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Journal articleVinther M, Philbert BT, Svendsen JH, et al., 2026,
Direct His/LBB Pacing as an Alternative to Biventricular Pacing in Patients With HFrEF and a Typical LBBB: The His-Alternative II Study.
, JACC Clin ElectrophysiolBACKGROUND: Cardiac resynchronization therapy (CRT) in patients with symptomatic heart failure and left bundle branch block (LBBB) can be achieved with biventricular pacing (BIV-CRT) or conduction system pacing (CSP-CRT). OBJECTIVES: The present study examined if CSP-CRT was feasible and noninferior to BIV-CRT. METHODS: A total of 150 patients with symptomatic heart failure, left ventricular ejection fraction (LVEF) ≤35%, and LBBB (Strauss criteria) were included. Patients were randomized 1:2 to either BiV-CRT or CSP-CRT (HIS-CRT or LBB-CRT) and followed for 6 months. The primary endpoint was the relative change in left ventricular end-systolic volume (LVESV). Two patients withdrew their consent before implant. RESULTS: At implantation, 15 patients (15 %) crossed over from the CSP-CRT group to the BiV-CRT group and 1 patient crossed over from BiV-CRT to the CSP-CRT group. Accordingly, 85 patients (57 %) were treated with CSP-CRT (26 His-CRT, 59 patients LBB-CRT) and 63 patients (43 %) with BiV-CRT. For the primary endpoint, intention-to-treat 6-month follow-up LVESV decreased by 35% ± 22% with CSP-CRT vs 34% ± 22% with BiV-CRT (between-group differences 0.9%, 95% CI: -6.0% to 7.8%; P < 0.01 for noninferiority, P = 0.80 for superiority). Furthermore, LVEF increased by 14% ± 8% with CSP-CRT vs 14% ± 9% with BiV-CRT (P = NS). QRS duration shortening (-31 ± 22 ms vs -31 ± 21 ms), 6-min walking distance increase (37 ± 53 m vs 24 ± 48 m), Minnesota Living with Heart Failure score reduction (-16 ± 18 vs -13 ± 15), NYHA functional class improvement (-0.6 ± 0.6 vs -0.6 ± 0.7), and N-terminal pro-B-type natriuretic peptide reductions (-72 ± 152 pmol/l vs -110 ± 116 pmol/l) were similar between groups. CONCLUSIONS: In heart failure patients with LBBB, CSP-CRT was noninferior to BiV-CRT in reducing LVESV and both treatment modalities provided similar and excellent improvement
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Journal articleSamways JW, Ali N, Arnold AD, et al., 2026,
Non-Invasive Methods for Identifying Electrical Responders to Conduction System Pacing Cardiac Resynchronization Therapy.
, Pacing Clin ElectrophysiolBACKGROUND: Conduction system pacing (CSP) is an emerging alternative modality of cardiac resynchronization therapy (CRT). However, not all patients obtain electrical resynchronization with CSP, there is a clinical need for reliable non-invasive predictors of response. We aimed to assess the ability of several non-invasive modalities to predict electrical resynchronization with CSP-CRT. METHODS: Patients with standard heart failure CRT indications (excluding right-bundle branch block) underwent CSP-CRT using His-bundle and left-bundle branch pacing. Electrical resynchronization was defined as a >10 ms reduction in left ventricular activation time or conversion to a physiological left ventricular activation pattern on non-invasive multi-electrode mapping. We assessed whether 12-lead ECG morphology, vector electrocardiogram (VCG) derived QRS area, Ultra High Frequency (UHF)-ECG parameters or MRI scar burden predicted electrical resynchronization. RESULTS: Thirty four patients were analyzed (mean age 69±10 years; 82% male; LVEF 30±6%; QRS duration 161±23 ms; 32% ischemic cardiomyopathy). Electrical resynchronization was achieved in 24/34 (71%; 95%CI 53-85). Strauss criteria positivity on 12-lead ECG yielded a positive predictive value (PPV) of 83% (95%CI 61-95%) and negative predictive value (NPV) of 55% (95%CI 23-83%). VCG QRS area >100µVs demonstrated PPV 100% (95% CI 81-100%) and NPV 73% (95%CI 85-100%). UHF-ECG e-DYS >50 ms gave PPV 93% (95%CI 66-100%) and NPV 47% (23%-72%); >60 ms gave PPV 90% (95%CI 66-100%) and NPV 38% (95%CI 18-62%). MRI scar burden <15% resulted in PPV 88% (95%CI 64-99%) and NPV 56% (95%CI 21-86%). Lines of propagation discontinuity on multi-electrode mapping showed PPV 100% (95%CI 85-100%) and NPV 83% (95%CI 52-98%). CONCLUSIONS: Multiple non-invasive markers, including QRS morphology, VCG QRS area, UHF-ECG e-DYS, MRI scar burden showed potential to identify patients who are likely
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Journal articleNikolaev VO, Gorelik J, 2026,
Cardiomyocyte T-tubule loss in heart failure: NFκB as a central signalling hub.
, Cardiovasc Res, Vol: 122, Pages: 1415-1416 -
Journal articleHou Y, Singal S, Swiatlowska P, et al., 2026,
Neuro-mechanical regulation of vascular smooth muscle cell behaviour under ageing-associated substrate stiff-ness
, Current Issues in Molecular Biology, Vol: 48, ISSN: 1467-3037Cardiovascular diseases (CVDs) remain a leading cause of mortality worldwide, and ageing is strongly associated with progressive arterial stiffening. Age-related alterations in extracellular matrix (ECM) mechanics influence vascular smooth muscle cell (VSMC) behaviour, while sympathetic innervation represents an additional regulator of vascular homeostasis. However, how neural signalling interacts with ageing-associated mechanical conditions to regulate VSMC behaviour remains unclear. In this study, an in vitro sympathetic neuron–VSMC co-culture model was established to investigate neuro-mechanical regulation. Primary rat sympathetic neurons and A7r5 VSMCs were cultured on glass or polydimethylsiloxane (PDMS) substrates with defined stiffness (20 and 130 kPa), representing healthy and ageing-associated stiffened arterial environments, respectively. VSMC behaviour was assessed through analysis of cell area, proliferation, migration, cellular Young’s modulus (YM), and DNA damage marker γH2AX. Sympathetic neuronal co-culture was associated with reduced VSMC spreading and decreased γH2AX levels. Under the conditions tested, neural signalling exerted limited effects on cell proliferation and migration. In contrast, increased substrate stiffness promoted cell proliferation and elevated YM. Both neuronal input and substrate stiffness were associated with increased cellular YM. Together, these findings indicate that neural and mechanical cues may jointly influence VSMC behaviour within ageing-associated mechanical environments. This co-culture system provides a controllable platform for studying neuro-mechanical interactions in vascular biology.
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Journal articleEllard S, Hanson H, Cassidy E-J, et al., 2026,
The British Society for Genetic Medicine guidance on managing incidental findings identified during rare disease genomic testing.
, J Med GenetBACKGROUND: Genomic testing will occasionally identify a highly actionable genetic variant or other finding that is not related to the reason for testing. Such incidental findings may be relevant to the patient undergoing testing or to their family members. METHODS: This guidance on managing incidental findings was developed by the British Society for Genetic Medicine to support clinicians requesting genomic tests and clinical scientists working in genomic laboratories within the National Health Service. RESULTS: Clinicians should include the possibility of incidental findings with a patient/parent(s) in discussions around genomic testing. Decisions regarding the reporting of a genetic variant unrelated to the referral reason will depend on clinical actionability, penetrance and the variant classification. Pathogenic variants may be reported if there is evidence of high penetrance and available treatment or surveillance that is likely to improve clinical outcome. Testing using large next generation sequencing gene panels and genome-wide array analysis increases the likelihood of revealing heterozygous carrier status for autosomal recessive disorders unrelated to the reason for testing. Reporting incidental heterozygous carrier status for autosomal recessive conditions is not recommended. CONCLUSION: This guidance provides a framework for the reporting of incidental findings with case examples and a cancer susceptibility gene list. Decision-making in accordance with guidelines will achieve greater consistency than case by case decisions. This guidance may be of use to healthcare professionals in other publicly funded healthcare systems with evolving genomic testing services.
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Journal articleRaman B, Prasad SK, 2026,
Late Gadolinium Enhancement in Nonischemic Dilated Cardiomyopathy.
, Circulation, Vol: 154, Pages: 512-516 -
Journal articleRajendra S, Salmasi Y, Raj B, et al., 2026,
Haemodynamics from Induction to Cardiopulmonary Bypass Improve Prediction of Right Ventricular Failure Following Left Ventricular Assist Device.
, Interdiscip Cardiovasc Thorac Surg, Vol: 41OBJECTIVES: Right ventricular failure (RVF) remains a frequent complication following left ventricular assist device (LVAD) implantation. Conventional risk scores rely on preoperative data acquired under stable conditions, which may overlook early signs of RV decompensation that emerge under perioperative stress. This study evaluates whether perioperative haemodynamic markers prior to cardiopulmonary bypass (CPB) improve RVF prediction compared to preoperative assessment obtained by right heart catheterization (RHC), echocardiographic parameters, and scoring systems such as the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) RHF score. METHODS: We conducted a retrospective single-centre study of 203 LVAD patients (2013-2023). The primary outcome was RVF. Preoperative data included clinical variables, echocardiography, and RHC. Perioperative data included vasoactive-inotropic score (VIS), pulmonary artery (PA) catheter, and arterial-line monitoring between induction and start of CPB. Two multivariable models were developed using least absolute shrinkage-and-selection operator (LASSO) logistic regression: (1) Preoperative model; (2) Pre-CPB model. Model performance was assessed using area under the curve (AUC) and compared against EUROMACS-RHF using DeLong tests. RESULTS: Thirty-six patients (17.7%) developed RVF. No preoperative RHC-derived parameter independently predicted RVF. The Preoperative model achieved moderate discrimination (AUC: 0.747). Incorporating intraoperative mean arterial pressure (MAP), pulmonary artery pulsatility index (PAPi), and maximum VIS yielded a Pre-CPB model with strong discrimination (AUC: 0.834). The Pre-CPB model significantly outperformed both EUROMACS-RHF (P = 0.0299) and the Preoperative model (P = 0.049), with no significant difference between our Preoperative model and EUROMACS-RHF (P = 0.222). CONCLUSIONS: Perioperative markers prior to CPB significantly outp
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Journal articleOng AQC, Ang C-S, Bojic I, et al., 2026,
Artificial intelligence in cardiovascular care: a systematic review and meta-analysis of randomised controlled trials
, EClinicalMedicine, Vol: 98, ISSN: 2589-5370Background: Artificial intelligence (AI) holds potential to transform cardiovascular care, but evidence on its effectiveness in clinical practice remains inconsistent. We aimed to synthesise evidence from randomised controlled trials (RCTs) on the effectiveness of AI-enabled cardiovascular care, summarise the trial design and characteristics of AI systems, and evaluate methodological quality and reporting transparency.Methods: In this systematic review and meta-analysis, we searched Embase, MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov for RCTs that evaluated effectiveness of AI interventions in cardiovascular care, published in English from database inception to July 07, 2025. The search was updated on April 28, 2026. We followed Cochrane guidance for study selection and data extraction. Risk of bias was assessed using Cochrane’s Risk of Bias tools and reporting transparency using CONSORT-AI checklist. We calculated summary effects using inverse-variance-weighted random-effects meta-analyses and assessed the certainty of evidence using GRADE. Between-study heterogeneity was quantified using χ² (Cochran’s Q) test and I² statistic. Publication bias was not assessed due to small number of studies. This study was registered with PROSPERO (CRD420251090250).Findings: Of 12,217 records identified, 31 RCTs from 13 regions (n=1,685,717 patients) were included in the systematic review, and 11 of these (n=1,614,689) in the meta-analysis. Most RCTs were published after 2021 (90%), multicentre (58%), and had short follow-up duration (<12 months; 52%). Risk of bias was low in seven trials (23%), and overall reporting transparency was moderate. Twenty-two trials (71%) reported significant benefit of AI interventions on primary endpoints, mostly intermediate process measures, while nine trials (29%) found no significant effect. Compared with routine care, image-based AI-clinical decision support system had sig
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Journal articleBoichenko V, Frolova S, Voellenkle C, et al., 2026,
Unifying and unique roles of non-coding RNA biomarkers in liver and heart fibrosis.
, Biomed Pharmacother, Vol: 201Liver and cardiac fibrosis are critical drivers of chronic organ dysfunction, characterised by fibroblast activation, excessive extracellular matrix deposition, and inflammation. While these fibrotic processes are initiated by distinct triggers and monitored by organ-specific biomarkers, emerging evidence reveals both shared and unique regulatory networks, particularly involving non-coding RNAs (ncRNAs). This review focuses on the roles of microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs), such as miR-21, miR-22, miR-29, miR-34a, miR-122, miR-133a, miR-210, miR-214, H19, MALAT1, MEG3, NEAT1, and circHIPK3, in modulating key fibrotic pathways including TGF-β/SMAD signalling, oxidative stress, and extracellular matrix remodelling in both hepatic and cardiac tissues. Some ncRNAs exhibit convergent regulatory functions across both organs, while others demonstrate divergent or context-dependent effects within and between tissues. Furthermore, circulating ncRNAs, potentially transferred via extracellular vesicles (EVs), hold potential as minimally invasive biomarkers for early detection of combined cardio-hepatic fibrosis, as exemplified in conditions like Fontan circulation, though extensive validation in large, prospective cohorts is essential. This article summarises established clinical biomarkers, discusses the ncRNA-mediated mechanisms operating in liver and heart fibrosis, distinguishing shared, divergent, and mixed evidence, and explores their translational potential in diagnostics and experimental therapeutics. Finally, it addresses remaining challenges and outlines future directions, emphasising multi-omic integration, longitudinal ncRNA profiling, and mechanistic validation to advance precision management of fibrotic diseases.
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Journal articleGonzález CR, Huang B, Yan S, et al., 2026,
Benchmarking Image-Based Motion-Correction Methods for Ultrasound Localization Microscopy.
, Ultrasound Med Biol, Vol: 52, Pages: 1544-1558BACKGROUND: Ultrasound localization microscopy (ULM) achieves sub-diffraction resolution imaging in vivo through localizing and tracking microbubbles. However, the need to accumulate microbubble signals over time makes ULM highly sensitive to tissue motion, necessitating accurate motion correction. The accuracy of motion-correction techniques poses a limit to the attainable resolution, and there is currently no gold standard algorithm or approach. METHODS: This study benchmarked seven publicly available implementations of non-rigid image registration algorithms using two simulated datasets illustrating soft tissue and cardiac images, as well as in vivo acquisitions of a rabbit kidney and human breast tumor. Five benchmarks were used to evaluate the seven implementations using image-based similarity metrics, errors against ground truth deformation fields, robustness to hyperparameter choice and image quality, including data with varying contrast-to-noise ratios. Using Bayesian optimization and Sobol sensitivity analysis, optimal parameters for each algorithm were identified, with guidelines for data-adaptive algorithm selection proposed. RESULTS: Parameter sensitivity analysis was reported for all implementations, which can be used to prioritize parameters when performing optimization. Motion characteristics and image spatial heterogeneity were found to be important factors for implementation accuracy. Spline-based algorithms, such as free-form deformations implemented in Elastix, performed optimally with small deformations and low spatial heterogeneity. In contrast, methods designed for large deformations, such as large deformation metric matching, implemented by Ceritoglu et al., or free-form deformations with diffeomorphic constraints, such as Niftyreg, were effective at correcting larger data displacements with high heterogeneity, but struggled to identify accurate correspondences when deformation magnitudes were small. Invertibility was beneficial when correctin
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Journal articlePastika L, Patlatzoglou K, Sieliwonczyk E, et al., 2026,
Artificial intelligence-enhanced electrocardiography for the prediction of future type 2 diabetes mellitus: a model-development and multicentre validation study.
, Eur Heart J Digit Health, Vol: 7AIMS: A significant proportion of type 2 diabetes cases remain undiagnosed despite screening advances, carrying substantial cardiometabolic risk. Artificial intelligence-enhanced electrocardiography (AI-ECG) detects subtle ECG changes in subclinical disease, potentially enabling opportunistic screening. METHODS AND RESULTS: We developed AI-ECG Risk Estimator for Diabetes Mellitus (AIRE-DM), a convolutional neural network with discrete-time survival loss, for diagnosis of prevalent and prediction of incident type 2 diabetes. It was trained on 1 163 401 ECGs from 189 537 individuals from Beth Israel Deaconess Medical Center (BIDMC) and externally validated in UK Biobank (UKB; n = 65 606) and ELSA-Brasil (n = 13 739). AI-ECG Risk Estimator for Diabetes Mellitus demonstrated moderate discrimination for prevalent type 2 diabetes (area under the receiver operating characteristic curve: BIDMC 0.724, UKB 0.733, ELSA-Brasil 0.706) and incident type 2 diabetes (C-index: BIDMC 0.667, UKB 0.688, ELSA-Brasil 0.625). The highest AIRE-DM risk quartile had elevated incident diabetes risk vs. the lowest (hazard ratio: BIDMC 4.75, UKB 7.52, ELSA-Brasil 3.96). AI-ECG Risk Estimator for Diabetes Mellitus was non-inferior to the American Diabetes Association Diabetes Risk Test in BIDMC, with improved predictive accuracy when combined. In normoglycaemic patients, AIRE-DM was superior to glycated haemoglobin (HbA1c) for predicting incident diabetes in BIDMC and non-inferior in ELSA-Brasil. The highest risk quartile reached 5% cumulative type 2 diabetes mellitus incidence 5.4 years (BIDMC) and 4.8 years (ELSA-Brasil) earlier than the lowest risk quartile, after adjusting for HbA1c, age, and sex. Phenome- and genome-wide association studies revealed biologically plausible associations with glucose regulation, cardiac morphology, diastolic dysfunction, arterial stiffness, and lipid metabolism. CONCLUSION: AI-ECG Risk Estimator for Diabetes Mellitus detects prevalent type 2 diabetes and predi
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Journal articleZeidaabadi Nezhad B, 2026,
Artificial intelligence-enhanced electrocardiography for prediction of cancer therapy-related cardiac dysfunction
, Europace, ISSN: 1099-5129 -
Journal articleXu W, Sa F, Song Y, et al., 2026,
Cardiac MRI-Derived Right Ventricular Strain for Risk Stratification in Pediatric and Adolescent Arrhythmogenic Cardiomyopathy: A Multicenter Cohort Study.
, JACC Cardiovasc ImagingBACKGROUND: Pediatric and adolescent arrhythmogenic cardiomyopathy (ACM) is a clinically severe phenotype that remains underrepresented in cardiac magnetic resonance (CMR) research. The prognostic value of CMR-derived right ventricular deformation analysis in this population is unclear. OBJECTIVES: This study sought to describe the burden of severe cardiac outcomes in pediatric and adolescent ACM, and to assess the prognostic and incremental value of CMR-derived right ventricular global longitudinal strain (RVGLS) for risk stratification when incorporated into conventional clinical and CMR markers. METHODS: This multicenter study included consecutive pediatric and adolescent patients (aged ≤21 years) with ACM who underwent baseline CMR evaluation. We assessed clinical, electrocardiographic, and CMR parameters according to the 2010 Task Force Criteria, along with biventricular strain parameters. Severe cardiac outcomes were defined as a composite of malignant ventricular arrhythmias (MVAs), heart transplantation, and heart failure-related death. RESULTS: The cohort included 102 patients (16.3 ± 3.4 years; 72% male) and 95 controls (mean age: 15.6 ± 3.3 years; 70% male). During a median of 58-month follow-up, 51 (50%) patients experienced severe cardiac outcomes and 28 (27.5%) MVA outcomes. Reduced RVGLS was independently associated with severe cardiac outcomes (HR: 1.14; P = 0.004) and MVA outcomes (subdistribution HR: 1.15; P < 0.001) after adjustment for clinical and conventional CMR parameters. Incorporation of RVGLS significantly improved prediction of severe cardiac outcomes beyond both right ventricular-based and left ventricular-based multivariable models, with significant improvement in discrimination and reclassification. Kaplan-Meier analysis further showed that RVGLS ≥-12.2% identified patients at higher risk of severe cardiac outcomes and MVA outcomes (both log-rank P < 0.001). CONCLUSIONS: Pediatric and adolescent ACM manifests
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Journal articleHua Z, Patlatzoglou K, Kappadan V, et al., 2026,
AI-enabled motion artefact correction to replace emission- and excitation-ratiometry in cardiac optical mapping: a proof-of-concept study.
, Cardiovasc Res, Vol: 122, Pages: 1283-1286 -
Journal articleMazzola M, Wang H, Lang D, et al., 2026,
Loss of caveolar A1 adenosine receptor signalling blunts anti-adrenergic control in heart failure.
, Cardiovasc Res, Vol: 122, Pages: 1329-1343AIMS: Adenosine, acting through A1 adenosine receptors (A1ARs), exerts anti-adrenergic effects by inhibiting β1-adrenergic receptor (β1AR)-mediated cyclic adenosine monophosphate (cAMP) production and contractility in the heart. While the functional interaction between A1ARs and β1ARs is well established in both atrial and ventricular myocytes, the subcellular compartmentalization of this crosstalk and how it is disrupted in heart failure (HF) remains incompletely understood. This study investigates the spatial confinement of A1AR-β1AR signalling within atrial microdomains and assesses how structural remodelling in HF alters this regulatory axis. METHODS AND RESULTS: Quantitative polymerase chain reaction (qPCR) analysis revealed that A1AR is the predominant adenosine receptor subtype in both rat and human atrial tissues. In healthy rat and mouse atrial myocytes, A1AR activation reduced β1AR-induced cAMP production and sarcomere shortening, with suppression of cAMP signals at sarcolemmal microdomains enriched in protein kinase A Type II. This was further supported by scanning ion conductance microscopy-guided scanning patch-clamp, which showed that A1AR suppressed β1AR-driven L-type Ca2+ channel activity at both T-tubule and crest membrane domains. In atrial myocytes isolated from failing rat and human hearts, A1AR-mediated inhibition of β1AR-induced cAMP production and contractility was impaired. Caveolar disruption by methyl-β-cyclodextrin in rat atrial myocytes or via cardiac-specific caveolin-3 (Cav3) knockout in mice abolished this A1AR-mediated inhibition. Notably, cholesterol repletion alone did not restore membrane cAMP regulation, whereas Cav3 overexpression rescued A1AR-dependent suppression, supporting a requirement for Cav3-dependent organization. In mouse atrial preparations isolated from failing hearts, high-resolution optical mapping showed that A1AR-mediated anti-adrenergic regulation of Ca2+ cycling was select
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Journal articlePerotto M, Radesich C, Paldino A, et al., 2026,
Variant Site-Specific Natural History of Titin-Induced Cardiomyopathy: An International Multicenter Registry.
, Circ Genom Precis MedBACKGROUND: Titin truncating variants (TTNtv) represent the most common genotype underlying dilated cardiomyopathy but are also detected in the general population, exhibiting incomplete penetrance and marked phenotypic variability. This heterogeneity complicates clinical interpretation and risk stratification. Emerging molecular evidence suggests that truncating location within the gene may influence disease mechanisms. We aimed to investigate whether TTNtv location also affects clinical phenotype and prognosis. METHODS: We established an international multicenter registry of phenotypically affected carriers of pathogenic or likely pathogenic TTNtv. Patients were classified into 3 groups: A-band, Z/I-band, and M-band. A case-control study assessed the enrichment of TTNtv across regions. The primary outcome was a composite of all-cause mortality and heart transplantation. Secondary outcomes included: (1) sudden cardiac death or major ventricular arrhythmias and (2) heart failure-related death/heart transplantation/left ventricular assist device implantation. RESULTS: The study included 467 patients (81% probands, 73% male, median age 47 years, 81% dilated cardiomyopathy phenotype). Most carried TTNtv in the A-band (80% versus 15% Z/I-band and 5% M-band). All groups showed enrichment compared with GnomAD, with greater Bayesian-estimated penetrance for A-band variants. Over a median follow-up of 83 months, the primary end point was similar across groups. However, the risk of sudden cardiac death/major ventricular arrhythmias was significantly higher in M-band carriers (45% M-band versus 23% Z/I-band versus 12% A-band; P=0.001), especially as the first disease manifestation. Band location independently predicted sudden cardiac death/major ventricular arrhythmias risk, whereas left ventricular ejection fraction was predictive only in A- and Z/I-band groups. CONCLUSIONS: TTNtv are differently enriched across the gene in patients with dilated cardiomyopathy/nondilated left
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Journal articleBlackman J, Quon S, Francis DP, et al., 2026,
Association Between Interventional Cardiologist Practice Characteristics, Coronary Artery Bypass Grafting Use, and Clinical Outcomes.
, Eur J Cardiothorac Surg, Vol: 68OBJECTIVES: Quantify inter-operator variation in referred coronary artery bypass grafting (CABG) following angiography and evaluate associations with practice patterns and long-term outcomes. METHODS: Observational study using administrative health data in British Columbia, Canada (2010-2024). Interventional cardiologist-level CABG Rate was defined as the proportion of referred CABGs to total angiograms performed. Variation across Interventionalists was correlated with other practice characteristics. Among patients undergoing angiography followed by revascularization, associations between operator CABG Rate and all-cause mortality, major adverse cardiovascular events (MACEs), and repeat revascularization were evaluated using hierarchical Cox regression. RESULTS: Among 252 408 angiograms by 40 Interventionalists, CABG Rate varied 13-fold (2.03%-26.4%) and was not explained by hospital-level factors alone (intraclass correlation coefficient [ICC]: 0.358; 95% confidence interval [CI], 0.054-0.621). Higher CABG Rates were associated with lower percutaneous coronary intervention (PCI) utilization (R = -0.60; P < .001), lower PCI extensiveness (R = -0.52; P < .001), and lower procedural volume (R = -0.36; P = .022). In 73,603 first-time revascularized patients, CABG Rate was associated with reduced repeat revascularization (hazard ratio [HR] = 0.075; P < .001), without differences in mortality or MACE. CONCLUSIONS: Referred CABG varies markedly between Interventionalists and reflects operator practice style. Higher CABG utilization is associated with more durable revascularization without impact on survival or MACE. Broader implementation of multidisciplinary Heart Teams may improve consistency of care.
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Journal articleTonko JB, Okafor J, Qureshi N, 2026,
Myocardial edema after pulsed field ablation: Underrecognized tissue effects with implications for concomitant left atrial appendage occlusion.
, Heart Rhythm -
Journal articleChiew K, Foley MJ, Chotai S, et al., 2026,
Focal and Diffuse Coronary Artery Disease Patterns and Placebo-Controlled Angina Relief With Percutaneous Coronary Intervention: ORBITA-2.
, J Am Coll Cardiol, Vol: 88, Pages: 42-58BACKGROUND: Unblinded studies have demonstrated superior procedural and clinical outcomes of percutaneous coronary intervention (PCI) in focal compared with diffuse coronary artery disease. However, data from the first placebo-controlled study did not demonstrate a differential impact of disease pattern on symptom endpoints. OBJECTIVES: The study sought to test the ability of pattern of coronary artery disease to predict the placebo-controlled efficacy of PCI. METHOD: In the ORBITA-2 (Objective Randomised Blinded Investigation with Optimal Medical Therapy of Angioplasty in Stable Angina-2) randomized placebo-controlled trial of angioplasty for stable angina, patients underwent prerandomization nonhyperemic pressure wire pullback assessments. Seven blinded interventional cardiologists independently reviewed each pullback trace to categorize disease patterns as focal, diffuse, or mixed. These were assigned numerical values of 1, 0, and 0.5, respectively. Overall disease pattern score was determined by the mean. A score >0.5 was considered focal and ≤0.5 was considered diffuse. Bayesian proportional odds modeling was used. RESULTS: A total of 245 patients with 300 target vessel pullbacks were analyzed. With adjustment for prerandomization nonhyperemic pressure ratio, PCI in focal compared with diffuse disease resulted in greater improvement in angina symptom score (OR: 1.80; 95% credible interval [CrI]: 1.48-2.18; Pr[Benefit] > 99.9%) and daily episodes of angina (OR: 1.55; 95% CrI: 1.26-1.89; Pr[Benefit] > 99.9%). Focal disease also predicted greater placebo-controlled benefit in exercise treadmill time (Pr[Interaction] > 99.9%), Canadian Cardiovascular Society class (Pr[Interaction] = 99.0%), EuroQol Group 5-Dimensions 5-Level questionnaire (Pr[Interaction] = 95.1%), and Seattle Angina Questionnaire angina frequency (Pr[Interaction] = 99.5%). There was weaker evidence of interaction between disease pattern and the placebo-controlled impact of PCI on im
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Journal articleKhan S, Sajjad U, Fawaz S, et al., 2026,
Randomized, Placebo-Controlled Trial of Chronic Total Occlusion Percutaneous Coronary Intervention in Stable Angina: The ORBITA-CTO Trial.
, J Am Coll Cardiol, Vol: 88, Pages: 4-18BACKGROUND: Percutaneous coronary intervention for coronary chronic total occlusion (CTO PCI) is offered for symptom and quality of life improvement, despite the absence of blinded randomized evidence. OBJECTIVES: The aim of this study was to assess the efficacy of CTO PCI in the first randomized, placebo-controlled trial of CTO PCI. METHODS: ORBITA-CTO is a multicenter, randomized, blinded trial comparing CTO PCI with a placebo procedure. Patients had angina attributable to a single-vessel CTO, without bystander coronary disease. Angina symptoms were recorded daily using the ORBITA app. After dual-injection coronary angiography, patients were randomized to either CTO PCI or placebo. Blinding was maintained using auditory isolation and deep conscious sedation. Antianginal medications were stopped at randomization and reintroduced on a patient-initiated protocol. At the 6-month follow-up, assessments were repeated. The primary efficacy outcome was the angina symptom score, an ordinal scale combining the daily symptom burden assessed by the ORBITA app, antianginal use, and over-ride events. Secondary outcomes were symptom and quality of life questionnaires and blinding fidelity. RESULTS: Between October 19, 2021 and October 21, 2025, 50 patients were randomly assigned to CTO PCI (n = 25) or placebo (n = 25). One patient randomized to PCI was withdrawn during the procedure because of a complication. All 50 patients were included in the primary analysis. Compared with placebo, CTO PCI resulted in an immediate and sustained improvement in the angina symptom score (OR: 4.38; 95% credible interval [CrI]: 1.57-12.69; probability of benefit [Pr{Benefit}] = 0.996), arising from a clear reduction in the number of episodes of angina (OR: 4.38; 95% CrI: 1.55-11.78; Pr[Benefit] = 0.997). This resulted in an additional 30.6 days free of angina (95% CrI: 11.1-50.7; Pr[Benefit] >0.999). Improvements were also observed with the Seattle Angina Questionnaire in angina frequency (+10
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