European heart journal open最新文献

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.

Aims: To study the prevalence of masked uncontrolled hypertension (MUCH) in patients recently hospitalized for myocardial infarction, and to develop machine learning-based prediction models identifying MUCH.

Methods and results: Ambulatory blood pressure measurement (ABPM) was performed in 99 patients following hospitalization for a myocardial infarction. Sixty-two clinical variables were eligible for machine learning. Variable importance for the prediction of MUCH (office blood pressure <140/90 mm Hg at ABPM start but mean 24-h blood pressure ≥130/80 mm Hg) was assessed using the least absolute shrinkage and selection operator (LASSO) and the Boruta algorithms. Logistic regression, LASSO, and random forest models based on the top variables were evaluated using receiver operating characteristic area under the curve (AUC) in repeated cross-validation. Mean age was 62.1 ± 8.2 years, 73 (74%) were males. The ABPM was performed at a median of 11 weeks after discharge. Among 96 patients with valid 24-h ABPM recordings, 32 (33%) had 24-h mean blood pressure ≥130/80 mm Hg and 17 (18%) were identified with MUCH. Machine learning identified discharge diagnoses of diabetes and hypertension, and kidney dysfunction as most important predictors of MUCH. The best random forest, logistic regression, and LASSO models showed mean AUC 0.82, 0.80, and 0.80, respectively, for prediction of MUCH.

Conclusion: One in five patients had MUCH at follow-up after a myocardial infarction. The readily available variables diabetes, hypertension, and kidney dysfunction were identified as the most important predictors of MUCH, which may be implemented in a prediction model for identifying this clinically challenging blood pressure phenotype.

Previous presentation: Preliminary results were presented at the European Society of Cardiology Congress in London 2024 as an oral abstract presentation. Hellqvist H, Erlinge D, Lindahl B, et al. Prevalence and prediction of masked uncontrolled hypertension in patients recently hospitalised for an acute coronary syndrome. European Heart Journal 2024;45 (Suppl 1). doi: 10.1093/eurheartj/ehae666.2566.

Aims: Myocardial ischaemic preconditioning (IPC) increases myocardial ability to withstand ischaemic injury. Myocardial stunning is a reversible dysfunction, while necrosis results in irreversible cell death. The link between IPC, stunning, and necrosis remains unclear. This study aimed to utilize a novel 13.5-min ischaemia-reperfusion (I/R) rat model, distinct from conventional I/R models, to identify transcriptomic changes associated with IPC and investigate the role of DNA methylation in regulating these changes, particularly in relation to myocardial stunning and necrosis.

Methods and results: A novel rat model of cardiac I/R injury was used, with IPC induced by two 5-min ischaemia-reperfusion cycles followed by 13.5-min of ischaemia, and a control group undergoing 13.5-min of ischaemia without IPC. Myocardial samples were collected at early (T1) and 4-h (T2) post-reperfusion, representing stunned myocardium in the IPC group and necrosis in the control group. RNA sequencing, DNA methyltransferase (DNMT) activity assay, Chromatin immunoprecipitation (ChIP), and DNA methylation analyses were performed. IPC reprogrammed the cardiac transcriptome, with 53 genes differentially expressed at T1 and 166 at T2, including key regulators of inflammation (Nfkbia), DNA repair (Gadd45b, Parp14), and stress responses (Cebpd, Jun). IPC reduced global DNMT activity, promoting hypomethylation of protective genes like Cebpd, Nfkbia, Gadd45b, Jun, and Aplod1 at T1, while selectively hypermethylating maladaptive genes like Tmem200c and Fgfr4. ChIP assays revealed reduced Dnmt1 binding at Jun and Parp14 promoters, aligning with increased protein levels.

Conclusion: IPC re-programmes the cardiac transcriptome through dynamic DNA methylation, enhancing myocardial resilience while increasing stunning as an adaptive mechanism to limit necrosis.

Aims: Myocarditis is a potentially life-threatening condition with diverse aetiologies including viral infections, toxins, and autoimmunity. We aimed to quantify the risk factors of index myocarditis hospitalization and subsequent myocarditis recurrence.

Methods and results: We conducted a retrospective cohort study in New South Wales (NSW), Australia, using the Admitted Patient Data Collection (APDC) of all hospitalized patients. Conditions temporally associated with myocarditis within 30 days of the index admission were identified using conditional logistic regression analysis. In patients with previous myocarditis, risk factors for recurrent myocarditis admission were calculated with both Cox regression using cause-specific hazards and competing risk analysis. There were 4071 cases of index myocarditis from 2004 to 2021. Over a median of 4.8 years of follow-up, there were 124 patients whose myocarditis recurred. Two-thirds of cases were male with an average age of 42 years. Index myocarditis cases were much more common within 30 days of a hospitalization for pericarditis, heart failure, ventricular arrhythmias, COVID-19, and several other cardiac, respiratory, and autoimmune conditions, compared to the baseline risk over the preceding 12 months. Similarly, myocarditis recurrence was more common within 30 days of pericarditis, ventricular arrhythmias, COVID-19, and autoimmune disease. Recurrence was not strongly predicted by any features of the index myocarditis admission. Our analysis is solely based on administrative coding, with limited clinical validation, which introduces potential for misclassification.

Conclusion: In our cohort, myocarditis was more frequently diagnosed following presentations with acute respiratory illness (including COVID-19), autoimmune conditions, or cardiac events including ventricular arrhythmias, atrial fibrillation, and heart failure.

Aims: To examine the association between a personal history of cancer and the likelihood of a cardiovascular diagnosis among patients presenting with chest pain.

Methods and results: We analyzed data from consecutive adult patients hospitalized with a primary diagnosis of chest pain between 2007 and 2022, excluding those with active cancer or ST-elevation myocardial infarction. Patients were categorized into two groups: cancer survivors and other patients. The primary outcome was a cardiovascular probable diagnosis, defined as a composite of non-ST-segment elevation myocardial infarction, pulmonary embolism, new-onset atrial fibrillation, or mortality within 30 days. The final cohort included 37 819 patients with a median age of 65 years (Q1-Q3: 55-75), of whom 24 644 (65%) were men. Among these, 1838 (5%) had a history of cancer. A multivariable logistic regression model demonstrated that cancer survivors were 70% more likely to reach the study primary endpoint compared with other patients (P < 0.001). A propensity score matching model consistently demonstrated that cancer survivors were 40% more likely to meet the study endpoint (95% CI 1.2-1.7, P < 0.001). Over a median follow-up of 4.3 years (Q1-Q3: 2.1-7.3), 7035 (19%) patients died. Kaplan-Meier survival analysis indicated a cumulative probability of death of 29% ± 22% for cancer survivors vs. 12% ± 9% for other patients (P < 0.001, Log rank).

Conclusion: Among patients admitted to the hospital with chest pain, a personal history of cancer is independently associated with a significantly higher likelihood of receiving a final cardiovascular diagnosis.