Open Heart最新文献

{"title":"High-sensitivity troponin T as a rule-out marker for myocardial inflammation detectable by CMR imaging.","authors":"Andreas Puetz, Martin Berger, Corinna Lebherz, Kevin Bauermann, Niels-Ulrik Hartmann, Ben Arpad Kappel, Rosalia Dettori, Alena Nonnast, Timm Dirrichs, Karsten Maruhn, Nikolaus Marx, Ertunc Altiok, Annemarie Kirschfink, Michael Frick","doi":"10.1136/openhrt-2025-003508","DOIUrl":"10.1136/openhrt-2025-003508","url":null,"abstract":"<p><strong>Background: </strong>Acute myocarditis is a potentially life-threatening cardiac condition and immediate assessment of this disease is imminent. While laboratory tests, electrocardiography or transthoracic echocardiography can provide indirect signs for the presence of acute myocarditis, cardiac magnetic resonance (CMR) imaging enables direct visualisation of myocardial inflammation and confirms the diagnosis.Since there is limited accessibility to CMR, the goal of this study was to evaluate the sensitivity and specificity of an elevation of established biomarkers for the diagnosis of myocarditis and to define a specific rule-out threshold for deferring CMR.</p><p><strong>Methods: </strong>244 consecutive patients with clinical suspicion of acute myocarditis underwent comprehensive CMR imaging. CMR data and laboratory parameters were retrospectively analysed.</p><p><strong>Results: </strong>Based on the CMR results, the diagnosis of acute myocarditis was confirmed in 72 individuals. Significant differences regarding age, cardiac function and biomarker levels were present between these groups. Receiver operating characteristics analysis revealed high-sensitivity troponin T (hsTNT) with high sensitivity and specificity for the result of the CMR examination. With a negative predictive value of 0.96 and a sensitivity of 0.92, a hsTNT cut-off of 18 pg/mL was defined as a safe rule-out value for suspected myocarditis.</p><p><strong>Conclusions: </strong>CMR imaging is the gold standard for the non-invasive confirmation of acute myocarditis. However, in this cohort, patients with a hsTNT level of ≤18 pg/mL have a very low likelihood of acute myocarditis, suggesting that CMR may not be necessary to exclude the diagnosis.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023853","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":"Role of stroke volume in patients presenting with uncomplicated anterior STEMI.","authors":"Muntaser Omari, Natasha James, Andrew Brown, Kadhim Kadhim, Bilal Bawamia, Adam McDiarmid, Mohammad Alkhalil","doi":"10.1136/openhrt-2025-003429","DOIUrl":"10.1136/openhrt-2025-003429","url":null,"abstract":"<p><strong>Background: </strong>Stroke volume is an established echocardiographic marker but has not been widely studied in patients with ST-segment elevation myocardial infarction (STEMI). We aimed to evaluate stroke volume in a cohort of uncomplicated anterior STEMI and to assess its prognostic role in those with severe left ventricle (LV) systolic dysfunction.</p><p><strong>Methods and results: </strong>This is a single-centre retrospective analysis of consecutive patients presenting with anterior STEMI who underwent uncomplicated primary percutaneous coronary intervention. Stroke volume was measured using echocardiography within in-hospital admission. The primary endpoint was cardiovascular mortality. Of 3592 patients with STEMI, 616 were included. The mean age was 65±14 years (76% males). The average left ventricular ejection fraction (LVEF) and stroke volume were 39±11% and 62±18 mL, respectively. There was a modest relationship between stroke volume and LVEF (r=0.33, p<0.001), which was not maintained in patients with severe LV dysfunction (r=0.11, p=0.19). On multivariate analysis, stroke volume was associated with cardiovascular death at 12 months (HR 0.92, 95% CI 0.86 to 0.98, p=0.015) in patients with severe LV systolic dysfunction. Receiver operating characteristic analysis demonstrated an area under the curve of 0.80 (95% CI 0.70 to 0.91, p<0.001) in this group with negative predictive value of 99% for cardiovascular mortality.</p><p><strong>Conclusions: </strong>Stroke volume is a readily and useful echocardiographic marker to assess prognosis in patients with anterior STEMI and severe LV systolic dysfunction. It identifies with a high degree of certainty those patients who are likely to survive despite their severe LV systolic dysfunction.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12414214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006478","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":"Prevalence and importance of coronary microvascular dysfunction in patients with heart failure and reduced or mildly reduced ejection fraction.","authors":"Charlotte Nordberg Backelin, Sara Svedlund, Entela Bollano, Clara Hjalmarsson, Akash Kumar Gupta, Karl Johan Dahllöf, Fredrik Wolfhagen Sand, Maria Lagerström Fermer, Erik Michaelsson, Alastair Moss, Ida Silfversparre, Tove Brodin, Carlo Pirazzi, Lars Lund, Camilla Hage, Charlotta Ljungman","doi":"10.1136/openhrt-2025-003509","DOIUrl":"10.1136/openhrt-2025-003509","url":null,"abstract":"<p><strong>Aims: </strong>We investigated the prevalence of coronary microvascular dysfunction (CMD) and its association with severity of heart failure in patients with reduced or mildly reduced ejection fraction (HFrEF and HFmrEF).</p><p><strong>Method: </strong>Patients with stable, symptomatic heart failure with left ventricular ejection fraction (LVEF) <50% were enrolled. Data collection included physical examination, blood samples, Kansas City Cardiomyopathy Questionnaire (KCCQ), carotid to femoral pulse wave velocity, echocardiography and adenosine-based transthoracic Doppler echocardiography to assess coronary flow reserve (CFR). A CFR <2.5 was used to diagnose CMD. Adjusted multivariable linear regression analysis with CFR as the dependent variable and adjusted multivariate logistic regression with CMD as the dependent variable were performed.</p><p><strong>Results: </strong>A total of 125 patients were included, of whom 99 (79%) were men. The overall mean age is 73.4 (±7.5) years. In patients eligible for CFR (n=68, 54%), CMD was present in 45 (66%). Patients with CMD had higher N-terminal pro B-type natriuretic peptide (NTproBNP), hsTroponin-T, lower KCCQ score, lower left and right ventricular and left atrial global longitudinal strain (GLS) (p<0.05). In multivariable linear regression, lower CFR was independently associated with reduced GLS, higher NTproBNP and hsTroponin-T. Furthermore, in adjusted logistic regression analysis, lower LVEF, reduced right ventricular GLS and higher biomarkers were independently associated with an increased risk of CMD.</p><p><strong>Conclusion: </strong>CMD was present in 66% of patients with chronic heart failure and HFrEF or HFmrEF. Markers of more severe heart failure, including reduced GLS and higher NTproBNP and hsTroponin-T, were independently associated with lower CFR. Reduced right ventricular GLS and higher levels of the biomarkers were also independently associated with CMD.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12414198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006466","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":"Left ventricular remodelling and vascular adaptation to pregnancy in women with type 1 diabetes.","authors":"Ása Wraae Olsen, Anne Nødgaard Weidemann Sørensen, Sidsel Linneberg Rathcke, Trine Tang Christensen, Jens Brøndum Frøkjær, Peter Søgaard, Tomas Zaremba","doi":"10.1136/openhrt-2025-003427","DOIUrl":"10.1136/openhrt-2025-003427","url":null,"abstract":"<p><strong>Background: </strong>Evidence regarding cardiovascular adaptation to pregnancy in women with pregestational diabetes is limited. Our study aimed to describe left ventricular (LV) remodelling and vascular adaptation to pregnancy in women with type 1 diabetes.</p><p><strong>Methods: </strong>In this prospective cohort study, three consecutive cardiac MRI scans were conducted on age-matched and BMI-matched pregnant women with pregestational type 1 diabetes and pregnant women without diabetes. The scans were performed at gestational weeks 15-20, 26-30 and 34-37 from November 2020 to April 2023. Data collection and analysis included LV imaging results, brachial blood pressure and stroke volume derived functional vascular parameters.</p><p><strong>Results: </strong>The study included 24 women with pregestational type 1 diabetes and 39 controls. Compared with controls, women with type 1 diabetes had significantly reduced LV end-diastolic volume index: 64.2±11.1 mL/m² vs 77.6±13.9 mL/m² (p<0.001), reduced end-systolic volume index: 26.0±7.3 mL/m² vs 33.5±7.7 mL/m² (p=0.003), increased concentricity: 0.84±0.13 g/mL vs 0.68±0.10 g/mL (p<0.001), reduced stroke volume index: 38.2±7.2 mL/m² vs 44.1±8.4 mL/m² (p=0.008), reduced cardiac index: 3.37±0.55 L/min/m² vs 3.62±0.51 L/min/m² (p=0.046), reduced global longitudinal strain: -13.5±2.3% vs -15.2±2.1% (p=0.04), increased myocardial T1 values: 998±28 ms vs 983±25 ms (p=0.03), increased systolic blood pressure: 128.1±7.8 mmHg vs 117.4±11.1 mmHg (p=0.007), increased mean arterial pressure: 94.8±6.7 mmHg vs 88.1±9.7 mmHg (p=0.03), increased total peripheral vascular resistance: 28.9±5.3 mmHg·min·m²/L vs 24.7±4.0 mmHg·min·m²/L (p=0.001), and reduced total arterial compliance: 0.79±0.19 mL/m²/mmHg vs 1.02±0.21 mL/m²/mmHg (p<0.001).</p><p><strong>Conclusion: </strong>Our study provides evidence of impaired LV remodelling and suboptimal vascular adaptation to pregnancy in women with type 1 diabetes when compared to women without diabetes. The clinical implications of these findings, particularly their association with the development of later cardiovascular disease, require further investigation.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12414166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006420","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 impact of mean pulmonary arterial pressure after balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension.","authors":"Ryo Takano, Aoki Tatsuo, Shinya Fujisaki, Mitsumasa Akao, Hiroyuki Endo, Naruhiro Nishi, Hiroya Hayashi, Akiyuki Kotoku, Hiroki Horinouchi, Takatoyo Kiko, Ryotaro Asano, Jin Ueda, Akihiro Tsuji, Kenichi Tsujita, Teruo Noguchi, Tetsuya Fukuda, Takeshi Ogo","doi":"10.1136/openhrt-2025-003532","DOIUrl":"10.1136/openhrt-2025-003532","url":null,"abstract":"<p><strong>Background: </strong>Balloon pulmonary angioplasty (BPA) improves haemodynamics in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Previous studies on BPA have set the treatment objective to achieve a mean pulmonary arterial pressure (mPAP) of <30 mm Hg. However, the clinical impact of mPAP after BPA remains unclear. This study aimed to stratify patients according to their mPAP after BPA and evaluate its association with clinical status and long-term outcomes.</p><p><strong>Methods: </strong>We retrospectively reviewed 304 patients with inoperable CTEPH (median age, 72 (61 to 79) years) who underwent BPA and follow-up right heart catheterisation. Patients were categorised by mPAP after BPA: ≤20, >20-<30 and ≥30 mm Hg groups.</p><p><strong>Results: </strong>The WHO functional classification, 6 min walk distance and right ventricular ejection fraction were significantly better in the group with a lower mPAP (trend test p=0.007, p<0.001 and p=0.002, respectively). Additionally, the proportions of patients who required pulmonary vasodilators or oxygen therapy were significantly lower in the group with a lower mPAP (trend test p<0.001 and p<0.001, respectively). Across all multivariable models, the mPAP ≥30 mm Hg group had a significantly poorer prognosis compared with the mPAP ≤20 mm Hg group. In contrast, no significant difference was observed between the mPAP ≤20 mm Hg and >20-<30 mm Hg groups.</p><p><strong>Conclusions: </strong>In patients with CTEPH after BPA, an mPAP of <30 mm Hg was associated with a favourable prognosis, and patients with an mPAP of ≤20 mm Hg presented with better symptoms, exercise capacity, right ventricular function and more withdrawal from oxygen therapy and pulmonary vasodilators. The BPA treatment goal may require individual adaptation.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12414211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006341","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":"Complications after complex device implantation: how important is implanter seniority?","authors":"Paul A Scott, Antonio Cannata, Daniel I Bromage, Ian J Wright, Anish Bhuva, Matthew J Lovell, Chris Plummer, Mark de Belder, Mark Dayer, Francis Murgatroyd","doi":"10.1136/openhrt-2025-003428","DOIUrl":"10.1136/openhrt-2025-003428","url":null,"abstract":"<p><strong>Background: </strong>The complication risk of procedures may be influenced by operator and institutional characteristics. Our aim was to assess whether supervising consultant seniority and operative volume, and hospital volume were associated with the risk of reintervention following complex device implantation.</p><p><strong>Methods: </strong>A nationwide population-based study was performed using the National Institute for Cardiovascular Outcomes Research registry including all patients receiving their first transvenous implantable cardioverter defibrillator or cardiac resynchronisation therapy (CRT) implant in England over 5 years (April 2014-March 2019). The primary endpoint was 1-year reintervention. We evaluated the association between reintervention and supervising consultant annualised complex device volume, supervising consultant seniority and hospital annualised complex device volume, using multilevel logistic regression.</p><p><strong>Results: </strong>47 630 implants were included. The 1-year reintervention rate was 6.1% (N=2916). There was no difference in reintervention risk with increasing supervising consultant volume (OR 0.89 Q4 vs Q1; 95% CI 0.76 to 1.05, p=0.17). When CRT-pacemakers/defibrillators implants were analysed separately (N=26 108), there was an association between operator volume and 1-year reintervention, but this was of borderline statistical significance and only evident in the highest compared with the lowest volume quartile of operators (adjusted OR 0.79 Q4 vs Q1; 95% CI 0.63 to 0.98, p=0.03). There was a non-linear relationship between reintervention risk and supervising consultant seniority, with the operators in the middle two quartiles of seniority having a lower risk (OR 0.87 Q2 vs Q1, p=0.02; OR 0.81 Q3 vs.Q1; p=0.003) while the most and least senior operators had a similar reintervention risk (OR 0.93 Q4 vs Q1, p=0.31). Hospital volume was not associated with 1-year reintervention.</p><p><strong>Conclusions: </strong>There is a U-shaped curve between operator seniority and reintervention risk for complex devices. Although there are several potential explanations, these data suggest that while newly qualified consultants may benefit from mentoring, all operators should continuously evaluate their outcomes and share them within their centre and more widely through the national audit.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992940","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":"Long-term mortality in patients who survive surgery for infective endocarditis versus the background population: a nationwide study.","authors":"Sikander Tajik Nielsen, Jeppe K Petersen, Katra Hadji-Turdeghal, Peter Laursen Graversen, Morten Holdgaard Smerup, Lauge Østergaard, Lars Koeber, Emil Loldrup Fosbøl","doi":"10.1136/openhrt-2025-003476","DOIUrl":"https://doi.org/10.1136/openhrt-2025-003476","url":null,"abstract":"<p><strong>Background: </strong>Valvular surgery for infective endocarditis (IE) can improve survival but carries substantial risk. Limited data exist on long-term outcomes for patients who survive surgery compared with a background population. We aim to compare long-term mortality and morbidity in patients with IE, who survive 90-days following valvular surgery to a matched Danish background population.</p><p><strong>Methods: </strong>Using Danish registries, we identified patients who survived >90 days post-valvular surgery for first-time IE (2010-2023). Each patient was matched 1:3 with controls from the background population by age, sex and selected comorbidities. All-cause mortality was assessed at 5 and 10 years using the Kaplan-Meier estimator and the multivariate Cox model. Further, we examined the time spent in hospital during the first year following the index date.</p><p><strong>Results: </strong>We identified 1050 patients (77.5% male, median age 65.8 years) surgically treated for IE and 3150 controls. The most common pathogens were: Viridans group streptococci (44.6%), <i>Staphylococcus aureus</i> (23.1%), Enterococci (17.9%). Patients with IE had higher absolute 5-year (20.1% vs 12.9%, p=0.001) and 10-year (38.5% vs 27.9%, p<0.001) mortality compared with controls. Adjusted 5-year and 10-year mortality rates were also higher in patients with IE (5-year HR=1.49 (95% CI 1.24 to 1.79) and 10-year HR 1.38 (95% CI 1.19 to 1.60)). Patients with IE experienced more frequent and longer hospitalisations within the first year postsurgery, as 36.8% patients with IE were hospitalised within the first year following index compared with 17.5% in the matched controls. 9.3% of patients with IE were hospitalised for >14 days compared with 3.0% in matched controls. 60 patients with IE (5.7%) died within the first year following index compared with 51 (1.6%) in the matched controls.</p><p><strong>Conclusion: </strong>Patients with IE who underwent valve surgery had a higher crude mortality than their controls from the background population. After adjusting for confounders, 5-year and 10-year mortality rates remained higher in the IE patient population.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963596","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":"Representation of women in cardiovascular disease management: a systematic analysis of ESC guidelines.","authors":"S Samaneh Lashkarinia, Angela W C Lee, Tiffany M G Baptiste, Rosie K Barrows, Charles P Sillett, Cristobal Rodero, Upasana Tayal, Antonio de Marvao, Nicholas Panay, Catherine Williamson, Carina Blomstrom-Lundqvist, Kristina Haugaa, Barbara Casadei, Mary M Maleckar, Marina Strocchi, Steven A Niederer","doi":"10.1136/openhrt-2025-003320","DOIUrl":"10.1136/openhrt-2025-003320","url":null,"abstract":"<p><strong>Objective: </strong>Sex differences play a critical role in the presentation, progression and treatment outcomes of cardiac diseases. However, historical male predominance in clinical studies has led to disparities in evidence supporting care for both sexes. Clinical guidelines are essential for cardiovascular care, shaping practice and influencing patient outcomes. In this study, we reviewed 34 European Society of Cardiology (ESC) guidelines between 2002 and 2024 to evaluate the representation of women and the inclusion of female-specific recommendations.</p><p><strong>Methods: </strong>We compiled 136 gender-related keywords, validated by six clinicians, and quantified their occurrence across guidelines. While our primary analysis focused on female-specific keywords, we also identified male-specific terms as a comparison point to help quantitatively interpret the representation of female-specific terminology in the guidelines. Each guideline underwent independent review by two auditors who used structured questions to assess its sensitivity to female-specific differences in disease presentation, diagnosis, management and treatment.</p><p><strong>Results: </strong>The most frequent terms were 'pregnancy', 'women' and 'sex', with 1768 (17.9%), 1573 (15.9%) and 676 (6.8%) overall repetitions, respectively, contrasted against 'cardiac' (6932 occurrences) as a baseline. Results showed inconsistency in addressing female-specific factors and health considerations in ESC guidelines. We were able to assess the relative frequency of female-specific language and highlight in contrast areas where female representation in cardiovascular guidelines may be insufficient. Most guidelines (24/34) mentioned pregnancy and provided related recommendations, with one of the guidelines entirely dedicated to cardiovascular disease (CVD) in pregnancy (2018) and a new one planned for 2025. Only 10/30 guidelines acknowledged menopause as a CVD risk factor and offered recommendations for clinical practice.</p><p><strong>Conclusions: </strong>These findings highlight the need for systematic integration of female-specific considerations across all guidelines. In the wider context, there is also a need for improved representation of women in clinical trials and for making the available evidence on which the guidelines are based less biased toward men.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963381","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":"SGLT2 inhibition, acylcarnitines and heart failure: a Mendelian randomization study.","authors":"Zhiyu Wu, Shuyao Song, Jun Lv, Canqing Yu, Dianjianyi Sun, Pei Pei, Ling Yang, Yiping Chen, Iona Y Millwood, Robin G Walters, Hong Guo, Xiaoming Yang, Dan Schmidt, Junshi Chen, Zhengming Chen, Liming Li, Yuanjie Pang","doi":"10.1136/openhrt-2024-003078","DOIUrl":"10.1136/openhrt-2024-003078","url":null,"abstract":"<p><strong>Objective: </strong>Sodium-glucose cotransporter 2 (SGLT2) inhibitors are guideline-recommended agents for treating heart failure (HF), but the role of metabolomic biomarkers in underlying mechanisms, particularly acylcarnitines, remains unclear. This study examined the associations of acylcarnitines with SGLT2 inhibition and incident HF.</p><p><strong>Methods: </strong>This subcohort study included 2178 participants from the prospective China Kadoorie Biobank without cardiovascular disease, diabetes or cancer at baseline. Plasma levels of 40 acylcarnitines were quantified using targeted mass spectrometry-based platforms. The impact of genetically predicted random plasma glucose (RPG) via SGLT2 inhibition on acylcarnitines was assessed with Mendelian randomization (MR). The associations of acylcarnitines with HF risk were assessed using Cox proportional hazards models. Acylcarnitines were classified into short-, medium- and long-chain groups and analysed individually or summed as scores.</p><p><strong>Results: </strong>Of the 2178 participants, the mean (SD) age was 53.2 (9.8) years. 13 incident HF cases occurred during a median follow-up of 10.5 years. SGLT2 inhibition was associated with higher levels of acylcarnitines, while higher levels of acylcarnitines were associated with reduced HF risk. An unweighted acylcarnitines score was associated with SGLT2 inhibition (β, 2.04 (0.29, 3.79) SD increase per 1 mmol/L lower genetic RPG via SGLT2 inhibition) and HF risk (HR, 0.97 (0.93, 0.99) per 1-SD higher of the score). Glucokinase activation, another antidiabetic agent used for comparison, showed weaker associations with acylcarnitines.</p><p><strong>Conclusion: </strong>MR analysis indicated SGLT2 inhibition showed associations with acylcarnitines, which are also associated with HF risk. Our findings highlighted the potential involvement of acylcarnitines in the mechanisms between SGLT2 inhibitors and HF.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963392","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":"Risk stratification of chest pain in the emergency department using artificial intelligence applied to electrocardiograms.","authors":"Julian S Haimovich, Márton Kolossváry, Ridwan Alam, Raimon Padrós-Valls, Michael T Lu, Aaron D Aguirre","doi":"10.1136/openhrt-2025-003343","DOIUrl":"10.1136/openhrt-2025-003343","url":null,"abstract":"<p><strong>Background: </strong>Despite standardised approaches, subjective assessment and inconsistent diagnostic testing for chest pain in the emergency department (ED) drive costs, disparities and adverse outcomes. Artificial intelligence offers potential to automate and improve risk stratification.</p><p><strong>Methods and results: </strong>Using a retrospective cohort of 15 048 patients presenting to the ED of a tertiary care hospital, we trained a neural network classifier ('Chest Pain-AI' or 'CP-AI') to predict a 7-day composite endpoint of major cardiovascular diagnoses including myocardial infarction, pulmonary embolism, aortic dissection and all-cause mortality. Inputs to CP-AI included age, sex, cardiac biomarkers (D-dimer or troponin I or T positivity) and numerical representations of presenting 12-lead ECGs. ECG representations were derived using a publicly available deep learning model known as patient contrastive learning of representations. In an external validation set of 14 476 patients, we evaluated CP-AI against comparator models, including a 'Biomarker Model' incorporating clinical data (age, sex, biomarker positivity), based on both the area under the receiver operating characteristic curve (AUROC) and area under the precision-recall curve (AUPRC). CP-AI outperformed the Biomarker Model in prediction of the 7-day composite endpoint with an AUROC of 0.82 (95% CI 0.81 to 0.83) vs 0.79 (95% CI 0.78 to 0.81) and an AUPRC of 0.46 (95% CI 0.44 to 0.49) vs 0.35 (95% CI 0.33 to 0.37) (p<0.05 for both comparisons).</p><p><strong>Conclusions: </strong>CP-AI, a fully automated neural network classifier, demonstrated superior performance in the prediction of 7-day major cardiovascular diagnoses for patients presenting with acute chest pain compared with conventional models trained on demographics and cardiac biomarkers. CP-AI may standardise and expedite risk stratification of patients presenting to the ED with chest pain.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963372","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}