European heart journal open最新文献

{"title":"Efficacy of renal denervation as an adjunct to pulmonary vein isolation for atrial fibrillation treatment: a systematic review and meta-analysis.","authors":"Karish Thavabalan, Majed Sheikh, YuZhi Phuah, Sanjay K Rajput, Noor Fatima, Aman Sutaria, Jonathan J H Bray, Mahmood Ahmad, Hannah Glatzel, Reubeen Ahmad, Lily Snell, Niraj S Kumar, Carmen-Lucía García-Pérez, Luciano Candilio, Rui Providencia","doi":"10.1093/ehjopen/oeae065","DOIUrl":"10.1093/ehjopen/oeae065","url":null,"abstract":"<p><strong>Aims: </strong>Catheter ablation, consisting of pulmonary vein isolation (PVI), is the most effective treatment modality for the management of symptomatic patients with atrial fibrillation (AF). Unfortunately, this procedure has a considerable relapse rate, ranging from 15 to 50% depending on AF type and other patient factors. Hypertension (HTN) is associated with a higher risk of developing AF and can also be managed with a catheter-based procedure-renal denervation (RDN). This meta-analysis aimed to compare the effect of PVI with and without RDN in hypertensive patients with AF.</p><p><strong>Methods and results: </strong>OVID MEDLINE and Embase were searched on 1 February 2023 and trials that reported the effects of RDN on AF recurrence in hypertensive patients were included. A total of 637 patients across 8 randomised controlled trials were included. The results from the pooled analysis showed that when compared with PVI alone, RDN added to PVI: (1) Lowered AF recurrence [RR 0.67 (0.53, 0.85), <i>P</i> = 0.001, <i>I</i> ² = 23%, NNT = 5.9 patients]; (2) Reduced both systolic blood pressure and diastolic blood pressure, with medium effect size, as reflected by standardised mean differences of 0.5 (<i>P</i> = 0.02, <i>I</i> ² = 80%) and 0.43 (<i>P</i> = 0.006, <i>I</i> ² = 60%), respectively; and (3) was not associated with a decrease in estimated glomerular filtration rate (+7.19 mL/min/1.73 m², <i>P</i> = 0.15, <i>I</i> ² = 89%).</p><p><strong>Conclusion: </strong>Adding RDN to PVI in patients with AF and resistant HTN was associated with a reduction of blood pressure levels and AF recurrence. Consideration to RDN should be given as an adjunctive treatment for patients with AF and resistant HTN.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 4","pages":"oeae065"},"PeriodicalIF":0.0,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11340072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038045","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":"It is time to address the contribution of cholesterol in all apoB-containing lipoproteins to atherosclerotic cardiovascular disease.","authors":"Peter P Toth, Maciej Banach","doi":"10.1093/ehjopen/oeae057","DOIUrl":"10.1093/ehjopen/oeae057","url":null,"abstract":"<p><p>On average, LDL particles are the most populous lipoprotein in serum under fasting conditions. For many reasons, it has been the primary target of lipid-lowering guidelines around the world. In the past 30 years, we have witnessed remarkable changes in each iteration of dyslipidaemia guidelines, with LDL-cholesterol (LDL-C) targets becoming lower and lower among patients at high and very high risk for atherosclerotic cardiovascular disease (ASCVD). The world over, goal attainment rates are low, and hence, ASCVD prevalence remains unacceptably high. Inadequate LDL-C lowering is a major issue in contemporary cardiovascular (CV) medicine. Another issue that vexes even the most astute clinician is that of 'residual risk', meaning the excess risk that remains even after LDL-C is appropriately reduced. In recent years, an important new component of residual risk has emerged: triglyceride-enriched lipoproteins or remnant lipoproteins. These precursors to LDL particles can assume outsized importance among patients with derangements in triglyceride metabolism (e.g. genetic variants, insulin resistance, and diabetes mellitus) and may be more atherogenic than LDL species. Consequently, to reduce total risk for acute CV events, the time has come to include the entire spectrum of apoB-containing lipoproteins in approaches to both risk evaluation and treatment.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 4","pages":"oeae057"},"PeriodicalIF":0.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11335015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142010104","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":"Ventricular volume asymmetry as a novel imaging biomarker for disease discrimination and outcome prediction","authors":"Celeste McCracken, Liliana Szabo, Z. A. Abdulelah, Dorina Condurache, H. Vago, T. Nichols, Steffen E Petersen, S. Neubauer, Z. Raisi-Estabragh","doi":"10.1093/ehjopen/oeae059","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae059","url":null,"abstract":"\u0000 \u0000 \u0000 Disruption of the predictable symmetry of the healthy heart may be an indicator of cardiovascular risk. This study defines the population distribution of ventricular asymmetry and its relationships across a range of prevalent and incident cardiorespiratory diseases.\u0000 \u0000 \u0000 \u0000 The analysis includes 44,796 UK Biobank participants (average age 64.1±7.7 years; 51.9% women). Cardiovascular magnetic resonance (CMR) metrics were derived using previously validated automated pipelines. Ventricular asymmetry was expressed as the ratio of left and right ventricular (LV, RV) end-diastolic volumes. Clinical outcomes were defined through linked health records. Incident events were those occurring for the first time after imaging, longitudinally tracked over an average follow-up time of 4.75 ± 1.52 years. The normal range for ventricular symmetry was defined in a healthy subset. Participants with values outside the 5th-95th percentiles of the healthy distribution were classed as either LV dominant (LV/RV > 112%) or RV dominant (LV/RV < 80%) asymmetry. Associations of LV and RV dominant asymmetry with vascular risk factors, CMR features, and prevalent and incident cardiovascular diseases were examined using regression models, adjusting for vascular risk factors, prevalent diseases, and conventional CMR measures. LV-dominance was linked to an array of pre-existing vascular risk factors and cardiovascular diseases, and a two-fold increased risk of incident heart failure, non-ischemic cardiomyopathies, and left-sided valvular disorders. RV dominance was associated with an elevated risk of all-cause mortality.\u0000 \u0000 \u0000 \u0000 Ventricular asymmetry has clinical utility for cardiovascular risk assessment, providing information that is incremental to traditional risk factors and conventional CMR metrics.\u0000","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"2 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141804816","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":"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}