European heart journal open最新文献

{"title":"Late referrals and high mortality in tricuspid regurgitation: a call for timely intervention.","authors":"Julius Jelisejevas, Ali Husain, Brian Chiang, Sophie Offen, Gnalini Sathananthan, Robert Moss, Jonathon A Leipsic, Philipp Blanke, Janarthanan Sathananthan, Robert H Boone, John G Webb, David A Wood, Anson Cheung","doi":"10.1093/ehjopen/oeaf072","DOIUrl":"10.1093/ehjopen/oeaf072","url":null,"abstract":"<p><strong>Aims: </strong>Tricuspid regurgitation (TR) is associated with increased morbidity and mortality. The optimal timing for referral and intervention remains uncertain. To evaluate outcomes in patients with TR referred for tricuspid valve intervention.</p><p><strong>Methods and results: </strong>Fifty-eight consecutive patients were referred from May 2018 to April 2023. Patients were stratified into two groups: Group 1 who underwent either tricuspid valve transcatheter edge-to-edge repair (T-TEER) or transcatheter tricuspid valve replacement (TTVR); Group 2 who died without intervention due to: awaiting candidacy assessment; awaiting intervention; deemed unsuitable for intervention. Key endpoints: in-patient, 30-day, 12- and 18-month mortality; new pacemaker implantation; echocardiographic TR grading; improvement in NYHA functional class; and heart failure-related readmissions at 30 days and 12 months. Among 58 patients, 43 underwent intervention (TTVR, <i>n</i> = 29; T-TEER, <i>n</i> = 14), 15 died without intervention (awaiting assessment <i>n</i> = 11; awaiting procedure <i>n</i> = 1, unsuitable <i>n</i> = 3). At the time of referral, the mean age was 77.0 ± 9.8 years, and 52 patients (90%) were diagnosed with functional TR; 30-day mortality in Group 1 was 12%, and 12-month mortality reached 33%, with heart failure readmission (37%); 12-month mortality in Group 2 was 73%. At 18 months, mortality reached 37% in Group 1 and 100% in Group 2. Baseline characteristics differed significantly between the groups for body mass index, severity of TR (massive or torrential), NYHA III-IV symptoms, and validated mortality scores.</p><p><strong>Conclusion: </strong>Referrals for TR often occur after substantial comorbidities have developed resulting in high mortality but should be considered for a referral and intervention at an earlier stage.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf072"},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510050","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":"IFNγ⁺ NKT-like cells are associated with increased incidence of atrial fibrillation in elderly women.","authors":"Kari Anne Sveen, J Gustav Smith, Daniel Engelbertsen, Alexandru Schiopu, Andreas Edsfeldt, Gunnar Engström, Isabel Goncalves, Jan Nilsson, Harry Björkbacka, Eva Bengtsson","doi":"10.1093/ehjopen/oeaf063","DOIUrl":"10.1093/ehjopen/oeaf063","url":null,"abstract":"<p><strong>Aims: </strong>T cells are present in atrial tissue from atrial fibrillation (AF) patients. However, prospective studies of T cells and AF development are few. The current aim was to investigate if T-cell subsets are associated with the risk of developing AF.</p><p><strong>Methods and results: </strong>T-cell subsets, measured by flow cytometry of cryopreserved mononuclear leucocytes isolated from blood at baseline, were analysed for associations of incident AF in 669 subjects from a population-based cohort. Subjects were followed for incidence of AF for 18.6 (11.5-21.7) years during which 145 subjects were diagnosed with AF. Incident AF cases had higher levels of CD3⁺CD56⁺ NKT-like cells. No differences in CD3⁺, CD3⁺CD4⁺, CD3⁺CD8, Th1, Th2, or regulatory T cells between incident AF cases and non-cases were observed. Women had higher levels of NKT-like cells than men. High numbers of NKT-like cells were associated with an increased risk of developing AF in women [HR (95% CI) 1.88 (1.10-3.23) above vs. below median], but not in men or in the total cohort. The majority of NKT-like cells were IFNγ⁺ after stimulation. High numbers of IFNγ⁺ NKT-like cells were associated with increased risk for developing AF in women. Median fluorescence intensity of IFNγ for NKT-like cells was higher in cases of incident AF in women, but not in the total cohort or in men.</p><p><strong>Conclusion: </strong>High levels of IFNγ⁺ NKT-like cells in blood are associated with increased risk of incident AF in women, supporting a role for T cells in development of AF and emphasizing sex differences in this context.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf063"},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510049","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":"Variable selection for causal inference, prediction, and descriptive research: a narrative review of recommendations.","authors":"Brett P Dyer","doi":"10.1093/ehjopen/oeaf070","DOIUrl":"10.1093/ehjopen/oeaf070","url":null,"abstract":"<p><p>There is a growing appreciation that the methods and analyses of medical studies should be tailored towards the type of research question. However, frequent conflation exists with respect to the reasons for statistically adjusting for variables in analyses and the methods that should be used for variable selection in regression models. Non-randomized causal studies require statistical adjustment for confounders that may bias the causal effect estimate. Predictor/prognostic factor studies may present unadjusted associations and/or present associations statistically adjusted for existing predictors to establish the added predictive value of the candidate predictor over and above known predictors. Prediction models aim to identify a set of variables that are clinically useable and are collectively the best at predicting the outcome. Descriptive studies may want to characterize the outcome distribution with respect to an additional variable or standardize with respect to a nuisance variable for which the study sample differs from the target population. This narrative review summarizes background theory and existing advice on how variable selection should differ for causal research, prediction modelling, predictor/prognostic factor research, and descriptive research. Examples of variable selection approaches from published cardiovascular research are also provided.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf070"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531936","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":"Endovascular management of intermediate-risk pulmonary embolism: evidence, outstanding questions, drivers of utilization, and the horizon.","authors":"Arman A Shahriar, Jonathan Paul, Adam Cifu","doi":"10.1093/ehjopen/oeaf071","DOIUrl":"10.1093/ehjopen/oeaf071","url":null,"abstract":"<p><p>In patients with acute intermediate-risk pulmonary embolism (PE) guidelines recommend systemic anticoagulation (Class I; Level A), but intermediate-risk patients are increasingly being treated with adjunctive endovascular (catheter-based) therapies. This review defines outstanding clinical questions, contextualizes completed and ongoing clinical studies, examines plausible drivers of utilization, and anticipates scenarios on the horizon for endovascular therapy in this large and heterogenous subgroup of patients. In intermediate-risk PE, up-front adjunctive systemic thrombolysis reduces haemodynamic deterioration or death, but the small benefit is outweighed by the risk of major bleeding. Endovascular modalities (e.g. ultrasound-assisted catheter directed thrombolysis, mechanical thrombectomy) aim to uphold these benefits while improving upon safety. Since 2014, five devices have entered the market based primarily on single-arm studies demonstrating short-term improvements in surrogate markers of effectiveness (e.g. 48 h reduction in RV/LV ratio). While thousands of patients with intermediate-risk PE (primarily intermediate-<i>high</i> risk PE) have been enrolled in prospective studies using these devices, only three small Randomized controlled trials (RCTs) have compared adjunctive endovascular therapy with anticoagulation alone, and none have included patient-centred efficacy endpoints (i.e. mortality or morbidity). In the absence of high-quality evidence or guideline recommendations, rising utilization in intermediate-risk patients may be driven by clinical uncertainty, PE response teams, favourable regulation and reimbursement, industry marketing, and financial incentives for various stakeholders. Three large RCTs are currently enrolling patients to evaluate both short- and long-term patient-centred measures of efficacy as well as safety of adjunct endovascular therapy relative to anticoagulation alone. The results of these trials will provide critical insights by the decade's end.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf071"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499916","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":"Does the type of oral anticoagulant matter for stroke prevention or bleeding in patients with atrial fibrillation after cardiac surgery? A systematic review and meta-analysis.","authors":"Marc M Terpstra, Tim A C de Vries, Ellis Oortwijn, Rob A F de Lind van Wijngaarden, Joris R de Groot","doi":"10.1093/ehjopen/oeaf062","DOIUrl":"10.1093/ehjopen/oeaf062","url":null,"abstract":"<p><strong>Aims: </strong>Unlike in non-surgical settings, many centres continue to favour vitamin K antagonists (VKAs) for stroke prevention in atrial fibrillation (AF) following major cardiac surgery. Current guidelines indicate insufficient data on the use of direct oral anticoagulants (DOACs) early after cardiac surgery. This study aims to evaluate whether DOACs are non-inferior to VKAs in terms of efficacy and safety for stroke prevention in post-operative AF.</p><p><strong>Methods and results: </strong>MEDLINE, EMBASE, CENTRAL, and Clinicaltrials.gov were searched from inception till 2 July 2024, and relevant reviews were screened as grey literature. Studies comparing DOACs with VKAs for stroke prevention in patients with (post-operative) AF after major cardiac surgery were included. Studies on patients with mechanical valve replacement or moderate to severe mitral stenosis were excluded. Outcomes of interest included thromboembolic events, major bleeding and mortality up to 6 months after cardiac surgery. Eleven studies, including two randomized controlled trials, reporting on >18,000 patients were analyzed. There were no significant differences between DOACs and VKAs in thromboembolic events (OR: 0.96; CI: 0.62-1.50; I²: 0%), any stroke (OR: 1.44; CI: 0.61-3.41; I²: 0%), major bleeding (OR: 0.97; CI: 0.60-1.56; I²: 48%), all-cause mortality (OR: 1.00; CI: 0.73-1.37; I²: 0%) or admission duration (MD: -0.33; CI: -1.16-0.49; I²: 0%) in the first 6 months after cardiac surgery.</p><p><strong>Conclusion: </strong>There is no high-quality evidence that DOACs and VKAs differ in efficacy or safety for stroke prevention in AF after cardiac surgery. While awaiting high-quality randomized data, our meta-analysis found no evidence to support routinely avoiding DOACs or favouring VKAs in this setting.</p><p><strong>Registration: </strong>Review registration number: CRD42023412592.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf062"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12166522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304089","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":"Machine learning integration of echocardiographic and clinical data to improve prediction of survival following myocardial infarction.","authors":"Sandhir B Prasad, Liam Scanlon, Anish Krishnan, Nicole Ivy Chan, Michael Mallouhi, William Vollbon, William Parsonage, Sankalp Khanna, Andrew Lin, John J Atherton","doi":"10.1093/ehjopen/oeaf064","DOIUrl":"10.1093/ehjopen/oeaf064","url":null,"abstract":"<p><strong>Aims: </strong>Machine learning (ML) could improve risk stratification following myocardial infarction (MI). However, previous ML studies for risk prediction following MI did not incorporate comprehensive echocardiographic data. This study sought to use machine learning (ML) to integrate comprehensive echocardiographic and clinical data for the predicting all-cause mortality following MI.</p><p><strong>Methods and results: </strong>Retrospective study of consecutive patients admitted with MI to a tertiary referral hospital, with echocardiography performed within 24 h of admission. The cohort was randomly split into training (70%) and test (30%) sets. Two ML models (XGBoost and a neural network) were developed using echocardiographic and clinical data, and then compared with conventional logistic regression. The Shapley Additive exPlanations method was used for ML model interpretation. In the final study population of 3202 patients (mean age, 63.2 ± 12.5 years; 29.2% females), ST-elevation MI was present in 28.8%, and the mean cohort LVEF was 52.5 ± 11.2%. At a median follow-up of 4.5 years, there were 465 deaths. In the test set, XGBoost achieved the highest performance (AUC, 0.854), compared with logistic regression (AUC, 0.824; <i>P</i> = 0.006) and the neural network (AUC, 0.808; <i>P</i> = <0.001) for the prediction of death. In the XGBoost model, the highest-ranked predictors included age, renal function, echocardiographic left ventricular outflow velocity time integral, and diastolic parameters. Further, in nested ML models, the addition of echocardiographic parameters provided incremental value beyond clinical variables alone (AUC, 0.854 vs. 0.820; <i>P</i> = 0.002).</p><p><strong>Conclusion: </strong>ML integration of comprehensive echocardiographic data with clinical data could lead to improved prediction of survival following MI. Clinical implementation should be considered.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf064"},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12203351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531933","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":"ICEBERG-3: carotid plaque score combined with the stress echo improves 5-year major adverse cardiovascular events risk prediction.","authors":"Murray F Matangi, Marie-France Hétu, David W J Armstrong, Jonas Shellenberger, Daniel Brouillard, Josh Baker, Ana Johnson, Hannah Willms, Amer M Johri","doi":"10.1093/ehjopen/oeaf065","DOIUrl":"10.1093/ehjopen/oeaf065","url":null,"abstract":"<p><strong>Aims: </strong>Stress echocardiography (SE), though widely accessible, has some limitations in its diagnostic test characteristics for predicting major adverse cardiovascular events (MACEs). Carotid plaque score provides direct detection of subclinical atherosclerosis and can be integrated into the stress protocol. The aim of our study was to assess the value of adding a carotid plaque score to SE to enhance the test diagnostics for predicting MACE in low-intermediate-risk patients.</p><p><strong>Methods and results: </strong>Patients aged 40-75 years referred for SE received a carotid ultrasound and were followed for 5-year MACE. Hard MACE was defined as a composite of cardiovascular death, non-fatal stroke or myocardial infarction, and emergency coronary revascularization. Soft MACE included non-emergency coronary revascularization. Patients aged >75 years, on a statin, with previously known vascular disease, a history of stroke, myocardial infarction, vascular intervention, or a resting wall motion abnormality on a baseline echo were excluded. Administrative data holdings housed at the Institute of Clinical Evaluative Sciences, ICES, were used for event follow-up. Of the 2588 patients, there were 49 cumulative incidence hard MACE and 119 soft MACE. Carotid plaque score improved the sensitivity of SE for predicting 1- and 5-year MACE. A plaque score threshold value of ≥2 provided clear differentiation of patients who experienced MACE in both positive and non-positive (negative/inconclusive for ischaemia) SE results.</p><p><strong>Conclusion: </strong>Plaque score enhances diagnostic test characteristics of SE. The combination of carotid ultrasound with SE is an important new tool for cardiovascular risk assessment. This simple tool may help differentiate risk in patients with non-positive SE results.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf065"},"PeriodicalIF":0.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12166518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304090","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":"Exploring breath metabolomics as a non-invasive tool for detecting pulmonary vascular disease.","authors":"Sarah Basler, Kai Fricke, Noriane A Sievi, Alexandra Arvaji, Felix Schmidt, Jonas Herth, Diego M Baur, Malcolm Kohler, Silvia Ulrich, Mona Lichtblau","doi":"10.1093/ehjopen/oeaf060","DOIUrl":"10.1093/ehjopen/oeaf060","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this initial study was to explore whether prediction models based on breath metabolome profiles could detect differences between pulmonary vascular disease (PVD) patients and healthy controls. Additionally, we sought to investigate the potential to distinguish between two major subtypes of PVD-pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH)-to support early detection and targeted treatment.</p><p><strong>Methods and results: </strong>We used real-time breath analysis to compare the breath profiles of patients with PVD to healthy controls, and the metabolome of patients with PAH to those with CTEPH. Pathway enrichment analysis was conducted to reveal underlying metabolic pathways. Breath profiles of 75 patients (47 (62.7%) with PAH and 28 (37.3%) with CTEPH) were analysed and compared with those of 115 healthy controls. The prediction models identified PVD with an area under the curve of 0.917 and distinguished PAH from CTEPH with an AUC of 0.764. PVD patients showed significant metabolic alterations, particularly in <i>de novo</i> fatty acid synthesis and fatty acid activation.</p><p><strong>Conclusion: </strong>Breath analysis shows potential as a non-invasive and real-time diagnostic tool by demonstrating detectable differences in breath profiles between PVD patients and healthy controls. Establishing these differences is a critical first step in assessing the feasibility of identifying breath markers for PVD and exploring further differentiation between PAH and CTEPH.</p><p><strong>Registration: </strong>Trial registration number: NCT05458934.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf060"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12138245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236221","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":"Sex differences based on the timing of invasive management among patients with non-ST-elevation acute coronary syndrome: an individual patient data meta-analysis.","authors":"Graziella Pompei, Gregory B Mills, Christos P Kotanidis, Shamir Mehta, Denise Tiong, Erik A Badings, Thomas Engstrøm, Arnoud W J Van't Hof, Dan Høfsten, Lene Holmvang, Alexander Jobs, Lars Køber, Dejan Milasinovic, Aleksandra Milosevic, Goran Stankovic, Holger Thiele, Roxana Mehran, Vijay Kunadian","doi":"10.1093/ehjopen/oeaf059","DOIUrl":"10.1093/ehjopen/oeaf059","url":null,"abstract":"<p><strong>Aims: </strong>Studies investigating the timing of coronary angiography in non-ST-elevation acute coronary syndrome (NSTE-ACS) have not evaluated sex differences. This study aims to investigate the sex-related differences in outcomes of NSTE-ACS patients undergoing early or delayed invasive management.</p><p><strong>Methods and results: </strong>An individual patient data (IPD) meta-analysis was performed after systematic review of randomized controlled trials (RCTs) comparing early vs. delayed invasive strategy among NSTE-ACS patients. The primary endpoint was a composite of all-cause death or myocardial infarction (MI) at 6 months. Secondary endpoints included all-cause death, MI, recurrent ischaemia, stroke, and major bleeding. One-stage, random-effects Cox models were conducted. This meta-analysis was registered with PROSPERO (CRD42023468604). Six RCTs including 6654 patients were identified, of whom 2257 (33.9%) were females with a median age of 69 years [interquartile range (IQR) 60-76], significantly higher than males (64.5 years, IQR 55-72.1, <i>P</i> < 0.001). Among patients undergoing early strategy, there was no sex difference in the occurrence of the primary [Hazard ratio (HR) 1.08, 95% confidence interval (CI) 0.83-1.41, <i>P</i> = 0.560] and secondary endpoints. Among patients undergoing delayed strategy, there was no difference in the occurrence of the primary endpoint (HR 1.12, 95% CI 0.88-1.43, <i>P</i> = 0.350). Female sex undergoing delayed strategy was associated with higher risk of recurrent ischaemia (HR 1.52, 95% CI 1.06-2.19, <i>P</i> = 0.023) and major bleeding (HR 1.88, 95% CI 1.22-2.87, <i>P</i> = 0.004) using univariable analysis but not using multivariable analysis.</p><p><strong>Conclusion: </strong>No sex-related differences in the composite of all-cause death or MI were identified among NSTE-ACS patients undergoing early and delayed invasive management.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf059"},"PeriodicalIF":0.0,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531935","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 clinical impact of mitochondrial autophagy on very late-onset recurrence after catheter ablation for atrial fibrillation.","authors":"Keisuke Uchida, Naoya Kataoka, Teruhiko Imamura, Takahisa Koi, Koichiro Kinugawa","doi":"10.1093/ehjopen/oeaf058","DOIUrl":"10.1093/ehjopen/oeaf058","url":null,"abstract":"<p><strong>Aims: </strong>The mechanisms underlying very late-onset atrial fibrillation (AF) recurrence, defined as occurring more than 1 year after catheter ablation, are hypothesized to differ from those responsible for recurrence within the first year; however, this remains uncertain.</p><p><strong>Methods and results: </strong>Two investigations were conducted in patients undergoing AF ablation. First, non-targeted metabolome analysis was performed in 10 patients with very late-onset recurrence and 10 without recurrence. Second, based on metabolomic findings implicating autophagy, serum levels of the autophagy-related proteins Parkin, a marker of mitophagy, and ATG5, an indicator of bulk autophagy, were measured using ELISA. Associations between these variables and very late-onset recurrence were analysed. Among the 203 patients (mean age 70 years, 63% male), 16 experienced very late-onset recurrence during a mean follow-up of 954 days. Metabolome analysis identified 255 peaks (177 cations and 78 anions). Principal component analysis revealed a reduction in γ-glutamyl dipeptides, contributors to mitochondrial autophagy, in the recurrence group. A serum Parkin level below the median was independently associated with very late-onset recurrence (hazard ratio 3.82, 95% confidence interval 1.20-12.13, <i>P</i> = 0.023), after adjustment for left atrial diameter and diabetes mellitus. In contrast, ATG5 levels were not significantly associated. Parkin levels did not predict recurrence within the first year (log-rank <i>P</i> = 0.09).</p><p><strong>Conclusion: </strong>Reduced serum Parkin levels were independently associated with very late-onset recurrence following AF ablation, suggesting that impaired mitochondrial autophagy may contribute to the pathogenesis of long-term AF recurrence.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf058"},"PeriodicalIF":0.0,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12138335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236222","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}