Open Heart最新文献

{"title":"Disparities in the care and direct-acting oral anticoagulant (DOAC) management in atrial fibrillation (AF) and chronic kidney disease (CKD) in English primary care between 2018 and 2022: primary care sentinel network database study.","authors":"Subo Emanuel, Benjamin Ct Field, Mark Joy, Xuejuan Fan, John Williams, Riyaz A Kaba, Gregory Y H Lip, Simon de Lusignan","doi":"10.1136/openhrt-2024-002923","DOIUrl":"10.1136/openhrt-2024-002923","url":null,"abstract":"<p><strong>Background: </strong>In England, most prescribing of direct-acting oral anticoagulants (DOACs) for patients with chronic kidney disease (CKD) and atrial fibrillation (AF) takes place in primary care. The 2024 European Society of Cardiology guidelines introduced the AF-CARE ((C) comorbidities and risk factors; (A) avoid stroke and thromboembolism by appropriate prescription of oral anticoagulants; (R) rate and rhythm control; (E) evaluation and reassessment should be individualised for every patient, with a dynamic approach) framework to address this.</p><p><strong>Objective: </strong>To describe any health disparities in CKD and AF, including anticoagulation management and correct dosing of DOACs.</p><p><strong>Methods: </strong>Using English primary care sentinel network data from 2018 to 2022, demographics of AF and CKD including anticoagulation and appropriate DOAC dosing according to creatinine clearance and other factors were assessed. The study also examined disparities in CKD and AF in relation to socioeconomic status and ethnicity. We defined socioeconomic status by Index of Multiple Deprivation (IMD), a weighted composite index combining information from the domains of deprivation including income.</p><p><strong>Results: </strong>Of 10 513 950 people registered with general practices in the sentinel network, 2.9% (n=304 678) were aged ≥18 years with a diagnosis of AF. The prevalence of CKD in AF was 26.0% (n=79 210) and 63.3% of people eligible for anticoagulation were prescribed a DOAC. Among the 54 897 people with AF and CKD 3 or 4, greater likelihood of DOAC prescribing was associated with higher socioeconomic status. Socioeconomic disparities in anticoagulation increased through the 5 years. No association was identified between ethnicity and likelihood of being anticoagulated.In terms of correct dosing, there was no association with socioeconomic status. Overdosing was more frequent than underdosing. Incorrect dosing was associated with male sex (OR 0.80 (95% CI 0.74, 0.86)), dementia (OR 0.94 (0.83, 1.07)) and frailty (OR 0.42 (0.37, 0.48)).</p><p><strong>Conclusions: </strong>People in the most deprived IMD quintile were least likely to be anticoagulated. Incorrect DOAC dosing was associated with male sex, increasing frailty and dementia. Socioeconomic and health disparities are apparent in anticoagulation prescribing and should be addressed in line with the AF-CARE framework.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120510","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 and cause of death after isolated primary aortic valve replacement at Oslo University Hospital (2012-2021): a retrospective registry-based study.","authors":"Johannes Lagethon Bjørnstad, Sandra Stedje Waagan, Tiril Karina Tegnander, Anne Madsi Ottestad","doi":"10.1136/openhrt-2025-003312","DOIUrl":"10.1136/openhrt-2025-003312","url":null,"abstract":"<p><strong>Background: </strong>The treatment of aortic valve disease has changed following the introduction of transcatheter aortic valve replacement (TAVR). Hence, the selection of patients for surgical aortic valve replacement (AVR) is changing. Thus, we aimed to study survival and causes of death following surgical AVR at a large Scandinavian Centre in the period 2012-21.</p><p><strong>Methods: </strong>Information about the surgical procedure, survival and cause of death was obtained from the National Norwegian Health Registries. The latest clinical information about the deceased patients was made available from the local hospitals and examined to evaluate the causes of death from The Norwegian Cause of Death Registry.</p><p><strong>Results: </strong>From 2012 to 2021, the number of surgical implantations of aortic valve bioprostheses (AVR(b)) and patient age at the time of surgery decreased. Outcomes were excellent, with 30-day survival of 98.6% following AVR(b) and 99.8% following AVR(m). 1-year survival after AVR(b) improved from 96.4% in the first half to 98.4% in the second half of the study period, probably due to a reduction of operative risk during the study period. Non-cardiovascular mortality was the most frequent cause of death, followed by cancer, cardiovascular and valve-related death. Deaths due to cerebral bleeding or stroke were the least frequent with 10-year estimators of 1.3% and 1.6% following AVR(m) and AVR(b), respectively. The inter-rater reliability between The Norwegian Cause of Death Registry and the journal information provided was moderate, with an unweighted Cohen's kappa of 0.56 (0.47-0.64).</p><p><strong>Conclusions: </strong>Valve-related death and death from cerebral bleeding or stroke was rare after surgical AVR. Survival was high and improved during the study period. Surgical AVR may be performed safely in low-risk patients.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120535","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 in patients with Fontan circulation: assessing risk factors for adverse outcomes.","authors":"Sabina Ericsson, Riitta Paakkanen, Marko Taipale, Emmi Helle, Juha Peltonen, Alma Kormi, Teemu Vepsäläinen, Ilkka Mattila, Tommi Pätilä, Laura Martelius, Tiina Ojala","doi":"10.1136/openhrt-2025-003306","DOIUrl":"10.1136/openhrt-2025-003306","url":null,"abstract":"<p><strong>Background: </strong>Cardiac magnetic resonance (CMR) imaging provides critical insight into the prognosis of Fontan patients, enhancing our understanding of their long-term outcomes. This study aimed to investigate the prognostic role of CMR in a carefully selected cohort of Fontan patients with the highest initial likelihood of survival.</p><p><strong>Methods: </strong>This retrospective nationwide cohort study included 148 Fontan patients who underwent post-Fontan CMR imaging in Finland between 2017 and 2023. The primary endpoint was death or listing for heart transplant. The secondary endpoint was myocardial fibrosis determined by native T1 mapping measured by CMR.</p><p><strong>Results: </strong>The median time from the Fontan procedure to CMR examination was 10.8 years, with a median post-CMR follow-up of 2.55 years. Six patients (4.1%) reached the primary endpoint. Significant haemodynamic risk factors for the primary endpoint included worse global longitudinal strain (p=0.03), worse global circumferential strain (p<0.001) and reduced ejection fraction (p=0.04). Notably, patients with decreased myocardial function showed higher native T1-mapping values. Additional clinical risk factors that were associated with the primary endpoint included arrhythmias (p=0.01), protein-losing enteropathy (p=0.01), New York Heart Association functional class ≥2 (p<0.001) and liver cirrhosis (p=0.01).</p><p><strong>Conclusions: </strong>CMR provides critical insights into long-term outcomes in Fontan patients. In our prioritised cohort, characterised by an initially high likelihood of survival, the observed risks of adverse outcomes corroborate findings from higher mortality cohorts. This underscores the importance of myocardial function and native myocardial T1 mapping in risk assessment, reaffirming CMR's role in effective risk stratification for this population.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120501","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":"Performance of the GRACE and the ACTION risk model in the prediction of in-hospital mortality: external validation, model revision and updating in the Thai Percutaneous Coronary Intervention Registry.","authors":"Songsak Kiatchoosakun, Noppadol Chamnarnphol, Chaiyasith Wongwipaporn, Burabha Pussadhamma, Worawut Roongsangmanoon, Sukanya Siriyotha, Ammarin Thakkinstian, Nakarin Sansanayudh","doi":"10.1136/openhrt-2024-003027","DOIUrl":"10.1136/openhrt-2024-003027","url":null,"abstract":"<p><strong>Background: </strong>External validation is crucial before implementing a risk score model in clinical practice. This study examined the performance of Global Registry of Acute Coronary Events (GRACE) and Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry-Get With The Guidelines (GWTG) (ACTION Registry-GWTG) Risk Score (AR-G RS) using the Thai Percutaneous Coronary Intervention Registry (TPCIR).</p><p><strong>Methods: </strong>Included in this study were 11 455 patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) between November 2015 and May 2018. GRACE and AR-G RS models were externally validated, revised and updated using discrimination (C-statistic score) and calibration (Hosmer-Lemeshow (HL) indexes). Clinical predictors were selected stepwise from the multivariate analysis to evaluate the performance of each risk score in the revised and updated model.</p><p><strong>Results: </strong>In-hospital mortality was 4.4%. GRACE and AR-G RS demonstrated good discrimination for in-hospital mortality (C-statistics 0.8957 and 0.8823, respectively) with optimal calibration (HL, p=0.036 and 0.006, respectively) and penalty rates of 0.005 and 0.006, respectively. The updated model significantly improved the discrimination performance compared with the original GRACE and AR-G RS models, with a C-statistic of 0.9118 and a penalty of 0.006.</p><p><strong>Conclusion: </strong>GRACE and AR-G RS maintained a good performance in TPCIR. Based on routine PCI practice, we demonstrated that the updated model could improve the accuracy of GRACE and AR-G RS in predicting in-hospital mortality among patients with ACS who underwent PCI.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120534","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":"Ending nuclear weapons, before they end us.","authors":"Chris Zielinski","doi":"10.1136/openhrt-2025-003426","DOIUrl":"10.1136/openhrt-2025-003426","url":null,"abstract":"","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079344","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":"Ratio of interventricular septal thickness to global longitudinal strain accurately identifies cardiac amyloidosis.","authors":"Louie Cao, Gloria J Hong, Michael Abiragi, Jonathan Le, P Ryan Tacon, I-Min Chiu, Jignesh Patel, Lily K Stern, Chathuri Daluwatte, David Ouyang, Piero Ricchiuto","doi":"10.1136/openhrt-2024-003120","DOIUrl":"10.1136/openhrt-2024-003120","url":null,"abstract":"<p><strong>Objectives: </strong>Conventional transthoracic echocardiographic measurements like global longitudinal strain (GLS) have shown promise in distinguishing cardiac amyloidosis (CA), but with limited specificity. We investigated the performance of common echo measurements, GLS, and their combinations in discriminating CA from an undifferentiated cohort with increased left ventricular wall thickness.</p><p><strong>Methods: </strong>We conducted a retrospective single-centre case-control study of 876 echos from 232 patients with CA and 1325 echos from 279 patients who underwent pyrophosphate scintigraphy but had CA definitively ruled out. Common echo measurements were collected and additional GLS measurements were performed post hoc. We reported discrimination performance with the area under the receiver operating characteristic curve (AUC) and associated sensitivity, specificity and positive predictive value at the optimal threshold.</p><p><strong>Results: </strong>We found that the ratio of end-diastolic interventricular septal thickness (IVSd) to GLS had the highest performance in differentiating CA with an AUC of 0.812. At the optimal threshold of >0.15, IVSd/GLS had a sensitivity of 0.70 and specificity of 0.80 for CA. Other measurements and ratios, including the ratio of left ventricular ejection fraction to GLS (AUC 0.682), had lower performance when evaluated against a suspicious control cohort with increased left ventricular wall thickness.</p><p><strong>Conclusion: </strong>If validated in prospective multi-centre studies, the routine measurement of IVSd/GLS can assist with earlier diagnosis of CA, resulting in earlier initiation of treatment in this underserved population.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079345","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 value and clinical impact of cardiac magnetic resonance imaging in patients after sudden cardiac arrest: a retrospective study.","authors":"Elke Boxhammer, Richard Rezar, Stefan Hecht, Christoph Knapitsch, Nikolaos Schörghofer, Bernhard Strohmer, Reinhard Kaufmann, Uta C Hoppe, Klaus Hergan, Bernhard Scharinger","doi":"10.1136/openhrt-2024-003090","DOIUrl":"10.1136/openhrt-2024-003090","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiac MRI (CMRI) is an important investigation in cases of unclear cause of sudden cardiac arrest (SCA). It demonstrates diagnostic utility in assessing reversibility and tissue scar burden and ultimately aids in further treatment planning.</p><p><strong>Methods: </strong>A retrospective analysis of all adult patients referred for CMRI after SCA between 2007 and 2022 by local intensive care units in our institution was performed. The patient cohort is highly selective, excluding those who did not reach the hospital, had cerebral oedema or had confirmed acute myocardial infarction as the cause of SCA. Data on clinical presentation, imaging findings and subsequent management were collected and analysed.</p><p><strong>Results: </strong>CMRI was diagnostic in 57 of 65 patients. The most common diagnosis by CMRI was ischaemic cardiomyopathy (28.1%), followed by dilated cardiomyopathy (17.5%) and structurally normal hearts (14%). In cases of myocardial oedema, extracellular volume (ECV) was determined in 10 patients and found to be elevated in 80% after resuscitation, whereas T2 mapping was elevated in only 50% of cases. The number of examinations has increased, whereas the time to examination has decreased over the years. Additionally, CMRI findings led to changes in treatment planning.</p><p><strong>Conclusion: </strong>CMRI after resuscitation is gaining increasing interest and clinical relevance as it provides additional diagnostic information that may be crucial for therapy planning. The sensitivity of ECV in detecting myocardial oedema after cardiac arrest highlights its potential utility over T2 mapping. Future studies should investigate the impact of CMRI on long-term patient outcomes and further refine its role in guiding treatment decisions.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079343","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":"Cardiovascular disease burden in the homeless population.","authors":"Samhita Korukonda, Nikith Erukulla, Jeffrey R Harris, Pranitha Kovuri, Kenneth Tyler Wilcox","doi":"10.1136/openhrt-2025-003190","DOIUrl":"10.1136/openhrt-2025-003190","url":null,"abstract":"<p><strong>Introduction: </strong>The burden of cardiovascular disease (CVD) among the homeless population has been rising, driven by factors such as lack of healthcare access, rising mental health disorders and substance use. This study aims to systematically analyse the CVD burden among homeless adults and characterise its prevalence and risk factors. Additionally, our literature review revealed a significant lack of cardiac-focused interventions in this population, thus we build on existing models to propose new CVD-specific interventions.</p><p><strong>Methods: </strong>A comprehensive systematic review and meta-analysis were performed on data collected from PubMed and Scopus until 22 October 2024. All observational studies that assessed homeless populations and met inclusion criteria were analysed. The primary outcomes reported were mortality, morbidity and hospitalisation due to CVD. These measures were collectively analysed to evaluate the overall CVD burden.</p><p><strong>Results: </strong>Our search strategy identified 22 studies, of which 12 were suitable for meta-analysis. We analysed data from 226 205 adults spanning more than 1 000 000 person-years and sought to characterise CVD distribution by demographic subgroups. Our findings indicate that homeless adults experience greater morbidity and mortality due to CVD than non-homeless adults (pooled OR 2.77; 95% CI 1.93 to 3.93; p<0.001; I² <i>=</i>96.2%). Subgroup analyses by age, sex and geographic region were performed, but no significant differences in CVD morbidity and mortality were found.</p><p><strong>Conclusion: </strong>Homeless adults have approximately three times greater odds of CVD than the general population. We found that the risk of CVD remains elevated regardless of demographic subgroup. Our findings emphasise the urgent need for targeted interventions within this population and highlight its associated risk factors, providing a foundation for the development of targeted interventions and policies.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079342","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 features of non-compaction cardiomyopathy across age groups: a retrospective study of 415 patients.","authors":"Ziqin Zhou, Min Qiu, Ruyue Zhang, Ying Li, Miao Tian, Jiazichao Tu, Linjiang Han, Shuheng Zhou, Xinming Li, Jian Zhuang, Shusheng Wen, Jimei Chen","doi":"10.1136/openhrt-2024-003030","DOIUrl":"https://doi.org/10.1136/openhrt-2024-003030","url":null,"abstract":"<p><strong>Background: </strong>Non-compaction cardiomyopathy (NCM) is a rare inherited cardiac disorder associated with adverse cardiovascular outcomes, including heart failure, arrhythmias and sudden cardiac death. Currently, the clinical manifestations of NCM lack comprehensive characterisation across different age groups in large-scale studies. This investigation aims to systematically analyse the clinical characteristics of patients with NCM across various age demographics.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 415 patients with NCM treated at the Guangdong Institute of Cardiovascular Disease from January 2013 to January 2023. We comprehensively collected and analysed clinical data, including presenting symptoms, arrhythmia patterns, echocardiographic parameters and cardiac magnetic resonance imaging findings.</p><p><strong>Results: </strong>The study cohort (n=415) was stratified into three age groups: infants (0-1 year, n=169), children/adolescents (1-18 years, n=149) and adults (>18 years, n=97). Heart failure was the predominant clinical manifestation across the entire cohort, affecting 112 patients (27%). Notably, heart failure was most prevalent in adult patients (54.6%, n=53), while cardiac murmur was the primary presenting symptom in both infant and child/adolescent groups (19.5%, n=33 and 17.4%, n=26, respectively). Across all age groups, patients with NCM with concurrent mitral regurgitation (MR) demonstrated significantly reduced left ventricular ejection fraction and fractional shortening compared with those without valvular disease (p<0.05). Additionally, left ventricular end-systolic diameter (LVESD) and end-diastolic diameter (LVEDD) were significantly increased in patients with MR (p<0.05). A significant correlation was observed between both LVESD and LVEDD measurements and MR area in patients with NCM (p<0.05).</p><p><strong>Conclusion: </strong>Patients with NCM with concomitant MR consistently exhibited left ventricular dilatation and systolic dysfunction across all age groups. Significant age-related variations were observed in clinical presentations, arrhythmia patterns and the prevalence of congenital and valvular heart disease. Understanding these age-specific clinical characteristics is crucial for accurate diagnosis, optimal therapeutic management and future research directions in NCM.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007319","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":"High afterload rather than myocardial fibrosis predicts reduced ejection fraction in severe aortic stenosis with afterload mismatch.","authors":"Megan Rian Rajah, Anton Doubell, Philip Herbst","doi":"10.1136/openhrt-2025-003345","DOIUrl":"https://doi.org/10.1136/openhrt-2025-003345","url":null,"abstract":"<p><strong>Background: </strong>Afterload mismatch (AM) refers to high-gradient (mean gradient ≥40 mm Hg) severe aortic stenosis (AS) with reduced left ventricular ejection fraction (LVEF <50%) that is hypothesised to arise from mechanisms other than true contractile impairment. The extent, pattern and functional impact of myocardial fibrosis (MF), which is associated with systolic impairment, is poorly understood in the context of AM.</p><p><strong>Methods: </strong>High-gradient severe AS patients with (n=25; low ejection fraction high-gradient, LEF-HG) and without (n=33; normal ejection fraction high-gradient (NEF-HG)) reduced LVEF underwent cardiovascular MRI. Using T1 mapping, extracellular volume (ECV) fraction and late gadolinium enhancement (LGE), the extent and pattern of MF was compared between the two groups. End-systolic wall stress (ESWS) as a measure of afterload was estimated, and its relationship with LVEF was compared with that of MF and LVEF.</p><p><strong>Results: </strong>Stenosis severity was worse in the LEF-HG group (aortic valve area 0.5±0.2 vs 0.7±0.2 cm², mean gradient 55 (46-66) vs 48 (41-69) mm Hg). In the LEF-HG group, high ESWS with cavity dilation and significant hypertrophy were observed compared with the NEF-HG group. MF was present in both groups with a significantly higher burden in the LEF-HG group (T1 time 1061±22 vs 1041±33 ms, ECV 26%±3% vs 24%±3%, LGE mass 4.3 (1.7-9.3) vs 0.1 (0.06-3.39) g). The association between MF and LVEF was weak, while ESWS was strongly associated with LVEF (r -0.8, p<0.0001) and was the best predictor of LVEF in multivariate prediction analysis.</p><p><strong>Conclusions: </strong>MF was present in both groups with a higher burden in those with LEF-HG AS. High ESWS, that is, afterload, rather than MF, was the strongest predictor of LVEF. While MF may not directly impact systolic function in AM, it is still an important factor to account for in AS given its association with increased mortality.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033159","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}