European Heart Journal最新文献

{"title":"Heart failure: the need for cardiologist-guided follow-up to improve outcomes.","authors":"Lars H Lund","doi":"10.1093/eurheartj/ehaf229","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf229","url":null,"abstract":"","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"32 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087484","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":"Cardiologist follow-up and improved outcomes of heart failure: a French nationwide cohort","authors":"Guillaume Baudry, Ouarda Pereira, François Roubille, Marc Villaceque, Thibaud Damy, Kévin Duarte, Philippe Tangre, Nicolas Girerd","doi":"10.1093/eurheartj/ehaf218","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf218","url":null,"abstract":"Background and Aims Outpatient cardiology follow-up is the cornerstone of heart failure (HF) management, requiring adaptation based on patient severity. However, risk stratification using administrative data is scarce, and the association between follow-up and prognosis according to patient risk has yet to be described at a population level. This study aimed to describe prognosis and management across different strata using simple criteria, including diuretic use and prior HF hospitalization (HFH). Methods This nationwide cohort included all French patients reported as having HF in the previous 5 years and alive on 1 January 2020. Patients were categorized into four groups: (i) HFH within the past year (HFH ≤ 1y), (ii) HFH 1–5 years ago (HFH > 1y), (iii) not hospitalized using loop diuretics (NoHFH/LD+), and (iv) not hospitalized without loop diuretics (NoHFH/LD−). Between-group associations, all-cause mortality (ACM), and cardiology follow-up were analysed using survival models. Results The study included 655 919 patients [80 years (70–87), 48% female]. One-year ACM risk was 15.9%, ranging from 8.0% (NoHFH/LD−) to 25.0% (HFH ≤ 1y). Mortality risk was 1.61-fold higher for NoHFH/LD+, 1.83-fold for HFH > 1y, and 2.32-fold for HFH ≤ 1y compared to NoHFH/LD− (P < .0001). During the first year of follow-up (2020), cardiology consultation rates were similar across groups, with 40% of patients lacking an annual visit. Compared to no consultation, a single cardiology visit in the previous year (2019) was associated with a 6%–9% absolute reduction in 1-year ACM during the following year (2020) across all groups. The number needed to consult (NNC) to prevent one modelled death was 11–16. Additional visits showed greater benefit with increasing HF severity, with NNC ranging from 55 (NoHFH/LD−) to 20 (HFH ≤ 1y). The optimal follow-up to minimize the number of deaths without increasing the total number of consultations was 1 annual visit for NoHFH/LD−, 2–3 visits for NoHFH/LD+ and HFH > 1y, and 4 visits for HFH ≤ 1y patients. Conclusions Despite having a HF diagnosis, 40% of patients do not see a cardiologist annually, regardless of disease severity. Simple stratification based on hospitalization history and diuretic use effectively predicts outcomes. Tailoring the annual number of HF consultations according to this stratification could optimize resource use and reduce avoidable modelled deaths.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"30 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083179","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":"Pre-arrest electrocardiogram changes due to vasospastic angina.","authors":"Tomohiro Fujisaki,Toshihiro Nakamura,Kengo Kusano","doi":"10.1093/eurheartj/ehaf344","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf344","url":null,"abstract":"","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"32 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065839","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":"Coronary artery bypass grafting with or without preoperative physiological stenosis assessment: a SWEDEHEART study.","authors":"Emma C Hansson,Elmir Omerovic,Dimitrios Venetsanos,Joakim Alfredsson,Andreas Martinsson,Björn Redfors,Amar Taha,Susanne J Nielsen,Anders Jeppsson","doi":"10.1093/eurheartj/ehaf327","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf327","url":null,"abstract":"BACKGROUND AND AIMSPhysiological flow assessment of coronary stenoses, such as fractional flow reserve, are routinely used to guide percutaneous coronary intervention, but it has not been equally recognized to guide coronary artery bypass grafting (CABG). Mid-term outcomes in CABG patients with and without preoperative flow assessment were compared.METHODSAll patients with first-time isolated CABG in Sweden 2013-2020 were identified in the SWEDEHEART registry (n = 18 211), which also provided information on flow assessment. Data were linked with three mandatory national registries. Median follow-up was 3.6 years (range 0-7.5). Incidence of all-cause mortality, stroke, new myocardial infarction, new coronary angiography, and new revascularization was compared using adjusted Cox regression models. The proportional hazard assumption was violated for new angiography and revascularization. Hence, follow-up was divided into 0-2 and >2 years.RESULTSOverall, 2869 patients (15.8%) had flow assessment before surgery, increasing from 7.1% in 2013% to 21.5% in 2020. Patients with flow assessment were younger, had a lower EuroSCORE II, and received fewer distal anastomoses (3.0 ± 0.9 vs 3.2 ± 1, P < .001). There were no associations between flow assessment and mortality, post-discharge myocardial infarction, or stroke. New angiography and new revascularization were not significantly different 0-2 years, but preoperative flow assessment was associated with a higher risk for new angiography [adjusted hazard ratio (aHR) 1.32, 95% confidence interval (CI) 1.08-1.62, P = .008] and new revascularization (aHR 1.55, 95% CI 1.18-2.04, P = .002) >2 years after CABG.CONCLUSIONSPreoperative flow assessment was not associated with improved clinical outcomes but with a higher risk for new angiography and new revascularization >2 years after CABG. The results suggest that the use of flow assessment with current cut-off levels may not be applicable in CABG, and further studies are needed.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"121 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065837","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":"Expanding the triglyceride range in clinical trials: therapeutic opportunities.","authors":"Ask T Nordestgaard, Aruna D Pradhan, Brendan M Everett, Jean G MacFadyen, Deepak L Bhatt, Frank L J Visseren, Peter Libby, Raul D Santos, Steven E Nissen, Børge G Nordestgaard, Paul M Ridker","doi":"10.1093/eurheartj/ehaf074","DOIUrl":"10.1093/eurheartj/ehaf074","url":null,"abstract":"<p><strong>Background and aims: </strong>Guidelines focus on individuals with triglycerides between 2.3 and 5.6 mmol/L (200 and 499 mg/dL). The hypotheses that triglycerides across the full biological range and within this constrained range associated with cardiovascular risk were re-assessed.</p><p><strong>Methods: </strong>Multivariable-adjusted hazard ratios for major cardiovascular events and death according to baseline triglycerides among 119 573 individuals with triglycerides across the full biological range from the Copenhagen General Population Study, among 27 757 individuals with baseline triglycerides between 2.3 and 5.6 mmol/L from the Copenhagen General Population Study and the Women's Health Study cohorts, and among 31 272 individuals with mild-to-moderate hypertriglyceridaemia from the PROMINENT, REDUCE-IT, and STRENGTH trials were calculated.</p><p><strong>Results: </strong>Increasing triglycerides across the full range (0.3 to 11.2 mmol/L) were associated with an increasing risk of major cardiovascular events (N = 12 241). In the cohorts, combined hazard ratios [95% confidence interval (triglyceride range in mmol/L)] for major cardiovascular events (N = 3928) from lowest to highest triglyceride quartile were 1.0 [referent (range: < 2.5)], 0.95 [0.87-1.04 (range: 2.5 to <3.0)], 1.04 [0.95-1.13 (range: 3.0 to <3.6)], and 1.13 [1.04-1.23 (range: ≥ 3.6)]. In the three contemporary trials, the corresponding hazard ratios (N = 4265 cardiovascular events) from lowest to highest quartile were 1.0 [referent (ranges for PROMINENT/REDUCE-IT/STRENGTH: < 2.6/2.0/2.2)], 1.01 [0.93-1.10 (ranges: 2.6 to <3.1/2.0 to <2.5/2.2 to <2.7)], 1.05 [0.96-1.14 (ranges: 3.1 to <3.9/2.5 to <3.1/2.7 to < 3.5)] and 1.09 [1.00-1.19 (ranges: ≥ 3.9/3.1/3.5)]. In neither cohorts nor trials were triglycerides across this range strongly associated with risk of cardiovascular or all-cause death.</p><p><strong>Conclusions: </strong>Individuals with mild-to-moderate hypertriglyceridaemia may not express the same magnitude of cardiovascular risk as that observed across the full range of plasma triglycerides. Future triglyceride-lowering therapy trials may want to consider enrolment across a wider range of triglyceride levels if there is no prior history of pancreatitis nor excessive alcohol intake.</p>","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":" ","pages":"1835-1848"},"PeriodicalIF":37.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413804","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":"Adult-onset type 1 diabetes: predictors of major cardiovascular events and mortality.","authors":"Yuxia Wei,Tomas Andersson,Tiinamaija Tuomi,Thomas Nyström,Sofia Carlsson","doi":"10.1093/eurheartj/ehaf304","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf304","url":null,"abstract":"BACKGROUND AND AIMSThe prognosis of adult-onset type 1 diabetes (T1D) and prognostic factors are sparsely investigated. This study assessed mortality, major adverse cardiovascular events (MACE), and prognostic factors in adult-onset T1D, particularly focusing on those diagnosed at age ≥40.METHODSParticipants were people diagnosed with adult-onset T1D (n = 10 184) or type 2 diabetes (T2D, n = 375 523) in 2001-20 from the Swedish National Diabetes Register and 509 172 population controls from the Total Population Register, followed until 2022. Hazard ratios (HR) and population attributable risk fraction (PAR%) were estimated.RESULTSPeople with T1D had higher incidence of MACE (HR 1.30 [95% confidence interval 1.17, 1.45]), all-cause mortality (1.71 [1.60, 1.84]), and mortality from cardiovascular or non-cardiovascular diseases, cancer, or infection than population controls. They had lower MACE incidence (0.67 [0.60, 0.75]) and higher mortality from diabetic coma or ketoacidosis (7.04 [4.54, 10.9]) than people with T2D. Smoking (PAR% 10.7%) and glycated haemoglobin (HbA1c) ≥ 53 mmol/mol (10.4%) accounted for most deaths while overweight/obesity (19.8%), smoking (8.4%), and high HbA1c (8.8%) accounted for most MACE events in T1D. Results were similar for T1D diagnosed at age ≥40, although they had lower insulin pump use and higher HbA1c than people diagnosed earlier.CONCLUSIONSAdult-onset T1D carries excess risk of death and MACE compared with population controls but less MACE risk than T2D. Individuals diagnosed after age 40 had similar excess risk and poorer glycaemic control than those diagnosed earlier, underscoring the need for improved management. Key prognostic factors were smoking, poor glycaemic control, and overweight/obesity.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"44 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945413","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":"An update on the ESC Council on Cardiovascular Genomics: out from the niche into the open.","authors":"Stefan Kääb, Antoine Bondue","doi":"10.1093/eurheartj/ehaf068","DOIUrl":"10.1093/eurheartj/ehaf068","url":null,"abstract":"","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":" ","pages":"1784-1786"},"PeriodicalIF":37.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624064","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":"Fibroblast growth factor 5: a novel biomarker for familial hypercholesterolaemia.","authors":"Andrea Baragetti, Asiiat S Alieva, Liliana Grigore, Fabio Pellegatta, Andrea Lupi, Chiara Scrimali, Angelo B Cefalù, Barbara A Hutten, Albert Wiegman, Paul Knaapen, Michiel J Bom, Nick S Nurmohamed, Olga Reutova, Alexandra Konradi, Evgeny Shlyakhto, Erik S G Stroes, Maurizio Averna, Alberico L Catapano","doi":"10.1093/eurheartj/ehaf045","DOIUrl":"10.1093/eurheartj/ehaf045","url":null,"abstract":"<p><strong>Background and aims: </strong>Identification of individuals affected by familial hypercholesterolaemia (FH) is suboptimal when genetic tests are unavailable. Relying only on low-density lipoprotein cholesterol (LDL-C) is challenging as it may not allow distinguishing individuals with FH from hypercholesterolaemic (HC) individuals from the general population. The aim of this study was to determine whether biomarkers associated with cardiovascular disease and/or inflammation identify FH individuals and distinguish them from HC individuals.</p><p><strong>Methods: </strong>A panel of 264 proteins in plasma was measured and machine learning was used to search for those that can distinguish FH individuals, either genetically proven (genFH) or clinically diagnosed (clinFH) from HC and control individuals.</p><p><strong>Results: </strong>Both genFH and clinFH had elevated plasma levels of fibroblast growth factor 5 (FGF-5) compared with controls (mean area under the curve [AUC] > .990 for both, P < .001) or HC individuals (mean AUC >.990, P < .001), even after matching for LDL-C levels. An immunoenzymatic assay confirmed that FGF-5 was elevated in genFH and clinFH in all cohorts analysed.</p><p><strong>Conclusions: </strong>This analysis suggests that FGF-5 could be a biomarker to discriminate individuals living with FH from HC individuals.</p>","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":" ","pages":"1819-1834"},"PeriodicalIF":37.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390570","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":"High temperature and cardiovascular disease in Australia under different climatic, demographic, and adaptive scenarios.","authors":"Jingwen Liu, Blesson M Varghese, Alana Hansen, Keith Dear, Timothy Driscoll, Ying Zhang, Geoffrey Morgan, Vanessa Prescott, Vergil Dolar, Michelle Gourley, Anthony Capon, Peng Bi","doi":"10.1093/eurheartj/ehaf117","DOIUrl":"10.1093/eurheartj/ehaf117","url":null,"abstract":"<p><strong>Background and aims: </strong>Cardiovascular disease (CVD), the leading cause of death globally and in Australia, is sensitive to heat exposure. This study assesses the burden of CVD attributable to high temperatures across Australia and projects future burden in the context of climate change.</p><p><strong>Methods: </strong>Disability-adjusted life years for CVD, including years of life lost and years lived with disability, were sourced from the Australian Burden of Disease database. A meta-regression model was constructed using location-specific predictors and relative risks from prior literature to estimate relative risks of CVD mortality and morbidity due to high temperatures in the Australian context. The baseline CVD burden attributable to high temperatures in Australia for 2003-18 was calculated, and future burdens under two greenhouse gas emissions scenarios [Representative Concentration Pathways (RCP4.5 and RCP8.5)] for the 2030s and 2050s were projected, considering demographic changes and human adaptation.</p><p><strong>Results: </strong>During the baseline period, high temperatures accounted for 7.3% (95% confidence interval: 7.0%-7.6%) of the CVD burden in Australia, equivalent to 223.8 Disability-adjusted life years (95% confidence interval: 221.0-226.6) per 100 000 population. Future projections suggest a steady increase in the CVD burden across all scenarios examined. By the 2050s, under the RCP8.5 scenario that considers population growth and no adaptation, the total attributable burden of CVD is projected to more than double compared with the baseline, with the Northern Territory facing the most significant increase. These impacts could be mitigated with effective human adaptation to the warming climate.</p><p><strong>Conclusions: </strong>Higher temperatures are expected to exacerbate the burden of CVD. This study highlights the need for urgent adaptation and mitigation efforts to minimize the negative health impacts of a warming climate on CVD.</p>","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":" ","pages":"1852-1862"},"PeriodicalIF":37.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12075934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639686","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":"Exercise prescription in hypertrophic cardiomyopathy: Dr Lown's lesson to break taboos.","authors":"Iacopo Olivotto, Flavio D'Ascenzi","doi":"10.1093/eurheartj/ehae659","DOIUrl":"10.1093/eurheartj/ehae659","url":null,"abstract":"","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":" ","pages":"1816-1818"},"PeriodicalIF":37.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556272","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}