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}
Pub Date : 2026-01-23DOI: 10.1136/openhrt-2025-003794
Nitin Chandra Mohan, Matt Govier, Thomas W Johnson, Ioannis Felekos, Gavin Richards, Julian Strange, Amardeep Dastidar, Novalia Sidik, Stephen Dorman, Nikhil Joshi, Stefan Gurney, Christopher Bourdeaux, Andrew Grant, Kieran Oglesby, George McInerney-Baker, Sodiq Yaya, Thomas Keeble, Nilesh Pareek, Paul Rees, Nick Curzen, Mark Mariathas
Background: Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) carries high mortality. Early revascularisation improves survival, but the effect of structured multidisciplinary care on outcomes remains underexplored.
Methods and results: ACT-SHOCK is a service evaluation at a UK tertiary cardiac centre. Between May 2023 and May 2024, 82 patients with AMI-related CS requiring emergent percutaneous coronary intervention (PCI) were identified using protocolised physiological criteria and managed by an Advanced Cardiogenic-Shock Team (ACT). The ACT comprised interventional cardiologists, intensivists, anaesthetists, critical care staff and cardiac physiologists, coordinating PCI and ongoing care. Outcomes were compared with 83 historical controls from the year preceding ACT roll-out, who received standard care without ACT activation. Primary endpoints were 30-day and 1-year all-cause mortality; secondary outcomes included predictors of 30-day mortality.Within the ACT cohort, elevated lactate, critical care admission, invasive ventilation, out-of-hospital cardiac arrest and Society for Cardiovascular Angiography and Interventions (SCAI) Shock Stage E at first medical contact predicted 1-year mortality. Adjusted analyses showed ACT management was associated with lower 1-year mortality compared with standard care (HR 0.53, 95% CI 0.30 to 0.92; p=0.026). Although 30-day mortality was lower in the ACT group, this did not reach statistical significance (HR 0.71, 95% CI 0.39 to 1.29; p=0.26). Escalation from coronary care to critical care during the recovery phase occurred more promptly in the ACT group (9.7% vs 2.4%, p=0.09). At 24 hours, a smaller proportion of ACT patients remained in SCAI stages D/E compared with standard care (42% vs 48%; p=0.003).
Conclusions: Implementation of physiological criteria to identify CS and activation of a multidisciplinary ACT in a UK tertiary centre was associated with earlier detection and improved 1-year survival in AMI-related CS. These pilot data support further study across multiple UK centres to inform national policy and standardise care pathways.
背景:心源性休克(CS)并发急性心肌梗死(AMI)具有很高的死亡率。早期血运重建可提高生存率,但结构化多学科护理对预后的影响仍未得到充分探讨。方法和结果:ACT-SHOCK是英国三级心脏中心的服务评估。在2023年5月至2024年5月期间,82名ami相关的CS患者需要紧急经皮冠状动脉介入治疗(PCI),并由高级心源性休克小组(ACT)进行治疗。ACT由介入心脏病专家、重症医师、麻醉师、重症监护人员和心脏生理学家组成,协调PCI和持续护理。结果与83名在ACT推广前一年接受标准治疗但未激活ACT的历史对照进行比较。主要终点为30天和1年全因死亡率;次要结局包括30天死亡率的预测因子。在ACT队列中,乳酸水平升高、重症监护住院、有创通气、院外心脏骤停和首次医疗接触时心血管血管造影和干预学会(SCAI)休克E期预测了1年死亡率。校正分析显示,与标准治疗相比,ACT治疗与较低的1年死亡率相关(HR 0.53, 95% CI 0.30 ~ 0.92; p=0.026)。ACT组30天死亡率较低,但差异无统计学意义(HR 0.71, 95% CI 0.39 ~ 1.29; p=0.26)。在恢复阶段,ACT组更迅速地从冠状动脉护理升级到重症监护(9.7% vs 2.4%, p=0.09)。24小时时,与标准治疗相比,ACT患者仍处于SCAI D/E期的比例较小(42% vs 48%; p=0.003)。结论:在英国三级医疗中心实施识别CS的生理标准和多学科ACT的激活与ami相关CS的早期发现和1年生存率的提高有关。这些试点数据支持在多个英国中心进行进一步研究,为国家政策和标准化护理途径提供信息。
{"title":"Advanced Cardiogenic-shock Team versus standard care in cardiogenic SHOCK: a single centre service evaluation project.","authors":"Nitin Chandra Mohan, Matt Govier, Thomas W Johnson, Ioannis Felekos, Gavin Richards, Julian Strange, Amardeep Dastidar, Novalia Sidik, Stephen Dorman, Nikhil Joshi, Stefan Gurney, Christopher Bourdeaux, Andrew Grant, Kieran Oglesby, George McInerney-Baker, Sodiq Yaya, Thomas Keeble, Nilesh Pareek, Paul Rees, Nick Curzen, Mark Mariathas","doi":"10.1136/openhrt-2025-003794","DOIUrl":"10.1136/openhrt-2025-003794","url":null,"abstract":"<p><strong>Background: </strong>Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) carries high mortality. Early revascularisation improves survival, but the effect of structured multidisciplinary care on outcomes remains underexplored.</p><p><strong>Methods and results: </strong>ACT-SHOCK is a service evaluation at a UK tertiary cardiac centre. Between May 2023 and May 2024, 82 patients with AMI-related CS requiring emergent percutaneous coronary intervention (PCI) were identified using protocolised physiological criteria and managed by an Advanced Cardiogenic-Shock Team (ACT). The ACT comprised interventional cardiologists, intensivists, anaesthetists, critical care staff and cardiac physiologists, coordinating PCI and ongoing care. Outcomes were compared with 83 historical controls from the year preceding ACT roll-out, who received standard care without ACT activation. Primary endpoints were 30-day and 1-year all-cause mortality; secondary outcomes included predictors of 30-day mortality.Within the ACT cohort, elevated lactate, critical care admission, invasive ventilation, out-of-hospital cardiac arrest and Society for Cardiovascular Angiography and Interventions (SCAI) Shock Stage E at first medical contact predicted 1-year mortality. Adjusted analyses showed ACT management was associated with lower 1-year mortality compared with standard care (HR 0.53, 95% CI 0.30 to 0.92; p=0.026). Although 30-day mortality was lower in the ACT group, this did not reach statistical significance (HR 0.71, 95% CI 0.39 to 1.29; p=0.26). Escalation from coronary care to critical care during the recovery phase occurred more promptly in the ACT group (9.7% vs 2.4%, p=0.09). At 24 hours, a smaller proportion of ACT patients remained in SCAI stages D/E compared with standard care (42% vs 48%; p=0.003).</p><p><strong>Conclusions: </strong>Implementation of physiological criteria to identify CS and activation of a multidisciplinary ACT in a UK tertiary centre was associated with earlier detection and improved 1-year survival in AMI-related CS. These pilot data support further study across multiple UK centres to inform national policy and standardise care pathways.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"13 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12853532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041489","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 : 2026-01-23DOI: 10.1136/openhrt-2025-003808
Nora Bacour, Mohammed Idhrees, Jedidiah Samraj, Simran Grewal, Bashi Velayudhan, Nafiye Busra Celik, Mohammad Zafar, John A Elefteriades, Nimrat Grewal
Background: Aortic dimensions are critical for assessing the risk of acute aortic complications and guiding surgical interventions. Current guidelines define absolute diameter thresholds based largely on Western cohorts, while data on Indian patients remain limited. To address this gap, our study provides a direct, large-scale comparison of aortic diameters between Indian and Dutch individuals to determine whether existing geometry-based surgical guidelines are equally applicable across populations.
Methods: In this retrospective cohort study, we analysed all consecutive patients who underwent CT imaging between January and December 2022 at SIMS Hospital (India) and Amsterdam University Medical Center (Netherlands). Aortic diameters were measured at five predefined anatomical locations: aortic root, ascending aorta, aortic arch, descending aorta and abdominal aorta. Multivariable linear regression models were used, adjusting for age, sex, height and comorbidities.
Results: A total of 3692 patients were included (2000 Indian and 1692 Dutch). Indian patients had a larger aortic root (33.9 ± 4.6 mm vs 31.5 ± 5.4 mm; p<0.001), whereas Dutch patients had significantly larger diameters of the ascending aorta (33.1 ± 5.4 mm vs 30.5 ± 4.3 mm; p<0.001), aortic arch (29.8 ± 4.5 mm vs 26.4 ± 3.7 mm; p<0.001), descending aorta (26.7 ± 4.2 mm vs 23.0 ± 3.9 mm; p<0.001) and abdominal aorta (23.1 ± 5.0 mm vs 21.3 ± 3.4 mm; p<0.001). These differences persisted after adjustment for age, sex, height and comorbidities.
Conclusions: In this first global comparison of ascending aortic dimensions between Indian and Dutch patients, we demonstrate substantial geographic heterogeneity. These findings highlight concerns about applying current surgical thresholds to Indian patients with aortopathy and emphasise the need for individualised risk assessment and treatment strategies in this population. Future guidelines should consider population-specific differences in India and incorporate indexed measurements to optimise personalised surgical decision-making.
背景:主动脉尺寸对于评估急性主动脉并发症的风险和指导手术干预至关重要。目前的指南定义的绝对直径阈值主要基于西方的队列,而印度患者的数据仍然有限。为了解决这一差距,我们的研究提供了印度和荷兰个体之间主动脉直径的直接、大规模比较,以确定现有的基于几何的手术指南是否同样适用于人群。方法:在这项回顾性队列研究中,我们分析了2022年1月至12月在SIMS医院(印度)和阿姆斯特丹大学医学中心(荷兰)接受CT成像的所有连续患者。在五个预定的解剖位置测量主动脉直径:主动脉根、升主动脉、主动脉弓、降主动脉和腹主动脉。采用多变量线性回归模型,调整年龄、性别、身高和合并症。结果:共纳入3692例患者(印度2000例,荷兰1692例)。印度患者的主动脉根较大(33.9±4.6 mm vs 31.5±5.4 mm)。结论:在印度和荷兰患者升主动脉尺寸的首次全球比较中,我们发现了明显的地理异质性。这些发现强调了对印度主动脉病变患者应用当前手术阈值的关注,并强调了在这一人群中进行个体化风险评估和治疗策略的必要性。未来的指南应考虑印度人群的具体差异,并纳入索引测量,以优化个性化的手术决策。
{"title":"Ethnic variation in thoracic aortic dimensions in the general population: a comparison between Indian and Dutch populations.","authors":"Nora Bacour, Mohammed Idhrees, Jedidiah Samraj, Simran Grewal, Bashi Velayudhan, Nafiye Busra Celik, Mohammad Zafar, John A Elefteriades, Nimrat Grewal","doi":"10.1136/openhrt-2025-003808","DOIUrl":"10.1136/openhrt-2025-003808","url":null,"abstract":"<p><strong>Background: </strong>Aortic dimensions are critical for assessing the risk of acute aortic complications and guiding surgical interventions. Current guidelines define absolute diameter thresholds based largely on Western cohorts, while data on Indian patients remain limited. To address this gap, our study provides a direct, large-scale comparison of aortic diameters between Indian and Dutch individuals to determine whether existing geometry-based surgical guidelines are equally applicable across populations.</p><p><strong>Methods: </strong>In this retrospective cohort study, we analysed all consecutive patients who underwent CT imaging between January and December 2022 at SIMS Hospital (India) and Amsterdam University Medical Center (Netherlands). Aortic diameters were measured at five predefined anatomical locations: aortic root, ascending aorta, aortic arch, descending aorta and abdominal aorta. Multivariable linear regression models were used, adjusting for age, sex, height and comorbidities.</p><p><strong>Results: </strong>A total of 3692 patients were included (2000 Indian and 1692 Dutch). Indian patients had a larger aortic root (33.9 ± 4.6 mm vs 31.5 ± 5.4 mm; p<0.001), whereas Dutch patients had significantly larger diameters of the ascending aorta (33.1 ± 5.4 mm vs 30.5 ± 4.3 mm; p<0.001), aortic arch (29.8 ± 4.5 mm vs 26.4 ± 3.7 mm; p<0.001), descending aorta (26.7 ± 4.2 mm vs 23.0 ± 3.9 mm; p<0.001) and abdominal aorta (23.1 ± 5.0 mm vs 21.3 ± 3.4 mm; p<0.001). These differences persisted after adjustment for age, sex, height and comorbidities.</p><p><strong>Conclusions: </strong>In this first global comparison of ascending aortic dimensions between Indian and Dutch patients, we demonstrate substantial geographic heterogeneity. These findings highlight concerns about applying current surgical thresholds to Indian patients with aortopathy and emphasise the need for individualised risk assessment and treatment strategies in this population. Future guidelines should consider population-specific differences in India and incorporate indexed measurements to optimise personalised surgical decision-making.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"13 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12853485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041405","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}