Open Heart最新文献

{"title":"Prognostic value of CMR parametric mapping in cardiac amyloidosis: an updated systematic review and meta-analysis.","authors":"Seyed Ali Forouzannia, Seyedeh Romina Rafiei Alavi, Seyed Mohammad Forouzannia, Jawdat Abdulla, Adam Ioannou, Giulia Francese, Muhammad Umair","doi":"10.1136/openhrt-2025-003551","DOIUrl":"10.1136/openhrt-2025-003551","url":null,"abstract":"<p><strong>Background: </strong>Cardiac amyloidosis (CA) is the leading cause of mortality in systemic amyloidosis, highlighting the need for accurate risk assessment to guide patient management. While the diagnostic value of cardiac MR (CMR) parametric mapping is well established, its prognostic utility remains inconsistent across studies. To perform a systematic review and meta-analysis to evaluate the prognostic value of CMR parametric mapping in predicting all-cause mortality, heart failure hospitalisation and major adverse cardiovascular events in patients with CA.</p><p><strong>Methods: </strong>An extensive search was conducted in Medline, Scopus, Embase and Web of Science databases. Eligible studies were observational studies that reported HRs for predicting predefined outcomes in patients with CA using CMR parametric mapping.</p><p><strong>Results: </strong>22 studies with 3398 patients were included in this systematic review. Higher extracellular volume (ECV) values were associated with increased mortality, both as a dichotomous (HR: 2.90; 95% CI: 1.68 to 5.01) and continuous variable (HR for 1% increase: 1.08; 95% CI: 1.06 to 1.10; HR for 3% increase: 1.17; 95% CI: 1.11 to 1.22 and HR for 10% increase: 2.11; 95% CI: 1.70 to 2.62). Higher native T1 mapping values were associated with mortality as a dichotomous variable (HR: 1.33; 95% CI: 0.79 to 2.24). Native T2 mapping showed inconsistent associations with prognosis across studies.</p><p><strong>Conclusions: </strong>Higher ECV and native T1 values are associated with worse prognosis in CA, supporting their role in risk stratification. Further studies with standardised CMR protocols are needed to enhance the prognostic utility of parametric mapping in clinical practice.</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/PMC12352251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855943","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":"<i>Bartonella</i> endocarditis: a complex diagnosis of blood culture-negative endocarditis in an endemic region of Africa.","authors":"Luke D Hunter, Simon Poerstamper, Philip G Herbst, Anton F Doubell, Colette Pienaar, Jantjie J Taljaard, Hans Prozesky, Jacques J Janson, Alfonso Jk Pecoraro","doi":"10.1136/openhrt-2025-003463","DOIUrl":"10.1136/openhrt-2025-003463","url":null,"abstract":"<p><strong>Introduction: </strong><i>Bartonella</i> species are an important emerging cause of blood culture-negative endocarditis (BCNE). The diagnosis requires serology by indirect immunofluorescence assay (IFA) and PCR testing on blood and/or tissue. Access to the guideline-referenced in-house IFA is limited in Africa and a commercially available IFA is used to identify patients with <i>Bartonella</i> spp. infection in our region. Prior study in South Africa has highlighted a high seroprevalence of <i>Bartonella</i> spp. in the general population. It is unclear how to incorporate these factors into the diagnostic thinking when interpreting a positive IFA result in a patient with BCNE. We explore these important knowledge gaps in a cohort of 31 patients with <i>Bartonella</i> endocarditis.</p><p><strong>Methods and results: </strong>Data from the Tygerberg Endocarditis Cohort Study were evaluated between October 2019 and May 2023. Continuous variables were reported as mean with SD if normally distributed, alternatively as median with IQR. Categorical variables were reported as counts and percentages. A Kaplan-Meier curve will be used to depict the mortality rate of operated versus unoperated patients. The mean age (±SD) was 38±9 years, 70.9% were male, 25.8% were either homeless or lived in informal housing, 70.9% were unemployed, 54.8% had an underlying alcohol-use disorder and 25.8% were HIV positive. Blood serology was positive (IgG titre ≥1:256) in 96.7% of patients with available sera. Valvular tissue was available for PCR testing in 18 cases. Of these, <i>Bartonella quintana</i> was identified in 16 cases and <i>Bartonella henselae</i> in one case. None of the cases with both serology and valve PCR data had negative serology. No cases of blood culture-positive endocarditis (BCPE) had a positive PCR for <i>Bartonella</i> spp. The most common isolated valve lesion on echocardiography was severe aortic regurgitation (43.3%). The 1-month and 6-month mortality in the operated cohort was 0% and 4.5%, respectively.</p><p><strong>Discussion: </strong><i>Bartonella quintana</i> is the most common cause of BCNE accounting for 49.2% of cases at our centre. None of the PCR-proven cases of <i>Bartonella</i> endocarditis had negative serology, which suggests that the test has a high negative predictive value. The current guideline diagnostic titre of ≥1:800 is assay dependent and is not generalisable to alternative, commercially available, assays. Crucially, none of the BCPE cases with available PCR on valve tissue had a positive PCR for <i>Bartonella</i> spp, suggesting a positive valve PCR is definitive evidence of true infection in an endemic region. The specific clinical, echocardiographic and mortality data were consistent with the reported literature and characterised a subacute, but ultimately destructive endocarditis with a high embolic risk and underscores the need for early surgical intervention.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804489","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 structure and function in anabolic-androgenic steroid users: a 16-year follow-up study.","authors":"Tea Sætereng Fyksen, Jørgen Gravning, Anne Rossebø, Paul Vanberg, Ole Jørgen Grøtta, Dan Atar, Sigrun Halvorsen","doi":"10.1136/openhrt-2025-003376","DOIUrl":"10.1136/openhrt-2025-003376","url":null,"abstract":"<p><strong>Background and aim: </strong>Long-term data on cardiac changes in anabolic-androgenic steroid (AAS) users are lacking. The aim of this study was to explore the effects of AAS on cardiac structure and function during long-term follow-up.</p><p><strong>Methods: </strong>In this prospective cohort study, AAS users and strength-trained non-users were included and examined at two time points with echocardiography and coronary CT angiography. AAS use and non-use were verified by blood and urine analyses.</p><p><strong>Results: </strong>A cohort of 32 AAS users (median age 33 years) and 13 non-users (median age 34 years) were followed for a median of 16 (IQR, 15-17) and 13 (7-15) years, respectively. At baseline, AAS users had been taking AAS for a median of 5-10 years. At follow-up, 15 had discontinued AAS, while 17 remained continued users. At baseline, AAS users presented with larger left ventricular mass (LVM) (266 g (213-319) vs 215 g (196-217), p<0.01), and lower left ventricular ejection fraction (LVEF) (49% (44-53) vs 53% (51-56), p=0.05), compared with non-users. At follow-up, LVM in discontinued users was reduced and similar to the non-users, while continued users still had larger LVM. LVEF remained significantly impaired in continued users versus non-users (p<0.01). In discontinued users, LVEF seemed to improve over time. The median change in LVEF over time differed significantly between continued and discontinued AAS users (-2 (-6 to 2) vs 3 (1 to 8), p<0.01). Despite higher cardiac troponin T levels in AAS users, coronary artery disease prevalence did not differ between groups.</p><p><strong>Conclusion: </strong>Long-term AAS use was associated with myocardial remodelling and left ventricular dysfunction. In AAS users who discontinued use during follow-up, left ventricular remodelling and systolic function seemed to improve, even after more than a decade of AAS use.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12323528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784914","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":"Adequately identifying low-risk chest pain in emergency primary care: evaluating the performance of preHEAR(T) based on two European cohorts.","authors":"Tonje R Johannessen, Indra M B Melessen, Odd Martin Vallersnes, Amy Manten, Sigrun Halvorsen, Dan Atar, Ralf E Harskamp","doi":"10.1136/openhrt-2025-003362","DOIUrl":"10.1136/openhrt-2025-003362","url":null,"abstract":"<p><strong>Background: </strong>Differentiating cardiac from non-cardiac acute chest pain poses a diagnostic challenge, especially in primary care. The History, ECG, Age, Risk factors and Troponin level (HEART) score aid in risk stratification in hospitals, while the prehospital HEART (preHEART) score was refined for paramedics' use. However, its accuracy in emergency primary care has not been studied. This study evaluates the preHEAR(T) score, with and without high-sensitivity cardiac troponin (hs-cTn), as a tool to rule out acute myocardial infarction (MI) in emergency primary care.</p><p><strong>Methods: </strong>Retrospective data from two European cohorts were analysed, namely the One-hoUr Troponin in a low-prevalence population of Acute Coronary Syndrome (OUT-ACS) study (1711 patients) at a Norwegian emergency primary care centre (2016-2018) and the TRiage of Acute Chest pain Evaluated in urgent primary care (TRACE) study (664 patients) at a Dutch emergency primary care centre (2017). The preHEAR (without hs-cTn) score was evaluated in both cohorts. The preHEART score was assessed in OUT-ACS only, as the TRACE study did not measure troponins. The threshold of ≤3 points has previously been determined as low risk for acute MI (AMI) and optimal for rule-out purposes. The primary outcome was diagnostic performance for ruling out MI, and the secondary outcome was the composite of 90-day AMI or all-cause death.</p><p><strong>Results: </strong>In OUT-ACS, 3.6% of patients had an AMI (median age 56 years (45-68); 47.7% female), and 3% in TRACE (median age 48 years (32-67); 56.9% female). PreHEAR identified 49.3% (OUT-ACS) and 82.7% (TRACE) as low risk, while preHEART identified 33.6% (OUT-ACS) as low risk. Sensitivity/specificity for AMI were 63.9% (95% CI 50.6 to 75.8)/49.8% (95% CI 47.3 to 52.7) (OUT-ACS) and 65% (95% CI 40.8 to 84.6)/84.2% (95% CI 81.1 to 86.9) (TRACE) for preHEAR and 93.4% (95% CI 84.1 to 98.2)/34.6% (95% CI 32.2 to 37) for preHEART. For the secondary outcome, similar diagnostic performance metrics were found. There were four missed AMI cases in the low-risk preHEART group, who were all female.</p><p><strong>Conclusion: </strong>Neither the preHEAR nor preHEART scores provide sufficient rule out safety in emergency primary care and may particularly underestimate AMI risk in females.</p><p><strong>Trial registration number: </strong>OUT-ACS: clinicaltrials.gov NCT02983123.</p><p><strong>Trace: </strong>Netherlands Trial Registry (NL-OMON20102); https://onderzoekmetmensen.nl/nl/trial/20102.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732552","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 prognostic value of myocardial perfusion scintigraphy in patients with suspected coronary artery disease: systematic review and meta-analysis.","authors":"Ugochukwu Ihekwaba, Nicholas Johnson, Ji Soo Choi, Gianluigi Savarese, Nicola Orsini, Jeffrey Khoo, Iain Squire, Attila Kardos","doi":"10.1136/openhrt-2025-003521","DOIUrl":"10.1136/openhrt-2025-003521","url":null,"abstract":"<p><strong>Background: </strong>Long-term outcome of contemporary myocardial perfusion scintigraphy (MPS) has not been assessed systematically.</p><p><strong>Objective: </strong>To evaluate the association between results of MPS and long-term outcomes for patients with suspected coronary artery disease (CAD).</p><p><strong>Methods: </strong>Electronic databases were searched for Randomised controlled trials evaluating long-term outcome (≥12 months) of MPS in patients with suspected of CAD since year 2000. A meta-analysis adopting the random effects model was used to derive pooled estimates. The primary outcome was the composite of all-cause or cardiovascular mortality and non-fatal myocardial infarction as defined in individual trials, termed as major adverse cardiovascular event (MACE). Secondary outcome was all-cause or cardiovascular mortality. Positive MPS result was defined as reversible perfusion defect in any coronary artery territory.</p><p><strong>Results: </strong>Four trials fulfilled the search criteria. A total of 1764 patient had MPS with a median follow-up of 35.7 months (range 17-57). The mean age was 59 years and 50% were male. Fifty-three per cent had hypertension, 43% had dyslipidaemia, 15% were current smokers and 61% had diabetes mellitus. The overall annual event rate was 1.42% for the composite MACE and 0.22% for all-cause or cardiovascular mortality. Compared with negative MPS results, positive MPS was associated with an increased risk of the composite MACE and all-cause or cardiovascular mortality with an annual event rate of 2.16% versus 0.66%, OR 2.71 (1.38, 5.32) and 0.34% versus 0.10%, OR 3.41 (1.44, 8.11), respectively.</p><p><strong>Conclusion: </strong>In this meta-analysis, reversible perfusion defect on MPS was associated with higher risk of composite MACE, and that of all-cause or cardiovascular mortality.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718206","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":"Comparative efficacy and safety of no-touch versus conventional vein harvesting techniques in coronary artery bypass grafting: a systematic review and meta-analysis.","authors":"Muhammad Abdullah Ali, Umama Alam, Fazia Khattak, Zaryab Bacha, Fatima Sajjad, Asad Iqbal Khattak, Abdullah Afridi, Sufyan Shahid, Maheen Sheraz, Naveed Ahmed Khan, Alifa Sabir, Raheel Ahmed","doi":"10.1136/openhrt-2025-003391","DOIUrl":"10.1136/openhrt-2025-003391","url":null,"abstract":"<p><strong>Objective: </strong>This meta-analysis aims to compare the clinical outcomes of the no-touch (NT) and conventional (CON) vein harvesting techniques in patients undergoing coronary artery bypass grafting (CABG).</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis following the guidelines of the Cochrane Handbook and PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) statement. We searched PubMed, Embase and Web of Science for randomised controlled trials (RCTs) comparing NT and CON vein harvesting techniques in CABG patients. Data were extracted on primary outcomes (graft failure incidence per patient, graft occlusion incidence per patient and leg infection) and secondary outcomes (revascularisation, all-cause death, myocardial infarction). Statistical analysis was performed using Review Manager V.5.4, with risk ratios (RRs) calculated for binary outcomes.</p><p><strong>Results: </strong>Seven RCTs involving 4176 patients were included. The NT group showed a significantly lower risk of graft failure incidence per patient (RR=0.74, p=0.0001) and graft occlusion incidence per patient (RR=0.62, p=0.0002) compared with the CON group. However, the NT group had a higher risk of leg infection (RR=1.91, p<0.00001). No significant differences were observed between groups for revascularisation (p=0.46), all-cause death (p=0.87), or myocardial infarction (p=0.95).</p><p><strong>Conclusions: </strong>The no-touch vein harvesting technique is associated with reduced graft failure incidence per patient and graft occlusion incidence per patient compared with conventional harvesting techniques in CABG, though it increases the risk of leg infection. These findings suggest NT as a preferable technique for improving graft patency but highlight the need for caution regarding leg infection.</p><p><strong>Prospero registration number: </strong>CRD42025646500.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12281317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691144","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":"Effect of sodium-glucose cotransporter 2 inhibitors on ventricular function in systemic right ventricular failure.","authors":"Ralph Ml Neijenhuis, Madelien V Regeer, Niki L Walker, Bart Ja Mertens, Amanda Hunter, Philippine Kiès, Lorna Swan, Hubert W Vliegen, Simon T MacDonald, Filip Zemrak, Ali N Zaidi, Ari M Cedars, Monique Rm Jongbloed, J Wouter Jukema, Gruschen R Veldtman, Anastasia D Egorova","doi":"10.1136/openhrt-2025-003445","DOIUrl":"10.1136/openhrt-2025-003445","url":null,"abstract":"<p><strong>Background: </strong>Systemic right ventricle (sRV) patients are at an increased risk of developing heart failure. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) could be a valuable treatment option. This study investigated the changes in ventricular function in sRV failure patients in the first year after starting SGLT2i.</p><p><strong>Methods: </strong>Adult sRV patients from the international, real-world ACHIEVE-SGLT2i registry were included if they had a clinical diagnosis of sRV failure, a transthoracic echocardiogram before starting SGLT2i, and at least one in the first year after starting available for analysis. The primary outcomes were changes in sRV global longitudinal strain (GLS) and fractional area change (FAC). Longitudinal changes were evaluated using linear mixed models.</p><p><strong>Results: </strong>Thirty-nine sRV failure patients (46±9.3 years old, 41% female) were included. Twenty-five (64%) had transposition of the great arteries after an atrial switch procedure and 14 (36%) had congenitally corrected transposition. sRV GLS improved significantly in the first 50 days (-1.4%-point per month, p<0.001) and stabilised afterwards (<0.1%-point per month, p=0.520). Though age had a significant overall negative effect on sRV GLS (0.1%-point per year of age, p=0.049), it did not influence the longitudinal changes after starting SGLT2i. sRV FAC also improved in the first 50 days (3.2%-point per month, p=0.002), after which sRV FAC deteriorated in patients with subpulmonary left ventricular pacing (-0.9%-point per month, p=0.012) while it stabilised in patients without pacing (0.1%-point per month, p=0.573). In the first 50 days, tricuspid annular plane systolic excursion also improved significantly in all patients (1.2 mm per month, p=0.006), and stabilised afterwards (p=0.721).</p><p><strong>Conclusions: </strong>SGLT2i therapy is associated with improvements in systolic ventricular function in sRV failure patients. Despite early improvement in sRV FAC, there was a negative longer term correlation with subpulmonary left ventricular pacing, potentially reflecting adverse effects of subpulmonary ventricular pacing on sRV function.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12281333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691145","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":"Artificial intelligence in coronary angiography: benchmarking the diagnostic accuracy of ChatGPT-4o against interventional cardiologists.","authors":"John Michael Hoppe, Antonia Kellnar, David Esser, Kathrin Diegruber, Christopher Stremmel","doi":"10.1136/openhrt-2025-003316","DOIUrl":"10.1136/openhrt-2025-003316","url":null,"abstract":"<p><strong>Background: </strong>The integration of artificial intelligence (AI) into medical diagnostics has significantly impacted cardiology by enhancing diagnostic precision and therapeutic strategies. Coronary artery disease continues to be a leading cause of global morbidity and mortality, with coronary angiography being the diagnostic gold standard. However, the subjective nature of angiographic interpretation can lead to inconsistent assessment. AI aims to provide automated, objective assessments to mitigate these challenges.</p><p><strong>Methods: </strong>This study evaluated ChatGPT with Generative Pre-trained Transformer (GPT)-4o (OpenAI, USA), for automated coronary angiogram interpretation. Due to its inability to process video data, we extracted maximum contrast frames from diagnostic angiogram views. These anonymised images were analysed by GPT-4o. Its diagnostic findings and stent recommendations were compared with expert cardiologist assessments.</p><p><strong>Results: </strong>We included 100 patients who underwent coronary interventions between January and April 2024. GPT-4o accurately identified coronary vessels in 98% of images. The overall sensitivity for detecting lesions requiring intervention was 71.6%, with a specificity of 57.2% (F1 score 0.652). Performance varied by vessel with best results for left anterior descending artery (sensitivity 81.0%; specificity 69.3%) and right coronary artery (sensitivity 86.5%; specificity 61.4%). Identification of the target vessel based solely on imaging was 47%, which improved to 87% with additional clinical information.</p><p><strong>Conclusions: </strong>GPT-4o shows potential as a supportive tool in coronary angiography interpretation. Its diagnostic performance improves significantly when contextual clinical information is included. However, its accuracy based on static images alone remains below the threshold required for reliable diagnostic and therapeutic support. The lack of cine-loop data as an essential element in real-world angiographic interpretation is a key limitation. Future developments should focus on enhancing AI capabilities for analysing complex anatomical structures and integrating dynamic imaging data to augment clinical utility.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675341","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":"'Vaccination' against myocardial infarction: the hidden long-term effect of coronary artery bypass grafting.","authors":"Hristo Kirov, Mathias W Pletz, Tulio Caldonazo, Torsten Doenst","doi":"10.1136/openhrt-2025-003163","DOIUrl":"10.1136/openhrt-2025-003163","url":null,"abstract":"","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668039","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":"Improved diagnosis of COVID-19 vaccine-associated myocarditis with cardiac scarring identified by cardiac magnetic resonance imaging.","authors":"Josephine Warren, Daryl Cheng, Nigel Crawford, Bryn Jones, Rui Lun Ng, Annette Alafaci, Dion Stub, Philip Lew, Andrew J Taylor","doi":"10.1136/openhrt-2025-003333","DOIUrl":"10.1136/openhrt-2025-003333","url":null,"abstract":"<p><strong>Background: </strong>Myocarditis is a rare but potentially serious complication of COVID-19 vaccination. Cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) imaging can identify cardiac scar, which may improve diagnostic accuracy and prognostication. We sought to define the incidence of long-term LGE post COVID-19 vaccine-associated myocarditis (C-VAM) and to establish the additive role of CMR in the diagnostic workup of this condition.</p><p><strong>Methods: </strong>Patients with Brighton Collaboration Criteria Level 1 (definite) or Level 2 (probable) C-VAM were prospectively recruited from the Surveillance of Adverse Events Following Vaccination In the Community database to undergo CMR at least 6 months after diagnosis. As there were limited patients with access to baseline CMR, prior CMR results were not included in the initial case definition. The presence of LGE at follow-up CMR was then integrated into the diagnostic algorithm, and the reclassification rate (definite vs probable) was calculated.</p><p><strong>Results: </strong>67 patients with C-VAM (mean age 30±13 years, 72% male) underwent CMR evaluation. The median time from vaccination to CMR was 548 (range 398-603) days. 20 patients (30%) had LGE. At diagnosis, nine patients (13%) were classified as definite and 58 (87%) as probable myocarditis. With the integration of CMR-LGE data, 16 patients (28%) were reclassified from probable to definite myocarditis.</p><p><strong>Conclusion: </strong>LGE on CMR occurred in one-third of patients with C-VAM. Without CMR at the time of diagnosis, almost one-third of patients are misclassified as probable rather than definite myocarditis, indicating a diagnostic strategy using echocardiography alone is insufficient.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668038","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}