European heart journal open最新文献

{"title":"Role of myocardial MicroRNAs in the long-term ventricular remodelling of patients with aortic stenosis","authors":"A. Gabriel, Marina C Costa, Daniel Caldeira, R. Plácido, J. Rigueira, P. Carrilho-Ferreira, Susana Gonçalves, Ricardo Ferreira, Ângelo Nobre, Fausto J. Pinto, F. Enguita, Ana G Almeida","doi":"10.1093/ehjopen/oeae060","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae060","url":null,"abstract":"\u0000 \u0000 \u0000 We hypothesize that miRs are key players in the dynamics of the hypertrophy phenotype in aortic stenosis (AS) patients. In our study, we aimed to identify the transcriptional patterns (protein-coding transcripts and miRs) from myocardial sample biopsies that could be associated with the absence of left ventricle (LV) mass regression after aortic valve replacement (AVR in patients with severe AS and LV hypertrophy.\u0000 \u0000 \u0000 \u0000 We prospectively included 40 patients with severe AS, LV hypertrophy and preserved EF undergoing AVR. Myocardial biopsies obtained during surgery were analysed for transcriptomic analysis performed by next generation sequencing. At a 1-year follow-up, no hypertrophy reversal was observed in about half of the patients in the absence of patient-prothesis mismatch, prosthesis dysfunction of uncontrolled hypertension. Predictors of mass regression were assessed From clinical, echocardiographic, biochemical variables as well as from 300 miRs obtained from myocardial specimens, allowing the identification 29 differentially expressed. miR 4709-3p was found as a positive independent predictor of hypertrophy regression together with hs-TNT as a negative predictor. Gene transcripts RFX1, SIX5, MAPK8IF3 and PKD1 were predicted as simultaneous targets of five upregulated miRs suggesting its importance in LV hypertrophy.\u0000 \u0000 \u0000 \u0000 In our cohort, tissue miR 4709-3p and hs-TNT were independent predictors of hypertrophy regression. The hypertrophy reversal process will likely depend from a complex network where miRNAs may have an important role, allowing a potential opportunity for therapy.\u0000","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"33 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141809071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early and Short-term Use of PCSK9-Inhibitors on Coronary Plaque Stability in Acute Coronary Syndrome","authors":"Hiroki Uehara, T. Kajiya, Masami Abe, M. Nakata, Shingo Hosogi, Shinichiro Ueda","doi":"10.1093/ehjopen/oeae055","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae055","url":null,"abstract":"\u0000 \u0000 \u0000 Proprotein convertase anti-subtilisin-kexin type 9 inhibitors (PCSK9Is) improve plaque volume and composition and reduce major adverse coronary events in chronic coronary artery disease.\u0000 \u0000 \u0000 \u0000 We evaluated the effects of the short-term use of PCSK9Is on coronary plaque stability in patients with acute coronary syndrome (ACS) using optical coherence tomography (OCT).\u0000 \u0000 \u0000 \u0000 This multicenter, open label randomized controlled trial. Enrolled 80 subjects met the inclusion criteria. Of these, 52 patients (age 60±11 years, 38 men, 14 women) with ST-elevated ACS who had undergone successful primary percutaneous coronary intervention with low-density lipoprotein cholesterol (LDL-C) levels >70 mg/dL while receiving high-intensity statins. Participants were randomly assigned to the PCSK9Is group (evolocumab 420 mg for 3 months, N=29) or the standard of care (SoC) group(N=23). OCT was performed at baseline (BL) and 3-months (3M) and 9- months (9M) after randomization to assess lipid-rich plaques in non-culprit lesions.The change in the minimum fibrous cap thickness (MFCT) from baseline to 9M was the primary endpoint.\u0000 \u0000 \u0000 \u0000 The percentage change in LDL-C levels from BL to 3M were significantly greater in the PCSK9Is group (-67.8±21.5% in the PCSK9Is group vs. -16.3±21.8% in the SoC group; p<0.0001) and though, the difference between two groups were disappeared from BL to 9M (-20.0±37.8% in the PCSK9Is group vs. -6.7±34.2% in the SoC group; p=0.20).The changes in MFCT from baseline to 9M were significantly greater in the PCSK9Is group, even after PCSK9Is discontinuation (100 μm [Interquartile range (IQR): 45–180 μm] vs. 50 μm [IQR: 0–110 μm]; p=0.032).\u0000 \u0000 \u0000 \u0000 Combination treatment with PCSK9Is and statins resulted in more marked plaque stabilization after ACS than SoC alone, and this effect persisted for 6 months after PCSK9I discontinuation.\u0000 \u0000 \u0000 \u0000 Adage-Joto study, UMIN ID No. 26516\u0000","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"119 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141811991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beta-blocker initiation under dobutamine infusion in acute advanced heart failure: a target trial emulation with observational data.","authors":"Yuichiro Mori, Kosuke Inoue, Hiroyuki Sato, Takahiro Tsushima, Shingo Fukuma","doi":"10.1093/ehjopen/oeae054","DOIUrl":"10.1093/ehjopen/oeae054","url":null,"abstract":"<p><strong>Aims: </strong>In patients with advanced heart failure requiring dobutamine infusion, it is usually recommended to initiate beta-blockers after weaning from dobutamine. However, beta-blockers are sometimes initiated under dobutamine infusion in a real-world scenario. The association between such early beta-blocker initiation with clinical outcomes is unknown. Therefore, this study investigates the association between initiating beta-blockers under dobutamine infusion and survival outcomes.</p><p><strong>Methods and results: </strong>This observational study with a multicentre inpatient-care database emulated a pragmatic randomized controlled trial (RCT) of the beta-blocker initiation strategy. First, 1151 patients on dobutamine and not on beta-blockers on the day of heart failure admission (Day 0) were identified. Among 1095 who met eligibility criteria, patients who were eventually initiated beta-blockers under dobutamine infusion by Day 7 (early initiation strategy) were 1:1 matched to those who were not initiated (conservative strategy). The methods of cloning, censoring, and weighting were applied to emulate the target trial. Patients were followed up for up to 30 days. The primary outcome was all-cause death. Among 780 matched patients (median age, 81 years), the adjusted hazard ratio was 1.11 (95% confidence interval 0.75-1.64, <i>P</i> = 0.59) for the early initiation strategy. The estimated 30-day all-cause mortalities in the early initiation strategy and the conservative strategy were 19.3% (10.6-30.7) and 16.2% (9.2-25.3), respectively. The results were consistent when we used different days to determine strategies (i.e. 5 and 9) instead of 7 days.</p><p><strong>Conclusion: </strong>The present observational study emulating a pragmatic RCT found no positive or negative association between beta-blocker initiation under dobutamine infusion and overall survival.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 4","pages":"oeae054"},"PeriodicalIF":0.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11247169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621965","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":"Preventive medication efficacy after 1-year follow-up for graft failure in coronary artery bypass surgery patients: Bayesian network meta-analysis.","authors":"Mikko Uimonen, Rasmus Liukkonen, Ville Ponkilainen, Matias Vaajala, Jeremias Tarkiainen, Oskari Pakarinen, Marjut Haapanen, Ilari Kuitunen","doi":"10.1093/ehjopen/oeae052","DOIUrl":"10.1093/ehjopen/oeae052","url":null,"abstract":"<p><p>To compare preventive medications against graft failures in coronary artery bypass graft surgery (CABG) patients after a 1-year follow-up. Systematic review with Bayesian network meta-analysis and meta-regression analysis. We searched PubMed, Scopus, and Web of Science databases in February 2023 for randomized controlled trials, comparing preventive medications against graft failure in CABG patients. We included studies that reported outcomes at 1 year after surgery. Our primary outcome was graft failure After screening 11,898 studies, a total of 18 randomized trials were included. Acetylsalicylic acid (ASA) [odds ratios (OR) 0.51, 95% credibility interval (CrI) 0.28-0.95, meta-regression OR 0.54, 95% CrI 0.26-1.00], Clopidogrel + ASA (OR 0.27, 95% CrI 0.09-0.76, meta-regression OR 0.28, 95% CrI 0.09-0.85), dipyridamole + ASA (OR 0.50, 95% CrI 0.30-0.83, meta-regression OR 0.49, 95% CrI 0.26-0.90), ticagrelor (OR 0.40, 95% CrI 0.16-1.00, meta-regression OR 0.43, 95% CrI 0.15-1.2), and ticagrelor + ASA (OR 0.26, 95% CrI 0.10-0.62, meta-regression OR 0.28, 95% CrI 0.10-0.68) were superior to placebo in preventing graft failure. Rank probabilities suggested the highest likelihood to be the most efficacious for ticagrelor + ASA [surface under the cumulative ranking (SUCRA) 0.859] and clopidogrel + ASA (SUCRA 0.819). The 95% CrIs of ORs for mortality, bleeding, and major adverse cardio- and cerebrovascular events (MACE) were wide. A trend towards increased bleeding risk and decreased MACE risk was observed when any of the medication regimens were used when compared to placebo. Sensitivity analysis excluding studies with a high risk of bias yielded equivalent results. Of the reviewed medication regimens, dual antiplatelet therapy combining ASA with ticagrelor or clopidogrel was found to result in the lowest rate of graft failures.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 4","pages":"oeae052"},"PeriodicalIF":0.0,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11227230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141556233","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 CHA₂DS₂-VASc and HAS-BLED in predicting stroke and bleeding in atrial fibrillation and cancer.","authors":"Alyaa M Ajabnoor, Salwa S Zghebi, Rosa Parisi, Darren M Ashcroft, Corinne Faivre-Finn, Mamas A Mamas, Evangelos Kontopantelis","doi":"10.1093/ehjopen/oeae053","DOIUrl":"10.1093/ehjopen/oeae053","url":null,"abstract":"<p><strong>Aims: </strong>To compare the predictive performance of CHA₂DS₂-VASc and HAS-BLED scores in atrial fibrillation (AF) patients with and without cancer.</p><p><strong>Methods and results: </strong>Using data from the Clinical Practice Research Datalink in England, we performed a retrospective cohort study of patients with new diagnoses of AF from 2009 to 2019. Cancer was defined as history of breast, prostate, colorectal, lung, or haematological cancer. We calculated the CHA₂DS₂-VASc and HAS-BLED scores for the 1-year risk of stroke and major bleeding events. Scores performance was estimated by discrimination [area under the receiver operating characteristic curve (AUC)] and calibration plots. Of 141 796 patients with AF, 10.3% had cancer. The CHA₂DS₂-VASc score had good to modest discrimination in prostate cancer AUC = 0.74 (95% confidence interval: 0.71, 0.77), haematological cancer AUC = 0.71 (0.66, 0.76), colorectal cancer AUC = 0.70 (0.66, 0.75), breast cancer AUC = 0.70 (0.66, 0.74), and lung cancer AUC = 0.69 (0.60, 0.79), compared with no-cancer AUC = 0.73 (0.72, 0.74). HAS-BLED discrimination was poor in prostate cancer AUC = 0.58 (0.55, 0.61), haematological cancer AUC = 0.59 (0.55, 0.64), colorectal cancer AUC = 0.57 (0.53, 0.61), breast cancer AUC = 0.56 (0.52, 0.61), and lung cancer AUC = 0.59 (0.51, 0.67), compared with no-cancer AUC = 0.61 (0.60, 0.62). Both the CHA₂DS₂-VASc score and HAS-BLED score were well calibrated across all study cohorts.</p><p><strong>Conclusion: </strong>Amongst certain cancer cohorts in the AF population, CHA₂DS₂-VASc performs similarly in predicting stroke to AF patients without cancer. Our findings highlight the importance of cancer diagnosis during the development of risk scores and opportunities to optimize the HAS-BLED risk score to better serve cancer patients with AF.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 4","pages":"oeae053"},"PeriodicalIF":0.0,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11234295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581862","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":"Exercise training improves exercise capacity and quality of life in heart failure with preserved ejection fraction: a systematic review and meta-analysis of randomized controlled trials.","authors":"Ranu Baral, Jamie Sin Ying Ho, Ayesha Nur Soroya, Melissa Hanger, Rosemary Elizabeth Clarke, Sara Fatima Memon, Hannah Glatzel, Mahmood Ahmad, Rui Providencia, Jonathan James Hyett Bray, Fabrizio D'Ascenzo","doi":"10.1093/ehjopen/oeae033","DOIUrl":"10.1093/ehjopen/oeae033","url":null,"abstract":"<p><strong>Aims: </strong>Heart failure with preserved ejection fraction (HFpEF) is associated with high morbidity and mortality, and there are limited proven therapeutic strategies. Exercise has been shown to be beneficial in several studies. We aimed to evaluate the efficacy of exercise on functional, physiological, and quality-of-life measures.</p><p><strong>Methods and results: </strong>A comprehensive search of Medline and Embase was performed. Randomized controlled trials (RCTs) of adult HFpEF patients with data on exercise intervention were included. Using meta-analysis, we produced pooled mean difference (MD) estimates with 95% confidence intervals (CIs) with Review Manager (RevMan) software for the peak oxygen uptake (VO₂), Minnesota living with heart failure (MLWHF) and, other diastolic dysfunction scores. A total of 14 studies on 629 HFpEF patients were included (63.2% female) with a mean age of 68.1 years. Exercise was associated with a significant improvement in the peak VO₂ (MD 1.96 mL/kg/min, 95% CI 1.25-2.68; <i>P</i> < 0.00001) and MLWHF score (MD -12.06, 95% CI -17.11 to -7.01; <i>P</i> < 0.00001) in HFpEF. Subgroup analysis showed a small but significant improvement in peak VO₂ with high-intensity interval training (HIIT) vs. medium-intensity continuous exercise (MCT; MD 1.25 mL/kg/min, 95% CI 0.41-2.08, <i>P</i> = 0.003).</p><p><strong>Conclusion: </strong>Exercise increases the exercise capacity and quality of life in HFpEF patients, and high-intensity exercise is associated with a small but statistically significant improvement in exercise capacity than moderate intensity. Further studies with larger participant populations and longer follow-up are needed to confirm these findings and elucidate potential differences between high- and medium-intensity exercise.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 4","pages":"oeae033"},"PeriodicalIF":0.0,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11231943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141565404","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-stratified analysis of long-term clinical outcomes and cumulative costs in Finnish patients with recent acute coronary syndrome or coronary revascularization: a 5-year real-world study using electronic health records.","authors":"Minna Oksanen, Jenna Parviainen, Christian Asseburg, Steven Hageman, Tuomas T Rissanen, Annukka Kivelä, Kristian Taipale, Frank Visseren, Janne Martikainen","doi":"10.1093/ehjopen/oeae049","DOIUrl":"10.1093/ehjopen/oeae049","url":null,"abstract":"<p><strong>Aims: </strong>Risk assessment is essential in the prevention of cardiovascular disease. In patients with recent acute coronary syndrome (ACS) or coronary revascularization, risk prediction tools, like the European Society of Cardiology guideline recommended SMART-REACH risk score, are increasingly used to predict the risk of recurrent cardiovascular events enabling risk-based personalized prevention. However, little is known about the association between risk stratification and the social and healthcare costs at a population level. This study evaluated the associations between baseline SMART-REACH risk scores, long-term recurrent clinical events, cumulative costs, and post-index event LDL-C goal attainment in patients with recent ACS and/or revascularization.</p><p><strong>Methods and results: </strong>This retrospective study used electronic health records and was conducted in the North Karelia region of Finland. The study cohort included all patients aged 45-85 admitted to a hospital for ACS or who underwent percutaneous coronary intervention or coronary artery bypass surgery between 1 January 2017 and 31 December 2021. Patients were divided into quintiles based on their baseline SMART-REACH risk scores to examine the associations between predicted 5-year scores and selected clinical and economic outcomes. In addition, simple age-based stratification was conducted as a sensitivity analysis. The observed 5-year cumulative incidence of recurrent events ranged from 20% in the lowest to 41% in the highest risk quintile, whereas the corresponding predicted risks ranged from 13% to 51%, and cumulative 5-year mean total costs per patient ranged from 15 827 to 46 182€, respectively. Both monitoring and attainment of low LDL-C values were suboptimal.</p><p><strong>Conclusion: </strong>The use of the SMART-REACH quintiles as a population-level risk stratification tool successfully stratified patients into subgroups with different cumulative numbers of recurrent events and cumulative total costs. However, more research is needed to define clinically and economically optimal threshold values for a population-level stratification.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 4","pages":"oeae049"},"PeriodicalIF":0.0,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11234202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581887","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 use of venoarterial extracorporeal membrane oxygenation in cardiogenic shock: a narrative review.","authors":"Tara Gédéon, Tetiana Zolotarova, Mark J Eisenberg","doi":"10.1093/ehjopen/oeae051","DOIUrl":"10.1093/ehjopen/oeae051","url":null,"abstract":"<p><strong>Aims: </strong>Cardiogenic shock (CS) develops in up to 10% of patients with acute myocardial infarction (AMI) and carries a 50% risk of mortality. Despite the paucity of evidence regarding its benefits, venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in clinical practice in patients with AMI in CS (AMI-CS). This review aims to provide an in-depth description of the four available randomized controlled trials to date designed to evaluate the benefit of VA-ECMO in patients with AMI-CS.</p><p><strong>Methods and results: </strong>The literature search was conducted on PubMed, Google Scholar, and clinicaltrials.gov to identify the four relevant randomized control trials from years of inception to October 2023. Despite differences in patient selection, nuances in trial conduction, and variability in trial endpoints, all four trials (ECLS-SHOCK I, ECMO-CS, EUROSHOCK, and ECLS-SHOCK) failed to demonstrate a mortality benefit with the use of VA-ECMO in AMI-CS, with high rates of device-related complications. However, the outcome of these trials is nuanced by the limitations of each study that include small sample sizes, challenging patient selection, and high cross-over rates to the intervention group, and lack of use of left ventricular unloading strategies.</p><p><strong>Conclusion: </strong>The presented literature of VA-ECMO in CS does not support its routine use in clinical practice. We have yet to identify which subset of patients would benefit most from this intervention. This review emphasizes the need for designing adequately powered trials to properly assess the role of VA-ECMO in AMI-CS, in order to build evidence for best practices.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 4","pages":"oeae051"},"PeriodicalIF":0.0,"publicationDate":"2024-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11227219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141556234","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":"Efficacy and safety of pulsed field ablation compared to cryoballoon ablation in the treatment of atrial fibrillation: a meta-analysis.","authors":"Isabel Rudolph, Giulio Mastella, Isabell Bernlochner, Alexander Steger, Gesa von Olshausen, Franziska Hahn, Reza Wakili, Karl-Ludwig Laugwitz, Eimo Martens, Manuel Rattka","doi":"10.1093/ehjopen/oeae044","DOIUrl":"10.1093/ehjopen/oeae044","url":null,"abstract":"<p><strong>Aims: </strong>Pulmonary vein isolation (PVI) represents the gold standard in the treatment of atrial fibrillation (AF) and the use of single-shot techniques, such as cryoballoon ablation (CBA) and pulsed field ablation (PFA) using a pentaspline catheter, has gained prominence. Recent studies hypothesize that PFA might be superior to CBA, although procedural efficacy and safety data are inconsistent. A meta-analysis was conducted to compare both energy sources for the treatment of AF.</p><p><strong>Methods and results: </strong>A structured systematic database search and meta-analysis were performed on studies investigating outcomes, periprocedural complications, and/or procedural parameters of AF patients treated by either CBA or PFA. Eleven studies reporting data from 3805 patients were included. Pulmonary vein isolation by PFA was associated with a significantly lower recurrence of atrial fibrillation/atrial tachycardia [odds ratio (OR) = 0.73, 95% confidence interval (CI) = 0.54-0.98, I² = 20%] and fewer periprocedural complications (OR = 0.62, 95% CI = 0.40-0.96, I² = 6%) compared to CBA. The lower complication rate following PFA was mainly driven by fewer phrenic nerve injuries (OR = 0.19, 95% CI = 0.08-0.43, I² = 0%). However, there were more cases of cardiac tamponades after PFA (OR = 2.56, 95% CI = 1.01-6.49, I² = 0%). Additionally, using PFA for PVI was associated with shorter total procedure times [mean difference (MD) = -9.68, 95% CI = -14.92 to -4.43 min, I² = 92%] and lower radiation exposure (MD = -148.07, 95% CI = -276.50 to -19.64 µGy·mI² = 7%).</p><p><strong>Conclusion: </strong>Our results suggest that PFA for PVI, compared to CBA, enables shorter procedure times with lower arrhythmia recurrence and a reduced risk of periprocedural complications. Randomized controlled trials need to confirm our findings.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 3","pages":"oeae044"},"PeriodicalIF":0.0,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11200106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141461350","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 the 2022 pulmonary hypertension definition on haemodynamic classification and mortality in patients with aortic stenosis undergoing valve replacement.","authors":"Micha T Maeder, Lukas Weber, Susanne Pohle, Joannis Chronis, Florent Baty, Johannes Rigger, Martin Brutsche, Philipp Haager, Hans Rickli, Roman Brenner","doi":"10.1093/ehjopen/oeae037","DOIUrl":"10.1093/ehjopen/oeae037","url":null,"abstract":"<p><strong>Aims: </strong>With the 2022 pulmonary hypertension (PH) definition, the mean pulmonary artery pressure (mPAP) threshold for any PH was lowered from ≥25 to >20 mmHg, and the pulmonary vascular resistance (PVR) value to differentiate between isolated post-capillary PH (IpcPH) and combined pre- and post-capillary PH (CpcPH) was reduced from >3 Wood units (WU) to >2 WU. We assessed the impact of this change in the PH definition in aortic stenosis (AS) patients undergoing aortic valve replacement (AVR).</p><p><strong>Methods and results: </strong>Severe AS patients (<i>n</i> = 503) undergoing pre-AVR cardiac heart catheterization were classified according to both the 2015 and 2022 definitions. The post-AVR mortality [median follow-up 1348 (interquartile range 948-1885) days] was assessed. According to the 2015 definition, 219 (44% of the entire population) patients had PH: 63 (29%) CpcPH, 125 (57%) IpcPH, and 31 (14%) pre-capillary PH. According to the 2022 definition, 321 (+47%) patients were diagnosed with PH, and 156 patients (31%) were re-classified: 26 patients from no PH to IpcPH, 38 from no PH to pre-capillary PH, 38 from no PH to unclassified PH, 4 from pre-capillary PH to unclassified PH, and 50 from IpcPH to CpcPH (CpcPH: +79%). With both definitions, only the CpcPH patients displayed increased mortality (hazard ratios ≈ 4). Among the PH-defining haemodynamic components, PVR was the strongest predictor of death.</p><p><strong>Conclusion: </strong>In severe AS, the application of the 2022 PH definition results in a substantially higher number of patients with any PH as well as CpcPH. With either definition, CpcPH patients have a significantly increased post-AVR mortality.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 3","pages":"oeae037"},"PeriodicalIF":0.0,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11135639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141176956","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}