Cardiology最新文献

{"title":"Advancing Assessment of Degenerative Mitral Stenosis: The Role of Three-Dimensional Echocardiography.","authors":"Gregorio Menzà, Alessandro Navazio","doi":"10.1159/000553579","DOIUrl":"https://doi.org/10.1159/000553579","url":null,"abstract":"<p><p>Degenerative mitral stenosis (MS) related to mitral annular calcification (MAC) is increasingly observed in elderly patients and differs fundamentally from rheumatic MS. While rheumatic MS is characterized by commissural fusion and a funnel-shaped orifice at the leaflet tips, MAC produces a rigid, tubular geometry with maximal narrowing at the annular level. Conventional two-dimensional echocardiography often provides unreliable assessment of degenerative MS: anatomical evaluation is challenging because the valve has a non-planar, tubular geometry and calcification can create acoustic shadowing, and hemodynamic measurements, such as transmitral gradients, may also be misleading, as coexisting atrial or diastolic dysfunction can elevate gradients and overestimate the severity of stenosis. Three-dimensional echocardiography enables multiplanar reconstruction tailored to the underlying etiology, allowing precise planimetric measurement of the true anatomical mitral valve area. In rheumatic MS, measurements are aligned at the leaflet tips, whereas in degenerative MS, the narrowest orifice at the annular level is accurately captured. Recognizing these morphological differences ensures that three-dimensional planimetry provides an anatomically faithful and clinically meaningful assessment of MS across different etiologies.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-14"},"PeriodicalIF":1.9,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148825295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of a Clinical Nomogram for Predicting Angiographic Progression of Coronary Heart Disease.","authors":"Gang Wang, Jianghong Liu, Jihong Fan, Huina Sun, Ruifeng Liu","doi":"10.1159/crd/absag007","DOIUrl":"https://doi.org/10.1159/crd/absag007","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The heterogeneous nature of coronary artery disease (CAD) progression significantly contributes to cardiovascular morbidity and mortality. Accurately identifying patients at high risk for progression is paramount for effective secondary prevention. This study aimed to develop and internally validate a novel clinical nomogram to precisely predict the probability of angiographic progression in patients with established CAD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective case-referent study enrolled 333 patients with established CAD who underwent at least two coronary angiograms at Beijing Friendship Hospital between January 2018 and December 2023. The cohort comprised 222 patients with angiographic progression and 111 referents without progression, matched at a 2:1 ratio to minimize potential bias. A comprehensive set of 146 pre-selected potential predictors was systematically collected. The Least Absolute Shrinkage and Selection Operator (LASSO) regression was employed for robust initial variable selection, followed by univariable and multivariable logistic regression to identify independent risk factors, which were subsequently integrated into the nomogram. Model performance was rigorously evaluated through assessment of discrimination (area under the receiver operating characteristic curve, AUC), calibration (calibration curve and Hosmer-Lemeshow test), and clinical utility (decision curve analysis, DCA). Internal validation was conducted using a non-parametric bootstrap resampling technique to mitigate optimism and provide robust performance estimates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Seven independent predictors of angiographic progression were identified: a shorter interval between angiograms (odds ratio OR 0.99, 95% CI 0.99-1.00, p=0.015), a higher preoperative Gensini score (OR 1.08, 95% CI 1.05-1.10, p&lt;0.001), male gender (vs. female, OR 3.31, 95% CI 1.69-6.45, p&lt;0.001), the absence of a prior history of stroke (vs. presence of stroke, OR 0.16, 95% CI 0.03-0.79, p=0.025), elevated low density lipoprotein cholesterol (LDL C) levels (OR 2.32, 95% CI 1.46-3.71, p&lt;0.001), higher glycated hemoglobin (HbA1c) levels (OR 1.52, 95% CI 1.12-2.05, p=0.006), and increased antithrombin III levels (OR 1.04, 95% CI 1.01-1.07, p=0.008). The developed nomogram demonstrated promising discrimination (apparent AUC 0.88, 95% confidence interval CI 0.84-0.92) and superior calibration (Hosmer-Lemeshow test p=0.990) within the internal validation cohort. Decision curve analysis indicated that the nomogram offered a statistically and clinically significant net benefit across a range of threshold probabilities (5-80%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;We successfully developed and internally validated a novel nomogram integrating seven readily available clinical and laboratory variables to accurately predict angiographic progression in CAD. This tool provides an individualized, quantitative risk assessment with promising predict","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1"},"PeriodicalIF":1.9,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TELEMETRIC-HF: Pilot Randomized Study of Telemetry-Guided Guideline-Directed Medical Therapy Optimization and Ventricular Arrhythmia Surveillance in Patients with Heart Failure with Reduced Ejection Fraction.","authors":"Saša Borovic, Dragana Kosevic, Jelena Stefanovic Neskovic, Jelena Lešanovic, Goran Loncar, Jelena Miladinovic, Bojana Milovanovic, Petar Dabic, Nadiia Rineiska, Milovan Bojic","doi":"10.1159/crd/absag008","DOIUrl":"https://doi.org/10.1159/crd/absag008","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the feasibility of telemetry-guided optimization of guideline-directed medical therapy (GDMT) and continuous arrhythmic surveillance in ambulatory patients with heart failure with reduced ejection fraction (HFrEF).</p><p><strong>Methods: </strong>TELEMETRIC-HF was a single-center, randomized, open-label pilot study including 30 patients with HFrEF assigned to telemetry-guided management (n=15) or standard outpatient care (n=15). Patients in the telemetry group underwent 8 weeks of continuous ambulatory monitoring using the CPC12 CE MDR Class IIb wearable system, providing continuous electrocardiographic and physiological monitoring with clinician oversight. The primary endpoint was the between-group difference in beta-blocker (BB) target-dose achievement at 8 weeks. Secondary endpoints included optimization of other GDMT classes, ventricular arrhythmia detection, clinical status, quality of life, safety, and healthcare utilization.</p><p><strong>Results: </strong>Telemetry-guided management was associated with significantly greater BB target-dose achievement at 8 weeks than standard care (60.0% vs. 39.2% of the guideline-recommended target dose; absolute difference 20.8 percentage points, 95% CI 2.7-39.2; p=0.028). Target-dose achievement for angiotensin receptor-neprilysin inhibitors, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors did not differ significantly between groups. Recurrent non-sustained ventricular tachycardia was detected only in the telemetry group, prompting additional clinical evaluation, antiarrhythmic therapy, and primary prevention implantable cardioverter-defibrillator implantation in one patient. Hemodynamic, laboratory, and echocardiographic parameters remained stable throughout follow-up, and telemetry was well tolerated. No heart failure hospitalizations or deaths occurred during the 8-week study period.</p><p><strong>Conclusion: </strong>In this pilot randomized study, telemetry-guided remote monitoring was feasible and was associated with earlier BB optimization and improved detection of clinically relevant ventricular arrhythmias without compromising safety. These exploratory findings support further evaluation of telemetry-guided outpatient heart failure management in larger, adequately powered multicenter randomized trials.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1"},"PeriodicalIF":1.9,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right Atrial Strain as a Predictor of Atrial High-Rate Episodes in Pacemaker Patients: A Case-Control Pilot Study.","authors":"Waseem Omar Ahmed, Ahmed Ali Fahmy Mostafa, Hosam El Din Hosni Helal, Mohamed Adel Attia, Khaled Abouelmagd, Ayman Ahmed Gad","doi":"10.1159/crd/absag006","DOIUrl":"https://doi.org/10.1159/crd/absag006","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Atrial high-rate episodes (AHRE) detected by cardiac implantable electronic devices (CIEDs) represent subclinical atrial tachyarrhythmias that are strongly associated with an increased risk of progression to clinical atrial fibrillation (AF) and thromboembolic events. The underlying bi-atrial electrical and mechanical remodeling that precedes AHRE remains incompletely understood, particularly the role of right atrial (RA) function.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This study aimed to identify combined electrocardiographic (ECG) and echocardiographic predictors of device-detected AHRE in patients with dual-chamber pacemakers, with a specific focus on the incremental predictive value of RA strain assessed by two-dimensional speckle-tracking echocardiography (2D-STE).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A single-center, case-control study was conducted on a cohort of prospectively followed patients involving 60 adult patients with dual-chamber (DDD) pacemakers, divided into two groups: 30 patients with device-detected AHRE (AHRE⁺) and 30 age- and sex-matched controls without AHRE (AHRE⁻). All participants underwent detailed clinical evaluation, 12-lead ECG analysis (including P-wave duration and dispersion), and comprehensive transthoracic echocardiography, including 2D-STE for assessment of RA reservoir strain (RASr) and contractile strain (RASct). AHRE was defined as an atrial tachyarrhythmia ≥180 bpm lasting ≥6 min, verified by intracardiac electrograms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;AHRE⁺ patients exhibited significantly prolonged P-wave duration (118 ± 14 ms vs 108 ± 12 ms; p = 0.04) and greater P-wave dispersion (42 ± 8 ms vs 36 ± 7 ms; p = 0.03). They also Echocardiographically, they demonstrated significantly higher left atrial volume index (LAVI) (34.2 ± 6.8 vs 28.5 ± 5.2 mL/m²; p = 0.012) and right atrial volume index (RAVI) (26.4 ± 5.1 vs 22.7 ± 4.3 mL/m²; p = 0.028), RA function was markedly impaired in the AHRE⁺ group, with reduced right atrial reservoir and contractile strain (RASr 15.8 % vs 25.9 %, p = 0.041; RASct -2.0 % vs -11.6 %, p = 0.012). Multivariate analysis identified four independent predictors of AHRE: RASr &lt; 20 % (OR 3.8; 95 % CI 1.7-8.4; p &lt; 0.001), LAVI ≥ 34 mL/m² (OR 3.1; 95 % CI 1.5-6.2; p = 0.003), P-wave dispersion ≥ 40 ms (OR 2.6; 95 % CI 1.2-5.8; p = 0.008), Ventricular pacing &gt; 90 % (OR 2.1; 95 % CI 1.0-4.4; p = 0.032). The model achieved strong discrimination (AUC = 0.84; 95 % CI 0.76-0.92) and good calibration (Hosmer-Lemeshow p = 0.47).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The occurrence of AHRE in DDD pacemaker patients is independently associated with a combination of electrical and mechanical bi-atrial remodeling. Impaired right atrial strain (RASr &lt; 20%) provides significant incremental predictive value beyond conventional metrics like P-wave dispersion and left atrial enlargement. Integrating RA strain into routine echocardiographic assessment may serve as a powerful, early ","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1"},"PeriodicalIF":1.9,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cell-specific epigenetic editing in cardiovascular disease: Mechanisms, therapeutic potential, and translational challenges.","authors":"Majed Alsulami, Mahmood Rasool, Ahmed N Masoud, Waleed A Al-Hoban, Ayat M Shorbaji, Isam M Abu Zeid","doi":"10.1159/000553321","DOIUrl":"https://doi.org/10.1159/000553321","url":null,"abstract":"<p><strong>Background: </strong>Cell-specific epigenetic editing provides a new approach to the therapy of cardiovascular disease (CVD) by rewriting pathological chromatin and RNA marks in exactly those cell populations responsible for causing disease. CVD is caused by interactions of genetics and environment on cell-type-specific epigenomic programs. Interventions that alter DNA methylation, histone marks, or RNA modifications can therefore correct maladaptive gene expression without altering DNA sequence.</p><p><strong>Summary: </strong>Recently developed technologies such as dCas9 fused to writers/erasers allow programmable, locus-directed modulation of promoters, enhancers, and transcripts. Proof-of-principle in vivo work has shown durable target silencing, illustrating both the potency and persistence of epigenetic edits. To achieve therapeutic benefit, cell-targeting strategies and rigorous single-cell/multi-omic validation of on-target activity and off-target safety will be required. Major translational challenges include scalable, cardiac-selective delivery, immune responses to vectors/editors, long-term monitoring for unintended chromatin changes, and regulatory pathways for nongenotoxic but durable interventions.</p><p><strong>Key messages: </strong>Altogether, cell-specific epigenetic editing holds very high therapeutic value for atherosclerosis, cardiomyopathy, and fibrosis, provided that delivery, specificity, and safety challenges are also addressed.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-25"},"PeriodicalIF":1.9,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Myocardial Work Meets Exercise: Redefining Functional Reserve in Hypertrophic Cardiomyopathy.","authors":"Erwan Donal, Paul Calin Craciun, Adrien Al Wazzan","doi":"10.1159/000551566","DOIUrl":"https://doi.org/10.1159/000551566","url":null,"abstract":"","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-4"},"PeriodicalIF":1.9,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes Among Coronary Artery Disease Patients Undergoing PCI with Ridaforolimus-Eluting Stents: A Proportional Meta-Analysis.","authors":"Mohammed S Beshr, Ibrahem A Beshr, Ali R Al-Gburi, Hibah Al-Qubati, Muhammed Elhadi","doi":"10.1159/crd/absag003","DOIUrl":"10.1159/crd/absag003","url":null,"abstract":"<p><p>Background Drug-eluting stents (DES) have become increasingly valuable in the management of coronary artery disease. Ridaforolimus-eluting stents (RES) are a novel DES, an analog of sirolimus with a similar mode of action. Our objective is to evaluate the efficacy and safety profile of RES. Methods A systematic search was conducted on 1 January 2026 for articles on patients with coronary artery disease who underwent percutaneous coronary intervention (PCI) with RES. The endpoints that were evaluated include major adverse cardiac events (MACE), target lesion failure (TLF), target vessel failure (TVF), device success, and stent thrombosis. Results Six studies were included in the review, consisting of 1709 participants. The results for our endpoints were as follows: the MACE rate was 2.2% at 30 days and 4.4% at 12 months. At 12 months, the TLF rate was 3.6%, and the TVF rate was 4.4%. At the one-year follow-up, the myocardial infarction (MI) rate was 2.8%, target vessel-related MI was 1.8%, ischemia-driven target lesion revascularization (TLR) was 1.3%, and ischemia-driven target vessel revascularization (TVR) rate was 0.8%. Stent thrombosis (ST; definite and probable) was about 0.2% at 30 days and remained the same at 12 months. Conclusions In this single-arm meta-analysis, the findings suggest that PCI with RES has a favorable efficacy and safety profile, as evidenced by the low observed rates of MACE, TLF, and stent thrombosis. These findings suggest that RES may be a safe option for patients undergoing PCI. However, head-to-head comparisons with other second-generation DES are still needed to confirm these results.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1"},"PeriodicalIF":1.9,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systematic Review of Clinical Practice Guidelines for Physical Activity in Patients with Coronary Heart Disease.","authors":"Yujie Zhou, Jiuxin Zhou, Haoran Gao, Shan Liang, Linlin Niu, Ke Song, Yuanmei Qin, Xiao Yang","doi":"10.1159/crd/absag005","DOIUrl":"10.1159/crd/absag005","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to appraise clinical practice guidelines relevant to physical activity in patients with coronary heart disease (CHD) and summarize consensus and discrepant recommendations.</p><p><strong>Methods: </strong>The websites of organizations that develop guidelines, including those of cardiovascular and medical sports associations, were searched in addition to 9 literature databases from January 2014 to November 2024. The included guidelines were published in English or Chinese, labeled as a recommendation guideline, position paper, practice parameter, or consensus statement; and addressed physical activity for patients with coronary heart disease. Two authors independently extracted recommendations. Three reviewers independently assessed guideline quality using the AGREE II instrument.</p><p><strong>Results: </strong>A total of 32 guidelines were included, with the Scottish Intercollegiate Guidelines Network and the American Heart Association deemed to have the highest methodological quality. A total of 26 consensus recommendations were identified, including general recommendations, principles for early in-hospital rehabilitation, and the FITT-VP principles for outpatient rehabilitation exercise prescriptions, of which 4 were classified as having moderate consensus and 22 as having low consensus.</p><p><strong>Conclusion: </strong>The guidelines have developed consensus recommendations for routine physical activity in patients with coronary heart disease. However, inconsistencies in exercise prescriptions indicate a need to develop core FITT standards that are applicable across various clinical settings and can be flexibly adapted to individual needs. Furthermore, international collaboration and standardization efforts should be pursued to enhance the applicability of evidence-based guidelines, and implementation frameworks should be introduced to bridge the gap between clinical practice and guideline recommendations.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1"},"PeriodicalIF":1.9,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and impact of frailty in older patients with chronic and acute coronary syndrome referred for coronary angiography.","authors":"Hanna Ratcovich, Francis R Joshi, Pernille Palm, Lia E Bang, Hans-Henrik Tilsted, Golnaz Sadjadieh, Thomas Engstrøm, Lene Holmvang","doi":"10.1159/000553079","DOIUrl":"https://doi.org/10.1159/000553079","url":null,"abstract":"<p><p>Background Frailty has been suggested as a valuable marker for predicting outcomes in older patients with cardiovascular disease. However, whether the association between frailty and adverse outcomes is similar in patients with chronic coronary syndrome (CCS) and acute coronary syndrome (ACS) remains unclear. Methods Patients ≥70 years old referred for coronary angiography (CAG) due to CCS or ACS were included and followed for 12 months. Frailty was assessed using the Clinical Frailty Scale (CFS). Patients were grouped according to their CFS into frail/vulnerable (CFS≥4) and robust (CFS=1-3). Study endpoints included all-cause mortality and new hospital admissions for bleeding, myocardial infarction, unplanned revascularisation or stroke. Results 678 patients aged ≥70 years with available CFS underwent CAG due to CCS (n=223) or ACS (n=455) and completed 12-month follow-up. The prevalence of frailty/vulnerability was higher in patients referred with CCS compared to those with ACS (CCS:43.0% vs. ACS:32.2%, p=0.009). Frail/vulnerable patients referred with CCS were younger (CCS: 76.6(±4.7) years vs. ACS: 79.6(±5.7) years, p<0.001) and less frequently treated with percutaneous coronary intervention (CCS:40.6% vs. ACS:54.6%, p=0.043). Cumulative all-cause mortality was higher in frail/vulnerable patients referred with ACS but not in those referred with CCS, compared to robust patients (log-rank p<0.001). Conclusion Among patients ≥70 years old referred for CAG 30-40% are frail/vulnerable. Frailty/vulnerability was associated with higher all-cause mortality in patients referred for CAG due to ACS, but not in those referred due to CCS. This difference in outcome may reflect variations in clinical presentation as well as potential referral bias.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-21"},"PeriodicalIF":1.9,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stepwise increasing input to machine learning models predicting 30-day AMI or death in emergency department chest-pain patients.","authors":"Pontus Olsson de Capretz, Axel Nyström, Anders Björkelund, Jonas Björk, Mattias Ohlsson, Ulf Ekelund","doi":"10.1159/crd/absag001","DOIUrl":"https://doi.org/10.1159/crd/absag001","url":null,"abstract":"<p><p>Introduction This study evaluated the performance of neural network (NN) models with stepwise increasing input for identifying acute myocardial infarction (AMI) or death within 30 days among emergency department (ED) chest-pain patients. Methods Data from 40 312 chest-pain patients were used to train NNs with increasing information in five steps. Step 1: age and sex; Step 2: past medical history, redeemed medications, and past coronary angiography results; Step 3: ECG features; Step 4: creatinine, hemoglobin, and glucose blood results; Step 5: the first high-sensitivity cardiac troponin T (hs-cTnT) results. The area under the receiver operating characteristic curve (AUROC) was evaluated at each step, both in isolation and combined with previous steps. For each combination, we also counted the number of patients safely ruled out by the NN, with set sensitivities for 30-day AMI/death of 100% for steps 1-4 and >99% for step 5. Results AUROC scores differed significantly for each step in isolation, but the added value of steps 2 and 4 was not significant. Using only age and sex, 16% of patients could be ruled out, while at step 5, 49% were ruled out. Adding all prior information to hs-cTnT alone did not significantly improve AUROC. Conclusion A model using clinical variables achieved an AUROC of 92.8%, ruling out nearly 50% of patients, while a simpler model with age and sex ruled out 16%. Sensitivity fell below prespecified criteria, especially when models were used sequentially. ECG and hs-cTnT were the most important predictors.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1"},"PeriodicalIF":1.9,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}