European heart journal open最新文献

[This corrects the article DOI: 10.1093/ehjopen/oeaf050.].

Aims: Cardiogenic shock (CS) is the leading cause of in-hospital mortality in patients suffering acute myocardial infarction (AMI). Despite advances in their management, short- and long-term mortality remain unacceptably high. We assessed short and intermediate-term outcomes for a contemporary cohort of patients with AMI-CS managed at a referral centre with a large catchment area, and sought to identify clinical factors portending a favourable prognosis.

Methods and results: Of 1162 consecutive, unselected patients with CS we studied 316 with AMI-CS. Our primary endpoint was native heart survival (NHS) defined as survival to discharge without advanced heart failure (HF) therapies. Our secondary endpoints were adverse events, overall survival, and readmissions up to 1 year following discharge. Association of clinical data with NHS was analysed using logistic regression. Of 316 patients, 168 (53.2%) achieved NHS, 140 (44.3%) died, and 8 (2.5%) were discharged after receiving advanced HF therapies. Overall, 181 patients (57.3%) received temporary mechanical circulatory support (MCS), with 78 (24.7%) receiving intra-aortic balloon pump, 107 (33.9%) percutaneous ventricular assist device, and 62 (19.6%) veno-arterial extracorporeal membrane oxygenation. Of 176 discharged patients (55.7%), 170 (53.8%) were alive at 30 days, and 156 (49.4%) at 1-year post-discharge, while 56 (31.8%) had at least one readmission and 30 (17.0%) one HF-related readmission, by 1-year post-discharge. Patients with NHS were younger, had lower CS severity by SCAI stage, less commonly underwent intubation, or received temporary MCS, had a shorter time from CS onset to MCS deployment, and more commonly underwent coronary intervention with fewer stents deployed, compared to patients who died or underwent advanced HF therapies. Bleeding and vascular complications were less common in patients achieving NHS compared to patients who died or received advanced HF therapies. After multivariable adjustments, clinical variables associated with NHS included: younger age, lower vasoactive-inotropic score, lower serum creatinine, and lactate at shock onset, successful coronary intervention with fewer stents deployed, and absence of intubation, or use of veno-arterial extracorporeal membrane oxygenation (all P ≤ 0.05).

Conclusion: We studied a contemporary cohort of patients with AMI-CS and high rates of temporary MCS use, and identified clinical factors associated with a higher likelihood for successful outcomes. The need for transfer to an advanced CS centre, the impact and management of adverse events, and the type and timing of temporary MCS as opposed to intensification of pharmacologic therapy, should be studied as clinical practice targets for improving patient outcomes.

Aims: Despite an overall decline in cardiovascular mortality in recent years and advances in diagnosis and treatment, acute coronary syndromes (ACS) remain a leading cause of morbidity and mortality among women worldwide. Sex-specific risk factors and mechanisms remain under-recognized and complicate early diagnosis and management.

Methods and results: The GEDI-ACS registry (PNRR-MCNT2-2023-12377431; NCT06441942) is a prospective, multicentre, non-randomized clinical study aiming to identify the phenotypic and genetic profiles of women with ACS. The study is enrolling 100 consecutive women presenting with ACS (ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction, or unstable angina) in Northern and Southern Italy. In these patients, comprehensive clinical, imaging, biochemical, and molecular phenotyping (including whole exome sequencing, transcriptomics, proteomics, and metabolomics) will be performed. Data on socioeconomic status, health literacy, and awareness of cardiovascular risk factors will be collected through standardized questionnaires. Follow-up, scheduled at 1 and 12 months, will assess clinical outcomes, quality of life, adherence to therapies, and lifestyle modifications.

Conclusion: The GEDI-ACS registry will provide novel insights into the sex-specific profile of ACS by integrating clinical, genetic, molecular, and socioeconomic data from female patients. The results may support the development of personalized interventions that account for gender diversity.

Aims/aims: Decreased cardiorespiratory fitness (CRF) is an all-cause mortality predictor. Oxygen consumption at peak exercise (VO_2max) during a cardiopulmonary exercise test (CPET) is the gold standard for its evaluation. Since cardiometabolic risk factors reduce CRF, we aimed to assess the cardiopulmonary and metabolic responses during CPET and evaluate their determinants.

Methods and results: Subjects underwent incremental treadmill CPET and bioelectrical impedance analysis. Insulin sensitivity was estimated using the HOMA, QUICKI, and METS-IR indices. Multivariate regressions were used to evaluate determinants of VO_2max. Nonlinearity was confirmed with an F-test between linear and polynomial models. Five hundred and three subjects were evaluated, 474 met maximum effort criteria, (64% females). Median age was 4(26-52); 41% had normal weight, 33% overweight, 26% obesity. Prevalence of insulin resistance ranged from 22% to 46%, depending on the equation used. VO_2max was 29.8(24-36) and 36.6 (30.6-43.3) mL/kg/min for females and males. Body composition analysis revealed that a higher BMI exhibited strong biological collinearity with metrics associated with adiposity excess and was inversely associated with CRF. After adjusting for age, sex, BMI, and fat mass, insulin resistance evaluated by QUICKI explained up to 43% of VO_2max variability and was inversely associated with CRF.

Conclusion: In a cohort of individuals without established CVD, the main determinants of CRF were modifiable risk factors associated with excess adiposity and insulin resistance. The potential mechanisms underlying the reduction in CRF include decreased relative muscle mass and insulin resistance, which reduce muscle glucose uptake and O₂ consumption during maximum effort, where anaerobic glycolysis plays a central role.

Graphical AbstractCentral Illustration. Primary endpoint was a composite of cardiac death, MI, or definite/probable stent thrombosis. BP-EES: biodegradable-polymer everolimus-eluting stent; CI: confidence interval; CV: cardiovascular; DAPT: dual antiplatelet therapy; HBR: high bleeding risk; HR: hazard ratio; MI: myocardial infarction; PCI: percutaneous coronary intervention; TLF: target lesion failure.For image description, please refer to the figure legend and surrounding text.

Aims: In persistent atrial fibrillation (AF), low-voltage areas (LVAs) in the left atrium are considered arrhythmogenic. Although substrate ablation targeting LVAs may reduce AF recurrence, its effect on broader clinical outcomes remains unclear, and procedural risks must be considered. This study aims to compare hierarchical clinical outcomes between pulmonary vein isolation (PVI) alone and PVI plus LVA ablation in patients with persistent AF and LVAs using a win ratio analysis.

Methods and results: This was a post hoc sub-analysis of the SUPPRESS-AF trial, including 341 patients with LVAs out of 1364 randomized. Patients received either PVI alone (n = 171) or PVI with LVA ablation (n = 170). Hierarchical outcomes were analysed in order of clinical importance: all-cause death, symptomatic stroke, AF recurrence, bleeding, and periprocedural complications. Win ratio analysis was used for comparison. Baseline characteristics were balanced between groups. The PVI plus LVA group had longer procedure times and higher energy delivery. The win ratio analysis showed no significant difference between groups (win ratio: 1.01, 95% confidence interval: 0.73-1.39, P = 0.940). The PVI-alone group had numerically fewer adverse events, while the LVA ablation group showed a numerical reduction in AF recurrence. Subgroup analyses showed consistent findings.

Conclusion: In patients with persistent AF and LVAs, LVA ablation added to PVI did not improve hierarchical clinical outcomes and prolonged procedures. Routine use of current LVA ablation strategies is not supported, though targeted substrate modification may warrant further research.

Registration: UMIN-CTR, https://www.umin.ac.jp/ctry. UMIN000035940.

Aims: Population-based data on cardiac-related symptoms in individuals without diagnosed cardiac disease remain limited, despite important implications for early detection and management. We aimed to assess the prevalence of self-reported symptoms and the association with quality of life (QoL) among adults aged ≥65 years with ≥1 additional stroke risk factor, but without diagnosed cardiac disease.

Methods and results: This is a cross-sectional study of the NORwegian atrial fibrillation self-SCREENing (NORSCREEN) trial population at baseline. NORSCREEN is an ongoing, nationwide, randomized atrial fibrillation screening study in adults aged ≥65 years at increased risk of stroke (CHA₂DS_2-VA ≥2). All participants completed a baseline questionnaire capturing clinical information, symptoms, and QoL. Of the 50 549 participants enrolled from 2023 to 2025, 39 281 (78%) reported no diagnosed cardiac disease. Among those, 17 069 (43%) reported cardiac-related symptoms compared to 7551 (67%) of 11 268 individuals with known cardiac disease. The most common symptoms were fatigue, exertional dyspnoea, and tachycardia. Female sex [adjusted odds ratio 1.66, (95% CI 1.58-1.75)], physical inactivity [1.43 (1.32-1.55)], current smoking [1.24 (1.12-1.37)], age <75 years [1.14 (1.08-1.20)], living alone [1.13 (1.07-1.20)], and comorbidities including chronic obstructive pulmonary disease [6.51 (5.63-7.54)] and anxiety [3.99 (3.64-4.38)] were associated with cardiac-related symptoms. Symptomatic individuals reported significantly lower RAND-36 QoL scores across all domains compared to those without symptoms.

Conclusion: In this cohort of individuals aged ≥65 years at increased risk of stroke, but without diagnosed cardiac disease, nearly half reported cardiac-related symptoms, which were associated with substantially reduced QoL. These findings suggest there might be unmet needs in identifying and managing cardiovascular disease. Registration: Clinical trials: NCT05914883.

Aims: Patients with cancer have an increased risk of cardiovascular (CV) events, although there is limited data on future trends in cancer prevalence amongst patients with an acute cardiovascular admission. The aim of this study was to evaluate trends in cancer prevalence among CV admissions with an attempt to predict future cancer and CV co-morbidity over the next 20 years.

Methods and results: The analysis included all hospital admissions with a primary CV diagnosis from the US National Inpatient Sample (NIS), from 2016 to 2020. The sample was stratified by specific CV admission and by cancer status and type. The chi-square and the Kruskal-Wallis tests were used to compare categorical and continuous data, respectively, across the years. A Poisson regression model was used to predict the prevalence of overall and specific cancer types through 2040, based on the 5-year baseline period. Among 4.79 million CV admissions from 2016 to 2020, there was a significant increase in cancer prevalence from 4.8% to 5.4% (P < 0.001). This upward trend was observed across all CV diagnoses. Predictive modelling estimates that cancer prevalence in CV inpatients will increase from a 4.8% baseline in 2016 to 11.9% by 2040, with the most pronounced rate of growth seen in liver (IRR 1.069; P < 0.001), breast (IRR 1.056; P < 0.001), and renal cancer (IRR 1.055; P < 0.001). Nevertheless, haematological and lung cancers show the highest prevalence, both at baseline and in 2040.

Conclusion: The prevalence of cancer among patients hospitalized with CV disease is predicted to increase 2.48-fold by 2040. This trend highlights the importance of integrated cardio-oncology and multidisciplinary care models.

Aims: We compared the effects of 'ablate and pace' to pharmacological therapy on mortality and left ventricular ejection fraction (LVEF) in patients with atrial fibrillation (AF), with or without heart failure (HF).

Methods and results: Articles were identified by searching PubMed, Central, and Embase until 30 June 2024. Inclusion criteria encompassed observational and randomized controlled trials (RCTs) comparing 'ablate and pace' with pharmacological therapy and investigating outcomes of mortality and LVEF in patients with AF. An exclusion criterion was lack of a parallel study design. The primary outcomes were all-cause mortality and the mean difference (MD) in LVEF. Endpoints were assessed through meta-analyses computing relative risks (RRs) and MDs. The clinical diagnosis of HF was used to distinguish between patients with and without HF. Initially, 3837 studies were identified, of which 24 (n = 4292 patients) fulfilled the inclusion criteria, including 17 (n = 3261 patients) that focused on HF. Follow-up time varied from 3 to 96 months. Only in HF patients, 'ablate and pace' reduced mortality significantly with a risk reduction of 36% [RR, 0.64; 95% confidence interval (CI), 0.49-0.85; P < 0.01; n = 10] as compared with pharmacological therapy. Except for two studies, cardiac resynchronization therapy (CRT) was the chosen pace mode. The mortality reduction was independent of study design: RCTs (RR, 0.41; 95% CI, 0.18-0.94; P = 0.04; n = 2) and observational studies (RR, 0.70; 95% CI, 0.55-0.90; P = 0.01; n = 8). 'Ablate and pace' and pharmacological therapy were similar for the LVEF outcome (MD, 1.1; 95% CI, -1.6-3.8; P = 0.39; n = 16), which was independent of both HF and study designs (results not shown).

Conclusion: 'Ablate and CRT' reduced mortality in HF patients as compared with pharmacological therapy, which was supported by statistical associations in observational studies. A single RCT corroborated the finding.

Aims: Inflammation and hyperlipidaemia play a pivotal role in atherosclerotic cardiovascular disease (ASCVD), and inflammatory risk may outweigh cholesterol risk among statin-treated patients. However, it is unclear how these risks relate to ASCVD outcomes in a real-world population.

Methods and results: Observational study of 39 638 ASCVD adults in Stockholm's healthcare (2007-21) who underwent routine testing for high-sensitivity C-reactive protein (hsCRP) and low-density lipoprotein cholesterol (LDL-C). Groups were defined by LDL-C (≥1.8 vs. < 1.8 mmol/L) and hsCRP (≥2 vs. < 2 mg/L): as low risk, high cholesterol risk (CR) alone, high inflammatory risk (IR) alone, and combined high cholesterol and inflammatory risk (CIR). Primary outcome was major adverse cardiovascular (CV) events (MACE); secondary outcomes included all-cause death, CV death, and heart failure (HF) hospitalization. Mean age at baseline was 69 years, 61% were men, 19.4% had chronic kidney disease (CKD), and 61% were receiving lipid-lowering therapy (LLT). Over follow-up (median 4.5 years), 5349 MACE, 7955 deaths (2088 CV deaths) and 4286 HF hospitalizations occurred. Compared with patients with low risk, those with IR or CIR experienced the highest MACE risk (HR 1.39; 95% CI 1.26-1.54 for CIR, HR 1.18; 1.05-1.33 for IR), followed by CR (HR 1.12; 1.01-1.24). Elevated hsCRP, with or without elevated LDL-C, was strongly associated with secondary outcomes, while CR alone was not. Patterns were generally consistent across CKD and LLT subgroups.

Conclusion: In routine care high inflammatory risk, alone or with high cholesterol risk, is a stronger predictor of adverse outcomes than high cholesterol alone.