Pub Date : 2024-02-22eCollection Date: 2024-01-01DOI: 10.1093/ehjopen/oeae008
Magnus Bäck, Maciej Banach, Frieder Braunschweig, Salvatore De Rosa, Frank A Flachskampf, Thomas Kahan, Daniel F J Ketelhuth, Patrizio Lancellotti, Susanna C Larsson, Linda Mellbin, Edit Nagy, Gianluigi Savarese, Karolina Szummer, Denis Wahl
{"title":"Editors' highlight picks from 2023 in <i>EHJ Open</i>.","authors":"Magnus Bäck, Maciej Banach, Frieder Braunschweig, Salvatore De Rosa, Frank A Flachskampf, Thomas Kahan, Daniel F J Ketelhuth, Patrizio Lancellotti, Susanna C Larsson, Linda Mellbin, Edit Nagy, Gianluigi Savarese, Karolina Szummer, Denis Wahl","doi":"10.1093/ehjopen/oeae008","DOIUrl":"10.1093/ehjopen/oeae008","url":null,"abstract":"","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 1","pages":"oeae008"},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10882979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Contemporary medical practices allow complete percutaneous coronary intervention (PCI) in a considerable number of patients who previously would have been considered too “high-risk” for such procedures. Use of mechanical circulatory support (MCS) devices during these high-risk PCIs (HR-PCIs) is thought to reduce the potential risk for major adverse events during and after revascularization. The Intra-aortic balloon pump (IABP), veno-arterial extracorporal membrane oxygenation (V-A ECMO), and the Impella are the most common MCS devices in use. This review aims to summarize the clinical evidence for each of these devices and the potential mechanisms for the improvement in patient outcomes in HR-PCI. IABP use has rapidly declined in recent years due to no evidence of benefit in HR-PCI and cardiogenic shock. V-A ECMO results in low rates of major adverse cardiac and cerebrovascular events (MACCEs) but higher rates of acute kidney injury and increased need for transfusions. In initial studies, Impella resulted in a reduced need for repeat interventions and reduced rates of hypotension, but no benefit in mortality. However, MACCE rates with Impella have gradually declined over the last ten years, reflecting increased operator experience and technical improvements. Thus, a large, randomized trial is needed to assess the efficacy of Impella in HR-PCI with contemporary standards of care. There is currently no individual parameter that can identify patients who would benefit from MCS use in elective HR-PCI. To address this gap, we propose an algorithm that combines anatomical complexity, co-morbidities, and clinical presentation to accurately identify candidates for MCS-assisted HR-PCI.
{"title":"The use of mechanical circulatory support in elective high-risk percutaneous coronary interventions: A literature-based review","authors":"Alexander Geppert, K. Mashayekhi, K. Huber","doi":"10.1093/ehjopen/oeae007","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae007","url":null,"abstract":"\u0000 Contemporary medical practices allow complete percutaneous coronary intervention (PCI) in a considerable number of patients who previously would have been considered too “high-risk” for such procedures. Use of mechanical circulatory support (MCS) devices during these high-risk PCIs (HR-PCIs) is thought to reduce the potential risk for major adverse events during and after revascularization. The Intra-aortic balloon pump (IABP), veno-arterial extracorporal membrane oxygenation (V-A ECMO), and the Impella are the most common MCS devices in use. This review aims to summarize the clinical evidence for each of these devices and the potential mechanisms for the improvement in patient outcomes in HR-PCI. IABP use has rapidly declined in recent years due to no evidence of benefit in HR-PCI and cardiogenic shock. V-A ECMO results in low rates of major adverse cardiac and cerebrovascular events (MACCEs) but higher rates of acute kidney injury and increased need for transfusions. In initial studies, Impella resulted in a reduced need for repeat interventions and reduced rates of hypotension, but no benefit in mortality. However, MACCE rates with Impella have gradually declined over the last ten years, reflecting increased operator experience and technical improvements. Thus, a large, randomized trial is needed to assess the efficacy of Impella in HR-PCI with contemporary standards of care. There is currently no individual parameter that can identify patients who would benefit from MCS use in elective HR-PCI. To address this gap, we propose an algorithm that combines anatomical complexity, co-morbidities, and clinical presentation to accurately identify candidates for MCS-assisted HR-PCI.","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139848295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Contemporary medical practices allow complete percutaneous coronary intervention (PCI) in a considerable number of patients who previously would have been considered too “high-risk” for such procedures. Use of mechanical circulatory support (MCS) devices during these high-risk PCIs (HR-PCIs) is thought to reduce the potential risk for major adverse events during and after revascularization. The Intra-aortic balloon pump (IABP), veno-arterial extracorporal membrane oxygenation (V-A ECMO), and the Impella are the most common MCS devices in use. This review aims to summarize the clinical evidence for each of these devices and the potential mechanisms for the improvement in patient outcomes in HR-PCI. IABP use has rapidly declined in recent years due to no evidence of benefit in HR-PCI and cardiogenic shock. V-A ECMO results in low rates of major adverse cardiac and cerebrovascular events (MACCEs) but higher rates of acute kidney injury and increased need for transfusions. In initial studies, Impella resulted in a reduced need for repeat interventions and reduced rates of hypotension, but no benefit in mortality. However, MACCE rates with Impella have gradually declined over the last ten years, reflecting increased operator experience and technical improvements. Thus, a large, randomized trial is needed to assess the efficacy of Impella in HR-PCI with contemporary standards of care. There is currently no individual parameter that can identify patients who would benefit from MCS use in elective HR-PCI. To address this gap, we propose an algorithm that combines anatomical complexity, co-morbidities, and clinical presentation to accurately identify candidates for MCS-assisted HR-PCI.
{"title":"The use of mechanical circulatory support in elective high-risk percutaneous coronary interventions: A literature-based review","authors":"Alexander Geppert, K. Mashayekhi, K. Huber","doi":"10.1093/ehjopen/oeae007","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae007","url":null,"abstract":"\u0000 Contemporary medical practices allow complete percutaneous coronary intervention (PCI) in a considerable number of patients who previously would have been considered too “high-risk” for such procedures. Use of mechanical circulatory support (MCS) devices during these high-risk PCIs (HR-PCIs) is thought to reduce the potential risk for major adverse events during and after revascularization. The Intra-aortic balloon pump (IABP), veno-arterial extracorporal membrane oxygenation (V-A ECMO), and the Impella are the most common MCS devices in use. This review aims to summarize the clinical evidence for each of these devices and the potential mechanisms for the improvement in patient outcomes in HR-PCI. IABP use has rapidly declined in recent years due to no evidence of benefit in HR-PCI and cardiogenic shock. V-A ECMO results in low rates of major adverse cardiac and cerebrovascular events (MACCEs) but higher rates of acute kidney injury and increased need for transfusions. In initial studies, Impella resulted in a reduced need for repeat interventions and reduced rates of hypotension, but no benefit in mortality. However, MACCE rates with Impella have gradually declined over the last ten years, reflecting increased operator experience and technical improvements. Thus, a large, randomized trial is needed to assess the efficacy of Impella in HR-PCI with contemporary standards of care. There is currently no individual parameter that can identify patients who would benefit from MCS use in elective HR-PCI. To address this gap, we propose an algorithm that combines anatomical complexity, co-morbidities, and clinical presentation to accurately identify candidates for MCS-assisted HR-PCI.","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":" 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139788709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"How to manage ventricular arrhythmia in patients with viral myocarditis","authors":"Naoya Kataoka, T. Imamura","doi":"10.1093/ehjopen/oeae005","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae005","url":null,"abstract":"","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"13 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139803547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"How to manage ventricular arrhythmia in patients with viral myocarditis","authors":"Naoya Kataoka, T. Imamura","doi":"10.1093/ehjopen/oeae005","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae005","url":null,"abstract":"","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"12 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139863531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Paddock, James Meng, Nicholas Johnson, Rahul Chattopadhyay, V. Tsampasian, V. Vassiliou
Cardiogenic shock remains the leading cause of death in patients hospitalised with acute myocardial infarction. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in the treatment of infarct-related cardiogenic shock. However, there is limited evidence regarding its beneficial impact on mortality. To systematically review studies reporting the impact of VA-ECMO on mortality in patients with acute myocardial infarction complicated by cardiogenic shock. Comprehensive search of medical databases (Cochrane Register, PubMed) was conducted. Studies that reported mortality outcomes in patients treated with VA-ECMO for infarct-related cardiogenic shock were included. The database search yielded 1194 results, of which 11 studies were included in the systematic review. Four of these studies, with a total of 586 patients, were randomised-controlled trials and were included in the meta-analysis. This demonstrated that there was no significant difference in 30-day all-cause mortality with the use of VA-ECMO compared to standard medical therapy (OR 0.91; 95% confidence interval (CI) 0.65-1.27). Meta-analysis of two studies showed that VA-ECMO was associated with a significant reduction in 12-month all-cause mortality (OR 0.31, CI 0.11-0.86). Qualitative synthesis of the observational studies showed that age, serum creatinine, serum lactate and successful revascularisation are independent predictors of mortality. VA-ECMO does not improve 30-day all-cause mortality in patients with cardiogenic shock following acute myocardial infarction, however there may be significant reduction in all-cause mortality at 12 months. Further studies are needed to delineate the potential benefit of VA-ECMO in long-term outcomes. The protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (ID: CRD42023461740).
{"title":"The impact of extracorporeal membrane oxygenation on mortality in patients with cardiogenic shock post acute myocardial infarction: a systematic review and meta-analysis","authors":"S. Paddock, James Meng, Nicholas Johnson, Rahul Chattopadhyay, V. Tsampasian, V. Vassiliou","doi":"10.1093/ehjopen/oeae003","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae003","url":null,"abstract":"\u0000 \u0000 \u0000 Cardiogenic shock remains the leading cause of death in patients hospitalised with acute myocardial infarction. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in the treatment of infarct-related cardiogenic shock. However, there is limited evidence regarding its beneficial impact on mortality.\u0000 \u0000 \u0000 \u0000 To systematically review studies reporting the impact of VA-ECMO on mortality in patients with acute myocardial infarction complicated by cardiogenic shock.\u0000 \u0000 \u0000 \u0000 Comprehensive search of medical databases (Cochrane Register, PubMed) was conducted. Studies that reported mortality outcomes in patients treated with VA-ECMO for infarct-related cardiogenic shock were included.\u0000 \u0000 \u0000 \u0000 The database search yielded 1194 results, of which 11 studies were included in the systematic review. Four of these studies, with a total of 586 patients, were randomised-controlled trials and were included in the meta-analysis. This demonstrated that there was no significant difference in 30-day all-cause mortality with the use of VA-ECMO compared to standard medical therapy (OR 0.91; 95% confidence interval (CI) 0.65-1.27). Meta-analysis of two studies showed that VA-ECMO was associated with a significant reduction in 12-month all-cause mortality (OR 0.31, CI 0.11-0.86). Qualitative synthesis of the observational studies showed that age, serum creatinine, serum lactate and successful revascularisation are independent predictors of mortality.\u0000 \u0000 \u0000 \u0000 VA-ECMO does not improve 30-day all-cause mortality in patients with cardiogenic shock following acute myocardial infarction, however there may be significant reduction in all-cause mortality at 12 months. Further studies are needed to delineate the potential benefit of VA-ECMO in long-term outcomes.\u0000 \u0000 \u0000 \u0000 The protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (ID: CRD42023461740).\u0000","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"76 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139526517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-16eCollection Date: 2024-01-01DOI: 10.1093/ehjopen/oead137
[This corrects the article DOI: 10.1093/ehjopen/oeac008.][This corrects the article DOI: 10.1093/ehjopen/oeab044.][This corrects the article DOI: 10.1093/ehjopen/oeab014.][This corrects the article DOI: 10.1093/ehjopen/oeab022.][This corrects the article DOI: 10.1093/ehjopen/oeab023.][This corrects the article DOI: 10.1093/ehjopen/oeac054.][This corrects the article DOI: 10.1093/ehjopen/oeab002.][This corrects the article DOI: 10.1093/ehjopen/oeab006.][This corrects the article DOI: 10.1093/ehjopen/oeab013.][This corrects the article DOI: 10.1093/ehjopen/oeac001.][This corrects the article DOI: 10.1093/ehjopen/oeac005.].
][此处更正文章 DOI：10.1093/ehjopen/eoac008。][此处更正文章 DOI：10.1093/ehjopen/eoab044。][此处更正文章 DOI：10.1093/ehjopen/eoab014。][此处更正文章 DOI：10.1093/ehjopen/eoab022。][此处更正文章 DOI：10.1093/ehjopen/eoab023。][此处更正文章 DOI：10.1093/ehjopen/oeac054.][This corrects the article DOI: 10.1093/ehjopen/oeab002.][This corrects the article DOI: 10.1093/ehjopen/oeab006.][This corrects the article DOI: 10.1093/ehjopen/oeab013.][This corrects the article DOI: 10.1093/ehjopen/oeac001.][This corrects the article DOI: 10.1093/ehjopen/oeac005.].
{"title":"Corrigendum to articles in EHJ Open missing data availability statements.","authors":"","doi":"10.1093/ehjopen/oead137","DOIUrl":"https://doi.org/10.1093/ehjopen/oead137","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1093/ehjopen/oeac008.][This corrects the article DOI: 10.1093/ehjopen/oeab044.][This corrects the article DOI: 10.1093/ehjopen/oeab014.][This corrects the article DOI: 10.1093/ehjopen/oeab022.][This corrects the article DOI: 10.1093/ehjopen/oeab023.][This corrects the article DOI: 10.1093/ehjopen/oeac054.][This corrects the article DOI: 10.1093/ehjopen/oeab002.][This corrects the article DOI: 10.1093/ehjopen/oeab006.][This corrects the article DOI: 10.1093/ehjopen/oeab013.][This corrects the article DOI: 10.1093/ehjopen/oeac001.][This corrects the article DOI: 10.1093/ehjopen/oeac005.].</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 1","pages":"oead137"},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10791141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139479719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aims: Revascularization guided by functional severity has presented improved outcomes compared with visual angiographic guidance. Quantitative flow ratio (QFR) is a reliable angiography-based method for functional assessment. We sought to investigate the prognostic value of discordance between QFR and visual estimation in coronary revascularization guidance.
Methods and results: We performed offline QFR analysis on all-comers undergoing coronary angiography. Vessels with calculated QFR were divided into four groups based on the decision to perform or defer percutaneous coronary intervention (PCI) and on the QFR result, i.e.: Group A (PCI-, QFR > 0.8); Group B (PCI+, QFR ≤ 0.8); Group C (PCI+, QFR > 0.8); Group D (PCI-, QFR ≤ 0.8). Patients with at least one vessel falling within the disagreement groups formed the discordance group, whereas the remaining patients formed the concordance group. The primary endpoint was the composite endpoint of cardiovascular death, myocardial infarction, and ischaemia-driven revascularization. Overall, 546 patients were included in the study. Discordance between QFR and visual estimation was found in 26.2% of patients. After a median follow-up period of 2.5 years, the discordance group had a significantly higher rate of the composite outcome (hazard ratio: 3.34, 95% confidence interval 1.99-5.60, P < 0.001). Both disagreement vessel Groups C and D were associated with increased cardiovascular risk compared with agreement Groups A and B.
Conclusion: Discordance between QFR and visual estimation in revascularization guidance was associated with a worse long-term prognosis. Our results highlight the importance of proper patient selection for intervention and the need to avoid improper stent implantations when not dictated by a comprehensive functional assessment.
{"title":"Prognostic role of discordance between quantitative flow ratio and visual estimation in revascularization guidance.","authors":"Dimitrios Terentes-Printzios, Dimitrios Oikonomou, Konstantia-Paraskevi Gkini, Vasiliki Gardikioti, Konstantinos Aznaouridis, Ioanna Dima, Konstantinos Tsioufis, Charalambos Vlachopoulos","doi":"10.1093/ehjopen/oead125","DOIUrl":"10.1093/ehjopen/oead125","url":null,"abstract":"<p><strong>Aims: </strong>Revascularization guided by functional severity has presented improved outcomes compared with visual angiographic guidance. Quantitative flow ratio (QFR) is a reliable angiography-based method for functional assessment. We sought to investigate the prognostic value of discordance between QFR and visual estimation in coronary revascularization guidance.</p><p><strong>Methods and results: </strong>We performed offline QFR analysis on all-comers undergoing coronary angiography. Vessels with calculated QFR were divided into four groups based on the decision to perform or defer percutaneous coronary intervention (PCI) and on the QFR result, i.e.: Group A (PCI-, QFR > 0.8); Group B (PCI+, QFR ≤ 0.8); Group C (PCI+, QFR > 0.8); Group D (PCI-, QFR ≤ 0.8). Patients with at least one vessel falling within the disagreement groups formed the discordance group, whereas the remaining patients formed the concordance group. The primary endpoint was the composite endpoint of cardiovascular death, myocardial infarction, and ischaemia-driven revascularization. Overall, 546 patients were included in the study. Discordance between QFR and visual estimation was found in 26.2% of patients. After a median follow-up period of 2.5 years, the discordance group had a significantly higher rate of the composite outcome (hazard ratio: 3.34, 95% confidence interval 1.99-5.60, <i>P</i> < 0.001). Both disagreement vessel Groups C and D were associated with increased cardiovascular risk compared with agreement Groups A and B.</p><p><strong>Conclusion: </strong>Discordance between QFR and visual estimation in revascularization guidance was associated with a worse long-term prognosis. Our results highlight the importance of proper patient selection for intervention and the need to avoid improper stent implantations when not dictated by a comprehensive functional assessment.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 1","pages":"oead125"},"PeriodicalIF":0.0,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10763540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139089731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Kusunose, Takumasa Tsuji, Y. Hirata, Tomonori Takahashi, Masataka Sata, Kimi Sato, Noor K Albakaa, Tomoko Ishizu, Jun’ichi Kotoku, Yoshihiro Seo
The aim of this study was to identify phenotypes with potential prognostic significance in aortic stenosis (AS) patients post-transcatheter aortic valve replacement (TAVR) through a clustering approach. This multicenter retrospective study included 1,365 patients with severe AS who underwent TAVR between January 2015 and March 2019. Among demographics, laboratory, and echocardiography parameters, 20 variables were selected through dimension reduction and used for unsupervised clustering. Phenotypes and outcomes were compared between clusters. Patients were randomly divided into a derivation cohort (n = 1092: 80%) and a validation cohort (n = 273: 20%). Three clusters with markedly different features were identified. Cluster 1 was associated predominantly with elderly age, a high aortic valve gradient, and left ventricular (LV) hypertrophy; cluster 2 consisted of preserved LV ejection fraction, larger aortic valve area, and high blood pressure; and cluster 3 demonstrated tachycardia and low flow/low gradient AS. Adverse outcomes differed significantly among clusters during a median of 2.2 years of follow-up (P<0.001). After adjustment for clinical and echocardiographic data in a Cox proportional-hazards model, cluster 3 (hazard ratio, 4.18; 95% CI, 1.76-9.94; P=0.001) was associated with increased risk of adverse outcomes. In sequential Cox models, a model based on clinical data and echocardiographic variables (χ2, 18.4) was improved by cluster 3 (χ2, 31.5; P=0.001) in the validation cohort. Unsupervised cluster analysis of patients after TAVR revealed 3 different groups for assessment of prognosis. This provides a new perspective in the categorization of patients after TAVR that considers comorbidities and extravalvular cardiac dysfunction.
{"title":"Unsupervised Cluster Analysis Reveals Different Phenotypes in Patients after Transcatheter Aortic Valve Replacement","authors":"K. Kusunose, Takumasa Tsuji, Y. Hirata, Tomonori Takahashi, Masataka Sata, Kimi Sato, Noor K Albakaa, Tomoko Ishizu, Jun’ichi Kotoku, Yoshihiro Seo","doi":"10.1093/ehjopen/oead136","DOIUrl":"https://doi.org/10.1093/ehjopen/oead136","url":null,"abstract":"\u0000 \u0000 \u0000 The aim of this study was to identify phenotypes with potential prognostic significance in aortic stenosis (AS) patients post-transcatheter aortic valve replacement (TAVR) through a clustering approach.\u0000 \u0000 \u0000 \u0000 This multicenter retrospective study included 1,365 patients with severe AS who underwent TAVR between January 2015 and March 2019. Among demographics, laboratory, and echocardiography parameters, 20 variables were selected through dimension reduction and used for unsupervised clustering. Phenotypes and outcomes were compared between clusters. Patients were randomly divided into a derivation cohort (n = 1092: 80%) and a validation cohort (n = 273: 20%). Three clusters with markedly different features were identified. Cluster 1 was associated predominantly with elderly age, a high aortic valve gradient, and left ventricular (LV) hypertrophy; cluster 2 consisted of preserved LV ejection fraction, larger aortic valve area, and high blood pressure; and cluster 3 demonstrated tachycardia and low flow/low gradient AS. Adverse outcomes differed significantly among clusters during a median of 2.2 years of follow-up (P<0.001). After adjustment for clinical and echocardiographic data in a Cox proportional-hazards model, cluster 3 (hazard ratio, 4.18; 95% CI, 1.76-9.94; P=0.001) was associated with increased risk of adverse outcomes. In sequential Cox models, a model based on clinical data and echocardiographic variables (χ2, 18.4) was improved by cluster 3 (χ2, 31.5; P=0.001) in the validation cohort.\u0000 \u0000 \u0000 \u0000 Unsupervised cluster analysis of patients after TAVR revealed 3 different groups for assessment of prognosis. This provides a new perspective in the categorization of patients after TAVR that considers comorbidities and extravalvular cardiac dysfunction.\u0000","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"98 32","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138994389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Swati Mittal, Maki Komiyama, Yuka Ozaki, H. Yamakage, N. Satoh‐Asahara, H. Wada, Akihiro Yasoda, Masafumi Funamoto, Y. Katanasaka, Yoichi Sunagawa, T. Morimoto, M. Akao, M. Abe, Yuko Takahashi, Takeo Nakayama, K. Hasegawa
Initiating smoking in early adolescence results in challenges with smoking cessation and is associated with high risk of cardiovascular disease. Recently, the initiation of smoking has transitioned from adolescence to young adulthood. However, there are few reports on the impact of initiating smoking at a later age. This study investigated the impact of the age of smoking initiation on nicotine dependency, smoking cessation rates, and cardiovascular risk factors, using a cutoff point of 20 years, within the Japanese population. This retrospective cohort study encompassed 1,382 smokers who sought smoking cessation treatment at Kyoto Medical Centre Hospital between 2007 and 2019. Clinical indicators were evaluated by adjusting for age at the time of hospital visit and sex. The smoking cessation rate was further adjusted for treatment medication. The group with a smoking initiation age of <20 years reported a higher number of cigarettes/day (p = 0.002), higher respiratory carbon monoxide levels (p < 0.001), a higher Fagerström test for nicotine Dependence (FTND) score (p < 0.001), and a higher self-rating depression scale score (p = 0.014). They also reported lower diastolic blood pressure (p = 0.020) and a lower successful smoking cessation rate (OR:0.736 95% CI (0.569, 0.951)) than the group with a smoking initiation age of ≥20 years. When smokers were divided into four groups based on the age they started smoking, the FTND score for those who started at 20–21 years was significantly higher than the score for those who started at 22 years or older. In young adulthood, initiating smoking later (beyond 20 years old) was associated with lower nicotine dependency and fewer depressive tendencies, as well as a higher success rate in smoking cessation among Japanese smokers. The results might suggest that raising the legal smoking initiation age from 20 to 22 years old or older could be effective in reducing nicotine dependency in smokers.
{"title":"Impact of Smoking Initiation age on Nicotine Dependency and Cardiovascular Risk Factors: A Retrospective Cohort Study in Japan","authors":"Swati Mittal, Maki Komiyama, Yuka Ozaki, H. Yamakage, N. Satoh‐Asahara, H. Wada, Akihiro Yasoda, Masafumi Funamoto, Y. Katanasaka, Yoichi Sunagawa, T. Morimoto, M. Akao, M. Abe, Yuko Takahashi, Takeo Nakayama, K. Hasegawa","doi":"10.1093/ehjopen/oead135","DOIUrl":"https://doi.org/10.1093/ehjopen/oead135","url":null,"abstract":"\u0000 \u0000 \u0000 Initiating smoking in early adolescence results in challenges with smoking cessation and is associated with high risk of cardiovascular disease. Recently, the initiation of smoking has transitioned from adolescence to young adulthood. However, there are few reports on the impact of initiating smoking at a later age. This study investigated the impact of the age of smoking initiation on nicotine dependency, smoking cessation rates, and cardiovascular risk factors, using a cutoff point of 20 years, within the Japanese population.\u0000 \u0000 \u0000 \u0000 This retrospective cohort study encompassed 1,382 smokers who sought smoking cessation treatment at Kyoto Medical Centre Hospital between 2007 and 2019. Clinical indicators were evaluated by adjusting for age at the time of hospital visit and sex. The smoking cessation rate was further adjusted for treatment medication.\u0000 \u0000 \u0000 \u0000 The group with a smoking initiation age of <20 years reported a higher number of cigarettes/day (p = 0.002), higher respiratory carbon monoxide levels (p < 0.001), a higher Fagerström test for nicotine Dependence (FTND) score (p < 0.001), and a higher self-rating depression scale score (p = 0.014). They also reported lower diastolic blood pressure (p = 0.020) and a lower successful smoking cessation rate (OR:0.736 95% CI (0.569, 0.951)) than the group with a smoking initiation age of ≥20 years. When smokers were divided into four groups based on the age they started smoking, the FTND score for those who started at 20–21 years was significantly higher than the score for those who started at 22 years or older.\u0000 \u0000 \u0000 \u0000 In young adulthood, initiating smoking later (beyond 20 years old) was associated with lower nicotine dependency and fewer depressive tendencies, as well as a higher success rate in smoking cessation among Japanese smokers. The results might suggest that raising the legal smoking initiation age from 20 to 22 years old or older could be effective in reducing nicotine dependency in smokers.\u0000","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"18 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138955179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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