European Heart Journal Supplements最新文献

{"title":"Focus on lipoprotein(a).","authors":"Marta Biolo, Camilla Portinari, Camilla Goffi, Riccardo Berti, Sandra Bertocco, Lorenzo Previato, Sabina Zambon, Paolo Simioni, Alberto Zambon","doi":"10.1093/eurheartjsupp/suag048","DOIUrl":"10.1093/eurheartjsupp/suag048","url":null,"abstract":"<p><p>Lipoprotein(a) [Lp(a)] is a causal and independent cardiovascular risk factor for atherosclerotic cardiovascular disease and calcific aortic valve stenosis, with elevated levels observed in approximately 20% of the general population. Plasma Lp(a) concentrations are predominantly determined by genetic factors, particularly polymorphisms of the <i>LPA</i> gene, which modulate apolipoprotein(a) [apo(a)] size and influence its hepatic synthesis. Structurally, Lp(a) consists of an LDL-like particle containing apolipoprotein B100, covalently bound to apo(a), conferring markedly enhanced atherogenic, pro-inflammatory, and prothrombotic properties compared with an LDL particle. In the absence of therapies specifically approved for Lp(a) reduction, current clinical management relies on an intensive approach to global cardiovascular risk reduction. ESC/EAS guidelines recommend aggressive lowering of LDL cholesterol, particularly through high-intensity statin therapy and, in patients at high or very high risk, the addition of ezetimibe and PCSK9 inhibitors, in order to mitigate the residual risk associated with elevated Lp(a) levels. Lipoprotein apheresis represents the only intervention capable of producing a substantial and immediate reduction in Lp(a); however, its use is limited to selected patients due to its invasive nature and limited availability. In parallel, innovative therapies targeting <i>LPA</i> gene silencing-such as antisense oligonucleotides and small interfering RNA-as well as oral agents inhibiting Lp(a) assembly, are in advanced stages of development. These approaches have demonstrated Lp(a) reductions of up to 80-90%, offering concrete prospects for a causal therapeutic strategy, pending the results of cardiovascular outcome trials.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 5","pages":"v181-v186"},"PeriodicalIF":2.7,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitral Valve Prolapse Associated with Mitral Annular Disjunction: Diagnosis, Prognosis, and Arrhythmic Risk.","authors":"Martina Perazzolo Marra, Cristina Basso","doi":"10.1093/eurheartjsupp/suag023","DOIUrl":"10.1093/eurheartjsupp/suag023","url":null,"abstract":"<p><p>Mitral valve prolapse (MVP) is the most common valvular heart disease, with a reported prevalence of 2-3% in the general population, and represents the leading structural cause of mitral regurgitation in Western countries. MVP has long been considered predominantly a benign condition; however, it may be associated with adverse clinical events, including severe mitral regurgitation, atrial fibrillation, congestive heart failure, endocarditis, stroke, and ventricular arrhythmias, potentially leading to sudden cardiac death.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 5","pages":"v14-v17"},"PeriodicalIF":2.7,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A leap into the future: excluding the ischaemic origin of chest pain through artificial intelligence.","authors":"Fabrizio Imola, Michela Cece, Lucia Fatima di Napoli, Domenico Mario Giamundo, Giuseppe Biondi-Zoccai, Francesco Versaci","doi":"10.1093/eurheartjsupp/suag020","DOIUrl":"10.1093/eurheartjsupp/suag020","url":null,"abstract":"<p><p>Chest pain remains one of the most common and challenging presentations in cardiovascular medicine. Clinical evaluation-including structured history-taking, recognition of anginal equivalents, and focused physical examination-continues to anchor early risk estimation. Artificial intelligence (AI) may augment cardiovascular specialist care through refined pre-test risk stratification by integrating clinical information, high-sensitivity troponin, electrocardiogram (ECG) data, and multimodal imaging. Deep-learning algorithms applied to ECGs identify subtle ischaemic patterns and support rule-out strategies with a high negative predictive value. Artificial intelligence-enhanced coronary computed tomography and cardiac magnetic resonance expand diagnostic capability by characterizing plaque, perfusion, and alternative non-ischaemic aetiologies. Multimodal models leveraging electronic health records produce dynamic risk estimates, while AI tools increasingly support identification of non-coronary but clinically relevant causes of chest pain. The clinical value of AI will ultimately depend on rigorous validation, thoughtful implementation, and clinician governance. When appropriately integrated, AI has the potential to improve consistency, equity, and accuracy in the assessment of chest pain.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 5","pages":"v32-v37"},"PeriodicalIF":2.7,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical activity in hypertrophic cardiomyopathy: from proscription to prescription.","authors":"Pier Luigi Temporelli, Marco Zuin","doi":"10.1093/eurheartjsupp/suag051","DOIUrl":"10.1093/eurheartjsupp/suag051","url":null,"abstract":"<p><p>Recent preclinical and clinical data suggest that moderate physical activity may be safe and beneficial in patients with hypertrophic cardiomyopathy (HCM). Evidence regarding a safe dose of high-intensity exercise remains limited; however, the marked heterogeneity in the morphology and pathophysiology of HCM implies that some individuals are capable of performing even vigorous exercise, including competitive high-intensity sports. Current data indicate that participation in intense exercise and competitive athletics may be considered in a carefully selected subset of predominantly adult patients with a low-risk profile. Studies evaluating the impact of vigorous exercise or moderate-to-high intensity competitive sports on the natural history of HCM remain few and are underpowered to definitively resolve this issue. Nonetheless, emerging evidence now supports a more liberal approach whereby-after appropriate selection, expert clinical evaluation, and shared decision-making-individuals with a low-risk profile may engage in high-intensity physical activity and competitive sports, leading active and fulfilling lives while minimizing risk.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 5","pages":"v169-v172"},"PeriodicalIF":2.7,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of vericiguat in the VICTOR trial: a study that is difficult to interpret.","authors":"Francesco Orso, Christian Basile","doi":"10.1093/eurheartjsupp/suag044","DOIUrl":"10.1093/eurheartjsupp/suag044","url":null,"abstract":"<p><p>Vericiguat is a soluble guanylate cyclase stimulator that acts by restoring the nitric oxide-cyclic guanosine monophosphate pathway, which is markedly impaired in heart failure with reduced ejection fraction (HFrEF). The VICTORIA trial demonstrated that treatment with vericiguat leads to a significant reduction in mortality and morbidity in patients with HFrEF and a recent episode of clinical decompensation. However, the role of vericiguat in clinically stable patients had remained unexplored until the recent publication of the VICTOR trial. In a population receiving optimal medical therapy and characterized by a lower risk of events, vericiguat did not demonstrate a significant reduction in the primary composite endpoint of cardiovascular death and hospitalization for heart failure. When analysing the individual components of the primary endpoint, no benefit was observed with respect to hospitalizations, whereas significant reductions in both cardiovascular and all-cause mortality were reported. This finding, which is highly unusual in the context of recent clinical trials in patients with HFrEF, warrants further consideration when interpreting the results of the study.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 5","pages":"v135-v138"},"PeriodicalIF":2.7,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2025 ESC/EACTS valvular heart disease guidelines: practical updates on mitral and tricuspid regurgitation.","authors":"Marianna Adamo, Mauro Massussi, Nina Ajmone Marsan, Michael A Borger, Fabien Praz, Marco Metra","doi":"10.1093/eurheartjsupp/suag001","DOIUrl":"10.1093/eurheartjsupp/suag001","url":null,"abstract":"<p><p>2025 ESC/EACTS guidelines for valvular heart disease reflect the rapid evolution of transcatheter technologies and multidisciplinary care. In primary mitral regurgitation, surgical repair remains the gold standard, with a new Class I recommendation for asymptomatic patients and refined timing incorporating indexed left ventricular end-systolic dimension. Transcatheter edge-to-edge repair (TEER) is upgraded to Class IIa for symptomatic high-risk patients. In secondary mitral regurgitation (SMR), the guidelines distinguish between atrial and ventricular phenotypes. Transcatheter edge-to-edge repair has now a Class I [Level of Evidence (LOE) A] recommendation for very selected patients with ventricular SMR symptomatic despite guideline-directed medical therapy. For atrial SMR, surgery-often involving concomitant atrial fibrillation ablation-is preferred in suitable candidates, while TEER is reserved to high-risk patients. Regarding tricuspid regurgitation, the guidelines emphasize early referral and structured evaluation of right ventricular function and pulmonary pressures (Class I). Transcatheter tricuspid valve interventions are upgraded to Class IIa (LOE A) for symptomatic high-risk patients, provided severe right ventricular dysfunction or precapillary pulmonary hypertension are absent. These updates redefine atrio-ventricular valve management by promoting earlier and personalized intervention. They solidify the role of transcatheter therapies as evidence-based, outcome-modifying options within a Heart Valve Centre framework, while precisely delineating the continued priority of surgery in lower-risk populations and complex anatomies.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 4","pages":"iv83-iv96"},"PeriodicalIF":2.7,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient selection for complex, high-risk indicated percutaneous coronary intervention procedures: an overview.","authors":"Vasileios Panoulas, Ovidio De Filippo, Matthias Bossard, Jürgen Leick, Jerzy Sacha, Mario Iannaccone, Arpad Lux, Guido Tavazzi, Nilesh Pareek, Roberto Lorusso, Nikos Werner","doi":"10.1093/eurheartjsupp/suag057","DOIUrl":"10.1093/eurheartjsupp/suag057","url":null,"abstract":"<p><p>Percutaneous coronary intervention (PCI) has evolved substantially over recent decades, enabling treatment of increasingly complex coronary anatomy through major technological advances, including enhanced stent platforms, intracoronary imaging, plaque modification devices, and mechanical circulatory support (MCS). Despite these developments, coronary artery bypass grafting often remains the guideline-preferred strategy for patients with complex and prognostically significant coronary artery disease. However, patients with complex and advanced coronary artery disease are often older and burdened by greater comorbidity than those enrolled in randomized clinical trials, rendering many patients poor surgical candidates, and prompting preference for less invasive therapies to preserve quality of life. This shift has driven the emergence of complex, high-risk indicated PCI (CHIP) and protected PCI as alternative treatment strategies. CHIP encompasses both anatomical complexity and heightened procedural risk related to haemodynamic compromise and patient comorbidities. As randomized trials capture only a small subset of real-world patients and are often subject to selection bias, current practice relies heavily on observational data-derived largely from registries, expert consensus, and institutional experience-to guide selection of patients most likely to benefit from MCS support. This review synthesizes available contemporary evidence and consensus frameworks to delineate the multifactorial nature of CHIP risk, organizing key determinants into four categories: complex coronary anatomy, impaired haemodynamics, cardiac comorbidities, and non-cardiac comorbidities. Understanding how these factors influence procedural risk, patient selection, and therapeutic benefit is essential to decision-making and optimization of outcomes in this vulnerable population.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 7","pages":"vii3-vii13"},"PeriodicalIF":2.7,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13294556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancement in pre- and peri-procedural imaging.","authors":"Georg Nickenig, Marcel Weber, Rebecca T Hahn, Marta Sitges, Julien Dreyfus","doi":"10.1093/eurheartjsupp/suaf095","DOIUrl":"10.1093/eurheartjsupp/suaf095","url":null,"abstract":"<p><p>Only recently, pathophysiology and relevance of tricuspid regurgitation (TR) has been acknowledged but remains still poorly understood. The rising interest in this valve disease has also fuelled the efforts to define and improve imaging modalities. Vice versa, understanding tricuspid disease initiation and progress, validation, and quantification as well as choice and monitoring of treatment critically rely on reproducible and sensitive imaging capabilities. The latter is dominated by ever improving ultrasound-based analysis applied from the outside, the oesophagus or within the heart. The increasing appreciation of the relevance of TR and the rapid evolution of catheter-based treatment options has stimulated engineers and industry to swiftly improve established methodologies as well as to provide novel tools including three-dimensional intra-cardiac echocardiography and fusion imaging. Ultrasound is necessarily complemented by MRI and CT in the tricuspid space urging the cardiologist to gain also expertise in these modalities. In this review, we will focus on the quantitative and reproducible measurements to quantify TR and concomitant left and right heart anatomy, function, and haemodynamics before, during and after treatment. In addition, we will share insights on adjunct and future technologies.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 4","pages":"iv21-iv38"},"PeriodicalIF":2.7,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing revascularization in the high-risk heart: Impella™-facilitated percutaneous coronary intervention in multivessel coronary artery disease with reduced left ventricular ejection fraction and mitral regurgitation.","authors":"Cristina Aurigemma, Jerzy Sacha, Pia Lanmüller, Aleksandra Gąsecka, Luca Baldetti, Ee Ling Heng, Stanislaw Bartus, Nikos Werner","doi":"10.1093/eurheartjsupp/suag007","DOIUrl":"10.1093/eurheartjsupp/suag007","url":null,"abstract":"<p><p>Percutaneous coronary intervention (PCI) is considered for patients at high risk for peri-operative mortality and complications during coronary artery bypass grafting, with further consideration of mechanical circulatory support (MCS) to prevent haemodynamic decompensation in patients with complex coronary artery disease and reduced ventricular function. However, current risk models do not account for crucial factors such as frailty or severity of valvular disease, potentially underestimating surgical risk. As such, the surgeon's clinical judgment may more accurately reflect a given patient's mortality risk. Here, we present a clinical scenario of a frail, inoperable 73-year-old male with mitral regurgitation and reduced left ventricular ejection fraction who underwent successful complex high-risk PCI supported by an Impella™ microaxial flow pump. A multidisciplinary approach was taken in determining the patient's anatomical and clinical risk profile, with consideration of both conventional risk scores as well as the patient's frailty. The multivessel procedure was carefully planned to minimize intra-procedural risk while achieving the most complete and durable revascularization possible. Planned early use of MCS played a central role in maintaining haemodynamic stability during the intervention. The patient recovered without vascular or device-related complications, and at 6 months, demonstrated improved left ventricular ejection fraction to 45%. This scenario highlights the feasibility and safety of this approach when performed in an experienced centre; however additional studies are needed to define optimal patient selection, procedural protocols, and follow-up pathways. Until then, meticulous multidisciplinary evaluation, tailored procedural planning, and rigorous post-procedural care remain the cornerstones of success.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 7","pages":"vii20-vii31"},"PeriodicalIF":2.7,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13294553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary evidence in protected percutaneous coronary intervention: a case-based review.","authors":"Ovidio De Filippo, Jürgen Leick, Giuseppe Tarantini, Ee Ling Heng, Guido Tavazzi, Roberto Lorusso, Assad Haneya, Nikos Werner","doi":"10.1093/eurheartjsupp/suag006","DOIUrl":"10.1093/eurheartjsupp/suag006","url":null,"abstract":"<p><p>High-risk percutaneous coronary intervention (PCI) in patients with markedly reduced left ventricular ejection fraction (LVEF) carries a substantial risk of haemodynamic collapse, creating an unmet need for strategies that allow complete, optimized revascularization without compromising safety. These cases often fall within the <i>Class IIb-III indications of the 2024</i> European Society of Cardiology (<i>ESC) Chronic Coronary Syndromes and Revascularization Guidelines</i>, which support PCI in patients with severe left ventricular (LV) dysfunction, complex or multivessel disease, and surgical ineligibility or refusal after Heart Team evaluation. For such individuals, protected PCI using percutaneous mechanical circulatory support (MCS), namely microaxial flow pumps (mAFP), may enable procedural completeness and improve outcomes. Herein, we present a case of a 66-year-old male that illustrates the expanding role of <i>protected PCI</i> in patients who meet <i>Class IIb-III ESC Guidelines criteria,</i> with severe LV dysfunction, multivessel or left main disease, and surgical refusal or ineligibility. Contemporary evidence supports the use of mAFP-assisted PCI to maintain forward flow and ventricular unloading during complex revascularization, thereby minimizing ischaemic and haemodynamic instability. Such an approach allows the operator to pursue meticulous lesion preparation, imaging-guided optimization, and bifurcation PCI techniques while preserving perfusion and procedural safety. In appropriately selected cases, Impella-supported high-risk PCI represents a safe and effective option. It enables complete, optimized revascularization and can promote early functional recovery, bridging a crucial therapeutic gap in contemporary revascularization practice.</p>","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 7","pages":"vii48-vii57"},"PeriodicalIF":2.7,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13294559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}