European heart journal open最新文献

{"title":"Correction: Clinical outcomes of percutaneous coronary interventions after transcatheter aortic valve replacement.","authors":"","doi":"10.1093/ehjopen/oeag170","DOIUrl":"https://doi.org/10.1093/ehjopen/oeag170","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1093/ehjopen/oeaf095.].</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 5","pages":"oeag170"},"PeriodicalIF":4.3,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198505","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":"Risk stratification of Stage B heart failure with BNP levels of 35-100 pg/mL: development of the PHASE Index from the CHART-2 Study.","authors":"Hiroyuki Takahama, Kotaro Nochioka, Satoshi Miyata, Hideka Hayashi, Takumi Inoue, Kai Susukita, Kazuma Oyama, Takashi Shiroto, Jun Takahashi, Hiroaki Shimokawa, Satoshi Yasuda","doi":"10.1093/ehjopen/oeag160","DOIUrl":"https://doi.org/10.1093/ehjopen/oeag160","url":null,"abstract":"<p><strong>Aims: </strong>B-type natriuretic peptide (BNP) levels of 35-100 pg/mL, common in preclinical heart failure (HF), are associated with heterogeneous prognosis and are influenced by age and renal function. We aimed to characterize risk heterogeneity in preclinical HF patients with BNP levels of 35-100 pg/mL and to develop a practical risk stratification model.</p><p><strong>Methods and results: </strong>Data from the Chronic Heart Failure Registry and Analysis in the Tohoku District-2 (CHART-2) Study, a prospective multicentre cohort with long-term follow-up, were analysed. Among patients with Stage B HF (<i>n</i> = 4074; age 67.6 ± 12.0 years), the predictability of BNP for 10-year HF-related events was evaluated across strata of age and estimated glomerular filtration rate (eGFR). In patients with BNP levels of 35-100 pg/mL, a composite risk score-the Pre-Heart Failure Assessment and Screening Evaluation (PHASE) Index-was developed using classification and regression tree analysis and multivariable Cox proportional hazards modelling. BNP discrimination varied significantly by age and eGFR (<i>P</i> < 0.05), indicating that a single BNP threshold is insufficient for risk stratification in preclinical HF. The PHASE Index, incorporating age, BNP, eGFR, left ventricular ejection fraction, body mass index, and hypertension, stratified patients with BNP levels of 35-100 pg/mL into four categories and demonstrated superior discrimination compared with BNP alone (c-index 0.723 vs. 0.587, <i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>Patients with preclinical HF and BNP levels of 35-100 pg/mL exhibit substantial risk heterogeneity. The PHASE Index improves identification of high-risk individuals and provides a pragmatic tool for risk stratification beyond the conventional BNP threshold.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 5","pages":"oeag160"},"PeriodicalIF":4.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198535","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":"Risk of atrial fibrillation according to electrocardiographic risk factors: a nationwide cohort study of 1.5 million patients.","authors":"Casper Binding, Christoffer Polcwiartek, Kristian Kragholm, Sam Riahi, Mikkel Porsborg Andersen, Helle Collatz Christensen, Mohamad Hassan El-Chouli, Signe Juul Riddersholm, Lise Da Riis-Vestergaard, Peter Søgaard, Gregory Y H Lip, Christian Torp-Pedersen, Daniel Friedman, Anders Nissen Bonde, Claus Graff","doi":"10.1093/ehjopen/oeag147","DOIUrl":"https://doi.org/10.1093/ehjopen/oeag147","url":null,"abstract":"<p><strong>Aims: </strong>Atrial fibrillation (AF) is associated with an increased risk of stroke, yet no evidence exists on the collective effect of electrocardiogram (ECG) risk factors in early detection of AF. We aimed to evaluate the risk of new-onset AF and stroke according to specific ECG risk factors to identify patients at high risk of developing AF.</p><p><strong>Methods and results: </strong>We included patients who had an ECG performed and grouped them according to how many of the following ECG risk factors they presented with: Elevated heart rate at rest, prolonged PR-interval, biphasic P-waves, abnormal P<i>-</i>terminal force in V1, and prolonged P-wave duration. Among 1 434 491 included patients, 632 628 had none of the five ECG risk factors and 802 163 had at least one ECG risk factor on their ECG. The 5-year cumulative incidence of AF and stroke was lowest among patients with no ECG changes and exceeded 8% and 7%, respectively among patients with all five ECG risk factors [AF: 8.3%, 95% confidence interval (CI): 5.7-11.0%, stroke: 7.3%, 95% CI: 4.7-9.9%]. Patients with all five ECG risk factors had a two-fold increased risk of AF [hazard ratio (HR): 2.57, 95% CI: 1.85-3.57] and of stroke (HR: 2.11, 95% CI: 1.47-3.01) compared to patients with none.</p><p><strong>Conclusion: </strong>The selected ECG risk factors were commonly observed. The 5-year incidence of AF and stroke was low among patients with no ECG risk factors, yet increased in a dose-response-like manner according to the number of ECG risk factors. Scoring patients according to simple ECG risk factors effectively identified patients at high risk of AF and stroke.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 5","pages":"oeag147"},"PeriodicalIF":4.3,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198500","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":"Transition from paediatric to adult congenital heart disease care in Central and South-Eastern Europe: current practices and opportunities for improvement.","authors":"Alexandra Arvanitaki, Katja Prokšelj, Iveta Šimkova, Irena Ivanac Vranešić, Agnese Strenge, Monika Komar, Magdalena Lipczynska, Anna Kaneva, Lina Gumbiene, Petra Antonova, Hajnalka Olga Balint, Ioan Mircea Coman, Umit Yasar Sinan, Maryanne Caruana, Aleksandra Nikolic, Maarja Maser, Elena Panfile, Margarita Bartsota, Elizabeta Srbinovska Kostovska, George Giannakoulas, Tamara Kovačević-Preradović, Gani Bajraktari, Pencho Kratunkov, Lidia Tomkiewicz-Pajak, Yuliia Klymyshyn, Ihor Lebid, Michael A Gatzoulis, Margarita Brida","doi":"10.1093/ehjopen/oeag144","DOIUrl":"https://doi.org/10.1093/ehjopen/oeag144","url":null,"abstract":"<p><strong>Aims: </strong>Transition from paediatric to adult congenital heart disease (ACHD) care is a critical determinant of lifelong disease management for individuals with congenital heart disease (CHD). However, structured transition programmes remain inconsistently implemented, and data are lacking on current practices in Central and South-Eastern European (CESEE) countries. This study aimed to evaluate existing transition practices across CESEE and to identify opportunities to improve the development and implementation of structured programmes.</p><p><strong>Methods and results: </strong>An online questionnaire was distributed to centres involved in CHD care across CESEE countries. The survey assessed centre characteristics, transition services, transfer processes, and development priorities. Responses from 60 healthcare CHD professionals representing 43 centres in 21 countries were analysed. A formal ACHD service was reported in 29 (67%) of 43 centres, mostly established after the year 2000 (72%), caring for a median of 1500 (interquartile range 782-4000) patients with ACHD. Overall, only 10 (23%) centres reported having a formal transition programme. Transition counselling was typically delivered in a single outpatient visit, commonly involving paediatric and adult CHD physicians, but rarely nurses and psychosocial professionals (20% each). Structured transfer processes were inconsistently implemented, and only half of the centres monitored non-attendance at initial adult visits. In centres without formal programmes, informal counselling largely occurred at the final paediatric or first adult visit, relying on patient self-referral, and lacking follow-up.</p><p><strong>Conclusion: </strong>Formal transition programmes remain limited across CESEE ACHD centres. Standardized clear pathways, investment in dedicated transition clinics, and trained workforce are needed to improve continuity of care for adolescents with CHD.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 5","pages":"oeag144"},"PeriodicalIF":4.3,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198650","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":"Telerehabilitation vs. centre-based cardiac rehabilitation after acute coronary syndrome: results of the pragmatic TELECOR randomized trial.","authors":"Maria Boldó Alcaine, Maria José Durà Mata, Gabriel-Fernando Sandoval Ruíz, Maria Llaberia Marcual, Marta Carceller de la Torre, Mar Domingo Teixidor, Evelyn Santiago Vacas, Antoni Bayés Genís","doi":"10.1093/ehjopen/oeag142","DOIUrl":"10.1093/ehjopen/oeag142","url":null,"abstract":"<p><strong>Aims: </strong>Cardiac rehabilitation (CR) improves cardiovascular outcomes after acute coronary syndrome (ACS), but access remains suboptimal. Telerehabilitation may overcome barriers, yet evidence from real-world, public health systems is limited. This randomized controlled trial study aimed to evaluate the effectiveness of a structured telerehabilitation programme compared with standard centre-based CR in patients after ACS, focussing on cardiovascular risk factor control and lifestyle adherence.</p><p><strong>Methods and results: </strong>TELECOR is a pragmatic, open-label, randomized trial conducted at a tertiary public hospital. Adults with recent ACS were randomized 1:1 to an 8 week structured telerehabilitation or a centre-based CR programme. The primary outcome was achievement of a composite target (≥4 of 7 predefined cardiovascular and lifestyle goals) at 8 weeks. Secondary outcomes included changes in functional capacity, medication adherence, quality of life, psychological status, satisfaction, and cardiovascular events at 6 months. A total of 129 patients were randomized (65 telerehabilitation, 64 centre-based). At 8 weeks, 86% of telerehabilitation vs. 79.7% of centre-based participants met the composite target (<i>P</i> = 0.37). At 6 months, this was 87% vs. 80.4% (<i>P</i> = 0.34). Both groups showed similar improvements in functional capacity (≈+1 metabolic equivalent of tasks), adherence (>84%), and satisfaction (>91/100). No between-group differences were observed in clinical events or psychological outcomes.</p><p><strong>Conclusion: </strong>In a real-world public hospital setting, telerehabilitation was non-inferior to conventional CR in achieving cardiovascular risk factor control and improving functional capacity. These results support the broader integration of digital CR models into routine secondary prevention care.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 5","pages":"oeag142"},"PeriodicalIF":4.3,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217670","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 differences in kidney function estimation by creatinine compared to cystatin C on clinical outcomes in patients with atrial fibrillation.","authors":"Philipp Krisai, Mikko Mutti, Stefanie Aeschbacher, Michael Coslovsky, Tobias Reichlin, Nicolas Rodondi, Peter Ammann, Giorgio Moschovitis, Elia Rigamonti, Giulio Conte, Moa L Haller, Amelie Stoecklin, Leo H Bonati, Stefan Osswald, David Conen, Felix Mahfoud, Michael Kühne","doi":"10.1093/ehjopen/oeag145","DOIUrl":"https://doi.org/10.1093/ehjopen/oeag145","url":null,"abstract":"<p><strong>Aims: </strong>Differences between cystatin C-based and creatinine-based glomerular filtration rate estimations (eGFRdiff) have been associated with adverse outcomes. We aimed to investigate the prevalence of eGFRdiff and its association with clinical outcomes and brain lesions in patients with atrial fibrillation (AF).</p><p><strong>Methods and results: </strong>We analysed 3804 patients with AF enrolled in two prospective, multicentre cohort studies. The eGFRdiff was calculated by 'cystatin C-based eGFR-creatinine-based eGFR'. Patients were stratified into three groups: eGFRdiff >10, -10 to 10, and <-10 mL/min/1.73 m². Associations with high-sensitivity troponin T (hs-TnT), NT-proBNP, major adverse cardiovascular (CV) events (stroke/systemic embolism, myocardial infarction and CV death), first heart failure (HF) hospitalization, and magnetic resonance imaging (MRI)-detected brain lesions were assessed. The mean age was 71 years, 28% were female, and 49% had paroxysmal AF. An eGFRdiff of >10, -10 to 10, and <-10 mL/min/1.73 m² was present in 17.7%, 71.7%, and 10.6% of the patients, respectively. Incidence rates per 100 patient-years increased across these groups for major CV events (MACEs: 1.7, 3.9, 6.8) and HF hospitalization (1.2, 3.5, 6.1). Similarly, the prevalence of MRI-detected brain infarcts (28%, 39%, 42%) and moderate-to-severe white matter hyperintensities (38%, 55%, 63%) increased with greater eGFRdiff. The levels of hs-TnT and NT-proBNP were inversely correlated with eGFRdiff. In multivariable-adjusted linear models, lower eGFRdiff was associated with MACE (<i>P</i> = 0.006) and HF hospitalization (<i>P</i> = 0.015).</p><p><strong>Conclusion: </strong>A substantial proportion of patients with AF exhibit clinically relevant eGFRdiff. More negative eGFR difference was associated with elevated cardiac biomarkers, greater burden of ischaemic brain lesions, and increased risk of CV events and HF hospitalization.</p><p><strong>Clinicaltrialsgov identifier: </strong>NCT02105844.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 5","pages":"oeag145"},"PeriodicalIF":4.3,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13643174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139562","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":"Biopsychosocial phenogroups in an urban population with coronary artery disease and their associations with adverse cardiovascular events.","authors":"Jeffery Osei, Baffour Otchere, Louis Y Li, Kara Suvada, Luis C Correia, J Douglas Bremner, Yi-An Ko, Arshed A Quyyumi, Yan V Sun, Viola Vaccarino, Amit J Shah","doi":"10.1093/ehjopen/oeag149","DOIUrl":"10.1093/ehjopen/oeag149","url":null,"abstract":"<p><strong>Aims: </strong>Patients with stable coronary artery disease (CAD) are clinically heterogeneous and exhibit differential treatment responses. We aimed to identify distinct CAD phenogroups based on psychosocial, autonomic, and cardiovascular characteristics and to examine their risk of adverse cardiovascular events.</p><p><strong>Methods and results: </strong>We pooled data from 949 participants with stable CAD enrolled in two related studies. Phenogroups were derived using Gaussian mixture model clustering applied to 12 pre-specified markers readily obtainable in ambulatory clinical settings: autonomic dysfunction, psychosocial stress, myocardial injury, obstructive CAD burden, left ventricular ejection fraction, and blood pressure. Hazard ratios (HRs) were estimated to examine the associations between the derived phenogroups and composite major adverse cardiovascular events (MACE), cardiovascular disease (CVD)-specific, and all-cause mortality. The mean age was 60 ± 10 years; 34% were women and 41% were Black. Four phenogroups were identified: phenogroup 1 (<i>n</i> = 257), the 'low-risk cluster'; phenogroup 2 (<i>n</i> = 387, most prevalent), the 'psychosocial stress-angina cluster'; phenogroup 3 (<i>n</i> = 142), the 'autonomic dysfunction cluster'; and phenogroup 4 (<i>n</i> = 163), the 'ischaemic cardiomyopathy cluster'. Compared with the low-risk cluster, the ischaemic cardiomyopathy cluster had the highest risk of composite MACE (HR, 2.93; 95% CI, 1.80-4.78), followed by the autonomic dysfunction cluster (MACE HR, 2.07; 95% CI, 1.21-3.53) and the psychosocial stress-angina cluster (HR, 1.65; 95% CI, 1.04-2.61). Similar associations were observed for CVD-specific and all-cause mortality.</p><p><strong>Conclusion: </strong>Psychosocial and autonomic factors, when combined with cardiovascular risk characteristics, result in clinically meaningful CAD phenogroups with varying risk of adverse cardiovascular events that may help guide personalized interventions.</p><p><strong>Lay summary: </strong>Patients with stable coronary artery disease exhibit distinct clusters of psychosocial, autonomic, and cardiovascular characteristics that influence their risk of adverse cardiovascular eventsAmong this high-risk population, the most prevalent group was characterized by elevated psychosocial stress and frequent angina and was associated with a higher risk of adverse cardiovascular events.More research is needed to test whether integrating psychosocial stress assessment and targeted behavioral or psychosocial interventions into secondary prevention strategies, alongside standard medical therapy, may help reduce the risk of adverse cardiovascular events in these high-risk patients.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 5","pages":"oeag149"},"PeriodicalIF":4.3,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083151","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":"Polyamines, cardiorespiratory fitness, body composition, and mitochondrial function in older patients with coronary artery disease.","authors":"Christian Thorup, Thomas Hvid Jensen, Chris Nørgaard Agerbo Jeppesen, Andreas Bugge Tinggaard, Mogens Johannsen, Jakob Hansen, Christian Lodberg Hvas, Charlotte Lock Rud, Bent Roni Ranghøj Nielsen, Jakob Wang, Jean Farup, Niels Jessen, Henrik Wiggers","doi":"10.1093/ehjopen/oeag150","DOIUrl":"10.1093/ehjopen/oeag150","url":null,"abstract":"<p><strong>Aims: </strong>Higher dietary spermidine intake has been associated with lower cardiovascular mortality. Spermidine and spermine support cellular homeostasis and mitochondrial function across species, but their relevance to physical and mitochondrial function in humans remains unclear. We examined associations of dietary spermidine and circulating and skeletal muscle spermidine and spermine with physical performance, body composition, and mitochondrial respiratory capacity in older patients with coronary artery disease.</p><p><strong>Methods and results: </strong>We included 187 patients with coronary artery disease [median age 72 (68-76) years; 80% men; 95% with prior coronary revascularization]. The primary outcomes were peak oxygen uptake and appendicular lean mass. Each doubling of dietary spermidine intake was associated with higher peak oxygen uptake (β 2.6 mL·kg^-1·min^-1, 95% CI 0.9-4.4; <i>P</i> = 0.003). This association remained after adjustment for age, sex, and physical activity. Dietary spermidine intake was also associated with higher appendicular lean mass, but this association was attenuated after adjustment. Among secondary outcomes, higher spermidine intake was associated with higher appendicular lean mass/body mass index and lower body fat percentage. In a subgroup, higher spermidine intake was associated with greater mitochondrial respiration. In exploratory analyses, a higher skeletal muscle spermine-to-spermidine ratio showed similar associations (all <i>P</i> ≤ 0.035).</p><p><strong>Conclusion: </strong>These observational findings warrant randomized trials to determine whether dietary spermidine interventions may influence physical and mitochondrial function in older patients with coronary artery disease.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 5","pages":"oeag150"},"PeriodicalIF":4.3,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13649080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of physiological discordance between fractional flow reserve and non-hyperaemic pressure ratios with lipid-rich plaque burden.","authors":"Hirohiko Aikawa, Kota Murai, Yu Kataoka, Yuriko Nakaoku, Soshiro Ogata, Kentaro Mitsui, Takamasa Iwai, Kenichiro Sawada, Hideo Matama, Hiroyuki Miura, Satoshi Honda, Masashi Fujino, Shuichi Yoneda, Kazuhiro Nakao, Kensuke Takagi, Yasuhide Asaumi, Kunihiro Nishimura, Teruo Noguchi","doi":"10.1093/ehjopen/oeag155","DOIUrl":"10.1093/ehjopen/oeag155","url":null,"abstract":"<p><strong>Aims: </strong>Fractional flow reserve (FFR) and non-hyperaemic pressure ratios (NHPRs) frequently yield discordant results in clinical practice, yet the mechanisms underlying this mismatch remain uncertain. Plaque composition has been suggested to influence FFR, raising the possibility that discordance reflects the features of lipid-rich plaque (LRP). This study aimed to investigate whether physiological discordance between FFR and NHPR is associated with increased lipid burden.</p><p><strong>Methods and results: </strong>We retrospectively analysed 217 intermediate coronary lesions from 189 patients who underwent FFR, NHPR, and near-infrared spectroscopy with intravascular ultrasound imaging. Lesions were classified using established cut-offs for FFR (0.80) and NHPR (0.89). Lipid burden was quantified by the maximum lipid core burden index within any 4-mm segment (maxLCBI_4mm). Lipid-rich plaque was defined as maxLCBI_4mm > 400. The clinical endpoint was 3-year target vessel failure (TVF). Physiological discordance occurred in 24.0% of lesions, predominantly as an FFR+/NHPR- pattern (19.8%). FFR was independently associated with maxLCBI_4mm [<i>β</i>, 65.2; 95% confidence interval (CI), 29.0-101.5; <i>P</i> < 0.001], whereas NHPR was not (<i>β</i>, 16.5; 95% CI, -15.9 to 49.0; <i>P</i> = 0.316). The FFR+/NHPR- group demonstrated the highest maxLCBI_4mm (525 ± 201) and the greatest prevalence of LRP (65.1%; both <i>P</i> < 0.001). In multivariable analysis, the FFR+/NHPR- pattern independently predicted LRP [adjusted odds ratio, 6.12; 95% CI, 1.20-31.28; <i>P</i> = 0.030]. TVF occurrences did not differ significantly across physiological groups.</p><p><strong>Conclusion: </strong>FFR+/NHPR- lesions exhibit markedly greater lipid burden, suggesting that hyperaemia-based indices better capture plaque vulnerability than resting physiology. This pattern may serve as a marker of plaque vulnerability, suggesting that deferral of FFR+/NHPR- lesions could warrant caution given their higher lipid burden.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 5","pages":"oeag155"},"PeriodicalIF":4.3,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083212","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":"Which kidney function estimate should guide anticoagulant dosing and risk assessment in atrial fibrillation?","authors":"Chih-Min Liu, Tze-Fan Chao","doi":"10.1093/ehjopen/oeag146","DOIUrl":"https://doi.org/10.1093/ehjopen/oeag146","url":null,"abstract":"","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 5","pages":"oeag146"},"PeriodicalIF":4.3,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13643175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139681","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}