Heart最新文献

{"title":"Severity of mobility limitation and adverse outcomes in heart failure.","authors":"Kotaro Iwatsu, Kensuke Takabayashi, Tomoyuki Hamada, Toru Kubo, Tsutomu Ikeda, Shoji Kitaguchi, Tetsuhisa Kitamura, Takeshi Kimura, Hiroaki Kitaoka, Ryuji Nohara","doi":"10.1136/heartjnl-2024-325120","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325120","url":null,"abstract":"<p><strong>Background: </strong>Mobility limitation is prevalent in patients with heart failure (HF), but the dose-response relationship between its severity and adverse outcomes remains unquantified.</p><p><strong>Methods: </strong>We conducted a patient-level pooled analysis of two prospective Japanese cohort studies, including 2103 hospitalised patients with HF with no exclusion criteria. Mobility limitation at discharge was categorised into four levels: category I (independent outdoor walking), category II (indoor independence but requiring outdoor assistance), category III (requiring indoor assistance) and category IV (unable to walk). The primary endpoint was a 2-year composite of HF rehospitalisation or all-cause mortality. Adjusted analyses accounted for age, sex, comorbidities, biomarkers and medications.</p><p><strong>Results: </strong>Among 2820.7 person-years of follow-up, 998 composite outcomes occurred. Incidence rates per 100 person-years for the primary outcome increased with mobility limitation severity: 24.9 (category I), 47.0 (II), 59.3 (III) and 84.8 (IV) (p for trend <0.001). Adjusted HRs (95% CI) using category I as reference were 1.22 (95% CI 1.04 to 1.45) for II, 1.39 (95% CI 1.11 to 1.73) for III and 1.71 (95% CI 1.34 to 2.20) for IV. While the graded association was clear for mortality, it was less evident for HF rehospitalisation alone, likely reflecting competing mortality risks.</p><p><strong>Conclusions: </strong>This study demonstrates a strong and graded association between mobility limitation severity and adverse outcomes in HF, suggesting its utility for refined risk stratification.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Composite complexities and multiplicities: navigating clinical outcomes in cardiovascular studies.","authors":"Ji Quan Samuel Koh, Jonathan Yap","doi":"10.1136/heartjnl-2025-326495","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326495","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome measures for randomised clinical trials and multicentre observational studies of cardiovascular diseases published in major clinical journals: systematic review and evidence mapping.","authors":"Asad Bhatty, Chris Wilkinson, Suleman Aktaa, Gorav Batra, Benjamin Beska, Phyo H H Khaing, Ali Wahab, Keerthenan Raveendra, Ahmed Taha, Ramesh Nadarajah, Deepak L L Bhatt, Rod Stables, John Camm, Rajesh K Kharbanda, David E Newby, Mark C Petrie, Jianhua Wu, Matthew R R Sydes, Chris P Gale","doi":"10.1136/heartjnl-2025-326045","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326045","url":null,"abstract":"<p><strong>Background: </strong>Outcome measure choice and definition can determine the result of the study. We describe outcome measures and their definitions for cardiovascular studies in highly cited medical journals.</p><p><strong>Methods: </strong>Cardiovascular phase III or IV randomised clinical trials (RCTs) or multicentre observational studies published in the <i>New England Journal of Medicine</i>, <i>Lancet</i> or <i>Journal of the American Medical Association</i> between 1 January 2013 and 6 June 2024 from Embase and Ovid Medline were included. Two independent reviewers selected the studies and extracted the primary and secondary outcome measures from each publication.</p><p><strong>Results: </strong>386 studies (83% RCTs; 17% observational) representing 10 699 147 participants were included. Studies investigated coronary heart disease (51%), cardiomyopathy/heart failure (22%), heart rhythm disease (15%), valvular heart disease (11%) and 'other' cardiovascular diseases (1%), with 45% investigating a device and 48% funded by industry. The most frequently reported primary outcome measure was a composite (63%), the most frequent component of which was myocardial infarction (58%). The use of a composite for the primary outcome measure increased from 49% of studies in 2013 to a peak of 85% in 2018. From 2013 to 2023, the median number of secondary outcome measures per study increased for RCTs (3-8) and observational studies (0-7). Definitions for cardiovascular mortality, myocardial infarction and stroke varied across the studies.</p><p><strong>Conclusions: </strong>For cardiovascular studies published in highly cited journals, there has been an expansion in the use of primary composite outcome measures and secondary outcome measures, with heterogeneity in the definition of primary outcome measures. A standardised approach to the use of cardiovascular outcomes measures is required.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insights from Norway on implementing the 2024 European Society of Cardiology Guidelines for elevated blood pressure and hypertension.","authors":"James M G Curneen, John William McEvoy","doi":"10.1136/heartjnl-2025-326336","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326336","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"It is time to treat cannabis as an important risk factor for cardiovascular disease.","authors":"Stanton Glantz, Lynn Silver","doi":"10.1136/heartjnl-2025-326169","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326169","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular risk associated with the use of cannabis and cannabinoids: a systematic review and meta-analysis.","authors":"Wilhelm Storck, Meyer Elbaz, Cécile Vindis, Amélia Déguilhem, Maryse Lapeyre-Mestre, Emilie Jouanjus","doi":"10.1136/heartjnl-2024-325429","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325429","url":null,"abstract":"<p><strong>Background: </strong>Awareness has recently risen about the potential associated risks to the cardiovascular health of cannabis users. The objective was to evaluate the possible association between major adverse cardiovascular events (MACE) and the use of cannabis or cannabinoids.</p><p><strong>Methods: </strong>Original pharmacoepidemiological studies providing risk estimates on cannabis-related MACE (ie, cardiovascular death, non-fatal acute coronary syndrome (ACS) including myocardial infarction (MI) or non-fatal stroke) published from 1 January 2016 to 31 January 2023 were included in the systematic review exploring PubMed, Web of Science and Scopus (last search: 20 September 2023). Design, duration, baseline characteristics, exposure, inclusion criteria, sample size, effect size and confusing factors, including exposure to psychoactive substances, were extracted. Study quality was assessed using the ROBINS-E (risk of bias in non-randomised studies-of exposures) tool. In the meta-analysis, adjusted effect estimates and their 95% CIs were pooled using a DerSimonian and Laird random effect model with inverse variance weighting based on the type of outcome (PROSPERO: CRD42023401401).</p><p><strong>Results: </strong>Overall, 24 articles were included from 3012 initial records, including 17 cross-sectional studies, 6 cohort studies and 1 case-control study. Exposure corresponded to the use of cannabis in all studies, with one focused on medical cannabis. The estimated risk ratio (RR) was 1.29 (95% CI 1.05 to 1.59) for ACS, 1.20 (1.13 to 1.26) for stroke and 2.10 (1.29 to 3.42) for cardiovascular death. As measured in two studies, no statistically significant association was found for the composite outcome combining ACS and stroke. The focused analysis restricted to cohort studies yielded comparable results to the primary model (RR=1.32, 1.01 to 1.73).</p><p><strong>Conclusions: </strong>This systematic review and meta-analysis uses an original approach centred on real-world data. The findings reveal positive associations between cannabis use and MACE. These findings should encourage investigating cannabis use in all patients presenting with serious cardiovascular disorders.</p><p><strong>Prospero registration number: </strong>CRD42023401401.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shadows and light in transcatheter mitral valve treatment: recent evidence and implications for clinical practice.","authors":"Mohammad Kassar, Muhammed Gerçek, Volker Rudolph","doi":"10.1136/heartjnl-2024-325621","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325621","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-stratified effects of intravenous ferric derisomaltose in heart failure with iron deficiency: insights from the IRONMAN trial.","authors":"Shirley Sze, Iain Squire, Paul R Kalra, John G Cleland, Mark C Petrie, Philip A Kalra, Fozia Ahmed, Prithwish Banerjee, Christopher J Boos, Callum Chapman, Peter James Cowburn, Lana Dixon, Simon Duckett, Rebecca Lane, Paul Foley, Ninian N Lang, Kristopher Lyons, Robin Ray, Rebekah Schiff, Elizabeth A Thomson, Michele Robertson, Ian Ford","doi":"10.1136/heartjnl-2024-324908","DOIUrl":"10.1136/heartjnl-2024-324908","url":null,"abstract":"<p><strong>Background: </strong>Intravenous iron therapy with ferric derisomaltose (FDI) has been shown to improve outcomes in patients with heart failure with reduced ejection fraction (HFrEF) and iron deficiency. However, its effects across different age groups remain unclear. This analysis of the Effectiveness of Intravenous Iron Treatment versus Standard Care in Patients with Heart Failure and Iron Deficiency (IRONMAN) trial explored the efficacy and safety of FDI across age groups.</p><p><strong>Methods: </strong>The IRONMAN trial was a prospective, open-label, blinded end point randomised controlled trial enrolling patients with HFrEF and iron deficiency. This prespecified analysis stratified the population into four quarters by age group: <67 years, 67-73 years, 74-79 years, >79 years. The primary outcome was a composite of recurrent heart failure hospitalisations and cardiovascular death. Secondary outcomes included changes in haemoglobin and quality of life. Clinical outcomes comparing FDI versus usual care in each age subgroup were analysed by the method of Lin <i>et al</i> for recurrent events and Cox proportional hazards model for time to first event. Interactions between age and treatment effects were explored.</p><p><strong>Results: </strong>Among 1137 randomised patients (median age 73 years), the primary outcome rate ratio (FDI vs usual care) was 0.87 (95% CI 0.61 to 1.23) in patients <67 years, 0.93 (95% CI 0.66 to 1.32) in those aged 67-73 years, 0.88 (95% CI 0.59 to 1.33) in those aged 74-79 years and 0.66 (95% CI 0.45 to 0.96) in those aged >79 years (p-interaction=0.38). Improvements in haemoglobin and quality of life scores at 4 months did not differ statistically across age groups (p-interaction=0.92 and 0.64, respectively). Older patients were more symptomatic at baseline, with higher N-terminal-pro B-type natriuretic peptide levels and poorer renal function, but safety outcomes did not differ across age groups.</p><p><strong>Conclusions: </strong>We found no evidence that the effects of FDI on heart failure hospitalisations, cardiovascular death, haemoglobin and quality of life differed by age. These findings support its use in patients with HFrEF and iron deficiency, including older adults.</p><p><strong>Trial registration number: </strong>NCT02642562.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"634-641"},"PeriodicalIF":5.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143407114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iron deficiency, heart failure and ageing: what do we know?","authors":"Abdallah Al-Mohammad","doi":"10.1136/heartjnl-2024-325652","DOIUrl":"10.1136/heartjnl-2024-325652","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"597-598"},"PeriodicalIF":5.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular health effects of vaping e-cigarettes: a systematic review and meta-analysis.","authors":"Anasua Kundu, Anna Feore, Sherald Sanchez, Nada Abu-Zarour, Megan Sutton, Kyran Sachdeva, Siddharth Seth, Robert Schwartz, Michael Chaiton","doi":"10.1136/heartjnl-2024-325030","DOIUrl":"10.1136/heartjnl-2024-325030","url":null,"abstract":"<p><strong>Background: </strong>There is substantial interest in the cardiovascular effects of e-cigarette use, highlighting the need to update our knowledge on the subject. We conducted this review to analyse whether e-cigarette use increases cardiovascular health risks and how these risks vary among different populations.</p><p><strong>Methods: </strong>We searched six databases and included peer-reviewed human, animal, cell/in vitro original studies but excluded qualitative studies, which were published between July 2021 and December 2023. Three types of e-cigarette exposure were examined: acute, short-to-medium term and long term. Different risk of bias tools were used for assessing the quality of the included human studies and we conducted meta-analysis when possible.</p><p><strong>Results: </strong>We included 63 studies in the main analysis, 12 studies in the meta-analysis and 32 studies in the sociodemographic factor-based subgroup analysis. Over half of the human studies had low risk of bias. Acute exposure to e-cigarette was associated with increased heart rate (HR) (mean difference (MD) 11.329, p<0.01) and blood pressure (BP) (MD 12.856, p<0.01 for systolic; MD 7.676, p<0.01 for diastolic) compared with non-use. While HR was lower after acute exposure to e-cigarettes compared with cigarettes (MD -5.415, p<0.01), no significant difference in systolic or diastolic BP was observed. Non-smoker current vapers had no significant differences in resting HR and BP compared with non-users but lower resting HR (MD -2.608, p<0.01) and diastolic BP (MD -3.226, p<0.01) compared with non-vaper current smokers. Despite some association between e-cigarette and endothelial dysfunction, short-to-medium-term transition from cigarettes to e-cigarettes may improve blood flow and BP, particularly among females and younger individuals. There is lack of evidence supporting any association of e-cigarette use with cardiovascular diseases and cardiac dysfunction or remodelling.</p><p><strong>Conclusions: </strong>This review highlighted several important cardiovascular impacts of e-cigarette use compared with non-use and cigarette smoking. However, the evidence is still limited and requires future research.</p><p><strong>Prospero registration number: </strong>CRD42023385632.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"599-608"},"PeriodicalIF":5.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}