Heart最新文献

{"title":"Prevalence and prognostic implications of the Valve Academic Research Consortium-High Bleeding Risk criteria in patients undergoing transcatheter aortic valve implantation.","authors":"Davide Cao, Marco Sandri, Philippe Garot, Francesco Pelliccia, Francesco Radico, Vincenzo Pasceri, Samantha Sartori, George D Dangas, Roxana Mehran, Davide Capodanno, Marie-Claude Morice, Italo Porto, Fausto Biancari, Fabrizio D'Ascenzo, Francesco Saia, Giampaolo Luzi, Francesco Bedogni, Ignacio J Amat-Santos, Vincenzo De Marzo, Arnaldo Dimagli, Timo Mäkikallio, Eugenio Stabile, Mario García-Gómez, Luca Testa, Marco Barbanti, Corrado Tamburino, Franco Fabbiocchi, Federico Conrotto, Giuliano Costa, Carmen Spaccarotella, Andrea Macchione, Michele La Torre, Francesco Bendandi, Tatu Juvonen, Wojciech Wanha, Wojtec Wojakowski, Umberto Benedetto, Ciro Indolfi, David Hildick-Smith, Fabio Miraldi, Marco Zimarino, Giulio Stefanini","doi":"10.1136/heartjnl-2025-326043","DOIUrl":"10.1136/heartjnl-2025-326043","url":null,"abstract":"<p><strong>Background: </strong>The Valve Academic Research Consortium (VARC) recently proposed a definition of high bleeding risk (HBR) for patients undergoing transcatheter aortic valve implantation (TAVI). This study aims to evaluate the prevalence and distribution of the VARC-HBR criteria and their ability to predict in-hospital bleeding.</p><p><strong>Methods: </strong>Patients undergoing TAVI at 18 European sites between 2007 and 2022 and included in the Transfusion Requirements in Transcatheter Aortic Valve Implantation (NCT03740425) registry were stratified into low, moderate, high or very high bleeding risk using the VARC-HBR criteria. The primary outcome was in-hospital major or life-threatening bleeding (VARC-2 definition).</p><p><strong>Results: </strong>Among 8464 patients, bleeding risk was very high in 1966 (23.2%), high in 3311 (39.1%), moderate in 2075 (24.5%) and low in 1112 (13.1%). In-hospital bleeding occurred in 11.0% of those at low risk, compared with 17.2%, 20.0% and 22.2% of patients at moderate, high and very high risk (p<0.001). The association between VARC-HBR criteria and bleeding remained significant after adjustment for calendar time. At 2 years, the incidence of major adverse cardiovascular events ranged from 13.8% in low-risk patients to 13.1%, 18.6% and 25.4% among those at moderate, high and very high risk (p<0.001). Mortality was higher after a bleeding event (HR 1.71, 95% CI 1.50 to 1.95), especially within the first 3 months (HR 2.88, 95% CI 2.33 to 3.56).</p><p><strong>Conclusions: </strong>Up to 60% of patients undergoing TAVI are at high or very high bleeding risk. The VARC-HBR criteria identified those at greater risk of adverse events. In-hospital bleeding complications and long-term cardiovascular events increased progressively across VARC-HBR categories.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144845590","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":"Variation in mechanical circulatory support use for acute myocardial infarction cardiogenic shock.","authors":"Arjun Verma, Nikhil L Chervu, Justin J Kim, Saad Mallick, Boback Ziaeian, Peyman Benharash","doi":"10.1136/heartjnl-2024-325413","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325413","url":null,"abstract":"<p><strong>Background: </strong>Cardiogenic shock (CS) is a leading cause of mortality following acute myocardial infarction (AMI). Some patients may require intra-aortic balloon pump (IABP) or percutaneous ventricular assist device (PVAD) placement; however, there is a paucity of standardised algorithms to guide the deployment of each device. The present study evaluated interhospital variation in the use of IABP and PVAD for AMI CS and identified institutional factors associated with hospital-level device preference.</p><p><strong>Methods: </strong>All non-elective adult hospitalisations entailing AMI and CS were identified within the 2019 Nationwide Readmissions Database. Patients were grouped into IABP, PVAD and non-mechanical circulatory support cohorts. The primary aim was to quantify the degree of interhospital variation in the use of IABP and PVAD. Escalation to extracorporeal membrane oxygenation (ECMO), left ventricular assist device (LVAD) implantation, length of stay and hospitalisation costs were secondarily assessed. Hospital factors, such as percutaneous coronary intervention (PCI) volume and safety net status, were also analysed.</p><p><strong>Results: </strong>Among 53 903 patients, 23.4% received IABP, and 12.5% received PVAD. After adjustment for patient factors, approximately 13% (11-14%) of variation in IABP use and 18% (15-20%) of PVAD use were attributable to centre-level differences. High-PVAD hospitals had higher annual PCI volume (257 (185-369) vs 204 (148-276) cases/year, p=0.032) and were more commonly safety net institutions (27.4% vs 11.3%, p=0.023), compared to high-IABP hospitals. Patients treated at high-IABP and high-PVAD hospitals faced similar length of stay (β -0.16, 95% CI -1.82 to 1.49) and costs (β -$3500, 95% CI -16 600 to 9600). Those at high-PVAD hospitals had lower adjusted risk of escalation to ECMO (0.52, 95% CI 0.29 to 0.95) and LVAD implantation (0.28, 95% CI 0.08 to 0.94).</p><p><strong>Conclusions: </strong>The present study identified wide interhospital variation in the use of IABP and PVAD for AMI CS. Although the likelihood of escalation to ECMO or LVAD differed between hospital types, resource utilisation was similar.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144951498","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":"Kidney function and risk of heart failure in older adults: findings from a prospective cohort study.","authors":"Oyunchimeg Buyadaa, Rory Wolfe, Andrew M Tonkin, Christopher M Reid, Zhen Zhou, James B Wetmore, Michelle A Fravel, Robyn L Woods, Kevan R Polkinghorne","doi":"10.1136/heartjnl-2025-325700","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-325700","url":null,"abstract":"<p><strong>Background: </strong>We examined whether impaired kidney function, identified through elevated levels of urine albumin to creatinine ratio (UACR) or reduced estimated glomerular filtration rate (eGFR), is associated with hospitalisation or death due to heart failure (HF) in a large community-based cohort of older adults.</p><p><strong>Methods: </strong>We included 17 834 participants from the ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial and follow-up ASPREE eXTension observational study with complete baseline data on albuminuria and eGFR. HRs for hospitalisation due to HF (HHF), HF death, a composite outcome of HHF and HF death, and HF re-admission were calculated using Cox models adjusting for potential confounders.</p><p><strong>Results: </strong>Over a median follow-up of 8.6 years, 354 (1.98%) participants had a first hospitalisation for HF and 147 (0.82%) died due to HF. Participants with albuminuria (UACR ≥3.0 mg/mmol; 11.3%) had higher risk for HHF, HF death and the combined HF outcome compared with those with no albuminuria (HRs 1.47 (95% CI 1.12 to 1.92), 1.55 (95% CI 1.04 to 2.33) and 1.33 (95% CI, 1.05 to 1.70), respectively). In participants with albuminuria, there was also an increased risk for re-admission due to HF (HR 1.30 (95% CI 1.03 to 1.65)), although there was no difference in risk of HF death. For eGFR, a U-shaped relationship was observed with increased risk of HHF, HF death and the HF composite outcome at both low (eg, <60 mL/min/1.73 m²) and high (eg, >90 mL/min/1.73 m²) eGFR levels. However, the association at high eGFR was not statistically significant and may reflect residual confounding. No association was observed between eGFR and HF re-admission.</p><p><strong>Conclusions: </strong>In this large cohort of older adults, albuminuria was associated with increased risk of HF outcomes, supporting its role in HF risk assessment. Low eGFR was also linked to higher risk of HHF, HF death and the HF composite outcome. Associations with high eGFR were not conclusive and should be considered hypothesis-generating.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144951483","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":"Is the FDA regulation of cardiology AI devices supporting cardiovascular innovation: a scoping review.","authors":"Ahmed Hussain, Ahmad Guni, Rishikesh Gandhewar, John Warner-Levy, Alexander Davidson, Kamal Shah, Ara Darzi, Hutan Ashrafian","doi":"10.1136/heartjnl-2025-326307","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326307","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) and machine learning (ML) have shown immense potential in cardiology, leveraging data-driven insights to enhance diagnosis, treatment planning and patient care. This study presents a comprehensive evaluation of US Food and Drug Administration (FDA)-approved AI/ML devices in cardiology, analysing trends in clinical applications, regulatory pathways and evidence transparency.</p><p><strong>Methods: </strong>FDA clearance summaries from the AI/ML medical device database were reviewed to identify cardiology-specific applications. Devices were categorised using the descriptive, diagnostic, predictive and prescriptive framework. Regulatory pathways, AI technologies and validation data were critically assessed.</p><p><strong>Results: </strong>Of 1016 FDA-approved AI/ML devices, 277 (27.3%) had cardiology applications, predominantly for imaging (65.3%) and diagnostics (64.3%). Predictive and prescriptive tools constituted only 5.4% and 0.7%, respectively. Most devices (97.1%) were cleared via the 510(k) pathway, with 58.0% at risk of predicate creep. Quality of clinical evidence was limited, with only 3.2% of devices supported by high-quality trials. The type of AI technology was often underreported (58.8%).</p><p><strong>Conclusion: </strong>While AI/ML technologies are reshaping cardiology, regulatory challenges and reporting transparency impede their optimal use. Strengthened regulatory frameworks, improved trial design and robust post-market surveillance are essential to ensure safety, efficacy and equity in the deployment of AI tools in cardiology.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144951538","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":"Association of high-sensitivity cardiac troponin I levels below the sex-specific 99th percentile with late-life dementia: the Perth Longitudinal Study of Ageing Women.","authors":"Carlos J Toro-Huamanchumo, Abadi Kahsu Gebre, Tiago Pecanha, Craig Sale, Wai Lim, Elizabeth Byrnes, Ee Mun Lim, Simon Laws, Kun Zhu, Carl Schultz, Richard L Prince, Blossom Cm Stephan, Mario Siervo, Joshua R Lewis, Marc Sim","doi":"10.1136/heartjnl-2025-326066","DOIUrl":"10.1136/heartjnl-2025-326066","url":null,"abstract":"<p><strong>Background: </strong>Elevated high-sensitivity cardiac troponin (hs-cTn) levels are linked with cardiovascular disease and cognitive impairment, both of which are strong risk factors for late-life dementia (LLD). This study examined the association between hs-cTnI levels below the sex-specific 99th percentile for myocardial injury and the incidence of LLD in older women.</p><p><strong>Methods: </strong>986 community-dwelling women aged ≥70 years without prior LLD and with hs-cTnI <15.6 ng/L (stratified into quartiles) were included from the Perth Longitudinal Study of Ageing Women. The primary outcome was incident LLD events, including LLD hospitalisation or death, over 14.5 years obtained from linked health records. Associations between hs-cTnI and LLD outcomes were explored using multivariable-adjusted Cox models, as part of restricted cubic splines.</p><p><strong>Results: </strong>At baseline, participants' mean (±SD) age was 75.2±2.7 years. Over 14.5 years of follow-up, LLD events (n=174, 17.7%), hospitalisations (n=155, 15.7%) and deaths (n=68, 6.9%) were recorded. Compared with those in the lowest quartile (Q1, median 3.1 ng/L), women in the highest quartile of hs-cTnI (Q4, median 7.3 ng/L) had a greater risk of developing LLD-related events (adjusted HR: 1.88, 95% CI: 1.22 to 2.91), hospitalisation (adjusted HR: 1.65, 95% CI: 1.04 to 2.64) and death (adjusted HR: 2.27, 95% CI: 1.13 to 4.59), after adjusting for established cardiovascular and dementia risk factors, including apolipoprotein E (<i>APOE</i>) genotype.</p><p><strong>Conclusion: </strong>Among older women, hs-cTnI levels below the sex-specific 99th percentile for myocardial injury were associated with an increased risk of LLD events over 14.5 years. These findings suggest that hs-cTnI may identify older women at higher risk of LLD, capturing both cardiovascular and brain health vulnerability in older age.</p><p><strong>Trial registration number: </strong>ACTRN12617000640303.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882796","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":"Asthma and risk of degenerative valvular heart disease: a prospective cohort study.","authors":"Zuoxiang Wang, Xifeng Qian, Junxing Lv, Ziang Li, Zheng Yin, Can Wang, Sheng Zhao, Xiaojin Gao, Yongjian Wu","doi":"10.1136/heartjnl-2024-325575","DOIUrl":"10.1136/heartjnl-2024-325575","url":null,"abstract":"<p><strong>Background: </strong>Asthma has been associated with the development and progression of various cardiovascular diseases but its relationship with degenerative valvular heart disease (VHD) remains unclear. This study investigated the association between asthma and incident degenerative VHD, including aortic stenosis (AS), aortic regurgitation (AR), mitral regurgitation (MR) and pulmonary regurgitation (PR).</p><p><strong>Methods: </strong>We analysed 483 735 participants from the UK Biobank (median age 56.5 years; 45.2% male) who were free of VHD at baseline. Asthma status was self-reported at recruitment. Incident VHD was ascertained through hospital admission and mortality records using International Classification of Diseases, Tenth Revision codes. Cox proportional hazards models were used to estimate HRs and 95% CIs for each VHD subtype, adjusting for demographic, lifestyle and clinical covariates. Sensitivity analyses accounted for asthma medications, duration of asthma and competing risks.</p><p><strong>Results: </strong>Over a median follow-up of 13.8 years, 5388 participants developed AS, 2650 AR, 6088 MR and 821 PR. Asthma was associated with increased risk of AS (HR 1.31; 95% CI 1.21 to 1.41), AR (HR 1.24; 95% CI 1.11 to 1.39), MR (HR 1.19; 95% CI 1.10 to 1.28) and PR (HR 1.34; 95% CI 1.10 to 1.62). The association with AR was attenuated after adjusting for asthma medications (HR 1.12; 95% CI 0.97 to 1.30). Results were robust across multiple sensitivity analyses, including adjustment for asthma duration and exclusion of participants with pre-existing cardiovascular disease.</p><p><strong>Conclusions: </strong>Asthma is independently associated with a modestly increased risk of several degenerative VHDs, particularly aortic and mitral valve diseases. These findings suggest a potential shared inflammatory pathway and highlight the need for heightened cardiovascular surveillance in individuals with asthma.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882797","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":"Current and future applications of photon-counting computed tomography in cardiovascular medicine.","authors":"Filippo Cademartiri, Erica Maffei, Riccardo Cau, Vincenzo Positano, Carmelo De Gori, Simona Celi, Luca Saba, Eduardo Bossone, Antonella Meloni","doi":"10.1136/heartjnl-2025-325790","DOIUrl":"10.1136/heartjnl-2025-325790","url":null,"abstract":"<p><p>Photon-counting CT (PCCT) represents a transformative advancement in cardiac imaging, addressing key limitations of conventional CT. This review synthesises current evidence to demonstrate how PCCT's superior spatial resolution, enhanced tissue characterisation and multienergy capabilities broaden the diagnostic potential of cardiac CT. Applications include the precise detection and quantification of coronary artery calcifications, evaluation of coronary plaque burden and composition, improved assessment of coronary stents, and comprehensive myocardial tissue characterisation and perfusion analysis. By offering high-quality spectral information and detailed tissue characterisation, PCCT provides a non-invasive alternative for assessing coronary artery disease and myocardial pathology, reducing the need for invasive coronary angiography and cardiac MRI. Despite ongoing challenges in technology and clinical implementation, PCCT has the potential to revolutionise cardiovascular diagnostics, optimise diagnostic workflows and enhance patient care through more accurate, streamlined and comprehensive assessments.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077691","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":"Incident cardiovascular events in women with left-sided versus right-sided breast cancer: a propensity score-matched study.","authors":"Laurent Fauchier, Lisa Lochon, Thibault Lenormand, Bertrand Pierre, Alexandre Bodin, Arnaud Bisson","doi":"10.1136/heartjnl-2025-325912","DOIUrl":"10.1136/heartjnl-2025-325912","url":null,"abstract":"<p><strong>Background: </strong>The cardiotoxic effects of breast cancer (BC) therapies, including drugs and radiotherapy (RT), may increase cardiovascular morbidity, particularly atrial fibrillation (AF). The specific impact of BC laterality on the incidence of cardiovascular events remains unclear. To evaluate laterality-specific cardiovascular risks in women with left-sided versus right-sided BC using a large international cohort.</p><p><strong>Methods: </strong>This cohort study used global healthcare data from the TriNetX network. Propensity score matching (1:1) was used to select a cohort of women with left-sided or right-sided BC, and follow-up was conducted with a maximum duration of 8 years. Mortality, AF, ventricular tachyarrhythmia, heart failure and implantation of an ICD during follow-up. HRs, cumulative incidences and 95% CIs were calculated for evaluating the treatment effect among the treated patients.</p><p><strong>Results: </strong>During follow-up (median 3.2 years), left-sided BC (compared with right-sided BC) was associated with a similar risk of all-cause death and of all incident cardiovascular events with the notable exception of a significantly higher risk of AF (HR 1.051, 95% CI 1.016 to 1.088, p=0.004). There was no statistical interaction for this higher risk of AF associated with left-sided BC when considering women treated with RT (1.024 (95% CI 0.941 to 1.113), p=0.58) or no RT (HR 1.045 (95% CI 1.006 to 1.084), p=0.02, p for interaction 0.66) CONCLUSIONS: In this large international analysis, left-sided BC was significantly associated with a numerically marginal but statistically significant higher risk of AF than right-sided BC, while there were no differences for BC laterality regarding all-cause death and other cardiovascular events.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882798","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":"Safety of internal thoracic artery use in patients with prior mediastinal radiation undergoing coronary artery bypass grafting: a Maryland statewide propensity-matched analysis.","authors":"Alice L Zhou, Ifeanyi D Chinedozi, Sari D Holmes, James S Gammie, Deven Patel, Armaan F Akbar, Diane Alejo, Jennifer Lawton, Glenn Whitman, Rawn Salenger, Jessica B Briscoe, Zachary E Darby, Duke Cameron, Hanghang Wang","doi":"10.1136/heartjnl-2025-325949","DOIUrl":"10.1136/heartjnl-2025-325949","url":null,"abstract":"<p><strong>Background: </strong>The safety of internal thoracic artery (ITA) grafting in patients undergoing coronary artery bypass grafting (CABG) with prior mediastinal radiation remains controversial due to concerns regarding compromised sternal perfusion and radiation-induced injury. This study evaluated whether prior mediastinal radiation is associated with adverse perioperative outcomes in patients undergoing CABG with ITA grafting.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the Maryland Cardiac Surgery Quality Initiative (MCSQI) database. A total of 29 206 patients who underwent CABG with ITA use between 1 July 2011 and 31 March 2023 were analysed. Patients with and without prior mediastinal radiation were propensity-matched (1:10) using the nearest neighbour method. The primary outcome was the composite of operative mortality and deep sternal wound infection (DSWI). Secondary outcomes included other infectious complications, major morbidities, postoperative hospital length of stay, and 30-day readmission.</p><p><strong>Results: </strong>Among 29 206 patients, 294 (1%) had a history of mediastinal radiation. Patients with prior radiation were older (median (IQR) 70 (60-75) vs 66 (59-73) years, p<0.001), more frequently female (66% vs 25%, p<0.001) and had a higher prevalence of chronic lung disease (31% vs 19%, p<0.001). After propensity matching, no significant differences were observed in the primary composite outcome (2% vs 3%, p=0.53) or in secondary outcomes.</p><p><strong>Conclusions: </strong>In this large retrospective cohort, prior mediastinal radiation was not associated with an increased risk of perioperative adverse events in patients undergoing CABG receiving ITA grafts. These findings demonstrate no evidence of safety concerns with the use of ITA grafting in patients with prior radiation and challenge the practice of excluding these patients from arterial revascularisation strategies.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882799","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":"When should we conduct surveillance for cardiac dysfunction in cancer survivors?","authors":"Peter Henriksen","doi":"10.1136/heartjnl-2025-326670","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326670","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144872823","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}