European heart journal open最新文献

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.

Aims: The number of patients undergoing percutaneous coronary interventions (PCI) after transcatheter aortic valve replacement (TAVR) is expected to increase, but their prognosis remains poorly understood.

Methods and results: Consecutive PCI patients with prior TAVR were compared to patients without prior TAVR between 2008 and 2023. The Kaplan-Meier method was used to estimate the 1-year incidence of major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death or myocardial infarction. An entropy balance approach was implemented to adjust for imbalances in patient and procedural characteristics. Adjusted hazard ratios (HRs) were estimated using weighted Cox regression models. Comparing 420 PCI patients with prior TAVR (mean age 80.8 years, 37.1% women) to 1197 without (mean age 70.4 years, 24.6% women), 1-year MACE was higher in the prior TAVR group (8.7 vs. 3.7%; unadjusted HR 2.35, 95% CI 1.49-3.69; P < 0.001). After adjustment for clinical and procedural characteristics, prior TAVR remained associated with an increased risk of MACE (adjusted HR 2.36, 95% CI 1.08-5.16; P = 0.032). This was primarily driven by higher cardiovascular death (adjusted HR 3.12, 95% CI 1.10-8.79, P = 0.032), while the association with myocardial infarction was attenuated post-adjustment and no longer statistically significant.

Conclusion: Patients undergoing PCI after TAVR experience a higher incidence of MACE compared to those undergoing PCI without prior TAVR, underscoring the importance of accurate patient selection before performing PCI in patients with chronic coronary syndrome and history of TAVR.

Aims: Approximately two-thirds of obesity-related mortality is attributable to cardiovascular disease (CVD). The aim of this analysis is to examine predicted CVD risk reduction following weight loss in persons with obesity for primary prevention between tirzepatide and semaglutide, and projected CVD events that could be potentially prevented in the USA.

Methods and results: SURMOUNT-5 was a Phase 3b, open-label, randomized trial conducted in participants with obesity and without Type-2 diabetes, comparing tirzepatide (10 or 15 mg) with semaglutide (1.7 or 2.4 mg) and administered via weekly subcutaneous injection. Predicted 10-year CVD risks were compared between treatments at baseline and up to 72 weeks post-treatment among participants without prior CVD. The impact of cardiovascular risk reduction was estimated as the projected preventable CVD events over 10 years for tirzepatide and semaglutide in the USA. The average predicted 10-year CVD risk score before treatment was 9.3%. Treatment with tirzepatide was associated with significantly greater reduction in predicted 10-year CVD risk compared with semaglutide (absolute reduction from baseline of 2.4% and 1.4%, respectively, P < 0.001). Translating risk reduction to the US population who met treatment eligibility criteria and without prior CVD (∼85 million), an estimated 2 million CVD events could be potentially prevented over 10 years after 72 weeks of tirzepatide treatment, vs. 1.15 million with semaglutide.

Conclusion: In SURMOUNT-5, treatment with tirzepatide was associated with greater predicted 10-year CVD risk reduction compared with semaglutide. This post hoc analysis suggests tirzepatide treatment may provide greater benefit in primary prevention of CVD than semaglutide in people with obesity and overweight.

Registration: ClinicalTrials.gov: NCT05822830.

Aims: Abdominal aortic calcification (AAC) is a marker of systemic atherosclerosis associated with adverse cardiovascular (CV) outcomes in the general population. This study aimed to evaluate the association of AAC with all-cause and CV mortality in cancer survivors.

Methods and results: Using 7 years of data from the National Health and Nutrition Examination Survey (NHANES, 2013-2019), we analysed a nationally representative cohort of US cancer survivors. AAC burden was quantified using the Kauppila AAC-24 scores on dual-energy X-ray absorptiometry (DXA) scans. Kaplan-Meier curves and multivariable Cox models were used to assess the associations between AAC and all-cause mortality, while Fine and Gray models assessed associations between AAC and CV mortality, accounting for non-CV mortality as a competing risk. A total of 23 126 424 cancer survivors (aged ≥40 years) were analysed, recording 4 199 131 (114 unweighted) all-cause deaths and 1 160 618 (34 unweighted) CV deaths over a 69-month median follow-up. AAC was present in 46%, with 19.5% of the cohort showing severe AAC (AAC-24 > 6). Each one-unit increase in AAC-24 score was associated with higher risks of all-cause mortality and CV mortality [adjusted hazard ratio, 95% confidence interval of 1.04 (1.00-1.09) and subdistribution hazard ratio 1.07 (1.02-1.12); P = 0.047 and P = 0.002, respectively] after adjustment for demographic, socioeconomic, traditional CV risk factors, baseline comorbidities, and cancer-specific characteristics.

Conclusion: AAC detected on DXA scans is independently associated with increased all-cause and CV mortality in cancer survivors aged 40 years and older. DXA-based AAC assessment may serve as a valuable tool for risk stratification in cardio-oncology.

Aims: Patients with bicuspid aortic valve (BAV) stenosis were excluded from major TAVR trials, and data comparing TAVR and SAVR in this population remain limited. To compare real-world, risk-adjusted outcomes of TAVR vs. SAVR in patients with BAV stenosis.

Methods and results: We conducted a retrospective cohort analysis using the TriNetX research network database. Adults (≥18 years) with echocardiographically confirmed BAV stenosis undergoing isolated TAVR or SAVR from 2012 to 2022 were included. Patients with prior cardiac procedures or concomitant cardiac interventions were excluded. Propensity score matching (PSM) (1:1) was used to balance covariates. Primary outcomes were 2-year all-cause mortality, stroke, and valve re-intervention. Secondary outcomes included new pacemaker implantation (PPM), 30-day AKI, and bleeding. 5547 patients (TAVR: 1444; SAVR: 4103) were included. In unadjusted analysis, TAVR patients were sicker and older at baseline and had a higher risk of death and/or stroke compared with those who underwent SAVR (10.9% vs. 5.37%, P < 0.0001). Following PSM, 663 matched pairs were analyzed with all covariates balanced. At 2 years, all-cause mortality (TAVR: 4.8% vs. SAVR: 5.3%; OR: 0.91, P = 0.71) and stroke (TAVR: 7.3% vs. SAVR: 4.5%; OR: 1.67, P = 0.058) were similar between the two groups. Re-intervention rates were low and comparable. TAVR was associated with higher PPM rates but lower AKI and bleeding rates.

Conclusion: In propensity-matched BAV patients, TAVR and SAVR demonstrated comparable 2-year mortality, stroke, and re-intervention rates. These findings support TAVR as a viable option in appropriately selected BAV patients, warranting further prospective validation.

Aims: Cancer survivors are at increased cardiovascular risk due to shared risk factors and treatment-related toxicity. The recently proposed cardiovascular-kidney-metabolic (CKM) syndrome framework provides a novel approach for cardiometabolic risk stratification, but its prognostic value in cancer patients remains unclear. In this study, we aimed to evaluate the association between CKM stages and cardiovascular outcomes in cancer patients using a large-scale nationwide dataset.

Methods and results: We conducted a retrospective cohort study of 76 111 cancer patients without prior CVD from the DeSC database (2014-2023). Participants were classified into CKM stages (0-3) at baseline, with Stage 4 defined as the composite outcome of myocardial infarction, heart failure, atrial fibrillation, stroke, or peripheral artery disease. Multivariable Cox proportional hazards models were used to assess the risk of progression to Stage 4. Over a median follow-up of 2.6 years, advancing CKM stages were associated with a graded increase in cardiovascular disease (CVD) risk. Compared to Stage 0-1 (reference), adjusted hazard ratios for Stage 4 were 1.23 (95% confidence interval: 1.13-1.33) for Stage 2 and 1.47 (1.36-1.60) for Stage 3. Sensitivity analyses confirmed consistent associations across different groups stratified by age, sex, chemotherapy history, and cancer types. Furthermore, sensitivity analyses using alternative risk prediction models or expanded CVD definitions yielded similar results.

Conclusion: The CKM staging system effectively stratifies cardiovascular risk in cancer patients, with higher stages predicting significantly worse outcomes. These findings advocate for integrating CKM assessment into onco-cardiologic practice to guide early intervention and improve patient outcomes.

Aims: Intravenous tolvaptan sodium phosphate (IV-tolvaptan) is a novel aquaretic agent for acute decompensated heart failure (ADHF). This study evaluated its short-term effects and prognostic implications in clinical practice.

Methods and results: In this retrospective cohort of 169 consecutive ADHF patients receiving IV-tolvaptan for the first time (mean age 76.0 ± 12.7 years; 50.9% female), we measured hourly urine output over 6 h and assessed clinical and biochemical parameters at baseline and 24 h post-dose. The primary endpoint was a composite of all-cause mortality and heart failure rehospitalization. At 24 h, IV-tolvaptan significantly reduced body weight (mean difference: -1.1 ± 2.3 kg, P < 0.001), NT-proBNP (median change: -1704 pg/mL; P < 0.001), and urinary osmolality (mean change: -71.4 ± 169.4 mOsm/kg; P = 0.015), while raising serum sodium (mean change: 1.7 ± 2.9 mEq/L; P < 0.001). Six-hour urine output correlated with baseline estimated glomerular filtration rate (eGFR) (r = 0.34; P < 0.001), urinary osmolality (r = 0.28; P = 0.003), and the change in serum sodium (r = 0.21; P = 0.005). In multivariable logistic regression, renal impairment (eGFR < 60 mL/min/1.73m²) [odds ratio (OR) 0.2; 95% confidence interval (CI) 0.1-0.4; P < 0.001] and higher furosemide doses (>20 mg) (OR 0.3; 95% CI 0.2-0.6; P = 0.01) predicted reduced responsiveness, whereas first hospitalization (OR 2.2; 95% CI 1.1-4.5; P = 0.04) and high urinary osmolality (OR 2.3; 95% CI 1.0-5.4; P = 0.05) predicted favourable response. Kaplan-Meier analysis demonstrated a lower incidence of the primary endpoint in patients achieving ≥ 1000 mL urine output (log-rank P = 0.032).

Conclusion: Intravenous tolvaptan sodium phosphate enhances decongestion and short-term outcomes in ADHF without worsening renal function. Early diuretic responsiveness is a robust prognostic marker.