European heart journal open最新文献

Aims: To compare outcomes of patients with severe mitral regurgitation (MR) after m-TEER and surgery.

Methods and results: PubMed, Scopus, and Google Scholar databases were searched for randomized controlled trials and propensity score matching studies comparing mid-term outcomes of m-TEER vs. surgical valve repair. All-cause of death, rehospitalization for heart failure, mitral reintervention, NYHA class at clinical follow-up and grade ≥ 3 at echocardiographic follow-up were the outcomes of interest. Additional sensitivity analyses were performed to account for heterogeneity. Nine studies (2 RCT and 7 propensity score matching studies) with a total of 23 825 patients (m-TEER group = 11 970; surgery group = 11 855) were included. Surgery and m-TEER were associated with comparable rates of all-cause mortality at a median follow-up of 18 months (RR 1.02, 95%CI 0.77-1.37, P-value 0.87). Surgical repair was associated with a reduced risk of rehospitalization for heart failure (RR 1.70, 95%CI 1.47-1.98, P value < 0.01) and mitral reintervention (RR 3.27, 95%CI 2.49-4.30, P value < 0.01), due to a reduced at least moderate residual MR (RR 6.35, 95%CI 1.43-28.22, P value 0.02).

Conclusion: In patients with severe MR, m-TEER resulted in comparable outcomes for all-cause deaths compared to surgery, although the latter was associated with reductions in heart failure rehospitalization, reintervention and MR residual rates at a median 18-month follow-up.

Aims: Individuals with a previous stroke face an increased risk of Non-ST-segment myocardial infarction (NSTEMI) and may have a higher associated mortality. However, the impact of inpatient care quality during the NSTEMI admission on long-term outcomes remains unclear. To assess whether there were disparities in care and NSTEMI clinical outcomes between individuals with and without a previous stroke.

Methods and results: We analysed 425 274 adults hospitalized between January 2005 and March 2019, with NSTEMI from the UK Myocardial Ischaemia National Audit Project (MINAP) registry, linked with Office for National Statistics mortality reporting. We examined long-term outcomes by previous stroke status and inpatient care quality for patients that survived to discharge using the opportunity-based quality-indicator score (OBQI) score, categorized as 'poor', 'fair', 'good' or 'excellent'. Individuals with previous stroke were older (median age 79 vs. 72 years) and underwent revascularization by PCI (22% vs. 37%) less frequently than those without a previous stroke. The adjusted mortality risk for those with a previous stroke was higher at 30 days (aHR 1.14, 95% CI 1.10, 1.18), 1 year (aHR 1.20, 95% CI 1.17, 1.22) and 10 years (aHR 1.27, 95% CI 1.26 1.29) with higher quality inpatient care associated with lower mortality rates compared with poor care (good: HR 0.86, 95% CI 0.80, 0.92; excellent: HR 0.76, 95% CI 0.71, 0.81).

Conclusion: Individuals with a previous stroke, experience disparities during inpatient care following NSTEMI and have a higher risk of long-term mortality. Higher quality inpatient care may lead to better long-term survival.

Introduction: There is a growing population with cardiac devices (pacemakers, implantable cardioverter defibrillators and cardiac resynchronization therapy), but whether this influences quality of care and long-term mortality after ST-elevation myocardial infarction (STEMI) is unknown.

Methods and results: Patients in England and Wales between January 2005 and March 2019 with a diagnosis of STEMI were included from the Myocardial Ischaemia National Audit Project, Hospital Episode Statistics and mortality linkage to July 2021. Primary outcomes were all-cause mortality over the study period, secondary outcomes were odds of undergoing reperfusion within guideline mandated timeframes. Multivariate cox-models compared all-cause mortality over specified time-periods and logistic regression models illustrated odds of undergoing reperfusion. 322 890 patients with STEMI were included, 2118 (0.7%) had a cardiac device at STEMI admission. Patients with cardiac devices were older (78 years old vs. 66 years old) and more often female (32% vs. 29%) (P < 0.001). After multivariate adjustment, patients with cardiac devices were less likely to have a 'door-to-balloon time' of under 60 min (aOR 0.61 95% CI 0.54-0.70) (P < 0.001). Patients with cardiac devices had an increased risk of all-cause mortality at 5-years (aHR 1.12 95% CI 1.05-1.20) (P < 0.001). Excluding patients dying within 30 days of admission, patients with cardiac devices still had a higher risk of death at 5-years (aHR 1.23 95% CI 1.13-1.33) (all P < 0.001).

Conclusion: Patients with cardiac devices were less likely to undergo revascularization for STEMI within guideline mandated timeframes. They remain at elevated risk of all-cause mortality up to 5-years compared with STEMI patients without cardiac devices.

Aims: The number of patients undergoing catheter ablation is continuously growing, and techniques are improving. However, studies reporting contemporary data on catheter ablations from large real-world populations are scarce. This study aims to report characteristics and outcomes of catheter ablation from 2006 to 2020, using a nationwide registry with virtually complete coverage.

Methods and results: From the Swedish Catheter Ablation Registry, patients >18 years of age undergoing catheter ablation from 2006 to 2020 were included. Periprocedural data and baseline characteristics were recorded retrospectively. A total of 61 243 procedures were included. There was an overall increase in the number of catheter ablations performed. From 2006, the number of atrial fibrillation (AF) ablations performed increased from 352 procedures in 2006 to 2609 procedures in 2020. Decreased procedural times were seen in catheter ablation of accessory pathway/Wolff-Parkinson-White syndrome, atrial tachycardia (AT), atrioventricular nodal reentry tachycardia, cavotricuspid isthmus (CTI), AF, and atrioventricular junction. Between the time periods 2006-15 and 2016-20, median procedural time in AF ablations decreased from 180 to 140 min (P < 0.001). There was a decreased trend in fluoroscopy time and median dose area product for all ablation procedures (P < 0.001). For AT, CTI, and AF, the cumulative probability of requiring a repeat ablation was significantly lower for procedures performed after January 2016 (P < 0.001).

Conclusion: With a yearly increase in the number of ablations performed, there was a reduction in the need for repeat ablations for AF, AT, and CTI, along with reduced procedural times and lower fluoroscopy levels.

Aims: To investigate potentially distinct associations of ankle brachial index (ABI), a marker of subclinical atherosclerosis, with calcification in different vascular beds and cardiac valves.

Methods and results: We studied 1420 ARIC participants (mean age 80.2 [SD 4.1] years, 60.2% female, and 16.6% Blacks). ABI was measured at visit 6 (2016-17) or visit 7 (2018-19), and coronary artery calcification (CAC) and extra-coronary calcification (thoracic aorta, aortic valve, and mitral valve) were assessed through non-contrast cardiac-gated computed tomography. We ran multivariable logistic regression models, with any (Agatston score >0) and high (≥75th percentile) calcification as primary and secondary outcome variables, respectively. For any calcification, ABI ≤0.9 had the strongest association with any CAC (odds ratio 9.51 [95%CI 1.26, 71.84]), followed by descending aorta calcification (6.01 [1.36, 26.56]), and weakest for cardiac valve calcification. Using high calcification as an outcome, ABI ≤0.9 was significantly associated with all vascular and valvular calcification tested, but weakest for aortic valve. High ABI [>1.3] tended to be more strongly associated with valvular calcification than vascular calcification with any calcification as an outcome.

Conclusion: Low ABI was most robustly associated with CAC. Its association was weaker for thoracic aorta calcification and weakest for valvular calcification. These findings further support distinct pathophysiology of calcification across vascular beds and cardiac valves.

Aims: PCI is frequently performed in patients with high-risk (HR) of adverse clinical events. Therefore, the COASTLINE HR analysis aimed to assess the safety and efficacy of Xience Sierra everolimus-eluting stents (EES) in patients with diabetes, prediabetes, or other criteria of increased cardiovascular risk.

Methods and results: This is the primary analysis of COASTLINE, an investigator-initiated, prospective, multicenter registry in all-comers treated with Xience Sierra EES. After enrolment, HR patients were identified according to prespecified criteria, and per protocol compared with HR patients treated in two randomized all-comer trials with Resolute-type zotarolimus-eluting stents (ZES). Primary endpoint at 1-year follow-up is target vessel failure (TVF), a composite of cardiac death, target vessel myocardial infarction (TVMI), or target vessel revascularization. Of 1768 all-comers, treated with Xience Sierra EES and enrolled in this registry, 1317 (74.5%) were HR patients. Clinical outcome of these patients was compared with the control group, consisting of 1682 HR patients treated with Resolute-type ZES. At 1-year follow-up, no significant difference was observed in TVF between-stents (EES: 4.9% vs. ZES: 6.0%, adjusted hazard ratio 0.78, 95% confidence interval (CI) 0.57-1.06, P = 0.12). Furthermore, a significantly lower rate of secondary endpoint TVMI was observed in Xience Sierra EES patients (1.4 vs. 2.5%, adjusted hazard ratio 0.50, 95% CI 0.28-0.87, P = 0.014), driven by periprocedural myocardial infarction.

Conclusion: In patients with diabetes, prediabetes, or other HR criteria, Xience Sierra EES showed safety and efficacy, comparable to Resolute-type ZES, including Resolute Onyx. The significant difference in TVMI was driven by periprocedural events, as a landmark analysis at 7 days found no between-stent differences.

Registration: https://clinicaltrials.gov/study/NCT04475380.

Aims: In non-congenital heart disease, secondary hyperparathyroidism (sHPT) is associated with an elevated risk of new-onset heart failure (HF) and an increased incidence of HF-related hospitalizations. Yet, for adults with congenital heart disease (ACHD), the role of sHPT and the factors contributing to its development remain poorly understood.

Methods and results: This cross-sectional, single-centre study assessed the prevalence of sHPT in 754 patients with ACHD. Independent predictors of sHPT were identified in both, within the entire cohort and specifically in ACHD with biventricular physiology.

Findings: We found a high prevalence of sHPT in ACHD at 14.9%, with the highest rates in patients with Eisenmenger syndrome/PAH-CHD (39.1%), Ebstein's anomaly (29.2%), Fontan palliation (25%), and pulmonary atresia (25%). SHPT was more common in patients with univentricular physiology (29.6%) than biventricular physiology (13.3%) (P < 0.001). In multivariate analysis, glomerular filtration rate (P < 0.001), serum 25-hydroxyvitamin D₃ (P = 0.004), use of loop diuretics (P = 0.001), oxygen saturation (P = 0.03), and liver stiffness (P = 0.033) were independently associated with sHPT. Among patients with biventricular physiology, right ventricular free wall longitudinal strain (P = 0.028)-rather than left ventricular global longitudinal strain-showed a significant association with the presence of sHPT.

Conclusion: sHPT is observed across the spectrum of ACHD but is more common in patients with complex and more severe disease, particularly those with predominant right heart involvement.

Aims: Endogenous endophthalmitis (EE) is a rarely reported complication of infective endocarditis (IE). In an international series, we sought to determine the clinical and microbiological profile, treatment, and outcome of patients presenting with IE-related EE.

Methods and results: Cases recorded from 2014 to 2023 in nine centres in Europe and the United States were collected. Results were compared to a matched control group.

Conclusion: Sixty-six patients with EE were reported, mean age of 65.2 ± 14.9 years, 71% (n = 47) male. Blood cultures were positive in 97% (64 cases) of patients, with a predominance of streptococci (46%, n = 30).As compared with the control group (n = 264), the EE group presented with more frequent diabetes (35% vs. 21%, P = 0.02), history of cirrhosis (9% vs. 3%, P = 0.04), glomerulonephritis (15% vs. 0.4%, P < 0.001), embolism before admission (92% vs. 55%, P < 0.001), and Janeway lesions (9% vs. 1%, P = 0.002). Streptococcal infection (46% vs. 26%, P = 0.001) was more frequent and Enterococcal infection (0% vs. 18%, P < 0.001) less frequent in the EE group.The main ocular symptoms were a decrease in visual acuity (96%), red eye (55%), and ocular pain (55%). Treatment of EE consisted of intravitreal antibiotic injection in 55 (83%) patients and vitrectomy in 17 (26%). Improvement of visual acuity was observed in 36 (55%) patients.

Conclusion: EE is a serious complication of IE with severe residual vision impairment. Patients with IE should be evaluated for ocular complications, since early detection of EE is crucial to prevent delays in management and to preserve visual function.

Introduction: ECG markers are associated with increased risk of sudden cardiac arrest (SCA) on the sinus rhythm ECG. A sizeable subgroup of patients at risk receives cardiac implantable electrical devices, but there are no known markers of SCA risk on the ventricular-paced (VP) ECG.

Methods and results: We conducted a case-control analysis within a community-based SCA study in Oregon USA (2002-2020; ∼1 million catchment population) with validation in an identically designed study in California USA (2015-2023; ∼850 000 catchment population). SCA cases included adults (≥18 years) with archived VP ECGs obtained prior and unrelated to their SCA. Controls met the same ECG criteria but without history of ventricular arrhythmias or SCA. The discovery analysis included 158 participants (119 SCA, 39 controls), mean age 76.9 ± 11.8 years. SCA cases had a higher ventricular rate (74.9 ± 16.0 bpm vs. 69.3 ± 12.0 bpm, P = 0.05), longer corrected QT interval (QTc; 525.9 ± 49.9 ms vs. 493.9 ± 31.0 ms, P < 0.001) and longer Tpeak-Tend (Tpe; 111.8 ± 23.3 ms vs. 95.9 ± 20.1 ms, P < 0.001). After adjustment, QTc and Tpe were significantly associated with SCA, with adjusted ORs 6.1 (95%CI: 1.4-26.2) and 7.9 (95%CI: 2.0-31.0) in the discovery population, and 6.1 (95%CI: 2.5-14.8) and 3.7 (95%CI: 1.6-8.6) in the validation population. In pooled analysis, the model combining QTc and Tpe achieved an AUC of 0.752, significantly outperforming each individually. Subjects with both prolonged QTc and Tpe had a 16-fold higher risk (adjusted OR:16.2, 95%CI: 6.0-43.6) compared to those without abnormalities.

Conclusion: Abnormal myocardial repolarization measured by QTc and Tpe was independently associated with SCA. These findings suggest that the VP ECG could also predict SCA risk.