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Journal articleSamways JW, Cheng T, Chow J-J, et al., 2026,
Ventricular repolarization is improved by His resynchronization therapy but not biventricular pacing.
, Heart Rhythm, Vol: 23, Pages: e220-e229BACKGROUND: Biventricular pacing (BVP) delivered cardiac resynchronization therapy (CRT) modestly improves activation synchrony in patients with heart failure and left bundle branch block (LBBB) but can trigger ventricular arrhythmias. His bundle pacing (HBP) can correct LBBB as an alternative CRT method, producing superior ventricular activation synchrony and hemodynamics. OBJECTIVE: The aim of the study was to investigate the relative effects of HBP-CRT and BVP-CRT on ventricular repolarization. METHODS: Patients with LBBB referred for BVP-CRT underwent intra-procedural non-invasive epicardial mapping during atrial pacing (intrinsic LBBB), BVP-CRT, and temporary HBP. When HBP corrected LBBB, changes from baseline (LBBB) in overall and left ventricular (LV) repolarization dispersion (ΔVRT, ΔLVRT), repolarization gradient (ΔVRG, ΔLVRG) and activation-recovery interval (ARI) dispersion (ΔVARI, ΔLVARI) were measured. RESULTS: 17 patients had full datasets. BVP-CRT had no effect on global repolarization dispersion, gradient steepness or ARI (ΔVRT -1.5 ms, 95% confidence interval [CI] -15.4 to +12.4, P = .82; ΔVRG -0.00549 ms/mm, -0.106 to +0.0954, P = .9; ΔVARI -5.0 ms, -24.3 to +14.3, P = .59) and worsened the parameters in the LV (ΔLVRT +14.5 ms, +0.05 to +28.9, P = .049; ΔLVRG +0.0931 ms/mm, -0.0635 to +0.25, P = .226, ΔLVARI +28.6 ms, 95% CI +6.0 to +51.2, P = .02). HBP-CRT significantly improved global repolarization dispersion, gradient steepness and ARI (ΔLVRT +14.5 ms, +0.05 to +28.9, P = .049; ΔLVRG +0.0931 ms/mm, -0.0635 to +0.25, P = .226; ΔVARI -49.5 ms, -69.0 to -29.9, P < .0001) and within the LV (ΔLVRT -38.2 ms, -48.7 to -27.6, P < .001; ΔLVRG -0.228 ms/mm, -0.334 to -0.122, P = .0003; ΔLVARI -37.2 ms, -59.4 to -15.0, P = .003). CONCLUSION: HBP-CRT improves LBBB-induced repolarization abnormalities through improved activation synchrony and AR
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Journal articleMahmoudi M, Nicholas Z, Jabbour RJ, et al., 2026,
Anatomical, physiological and inflammatory characterization of nonculprit vessels in patients undergoing primary PCI for ST-elevation myocardial infarction in the presence of multivessel disease: Rationale and design of the PICNIC study
, AMERICAN HEART JOURNAL, Vol: 292, ISSN: 0002-8703 -
Journal articleSimader FA, Rajkumar CA, Foley MJ, et al., 2026,
Association Between Age and PCI Effectiveness in Stable CAD: Secondary Analysis of ORBITA-2.
, J Am Coll Cardiol, Vol: 87, Pages: 253-265BACKGROUND: ORBITA-2 (Objective Randomized Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina) was the first randomized placebo-controlled trial to show the efficacy of percutaneous coronary intervention (PCI) in patients with stable angina and single- or multivessel coronary artery disease without background antianginal medication. Whether the effect is consistent across age groups is unknown. OBJECTIVES: The authors sought to evaluate the interaction between age and symptom and stenosis severity, and the efficacy of PCI on the ORBITA-2 primary and secondary endpoints. METHODS: All patients from the primary ORBITA-2 trial contributed data to this post hoc analysis. For daily symptoms, a bayesian longitudinal Markov model was constructed. For treadmill exercise time, stress echocardiography, and questionnaires, a bayesian ordinal proportional odds model was used, including the prerandomization value and treatment arm, which were allowed to interact with age. RESULTS: The mean age was 64 ± 9 years, ranging from 40 to 82 years. There was little relationship between age and symptom and stenosis severity. In older patients, PCI was more effective for symptom relief (OR: 2.03; 95% CrI: 1.67-2.45; Pr > 0.99) than in younger patients (OR: 1.70; 95% CrI: 1.38-2.15; Pr > 0.99; Pr [interaction] = 0.99). In contrast, the effect of PCI on treadmill exercise time was far greater in younger than in older patients (50-year-old: +125 s [95% CrI: 35.8-215.0 s; Pr > 0.99]; 70-year-old: +31.9s [95% CrI: -12.6 to 78.3; Pr = 0.92]; Pr [interaction] = 0.96). CONCLUSIONS: PCI was effective across all ages in reducing angina frequency. Notably, there was limited improvement in treadmill exercise time in the elderly, challenging its role as a primary endpoint in many antianginal trials. These data should inform cardiovascular clinical trial design to ensure applicability across all ages. (Objective Randomized Blinded Investigation With Optimal
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Journal articleMohal JS, Whinnett ZI, Mohiddin SA, et al., 2026,
Electromechanically Optimized Right Ventricular Pacing for Obstructive Hypertrophic Cardiomyopathy: The EMORI-HCM Trial.
, J Am Coll Cardiol, Vol: 87, Pages: 124-139BACKGROUND: Many patients with symptomatic obstructive hypertrophic cardiomyopathy (oHCM) have devices capable of right ventricular pacing (RVP). Although pacing can reduce left ventricular outflow tract gradient (LVOTg), it can also reduce cardiac output, so its net effect is variable. OBJECTIVES: We tested whether electromechanical optimization of the programmed atrio-ventricular delay (AVD) allows RVP to achieve a net benefit on symptoms. METHODS: EMORI-HCM (Electromechanically Optimized Right Ventricular Pacing in Obstructive Hypertrophic Cardiomyopathy) is a multicenter, blinded, randomized, crossover trial of AVD-optimized RVP in patients with symptomatic oHCM with resting or provoked gradient of at least 30 mm Hg. Patients with existing dual-chamber devices were randomized to either 3 months of continuous AVD-optimized RVP (intervention) followed by 3 months of backup-only RVP (control), or vice versa. AVD was optimized using a high-precision multiple-alternation protocol assessing acute change in beat-by-beat blood pressure while varying AVD. The primary outcome was symptoms measured by the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score. Secondary outcomes include patient-reported daily symptom data collected using a dedicated smartphone application (ORBITA-app), dichotomous patient preference, EQ-5D, exercise capacity, and LVOTg. Patients were blinded to treatment allocation. Symptom assessments were self-administered. Outcome measures were recorded at baseline, crossover, and completion. Analysis was by Bayesian ordinal mixed modeling. RESULTS: Between October 2021 and October 2024, 117 screened patients met the inclusion criteria, of whom 60 were randomized. AVD-optimized RVP improved Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (+4.5; 95% credible interval [CrI]: 1.3-8.1; probability of benefit [Prbenefit] = 0.997) and daily symptom scores (OR: 1.29; 95% CrI: 0.98-1.68; Prbenefit: 0.969) compared with backup-only pacin
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Journal articleMonguillon V, Kelly PJ, O'Donoghue ML, et al., 2026,
Efficacy and Safety of Very Low Achieved LDL Cholesterol in Patients With Previous Ischemic Stroke.
, Circulation, Vol: 153, Pages: 86-93BACKGROUND: Patients with previous ischemic stroke are at high risk for recurrent stroke and other major adverse cardiovascular events. The benefits of achieving very low levels of low-density lipoprotein cholesterol (LDL-C) in such patients is unclear. METHODS: We analyzed patients with previous ischemic stroke enrolled in FOURIER (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk), a randomized placebo-controlled trial studying evolocumab in patients with stable atherosclerotic cardiovascular disease (median follow-up, 2.2 years), and through the open-label extension (FOURIER-OLE) period (additional median follow-up, 5 years), to examine the relationship between achieved LDL-C and the long-term incidence of the primary end point (cardiovascular death, myocardial infarction, stroke, or hospitalization for unstable angina or coronary revascularization) and stroke-related end points. RESULTS: The analysis included 5291 patients with previous ischemic stroke (>4 weeks). Of these, 666 (12.6%), 1410 (26.6%), 586 (11.1%), 508 (9.6%), and 2121 (40.1%) patients achieved LDL-C values of <20, 20 to <40, 40 to <55, 55 to <70, and ≥70 mg/dL, respectively. The incidence of the primary end point, all stroke, and ischemic stroke each decreased in a monotonic fashion with lower achieved LDL-C levels on a continuous scale (Ptrend<0.001, 0.002, and 0.002, respectively). Compared with patients with LDL-C ≥70 mg/dL, those who achieved levels <40 mg/dL had incidence rate ratios of 0.69 (95% CI, 0.57-0.84), 0.73 (95% CI, 0.53-0.99), and 0.75 (95% CI, 0.54-1.05) for the outcomes of the primary end point, all stroke, and ischemic stroke, respectively. Hemorrhagic strokes were infrequent and unrelated to achieved LDL-C (Ptrend=0.85). CONCLUSIONS: In patients with previous ischemic stroke, it appeared that the lower the LDL-C, down to levels <40 mg/dL, the lower the risk of major adverse cardiovascular events, includi
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Journal articleHada M, Collet C, Storozhenko T, et al., 2026,
Rationale and design of European microcirculatory resistance and absolute flow team: The Euro-CRAFT registry
, AMERICAN HEART JOURNAL, Vol: 291, Pages: 136-143, ISSN: 0002-8703 -
Journal articleZiotti SDV, Dourado LOC, Silva RD, et al., 2026,
Coronary Sinus Reduction for the Treatment of Refractory Angina: What Have We Learned after 70 Years of the Beck Surgery?
, Arq Bras Cardiol, Vol: 122With the increasing prevalence of chronic coronary syndromes, many patients with extensive atherosclerosis experience uncontrolled angina, even while receiving optimal medical therapy. This is especially true for patients who are not suitable candidates for surgical or percutaneous revascularization. Numerous treatments have been investigated for managing angina pectoris, and in this context, the coronary sinus reducer has emerged as a promising therapeutic option. Since the 1950s, beginning with Beck's surgery, the coronary venous sinus has been a focal point of research in anti-ischemic therapies. Significant scientific advances have been made in narrowing the venous sinus in the past two decades. Thanks to technological improvements in minimally invasive procedures and better methods for assessing myocardial blood flow, a new therapeutic option has become available for patients suffering from refractory angina and, possibly, for microvascular dysfunction. In this review, we aim to examine key concepts related to angina pectoris and myocardial ischemia, highlighting the historical background, pathophysiological rationale, and technical aspects of coronary sinus reduction as a therapy for refractory angina. Additionally, we will explore the scientific evidence from recent decades, as well as identify existing gaps and outline future research directions concerning this emerging treatment.
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Conference paperJevsikov J, Stowell CC, Ng T, et al., 2026,
Robustness of Human vs. AI Measurements Under Progressive Image Degradation
, 2nd International Conference on Artificial Intelligence in Healthcare-AIiH, Publisher: SPRINGER INTERNATIONAL PUBLISHING AG, Pages: 261-268, ISSN: 0302-9743 -
Book chapterNaidoo P, Fernandes P, Ufumaka I, et al., 2026,
Spatiotemporal Contrastive Learning for Echocardiography View Classification
, Editors: Rittman, Ni, Cafolla, Publisher: SPRINGER INTERNATIONAL PUBLISHING AG, Pages: 247-260, ISBN: 978-3-032-00627-1 -
Book chapterFernandes P, Naidoo P, Ufumaka I, et al., 2026,
Deep Learning for Assessing Rotational Misalignment in Echocardiographic Imaging
, Editors: Rittman, Ni, Cafolla, Publisher: SPRINGER INTERNATIONAL PUBLISHING AG, Pages: 269-282, ISBN: 978-3-032-00627-1 -
Journal articleRajendra S, Salmasi Y, Raj B, et al., 2025,
Perioperative Predictors of Right Ventricular Failure Following Left Ventricular Assist Device Implantation.
, ASAIO JRight ventricular failure (RVF) is an important complication following implantation of a left ventricular assist device (LVAD) in patients with advanced heart failure. This study aims to identify perioperative hemodynamic predictors of RVF following LVAD implantation and develop an internally validated predictive model. Patients who underwent LVAD implantations between March 2013 and March 2023 at a large-volume tertiary center were retrospectively analyzed. The primary outcome was early post-implant RVF, defined by need for right ventricular assist device (RVAD), prolonged inotrope dependence (> 14 days), or death within 14 days while on inotropes. Perioperative hemodynamic variables were analyzed using univariate logistic regression. A prediction model was then developed using stepwise multivariate logistic regression, and internally validated using k-fold cross-validation. Among 210 patients, 73 patients (34.8%) developed early post-implant RVF. Decreased post-implant cardiac index (odds ratio [OR]: 0.0122, p = 0.001), decreased mean arterial pressure (OR: 0.932, p = 0.008), and simultaneously increased cardiac index and pulmonary pulse pressure (OR: 1.13, p = 0.021) independently predicted RVF. Preimplantation IV inotrope therapy was a significant confounder (OR: 3.96, p = 0.021). Our proposed predictive model achieved strong discriminatory power (area under the curve [AUC] of 0.830) and stable cross-validation performance. External validation with multicenter cohorts is warranted to confirm predictive accuracy and clinical applicability.
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Journal articleKose O, Sahal A, Zhang GK, et al., 2025,
Framework for Analytical Validation of DHT-Based Actigraphy and Signal Measures in HF Trials: The VALIDATE-HF Program.
, JACC Heart Fail -
Journal articleRajkumar CA, Foley MJ, Ahmed-Jushuf F, et al., 2025,
The Role of the Collateral Circulation in Stable Angina: An Invasive Placebo-Controlled Study
, CIRCULATION, Vol: 152, Pages: 1541-1551, ISSN: 0009-7322 -
Journal articleHaworth PAJ, Bent C, Chapman N, et al., 2025,
Renal denervation for hypertension management in the UK: a Delphi expert consensus
, HEART, ISSN: 1355-6037 -
Journal articleStevens C, Smith J, Brandts J, et al., 2025,
Optimising lipid-lowering therapy for acute coronary syndrome using a decision support system: insights from a cluster randomised trial
, European Heart Journal: Digital Health, ISSN: 2634-3916AIMS: Lipid-lowering therapy (LLT) after acute coronary syndrome (ACS) typically follows stepwise intensification, delaying use of combination therapies and LDL-C goal attainment. We assessed whether access to a Decision Support System (DSS) altered the intensity of LLT prescribing vs standard-of-care (SoC).METHODS: Pragmatic, multinational, parallel 1:1 cluster-randomised controlled trial of ACS patients comparingmandatory access to a DSS (providing estimates of cardiovascular events and benefits from different LLT scenarios) to SoC. The primary endpoint was the proportion receiving intensified monotherapy or initiated/escalated combination LLT by week 16 compared to pre-admission LLT; secondary endpoints included individual components of the primary endpoint, proportions at goal (LDL-C<1.4mmol/L), and timing of LLT escalations.RESULTS: 42 sites from UK, Italy and Spain were randomised, enrolling 1139 participants, 79% male, median age 62 years (IQR: 55, 69), 84% without prior CVD, 69% LLT-naïve at admission, median admission LDL-C 3.0 mmol/L (IQR: 2.46, 3.75). The primary endpoint was met in 71.7% (DSS) vs 65.7% (SoC), risk ratio (RR) 1.11 (95%CI:0.92-1.33, p=0.29). Intensification of monotherapy occurred in 9.0% vs 13.1% (RR:0.68, 95%CI:0.46-1.00), combination LLT in 61.6% vs 50.6% (RR:1.35, 95%CI:0.93-1.98). LDL-C goal achievement was 54.8% vs 50.3% (RR 1.06, 95%CI: 0.88-1.28), with LLT escalation before discharge in 64.8% vs 60.7%.CONCLUSIONS: Access to a DSS, in hospitals managing ACS, did not improve LLT intensification within 16 weeks or LDL-C goal attainment, but revealed a favourable trend towards earlier combination LLT use, which merits larger, longer studies in other settings.
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Journal articleKhialani B, Alfonso F, Malakouti S, et al., 2025,
Preventive Percutaneous Intervention of Vulnerable Coronary Plaques
, AMERICAN JOURNAL OF CARDIOLOGY, Vol: 255, Pages: 89-98, ISSN: 0002-9149- Cite
- Citations: 1
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Conference paperFoley M, Mohsin M, Ahmed-Jushuf F, et al., 2025,
Endocardial to epicardial blood flow ratio predicts the placebo-controlled efficacy of the coronary sinus reducer
, American-Heart-Association Scientific Sessions / American-Heart-Association Resuscitation Science Symposium, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0009-7322 -
Journal articleNaidoo P, Fernandes P, Dadashi Serej N, et al., 2025,
Consensus-guided evaluation of self-supervised learning in echocardiographic segmentation.
, Comput Biol Med, Vol: 198BACKGROUND: Left ventricle segmentation is a fundamental task in echocardiography, essential for assessing cardiac function. However, deep learning models for segmentation rely on large labelled datasets, which are expensive and time-consuming to annotate. Self-supervised learning has emerged as a promising approach to leverage unlabelled data, but its effectiveness for left ventricle segmentation remains underexplored. METHODS: This study investigates self-supervised learning for echocardiographic segmentation, comparing various pretext tasks. The impact of dataset size and distribution on pre-training is examined, revealing that excessive unlabelled data can degrade performance due to redundancy and low variability. A novel multi-expert labelled dataset is introduced to enhance segmentation evaluation, using consensus-based annotations to reduce annotation noise and improve reliability. RESULTS: Among the self-supervised learning methods evaluated, contrastive learning consistently outperforms other approaches, particularly in low-label settings. The study demonstrates that AI models pre-trained using self-supervised learning and fine-tuned with only 15% of labelled data achieve stronger alignment with multi-expert consensus than any individual expert. CONCLUSION: The findings suggest that AI models can generalise well across expert annotations, providing more reliable and reproducible assessments.
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Journal articleChotai S, Chiew K, Al-Lamee R, 2025,
Symptoms, coronary artery disease and percutaneous coronary intervention: connecting the dots
, CURRENT OPINION IN CARDIOLOGY, Vol: 40, Pages: 417-423, ISSN: 0268-4705 -
Journal articleNijveldt R, Maeng M, Beijnink CWH, et al., 2025,
Immediate or Deferred Nonculprit-Lesion PCI in Myocardial Infarction
, NEW ENGLAND JOURNAL OF MEDICINE, ISSN: 0028-4793 -
Conference paperRajkumar C, Foley M, Ahmed-Jushuf F, et al., 2025,
The Role of the Collateral Circulation in Stable Angina: An Invasive Placebo-Controlled Study (ORBITA-STAR)
, 37th Annual Symposium on Transcatheter Cardiovascular Therapeutics (TCT), Publisher: ELSEVIER SCIENCE INC, ISSN: 0735-1097 -
Journal articleWoehrle H, Wegscheider K, Simonds AK, et al., 2025,
Assessing new treatments for central sleep Apnoea in heart failure: sample size considerations for reliable detection of safety signals
, SLEEP AND BREATHING, Vol: 29, ISSN: 1520-9512 -
Journal articleDeharo F, Lyon AR, Thuny F, 2025,
Non-bacterial thrombotic endocarditis in cancer
, EUROPEAN HEART JOURNAL, ISSN: 0195-668X -
Journal articleKrychtiuk KA, Lopes RD, Cargill VA, et al., 2025,
Overcoming Barriers to Developing and Implementing Novel Therapies for Hypertension
, HYPERTENSION, Vol: 82, Pages: 1599-1611, ISSN: 0194-911X -
Journal articleAl-Lamee R, Chotai S, 2025,
The Persistent Family Feud: CABG Versus PCI. Do We Even Need a Winner?
, CIRCULATION, Vol: 152, Pages: 859-861, ISSN: 0009-7322
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