Open Heart最新文献

{"title":"Secular trends in types of cardiovascular disease in the West of Scotland.","authors":"Anna Kamdar, Jocelyn M Friday, Tran Q B Tran, Clea du Toit, Alan Stevenson, Jim D Lewsey, Colin Berry, Denise Brown, Claire E Hastie, Michael Fleming, Claudia Geue, Daniel F Mackay, Ruth Dundas, Christian Delles, Naveed Sattar, Sandosh Padmanabhan, Jill Pell, Frederick K Ho","doi":"10.1136/openhrt-2024-003003","DOIUrl":"10.1136/openhrt-2024-003003","url":null,"abstract":"<p><strong>Objective: </strong>Historical reductions in cardiovascular disease (CVD) due to lifestyle and treatment improvements are now threatened by factors such as increasing obesity and diabetes, but the relative importance of different risk factors varies by CVD condition. This study describes secular trends in CVD events by individual condition from 2012 to 2022.</p><p><strong>Methods: </strong>In a cohort of 452 094 Greater Glasgow and Clyde residents aged ≥51 years, linked hospital admission and death data were used to ascertain total annual events for ischaemic heart disease (IHD), myocardial infarction (MI), heart failure (HF), atrial fibrillation (AF), stroke, abdominal aortic aneurysm (AAA) and peripheral artery disease (PAD). Poisson regressions with robust standard errors were used to examine the relative change in event rates over time, overall and by subgroup.</p><p><strong>Results: </strong>Overall, the event rate ratios (RRs) for IHD, MI, AF and AAA all fell between 2012 and 2021 after adjustment for age, sex and deprivation. However, on subgroup analysis, the RRs increased between 2012 and 2022 among those aged 51-64 years for HF (RR 1.5), stroke (RR 1.4) and PAD (RR 1.8).</p><p><strong>Conclusions: </strong>Overall declines in most types of CVD mask an increasing burden of events relating to HF, stroke and PAD among individuals aged 51-64 years.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693096","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":"MIRACLE2 score validation for neuroprognostication after out-of-hospital cardiac arrest: a district general hospital experience.","authors":"Ibrahim Antoun, Sotirios Dardas, Falik Sher, Manoj Bhandari","doi":"10.1136/openhrt-2024-002836","DOIUrl":"10.1136/openhrt-2024-002836","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Decision-making regarding prognosticating out-of-hospital cardiac arrest (OHCA) remains challenging at the front door. The MIRACLE2 score provides a simple and practical tool for early neuroprognostication to aid decision-making. The study aims to validate the MIRACLE2 score in a district general hospital (DGH).</p><p><strong>Material and methods: </strong>This is a retrospective analysis of the patients with OHCA and return of spontaneous circulation (ROSC) in the community who attended the cardiac catheter laboratory in a DGH between 1 September 2021 and 25 September 2023. Patients with a Glasgow Coma Scale of 15/15 after ROSC were excluded. Medical notes were examined, and the MIRACLE2 score was calculated and correlated with the Cerebral Performance Category (CPC) on discharge and compared with other neuroprognostication risk scores. The primary outcome was poor neurological recovery at hospital discharge, and the secondary outcome included poor neurological recovery at 6 months.</p><p><strong>Results: </strong>A total of 46 patients satisfied the study criteria, of which 43 (93%) were males. The median age was 64; half had a CPC of 0-2 on discharge and at 6 months. The MIRACLE2 score was low (0-2) in 14 patients (30%), intermediate (3-4) in 16 patients (35%) and high (≥5) in 16 patients (35%). The MIRACLE2 score performed well in neuroprognostication as a MIRACLE2 score ≥5 had a positive predictive value of 91%, while a MIRACLE2 score ≤2 had a negative predictive value of 92% for poor neurological outcomes at discharge.</p><p><strong>Conclusions: </strong>The MIRACLE2 score provides an accurate and practical neuroprognostication tool in patients with OHCA of cardiac origin presenting to this DGH.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693088","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":"Effects of 1-year exercise in patients with atrial fibrillation: study protocol for the Norwegian Exercise in Atrial Fibrillation (NEXAF) randomised controlled trial.","authors":"Bjarne M Nes, Jon Magne Letnes, Kristin Espolin Johnson, Andreas Berg Sellevold, Rune Byrkjeland, Fedelix Phetogo Brown, Turid Follestad, Håvard Dalen, Ulrik Wisløff, Maja-Lisa Løchen, Arnljot Tveit, Bente Morseth, Marius Myrstad, Jan Pål Loennechen","doi":"10.1136/openhrt-2024-003077","DOIUrl":"https://doi.org/10.1136/openhrt-2024-003077","url":null,"abstract":"<p><strong>Introduction: </strong>Atrial fibrillation is the most prevalent sustained arrhythmia worldwide and is expected to increase substantially within the coming years. Although lifestyle changes and risk factor modification are now acknowledged as central components of atrial fibrillation management, the effects of exercise on disease-specific outcomes are still not extensively documented due to few high-quality randomised trials. The primary objective of the Norwegian Exercise in Atrial Fibrillation Trial (NEXAF) is to assess the effects of exercise over 12 months on key clinical and patient-reported outcomes in previously inactive patients with atrial fibrillation.</p><p><strong>Methods and analysis: </strong>NEXAF is a multicentre, two-arm, randomised controlled trial inviting patients 18-80 years with a confirmed diagnosis of paroxysmal or persistent atrial fibrillation. Eligible patients are randomised 1:1 to either a combined supervised and eHealth-based exercise intervention or usual care for 12 months. The primary outcomes are total time in atrial fibrillation measured by insertable cardiac monitors, and disease-specific quality of life measured by the Atrial Fibrillation Effect on Quality-of-Life questionnaire.</p><p><strong>Ethics and dissemination: </strong>Ethical approval was obtained from the Regional Ethics Committee in Mid-Norway in April 2021 (ID 213848).</p><p><strong>Trial registration number: </strong>NCT05164718.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693083","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":"Hypoxia in myocardial infarction and natriuretic peptides.","authors":"Olli Arjamaa","doi":"10.1136/openhrt-2024-003130","DOIUrl":"10.1136/openhrt-2024-003130","url":null,"abstract":"<p><strong>Background: </strong>Mechanical stress on the heart is commonly considered the sole stimulus explaining the synthesis and release of circulating natriuretic peptides and their derivatives. While one of the most critical paradigms in cardiology is that mechanical load increases oxygen consumption, clinical studies on these peptides have neglected the relationship between mechanical stress and oxygen metabolism. At the cellular level, cardiac myocytes have a ubiquitous oxygen-sensing pathway mediated by a nuclear transcription factor, the hypoxia-inducible factor (HIF). Published studies indicate that the human myocardium starts expressing HIF during infarction. In myocardial cell cultures, natriuretic peptides are synthesised and released under hypoxic conditions through immediate and sufficient actions of HIF.</p><p><strong>Conclusion: </strong>Myocardial oxygen metabolism directly regulates the plasma levels of natriuretic peptides in heart diseases. The function of oxygen gradients should be correlated with circulating natriuretic peptides to achieve better sensitivity in plasma measurements of natriuretic peptides in myocardial infarction.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693085","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":"Investigating the impact of multidimensional sleep traits on cardiovascular diseases and the mediating role of depression.","authors":"Hao Zhao, Xiaojie Wang, Lan Guo, Xiuwen Li, Kayla M Teopiz, Roger S McIntyre, Wanxin Wang, Ciyong Lu","doi":"10.1136/openhrt-2024-002866","DOIUrl":"10.1136/openhrt-2024-002866","url":null,"abstract":"<p><strong>Background: </strong>Observational studies have reported that sleep is associated with the risk of major depressive disorder (MDD) and cardiovascular diseases (CVDs). However, the causal relationships among various sleep traits remain contentious, and whether MDD mediates the impact of specific sleep traits on CVDs is unclear.</p><p><strong>Methods: </strong>We performed two-sample Mendelian randomisation analyses to explore whether insomnia, sleep time, daytime napping, daytime sleepiness, chronotype, snoring or obstructive sleep apnoea were causally associated with the risk of five CVDs, including coronary artery disease (CAD), myocardial infarction (MI), heart failure (HF), atrial fibrillation and stroke. Mediation analyses were performed to assess the proportion mediated by MDD.</p><p><strong>Results: </strong>Genetically predicted insomnia, short sleep, daytime napping and daytime sleepiness increased the risk of CVDs, with the OR ranging from 1.24 (95% CI 1.06 to 1.45) for insomnia on stroke to 1.55 (95% CI 1.28 to 1.89) for insomnia on MI. In contrast to short sleep, genetically predicted sleep duration decreased the risk of CAD (OR 0.88 (95% CI 0.80 to 0.97)), MI (OR 0.89 (95% CI 0.80 to 0.99)) and HF (OR 0.90 (95% CI 0.83 to 0.98)). However, we found no significant associations of long sleep, chronotype, snoring and obstructive sleep apnoea with increased risk for any CVD subtype. Additionally, the effect of insomnia was partially mediated by MDD for the risk of CAD (proportion mediated: 8.81% (95% CI 1.20% to 16.43%)), MI (9.17% (95% CI 1.71% to 16.63%)) and HF (14.46% (95% CI 3.48% to 25.45%)). Similarly, the effect of short sleep was partially mediated by MDD for the risk of CAD (8.92% (95% CI 0.87% to 16.97%)), MI (11.43% (95% CI 0.28% to 22.57%)) and HF (12.65% (95% CI 1.35% to 23.96%)). MDD also partially mediated the causal effects of insomnia on stroke, sleep duration on CAD, MI and HF, daytime napping on HF and daytime sleepiness on CAD.</p><p><strong>Conclusions: </strong>Our study provides evidence that genetically predicted insomnia, short sleep, frequent daytime napping and sleepiness are associated with a higher risk of certain CVD subtypes, partly mediated by MDD.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630640","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":"Survival outcomes in isolated severe tricuspid regurgitation according to therapeutic modalities: a systematic review and meta-analysis.","authors":"Gaspard Suc, Jules Mesnier, Audrey Cailliau, Mustafa Habib, Clemence Delhomme, Dimitri Arangalage, Dominique Himbert, Gregory Ducrocq, Eric Brochet, Alec Vahanian, Bernard Iung, Marina Urena-Alcazar","doi":"10.1136/openhrt-2024-002986","DOIUrl":"10.1136/openhrt-2024-002986","url":null,"abstract":"<p><strong>Importance: </strong>Managing isolated severe tricuspid regurgitation (TR) poses significant challenges, with questions recently arising about the efficacy of surgery and percutaneous therapies compared with conservative approaches in improving survival.</p><p><strong>Objective: </strong>We aimed to assess the available evidence on mortality associated with different treatment modalities for isolated severe TR.</p><p><strong>Evidence review: </strong>A comprehensive search of medical databases was conducted. Studies reporting mortality of isolated TR at 1-year follow-up, with TR severity classified as moderate-to-severe or worse, were included. Exclusion criteria were TR associated with left-heart disease and combined procedures (treating other valves). The primary endpoint was all-cause mortality at 1 year, with secondary outcomes including in-hospital, 2-year and 5-year mortality. Mortality was compared by meta-analysis and meta-regression using age, sex and left ventricular ejection fraction as confounders.</p><p><strong>Findings: </strong>25 studies met the inclusion criteria. Mean age was 72.0 years among the 5702 patients managed medically, 71.3 years among the 1416 patients treated percutaneously and 59.3 years among the 1990 patients managed surgically. In medically managed patients, 1-year, 2-year and 5-year mortality rates were 14%, 20% and 46%, respectively. Among percutaneously managed patients, there was an in-hospital mortality of 1% and a 1-year mortality rate of 18%, which increased to 22% at 2 years. Surgically managed patients experienced an in-hospital mortality of 8% with 1-year, 2-year and 5-year mortality rates of 15%, 20% and 30%, respectively. No statistical differences in mortality were observed at 1, 2 or 5 years. Those results were confirmed after adjusted meta-regression.</p><p><strong>Conclusions: </strong>These findings underscore the significant long-term mortality associated with isolated severe TR, regardless of treatment group. Despite potential selection bias, both percutaneous and surgical interventions did not offer lower mortality rates compared with medical management after 2 years. Further research is warranted to improve outcomes in the management of isolated TR.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625582","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":"Carotid artery dissection and neurological complications after surgery for type 1 aortic dissection.","authors":"Fausto Biancari, Timo Mäkikallio, Stefano Rosato, Tatu Juvonen, Giovanni Mariscalco, Zein El-Dean, Metesh Acharya, Matteo Pettinari, Javier Rodriguez-Lega, Angel G Pinto, Andrea Perrotti, Francesco Onorati, Konrad Wisniewski, Lenard Conradi, Till Demal, Marek Pol, Jan Rocek, Petr Kacer, Giuseppe Gatti, Igor Vendramin, Daniela Piani, Mauro Rinaldi, Luisa Ferrante, Eduard Quintana, Robert Pruna-Guillen, Sven Peterss, Joscha Buech, Caroline Radner, Mark Field, Amer Harky, Antonio Fiore, Jean Sénémaud, Caius Mustonen, Angelo M Dell'Aquila, Paola D'Errigo, Gianluca Polvani, Dario Di Perna","doi":"10.1136/openhrt-2024-002882","DOIUrl":"10.1136/openhrt-2024-002882","url":null,"abstract":"<p><strong>Background: </strong>Data on the prognostic impact of type A aortic dissection involving the common carotid arteries (CCAs) are scarce.</p><p><strong>Methods: </strong>Data on the status of the CCAs were available in 1106 patients who underwent surgery for acute DeBakey type 1 aortic dissection who were recruited in a retrospective, multicentre European registry, that is, the ERTAAD. Postoperative neurological complications were defined as ischaemic stroke, haemorrhagic stroke and/or global brain ischaemia.</p><p><strong>Results: </strong>Patients without carotid artery dissection, those with unilateral or bilateral CCA dissection had in-hospital mortality rates of 19.5%, 16.9% (OR 1.006, 95% CI 0.614 to 1.647) and 27.3% (p<0.001, OR 1.719, 95% CI 1.086 to 2.722), respectively. Bilateral, but not unilateral, dissection of the CCAs increased the risk of neurological complications (40.0% vs 18.9%, OR 2.453, 95% CI 1.683 to 3.576). The negative prognostic effect of bilateral dissection of the CCAs was increased among patients without cerebral malperfusion who underwent surgery with the use of hypothermic circulatory arrest (28.7% vs 4.3%, p=0.014).</p><p><strong>Conclusions: </strong>Bilateral, but not unilateral, dissection of the CCAs may increase the risk of neurological complications and in-hospital mortality after surgery for DeBakey type 1 aortic dissection.</p><p><strong>Trial registration number: </strong>NCT04831073.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625580","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 impact of combined assessment of myocardial inflammation and fibrosis using myocardial biopsy in patients with dilated cardiomyopathy: a multicentre, retrospective cohort study.","authors":"Takafumi Nakayama, Keiko Ohta Ogo, Yasuo Sugano, Tetsuro Yokokawa, Hiromitsu Kanamori, Yoshihiko Ikeda, Michiaki Hiroe, Kinta Hatakeyama, Hatsue Ishibashi-Ueda, Kazufumi Nakamura, Kaoru Dohi, Toshihisa Anzai, Yoshihiro Seo, Kyoko Imanaka-Yoshida","doi":"10.1136/openhrt-2025-003250","DOIUrl":"10.1136/openhrt-2025-003250","url":null,"abstract":"<p><strong>Background: </strong>Among patients with dilated cardiomyopathy (DCM), myocardial inflammation and fibrosis are risk factors for poor clinical outcomes. Here, we investigated the combined prognostic value of these two factors, as evaluated using myocardial biopsy samples.</p><p><strong>Methods: </strong>This retrospective and multicentre study included patients with DCM-defined as LVEF of ≤45% and left diastolic diameter of >112% of predicted value, without evidence of secondary or ischaemic cardiomyopathy. In myocardial biopsy samples, inflammatory cells were counted using immunohistochemistry, and Masson's Trichrome staining was performed to quantify the myocardial fibrosis as collagen area fraction (CAF). Higher myocardial inflammation was defined as leucocytes of ≥14/mm², including ≤4 monocytes/mm², with CD3⁺ T lymphocytes of≥7/mm². Greater myocardial fibrosis was defined as CAF of>5.9% by the Youden's index. The primary endpoint was cardiac death or left ventricular assist device implantation.</p><p><strong>Results: </strong>A total of 255 DCM patients were enrolled (average age, 53.1 years; 78% males). Within this cohort, the mean LVEF was 28.0%, mean CAF was 10.7% and median CD3⁺ cell count was 8.3/mm². During the median follow-up period of 2688 days, 46 patients met the primary endpoint. Multivariable Cox proportional hazard analyses revealed that CD3⁺ cell count and CAF were independent determinants of the primary endpoint. Kaplan-Meier analysis showed that patients with both higher myocardial inflammation and greater fibrosis had the worst prognosis (log-rank p<0.001). When myocardial inflammation was graded as one of three degrees: T lymphocytes of <13/mm² (low); 13 of 13.1-23.9/mm² (moderate); and T lymphocytes of ≥24 /mm² (high), patients with moderate inflammation exhibited a superior survival rate when CAF was ≤5.9%, but a worse survival rate when CAF was >5.9%.</p><p><strong>Conclusions: </strong>Having both biopsy-proven higher myocardial inflammation and greater fibrosis predicted the worst clinical prognosis in patients with DCM.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625581","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":"Durable versus biodegradable polymer drug-eluting stents in all-comers.","authors":"Thierry Witzig, Serban Puricel, Alain Witzig, Pascal Meier, Diego Arroyo, Mario Togni, Stéphane Cook","doi":"10.1136/openhrt-2024-003104","DOIUrl":"10.1136/openhrt-2024-003104","url":null,"abstract":"<p><strong>Background: </strong>Drug-eluting stents (DESs) have become the gold standard of coronary angioplasty since their inception in 2002. Biodegradable polymer DESs (BP-DESs) have been postulated to be superior to durable polymer DESs (DP-DESs) due to their more biocompatible polymer. To date, no study has shown the superiority of one type of polymer compared with the other. We aimed to compare outcomes between a broad range of second-generation DP-DES and BP-DES in an all-comer population.</p><p><strong>Methods: </strong>We analysed data from 2824 patients who underwent percutaneous coronary intervention (PCI) with BP-DES or DP-DES in the Cardio-FR database. Of these, 2079 (1286 DP-DES and 793 BP-DES) met the inclusion and exclusion criteria and completed a 2-year follow-up: The primary outcome was the device-oriented composite endpoint (DOCE) of cardiac death, non-fatal target vessel myocardial infarction and target lesion revascularisation.</p><p><strong>Results: </strong>Mean age was 67 years, with 75% male. Despite the DP-DES group exhibiting significantly higher rates of risk factors, such as arterial hypertension (63.1% vs 57.5%, p=0.010), a greater average number of stents implanted per patient (1.72±0.92 vs 1.63±0.84, p=0.040), more acute coronary syndrome (ACS) (55.1% vs 50.2%, p=0.031) and a higher rate of post-dilatation (42.2% vs 35.2%, p<0.001), the rate of acute stent thrombosis (ST) was significantly lower than in the BP-DES group (HR 0.240, 95% CI 0.075 to 0.766; p=0.016). This difference remained significant even after adjusting for covariates using a Cox proportional hazards model and performing a win ratio analysis (4.09, 95% CI 1.28 to 13.09; p=0.018). Despite this increased rate of acute ST, there was no difference in DOCE (12.1% vs 14.5%, OR 1.218, 95% CI 0.926 to 1.600; p=0.158) between the two groups up to 2 years.</p><p><strong>Conclusion: </strong>Clinical follow-up up to 2 years shows similar outcomes between BP-DES and DP-DES. The rate of acute ST is higher in patients with BP-DES.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542955","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":"Patterns of systolic blood pressure response at the end of exercise and mortality and morbidity in patients referred for exercise testing.","authors":"Anna Carlén, Thomas Lindow, Nicholas Cauwenberghs, Viktor Elmberg, Lars Brudin, Francisco B Ortega, Magnus Ekström, Kristofer Hedman","doi":"10.1136/openhrt-2025-003246","DOIUrl":"10.1136/openhrt-2025-003246","url":null,"abstract":"<p><strong>Objectives: </strong>Peak exercise systolic blood pressure (SBP) is associated with future cardiovascular disease (CVD) and mortality. We aimed to evaluate the predictive value of different SBP patterns at the end of exercise with these outcomes.</p><p><strong>Methods: </strong>We studied 6329 adults (45% women) referred for exercise testing, with test duration of 6-14 min, maximal effort and valid SBP measurements at the end of exercise. The two last SBPs were indexed to work rate (mmHg/Watt), defining responses as: <i>drop</i> (negative change), <i>plateau</i> (no change), <i>slow</i> (lower tertile of increase), <i>intermediate</i> (middle tertile) and <i>steep</i> (upper tertile). Data were cross-linked with nationwide disease and mortality registries. Associations with all-cause mortality and incident CVD were analysed using Cox proportional hazards regression (hazard ratio (HR), 95% confidence interval), using slow SBP increase as reference, adjusted for sex, age, body mass index, baseline CVD (mortality analysis only), beta-blockers and exercise capacity (peak Watt).</p><p><strong>Results: </strong>The prevalence of SBP responses at the end of exercise were drop (1.1%), plateau (15.0%), slow (30.4%), intermediate (25.2%) and steep increase (28.3%). Follow-up was 8.8±3.4 years. Compared with a slow increase, the adjusted all-cause mortality risks were not statistically different for a drop (HR 1.16 (0.50-2.65)), plateau (HR 1.19 (0.85-1.66)), intermediate (HR 1.24 (0.93-1.66)) or steep SBP increase (HR 1.16 (0.89-1.52)). CVD risk was increased in those with a SBP drop (HR 3.10 (1.85-5.19), but not significantly for plateau (HR 1.17 (0.92-1.48)), intermediate or steep SBP increases (HRs 0.99-1.00).</p><p><strong>Conclusion: </strong>Subjects with a slow SBP increase at the end of exercise tended to have the lowest mortality risk, although no SBP response pattern predicted all-cause mortality independently. CVD risk was strongly increased in patients with a drop in SBP and tended to be increased (non-significantly) also in patients with a plateau in SBP at the end of exercise, in comparison with increasing SBP.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542957","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}