Heart最新文献

{"title":"Urinary proteomic signature of mineralocorticoid receptor antagonism by spironolactone: evidence from the HOMAGE trial.","authors":"Yu-Ling Yu, Justyna Siwy, De-Wei An, Arantxa González, Tine Hansen, Agnieszka Latosinska, Pierpaolo Pellicori, Susana Ravassa, Beatrice Mariottoni, Job Aj Verdonschot, Fozia Ahmed, Johannes Petutschnigg, Patrick Rossignol, Stephane Heymans, Joe J Cuthbert, Nicolas Girerd, Andrew L Clark, Peter Verhamme, Tim S Nawrot, Stefan Janssens, John G Cleland, Faiez Zannad, Javier Diez, Harald Mischak, João Pedro Ferreira, Jan A Staessen","doi":"10.1136/heartjnl-2023-323796","DOIUrl":"10.1136/heartjnl-2023-323796","url":null,"abstract":"<p><strong>Objective: </strong>Heart failure (HF) is characterised by collagen deposition. Urinary proteomic profiling (UPP) followed by peptide sequencing identifies parental proteins, for over 70% derived from collagens. This study aimed to refine understanding of the antifibrotic action of spironolactone.</p><p><strong>Methods: </strong>In this substudy (n=290) to the Heart 'Omics' in Ageing Study trial, patients were randomised to usual therapy combined or not with spironolactone 25-50 mg/day and followed for 9 months. The analysis included 1498 sequenced urinary peptides detectable in ≥30% of patients and carboxyterminal propeptide of procollagen I (PICP) and PICP/carboxyterminal telopeptide of collagen I (CITP) as serum biomarkers of COL1A1 synthesis. After rank normalisation of biomarker distributions, between-group differences in their changes were assessed by multivariable-adjusted mixed model analysis of variance. Correlations between the changes in urinary peptides and in serum PICP and PICP/CITP were compared between groups using Fisher's Z transform.</p><p><strong>Results: </strong>Multivariable-adjusted between-group differences in the urinary peptides with error 1 rate correction were limited to 27 collagen fragments, of which 16 were upregulated (7 COL1A1 fragments) on spironolactone and 11 downregulated (4 COL1A1 fragments). Over 9 months of follow-up, spironolactone decreased serum PICP from 81 (IQR 66-95) to 75 (61-90) µg/L and PICP/CITP from 22 (17-28) to 18 (13-26), whereas no changes occurred in the control group, resulting in a difference (spironolactone minus control) expressed in standardised units of -0.321 (95% CI 0.0007). Spironolactone did not affect the correlations between changes in urinary COL1A1 fragments and in PICP or the PICP/CITP ratio.</p><p><strong>Conclusions: </strong>Spironolactone decreased serum markers of collagen synthesis and predominantly downregulated urinary collagen-derived peptides, but upregulated others. The interpretation of these opposite UPP trends might be due to shrinking the body-wide pool of collagens, explaining downregulation, while some degree of collagen synthesis must be maintained to sustain vital organ functions, explaining upregulation. Combining urinary and serum fibrosis markers opens new avenues for the understanding of the action of antifibrotic drugs.</p><p><strong>Trial registration number: </strong>NCT02556450.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"1180-1187"},"PeriodicalIF":5.1,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140903537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tirzepatide and blood pressure reduction: stratified analyses of the SURMOUNT-1 randomised controlled trial.","authors":"Harlan M Krumholz, James A de Lemos, Naveed Sattar, Bruno Linetzky, Palash Sharma, Casey J Mast, Nadia N Ahmad, Mathijs C Bunck, Adam Stefanski","doi":"10.1136/heartjnl-2024-324170","DOIUrl":"10.1136/heartjnl-2024-324170","url":null,"abstract":"<p><strong>Background: </strong>Treating obesity may be a pathway to prevent and control hypertension. In the SURMOUNT-1 trial in people with obesity or overweight with weight-related complications, 72-week tirzepatide treatment led to clinically meaningful body weight and blood pressure reduction. Post hoc analyses were conducted to further explore the effects of tirzepatide on the pattern of blood pressure reduction and whether the effects were consistent across various subgroups.</p><p><strong>Methods: </strong>The mixed effect for repeated measure model was used to compare changes in overall blood pressure, across demographic and clinical subgroups, baseline blood pressure subgroups and hypertension categories between SURMOUNT-1 participants randomised to treatment with tirzepatide and placebo. The association between weight changes and blood pressure and adverse events associated with low blood pressure were also evaluated by mediation analysis.</p><p><strong>Results: </strong>Tirzepatide treatment was associated with a rapid decline in systolic and diastolic blood pressure over the first 24 weeks, followed by blood pressure stabilisation until the end of the observation period, resulting in a significant net reduction by 72 weeks of 6.8 mm Hg systolic and 4.2 mm Hg diastolic blood pressure versus placebo. Participants randomly assigned to any tirzepatide group were more likely than those assigned to placebo to have normal blood pressure at week 72 (58.0% vs 35.2%, respectively). The effects were broadly consistent across baseline blood pressure subgroups, shifting the blood pressure distribution curve to lower blood pressure levels. The mediation analysis indicated that weight loss explained 68% of the systolic and 71% of the diastolic blood pressure reduction. Low blood pressure adverse events were infrequent, but the rate was higher in the tirzepatide group.</p><p><strong>Conclusions: </strong>In these post hoc analyses, in participants with obesity or overweight, tirzepatide was associated with reduced blood pressure consistently across participant groups primarily via weight loss, with relatively few blood pressure-related adverse events.</p><p><strong>Trial registration number: </strong>NCT04184622.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"1165-1171"},"PeriodicalIF":5.1,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management strategies and outcomes in pregnancy-related acute aortic dissection: a multicentre cohort study in China","authors":"Hong Liu, Liu Yang, Cui-ying Chen, Si-chong Qian, Lu-yao Ma, Yi-fei Diao, Xiao-yu Wu, Shu-yan Wu, Zhi-qiang Dong, Yong-feng Shao, Hong-jia Zhang, Li-Zhong Sun, Jun-ming Zhu, Jia-rong Zhang, Haiyang Li","doi":"10.1136/heartjnl-2024-324009","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-324009","url":null,"abstract":"Background Acute aortic dissection (AD) in pregnancy poses a lethal risk to both mother and fetus. However, well-established therapeutic guidelines are lacking. This study aimed to investigate clinical features, outcomes and optimal management strategies for pregnancy-related AD. Methods We conducted a retrospective multicentre cohort study including 67 women with acute AD during pregnancy or within 12 weeks postpartum from three major cardiovascular centres in China between 2003 and 2021. Patient characteristics, management strategies and short-term outcomes were analysed. Results Median age was 31 years, with AD onset at median 32 weeks gestation. Forty-six patients (68.7%) had type A AD, of which 41 underwent immediate surgery. Overall maternal mortality was 10.4% (7/67) and fetal mortality was 26.9% (18/67). Compared with immediate surgery, selective surgery was associated with higher risk of composite maternal and fetal death (adjusted RR: 12.47 (95% CI 3.26 to 47.73); p=0.0002) and fetal death (adjusted RR: 8.77 (95% CI 2.33 to 33.09); p=0.001). Conclusions Immediate aortic surgery should be considered for type A AD at any stage of pregnancy or postpartum. For pregnant women with AD before fetal viability, surgical treatment with the fetus in utero should be considered. Management strategies should account for dissection type, gestational age, and fetal viability. Trial registration number [NCT05501145][1]. All data relevant to the study are included in the article or uploaded as supplementary information. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05501145&atom=%2Fheartjnl%2Fearly%2F2024%2F09%2F12%2Fheartjnl-2024-324009.atom","PeriodicalId":12835,"journal":{"name":"Heart","volume":"23 1","pages":""},"PeriodicalIF":5.7,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142194809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting future atrial fibrillation: risk factors, proteomics and beyond","authors":"Mark T Mills, Garry McDowell, Gregory Y H Lip","doi":"10.1136/heartjnl-2024-324954","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-324954","url":null,"abstract":"The term ‘epidemic’ is increasingly used to describe the rising global prevalence of atrial fibrillation (AF). Recent estimates suggest that AF accounts for between 0.9% and 1.6% of total healthcare expenditure in the UK, forecast to rise to 4% over the next two decades.1 This trend—which is also anticipated internationally—underpins efforts to identify individuals at high risk of future AF, in addition to those with AF without manifest symptoms, in the hope of targeted prevention and early treatment. Indeed, numerous studies are currently investigating the impact of such approaches on clinical outcomes and healthcare utilisation. The association between AF and various conditions—including hypertension, heart failure, sleep apnoea and chronic kidney disease—is well-described, highlighting that AF is often a multisystem disorder. Accordingly, the management of AF has shifted towards a holistic and integrated approach, targeting comorbidities and risk factors, itself associated with improved outcomes.2 Before the actual onset of AF, some focus has been directed toward the identification of patients at high risk of incident AF. Various clinical risk scores have been proposed, such as the simple C2HEST score (ie, C2: Coronary artery disease/Chronic obstructive pulmonary disease (1 point each); H: Hypertension (1 point); E: Elderly (age ≥ 75 years, 2 points); S: Systolic heart failure (2 points); and T: Thyroid disease (hyperthyroidism, 1 point)).3 More complicated clinical risk scores have also been described for incident AF prediction, including the CHARGE-AF, Framingham and HARMS2-AF scores, as well as the CHADS2 and CHA2DS2-VASc scores (although the latter two were designed for stroke risk stratification, not for prediction of incident AF).4 Unsurprisingly, more complicated clinical risk scores will improve …","PeriodicalId":12835,"journal":{"name":"Heart","volume":"14 1","pages":""},"PeriodicalIF":5.7,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142194807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lifetime effects and cost-effectiveness of statin therapy for older people in the United Kingdom: a modelling study","authors":"Borislava Mihaylova, Runguo Wu, Junwen Zhou, Claire Williams, Iryna Schlackow, Jonathan Emberson, Christina Reith, Anthony Keech, John Robson, Richard Parnell, Jane Armitage, Alastair Gray, John Simes, Colin Baigent","doi":"10.1136/heartjnl-2024-324052","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-324052","url":null,"abstract":"Background Cardiovascular disease (CVD) risk increases with age. Statins reduce cardiovascular risk but their effects are less certain at older ages. We assessed the long-term effects and cost-effectiveness of statin therapy for older people in the contemporary UK population using a recent meta-analysis of randomised evidence of statin effects in older people and a new validated CVD model. Methods The performance of the CVD microsimulation model, developed using the Cholesterol Treatment Trialists’ Collaboration (CTTC) and UK Biobank cohort, was assessed among participants ≥70 years old at (re)surveys in UK Biobank and the Whitehall II studies. The model projected participants’ cardiovascular risks, survival, quality-adjusted life years (QALYs) and healthcare costs (2021 UK£) with and without lifetime standard (35%–45% low-density lipoprotein cholesterol reduction) or higher intensity (≥45% reduction) statin therapy. CTTC individual participant data and other meta-analyses informed statins’ effects on cardiovascular risks, incident diabetes, myopathy and rhabdomyolysis. Sensitivity of findings to smaller CVD risk reductions and to hypothetical further adverse effects with statins were assessed. Results In categories of men and women ≥70 years old without (15,019) and with (5,103) prior CVD, lifetime use of a standard statin increased QALYs by 0.24–0.70 and a higher intensity statin by a further 0.04–0.13 QALYs per person. Statin therapies were cost-effective with an incremental cost per QALY gained below £3502/QALY for standard and below £11778/QALY for higher intensity therapy and with high probability of being cost-effective. In sensitivity analyses, statins remained cost-effective although with larger uncertainty in cost-effectiveness among older people without prior CVD. Conclusions Based on current evidence for the effects of statin therapy and modelling analysis, statin therapy improved health outcomes cost-effectively for men and women ≥70 years old. Data may be obtained from a third party and are not publicly available. The datasets used in the current study may be obtained from third parties (UK Biobank <https://www.ukbiobank.ac.uk/>; Whitehall II study [www.ucl.ac.uk/epidemiology-health-care/research/epidemiology-and-public-health/research/whitehall-ii][1]) and are not publicly available. Researchers can apply to use the UK Biobank resource and Whitehall II study data. [1]: http://www.ucl.ac.uk/epidemiology-health-care/research/epidemiology-and-public-health/research/whitehall-ii","PeriodicalId":12835,"journal":{"name":"Heart","volume":"63 1","pages":""},"PeriodicalIF":5.7,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142194808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pericarditis for the ages: differential outcomes and therefore age-specific therapies?","authors":"Tom Kai Ming Wang, Allan L Klein","doi":"10.1136/heartjnl-2024-324577","DOIUrl":"10.1136/heartjnl-2024-324577","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"1111-1112"},"PeriodicalIF":5.1,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of plasma big endothelin-1 in patients with light chain cardiac amyloidosis.","authors":"Zhongli Chen, Anteng Shi, Zhiyan Wang, Yanjia Chen, Yahui Lin, Mingming Su, Hongbin Dong, Natallia Laptseva, Yuxiao Hu, Andreas J Flammer, Firat Duru, Wei Jin, Liang Chen","doi":"10.1136/heartjnl-2024-324000","DOIUrl":"10.1136/heartjnl-2024-324000","url":null,"abstract":"<p><strong>Background: </strong>Light chain cardiac amyloidosis (AL-CA) is associated with a high incidence of mortality. Big endothelin-1 (ET-1), the precursor of endothelial-vasoconstrictive ET-1, is closely related to the concentration of bioactive ET-1. Association between big ET-1 and prognosis of AL-CA has not yet been documented. The purpose of this study was to evaluate the prognostic value of big ET-1 for poor outcomes in moderate to severe AL-CA.</p><p><strong>Methods: </strong>Big ET-1 levels were determined on admission in patients with newly diagnosed AL-CA with modified Mayo 2004 stage II or III. Primary outcome was all-cause mortality. The secondary outcomes included death from cardiac cause and the composite of the primary outcome or hospitalisations due to worsening heart failure.</p><p><strong>Results: </strong>Overall, 141 patients were retrospectively included (57 stage II, 34 stage IIIa, 50 stage IIIb). During a median follow-up time of 25.7 months, 84 (59.6%) patients died. Patients with big ET-1 levels of ≤0.88 pmol/L had longer survival than those with >0.88 pmol/L (median survival time: 34.1 months vs 15.3 months, log-rank p<0.001), which was also observed in the validation cohort (log-rank p=0.026). Higher big ET-1 levels were predictive for all-cause mortality after multivariable adjustment (HR 1.91, 95% CI 1.05 to 3.49, p=0.035). Big ET-1 levels added an incremental prognostic value over modified Mayo 2004 stage (C-index: from 0.671 to 0.696, p=0.025; integrated discrimination improvement 0.168, p=0.047).</p><p><strong>Conclusions: </strong>Big ET-1 is a strong and independent predictor of mortality in patients with moderate to severe AL-CA, which may indicate a possible role for risk stratification in patients with this disease.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"1124-1132"},"PeriodicalIF":5.1,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-stratified patterns in clinical presentation, treatment and outcomes in acute pericarditis: a retrospective cohort study.","authors":"Valentino Collini, Luca Siega Vignut, Federico Angriman, Gioia Braidotti, Marzia De Biasio, Massimo Imazio","doi":"10.1136/heartjnl-2024-324214","DOIUrl":"10.1136/heartjnl-2024-324214","url":null,"abstract":"<p><strong>Background: </strong>There are limited data on acute pericarditis according to different age groups. The aim of this study is to investigate the role of age-related features in clinical characteristics, management, and outcomes of acute pericarditis, with a focus on the geriatric population.</p><p><strong>Methods: </strong>Patients with a first episode of acute pericarditis were consecutively enrolled between January 2014 and June 2022, and divided into four groups according to age (G1: 18-35 years; G2: 35-55 years; G3: 55-75 years; G4: >75 years). Clinical characteristics and medical therapy were recorded at baseline, and during follow-up.</p><p><strong>Results: </strong>A total of 471 patients (median age 56.3 (IQR 33-73) years, 32.3% women) were included. Younger age (G1-G2-G3) was associated with a higher frequency of chest pain, pericardial rubs (p<0001), ECG changes (p=0.002) and were more commonly treated with colchicine (p<0.001), and non-steroidal anti-inflammatory drugs (p=0.006). Older patients (G4) depicted more commonly dyspnoea, pericardial/pleural effusion (p=0.007) and were more often treated with corticosteroids (p=0.037). A secondary cause of pericarditis was detected in 128/471 (27.2%) patients. Older patients were more commonly hospitalised and had a complicated course with new-onset atrial fibrillation (p<0.001) and cardiac tamponade (p=0.005), compared with younger patients, who presented more recurrences (respectively G1: 43.0%, G2: 34.7%, G3: 28.2% and G4: 16.2%; p<0.001). After multivariable analysis, younger age remained the strongest independent predictor for recurrences (HR 3.23, 95% CI 1.81 to 5.58, p<0.001).</p><p><strong>Conclusion: </strong>Older age is associated with less recurrences of pericarditis, but more severe complications with need for hospitalisation.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"1139-1144"},"PeriodicalIF":5.1,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141456347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low diffusing capacity for carbon monoxide in chronic thromboembolic pulmonary hypertension: a biomarker for microvascular disease?","authors":"Christian Gerges, Hiromi Matsubara, Irene Lang","doi":"10.1136/heartjnl-2024-324237","DOIUrl":"10.1136/heartjnl-2024-324237","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"1109-1110"},"PeriodicalIF":5.1,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac magnetic resonance for ventricular arrhythmias: a systematic review and meta-analysis.","authors":"Christos A Papanastasiou, Maria-Anna Bazmpani, Polydoros N Kampaktsis, Thomas Zegkos, Thomas Gossios, Despoina Parcharidou, Damianos G Kokkinidis, Ioannis Tziatzios, Fotios I Economou, Chrysovalantou Nikolaidou, Vasileios Kamperidis, Apostolos Tsapas, Antonios Ziakas, Georgios Efthimiadis, Theodoros D Karamitsos","doi":"10.1136/heartjnl-2024-324182","DOIUrl":"10.1136/heartjnl-2024-324182","url":null,"abstract":"<p><strong>Background: </strong>Cardiac magnetic resonance (CMR) allows comprehensive myocardial tissue characterisation, revealing areas of myocardial inflammation or fibrosis that may predispose to ventricular arrhythmias (VAs). With this study, we aimed to estimate the prevalence of structural heart disease (SHD) and decipher the prognostic implications of CMR in selected patients presenting with significant VAs.</p><p><strong>Methods: </strong>Electronic databases were searched for studies enrolling adult patients that underwent CMR for diagnostic or prognostic purposes in the setting of significant VAs. A random effects model meta-analysis of proportions was performed to estimate the prevalence of SHD. HRs were pooled together in order to evaluate the prognostic value of CMR.</p><p><strong>Results: </strong>The prevalence of SHD was reported in 18 studies. In all-comers with significant VAs, the pooled rate of SHD post-CMR evaluation was 39% (24% in the subgroup of premature ventricular contractions and/or non-sustained ventricular tachycardia vs 63% in the subgroup of more complex VAs). A change in diagnosis after use of CMR ranged from 21% to 66% with a pooled average of 35% (29%-41%). A non-ischaemic cardiomyopathy was the most frequently identified SHD (56%), followed by ischaemic heart disease (21%) and hypertrophic cardiomyopathy (5%). After pooling together data from six studies, we found that the presence of late gadolinium enhancement was associated with increased risk of major adverse outcomes in patients with significant VAs (pooled HR: 1.79; 95% CI 1.33 to 2.42).</p><p><strong>Conclusion: </strong>CMR is a valuable tool in the diagnostic and prognostic evaluation of patients with VAs. CMR should be considered early after initial evaluation in the diagnostic algorithm for VAs of unclear aetiology as this strategy may also define prognosis and improve risk stratification.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"1113-1123"},"PeriodicalIF":5.1,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}