American Journal of Cardiology最新文献

Brain natriuretic peptide (BNP) is a key predictor of clinical events after catheter ablation (CA) for atrial fibrillation (AF), but BNP levels are influenced by multiple factors. It remains unclear how these factors affect prognosis in AF patients after CA. Persistent AF (PerAF) patients undergoing initial CA were enrolled. Independent factors associated with BNP levels were identified using multivariable analysis. A total of 554 patients with high BNP (>100 pg/mL) were classified by hierarchical cluster analysis incorporating these factors. We compared baseline characteristics and the composite outcome of heart failure (HF) hospitalization and all-cause mortality among phenogroups. High BNP levels were significantly associated with increased risk of the composite endpoint after CA in PerAF patients (p <0.001). Multivariable regression analysis identified body mass index (BMI), creatinine, left ventricular (LV) ejection fraction, septal E/e', and severe tricuspid regurgitation (TR) as independent determinants of BNP levels. Hierarchical clustering analysis identified 5 phenotypes: Phenotype 1, "No risk factors for high BNP level," Phenotype 2, "LV diastolic dysfunction," Phenotype 3, "Low BMI," Phenotype 4, "LV systolic dysfunction," and Phenotype 5, "Renal dysfunction." Cox proportional hazards analysis demonstrated that Phenotype 4 and Phenotype 5 were independently associated with a higher risk of the composite endpoint compared to Phenotype 1 (hazard ratios: 3.67 and 7.44, p = 0.034 and p <0.001, respectively). In conclusion, BNP-based phenotyping identified high-risk subgroups among PerAF patients post-CA. Patients with LV systolic dysfunction or renal dysfunction exhibited the highest risk of HF hospitalization and mortality post-CA, suggesting the need for tailored postablation management strategies.

The EuroSCORE II is a widely used risk stratification tool for estimating perioperative mortality in cardiac surgery. However, its prognostic utility in broader coronary artery disease (CAD) management, including in patients undergoing percutaneous coronary intervention (PCI) or medical therapy, is less well defined. We conducted a retrospective cohort study of patients with complex CAD discussed in a multidisciplinary Heart Team meeting at a tertiary Australian centre (2019-2024). EuroSCORE II was calculated for each patient, with a threshold of ≥2% used to define higher risk. The primary endpoint was a composite of major adverse cardiovascular events (MACE), including myocardial infarction, stroke, and all-cause mortality. Associations were assessed using Cox proportional hazards models, ROC analysis, and Kaplan-Meier survival estimates. Overall, 546 patients were included (mean age 67 years, 17% female sex) with a median EuroSCORE II of 1.19% (IQR 0.78-2.03) Final treatment strategies were CABG (65.2%), PCI (12.6%), or medical therapy (19.6%). Over a median follow-up of 3.2 years, 79 patients (14.5%) experienced MACE. EuroSCORE II ≥2% was significantly associated with higher risk of MACE (HR 2.58, 95% CI 1.65-4.05, p < 0.001). Predictive accuracy was limited (AUC 0.66), with an AUC of 0.59, 0.72 and 0.66 for CABG, PCI and medical therapy, respectively. In conclusion, in a contemporary Heart Team setting, EuroSCORE II ≥2% was independently associated with long-term MACE and mortality across treatment strategies. These findings suggest that EuroSCORE II may serve as a pragmatic adjunct to guide risk stratification and treatment planning beyond its traditional surgical context.