Open Heart最新文献

{"title":"Prognostic role of con-/discordant coronary flow reserve and microvascular resistance in coronary microvascular disease: a systematic review and network meta-analysis.","authors":"Jin Al-Gully, Federico Oliveri, Jessica Parisa Forouzanfar, Jose Manuel Montero-Cabezas, Johan Wouter Jukema, Melina Cynthia den Haan, Ibtihal Al Amri, Brian Oscar Bingen","doi":"10.1136/openhrt-2024-003055","DOIUrl":"10.1136/openhrt-2024-003055","url":null,"abstract":"<p><strong>Background: </strong>Coronary microvascular disease (CMD) is defined as impaired coronary flow reserve (CFR) and/or increased microvascular resistance (MR) without significant epicardial coronary stenosis. This definition allows for discordant CFR and MR values within patients with CMD. The aim of this meta-analysis is to characterise the prognostic value and pathophysiological backgrounds of CFR and MR con-/discordance.</p><p><strong>Methods: </strong>A systematic search (PROSPERO CRD42024573004) identified studies determining CFR and MR in patients without significant epicardial coronary artery disease. Patients were divided into four groups: (1) normal CFR and MR, (2) abnormal CFR and MR, (3) abnormal CFR with normal MR and (4) normal CFR with abnormal MR and analysed for all-cause mortality and major adverse cardiovascular events (MACE).</p><p><strong>Results: </strong>We identified four studies representing 2310 total participants. Group B had the highest MACE (OR: 3.23; 95% CI 1.95 to 5.36) and mortality rate (OR: 2.27; 95% CI 1.12 to 4.58) compared with group A. Group C, associated with female sex, showed significantly higher MACE (OR: 2.07; 95% CI 1.25 to 3.45) but not mortality (OR: 1.89; 95% CI 0.92 to 3.88) compared with group A. In group D, associated with high body mass index, MACE and mortality rates did not differ significantly from group A (OR: 1.19; 95% CI 0.67 to 2.11 and OR: 0.55; 95% CI 0.16 to 1.90, respectively).</p><p><strong>Conclusions: </strong>Abnormal CFR and MR are associated with a high risk of MACE and death. Abnormal CFR and normal MR are associated with an increased MACE-but not death. MACE and mortality risk in discordantly normal CFR and abnormal MR are low. Our findings show the need for tailoring CFR and MR diagnostic thresholds to patient characteristics and raise questions about the presence of CMD in patients with abnormal MR with normal CFR.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024148","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":"Systolic blood pressure response during exercise testing in symptomatic severe aortic stenosis.","authors":"Henric Nilsson, Carl Bellander, Anna Carlén, Eva Nylander, Kristofer Hedman, Éva Tamás","doi":"10.1136/openhrt-2024-003084","DOIUrl":"10.1136/openhrt-2024-003084","url":null,"abstract":"<p><strong>Aims: </strong>Exercise testing remains underused in patients with aortic stenosis (AS), partly due to concerns about an exercise-induced drop in systolic blood pressure (SBP). We aimed to study the SBP response to exercise in patients with severe symptomatic AS prior to surgery and 1 year postoperatively.</p><p><strong>Methods: </strong>Patients scheduled for aortic valve replacement due to severe symptomatic AS were enrolled at a single centre in a prospective observational cohort study. Maximal cardiopulmonary exercise testing (CPET) was performed on a cycle ergometer at baseline and 1 year postoperatively, using standard termination criteria. The SBP response was categorised according to the last measurements of SBP during exercise, in relation to workload (the SBP/watt-slope) as 'normal' (>0.25 mm Hg/watt), 'flat' (0-0.25 mm Hg/watt) or 'drop' (<0 mm Hg/watt).</p><p><strong>Results: </strong>45 patients (28 male, 66±9 years, left ventricular ejection fraction 59%±5%, aortic jet velocity 4.6±0.5 m/s) were included, with pairwise comparison available in 31 cases. There were no adverse events. Preoperatively, 4/45 patients were categorised as 'drop', 23 as 'flat' and 18 as 'normal'. There was a change in the distribution of categories from preoperative to postoperative measurements (43% 'normal' vs 74% 'normal', p=0.0046). Maximal SBP and workload-indexed SBP were higher postoperatively than preoperatively (203±26 vs 182±28 mm Hg, p<0.001 and 0.43±0.14 vs 0.29±0.15 mm Hg/watt, p<0.001).</p><p><strong>Conclusion: </strong>As a drop in SBP was infrequent (<10%) in patients with severe symptomatic AS and no adverse events occurred, our results indicate that CPET may be performed under careful monitoring in AS patients. Postoperatively, the SBP reaction improved, with no patient having a drop in SBP.</p><p><strong>Trial registration number: </strong>NCT02790008.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024073","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":"Pregnancy and cardiovascular outcomes among patients post Fontan surgery: a 25-year single-centre retrospective cohort study.","authors":"Daniel Yehuda, Omri Soudry, Eyal Schwartz, Ilan Richter, Alexander Dadashev, Shahar Vig, Shimon Kolker, Ohad Houri, Eran Hadar, Ran Kornowski, Rafael Hirsch, Nili Schamroth Pravda","doi":"10.1136/openhrt-2024-002843","DOIUrl":"https://doi.org/10.1136/openhrt-2024-002843","url":null,"abstract":"<p><strong>Introduction: </strong>Data on the characteristics and outcomes of pregnancy and among patients with Fontan physiology are limited. We aimed to evaluate the immediate and long-term outcomes among these patients who were followed at our centre.</p><p><strong>Methods: </strong>We included adult patients who had undergone Fontan surgery for congenital heart disease and were pregnant between 1994 and 2021. We examined maternal and obstetric outcomes.</p><p><strong>Results: </strong>In a cohort of 109 patients following Fontan procedure, 51 patients were women, and 19 patients (37%) had a pregnancy during the follow-up period, accounting for a total of 46 pregnancies. Intrauterine growth retardation of the fetus was common, observed in 23% of all pregnancies and 50% of live births. The main fetal complication was prematurity, observed in 43% of all pregnancies and 90% of live birth. The maternal complications included pre-eclampsia (one patient), placental detachment (one patient), acute heart failure exacerbation (one patient), arrhythmia (three atrial arrhythmias) and major peripartum haemorrhage (two patients), with no peripartum death.</p><p><strong>Conclusions: </strong>Over one-third of women with Fontan physiology in our cohort had a documented pregnancy. Maternal and obstetric complications were common among these patients, and expanded long-term data is needed. Limitations, including small sample size and survival bias, may have underestimated the risk of adverse outcomes in this cohort.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009051","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":"Role and prognostic value of growth differentiation factor 15 in patient of heart failure with preserved ejection fraction: insights from the PURSUIT-HFpEF registry.","authors":"Daisuke Sakamoto, Yuki Matsuoka, Daisaku Nakatani, Katsuki Okada, Akihiro Sunaga, Hirota Kida, Taiki Sato, Tetsuhisa Kitamura, Shunsuke Tamaki, Masahiro Seo, Masamichi Yano, Takaharu Hayashi, Akito Nakagawa, Yusuke Nakagawa, Yoshio Yasumura, Takahisa Yamada, Shungo Hikoso, Yohei Sotomi, Yasushi Sakata","doi":"10.1136/openhrt-2024-003008","DOIUrl":"10.1136/openhrt-2024-003008","url":null,"abstract":"<p><strong>Background: </strong>Growth differentiation factor 15 (GDF15) is a cytokine responding to oxidative stress and inflammation, and it regulates appetite and energy balance. The association between GDF15 and clinical factors and its prognostic value in elderly multimorbid patients with heart failure with preserved ejection fraction (HFpEF) have not been well unknown.</p><p><strong>Methods: </strong>This exploratory analysis is part of the Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with preserved Ejection Fraction study (N=1231), an ongoing, prospective, multicentre observational study of acute decompensated HFpEF (UMIN000021831). A predefined subcohort of 212 patients underwent multi-biomarker testing. Of these, we analysed 181 patients with available GDF15 data. The primary endpoint was a composite of all-cause death and hospitalisation for HF.</p><p><strong>Results: </strong>In this analysis population, the median age was 81 (75-85) years, with 48% male patients. GDF15 significantly correlated with cardiac burden, anaemia, renal dysfunction and inflammation. Notably, poor nutritional status was significantly associated with GDF15. GDF15 was linked to poor prognosis in this elderly multimorbid cohort with HFpEF (adjusted HR for log-transformed GDF15: 13.67, 95% CI: 2.78 to 67.22, p=0.001). Furthermore, GDF15 added significant incremental value to the MAGGIC risk score (net reclassification improvement=0.4955 (95% CI: 0.1367 to 0.8543), p=0.007; integrated discrimination improvement=0.0278 (95% CI: 0.0013 to 0.0543), p=0.040).</p><p><strong>Conclusions: </strong>GDF15 was associated with anaemia, inflammation, renal dysfunction, cardiac burden and malnutrition. It demonstrated prognostic value in elderly multimorbid HFpEF patients, suggesting its potential role as a complementary marker for the prognostic risk assessment of HFpEF patients.</p><p><strong>Trial registration number: </strong>UMIN-CTR ID: UMIN000021831.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009054","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":"Emulation of ARISTOTLE and ROCKET AF trials in real-world atrial fibrillation patients results in similar efficacy and safety as original landmark trials: insights from the GARFIELD-AF registry.","authors":"Jelle C L Himmelreich, Saverio Virdone, A John Camm, Karen Pieper, Ralf E Harskamp, Freek W A Verheugt, Jean-Pierre Bassand, Frank Misselwitz, Antônio C Pereira-Barretto, Frank Cools, Harry Gibbs, Ajay K Kakkar","doi":"10.1136/openhrt-2024-002966","DOIUrl":"10.1136/openhrt-2024-002966","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to determine the robustness, reproducibility and representativeness of the landmark Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (AF) (ARISTOTLE) and Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in AF (ROCKET AF) randomised trials through replication in an observational AF patient registry.</p><p><strong>Methods and results: </strong>Patients from the Global Anticoagulant Registry in the FIELD (GARFIELD)-AF registry treated with apixaban, rivaroxaban or vitamin K antagonist (VKA) were assessed for eligibility for the ARISTOTLE and ROCKET AF trials. HRs of apixaban and rivaroxaban versus comparator for stroke/systemic embolism, major bleeding and all-cause mortality within 2 years follow-up were calculated using propensity score overlap-weighted Cox models. Among GARFIELD-AF patients on apixaban, 2570/3615 (71%) would have been eligible for ARISTOTLE. Among patients using rivaroxaban, 2005/4914 (41%) would have been eligible for ROCKET AF. Eligibility rates were steady over time, with minor differences across medical specialties. Real-world AF patients selected according to trial criteria had lower cardiovascular burden than the original trial participants, especially compared with ROCKET AF. HRs (95% CI) for apixaban versus VKA among ARISTOTLE-eligible users were 0.57 (0.34 to 0.94) for stroke/systemic embolism, 0.76 (0.48 to 1.20) for major bleeding and 0.89 (0.70 to 1.12) for all-cause mortality. Among ROCKET AF-eligible rivaroxaban users, HRs for rivaroxaban versus VKA were 0.90 (0.57 to 1.43), 0.92 (0.59 to 1.43) and 0.86 (0.69 to 1.08), respectively. All safety and efficacy estimates were similar to those in the original trials.</p><p><strong>Conclusion: </strong>Real-world representativeness of the selection criteria was greater for ARISTOTLE than ROCKET AF. The pivotal randomised trials of apixaban and rivaroxaban versus warfarin can be successfully emulated in real-world AF patients by applying trial-specific selection criteria and appropriate methodology for non-randomised treatment allocation.</p><p><strong>Trial registration number: </strong>NCT01090362.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009049","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":"Emergency interventions for cardiogenic shock due to decompensated aortic stenosis: a systematic review and meta-analysis.","authors":"Stephanie Gladys Kühne, Andrea Patrignani, Sebastien Elvinger, Bastian Wein, Eva Harmel, Damyan Penev, Tamer Owais, Evaldas Girdauskas, Philip W Raake, Mauro Chiarito, Dario Bongiovanni","doi":"10.1136/openhrt-2024-003110","DOIUrl":"10.1136/openhrt-2024-003110","url":null,"abstract":"<p><strong>Background: </strong>Cardiogenic shock (CS) induced by severe aortic stenosis (AS) is a life-threatening condition with high mortality. Despite advancements in emergency interventions, the optimal treatment approach remains uncertain.</p><p><strong>Aim: </strong>This study aimed to systematically review and analyse the existing evidence on outcomes of emergency transcatheter aortic valve implantation (eTAVI) and emergency balloon aortic valvuloplasty (eBAV) in CS patients.</p><p><strong>Methods: </strong>A systematic literature review and meta-analysis was performed. The primary endpoint was mortality at 30 days. Secondary endpoints were in-hospital mortality, 1-year mortality, bleeding, major vascular complications, myocardial infarction, stroke, incidence of pacemaker implantation, acute kidney injury and aortic regurgitation.</p><p><strong>Results: </strong>Seventeen studies were included, totalling 2811 patients. The analysis revealed a 30-day mortality pooled estimated rate for eTAVI of 19% (CI 0.17 - 0.20) and for eBAV 39% (CI 0.32 - 0.46). In-hospital mortality pooled estimated rates were 11% for eTAVI (CI 0.06 - 0.18) and for eBAV 40% (CI 0.28 - 0.54). One-year mortality pooled estimated rates for eTAVI were 29% (CI 0.20 - 0.40) and for eBAV 67% (CI 0.58 - 0.74). Pooled estimated rates of any bleeding were 12% for eTAVI (CI 0.06 - 0.20) and 15% for eBAV (CI 0.10 - 0.21). The rate of major vascular complications for eTAVI was 8% (CI 0.07 - 0.10) and 3% for eBAV (CI 0.0 - 0.23).</p><p><strong>Conclusions: </strong>This meta-analysis indicates that mortality in CS due to AS remains high despite emergency interventional treatment. These findings offer critical insights for clinical decision-making optimising patient care in this critically ill population.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009147","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 left ventricular reverse remodelling and the B-type natriuretic peptide-cGMP cascade after anterior acute myocardial infarction.","authors":"Marina Arai, Yasuhide Asaumi, Satoshi Honda, Soshiro Ogata, Eri Kiyoshige, Kazuhiro Nakao, Hiroyuki Miura, Yoshiaki Morita, Takahiro Nakashima, Kota Murai, Takamasa Iwai, Kenichiro Sawada, Hideo Matama, Masashi Fujino, Hiroyuki Takahama, Shuichi Yoneda, Kensuke Takagi, Fumiyuki Otsuka, Yu Kataoka, Kunihiro Nishimura, Teruo Noguchi, Naoto Minamino, Satoshi Yasuda","doi":"10.1136/openhrt-2024-002927","DOIUrl":"10.1136/openhrt-2024-002927","url":null,"abstract":"<p><strong>Background: </strong>The role of cyclic guanosine 3',5'-monophosphate (cGMP) after acute myocardial infarction (AMI) is not well understood despite its significance as a second messenger of natriuretic peptides (NPs) in cardiovascular disease. We investigated the association between the NP-cGMP cascade and left ventricular reverse remodelling (LVRR) in anterior AMI.</p><p><strong>Methods: </strong>67 patients with their first anterior AMI (median age, 64 years; male, 76%) underwent prospective evaluation of plasma concentrations of the molecular forms of A-type and B-type natriuretic peptide (BNP) and cGMP from immediately after primary percutaneous coronary intervention (PPCI) to 10 months post-AMI. The estimated mature BNP (emBNP) concentration was calculated as the difference between total BNP and prohormone of BNP (proBNP) concentrations. Patients were divided into LVRR and non-LVRR groups on the basis of residuals between observed change in left ventricular end-systolic volume index on MR during the first 11 months after AMI and change adjusted for proBNP concentration immediately post-PPCI, which was calculated with regression. The LVRR group (n=33) had residuals below the median; the non-LVRR group (n=34) had residuals at or above the median.</p><p><strong>Results: </strong>The LVRR group had higher freedom from major adverse cardiac and cerebrovascular events (MACCEs) than the non-LVRR group during a median follow-up of 9.9 years (p=0.008). The presence of LVRR (HR 0.256; 95% CI 0.081 to 0.809; p=0.028) and peak creatine phosphokinase-myocardial band level (per 100 IU/L) (HR 1.22; 95% CI 1.02 to 1.46; p=0.027) were independent predictors of MACCE after adjusting for age, male sex, infarct size and hypertension. Multivariable analyses identified logarithmic proBNP and emBNP concentrations from 12 hours to 5 days post-AMI and logarithmic cGMP concentration from immediately post-PPCI to 3 days post-AMI as independent predictors of LVRR (p<0.05).</p><p><strong>Conclusions: </strong>Early-phase BNP-cGMP cascade activation might play a crucial role in LVRR in anterior AMI.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971761","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":"Diagnostic accuracy in coronary CT angiography analysis: artificial intelligence versus human assessment.","authors":"Rachel Bernardo, Nick S Nurmohamed, Michiel J Bom, Ruurt Jukema, Ruben W de Winter, Ralf Sprengers, Erik S G Stroes, James K Min, James Earls, Ibrahim Danad, Andrew D Choi, Paul Knaapen","doi":"10.1136/openhrt-2024-003115","DOIUrl":"10.1136/openhrt-2024-003115","url":null,"abstract":"<p><strong>Background: </strong>Visual assessment of coronary CT angiography (CCTA) is time-consuming, influenced by reader experience and prone to interobserver variability. This study evaluated a novel algorithm for coronary stenosis quantification (atherosclerosis imaging quantitative CT, AI-QCT).</p><p><strong>Methods: </strong>The study included 208 patients with suspected coronary artery disease (CAD) undergoing CCTA in Perfusion Imaging and CT Coronary Angiography With Invasive Coronary Angiography-1. AI-QCT and blinded readers assessed coronary artery stenosis following the Coronary Artery Disease Reporting and Data System consensus. Accuracy of AI-QCT was compared with a level 3 and two level 2 clinical readers against an invasive quantitative coronary angiography (QCA) reference standard (≥50% stenosis) in an area under the curve (AUC) analysis, evaluated per-patient and per-vessel and stratified by plaque volume.</p><p><strong>Results: </strong>Among 208 patients with a mean age of 58±9 years and 37% women, AI-QCT demonstrated superior concordance with QCA compared with clinical CCTA assessments. For the detection of obstructive stenosis (≥50%), AI-QCT achieved an AUC of 0.91 on a per-patient level, outperforming level 3 (AUC 0.77; p<0.002) and level 2 readers (AUC 0.79; p<0.001 and AUC 0.76; p<0.001). The advantage of AI-QCT was most prominent in those with above median plaque volume. At the per-vessel level, AI-QCT achieved an AUC of 0.86, similar to level 3 (AUC 0.82; p=0.098) stenosis, but superior to level 2 readers (both AUC 0.69; p<0.001).</p><p><strong>Conclusions: </strong>AI-QCT demonstrated superior agreement with invasive QCA compared to clinical CCTA assessments, particularly compared to level 2 readers in those with extensive CAD. Integrating AI-QCT into routine clinical practice holds promise for improving the accuracy of stenosis quantification through CCTA.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971140","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":"Can aortic valve calcium score predict a need for permanent pacemaker implantation after transcatheter aortic valve implantation?","authors":"Thomas Barbe, Charles Fauvel, Thibaut Hemery, Guillaume Le Pessec, Christophe Tron, Najime Bouhzam, Nicolas Bettinger, Julie Burdeau, Jade Makke, Quentin Laissac, Jean-Nicolas Dacher, Helene Eltchaninoff, Eric Durand","doi":"10.1136/openhrt-2024-002934","DOIUrl":"https://doi.org/10.1136/openhrt-2024-002934","url":null,"abstract":"<p><strong>Introduction: </strong>Conductive disturbances requiring permanent pacemaker (PPM) implantation remain a major concern after transcatheter aortic valve implantation (TAVI).</p><p><strong>Aims: </strong>To assess the impact of aortic valve calcium score (AVCS) on conductive disturbances requiring PPM after TAVI.</p><p><strong>Methods: </strong>All patients who underwent TAVI with accessible AVCS from the preprocedural CT scan report were included in this retrospective single-centre study. The primary endpoint was the occurrence of a conductive disturbance requiring PPM at 30 days. The association between PPM and AVCS, with its incremental prognostic value, was analysed using multivariable logistic regression, receiver operating characteristic curve analysis and likelihood ratio (LR) test.</p><p><strong>Results: </strong>We included 761 patients of which 125 (16%) required PPM at 30 days. AVCS score was significantly higher in patients requiring PPM (3788 (2487-5218) vs 3050 (2043-4367) AU, p<0.001). Using multivariable analysis, preprocedural right bundle branch block (RBBB) (OR 6.61, 95% CI 3.82 to 11.5, p<0.001), first atrioventricular block (OR 1.71, 95% CI 1.03 to 2.83, p=0.037), self-expanding valve (OR 3.25, 95% CI 1.17 to 9.09, p=0.025) and AVCS>4510 AU (OR 1.83, 95% CI 1.04 to 3.20, p=0.035) were independently associated with PPM. AVCS had an incremental discriminative value (C-index 0.79 vs 0.77, LR test p=0.036) over and above traditional PPM risk factors. An algorithm was proposed based on the initial presence of RBBB, AVCS and the type of implanted valve.</p><p><strong>Conclusion: </strong>Even if RBBB remained the strongest predictor of PPM post-TAVI, this study suggests that a high AVCS may help identifying patients at increased risk of PPM after TAVI, especially among those without pre-existing RBBB.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056084","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":"End-to-end deep-learning model for the detection of coronary artery stenosis on coronary CT images.","authors":"Vibha Gupta, Petur Petursson, Aidin Rawshani, Jan Boren, Truls Ramunddal, Deepak L Bhatt, Elmir Omerovic, Oskar Angerås, Gustav Smith, Naveed Sattar, Erik Andersson, Björn Redfors, Lukas Hilgendorf, Göran Bergström, Carlo Pirazzi, Kristofer Skoglund, Araz Rawshani","doi":"10.1136/openhrt-2024-002998","DOIUrl":"10.1136/openhrt-2024-002998","url":null,"abstract":"<p><strong>Purpose: </strong>We examined whether end-to-end deep-learning models could detect moderate (≥50%) or severe (≥70%) stenosis in the left anterior descending artery (LAD), right coronary artery (RCA) or left circumflex artery (LCX) in iodine contrast-enhanced ECG-gated coronary CT angiography (CCTA) scans.</p><p><strong>Methods: </strong>From a database of 6293 CCTA scans, we used pre-existing curved multiplanar reformations (CMR) images of the LAD, RCA and LCX arteries to create end-to-end deep-learning models for the detection of moderate or severe stenoses. We preprocessed the images by exploiting domain knowledge and employed a transfer learning approach using EfficientNet, ResNet, DenseNet and Inception-ResNet, with a class-weighted strategy optimised through cross-validation. Heatmaps were generated to indicate critical areas identified by the models, aiding clinicians in understanding the model's decision-making process.</p><p><strong>Results: </strong>Among the 900 CMR cases, 279 involved the LAD artery, 259 the RCA artery and 253 the LCX artery. EfficientNet models outperformed others, with EfficientNetB3 and EfficientNetB0 demonstrating the highest accuracy for LAD, EfficientNetB2 for RCA and EfficientNetB0 for LCX. The area under the curve for receiver operating characteristic (AUROC) reached 0.95 for moderate and 0.94 for severe stenosis in the LAD. For the RCA, the AUROC was 0.92 for both moderate and severe stenosis detection. The LCX achieved an AUROC of 0.88 for the detection of moderate stenoses, though the calibration curve exhibited significant overestimation. Calibration curves matched probabilities for the LAD but showed discrepancies for the RCA. Heatmap visualisations confirmed the models' precision in delineating stenotic lesions. Decision curve analysis and net reclassification index assessments reinforced the efficacy of EfficientNet models, confirming their superior diagnostic capabilities.</p><p><strong>Conclusion: </strong>Our end-to-end deep-learning model demonstrates, for the LAD artery, excellent discriminatory ability and calibration during internal validation, despite a small dataset used to train the network. The model reliably produces precise, highly interpretable images.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971115","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}