Heart最新文献

{"title":"Mortality associated with moderate and severe mitral regurgitation in 608 570 men and women undergoing echocardiography.","authors":"David Playford, Simon Stewart, Sarah Ann Harris, Gregory Scalia, David S Celermajer, Liza Thomas, Elizabeth Davida Paratz, Yih-Kai Chan, Geoff Strange","doi":"10.1136/heartjnl-2024-324790","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-324790","url":null,"abstract":"<p><strong>Background: </strong>Although the prognostic implications of severe mitral regurgitation (MR) are well recognised, they are less clear in moderate MR. We therefore explored the prognostic impact of both moderate and severe MR within the large National Echocardiography Database Australia cohort.</p><p><strong>Methods: </strong>Echocardiography reports from 608 570 individuals were examined using natural language processing to identify MR severity and leaflet pathology. Atrial (aFMR) or ventricular (vFMR) functional MR was assessed in those without reported leaflet pathology. Using individual data linkage over median 1541 (IQR 820 to 2629) days, we examined the association between MR severity and all-cause (153 612/25.2% events) and cardiovascular-related mortality (47 840/7.9% events).</p><p><strong>Results: </strong>There were 319 808 men and 288 762 women aged 62.1±18.5 years, of whom 456 989 (75.1%), 102 950 (16.9%), 38 504 (6.3%) and 10 127 (1.7%) individuals had no/trivial, mild, moderate and severe MR, respectively, reported on their last echo. Compared with those with no/trivial MR (26.5% had leaflet pathology, 19.2% died), leaflet pathology (51.8% and 78.9%, respectively) and actual 5-year all-cause mortality (54.6% and 67.5%, respectively) increased with MR severity. On an adjusted basis (age, sex and leaflet pathology), long-term mortality was 1.67-fold (95% CI 1.65 to 1.70) and 2.36-fold (95% CI 2.30 to 2.42) higher in moderate and severe MR cases (p<0.001) compared with no/trivial MR. The prognostic pattern for moderate and severe MR persisted for cardiovascular-related mortality and within prespecified subgroups (leaflet pathology, vFMR or aFMR, and age<65 years).</p><p><strong>Conclusions: </strong>Within a large real-world clinical cohort, we confirm that conservatively managed severe MR is associated with a poor prognosis. We further reveal that moderate MR is associated with increased mortality, irrespective of underlying aetiology.</p><p><strong>Trial registration: </strong>Australian New Zealand Clinical Trials Registry (ACTRN12617001387314).</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871937","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":"Improving antiarrhythmic therapy for patients with atrial fibrillation using common genetic variants.","authors":"Marc D Lemoine, Larissa Fabritz","doi":"10.1136/heartjnl-2024-325242","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325242","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853632","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":"Heart age tools are good for raising awareness, but bad for shared decision-making about medication.","authors":"Carissa Bonner, Jenny Doust","doi":"10.1136/heartjnl-2024-325367","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325367","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853631","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":"Assessing diagnostic accuracy of intravascular imaging for functionally significant coronary stenosis: updated findings from a meta-analysis.","authors":"Fabrizio D'Ascenzo, Riccardo Improta, Federico Giacobbe, Gianluca Di Pietro, Daniela Zugna, Stefano Siliano, Marco Gatti, Francesco Bruno, Tsunekazu Kakuta, Seung-Jea Tahk, Tomasz Pawlowski, Francesco Burzotta, Riccardo Faletti, Gennaro Sardella, Gaetano Maria Deferrari, Massimo Mancone, Ovidio De Filippo","doi":"10.1136/heartjnl-2024-324499","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-324499","url":null,"abstract":"<p><strong>Background: </strong>Accurate discrimination of functionally significant coronary stenosis using intravascular imaging remains uncertain, particularly with regard to vessel size. This meta-analysis evaluates the diagnostic performance of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) for identifying functionally significant coronary stenosis as confirmed by fractional flow reserve (FFR).</p><p><strong>Methods: </strong>A systematic search of PubMed, Scopus and Google Scholar identified studies that assessed the diagnostic accuracy of IVUS and OCT by minimal luminal area (MLA) with FFR as the reference standard. Sensitivity and specificity were analysed across different vessel diameters including left main coronary artery (LM) lesions. Hierarchical models estimated the summary receiver operating characteristic curve, sensitivity and specificity.</p><p><strong>Results: </strong>31 studies involving 4039 patients and 4413 lesions were analysed. For IVUS, a median MLA threshold of 2.9 mm² (IQR: 2.6-3.2) predicted significant lesions, yielding an area under the curve (AUC) of 0.76. In vessels≥3 mm, this threshold increased to 3.0 mm² (IQR: 2.7-3.1) with an AUC of 0.76 while in smaller vessels it decreased to 2.6 mm² (IQR: 2.4-2.7) with an AUC of 0.79. For LM lesions, the median threshold was 6.0 mm² (IQR: 4.9-6.2) with an AUC of 0.88. OCT demonstrated a median threshold of 2.0 mm² (IQR: 1.7-2.3) and an AUC of 0.82 with better performance in larger vessels (≥3 mm, median 3.0 mm², AUC 0.87) than in smaller ones (<3 mm, median 1.8 mm², AUC 0.75).</p><p><strong>Conclusions: </strong>IVUS and OCT show moderate diagnostic accuracy for identifying functionally significant coronary stenosis with OCT providing improved accuracy in vessels≥3 mm. IVUS is more accurate in assessing LM lesions, suggesting that vessel size should guide modality selection.</p><p><strong>Prospero registration number: </strong>CRD 42024514538.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846349","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":"International collaborative action to advance women's cardiovascular health research.","authors":"Stacey Matthews, Rebecca Abma-Schouten, Sonya V Babu-Narayan","doi":"10.1136/heartjnl-2024-325060","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325060","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846301","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":"Leucocyte telomere length and conduction system ageing.","authors":"Stefan van Duijvenboden, Christopher P Nelson, Zahra Raisi-Estabragh, Julia Ramirez, Michele Orini, Qingning Wang, Nay Aung, Veryan Codd, Svetlana Stoma, Elias Allara, Angela M Wood, Emanuele Di Angelantonio, John Danesh, Nicholas C Harvey, Steffen E Petersen, Patricia B Munroe, Nilesh J Samani","doi":"10.1136/heartjnl-2024-324875","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-324875","url":null,"abstract":"<p><strong>Background: </strong>Deterioration of the cardiac conduction system is an important manifestation of cardiac ageing. Cellular ageing is accompanied by telomere shortening and telomere length (TL) is often regarded as a marker of biological ageing, potentially adding information regarding conduction disease over and above chronological age. We therefore sought to evaluate the association between leucocyte telomere length (LTL) on two related, but distinct aspects of the cardiac conduction system: ECG measures of conduction (PR interval and QRS duration) and incident pacemaker implantation in a large population-based cohort.</p><p><strong>Methods: </strong>In the UK Biobank, we measured PR interval and QRS duration from signal-averaged ECG waveforms in 59 868 and 62 266 participants, respectively. Incident pacemaker implantation was ascertained using hospital episode data from 420 071 participants. Associations with LTL were evaluated in (Cox) multivariable regression analyses adjusted for potential confounders. Putative causal effects of LTL were investigated by mendelian randomisation (MR).</p><p><strong>Results: </strong>Mean PR interval and QRS duration were 144.2 ms (± 20.4) and 92.3 ms (± 7.8), respectively, and there were 7169 (1.7%) incident pacemaker implantations, during a median follow-up period of 13.6 (IQR 1.5) years. LTL was significantly associated with PR interval (0.19 ms (95% CI: 0.03 to 0.35), per 1 SD shorter LTL, p=0.021), but not QRS duration. After adjusting for age, sex and cardiovascular risk factors, shorter LTL remained associated with an increased risk for incident pacemaker implantation (HR per SD decrease in LTL: 1.03 (95% CI: 1.01 to 1.06), p=0.012). MR analysis showed a trend towards an association of shorter LTL with longer PR interval and higher risk of pacemaker implantation but was likely to be underpowered.</p><p><strong>Conclusions: </strong>Shorter LTL was significantly, and possibly causally, associated with prolongation of atrioventricular conduction and pacemaker implantation, independent of traditional cardiovascular risk factors. Our findings support further research to explore the role of ageing on cardiac conduction beyond chronological age.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846445","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 of menopause, healthy lifestyle and cardiovascular disease in women: a prospective cohort study.","authors":"Anushriya Pant, Alice A Gibson, Simone Marschner, Lee P Liao, Liliana Laranjo, Clara K Chow, Sarah Zaman","doi":"10.1136/heartjnl-2024-324602","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-324602","url":null,"abstract":"<p><strong>Background: </strong>Menopause is a timely opportunity to screen for cardiovascular disease (CVD) and intervene with healthier lifestyles. We investigated the association between premature/early menopause and the likelihood of CVD and whether a healthy lifestyle is associated with a lower likelihood of CVD in menopausal woman.</p><p><strong>Methods: </strong>The Sax Institute's 45 and Up Study prospectively recruited participants aged ≥45 years (n=267 357) between 2005 and 2009 (New South Wales, Australia). Our study included women without prior CVD and reporting menopausal age at baseline. Primary outcome was new-onset CVD (self-reported heart disease/stroke) based on survey data at Wave 2 (2012-2015) and/or Wave 3 (2018-2020). Logistic regression models assessed the associations of premature (age <40 years) and early (age 40-44 years) menopause with CVD, compared with menopause between 50 and 52 years, adjusting for sociodemographic and clinical variables. Healthy lifestyle adherence was assessed using a score of five factors: smoking, physical activity, sitting, sleep and diet.</p><p><strong>Results: </strong>We included 46 238 women (mean age 62.1±8.2 years), with 5416 (11.7%) cases of CVD over 15-year follow-up. After adjustment, the odds of CVD was higher in women with premature menopause (OR 1.36, 95% CIs 1.17 to 1.59; p<0.0001) and early menopause (OR 1.15, 95% CI 1.03 to 1.28; p=0.013) compared with menopause between 50 and 52 years. Among all women, high (score 9-10) versus low (score 0-5) healthy lifestyle adherence led to 23% lower odds of CVD (OR 0.77, 95% CI 0.68 to 0.86; p<0.0001), and in women with premature menopause, led to 52% lower odds of CVD (OR 0.48, 95% CI 0.30 to 0.77, p=0.0022). Lifestyle effect did not significantly differ between menopause categories (interaction, p=0.71).</p><p><strong>Conclusion: </strong>Women with premature/early menopause are at higher likelihood for CVD. Lifestyle modification is associated with consistent reduction of the likelihood of CVD in women and should be encouraged across the life course.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846341","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":"Outcomes of tricuspid valve surgery in patients with significant tricuspid regurgitation and low to intermediate risk.","authors":"Seo-Yeon Gwak, Kyu Kim, Hyun-Jung Lee, Iksung Cho, Geu-Ru Hong, Jong-Won Ha, Chi Young Shim","doi":"10.1136/heartjnl-2024-324891","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-324891","url":null,"abstract":"<p><strong>Background: </strong>In patients with tricuspid regurgitation (TR), delayed surgical intervention is associated with poor outcomes, particularly in advanced stages. This study aimed to assess whether earlier tricuspid valve (TV) surgery provides a survival benefit in patients with moderate to severe TR who are considered at low to intermediate risk of adverse clinical or surgical outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study included 10 016 patients diagnosed with moderate to severe TR between 2008 and 2020. Patients were stratified using the the Tricuspid Regurgitation Impact on Outcomes (TRIO) Score (for general health risk) and TRI-SCORE (for perioperative risk). We focused on patients deemed at low or intermediate risk by these scores, comparing the all-cause mortality of those who underwent TV surgery to those managed medically.</p><p><strong>Results: </strong>Among 8874 patients categorised as low or intermediate risk, 871 (9.8%) underwent TV surgery. Patients in the surgical group were younger and had a higher prevalence of RV enlargement and RV dysfunction compared to those in the medical treatment group. During a mean follow-up of 5.2 years, surgical patients had a lower risk of death (HR 0.38, 95% CI 0.29 to 0.50) compared with medically managed patients after adjusting for confounders. This association persisted in patients who underwent isolated TV surgery. However, the potential for residual confounding in this non-randomised analysis should be considered.</p><p><strong>Conclusions: </strong>TV surgery was associated with higher survival rates in patients with moderate to severe TR and low to intermediate prognostic risk. However, the observational nature of the study means that uncontrolled confounding cannot be excluded. These findings warrant further investigation in randomised studies.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846447","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":"Pathological findings at invasive assessment in MINOCA: a systematic review and meta-analysis.","authors":"Damiano Fedele, Daniele Cavallo, Francesca Bodega, Nicole Suma, Lisa Canton, Mariachiara Ciarlantini, Khrystyna Ryabenko, Sara Amicone, Virginia Marinelli, Claudio Asta, Giuseppe Pastore, Marcello Casuso Alvarez, Rebecca Belà, Angelo Sansonetti, Francesco Angeli, Matteo Armillotta, Alberto Foà, Luca Bergamaschi, Pasquale Paolisso, Marta Belmonte, Paola Rucci, Emanuele Barbato, Carmine Pizzi","doi":"10.1136/heartjnl-2024-324565","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-324565","url":null,"abstract":"<p><strong>Background: </strong>Pathological mechanisms of myocardial infarction with non-obstructive coronary arteries (MINOCA) are heterogeneous, with an unknown impact on prognosis, and often remain unrecognised in clinical practice. This study aimed to evaluate the prevalence and prognostic impact of pathological findings by invasive coronary angiography (ICA), optical coherence tomography (OCT), and coronary function testing in MINOCA.</p><p><strong>Methods: </strong>Studies published until August 2023 were searched on PubMed and SCOPUS and included if reporting the prevalence of patients with non-obstructive coronary arteries (NObs-CA; 1-49% coronary stenosis) versus normal coronary arteries (NCA; 0% coronary stenosis) by ICA, pathological findings by OCT, and/or coronary vasomotor tests in MINOCA. Newcastle-Ottawa Scale was used for quality assessment. The pooled prevalence of pathological findings was estimated with random-effects models. Pooled risk ratios (RRs) with 95% CIs of all-cause death, MI and the composite of both in patients with NObs-CA versus NCA were calculated at short-term (<1 month), 1-year and long-term follow-up (> 1 year).</p><p><strong>Results: </strong>Forty-five studies including 17 539 patients were analysed. The pooled prevalence of NObs-CA at ICA was 53% (95% CI 0.47 to 0.60). OCT showed acute pathological findings in 62% (95% CI 0.44 to 0.78) of patients and coronary vasomotor tests were positive in 49% (95% CI 0.31 to 0.67). NObs-CA compared with NCA was associated with an increased 1-year risk of all-cause death or MI (RR=1.49 (95% CI 1.17 to 1.90)) and MI alone (RR=1.80 (95% CI 1.26 to 2.59)), whereas the risk of all-cause death was comparable. Similar results were seen at long-term, but not at short-term follow-up.</p><p><strong>Conclusions: </strong>Stratification of MINOCA into NObs-CA versus NCA has prognostic value. OCT and vasospasm testing, often informative about the pathological mechanism of MINOCA, should be part of an invasive diagnostic algorithm.</p><p><strong>Prospero registration number: </strong>CRD42023468183.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846451","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":"Correction: The efficacy of extraembryonic stem cells in improving blood flow within animal models of lower limb ischaemia.","authors":"","doi":"10.1136/heartjnl-2015-308322corr1","DOIUrl":"https://doi.org/10.1136/heartjnl-2015-308322corr1","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":"111 1","pages":"e1"},"PeriodicalIF":5.1,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824039","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}