Open Heart最新文献

Objective: To develop and validate a 10-year predictive model for cardiovascular and metabolic disease (CVMD) risk using comprehensive health examination data from nearly 37 701 individuals.

Methods: This retrospective cohort study used health examination data, including demographic information, clinical measurements, laboratory tests and lifestyle factors. Potential predictors were selected based on a literature review and exploratory analysis. Machine learning techniques (including random forest and gradient boosting) were employed to develop the predictive model. The model's performance was evaluated using accuracy, sensitivity, specificity and area under the receiver operating characteristic curve (AUC). Model validation was conducted on separate test and validation sets.

Results: A total of 37 701 electric power employees were included in this study after applying rigorous inclusion and exclusion criteria. The dataset was divided into training, validation and testing sets in a 70:15:15 ratio, with no significant differences observed in baseline characteristics, ensuring robust analysis. Feature selection using the random forest classifier identified the top predictors of CVMD. Machine learning models, particularly random forest and gradient boosting, demonstrated superior predictive performance compared with traditional Cox regression methods. These results significantly outperformed traditional Cox models, which yielded an AUC of approximately 0.60. Correlation analysis revealed strong associations between key variables, such as systolic and diastolic blood pressure, low-density lipoprotein and total cholesterol, and creatinine and blood urea nitrogen, highlighting the complex interactions among CVMD risk factors.

Conclusion: The developed 10-year predictive model for CVMD risk, based on health examination data, shows promising potential for early identification and targeted intervention in individuals at high risk for CVMDs. This approach could contribute to the reduction of CVMD incidence and related morbidity and mortality.

Background: Patients with single-ventricle physiology are often palliated with the Fontan operation, which may involve the creation of a fenestration. We aimed to evaluate differences in cardiopulmonary exercise test (CPET) performance between patients with fenestrated and non-fenestrated Fontan circulation.

Methods: Patients with a Fontan circulation referred to CPET between 2006 and 2024 were included and were categorised based on their fenestration status at the time of CPET. Logistic regression analyses were performed to assess the impact of fenestration on peak oxygen consumption (VO₂), and Cox proportional hazard to evaluate the impact of fenestration on cardiovascular outcomes (death, heart transplant and Fontan-related hospitalisation).

Results: Of the 184 patients, 141 were classified as non-fenestrated and 43 as fenestrated. The minute ventilation-carbon dioxide production (V_E/VCO₂ slope) was higher in the fenestrated (36.9±7.9) versus (33.2±6.2; p=0.009) in the non-fenestrated group. There was no significant difference in predicted VO₂ between groups (non-fenestrated 51.9%±14.4 vs 51.3%±15.6; p=0.7). Resting oxygen saturation was higher in the non-fenestrated group (93%±4.7 compared with fenestrated group 90.1%±5; p<0.001). Fontan fenestration was not significantly associated with the composite outcome; older patient age at the time of the CPET, cirrhosis and ventricular ejection fraction <40% were significantly associated with higher risk, while higher resting systolic blood pressure, left ventricular morphology and higher predicted peak VO₂ were protective.

Conclusions: The increased hypoxia and reduced ventilatory efficiency associated with Fontan fenestration offset any potential benefits, resulting in similar exercise performance between the groups. Fontan fenestration was not significantly associated with cardiovascular outcomes.

Background: Left ventricular mass (LVM) is suggested to be a sensitive predictor of adverse cardiovascular outcomes, such as heart failure. In recent years, genome-wide association studies have discovered loci that associate with outcomes related to LVM, providing an opportunity for the development of genetic risk scores. However, the relevance of these genetic variants to non-European ancestry groups requires additional testing. Here, we examined if variants that have been associated with heart failure and LVM in multi-ancestry populations are associated with LVM among African American individuals in the Jackson Heart Study (JHS).

Methods: Heart failure and LVM associated variants were identified from two published multi-ancestry studies. Two polygenic risk scores (PRSs) were computed for 2175 African American participants (mean age 53, 63% female). We assessed the linear association of both PRSs with LVM indexed to height (LVM_h) and indexed to body surface area (LVM_bsa) and fit a multivariate general linear model to LVM containing both PRS and covariates (age, sex, body mass index (BMI), diabetes and hypertension). Type III MANOVA Pillai tests were run to assess the effects of the PRS on the log LVM values.

Results: Linear correlation analysis showed positive associations between age and LVM_h (r=0.278) and LVM_bsa (r=0.296) as well as BMI with LVM_h (r=0.320). A strong linear correlation was observed between LVM_h and LVM_bsa (r=0.894). Elevated LVM among individuals with diabetes and hypertension was observed. When accounting for age, sex, BMI, diabetes and hypertension, we found insufficient evidence to suggest that the heart failure PRS affected either measure of LVM; the same can be said for the LVM PRS.

Conclusion: We find insufficient evidence to suggest that heart failure and LVM genetic variants derived from predominantly European multi-ancestry populations are linearly associated with log LVM among African American participants in the JHS.

Introduction: Atrial fibrosis identified on cardiac magnetic resonance (CMR) imaging has been proposed as a preprocedural imaging biomarker for patient selection for rhythm control interventions in patients with atrial fibrillation (AF). Whether atrial fibrosis is present in patients considered as 'pre-AF' is unknown.

Methods and results: We prospectively recruited 12 participants with pre-AF as defined by the Future Innovations in Novel Detection for Atrial Fibrillation (FIND-AF machine learning algorithm, without AF diagnosed during AF screening, and compared them to 25 participants with confirmed AF. All participants underwent CMR using a 3T system with left atrial fibrosis quantification and ADAS-3D left atrial image postprocessing software. Participants with pre-AF had smaller left atrial end-systolic (33.6±9.8 vs 43.0±17.0, p=0.003) and end-diastolic (16.5±8.7 vs 28.2±14.4, p=0.007) volumes, and higher left atrial ejection fraction (59.6±14.6 vs 40.7±17.5, p=0.005) than participants with AF. The extent of atrial fibrosis was not different between those with pre-AF and AF (borderzone (%) 5.2±5.0 vs 2.9±6.9, p=0.772; borderzone fibrosis (cm) 6.2±5.8 vs 6.8±10.7, p=0.927).

Conclusion: CMR identifies atrial fibrosis before manifest AF in patients with pre-AF as defined by a machine learning algorithm.

Background: Mitral regurgitation (MR) is the most common valvular heart disease and the most common comorbidities of atrial fibrillation (AF), which is prevalent with age. Nonetheless, the prognosis of MR in elderly patients with AF has not been fully elucidated.

Aim: This study is a post hoc analysis of the CABANA (Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation) trial.

Methods: Patients were classified into two groups: those with moderate or severe MR (msMR) and those with no or mild MR (nmMR). The primary endpoint was a composite of death, disabling stroke, serious bleeding or cardiac arrest. The secondary endpoints included all-cause mortality and the composite of all-cause mortality and heart failure hospitalisation. Quality of life was assessed at baseline, 3 and 12 months, and annually up to 60 months.

Results: Overall, 1368 participants were included in the final analysis (mean age: 65.6±8.2; female 61.3%), including 135 patients with msMR and 1233 with nmMR. The primary endpoint occurred in 7.2% of patients with nmMR versus 14.1% with msMR (HR 1.97, 95% CI 1.20 to 3.25; p=0.008). The secondary endpoint rates for nmMR versus msMR, respectively, were 4.7% vs 8.8% for all-cause mortality (HR 1.73, 95% CI 0.92 to 3.25; p=0.089) and 10.8% vs 15.5% for the composite of death and heart failure hospitalisation (HR 1.25, 95% CI 0.78 to 1.99; p=0.357).

Conclusions: Among elderly patients with AF, msMR is associated with an increased risk of the primary composite endpoint of death, disabling stroke, serious bleeding or cardiac arrest.

Trial registration number: NCT00911508.

Heart failure (HF) is of worldwide public health concern, yet with higher morbidity and mortality in low- and middle-income countries compared with high-income nations, posing a significant burden to the already overstrained and unprepared health systems in many countries.In sub-Saharan Africa (SSA), while community level data is sparse, a number of hospital-based HF studies have been conducted, highlighting the distinct presentation of HF when compared with data from other regions of the world. It is imperative that more data on the precise nature of HF in Africa are obtained, but multiple barriers exist to obtaining reliable data. In the present commentary, we discuss characteristics of HF in Africa, their potential impact on conducting screening studies at the community level and describe the strategies that we have incorporated in the MAPUTO-HF (The Maputo Antecedents, Prevalence and Urban Transition Of Heart Failure Project: feasibility of a population-based study in a low-resource African setting) study, a feasibility study that was designed to overcome these barriers and facilitate HF research in SSA in both a rural and urban setting.

Background: Left ventricular (LV) thrombus is a complication of myocardial infarction and dilated cardiomyopathy and is associated with a high thromboembolic risk. Although warfarin has traditionally been used, direct oral anticoagulants (DOACs) offer a more convenient alternative. With the addition of the RIVAWAR trial, we conducted an updated systematic review and meta-analysis to assess the efficacy and safety of DOACs compared with warfarin in patients with LV thrombus.

Methods: A systematic search of electronic databases (PubMed, EMBASE, Cochrane and clinicaltrials.gov) from inception to April 2025 identified randomised clinical trials (RCTs) comparing DOACs with warfarin for the treatment of LV thrombus. The main outcome of interest was thrombus resolution at 3 months. Risk ratios (RRs) with 95% CIs were calculated using random-effects models.

Results: Seven RCTs comprising 554 patients were included. Non-contrast transthoracic echocardiography was used for LV thrombus assessment in all RCTs. There was no difference between DOACs and warfarin in thrombus resolution at 3 months (RR 1.02; 95% CI 0.95 to 1.09), major adverse cardiovascular events (RR 0.50; 95% CI 0.16 to 1.54), all-cause mortality (RR 0.92; 95% CI 0.36 to 2.31), stroke/systemic embolism (RR 0.76; 95% CI 0.12 to 4.68), rehospitalisation (RR 1.36; 95% CI 0.47 to 3.94) or major bleeding (RR 0.54; 95% CI 0.20 to 1.48). Subgroup and sensitivity analyses confirmed the robustness of these results.

Conclusions: DOACs demonstrated similar efficacy and safety to warfarin for LV thrombus management in this meta-analysis, supporting their use for the treatment of LV thrombus. However, large-scale RCTs with longer follow-up periods and using diagnostic modalities with higher sensitivity and specificity for detecting LV thrombus resolution are warranted to confirm these findings and clarify long-term outcomes.

Prospero registration number: CRD420251023513.

Background: Eisenmenger syndrome (ES) is a severe and fatal complication of uncorrected congenital heart disease characterised by the development of pulmonary arterial hypertension (PAH) due to chronic left-to-right shunting. Despite the increasing use of PAH-targeted therapies, evidence of their long-term effects on the survival of patients with ES remains limited.

Methods: We reviewed 101 consecutive adult patients with ES (69% female; mean age, 34±18 years) who were referred to our centre between December 1972 and December 2023. We investigated the clinical, haemodynamic and treatment data from medical records. The primary outcome measure was transplantation-free survival. The effect of PAH-targeted therapy on transplantation-free survival was analysed using a time-dependent Cox proportional hazards model.

Results: Among the 101 patients, 57 (56%) received PAH-targeted therapy (PAH therapy group), while 44 (44%) did not (treatment-naïve group). In the PAH therapy group, 75% received combination therapy (25%, monotherapy; 56%, dual-combination therapy; and 19%, triple-combination therapy). The median follow-up time since diagnosis of ES was 8.8 (IQR: 4.1-22.3) years. The median follow-up transplantation-free survival rates were significantly higher in the PAH therapy group than in the treatment-naïve group (100%, 100% and 89% vs 95%, 66% and 53% at 1, 5 and 10 years, respectively; p<0.001). In the multivariate analysis adjusting for age, sex, WHO functional class (III/IV vs I/II) and PAH-targeted therapy, PAH-targeted therapy was independently associated with improved transplantation-free survival (adjusted HR=0.275, 95% CI 0.132 to 0.572).

Conclusions: The long-term survival of patients with ES who received PAH-targeted therapy was better than that of those who did not. These results support the benefits of PAH-targeted therapies in this population while underscoring the need for large-scale studies to better define optimal treatment strategies.

Background: Nonagenarians and centenarians admitted to intensive care units (ICUs) following in-hospital cardiac arrest (IHCA) represent a growing yet understudied population. Clinicians require accurate prognostic tools to inform early goals of care discussions and resource allocation. This study evaluated the predictive performance of commonly used clinical scores in this unique cohort.

Methods: We conducted a retrospective binational cohort study of nonagenarian and centenarian patients admitted to ICUs in Australia and New Zealand between 2010 and 2024 after IHCA, using data from the ANZICS Adult Patient Database. We assessed the prognostic accuracy of four clinical scores: Acute Physiology and Chronic Health Evaluation III (APACHE III), Sequential Organ Failure Assessment (SOFA), Clinical Frailty Scale (CFS) and Glasgow Coma Scale, in predicting ICU and hospital mortality. Discrimination was measured using area under the receiver operating characteristic curve (AUROC). Multivariable Cox regression and Fine-Gray competing risk models were used to examine associations with mortality and discharge outcomes.

Results: A total of 219 patients (median age 91.6 years; 44% female) were included. ICU and hospital mortality were 45.2% and 55.7%, respectively. The APACHE III score showed the highest discriminatory ability (ICU mortality AUROC=0.850; hospital mortality AUROC=0.842), followed by the SOFA score (AUROCs=0.758 and 0.761, respectively). The CFS showed poor prognostic performance (AUROCs close to 0.5). In adjusted Cox models, both APACHE III and SOFA scores were independently associated with mortality. SOFA scores were associated with longer ICU length of stay, while higher APACHE III scores were associated with shorter hospital stay, likely reflecting early mortality.

Conclusions: In the oldest critically ill patients following IHCA, physiologic severity scores, particularly APACHE III and SOFA, outperform frailty in predicting short-term mortality and resource use. These findings support the integration of validated scoring systems into early clinical decision-making to improve care precision and guide resource allocation in ageing ICU populations.

Background: Heart failure (HF) is a major cause of morbidity and mortality worldwide. Despite significant improvements in the management of HF, the overall outcome remains poor. In addition to pharmacotherapy and device therapy, non-pharmacological interventions are needed to mitigate the effects of this illness. The aim of this study was to evaluate the impact of the HF outreach programme on the rate of mortality, HF hospitalisations and guideline-directed medical therapy (GDMT) for HF in South-Western Sydney Local Health District (SWSLHD).

Methods: In this observational, registry-based study, adult patients diagnosed with HF with reduced ejection fraction (HFrEF) in SWSLHD were invited to participate in the HF outreach service between March 2011 and January 2016. The primary outcome was all-cause mortality. The secondary outcomes were the rate of optimal GDMT and HF hospitalisations.

Results: There were 818 patients included in the study; 470 (57.5%) patients were enrolled and 348 (42.5%) not enrolled into the programme. At the end of the follow-up period (median 978 days, IQR 720-1237), the primary outcome of mortality was observed less in the enrolled group (122 (26%) vs 133 (38.2%), p<0.001) independently of other variables. In addition, fewer enrolled patients had >3 hospital admissions for HF (16.2% vs 35.6%, p<0.001) and reduced median admission days (14.5 days (IQR 8-25) vs 22 days (IQR 12-37), p<0.001). Patients enrolled into the programme were more likely to be on optimal GDMT (76.6% vs 56.6%, p<0.001).

Conclusions: Enrolment in the HF outreach programme was associated with a significant reduction in mortality and the frequency and length of hospital HF admissions. In addition, the rate of optimal GDMT was significantly higher in the enrolled group. With the high prevalence of HF, these programmes should be considered in the routine management of patients with HFrEF.