Open Heart最新文献

Background: Stroke after transcatheter aortic valve implantation (TAVI) is an infrequent but serious complication with important impact on morbidity and mortality. Contemporary real-world evidence on the risk factors of early stroke after TAVI is scarce. We aimed to evaluate the incidence, temporal trends and predictors of in-hospital stroke after TAVI and to assess its association with mortality.

Methods: We conducted a retrospective, observational cohort study using data from the Netherlands Heart Registration of all TAVI procedures performed in the Netherlands between 2013 and 2023. The primary endpoint was the incidence of in-hospital stroke. The secondary endpoints were trends, mortality and risk factors associated with in-hospital stroke and early mortality as identified by logistic regression.

Results: Among 23 593 TAVI procedures, the overall incidence of in-hospital stroke was 2.0% and remained stable after an initial decline. Independent covariates associated with in-hospital stroke included female gender (OR 1.29; 95% CI 1.07 to 1.56), peripheral arterial disease (OR 1.55; 95% CI 1.24 to 1.93), non-transfemoral access (OR 1.54; 95% CI 1.21 to 1.93) and postdilation (OR 1.40; 95% CI 1.10 to 1.76). In-hospital stroke was strongly associated with an increased risk of mortality at 30 days (OR 8.54; 95% CI 6.56 to 11.02), and 1 year (OR 4.38; 95% CI 3.55 to 5.40).

Conclusions: In-hospital stroke remains an important complication after TAVI with a strong impact on mortality. Identification of high-risk patients and procedural optimisation is essential in optimisation of outcome.

Background: Atrial fibrillation (AF) is a prevalent arrhythmia associated with adverse outcomes, often presenting paroxysmally. The lack of an efficient method to promptly detect paroxysmal AF and the absence of a unified screening approach necessitate exploring novel solutions. Artificial intelligence (AI) models show promise in addressing this gap, enabling early intervention. This study assessed the effectiveness of AI in detecting AF using baseline sinus rhythm-ECG (SR-ECG) and factors influencing their performance.

Methods: A systematic review was conducted across eight databases and registries (International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) registration: INPLASY202530059). References up to May 2024 were double-screened for eligibility. Included studies used AI to detect AF from baseline SR-ECGs in patients without prior AF confirmation. Quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Performance metrics were summarised using medians with subgroup analyses by AI type and AF confirmation timeframe.

Results: 14 studies and 33 AI models were analysed. Participant data were available for 13 studies, totalling 1459653 patients, with one study providing only testing dataset data. Median (95% CI) performance metrics were: accuracy 58.0% (55.0 to 62.0), sensitivity 62.0% (57.0 to 70.2), specificity 57.8% (51.0 to 61.1), precision 52.0% (47.0 to 56.0) and area under the receiver operating characteristic curve (AUC) 0.740 (0.630 to 0.830). Deep learning (DL) models outperformed traditional machine learning in sensitivity (72.6% vs 54.5%; q=0.027) and AUC (0.830 vs 0.610; q<0.001). Models using a 31-day confirmation window showed higher accuracy (83.2% vs 56.0%; q=0.010) and AUC (0.851 vs 0.630; q<0.001) than those using a 1-year timeframe. 11 studies (78.6%) cited possible negative cases misclassification as a limitation, and nine (64.3%) were deemed 'high risk of bias' in at least one domain.

Conclusions: AI-enhanced SR-ECG for identifying AF patients holds growing potential. Our findings show that DL and models incorporating a 31-day confirmation window are more effective in this context. Further research is needed to explore clinical benefits and cost-effectiveness.

Introduction: Takotsubo cardiomyopathy (TC) is a stress-induced catecholamine acute myocardial dysfunction in the absence of significant coronary disease. The pathophysiology of TC remains poorly understood, and the use of beta-blockers (β-Blockers) appears promising. However, the impact of β-blockers in acute-phase management remains uncertain.

Aims: We aimed to conduct a systematic review and meta-analysis evaluating the early use of β-Blocker in TC and its effects on in-hospital mortality.

Methods: PubMed, Embase and Cochrane were searched for studies that evaluated the use of BBs in TC patients and its short-term effects. Statistical analysis was performed using RevMan V,5.4.1. The results are expressed using HRs and 95% confidence intervals (CI) were extracted using a random-effects model. Heterogeneity was assessed with I².

Results: We included five cohort studies, with a total of 5428 patients. The vast majority were women (81%) with a mean age of 70.1±12.6 years. More than half of the patients (52.0%) had previous hypertension. ST-elevation in the first ECG was observed in 37.3% of the patients. Early administration of β-blockers was not associated with a statistically significant reduction in in-hospital mortality (HR 0.78, 95% CI 0.59 to 1.02, p=0.07), and this finding was consistent across different β-blocker types, doses and routes of administration.

Conclusion: Early β-Blocker therapy did not significantly influence in-hospital mortality in patients with TC. Future randomised studies are essential to clarify beta-blockers' role in this setting.

Prospero registration number: CRD420251055617.

Background: Birth weight (BW) has been linked to cardiometabolic diseases, but causal associations with a comprehensive range of cardiovascular outcomes and underlying metabolic mechanisms remain unclear.

Methods: We applied a two-sample Mendelian randomisation (MR) approach to evaluate causal relationships between genetically predicted BW and 16 distinct cardiovascular diseases (CVD). We further conducted a two-step MR mediation analysis to quantify the mediating roles of 24 metabolic traits covering body composition, glucose metabolism, lipid metabolism, blood pressure, fatty acids and amino acids.

Results: Genetically lower BW was associated with higher risks of coronary heart disease (OR 0.72, 95% CI 0.65 to 0.81), myocardial infarction (OR 0.71, 95% CI 0.63 to 0.80) and angina pectoris (OR 0.81, 95% CI 0.72 to 0.90). These effects were partly mediated by type 2 diabetes, systolic blood pressure, total cholesterol and triglycerides, explaining 11.76-33.33% of the total associations. In contrast, genetically higher BW increased the risk of aortic aneurysm (OR 1.46, 95% CI 1.21 to 1.75), venous thromboembolism (OR 1.22, 95% CI 1.09 to 1.36) and atrial fibrillation (OR 1.34, 95% CI 1.21 to 1.48). These associations were partly explained by body composition traits, with appendicular lean mass and body mass index mediating 10.53-26.32% of the effect on aortic aneurysm, 15.79-68.42% of the effect on venous thromboembolism and 10.34-58.62% of the effect on atrial fibrillation.

Conclusions: Our study provides robust evidence of distinct causal pathways linking BW with adult cardiovascular risks through specific metabolic mediators. These findings highlight the importance of optimal fetal growth and lifelong metabolic health management as critical strategies to reduce CVD burden.

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.