IJC Heart and Vasculature最新文献

{"title":"Association of stress-induced autonomic dysfunction with heart failure in individuals with stable coronary artery disease","authors":"Maggie Wang ,&nbsp;Chang Liu ,&nbsp;Anish Shah ,&nbsp;Yi-An Ko ,&nbsp;Rachel Lampert ,&nbsp;Yan V. Sun ,&nbsp;Kasra Moazzami ,&nbsp;Mariana Garcia ,&nbsp;Zakaria Almuwaqqat ,&nbsp;Gabriel Najarro PA-C ,&nbsp;Samaah Sullivan ,&nbsp;Paolo Raggi ,&nbsp;J. Douglas Bremner ,&nbsp;Arshed A. Quyyumi ,&nbsp;Viola Vaccarino ,&nbsp;Alanna A. Morris ,&nbsp;Amit J. Shah","doi":"10.1016/j.ijcha.2025.101694","DOIUrl":"10.1016/j.ijcha.2025.101694","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure (HF) is a common complication in individuals with coronary artery disease (CAD). Autonomic effects of psychological stress may play an important, under-recognized role in this relationship. We hypothesized that stress-induced autonomic dysfunction, measured by change in low-frequency heart rate variability (HRV) during mental stress challenge, associates with increased HF risk.</div></div><div><h3>Methods</h3><div>We examined 662 participants with stable CAD and no known diagnosis of HF who underwent mental stress challenge via a standardized speaking task in conjunction with Holter monitoring. We evaluated HRV in 5-minute windows and examined its change from rest to stress as our primary exposure. Repeated events Cox proportional hazard models were used to examine incident and recurrent acute HF in the outpatient and inpatient setting.</div></div><div><h3>Results</h3><div>The mean age was 58 years, 35 % were women, and 43 % self-identified as Black. In models adjusted for age, sex, race, comorbidities, ejection fraction, and resting low-frequency HRV, each standard deviation decrease (negative change) in low-frequency HRV change from rest to stress was associated with an increased risk of incident and recurrent acute HF (HR 1.39 [95 % CI 1.02–1.90], p = 0.035) over a median follow-up of 5.7 years. These estimates for HF risk were higher than those of resting HRV.</div></div><div><h3>Conclusion</h3><div>Greater decreases in low-frequency HRV change during acute mental stress challenge independently associate with higher risks of future HF development in individuals with stable CAD and had stronger effect sizes than resting HRV alone, highlighting an important role of stress autonomic pathways in the pathogenesis of HF.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"59 ","pages":"Article 101694"},"PeriodicalIF":2.5,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143928048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimorbidity increases risk of atrial fibrillation recurrence after cryoballoon ablation","authors":"Marieke J.H. Velt ,&nbsp;Colinda van Deutekom ,&nbsp;Michelle Lobeek ,&nbsp;Michiel Rienstra ,&nbsp;Yuri Blaauw ,&nbsp;Bart A. Mulder","doi":"10.1016/j.ijcha.2025.101700","DOIUrl":"10.1016/j.ijcha.2025.101700","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Despite advancements in atrial fibrillation (AF) catheter ablation techniques, atrial arrhythmia recurrence after the procedure remains common. Although individual comorbidities are known to affect ablation outcomes, the role of multimorbidity is unclear. This study aimed to investigate the association between multimorbidity and atrial arrhythmia recurrence after cryoballoon AF ablation.</div></div><div><h3>Methods</h3><div>The cryoballoon ablation study is a single-center, prospective registry including 349 consecutive patients undergoing cryoballoon AF ablation. The presence of eleven comorbidities was assessed and the population divided into two groups: no multimorbidity (0–1 comorbidity) and multimorbidity (≥2 comorbidities). Clinical follow-up visits combined with 12-lead ECG and 24-hour Holter monitoring were scheduled at 3, 6 and 12 months post-procedure. Cox proportional hazard regression analyses were conducted to assess the association with atrial arrhythmia recurrence. Kaplan-Meier estimates for the cumulative risk of the first recurrence were calculated and plotted.</div></div><div><h3>Results</h3><div>The mean age was 62 ± 9 years and 123 (35 %) were women. Multimorbidity was present in 184 (53 %) patients. During a median follow-up of 328 [IQR 203–409] days, 114 patients (33 %) experienced atrial arrythmia recurrence within one year after cryoballoon AF ablation. Cox proportional hazard regression analyses, adjusted for age and sex, revealed a significant association between multimorbidity (HR 1.64, 95 % CI 1.12–2.39) and atrial arrhythmia recurrence. Furthermore, hypertension (HR 1.58, 95 % CI 1.01–2.49) and obesity (HR 1.63, 95 % CI 1.09–2.42) were associated with recurrence at one year post-ablation.</div></div><div><h3>Conclusion</h3><div>In AF patients undergoing cryoballoon AF ablation, multimorbidity was associated with atrial arrhythmia recurrence within one year post-ablation.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"59 ","pages":"Article 101700"},"PeriodicalIF":2.5,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143928047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemoglobin is associated with cardiotoxicity in melanoma patients without anemia receiving immune checkpoint inhibitor therapy","authors":"Elias Haj-Yehia,&nbsp;Raluca I. Mincu,&nbsp;Phillip Schulte,&nbsp;Sebastian Korste,&nbsp;Samuel Dautzenberg,&nbsp;Lars Michel,&nbsp;Amir A. Mahabadi,&nbsp;Tienush Rassaf,&nbsp;Matthias Totzeck","doi":"10.1016/j.ijcha.2025.101693","DOIUrl":"10.1016/j.ijcha.2025.101693","url":null,"abstract":"<div><h3>Background</h3><div>Low hemoglobin values are associated with cardiotoxicity in patients with melanoma and other cancer entities receiving immune checkpoint inhibitor (ICI) therapy. However, in cancer patients under chemotherapy, enhanced incidence of cardiotoxicity events are also reported with increasing hemoglobin values. So far, the association between hemoglobin values within the normal limits and the incidence of cardiotoxicity in melanoma patients treated with ICI therapy has not been examined.</div></div><div><h3>Methods</h3><div>We analyzed 114 melanoma patients receiving ICI therapy (61 ± 13 years; 38 % female) from the prospective Essen Cardio-Oncology Registry (EcoR). Patients with cancer-related anemia (hemoglobin &lt; 11 g/dL) were excluded from the analysis. Baseline hemoglobin levels were assessed at patient enrollment before initiation of ICI therapy. Endpoint was the whole spectrum of cancer therapy-related cardiovascular toxicity (CTR-CVT) according to the European guidelines on cardio-oncology with a median follow-up of 464 days.</div></div><div><h3>Results</h3><div>Hemoglobin values and overall CTR-CVT were positively associated with hazard ratio (HR) rising in a J-shaped curve depending on increasing hemoglobin values. Subgroup analysis revealed only a significant association of hemoglobin and cancer therapy-related cardiac dysfunction (CTRCD) (HR: 1.417; 95 % confidence interval (CI): 1.101 – 1.825; <em>p</em> = 0.007). This association also remained significant after adjustment for further confounders.</div></div><div><h3>Conclusions</h3><div>Hemoglobin values within the normal limits are associated with cardiovascular toxicity in terms of CTRCD in this cohort of melanoma patients receiving ICI treatment. Future studies are needed to investigate underlying mechanisms and validate the clinical utility of hemoglobin as a potential additional biomarker for risk stratification in cancer patients.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"59 ","pages":"Article 101693"},"PeriodicalIF":2.5,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143922183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer history and mortality risk in acute myocardial infarction: Insights from the Japan AMI registry","authors":"Ayumi Adachi ,&nbsp;Kazuma Oyama ,&nbsp;Jun Takahashi ,&nbsp;Satoshi Honda ,&nbsp;Kensaku Nishihira ,&nbsp;Sunao Kojima ,&nbsp;Misa Takegami ,&nbsp;Yasuhide Asaumi ,&nbsp;Jun Yamashita ,&nbsp;Mike Saji ,&nbsp;Kiyoshi Hibi ,&nbsp;Yasuhiko Sakata ,&nbsp;Morimasa Takayama ,&nbsp;Tetsuya Sumiyoshi ,&nbsp;Hisao Ogawa ,&nbsp;Kazuo Kimura ,&nbsp;Satoshi Yasuda","doi":"10.1016/j.ijcha.2025.101695","DOIUrl":"10.1016/j.ijcha.2025.101695","url":null,"abstract":"<div><h3>Background</h3><div>The association between a history of cancer and clinical outcomes in patients with acute myocardial infarction (AMI) remains unclear. This study aimed to analyze the characteristics and clinical outcomes of AMI patients based on their history of cancer in a contemporary cohort undergoing antithrombotic therapy with potent P2Y₁₂ inhibitors.</div></div><div><h3>Methods</h3><div>Consecutive patients with spontaneous onset were enrolled in the Japan AMI Registry (JAMIR), a multi-center, nationwide prospective registry. The outcomes included all-cause death, major bleeding, and composite ischemic events defined as cardiovascular (CV) death, MI, and ischemic stroke.</div></div><div><h3>Results</h3><div>A total of 3,411 AMI patients were enrolled with a median follow-up duration of 358 days. Among those, 292 patients (8.6 %) had a history of cancer. They were older and had lower body mass index. While they had a similar risk of composite ischemic event and major bleeding, they were at higher risk for all-cause mortality than those without (adjHR 1.64 [95 %CI 1.16–2.32], P = 0.005). The risk for non-CV death and death due to cancer were higher in the cancer group (adjHR 2.05 [1.24–3.39], P = 0.005; adjHR 18.16 [6.76–48.97], P &lt; 0.001, respectively). When further stratified by age, the difference in all-cause mortality became pronounced in the group aged &lt; 75 years but not in the group aged ≥ 75 years (adjHR 3.32 [1.88–5.85] and 1.26 [0.81–1.96], respectively; P-interaction = 0.008).</div></div><div><h3>Conclusion</h3><div>The JAMIR demonstrated that a history of cancer was associated with increased mortality in AMI patients aged &lt; 75 years. These results might suggest the need for a multidisciplinary approach to improve their prognosis.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"59 ","pages":"Article 101695"},"PeriodicalIF":2.5,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143922287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SAVR and TAVI comparison across the globe based on current regional registry evidence – A meta-analysis of reconstructed time-to-event data","authors":"Tulio Caldonazo ,&nbsp;Hristo Kirov ,&nbsp;Anna Vogel ,&nbsp;Angelique Runkel ,&nbsp;Murat Mukharyamov ,&nbsp;Johannes Fischer ,&nbsp;Aryan Dadashzadeh ,&nbsp;Torsten Doenst","doi":"10.1016/j.ijcha.2025.101703","DOIUrl":"10.1016/j.ijcha.2025.101703","url":null,"abstract":"<div><h3>Background</h3><div>There is debate whether surgical aortic valve replacement (SAVR) or transcatheter implantation (TAVI) provide better results for treatment of aortic valve stenosis. While randomized clinical trials (RCTs) are considered to compare the average treatment effect of two methods in a selected patient population, registry data, although biased, reflect every day clinical practice and provide external validation of RCTs. We evaluated the impact of SAVR or TAVI on long-term survival based on local reports from all available regions in the world.</div></div><div><h3>Methods</h3><div>We systematically searched three databases selecting risk-adjusted registry studies comparing outcomes for SAVR and TAVI with at least five years of follow-up. Reports without all-cause mortality were excluded. One time-to-event curve was reconstructed from survival curves. Cox regression model and sensitivity analysis were performed.</div></div><div><h3>Results</h3><div>From 10,399 screened studies, 13 met the inclusion criteria with 28,344 patients in the final analysis (follow-up: 5–9 years). In ten studies, survival rates favored SAVR, three showed no difference and none favored TAVI. Hazard ratio (HR) for overall survival was 0.58 (95 %CI: 0.54–0.61, p &lt; 0.01 – favors SAVR). A landmark analysis with a 6-months split showed no significant survival difference in the first 6 months (HR: 0.94, 95 %CI: 0.86–1.02, p = 0.14) and better survival for SAVR compared to TAVI thereafter (HR: 0.43, 95 %CI: 0.40–0.46, p &lt; 0.01). All sensitivity analyses supported this outcome.</div></div><div><h3>Conclusions</h3><div>This systematic regional registry-type comparison revealed that SAVR is associated with increased long-term survival compared to TAVI, which appears to be independent of the world region in which the study was performed.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"59 ","pages":"Article 101703"},"PeriodicalIF":2.5,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143922116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of national stress events on the incidence of Takotsubo syndrome","authors":"Yuval Kahila ,&nbsp;Maguli S. Barel ,&nbsp;Sharon Bruoha ,&nbsp;Hadar Gadon ,&nbsp;Efrat M. Yeshurun Shemesh ,&nbsp;Irina Lapidus ,&nbsp;Karam Abd El Hay ,&nbsp;Yuri Gluzman ,&nbsp;Artyom Star ,&nbsp;Chaim Yosefy ,&nbsp;Ronen Rubinshtein ,&nbsp;Abid Assali ,&nbsp;Moti Haim ,&nbsp;Shmuel Fuchs ,&nbsp;Eli I. Lev ,&nbsp;Ariel Roguin","doi":"10.1016/j.ijcha.2025.101697","DOIUrl":"10.1016/j.ijcha.2025.101697","url":null,"abstract":"<div><div>We aimed to analyze whether national level stressful events were associated with an increase the incidence of Takotsubo syndrome. Takotsubo syndrome is an acute reversible heart failure, characterized by transient regional wall abnormality in the absence of a culprit coronary disease, usually caused by acute stressful etiologies. The terror attack of October 7th 2023 and the subsequent war had an enormous impact on the society in Israel. This was a multi-center, observational, analytic, retrospective, case-control study. To examine our hypothesis, we compared the incidence of Takotsubo syndrome in 7 medical centers in Israel during the period of October-December 2023 (“during war”) to the period of October-December 2022 (“before war”), both as an absolute number and as a percentage of all admissions in these 7 medical centers. During the period before the war, 20 patients (0.54 % of all admissions to the cardiology departments) were hospitalized with a proven diagnosis of Takotsubo syndrome, compared with 39 patients (1.07 % of all admissions to the cardiology departments) during the war, accounting for a 95 % increase in the absolute number, and 98 % increase in the percentage of all admissions (p = 0.01, OR = 1.98). Most of the demographic and clinical characteristics, laboratory results, ECG, echocardiogram and angiographic findings were similar between the two groups. Our study showed a significant increase in the incidence of Takotsubo syndrome in Israel during the first three months of the war, suggesting the October 7th terror attack and the consequent war was a traumatic event for the society of Israel.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"59 ","pages":"Article 101697"},"PeriodicalIF":2.5,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143917587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NaV1.5 or KCa2 channel blockade does not increase arrhythmia risk in hypokalemic rabbit hearts, unlike KV11.1 inhibition with dofetilide","authors":"Yannan Yan ,&nbsp;Lea Abildgaard ,&nbsp;Mark Alexander Skarsfeldt ,&nbsp;Sofia Hammami Bomholtz ,&nbsp;Ulrik Sørensen ,&nbsp;Anders Gaarsdal Holst ,&nbsp;Morten Grunnet ,&nbsp;Jonas Goldin Diness ,&nbsp;Bo Hjorth Bentzen","doi":"10.1016/j.ijcha.2025.101699","DOIUrl":"10.1016/j.ijcha.2025.101699","url":null,"abstract":"<div><h3>Aims</h3><div>The small conductance calcium activated potassium channel (<em>KCNN1-3</em>; K_Ca2.1–3) is recognized as a possible new anti-arrhythmic drug target for treatment of atrial fibrillation (AF). The aim of this study is to investigate potential ventricular effects of K_Ca2 channel inhibition under normal, bradycardic and hypokalemic conditions and compare these to classical class I and III anti-arrhythmic drugs.</div></div><div><h3>Methods and results</h3><div>Rabbit hearts were isolated, AV-ablated, mounted in an ex vivo Langendorff preparation and perfused with normokalemic (4 mM K⁺) Krebs-Henseleit solution, followed by perfusion with drug (AP14145 3 µM; AP30663 1.5 µM; dofetilide 10 nM; flecainide 1.5 µM) or vehicle control. The perfusion was then changed to hypokalemic solution (2.5 mM K⁺) in presence of drug. Changes in ventricular action potential duration were assessed by monophasic action potential recordings. Neither of the K_Ca2 channel inhibitors (AP14145 or AP30663) or flecainide (Na_V1.5 inhibitor) prolonged ventricular action potential duration (APD90) or increased pro-arrhythmic markers, whereas dofetilide (K_V11.1 blocker) prolonged APD and increased the susceptibility to ventricular arrhythmia.</div></div><div><h3>Conclusions</h3><div>These findings suggests that K_Ca2 channels have minimal importance for ventricular repolarization in healthy rabbit hearts under both normo- and hypokalemic conditions.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"59 ","pages":"Article 101699"},"PeriodicalIF":2.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"QFR measurements post CTO percutaneous coronary intervention: Can the long term outcome be predicted?","authors":"Yanguo Xin ,&nbsp;Jiayu Li ,&nbsp;Xiaosong Ding,&nbsp;Xuhe Gong,&nbsp;Li Zhou,&nbsp;Hui Chen","doi":"10.1016/j.ijcha.2025.101689","DOIUrl":"10.1016/j.ijcha.2025.101689","url":null,"abstract":"<div><h3>Background</h3><div>QFR, a non-invasive tool using 3D coronary artery imaging and fluid dynamics, helps assess revascularization benefits in patients with coronary chronic total occlusion (CTO).</div></div><div><h3>Methods and Results</h3><div>A retrospective study of 616 CTO patients who underwent PCI for CTO, with QFR assessed post-procedure. In a 5-year follow-up study involving 616 patients, the study used three tertiles (first tertile: QFR ≥ 0.88, second tertile: 0.85 ≤ QFR &lt; 0.88, third tertile: QFR &lt; 0.85) to determine the “cut-off” value. QFR showed strong predictive power with an area under the curve (AUC) of 0.80 (95 % confidence interval: 0.77–0.83, P &lt; 0.001). The occurrence of MACCEs among all participants in the study was 28.4 %. This rate varied across different groups, with 63.9 % in the low QFR tertile, 14.8 % in the middle tertile, and 12.6 % in the high QFR group. During the follow-up period, a variation in the occurrence of MACCEs was observed among the three groups (P &lt; 0.05). Analysis using Kaplan-Meier curves indicated a statistically major difference in the cumulative rates of MACCEs across the groups. Competing risk regression analysis indicated that QFR is negatively associated with all-cause mortality, cardiovascular mortality, and composite MACCEs.</div></div><div><h3>Conclusion</h3><div>The study found a high prognostic value of physiological assessment using QFR after successful CTO intervention.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"59 ","pages":"Article 101689"},"PeriodicalIF":2.5,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcatheter aortic valve replacement in low-risk patients: an updated meta-analysis of randomized controlled trials","authors":"Roel Meeus ,&nbsp;Pavell Dhondt ,&nbsp;Jesslyn Hariyanto ,&nbsp;Hadiah Ashraf ,&nbsp;Caterina Lecchi ,&nbsp;Caroline O. Fischer-Bacca ,&nbsp;Leen Van Langenhoven ,&nbsp;Lennert Minten ,&nbsp;Christophe Dubois","doi":"10.1016/j.ijcha.2025.101692","DOIUrl":"10.1016/j.ijcha.2025.101692","url":null,"abstract":"<div><h3>Background</h3><div>Transcatheter aortic valve replacement (TAVR) is increasingly used in patients with aortic valve stenosis (AS) at low risk for surgical aortic valve replacement (SAVR), despite uncertainty regarding medium and long-term clinical outcomes.</div></div><div><h3>Objectives</h3><div>We performed an updated meta-analysis comparing TAVR with SAVR in this population.</div></div><div><h3>Methods</h3><div>We searched PubMed, EMBASE and Cochrane Central for randomized controlled trials (RCT) comparing TAVR with SAVR in low-risk patients with either bicuspid or tricuspid AS. Outcomes of interest were all-cause mortality, rehospitalization and stroke at 30 days, 1 year and up to 5 years follow-up.</div></div><div><h3>Results</h3><div>We included six RCTs with in total 4487 patients, mean age 74.2 ± 5.5y and of which 50.1 % underwent TAVR. The STS-PROM Score was similar for TAVR and SAVR (2.1 ± 0.7 vs. 2.2 ± 0.8 %). Thirty-day all-cause mortality showed a borderline significant difference favoring TAVR (RR 0.55; 95 % CI 0.30–1.01; p = 0.05). One-year all-cause mortality was significantly lower for TAVR (RR 0.60; 95 % CI 0.41–0.98; p = 0.01), while no differences were seen at 5-year follow up (RR 1.02; 95 % CI 0.81–1.29; p = 0.85).<!--> <!-->TAVR was associated with reduced 30-day (RR 0.67; 95 % CI 0.46–0.95; p = 0.03) and one-year rehospitalization rates (RR 0.72; 95 % CI 0.53–0.98; p = 0.04). Stroke rates at 30 days (RR 0.78; 95 % CI 0.48–1.32; p = 0.37), one-year (RR 0.79; 95 % CI 0.48–1.32; p = 0.37) and 5-year follow-up (RR 1.09; 95 % CI 0.81–1.46; p = 0.56) were not significantly different.</div></div><div><h3>Conclusions</h3><div>TAVR in low-risk patients with AS results in reduced 1-year all-cause mortality and rehospitalization rates as compared with SAVR. This benefit is attenuated during protracted follow-up.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"59 ","pages":"Article 101692"},"PeriodicalIF":2.5,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143899586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computed tomography angiography in the diagnosis of non-ST-elevation myocardial infarction: redefining our first line of defense","authors":"Yvonne J.M. van Cauteren ,&nbsp;Marie-Julie D.K. Lemmens ,&nbsp;Sebastiaan C.A.M. Bekkers ,&nbsp;Bas L.J.H. Kietselaer ,&nbsp;Jordi Heijman ,&nbsp;Ralph A.L.J. Theunissen ,&nbsp;Braim Rahel ,&nbsp;Talitha Voorn ,&nbsp;Sander M.J. van Kuijk ,&nbsp;Robin Nijveldt ,&nbsp;Kevin Vernooy ,&nbsp;Joachim E. Wildberger ,&nbsp;Casper Mihl ,&nbsp;Martijn W. Smulders","doi":"10.1016/j.ijcha.2025.101690","DOIUrl":"10.1016/j.ijcha.2025.101690","url":null,"abstract":"<div><h3>Background</h3><div>Approximately one-third of patients with suspected non-ST-elevation myocardial infarction (NSTEMI) have non-obstructive coronary artery disease. Low-risk patients might benefit from early non-invasive diagnostic testing that can appropriately select those without obstructive coronary artery disease and prevent unnecessary invasive coronary angiography (ICA). The purpose of this study is to evaluate the diagnostic value of computed tomography angiography (CTA) in suspected NSTEMI.</div></div><div><h3>Methods</h3><div>Patients with clinically suspected type 1 NSTEMI were included. In case ICA was indicated, CTA was performed prior to ICA. The accuracy of CTA to diagnose NSTEMI, assigned by an adjudicated final diagnosis committee, was investigated.</div></div><div><h3>Results</h3><div>Of the 66 included patients, 40 (61%) were diagnosed with NSTEMI. CAD-RADS ≥ 3 (i.e. stenosis ≥50%) had a sensitivity of 95% (95%CI 83–99%), a specificity of 65% (95%CI 44–83%) and an overall accuracy of 83% (95%CI 72–91%). The Agatston score was significantly different between patients with and without NSTEMI (404 [IQR 132–883] and 31 [IQR 0–163], respectively, p &lt; 0.001). Nineteen patients (29%) met the criteria of ≥2 high-risk plaque (HRP) features, which was more often present in patients with NSTEMI compared to those without NSTEMI (43% and 8%, respectively, p = 0.002). Combining all CTA parameters (CAD-RADS ≥ 3, Agatston score &gt;1.000 and ≥2 HRP features) did not improve the diagnostic accuracy compared with CAD-RADS alone.</div></div><div><h3>Conclusion</h3><div>CTA accurately diagnoses NSTEMI in patients with acute chest pain and elevated high-sensitivity cardiac troponin T levels. Patients with NSTEMI more often presented with CAD-RADS ≥ 3, Agatston score &gt;1.000 and HRP features.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"59 ","pages":"Article 101690"},"PeriodicalIF":2.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143899600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}