European heart journal open最新文献

{"title":"Prevalence of albuminuria and its association with left atrial remodelling in patients with atrial fibrillation.","authors":"Koki Nakanishi, Masao Daimon, Katsuhito Fujiu, Kentaro Iwama, Kazutoshi Hirose, Yuriko Yoshida, Yasuhiro Mukai, Hikari Seki, Yuko Yamamoto, Megumi Hirokawa, Tomoko Nakao, Tsukasa Oshima, Takumi Matsubara, Yu Shimizu, Gaku Oguri, Toshiya Kojima, Eriko Hasumi, Hiroyuki Morita, Makoto Kurano, Norihiko Takeda","doi":"10.1093/ehjopen/oeaf054","DOIUrl":"10.1093/ehjopen/oeaf054","url":null,"abstract":"<p><strong>Aims: </strong>Although recent epidemiological studies identified albuminuria as an independent risk for atrial fibrillation (AF), even in individuals with a preserved or mildly reduced estimated glomerular filtration rate (eGFR), the prevalence of albuminuria and its association with left atrial (LA) remodelling in patients with AF remains unknown. This study aimed to investigate the association of albuminuria with LA structure and mechanics before and after catheter ablation (CA) in AF patients.</p><p><strong>Methods and results: </strong>We examined 133 AF patients with an eGFR ≥60 mL/min/1.73 m² who underwent first CA. Conventional and speckle-tracking echocardiography was performed before and 6 months after CA to assess the LA volume index, LA reservoir strain, and LA stiffness. The median eGFR was 70 mL/min/1.73m², and 21 (15.8%) patients had albuminuria. The difference between the eGFR values of patients with and without albuminuria was not significant (<i>P</i>  <i>=</i> 0.709). Patients with albuminuria had a larger LA volume index, reduced LA reservoir strain and increased LA stiffness compared with patients without albuminuria (all <i>P</i> < 0.001). The presence of albuminuria was associated with reduced LA reservoir strain and increased LA stiffness, independent of age, AF type, and AF risk factors. After CA, there was significant improvement in LA size and function in both groups, while albuminuria group still had a larger LA volume index and increased LA stiffness (both <i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>Approximately 16% of AF patients with preserved or mildly reduced eGFR had albuminuria. The presence of albuminuria was related to unfavourable LA remodelling and its persistence even after restoration of sinus rhythm.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf054"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183452","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":"Aspirin does not modify cardiovascular event risk in endometriosis in the California Teachers Study.","authors":"Alison Seitz, Cenai Zhang, Leslie Bull, Hooman Kamel, Halina White, Babak B Navi, Ja Hyun Shin, Jill Berkin, Jed H Kaiser, Vanessa Liao, Ava L Liberman","doi":"10.1093/ehjopen/oeaf023","DOIUrl":"10.1093/ehjopen/oeaf023","url":null,"abstract":"<p><strong>Aims: </strong>Endometriosis frequently affects reproductive aged females and is associated with increased cardiovascular disease risk. The aims of this study were (i) to confirm the relationship between cardiovascular disease and endometriosis and (ii) to test whether aspirin modified the effect of endometriosis on cardiovascular disease risk.</p><p><strong>Methods and results: </strong>A longitudinal cohort study was conducted using data from the California Teachers Study from enrolment (1995-1996) through the current administrative end follow-up (31 December 2020). Primary outcome was any incident major adverse cardiovascular event (MACE) defined using validated ICD-9/ICD-10 codes for stroke, myocardial infarction, and coronary heart disease. Inverse probability (IP) weights were used to estimate the causal effect of self-reported endometriosis on cardiovascular events. Of the included 120 435 participants, 13 754 (11.4%) reported history of endometriosis. There were 2159 admissions for MACE in the endometriosis group vs. 16 632 in the non-endometriosis group. After controlling for demographics and vascular comorbidities, risk of MACE was higher in the endometriosis group than in the non-endometriosis group [IP-weighted hazard ratio (HR) 1.10, confidence interval (CI) 1.04-1.15], particularly in participants < 40 years of age (IP-weighted HR 1.48, CI 1.08-2.02). Aspirin use did not modify the effect of endometriosis on MACE (<i>P</i> interaction = 0.467). Among participants taking aspirin, the adjusted HR for endometriosis was 1.07 (95% CI, 0.96-1.19) whereas among participants not taking aspirin, adjusted HR was 1.10 (95% CI, 1.04-1.17).</p><p><strong>Conclusion: </strong>In a large American cohort, endometriosis was associated with increased risk of adverse cardiovascular events, especially in younger participants. Aspirin did not modify this risk. Research to determine how to best reduce cardiovascular risk in endometriosis is warranted.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf023"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082941","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 capacity in heart failure: a systematic review and meta-analysis of HFrEF and HFpEF disparities in VO₂peak and 6-minute walking distance.","authors":"Konstantinos Prokopidis, Krzysztof Irlik, Theocharis Ispoglou, Panagiotis Ferentinos, Alexandros Mitropoulos, Mathias Schlögl, Masoud Isanejad, Kamil Kegler, Katarzyna Nabrdalik, Gregory Y H Lip","doi":"10.1093/ehjopen/oeaf055","DOIUrl":"10.1093/ehjopen/oeaf055","url":null,"abstract":"<p><strong>Aims: </strong>Heart failure (HF) with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF) exhibit unique physiological pathways, influencing exercise capacity and functional performance. This systematic review and meta-analysis aimed to compare peak oxygen consumption (VO_2peak), six-minute walk distance (6MWD), cardiac output (CO), and stroke volume (SV), between these phenotypes.</p><p><strong>Methods and results: </strong>A systematic literature search of cohort studies via databases (PubMed, Web of Science, Scopus, and Cochrane Library) was conducted from inception until October 2024. A meta-analysis using a random-effects model to calculate the pooled effects was employed. Forty-six studies were included. HFrEF patients demonstrated significantly greater 6MWD compared to HFpEF (<i>k</i> = 20; mean difference (MD): 18.09 m, 95% confidence interval (CI) 1.59-34.59, I² = 86%, <i>P</i> = 0.03), though this difference became insignificant after adjusting for comorbidities. Conversely, HFpEF patients exhibited higher VO_2peak (<i>k</i> = 20; MD: -0.78 mL/kg/min, 95% CI -1.45--0.11, I² = 89%, <i>P</i> = 0.02), CO (<i>k</i> = 12; MD: -1.15 L/min, 95% CI -2.11--0.19, I² = 97%, <i>P</i> = 0.02), and SV (<i>k</i> = 14; SMD: -1.00, 95% CI -1.60--0.39, I² = 95%, <i>P</i> < 0.01). Age was identified as a significant moderator of VO_2peak.</p><p><strong>Conclusion: </strong>HFpEF patients demonstrated superior VO_2peak, CO, and SV compared to HFrEF patients, while the observed 6MWD advantage in HFrEF was likely influenced by comorbidities. Our findings emphasize the importance of tailoring rehabilitation strategies to HF phenotype-specific physiological profiles, particularly focusing on improving VO_2peak and cardiac efficiency in HFpEF.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf055"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510048","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":"Sodium-glucose cotransporter-2 inhibitors and ketoacidosis in heart failure: analysis of US Adverse Event Reporting System (FAERS).","authors":"Samantha L Yeung, Mengxi Wang, Mimi Lou, Tien M H Ng","doi":"10.1093/ehjopen/oeaf056","DOIUrl":"10.1093/ehjopen/oeaf056","url":null,"abstract":"","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf056"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12117328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176214","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-guided percutaneous coronary intervention in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: are we there yet?","authors":"Lennert Minten, Christophe Dubois","doi":"10.1093/ehjopen/oeaf052","DOIUrl":"10.1093/ehjopen/oeaf052","url":null,"abstract":"","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf052"},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251505","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":"Cardiac function after catheter ablation of ventricular arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy.","authors":"Fatima M Ezzeddine, Nathaniel E Davis, Samuel J Asirvatham, John P Bois, Ian C Chang, Abhishek Deshmukh, Paul A Friedman, John Giudicessi, Suraj Kapa, Gurukripa G Kowlgi, Siva K Mulpuru, Nicholas Y Tan, Konstantinos C Siontis, Alan Sugrue, Ammar M Killu","doi":"10.1093/ehjopen/oeaf049","DOIUrl":"10.1093/ehjopen/oeaf049","url":null,"abstract":"<p><strong>Aims: </strong>Catheter ablation is commonly performed in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) for management of ventricular arrhythmias (VAs). The impact of catheter ablation on cardiac function is unknown. The aim is to assess the impact of catheter ablation for VAs on cardiac function in patients with ARVC.</p><p><strong>Methods and results: </strong>This retrospective study included consecutive patients with ARVC who underwent catheter ablation for VAs. Cardiac and valvular functions were assessed on pre- and post-procedure cardiac imaging. The severities of tricuspid regurgitation, pulmonic regurgitation, right ventricular (RV) enlargement, and RV systolic dysfunction was graded as absent (=0), mild (=1), mild-moderate (=2), moderate (=3), moderate-severe (=4), or severe (=5). Thirty-four patients were included. Median age at the time of ablation was 49 [inter-quartile range (IQR), 23] years, and 10 (29%) patients were female. After a median follow-up of 1 (IQR, 0) day, 11 (34%) patients had worsening RV function, and 4 (12%) patients had worsening left ventricular ejection fraction (LVEF) >5%. Five (15%) patients required inotropic support. After a median follow-up of 6.5 (IQR, 6.4) months, 20 (59%) patients had repeat transthoracic echocardiograms. Among patients with worsening RV function post-ablation, one-sixth (17%) had improvement in the RV function at follow-up. In contrast, among patients who had an acute drop in LVEF post-ablation, two-thirds (67%) had improvement at follow-up.</p><p><strong>Conclusion: </strong>Right ventricular dysfunction following catheter ablation in patients with ARVC is common, affecting one-third of patients. Patients undergoing catheter ablation of VAs should be counselled on the potential negative impact of ablation on cardiac function.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf049"},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12127728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210549","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 impact of high microvascular resistance on coronary wave energetics depends on coronary microvascular functionality.","authors":"Ahmet Tas, Yaren Alan, Ilke Kara Tas, Sabahattin Umman, Kim H Parker, Tim P van de Hoef, Murat Sezer, Jan J Piek","doi":"10.1093/ehjopen/oeaf050","DOIUrl":"10.1093/ehjopen/oeaf050","url":null,"abstract":"<p><strong>Aims: </strong>The pathophysiological relevance of high hyperemic microvascular resistance (hMR) in stable coronary artery disease is controversial. Using wave intensity analysis (WIA, defined as the product of the time derivatives of the coronary pressure and velocity), we aim to compare the impact of high hMR on coronary wave energetics with respect to coronary microvascular dysfunction (CMD), defined as reduced coronary flow reserve (CFR < 2.5), in unobstructed arteries.</p><p><strong>Methods and results: </strong>The study population (<i>n</i> = 258, mean age = 68 ± 10 years, 73% male) had a high cardiovascular risk profile including dyslipidemia (88%), hypertension (70%), smoking (55%) and diabetes (28%). The mean fractional flow reserve was 0.89 ± 0.05. Vessels (<i>n</i> = 312) were divided into four endotypes: no CMD-low hMR (CFR ≥ 2.5, hMR < 2.5 mmHg.s.cm^-1), Functional CMD (CFR < 2.5, hMR < 2.5 mmHg.s.cm^-1), Structural CMD (CFR < 2.5, hMR ≥ 2.5 mmHg.s.cm^-1), and no CMD-high hMR (CFR ≥ 2.5, hMR ≥ 2.5 mmHg.s.cm^-1). The no CMD-high hMR endotype had the lowest mean resting velocity (bAPV = 10 ± 3 cm.s^-1  <i>P</i> < 0.001), highest mean basal microvascular resistance (bMR = 9 ± 2 mmHg/cm.s^-1  <i>P</i> < 0.001) amongst all endotypes, yet, it had reference-level CFR, microvascular resistance reserve and resistive reserve ratio (<i>P</i> > 0.05 for all compared to no CMD-low hMR), unlike CMD endotypes (<i>P</i> < 0.05 compared to CMD endotypes). The no CMD-high hMR endotype exhibited the highest hyperemic increase in the accelerating wave energy proportion (AEP) (13% ± 13%, <i>P</i> = 0.042), indicating an intact autoregulatory response. Only in the CMD endotypes, high hMR was associated with reduced AEP (<i>r</i> = -0.229, <i>P</i> < 0.001), unlike no CMD endotypes (<i>P</i> = 0.383).</p><p><strong>Conclusion: </strong>High hMR alone is not a definitive CMD marker. In line with the adaptive high hMR hypothesis, increased hMR does not necessarily limit augmentation of AEP, and is associated with robust autoregulatory capacity in vessels with preserved CFR. Cardiologists should be alert to a potential adaptive no CMD-high hMR endotype to avoid misdiagnosis.</p><p><strong>Registration: </strong>NCT02328820.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf050"},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12100483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144436","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 role of sphingolipids in heart failure.","authors":"Rana Hamouche, Scott A Summers, William L Holland, Sutip Navankasattusas, Stavros G Drakos, Eleni Tseliou","doi":"10.1093/ehjopen/oeaf035","DOIUrl":"10.1093/ehjopen/oeaf035","url":null,"abstract":"<p><p>Advanced heart failure (HF) is characterized by changes in the structure, function, and metabolism of cardiac muscle. As the disease progresses, cardiomyocytes shift their ATP production from fatty acid oxidation to glycolysis. This shift results in an accumulation of lipid metabolites, particularly sphingolipids, which can disrupt normal cellular function and contribute to cardiac dysfunction. In animal models of obesity, accumulation of toxic sphingolipid metabolites in the heart has been described as cardiac lipotoxicity. In humans, HF is classified into two groups based on ejection fraction (EF): HF with reduced EF of less than 40% (HFrEF) and HF with preserved EF of greater than 50% (HFpEF). Despite shared risk factors and comorbidities, the structural and cellular differences between HFrEF and HFpEF distinguish them as separate conditions. Ceramides (Cer), a type of sphingolipid, have gained significant attention for their involvement in the development and prognosis of atherosclerotic disease and myocardial infarction, while sphingosine-1-phosphate, a downstream product of Cer, has shown cardioprotective properties. The aim of this review is to describe the role of sphingolipids in HF with reduced and preserved EF. By understanding the role of sphingolipids through animal and human studies, this review aims to pave the way for developing strategies that target abnormal signalling pathways in the failing heart, ultimately bridging the gap between scientific research and clinical applications.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf035"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12046129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035825","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":"Cardiovascular magnetic resonance imaging markers of ageing: a multi-centre, cross-sectional cohort study.","authors":"Hosamadin S Assadi, Xiaodan Zhao, Gareth Matthews, Rui Li, Jordi Broncano Cabrero, Bahman Kasmai, Samer Alabed, Javier Royuela Del Val, Hilmar Spohr, Yashoda Gurung-Koney, Nay Aung, Sunil Nair, Andrew J Swift, Vassilios S Vassiliou, Liang Zhong, Abdallah Al-Mohammad, Rob J van der Geest, Peter P Swoboda, Sven Plein, Pankaj Garg","doi":"10.1093/ehjopen/oeaf032","DOIUrl":"10.1093/ehjopen/oeaf032","url":null,"abstract":"<p><strong>Aims: </strong>Cardiac ageing involves a series of anatomical and physiological changes contributing to a decline in overall performance. Cardiac magnetic resonance (CMR) provides comprehensive structural and functional assessment for detecting age-related cardiovascular remodelling. We aimed to develop a fully automated CMR model to predict functional heart age.</p><p><strong>Methods and results: </strong>This international, multi-centre, retrospective observational study enrolled 191 healthy individuals with normal body mass index (BMI), free of metabolic, cardiovascular, and respiratory disease as the derivation cohort. Left atrial (LA) end-systolic volume and LA ejection fraction were selected for the final model. The model was validated on 366 patients with BMI >25 kg/m² and one or more comorbidities [hypertension, diabetes mellitus (DM), atrial fibrillation (AF), and obesity]. In healthy individuals [median age: 34 years, 105 (55%) female], CMR-derived functional heart age was similar to the chronological age [bias: 0.05%, 95% confidence interval (CI): 9.56-9.67%, <i>P</i> = 0.993]. In the validation cohort [median age: 53 years, 157 (43%) female], CMR-derived functional heart age was 4.6 years higher than chronological age (95% CI: 1.6-7.6 years, <i>P</i> = 0.003). Cardiac magnetic resonance-derived functional heart age was significantly higher in patients with hypertension (<i>P</i> < 0.001), DM (<i>P</i> < 0.001), and AF (<i>P</i> < 0.001) than age-matched healthy controls. Moreover, CMR-derived functional heart age was higher than the chronological age in obesity Class I (<i>P</i> = 0.07), obesity Class II (<i>P</i> = 0.11), and obesity Class III (<i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>This study highlights the time course of structural and physiological changes in the heart during healthy and unhealthy ageing. We propose simple equations that should help communicate subtle changes in heart assessment with ageing.</p><p><strong>Registration: </strong>ClinicalTrials.gov: NCT05114785.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf032"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038882","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":"Mechanistic classification of isolated severe aortic regurgitation in a contemporary cohort of patients.","authors":"Rudy R Unni, Munir Boodhwani, Ibrahim Jelaidan, David T Harnett, Samia Massalha, Calvin Liang, Graeme Prosperi-Porta, David Glineur, Ian G Burwash, Kwan-Leung Chan, Thais Coutinho, Angel Fu, Nadav Willner, David Messika-Zeitoun, Luc Beauchesne","doi":"10.1093/ehjopen/oeaf042","DOIUrl":"https://doi.org/10.1093/ehjopen/oeaf042","url":null,"abstract":"<p><strong>Aims: </strong>Aortic regurgitation (AR) arises from leaflet disease and/or dilatation of the functional aortic annulus complex. Understanding the mechanisms of AR informs surgical planning of valve and aorta repair. This study investigates the mechanisms, aetiologies, and outcomes of isolated native severe AR in a consecutive cohort of patients.</p><p><strong>Methods and results: </strong>Patients with moderate-to-severe (3+)/severe (4+) native valve AR, identified from our institutional echocardiography database (2014-2018), were included. Exclusions were significant concomitant valve disease, endocarditis, or aortic dissection. AR was classified per the El-Khoury system: Type I (normal leaflet motion: Ia-ascending aorta/sinotubular junction dilatation, Ib-aortic root dilation, Ic-aortic annular dilation), Type II (leaflet prolapse), and Type III (leaflet restriction). Valve anatomy and clinical outcomes, including mortality and surgical intervention, were analyzed. Of 282 patients (77.3% male), 58.5% had multiple AR mechanisms. Type II (leaflet prolapse) was most common (48.6%), followed by Type III (36.2%). Bicuspid aortic valve (BAV) represented 35.5% of the population, with leaflet prolapse observed in 72%. Multiple mechanisms were more frequent in BAV (77% vs. 48%, <i>P</i> < 0.001). After a median follow-up of 4.7 years (available for 97.5% of patients), 158 (57.5%) underwent an intervention with 48.7% having an aortic valve repair or valve-sparing aortic root replacement.</p><p><strong>Conclusion: </strong>Although leaflet prolapse (Type II) was the pre-dominant AR mechanism, multiple contributing mechanisms were often present, particularly in BAV patients. Aortic valve repair accounted for nearly half of surgical interventions, underscoring the importance of mechanism identification to optimize repair and avoid valve replacement.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 3","pages":"oeaf042"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082944","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}