom overlap and residual confounding that has not been fully accounted for.

Objectives: This study aimed to evaluate the association between clinically significant depressive symptoms and the risk of all-cause, cardiovascular and non-cardiovascular mortality in adults with CVD.

Methods: We conducted a secondary analysis of 2064 adults with a history of CVD using data from the National Health and Nutrition Examination Survey 2011-2018 linked with the National Death Index. Depression was defined using the Patient Health Questionnaire-9 with a cut-off score of 10 or higher. Primary outcomes were all-cause, cardiovascular and non-cardiovascular mortality. Statistical analyses were performed using R software. We employed multivariable Cox regression models as well as propensity score matching and inverse probability weighting to control for potential confounders.

Results: Over a median follow-up of 4.67 years, 403 deaths were recorded. In an adjusted multivariable Cox model controlling for age, sex and race, depression was associated with an increased risk of all-cause mortality (HR 1.33; 95% CI 1.02 to 1.75) and non-cardiovascular mortality (HR 1.46; 95% CI 1.04 to 2.05). However, after applying propensity score matching and inverse probability weighting, these associations were no longer statistically significant for any mortality outcome.

Conclusions: After rigorous adjustment for confounders and comorbidities, depression was no longer identified as an independent risk factor for mortality among patients with CVD.

Objectives: Cascade-tested relatives of individuals with pathogenic genetic variants in sarcomere genes causing hypertrophic cardiomyopathy are recommended. Little is known about the outcomes in cascade-identified relatives. We aimed to characterise the endpoints for these individuals.

Methods: A retrospective cohort case note evaluation of 64 families reviewed by NHS Tayside Clinical Genetics between January 2010 and December 2018 was conducted, identifying 280 patients. The primary endpoint of the study was the composite endpoint of the onset of a repeat major adverse cardiac event (MACE). Analysis of covariance was used to model marginal mean estimates for baseline interventricular size. Cox proportional hazards model was used to depict time to MACEs.

Results: Asymmetrical septal hypertrophy fulfilling diagnostic criteria on echocardiography was noted in 35.4% of cascade-tested individuals. Adjusted interventricular septal size for cascade-tested individuals with a positive genotype (13.9 mm; 95% CI (12.1 to 15.8)) was lower than that of probands with a pathogenic variant (22.1 mm; 95% CI (19.7 to 24.4); p<0.001) but higher than that of cascade-tested individuals with no genotype (12.3 mm; 95% CI (10.2 to 14.4); p<0.001). Adjusted multivariate event analysis demonstrated decreased risk of adverse cardiac events in cascade-identified individuals compared with probands with a genotype (HR 4.0; 95% CI (1.9 to 8.5); p<0.001) and increased risk compared with cascade-identified relatives without a genotype (HR 3.3 (1.2 to 9.1); p<0.001).

Conclusion: Our results demonstrate that cascade-tested individuals carrying a pathogenic sarcomere variant retain a degree of complication justifying their identification and follow-up.

Background: Patients with heart failure (HF) frequently suffer from undetected declines in cardiorespiratory fitness (CRF), which significantly increases their risk of poor outcomes. However, current clinical practice lacks effective tools for early CRF risk stratification.

Methods: We conducted an artificial intelligence (AI)-driven unsupervised clustering analysis based on 15 multimodal clinical variables-including metabolic, inflammatory and body composition indicators-in 505 patients with HF. The associations between clustering-derived phenotypes and CRF impairment (maximal oxygen uptake (VO₂ max) ≤20 mL/kg/min) were evaluated using multivariable logistic regression and five supervised machine learning models. SHapley Additive exPlanations analysis was applied for model interpretability. External validation was performed in an independent cohort of 201 patients.

Results: Three distinct phenotypes were identified: balanced, inflammatory-sarcopenic and metabolically dysregulated. Compared with the balanced phenotype, both non-balanced phenotypes showed significantly higher odds of impaired VO_₂ max. In the derivation cohort test set, random forest (area under the curve (AUC)=0.75; 95% CI 0.62 to 0.87) and XGBoost (AUC=0.74; 95% CI 0.62 to 0.87) demonstrated the best discriminative performance. In the external validation cohort, the highest discrimination was observed for Naive Bayes (AUC=0.75; 95% CI 0.67 to 0.83), followed by random forest (AUC=0.74; 95% CI 0.58 to 0.91).

Conclusion: By integrating multimodal clinical data with AI-driven clustering and machine learning, this study identified novel CRF risk phenotypes in patients with HF and established a highly interpretable and generalisable risk stratification model. These findings offer a valuable framework for early functional assessment and pave the way for precision rehabilitation strategies in HF management.

Background: People living with HIV (PWH) are at increased risk of cardiovascular disease; however, evidence from Asian populations remains limited. We evaluated the prevalence and characteristics of carotid plaques among PWH and people without HIV (PWoH) in China to examine the impact of HIV infection on subclinical atherosclerosis.

Methods: In this cross-sectional study conducted at the Shanghai Public Health Clinical Center, China, we enrolled 1390 PWH and 1390 age-frequency and sex-frequency matched PWoH aged 40 years or older. Carotid ultrasonography was used to assess the presence, number and echogenicity of carotid plaques.

Results: The prevalence of carotid plaques was significantly higher in PWH than in PWoH (45.3% vs 37.5%, p<0.001), and the prevalence of echo-lucent plaques was also higher (21.1% vs 18.0%, p=0.045). Among participants with carotid plaques, PWH were more likely to have three or more plaques (35.8% vs 21.2%, p<0.001) and a greater maximum plaque thickness (2.0 mm vs 1.9 mm; p=0.026). After adjustment for age, sex and dyslipidaemia, HIV infection remained independently associated with increased odds of carotid plaques (adjusted OR (aOR)=1.45; 95% CI 1.23 to 1.70) and echo-lucent plaques (aOR=1.24; 95% CI 1.02 to 1.50). Associations were strongest among men and younger participants. No HIV-related clinical factors were significantly associated with carotid plaque presence.

Conclusion: HIV infection is independently associated with an increased carotid plaque burden and echo-lucent plaque features, suggesting accelerated atherosclerosis beyond traditional risk factors. These findings support routine cardiovascular risk assessment and early preventive strategies in PWH.

Background: Estimates of long-term atrial fibrillation (AF) incidence in individuals with sinus rhythm are limited. This study investigated age-stratified and sex-stratified long-term incidence of AF in individuals with baseline sinus rhythm and no history of AF, and examined associations between AF, ischaemic stroke and overall cardiovascular disease (CVD).

Methods: Participants were recruited to the population-based Interplay Between Genetic Susceptibility and External Factors cohort, initiated in western Sweden (2001-2004). Follow-up of incident diagnoses and mortality continued through national registers until 31 December 2022. Cumulative incidence of AF was calculated accounting for the competing risk of death. Cox regression models assessed associations between AF as a time-varying exposure, incident ischaemic stroke and overall CVD, adjusting for confounding.

Results: 2967 AF-free participants were included (mean age 50.7±13.4 years; 52.9% female). During 53 447 person-years of follow-up (median 20.1 years), 356 (12.0%) developed AF (incidence rate 6.66 per 1000 person-years). At 20 years, the cumulative incidence of AF accounting for competing risk of death was 2.1% (<45 years at baseline), 13.3% (45-65 years) and 29.5% (>65 years). Men had a higher incidence than women in all age groups. Incident AF was associated with ischaemic stroke (HR 1.80, 95% CI 1.19 to 2.72) and overall CVD (HR 2.07, 95% CI 1.60 to 2.68).

Conclusions: AF was a common long-term outcome, particularly among older adults and men, and was associated with subsequent stroke and CVD. Age-specific and sex-specific risk stratification may inform targeted follow-up and early AF detection.

Background: Worse prognosis in cardiac sarcoidosis (CS) is likely associated with diagnostic delay and cardiac involvement as first sarcoidosis (de novo) presentation, but data are limited.

Methods: We retrospectively investigated 95 patients with CS diagnosed 2003-2024. Using electronic health records, the date of first CS symptoms/signs, immunosuppressant therapy and follow-up data including left ventricular ejection fraction (LVEF), biomarkers and cardiac device therapy were extracted. Median time from first symptoms/signs to CS diagnosis (9 months) was used to define delayed diagnosis.

Results: Implantation of cardiac resynchronisation therapy defibrillator was more likely in patients with diagnostic delay (p=0.01). No difference was observed in time to diagnosis between patients with de novo CS (n=49) and those with prior extracardiac sarcoidosis (ECS) (n=46). Severe symptoms at disease onset were more common in de novo CS. At a median of 46 months from diagnosis, de novo patients more often had reduced LVEF (p=0.006) and an implantable cardioverter defibrillator (p<0.05) than those with prior ECS despite receiving more immunosuppressant therapy. De novo patients with diagnostic delay more often had reduced LVEF at CS presentation.

Conclusions: Symptom presentation is likely associated with diagnostic delay, but the disease presentation and course seem more severe in de novo CS and may not be altered by immunosuppressants, or demand more aggressive therapy.

Background: Invasive coronary function testing (CFT) is indicated in patients with refractory angina with non-obstructed coronary arteries (ANOCA). Despite this, questions remain regarding patient selection for testing, safety and integration of CFT within clinical pathways and the impact that endotyping has on long term management of these patients. This study aims to investigate the safety of CFT in patients presenting with anginal chest pain, the prevalence of ANOCA endotypes in the tested population, and the impact of CFT on prescribed medical therapy and secondary care resource utilisation.

Methods: A retrospective analysis of electronic case records of 159 consecutive patients who underwent complete invasive CFT at two UK centres between June 2022 and December 2024 was performed. All patients were tested for endothelium-independent coronary microvascular dysfunction (CMD) and coronary vasospasm (vasospastic angina (VSA)). 44 patients (27.6%) also underwent endothelial function assessment. The median length of follow-up was 9 months (IQR 4-16).

Results: An ANOCA endotype was identified in 101 patients (63.5%) (CFT+ve). Of those, 24 (23.8%) were diagnosed with isolated CMD, 53 (52.4%) with isolated VSA and 24 (23.8%) with a mixed endotype. Five (3.1%) experienced intraprocedural adverse events. In 123 patients (77.3%), CFT led to a change in medical therapy. Re-hospitalisation for recurrent chest pain occurred in 21.7% of CFT+ve and 13.7% of CFT-ve patients, with the majority re-presenting within 6 months of CFT. VSA was linked to higher re-hospitalisation odds (OR 2.64 (1.10-6.33), p=0.03), and patients with VSA tended to re-present earlier than others (p=0.017). Higher antianginal therapy prescription and prior emergency presentations were also predictive of risk of re-presentation (OR 1.61, p=0.02 and OR 4.18, p=0.001, respectively).

Conclusions: CFT testing had low intraprocedural risk and influenced onward management. Hospitalisation for chest pain post CFT testing was common. Further refinement of clinical pathways, including early follow-up for medical optimisation, is suggested.

Background: Delays in performing urgent coronary artery bypass graft (CABG) surgery are increasing across the UK, with national wait times now exceeding guideline targets. Prolonged preoperative admissions contribute to hospital bed pressures, increased costs and negative psychosocial effects for patients. Virtual wards using remote patient monitoring (RPM) may enable safe early discharge for clinically stable patients awaiting surgery.

Objectives: To evaluate the feasibility, safety and outcomes of a virtual ward pathway using RPM for patients awaiting urgent CABG surgery.

Methods: A prospective, multicentre, single-arm study was conducted across three UK cardiac centres (December 2022-May 2025). Eligible patients were discharged home with daily symptom reporting via a digital platform and structured clinician review. The primary outcome was preoperative major adverse cardiovascular events (MACE). Secondary outcomes included 30-day mortality, resternotomy, time to surgery, postoperative stay, readmissions and patient experience.

Results: 128 patients were enrolled (mean age 61 years; 87% male). No preoperative MACE occurred (0%; 95% CI 0.0% to 2.3%). 30-day mortality was 0% (95% CI 0.0% to 2.9%), and resternotomy occurred in 2.3%, comparable to national rates. Median time from discharge to surgery was 10 days, saving an estimated 1152 inpatient bed-days. Postoperative length of stay was 7.0 days compared with a national average of 8.0 (p=0.084). Patient experience was favourable: 95% felt safe at home, and 89% found the platform easy to use.

Conclusions: A virtual ward pathway with remote monitoring for selected patients awaiting urgent CABG was safe, feasible and associated with high patient acceptability and major reductions in inpatient utilisation. These findings support this model as a scalable approach to managing urgent surgical pathways while preserving safety and surgical timelines.