Open Heart最新文献

{"title":"Pericardial segmentation: a proposed model to quantify disease burden.","authors":"Louis Jonas Giliomee, Janette Verster, Innocent Maposa, Anton Doubell, Pieter-Paul Strauss Robbertse, Philip Herbst","doi":"10.1136/openhrt-2025-003512","DOIUrl":"10.1136/openhrt-2025-003512","url":null,"abstract":"<p><strong>Background: </strong>Cardiac MR (CMR) provides a comprehensive assessment of pericardial structure, tissue characteristics and constriction-related haemodynamics, making it an excellent tool for assessing the complex mechanisms that underlie constrictive pericarditis. To facilitate the reproducible quantification of pericardial disease burden, this article introduces the first standardised pericardial segmentation model validated against anatomical specimens, obtainable using standard CMR sectioning planes, and designed with equal weighting of individual pericardial segments for ease of use.</p><p><strong>Methods: </strong>The model was created by assessing 100 morphologically normal forensic cardiac specimens with an equal gender distribution and a broad age range. Direct measurements of left ventricular (LV) and right ventricular (RV) surface areas were obtained on standard cardiac short-axis forensic dissection slices. To assess variability in respective LV and RV segment sizes, data from the 100 specimens were compared with an idealised model developed to have identical respective LV and RV segment sizes.</p><p><strong>Results: </strong>On average, the LV and RV contributed similar areas (49.9% and 50.1%, respectively) of the total ventricular surface area. The LV pericardial area was well represented by those 11 segments of the 17-segment American Heart Association model that borders pericardium (measuring 4.51%±0.2% of the total pericardial area, per segment). The RV surface area was best represented by nine novel segments (measuring 5.54%±0.3% of the total pericardial area, per segment). A correlation between the measured and idealised models showed a mean difference of only 0.04% and 0.02% per segment for the LV and RV, respectively.</p><p><strong>Conclusions: </strong>This pericardial segmentation model, validated against anatomical specimens and obtainable using only standard CMR views, incorporates equal-sized LV and RV pericardial segments to ensure clinical usability. By enabling quantification of disease distribution and burden across both ventricles, the model has the potential to improve clinical decision-making and enhance precision in pericardial research.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138073","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":"Non-adherence to medications prescribed to patients with heart failure in general practice: prevalence, risk factors and association with mortality and hospitalisation.","authors":"Tarita Murray-Thomas, Alex Bottle, Jamil Mayet, Puja Myles","doi":"10.1136/openhrt-2025-003373","DOIUrl":"10.1136/openhrt-2025-003373","url":null,"abstract":"<p><strong>Aim: </strong>In the UK, pharmacological management of patients with heart failure (HF) occurs predominantly in general practice. Using data from the Clinical Practice Research Datalink, we examined the prevalence and risk factors for medication non-adherence and its association with hospitalisation and mortality over a 9-year period.</p><p><strong>Methods: </strong>A retrospective cohort study of 127 927 patients, ≥18 years old in England with incident HF diagnosed during 1 January 2009 to 31 December 2018. We evaluated non-adherence to any ACE inhibitor, angiotensin receptor blocker, β-blocker or mineralocorticoid receptor antagonist, over 24 months. Non-adherence was based on proportion of days covered (PDC) and defined as PDC<80%. Risk factors for non-adherence and all-cause mortality were examined using multiple logistic regression and Cox regression, respectively. Rates of any-cause emergency hospitalisations, cardiovascular disease (CVD) and HF mortality was estimated using Fine-Gray competing risk models. PDC was also assessed as a continuous variable.</p><p><strong>Results: </strong>About 43.6% of patients were non-adherent to therapy. Crude rates of emergency admissions, all-cause, CVD and HF mortality overall were 306.8/1000, 119.6/1000, 44.6/1000 and 3.3/1000 person-years, respectively. The strongest predictor of non-adherence was any-cause hospitalisation ≤12 months prior. Non-adherence was associated with a higher rate of all-cause mortality (HR 1.31, 95% CI 1.28 to 1.33) and significantly associated with CVD-related mortality (subdistribution HR (SHR) 1.20, 95% CI 1.16 to 1.23), HF deaths (SHR 1.18, 95% CI 1.05 to 1.32) and any-cause emergency admissions (SHR 1.11, 95% CI 1.10 to 1.13). In the analysis treating PDC as a continuous variable, every 10% decrease in PDC levels was associated with a 6% increased hazard of all-cause mortality (HR 1.06, 95% CI 1.05 to 1.06) and was significantly associated with CVD, but not HF mortality.</p><p><strong>Conclusion: </strong>Medication non-adherence over 24 months was relatively high and associated with poorer health outcomes. Interventions to improve adherence among patients with HF are needed.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138007","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":"Association between serum uric acid and high-risk plaques assessed by coronary CT angiography.","authors":"Xinguang Long, Yao Jing, Zhou Haitao","doi":"10.1136/openhrt-2025-003579","DOIUrl":"10.1136/openhrt-2025-003579","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the association between serum uric acid (UA) and high-risk plaques (HRPs) assessed by coronary CT angiography (CCTA).</p><p><strong>Methods: </strong>In this retrospective study, we included outpatients who underwent CCTA. HRP was defined as ≥any 2 of the following features: positive remodelling, low-attenuation plaque (LAP), napkin ring sign and spotty calcification. Plaque volume, Agatston score, vessel stenosis, segment stenosis score (SSS) and segment involvement score (SIS) were also determined by CCTA. Logistic regression analysis was used to assess the relationship between serum UA and the risk of HRP. Receiver operating characteristic (ROC) curve analysis was performed to assess model's accuracy and discrimination. Subgroup analysis based on sex (male/female), diabetes mellitus (yes/no), smoking status (yes/no), alcohol use (yes/no), obstructive coronary artery disease (CAD) (yes/no), Agatston score (<300 or ≥300) was performed.</p><p><strong>Results: </strong>1411 subjects were included in the final analysis, with a mean age of 64.26±9.92 years and a median serum UA value of 425 µmol/L (IQR 296-622). A total of 344 cases of HRPs were identified. Multivariable logistic regression showed that serum UA (OR 2.96 per SD increment, 95% CI 1.85~4.76, p<0.001) was associated with higher risk of HRP after adjustment of sex, diabetes mellitus, smoking, obstructive CAD, age, Agatston score, total plaque volume, LAP volume, SSS and SIS. ROC analysis showed that area under curve of the model was 0.86 (95% CI 0.83 to 0.88, p<0.001). In subgroup analysis, no effect modification was found (all p>0.05).</p><p><strong>Conclusion: </strong>Serum UA is an independent risk factor for high-risk coronary artery plaques on CCTA. Measuring serum UA might provide improvement of discrimination and reclassification for CAD when added to clinical characteristics.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138089","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":"Triglyceride-Glucose Index: a novel prognostic predictor for postoperative cerebral infarction in off-pump coronary artery bypass grafting - insights from a nationwide multicentre study.","authors":"Shipan Wang, Yilin Li, Hao Han, Tianxu Han, Zhiran Yang, Youjin Li, Haiping Yang, Hongli Li, Gang Liu, Minjia Zhu, Jian Huang, Qingwu Zhao, Jihong Liu, Haibin Li, Shuaitong Zhang, Yuan Xue, Hongjia Zhang, Haiyang Li","doi":"10.1136/openhrt-2025-003673","DOIUrl":"10.1136/openhrt-2025-003673","url":null,"abstract":"<p><strong>Background: </strong>Postoperative cerebral infarction following coronary artery bypass grafting (CABG) for multivessel coronary artery disease (CAD) is a major complication and is associated with insulin resistance (IR). This study used the Triglyceride-Glucose (TyG) Index, a robust indicator of IR, to assess its association with cerebral infarction and other adverse events in patients with off-pump CABG (OPCABG).</p><p><strong>Methods: </strong>This retrospective observational study included 3654 CAD cases from eight centres across China. The primary outcome was postoperative cerebral infarction. The predictive role of the TyG Index was evaluated using multivariate logistic regression and restricted cubic spline regression. Receiver operating characteristics analysis was conducted to assess its impact on model performance.</p><p><strong>Results: </strong>A total of 89 patients experienced postoperative cerebral infarction. After adjusting for confounding factors, the TyG Index, whether treated as a categorical variable (OR=2.23, 95% CI 1.24 to 4.02) or a continuous variable (OR=1.80, 95% CI 1.29 to 2.51), was found to be a significant independent risk factor for postoperative cerebral infarction (both p<0.001). The restricted cubic splines regression model revealed a linear dose-response association between the TyG Index and the risk of postoperative cerebral infarction (p for non-linearity=0.861). Subgroup analysis did not indicate any interactions among subgroups (p for interaction >0.05). Incorporating the TyG Index yielded a modest but statistically significant improvement in discrimination for postoperative cerebral infarction (area under the receiver operating characteristics curve 0.724 vs 0.708; p<0.001).</p><p><strong>Conclusions: </strong>IR reflected by an elevated TyG Index predicts the risk of postoperative cerebral infarction in patients undergoing OPCABG.</p><p><strong>Trial registration number: </strong>Chinese Clinical Trial Registry: Chictr2400085741.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138142","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":"Wearable cardioverter defibrillator for transient arrhythmic risk and sudden cardiac death prevention: a systematic review and updated meta-analysis.","authors":"Andrea Matteucci, Michela Bonanni, Luca Sgarra, Carlo Pignalberi, Stefano Aquilani, Stefania Angela Di Fusco, Marco Valerio Mariani, Nicola Pierucci, Carlo Lavalle, Silvio Fedele, Federico Nardi, Furio Colivicchi","doi":"10.1136/openhrt-2025-003648","DOIUrl":"10.1136/openhrt-2025-003648","url":null,"abstract":"<p><strong>Background: </strong>Sudden cardiac death (SCD) is a common cause of cardiovascular mortality, often triggered by ventricular arrhythmias in the setting of myocardial vulnerability. The wearable cardioverter-defibrillator (WCD) offers temporary protection against SCD, particularly when an implantable device is contraindicated or premature.</p><p><strong>Objectives: </strong>We conducted a comprehensive meta-analysis to assess the effectiveness of the WCD in appropriately terminating life-threatening arrhythmias such as sustained ventricular tachycardia (VT) and ventricular fibrillation (VF), preventing sudden cardiac death.</p><p><strong>Methods: </strong>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we systematically reviewed 40 studies comprising 59 647 adults fitted with a WCD for primary or secondary SCD prevention. Random-effects meta-analysis, subgroup analysis, meta-regression and sensitivity analyses were performed.</p><p><strong>Results: </strong>The pooled incidence of appropriate WCD intervention was 3% (95% CI 2% to 3%), with substantial heterogeneity (I²=88.9%). The prediction interval ranged from 1% to 8%, indicating that future studies conducted in selected high-risk populations may observe significantly higher WCD intervention. Life-threatening arrhythmias were higher during early follow-up (≤60 days). An appropriate daily WCD wearing time significantly influenced the results. Gender, age, ejection fraction and study design were not significant modifiers. No publication bias was detected.</p><p><strong>Conclusions: </strong>The WCD represents an effective strategy for preventing SCD in early high-risk settings, with its benefit closely linked to adherence and appropriate patient selection.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138147","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":"Phenomapping-derived selection of fractional flow reserve or optical coherence tomography to personalise percutaneous coronary intervention.","authors":"Fabrizio D'Ascenzo, Isabella Caranzano, Ovidio De Filippo, Federico Giacobbe, Antonio Maria Leone, Tiziana Sanavia, Emanuele Ravetti, Fabrizio Ugo, Carlo Trani, Nicolas Amabile, Samuele Sandrone, Cristina Aurigemma, Geraud Souteyrand, Davide Capodanno, Irene Borzillo, Francesco Bruno, Giacomo Boccuzzi, Piero Fariselli, Gaetano Maria De Ferrari, Mario Iannaccone, Francesco Burzotta","doi":"10.1136/openhrt-2025-003453","DOIUrl":"10.1136/openhrt-2025-003453","url":null,"abstract":"<p><strong>Introduction: </strong>An evidence-based selection between fractional flow reserve (FFR) and optical coherence tomography (OCT) to drive percutaneous coronary intervention is still lacking.</p><p><strong>Methods: </strong>Patients enrolled in the Fractional Flow Reserve vs. Optical Coherence Tomography to Guide Revascularization of Intermediate Coronary Stenoses (FORZA) trial and in the OCT-Features Of moRphology, coMposItion anD instABility of culprit and not culprit coronary pLaquE in ACS patient (OCT-FORMIDABLE) registry were included. Target vessel revascularisation (TVR) and major adverse cardiac events (MACE), a composite endpoint of cardiac death, myocardial infarction (MI) and TVR were considered as coprimary endpoints. Phenomapping with clustering was performed: incidence of outcomes according to FFR and OCT was explored.</p><p><strong>Results: </strong>405 patients were treated according to OCT and 405 to FFR. Three different clusters were identified. 48% of the patients were included in the first cluster, presenting mainly with stable angina and a relevant burden of risk factors (cardiovascular risk factors, CVRFs). 21% of the patients were included in the second cluster, presenting with ST segment elevation MI (STEMI) and with low rates of CVRFs. 31% of the patients, being admitted mostly for non-STEMI (NSTEMI) and with high rates of CVRFs, were included in the third cluster. FFR and OCT performed similarly in terms of MACE and TVR in the first cluster. In the second cluster, rates of MACE were lower in the OCT arm (3% vs 12%, p 0.04), mainly driven by TVR (2% vs 6%, p 0.18). In the third cluster, rates of TVR were significantly reduced in the OCT arm (6% vs 14%, p 0.037) with a neutral impact on MACE (12% vs 15%, p 0.71).</p><p><strong>Conclusions: </strong>Compared with a functional assessment, an OCT-based approach reduces revascularisation in patients with STEMI/NSTEMI, while FFR proved non-inferior for patients with stable angina.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086611","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":"Anatomical characterisation of an additional atrioventricular node artery contributing to the arterial complex of proximal conduction components: Bonapace's septal branch or Kugel's collateral artery.","authors":"Tomokazu Kawashima","doi":"10.1136/openhrt-2025-003520","DOIUrl":"10.1136/openhrt-2025-003520","url":null,"abstract":"<p><strong>Background: </strong>Transient or permanent iatrogenic conduction disturbances from injury to arteries supplying the cardiac conduction system (CCS) have increased. A more comprehensive understanding of CCS arterial anatomy is essential for advancing electrophysiological studies. Compared with the sinus node (SN) artery, atrioventricular node (AVN) artery is more variable and difficult to identify because of the thicker surrounding myocardium. Arterial sources other than the main AVN artery branching near the cardiac crux-such as the Bonapace's septal branch or Kugel's collateral artery-have often been overlooked or regarded as atypical and remain poorly characterised.</p><p><strong>Methods: </strong>An alternative origin and course of the AVN artery were examined in 116 hearts via microdissection and in 14 additional hearts using serial histological sections of physiologically aged hearts without coronary artery occlusion.</p><p><strong>Results: </strong>An additional descending AVN artery was observed in 22.4% of cases and an interatrial septal branch extending to Koch's triangle was found in 11.2% based on the macroscopic analysis-findings aligning well with the histologically verified incidence of 35.7%. These results suggest that approximately one-third of individuals exhibit an additional descending AVN artery with features resembling the normal Bonapace's septal branch. Notably, this additional artery originates from a common trunk with the SN artery and Bachmann's bundle branches, forming an arterial complex supplying the proximal conduction components.</p><p><strong>Conclusions: </strong>Using a large sample size, our findings highlight the anatomical and clinical importance of the arterial complex supplying the proximal conduction components, including the additional descending AVN artery. This arterial complex may include the Bonapace's septal branch and serve as a Kugel's collateral route in coronary occlusion. This characterisation provides basic essential anatomical data to support future research on iatrogenic conduction disturbances.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145054881","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":"Prominent V waves in right heart catheterisation as a marker of left atrial stiffness in pulmonary hypertension.","authors":"Jayant Vignesh Ravindran, Tommy Chung, Christopher Naoum, John Yiannikas","doi":"10.1136/openhrt-2025-003399","DOIUrl":"10.1136/openhrt-2025-003399","url":null,"abstract":"<p><strong>Introduction: </strong>Stiff left atrium (LA) is important in the pathophysiology and progression of heart failure with preserved ejection fraction. Non-invasive techniques used to measure stiff LA have significant limitations. Prominent V waves seen during right heart catheterisation (RHC) have been linked to a stiff LA; however, there are no studies exploring the prevalence of this in patients with pulmonary hypertension (PH). We present the first study assessing stiff LA using invasive techniques in patients with PH using V wave measurements on RHC.</p><p><strong>Methods: </strong>50 patients with PH (66.9±14.5 years, 30% male) and 18 controls were studied. Patients with left ventricular (LV) dysfunction, moderate or greater mitral regurgitation or atrial fibrillation were excluded. Echocardiographic (LA area, E/E' average, LV hypertrophy) and RHC (peak/mean pulmonary artery pressures, mean pulmonary capillary wedge pressure (mPCWP), V wave) parameters were collected. Prominent V wave was defined as ≥10 mm Hg above mPCWP. Prevalence of prominent V waves and its correlations between echocardiographic and RHC parameters were determined.</p><p><strong>Results: </strong>Six (12%) patients with PH had prominent V waves, while none of the control patients did (12% vs 0%, respectively, p=0.18). Prominent V waves were only seen in patients with postcapillary PH (28.6% vs 0%; p=0.003) and were strongly associated with echocardiographic parameters-LA size and E/E' ratio.</p><p><strong>Conclusions: </strong>Prominent V waves, a marker of stiff LA, can be easily and readily assessed by RHC and are common with postcapillary PH. Larger studies are needed to elucidate its clinical implications.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145054873","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":"Risk factor monitoring, management and use of prevention medicines in those with a history of premature coronary heart disease.","authors":"Samia Kazi, Desi Quintans, Simone Marschner, Haeri Min, James Chong, Clara K Chow","doi":"10.1136/openhrt-2024-003092","DOIUrl":"10.1136/openhrt-2024-003092","url":null,"abstract":"<p><strong>Background: </strong>Those with premature coronary heart disease (pCHD) have a lower 5-year risk of repeat events; however, their lifetime risk is high. The aim of this study was to assess secondary prevention (SP) medical therapy and risk factor (RF) monitoring in patients with pCHD compared with those without pCHD.</p><p><strong>Methods: </strong>Analysis of a national primary care database including patients attending the same practice between January 2015 and March 2021 with at least 3 follow-up appointments, a history of CHD and a follow-up duration of at least 2 years. pCHD was defined as males under 55 and females under 65 at age of diagnosis of their CHD.</p><p><strong>Results: </strong>Among the 64 704 with CHD, 21 035 (32.5%) had pCHD (10 339 women <65 years of age and 10 696 men <55 years of age). Patients with pCHD compared with non-pCHD were more likely to be smokers (59.4% vs 52.6%, p<0.001), less likely to have hypertension (61.9% vs 73.2%, p<0.001) and similar rates of dyslipidaemia (57.8% and 57.5%, p=0.806) and diabetes (30.8% vs 30%, p=0.696). After adjusting for RF, pCHD was not associated with odds of blood pressure (BP) assessment (OR 0.63, 95% CI 0.40 to 1.00), measurement of glycated haemoglobin (OR 0.99, 95% CI 0.94 to 1.04) and any lipid monitoring (OR 1.05, 95% CI 0.96 to 1.14). Patients with PCHD had lower odds of prescription of statins (OR 0.81, 95% CI 0.76 to 0.87), any antiplatelets (OR 0.81, 95% CI 0.77 to 0.86), antihypertensive medication (OR 0.73, 95% CI 0.67 to 0.79) and beta blockers (OR 0.94, 95% CI 0.90 to 0.98) after adjustment for baseline RF. Women with pCHD were even less likely to be prescribed SP medicines of BP lowering and antiplatelets, both p value for interaction <0.000.1 CONCLUSIONS: Patients with a history of pCHD had similar rates of RF monitoring to patients without pCHD, but patients with pCHD were less likely to be prescribed SP medication of statins, antihypertensives and antiplatelets.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145054811","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":"Value of implantable loop recorders in detecting atrial fibrillation for stroke prevention: a systematic review and meta-analysis.","authors":"Mahrokh Janmohamadi, Amirreza Peyrovinasab, Seyedhesamoddin Khatami, Sepehr Moghaddam, Seyed Mohammad Forouzannia, Seyed Ali Forouzannia, Mohammadsadegh Faghihi, Arash Sarveazad, Seyedeh Romina Rafiei Alavi, Mostafa Hosseini, Mahmoud Yousefifard","doi":"10.1136/openhrt-2025-003456","DOIUrl":"10.1136/openhrt-2025-003456","url":null,"abstract":"<p><strong>Background: </strong>Though undiagnosed in many patients, especially those with cryptogenic stroke, atrial fibrillation (AF) is a key cause of ischaemic stroke. By allowing extended cardiac monitoring, implantable loop recorders (ILRs) may help enhance AF identification and secondary stroke prevention. Compared with standard therapy, this meta-analysis and systematic review assesses the effectiveness of ILRs in identifying AF and preventing recurrent stroke.</p><p><strong>Methods: </strong>We searched Web of Science, Scopus, Embase and PubMed up to September 2024 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Included were observational studies comparing ILR with conventional therapy in stroke or high-risk patients as well as randomised controlled trials (RCTs). AF detection, recurrent stroke and mortality were primary outcomes. Random-effects models were used to compute pooled HRs with 95% CIs. We looked at publication bias and heterogeneity.</p><p><strong>Results: </strong>Included were 12 studies with four RCTs and eight cohorts. Compared with controls, ILR use was linked to a much greater AF detection rate (HR=3.13, 95% CI 1.97 to 4.97). Embolic events fell insignificantly (HR=0.81, 95% CI 0.65 to 1.02) and mortality showed no change (HR=1.01, 95% CI 0.77 to 1.31). Subgroup analysis showed more AF detection in RCTs than in cohort studies (p=0.035). Although no major publishing bias was found, heterogeneity was considerable.</p><p><strong>Conclusion: </strong>By greatly enhancing AF detection in patients who had a stroke and at high risk, ILRs did not help to prevent secondary strokes. Therefore, they did not have enough efficacy in lowering recurrent stroke and death. Larger, more comprehensive studies are still required to clarify long-term therapeutic advantages and maximise patient selection.</p><p><strong>Prospero registration number: </strong>CRD420251051946.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040915","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}