Open Heart最新文献

{"title":"Microcosting analysis of percutaneous coronary intervention with and without intracoronary imaging in an Irish tertiary referral centre.","authors":"Rory A Gallen, James F O'Mahony, Karen M Kuntz, Catherine McGorrian, Ivan P Casserly, Gavin J Blake","doi":"10.1136/openhrt-2024-002988","DOIUrl":"10.1136/openhrt-2024-002988","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous coronary intervention (PCI) is a well-established treatment for coronary artery disease, one of the most significant causes of morbidity and mortality worldwide. Intracoronary imaging, including intravascular ultrasound (IVUS) and optical coherence tomography (OCT), has been shown to improve outcomes for patients following PCI by reducing complications and the need for repeat procedures. Uptake remains highly variable, in part due to concerns over up-front costs.</p><p><strong>Aim: </strong>The purpose of this micro-costing analysis was to establish the costs and resource implications of PCI with and without intracoronary imaging.</p><p><strong>Methods: </strong>The costing model considered costs associated with the index procedure and related hospital admission and was designed using data obtained from primary data collection, previously published literature and expert opinion. Unit costs were established through communication with the hospital finance department and industry representatives and were reported in 2024 euro. Costs were categorised as staffing, capital and consumables. Staffing costs were calculated in accordance with local guidelines. Capital costs were averaged over a 10-year period. A sensitivity analysis was conducted to assess the impact of the use of IVUS and OCT during PCI.</p><p><strong>Results: </strong>The use of intracoronary imaging extends the average procedure time from 45 min to 60 min. The total procedural cost of PCI without intracoronary imaging was €3082. The incremental cost with intracoronary imaging was €752 for IVUS and €884 with OCT.</p><p><strong>Conclusion: </strong>This study provides robust data on the cost drivers of PCI with intracoronary imaging in Ireland which has not previously been described. This framework may be of use to finance departments and physicians alike when seeking to establish the cost and resource implications of future modifications to PCI procedures, such as the description of the impact of intracoronary imaging in this study.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441473","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":"Global, regional and national burdens of cardiovascular disease attributable to secondhand smoke from 1990-2019: an age-period-cohort analysis.","authors":"Hong Jiang, Zeye Liu, Peijian Wei, Fengwen Zhang, Shouzheng Wang, Wen-Bin Ou-Yang, Xiaofei Li, Xiang-Bin Pan","doi":"10.1136/openhrt-2024-003079","DOIUrl":"10.1136/openhrt-2024-003079","url":null,"abstract":"<p><strong>Background: </strong>Over the past three decades, significant disparities in the global burden of cardiovascular disease (CVD) have been observed, particularly CVD attributed to secondhand smoke. However, a comprehensive understanding of global trends and their interaction with secondhand smoke remains inadequate.</p><p><strong>Methods: </strong>Using Global Burden of Disease data (1990-2019), an age-period-cohort analysis examined temporal trends in CVD mortality among secondhand smoke-exposed populations, considering age, period and cohort interactions.</p><p><strong>Results: </strong>Over the 30-year period, the global number of CVD deaths attributed to secondhand smoke increased substantially, from 432.6 thousand in 1990 (95% UI: 357.4-508.3) to 598.5 thousand in 2019 (95% UI: 489.7-713.5), representing a 38.4% increase (95% UI: 26.8%-49.5%). In 2019, CVD accounted for 45.9% of all deaths attributable to secondhand smoke among both sexes globally. Among these CVD deaths, ischaemic heart disease predominated, accounting for 66.4% of cases, compared with stroke. The distribution by sex revealed a slightly lower percentage of males (46.5%) than females (53.5%). Age-period-cohort models show overall global decline in CVD mortality due to secondhand smoke over 30 years, with regional, sex and subtype variations. Notably, a higher Sociodemographic Index (SDI) correlated with a greater reduction in mortality, exhibiting a significant 39.1% decrease in high SDI areas (95% UI: 35.6%-42.3%), in stark contrast to the minimal change observed in low SDI areas (0.1%, 95% UI: -52.4%-62.2%).</p><p><strong>Conclusions: </strong>This study highlights the importance of considering secondhand smoke as a modifiable CVD risk. Further research is needed to understand disparities in CVD burden across development levels, sexes and subtypes.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11815441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399602","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":"Phase 1 study of novel anti-platelet agent to overcome pharmacogenomic limitations of clopidogrel.","authors":"Anil Pareek, Nitin Chandurkar, Vivek Raut, Kumar Naidu","doi":"10.1136/openhrt-2024-003088","DOIUrl":"10.1136/openhrt-2024-003088","url":null,"abstract":"<p><strong>Aims: </strong>Clopidogrel is the most commonly prescribed thienopyridine as part of dual anti-platelet therapy for the treatment of cardiovascular diseases. However, clopidogrel responsiveness shows variability based on CYP2C19 polymorphism. Therefore, we planned a study with an objective of evaluating safety, tolerability, pharmacodynamics and pharmacokinetics of a novel thienopyridine antiplatelet agent AT-10 in healthy Indian subjects compared with standard dosage regimen of clopidogrel based on their CYP2C19 genotyping.</p><p><strong>Methods: </strong>Two CYP2C19 genotype-based groups were identified, that is, poor metabolisers and extensive metabolisers, with 20 subjects in each group (n=40) for participating in a randomised, two-period, crossover study. Each study period lasted 6 days including administration of loading and maintenance doses of AT-10 (40 mg/10 mg) or clopidogrel (300 mg/75 mg). The pharmacokinetics and pharmacodynamics were assessed on day 1 and day 6 at several time intervals.</p><p><strong>Results: </strong>Overall result of pharmacodynamic parameters showed that mean %inhibition of platelet aggregation between AT-10 and clopidogrel in all subjects at 6 hours postdose (loading dose) (AT-10: clopidogrel; 73.30% vs 18.53%) and 6 hours postdose on day 6 (maintenance dose) (AT-10: clopidogrel; 83.41% vs 51.19 %) obtained from the AT-10 group was significantly higher than the clopidogrel group. Further, %inhibition of platelet aggregation from AT-10 treatment in poor metaboliser group was significantly higher than the clopidogrel treatments in extensive metaboliser group.Overall pharmacokinetic comparison in all subjects indicates that AT-10 gives greater exposure to active Metabolite H4 than clopidogrel.</p><p><strong>Conclusion: </strong>AT-10 showed better inhibition of platelet aggregation in poor metabolizers as compared to Clopidogrel. AT-10 may emerge as a potential alternative to Clopidogrel as an anti-platelet drug. It can be further developed in clinical studies for the unmet medical needs in management of CVDs and overcome the pharmacogenomic limitations of Clopidogrel.</p><p><strong>Trial registration number: </strong>Clinical Trial Registry-India URL: http://ctri.nic.in.</p><p><strong>Registration number: </strong>CTRI/2021/03/032206.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11815446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399610","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 of blood pressure and left ventricular mass with subclinical coronary atherosclerosis.","authors":"Enver De Wei Loh, Weiting Huang, Rehena Sultana, Siew Ching Kong, Chirk Jenn Ng, Swee Yaw Tan, Calvin Chin, Jonathan Jiunn Liang Yap, Khung K Yeo","doi":"10.1136/openhrt-2024-002791","DOIUrl":"10.1136/openhrt-2024-002791","url":null,"abstract":"<p><strong>Background: </strong>Left ventricular (LV) mass is closely associated with atherosclerotic heart disease, but the mechanisms are not well defined. This study aimed to evaluate the risk factors associated with LV mass and subclinical coronary atherosclerosis, in an Asian population free of baseline cardiovascular disease.</p><p><strong>Methods: </strong>The SingHEART study is a population-based cohort in which individuals underwent ambulatory blood pressure (BP) monitoring, cardiac MRI to measure indexed LV mass index (LVMI) and coronary artery calcium (CAC) scoring. Individuals were stratified based on LVMI and the presence of CAC, and intergroup differences in risk factors were analysed. Logistic regression models were used to assess the interaction of BP and LVMI on prevalent CAC.</p><p><strong>Results: </strong>The study included 880 subjects (mean age 45.8±11.7 years, 51.4% women). Individuals with high LVMI had higher BP than those with normal LVMI. Across all LVMI groups, higher BP was associated with the presence of CAC. Compared with individuals with normotensive BP and normal LVMI, those with normotensive BP and high LVMI had no increased risk of prevalent CAC (p=0.530); however, risk was progressively higher in those with hypertensive BP and normal LVMI (risk ratio (RR) 1.47, 95% CI 1.13 to 1.91), or hypertensive BP and high LVMI (RR 1.72, 95% CI 1.26 to 2.36).</p><p><strong>Conclusions: </strong>In this healthy asymptomatic population, hypertension was the strongest risk factor for high LVMI and prevalent CAC. LV hypertrophy was a risk modifier, and its prognostic significance in adults without hypertension requires further study.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11815405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399457","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":"Discrimination and calibration performances of non-laboratory-based and laboratory-based cardiovascular risk predictions: a systematic review.","authors":"Yihun Mulugeta Alemu, Sisay Mulugeta Alemu, Nasser Bagheri, Kinley Wangdi, Dan Chateau","doi":"10.1136/openhrt-2024-003147","DOIUrl":"10.1136/openhrt-2024-003147","url":null,"abstract":"<p><strong>Background and objective: </strong>This review compares non-laboratory-based and laboratory-based cardiovascular disease (CVD) risk prediction equations in populations targeted for primary prevention.</p><p><strong>Design: </strong>Systematic review.</p><p><strong>Methods: </strong>We searched five databases until 12 March 2024 and used prediction study risk of bias assessment tool to assess bias. Data on hazard ratios (HRs), discrimination (paired c-statistics) and calibration were extracted. Differences in c-statistics and HRs were analysed.</p><p><strong>Protocol: </strong>PROSPERO (CRD42021291936).</p><p><strong>Results: </strong>Nine studies (1 238 562 participants, 46 cohorts) identified six unique CVD risk equations. Laboratory predictors (eg, cholesterol and diabetes) had strong HRs, while body mass index in non-laboratory models showed limited effect. Median c-statistics were 0.74 for both models (IQR: lab 0.77-0.72; non-lab 0.76-0.70), with a median absolute difference of 0.01. Calibration measures between laboratory-based and non-laboratory-based equations were similar, although non-calibrated equations often overestimated risk.</p><p><strong>Conclusion: </strong>The discrimination and calibration measures between laboratory-based and non-laboratory-based models show minimal differences, demonstrating the insensitivity of c-statistics and calibration metrics to the inclusion of additional predictors. However, in most reviewed studies, the HRs for these additional predictors were substantial, significantly altering predicted risk, particularly for individuals with higher or lower levels of these predictors compared with the average.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11815431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391403","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":"Atrial fibrillation outcomes in patients from Asia and non-Asia countries: insights from GARFIELD-AF.","authors":"Chun-Yan Cheng, Tian-Yu Lian, Xi-Jie Zhu, Saverio Virdone, Kai Sun, John Camm, Xian-Mei Li, Shinya Goto, Karen Pieper, Gloria Kayani, Xian-Hong Fang, Zhi-Cheng Jing, Ajay K Kakkar","doi":"10.1136/openhrt-2024-003109","DOIUrl":"10.1136/openhrt-2024-003109","url":null,"abstract":"<p><strong>Background: </strong>Differences in the clinical outcomes and level of risk among Asian versus non-Asian patients with atrial fibrillation (AF) have been sparsely investigated.</p><p><strong>Objective: </strong>To provide a contemporary prospective comparison of outcomes for newly diagnosed patients with AF, between Asian and non-Asian regions.</p><p><strong>Methods: </strong>Six Asian countries (China, Japan, India, Singapore, South Korea and Thailand) and 29 countries outside Asia participated in the Global Anticoagulant Registry in the FIELD-AF (GARFIELD-AF) study. Newly diagnosed patients with AF, enrolled between 2010 and 2016, were followed up for≥2 years. The outcome studies were all-cause, cardiovascular and non-cardiovascular mortality, non-haemorrhagic stroke/systemic embolism (SE), major bleeding. The association of geographical region with clinical outcomes (event rates per 100 person-years) were estimated using multivariable Cox models.</p><p><strong>Results: </strong>13 841/52 057 (26.6%) GARFIELD-AF participants were enrolled in Asia. Average age and prevalence of cardiovascular comorbidities were lower than in non-Asian countries and patients at high risk of stroke (ie, CHA₂DS₂-VASc≥2 excl. sex) were less frequently anticoagulated (60.1% vs 73.2%). Non-vitamin K oral anticoagulant (NOAC) was similar in both regions (∼28%), though Asian patients were more frequently underdosed. Both Asian and non-Asian patients who received NOAC at enrolment experienced lower all-cause mortality and non-haemorrhagic stroke/SE compared with patients on other treatments or none.All-cause mortality, non-cardiovascular mortality and major bleeding were less frequent in patients from Asia versus non-Asia (HR (95% CI): 0.62 (0.39 to 0.99), 0.52 (0.28 to 0.97), 0.58 (0.36 to 0.96), respectively). Associations of moderate-to-severe chronic kidney disease and vascular disease with increased risk of all-cause mortality were stronger in Asian versus non-Asian patients (interaction p values: 0.0250 and 0.0076, respectively). There was notable heterogeneity in oral anticoagulant (OAC) usage within the Asian countries.</p><p><strong>Conclusions: </strong>Patients in Asian countries had a lower risk of all-cause mortality and major bleeding compared to the rest of the world. NOAC had evident benefits for reducing mortality and stroke across populations. Further studies on sociocultural impacts on OAC outcomes are needed.</p><p><strong>Trial registration number: </strong>ClinicalTrials.gov NCT01090362.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365398","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":"Revealing the limitations of 10-year MACE observations: 20-year observed total cardiovascular burden in the EPIC-Norfolk study.","authors":"Tinka J van Trier, Marjolein Snaterse, Jannick An Dorresteijn, Manon van den Bogaart, Wilma Jm Scholte Op Reimer, Frank Lj Visseren, Ron Jg Peters, Harald T Jørstad, S Matthijs Boekholdt","doi":"10.1136/openhrt-2024-002981","DOIUrl":"10.1136/openhrt-2024-002981","url":null,"abstract":"<p><strong>Background: </strong>Primary prevention strategies for cardiovascular disease (CVD) conventionally rely on 10-year risk estimates of major adverse cardiovascular events (MACE). However, communicating longer-term total CVD risk may better facilitate informed preventive decisions. Therefore, we aimed to quantify how well 10-year observed incidence reflects 20-year observed incidence and how MACE reflects total CVD events across demographic groups, using observations in long-term prospective data.</p><p><strong>Methods: </strong>In individuals aged 40-79 without CVD or diabetes from the population-based EPIC-Norfolk cohort, we compared the first occurrence of 10 and 20 years (1) 3-point MACE events (non-fatal myocardial infarction+non-fatal stroke+fatal CVD) and (2) total CVD events (all non-fatal and fatal CVD events leading to hospitalisation), stratified by sex and age.</p><p><strong>Results: </strong>Among 22 569 participants (57% women), incident 10-year and 20-year 3-point MACE was 5.3% and 15.5%, respectively, yielding 20/10 year ratios from 2.2 (in older men) to 4.5 (in younger women). Total CVD increased from 10.5% at 10 years to 26.9% at 20 years, with ratios ranging from 1.9 (older men) to 3.9 (younger women). Ratios between 10-year MACE and 20-year total CVD varied substantially, ranging from 3-fold in (older men) to 10-fold (younger women).</p><p><strong>Conclusions: </strong>The observed incidence of CVD roughly triples from 10 to 20 years of follow-up, with 10-year MACE observations underestimating 20-year total CVD burden by a factor ranging from 3 (older men) to 10 (younger women). These findings highlight the limitations of communicating 10-year MACE risk assessments to facilitate informed decisions in longer-term CVD prevention-particularly in younger women.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190176","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":"Tissue Doppler echocardiography predicts long-term cardiovascular mortality: the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) legacy 20-year follow-up study.","authors":"Anenta Ratneswaren, Tong Wu, Amit Kaura, Devan Wasan, Somayeh Rostamian, Andrew Sharp, Neil R Poulter, P S Sever, Alice Stanton, Simon Thom, Darrel Francis, Alun D Hughes, Anoop Sv Shah, Jamil Mayet","doi":"10.1136/openhrt-2024-002795","DOIUrl":"10.1136/openhrt-2024-002795","url":null,"abstract":"<p><strong>Background: </strong>Left ventricular diastolic function as assessed by tissue Doppler echocardiography predicts cardiovascular event rates at 4 years of follow-up in patients with hypertension. Our aim was to evaluate whether this extends to predicting cardiovascular mortality after 20 years of follow-up.</p><p><strong>Methods: </strong>Conventional (E) and tissue Doppler (e') echocardiography was performed on hypertensive participants in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) with long-term follow-up ascertained via linkage to the Office of National Statistics. Cardiovascular mortality was defined as death from coronary heart disease, stroke and other cardiovascular aetiology such as heart failure or peripheral vascular disease. Unadjusted and adjusted Cox regression survival models were constructed to investigate the association between tissue Doppler echocardiography measurements and long-term cardiovascular mortality.</p><p><strong>Results: </strong>Among 506 hypertensive patients (median age 64, interquartile range (58, 69), 87% male), there were 200 (40%) deaths over a 20-year follow-up period. 60 deaths (12%) were cardiovascular-related.A reduction in e' was independently associated with increased cardiovascular mortality, after adjusting for the ACC/AHA Atherosclerotic Cardiovascular Disease (ASCVD) risk score, with an inverse HR of 1.22 per 1 cm/s decrease (95% CI 1.04-1.43). A higher E/e' ratio was independently associated with increased cardiovascular mortality, after adjusting for the ASCVD risk score, with an HR of 1.12 per 1-unit increase (95% CI, 1.02 to 1.23).</p><p><strong>Conclusions: </strong>Impaired left ventricular diastolic function, measured using tissue Doppler echocardiography through e' and E/e', independently predicts increased cardiovascular mortality over 20 years in hypertensive patients, highlighting its long-term prognostic significance.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190103","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 events and procedures following COVID-19 compared with other pneumonias: a national register study.","authors":"Tarjei Øvrebotten, Birgitte Tholin, Kristian Berge, Peder Langeland Myhre, Knut Stavem","doi":"10.1136/openhrt-2024-002914","DOIUrl":"10.1136/openhrt-2024-002914","url":null,"abstract":"<p><strong>Background: </strong>Studies have shown an increased risk of cardiac disease following COVID-19, but how it compares to pneumonia of other etiologies is unclear.</p><p><strong>Aims: </strong>To determine the incidence and HRs of cardiac disease in patients hospitalised with COVID-19 compared with other viral or bacterial pneumonias.</p><p><strong>Methods: </strong>Using nationwide registry data, we estimated the incidence of cardiac events after hospitalisation with COVID-19 (n=2082) in February to November 2020 vs hospitalisation with viral (n=9018) or bacterial (n=29 339) pneumonia in 2018-2019. We defined outcomes using ICD-10 codes for incident myocarditis, acute myocardial infarction, atrial fibrillation/flutter, heart failure, ischaemic heart disease, other cardiac disease and total cardiac disease (any heart condition). We used Cox regression and logistic regression for analysis.</p><p><strong>Results: </strong>Patients with COVID-19 had a mean (SD) age of 60 (18) years, compared with 69 (19) years for viral and 72 (17) years for bacterial pneumonia. Those with COVID-19 were more often male and had fewer comorbidities and fewer prior hospitalisations. Patients with COVID-19 had a lower hazard of new-onset cardiac disease compared with viral (HR 0.79 [95%CI 0.66 to 0.93]) and bacterial pneumonia (HR 0.66 [95%CI 0.57 to 0.78]), adjusted for age, sex, comorbidity, hospital admission prior year and respiratory support. Results were similar when including recurrent events.</p><p><strong>Conclusion: </strong>Patients hospitalised with COVID-19 had a lower hazard of new-onset cardiac disease during the first 9 months after hospitalisation compared with patients with other viral or bacterial pneumonias after adjusting for multiple possible confounders. However, there may still be residual confounding from other or unknown factors.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190159","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":"Embolic risk management in infective endocarditis: predicting the 'embolic roulette'.","authors":"Adela Mihaela Serban, Diana Pepine, Andreea Inceu, Alexandra Dadarlat, Alexandru Achim","doi":"10.1136/openhrt-2024-003060","DOIUrl":"10.1136/openhrt-2024-003060","url":null,"abstract":"<p><p>Life-threatening complications of infective endocarditis (IE,) are heart failure, uncontrolled infection and embolic events (EE), which pose significant morbidity and mortality risks. EE from vegetation rupture are frequent, occurring in more than 50% of patients and can lead to ischaemic stroke and systemic organ infarctions, contributing to poor patient outcomes. Early identification and characterisation of embolic risk factors, including vegetation size, mobility and echogenicity assessed through transthoracic and transoesophageal echocardiography, but also certain pathogens and biomarkers are important for guiding clinical decisions. The latest European Guidelines recommendations emphasise the role of imaging modalities like CT and MRI in detecting silent emboli and guiding therapeutic interventions, including the timely consideration of surgical options to mitigate embolic risks. In this regard, embolic vascular dissemination-including asymptomatic cases detected through multimodality imaging-has been introduced as a new minor criterion for the diagnosis of IE.Depending on the location and severity of the embolism, the embolic risk can either escalate or alternatively, complicate and delay cardiac surgery. The decision to proceed with surgery should not hinge solely on the occurrence of an embolic event, although current guidelines often emphasise this criterion. Therefore, future perspectives should focus on identifying high-risk profiles for EE and investigating whether early surgical intervention benefits these patients, even if they respond favourably to antibiotic therapy. This review explores current literature on echocardiographic and biomarker predictors of EE in IE, aiming to enhance clinical strategies for mitigating embolic complications and improving patient outcomes.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075174","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}