European heart journal open最新文献

{"title":"From simulator to patient: transfer of procedural skills to practice in cardiac device implantation.","authors":"Jorio Mascheroni, Martin Stockburger, Ashish Patwala, Hartwig Retzlaff, Anthony G Gallagher","doi":"10.1093/ehjopen/oeag120","DOIUrl":"10.1093/ehjopen/oeag120","url":null,"abstract":"<p><strong>Aims: </strong>Cardiac implantable electronic devices (CIED) training for novice implanters typically occurs <i>in vivo</i>, varies across countries/institutions, and results in inconsistent skill levels. Proficiency-based progression (PBP) simulation training-requiring attainment of expert-derived performance benchmarks before clinical practice-reduced procedural errors by 61-77% compared with traditional simulation-based training (SBT) in randomized simulation trials. This study aimed to quantify clinical skill transfer in CIED implantation for the first time, comparing <i>in vivo</i> deviations from expert-agreed optimal technique in early-career implanters previously randomized to PBP vs. SBT.</p><p><strong>Methods and results: </strong>Prospective observational cohort study following participants from a prior multinational randomized simulation trial to assess transfer of training to clinical practice. Early-career implanters (≥20 prior pacemaker/defibrillator cases; limited CRT first-operator experience) reported the implant technique they applied in their first two routine clinical cases within 30 days of training, using a validated standardized performance metrics form assessing surgical and lead implantation steps. The primary outcome was the mean percentage of deviations from optimal technique per participant.Of 30 randomized participants, 21 (70%) submitted 42 case reports (10 PBP, 11 SBT). Baseline characteristics were similar, and case complexity did not differ between groups (<i>P</i> = 0.43). PBP trainees demonstrated 60% fewer procedural deviations than SBT trainees (mean [SD], 5.8% [3.8%] vs. 14.4% [9.1%]; <i>P</i> = 0.013).</p><p><strong>Conclusion: </strong>Metrics-based PBP training was associated with significantly fewer procedural deviations from optimal CIED implant technique during early clinical practice compared with traditional simulation. These findings support benchmark-based simulation as a strategy to improve early clinical skill transfer in cardiac electrophysiology.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 4","pages":"oeag120"},"PeriodicalIF":4.3,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681673","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 angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on cardiovascular and non-cardiovascular outcomes in patients at high/very-high cardiovascular risk without heart failure: a systematic review and meta-analysis of randomized, double-blind, placebo-controlled trials ^†.","authors":"Stefano Masi, Gianluigi Savarese, Nicola Orsini, Martin H Strauss","doi":"10.1093/ehjopen/oeag119","DOIUrl":"10.1093/ehjopen/oeag119","url":null,"abstract":"<p><strong>Aims: </strong>To assess the impact of angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) on all-cause and cardiovascular (CV) mortality, as well as CV, cerebrovascular, and renal outcomes in patients at high/very-high CV risk without heart failure by a systematic review and meta-analysis of placebo-controlled, double-blind, randomized trials.</p><p><strong>Methods and results: </strong>The CENTRAL, ClinicalTrials.gov, Ovid-MEDLINE, Ovid-Embase, Science Citation Index-Expanded, and WHO-ICTRP databases were searched between August and September 2023. Heart failure trials were excluded. The hypothesis of a homogeneous treatment effect between ACE-Is and ARBs was tested with a Cochran's Q statistic. The protocol for the systematic review was registered on PROSPERO (CRD42023452406) and the study reported as per PRISMA guidelines.17 trials (9 ACE-Is and 8 ARBs, total of 87 908 participants) were included. The event rates for all-cause mortality, CV mortality, and major CV events (MACEs) did not differ in the parallel placebo arms of ACE-I and ARB trials; however, compared to placebo, ACE-Is reduced the rate of CV mortality [hazard ratio (HR) 0.88; 95% confidence interval (CI) 0.78-0.99], all-cause mortality (HR 0.92; 95% CI 0.85-0.99) and myocardial infarction (HR 0.83; 95% CI 0.73-0.94), while ARBs did not. The rates of HF, stroke, and MACEs were significantly reduced by both drug classes. Angiotensin-converting enzyme inhibitors induced a greater reduction of CV mortality than ARBs (<i>Q</i> = 4.59; <i>P</i>-value = 0.03).</p><p><strong>Conclusion: </strong>In patients at high/very-high CV risk, ACE-Is were more protective against CV mortality than ARBs, supporting their preferential use for CV protection.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 4","pages":"oeag119"},"PeriodicalIF":4.3,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13409322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148623436","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":"Angiotensin-converting enzyme inhibitors show an edge over angiotensin II receptor blockers in cardiovascular outcomes.","authors":"Carl J Lavie, Maciej Banach","doi":"10.1093/ehjopen/oeag118","DOIUrl":"10.1093/ehjopen/oeag118","url":null,"abstract":"","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 4","pages":"oeag118"},"PeriodicalIF":4.3,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13409131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148623333","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":"Authors' response: low-voltage area ablation in atrial fibrillation.","authors":"Akihiro Sunaga, Yohei Sotomi, Yasushi Sakata","doi":"10.1093/ehjopen/oeag113","DOIUrl":"10.1093/ehjopen/oeag113","url":null,"abstract":"","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 4","pages":"oeag113"},"PeriodicalIF":4.3,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581667","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":"TAVI in asymptomatic severe aortic stenosis: is the economic case universal?","authors":"Patrizio Lancellotti, Yun Yun Go, Magnus Bäck","doi":"10.1093/ehjopen/oeag116","DOIUrl":"10.1093/ehjopen/oeag116","url":null,"abstract":"","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 4","pages":"oeag116"},"PeriodicalIF":4.3,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581802","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":"Ablate, or not to ablate left atrial low-voltage areas in atrial fibrillation patients?","authors":"Roberto De Ponti, Carola Griffith Brookles, Matteo Anselmino","doi":"10.1093/ehjopen/oeag112","DOIUrl":"10.1093/ehjopen/oeag112","url":null,"abstract":"","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 4","pages":"oeag112"},"PeriodicalIF":4.3,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581713","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":"Cost-effectiveness analysis of transcatheter aortic valve implantation for asymptomatic severe aortic stenosis across nine European countries.","authors":"Philippe Genereux, Suzanne Baron, Helene Eltchaninoff, Lutz Frankenstein, Christophe Dubois, Tiffany Patterson, Francesco Saia, Pim Tonino, Eduardo Pinar, Christophe Wyss, Lucy Hillcoat, Heather Davies, Tom Bromilow, Reagan Davis, Pascal Candolfi, Valentina Sellitto, Stefan James, Martine Gilard","doi":"10.1093/ehjopen/oeag115","DOIUrl":"10.1093/ehjopen/oeag115","url":null,"abstract":"<p><strong>Aims: </strong>Asymptomatic severe aortic stenosis (aSAS) is associated with morbidity, with mortality increasing once symptoms develop. Benefits of early aortic valve replacement (AVR) over clinical surveillance (CS) with delayed AVR upon symptom onset have been demonstrated, and it is now recommended from the latest European Guidelines if procedural risk is low (Class IIa, Level A). The aim of this study is to estimate the economic impact of transcatheter aortic valve implantation (TAVI) for the treatment of aSAS.</p><p><strong>Methods and results: </strong>A cost-utility analysis compared TAVI using the SAPIEN 3/SAPIEN 3 Ultra valve vs. CS in patients with aSAS across nine European countries. A lifetime Markov model captured peri-procedural and long-term outcomes across three health states: alive and well, stroke, and death. Inputs were derived from the EARLY TAVR trial (NCT03042104) and literature sources. Clinical event rates were estimated via parametric survival analysis. Transcatheter aortic valve implantation treatment for patients with aSAS was modelled to be the economically dominant strategy for treating aSAS across all nine European healthcare systems, with cost-effectiveness probabilities ranging from 97.3% (UK) to 99.9% (Belgium). Incremental results per person included cost savings from -£1788 (UK) to -CHF15 802 (Switzerland), quality-adjusted life years gains of 0.18 (Germany, UK) to 0.23 (Switzerland), and life-year gains of 0.12 (UK) to 0.17 (Belgium). Annual discounting of upfront TAVI costs vs. delayed AVR costs drove results.</p><p><strong>Conclusion: </strong>For patients with aSAS, early intervention with TAVI is estimated to deliver greater health benefits and reduce costs compared with CS. These findings support policies promoting early detection and timely intervention before symptom onset.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 4","pages":"oeag115"},"PeriodicalIF":4.3,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581797","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":"Correction to: Intravascular imaging in peripheral arterial disease: a contemporary literature review.","authors":"","doi":"10.1093/ehjopen/oeag117","DOIUrl":"https://doi.org/10.1093/ehjopen/oeag117","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1093/ehjopen/oeag016.].</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 4","pages":"oeag117"},"PeriodicalIF":4.3,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13387054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551791","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":"Enigma of medial coronary artery calcifications: an unfolding story.","authors":"Peter Lanzer","doi":"10.1093/ehjopen/oeag093","DOIUrl":"10.1093/ehjopen/oeag093","url":null,"abstract":"","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 4","pages":"oeag093"},"PeriodicalIF":4.3,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414090","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":"The evolution of dual antiplatelet therapy in patients with coronary artery disease.","authors":"Moa Simonsson, Stefan James, Jurriën M Ten Berg, Bruna Gigante","doi":"10.1093/ehjopen/oeag107","DOIUrl":"10.1093/ehjopen/oeag107","url":null,"abstract":"<p><p>Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor has been the mainstay of therapy for acute coronary syndrome (ACS) and chronic coronary syndrome (CCS) following percutaneous coronary intervention (PCI) for more than two decades. Over this period, numerous trials have evaluated different antiplatelet strategies, initially focusing on more effective and prolonged regimens, and more recently on decreasing the intensity or duration of DAPT. Despite a wealth of accumulated evidence, the optimal antiplatelet strategy-including the ideal agent, combination, or treatment duration-remains a subject of active debate. This review summarizes the evolution of antiplatelet therapy, with particular emphasis on randomized controlled trials of DAPT in patients with ACS or CCS undergoing PCI.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 4","pages":"oeag107"},"PeriodicalIF":4.3,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13507760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835631","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}