Open Heart最新文献

{"title":"Adequately identifying low-risk chest pain in emergency primary care: evaluating the performance of preHEAR(T) based on two European cohorts.","authors":"Tonje R Johannessen, Indra M B Melessen, Odd Martin Vallersnes, Amy Manten, Sigrun Halvorsen, Dan Atar, Ralf E Harskamp","doi":"10.1136/openhrt-2025-003362","DOIUrl":"10.1136/openhrt-2025-003362","url":null,"abstract":"<p><strong>Background: </strong>Differentiating cardiac from non-cardiac acute chest pain poses a diagnostic challenge, especially in primary care. The History, ECG, Age, Risk factors and Troponin level (HEART) score aid in risk stratification in hospitals, while the prehospital HEART (preHEART) score was refined for paramedics' use. However, its accuracy in emergency primary care has not been studied. This study evaluates the preHEAR(T) score, with and without high-sensitivity cardiac troponin (hs-cTn), as a tool to rule out acute myocardial infarction (MI) in emergency primary care.</p><p><strong>Methods: </strong>Retrospective data from two European cohorts were analysed, namely the One-hoUr Troponin in a low-prevalence population of Acute Coronary Syndrome (OUT-ACS) study (1711 patients) at a Norwegian emergency primary care centre (2016-2018) and the TRiage of Acute Chest pain Evaluated in urgent primary care (TRACE) study (664 patients) at a Dutch emergency primary care centre (2017). The preHEAR (without hs-cTn) score was evaluated in both cohorts. The preHEART score was assessed in OUT-ACS only, as the TRACE study did not measure troponins. The threshold of ≤3 points has previously been determined as low risk for acute MI (AMI) and optimal for rule-out purposes. The primary outcome was diagnostic performance for ruling out MI, and the secondary outcome was the composite of 90-day AMI or all-cause death.</p><p><strong>Results: </strong>In OUT-ACS, 3.6% of patients had an AMI (median age 56 years (45-68); 47.7% female), and 3% in TRACE (median age 48 years (32-67); 56.9% female). PreHEAR identified 49.3% (OUT-ACS) and 82.7% (TRACE) as low risk, while preHEART identified 33.6% (OUT-ACS) as low risk. Sensitivity/specificity for AMI were 63.9% (95% CI 50.6 to 75.8)/49.8% (95% CI 47.3 to 52.7) (OUT-ACS) and 65% (95% CI 40.8 to 84.6)/84.2% (95% CI 81.1 to 86.9) (TRACE) for preHEAR and 93.4% (95% CI 84.1 to 98.2)/34.6% (95% CI 32.2 to 37) for preHEART. For the secondary outcome, similar diagnostic performance metrics were found. There were four missed AMI cases in the low-risk preHEART group, who were all female.</p><p><strong>Conclusion: </strong>Neither the preHEAR nor preHEART scores provide sufficient rule out safety in emergency primary care and may particularly underestimate AMI risk in females.</p><p><strong>Trial registration number: </strong>OUT-ACS: clinicaltrials.gov NCT02983123.</p><p><strong>Trace: </strong>Netherlands Trial Registry (NL-OMON20102); https://onderzoekmetmensen.nl/nl/trial/20102.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732552","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}

{"title":"Long-term prognostic value of myocardial perfusion scintigraphy in patients with suspected coronary artery disease: systematic review and meta-analysis.","authors":"Ugochukwu Ihekwaba, Nicholas Johnson, Ji Soo Choi, Gianluigi Savarese, Nicola Orsini, Jeffrey Khoo, Iain Squire, Attila Kardos","doi":"10.1136/openhrt-2025-003521","DOIUrl":"10.1136/openhrt-2025-003521","url":null,"abstract":"<p><strong>Background: </strong>Long-term outcome of contemporary myocardial perfusion scintigraphy (MPS) has not been assessed systematically.</p><p><strong>Objective: </strong>To evaluate the association between results of MPS and long-term outcomes for patients with suspected coronary artery disease (CAD).</p><p><strong>Methods: </strong>Electronic databases were searched for Randomised controlled trials evaluating long-term outcome (≥12 months) of MPS in patients with suspected of CAD since year 2000. A meta-analysis adopting the random effects model was used to derive pooled estimates. The primary outcome was the composite of all-cause or cardiovascular mortality and non-fatal myocardial infarction as defined in individual trials, termed as major adverse cardiovascular event (MACE). Secondary outcome was all-cause or cardiovascular mortality. Positive MPS result was defined as reversible perfusion defect in any coronary artery territory.</p><p><strong>Results: </strong>Four trials fulfilled the search criteria. A total of 1764 patient had MPS with a median follow-up of 35.7 months (range 17-57). The mean age was 59 years and 50% were male. Fifty-three per cent had hypertension, 43% had dyslipidaemia, 15% were current smokers and 61% had diabetes mellitus. The overall annual event rate was 1.42% for the composite MACE and 0.22% for all-cause or cardiovascular mortality. Compared with negative MPS results, positive MPS was associated with an increased risk of the composite MACE and all-cause or cardiovascular mortality with an annual event rate of 2.16% versus 0.66%, OR 2.71 (1.38, 5.32) and 0.34% versus 0.10%, OR 3.41 (1.44, 8.11), respectively.</p><p><strong>Conclusion: </strong>In this meta-analysis, reversible perfusion defect on MPS was associated with higher risk of composite MACE, and that of all-cause or cardiovascular mortality.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718206","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}

{"title":"Comparative efficacy and safety of no-touch versus conventional vein harvesting techniques in coronary artery bypass grafting: a systematic review and meta-analysis.","authors":"Muhammad Abdullah Ali, Umama Alam, Fazia Khattak, Zaryab Bacha, Fatima Sajjad, Asad Iqbal Khattak, Abdullah Afridi, Sufyan Shahid, Maheen Sheraz, Naveed Ahmed Khan, Alifa Sabir, Raheel Ahmed","doi":"10.1136/openhrt-2025-003391","DOIUrl":"10.1136/openhrt-2025-003391","url":null,"abstract":"<p><strong>Objective: </strong>This meta-analysis aims to compare the clinical outcomes of the no-touch (NT) and conventional (CON) vein harvesting techniques in patients undergoing coronary artery bypass grafting (CABG).</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis following the guidelines of the Cochrane Handbook and PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) statement. We searched PubMed, Embase and Web of Science for randomised controlled trials (RCTs) comparing NT and CON vein harvesting techniques in CABG patients. Data were extracted on primary outcomes (graft failure incidence per patient, graft occlusion incidence per patient and leg infection) and secondary outcomes (revascularisation, all-cause death, myocardial infarction). Statistical analysis was performed using Review Manager V.5.4, with risk ratios (RRs) calculated for binary outcomes.</p><p><strong>Results: </strong>Seven RCTs involving 4176 patients were included. The NT group showed a significantly lower risk of graft failure incidence per patient (RR=0.74, p=0.0001) and graft occlusion incidence per patient (RR=0.62, p=0.0002) compared with the CON group. However, the NT group had a higher risk of leg infection (RR=1.91, p<0.00001). No significant differences were observed between groups for revascularisation (p=0.46), all-cause death (p=0.87), or myocardial infarction (p=0.95).</p><p><strong>Conclusions: </strong>The no-touch vein harvesting technique is associated with reduced graft failure incidence per patient and graft occlusion incidence per patient compared with conventional harvesting techniques in CABG, though it increases the risk of leg infection. These findings suggest NT as a preferable technique for improving graft patency but highlight the need for caution regarding leg infection.</p><p><strong>Prospero registration number: </strong>CRD42025646500.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12281317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691144","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}

{"title":"Effect of sodium-glucose cotransporter 2 inhibitors on ventricular function in systemic right ventricular failure.","authors":"Ralph Ml Neijenhuis, Madelien V Regeer, Niki L Walker, Bart Ja Mertens, Amanda Hunter, Philippine Kiès, Lorna Swan, Hubert W Vliegen, Simon T MacDonald, Filip Zemrak, Ali N Zaidi, Ari M Cedars, Monique Rm Jongbloed, J Wouter Jukema, Gruschen R Veldtman, Anastasia D Egorova","doi":"10.1136/openhrt-2025-003445","DOIUrl":"10.1136/openhrt-2025-003445","url":null,"abstract":"<p><strong>Background: </strong>Systemic right ventricle (sRV) patients are at an increased risk of developing heart failure. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) could be a valuable treatment option. This study investigated the changes in ventricular function in sRV failure patients in the first year after starting SGLT2i.</p><p><strong>Methods: </strong>Adult sRV patients from the international, real-world ACHIEVE-SGLT2i registry were included if they had a clinical diagnosis of sRV failure, a transthoracic echocardiogram before starting SGLT2i, and at least one in the first year after starting available for analysis. The primary outcomes were changes in sRV global longitudinal strain (GLS) and fractional area change (FAC). Longitudinal changes were evaluated using linear mixed models.</p><p><strong>Results: </strong>Thirty-nine sRV failure patients (46±9.3 years old, 41% female) were included. Twenty-five (64%) had transposition of the great arteries after an atrial switch procedure and 14 (36%) had congenitally corrected transposition. sRV GLS improved significantly in the first 50 days (-1.4%-point per month, p<0.001) and stabilised afterwards (<0.1%-point per month, p=0.520). Though age had a significant overall negative effect on sRV GLS (0.1%-point per year of age, p=0.049), it did not influence the longitudinal changes after starting SGLT2i. sRV FAC also improved in the first 50 days (3.2%-point per month, p=0.002), after which sRV FAC deteriorated in patients with subpulmonary left ventricular pacing (-0.9%-point per month, p=0.012) while it stabilised in patients without pacing (0.1%-point per month, p=0.573). In the first 50 days, tricuspid annular plane systolic excursion also improved significantly in all patients (1.2 mm per month, p=0.006), and stabilised afterwards (p=0.721).</p><p><strong>Conclusions: </strong>SGLT2i therapy is associated with improvements in systolic ventricular function in sRV failure patients. Despite early improvement in sRV FAC, there was a negative longer term correlation with subpulmonary left ventricular pacing, potentially reflecting adverse effects of subpulmonary ventricular pacing on sRV function.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12281333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691145","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}

{"title":"Artificial intelligence in coronary angiography: benchmarking the diagnostic accuracy of ChatGPT-4o against interventional cardiologists.","authors":"John Michael Hoppe, Antonia Kellnar, David Esser, Kathrin Diegruber, Christopher Stremmel","doi":"10.1136/openhrt-2025-003316","DOIUrl":"10.1136/openhrt-2025-003316","url":null,"abstract":"<p><strong>Background: </strong>The integration of artificial intelligence (AI) into medical diagnostics has significantly impacted cardiology by enhancing diagnostic precision and therapeutic strategies. Coronary artery disease continues to be a leading cause of global morbidity and mortality, with coronary angiography being the diagnostic gold standard. However, the subjective nature of angiographic interpretation can lead to inconsistent assessment. AI aims to provide automated, objective assessments to mitigate these challenges.</p><p><strong>Methods: </strong>This study evaluated ChatGPT with Generative Pre-trained Transformer (GPT)-4o (OpenAI, USA), for automated coronary angiogram interpretation. Due to its inability to process video data, we extracted maximum contrast frames from diagnostic angiogram views. These anonymised images were analysed by GPT-4o. Its diagnostic findings and stent recommendations were compared with expert cardiologist assessments.</p><p><strong>Results: </strong>We included 100 patients who underwent coronary interventions between January and April 2024. GPT-4o accurately identified coronary vessels in 98% of images. The overall sensitivity for detecting lesions requiring intervention was 71.6%, with a specificity of 57.2% (F1 score 0.652). Performance varied by vessel with best results for left anterior descending artery (sensitivity 81.0%; specificity 69.3%) and right coronary artery (sensitivity 86.5%; specificity 61.4%). Identification of the target vessel based solely on imaging was 47%, which improved to 87% with additional clinical information.</p><p><strong>Conclusions: </strong>GPT-4o shows potential as a supportive tool in coronary angiography interpretation. Its diagnostic performance improves significantly when contextual clinical information is included. However, its accuracy based on static images alone remains below the threshold required for reliable diagnostic and therapeutic support. The lack of cine-loop data as an essential element in real-world angiographic interpretation is a key limitation. Future developments should focus on enhancing AI capabilities for analysing complex anatomical structures and integrating dynamic imaging data to augment clinical utility.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675341","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}

{"title":"'Vaccination' against myocardial infarction: the hidden long-term effect of coronary artery bypass grafting.","authors":"Hristo Kirov, Mathias W Pletz, Tulio Caldonazo, Torsten Doenst","doi":"10.1136/openhrt-2025-003163","DOIUrl":"10.1136/openhrt-2025-003163","url":null,"abstract":"","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668039","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}

{"title":"Improved diagnosis of COVID-19 vaccine-associated myocarditis with cardiac scarring identified by cardiac magnetic resonance imaging.","authors":"Josephine Warren, Daryl Cheng, Nigel Crawford, Bryn Jones, Rui Lun Ng, Annette Alafaci, Dion Stub, Philip Lew, Andrew J Taylor","doi":"10.1136/openhrt-2025-003333","DOIUrl":"10.1136/openhrt-2025-003333","url":null,"abstract":"<p><strong>Background: </strong>Myocarditis is a rare but potentially serious complication of COVID-19 vaccination. Cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) imaging can identify cardiac scar, which may improve diagnostic accuracy and prognostication. We sought to define the incidence of long-term LGE post COVID-19 vaccine-associated myocarditis (C-VAM) and to establish the additive role of CMR in the diagnostic workup of this condition.</p><p><strong>Methods: </strong>Patients with Brighton Collaboration Criteria Level 1 (definite) or Level 2 (probable) C-VAM were prospectively recruited from the Surveillance of Adverse Events Following Vaccination In the Community database to undergo CMR at least 6 months after diagnosis. As there were limited patients with access to baseline CMR, prior CMR results were not included in the initial case definition. The presence of LGE at follow-up CMR was then integrated into the diagnostic algorithm, and the reclassification rate (definite vs probable) was calculated.</p><p><strong>Results: </strong>67 patients with C-VAM (mean age 30±13 years, 72% male) underwent CMR evaluation. The median time from vaccination to CMR was 548 (range 398-603) days. 20 patients (30%) had LGE. At diagnosis, nine patients (13%) were classified as definite and 58 (87%) as probable myocarditis. With the integration of CMR-LGE data, 16 patients (28%) were reclassified from probable to definite myocarditis.</p><p><strong>Conclusion: </strong>LGE on CMR occurred in one-third of patients with C-VAM. Without CMR at the time of diagnosis, almost one-third of patients are misclassified as probable rather than definite myocarditis, indicating a diagnostic strategy using echocardiography alone is insufficient.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668038","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}

{"title":"Age-stratified differences in coronary artery plaque phenotypes in women and men with non-obstructive coronary artery disease.","authors":"Caroline Annette Berge Hondros, Silja Hanseth, Margrete Solvik, Eva Kristine Ringdal Pedersen, Ingela Khan, Siren Hovland, Terje Hjalmar Larsen, Mai Tone Lønnebakken","doi":"10.1136/openhrt-2025-003371","DOIUrl":"10.1136/openhrt-2025-003371","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery disease (CAD) progression and risk of cardiac events differ between women and men during the lifespan. Accordingly, we aimed to explore the impact of sex and age on plaque phenotype in non-obstructive CAD.</p><p><strong>Method: </strong>We included 1189 patients with non-obstructive CAD (48% women) from the Norwegian Registry of Invasive Cardiology and quantitatively assessed each patient's plaque phenotype by coronary CT angiography. Plaque subtypes included calcified (>350 Hounsfield units [HU]), fibrous (131 to 350 HU), fibrofatty (76 to 130 HU) and necrotic core plaques (-30 to 75 HU). The impact of sex on plaque phenotype was assessed after age stratification (≤50, 51-64 and ≥65 years).</p><p><strong>Results: </strong>Total plaque burden adjusted for vessel volume was higher in middle-aged and older women compared with men (all p<0.05). Women had lower proportions of fibrofatty plaques compared with men across all age groups, while middle-aged and older women had higher proportions of calcified and fibrous plaques compared with men. Middle-aged and older men had higher proportions of necrotic core plaques compared with women (all p<0.05). After adjusting for cardiovascular risk factors, female sex remained independently associated with total plaque burden (β=1.0 [0.5 to 1.5], p<0.001), and younger age and male sex with fibrofatty plaque burden (β=-2.8 [-4.4 to -1.2], p<0.001, and β=-3.8 [-4.9 to -2.8], p<0.001, respectively).</p><p><strong>Conclusion: </strong>In non-obstructive CAD, female sex was associated with a higher total plaque burden, whereas male sex and younger age were associated with a higher proportion of vulnerable fibrofatty plaques. Our results highlight important sex differences in plaque phenotypes among patients with non-obstructive CAD during the lifespan, which may impact risk-stratification.</p><p><strong>Trial registration number: </strong>NCT04009421.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12248207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144619708","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}

{"title":"Evaluating an alert-based multiparametric algorithm for predicting heart failure hospitalisations in patients with implantable cardioverter-defibrillators: a meta-cohort study.","authors":"Alan Bulava, João De Sousa, Laurence Guédon-Moreau, Morio Shoda, Tobias Timmel, Sally Thompson Hilpert, Antonio D'Onofrio","doi":"10.1136/openhrt-2025-003474","DOIUrl":"10.1136/openhrt-2025-003474","url":null,"abstract":"<p><strong>Background: </strong>The alert-based HeartInsight algorithm predicts risk of worsening heart failure hospitalisations (WHFHs) by evaluating temporal trends of seven physiologic parameters obtained through automatic daily remote monitoring of implantable cardioverter-defibrillators. The aim of the present study was to evaluate the predictive performance of HeartInsight in a larger and more heterogeneous meta-cohort of patients, incorporating newer device generations and including patients managed with the most recent guideline-directed medical therapy (GDMT).</p><p><strong>Methods: </strong>The HeartInsight algorithm was retrospectively applied to data from four clinical trials in which WHFH events were adjudicated by independent external boards and remote monitoring was activated to provide relevant parameter trends. The analysis comprised 1352 patients with New York Heart Association (NYHA) class II/III, and no long-standing atrial fibrillation.</p><p><strong>Results: </strong>During a median follow-up of 599 days, 110 patients (median age 68 years (IQR, 61-75), 75.7% male) had a total of 165 WHFHs. The estimated sensitivity of WHFH prediction, as determined by generalised estimating equations, was 51.5% (95% CI 43.0% to 59.9%). The false alert rate was 0.85 per patient-year, the median alerting time was 34 days (IQR, 16-78) and the specificity was 81.4% (95% CI 80.4 to 82.4%). The results were verified in the multivariable analysis with two adjusting covariates (newer/older device generation and quadruple/other GDMT) and in the univariable analysis of prespecified patient subgroups according to NYHA class, aetiology and sex, showing no significant differences.</p><p><strong>Conclusions: </strong>Study results underscore the robustness of the predictive algorithm in a heterogeneous and contemporarily managed heart failure population.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12243582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591893","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}

{"title":"Effectiveness of semaglutide on survival outcomes in patients with type 2 diabetes and chronic kidney disease.","authors":"Takefumi Kishimori, Takao Kato, Atsuyuki Wada, Akira Tani, Ryosuke Yamaji, Jumpei Koike, Yoshihiro Iwasaki, Takehiro Matsumoto, Takafumi Yagi, Masaharu Okada","doi":"10.1136/openhrt-2025-003382","DOIUrl":"10.1136/openhrt-2025-003382","url":null,"abstract":"<p><strong>Background: </strong>Type 2 diabetes (T2D) and chronic kidney disease (CKD) significantly increase the risk of cardiovascular events, including death and heart failure (HF). The FLOW trial demonstrated that semaglutide reduces all-cause death, cardiovascular events and HF risk in patients with T2D and CKD. Since there is a difference in patient characteristics between clinical trials and real-world data, this study aims to investigate the association of semaglutide and all-cause death, acute HF or cardiovascular outcomes in patients with T2D and CKD using the data platform.</p><p><strong>Methods: </strong>This multicentre retrospective observational study using TriNetX, a global healthcare data platform. We identified 1 151 750 patients aged ≥18 years with T2D and CKD diagnosed before 31 December 2020. Among these, 14 511 patients initiated semaglutide and 69 700 initiated sitagliptin between 1 January 2018 and 31 December 2020. After propensity score matching, 13 703 patients were included in each group. The primary outcome was the 3-year incidence of all-cause death. Secondary outcomes included acute HF, acute myocardial infarction and stroke.</p><p><strong>Results: </strong>The 3-year risk of all-cause death in the semaglutide group relative to the sitagliptin group was significantly lower (7.2% (943/13 703) vs 9.5% (1196/13 703); p<0.001; HR, 0.76; 95% CI, 0.70 to 0.83). Similarly, the semaglutide group was less likely to have acute HF (12.1% vs 13.1%; HR, 0.92; 95% CI, 0.86 to 0.98). However, the risks of acute myocardial infarction and stroke in the semaglutide group relative to the sitagliptin group were not significant (9.6% vs 9.5%; HR, 1.01; 95% CI, 0.93 to 1.09 in acute myocardial infarction, and 9.2% vs 9.0%; HR, 1.02; 95% CI, 0.94 to 1.10 in stroke).</p><p><strong>Conclusions: </strong>In patients with T2D and CKD, semaglutide was associated with a lower 3-year risk of all-cause death compared with sitagliptin.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12243591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591892","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}