European heart journal open最新文献

{"title":"Learning from cardiogenic shock deaths: a comparative analysis between hypotensive and normotensive cardiogenic shock.","authors":"Patrick Tran, Mithilesh Joshi, Prithwish Banerjee, Sendhil Balasubramanian, Uday Dandekar, Emmanuel Otabor, Stephen Adeyeye, Jaffar Al-Sheikhli, Michael Kuehl","doi":"10.1093/ehjopen/oeaf053","DOIUrl":"10.1093/ehjopen/oeaf053","url":null,"abstract":"<p><strong>Aims: </strong>This study characterizes the under-recognized normotensive cardiogenic shock (CS) phenotype by analysing fatal cases, comparing haemodynamics, shock trajectories, and management gaps with hypotensive CS.</p><p><strong>Methods and results: </strong>We analysed 112 patients who died from CS between 2017 and 2022. Patients > 70 were excluded due to local eligibility criteria. Normotensive (<i>n</i> = 51) and hypotensive CS (<i>n</i> = 61) had similar degrees of cardiac impairment, with cardiac indices well below 2.0 L/min/m² and LVEF < 35%. Both groups exhibited comparable end-organ dysfunction, including lactate levels (7.0 ± 5.0 vs. 6.1 ± 5.6 mmol/L, <i>P</i> = 0.441) and acute liver injury (51-56%). Hypotensive CS typically followed a predictable decline in shock stage [75.4% deteriorated to Society for Cardiovascular Angiography Interventions (SCAI) stages D-E], whereas normotensive CS demonstrated less predictable trajectories, with 51% showing apparent stability before rapid deterioration and death. Receiver operating characteristic analysis revealed that only the rise in serum creatinine weakly predicted deterioration to advanced SCAI stages (Area under the curve 0.62, <i>P</i> = 0.035), while initial lactate and liver function tests lacked predictive value. Normotensive cases had a median 14 h longer referral window from onset of CS but were referred less frequently. Twenty-six were considered potential candidates for advanced heart failure therapy but were not referred.</p><p><strong>Conclusion: </strong>Normotensive and hypotensive CS share similar degrees of hypoperfusion but differ in their shock trajectories. The delay in referrals for normotensive CS highlights the need for earlier recognition of this phenotype and standardized protocols to ensure timely referrals for mechanical circulatory support.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf053"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12203784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531932","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":"Aortic valve sclerosis in heart failure: marker of severity or harbinger of progression?","authors":"Patrizio Lancellotti, Yun Yun Go","doi":"10.1093/ehjopen/oeaf067","DOIUrl":"10.1093/ehjopen/oeaf067","url":null,"abstract":"","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf067"},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12199753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510014","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":"Virtual physiological analysis of non-culprit disease in patients with STEMI and multivessel disease: a substudy of the COMPLETE trial.","authors":"Gareth J Williams, Daniel J Taylor, Abdulaziz Al Baraikan, Hazel Haley, Mina Ghobrial, Matthew Knight, Kenneth Anigboro, Vignesh Rammohan, Rebecca Gosling, Tom Newman, Mark Mills, Rod Hose, David A Wood, John A Cairns, Chinthanie Ramasundarahettige, Rutaba Khatun, Helen Nguyen, Shamir R Mehta, Robert F Storey, Julian P Gunn, Paul D Morris","doi":"10.1093/ehjopen/oeaf057","DOIUrl":"10.1093/ehjopen/oeaf057","url":null,"abstract":"<p><strong>Aims: </strong>In the complete revascularization with multivessel PCI for myocardial infarction (COMPLETE) trial, staged complete revascularization in patients with ST-segment-elevation myocardial infarction (MI) reduced major adverse cardiovascular events compared with culprit-only revascularization. Inclusion was based on angiographic criteria.</p><p><strong>Objectives: </strong>We modelled non-culprit virtual fractional flow reserve (vFFR) and investigated interactions between physiological lesion severity and the benefits of complete revascularization in COMPLETE.</p><p><strong>Methods and results: </strong>All suitable angiograms from COMPLETE underwent software-based 3-dimensional (3D) arterial reconstruction and analysis of 3D-quantitative coronary angiography (QCA) and vFFR using computational fluid dynamics software. Physiological lesion significance was defined as vFFR ≤0.80 and was compared with operators' visual angiographic analysis, 2D-QCA and 3D-QCA. vFFR was computed in 635 patients (710 lesions). 302 patients (48%) had ≥1 physiologically significant lesion and 333 (52%) had none. 321 (45%) lesions were physiologically significant and 389 (55%) were not. There was no statistically significant interaction between physiological lesion significance and any of the trial co-primary or key secondary clinical outcomes, or an exploratory outcome of ischaemia-driven revascularization without preceding MI (all interaction <i>P</i> > 0.30). 3D-QCA predicted vFFR significance more accurately than visual and 2D-QCA (concordance 73% vs. 49% vs. 59%, respectively).</p><p><strong>Conclusion: </strong>In this virtual physiological substudy of the COMPLETE trial, 52% of patients lacked any physiologically significant lesions and the benefits of complete revascularization appeared to be independent of physiological lesion significance. 3D-QCA was a better predictor of physiological significance than either 2D-QCA or operator visual analysis. Further research is warranted to compare angiography-guided and physiology-guided complete revascularization strategies.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf057"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144277132","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":"Oxygen supplementation in ambulatory patients with heart failure: a randomized proof-of-concept study.","authors":"Maxime Tremblay-Gravel, Anna Nozza, Stanislav Glezer, Alan Kamada, Jacinthe Boulet, Marie-Claude Parent, Geneviève Giraldeau, Normand Racine, Anil Nigam, Isabelle Cloutier, Raynold Pierre, Jean-Lucien Rouleau, Eileen O'Meara, Anique Ducharme, Jean-Claude Tardif","doi":"10.1093/ehjopen/oeaf074","DOIUrl":"10.1093/ehjopen/oeaf074","url":null,"abstract":"<p><strong>Aims: </strong>The aims of this study were to describe the short-term effects of oxygen therapy on the physiological response and symptoms during ambulation in patients with chronic heart failure (HF).</p><p><strong>Methods and results: </strong>In this pilot, cross-over, randomized study, subjects with chronic HF underwent two 6-min walk tests (6MWTs) on the same day. They were randomized to either receive oxygen through a portable oxygen concentrator (POC ON) during the first test and no oxygen (POC OFF) during the second test, or vice versa. Endpoints included (i) peripheral oxygen saturation, (ii) heart rate, and (iii) modified BORG scale. A linear mixed model for repeated measures was used for comparisons. A total of 20 participants were included, aged 70 ± 10 years, with the mean left ventricular ejection fraction 33% ± 10% and N-terminal pro-B-type natriuretic peptide 1115 ± 1625 pg/mL. There was no difference in distance walked with or without oxygen supplementation. Oxygen saturation during 6MWT was higher with POC ON [3 min, SpO₂ + 3.4%, 95% confidence interval (CI) 1.8-5.0%; 6 min, + 2.8%, 95% CI 2.2-3.3%]. Heart rate recovery tended to be better in patients with POC ON (difference 7.4 b.p.m., 95% CI -2.4 to 17.2). Perceived exertion and fatigue were significantly lower with POC ON during exercise (3 min, -0.7, 95% CI -1.2 to -0.2; 6 min, -0.75, 95% CI -1.1 to -0.4; and 3 min into recovery, -0.5, 95% CI -0.8 to -0.2).</p><p><strong>Conclusion: </strong>Our results suggest that for a same amount of physical activity, supplemental oxygen can improve peripheral oxygen saturation and breathlessness in symptomatic patients with chronic HF.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf074"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12205361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531934","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":"Age and sex differences in vasovagal syncope: triggers, clinical presentation, prodromal symptoms, and head-up tilt test results.","authors":"Mohammadreza Babaei, Masih Tajdini, Ali Bozorgi, Saeed Sadeghian, Morvarid Taebi, Hamed Tavolinejad, Mehrdad Mahalleh, Homa Taheri, Florian Rader, Jeffrey R Boris, Artur Fedorowski","doi":"10.1093/ehjopen/oeaf061","DOIUrl":"10.1093/ehjopen/oeaf061","url":null,"abstract":"<p><strong>Aims: </strong>Previous studies show inconsistencies in vasovagal syncope (VVS) symptoms and haemodynamic responses across age and sex groups, with limited evaluation of tilt test results. This study comprehensively examines differences in triggers, prodromal and syncopal symptoms, and head-up tilt test (HUTT) responses among VVS patients by age and sex providing new insights.</p><p><strong>Methods and results: </strong>We analysed data from Syncope Unit of Tehran Heart Center, including adults (≥18 years) with suspected VVS diagnosis based on clinical history and physical exams according to syncope guidelines, to explore sex- and age-specific clinical features and HUTT outcomes. The study included 1914 VVS patients (mean age: 46.6 ± 17.8; 51.3% male). Males were more likely to experience first-time syncope (31.6% vs. 19.8%, <i>P</i> < 0.001), whereas females had more recurrent episodes (37.5% vs. 31.2%, <i>P</i> < 0.01) and reported more identifiable triggers. During the HUTT passive phase, females exhibited a greater diastolic blood pressure drop [49.5 ± 12.2 vs. 34.4 ± 17.2, <i>P</i> = 0.012], while in the active phase, they experienced a more pronounced heart rate reduction 39.7 ± 26.9 vs. 30.2 ± 23.3, <i>P</i> < 0.001. Cardioinhibitory syncope was more prevalent in younger patients, with over two-thirds of cases occurring in individuals under 50 years old, and its frequency declined with age. In contrast, vasodepressor syncope peaked in the 51-70 age group. Agreement between spontaneous and HUTT-induced syncope was low (κ = 0.06-0.32).</p><p><strong>Conclusion: </strong>Age and sex shape VVS presentation, triggers, and haemodynamic response, emphasizing the need for demographic considerations in management and the limitations of HUTT.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf061"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144277130","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":"Prognostic significance of early stage aortic valve disease development in heart failure: insights from the MECKI score cohort.","authors":"Veronika A Myasoedova, Elisabetta Salvioni, Alice Bonomi, Arianna Galotta, Massimo Mapelli, Irene Mattavelli, Valentina Rusconi, Francesca Bertolini, Jeness Campodonico, Mauro C Contini, Ilaria Massaiu, Vincenza Valerio, Paolo Poggio, Piergiuseppe Agostoni","doi":"10.1093/ehjopen/oeaf066","DOIUrl":"10.1093/ehjopen/oeaf066","url":null,"abstract":"<p><strong>Aims: </strong>Heart failure (HF) continues to pose a major clinical challenge, making the identification of high-risk HF patients crucial for improving patient care, optimizing resource allocation, and streamlining healthcare processes. Among various risk models, the metabolic exercise test data combined with cardiac and kidney indexes score stands out as a strong predictor of HF prognosis. However, the relationship between aortic valve (AV) sclerosis, an emerging marker of cardiovascular disease, and HF prognosis are currently poorly studied.</p><p><strong>Methods and results: </strong>We evaluated 1397 HF patients (2006-2019) and AV sclerosis was identified by transthoracic echocardiography. All-cause mortality and composite cardiovascular outcomes were assessed. Statistical analyses included Kaplan-Meier curves and Cox regression models. Time-dependent analyses were conducted to evaluate the role of AV sclerosis development in HF patients. At baseline, 707 patients presented AV sclerosis (50.6%). Patients with AV sclerosis were older and had more severe HF. After 5 years, AV sclerosis at baseline was linked to increased all-cause mortality (HR = 1.4, 95% CI: 1.1-1.8; <i>P</i> = 0.005) and cardiovascular outcomes (HR = 1.4, 95% CI: 1.0-2.0; <i>P</i> = 0.044) but, after adjustment for all variables different between the two groups, significance was lost. Further echocardiographic evaluation of patients without AV sclerosis at baseline reveals that AV sclerosis development, observed in >40% of cases, was strongly associated with all-cause mortality (HR = 3.4, 95% CI: 1.3-10.8; <i>P</i> = 0.017) and cardiovascular outcomes (HR = 6.0, 95% CI: 1.3-26.9; <i>P</i> = 0.02).</p><p><strong>Conclusion: </strong>In HF, AV sclerosis is a marker of HF severity and its development should be considered a marker of disease progression rather than an independent prognostic factor for poor outcomes.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf066"},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510051","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":"Fuelling aortic stenosis: the integral role of 6-phosphofructo-2-kinase/fructose-2,6-biphosphatase 3-mediated glycolysis in Lp(a)-induced valve inflammation.","authors":"Merel Peletier, Lubna Ali, Kim Dzobo, Tarik El Bouazzati, Emilie L Gaillard, María Leonor Romero Prats, Miranda Versloot, Jorge Peter, Sotirios Tsimikas, Mark Dweck, S Matthijs Boekholdt, Kang He Zheng, Erik Stroes, Jeffrey Kroon","doi":"10.1093/ehjopen/oeaf068","DOIUrl":"10.1093/ehjopen/oeaf068","url":null,"abstract":"<p><strong>Aims: </strong>Calcific aortic valve disease is the most common valvular heart disease characterized by an inflammatory response in the leaflets followed by fibro-calcific remodelling of valvular interstitial cells (VICs). Lipoprotein(a) [Lp(a)] is a well-recognized risk factor for CAVD, however the role of metabolism in driving Lp(a)-induced inflammation remains largely elusive. Therefore, we aim to investigate the role of Lp(a) in driving inflammatory and metabolic changes in VICs and examine how alterations in cellular metabolism can alter their inflammatory phenotype.</p><p><strong>Methods and results: </strong>Inflammatory activity in the aortic valve of patients with mild to severe aortic stenosis with elevated Lp(a) levels (>50 mg/dL) is increased, as reflected by increased ¹⁸F-FDG uptake in the aortic valve, compared with those with low Lp(a) levels (<50 mg/dL) with a maximal TBR of 1.60 ± 0.20 vs. 1.43 ± 0.16 (<i>P</i> < 0.002). RNA-seq analysis of VICs stimulated with a physiological relevant concentration Lp(a) revealed that Lp(a)-induced inflammation <i>in vitro</i> initially occurs in an NF-κB-dependent manner, but switches to glycolysis driven inflammation after long-term exposure. Glucose uptake, lactate secretion and maximal glycolytic capacity were increased by Lp(a) via the glycolytic enzyme 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase (PFKFB3), while inhibition of PFKFB3 results in a 50% reduction of Lp(a)-induced cytokine gene expression and secretion.</p><p><strong>Conclusion: </strong>Lipoprotein(a)-induced PFKFB3-mediated glycolysis in VICs sustains NF-κB-dependent inflammatory response. These insights into the inflammation-metabolic axis may offer a more refined approach to decrease valvular inflammation.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 4","pages":"oeaf068"},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12402982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994814","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":"Adaptive high microvascular resistance: a diagnostic dilemma in coronary physiology.","authors":"Ioannis Skalidis, Philippe Garot, Panagiotis Antiochos","doi":"10.1093/ehjopen/oeaf073","DOIUrl":"10.1093/ehjopen/oeaf073","url":null,"abstract":"","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 4","pages":"oeaf073"},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577416","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":"Glycolysis hijacked: a novel pathogenic role of lipoprotein(a) in valve disease.","authors":"Luisa Weiss, Elena Aikawa","doi":"10.1093/ehjopen/oeaf069","DOIUrl":"10.1093/ehjopen/oeaf069","url":null,"abstract":"","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 4","pages":"oeaf069"},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12246370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144628220","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":"Physiology guidance for coronary artery disease in patients with severe aortic stenosis: are we there yet?","authors":"Jacob T Lønborg","doi":"10.1093/ehjopen/oeaf051","DOIUrl":"10.1093/ehjopen/oeaf051","url":null,"abstract":"","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf051"},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251504","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}