Open Heart最新文献

{"title":"Left ventricular thrombus in Takotsubo syndrome and ST-elevation myocardial infarction.","authors":"Sandeep Jha, Moa Simonsson, Angela Poller, Linnea Molander, Sigurdur Thorleifsson, Carlo Pirazzi, Sara Bentzel, Petronella Torild, Erik A Andersson, Aaron Shekka Espinosa, Valentyna Sevastianova, Sabin Salahuddin, Rickard Zeijlon, Ahmed Elmahdy, Kristofer Skoglund, Elmir Omerovic, Björn Redfors","doi":"10.1136/openhrt-2026-004154","DOIUrl":"https://doi.org/10.1136/openhrt-2026-004154","url":null,"abstract":"<p><strong>Background: </strong>Both Takotsubo syndrome (TS) and ST-elevation myocardial infarction (STEMI) are conditions characterised by the acute onset of left ventricular (LV) dysfunction. While LV thrombus is a known complication of LV dysfunction, its epidemiology in these two patient groups remains poorly understood.</p><p><strong>Methods: </strong>We used data from the Stunning in Takotsubo versus Acute Myocardial Infarction (STAMI) study, which prospectively enrolled patients with TS and STEMI at Sahlgrenska University Hospital. Serial echocardiography was performed on admission and on days 1, 2, 3, 7, 14 and 30. Predictors of LV thrombus were identified using Cox regression analyses.</p><p><strong>Results: </strong>314 patients were included; 68 with TS, 148 with anterior STEMI and 98 with non-anterior STEMI. Mean LV ejection fraction (LVEF) at admission was 39% (95% CI 35.8 to 42.2) in TS, 46.7% (95% CI 43.3 to 50.1) in anterior STEMI and 52.8% (95% CI 48.9 to 56.7) in non-anterior STEMI. LV thrombus occurred in 20 of 246 (8.1%) STEMI patients but in none of the TS patients. All but one LV thrombus was found in anterior STEMI. All LV thrombi in anterior STEMI were detected within 7 days, while the single non-anterior LV thrombus was found on day 30. All patients with LV thrombi received anticoagulation. Predictors of LV thrombus included lower LVEF and higher troponin levels.</p><p><strong>Conclusions: </strong>Despite more severe LV dysfunction in TS compared with STEMI, LV thrombus was exclusively found in STEMI patients. Almost all LV thrombi were found in anterior STEMI within the first week and showed a high-resolution rate at 30 days. Our findings highlight pathophysiological differences between these two conditions, warranting further investigation and implications for differing surveillance needs after TS and STEMI.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"13 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841064","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":"Myocarditis after COVID-19 mRNA vaccination in Norway: a nationwide validation study.","authors":"Bendik Skinningsrud Hagen, Katarina Vlaisavljevic, Lars Sandve Oppedal, Johannes Endresen, Vilde Storesund Mohn, Kristina Fladseth, Trygve Moe Lysaker, Margareth Pleym Ribe, Thomas Friedrich Möller, Torstein Laurits Hole, Jesper Dahl, Øystein Karlstad, Hanne Løvdal Gulseth, David Benee Olsen, Margrethe Greve-Isdahl, Sara Viksmoen Watle, Mette-Elise Estensen, Kaspar Broch, Kristina H Haugaa, Nina Eide Hasselberg","doi":"10.1136/openhrt-2026-004112","DOIUrl":"https://doi.org/10.1136/openhrt-2026-004112","url":null,"abstract":"<p><strong>Background: </strong>Myocarditis is a potentially severe adverse event after COVID-19 messenger RNA (mRNA) vaccination. Validation of reported cases is essential. We aimed to determine the occurrence, clinical characteristics and short-term outcomes of vaccine-associated myocarditis (VAM) in Norway.</p><p><strong>Methods: </strong>In this nationwide, population-based validation study, we used national health registry data and hospital electronic medical records from 27 December 2020 to 30 April 2022. We identified all Norwegian residents who received at least one dose of BNT162b2 or mRNA-1273. By cross-linking registries, we identified myocarditis within 90 days after vaccination. Diagnoses were validated through individual chart review using Brighton Collaboration criteria. VAM was defined as myocarditis without a more likely alternative cause.</p><p><strong>Results: </strong>Among 4.1 million vaccinated individuals who received 10.9 million doses, we identified 367 potential myocarditis cases. Of 349 cases reviewed, 177 (51%) were validated as VAM, corresponding to 4.5 cases per 100 000 vaccinated individuals. In total, 110 (62%) cases occurred after the second dose. Of validated cases, 139 (79%) occurred in men. Median age was 30 (IQR 24-50) years for men and 54 (IQR 32-65) years for women. Three (2%) cases were under 18 years. The median hospital stay was 4 (IQR 3-5) days, and the median ejection fraction was 55% (IQR 53%-60%). Seven (4%) patients required intensive care and two (1%) older patients died. No patient required mechanical circulatory support or heart transplantation.</p><p><strong>Conclusions: </strong>VAM occurred in 4.5 per 100 000 vaccinated individuals, based on validation of about half of registry-identified myocarditis cases. The acute clinical course was generally mild. National surveillance and systematic validation are essential for reliable estimates of vaccine-associated adverse events.</p><p><strong>Trial registration number: </strong>NCT05610423.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"13 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841091","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":"Incorporating angina into the H₂FPEF score improves diagnostic performance for HFpEF in women.","authors":"Kaiyong Qu, N Charlotte Onland-Moret, Amber de Vos, Anne Margje Lisa Naomi van Ommen, Yvonne van Mourik, Evelien E van Riet, Leandra Boonman-de Winter, M L Handoko, Maarten Jan Cramer, Arco J Teske, Roxana Menken, Frans Rutten, Hester M den Ruijter, Elisa Dal Canto","doi":"10.1136/openhrt-2026-004054","DOIUrl":"https://doi.org/10.1136/openhrt-2026-004054","url":null,"abstract":"<p><strong>Background and aims: </strong>The Heavy, Hypertensive, Atrial fibrillation, Pulmonary hypertension, Elder, Filling pressure (H₂FPEF) score is a widely used diagnostic tool for heart failure with preserved ejection fraction (HFpEF). Angina symptoms are common in patients with HFpEF but are not included in the score. We aimed to determine whether incorporating angina into the H₂FPEF score improves its diagnostic performance sex-specifically, given the well-known sex differences in both HFpEF and angina presentation.</p><p><strong>Methods: </strong>We included 515 individuals from the UHFO-DM cohort with suspected HFpEF. Participants underwent standardised symptom collection, including angina using WHO questionnaires, and expert-panel adjudication of HFpEF. Following evaluation of H₂FPEF, we assessed the association of angina with HFpEF independent of H₂FPEF using logistic regression. By adding angina to H₂FPEF, we developed a modified algorithm and evaluated it by the area under the receiver operating characteristic curve (AUC), calibration, reclassification and decision curve analysis. All analyses were stratified by sex. We also included another 751 individuals with suspected HFpEF from a Combination cohort of UHFO-COPD (n=136), STRETCH (n=331) and TREE (n=284) for regression analysis.</p><p><strong>Results: </strong>In the UHFO-DM cohort, HFpEF prevalence was 24%. Overall H₂FPEF discrimination (AUC) was 0.72, with 0.69 in women and 0.74 in men. Angina was independently associated with HFpEF in women (OR 3.96, 95% CI 1.72 to 9.11, p=0.001) but not in men (1.90, 0.88 to 4.10, 0.102). Adding one point for angina in a modified H₂FPEF score in women improved AUC from 0.69 to 0.71 (DeLong p=0.030), increased sensitivity (0.53 to 0.60) and negative predictive value (0.80 to 0.82) and yielded a continuous net reclassification improvement of 0.449, with preserved calibration and higher net clinical benefit on decision curves. No performance gain was observed with the same modification in men. In the Combination cohort, angina was also independently associated with HFpEF only in women (women, 2.13, 1.14 to 3.97, 0.018; men, 0.85, 0.44 to 1.66, 0.638).</p><p><strong>Conclusions: </strong>In women with suspected HFpEF, the presence of angina provides diagnostic information independent of H₂FPEF to uncover HFpEF. A simple sex-specific modification of H₂FPEF, adding one point for angina in women, may slightly improve discrimination and rule-out performance in women.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"13 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841078","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":"Ethnic disparities in mortality from acute coronary syndromes: a systematic review and meta-analysis.","authors":"Yasmin Mayet, Devan Wasan, Dario Sesia, Anoop S V Shah, Thomas Johnson, Amit Kaura","doi":"10.1136/openhrt-2026-004072","DOIUrl":"10.1136/openhrt-2026-004072","url":null,"abstract":"<p><strong>Objective: </strong>To quantify ethnic disparities in mortality after acute coronary syndrome (ACS) by comparing outcomes in Black, Asian and hite population groups.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of observational studies reporting mortality after ACS by ethnicity. Embase, Global Health, Ovid MEDLINE and Web of Science were searched through to March 2026 for English-language studies of adults with ST-elevation myocardial infarction (STEMI), non-STEMI or unstable angina. Two reviewers independently screened records, extracted data and assessed risk of bias using the Newcastle-Ottawa Scale. The primary outcome was all-cause mortality. Risk ratios (RRs), ORs and HRs were pooled as relative risk (RRs) with 95% CIs using random-effects models. Heterogeneity was quantified with I² and explored using prespecified subgroup analyses and meta-regression.</p><p><strong>Results: </strong>Forty cohort and registry studies from the USA, UK and Canada including 14 million patients met the inclusion criteria. Overall mortality was similar in black versus white patients (RR 0.99, 95% CI 0.94 to 1.03) and Asian versus white patients (RR 1.06, 95% CI 0.95 to 1.17); however, restriction to US-based studies demonstrated higher mortality in Asian patients (RR 1.14, 95% CI 1.03 to 1.27). Subgroup analyses showed higher mortality in black patients following STEMI (RR 1.09, 95% CI 1.02 to 1.17). Meta-regression showed age-dependent effect modification in black versus white comparisons, with differences attenuating in older populations. The pooled risk of major bleeding was similar between groups.</p><p><strong>Conclusions: </strong>Black patients had higher mortality than white patients following STEMI, and Asian patients demonstrated higher mortality in US-based studies. Overall post-ACS mortality was otherwise similar across ethnic groups. These findings suggest disparities persist in specific contexts and may be more pronounced in younger populations, but should be interpreted with caution due to substantial heterogeneity. PROSPERO REGISTRATION NUMBER: https://www.crd.york.ac.uk/PROSPERO/view/CRD420250465260.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"13 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818592","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":"Clinical outcomes of conduction system pacing versus right ventricular pacing in patients with atrioventricular block: a systematic review and meta-analysis of randomised controlled trials.","authors":"John Cedric Mojica, Jasmine Interior, Michael Christian Virata, Omar Kasimieh, Angelo Guingon, Muhammad Aqib Faizan, Tooba Rehman, Francis Charles Fernandez","doi":"10.1136/openhrt-2025-003954","DOIUrl":"10.1136/openhrt-2025-003954","url":null,"abstract":"<p><strong>Background: </strong>Conduction system pacing (CSP) has emerged as an alternative to right ventricular pacing (RVP) for atrioventricular block (AVB) aiming to avoid ventricular dyssynchrony and adverse heart failure outcomes yet clinical adoption remains limited due to insufficient randomised evidence.</p><p><strong>Objectives: </strong>This study aimed to assess the clinical outcomes of CSP versus RVP in patients with AVB based exclusively on randomised controlled trials (RCTs).</p><p><strong>Methods: </strong>MEDLINE, Embase and Cochrane were searched from inception to October 2025. Clinical outcomes comparing CSP and RVP were analysed using HR, risk ratio (RR) and mean difference with 95% CIs. Heterogeneity was assessed with I² and robustness tested by sensitivity analyses. Outcomes included heart failure hospitalisation (HFH), all-cause mortality (ACM), composite endpoint and key cardiac parameters.</p><p><strong>Results: </strong>Data from five RCTs involving 985 patients with AVB were analysed. In the pooled analysis, the composite endpoint is significantly improved in the intervention pacing (HR=0.54; 95% CI 0.31 to 0.95; p=0.03), similarly with markedly reduced risk for HFH (RR=0.30; 95% CI 0.17 to 0.54; p<0.0001). However, no significant difference was observed between CSP and RVP in ACM (RR=0.69; 95% CI 0.36 to 1.30; p=0.25). Secondary outcomes significantly favoured the CSP group, as the change in left ventricular ejection fraction (LVEF) was significantly increased (p=0.008) and the QRS duration was significantly shorter (p=0.002) compared with RVP.</p><p><strong>Conclusion: </strong>In patients with AVB, CSP provides enhanced cardiac and clinical benefit compared with RVP driven by reduced HFH, improved LVEF and shorter QRS, while evidence regarding its influence on overall mortality remains uncertain.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"13 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13140984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777177","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":"Navigating the intelligence revolution: transforming cardiovascular care through AI-driven innovation.","authors":"Yun Tang, Kankan Zhao, Shihua Zhao","doi":"10.1136/openhrt-2026-004160","DOIUrl":"10.1136/openhrt-2026-004160","url":null,"abstract":"","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"13 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777673","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 value of left atrial strain in ACHD patients with right-sided cardiac pathology.","authors":"Sahra Ünlütürk, Manouk H C Linderhof, Judith A A E Cuypers, Daniel J Bowen, Natasja M S de Groot, Jolien W Roos-Hesselink, Robert M Kauling, Annemien E van den Bosch","doi":"10.1136/openhrt-2026-004033","DOIUrl":"10.1136/openhrt-2026-004033","url":null,"abstract":"<p><strong>Background: </strong>Patients with adult congenital heart disease (ACHD) frequently develop late complications despite early surgical repair, including ventricular dysfunction and arrhythmias. In conditions with predominant right-sided pathology such as atrial septal defect (ASD), pulmonary stenosis (PS) and Tetralogy of Fallot (ToF), leading to right ventricular dilatation or systolic/diastolic dysfunction, ventricular interdependence may result in impaired left ventricular filling and left atrial (LA) dysfunction, despite the absence of primary left-sided disease. LA strain (LAS) has demonstrated prognostic value in acquired heart disease but its role in ACHD remains incompletely defined.</p><p><strong>Objective: </strong>To evaluate the prognostic significance of LAS in adults with repaired right-sided CHD.</p><p><strong>Methods: </strong>This single-centre longitudinal study includes patients with ACHD such as ASD, PS and ToF from the Quality of Life study at the Erasmus Medical Center. All patients underwent surgical repair during childhood between 1968 and 1980. Detailed cardiological evaluation, including STE-derived assessment of LA reservoir (LASr), conduit and contractile (LASct) function, was performed in 2012. Clinical outcomes were collected over a 10-year follow-up period, including mortality, reinterventions, heart failure and symptomatic tachyarrhythmias (supraventricular or ventricular) requiring treatment.</p><p><strong>Results: </strong>A total of 195 patients were included (ASD=78 (40%); PS=45 (23%); ToF=72 (37%)), with a mean age of 40.7±5.2 years at the time of evaluation. Patients with ToF exhibited more frequent interventricular conduction abnormalities at baseline and had 2.7-fold higher odds of reaching the composite endpoint compared with patients with ASD. In Cox regression analyses, LASr and LASct were independently associated with symptomatic tachyarrhythmias (LASr: HR=0.952, p=0.013; LASct: HR=0.936, p=0.046), and these associations remained significant after adjustment for left ventricular ejection fraction, LA volume index or N-terminal pro B-type natriuretic peptide.</p><p><strong>Conclusion: </strong>LAS provides independent prognostic information after surgical repair of right-sided CHD, particularly for predicting symptomatic tachyarrhythmias. Impaired LA deformation identifies patients at increased risk, underscoring the clinical relevance of LA mechanics in ACHD follow-up.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"13 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777686","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":"Are clinical improvements in anxiety or depression associated with improvement in walking fitness following a cardiac rehabilitation programme?","authors":"Serdar Sever, Alexander Harrison, Patrick Doherty","doi":"10.1136/openhrt-2026-004051","DOIUrl":"10.1136/openhrt-2026-004051","url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether achieving minimum clinically important difference in anxiety and depression is associated with meeting minimum clinically important difference in walking fitness following cardiac rehabilitation.</p><p><strong>Methods: </strong>This retrospective observational study analysed routinely collected data from the UK National Audit of Cardiac Rehabilitation. Univariate analyses were employed to investigate the baseline characteristics associated with walking fitness. Then, a logistic regression analysis was conducted to examine whether achieving the minimum clinically important difference in anxiety and depression (defined as >1.7 score improvement in the Hospital Anxiety and Depression Scale) was associated with achieving the minimum clinically important difference in walking fitness (defined as >70 m improvement in the incremental shuttle walk test) following cardiac rehabilitation.</p><p><strong>Results: </strong>A total of 4585 acute coronary syndrome patients at the National Audit of Cardiac Rehabilitation underwent valid incremental shuttle walk test and the Hospital Anxiety and Depression Scale assessments before and after cardiac rehabilitation between 1 January 2021 and 30 June 2024. Patients who achieved the minimum clinically important difference for depression had 23% higher odds of meeting the minimum clinically important difference for walking fitness (OR 1.23, 95% CI 1.01 to 1.49). Compared with home-based programmes, centre-based group programmes and hybrid programmes (combining centre-based and home-based components) were associated with higher odds of achieving clinically meaningful improvement in walking fitness. Factors such as older age, female sex, physical inactivity, obesity and longer waiting times to commence cardiac rehabilitation were associated with a lower likelihood of achieving minimum clinically important difference in walking fitness, adjusting for baseline anxiety, depression and incremental shuttle walk test scores.</p><p><strong>Conclusion: </strong>Clinically meaningful improvement in depressive symptoms was associated with clinically meaningful improvement in walking fitness, underscoring the relevance of addressing depression within cardiac rehabilitation.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"13 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147778011","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":"Isolated secondary tricuspid regurgitation after left-sided valve surgery: impact on clinical outcomes.","authors":"Mihaela Ioana Dregoesc, Evin Yucel, Jacob Dal-Bianco, Shani Dahan, Xin Zeng, Dana Cramariuc, Dhaval Kolte, Ignacio Inglessis-Azuaje, Jonathan J Passeri, Jacqueline Danik, Asishana Avo Osho, Antonia Kreso, Paul A Grayburn, Judy W Hung","doi":"10.1136/openhrt-2026-004063","DOIUrl":"10.1136/openhrt-2026-004063","url":null,"abstract":"<p><strong>Background: </strong>Secondary tricuspid regurgitation (TR) often develops or persists following left-sided valve surgery. However, its impact on outcomes and the optimal timing of intervention is unclear. This study examined the association between isolated postoperative secondary TR and outcomes in patients with a history of mitral or aortic valve surgery.</p><p><strong>Methods: </strong>This observational single-centre cohort study included patients with left-sided valve surgery and less than moderate preoperative TR who underwent follow-up echocardiography between 2002 and 2024. The presence of isolated postoperative secondary TR was evaluated in relation to clinical outcomes. The primary endpoint was a composite of all-cause death and heart failure hospitalisations (HFH).</p><p><strong>Results: </strong>The cohort consisted of 2487 patients with a mean age of 68 years and a median follow-up time of 3 years. All-cause mortality and HFH increased with the grade of postoperative TR (p<0.001). Postoperative TR was associated with the composite endpoint independent of cardiovascular risk factors and baseline comorbidities (adjusted HR 1.29; 95% CI 1.18 to 1.41; p<0.001). The association between postoperative TR and the primary endpoint remained significant after adjustment for right ventricular (RV) remodelling and moderate mitral regurgitation (adjusted HR 1.40; 95% CI 1.28 to 1.53; p<0.001). An increase in TR by at least two grades from the preoperative assessment was observed in 12.5% of patients and was associated with the composite endpoint (p<0.001). Age, sex, myocardial infarction, coronary artery bypass grafting, atrial fibrillation and RV remodelling were factors associated with TR progression (p<0.01).</p><p><strong>Conclusions: </strong>In patients following left-sided valve surgery, isolated postoperative secondary TR is independently associated with mortality and HFH independent of RV size, function and baseline comorbidities. An increase in TR severity by at least two grades from the preoperative assessment is associated with adverse outcomes.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"13 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777513","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":"Sex differences in the diagnosis, management and outcomes of patients with infective endocarditis.","authors":"Eefje M Dalebout, Ricardo P J Budde, Tjebbe W Galema, Ali R Wahadat, Laurens E Swart, Kevin M Veen, Nelianne J Verkaik, Alexander Hirsch, Jolanda Kluin, Jolien W Roos-Hesselink","doi":"10.1136/openhrt-2026-004026","DOIUrl":"https://doi.org/10.1136/openhrt-2026-004026","url":null,"abstract":"<p><strong>Background: </strong>Despite growing interest in male-female differences in cardiovascular disease, evidence in infective endocarditis (IE) is limited and contradictory.</p><p><strong>Methods: </strong>This prospective study included all patients with definite or possible valvular IE discussed by the endocarditis team from 2016 to 2025. Baseline characteristics, diagnostics, treatment and outcomes were compared between sexes. A Cox model was conducted to assess survival adjusted for baseline characteristics, IE type and treatment.</p><p><strong>Results: </strong>The cohort included 791 patients with definite or possible IE (72.8% males, 27.2% females). Age was not different (male: 67 (IQR 56-75), female: 71 (IQR 55-78) years, p=0.07). Females more often had hypertension (46.0% vs 35.2%, p=0.07) and mitral valve IE (45.6% vs 32.3%, p<0.001). Males had more predisposing conditions (71.5% vs 60.5%, p=0.004) and more aortic valve IE (71.0% vs 62.3%, p=0.02) and <i>Cutibacterium</i> species (5.7% vs 1.4%, p=0.007). There was no difference in indication for surgery. However, males were more often treated surgically (41.1% vs 29.3%, p=0.002), and females with an indication for surgery were more often treated conservatively (22.5% vs 37.0%, p=0.006). After a median follow-up of 2.1 (IQR 0.4-4.4) years, females had higher mortality (adjusted HR (aHR) 1.39 (95% CI 1.03 to 1.89), p=0.03). Surgery was associated with higher mortality in males (aHR 1.32 (95% CI 0.90 to 1.94) vs aHR 0.62 (95% CI 0.32 to 1.20), p value for interaction=0.03).</p><p><strong>Conclusions: </strong>Differences were observed in baseline characteristics, IE type and survival. Females had worse overall adjusted survival, suggesting a less favourable overall prognosis. In terms of surgical decision-making, surgery was withheld more often in females despite surgical indication, and after excluding these patients, surgery appeared more protective in females than in males. These findings may reflect sex differences in surgical selection.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"13 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13110707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777714","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}