European heart journal open最新文献

{"title":"Autonomic reactivity to mental stress is associated with cardiovascular mortality.","authors":"Anish S Shah, Viola Vaccarino, Kasra Moazzami, Zakaria Almuwaqqat, Mariana Garcia, Laura Ward, Lisa Elon, Yi-An Ko, Yan V Sun, Brad D Pearce, Paolo Raggi, J Douglas Bremner, Rachel Lampert, Arshed A Quyyumi, Amit J Shah","doi":"10.1093/ehjopen/oeae086","DOIUrl":"10.1093/ehjopen/oeae086","url":null,"abstract":"<p><strong>Aims: </strong>The mechanisms linking acute psychological stress to cardiovascular disease (CVD) mortality are incompletely understood. We studied the relationship of electrocardiographic measures of autonomic dysfunction during acute mental stress provocation and CVD death.</p><p><strong>Methods and results: </strong>In a pooled cohort of 765 participants with stable CVD from two related studies, we collected Holter data during standardized laboratory-based mental stress testing with a speech task and followed them for events. We assessed autonomic function using low-frequency (LF) heart rate variability (HRV) in 5-min intervals before, during, and after stress induction, and specifically examined changes from rest to stress. We employed cause-specific survival models to examine its association with CVD and all-cause mortality, controlling for demographic and CVD risk factors. The mean (SD) age was 58 (10) years, 35% were women, and 44% self-identified as Black. After a median follow-up of 5.6 years, 37 (5%) died from CVD causes. A stress-induced LF HRV decrease (67% of sample), vs. increase, was associated with a hazard ratio (HR) of 3.48 (95% confidence interval-3.25, 3.73) for CVD mortality. Low rest LF HRV (bottom quartile) was also independently associated with CVD mortality, HR = 1.75 (1.58, 1.94), vs. normal rest LF HRV (upper three quartiles). The combination of stress-induced LF HRV decrease and low rest LF HRV was associated with HR = 5.73 (5.33, 6.15) vs. the normal stress/rest LF HRV reference. We found similar results with HF HRV.</p><p><strong>Conclusion: </strong>Stress-induced LF HRV decrease and low rest LF HRV are both independently and additively associated with a higher CVD mortality risk. Additional research is needed to assess whether targeting autonomic dysfunction may improve CVD outcomes.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 6","pages":"oeae086"},"PeriodicalIF":0.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142718114","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":"Call to action for acute myocardial infarction in women: international multi-disciplinary practical roadmap.","authors":"Stephane Manzo-Silberman, Michal Hawranek, Shrilla Banerjee, Marta Kaluzna-Oleksy, Mirvat Alasnag, Valeria Paradies, Biljana Parapid, Pierre Sabouret, Agnieszka Wolczenko, Vijay Kunadian, Izabella Uchmanowicz, Jacky Nizard, Martine Gilard, Roxana Mehran, Alaide Chieffo","doi":"10.1093/ehjopen/oeae087","DOIUrl":"10.1093/ehjopen/oeae087","url":null,"abstract":"<p><p>Cardiovascular diseases are the leading cause of death among women, and the incidence among younger women has shown the greatest increase over the last decades, in particular for acute myocardial infarction (AMI). Moreover, the prognosis of women post-AMI is poor when compared with men of similar ages. Since the 1990s, an abundant literature has highlighted the existing differences between sexes with regard to presentation, burden, and impact of traditional risk factors and of risk factors pertaining predominantly to women, the perception of risk by women and men, and the pathophysiological causations, their treatment, and prognosis. These data that have been accumulated over recent years highlight several targets for improvement. The objective of this collaborative work is to define the actions required to reverse the growing incidence of AMI in women and improve the patient pathway and care, as well as the prognosis. We aim to provide practical toolkits for different health professionals involved in the care of women, so that each step, from cardiovascular risk assessment to symptom recognition, to the AMI pathway and rehabilitation, thus facilitating that from prevention to intervention of AMI, can be optimized.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 6","pages":"oeae087"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11539024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591075","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 venous thromboembolism in patients with congenital heart disease: a nationwide, register-based, case-control study.","authors":"Dagmara Cuszynska-Kruk, Maria Fedchenko, Kok Wai Giang, Mikael Dellborg, Peter Eriksson, Per-Olof Hansson, Zacharias Mandalenakis","doi":"10.1093/ehjopen/oeae089","DOIUrl":"10.1093/ehjopen/oeae089","url":null,"abstract":"<p><strong>Aims: </strong>Patients with congenital heart disease (CHD) have an increased risk of developing acquired cardiovascular diseases. However, the risk of venous thromboembolism (VTE) in patients with CHD is unknown. We aimed to investigate the incidence and risk of VTE in patients with CHD compared with matched controls without CHD.</p><p><strong>Methods and results: </strong>Data from Swedish health registers were used to identify all patients with CHD between 1970 and 2017 in Sweden. Each patient with CHD was matched with 10 controls from the Swedish Total Population Register. The primary outcome of the study was an event of VTE. Follow-up was from birth until VTE, death, or the end of the study (2017). Cox proportional hazard models were used to investigate the risk of VTE in patients with CHD and controls. A total of 67 814 patients with CHD and 583 709 matched controls were identified and included in the study. During a mean follow-up of 15.9 (SD ± 12.5) years, 554 (0.8%) patients with CHD and 1571 (0.3%) controls developed VTE. The risk of VTE was 3.3 [95% confidence interval [CI] 2.6-3.4) times higher in patients with CHD than in controls. Patients with conotruncal defects had the highest risk of VTE (hazard ratio 7.06, 95% CI 5.52-9.03).</p><p><strong>Conclusion: </strong>In our nationwide study, we found that the risk of VTE in patients with CHD was more than three times higher than in matched controls. The highest risk of VTE was in patients with the most complex lesions. Further research is crucial to clarify the underlying risk factors and prevent VTE in patients with CHD.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 6","pages":"oeae089"},"PeriodicalIF":0.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11529300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570736","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":"Revisiting secondary mitral regurgitation threshold severity: insights and lessons from the RESHAPE-HF2 trial.","authors":"Patrizio Lancellotti, Tadafumi Sugimoto, Magnus Bäck","doi":"10.1093/ehjopen/oeae084","DOIUrl":"10.1093/ehjopen/oeae084","url":null,"abstract":"<p><strong>Aims: </strong>This article revisits the severity threshold for secondary mitral regurgitation (MR), focusing on insights and lessons from the RESHAPE-HF2 trial. It aims to challenge the traditional effective regurgitant orifice area (EROA) threshold of ≥0.40 cm² used for intervention, suggesting that earlier intervention may benefit patients with lower EROA. It also explores how transcatheter edge-to-edge repair (TEER) improves outcomes in patients with secondary MR and assesses the impact of left ventricular (LV) remodeling on treatment success.</p><p><strong>Methods and results: </strong>The RESHAPE-HF2 trial evaluated the use of TEER in patients with moderate-to-severe secondary MR, comparing outcomes in those with an EROA ≥0.2 cm² and no extensive LV remodeling. TEER significantly reduced heart failure hospitalizations and improved quality of life in these patients. This supports the notion that patients with less severe MR, who still show symptoms despite optimal medical therapy, may benefit from earlier intervention. Comparisons with COAPT and MITRA-FR trials underscored the importance of selecting patients based on MR severity relative to LV dilatation.</p><p><strong>Conclusions: </strong>The RESHAPE-HF2 trial highlights the need to reconsider the current EROA threshold for secondary MR intervention. TEER has shown to be beneficial even in patients with lower MR severity, suggesting that earlier intervention could improve outcomes. A more dynamic and integrated approach, considering both MR severity and LV remodeling, is essential for optimizing patient selection and treatment success.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 5","pages":"oeae084"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549741","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":"Health-related quality of life with rivaroxaban plus aspirin vs. aspirin alone in chronic stable cardiovascular disease: Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial.","authors":"Feng Xie, Jiajun Yan, John Eikelboom, Sonia Anand, Eva Muehlhofer, Eleanor Pullenayegum, Yang Wang, Alvaro Avezum, Deepak L Bhatt, Salim Yusuf, Jackie Bosch","doi":"10.1093/ehjopen/oeae083","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae083","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to compare the effects of the combination of rivaroxaban and aspirin with aspirin alone on health-related quality of life in the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial.</p><p><strong>Methods and results: </strong>Health-related quality of life assessed using the EQ-5D-3L. The treatment effects on health utility and EQ visual analogue scale (EQ VAS) scores were compared between rivaroxaban plus aspirin and aspirin alone in terms of adjusted mean difference in change from baseline and odds ratio of having deterioration events. Nine thousand forty-nine (98.9%) and 6916 (75.5%) completed the EQ-5D-3L at baseline and at final visit, respectively. Nine thousand twenty-eight (98.9%) and 6887 (76.3%) completed the EQ-5D-3L at baseline and final visit, respectively. Mean (standard deviation) health utility and EQ VAS scores at baseline were 0.871 (0.141) and 76.0 (15.3), respectively, for the rivaroxaban plus aspirin group, compared with 0.873 (0.139) and 75.8 (15.1) for the aspirin group. Adjusted mean difference in change from baseline utility was -0.002 [95% confidence interval (CI), -0.006, 0.002, <i>P</i> = 0.30] between the combination therapy group and the aspirin group. The odds ratio (95% CI) of experiencing deterioration in health utility was 1.01 (95% CI, 0.93, 1.10, <i>P</i> = 0.81) between the two groups. Adjusted mean difference in change from baseline EQ VAS was 0.02 (95% CI, -0.43, 0.47, <i>P</i> = 0.93) between the two groups.</p><p><strong>Conclusion: </strong>This analysis of the COMPASS trial demonstrated that the quality of life of patients was similar between the rivaroxaban plus aspirin group and the aspirin alone group.</p><p><strong>Registration: </strong>Trial registration number: ClinicalTrials.gov number (NCT01776424). Trial protocol and statistical analysis plan: https://www.nejm.org/doi/full/10.1056/NEJMoa1709118#APPNEJMoa1709118PRO.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 5","pages":"oeae083"},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11495100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515234","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 whole-body and skeletal muscle composition on peak oxygen uptake in heart failure: a systematic review and meta-analysis.","authors":"Veronika Schmid, Stephen J Foulkes, Devyn Walesiak, Jing Wang, Corey R Tomczak, Wesley J Tucker, Siddhartha S Angadi, Martin Halle, Mark J Haykowsky","doi":"10.1093/ehjopen/oeae082","DOIUrl":"10.1093/ehjopen/oeae082","url":null,"abstract":"<p><strong>Aims: </strong>Heart failure (HF) has a major impact on exercise tolerance that may (in part) be due to abnormalities in body and skeletal muscle composition. This systematic review and meta-analysis aims to assess how differences in whole-body and skeletal muscle composition between patients with HF and non-HF controls (CON) contribute to reduced peak oxygen uptake (VO₂peak).</p><p><strong>Methods and results: </strong>The PubMed database was searched from 1975 to May 2024 for eligible studies. Cross-sectional studies with measures of VO₂peak, body composition, or muscle biopsies in HF and CON were considered. Out of 709 articles, 27 studies were included in this analysis. Compared with CON, VO₂peak [weighted mean difference (WMD): -9.96 mL/kg/min, 95% confidence interval (CI): -11.71 to -8.21), total body lean mass (WMD: -1.63 kg, 95% CI: -3.05 to -0.21), leg lean mass (WMD: -1.38 kg, 95% CI: -2.18 to -0.59), thigh skeletal muscle area (WMD: -10.88 cm² , 95% CI: -21.40 to -0.37), Type I fibres (WMD: -7.76%, 95% CI: -14.81 to -0.71), and capillary-to-fibre ratio (WMD: -0.27, 95% CI: -0.50 to -0.03) were significantly lower in HF. Total body fat mass (WMD: 3.34 kg, 95% CI: 0.35-6.34), leg fat mass (WMD: 1.37 kg, 95% CI: 0.37-2.37), and Type IIx fibres (WMD: 7.72%, 95% CI: 1.52-13.91) were significantly higher in HF compared with CON. Absolute VO₂peak was significantly associated with total body and leg lean mass, thigh skeletal muscle area, and capillary-to-fibre ratio.</p><p><strong>Conclusion: </strong>Individuals with HF display abnormalities in body and skeletal muscle composition including reduced lean mass, oxidative Type I fibres, and capillary-to-fibre ratio that negatively impact VO₂peak.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 5","pages":"oeae082"},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11505452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515235","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":"Anticoagulant-related bleeding as a sign of underlying tumoural lesions in patients with atrial fibrillation: a nationwide cohort study.","authors":"Kristiaan Proesmans, Maxim Grymonprez, Sylvie Rottey, Lies Lahousse","doi":"10.1093/ehjopen/oeae081","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae081","url":null,"abstract":"<p><strong>Aims: </strong>Bleeding events are a well-known complication of oral anticoagulant (OAC) use in patients with atrial fibrillation (AF). While these are undesirable, bleedings could have a warning potential for underlying tumoural lesions. Therefore, we aimed to investigate the association between anticoagulant-related bleeding and newly diagnosed tumoural lesions in a nationwide cohort study.</p><p><strong>Methods and results: </strong>Using Belgian nationwide data, AF patients without any tumoural lesions were included when initiating OACs between 2013 and 2019. The absolute and relative risks of newly diagnosed tumoural lesions were investigated in OAC users with vs. without an OAC-related bleeding event. Analyses were additionally stratified by tumoural lesion, location-specific bleeding, and OAC type. A total of 230 386 OAC users were included, among whom 35 192 persons were diagnosed with a tumoural lesion during follow-up. Persons with a clinically relevant bleeding during OAC use had a tumoural lesion incidence of 15.33 per 100 person-years compared to an incidence of 5.22 per 100 person-years in persons without bleeding. Site-specific gastrointestinal, urogenital, respiratory, and intracranial bleeding events were respectively associated with a significantly increased risk of incident gastrointestinal [adjusted hazard ratio (aHR) 8.13 (95% confidence interval (CI): 7.08-9.34)], urological [aHR 12.73 (95% CI: 10.56-15.35)], respiratory [aHR 4.91 (95% CI: 3.24-7.44)], and intracranial tumoural lesions [aHR 27.89 (95% CI: 16.53-47.04)].</p><p><strong>Conclusion: </strong>Bleeding events in AF patients initiated on OAC were associated with an increased risk of tumoural lesions. Therefore, OAC-related bleeding events could unmask an underlying tumoural lesion.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 5","pages":"oeae081"},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484034","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":"Short-term impact of cardiovascular screening by traditional risk assessment or coronary artery calcium score on health-related quality of life: the ROBINSCA trial.","authors":"Dana Moldovanu, Harry J de Koning, Marleen Vonder, Jan Willem C Gratama, Henk J Adriaansen, Jeanine E Roeters van Lennep, Rozemarijn Vliegenthart, Pim van der Harst, Richard L Braam, Paul R M van Dijkman, Matthijs Oudkerk, Carlijn M van der Aalst","doi":"10.1093/ehjopen/oeae080","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae080","url":null,"abstract":"<p><strong>Aims: </strong>Evidence on the impact of screening for cardiovascular diseases (CVDs) on health-related quality of life (HRQoL) is important for policy decisions about screening implementation and to uncover teachable moments to motivate healthy lifestyle choices. It is unknown whether screening by cardiac computed tomography (CT) scan has a stronger impact on HRQoL than screening by traditional risk prediction models. The study aims to investigate differences in HRQoL across the screening process between participants who were randomized to CVD risk estimation by coronary artery calcium score or Systematic COronary Risk Evaluation.</p><p><strong>Methods and results: </strong>A subset of 2687 ROBINSCA participants filled in questionnaires at (T0) randomization, (T1) invitation, (T2) 1-3 days before screening, (T3) 1-3 days after, and (T4) screening result. Generic HRQoL (SF-12; EQ-5D) and anxiety (STAI-6) were measured. We investigated the differences in changes in HRQoL across the screening process with linear mixed models. We found comparable levels of HRQoL at all screening moments for the two intervention groups. Mental health scores were worse at invitation and randomization than at the later time points, irrespective of screening group (all <i>P</i> < 0.001). A result indicating a heightened CVD risk was associated with increased anxiety in the CT screening group.</p><p><strong>Conclusion: </strong>Computed tomography screening for CVD risk has no detrimental impact on HRQoL and anxiety levels compared to screening by traditional risk assessment. Receiving an invitation to screenning or a result implying increased CVD risk could function as teachable moments for high-risk individuals.</p><p><strong>Registration: </strong>ROBINSCA trial registration number: NTR6471 in Dutch Trial Register (NTR).</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 5","pages":"oeae080"},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484036","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 D-dimer, cardiac troponin T, C-reactive protein, and NT-proBNP in prediction of long-term mortality in patients with suspected pulmonary embolism.","authors":"Juha Kauppi, K E Juhani Airaksinen, Joonas Lehto, Jussi-Pekka Pouru, Juuso Saha, Petra Purola, Samuli Jaakkola, Jarmo Lehtonen, Tuija Vasankari, Markus Juonala, Tuomas Kiviniemi","doi":"10.1093/ehjopen/oeae079","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae079","url":null,"abstract":"<p><strong>Aims: </strong>Pulmonary embolism (PE) is a common and potentially life-threatening condition requiring emergent diagnostic work-up. Despite wide use of biomarkers, little is known how they predict long-term prognosis of patients evaluated for suspected PE.</p><p><strong>Methods and results: </strong>We sought to assess the predictive performance of N-terminal pro-brain natriuretic peptide (NT-proBNP), C-reactive protein, fibrin D-dimer (FIDD), and cardiac troponin T (cTnT) in patients who underwent computed tomography pulmonary angiography (CTPA) for clinical suspicion of PE. The analysis involved 1001 patients, with 222 (22.2%) receiving a PE diagnosis at index imaging. Mean ages of patients with and without PE were 65.0 ± 17.1 and 64.5 ± 17.7 years, respectively. Median follow-up time was 3.9 years (interquartile range 2.9-4.9). Mortality was relatively high among both patients with and without documented PE (24.8% vs. 31.7%, <i>P</i> = 0.047). In patients with PE, only elevated NT-proBNP > 1000 ng/L and C-reactive protein > 50 mg/L levels at hospital admission were associated with higher mortality in an adjusted Cox regression model, but receiver operating characteristic (ROC) analysis showed no improved prediction compared to clinical variables. Among patients without PE, elevated NT-proBNP > 1000 ng/L, C-reactive protein > 10 mg/L, cTnT > 50 ng/L, and FIDD > 1.0 mg/L all predicted mortality. In an ROC analysis among patients without PE, models including NT-proBNP, cTnT, or C-reactive protein provided improved predictive performance.</p><p><strong>Conclusion: </strong>Patients evaluated for clinical suspicion of PE have high long-term mortality. Commonly used biomarkers provide long-term prognostic value in patients without PE. Given the relatively young age, it is vital to identify these high-risk patients and perform differential diagnosis work-up for alternative life-threatening conditions, and manage them as appropriate.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 5","pages":"oeae079"},"PeriodicalIF":0.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484035","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":"Epicardial adipose tissue and muscle distribution affect outcomes in very old patients after transcatheter aortic valve replacement.","authors":"Susanne Rohrbach, Oezge Uluocak, Marieke Junge, Fabienne Knapp, Rainer Schulz, Andreas Böning, Holger M Nef, Gabriele A Krombach, Bernd Niemann","doi":"10.1093/ehjopen/oeae073","DOIUrl":"10.1093/ehjopen/oeae073","url":null,"abstract":"<p><strong>Aims: </strong>To analyse the relevance of body composition and blood markers for long-term outcomes in very old patients after transcatheter aortic valve replacement (TAVR).</p><p><strong>Methods and results: </strong>A total of 403 very old patients were characterized with regard to subcutaneous, visceral, and epicardial fat, psoas muscle area, plasma growth differentiation factor 15 (GDF-15), and leptin. Cohorts grouped by body mass index (BMI) were analysed for long-term outcomes. Patients underwent transapical and transfemoral TAVR (similar 30-day/1-year survival). Body mass index >35 kg/m² showed increased 2- and 3-year mortality compared with BMI 25-34.9 kg/m² but not compared with BMI <25 kg/m². Fat areas correlated positively to BMI (epicardial: <i>R</i> ² = 0.05, <i>P</i> < 0.01; visceral: <i>R</i> ² = 0.20, <i>P</i> < 0.001; subcutaneous: <i>R</i> ² = 0.13, <i>P</i> < 0.001). Increased epicardial or visceral but not subcutaneous fat area resulted in higher long-term mortality. Patients with high BMI (1781.3 mm² ± 75.8, <i>P</i> < 0.05) and lean patients (1729.4 ± 52.8, <i>P</i> < 0.01) showed lower psoas muscle area compared with those with mildly elevated BMI (2055.2 ± 91.7). Reduced psoas muscle area and increased visceral fat and epicardial fat areas were independent predictors of long-term mortality. The levels of serum GDF-15 were the highest in BMI >40 kg/m² (2793.5 pg/mL ± 123.2) vs. BMI <25 kg/m² (2017.6 pg/mL ±130.8), BMI 25-30 kg/m² (1881.8 pg/mL ±127.4), or BMI 30-35 kg/m² (2054.2 pg/mL ±124.1, all <i>P</i> < 0.05). Increased GDF-15 level predicted mortality (2587 pg/mL, area under the receiver operating characteristic curve 0.94). Serum leptin level increased with BMI without predictive value for long-term mortality.</p><p><strong>Conclusion: </strong>Morbidly visceral and epicardial fat accumulation, reduction in muscle area, and GDF-15 increase are strong predictors of adverse outcomes in very old patients post-TAVR.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 5","pages":"oeae073"},"PeriodicalIF":0.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11414403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142304542","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}