Daily Cardiology Research Analysis

BACKGROUND AND AIMS: Although women with severe symptomatic aortic stenosis have more complications than men when undergoing surgical valve replacement, they are under-represented in clinical trials. The Randomized researcH in womEn all comers wIth Aortic stenosis (RHEIA) trial investigates the balance of benefits and risks of transcatheter aortic valve implantation (TAVI) vs. surgery in women. METHODS: Women were randomized 1:1 to transfemoral TAVI with a balloon-expandable valve or surgery. The primary composite endpoint was death, stroke, or (valve, procedure or heart failure related) rehospitalization at 1 year. Non-inferiority testing with a pre-specified 6% margin and superiority testing were performed in the as-treated population. RESULTS: At 48 European centres, 443 women underwent randomization, and 420 were treated as randomized. Mean age was 73 years, and the mean estimated surgical risk of death was 2.1% (Society of Thoracic Surgeons risk score). Kaplan-Meier estimates of the primary endpoint event rates at 1 year were 8.9% in the TAVI and 15.6% in the surgery group. This difference of -6.8% with an upper 95% confidence limit of -1.5% demonstrated the non-inferiority of TAVI (P < .001). The two-sided 95% confidence interval of -13.0% to -.5% further resulted in superiority (P = .034). The 1-year incidence of the primary endpoint components was: .9% with TAVI vs. 2.0% with surgery for death from any cause, 3.3% vs. 3.0% for stroke, and 5.8% vs. 11.4% for rehospitalization. CONCLUSIONS: Among women with severe aortic stenosis, the incidence of the composite of death, stroke, or rehospitalization at 1 year was lower with TAVI than with surgery. CLINICALTRIALS.GOV NUMBER: NCT04160130.

Anomalous aortic origin of the coronary artery (AAOCA) is a rare cardiac condition that can lead to ischemia or sudden cardiac death, yet it is often overlooked or falsely classified in routine coronary CT angiography (CCTA). Here, we developed, validated, externally tested, and clinically evaluated a fully automated artificial intelligence (AI)-based tool for detecting and classifying AAOCA in 3D-CCTA images. The discriminatory performance of the different models achieved an AUC ≥ 0.99, with sensitivity and specificity ranging 0.95-0.99 across all internal and external testing datasets. Here, we present an AI-based model that enables fully automated and accurate detection and classification of AAOCA, with the potential for seamless integration into clinical workflows. The tool can deliver real-time alerts for potentially high-risk AAOCA anatomies, while also enabling the analysis of large 3D-CCTA cohorts. This will support a deeper understanding of the risks associated with this rare condition and contribute to improving its future management.

IMPORTANCE: The impact of hypertensive disorders of pregnancy on developing dilated cardiomyopathy is unknown. OBJECTIVE: To determine whether hypertensive disorders of pregnancy are associated with long-term risk of dilated cardiomyopathy. DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study performed in England used the following linked electronic health records databases: Clinical Practice Research Datalink (CPRD) Pregnancy Register, CPRD Aurum (primary care), Hospital Episode Statistics Admitted Patient Care, and Office for National Statistics mortality data. Participants included an exposed cohort of 14 083 patients in their first pregnancy with hypertensive disorders of pregnancy (index date observed: January 1997 to December 2018; followed up until July 2023) and unexposed cohort of 70 415 with normotensive pregnancies randomly sampled from the Pregnancy Register (5:1 ratio). EXPOSURE: Hypertensive disorder of pregnancy (preeclampsia, gestational hypertension). MAIN OUTCOMES AND MEASURES: Cox proportional hazards models were fitted to estimate hazard ratios (HRs) of developing dilated cardiomyopathy. RESULTS: The cohort included 14 083 individuals with a hypertensive disease of pregnancy during their first pregnancy and 70 415 individuals with normotensive first pregnancies. A first-time pregnancy complicated by a hypertensive disorder of pregnancy, compared with a normotensive first-time pregnancy, was associated with a 93% higher risk of developing dilated cardiomyopathy (adjusted HR, 1.93 [95% CI, 1.33-2.81]; P = .001; adjusted for maternal age). Dilated cardiomyopathy developed a median (IQR) of 5.1 (0.7-10.6) years post partum in those with HDP and 10.6 (4.2-15.8) years post partum in those with normotensive first pregnancies. The association remained significant after adjusting for maternal age, birth year, gestational diabetes, postpregnancy diabetes, postpregnancy hypertension, total parity, ethnicity, and socioeconomic status (adjusted HR, 1.55 [95% CI, 1.04-2.31]; P = .03). There was a dose response; there was a higher risk of DCM in those with preeclampsia (adjusted HR, 1.85 [95% CI, 1.24-2.76]; P = .002) and severe preeclampsia (adjusted HR, 4.29 [95% CI, 2.32-7.96]; P < .001). Maternal age (adjusted HR per year of age, 1.06 [95% CI, 1.03-1.08]; P < .001) and postpartum incident hypertension (adjusted HR, 1.68 [95% CI, 1.16-2.42]; P = .006) were independently associated with the development of DCM. CONCLUSIONS: Patients with hypertensive disorders of pregnancy had a greater risk of developing dilated cardiomyopathy. Older maternal age and postpartum hypertension were associated with higher risk of dilated cardiomyopathy after a hypertensive disorder of pregnancy. These findings support long-term clinical vigilance of patients with a history of hypertensive disorders of pregnancy.