Heart最新文献

{"title":"Retinal image-based deep learning for mild cognitive impairment detection in coronary artery disease population.","authors":"Yi Ye, Wei Feng, Yaodong Ding, Qing Chen, Yang Zhang, Li Lin, Peng Xia, Tong Ma, Lie Ju, Bin Wang, Xiangang Chang, Xiaoyi Wang, Longjun Cai, Zongyuan Ge, Yong Zeng","doi":"10.1136/heartjnl-2024-325486","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325486","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery disease (CAD) is linked to an increased risk of mild cognitive impairment (MCI). Effective and convenient screening methods for identifying MCI from the CAD population are still lacking. This study aims to develop a deep learning model using fundus images to optimise MCI diagnosis in the CAD population, achieving early intervention and improving prognosis.</p><p><strong>Methods: </strong>Patients with CAD (at least one ≥50% stenosis) from July 2021 to July 2023 at Beijing Anzhen Hospital were included in the single-centre cross-sectional study. Eligible patients from July 2021 to May 2023 were randomly assigned in an 8:2 ratio for training and internal testing of the model. Patients enrolled from June 2023 to July 2023 were included in the external validation group. Four different convolutional neural network architectures were used to train the subjects' fundus images. The reference standards were a Mini-Mental State Examination (MMSE) score of <27 and a Montreal Cognitive Assessment (MoCA) score of <26, respectively. A comprehensive visual model of MCI detection was established through model integration.</p><p><strong>Results: </strong>A total of 9009 eligible images from 4357 patients with CAD were collected. The artificial intelligence (AI) algorithm based on the MMSE achieved an area under the curve (AUC) of 0.832 (95% CI 0.800 to 0.863) in the test group and 0.776 (95% CI 0.730 to 0.821) in the validation group. The AI algorithm based on the MoCA achieved an AUC of 0.764 (95% CI 0.742 to 0.785) in the test group and 0.725 (95% CI 0.701 to 0.750) in the validation group. The calibration curves of the internal test sets of the two models exhibited a good calibration effect. The results of decision curves revealed extensive clinical application value.</p><p><strong>Conclusion: </strong>The AI algorithm trained on fundus images in this study exerted promising performance in screening MCI in the CAD population and might be a non-invasive and effective alternative for early diagnosis of the disease.</p><p><strong>Trial registration number: </strong>NCT06102226.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086146","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":"Colchicine in acute coronary syndromes: a systematic review and meta-analysis of randomised controlled trials.","authors":"Ramon Huntermann, Juan Peres de Oliveira, Lucas M Barbosa, Ivo Queiroz, Douglas Nunes Cavalcante, Caroline de Oliveira Fischer Bacca","doi":"10.1136/heartjnl-2025-325826","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-325826","url":null,"abstract":"<p><strong>Background: </strong>Acute coronary syndrome (ACS) is a global leading cause of morbidity, with residual inflammation contributing to recurrent events. Colchicine has been proposed as an adjunct therapy, but its efficacy remains uncertain.</p><p><strong>Methods: </strong>We performed a systematic review and meta-analysis. PubMed, Embase and Cochrane databases were searched for randomised controlled trials (RCTs) data comparing colchicine versus placebo in ACS. Risk ratio (RR) and mean difference with 95% CIs were computed for binary and continuous outcomes, respectively. Primary outcomes were adverse cardiovascular events (ACEs), mortality and safety. Random-effects models were used for pooled estimates.</p><p><strong>Results: </strong>Seventeen RCTs comprising 14 794 patients were included, of whom 7390 (50%) were randomised to colchicine. The mean patient age across the studies ranged from 54 to 63 years, in a follow-up period ranging from 5 days to 12 months. Colchicine reduced the incidence of recurrent ACS (RR 0.41, 95% CI 0.19 to 0.92; p=0.03; I²=55%) and unstable angina (RR 0.27, 95% CI 0.11 to 0.63; p<0.01; I²=0%). No meaningful differences were observed in all-cause mortality (RR 0.95, 95% CI 0.79 to 1.14; I²=12%), cardiovascular death (RR 1.03, 95% CI 0.82 to 1.30; I²=0%) or ACE (RR 0.77, 95% CI 0.59 to 1.01; p=0.05; I²=58%). Subgroup analyses suggested a dose-dependent effect, with 0.5 mg/day potentially reducing ACE (RR 0.63, 95% CI 0.45 to 0.88; I²=41%), but higher doses increasing gastrointestinal symptoms.</p><p><strong>Conclusion: </strong>Low-dose colchicine may reduce recurrent ischaemic events in ACS, but evidence remains uncertain due to heterogeneity and limited long-term data. Safety and efficacy in women and optimal dosing require further investigation.</p><p><strong>Trial registration number: </strong>CRD42024627348.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086143","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":"Ending nuclear weapons, before they end us.","authors":"Chris Zielinski","doi":"10.1136/heartjnl-2025-326383","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326383","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077694","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":"Long-term outcomes of intravascular ultrasound-guided percutaneous coronary intervention versus coronary artery bypass grafting for multivessel coronary artery disease.","authors":"Jinho Lee, Jung-Min Ahn, Hoyun Kim, Yeonwoo Choi, Sangyong Jo, Do-Yoon Kang, Min-Ju Kim, Seung Ho Hur, Hun-Jun Park, Damras Tresukosol, Woong Chol Kang, Hyuck Moon Kwon, Seung-Woon Rha, Do-Sun Lim, Myung-Ho Jeong, Bong-Ki Lee, He Huang, Young-Hyo Lim, Jang Ho Bae, Byung Ok Kim, Tiong Kiam Ong, Sung Gyun Ahn, Cheol-Hyun Chung, Duk-Woo Park, Seung-Jung Park","doi":"10.1136/heartjnl-2024-325107","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325107","url":null,"abstract":"<p><strong>Background: </strong>Intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) has been shown to improve outcomes in complex coronary artery disease compared with angiography-guided PCI. However, long-term comparisons between IVUS-guided PCI and coronary artery bypass grafting (CABG) for multivessel disease (MVD) remain limited.</p><p><strong>Methods: </strong>This post hoc analysis of the Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment Extended Follow-up study included 880 patients with MVD, excluding 15 patients who received medical therapy. Patients were categorised into IVUS-guided PCI (n=333), angiography-guided PCI (n=131) and CABG (n=401). The primary endpoint was the composite of death, myocardial infarction (MI) or target-vessel revascularisation over a median follow-up of 11.8 years.</p><p><strong>Results: </strong>The IVUS-guided PCI group showed no difference in the primary endpoint compared with CABG (adjusted HR 1.013; 95% CI 0.747 to 1.374; p=0.93). In contrast, angiography-guided PCI was associated with a higher risk of clinical events (adjusted HR 2.231; 95% CI 1.582 to 3.145; p<0.001). The safety endpoint (composite of death, MI and stroke) did not differ between IVUS-guided PCI and CABG (adjusted HR 0.845; 95% CI 0.605 to 1.181; p=0.324), while angiography-guided PCI was associated with a higher risk (adjusted HR 2.016; 95% CI 1.405 to 2.895; p<0.001). Both PCI groups had higher rates of repeat revascularisation compared with CABG.</p><p><strong>Conclusions: </strong>IVUS-guided PCI demonstrated comparable long-term outcomes to CABG in terms of mortality and safety endpoints, supporting its use in the treatment of MVD. These findings highlight the potential benefits of IVUS guidance in complex PCI procedures.</p><p><strong>Trial registration numbers: </strong>NCT05125367 and NCT00997828.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077632","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":"Predictive performance of cardiovascular disease risk prediction models in older adults: a validation and updating study.","authors":"Shiva Ganjali, Mojtaba Lotfaliany, Andrew Tonkin, Mark R Nelson, Christopher M Reid, John J McNeil, Rory Wolfe, Enayet Karim Chowdhury, Robyn L Woods, Michael Berk, Mohammadreza Mohebbi","doi":"10.1136/heartjnl-2025-325665","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-325665","url":null,"abstract":"<p><strong>Background: </strong>Current cardiovascular disease (CVD) risk prediction models tailored for older adults are inadequate. This study aimed to validate, update and assess the utility of widely used CVD risk prediction models including American College of Cardiology/American Heart Association, 2008 Framingham, GloboRisk, National Vascular Disease Prevention Alliance and Predict1 originally developed for middle-aged population, as well as an age-specific Systematic COronary Risk Evaluation 2-Older Person model, in Australian and the US community-dwelling older adults.</p><p><strong>Methods: </strong>Participants, without history of CVD events, dementia or physical disability, enrolled in the ASPREE (ASPirin in Reducing Events in the Elderly) clinical trial and ASPREE-eXTention observational post-trial follow-up, were considered for CVD risk prediction. The main outcome was predicted CVD risk from adjudicated CVD events. The performance of the original, recalibrated (adjusting models' intercept and slope) and updated (adjusting models' coefficients) models was evaluated by discrimination (C statistic), calibration (calibration plots) and clinical utility (decision curves). Models were extended by incorporating predictors including serum creatinine, depression and socioeconomic status index (Index of Relative Socio-economic Advantage and Disadvantage, IRSAD) into models' equation, and the changes in discrimination were evaluated.</p><p><strong>Results: </strong>Among 15 618 adults (mean age 75 (4.4) years), 520 men and 498 women experienced CVD events over a median follow-up of 6.3 (IQR: 5.2-7.7) years. Following updating, the discrimination power of models increased for both sexes (C statistics ranged 0.62-0.64 for men and 0.68-0.69 for women). Updated models indicated good calibration, with an added net benefit at the risk thresholds ranging from 4%-10% for women to 5%-12% for men. Incorporating IRSAD, depression and serum creatinine did not improve CVD risk discrimination of updated models.</p><p><strong>Conclusions: </strong>Updating models, by adjusting model coefficients to better reflect the characteristics and risk factors of older adults, improves CVD risk prediction in a large cohort of relatively healthy Caucasian population aged 70+. Further external validation in diverse older populations including those with frailty and multimorbidity is recommended before clinical implementation.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077635","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":"Current and future applications of photon-counting computed tomography in cardiovascular medicine.","authors":"Filippo Cademartiri, Erica Maffei, Riccardo Cau, Vincenzo Positano, Carmelo De Gori, Simona Celi, Luca Saba, Eduardo Bossone, Antonella Meloni","doi":"10.1136/heartjnl-2025-325790","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-325790","url":null,"abstract":"<p><p>Photon-counting CT (PCCT) represents a transformative advancement in cardiac imaging, addressing key limitations of conventional CT. This review synthesises current evidence to demonstrate how PCCT's superior spatial resolution, enhanced tissue characterisation and multienergy capabilities broaden the diagnostic potential of cardiac CT. Applications include the precise detection and quantification of coronary artery calcifications, evaluation of coronary plaque burden and composition, improved assessment of coronary stents, and comprehensive myocardial tissue characterisation and perfusion analysis. By offering high-quality spectral information and detailed tissue characterisation, PCCT provides a non-invasive alternative for assessing coronary artery disease and myocardial pathology, reducing the need for invasive coronary angiography and cardiac MRI. Despite ongoing challenges in technology and clinical implementation, PCCT has the potential to revolutionise cardiovascular diagnostics, optimise diagnostic workflows and enhance patient care through more accurate, streamlined and comprehensive assessments.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077691","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-specific prognosis of acute and steady minor elevations in cardiac troponin among non-acute myocardial infarction inpatients: a large real-world cohort study.","authors":"Pengfei Sun, Wen-Nan Liu, Xilong Qian, Zhiqiang Zhang, Hangkuan Liu, Geru A, Yuanyuan Liu, Gregg Fonarow, Roger Sik-Yin Foo, Mark Yan-Yee Chan, Lu Wang, Yongle Li, Qing Yang, Xin Zhou","doi":"10.1136/heartjnl-2024-325079","DOIUrl":"10.1136/heartjnl-2024-325079","url":null,"abstract":"<p><strong>Background: </strong>The upper reference limit of normal (ULN) of cardiac troponin (cTn) for older adults can be higher than for young adults, while the same ULN is used for both older and young adults in the current clinical practice.</p><p><strong>Methods: </strong>In this multicentre longitudinal cohort study, non-acute myocardial infarction (non-AMI) inpatients with at least two cTn concentrations hospitalised between 2013 and 2022 in the Tianjin Health and Medical Data Platform were included. Multivariable Cox proportional hazards and landmark regression models were used to estimate the risk of in-hospital, 30-day and 1-year mortality in different cTn groups (normal, stable minor elevation (1-2×ULN with variation ≤20%), acute minor elevation (1-2×ULN with variation >20%) and apparent elevation (>2×ULN)).</p><p><strong>Results: </strong>A total of 57 117 patients (mean age, 69.6 (13.6) years; 25 037 (43.8%) female) were included. Even minor elevation in cTn was associated with higher mortality risk. Compared with the normal cTn group, the adjusted HRs of in-hospital mortality for patients with steady minor elevation, acute minor elevation and >2× ULN in cTn were 1.70 (95% CI 1.25 to 2.33), 1.92 (95% CI 1.59 to 2.32) and 4.03 (95% CI 3.50 to 4.65), respectively. Similar trends were found for all-cause 30-day and 30-day to 1-year mortality. Among older adults, compared with the steady minor elevation group, patients with acute minor elevation in cTn had higher 30-day mortality risk (HR 1.30, 95% CI 1.02 to 1.65) but similar 30-day to 1-year mortality risk (HR 0.95, 95% CI 0.82 to 1.10), while among non-older adults, differences in short-term and 1-year mortality risks between the two groups were not statistically significant (p>0.05).</p><p><strong>Conclusions: </strong>In non-AMI inpatients, including older adults, any stable or acute elevation in cTn, even minor, warrants attention. Further studies are needed to assess whether these patients can benefit from more aggressive treatment approaches.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"513-521"},"PeriodicalIF":5.1,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004414","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":"Importance of early diagnosis and implementation of guideline-directed therapies in heart failure: a message worth repeating, but we need to act!","authors":"Camilla Hage, Angiza Shahim","doi":"10.1136/heartjnl-2024-325649","DOIUrl":"10.1136/heartjnl-2024-325649","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"493-494"},"PeriodicalIF":5.1,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556687","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":"Albuminuria and cardiovascular outcomes in early-stage chronic kidney disease.","authors":"Carmine Zoccali, Francesca Mallamaci","doi":"10.1136/heartjnl-2024-325660","DOIUrl":"10.1136/heartjnl-2024-325660","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"490-492"},"PeriodicalIF":5.1,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364411","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":"British Cardiovascular Society Annual Conference, 2025: message from Vice President Dr Shouvik Haldar and Chair of the Programme Committee, Professor Andrew Clark.","authors":"Andrew L Clark, Shouvik Haldar","doi":"10.1136/heartjnl-2025-326235","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326235","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":"111 11","pages":"487-488"},"PeriodicalIF":5.1,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977253","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}