Open Heart最新文献

{"title":"Radiomic features of peri-left atrial epicardial adipose tissue and atrial fibrillation recurrence after ablation.","authors":"Yifan Hu, Longzhe Gao, Qiangrong Wang, Jin Chen, Shanshan Jiang, Genqing Zhou, Jiayin Zhang","doi":"10.1136/openhrt-2025-003364","DOIUrl":"10.1136/openhrt-2025-003364","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to establish a prediction model that incorporates the radiomic features of epicardial adipose tissue (EAT) to predict atrial fibrillation (AF) recurrence after ablation.</p><p><strong>Methods: </strong>We prospectively enrolled patients with AF who underwent pulmonary CT venography before ablation therapy at two hospitals (470 patients in the internal cohort and 81 in the external cohort) between June 2018 and December 2019. Stepwise regression was used to identify clinically relevant factors, including quantitative EAT and left atrial (LA)-EAT measurements (model 1). The random forest algorithm was used to select the radiomic features of EAT and LA-EAT. A radiomics model predicting AF recurrence within 1 year after ablation was developed using these features (model 2). Subsequently, logistic regression was used to integrate radiomic features with clinical data (model 3).</p><p><strong>Results: </strong>In total, 551 patients were enrolled (median age: 66 years, IQR: 60-72 years; 340 men), with 145 experiencing AF recurrence within 1 year. Model 2, based on LA-EAT radiomic features, demonstrated significantly better performance than model 1 (clinical predictive factors and LA-EAT volume) for predicting AF recurrence (areas under the curve (AUC): 0.737 vs 0.584 in the external validation cohort). Model 3 exhibited the highest performance (AUC=0.790 in the external validation cohort, sensitivity value=0.800). Additionally, the combined model provided the highest net clinical benefit within a threshold probability range of 0.2-0.4.</p><p><strong>Conclusions: </strong>The LA-EAT radiomics model along with LA-EAT volume and clinical risk factors exhibited the highest predictive performance for AF recurrence following ablation therapy.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12243630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591894","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":"Contemporary study of acute myocarditis in South Africa: CAMISA.","authors":"Karim Hassan, Anton Doubell, Charles Kyriakakis, Lloyd Joubert, Dan Zaharie, Gert Van Zyl, Rory Leisegang, Philip Herbst","doi":"10.1136/openhrt-2024-002845","DOIUrl":"10.1136/openhrt-2024-002845","url":null,"abstract":"<p><strong>Aims: </strong>This study aims to determine the clinical presentations, aetiologies and outcomes of patients presenting with acute myocarditis (AM) in South Africa.</p><p><strong>Methods: </strong>This is a prospective cohort study. Consecutive patients presenting to Tygerberg Hospital, Cape Town, South Africa, between August 2017 and November 2021 who fulfilled the European Society of Cardiology diagnostic criteria for clinically suspected myocarditis undergoing all recommended investigations, including cardiac MRI (CMR) and endomyocardial biopsy (EMB), were included.</p><p><strong>Results: </strong>111 cases (mean age 41.2 years, 66.3% male) of clinically suspected myocarditis were recruited. AM was confirmed in 89: 44 (49.4%) on CMR only, 16 (18.0%) on EMB only and 29 (32.6%) on both CMR and EMB. 46 (51.7%) presented with infarct-like symptoms, 31 (34.8%) presented with heart failure (HF), 8 (9.0%) with sustained ventricular tachycardia (VT) and 4 (4.5%) with complete heart block (CHB). Viral pathogens were detected in 52 (58.4%) patients with AM, with Parvovirus B19 the most frequent in 39 (75.0%) as monoinfection and as coinfection in 4 (3 (5.8%) with Epstein-Barr virus (EBV) and 1 (1.9%) with EBV and human herpesvirus 6. The prespecified adverse outcome, defined as the occurrence of major adverse clinical events, including cardiac death, documented sustained VT, recurrence of AM and HF hospitalisation, occurred in 30.3%. Initial presentation with sustained VT (HR 5.36, 95% CI 1.76 to 16.33, p=0.003) or CHB (HR 5.67, 95% CI 1.38 to 23.26, p=0.016) was a significant predictor of adverse outcome on multivariate analysis.</p><p><strong>Conclusion: </strong>We report data from the largest cohort of patients with AM outside of the developed world. It provides insight into the clinical presentation, aetiology, viral pathogens and outcomes of patients with AM locally. The findings in this cohort from Africa appear similar to the developed world.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584388","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, adverse events and management of silent in-hospital coronary bypass graft occlusion.","authors":"Islam Salikhanov, Luca Koechlin, Brigitta Gahl, Luise Voehringer, Oliver Reuthebuch, Daniel Dimanski, Brian M Mawad, Denis Berdajs","doi":"10.1136/openhrt-2025-003368","DOIUrl":"10.1136/openhrt-2025-003368","url":null,"abstract":"<p><strong>Objectives: </strong>To assess mid-term outcomes in patients with early silent coronary bypass occlusion.</p><p><strong>Methods: </strong>292 consecutive patients who underwent isolated coronary artery bypass grafting (CABG) between July 2021 and December 2023 were included in this prospective cohort study. Silent CABG occlusion was defined as a bypass occlusion detected by coronary CT before discharge and without clinical suspicion of perioperative myocardial infarction. The primary endpoint was the incidence of angina-related rehospitalisation and coronary revascularisation during the follow-up. The secondary endpoint was the incidence of major adverse cardiovascular and cerebrovascular events, defined as a composite of all-cause mortality, myocardial infarction and stroke.</p><p><strong>Results: </strong>The mean age was 67±9.5 years, with 85.3% (n=249) being male. Early silent occlusion was identified in 25 patients (8.5%). The median hospital stay was longer in the occlusion group with 10 days (IQR 8.0-12.0), versus 8.0 days (IQR 7.0-9.0) in the non-occlusion group (p<0.001). The median follow-up duration was 14.5 (IQR 13.3-16.5) months. The incidence of angina-related rehospitalisation and revascularisation was significantly higher in patients with graft occlusion (p<0.01). Cox proportional hazards regression identified graft occlusion as a strong predictor of rehospitalisation (HR=8.55, 95% CI: 3.23 to 22.64; p<0.001) and reintervention (HR=15.12, 95% CI: 4.89 to 46.74; p<0.001), indicating nearly a 9-fold higher risk of rehospitalisation and a 15-fold increased hazard of reintervention.</p><p><strong>Conclusion: </strong>In-hospital silent graft occlusion following CABG is associated with a higher incidence of angina-related rehospitalisation and revascularisation during mid-term follow-up.</p><p><strong>Trial registration number: </strong>NCT04595630.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584459","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":"Safety and efficacy of stem cell therapy in acute myocardial infarction: a systematic review and meta-analysis of adverse events, infarct size and LV ejection fraction assessed by CMRI.","authors":"Dede Moeswir, Putri Nurbaeti, Hari Hendarto, Muhammad Farhan Abdul Rahman","doi":"10.1136/openhrt-2025-003301","DOIUrl":"10.1136/openhrt-2025-003301","url":null,"abstract":"<p><strong>Introduction: </strong>The current standard treatment for ST-segment elevation myocardial infarction is prompt reperfusion through primary percutaneous coronary intervention. However, myocardial infarction remains the leading cause of heart failure, contributing to prolonged hospital stay and a 30% rehospitalisation rate within 6 months. Stem cell therapy has emerged as a potential approach to repair myocardial damage.</p><p><strong>Methods: </strong>This study is a meta-analysis of randomised clinical trials available online. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and the study was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions.</p><p><strong>Results: </strong>21 articles from 15 trials (21 clinical trial interventions) with a total of 1218 participants were included. Stem cell therapy was associated with fewer adverse events than controls (OR 0.66, 95% CI 0.44 to 0.99, p=0.05), supporting its short-term to mid-term safety. No cardiac-related cancer cases were reported in any group, but longer follow-up is needed to assess potential oncogenic risks. Efficacy analyses showed no significant effect on infarct size (absolute or relative) or left ventricular ejection fraction (LVEF) in short-term follow-up. In long-term follow-up, relative infarct size became statistically significant in favour of stem cell therapy only after exclusion of an outlier study (standardised mean difference -0.63, 95% CI -0.94 to -0.32, p<0.0001). Long-term LVEF improvement was also significant (mean difference 2.63%, 95% CI 0.50% to 4.76%, p=0.02), although substantial heterogeneity remained unexplained despite sensitivity analyses, including the removal of low-correlation studies.</p><p><strong>Conclusion: </strong>Stem cell therapy for acute myocardial infarction demonstrates a favourable safety profile. While overall efficacy remains uncertain, long-term benefits may exist, particularly for relative infarct size and LVEF. However, interpretation is limited by study heterogeneity. Future trials with standardised protocols and longer follow-up are warranted.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512255","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":"Palliative Performance Scale predicts mortality in cardiac intensive care unit.","authors":"Laura Sofia Cardelli, Lorenzo Gamberini, Beatrice Dal Passo, Silvia Zagnoni, Francesca Sciarra, Federica Frascaro, Alice Vitagliano, Valeria Carinci, Maria Laura Canale, Gianni Casella","doi":"10.1136/openhrt-2025-003302","DOIUrl":"10.1136/openhrt-2025-003302","url":null,"abstract":"<p><strong>Background: </strong>The ageing population has led to an increased prevalence of chronic diseases, posing challenges for the management of critically ill cardiac patients with multiple comorbidities. The Palliative Performance Scale (PPS), initially developed for terminally ill cancer patients, has shown prognostic value in various medical settings but remains understudied in cardiac intensive care units (CICUs). This study evaluates the PPS as a prognostic tool for in-hospital and 1-year all-cause mortality in CICU patients.</p><p><strong>Methods: </strong>We conducted a single-centre, prospective, observational study at the Maggiore Hospital in Bologna, including 1131 patients admitted to the CICU between August 2022 and November 2023. Patients were stratified into two groups based on their PPS at admission (≤70 and >70). Multivariable regression models were used to assess predictors of mortality, and Kaplan-Meier survival curves were generated. Model accuracy and calibration were evaluated using receiver operating characteristic curves and the Hosmer-Lemeshow test.</p><p><strong>Results: </strong>Patients with PPS ≤70 had significantly higher 1-year all-cause mortality (37.0% vs 9.8%, p<0.001) and in-hospital all-cause mortality (17.7% vs 3.3%, p<0.001). In the multivariable regression models, PPS emerged as an independent predictor of both 1-year and in-hospital all-cause mortality, along with age and Sequential Organ Failure Assessment score. The models demonstrated good discriminatory performance (area under the curve of 0.841 for 1-year mortality, 0.862 for in-hospital mortality) and acceptable calibration.</p><p><strong>Conclusions: </strong>The PPS is a reliable and independent predictor of mortality in CICU patients. Incorporating PPS into clinical practice may enhance risk stratification, guide decision-making and optimise resource allocation in this high-risk population.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of the GRACE risk score according to troponin elevation in patients admitted with non-ST elevation acute coronary syndrome: a post hoc analysis of the UKGRIS parallel group cluster randomised controlled trial.","authors":"Chris P Gale, Deborah Stocken, Ramesh Nadarajah, Suleman Aktaa, Catherine Reynolds, Rachael Gilberts, David B Brieger, Kathryn Carruthers, Derek P Chew, Shaun Goodman, Catherine Fernandez, Linda Sharples, Andrew T Yan, Keith A A Fox","doi":"10.1136/openhrt-2025-003213","DOIUrl":"10.1136/openhrt-2025-003213","url":null,"abstract":"<p><strong>Background: </strong>The effectiveness of risk stratification using the Global Registry of Acute Coronary Events (GRACE) Risk Score (GRS) for patients presenting to hospital with suspected non-ST elevation acute coronary syndrome (NSTEACS) according to troponin elevation is unknown.</p><p><strong>Methods: </strong>Post hoc analysis of a phase 3 parallel group cluster randomised controlled trial (UK GRACE Risk Score, UKGRIS) of adult patients presenting with suspected NSTEACS to 42 hospitals in England between 9 March 2017 and 30 December 2019, with hospitals randomised (1:1) to standard care or according to the GRS and associated guidelines. Coprimary outcome measures were use of guideline-recommended management and time to the composite of cardiovascular death, non-fatal myocardial infarction, new-onset heart failure hospitalisation or readmission for cardiovascular event at a minimum of 24 months follow-up.</p><p><strong>Results: </strong>A total of 3050 patients were randomised in UKGRIS, of whom 2602 had troponin elevation. The relative effect of GRS compared with standard care on the uptake of guideline-recommended care was greater for participants with troponin elevation compared with those without (relative OR 1.52, 95% CI 1.16 to 2.00, p<0.01). The time to the first composite event was not improved by the GRS among participants with (HR 0.89, 95% CI 0.70 to 1.14) or without troponin elevation (HR 1.14, 95% CI 0.79 to 1.64), with no interaction (relative HR 0.79, 95% CI 0.57 to 1.08, p=0.14 for interaction).</p><p><strong>Conclusions: </strong>For suspected NSTEACS, the effect of the GRS compared with standard care on uptake of recommended processes in those with elevated troponin was higher than in those without. However, this did not translate into a reduction in the composite primary or secondary outcomes at 24 months.</p><p><strong>Trial registration number: </strong>ISRCTN29731761.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144507312","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":"First year after surgery is the optimal period to define early prosthetic valve endocarditis: a cohort study.","authors":"Jorge Calderón-Parra, Francesc Escrihuela, Guillermo Cuervo, Juan Carlos López-Azor, Patricia Muñoz, Marina Machado, Mercedes Marín, María Ángeles Rodríguez-Esteban, Raquel Rodríguez-García, Francisco Gutiérrez, Jose M Miró Meda, Miguel Ángel Goenaga, Josune Goikoetxea-Agirre, Arístides de Alarcón, Laura Vidal-Bonnet, Antonio Ramos-Martinez","doi":"10.1136/openhrt-2025-003378","DOIUrl":"10.1136/openhrt-2025-003378","url":null,"abstract":"<p><strong>Background: </strong>The definition of early prosthetic valve endocarditis (PVE) remains controversial. This study aims to refine the definition of early PVE by analysing data from the Spanish endocarditis registry (Spanish Collaboration on Endocarditis).</p><p><strong>Methods: </strong>From 2008 to 2022, 1305 consecutive cases of PVE were included. The objective was to identify the time period that best defined early PVE by comparing the frequency of cases due to nosocomial micro-organisms and the frequency of intracardiac complications. For this purpose, the periods most frequently considered in the literature were selected: the first 4, 6 or 12 months after surgery. Each of these three periods was compared with a period immediately thereafter.</p><p><strong>Results: </strong>Most cases of PVE diagnosed within the first year were caused by nosocomial pathogens, such as coagulase-negative staphylococci (CoNS) (236 cases, 49.3 %) and <i>Candida</i> spp (23 cases, 4.8 %) and was associated with higher rates of intracardiac complications (252 cases 52.6%). In patients diagnosed after the first year, these figures were 197 cases (23.8%, p<0.001); 10 cases (1.2%, p<0.001) and 298 cases (36.1%, p<0.001), respectively. No significant differences were found between the first 4 months and the 5th-6th months. When comparing cases diagnosed in the first 6 months with those diagnosed during the 7^th and 12^th months, there was a higher prevalence of cases due to CoNS (186 cases, 52.1% vs 50 cases 41%; p=0.034). Hospital mortality among patients who did not undergo surgery due to lack of indication was similar in those diagnosed during or after the first 6 months (17.1% vs 13.8%; p=0.663, respectively).</p><p><strong>Conclusions: </strong>We consider that the first year after surgery is the most appropriate period for defining early PVE. Our results question whether cases diagnosed in the first 6 months after surgery constitute cases of early EVP and the need for valve replacement, as postulated by European guidelines.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144507313","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":"Cardiac MRI-derived mean right atrial pressure and its prognostic importance.","authors":"Tom Alexander Howard Newman, Gareth Matthews, Hosamadin Assadi, Rui Li, Ciaran Grafton-Clarke, Zia Mehmood, Bahman Kasmai, Chris Sawh, Liang Zhong, Samer Alabed, Joao L Cavalcante, Ross J Thomson, Nay Aung, Rob J van der Geest, Andrew J Swift, Pankaj Garg","doi":"10.1136/openhrt-2025-003216","DOIUrl":"10.1136/openhrt-2025-003216","url":null,"abstract":"<p><strong>Background: </strong>Right atrial pressure (RAP) is a key variable that cardiac MRI (CMR) cannot currently measure. We aimed to develop a model to estimate mean RAP (mRAP) using CMR and assess the prognostic value of CMR-derived mRAP in an independent patient cohort.</p><p><strong>Methods: </strong>The derivation cohort consisted of patients investigated for heart failure symptoms with right heart catheterisation and CMR. Right atrial and ventricular CMR measurements were correlated with invasive mRAP to inform multivariable linear regression models incorporating patient characteristics. CMR-derived mRAP was tested as a predictor for clinical outcomes (lower-limb oedema, heart failure hospitalisation and all-cause mortality) on an independent cohort of patients receiving CMR. Both cohorts were derived from hospital registries.</p><p><strong>Results: </strong>In the derivation cohort (n=672), invasive mRAP was >8 mm Hg in 56% of patients. Right atrial end-systolic volume (RAESV) had the strongest correlation with invasive mRAP (Pearson's coefficient 0.58, p<0.01). RAESV was as accurate as more complex models for mRAP prediction (p>0.05). CMR-derived mRAP ≥10 mm Hg was better associated with outcomes than mRAP ≥8 mm Hg in the clinical cohort (n=101) with diagnostic power for peripheral oedema (area under the curve (AUC) 0.75, p=0.02) and heart failure hospitalisation (AUC 0.93, p<0.01). Kaplan-Meier analysis demonstrated elevated CMR-derived mRAP (≥10 mm Hg) was associated with reduced survival compared with mRAP <10 mm Hg (χ²=5, p=0.02) over a mean follow-up of 6.8 years.</p><p><strong>Conclusion: </strong>mRAP can be estimated by CMR. Raised CMR-derived mRAP is predictive of lower-limb oedema, heart failure hospitalisation and all-cause mortality.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12184376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476210","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":"Need for a permanent pacemaker after transcatheter aortic valve implantation in Spain: a retrospective analysis of the national Minimum Basic Dataset from 2017 to 2022.","authors":"Manuel Carnero-Alcázar, Ivan Javier Nuñez-Gil, Isidre Vilacosta, Lourdes Montero, Gregorio Cuerpo, Jose Lopez-Menendez, Gisela Feltes-Guzman, Rosa Beltrao-Sial, Daniel Pérez-Camargo, Álvaro Vicedo-López, Juan Miranda-Torrón, María Belén Solís-Chávez, Javier Cobiella, Luis Maroto","doi":"10.1136/openhrt-2025-003396","DOIUrl":"10.1136/openhrt-2025-003396","url":null,"abstract":"<p><strong>Background: </strong>There is no available information on the risk of permanent pacemaker implantation following transcatheter aortic valve implantation (TAVI) in Spain. Our objective was to investigate the incidence, temporal trends, and factors associated with this complication between 2017 and 2022, using data from the Spanish National Hospital Discharge Database (CMBD).</p><p><strong>Methods: </strong>This retrospective study was based on CMBD data of patients who underwent TAVI between 2017 and 2022. Patients under 60 years of age and those with a prior pacemaker or valve prosthesis were excluded. Demographic variables, comorbidities, hospital procedural volume and pacemaker incidence were analysed. A multivariable analysis was performed to evaluate changes in risk over time, adjusted for age, sex and Charlson Comorbidity Index.</p><p><strong>Results: </strong>A total of 20 826 procedures were included. The overall incidence of pacemaker implantation was 16.8%, increasing from 15.2% in 2017 to 18.2% in 2022 (p<0.001). This increase was independent of age, sex and Charlson index. No modifying effect of hospital procedural volume on the rising pacemaker risk was identified.</p><p><strong>Conclusions: </strong>The risk of permanent pacemaker implantation after TAVI has increased in Spain between 2017 and 2022. This increase was independent of demographic factors, comorbidities or hospital procedural volume. These findings highlight the need to optimise patient selection and improve TAVI implantation strategies to reduce this complication.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326469","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":"Cardiac magnetic resonance comparison of non-dilated and dilated cardiomyopathy: imaging features and prognostic predictors in non-dilated left ventricular cardiomyopathy.","authors":"Baiyan Zhuang, Shuang Li, Hongkai Zhang, Zhonghua Sun, Hui Wang, Lei Xu","doi":"10.1136/openhrt-2025-003441","DOIUrl":"10.1136/openhrt-2025-003441","url":null,"abstract":"<p><strong>Objectives: </strong>Non-dilated left ventricular cardiomyopathy (NDLVC) is a novel cardiomyopathy characterised by normal LV size and non-ischaemic myocardial scarring or fatty tissue replacement. This study aimed to explore the clinical and cardiac magnetic resonance (CMR) characteristics of NDLVC compared with dilated cardiomyopathy (DCM) and event rates of patients with NDLVC and reduced LV ejection fraction (NDLVC-REF).</p><p><strong>Materials and methods: </strong>A retrospective cohort study of 396 patients, including 210 with NDLVC (135 classified as NDLVC-REF) and 186 with DCM, who underwent CMR imaging between 2015 and 2017, was conducted. Follow-up lasted until May 2024, with a composite endpoint of major adverse cardiovascular events (only NDLVC patients were followed).</p><p><strong>Results: </strong>NDLVC patients exhibited better cardiac function than those with DCM, with higher LVEF (40.1%±15.8% vs 23.3%±8.8%, p<0.001). Compared with DCM, the presence of late gadolinium enhancement (LGE) was lower in the NDLVC group (77.4% vs 64.8%, p<0.001). NDLVC-REF showed a comparable prevalence of LGE presence with DCM (70.4% vs 77.4%, p=0.06) but lower LGE mass (4.8 (0, 9.9) g vs 6.8 (4.0, 11.0) g, p=0.01). Over a median follow-up of 83 months, 62 patients with NDLVC (29.5%) reached the composite endpoint. Multivariable analyses (forward logistic regression) identified right ventricular ejection fraction (RVEF) (0.98 (0.96, 0.99), p=0.01, Harrell's C-index=0.65) as the significant predictor of adverse outcomes in NDLVC. The presence of epicardium-involved LGE, left atrial volume index, LVEF, global radial strain and global circumferential strain was also associated with adverse events in NDLVC. In NDLVC-REF, RVEF <40% independently predicted major adverse cardiovascular events (2.19 (1.14-4.20), p=0.01).</p><p><strong>Conclusion: </strong>The clinical baseline and CMR parameters of NDLVC were different from those of DCM. RVEF was a powerful predictor of adverse events in NDLVC and NDLVC-REF.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326468","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}