European heart journal open最新文献

{"title":"Proximal tubule reabsorptive dysfunction and risk of cardiovascular death among community-living adults: the HUNT-3 cohort.","authors":"Jesse C Ikeme, Ronit Katz, Marius A Øvrehus, Knut Asbjørn R Langlo, Michelle M Estrella, Michael G Shlipak, Joachim H Ix, Stein I Hallan","doi":"10.1093/ehjopen/oeag091","DOIUrl":"10.1093/ehjopen/oeag091","url":null,"abstract":"<p><strong>Aims: </strong>Proximal tubule dysfunction in the kidney is associated with cardiovascular disease (CVD) in populations with prevalent chronic kidney disease (CKD). We sought to evaluate the nature of this association in the general population.</p><p><strong>Methods and results: </strong>We conducted a case-cohort study within the North Trøndelag Health Study (HUNT-3). We randomly sampled 1246 participants and all cases of cardiovascular death. Alpha-1 microglobulin (A1M) and beta-2 microglobulin (B2M) were measured in urine to assess proximal tubule reabsorptive dysfunction. Cardiovascular death was assessed using the Norwegian Cause of Death registry. We estimated the association of each biomarker with cardiovascular death after adjustment for baseline characteristics, including estimated glomerular filtration rate (eGFR) and albuminuria. Mean participant age was 51 years, 55% were female. Median urine albumin-to-creatinine ratio was 1.3 [interquartile range (IQR) 1.0-1.8] mg/mmol and mean eGFR was 98 (SD 17) mL/min/1.73 m². Cardiovascular death occurred in 166 participants over a median follow-up of 13 years. The weighted incidence among those with low-normal, mid-normal, high-normal, and elevated A1M was 0.8 (0.6-1.1), 1.5 (1.0-2.0), 2.0 (1.3-2.6), and 4.5 (2.6-6.4) per cent, respectively. After adjustment for baseline characteristics, 1-SD higher urine A1M [hazard ratio (HR) 1.33, 95% confidence interval (CI) 1.12-1.58] and urine B2M (HR 1.28, 95% CI 1.10-1.48) were each associated with higher risk of cardiovascular death. We did not observe interaction across subgroups based on age, sex, albuminuria, or prevalent CVD.</p><p><strong>Conclusion: </strong>In a population-based cohort of adults, proximal tubule reabsorptive dysfunction, as indicated by elevated levels of urinary A1M and B2M, was associated with higher risk of cardiovascular death independent of eGFR and albuminuria.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 3","pages":"oeag091"},"PeriodicalIF":4.3,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13262532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148255213","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":"Comparative long-term prognosis of acute myocardial infarction and acute aortic dissection in a population-based registry.","authors":"Yuichi Sawayama, Akiko Harada, Naoyuki Takashima, Takashi Yamamoto, Yosuke Higo, Kensuke Takabayashi, Wataru Shioyama, Takako Fujii, Sachiko Tanaka-Mizuno, Yoshikuni Kita, Katsuyuki Miura, Kazumichi Yoshida, Kazuhiko Nozaki, Tomoaki Suzuki, Yoshihisa Nakagawa","doi":"10.1093/ehjopen/oeag094","DOIUrl":"10.1093/ehjopen/oeag094","url":null,"abstract":"<p><strong>Aims: </strong>Acute myocardial infarction (AMI) and acute aortic dissection (AAD) are major cardiovascular emergencies with high mortality; however, their long-term prognoses have rarely been directly compared within the same population. Understanding differences in real-world outcomes between these conditions is important for patient informing and evaluation of cardiovascular care.</p><p><strong>Methods and results: </strong>We analysed 1923 patients enrolled in the Shiga Stroke and Heart Attack Registry, a population-based registry covering an entire Shiga Prefecture in Japan, who developed AMI or AAD between 2014 and 2015. The primary outcome was all-cause death, and the secondary outcome was cardiovascular death during 5-year follow-up. Hazard ratios (HRs) were estimated using multivariable Cox models adjusted for age and sex. Landmark analyses beyond 30 days evaluated outcomes among early survivors. Of the total cohort, 1550 were AMI [ST-elevation myocardial infarction (MI): <i>n</i> = 902 (58%); non-ST-elevation MI: <i>n</i> = 464 (30%); and sudden cardiac death due to MI: <i>n</i> = 184 (12%)], and 373 were AAD [type A: <i>n</i> = 219 (59%); type B: <i>n</i> = 154 (41%)]. Five-year all-cause mortality was higher in AAD than AMI [50.0% vs. 35.4%; adjusted HR 1.53, 95% confidence interval (CI) 1.29-1.83; <i>P</i> < 0.001]. Cardiovascular mortality was also higher in AAD (38.7% vs. 27.4%; adjusted HR 1.41, 95% CI 1.17-1.71; <i>P</i> < 0.001). Landmark analysis showed that excess mortality in AAD was mainly driven by early deaths, whereas cardiovascular mortality among 30-day survivors was similar between diseases.</p><p><strong>Conclusion: </strong>In this population-based study in Japan, AAD was associated with worse 5-year survival than AMI. Among acute-phase survivors, long-term cardiovascular outcomes were comparable.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 3","pages":"oeag094"},"PeriodicalIF":4.3,"publicationDate":"2026-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13256082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148255187","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":"Imaging and biomarker-based risk stratification in TAVI: the role of epicardial fat, visceral fat, and adiponectin.","authors":"Tatyana Storozhenko, Dimitri Buytaert, Raffaella Mistrulli, Michele Mattia Viscusi, Sara Corradetti, Emiliano Fiori, Leen Delrue, Monika Beles, Jozef Bartunek, Liesbeth Rosseel, Eric Wyffels, Marc Vanderheyden","doi":"10.1093/ehjopen/oeag085","DOIUrl":"10.1093/ehjopen/oeag085","url":null,"abstract":"<p><strong>Aims: </strong>Transcatheter aortic valve implantation (TAVI) has become a standard treatment for severe aortic stenosis, yet clinical outcomes vary significantly. Epicardial adipose tissue (EAT), visceral adipose tissue (VAT), and circulating adiponectin may contribute to this heterogeneity. This study aimed to determine how adipose tissue characteristics, in combination with adiponectin levels, affect clinical outcomes following TAVI.</p><p><strong>Methods and results: </strong>This single-centre retrospective study included 243 patients with severe aortic stenosis who underwent TAVI. Pre-procedural computed tomography scans were processed using artificial intelligence to quantify EAT density (EAT_HU) and VAT area at the level of the L3 vertebra (VAT_L3A). Patients were stratified into groups based on median adiponectin (6.54 µg/mL), VAT_L3A (135 mm), EAT_HU (-82.0 HU), and EAT_VOL (31 mL). The primary endpoint was 1-year major adverse cardiac and cerebrovascular events (MACCE), defined as all-cause mortality, heart failure hospitalization, or stroke. Over a mean follow-up of 344 ± 77 days, there were 25 deaths (10%), 12 heart failure hospitalizations (5%), and 7 strokes (3%). Circulating adiponectin (adjusted HR 1.34 per 5 μg/mL, 95% CI 1.05-1.70; <i>P</i> = 0.017) and VAT_L3A (adjusted HR 0.63 per 100 mm², 95% CI 0.44-0.91; <i>P</i> = 0.014) independently associated with MACCE, EAT_HU, and EAT_VOL did not. All three combined adipose-adiponectin phenotypes demonstrated significant graded risk (<i>P</i>-for-trend 0.003-0.048), with the high EAT_VOL/high adiponectin phenotype showing the strongest association (adjusted HR 4.25, 95% CI 1.80-10.07).</p><p><strong>Conclusion: </strong>Circulating adiponectin and VAT_L3A independently predict 1-year MACCE after TAVI. EAT parameters become prognostically informative only when combined with adiponectin.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 3","pages":"oeag085"},"PeriodicalIF":4.3,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229236","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":"Outcomes after inhospital, subacute, and elective TAVI in COMPARE-TAVI 1.","authors":"Troels Thim, Henrik Nissen, Phillip Freeman, Jordi Sanchez Dahl, Rebekka Vibjerg Jensen, Evald Høj Christiansen, Ashkan Eftekhari, Bjarne Linde Nørgaard, Jonas Agerlund Povlsen, Steen Hvidtfeldt Poulsen, Kristian Altern Øvrehus, Christian Juhl Terkelsen","doi":"10.1093/ehjopen/oeag083","DOIUrl":"10.1093/ehjopen/oeag083","url":null,"abstract":"<p><strong>Aims: </strong>We aimed to compare procedural, echocardiographic, and clinical outcomes within the first year after transcatheter aortic valve implantation (TAVI) among inhospital and subacute patients to elective patients in the COMPARE-TAVI 1 cohort.</p><p><strong>Methods and results: </strong>Among 1030 patients treated with TAVI, 927 (90%) had an elective procedure, 63 (6.1%) had a subacute procedure, and 40 (3.9%) had an inhospital procedure. Procedural characteristics and outcomes were comparable. Among elective, subacute, and inhospital patients, mortality at 30 days was 15 (1.6%), 0 (0%), and 0 (0%) and at 1 year 54 (5.8%), 4 (6.3%), and 2 (5.0%). Stroke at 30 days was 28 (3.0%), 0 (0%), and 3 (7.5%) and at 1 year 42 (4.5%), 5 (7.9%), and 3 (7.5%). New pacemaker at 30 days was 119 (14%), 12 (21%), and 6 (17%) and at 1 year 130 (16%), 14 (25%), and 7 (19%). Elective, subacute, and inhospital patients with LVEF ≤40%, improved their LVEF from 33% (28-37), 33% (27-37), and 28% (22-33) before TAVI to 46% (35-60), 43% (33-52), and 42% (33-55) at 30-days, and 54% (45-62), 53% (43-61), and 49% (39-63) at 1-year. Differences between the groups were not statistically significant.</p><p><strong>Conclusion: </strong>After transfemoral TAVI with balloon-expandable valves in COMPARE-TAVI 1, procedural, echocardiographic, and clinical outcomes were comparable among elective, subacute, and inhospital patients within the first year.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 3","pages":"oeag083"},"PeriodicalIF":4.3,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229605","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":"Association of self-reported sports volume and discipline with atrial arrhythmia prevalence in middle-aged males.","authors":"Jarne De Paepe, Astrid Witters, Ruben De Bosscher, Christophe Dausin, Rik Pauwels, Boris Delpire, Youri Bekhuis, Hein Heidbuchel, Guido Claessen, Andre La Gerche, Rik Willems, Tomas Robyns","doi":"10.1093/ehjopen/oeag089","DOIUrl":"10.1093/ehjopen/oeag089","url":null,"abstract":"<p><strong>Aims: </strong>A J-shaped relationship between exercise and atrial fibrillation (AF) or atrial flutter (AFL) has been described, but the influence of specific sport disciplines is unknown.</p><p><strong>Purpose: </strong>To examine the relationship between endurance exercise and AF/AFL prevalence in middle-aged men.</p><p><strong>Methods and results: </strong>We analysed questionnaire data from 3939 candidates for the Master@Heart study, assessing self-reported exercise history, cardiovascular risk factors and history of AF/AFL. Participants were divided into quartiles of lifetime endurance exercise hours: Q1 ≤ 1778, Q2 1779-5977, Q3 5978-12231, and Q4 > 12 231 h. Multivariable logistic regression was performed to assess the relationship between exercise volume and type and AF/AFL. AF/AFL prevalence was 7.5% and increased significantly across lifetime exercise quartiles (4.8%, 7.6%, 8.0%, and 9.6% from Q1 to Q4; <i>P</i> < 0.001). Adjusting for age, height, and traditional risk factors, Q2-Q4 had significantly higher odds ratios of AF/AFL compared to Q1, with the largest effect for Q4 (OR 2.16, 95% CI [1.48-3.15], <i>P</i> < 0.001). As sport, only cycling was independently associated with AF/AFL (OR 1.51 [1.11-2.07], <i>P</i> = 0.010).</p><p><strong>Conclusion: </strong>In middle-aged males, greater lifetime endurance exercise volume (>1778 h) was associated with progressively increased odds ratios of AF/AFL, with the greatest risk in the highest quartile (>12 231 h), independent of traditional risk factors. Cycling specifically was associated with AF/AFL. These findings support existing evidence that high-volume endurance exercise may increase AF/AFL risk, even in traditionally low-risk individuals, and furthermore suggest a possible sports-specific effect.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 3","pages":"oeag089"},"PeriodicalIF":4.3,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13310086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148348000","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":"Septal reduction therapy in obstructive hypertrophic cardiomyopathy: contextualizing outcomes in an era of cardiac myosin inhibition.","authors":"Anirudh Govind","doi":"10.1093/ehjopen/oeag087","DOIUrl":"10.1093/ehjopen/oeag087","url":null,"abstract":"","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 3","pages":"oeag087"},"PeriodicalIF":4.3,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13273410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280519","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":"Oral anticoagulation discontinuation after atrial fibrillation ablation: a systematic review and meta-analysis of randomized trials.","authors":"Ahmed Salih, Antonio Creta, Hussam Ali, Riccardo Cappato, Rui Providencia","doi":"10.1093/ehjopen/oeag067","DOIUrl":"10.1093/ehjopen/oeag067","url":null,"abstract":"<p><strong>Aims: </strong>The need for long-term oral anticoagulation (OAC) after apparently successful atrial fibrillation (AF) catheter ablation remains uncertain. Although ablation reduces AF recurrence, it is unclear whether this translates into a low stroke risk to sufficiently discontinue anticoagulation. This systematic review assesses whether stopping OAC after successful AF ablation affects thromboembolic or bleeding risk.</p><p><strong>Methods and results: </strong>We searched MEDLINE, Embase, and Scopus up to 13 November 2025 for randomized controlled trials (RCTs) enrolling adults with AF who underwent catheter ablation and were subsequently randomized to continue or discontinue OAC. Outcomes were pooled using random-effects models. The primary endpoints were stroke, systemic embolism, and major bleeding. Three RCTs met inclusion criteria (<i>n</i> = 2324). Participants remained arrhythmia-free for at least 6 months before randomization and had mean CHA₂DS₂VASc score range of 2.0-2.6. Over a median follow-up of 25.14 months (IQR 17.44-30.57), discontinuing OAC did not increase stroke risk [OAC 0.86% vs. no OAC 0.69%; risk difference (RD) 0.24%; 95% confidence interval (CI) -0.67% to 1.15%; <i>P</i> = 0.61]. No systemic embolic events occurred in either group. Annualized stroke incidence was similarly low between groups (incidence rate ratio 1.32; 95% CI 0.32-5.41; <i>P</i> = 0.70). Continuing OAC significantly increased major bleeding (OAC 0.90% vs. no OAC 0.34%; RD 0.91%; 95% CI 0.17-1.65%; <i>P</i> = 0.02).</p><p><strong>Conclusion: </strong>In patients who remain arrhythmia-free after AF ablation, stopping OAC did not increase thromboembolic events and substantially reduced major bleeding, suggesting that in post-ablation patients with low thromboembolic risk, and no demonstration of AF relapse for at least 6-12 months, discontinuation of OAC may be potentially safe.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 3","pages":"oeag067"},"PeriodicalIF":4.3,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229372","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":"Standardized processing of explanted hearts after stereotactic arrhythmia radiotherapy (Bio-STAR): a STOPSTORM framework and first human findings.","authors":"Sotirios Nedios, Judith Hüttemeister, Emanuel Heil, Petra Büttner, Kerstin Bode, Nils Henrik Nicolay, Franziska Nägler, Christos Moustakis, Alexey Dashkevich, Michal Nozdrzykowski, Michael Borger, Martin Neef, Rolf Wachter, Ulrich Laufs, Tomasz Jadczyk, Bert Vandenberk, Tevfik Ismail, Ursula Rohrer, Claudia Herrera Siklódy, Moritz Sinner, Niccolò Giaj Levra, Gaetano Maria De Ferrari, Daniel Scherr, Adrian Zaman, Boldizsar Kovacs, Stephan Hohmann, Nicolaus Andratschke, Franziska Hausmann, Felix Mehrhof, Etienne Pruvot, Katja Zeppenfeld, Oliver Blanck, Gerhard Hindricks, Felix Hohendanner","doi":"10.1093/ehjopen/oeag086","DOIUrl":"10.1093/ehjopen/oeag086","url":null,"abstract":"<p><strong>Aims: </strong>Stereotactic arrhythmia radiotherapy (STAR) is an emerging non-invasive option for refractory ventricular tachycardia (VT); yet, the underlying myocardial effects in humans remain poorly understood. Within the STOPSTORM consortium, we developed the Bio-STAR framework for standardized <i>ex vivo</i> assessment of STAR-treated myocardium and here report its feasibility and initial findings in human samples.</p><p><strong>Methods and results: </strong>Bio-STAR standardizes myocardial sampling into non-irradiated control (NFNI), minimally fibrotic irradiated, and fibrotic irradiated zones, guided by visual inspection, electroanatomical maps, and radiotherapy dose overlays. Recommended analyses span <i>ex vivo</i> MRI, histology, immunohistochemistry/-fluorescence, molecular panels, and live-cell assays. Application to two explanted non-ischaemic cardiomyopathy hearts (transplantation 3-5 months post-STAR) confirmed the protocol's applicability to end-stage remodelling. In exploratory analyses of irradiated regions, patient-specific patterns emerged, including stress marker upregulation, and altered NaV1.5, SERCA2a, and CaV1.2 when normalized to cardiomyocyte content. Functional analyses in a limited number of viable cardiomyocytes from the respective regions demonstrated heterogeneous excitability, supporting the feasibility of isolating live cells from STAR-treated regions in which Ca²⁺ signalling can be quantitatively assessed in future studies involving larger patient cohorts.</p><p><strong>Conclusion: </strong>Bio-STAR provides a reproducible framework for multimodal analysis of STAR-treated myocardium, enabling harmonized cross-centre research. Early human data demonstrate that cardiomyocyte viability and isolatability are preserved across all assessed regions and that STAR-exposed areas may exhibit region-specific structural features, while functional data on Ca²⁺ handling remain exploratory and require validation in larger datasets. Broad adoption will be the key to delineating dose-time-substrate relationships and disentangling radiation effects from underlying cardiomyopathy.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 3","pages":"oeag086"},"PeriodicalIF":4.3,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229742","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 cumulative incidence of atrial fibrillation in the hospitalized medical patient: a systematic review and meta-analysis.","authors":"Hani Essa, Ashwin Balu, Gregory Y H Lip, Ingeborg Welters","doi":"10.1093/ehjopen/oeag080","DOIUrl":"10.1093/ehjopen/oeag080","url":null,"abstract":"<p><p>New-onset atrial fibrillation (NOAF) is the most common cardiac arrhythmia occurring in hospitalized patients. NOAF confers a significant risk of cardiovascular morbidity and mortality in the form of symptomatic tachyarrhythmia, heart failure, stroke and sudden cardiac death. It is unclear what the cumulative incidence of NOAF is in the hospitalized medical (non-surgical) patient. MEDLINE and Embase were searched for studies published between 01 January 2000 and 10 March 2026. All studies reporting the cumulative incidence of NOAF in hospitalized medical (non-surgical) patients were included. The pooled cumulative incidence of NOAF, 95% confidence intervals (CI), and 95% prediction intervals (PI) were computed using a random-effects model. The inconsistency index (<i>I</i> ²) was calculated to measure heterogeneity. Subgroup analyses were also performed. A study protocol was registered with the PROSPERO database of systematic reviews (CRD42024626333) A total of 10 323 articles were identified from our searches, and of these 62 met the inclusion criteria. The cumulative incidence of NOAF across all studies was 99 474 (crude incidence 2.4%) out of 3 608 663 patients. The pooled cumulative incidence of NOAF was 9% (95% CI: 7-11%), with substantial heterogeneity (<i>I</i> ² = 99.9%) and a wide prediction interval (1-42%). In meta-regression, ICU setting (OR 2.46, 95% CI: 1.22-5.00; <i>P</i> = 0.013) and prospective study design (OR 1.73, 95% CI: 1.01-2.95; <i>P</i> = 0.044) were independently associated with higher NOAF incidence, while year of publication and use of administrative data were not significant. Subgroup analyses demonstrated consistently higher incidence in prospective and critically ill populations. The cumulative incidence of NOAF in patients hospitalized for acute medical illness varies significantly dependent on disease severity and methods to detect it. Attempts to pool data across studies are limited by differences in study design, patient populations and disease severity.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 3","pages":"oeag080"},"PeriodicalIF":4.3,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229724","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 chronic kidney disease on clinical outcomes among patients with atrial fibrillation following percutaneous left atrial appendage occlusion: a multicentre cohort study.","authors":"Ahmed Mazen Amin, Ameer Awashra, Ubaid Khan, Christopher V DeSimone","doi":"10.1093/ehjopen/oeag082","DOIUrl":"10.1093/ehjopen/oeag082","url":null,"abstract":"<p><strong>Aims: </strong>Atrial fibrillation (AF) and chronic kidney disease (CKD) often coexist, and both increase the risk of thromboembolism and bleeding. We aim to investigate the impact of CKD in patients with AF undergoing left atrial appendage occlusion (LAAO).</p><p><strong>Methods and results: </strong>We conducted a retrospective analysis using the TriNetX database, from April 2015 to February 2023. Patients aged ≥ 18 years with AF undergoing their first LAAO were included. We performed a comparative analysis of patients with CKD/end-stage renal disease (ESRD) vs. those without. Propensity Score Matching (PSM) (1:1) was employed based on baseline characteristics. The primary outcomes were ischaemic stroke/transient ischaemic attack (TIA)/systemic embolism (SE) and major bleeding over a three-year follow-up. We included 10 689 patients, of whom 4140 had CKD/ESRD, and 6549 had no CKD. PSM resulted in 3085 patients in each cohort. CKD/ESRD was significantly associated with a higher risk of major bleeding [HR: 1.179, 95% CI (1.080, 1.288), <i>P</i> < 0.001], acute myocardial infarction, acute heart failure, acute kidney injury, cardiac-related haemodynamic instability (CRHI), hospitalizations, and all-cause mortality (<i>P</i> < 0.001), with no significant difference in ischaemic stroke/TIA/SE [HR: 1.019, 95% CI (0.909, 1.141), <i>P</i> = 0.750].</p><p><strong>Conclusion: </strong>Our study suggests that CKD/ESRD was significantly associated with a higher risk of major bleeding, acute myocardial infarction, acute heart failure, acute kidney injury, CRHI, hospitalizations, and all-cause mortality, with no significant difference in ischaemic stroke/TIA/SE among patients with AF undergoing LAAO.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 3","pages":"oeag082"},"PeriodicalIF":4.3,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13262529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148255190","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}