Open Heart最新文献

Background: Hospitalisation with acute heart failure (AHF) carries a high risk of death, and those surviving to discharge remain at high risk of death or rehospitalisation with AHF. The impact of outpatient heart failure (HF) specialist care after discharge from AHF hospitalisation on longer-term outcomes is unclear in contemporary UK practice.

Methods: A retrospective analysis of a cohort of 2104 patients admitted to hospital due to AHF between 2014-2022 in a single UK county was performed. Patient characteristics, left ventricular ejection fraction (EF) (LVEF) category (HF with reduced EF (LVEF ≤40%; HFrEF), HF with mildy reduced EF (LVEF 41%-49%; HFmrEF) and HF with preserved EF (LVEF ≥50%; HFpEF)) and survival free from a composite end point of AHF rehospitalisation or death are described. Cox regression survival analysis was performed to explore the impact of baseline patient characteristics and HF specialist care on long-term outcomes.

Results: The median age of the cohort was 83 years. HFrEF was present in 36%, HFmrEF in 9% and HFpEF in 55%. 13% died during index AHF hospitalisation. Median follow-up for those surviving to discharge was 618 (IQR 264-1275) days. 21% were rehospitalised due to AHF, and 63% died during follow-up. On adjusted survival analysis of 1511 patients with echocardiogram data available, HF specialist care after discharge from hospital was independently associated with a significant reduction in the composite end point across all LVEF categories (HFrEF: HR 0.577, 95% CI 0.429 to 0.775, p<0.001; HFmrEF: HR 0.485, 0.281-0.834, p=0.009; HFpEF HR 0.762, 0.623-0.931, p=0.008).

Conclusions: HF specialist care after discharge for patients hospitalised with AHF is associated with a significant reduction in the long-term risk of rehospitalisation and all-cause death. This association was present across the three LVEF categories (HFrEF, HFmrEF and HFpEF) and was independent of age and important comorbidities.

Background: In patients with acute ischaemic stroke (AIS) and concomitant non-ST-elevation acute coronary syndrome (NSTE-ACS), the role of intravenous thrombolysis (IVT) before percutaneous coronary intervention (PCI) is unclear.

Methods: We performed a subanalysis of the PRAISE (PRediction of Acute coronary syndrome in acute Ischemic StrokE) study, a multicentre, prospective observational study in 247 patients with AIS and elevated high-sensitivity cardiac troponin who underwent coronary angiography based on European Society of Cardiology guidelines. The impact of IVT prior to PCI on coronary artery flow (Thrombolysis in Myocardial Infarction (TIMI) score) and myocardial perfusion (TIMI myocardial perfusion score) was compared using Fisher's exact test and logistic regression analysis, adjusting for time from stroke onset to PCI.

Results: Among 71 patients with AIS undergoing PCI, those who received IVT prior to PCI for NSTE-ACS (33 women; median age 77 (66-82 IQR)) achieved a TIMI grade 3 flow more frequently than those undergoing direct PCI (97% vs 79%; p=0.04). Regression analysis indicated a trend toward improved coronary artery flow with IVT (adjusted OR 8.5, 95% CI 0.9 to 75.3; p=0.05). Myocardial perfusion did not differ between groups (p=0.06).

Conclusions: This subanalysis suggests that IVT before PCI may enhance coronary artery flow in selected patients with NSTE-ACS with AIS. The results of this exploratory subanalysis warrant further investigation, particularly in patients with delayed access to PCI.

Background: Mavacamten has revolutionised the treatment of hypertrophic obstructive cardiomyopathy (HOCM) but requires frequent follow-up. Routine ECG may offer an accessible tool to indicate response to therapy. This study evaluates ECG-based indices of left ventricular hypertrophy (LVH) in patients with HOCM receiving mavacamten therapy.

Methods: In this retrospective study, after screening of 62 consecutive patients with HOCM treated at a German tertiary referral centre from August 2023 to February 2025, 31 patients (42% female, mean age 61±12 years) were included. During the first 12 weeks of myosin inhibitor treatment, echocardiographic parameters, laboratory values, symptoms and ECG LVH indices were assessed.

Results: Mavacamten reduced the mean left ventricular outflow tract obstruction (LVOTO) during Valsalva from 103 mm Hg (73-145) to 32 mm Hg (19-60), (p<0.001). All ECG LVH indices significantly decreased with treatment (Sokolow-Lyon Index: 2.56±0.97 mm vs 2.04±0.75 mm, p<0.001; Cornell criteria: 1.23 mm (0.92-2.21) vs 0.92 mm (0.75-1.75), p=0.001; Peguero-Lo Presti criteria: 2.39 mm (1.62-3.22) vs 1.61 mm (1.12-2.01), p<0.001; all pre vs post mavacamten). Notably, an increase in the Sokolow-Lyon Index and Peguero-Lo Presti criteria correlated with worsening LVOTO (area under the curve 0.72 and 0.88, respectively). Sensitivity and specificity of ECG LVH indices for detecting LVOTO progression during therapy were 100% and 88.6%, respectively.

Conclusion: A combinatory ECG-based approach using the Sokolow-Lyon Index and Peguero-Lo Presti criteria may serve as an accessible tool for monitoring LVOTO progression in patients with HOCM on mavacamten. Prospective validation is warranted.

Background: The long-term effects of myocarditis following COVID-19 vaccination on cardiac function and symptoms remain unclear.

Purpose: To assess the long-term effects of myocarditis following COVID-19 vaccination on cardiac function, inflammatory biomarkers and symptoms.

Methods: Patients with myocarditis within 50 days of receiving COVID-19 vaccination (2021-2022) were invited to follow-up approximately 2 years after initial hospitalisation. Follow-up assessment included echocardiography, biomarkers, ECG, lung ultrasound (LUS) and symptom questionnaires. Patients with myocarditis following COVID-19 vaccination (V-myocarditis) were compared with non-vaccine-related myocarditis (NV-myocarditis) controls admitted during the same period.

Results: 17 patients with V-myocarditis (median age 47 (27-59) years, 53% women) were included. Median time from vaccination to admission was 6 days, with 88% admitted within 30 days. At follow-up (28±6 months), patients with V-myocarditis showed mildly impaired left ventricular (LV) function (median global longitudinal strain (GLS) 16.0% (13.2%-18.2%)) and diastolic dysfunction in 71%. Right ventricular (RV) and LUS findings were preserved. Biomarkers normalised from admission to follow-up with significant reductions in troponin-I (p<0.001) and C-reactive protein (p=0.001), while 35% showed persistent low-grade inflammation. Symptoms were common at follow-up, including fatigue (35%) and chest pain (41%). Compared with NV-myocarditis, patients with V-myocarditis had similar symptoms and biomarker recovery, but lower GLS at follow-up (NV-myocarditis: 18.5% (15.4%-20.3%), p=0.04).

Conclusion: In one of the longest reported follow-up studies of myocarditis following COVID-19 vaccination, patients exhibited mild LV and diastolic dysfunction, preserved RV function and overall normalised biomarkers. A notable proportion continued reporting symptoms, highlighting the need for long-term follow-up.

Background: The aim of the study was to estimate the sex-specific prevalence and incidence of atrial fibrillation or flutter (AF) in the German population-based Heinz Nixdorf Recall study.

Methods: We analysed data from 4814 participants at baseline 2000-2003 (T0, 50.2% women, 45-75 years), first and second follow-up examination (T1: n=4157, 2005-2008; T2: n=3087, 2010-2015) and yearly postal questionnaires for the AF occurrence until 29 November 2023. We determined the AF prevalence at T0, if participants were aware of having AF at T0, if participants with ECG-proven AF at T0 were anticoagulated, the cumulative incidence and the incidence rate per 1000 person-years over two decades of follow-up.

Results: Overall, 152 (3.2%) participants were identified with AF at or before T0. Of those, only n=89 (58.6%) participants were able to name an existing AF diagnosis. n=80 (1.7%) participants had ECG-confirmed AF and 13 (0.3%) participants were not aware of having AF at T0. Of 4662 participants without AF at T0, 640 (13.7%) developed AF during a median follow-up time of 16.7 (Q1; Q3: 10.5-18.9) years. The overall incidence rate was 9.4 (95% CI: 8.7 to 10.1) per 1000 person-years.

Conclusions: The results of our study show that AF is an epidemic disease in the middle-aged and elderly population. The proportion of patients who do not know that they have AF should be reduced in the future. Patients also need to be better informed about their disease and anticoagulation. This is important in order to prevent avoidable adverse events.

Background: Cardiac MR (CMR) provides a comprehensive assessment of pericardial structure, tissue characteristics and constriction-related haemodynamics, making it an excellent tool for assessing the complex mechanisms that underlie constrictive pericarditis. To facilitate the reproducible quantification of pericardial disease burden, this article introduces the first standardised pericardial segmentation model validated against anatomical specimens, obtainable using standard CMR sectioning planes, and designed with equal weighting of individual pericardial segments for ease of use.

Methods: The model was created by assessing 100 morphologically normal forensic cardiac specimens with an equal gender distribution and a broad age range. Direct measurements of left ventricular (LV) and right ventricular (RV) surface areas were obtained on standard cardiac short-axis forensic dissection slices. To assess variability in respective LV and RV segment sizes, data from the 100 specimens were compared with an idealised model developed to have identical respective LV and RV segment sizes.

Results: On average, the LV and RV contributed similar areas (49.9% and 50.1%, respectively) of the total ventricular surface area. The LV pericardial area was well represented by those 11 segments of the 17-segment American Heart Association model that borders pericardium (measuring 4.51%±0.2% of the total pericardial area, per segment). The RV surface area was best represented by nine novel segments (measuring 5.54%±0.3% of the total pericardial area, per segment). A correlation between the measured and idealised models showed a mean difference of only 0.04% and 0.02% per segment for the LV and RV, respectively.

Conclusions: This pericardial segmentation model, validated against anatomical specimens and obtainable using only standard CMR views, incorporates equal-sized LV and RV pericardial segments to ensure clinical usability. By enabling quantification of disease distribution and burden across both ventricles, the model has the potential to improve clinical decision-making and enhance precision in pericardial research.

Aim: In the UK, pharmacological management of patients with heart failure (HF) occurs predominantly in general practice. Using data from the Clinical Practice Research Datalink, we examined the prevalence and risk factors for medication non-adherence and its association with hospitalisation and mortality over a 9-year period.

Methods: A retrospective cohort study of 127 927 patients, ≥18 years old in England with incident HF diagnosed during 1 January 2009 to 31 December 2018. We evaluated non-adherence to any ACE inhibitor, angiotensin receptor blocker, β-blocker or mineralocorticoid receptor antagonist, over 24 months. Non-adherence was based on proportion of days covered (PDC) and defined as PDC<80%. Risk factors for non-adherence and all-cause mortality were examined using multiple logistic regression and Cox regression, respectively. Rates of any-cause emergency hospitalisations, cardiovascular disease (CVD) and HF mortality was estimated using Fine-Gray competing risk models. PDC was also assessed as a continuous variable.

Results: About 43.6% of patients were non-adherent to therapy. Crude rates of emergency admissions, all-cause, CVD and HF mortality overall were 306.8/1000, 119.6/1000, 44.6/1000 and 3.3/1000 person-years, respectively. The strongest predictor of non-adherence was any-cause hospitalisation ≤12 months prior. Non-adherence was associated with a higher rate of all-cause mortality (HR 1.31, 95% CI 1.28 to 1.33) and significantly associated with CVD-related mortality (subdistribution HR (SHR) 1.20, 95% CI 1.16 to 1.23), HF deaths (SHR 1.18, 95% CI 1.05 to 1.32) and any-cause emergency admissions (SHR 1.11, 95% CI 1.10 to 1.13). In the analysis treating PDC as a continuous variable, every 10% decrease in PDC levels was associated with a 6% increased hazard of all-cause mortality (HR 1.06, 95% CI 1.05 to 1.06) and was significantly associated with CVD, but not HF mortality.

Conclusion: Medication non-adherence over 24 months was relatively high and associated with poorer health outcomes. Interventions to improve adherence among patients with HF are needed.

Background: Sudden cardiac death (SCD) is a common cause of cardiovascular mortality, often triggered by ventricular arrhythmias in the setting of myocardial vulnerability. The wearable cardioverter-defibrillator (WCD) offers temporary protection against SCD, particularly when an implantable device is contraindicated or premature.

Objectives: We conducted a comprehensive meta-analysis to assess the effectiveness of the WCD in appropriately terminating life-threatening arrhythmias such as sustained ventricular tachycardia (VT) and ventricular fibrillation (VF), preventing sudden cardiac death.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we systematically reviewed 40 studies comprising 59 647 adults fitted with a WCD for primary or secondary SCD prevention. Random-effects meta-analysis, subgroup analysis, meta-regression and sensitivity analyses were performed.

Results: The pooled incidence of appropriate WCD intervention was 3% (95% CI 2% to 3%), with substantial heterogeneity (I²=88.9%). The prediction interval ranged from 1% to 8%, indicating that future studies conducted in selected high-risk populations may observe significantly higher WCD intervention. Life-threatening arrhythmias were higher during early follow-up (≤60 days). An appropriate daily WCD wearing time significantly influenced the results. Gender, age, ejection fraction and study design were not significant modifiers. No publication bias was detected.

Conclusions: The WCD represents an effective strategy for preventing SCD in early high-risk settings, with its benefit closely linked to adherence and appropriate patient selection.

Objectives: To investigate the association between serum uric acid (UA) and high-risk plaques (HRPs) assessed by coronary CT angiography (CCTA).

Methods: In this retrospective study, we included outpatients who underwent CCTA. HRP was defined as ≥any 2 of the following features: positive remodelling, low-attenuation plaque (LAP), napkin ring sign and spotty calcification. Plaque volume, Agatston score, vessel stenosis, segment stenosis score (SSS) and segment involvement score (SIS) were also determined by CCTA. Logistic regression analysis was used to assess the relationship between serum UA and the risk of HRP. Receiver operating characteristic (ROC) curve analysis was performed to assess model's accuracy and discrimination. Subgroup analysis based on sex (male/female), diabetes mellitus (yes/no), smoking status (yes/no), alcohol use (yes/no), obstructive coronary artery disease (CAD) (yes/no), Agatston score (<300 or ≥300) was performed.

Results: 1411 subjects were included in the final analysis, with a mean age of 64.26±9.92 years and a median serum UA value of 425 µmol/L (IQR 296-622). A total of 344 cases of HRPs were identified. Multivariable logistic regression showed that serum UA (OR 2.96 per SD increment, 95% CI 1.85~4.76, p<0.001) was associated with higher risk of HRP after adjustment of sex, diabetes mellitus, smoking, obstructive CAD, age, Agatston score, total plaque volume, LAP volume, SSS and SIS. ROC analysis showed that area under curve of the model was 0.86 (95% CI 0.83 to 0.88, p<0.001). In subgroup analysis, no effect modification was found (all p>0.05).

Conclusion: Serum UA is an independent risk factor for high-risk coronary artery plaques on CCTA. Measuring serum UA might provide improvement of discrimination and reclassification for CAD when added to clinical characteristics.

Background: Postoperative cerebral infarction following coronary artery bypass grafting (CABG) for multivessel coronary artery disease (CAD) is a major complication and is associated with insulin resistance (IR). This study used the Triglyceride-Glucose (TyG) Index, a robust indicator of IR, to assess its association with cerebral infarction and other adverse events in patients with off-pump CABG (OPCABG).

Methods: This retrospective observational study included 3654 CAD cases from eight centres across China. The primary outcome was postoperative cerebral infarction. The predictive role of the TyG Index was evaluated using multivariate logistic regression and restricted cubic spline regression. Receiver operating characteristics analysis was conducted to assess its impact on model performance.

Results: A total of 89 patients experienced postoperative cerebral infarction. After adjusting for confounding factors, the TyG Index, whether treated as a categorical variable (OR=2.23, 95% CI 1.24 to 4.02) or a continuous variable (OR=1.80, 95% CI 1.29 to 2.51), was found to be a significant independent risk factor for postoperative cerebral infarction (both p<0.001). The restricted cubic splines regression model revealed a linear dose-response association between the TyG Index and the risk of postoperative cerebral infarction (p for non-linearity=0.861). Subgroup analysis did not indicate any interactions among subgroups (p for interaction >0.05). Incorporating the TyG Index yielded a modest but statistically significant improvement in discrimination for postoperative cerebral infarction (area under the receiver operating characteristics curve 0.724 vs 0.708; p<0.001).

Conclusions: IR reflected by an elevated TyG Index predicts the risk of postoperative cerebral infarction in patients undergoing OPCABG.

Trial registration number: Chinese Clinical Trial Registry: Chictr2400085741.