Heart最新文献

{"title":"Clot-in-transit and pulmonary embolism: an urgent call for awareness and action.","authors":"Mario Di Marino, Vincenzo Cicchitti, Umberto Ianni, Fabrizio Ricci, Cesare Mantini, Giampaolo Niccoli, Francesco Pelliccia, Sabina Gallina, Raffaele De Caterina, Juan-Carlos Kaski, Mamas A Mamas, Marco Zimarino","doi":"10.1136/heartjnl-2024-324747","DOIUrl":"10.1136/heartjnl-2024-324747","url":null,"abstract":"<p><p>Patients with acute pulmonary embolism (PE) have a wide spectrum of clinical presentations, from incidental findings to sudden cardiac death. Management and treatment recommendations in currently available guidelines vary according to patient risk and haemodynamic profile. A clot-in-transit (CiT) in the right heart chambers may be occasionally identified and is, therefore, an under-recognised but challenging condition, often preceding an abrupt clinical deterioration, and associated with increased mortality. Data on the detection of a CiT are sparse but consistent in attributing negative prognostic relevance, and therefore the presence of CiT should be systematically investigated and recorded in the setting of PE.In this review, the challenges related to the identification of a CiT are highlighted. Here, we propose an algorithm where the role of the Pulmonary Embolism Response Team (PERT) is reinforced. The PERT should convene once the CiT is suspected, to define the timeline for the diagnostic steps and subsequent management on a case-by-case basis. A patient with PE and CiT requires close bedside monitoring and rapid escalation therapy in case of clinical deterioration. Beyond anticoagulation alone, more aggressive strategies can be considered, including systemic thrombolysis, surgical pulmonary embolectomy and the currently emerging catheter-directed therapies. PROSPERO registration number: CRD42024493303.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"151-158"},"PeriodicalIF":5.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754975","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":"New wearable cardiac acoustic monitoring technology for evaluation of subclinical leaflet thrombosis after transcatheter aortic valve replacement.","authors":"Ran Liu, Zhaolin Fu, Yunfeng Yan, Meng Xie, Yang Li, Jing Yao, Xiaowei Yan, Zhinan Lu, Chun Zhang, Lei Xu, Guangyuan Song","doi":"10.1136/heartjnl-2024-324698","DOIUrl":"10.1136/heartjnl-2024-324698","url":null,"abstract":"<p><strong>Background: </strong>Subclinical leaflet thrombosis (SLT) is a common complication after transcatheter aortic valve replacement (TAVR). Multidimensional CT (MDCT) is the main imaging mortality for the diagnosis of SLT but it enhances the risk of contrast-induced nephropathy. Our study aimed to use an innovative wearable acoustic cardiography (ACG) device to diagnose SLT as an alternative option.</p><p><strong>Methods: </strong>This prospective cohort study consecutively enrolled patients with severe symptomatic aortic stenosis who underwent successful TAVR. We collected and analysed clinical data including ACG measurements and imaging results. Discrimination capability analysis (ie, area under the curve (AUC), sensitivity, specificity) of a composite feature from ACG readings in predicting SLT during follow-up was performed. Based on the severity of SLT, patients were categorised into three groups: Group 1 (no SLT), Group 2 (mild SLT) and Group 3 (moderate-to-severe SLT).</p><p><strong>Results: </strong>116 patients consented and enrolled in the stud<u>y</u>. At the 1-month follow-up, MDCT revealed a 25% prevalence of SLT with 11.2% classified as moderate-to-severe. ACG analysis revealed distinctive patterns of early systolic, baseless and high-energy murmurs exclusively in patients in Group 3 but not in group 2. The diagnostic performance of ACG for moderate-to-severe SLT showed a sensitivity of 84.62%, specificity of 91.26% and AUC of 0.920 (95% CI: 0.855 to 0.962, p<0.001). At 6 months, both MDCT and ACG indicated that nine (70%) patients in Group 3 who received anticoagulant therapy achieved complete resolution of SLT.</p><p><strong>Conclusion: </strong>ACG can be considered as an effective tool to assist in the diagnosis of SLT based on deterioration of transvalvular haemodynamics post-TAVR. Further studies are required to confirm its utility as a valuable non-invasive diagnostic and monitoring tool.</p><p><strong>Trial registration number: </strong>ChiCTR2300072300.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"180-189"},"PeriodicalIF":5.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142893948","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":"Prevalence and relevance of H558R in the efficacy and toxicity of flecainide in patients with atrial fibrillation: a cohort study.","authors":"Mauro Trincado Ave, Maria Brion, Alejandro Blanco-Verea, Carlos Tilves, Martin Pérez Hermilla, Carlos Minguito Carazo, Javier Garcia Seara, Jose Ramon González-Juanatey, Moisés Rodriguez-Mañero","doi":"10.1136/heartjnl-2024-324506","DOIUrl":"10.1136/heartjnl-2024-324506","url":null,"abstract":"<p><strong>Background: </strong>The SCN5A gene polymorphism histidine-558-to-arginine (H558R) has been associated with atrial fibrillation (AF) and may affect the therapeutic effects of flecainide. This study aimed to assess the prevalence of the H558R polymorphism in a European cohort of patients with AF and examine its association with flecainide's effects on AF recurrence and toxicity.</p><p><strong>Methods: </strong>This cohort study included patients diagnosed with AF and prescribed flecainide between 2017 and 2021 in a regional health area. Patients without the polymorphism (H558R-/-) were compared with heterozygous patients (H558R+/-) for a primary outcome of combined 6-month AF recurrence or toxicity. Secondary analyses evaluated the long-term outcomes and compared the prevalence of H558R in the AF cohort to a general population sample (n=3401).</p><p><strong>Results: </strong>A total of 104 patients were enrolled, with 57% H558R-/-, 37% H558R+/- and 6% H558R+/+. The prevalence of the H558R polymorphism was significantly higher in the AF cohort than in the general population (43.27% vs 24.37%, prevalence ratio 1.78, 95% CI 1.41 to 2.23, p<0.01). H558R+/- patients had a significantly lower risk of 6-month AF recurrence or toxicity (p=0.023, risk ratio 0.423, 95% CI 0.189 to 0.947), corresponding to an absolute risk difference of 21.5%. These findings were similar in the multivariable analysis. In long-term follow-up, H558R+/- patients continued to demonstrate a lower risk of AF recurrence or toxicity (p=0.039, HR 0.53, 95% CI 0.276 to 0.999).</p><p><strong>Conclusions: </strong>The H558R polymorphism is more prevalent in patients with AF compared with the general population and its presence is associated with a more favourable response to flecainide treatment.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"159-165"},"PeriodicalIF":5.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564304","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":"Circulating bone morphogenetic protein 10 as a novel marker of atrial stress and remodelling in heart failure.","authors":"Daan C H Ceelen, Valentina Bracun, Bart J van Essen, Adriaan A Voors, Rudolf A de Boer, Jozine M Ter Maaten, Serge Masson, Peter Kastner, Chim C Lang, Navin Suthahar","doi":"10.1136/heartjnl-2024-324486","DOIUrl":"10.1136/heartjnl-2024-324486","url":null,"abstract":"<p><strong>Background: </strong>We evaluated the potential of circulating bone morphogenetic protein 10 (BMP10) as a biomarker for atrial stress and remodelling in patients with heart failure (HF), in comparison to N-terminal pro-B-type natriuretic peptide (NT-proBNP). We also assessed the predictive value of BMP10 for adverse clinical outcomes.</p><p><strong>Methods: </strong>BMP10 levels were quantified in 2085 chronic HF patients from the European BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF) cohort and in 1487 patients from the Scottish validation cohort. Multivariable linear regression identified independent associates of BMP10. Proteomic analysis of 6369 proteins with subsequent gene set enrichment analysis was used to explore biological pathways associated with elevated BMP10. Cox proportional hazards models adjusting for established risk factors were used to associate BMP10 levels with clinical outcomes, including all-cause mortality and HF hospitalisation.</p><p><strong>Results: </strong>In a multivariable model including clinical and echocardiographic parameters, log-transformed and standardised BMP10 levels were significantly associated with a history of atrial fibrillation (Sβ=0.419; p<0.001), and with echocardiographic features reflecting atrial stress, such as increased left atrial diameter (Sβ=0.075; p=0.048). By contrast, these were not among the strongest associates of NT-proBNP levels. Gene set enrichment analysis showed significant overrepresentation in pathways of muscle contraction and extracellular matrix organisation. Higher log-transformed and standardised BMP10 levels predicted a combined outcome of 2-year all-cause mortality and HF rehospitalisation (HR=1.10, 95% CI=1.02-1.19), with the validation cohort yielding comparable results.</p><p><strong>Conclusion: </strong>BMP10 emerges as a novel biomarker reflecting atrial stress and remodelling in chronic HF patients. Its additional predictive value for adverse outcomes underscores its potential utility in enhancing risk stratification and guiding therapeutic interventions in HF management.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"172-179"},"PeriodicalIF":5.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754974","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":"Industry marketing payments to physicians and prescription patterns for sacubitril/valsartan in the USA.","authors":"Anju Murayama","doi":"10.1136/heartjnl-2024-324453","DOIUrl":"10.1136/heartjnl-2024-324453","url":null,"abstract":"<p><strong>Objectives: </strong>Although financial interactions between physicians and pharmaceutical and medical device companies could be potential conflicts of interest, in certain instances, industry promotion targeted at physicians may facilitate the early adoption of effective, novel care for patients such as sacubitril/valsartan in the USA. This study aims to evaluate associations between industry-sponsored meal payments to physicians and their prescribing patterns for sacubitril/valsartan in the USA.</p><p><strong>Methods: </strong>Using the publicly accessible Centers for Medicare and Medicaid Services Medicare Part D database and the Open Payments Database, this study assessed associations between industry-sponsored meal payments to physician prescribers and total amounts of Medicare claims and spending for sacubitril/valsartan between 2015 and 2021.</p><p><strong>Results: </strong>Among 220 147 eligible physician prescribers, 60 568 (27.5%) received at least one meal payment related to sacubitril/valsartan from the manufacturer, totaling US$13.9 million. The receipt of meal payments was significantly associated with a higher proportion of sacubitril/valsartan prescriptions to all sacubitril/valsartan, angiotensin receptor blocker and angiotensin-converting enzyme inhibitor prescriptions, with an OR of 2.04 (95% CI: 1.98 to 2.10, p<0.001). Moreover, a 10% increase in the annual number of meal payments was associated with a 2.6% (95% CI: 2.5% to 2.6%, p<0.001) increase in the annual number of Medicare claims and a 7.3% (95% CI: 7.1% to 7.5%, p<0.001) increase in annual Medicare spending per physician.</p><p><strong>Conclusions: </strong>Given the underprescription of sacubitril/valsartan in the USA, the positive associations between meal payments and physicians' prescribing patterns suggest that industry-sponsored meals may contribute to the early adoption of this cost-effective, novel heart failure drug among US Medicare beneficiaries.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"147-150"},"PeriodicalIF":5.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-stratified comparison of heart age and predicted cardiovascular risk in 370 000 primary care patients.","authors":"Kathrine Stjernholm, Andrew Kerr, Katrina K Poppe, Anders Elkær Jensen, Suneela Mehta, Jesper Bo Nielsen, Rod Jackson, Susan Wells","doi":"10.1136/heartjnl-2024-324156","DOIUrl":"10.1136/heartjnl-2024-324156","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease (CVD) preventive medications are recommended for patients at high short-term CVD risk. As most younger people with multiple raised CVD risk factors levels have low short-term risk, they could be falsely reassured to take no action. Heart age-the chronological age of a hypothetical person with the same short-term absolute CVD risk as the patient being assessed, but with an 'ideal' risk profile-is a complementary relative CVD risk metric developed to encourage these younger patients to make long-term lifestyle changes. However, clinicians sometimes use heart age to inform medication decisions. We assessed the appropriateness of this practice by comparing heart age and short-term CVD risk.</p><p><strong>Methods: </strong>New Zealand primary care patients are recruited to the PREDICT cohort when their CVD risk is assessed. PREDICT is an ongoing prospective study in one-third of New Zealand general practices, designed to derive CVD risk prediction algorithms. Five-year CVD risk was calculated for 35-74-year-old PREDICT participants using published equations. Heart age was calculated using non-smoking, systolic blood pressure of 120 mm Hg and total cholesterol/high-density lipoprotein ratio of 3.5, as the 'ideal' risk profile. CVD risk and heart age gaps (difference between chronological age and heart age) were compared.</p><p><strong>Results: </strong>Among 371 676 PREDICT participants, 5-year CVD risk increased with age, approximately doubling every 10 years, whereas heart age gaps decreased with increasing age, approximately halving between 35 and 44-year olds and 65-74-year olds. There were 5-40-year heart age gap differences between groups with similar 5-year CVD risks, but different ages.</p><p><strong>Conclusion: </strong>Short-term CVD risk and heart age are not interchangeable risk metrics. Short-term risk increases with increasing age whereas heart age gaps generally decline, with major differences between younger and older people with similar short-term risk. If heart age is used to inform medication decisions rather than encourage long-term lifestyle changes, older people at high short-term risk could be undertreated and younger people at low short-term risk could be unnecessarily medicated.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"166-171"},"PeriodicalIF":5.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","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":"10.1136/heartjnl-2024-325242","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"145-146"},"PeriodicalIF":5.1,"publicationDate":"2025-01-29","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":"Inpatient versus outpatient diagnosis of heart failure across the spectrum of ejection fraction: a population cohort study.","authors":"Huan Wang, Chuang Gao, Magalie Guignard-Duff, Christian Cole, Christopher Hall, Resham Baruah, Shikta Das, He Gao, Jil Billy Mamza, Chim C Lang, Ify R Mordi","doi":"10.1136/heartjnl-2024-324160","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-324160","url":null,"abstract":"<p><strong>Background: </strong>Early heart failure (HF) diagnosis is crucial to ensure that optimal guideline-directed medical therapy (GDMT) is administered to reduce morbidity and mortality. Limited access to echocardiography could lead to a later diagnosis for patients, for example, during an HF hospitalisation (hHF). This study aimed to compare the incidence and outcomes of inpatient versus outpatient diagnosis of HF.</p><p><strong>Methods: </strong>Electronic health records were linked to echocardiography data between 2015 and 2021 from patients in Tayside, Scotland (population~450 000). Incident HF diagnosis was classified into inpatient or outpatient and stratified by ejection fraction (EF). A non-HF comparator group with normal left ventricular function was also defined. The primary outcome was time to cardiovascular death or hHF within 12 months of diagnosis.</p><p><strong>Results: </strong>In total, 5223 individuals were identified, 4231 with HF (1115 heart failure with reduced ejection fraction (HFrEF), 666 heart failure with mildly reduced ejection fraction, 1402 heart failure with preserved ejection fraction and 1048 HF with unknown EF) and 992 with non-HF comparators. Of the 4231 HF patients, 2169 (51.3%) were diagnosed as inpatients. The primary outcome was observed in 1193 individuals with HF (28.1%) and 32 (3.2%) non-HF comparators and was significantly more likely to occur in individuals diagnosed as inpatients than outpatients (809 vs 384 events; adjusted HR: 1.62 (1.39-1.89), p<0.001), and this was consistent regardless of EF. For HFrEF patients first diagnosed as inpatients, those discharged on ≥2 GDMT had a reduced incidence of the primary outcome compared with those discharged on <2 GDMT (303 vs 175 events; adjusted HR: 0.72 (0.55-0.94), p=0.016).</p><p><strong>Conclusions: </strong>Individuals whose first presentation was a HF hospitalisation had a significantly worse outcome than those who were diagnosed in the community. Among hospitalised individuals, higher use of GDMT was associated with improved outcomes. Our results highlight the importance of improving diagnostic pathways to allow for earlier identification and treatment of HF.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065178","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":"Decoding dyspnoea: fluoroscopy of prosthetic valve dynamics in a young patient.","authors":"Enosh Katta, Karan Kalani, A Shaheer Ahmed","doi":"10.1136/heartjnl-2024-325076","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325076","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":"111 4","pages":"165-190"},"PeriodicalIF":5.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065108","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":"10.1136/heartjnl-2024-325367","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"143-144"},"PeriodicalIF":5.1,"publicationDate":"2025-01-29","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}