Open Heart最新文献

{"title":"Clinical course and outcomes of supravalvular aortic stenosis in adults.","authors":"Adine R de Keijzer, Zoë A Keuning, Frederike Meccanici, Roland R L van Kimmenade, Joost P van Melle, Berto J Bouma, Jolanda Kluin, Monique R M Jongbloed, Michiel Voskuil, Jolien W Roos-Hesselink, Annemien E van den Bosch","doi":"10.1136/openhrt-2025-003355","DOIUrl":"10.1136/openhrt-2025-003355","url":null,"abstract":"<p><strong>Background: </strong>Supravalvular aortic stenosis (SVAS) is a rare condition with limited data on patients beyond childhood. This study aims to investigate the clinical course and outcomes of SVAS in adults.</p><p><strong>Methods: </strong>All adult (≥18 years) patients with SVAS, prospectively registered in the Dutch Congenital Cor Vitia database between 2001 and 2019, were included. Survival and event-free survival were assessed. Evolution of peak velocity was analysed using linear mixed models. Differences in previous operated state, sex and Williams-Beuren syndrome were explored.</p><p><strong>Results: </strong>65 patients were included (age: 23 (IQR: 20, 31) years, 31% female, 46% previous SVAS correction, 47% Williams-Beuren syndrome). The peak velocity was 2.3±1.0 m/s at inclusion. Median follow-up time was 13 (IQR: 10, 17) years. Four patients died (one patient after cardiac surgery, two of non-cardiac causes and in one patient the cause of death was unknown) resulting in a 10-year survival of 95% (95% CI 90% to 100%) and event-free survival of 83% (95% CI 74% to 93%). There were no differences in event-free survival between previous operated state (p=0.2), sex (p=0.48) or Williams-Beuren syndrome (p=0.85). 31 cardiovascular events occurred in 15 patients, with the majority being arrhythmias. All SVAS-related interventions (three surgeries in two patients) occurred in unoperated patients (7 (95% CI 2 to 21)/1000 patient years). Although no patient showed fast progression (≥0.3 m/s/year), the peak velocity evolution over time increased faster in females compared with males (first time spline: 0.8 m/s, p=0.017).</p><p><strong>Conclusion: </strong>In adulthood, SVAS patients showed a stable clinical course without rapid progression. While cardiovascular events occurred in this young cohort, they were mostly obsereved in those with additional congenital heart defects, suggesting a more optimistic view for SVAS itself. No significant differences in outcomes were observed in patients with/without Williams-Beuren syndrome. Overall, SVAS tends to follow a more benign course in adulthood compared with childhood, potentially allowing for less intensive follow-up- though follow-up should still be individualised based on associated congenital heart defects and cardiovascular risks.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174390","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":"Impact of aortic landing zone geometry on TAVI implantation depth: comparison between ACURATE <i>neo2</i> and Portico/Evolut.","authors":"Francesco Sturla, Filippo Pensotti, Omar Alessandro Oliva, Mattia Squillace, Enrico Poletti, Maurizio Tusa, Jessica Zannoni, Emiliano Votta, Nedy Brambilla, Luca Testa, Francesco Bedogni, Riccardo Gorla","doi":"10.1136/openhrt-2025-003181","DOIUrl":"10.1136/openhrt-2025-003181","url":null,"abstract":"<p><strong>Background: </strong>During transcatheter aortic valve implantation (TAVI), increased aortic angulation can affect the final implantation depth of self-expandable (SE) devices due to the interaction between the high stent frame and the targeted aortic landing zone (LZ). We herein sought to investigate the behaviour of the ACURATE <i>neo</i>2, a SE device with a unique release mechanism, in relation to patient-specific angulation and curvature of the aortic LZ.</p><p><strong>Methods: </strong>The mismatch between the intended and the final implantation depth (∆H) was compared between patients treated with ACURATE <i>neo2</i> (Acurate, n=106) and Evolut/Portico (n=101) SE devices. To do so, curvature (<i>κ</i> _{<i>LZ,tot</i>} ) and angulation (<i>α_LZ,Dist</i> ) were calculated based on the three-dimensional aortic LZ centerline available from pre-TAVI CT.</p><p><strong>Results: </strong>The Acurate and Evolut/Portico groups showed a negligible difference (p=0.09) for ∆H averaged between non-coronary (NCC) and left coronary cusp (LCC). However, when splitting both ∆H_NCC and ∆H_LCC values into two subgroups based on <i>κ</i> _{<i>LZ,tot</i>} and <i>α_LZ,Dist</i> median values, ∆H significantly increased on LCC compared with NCC in Evolut/Portico patients with high LZ curvature (κ_LZ,tot >0.123/mm, p=0.016) and high LZ distal angulation (<i>α_LZ,Dist</i> >28.5°, p=0.012). No statistically significant differences arose within the Acurate group.</p><p><strong>Conclusions: </strong>Among SE devices, the ACURATE <i>neo</i>2 was the least affected by the curvature and angulation of the LZ anatomy, leading to a more predictable and symmetrical implantation depth. The clinical impact of this finding on TAVI outcomes in patients with an angulated aortic LZ warrants further investigation in larger studies.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172822","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 atrial appendage function by strain and structure is associated with thromboembolic risk in patients with cryptogenic stroke and TIA.","authors":"Loreta Skrebelyte-Strøm, Jørg Saberniak, Eivind Bjørkan Orstad, Janne Elin Mykland Hilde, Ole Morten Rønning, Kjetil Steine","doi":"10.1136/openhrt-2025-003287","DOIUrl":"10.1136/openhrt-2025-003287","url":null,"abstract":"<p><strong>Background: </strong>We investigated the impact of left atrial appendage (LAA) function by LAA strain, LAA morphology and subclinical atrial fibrillation (AF) on LAA thrombus presence and thromboembolic risk conditions (TRC) in patients with cryptogenic stroke and transient ischaemic attack (TIA).</p><p><strong>Methods: </strong>185 patients (mean age 68±13 years, 33% female) were included in this prospective cohort study and underwent clinical evaluation, comprehensive transthoracic and transoesophageal echocardiography shortly after index event. LAA function and morphology were evaluated by monoplane/multiplane/speckle tracking strain and three-dimensional echocardiography. Combination of LAA thrombus and/or spontaneous echo contrast (SEC) was defined as TRC. An insertable cardiac monitor was implanted in all patients to detect subclinical AF.</p><p><strong>Results: </strong>LAA function by novel LAA strain and LAA chicken wing were independent predictors of LAA thrombus (OR 0.9 (95% CI 0.8 to 0.95), p<0.01 and OR 2.5 (95% CI 1.1 to 5.8), p=0.04, respectively). LAA chicken wing and multilobate LAA were independent predictors of TRC (OR 2.3 (95% CI 1.2 to 4.5), p=0.01 and OR 2.2 (95% CI 1.2 to 4.2), p=0.02, respectively).LAA morphology was characterised as chicken wing in 79 (43%), windsock in 64 (34%), cactus in 35 (19%), cauliflower in 7 (4%) and multilobate LAA in 115 (62%) patients. LAA thrombus was found in 29 (16%), TRC in 123 (67%) and subclinical AF in 60 (32%) patients. Duration of subclinical AF >6 hours was associated with SEC and recurrent stroke and TIA.</p><p><strong>Conclusion: </strong>LAA function by novel LAA strain and LAA structure are independently associated with LAA thrombus and TRC in patients with cryptogenic stroke and TIA.</p><p><strong>Trial registration number: </strong>NCT02725944.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173147","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":"Assessing the psychometric properties of generic (EQ-5D-5L) and disease-specific (KCCQ) quality of life in patients with hypertrophic cardiomyopathy in the AFFECT-HCM study.","authors":"Isabell Wiethoff, Stephan A C Schoonvelde, Rudolf A de Boer, Silvia M A A Evers, Tjeerd Germans, Alexander Hirsch, Christian Knackstedt, Wouter P Te Rijdt, Marjon A van Slegtenhorst, Arend F L Schinkel, Peter-Paul Zwetsloot, Michelle Michels, Mickael Hiligsmann","doi":"10.1136/openhrt-2024-003143","DOIUrl":"10.1136/openhrt-2024-003143","url":null,"abstract":"<p><strong>Background: </strong>To assess the psychometric properties (content validity, reliability and construct validity) of generic and disease-specific health-related quality of life (HRQoL) instruments in patients with hypertrophic cardiomyopathy (HCM) and genotype-positive, phenotype-negative (G+/P-) individuals.</p><p><strong>Methods: </strong>As part of the multicentre, observational AFFECT-HCM study, HRQoL was measured using the generic EuroQoL-5 Dimension-5 Level (EQ-5D-5L) questionnaire, the Visual Analogue Scale (EQ VAS) and the disease-specific Kansas City Cardiomyopathy Questionnaire (KCCQ). The study included G+/P- individuals and HCM patients. EQ-5D-5L profiles were translated into EQ-5D values (utilities) using the Dutch value set. All instruments were evaluated regarding their general characteristics and health dimensions (content validity). Reliability was assessed using internal consistency (Cronbach's alpha), response rate, floor/ceiling effects (percentage scoring highest/lowest), correlation and level of agreement between instruments (using Bland-Altman plots). Construct validity was assessed using the known-groups method to identify expected differences between relevant groups.</p><p><strong>Results: </strong>A total of 393 HCM patients and 78 G+/P- individuals were included in the psychometric assessment. Mean EQ-5D value in G+/P- individuals was 0.90 (81 EQ VAS, 93 KCCQ) and in HCM patients 0.84 (75 EQ VAS, 78 KCCQ). Ceiling effects were highest for EQ-5D values (51% in G+P; 32% in HCM), followed by the KCCQ (38% in G+P-; 12% in HCM) and the EQ VAS (8% in G+P-; 5% in HCM). KCCQ and EQ-5D values had the highest correlation (Spearman's ρ=0.77) and showed good overall agreement according to the Bland-Altman plots. In HCM, EQ-5D values showed a slightly biased pattern with EQ-5D values scoring higher than the KCCQ. The KCCQ discriminated more nuances between relevant groups.</p><p><strong>Conclusions: </strong>Due to its simplicity and good overall agreement with the KCCQ-which showed slightly better discrimination-we propose from our data that the EQ-5D-5L is a suitable instrument for the HRQoL assessment in clinical practice in patients with HCM.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174388","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":"Intravascular imaging for percutaneous coronary intervention on bifurcation and unprotected left main lesions: a systematic review and meta-analysis.","authors":"Andrea Zito, Francesco Burzotta, Cristina Aurigemma, Enrico Romagnoli, Lazzaro Paraggio, Francesco Fracassi, Mattia Lunardi, Luigi Cappannoli, Francesco Bianchini, Carlo Trani","doi":"10.1136/openhrt-2024-003026","DOIUrl":"10.1136/openhrt-2024-003026","url":null,"abstract":"<p><strong>Background: </strong>The efficacy of intravascular imaging (IVI) guidance for percutaneous coronary intervention (PCI) represents a contemporary hot topic. PCI in patients with bifurcation coronary lesions and unprotected left main lesions offers specific challenges that, theoretically, may particularly benefit from IVI.</p><p><strong>Objective: </strong>To compare the clinical outcomes between IVI and angiography guidance for PCI in bifurcation and unprotected left main lesions.</p><p><strong>Methods: </strong>Randomised clinical trials (RCTs) comparing IVI (with either intravascular ultrasound or optical coherence tomography) with angiography to guide PCI in patients with bifurcation and unprotected left main lesions were searched in PubMed and Cochrane Central Register of Controlled Trials. Two investigators independently extracted study data. Risk ratios (RRs) were calculated using the random-effects model with inverse variance weighting and the 95% CIs with the modified Knapp-Hartung-Sidik-Jonkman method. The primary outcome was target vessel failure (TVF).</p><p><strong>Results: </strong>A total of seven RCTs were included, collecting data on 2494 patients in the analysis for bifurcation lesions and 1107 patients in the analysis for unprotected left main lesions. The mean follow-up duration ranged from 12 to 36 months. Compared with angiography guidance, IVI guidance significantly reduced TVF both in bifurcation lesions (RR 0.70, 95% CI 0.53 to 0.92) and unprotected left main lesions (RR 0.55, 95% CI 0.36 to 0.84). The number needed to treat to prevent one TVF with IVI was 27 in bifurcation lesions PCI and 11 in unprotected left main PCI.</p><p><strong>Conclusion: </strong>In patients undergoing PCI on bifurcation and unprotected left main lesions, IVI guidance significantly reduces the risk of TVF compared with angiography guidance.</p><p><strong>Prospero registration number: </strong>CRD42024580321.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172907","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":"Urinary albumin-to-creatinine ratio in patients with hypertension and risk of major cardiovascular events.","authors":"Casper Binding, Mariam Elmegaard, Deewa Zahir Anjum, Nicholas Carlson, Morten Schou, Anders Nissen Bonde","doi":"10.1136/openhrt-2025-003270","DOIUrl":"10.1136/openhrt-2025-003270","url":null,"abstract":"<p><strong>Introduction/aims: </strong>Evaluation of urinary albumin-to-creatinine ratio (uACR) is a key component in the management of hypertension, yet there is a lack of data on the association between uACR and major cardiovascular events (MACEs) in large hypertensive cohorts, and it is also unknown how often uACR is measured among these patients.We aimed to evaluate the usage of uACR in a nationwide population of patients with hypertension. Furthermore, we sought to assess the risk of cardiorenal events according to uACR, among patients with hypertension.</p><p><strong>Methods: </strong>We used Danish nationwide registries to identify patients who initiated antihypertensive treatment. The patients were grouped at treatment initiation according to uACR: normoalbuminuria, microalbuminuria, macroalbuminuria and no uACR measurement, and followed for 2 years, to evaluate the risk of a MACE, hospitalisation for heart failure (HF), 40% decline in estimated glomerular filtration rate (eGFR) and end-stage kidney disease (ESKD) according to uACR.</p><p><strong>Results: </strong>We included 144 644 patients, of whom 116 039 (80%) did not have their uACR evaluated at treatment initiation. Patients with macroalbuminuria comprised the greatest 2 year absolute risk of MACE (5.3%, 95% CI: 4.0% to 6.6%) and had a greater risk of MACE (HR: 2.02, 95% CI: 1.54 to 2.66), HF (HR: 1.99, 95% CI: 1.35 to 2.95), 40% decline in eGFR (HR: 4.81, 95% CI: 3.78 to 6.10) and ESKD (HR: 4.52, 95% CI: 3.00 to 6.82) compared with patients with normoalbuminuria. Increased risk of MACE, HF and 40% decline in eGFR among patients with macroalbuminuria was persistent across subgroups of eGFR 120-30 mL/min/1.73 m².</p><p><strong>Conclusions: </strong>In this real-world cohort, uACR was not regularly measured among patients initiating antihypertensive treatment. Nonetheless, the 2-year risks of cardiorenal events were considerably higher among patients with albuminuria compared with patients without.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120536","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":"Disparities in the care and direct-acting oral anticoagulant (DOAC) management in atrial fibrillation (AF) and chronic kidney disease (CKD) in English primary care between 2018 and 2022: primary care sentinel network database study.","authors":"Subo Emanuel, Benjamin Ct Field, Mark Joy, Xuejuan Fan, John Williams, Riyaz A Kaba, Gregory Y H Lip, Simon de Lusignan","doi":"10.1136/openhrt-2024-002923","DOIUrl":"10.1136/openhrt-2024-002923","url":null,"abstract":"<p><strong>Background: </strong>In England, most prescribing of direct-acting oral anticoagulants (DOACs) for patients with chronic kidney disease (CKD) and atrial fibrillation (AF) takes place in primary care. The 2024 European Society of Cardiology guidelines introduced the AF-CARE ((C) comorbidities and risk factors; (A) avoid stroke and thromboembolism by appropriate prescription of oral anticoagulants; (R) rate and rhythm control; (E) evaluation and reassessment should be individualised for every patient, with a dynamic approach) framework to address this.</p><p><strong>Objective: </strong>To describe any health disparities in CKD and AF, including anticoagulation management and correct dosing of DOACs.</p><p><strong>Methods: </strong>Using English primary care sentinel network data from 2018 to 2022, demographics of AF and CKD including anticoagulation and appropriate DOAC dosing according to creatinine clearance and other factors were assessed. The study also examined disparities in CKD and AF in relation to socioeconomic status and ethnicity. We defined socioeconomic status by Index of Multiple Deprivation (IMD), a weighted composite index combining information from the domains of deprivation including income.</p><p><strong>Results: </strong>Of 10 513 950 people registered with general practices in the sentinel network, 2.9% (n=304 678) were aged ≥18 years with a diagnosis of AF. The prevalence of CKD in AF was 26.0% (n=79 210) and 63.3% of people eligible for anticoagulation were prescribed a DOAC. Among the 54 897 people with AF and CKD 3 or 4, greater likelihood of DOAC prescribing was associated with higher socioeconomic status. Socioeconomic disparities in anticoagulation increased through the 5 years. No association was identified between ethnicity and likelihood of being anticoagulated.In terms of correct dosing, there was no association with socioeconomic status. Overdosing was more frequent than underdosing. Incorrect dosing was associated with male sex (OR 0.80 (95% CI 0.74, 0.86)), dementia (OR 0.94 (0.83, 1.07)) and frailty (OR 0.42 (0.37, 0.48)).</p><p><strong>Conclusions: </strong>People in the most deprived IMD quintile were least likely to be anticoagulated. Incorrect DOAC dosing was associated with male sex, increasing frailty and dementia. Socioeconomic and health disparities are apparent in anticoagulation prescribing and should be addressed in line with the AF-CARE framework.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival and cause of death after isolated primary aortic valve replacement at Oslo University Hospital (2012-2021): a retrospective registry-based study.","authors":"Johannes Lagethon Bjørnstad, Sandra Stedje Waagan, Tiril Karina Tegnander, Anne Madsi Ottestad","doi":"10.1136/openhrt-2025-003312","DOIUrl":"10.1136/openhrt-2025-003312","url":null,"abstract":"<p><strong>Background: </strong>The treatment of aortic valve disease has changed following the introduction of transcatheter aortic valve replacement (TAVR). Hence, the selection of patients for surgical aortic valve replacement (AVR) is changing. Thus, we aimed to study survival and causes of death following surgical AVR at a large Scandinavian Centre in the period 2012-21.</p><p><strong>Methods: </strong>Information about the surgical procedure, survival and cause of death was obtained from the National Norwegian Health Registries. The latest clinical information about the deceased patients was made available from the local hospitals and examined to evaluate the causes of death from The Norwegian Cause of Death Registry.</p><p><strong>Results: </strong>From 2012 to 2021, the number of surgical implantations of aortic valve bioprostheses (AVR(b)) and patient age at the time of surgery decreased. Outcomes were excellent, with 30-day survival of 98.6% following AVR(b) and 99.8% following AVR(m). 1-year survival after AVR(b) improved from 96.4% in the first half to 98.4% in the second half of the study period, probably due to a reduction of operative risk during the study period. Non-cardiovascular mortality was the most frequent cause of death, followed by cancer, cardiovascular and valve-related death. Deaths due to cerebral bleeding or stroke were the least frequent with 10-year estimators of 1.3% and 1.6% following AVR(m) and AVR(b), respectively. The inter-rater reliability between The Norwegian Cause of Death Registry and the journal information provided was moderate, with an unweighted Cohen's kappa of 0.56 (0.47-0.64).</p><p><strong>Conclusions: </strong>Valve-related death and death from cerebral bleeding or stroke was rare after surgical AVR. Survival was high and improved during the study period. Surgical AVR may be performed safely in low-risk patients.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac MRI in patients with Fontan circulation: assessing risk factors for adverse outcomes.","authors":"Sabina Ericsson, Riitta Paakkanen, Marko Taipale, Emmi Helle, Juha Peltonen, Alma Kormi, Teemu Vepsäläinen, Ilkka Mattila, Tommi Pätilä, Laura Martelius, Tiina Ojala","doi":"10.1136/openhrt-2025-003306","DOIUrl":"10.1136/openhrt-2025-003306","url":null,"abstract":"<p><strong>Background: </strong>Cardiac magnetic resonance (CMR) imaging provides critical insight into the prognosis of Fontan patients, enhancing our understanding of their long-term outcomes. This study aimed to investigate the prognostic role of CMR in a carefully selected cohort of Fontan patients with the highest initial likelihood of survival.</p><p><strong>Methods: </strong>This retrospective nationwide cohort study included 148 Fontan patients who underwent post-Fontan CMR imaging in Finland between 2017 and 2023. The primary endpoint was death or listing for heart transplant. The secondary endpoint was myocardial fibrosis determined by native T1 mapping measured by CMR.</p><p><strong>Results: </strong>The median time from the Fontan procedure to CMR examination was 10.8 years, with a median post-CMR follow-up of 2.55 years. Six patients (4.1%) reached the primary endpoint. Significant haemodynamic risk factors for the primary endpoint included worse global longitudinal strain (p=0.03), worse global circumferential strain (p<0.001) and reduced ejection fraction (p=0.04). Notably, patients with decreased myocardial function showed higher native T1-mapping values. Additional clinical risk factors that were associated with the primary endpoint included arrhythmias (p=0.01), protein-losing enteropathy (p=0.01), New York Heart Association functional class ≥2 (p<0.001) and liver cirrhosis (p=0.01).</p><p><strong>Conclusions: </strong>CMR provides critical insights into long-term outcomes in Fontan patients. In our prioritised cohort, characterised by an initially high likelihood of survival, the observed risks of adverse outcomes corroborate findings from higher mortality cohorts. This underscores the importance of myocardial function and native myocardial T1 mapping in risk assessment, reaffirming CMR's role in effective risk stratification for this population.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of the GRACE and the ACTION risk model in the prediction of in-hospital mortality: external validation, model revision and updating in the Thai Percutaneous Coronary Intervention Registry.","authors":"Songsak Kiatchoosakun, Noppadol Chamnarnphol, Chaiyasith Wongwipaporn, Burabha Pussadhamma, Worawut Roongsangmanoon, Sukanya Siriyotha, Ammarin Thakkinstian, Nakarin Sansanayudh","doi":"10.1136/openhrt-2024-003027","DOIUrl":"10.1136/openhrt-2024-003027","url":null,"abstract":"<p><strong>Background: </strong>External validation is crucial before implementing a risk score model in clinical practice. This study examined the performance of Global Registry of Acute Coronary Events (GRACE) and Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry-Get With The Guidelines (GWTG) (ACTION Registry-GWTG) Risk Score (AR-G RS) using the Thai Percutaneous Coronary Intervention Registry (TPCIR).</p><p><strong>Methods: </strong>Included in this study were 11 455 patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) between November 2015 and May 2018. GRACE and AR-G RS models were externally validated, revised and updated using discrimination (C-statistic score) and calibration (Hosmer-Lemeshow (HL) indexes). Clinical predictors were selected stepwise from the multivariate analysis to evaluate the performance of each risk score in the revised and updated model.</p><p><strong>Results: </strong>In-hospital mortality was 4.4%. GRACE and AR-G RS demonstrated good discrimination for in-hospital mortality (C-statistics 0.8957 and 0.8823, respectively) with optimal calibration (HL, p=0.036 and 0.006, respectively) and penalty rates of 0.005 and 0.006, respectively. The updated model significantly improved the discrimination performance compared with the original GRACE and AR-G RS models, with a C-statistic of 0.9118 and a penalty of 0.006.</p><p><strong>Conclusion: </strong>GRACE and AR-G RS maintained a good performance in TPCIR. Based on routine PCI practice, we demonstrated that the updated model could improve the accuracy of GRACE and AR-G RS in predicting in-hospital mortality among patients with ACS who underwent PCI.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}