Heart最新文献

{"title":"Impact of diabetes on outcomes in hypertrophic cardiomyopathy: a GRADE meta-analysis.","authors":"Seyedeh-Tarlan Mirzohreh, Niloofar Deravi, Elnaz Javanshir, Mohammad Asghari Jafarabadi, Neda Roshanravan","doi":"10.1136/heartjnl-2025-326085","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326085","url":null,"abstract":"<p><strong>Background: </strong>Diabetes mellitus (DM) is a common comorbidity in hypertrophic cardiomyopathy (HCM) and may exacerbate arrhythmic risk, promote structural remodelling and worsen heart failure outcomes. Its overall prognostic impact and effect on cardiac structure and function in adults with HCM remain uncertain.</p><p><strong>Method: </strong>We systematically searched PubMed, Scopus, Web of Science and Cochrane to January 2025 for observational studies comparing adults with HCM-DM versus HCM without DM. Random-effects meta-analyses were performed to pool ORs for clinical outcomes and standardised mean differences (SMDs) for echocardiographic parameters. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework after Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) evaluation. Subgroup, sensitivity and heterogeneity analyses were undertaken.</p><p><strong>Result: </strong>Eight studies encompassing approximately 47 592 patients met inclusion criteria. DM was associated with higher odds of all-cause mortality (OR 1.43, 95% CI 1.29 to 1.58; high certainty), heart failure (OR 1.34, 95% CI 1.25 to 1.43; moderate certainty) and atrial fibrillation (OR 1.41, 95% CI 1.18 to 1.68; high certainty). The association with atrial fibrillation was most pronounced in patients younger than 50 years (OR 2.55) and attenuated in those with body mass index ≥30 kg/m². HCM-DM was also linked to smaller left ventricular end-diastolic volumes (SMD -0.26) and impaired global longitudinal strain (SMD 0.58), consistent with subclinical systolic dysfunction, although heterogeneity was high and certainty low to moderate. Evidence for left ventricular ejection fraction, mass and septal thickness was inconclusive. Results were robust across sensitivity analyses.</p><p><strong>Conclusions: </strong>DM is a clinically important risk marker in HCM, associated with excess mortality, heart failure and atrial fibrillation, as well as adverse structural-functional changes. These findings support closer rhythm and function monitoring in HCM-DM and highlight the need for prospective studies to determine whether targeted metabolic interventions can improve outcomes.</p><p><strong>Prospero registration number: </strong>CRD420250650799.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250805","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":"Beyond recurrence: redefining atrial fibrillation burden as a prognostic and therapeutic endpoint.","authors":"Andrea Ballatore, Carola Griffith Brookles, Mark O'Neill, Andrea Saglietto, Gaetano Maria De Ferrari, Andrea Sarkozy, Matteo Anselmino","doi":"10.1136/heartjnl-2025-325779","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-325779","url":null,"abstract":"<p><p>Atrial fibrillation (AF) has traditionally been classified by episode duration, whereas rhythm control outcomes-via antiarrhythmic drugs or catheter ablation (CA)-have typically been evaluated using a binary approach, with any arrhythmic recurrence lasting over 30 s deemed a failure. Both definitions have notable limitations. Clinical classification often fails to accurately represent the actual time spent in arrhythmia, and AF recurrence following CA does not always correlate well with relevant clinical outcomes. This has driven increasing interest in the concept of AF burden which, although not consistently defined in literature, generally refers to the total percentage of time spent in arrhythmia during the monitoring period. Emerging evidence suggests that AF burden more accurately reflects the impact of CA on symptoms and serves as a valuable prognostic marker, particularly in specific patient subgroups.This review aims to summarise current knowledge on the impact and prognostic value of AF burden, highlighting unsolved issues, such as the absence of a standardised definition and the need for consensus on its use. Additionally, the review underscores the significance of monitoring strategies, highlighting the potential role that wearable devices and artificial intelligence could play in enhancing continuous monitoring in the near future.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244447","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":"Broadening the concept of 'burden' from the assessment of arrhythmias to symptom evaluation in patients with atrial fibrillation.","authors":"Dominik Linz, Sevasti-Maria Chaldoupi","doi":"10.1136/heartjnl-2025-326551","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326551","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244387","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":"Characterisation and prognostic implications of the 12-lead electrocardiogram in children with RASopathy-associated hypertrophic cardiomyopathy.","authors":"Olga Boleti, Angela Sunjaya, Ella Field, Gabrielle Norrish, Jennifer Tollit, Elena Cervi, Juan Pablo Kaski","doi":"10.1136/heartjnl-2025-326268","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326268","url":null,"abstract":"<p><strong>Background: </strong>The 12-lead ECG is a simple, inexpensive clinical tool with a key role in the assessment of patients with hypertrophic cardiomyopathy (HCM). The aims of this single centre, retrospective cohort study were to characterise ECG findings and to identify potential ECG predictors of major adverse cardiovascular events (MACE-cardiovascular mortality, resuscitated cardiac arrest, ventricular arrhythmias with haemodynamic compromise, appropriate implantable cardioverter defibrillator therapy or heart failure hospitalisation) in children with RASopathy-associated HCM (RAS-HCM).</p><p><strong>Methods: </strong>The resting 12-lead ECGs of 84 children with RAS-HCM were compared with those from 113 patients with sarcomeric HCM (s-HCM).</p><p><strong>Results: </strong>A significant proportion of ECGs in RAS-HCM had superior axis deviation (29.8% vs 2.5%, p value<0.001) and voltage criteria for right ventricular hypertrophy (52.4% vs 28.3%, p value<0.001), and a significantly lower prevalence of pathological Q waves (27.4% vs 47.8%, p value<0.001). Over a median follow-up period of 6.8 years (3.1-9.7), 19 patients (22.6%) with RAS-HCM suffered an MACE. Right atrial enlargement and ST segment changes>2 mm correlated with MACE on univariate analysis, with the latter remaining significant after adjustment in a multivariate model (adjusted relative risk (RR) 2.33, 95% CI 1.12 to 4.86, p value 0.024).</p><p><strong>Conclusion: </strong>These findings suggest that the 12-lead ECG may be a useful screening tool to distinguish RAS-HCM from s-HCM in everyday practice and could have potential implications for prediction of adverse outcomes.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244402","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":"Ventricular tachycardia ablation in ischaemic cardiomyopathy: who, when and how?","authors":"Alexios Hadjis, Corrado De Marco, Jean-Marc Raymond, John L Sapp","doi":"10.1136/heartjnl-2024-325370","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325370","url":null,"abstract":"<p><p>Ventricular tachycardia (VT) is an abnormal rapid heart rhythm that most commonly occurs in the setting of ventricular scar. In patients with ischaemic cardiomyopathy and VT, the most common mechanism is re-entry of electrical activation through narrow channels of diseased myocardium manifesting on the ECG as a regular sustained wide-complex tachycardia that can present clinically with sudden cardiac death (SCD).Implantable cardioverter-defibrillators (ICDs) are proven to reduce the risk of SCD, but do not prevent VT; they treat it when it occurs. Although antiarrhythmic drug therapy has a long history of use to suppress VT, recurrence rates remain high and adverse effects are not negligible. Significant advances have been made over the past decades in catheter-based techniques for VT suppression. Improvements in both mapping accuracy and ablation efficacy have resulted in recent studies demonstrating improved outcomes of catheter ablation of VT. Patient selection for a procedural approach will be important for achieving optimal clinical outcomes.This review provides a comprehensive overview of randomised trials of catheter ablation for VT as well as contemporary VT ablation techniques, and aims to understand which patients should undergo VT ablation, when is the ideal timing for intervention, and how best to achieve freedom from recurrent VT.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244398","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":"Risk and protective factors for stroke and transient ischaemic attack in patients with atrial fibrillation: an umbrella review of meta-analyses.","authors":"Axel Kylhammar, Dimitrios Tsartsalis, Ziad Hijazi, Constantina Aggeli, Costas Tsioufis, Lars O Karlsson, Dimitrios Venetsanos, Frieder Braunschweig, Nikola Drca, Astrid Paul-Nordin, Finn Akerström, Emma Svennberg, Emmanouil Charitakis","doi":"10.1136/heartjnl-2025-325926","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-325926","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is linked to significant morbidity and mortality, with ischaemic stroke being a leading cause of death. Identifying modifiable risk and protective factors may help reduce stroke incidence in patients with AF.</p><p><strong>Methods: </strong>This umbrella review evaluated meta-analyses of observational studies and randomised controlled trials (RCTs) to assess the association of protective and risk factors with stroke and transient ischaemic attack (TIA) in patients with AF. Observational associations were graded with the Ioannidis framework. Associations from RCTs and non-randomised baseline factors in meta-analyses of RCTs were assessed with GRADE (Grading of Recommendations Assessment, Development and Evaluation). Composite risk scores were summarised separately as risk-stratification tools.</p><p><strong>Results: </strong>35 studies were included, comprising 23 meta-analyses of observational studies, reporting on 45 associations and 22 meta-analyses of RCTs on 24 associations based on data from over 7 276 000 participants. Among observational studies, only high levels of N-terminal pro-brain Natriuretic Peptide (NT-proBNP) provided convincing evidence of stroke risk. Previous stroke/TIA and age (65-74 years) were also associated with stroke, supported by a highly suggestive level of evidence. Among meta-analyses of non-randomised factors, female sex, kidney failure, non-paroxysmal AF and type 2 diabetes mellitus were risk factors with moderate to high evidence. However, other well-established risk factors, such as hypertension and vascular disease, were associated with stroke; however, they were supported with a weak level of evidence.</p><p><strong>Conclusions: </strong>Despite stroke being the most severe complication of AF, this umbrella review reveals that few risk factors are supported by high-level evidence. Our findings confirm that elevated NT-proBNP, age and prior stroke are credible stroke risk factors in patients with AF. However, risk factors with weaker evidence, such as hypertension and vascular disease, require further investigation to clarify their actual impact.PROSPERO registration numberCRD42023471263.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244366","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":"Still waters run deep: prognostic value of frequent premature ventricular complexes in seemingly normal hearts.","authors":"Akhmetzhan Galimzhanov, Mamas A Mamas","doi":"10.1136/heartjnl-2025-326604","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326604","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238470","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":"Frequent premature ventricular complexes and risk of atrial fibrillation, heart failure, stroke and mortality: a meta-analysis.","authors":"Mustafa Eray Kiliç, Mehmet Emin Arayici, Resit Yigit Yilancioglu, Oguzhan Ekrem Turan, Emin Evren Ozcan, Mehmet Birhan Yilmaz","doi":"10.1136/heartjnl-2025-326174","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326174","url":null,"abstract":"<p><strong>Background/aim: </strong>Frequent premature ventricular complexes (PVCs) have historically been regarded as benign in structurally normal hearts, yet emerging evidence suggests substantial cardiovascular risk. This meta-analysis aimed to quantify associations between frequent PVCs and incident atrial fibrillation, heart failure, stroke and all-cause mortality in adults without established cardiovascular disease.</p><p><strong>Methods: </strong>PubMed/MEDLINE, Embase, CENTRAL, Web of Science and Scopus were searched through February 2025. Databases were searched from inception to February 2025. Eligible studies employed standardised PVC assessment methods with a minimum 12-month follow-up reporting adjusted effect estimates. Data were independently extracted and quality was assessed (Risk of Bias in Non-randomized Studies of Interventions) by two reviewers. Random-effects meta-analyses yielded pooled HRs with 95% CIs and prediction intervals (PI). Study-level meta-regression was used to evaluate dose-response relationships, and heterogeneity sources were explored via further meta-regression.</p><p><strong>Outcomes: </strong>20 articles (17 studies; 26 783 590 participants) were analysed. Frequent PVCs were significantly associated with increased risks of atrial fibrillation (HR 1.69, 95% CI 1.39 to 2.05; PI 0.91-3.12), heart failure (HR 1.73, 95% CI 1.50 to 2.00; PI 1.18-2.54), stroke (HR 1.28, 95% CI 1.10 to 1.50; PI 0.90-1.82) and all-cause mortality (HR 1.31, 95% CI 1.10 to 1.56; PI 0.79-2.18). Heterogeneity was substantially reduced in sensitivity analyses restricted to Holter-quantified PVCs. Meta-regression identified a 5.4% increased atrial fibrillation risk per 1% increment in PVC burden.</p><p><strong>Conclusion: </strong>Frequent PVCs confer significantly increased cardiovascular risks in populations largely without overt structural heart disease, though baseline cardiac assessment varied across studies. Patients with frequent PVCs (≥500/day) may benefit from periodic echocardiography and rhythm monitoring to detect early structural or arrhythmic progression. Randomised trials are needed to determine if PVC burden-guided interventions can reduce cardiovascular risk.</p><p><strong>Prospero registration number: </strong>CRD420251006111.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238429","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":"Underdosing in antithrombotic care: rethinking 'less'.","authors":"Joon Ho Ahn, Seung Hun Lee","doi":"10.1136/heartjnl-2025-327052","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-327052","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232450","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":"Towards patient-centred benefit-risk assessment with generalised pairwise comparisons.","authors":"Johan Verbeeck","doi":"10.1136/heartjnl-2025-327051","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-327051","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232464","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}