Open Heart最新文献

{"title":"Initial experience of transoesophageal echocardiography-guided percutaneous pulsed field ablation of atrial fibrillation.","authors":"Jun Liu, Min Tang, Guodong Niu, Chao Li, Daoliang Zhang, Yong Jiang, Yan Yao, Xiang-Bin Pan","doi":"10.1136/openhrt-2025-003172","DOIUrl":"https://doi.org/10.1136/openhrt-2025-003172","url":null,"abstract":"<p><strong>Objective: </strong>Pulsed-field ablation (PFA) is a new technology of catheter ablation for atrial fibrillation (AF). This research is to investigate the feasibility of a new strategy (transoesophageal echocardiography-guided pulsed field ablation, TEEP) to guide PFA for AF with no contrast and zero fluoroscopy.</p><p><strong>Methods: </strong>Patients with AF underwent TEEP under general anaesthesia with the guidance of three-dimensional (3D) transoesophageal echocardiography (TEE) throughout the procedure. After a successful transseptal puncture, the PFA catheter (CardiPulse) was delivered to the different pulmonary veins sequentially for standard PFA, and the pulmonary vein electrical isolation (PVI) was observed in real-time. After the ablation, left atrial bipolar voltage mapping under sinus rhythm was performed to verify the PVI.</p><p><strong>Results: </strong>10 patients with AF were enrolled, including 6 patients with paroxysmal AF and 4 patients with persistent AF. The mean operative time was 99±14 min, the mean time of the left atrial manoeuvre was 66±23 min, and the mean PFA ablation time was 105±8 s. First-pass PVI of all veins was achieved in all patients, thus no additional PFA applications were needed after the initial set. No contrast was needed and no X-ray was exposed. No complications were observed.</p><p><strong>Conclusions: </strong>We report the preliminary application of 3D TEE-guided PFA for AF in the world. Its immediate safety and efficacy are promising. Compared with traditional PFA procedures, TEEP has many advantages, including accuracy of the transeptal puncture, direct visualisation of contact between the catheter and myocardial tissue, no contrast and zero fluoroscopy.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic pathways, cardiac manifestations and outcomes in light chain amyloidosis: analysis of a US claims database.","authors":"Genevieve Lyons, Jeffrey Thompson, Isabelle Lousada, Julia Catini, Richa Manwani, Mathew S Maurer","doi":"10.1136/openhrt-2024-003124","DOIUrl":"https://doi.org/10.1136/openhrt-2024-003124","url":null,"abstract":"<p><strong>Background: </strong>Patients with light chain (AL) amyloidosis, a rare life-threatening disease, often go through a lengthy diagnostic journey. We qualitatively and quantitatively characterised the diagnostic pathway and the impact of delayed diagnosis on health outcomes among patients with AL amyloidosis.</p><p><strong>Methods: </strong>We conducted a retrospective cohort analysis of adults (age ≥18 years) with ≥2 AL amyloidosis diagnoses (index date: first diagnosis date) using the IQVIA PharMetrics Plus US claims data from 1 January 2016 to 31 December 2022. We stratified patients based on time from first cardiovascular (CV) manifestation onset to diagnosis. Patients were categorised as having a delayed diagnosis if the first CV manifestation occurred >1 year prior to diagnosis, and patients were categorised as without a delayed diagnosis if the first CV manifestation occurred <1 year prior to diagnosis.</p><p><strong>Results: </strong>Our study included 470 patients (mean age 61.8 years, 60% males). In the 24 months before diagnosis, CV manifestations occurred in 86% of patients and renal manifestations in 74%. Patients most frequently visited on average four different cardiologists. Patients were most frequently diagnosed by haematologists/oncologists (49.8%). Patients with a delayed diagnosis (179/470, 38.1%) were twice as likely as those without a delayed diagnosis to have CV-related emergency room visits (adjusted OR: 1.98; 95% CI: 1.21 to 3.24; p<0.010). Patients with a delayed diagnosis were one and a half times more likely than those without a delayed diagnosis to have CV-related inpatient hospitalisations (adjusted OR: 1.65; 95% CI: 1.1 to 2.46; p=0.020).</p><p><strong>Conclusions: </strong>This claims database study suggests that patients with delayed diagnosis experienced more CV-related emergency room visits and inpatient hospitalisations, underscoring the need for timely diagnosis of AL amyloidosis and the role of cardiologists in the diagnostic pathway.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of myectomy and radiofrequency septal ablation for treating hypertrophic obstructive cardiomyopathy.","authors":"Larissa Ventura Ribeiro Bruscky, Bruno Pereira Valdigem, Edileide de Barros Correia, Paulo Chaccur, Andrea de Andrade Vilela, Antônio Tito Paladino Filho, Ibraim Pinto, Rui Fernando Ramos, Jorge Eduardo Assef","doi":"10.1136/openhrt-2025-003166","DOIUrl":"https://doi.org/10.1136/openhrt-2025-003166","url":null,"abstract":"<p><strong>Background: </strong>Novel treatments are needed for patients with severely symptomatic obstructive hypertrophic cardiomyopathy (oHCM). Radiofrequency (RF) septal ablation has emerged as a promising technique for improving the left ventricular outflow tract (LVOT) gradient and alleviating symptoms, potentially achieving outcomes comparable to the gold-standard surgical myectomy.</p><p><strong>Objectives: </strong>To compare the 1-year efficacy and safety of surgical myectomy with RF septal ablation in patients with oHCM.</p><p><strong>Methods: </strong>This observational, retrospective cohort study included patients aged≥18 years with oHCM and an LVOT gradient≥50 mm Hg, unresponsive to medical therapy, who underwent surgical myectomy or RF septal ablation between 2012 and 2022.</p><p><strong>Results: </strong>The mean age was 49.8±14 and 56.9±10.9 years for the myectomy and RF groups, respectively, with the same sex distribution. The proportions of patients in functional class III distributions were 54.5% and 76.1% in the myectomy and RF groups, respectively. The LVOT gradient was 108.6±49.8 and 101.1±40.3 mm Hg for the myectomy and RF groups, respectively. Procedural success, defined as a reduction in the LVOT gradient to <50 mm Hg or an improvement to functional class I or II, showed no significant difference between the groups (HR: -3.5; 95% CI: -20.2 to 13.12; p=0.673). Complications occurred in 57.6% and 4.6% of the patients in the myectomy and RF groups, respectively (p<0.001).</p><p><strong>Conclusions: </strong>RF septal ablation and surgical myectomy demonstrated similar efficacy in reducing LVOT gradients and improving symptoms. However, RF ablation exhibited a superior safety profile.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and prognosis in acute myocarditis and unexplained acute chest pain: a nationwide longitudinal cohort study.","authors":"Marie Björkenstam, Emanuele Bobbio, Christian L Polte, Clara Hjalmarsson, Niklas Bergh, Elmir Omerovic, Entela Bollano","doi":"10.1136/openhrt-2024-003050","DOIUrl":"https://doi.org/10.1136/openhrt-2024-003050","url":null,"abstract":"<p><strong>Aims: </strong>Acute myocarditis (AM) is a disease with variable prognosis, ranging from complete recovery to end-stage heart failure (HF) and death but often challenging to differentiate from unexplained acute chest pain (UCP) in the acute setting. This study examines the short-tem and long-term outcomes of AM compared with UCP, focusing on the risk of HF development.</p><p><strong>Methods: </strong>We used the Swedish Web System for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies-registry to identify patients >16 years admitted to hospital between 1 January 1998 and 31 December 2018 with either AM or UCP. Patients were followed for outcomes including mortality, rehospitalisation and HF development over both short-term (30 days) and long-term periods. Cox proportional hazards models were used to compare the risks, adjusting for demographic and clinical-related factors.</p><p><strong>Results: </strong>A total of 3792 patients with AM and 109 934 patients with UCP were included. Median follow-up time was 7.8 years (Q1, Q3; 3.4, 12.3). AM patients were younger compared with UCP patients, median age 37 years (Q1, Q3; 26, 52) vs 59 years (Q1, Q3; 49, 69) and more likely to be men (79.9% vs 51.4%, p<0.001). Comorbidity burden was less pronounced within the AM cohort. Chest pain was the most common presenting symptom in both groups. Mortality rate at 30 days (OR 3.75, 95% CI 1.9 to 7.3, p<0001) as well as long term (OR 2.0, 95% CI 1.69 to 2.39, p<0.001) were significantly higher in AM patients compared with UCP. AM patients were more likely to develop HF during follow-up (OR 2.3, 95% CI 1.81 to 2.93, p<0001).</p><p><strong>Conclusions: </strong>AM is associated with worse short-term and long-term outcomes compared with UCP, including a higher risk of developing HF even after the first year.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in incidence rates of acute myocardial infarction and stroke among immigrant groups in Norway, 1999-2019: the NCDNOR project.","authors":"Kjersti Stormark Rabanal, Randi Marie Selmer, Jannicke Igland, Inger Ariansen, Haakon Eduard Meyer","doi":"10.1136/openhrt-2024-003114","DOIUrl":"https://doi.org/10.1136/openhrt-2024-003114","url":null,"abstract":"<p><strong>Aims: </strong>We aimed to study time trends of acute myocardial infarction (AMI) and stroke incidence rates among immigrant groups living in Norway, with a special focus on immigrants from South Asia and former Yugoslavia.</p><p><strong>Methods: </strong>All incident AMI and stroke events were identified in Norwegian residents aged 35-79 years during 1996-2019 using hospital and cause of death registry data. A 3-year wash-out period was used to identify incident events. Thus, cases were counted from 1999 onwards. We calculated annual age-standardised incidence rates using direct standardisation. Poisson regression was used to calculate the average annual change in incidence rates of AMI and stroke and to study differences between immigrant groups and the Norwegian-born population.</p><p><strong>Results: </strong>Age-standardised incidence rates of AMI were higher in immigrants from South Asia and former Yugoslavia than in the Norwegian-born population. For Norwegian-born men and women, and former Yugoslavian women, the annual age-standardised AMI incidence rates declined over the study period by 2.4%, 2.0% and 2.3%, respectively. South Asian men and women and former Yugoslavian men did not experience such a decline, although there was an apparent decline in the last 3 years of the period for South Asian men. For former Yugoslavian men, this resulted in increasing differences compared with Norwegian-born men. For stroke, all these groups had declining trends in incidence rates, and former Yugoslavian women had the strongest decline of 4.3% annually.</p><p><strong>Conclusion: </strong>During 1999-2019, immigrants from South Asia and former Yugoslavia did not experience the same beneficial decline in AMI incidence as the Norwegian-born population. However, both immigrant groups experienced similar or larger declines in the incidence of stroke as Norwegian-born men and women.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of pulmonary hypertension in adults with left ventricular diastolic dysfunction.","authors":"Seshika Ratwatte, Simon Stewart, David Playford, Geoff Strange, David S Celermajer","doi":"10.1136/openhrt-2025-003174","DOIUrl":"10.1136/openhrt-2025-003174","url":null,"abstract":"<p><strong>Background and objectives: </strong>Left ventricular diastolic dysfunction (LVDD) is commonly associated with pulmonary hypertension (PHT); however, the factors associated with the presence and severity of PHT in patients with LVDD have not been well characterised.</p><p><strong>Methods: </strong>We analysed the profiles and echo characteristics of 16 058 adults with LVDD and preserved left ventricular ejection fraction (LVEF, >50%) from the National Echocardiography Database of Australia. Peak tricuspid regurgitation velocity (TRV) was used to determine the presence of PHT. Univariate and multivariate analyses were performed to evaluate the parameters associated with the presence/increasing severity of PHT.</p><p><strong>Results: </strong>Mean age was 73±12 years and 9216 (57.4%) were women. 2503 (15.6%) subjects had atrial fibrillation (AF) and 13 555 (84.4%) were in sinus rhythm. Overall, 9976 (62.1%) had PHT (TRV >2.9 m/s). There was a progressive increase in indexed left atrial volume with rising TRV levels. AF and right ventricular (RV) dilation were strongly associated with the presence of PHT (adjusted OR (aOR) 1.27 (95% CI 1.12 to 1.43) and aOR 4.99 (95% CI 4.44 to 5.62), respectively). Increased age, LVEF and body mass index were also independently associated with PHT (p<0.001). On multivariate analysis, older age, female sex, AF, lower E/e' and LVEF were independently associated with the severity of PHT (p<0.001). The presence of AF increased the TRV by an average of 0.32 m/s, RV dilation by 1.82 m/s, female sex by 0.32 m/s and age (per decade) by 0.3 m/s.</p><p><strong>Conclusion: </strong>In this large study, PHT was common in LVDD and was strongly associated with the presence of enlarged left atrium, AF and older age, in particular.</p><p><strong>Trial registration number: </strong>ACTRN12617001387314.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773053","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":"Evaluation of vascular responses to moderate-intensity continuous and high-intensity interval physical exercise in subjects with elevated blood pressure: a randomised, cross-over clinical trial.","authors":"Sara Rodrigues, Renata Gomes Sanches Verardino, Valéria Costa-Hong, Camila Paixao Jordao, Marcel Jose Andrade da Costa, Luiz Bortolotto","doi":"10.1136/openhrt-2024-003121","DOIUrl":"10.1136/openhrt-2024-003121","url":null,"abstract":"<p><strong>Objective: </strong>In this randomised two-period crossover trial, the objective was to compare acute changes in arterial distensibility between high-intensity interval physical exercise (HIIPE) and moderate-intensity continuous physical exercise (MICPE) sessions in subjects with elevated blood pressure (BP).</p><p><strong>Methods and analysis: </strong>Participants underwent either MICPE-HIIPE or HIIPE-MICPE sequences with intensity based on cardiopulmonary exercise testing. The main outcome measures included arterial stiffness (by pulse wave velocity (PWV)) at baseline, until 30 min and 24 hours after each physical exercise session. Other measures include office BP, 24-hour ambulatory blood pressure monitoring (ABPM) and applanation tonometry.</p><p><strong>Results: </strong>The study involved 29 subjects with elevated BP (76% female, 48±7 years, body mass index=28.3±4.3 kg/m², systolic BP=126±9 mm Hg and diastolic BP=84±4 mm Hg). They presented lower PWV 24 hours after MICPE compared with baseline and to 24-hour HIIPE ((-0.83 (-1.29;-0.37) p=0.001) and (-0.98 (-1.84;-0.12), p=0.021), respectively). Despite no differences in office BP, aortic systolic BP was lower after HIIPE compared with baseline and to 24-hour MICPE (113±19; 118±10 and 117±10 mm Hg; p=0.013).</p><p><strong>Conclusion: </strong>In subjects with elevated BP, arterial distensibility is greater 24 hours after MICPE, while aortic systolic BP is lower after HIIPE. The particularities of each method and each exercise intensity can provide specific mechanisms of vascular response to exercise and detect vascular damage early in these subjects.</p><p><strong>Trial registration number: </strong>NCT04200716.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773057","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":"Integrating deep learning with ECG, heart rate variability and demographic data for improved detection of atrial fibrillation.","authors":"Araz Rawshani, Aidin Rawshani, Gustav Smith, Jan Boren, Deepak L Bhatt, Mats Börjesson, Johan Engdahl, Peter Kelly, Antros Louca, Truls Ramunddal, Erik Andersson, Elmir Omerovic, Zacharias Mandalenakis, Vibha Gupta","doi":"10.1136/openhrt-2025-003185","DOIUrl":"10.1136/openhrt-2025-003185","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is a common but often undiagnosed condition, increasing the risk of stroke and heart failure. Early detection is crucial, yet traditional methods struggle with AF's transient nature. This study investigates how augmenting ECG data with heart rate variability (HRV) and demographic data (age and sex) can improve AF detection.</p><p><strong>Methods: </strong>We analysed 35 634 12-lead ECG recordings from three public databases (China Physiological Signal Challenge-Extra, PTB-XL and Georgia), each with physician-validated AF labels. A range of convolutional neural network models, including AlexNet, VGG-16, ResNet and transformers, were tested for AF prediction, enriched with HRV and demographic data to explore the effectiveness of the multimodal approach. Each data modality (ECG, HRV and demographic) was assessed for its contribution to model performance using fivefold cross-validation. Performance improvements were evaluated across key metrics, and saliency maps were generated to provide further insights into model behaviour and identify critical features in AF detection.</p><p><strong>Results: </strong>Integrating HRV and demographic data with ECG substantially improved performance. AlexNet and VGG-16 outperformed more complex models, achieving AUROC of 0.9617 (95% CI 0.95 to 0.97) and 0.9668 (95% CI 0.96 to 0.97), respectively. Adding HRV data showed the most significant improvement in sensitivity, with AlexNet increasing from 0.9117 to 0.9225 and VGG-16 from 0.9216 to 0.9225. Combining both HRV and demographic data led to further improvements, with AlexNet achieving a sensitivity of 0.9225 (up from 0.9192 with HRV) and VGG-16 reaching 0.9113 (up from 0.9097 with HRV). The combination of HRV and demographic data resulted in the highest gains in sensitivity and area under the receiver operating characteristic curve. Saliency maps confirmed the models identified key AF features, such as the absence of the P-wave, validating the multimodal approach.</p><p><strong>Conclusions: </strong>AlexNet and VGG-16 excelled in AF detection, with HRV data improving sensitivity, and demographic data providing additional benefits. These results highlight the potential of multimodal approaches, pending further clinical validation.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753773","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":"Mavacamten maintenance dose determination: insights into individualised therapy for hypertrophic cardiomyopathy.","authors":"Smita Scholtz, Cédric Coppée, Kawa Mohemed, Max Potratz, Vasco Sequeira, Volker Rudolph, Werner Scholtz, Jan-Christian Reil","doi":"10.1136/openhrt-2025-003192","DOIUrl":"10.1136/openhrt-2025-003192","url":null,"abstract":"<p><strong>Aims: </strong>Mavacamten, the first approved myosin inhibitor for symptomatic obstructive hypertrophic cardiomyopathy (oHCM), addresses hypercontractility and left ventricular outflow tract (LVOT) obstruction. This study evaluates real-world experience with mavacamten, focusing on maintenance dose determination to optimise individual therapy and enhance patient safety.</p><p><strong>Methods: </strong>36 patients with symptomatic oHCM who completed the initiating phase of mavacamten therapy were analysed. <i>CYP2C19</i> genetic testing determined metabolic status prior to treatment. Echocardiographic measurements (eg, LVOT gradient, left atrial volume index, left ventricular ejection fraction (LVEF) and E/E') and biomarkers (high-sensitivity troponin I, N-terminal pro B-type natriuretic peptide (NT-proBNP)) were assessed at baseline and after 3 months. Clinical status was evaluated using New York Heart Association (NYHA) class and Kansas City Cardiomyopathy Questionnaire (KCCQ) score.</p><p><strong>Results: </strong>The mean age of patients was 60.6±12.1, and all had normal <i>CYP2C19</i> metabolic status. LVEF was 68% (IQR 8) at baseline and decreased mildly to 60.5% (IQR 7.25; p=0.0004) without cases dropping below 50%. Resting and provoked LVOT gradients decreased from 65 mm Hg (IQR 43.75) and 105 mm Hg (IQR 36.25) to 12 mm Hg (IQR 15.5; p<0.001) and 52.5 mm Hg (IQR 46.5; p<0.001), respectively. NT-proBNP and high-sensitivity troponin I decreased significantly from 1040 ng/mL (IQR 1255) to 285 ng/mL (IQR 483; p=0.0005) and from 11 ng/mL (IQR 15.5) to 10 ng/mL (IQR 5; p<0.0001). Diastolic function improved slightly; and clinically, patients improved significantly, with improvement in NYHA class and increase in KCCQ score. Mean time to reach maintenance dose was 14 weeks, with the necessity of dose adjustments in more than 50% of cases.</p><p><strong>Conclusion: </strong>Mavacamten therapy is safe and effective in the initiating phase. Determination of starting and maximum dose is based on <i>CYP2C19</i> metabolic status, while individualised dose adjustments are guided by echocardiographic response to optimise patient safety.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742560","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":"Prognostic implications of stress test-induced arrhythmias: a systematic review and meta-analysis.","authors":"Paul Y Lee, Juan Bello, Sarthak Patel, Rafael Toro-Manotas, Angelo Biviano, Elaine Wan, Hasan Garan, Jose Dizon, Matthew Yuyun, Hirad Yarmohammadi","doi":"10.1136/openhrt-2024-003133","DOIUrl":"10.1136/openhrt-2024-003133","url":null,"abstract":"<p><strong>Background: </strong>The significance of stress-test induced arrhythmias has been examined in prior studies, but there is no clear consensus regarding its significance.</p><p><strong>Objectives: </strong>To determine the significance of stress test-induced arrhythmias.</p><p><strong>Methods: </strong>Relevant studies examining arrhythmia in both exercise and pharmacological stress testing were searched for in PubMed, Embase and Cochrane databases from inception to 14 June 2023. The primary outcomes of interest were mortality in ventricular and atrial arrhythmias, and later diagnosis of cardiac disease in atrial arrhythmias.</p><p><strong>Results: </strong>The presence of any ventricular arrhythmia during stress testing was significantly associated with mortality at all time points: OR 2.11 (95% CI 1.75, 2.54), p<0.00001. This association was still seen in the subgroup of healthy, asymptomatic patients: OR 2.22 (95% CI 1.45, 3.41), p=0.0003. Frequent premature ventricular complexes (PVCs) were associated with higher mortality compared with infrequent PVCs: OR 1.85 (95% CI 1.27, 2.69), p=0.001. The presence of atrial fibrillation (AF) during stress testing was not associated with mortality at all time points: OR 1.53 (95% CI 0.05, 50.19), p=0.81. However, it was associated with later diagnosis of AF: OR 4.60 (95% CI 1.59, 13.26), p=0.005. The presence of atrial arrhythmias during stress testing at all time points was also associated with later diagnosis of coronary artery disease or myocardial infarction: OR 1.82 (95% CI 1.09, 3.03), p=0.02.</p><p><strong>Conclusions: </strong>Patients experiencing ventricular arrhythmia during stress testing face double the odds of mortality compared with those without such arrhythmias. Atrial arrhythmia during stress testing, on the other hand, shows no association with mortality. However, it is linked to subsequent diagnosis of AF, coronary artery disease and myocardial infarction.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742980","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}