European heart journal open最新文献

Graphical Abstract.

Aims: Mortality from cardiogenic shock complicating acute myocardial infarction (AMI-CS) remains high, despite the increasing mechanical circulatory support (MCS) use in clinical practice.

Methods and results: We undertook a systematic review and meta-analysis of trials assessing MCS in adults with AMI-CS. We searched Medline, EMBASE, CENTRAL, Web of Science, and Scopus from inception to May 2024. We evaluated the effect of each intervention on early mortality using a random-effects network meta-analysis of odds ratios (ORs). Safety outcomes included stroke, bleeding, and sepsis. Fourteen trials randomizing 1858 patients were included: intra-aortic balloon pump (IABP) vs. medical therapy (four trials, n = 748 patients), veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) vs. No VA-ECMO (four trials, n = 568 patients), percutaneous ventricular assist device (pVAD) vs. No pVAD (six trials, n = 542 patients). No MCS device showed a significant effect on early mortality vs. initial medical therapy {IABP (OR 0.87, 95% CI 0.66-1.15), VA-ECMO (OR 0.91, 95% CI 0.65-1.27), pVAD (OR 0.80, 95% CI 0.56-1.14), and P (inconsistency) = 0.76}. VA-ECMO and pVAD were associated with increased major bleeding [OR 2.81 (95% CI 1.68-4.71) and OR 5.13 (95% CI 1.87-14.04), respectively]. Higher rates of stroke and sepsis were noted with pVAD. No significant safety concerns were identified with IABP.

Conclusion: The mortality benefit of MCS devices in AMI-CS remains uncertain. Using such devices may be associated with increased risks, including major bleeding, stroke, and sepsis. Current evidence does not support the routine use of MCS devices in the management of AMI-CS.

Aims: The association between inflammation and atrial fibrillation (AF) is evident, but assessing the specific inflammatory pathways involved in the pathogenesis remains complex. This study aimed to identify inflammatory biomarkers associated with paroxysmal (PAF) and persistent (PeAF) AF by evaluating blood samples from the intra- and extracardiac space.

Methods and results: This is an observational, cross-sectional, single-centre study. A total of 92 inflammatory biomarkers were analyzed from blood samples taken from the coronary sinus (CS) and the femoral vein (FV) in 88 patients with AF who had been referred for catheter ablation at the Linköping University Hospital, Sweden. The concentrations of the biomarkers were compared between PAF and PeAF patients in the CS and FV. Significant differences in concentration were found in 36 of 92 biomarkers. Among these, 12 proteins stand out for exhibiting a higher concentration in PeAF patients: Interleukin 6 (IL-6), CUB domain-containing protein 1 (CDCP1), Interleukin 18 receptor 1 (IL-18R1) and cystatin D (CST5) in the FV, β nerve growth factor (β-NGF) and tissue growth factor α (TGF-α) at the CS level, as well as interleukin 18 (IL-18), chemokine ligand 3 (CCL-3) and tumour necrosis factor superfamily 14 (TNFSF-14) in both FV and CS. Moreover, chemokine ligand 25 (CCL-25), chemokine ligand 28 (CCL-28), and artemin (ARTN) were found at a higher concentration in the CS in the overall population.

Conclusion: This study supports the involvement of TNFSF-14, IL-6, and IL-18 in the pathogenesis and maintenance of PeAF. Furthermore, it identifies β-NGF and TGF-α as potential participants in the pathogenesis and/or maintenance of PeAF locally in the atria. Novel inflammatory biomarkers, mainly chemokines, are also identified as possibly involved in the pathophysiology of AF.

Aims: Whether exercise stress testing (ET) for early identification of coronary artery disease (CAD) should be performed for preparticipation screening (PPS) in all master athletes (MAs) or in high-risk athletes only remains debated. We evaluated the prevalence and characteristics of CAD in MAs who underwent coronary computed tomography angiography (CCTA) after a positive preparticipation ET.

Methods and results: According to Italian law and guidelines, all MAs ≥40 years old must undergo annual ET as part of PPS. We retrospectively enrolled MAs without symptoms, baseline ECG abnormalities or history of heart disease referred to CCTA for ST-segment depression (STD) and/or high-risk premature ventricular beats (PVBs) during ET. We evaluated CAD burden, plaque characteristics, and pericoronary fat attenuation index. Athletes with at-risk PVBs also underwent cardiac magnetic resonance (CMR). We enrolled 130 Caucasian MAs (84% males, median age 54 years): 49 (37%) with high-risk PVBs, and 82 (62%) with STD. Coronary artery disease with ≥50% stenosis was identified in 17 (13%) MAs, including 1 with high-risk plaques, without differences according to CCTA indications (P = 0.83). Age ≥ 60 years and dyslipidemia were independent predictors of ≥50% stenosis, and none of the 45 athletes without risk factors had CAD. Only three athletes eventually required coronary revascularization. Among MAs with PVBs, 20/49 (41%) had abnormal CMR and one cathecolaminergic polymorphic ventricular tachycardia.

Conclusion: In a sample of asymptomatic MAs, STD and PVBs during ET were poor predictors for the presence of significant CAD, strongly influenced by the presence of traditional cardiovascular risk factors. However, ET may have a broader diagnostic value by identifying exercise-induced PVBs, enabling the detection of concealed arrhythmogenic conditions.

Aims: This study aims to examine the association between frailty and cardiac structure and function in hospitalized older adults with preserved ejection fraction, using echocardiographic parameters and the Fried frailty index.

Methods and results: A cross-sectional analytical study was conducted in two referral centres. A total of 269 individuals aged 60 years or older were included. The exclusion criteria were conditions that affect ventricular mechanics. Patients were categorized into non-frail, prefrail, and frail groups. Transthoracic echocardiography included 2D imaging, Doppler, and Global Longitudinal Strain (GLS) of the left ventricle. Comparative analysis was considered statistically significant if P < 0.05. Frailty was significantly associated with diastolic dysfunction, with an adjusted odds ratio of 3.49 (95% CI: 1.90-6.39, P < 0.001). After adjusting for potential confounders-including age, hypertension, diabetes mellitus, coronary heart disease, chronic obstructive pulmonary disease, and chronic kidney disease-frailty remained strongly associated with diastolic dysfunction. In addition, frail patients exhibited distinctive cardiac structural changes, including larger atrial volumes and smaller ventricular volumes. Pulmonary artery systolic pressure and tricuspid regurgitation velocity were also significantly elevated in frail individuals, while GLS of the left ventricle did not differ between groups.

Conclusion: Frailty is independently associated with diastolic dysfunction. Even after adjusting for key comorbidities, it remains strongly associated with significant structural and functional cardiac alterations in hospitalized older adults with preserved ejection fraction.

Acidic calcium stores significantly influence basal calcium transient amplitude and β-adrenergic responses in cardiomyocytes. Atrial myocytes contain atrial granules (AGs), small acidic organelles that store and secrete atrial natriuretic peptide (ANP) and are absent in healthy ventricular myocytes. AGs are known to be acidic and calcium-rich, but their number and location relative to other signalling sites remain unexplored. Labelling of acidic organelles in adult guinea pig cardiomyocytes showed the presence of acidic puncta throughout the cytosol. Atrial myocytes exhibited an increased concentration of acidic organelles at the nuclear poles. Live cell fluorescent studies using 4-phenyl-3-butenoic acid (PBA) to inhibit peptidylglycine α-amidating monooxygenase, a crucial component of AGs membranes, effectively eliminated staining at the nuclear poles and most acidic puncta in atrial cells, but not in ventricular cells. Our immunofluorescent labelling also emphasizes the differences in acidic punctae between atrial and ventricular myocytes by showing minimal co-localization between AG-specific ANP and lysosomal-associated membrane protein. Electron microscopy studies on goat atrial fibrillation (AF) and sham control tissue allowed visualization of AGs. Quantitative analysis revealed that AGs were positioned significantly further away from the nearest sarcoplasmic reticulum and were closer to mitochondria in AF compared to sinus rhythm control tissue. We raise the question whether the positioning of AGs is strategic for communication with other calcium-containing organelles.

Aims: High-frequency low-tidal volume (HFLTV) ventilation may improve catheter stability and enhance procedural success in radiofrequency (RF) catheter ablation of atrial fibrillation (AF). Long-term findings remained unclear.

Methods and results: We conducted a meta-analysis that included all studies that directly compared AF patients who underwent RF ablation under HFLTV compared with standard ventilation. Primary outcomes included acute first-pass pulmonary vein isolation (PVI) and long-term recurrence of AF/atrial arrhythmias after 12 months. Secondary outcomes included total procedure duration, ablation time, and RF time, with pooled standardized mean difference derived using the inverse variance method. Five cohort studies (publication period: 2019-2024) were identified and included in the meta-analysis (final sample: HFLTV n = 460 vs. standard ventilation n = 705). High-frequency low-tidal volume ventilation was significantly associated with lower risk of AF recurrence after 12 months {pooled odds ratio (OR) = 0.62 [95% confidence interval (CI): 0.42-0.92]}, as well as total atrial arrhythmia [OR = 0.59 (95% CI: 0.42-0.81)], with no between-study heterogeneity (I ² = 0%). Acutely, HFLTV was associated with higher probability of first-pass PVI with borderline statistical significance [OR = 1.24 (95% CI: 0.94-1.63)]. Furthermore, HFLTV was associated with significant reductions in total procedure time [-0.71 (95% CI: -1.00 to -0.42), unit in standard deviation], ablation time [-0.83 (95% CI: -1.07 to -0.59)], and total RF time [-0.72 (95% CI: -0.85 to -0.59)] (heterogeneity I ² = 76%). Notably, there was no effect modification by paroxysmal or persistent AF (P > 0.05). All studies reported no major complications in either group.

Conclusion: High-frequency low-tidal volume ventilation is associated with improved long-term success of arrhythmia control in AF patients who undergo RF catheter ablation, regardless of paroxysmal or persistent status.

Aims: We hypothesize that sinus rhythm (SR) maintenance in persistent atrial fibrillation (AF) patients taking anti-arrhythmic drugs (AADs) after pre-procedural electrical cardioversion (ECV) could predict outcomes after catheter ablation procedures.

Methods and results: 219 persistent AF patients on AADs underwent ECV 1-6 months before ablation. Patients were categorized into two groups according to their response to ECV: patients in whom SR was restored and maintained until the ablation procedure (ECV-SR group), and patients with AF recurrence before the procedure (ECV-AF group). Then, 1:1 propensity score matching was used to create study groups (94-94 patients). The efficacy outcomes of the present study were freedom from atrial tachyarrhythmia on/off AADs following a single ablation procedure and recurrence of persistent AF. The median follow-up duration was 42 (20-73) months. Freedom from atrial tachyarrhythmia at 36 months was lower in the ECV-AF group compared to ECV-SR patients (31.4% vs. 51.2%, respectively; crude HR = 2.58, 95% CI = 1.58-3.70, P < 0.001). The most frequent pattern of atrial arrhythmia recurrence was persistent AF in the ECV-AF group and paroxysmal AF in the ECV-SR group. Freedom from persistent AF at 36 months was 54% and 84.3%, respectively (crude HR = 3.72, 95% CI = 1.94-7.14, P < 0.001). Differences in the risk of the efficacy outcomes were similar after multi-variable adjustment and in all analysed subgroups, including pulmonary vein isolation (PVI)-only procedures.

Conclusion: Our findings indicate that the positive response to pre-procedural ECV may be a valuable marker for identifying persistent AF patients in whom a PVI-only strategy is sufficient.

Aims: The study aimed to investigate international trends in the adoption of the radial artery (RA) as a conduit for coronary artery bypass grafting across different national and regional registries.

Methods and results: Data were extracted from four databases: the UK cardiac surgery database, the Ontario provincial administrative database, the Austrian national adult cardiac surgery database, and the Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS ACSD). Radial artery use rates were 4.3% in the UK, 23.3% in Ontario, 4.8% in Austria, and 6.4% in the STS ACSD. Significant uptrends in RA use were observed in Ontario (P = 0.001), Austria (P = 0.004), and the STS ACSD (P = 0.02), while a downtrend was noted in the UK (P = 0.015). Endoscopic RA harvesting was increasingly adopted, particularly in Ontario and the STS ACSD.

Conclusion: Global adoption of RA remains variable and generally low with a general uptrend and higher adoption of endoscopic harvesting.