European heart journal open最新文献

Aims: Aetiologies of sudden death (SD) have been reported in autopsied case series and less frequently in resuscitated patients, but large series are scarce and if causes are similar between deceased and surviving patients is unknown.

Methods and results: All successive adult patients with resuscitated SD (n = 283) and autopsied SD cases (n = 1258) over the last 10 years at our centre were included. Causes were detailed and compared between resuscitated and autopsied cases. Coronary artery disease was present in 87% of resuscitated patients and in 48% of autopsied subjects (P < 0.0001). In coronary artery disease patients, an acute coronary event was present in 85% of resuscitated patients vs. 22% of autopsied cases (P < 0.0001).No coronary artery disease was present in 13% of resuscitated patients (42% cardiomyopathy, 58% primary electrical disease) and noncardiac causes were absent. In autopsied cases, some cardiomyopathy was present in 19%, noncardiac causes were noted in 16% (pulmonary embolisms, aortic dissections/aortic aneurysm ruptures or strokes, and brain/meningeal haemorrhages) and no apparent cardiac or noncardiac cause for explaining SD was present in 15% (sudden arrhythmic death syndrome).

Conclusion: In this large series of resuscitated and autopsied SD cases, coronary artery disease remains the main aetiology but was significantly less frequent in autopsied cases, with a majority of acute coronary events in resuscitated patients vs. a majority of remote myocardial infarction without fresh thrombus in autopsied cases. Noncardiac causes were present in 15% of autopsies but never in surviving patients.

Introduction: Coronary no-reflow phenomenon occurs when cardiac tissue fails to perfuse normally despite opening of the occluded vessel. It is one of the manifestations of reperfusion injury, a series of pathological conditions associated with an increase in infarct size and adverse clinical outcomes. While there is currently no specific treatment to limit or prevent reperfusion injury, preclinical models have shown promising results with iSGLT2 inhibitors in this regard. However, there are no human studies specifically designed to evaluate the effects of empagliflozin on the no-reflow phenomenon or reperfusion injury.

Methods and analysis: The EMPA-PCI is a single-centre, open-label, randomized clinical trial that compares the use of empagliflozin vs. standard treatment in reducing reperfusion injury in patients with STEMI. A total of 162 patients will be randomized to receive either 25 mg of Empagliflozin as a loading dose before angioplasty followed by 10 mg per day for three doses in the treatment group, or standard treatment in the control group. The incidence of the no-reflow phenomenon during PCI, infarct size by magnetic resonance imaging, myocardial injury biomarkers will be compared. Clinical follow-up will be conducted for 3 months following patient enrollment.

Conclusion: Empagliflozin administered prior to PCI in patients with STEMI may contribute to prevent the no-reflow phenomenon and limit reperfusion injury. This could provide new insights into the cardiovascular benefits already known for SGLT2 inhibitors.

Trial registration: ClinicalTrials registry. NCT06342141.

Aims: P-wave indices (PWIs) are associated with incidence of atrial fibrillation (AF) and extent of left atrial fibrosis. We investigated associations of P-wave duration and P-wave terminal force in V1 (PTFV1) with incidence of AF and extent of atrial fibrosis in a Japanese community.

Methods and results: Participants were classified based on P-wave duration in lead II (≥120 and <120 ms) or PTFV1 (≥4000 and <4000 μV*ms). Fibrosis in the left atrial posterior wall was pathologically evaluated in 133 autopsied cases with clinical information. Hazard ratios for AF were estimated using a Cox proportional hazards model. Differences in the extent of left atrial fibrosis between P-wave index categories were tested by analysis of covariance. A total of 2907 community-dwelling individuals aged ≥40 years without prior AF were followed for 10 years. Participants with prolonged P-wave duration or elevated PTFV1 were older and had more cardiovascular risk factors. During follow-up, 140 participants developed AF. Unadjusted incidence rates of AF were significantly higher in participants with P-wave duration ≥120 ms or PTFV1 ≥ 4000 μV*ms than in those with values below these cut-offs (4.6 vs. 10.6, and 4.7 vs. 14.4 per 1000 person-years, respectively; both P < 0.001). Participants with P-wave duration ≥120 ms had a significantly higher age- and sex-adjusted geometric mean percentage of left atrial fibrosis than those with P-wave duration <120 ms (P = 0.04).

Conclusion: P-wave duration and PTFV1 are useful indicators for assessing AF risk. Furthermore, prolonged P-wave duration reflects the extent of left atrial fibrosis.

Aims: Little is known about the importance of blood lipids for risk of myocardial infarction (MI) in Chinese vs. European populations. We compared the associations with MI of apolioprotein B (ApoB) vs. low-density lipoprotein cholesterol (LDL-C) and remnant-cholesterol (remnant-C) vs. triglycerides in the China Kadoorie Biobank (CKB) and UK Biobank (UKB).

Methods and results: Plasma levels of LDL-C, high-density lipoprotein-cholesterol (HDL-C), apolipoprotein B (ApoB), apolipoprotein A1 (ApoA1), non-HDL-C, remnant-C, LDL-C/ApoB, and HDL-C/ApoA1 ratios were measured in a nested case-control study of MI (948 cases, 6101 controls) in CKB and a prospective study (5344 cases in 279 989 participants) in UKB. Associations of lipids with MI were assessed using logistic regression in CKB and Cox regression in UKB after adjustment for confounders and correction for regression dilution. The mean levels of LDL-C were about 30% lower in CKB than in UKB [2.3 (0.6) vs. 3.7 (0.8) mmol/L], but mean levels of HDL-C were comparable [1.3 (0.3) vs. 1.5 (0.4) mmol/L], as were those for triglycerides [1.8 (1.1) vs. 1.7 (1.1) mmol/L]. While the rate ratios (RRs) of MI for 1 SD higher usual levels of LDL-C in Chinese were about half those in Europeans (1.27; 1.13-1.44 vs. 1.55; 1.49-1.61), the corresponding RRs for ApoB or non-HDL with MI were comparable between Chinese and Europeans.

Conclusion: The findings reinforce current guidelines for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in China that advocate initiation of statin treatment in individuals at high-risk of ASCVD rather than high levels of LDL-C.

Aims: Cardiac impairment in AL amyloidosis is the major determinant of survival. Treatment goals include reducing circulating light chains to improve organ function. Global longitudinal strain (GLS) is an independent predictor of survival and useful for assessing cardiac function before and after therapy. This study aimed to describe GLS change from baseline to one year post-treatment, identify factors associated with GLS improvement (GLS+), and evaluate its prognostic significance.

Methods and results: Ninety-seven patients with AL amyloidosis and cardiac stage II/III disease who underwent echocardiogram and haematologic evaluation at baseline and one year were included. GLS+ was defined as a 2.0%-point increase. A cardiac or B-type natriuretic peptide (BNP+) response was defined as a 30% reduction from baseline. Overall survival was measured from baseline echocardiogram to death. Of 97 patients, 62% had Stage II, 29% Stage IIIa, and 9% Stage IIIb disease. Baseline median left ventricular ejection fraction, GLS, and septal thickness were 65%, -14.9%, and 1.3 cm, respectively. GLS+ was observed in 36% of patients and BNP+ in 51%. Median overall survival was 113.4 months. The hazard ratio for survival was 0.42 in the GLS+ group and 0.46 in the BNP+ group, after adjusting for haematologic response.

Conclusion: GLS improvement post-treatment confers a significant survival benefit. This study supports GLS as an important marker for risk stratification and cardiac response.

Aims: Over recent decades, numerous measures have been implemented to improve treatment and timely intervention for ST-elevation myocardial infarction (STEMI). For deeper insights into the current state of care, this study investigates whether patient outcomes differ based on the timing of presentation (on-hours vs. off-hours) for primary percutaneous coronary intervention (PCI) for STEMI.

Methods and results: Data from STEMI PCIs performed from 2017 to October 2020, as registered within the Netherlands Heart Registration (NHR), were analysed. Off-hours presentation was defined as arrival at the catheterization laboratory (cath lab) on weekends, during working days between 17.00 and 08.00, or Monday between midnight and 08.00. Short-term outcomes included 30-day all-cause mortality and acute MI within 30 days. Long-term outcomes included all-cause mortality rates up till 5 years after PCI, target vessel revascularization within 1 year, and repeat revascularization with elective or non-STEMI PCI. The study included 19 090 STEMI patients from 17 centres, with 11 719 (61.4%) PCIs performed on-hours. No significant difference in 30-day mortality was observed between on-hours and off-hours patients (5.7% vs. 5.8%). On-hours patients had a longer time from symptom onset to cath lab arrival (≤6 h: 80.2% vs. 84.4%, P < 0.001) and were less likely to present with out-of-hospital cardiac arrest (7.6% vs. 9.5%, P < 0.001). No statistically significant differences in long-term outcomes were observed after adjusting for confounders.

Conclusion: Outcomes after primary PCI for STEMI are comparable between on-hours and off-hours presentations. The quality of care appears to be independent of time of arrival at the cath lab.