Open Heart最新文献

Background: Fabry disease (FD) is an X linked lysosomal disorder with ventricular myocardial involvement that drives morbidity and mortality. Early diagnosis of cardiac involvement can be difficult. This study explored whether abnormal left atrial (LA) strain by cardiovascular magnetic resonance (CMR) may be an early sign of ventricular involvement in FD.

Methods: A multicentre, multinational cohort of patients with FD was assembled with images centralised for core lab analysis. Adult patients with gene-positive FD and healthy volunteers (HV) underwent CMR. LA strain analyses included manually contouring the left atrium in end-diastole and end-systole to calculate LA volumes and ejection fraction, then semiautomatic analysis for LA reservoir strain.

Results: There were n=214 patients with FD (mean age 45±15 years, 39% males) and n=76 HV (49±15 years, 53% males). CMR results in FD: left ventricular ejection fraction 73% (IQR=9), left ventricular mass index (LVMi) 89±39 g/m², 99 (46%) had left ventricular hypertrophy (LVH), 36% had late gadolinium enhancement. In FD, LA strain correlated with LVMi (r=-0.52, p<0.01), left ventricular (LV) global longitudinal strain (GLS) (r=-0.61, p<0.01) and native myocardial T1 (r=0.34, p<0.01). FD had abnormal LA strain in overt disease (LVH positive) compared with HV (p<0.01). LVH-negative FD did not differ in LA strain compared with HV (p>0.5). FD with low T1+LVH negative did not differ in LA strain compared with normal T1/LVH-negative FD or HV (p>0.3).

Conclusions: LA strain is abnormal in FD with LVH (overt disease) and correlates with LVMi, native T1 and GLS. LA strain is normal in FD with early disease (LVH negative+low T1) and normal in FD with no myocardial disease (LVH negative+normal T1). These findings indicate that LA strain is a consequence of abnormal LV mechanics such as LVH and abnormal GLS, rather than isolated myocardial sphingolipid deposition.

Trial registration number: NCT03199001.

Background: Stress echocardiography is a widely available and used imaging modality in the assessment of ischaemic heart disease (IHD) and preoperative risk stratification. Despite the higher rate of major adverse cardiovascular events (MACE) observed in positive stress echocardiography results, the prognostic relevance of a false-positive (FP) stress echocardiogram is unclear.

Methods: The authors searched Medline, Embase, CINAHL, Web of Science, The Cochrane Central Register of Controlled Trials, EBSCO Open Dissertation and Clinicaltrials.gov from inception to 15 April 2024, for studies evaluating the prognostic relevance of a FP stress echocardiogram response in patients with suspected or known IHD. Primary outcomes included the occurrence of MACE within the studied follow-up duration. Random effects meta-analysis was performed to evaluate the direction of effect and allow comparisons between FP, true-positive and true-negative stress echocardiography results.

Results: A total of five studies were included with 2426 patients (mean age 56-66 years, 60.2% males). In total, there were 737 (30.3%) FP stress echocardiogram results. MACE occurred in 274 participants, of which 79 (28.8%) occurred within the FP stress echocardiography group. Meta-analysis from three studies demonstrated more MACE outcomes in patients with a true positive in comparison to a FP stress echocardiography result (RR 1.64, 95% CI: 1.22 to 2.20). Two studies reported increased MACE outcomes in patients with a FP result when compared with a true negative result.

Conclusions: An FP stress echocardiogram result is common and frequently associated with patients who have a low pre-test probability for IHD. FP results are not associated with increased incidence of MACE when compared with true positive results; however, there is insufficient evidence to establish whether FP results in dobutamine stress echocardiography identify a cohort of high-risk patients in comparison to true negative results.

Prospero registration number: CRD 42024526741.

Background: Coronary artery disease (CAD) is one of the biggest causes of mortality worldwide. Risk stratification for early detection is essential for the primary prevention of CAD. QRISK3 is known to overestimate future CAD risk in some populations, resulting in unnecessary preventive treatment that reduces the cost-effectiveness and safety. Combining machine learning with a metaheuristic optimisation approach using the Particle Swarm Optimization algorithm may outperform QRISK3 in predicting CAD. It may improve performance by selecting the best-performing subset of features related to clinical outcomes.

Methods: This study uses the UK Biobank dataset consisting of 348 015 participants aged 24-84 years with no prior diagnosis of CAD. The performance of both QRISK3 and machine learning models was evaluated separately using receiver operating characteristic analysis. Several machine learning models were assessed: Logistic Regression, Decision Tree, Random Forest, Naïve Bayes and Gradient Boosting. The dataset was split into training and test sets with a ratio of 4:1 for the machine learning models. Each model has been developed by adding a Particle Swarm Optimization algorithm to enhance the model's classification accuracy.

Results: Out of 348 015 participants, 23 136 individuals (6.64%) were diagnosed with CAD within 10 years following their first visit, while 324 879 individuals (93.4%) did not develop CAD. The area under the curve (AUC) value of the QRISK3 prediction was 0.6113, while the gradient boosting model using Particle Swarm Optimization achieved a better performance AUC of 0.7258.

Conclusions: This study shows hybrid machine learning models optimised with the Particle Swarm Optimization algorithm can better predict CAD than QRISK3. The application of such machine learning models can effectively identify high-risk CAD patients, allowing for more personalised preventative strategies and supporting policymakers in implementing lifestyle change recommendations.

Background: Since the 1960s, beta blockers have been used to treat hypertrophic obstructive cardiomyopathy (HOCM), a genetic disorder causing abnormal heart muscle thickening. This systematic review evaluates their efficacy across clinical outcomes.

Methods: Registered on PROSPERO (CRD42022344255), searches were performed in June 2022 and updated in September 2025 across MEDLINE, Embase, CINAHL and PubMed. Two reviewers independently screened studies. Meta-analysis was undertaken when ≥3 comparable datasets were available; otherwise, narrative synthesis was used.

Results: 21 studies including 775 adults met inclusion criteria. Beta blockers significantly reduced left ventricular outflow tract (LVOT) gradient (Standardised mean difference (SMD) -1.57; 95% CI -2.07 to -1.07) and heart rate (SMD -1.19; 95% CI -2.24 to -0.14). Sensitivity analyses confirmed the robustness of the LVOT effect, while heart rate effects remained heterogeneous. Improvements in New York Heart Association class, exercise tolerance and symptom burden were consistently reported, although data were subjective and small in scale. Mortality evidence was limited to two retrospective cohorts with divergent findings.

Conclusions: Beta blockers provide consistent haemodynamic and symptomatic benefits in HOCM, but most evidence derives from small, older studies with high risk of bias and limited survival data. Contemporary, adequately powered randomised controlled trials are required to define optimal agent selection, dosing and long-term outcomes.

Prospero registration number: CRD42022344255.

Background: The life-long exposure of the left heart chambers to systemic blood pressures may be important to changes in left atrial (LA) function with age, but long-term follow-up studies are scarce. We aimed to assess the impact of blood pressure in mid-life on LA function assessed by echocardiographic reservoir (LASr) and contractile (LASct) strain two decades later, in men and women.

Methods: Echocardiography was performed at ages 62-65 in 3706 participants born in 1950 of the prospective observational Akershus Cardiac Examination (ACE) 1950 Study. Data was linked with blood pressure measurements from the Age 40 Programme, a national health survey performed when the participants were 40-43 years of age. Participants were categorised into three groups representing normal blood pressure, elevated blood pressure and hypertension, based on measurements at ages 40-43. Linear regression models were used to assess associations between blood pressure and echocardiographic LA strain analysis.

Results: A total of 2399 participants (51.6% women) had available LA strain analysis from the ACE 1950 Study (mean age 63.9±0.6 years) and blood pressure data from the Age 40 Programme (mean age 40.1±0.3 years). At ages 62-65, mean LASr was 35.1±9.2% and LASct was 17.7±5.6%. Adjusted regression models showed a significant association between blood pressure category increase at ages 40-43 and LASct (adjusted β 1.03% (95% CI 0.37% to 1.69%), p=0.002) at ages 62-65, but not with LASr. In women, no associations were evident between blood pressure at ages 40-43 and LA strain two decades later.

Conclusions: Increased blood pressure in the early 40s was associated with higher LA contractile strain two decades later in men, but not in women.

Background: Pocket haematoma is a common complication of cardiac implantable electronic device (CIED) procedures and may lead to pain, delayed healing, surgical evacuation or infection. Although pressure dressings with adhesive tapes are widely used for haematoma prevention, they can cause skin erosion. Therefore, this study evaluated the efficacy of the Heart band, a novel compression tool, in preventing device implantation-related complications in patients who underwent CIED procedures.

Methods: Among 663 consecutive patients who underwent CIED procedures, we retrospectively analysed 532 (compression tool use, n=283; adhesive tape use, n=249) who underwent CIED implantation or generator replacement between April 2019 and March 2021. Either adhesive tape (2019-2020) or the compression tool (2020-2021) was used in the patients. Compression was applied for 2 days postoperatively, and recompression was performed at the physician's discretion if haematoma-related swelling was noted. The primary endpoints were postoperative complications including recompression, haematoma and skin erosion. Intervention-requiring haematoma (IRH) was defined as haematomas for which transfusion or surgical evacuation was necessary.

Results: Skin erosion occurred significantly less often in the compression tool group (0.4% vs 9.6%, p<0.01), whereas there were no significant intergroup differences in the rates of recompression (19.4% (compression tool group) vs 16.1% (adhesive tape group), p=0.36) and IRH (0.7% (compression tool group) vs 0% (adhesive tape group), p=0.50). These trends were consistent in high-risk subgroups, including patients receiving antithrombotic therapy, with diabetes or with implantable cardioverter-defibrillator/cardiac resynchronisation therapy-defibrillator. Multivariate analysis identified the compression tool as an independent negative predictor of skin erosion (OR 0.03, 95% CI <0.01 to 0.26, p<0.01).

Conclusion: The compression tool had efficacy comparable to that of conventional pressure dressing with adhesive tape in preventing IRH. Compression tools are also associated with a lower incidence of skin erosion.

Background: We aimed to estimate mental disorder disparities in cardiovascular disease (CVD) incidence and determine whether these disparities were worsened by the COVID-19 pandemic.

Methods: For each outcome (myocardial infarction (MI), heart failure and stroke), we created a population-based cohort of people without a prior diagnosis of the outcome using linked electronic health records, with follow-up from November 2019 until December 2023. We ascertained pre-existing schizophrenia, bipolar disorder and depression, and each CVD outcome from primary care and hospital admission records and (for CVD outcomes) mortality records. We calculated sex-stratified age-standardised incidence rates by mental disorder diagnosis and used quasi-Poisson modelling to obtain rate ratios (RRs) of CVD among people with each of schizophrenia, bipolar disorder or depression versus those without any of these disorders, adjusting for sociodemographic factors and time period. We investigated whether mental disorder disparities changed as a consequence of the COVID-19 pandemic by including an interaction term between mental disorder and time.

Results: During follow-up, 383 365 people had incident MI, 868 590 had incident heart failure and 455 300 had incident stroke. Age-standardised incidence of each CVD outcome decreased markedly between February and April 2020, with incidence levels returning to, but not exceeding, prepandemic levels in subsequent years. Mental disorder was associated with a higher incidence of each CVD outcome, with RRs ranging from 1.31 (95% CI 1.25 to 1.38) to 2.15 (95% CI 2.05 to 2.24). There was generally no evidence of interaction between mental disorder and time, with mental disorder disparities in CVD incidence stable over time.

Conclusion: We found no clear evidence that the mental disorder disparities in CVD incidence widened during the acute period of the pandemic or during the subsequent years. Continued monitoring of the CVD burden in the general population and among marginalised groups is critical to identifying longer-term impacts on CVD and worsening disparities.

Background: The minimally important difference (MID) for frailty variation associated with adverse outcomes remains unknown in patients with heart failure and preserved ejection fraction (HFpEF), and whether spironolactone can ameliorate frailty progression in this population remains unclear.

Methods: We analysed data from 1767 participants in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial. The MID for frailty was calculated using an anchor-based approach, with the EuroQol-Visual Analogue Scale (EQ-VAS) as the anchor. Frailty index (FI), defined as a 35-item cumulative deficit score, and EQ-VAS were assessed at baseline and 1-year follow-up. The primary composite outcome (cardiovascular death, aborted cardiac arrest or heart failure hospitalisation) was assessed from the 1-year follow-up visit. Adjusted Cox proportional hazards models evaluated the link between FI changes (ΔFI≥MID) and the primary outcome. Longitudinal FI changes were analysed using linear mixed-effects models to evaluate spironolactone's effect.

Results: The MID for the FI was 0.03 points. An FI reduction ≥MID was associated with a lower risk of the primary composite outcome (aHR, 0.63; 95% CI 0.48 to 0.82), all-cause mortality (aHR, 0.57; 95% CI 0.42 to 0.76) and heart failure hospitalisation (aHR, 0.55; 95% CI 0.40 to 0.75) after adjusting for baseline FI, age, sex, New York Heart Association class, smoking status and treatment assignment. No between-group difference in FI change was observed with spironolactone versus placebo (aOR, 0.85; 95% CI 0.67 to 1.09).

Conclusions: Frailty improvement exceeding the 0.03 FI threshold predicts better prognosis in HFpEF, underscoring the value of routine assessment. Spironolactone use was associated with neutral effects on frailty progression in our analysis, suggesting potential safety in this vulnerable population.

Trial registration number: NCT00094302.

Background: Many observational studies highlight clonal haematopoiesis (CH) as a novel determinant of cardiovascular disease (CVD). However, disentangling cause and effect from important confounders, such as age and smoking, is challenging.

Objectives: Mendelian randomisation (MR) was used to assess the causal relationships of CH with (1) major CVD outcomes associated with adverse remodelling, and (2) cardiovascular magnetic resonance (CMR) phenotypes which have not been examined previously.

Methods: Uncorrelated (r²<0.001), genome-wide significant (p<5×10^-6) single nucleotide polymorphisms were extracted from Genome-Wide Association Study summary statistics for CH (any subtype), gene-specific CH subtypes (DNMT3A and TET2), and CH clonal size subtypes (small clone and large clone). Mendelian Randomisation using a Robust Adjusted Profile Score (MR-RAPS) was used for analyses on outcomes of atrial fibrillation (AF), heart failure and 13 CMR phenotypes. Multiple comparisons in the discovery analyses were accounted for by Benjamini-Hochberg correction.

Results: Both DNMT3A-CH and small-clone-CH were associated with increased AF risk. Overall-CH was associated with larger left ventricular end-diastolic volume. DNMT3A-CH was associated with larger right atrial size, and left and right ventricular end-diastolic volumes. TET2-CH was associated with higher myocardial native T1 time. Small-clone-CH was associated with larger left atrial size and lower aortic distensibility.

Conclusions: Common forms of CH are associated with higher AF risk and adverse remodelling patterns comprising larger atrial and ventricular sizes, myocardial fibrosis, and reduced aortic compliance. Using MR methods, this study triangulates previous observational studies and provides new evidence to support likely causal links between CH and CVD. This study, for the first time, describes associations of CH with adverse CMR phenotypes suggesting early remodelling patterns; these changes may indicate a window of opportunity for intervention such as by risk stratification and early preventative strategies to improve patient outcomes; however, further examination of the utility of such interventions is warranted.

Background: Transcatheter aortic valve replacement (TAVR) has emerged as an alternative treatment for aortic regurgitation (AR) in patients at high surgical risk. However, evidence comparing outcomes of different new-generation devices remains limited.

Objectives: To compare clinical outcomes of on-label, off-label self-expanding (SE) and off-label balloon-expandable (BE) TAVR devices in AR patients.

Methods: A systematic review and meta-analysis were conducted, including studies reporting clinical outcomes of new-generation TAVR devices in AR. The primary outcome was 1-year all-cause mortality. Secondary outcomes included procedural success, moderate or severe AR and perioperative complications. Subgroup and meta-regression analyses assessed the impact of valve type and clinical variables.

Results: 32 studies involving 2682 patients were included. 1-year mortality was 10.4% (95% CI: 7.2% to 14.7%) with no significant difference among valve types. Technical success was highest with on-label devices (97%), followed by off-label:BE (92%) and off-label:SE (85%) (p<0.001). Valve migration occurred in 2% of on-label, 7% of off-label:BE and 10% of off-label:SE cases (p=0.004). Moderate or severe AR was observed in 2% of on-label, 4% of off-label:BE and 8% of off-label:SE recipients (p<0.001). Meta-regression identified coronary heart disease as an independent predictor of 1 year mortality (p=0.026), while other factors showed no significant association.

Conclusions: On-label devices were associated with improved procedural outcomes, including lower rates of valve migration and residual AR, although 1-year mortality did not differ significantly between device groups. Further prospective studies with longer follow-up are needed to assess valve durability and long-term clinical outcomes.

Prospero registration number: CRD 42024611296.