European Heart Journal最新文献

{"title":"Blinded withdrawal of randomized treatment with low-dose digoxin or placebo in heart failure: the DECISION trial.","authors":"Peter van der Meer, Dirk J van Veldhuisen, Geert H D Voordes, Jan Tijssen, Marco Alings, Marcel L Bouvy, Henk P Swart, H Jaco Houtgraaf, H G Reinhart Dorman, Michiel Rienstra, Kevin Damman, Arend Mosterd","doi":"10.1093/eurheartj/ehag385","DOIUrl":"10.1093/eurheartj/ehag385","url":null,"abstract":"<p><strong>Background and aims: </strong>Whether digoxin withdrawal is safe in patients with heart failure (HF) optimized on contemporary guideline-recommended medical therapy remains unknown. This pre-specified analysis of the DECISION trial evaluated outcomes following blinded withdrawal of digoxin or placebo.</p><p><strong>Methods: </strong>In DECISION, 1001 patients were randomized to low-dose digoxin or placebo and treated for a median of 36.5 months. At the end of the study, 587 patients on active treatment (digoxin 288 and placebo 299) underwent blinded withdrawal with an in-person follow-up visit at 6 weeks. All events were adjudicated.</p><p><strong>Results: </strong>During the pre-withdrawal phase (100 days), incidence rates of cardiovascular (CV) death or worsening HF events were 5.7 vs 6.5 events per 100 patient-years in the digoxin vs placebo group; rate ratio (RR) 0.88; 95% confidence interval (CI) [0.24-3.10]. Following withdrawal, the incidence rate increased markedly in patients withdrawn from digoxin but not placebo (42.8 vs 5.9 events per 100 patient-years; time period-by-treatment interaction, P = .036). Fourteen events (12 hospitalizations and 2 urgent HF visits) occurred in the digoxin withdrawal arm vs two (one HF hospitalization and one CV death) in the placebo withdrawal arm (RR 7.37, 95% CI 1.56-34.88; P = .012). Withdrawal of digoxin was accompanied by an increase in heart rate (P = .003), reduction in systolic blood pressure (P = .014), and rise in NT-proBNP (P = .002).</p><p><strong>Conclusions: </strong>Discontinuation of digoxin after long-term treatment is associated with clinical deterioration in patients with HF and a reduced or mildly reduced ejection fraction. These findings warrant caution when stopping digoxin.</p>","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":" ","pages":"5545-5553"},"PeriodicalIF":45.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147867337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Soluble ST2 drives fulminant myocarditis progression via the IGF2R-YY1 mitochondrial axis.","authors":"Yan Zhuang, Zhuo Zhang, Huihui Li, Kudusi Abuduwufuer, Donghui Zhang, Zheng Wen, Xiaoquan Rao, Chen Chen, Ingrid Fleming, Dao Wen Wang","doi":"10.1093/eurheartj/ehag105","DOIUrl":"10.1093/eurheartj/ehag105","url":null,"abstract":"<p><strong>Background and aims: </strong>Fulminant myocarditis (FM) is a life-threatening inflammatory cardiomyopathy with high mortality. Soluble ST2 (sST2), traditionally regarded as a decoy receptor for interleukin-33 (IL-33), is markedly elevated in FM, yet its mechanistic and translational roles remain unclear.</p><p><strong>Methods: </strong>A Coxsackievirus B3-induced FM mouse model was used to define the cellular source and function of sST2 through histological, molecular, and integrated single-cell and single-nucleus transcriptomic analyses. Cardiomyocyte responses were assessed in neonatal murine cardiomyocytes and human engineered heart tissues. The therapeutic efficacy and safety of sST2-neutralizing antibodies were evaluated in vivo, with clinical relevance examined in a cohort of FM patients.</p><p><strong>Results: </strong>sST2 originated predominantly from infiltrating CCR2+ macrophages in FM hearts and aggravated cardiac damage by amplifying inflammation, mitochondrial dysfunction, and contractile failure. Mechanistically, sST2 acted independently of IL-33. It entered cardiomyocytes via IGF2R and bound the transcription factor YY1, preventing its nuclear translocation and repressing mitochondrial electron transport chain gene expression, thereby reducing ATP synthesis. Neutralizing antibodies targeting sST2 effectively restored mitochondrial function, improved hemodynamics, and reduced mortality without evident short-term systemic toxicity. Integrated single-cell and single-nucleus transcriptomic analyses revealed broad therapeutic effects across cardiomyocytes, fibroblasts, endothelial cells, and macrophages. Combined glucocorticoid and anti-sST2 therapy provided additive benefit. Clinically, elevated plasma sST2 independently predicted 30-day mortality or extracorporeal membrane oxygenation requirement in FM patients, outperforming N-terminal pro-B-type natriuretic peptide and cardiac troponin I for prognostic discrimination.</p><p><strong>Conclusions: </strong>sST2 drives FM by disrupting cardiomyocyte mitochondrial homeostasis independently of IL-33 and represents both a clinically prognostic biomarker and a therapeutic target.</p>","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":" ","pages":"5572-5589"},"PeriodicalIF":45.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146178691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: 2025 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the task force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS).","authors":"","doi":"10.1093/eurheartj/ehag625","DOIUrl":"10.1093/eurheartj/ehag625","url":null,"abstract":"","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":" ","pages":"5507"},"PeriodicalIF":45.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypokalaemia and hyperkalaemia in heart failure: risk factor or risk marker?","authors":"Lars H Lund, Barna Szabo-Söderberg","doi":"10.1093/eurheartj/ehag664","DOIUrl":"10.1093/eurheartj/ehag664","url":null,"abstract":"","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":" ","pages":"5602-5603"},"PeriodicalIF":45.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mineralocorticoid inhibition in heart failure: does one size fit all?","authors":"Jenifer M Brown, Jonathan W Cunningham","doi":"10.1093/eurheartj/ehag603","DOIUrl":"10.1093/eurheartj/ehag603","url":null,"abstract":"","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":" ","pages":"5569-5571"},"PeriodicalIF":45.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digitoxin in heart failure with reduced ejection fraction according to atrial fibrillation status: the DIGIT-HF trial.","authors":"Udo Bavendiek, Nele Henrike Thomas, Lars S Maier, Dominik Berliner, Peter M Becher, Johannes Schwab, Andreas Rieth, Thomas Gaspar, Xiaofei Liu, Sven Schallhorn, Samira Soltani, Lea Haebel, Marija Zdravkovic, Martin Hülsmann, Anika Seltmann, Paulus Kirchhof, Heiko von der Leyen, Christian Veltmann, Stefan Störk, Michael Böhm, Armin Koch, Anika Großhennig, Johann Bauersachs","doi":"10.1093/eurheartj/ehag379","DOIUrl":"10.1093/eurheartj/ehag379","url":null,"abstract":"","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":" ","pages":"5597-5601"},"PeriodicalIF":45.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147867247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Albuminuria and heart failure.","authors":"Javed Butler, Adeena Jamil, David Z I Cherney, Tazeen H Jafar, Jeffrey M Testani, Muhammad Shahzeb Khan","doi":"10.1093/eurheartj/ehag426","DOIUrl":"10.1093/eurheartj/ehag426","url":null,"abstract":"<p><p>Albuminuria, typically measured by urinary albumin-to-creatinine ratio, is present in nearly half of all patients with heart failure. Even at low levels, albuminuria is a well-established, independent risk marker for incident heart failure and adverse outcomes in those with pre-existing heart failure. Currently, routine urinary albumin-to-creatinine ratio screening is not universally recommended in heart failure guidelines, unlike in guidelines for Type 2 diabetes, chronic kidney disease, and hypertension. Emerging data suggest that this may limit opportunities for early detection, risk stratification, and pharmacologic intervention to improve outcomes. Clinical trials of guideline-directed therapies, including renin-angiotensin inhibitors, sodium-glucose cotransporter 2 inhibitors and finerenone show that reductions in urinary albumin-to-creatinine ratio is associated with risk reductions for cardiovascular, heart failure, and chronic kidney disease outcomes, indicating that albuminuria may function as both a marker of risk and potentially a modifiable factor. This review evaluates the role of albuminuria in predicting heart failure development and progression, its potential as a modifiable risk factor, approaches for measurement, current guideline recommendations for testing, and how heart failure therapies influence albuminuria and associated outcomes.</p>","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":" ","pages":"5483-5500"},"PeriodicalIF":45.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Staging a comeback for digitalis.","authors":"Lynne W Stevenson, Katherine T Murray","doi":"10.1093/eurheartj/ehag629","DOIUrl":"10.1093/eurheartj/ehag629","url":null,"abstract":"","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":" ","pages":"5554-5557"},"PeriodicalIF":45.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do women and men have equal benefits from heart failure medications?","authors":"Cecilia Linde","doi":"10.1093/eurheartj/ehag559","DOIUrl":"10.1093/eurheartj/ehag559","url":null,"abstract":"","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":" ","pages":"5542-5544"},"PeriodicalIF":45.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148688639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Haemodynamic diagnosis of pulmonary vascular disease in heart failure.","authors":"Robert Naeije, Stefano Ghio","doi":"10.1093/eurheartj/ehag318","DOIUrl":"10.1093/eurheartj/ehag318","url":null,"abstract":"","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":" ","pages":"5504-5507"},"PeriodicalIF":45.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}