Open Heart最新文献

{"title":"Adverse cardiovascular events in coronary Plaques not undeRgoing pErcutaneous coronary intervention evaluateD with optIcal Coherence Tomography. The PREDICT-AI risk model.","authors":"Francesco Bruno, Maddalena Immobile Molaro, Michela Sperti, Francesco Bianchini, Miao Chu, Camilla Cardaci, Wojciech Wańha, Pawel Gasior, Simone Zecchino, Marco Pavani, Rocco Vergallo, Simone Biscaglia, Enrico Cerrato, Gioel Gabrio Secco, Marco Mennuni, Massimo Mancone, Ovidio De Filippo, Alessio Mattesini, Paolo Canova, Alberto Boi, Fabrizio Ugo, Roberto Scarsini, Francesco Costa, Enrico Fabris, Gianluca Campo, Wojtek Wojakowski, Umberto Morbiducci, Marco Deriu, Shengxian Tu, Raffaele Piccolo, Fabrizio D'Ascenzo, Claudio Chiastra, Francesco Burzotta","doi":"10.1136/openhrt-2025-003389","DOIUrl":"10.1136/openhrt-2025-003389","url":null,"abstract":"<p><strong>Introduction: </strong>Most acute coronary syndromes (ACS) originate from coronary plaques that are angiographically mild and not flow limiting. These lesions, often characterised by thin-cap fibroatheroma, large lipid cores and macrophage infiltration, are termed 'vulnerable plaques' and are associated with a heightened risk of future major adverse cardiovascular events (MACE). However, current imaging modalities lack robust predictive power, and treatment strategies for such plaques remain controversial.</p><p><strong>Methods and analysis: </strong>The PREDICT-AI study aims to develop and externally validate a machine learning (ML)-based risk score that integrates optical coherence tomography (OCT) plaque features and patient-level clinical data to predict the natural history of non-flow-limiting coronary lesions not treated with percutaneous coronary intervention (PCI). This is a multicentre, prospective, observational study enrolling 500 patients with recent ACS who undergo comprehensive three-vessel OCT imaging. Lesions not treated with PCI will be characterised using artificial intelligence (AI)-based plaque analysis (OctPlus software), including quantification of fibrous cap thickness, lipid arc, macrophage presence and other microstructural features. A three-step ML pipeline will be used to derive and validate a risk score predicting MACE at follow-up. Outcomes will be adjudicated blinded to OCT findings. The primary endpoint is MACE (composite of cardiovascular death, myocardial infarction, urgent revascularisation or target vessel revascularisation). Event prediction will be assessed at both the patient level and plaque level.</p><p><strong>Ethics and dissemination: </strong>The PREDICT-AI study will generate a clinically applicable, AI-driven risk stratification tool based on high-resolution intracoronary imaging. By identifying high-risk, non-obstructive coronary plaques, this model may enhance personalised management strategies and support the transition towards precision medicine in coronary artery disease.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963549","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":"Machine-learning approach to atrial fibrillation prediction among individuals without prior cardiovascular diseases.","authors":"Mozhu Ding, Shunsuke Murata, Javier Louro, Niklas Hammar, Karin Modig","doi":"10.1136/openhrt-2025-003451","DOIUrl":"https://doi.org/10.1136/openhrt-2025-003451","url":null,"abstract":"<p><strong>Background: </strong>There is a lack of atrial fibrillation (AF) prediction models tailored for individuals without prior cardiovascular diseases (CVDs) to facilitate early intervention. This study aimed to develop and validate an AF prediction model using machine-learning methods based on routine biomarkers in middle-aged individuals without overt CVD.</p><p><strong>Methods: </strong>Data were derived from 122 822 individuals in the Swedish AMORIS (Apolipoprotein-Mortality Risk) cohort who were aged 40-65 years and without CVD diagnosis at baseline (1985-96) and followed for 20 years for incident AF. The sample was split into training and validation data sets. Random forest was used to identify AF predictors from 16 routine biomarkers covering lipids, liver/kidney markers, glucose control and inflammation.</p><p><strong>Results: </strong>10 356 (8.4%) incident AF diagnosis occurred over a mean of 18.1 years (SD 4.4). Model performance increased sharply when adding the first seven predictors and plateaued when adding additional ones. Therefore, a final AF prediction model was established based on seven predictors: age, albumin, uric acid, triglycerides, glucose, alkaline phosphatase and sex. C-statistics of the final model were 0.82 (95% CI: 0.81 to 0.82) in the training and 0.71 (0.70 to 0.72) in the validation data set in predicting 20-year AF. The model was well-calibrated in the full sample and age and sex subgroups.</p><p><strong>Conclusions: </strong>A new AF prediction model was established using seven biomarkers from a population without pre-existing CVDs, thus complementing currently available AF prediction models. These markers are readily accessible in primary and specialist care and demonstrate acceptable performance in predicting short- and long-term AF risk.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963560","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 serum potassium time in target range with cardiovascular outcomes in patients with HFpEF.","authors":"Wenlong Xu, Zhiwen Xiao, Yating Tang, Yingxuan Li, Xingqiao Chen, Fengling He, Haoxiang Huang, Chuling Li, Yu Liu, Jiajun Zhou, Yuegang Wang, Jianping Bin, Yanmei Chen","doi":"10.1136/openhrt-2025-003439","DOIUrl":"10.1136/openhrt-2025-003439","url":null,"abstract":"<p><strong>Background: </strong>Serum potassium (sK) disorders are associated with worse outcomes in patients with heart failure with preserved ejection fraction (HFpEF). This study introduced a novel metric, time in target range (TTR), for long-term monitoring of sK levels and determined its prognostic value in patients with HFpEF from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial.</p><p><strong>Methods: </strong>The TTR for sK levels was defined as the percentage of time during which the sK was within the target range of 4.3-4.9 mmol/L, and was estimated using linear interpolation based on at least five valid measurements of sK. The association between sK TTR and cardiovascular (CV) events was estimated using adjusted Cox proportional hazards regression models.</p><p><strong>Results: </strong>A total of 3141 TOPCAT participants with HFpEF were evaluated over a median follow-up period of 3.9 years. A greater time within the range of 4.3-4.9 mmol/L for sK was associated with a lower risk of CV events in patients with HFpEF (HR: 0.712; 95% CI: 0.571 to 0.889). The benefits remained when the range of sK was set at 4.3-4.6, or 4.6-4.9, while no benefits or even negative effects were observed at 4.0-4.3, or 4.9-5.2 mmol/L. The association between a higher TTR and lower risk of CV outcomes was consistent across subgroups. The sK TTR predicted a lower risk of CV events, even after adjusting for traditional CV risk factors, mean sK and sK variability.</p><p><strong>Conclusion: </strong>Maintaining sK levels within the range of 4.3-4.9 mmol/L most of the time in patients with HFpEF is associated with a lower risk of CV events or all-cause mortality.</p><p><strong>Trial registration number: </strong>NCT00094302.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963612","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":"Elucidating associations between technetium pyrophosphate scintigraphy, echocardiography and cardiac biomarkers in transthyretin cardiac amyloidosis.","authors":"Bennett Di Giovanni, Dakota Gustafson, Priya Arivalagan, Mitchell B Adamson, Julie Vishram-Nielsen, Diego Delgado","doi":"10.1136/openhrt-2024-002686","DOIUrl":"https://doi.org/10.1136/openhrt-2024-002686","url":null,"abstract":"<p><strong>Background: </strong>Transthyretin amyloidosis is an under-recognised systemic disease whereby misfolded transthyretin proteins form fibrils capable of depositing in various tissues and organs. Despite improvements to diagnostic modalities, the associations between imaging techniques and clinical laboratory metrics remain unclear.</p><p><strong>Methods: </strong>A single-centre retrospective cohort study was performed including 183 patients aged 18 years or older diagnosed with transthyretin cardiac amyloidosis (ATTR-CA) in a tertiary care setting. Linear regression and multivariate proportional hazard models were used to examine the associations between established imaging modalities (ie, technetium-99m pyrophosphate (^99mTc-PYP) scintigraphy and echocardiography) and cardiac biomarkers (ie, cardiac troponin I and B-type natriuretic peptide (BNP)). The study included patients who visited the Toronto General Hospital Peter Munk Cardiac Centre between October 2012 and December 2022.</p><p><strong>Results: </strong>Of the 183 patients included, 143 (78.1%) were male, with a median age (IQR) of 73.0 (66.0-79.0) years. Primary analyses revealed significant associations between positive ^99mTc-PYP grading and echocardiographic parameters, particularly increased left ventricular (LV) mass (β=111.21, p=0.009) and greater interventricular septal thickness at end-diastole (IVSd) (β=0.48, p=0.003) in patients with hereditary transthyretin amyloidosis (ATTRm). Additionally, positive ^99mTc-PYP grades correlated significantly with cardiac biomarkers, including log-transformed BNP (logBNP; β=1.99, p=0.002) in patients with ATTRm and log-transformed Troponin (logTroponin; β=1.68, p=0.007) in patients with wild type ATTR (ATTRwt). Conversely, the heart-to-contralateral lung ratio, a quantitative index derived from ^99mTc-PYP scintigraphy, did not show significant correlations with cardiac biomarkers (logBNP and logTroponin), but demonstrated significant associations with LV mass (β=134.52, p=0.001) and IVSd (β=0.46, p=0.002) in patients with ATTRm.</p><p><strong>Conclusions: </strong>These data suggest strong associations exist between cardiac biomarkers, structural echocardiographic changes and ^99mTc-PYP scintigraphy, emphasising the importance of a multipronged diagnostic approach stratified by genotype.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963640","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":"PCSK9 targeting therapies for familial hypercholesterolaemia: a meta-analysis of efficacy on lipid biomarkers and safety in adults and children across 23 RCTs.","authors":"Vinh Q T Ho, Nghi Bao Tran, Nhan Nguyen, Giang Son Arrighini, David Downes, Mrunalini Dandamudi, Victoria Zecchin Ferrara, Tri Huynh Quang Ho, Hemank Walia, Alejandro Barbagelata, Thorsten M Leucker, Juliana Giorgi","doi":"10.1136/openhrt-2025-003490","DOIUrl":"https://doi.org/10.1136/openhrt-2025-003490","url":null,"abstract":"<p><strong>Background: </strong>Familial hypercholesterolaemia (FH) is a hereditary disorder characterised by elevated low-density lipoprotein cholesterol (LDL-C) levels, substantially increasing the risk of atherosclerotic cardiovascular disease. Proprotein convertase subtilisin/kexin type 9 (PCSK9) targeting therapies, including monoclonal antibodies and small interfering RNA (siRNA) agents, have emerged as effective lipid lowering therapies.</p><p><strong>Objective: </strong>To assess the efficacy and safety of PCSK9-targeting therapy on lipid biomarkers and adverse events in patients with FH, compared with placebo on the background of standard lipid-lowering therapy.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted, incorporating data from 23 randomised controlled trials involving adult and paediatric FH patients treated with PCSK9 inhibitors (PCSK9i) or siRNA, including alirocumab, bococizumab, evolocumab, tafolecimab and inclisiran. Eligible studies reported changes in LDL-C, apolipoprotein B (ApoB), lipoprotein a (Lp(a)), triglycerides (TGL) and adverse effects. Pooled mean differences (MDs) and ORs with 95% CIs were calculated using random-effects models, and heterogeneity was assessed with I² statistic. This meta-analysis was registered on PROSPERO (CRD42025631510).</p><p><strong>Results: </strong>A total of 4282 patients were included. PCSK9-targeting therapies significantly reduced LDL-C levels compared with control therapies (MD=-46.64%; 95% CI -50.77% to -42.52%; p<0.00001) and TGL (MD=-15.18%; 95% CI -19.34% to -11.03%; p<0.00001). Significant reductions were also observed for ApoB (MD=-34.94%; 95% CI -40.89% to -28.99%; p<0.00001) and Lp(a) (MD=-22.7%; 95% CI -25.95% to -19.44%; p<0.00001). LDL-C, TGL and ApoB reduction were more significant in heterozygous FH patients than in homozygous patients. The safety profile of these therapies was favourable, with adverse event rates comparable to those of the controls.</p><p><strong>Conclusions: </strong>PCSK9i and Inclisiran demonstrate significant and sustained reductions in LDL-C, ApoB, Lp(a) and TGL in FH patients, especially in heterozygous FH patients. These agents are generally well-tolerated and represent effective treatment options for FH patients inadequately controlled by standard lipid-lowering therapies.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963568","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":"Exploring sex differences in mortality among acute myocardial infarction.","authors":"Lorenzo Cangiano, Alice Bonomi, Nicola Cosentino, Olivia Leoni, Filippo Trombara, Veronika A Myasoedova, Paolo Poggio, Daniela Trabattoni, Piergiuseppe Agostoni, Giancarlo Marenzi","doi":"10.1136/openhrt-2025-003517","DOIUrl":"10.1136/openhrt-2025-003517","url":null,"abstract":"<p><strong>Background: </strong>Women with acute myocardial infarction (AMI) experience higher mortality rates than men. This disparity is influenced by factors such as older age, greater comorbidity burden, atypical symptom presentation and delays in treatment. This study analysed patients with AMI (2003-2018) from the Lombardy Health Database (Italy) to examine sex differences in in-hospital and 1-year mortality and the role of age, percutaneous coronary intervention (PCI) and postdischarge therapy.</p><p><strong>Methods and results: </strong>Among 263 564 patients with AMI (93 363 women, 170 201 men), primary and secondary endpoints were in-hospital and 1-year mortality, respectively. Path analysis evaluated the direct and indirect effects of sex on outcomes, incorporating age, PCI and postdischarge therapy as mediators. Women had higher in-hospital (10% vs 5%; p<0.0001) and 1-year mortality (24% vs 14%; p<0.0001) but were less likely to receive PCI (40% vs 61%; p<0.0001) and postdischarge therapy (dual antiplatelet therapy 53% vs 63%; ACE inhibitors/angiotensin receptor blockers 60% vs 64%; beta blockers 53% vs 61%; lipid-lowering drugs 45% vs 58%; p<0.0001 for all differences). After adjusting for age, major comorbidities, PCI and postdischarge treatment, mortality differences were no longer significant (adjusted OR 1.04; 95% CI 0.99 to 1.07 for in-hospital mortality) or even reversed (adjusted HR 0.94; 95% CI 0.92 to 0.96 for 1-year mortality). Path analysis showed that female sex directly contributed 12% to in-hospital mortality and 4% to 1-year mortality, while age and undertreatment accounted for most of the disparity (88% and 96%, respectively).</p><p><strong>Conclusion: </strong>Women with AMI face higher mortality largely due to older age and undertreatment during hospitalisation and after discharge. Addressing these gaps could improve outcomes.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144883379","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":"Intrinsic capacity and its change predict cardiovascular disease risk in early cardiovascular-kidney-metabolic syndrome: a nationwide cohort study.","authors":"Fei Song, Meng-Jin Hu, Jinggang Xia, Chunlin Yin","doi":"10.1136/openhrt-2025-003395","DOIUrl":"10.1136/openhrt-2025-003395","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular-kidney-metabolic (CKM) syndrome plays a critical role in the pathogenesis of cardiovascular diseases (CVD). Growing evidence has established that impaired intrinsic capacity (IC) served as a robust predictor of adverse health outcomes. However, its specific association with incident CVD in CKM syndrome populations has not been established.</p><p><strong>Methods: </strong>The China Health and Retirement Longitudinal Study is a nationally representative cohort study in China. First, the relationship between baseline IC and the incidence of CVD was analysed using Cox regression models. Subsequently, subgroup and interaction analyses were conducted among different groups. To investigate the potential non-linear relationship between baseline IC and CVD risk, restricted cubic spline (RCS) regression of HR was employed. Furthermore, IC trajectories over time were analysed using group-based trajectory modelling. The associations of the trajectory memberships with CVD risk were analysed using logistic regression models.</p><p><strong>Results: </strong>Among 5346 participants included, of whom 2712 (50.7%) were men and 2634 (49.3%) were women, with a mean age of 57.3 (9.02) years. The results of the fully adjusted Cox regression analyses indicated that there was an 8% decrease in risk for every 1-score rise in IC (HR=0.92, 95% CI: 0.87 to 0.98). The RCS regression analyses demonstrated a linear association between baseline IC and CVD risk in the CKM syndrome population. Subgroup and interaction analyses showed no interactions observed in any subgroups. Trajectory analysis identified three longitudinal patterns of IC with age: class 1, 'low level' (12%); class 2, 'medium level' (25%); class 3, 'high level' (63%). Logistic regression models indicated that both 'low level' and 'medium level' IC trajectories were independently associated with significantly higher CVD risk compared with the 'high level' reference group.</p><p><strong>Conclusions: </strong>This prospective cohort study demonstrated significant associations between both baseline IC and its longitudinal changes with incident CVD risk among individuals with CKM syndrome stages 0-3.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144883380","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":"Differences in the management of heart failure with preserved ejection fraction among physicians from Europe, the Middle East and North Africa: an international survey.","authors":"Mohamed H Omer, Anastasia Shchendrygina, Omar Ahmad, Clara Saldarriaga, Sydney Goldfeder de Gracia, Mosaad Alhussain, Najmeddine Echahidi, Suleiman M Kharabsheh, Fakhr Ayoubi, Kamal Alghalayni, Jehad Alburaiki, Bahaa Fadel, Feras Bader, Hadi Skouri, Mohamad Hamade, Marta Załęska-Kocięcka, Federica Guidetti, Nathan Mewton, Dania Mohty","doi":"10.1136/openhrt-2025-003548","DOIUrl":"10.1136/openhrt-2025-003548","url":null,"abstract":"<p><strong>Background: </strong>Heart failure with preserved ejection fraction (HFpEF) poses global diagnostic and therapeutic challenges, with potential regional differences in clinical practice that remain underexplored. This study aimed to map physician-reported HFpEF diagnostic and management practices across Europe and the Middle East-North Africa (MENA) region to identify similarities, differences and opportunities for improved care.</p><p><strong>Methods: </strong>An independent, academically developed survey consisting of 29 questions was designed through expert collaboration to capture detailed information on physician demographics, diagnostic strategies, screening practices, pathophysiological understanding and treatment approaches for HFpEF. The survey was validated by heart failure specialists to ensure relevance and accuracy and distributed widely through professional societies, email and social media channels to reach cardiologists, general practitioners and other physicians involved in heart failure care across Europe and MENA.</p><p><strong>Results: </strong>A total of 723 physicians participated (77 from MENA, 646 from Europe). The proportion of heart failure specialists was higher in Europe (26%) than in MENA (12%, p<0.001), while general cardiologists comprised a larger share in MENA (81% vs 59%, p<0.001). Natriuretic peptide testing use was lower in MENA (82%) compared with Europe (92%, p=0.023). Pharmacotherapy preferences showed both regional similarities and differences, with SGLT2 inhibitors being the most preferred drug of choice universally. In contrast, there was a higher ranking of mineralocorticoid receptor antagonists in Europe (p=0.007) and greater reported use of angiotensin receptor-neprilysin inhibitors in MENA (p=0.03).</p><p><strong>Conclusion: </strong>This large international survey offers a descriptive mapping of HFpEF care practices across Europe and MENA, revealing overall guideline alignment but also regional differences in diagnostic test use and pharmacotherapy preferences. These findings underscore the need for targeted education, improved diagnostic and therapeutic access and tailored guideline implementation to ensure equitable, evidence-based HFpEF management across diverse healthcare settings.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12359493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874328","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 associated outcomes of right ventricular dysfunction in peripartum cardiomyopathy: a systematic review, meta-analysis and meta-regression.","authors":"Matthew Aldo Wijayanto, Christopher Daniel Tristan, Graciella Angelica Lukas, Annisa Aghnia Rahma, Muhana Fawwazy Ilyas, Risalina Myrtha, Hary Sakti Muliawan, Bambang Budi Siswanto","doi":"10.1136/openhrt-2025-003253","DOIUrl":"10.1136/openhrt-2025-003253","url":null,"abstract":"<p><strong>Introduction: </strong>Recent studies have highlighted the presence of right ventricular dysfunction (RVD) in a substantial proportion of peripartum cardiomyopathy (PPCM), with evidence suggesting that RVD is associated with worse outcomes and a lower likelihood of left ventricular (LV) recovery. This study aims to comprehensively assess the pooled prevalence, associated outcomes and LV recovery of RVD in PPCM.</p><p><strong>Methods: </strong>PubMed, Scopus and ScienceDirect were used to identify relevant literature prior to 19 January 2025. Statistical analysis was conducted using RStudio. All meta-analyses were performed using random effects, with subsequent subgroup analysis and univariate meta-regression conducted for prevalence meta-analysis.</p><p><strong>Results: </strong>The pooled prevalence of RVD in PPCM was 0.48 (95% CI: 0.36 to 0.59; I² 95.3%) across 14 studies (1385 patients). RVD was diagnosed using multimodality imaging (e.g., echocardiography and cardiac magnetic resonance imaging), with diagnostic criteria defined in the original studies. Meta-regression showed a decreasing trend in RVD prevalence in more recent publications (p=0.03), with variability based on study design, location and diagnostic modality on subgroup analysis. Patients with RVD had a significantly higher risk of composite adverse outcomes (including death, LV assist device implantation, heart transplantation or the use of extracorporeal membrane oxygenation; hazard ratio 2.71; 95% CI 1.08 to 6.84; p=0.04; three studies) and heart transplantation (risk ratio (RR) 4.71; 95% CI 1.82 to 12.20; p<0.01; two studies). Additionally, RVD was associated with a lower baseline LV ejection fraction (mean difference -10.94; 95% CI -14.80 to -7.08; p<0.01; six studies) and an increased risk of unrecovered LV function (RR 1.62; 95% CI 1.25 to 2.11; p<0.01; four studies).</p><p><strong>Conclusion: </strong>RVD occurs in nearly half of patients with PPCM and is associated with a poor prognosis. It may represent a crucial marker for prognostic stratification, particularly for the risk of unrecovered LV function.</p><p><strong>Prospero registration number: </strong>CRD42025626739.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12359473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874329","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":"Treatment disparities and prognostic implications in octogenarians versus non-octogenarians with high-gradient severe aortic stenosis.","authors":"Eias Massalha, Or Shimoni, Olga Rapp, Avi Sabbag, Amer Dakka, Robert Klempfner, Tal Patalon, Chris Pounds, Amit Segev","doi":"10.1136/openhrt-2025-003405","DOIUrl":"10.1136/openhrt-2025-003405","url":null,"abstract":"<p><strong>Background: </strong>Aortic valve replacement (AVR) is considered one of the most potent disease-modifying procedures among patients with severe aortic stenosis (sAS). Accordingly, we have witnessed a consistent increase in the procedure rates in recent years. Nevertheless, the elderly population, particularly octogenarians, remains relatively undertreated. The current study aims to document the disparities in AVR rates among octogenarians and its prognostic significance.</p><p><strong>Methods: </strong>A vast database of Maccabi Health Services, the second largest health maintenance organisation in Israel, counting nearly 2.8 million members, was retrospectively analysed from 2005 to 2021 for all patients over 60 years, with a detailed echocardiography report compatible with a diagnosis of high-gradient sAS. The database was extracted using the MDClone healthcare data platform, generating synthetic data reliably representing the original population. All-cause mortality was set to be the primary outcome, and survival models using adjusted multivariable analyses for several clinical and echocardiographic parameters were applied.</p><p><strong>Results: </strong>The cohort consisted of 1396 patients with high-gradient sAS (76±7 years) with 39% octogenarians. Octogenarians were less likely to undergo AVR (42% vs 60%, p<0.01) and presented more severe clinical profiles. AVR significantly reduced mortality and hospitalisations in both age groups, but octogenarians showed a pronounced survival benefit regardless of symptom status. A time-dependent analysis showed that AVR was associated with reduced all-cause mortality (HR 0.30, 95% CI 0.23 to 0.41, p<0.001) within the octogenarian group in 5 years. A similar protective effect was shown in the non-octogenarian group (HR 0.32, 95% CI 0.22 to 0.46, p<0.001).</p><p><strong>Conclusion: </strong>This study highlights significant treatment disparities in AVR among octogenarians with high-gradient sAS despite clear benefits in survival and reduced hospitalisations. The findings suggest the need for more inclusive treatment strategies, particularly for older patients, and underscore the importance of AVR in improving clinical outcomes in this population.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12352216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855944","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}