Heart最新文献

{"title":"Inflammation in coronary atherosclerosis: diagnosis and treatment.","authors":"Giovanni Occhipinti, Salvatore Brugaletta, Antonio Abbate, Daniela Pedicino, Marco Giuseppe Del Buono, Ramona Vinci, Giuseppe Biondi Zoccai, Manel Sabate, Dominick Angiolillo, Giovanna Liuzzo","doi":"10.1136/heartjnl-2024-325408","DOIUrl":"10.1136/heartjnl-2024-325408","url":null,"abstract":"<p><p>Coronary atherosclerosis is a chronic condition characterised by the development of an atherosclerotic plaque in the inner layer of the coronary artery, mainly associated with cholesterol accumulation and favoured by endothelial dysfunction related to other cardiovascular risk factors, such as smoking, diabetes and hypertension. A key actor in this process is the systemic inflammatory response, which can make plaques either grow slowly over the course of years (like a 'mountain'), obstructing coronary flow, and causing stable coronary artery disease, or make them explode (like a 'volcano') with subsequent abrupt thrombosis causing an acute coronary syndrome. This central role of inflammation in coronary atherosclerosis has led to its consideration as a modifiable cardiovascular risk factor and a therapeutic target. Classic anti-inflammatory drugs have been tested in clinical trials with some encouraging results, and new drugs specifically designed to tackle inflammation are currently being under investigation in ongoing trials. The objectives of this review are to (1) summarise the role of inflammatory biomarkers and imaging techniques to detect inflammation at each stage of plaque progression, and (2) explore currently available and upcoming anti-inflammatory therapies.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"801-810"},"PeriodicalIF":4.4,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729562","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":"Subclinical atherosclerosis in women after pre-eclampsia: a systematic review and meta-analysis.","authors":"Jessica Victoria Yao, Benjamen Wang, Anand Ganes, Stacey Peters, Andrew Taylor, Shaun Brennecke, Ingrid Winship, Dominica Zentner","doi":"10.1136/heartjnl-2024-325493","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325493","url":null,"abstract":"<p><strong>Background: </strong>Women with pre-eclampsia are at increased risk of later-life cardiovascular disease (CVD). Despite suggestions that women affected by pre-eclampsia should undergo routine CVD screening, uniform recommendations are lacking. Subclinical atherosclerosis provides a window of opportunity to identify and treat those at risk of CVD. Coronary artery calcium scoring (CAC), carotid intima-media thickness (CIMT) and ankle brachial index (ABI) are effective methods of detecting subclinical atherosclerosis. This systematic review sought to explore associations between timing of measurement and presence of subclinical atherosclerosis in women with a history of pre-eclampsia.</p><p><strong>Methods: </strong>We searched the MEDLINE, EMBASE and CINAHL databases for all studies which reported subclinical atherosclerosis in women with a history of pre-eclampsia. Common and random effects models were used to examine the associations between pre-eclampsia and subclinical atherosclerosis.</p><p><strong>Results: </strong>35 case-control studies comprising 20 235 women were included in the final analysis. 3376 had a history of pre-eclampsia. Among the 26 studies assessing CIMT, pre-eclampsia was associated with increased CIMT (standardised mean difference 0.63 (95% CI 0.32, 0.93)). This difference was present during pregnancy (0.65 (95% CI 0.33, 0.98)) and persisted for 12 months post partum (0.84 (95% CI 0.20, 1.47)) and beyond (0.50 (95% CI 0.01, 0.99)). Pooled analysis of the eight CAC studies also demonstrated that the odds of having subclinical atherosclerosis were 1.57 (95% CI 1.39, 1.77) times higher in women with a history of pre-eclampsia.</p><p><strong>Conclusions: </strong>Among women with a history of pre-eclampsia, subclinical atherosclerosis can be seen during pregnancy and persists long term. Our review supports the importance of early follow-up in patients who have had pre-eclampsia.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834933","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":"<b>Is cardiac auscultation still needed in a digital world?</b>","authors":"Andrea Faggiano, Nicola Gaibazzi, Gregg Pressman, Pompilio Faggiano","doi":"10.1136/heartjnl-2025-326603","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326603","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144821229","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":"Atrial fibrillation in chronic aortic regurgitation: the missing link in prognosis and surgical timing.","authors":"Hiroyuki Tsurumi, Kenya Kusunose","doi":"10.1136/heartjnl-2025-326727","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326727","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144821230","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":"Premature ventricular complex, atrial fibrillation and stroke: causality or coincidence?","authors":"Jaume Francisco-Pascual, Kinan Rajjoub","doi":"10.1136/heartjnl-2025-326530","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326530","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803964","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 disease in Sickle cell: mechanisms, diagnostics and therapeutic advances.","authors":"Elio Haroun, Ankit Agrawal, Aro Daniela Arockiam, Joseph El Dahdah, Joseph Kassab, Michael Nakhla, Michel Chedid El Helou, Harsha Sanaka, Ziad Zalaquett, Simrat Kaur, Tiffany Dong, Rabi Hanna, Brian Griffin, Tom Kai Ming Wang","doi":"10.1136/heartjnl-2025-325837","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-325837","url":null,"abstract":"<p><p>Cardiovascular complications are increasingly recognised as a major driver of morbidity and early mortality in patients with sickle cell disease (SCD), yet they remain underdiagnosed and underappreciated. This contemporary review synthesises current knowledge across a spectrum of cardiovascular manifestations-including myocardial dysfunction, pulmonary hypertension, cardiac iron overload, arrhythmias, myocardial infarction, stroke and sudden death-with emphasis on their unique pathophysiological mechanisms in SCD. We highlight emerging diagnostic tools such as cardiac magnetic resonance with T2* mapping and extracellular volume sequences, speckle-tracking echocardiography and invasive exercise testing, which can revealing a distinct phenotype combining restrictive cardiomyopathy and high-output heart failure. Practical algorithms for risk stratification and disease monitoring are presented alongside evidence-based and SCD-specific management approaches, including the role of hydroxyurea, transfusions, anticoagulation and gene therapy. By integrating multimodality imaging, updated guideline recommendations and recent clinical insights, this review provides a comprehensive resource to support early recognition, personalised therapy and improved cardiovascular outcomes in SCD.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803963","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":"Prognostic impact of guideline-directed medical therapy after functionally complete revascularisation in patients with obstructive coronary artery diseases.","authors":"Yingyang Geng, Changdong Guan, Yao Jiang, WeiXian Yang, Bo Yu, Guosheng Fu, Jun Pu, Xinkai Qu, Qi Zhang, Yanyan Zhao, Lilei Yu, Yunfei Huang, Shengxian Tu, Shubin Qiao, Lei Song","doi":"10.1136/heartjnl-2025-325670","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-325670","url":null,"abstract":"<p><strong>Objective: </strong>Functional complete revascularisation (FCR) has been proven to be associated with superior prognosis following percutaneous coronary intervention. Whether guideline-directed medical therapy (GDMT) still impacts clinical outcomes in patients who have achieved FCR requires further evaluation.</p><p><strong>Methods: </strong>The study population was drawn from patients who achieved FCR in the FAVOR III China trial, defined as a quantitative flow ratio (QFR)-based residual functional Synergy between percutaneous coronary intervention with taxus and cardiac Surgery score of 0, measured only in vessels with QFR≤0.80. GDMT was defined as the combination of single or dual antiplatelet therapy, a beta-blocker and a statin, with or without an ACE inhibitor or angiotensin receptor blocker, according to contemporary guideline recommendations. Patients were categorised into the GDMT group (compliance with all 4 agents) or non-GDMT group (compliance with 0-3 agents). The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) at 3 years, a composite of death, myocardial infarction, stroke and ischaemia-driven revascularisation.</p><p><strong>Results: </strong>Among 3221 (85.2%) patients who achieved FCR, a total of 1964 (61.2%), 1919 (59.9%), 1545 (48.4%), 1483 (46.6%) and 1084 (35.3%) patients adhered to GDMT at 1 month, 6 months, 1 year, 2 years and 3 years, respectively. The MACCE occurred in 313 (10.2%) patients through 3 years. The rate of MACCE was similar between GDMT and non-GDMT groups within the first year, but significantly lower in the GDMT group from the second year (adjusted HR: 0.66, 95% CI: 0.51 to 0.85; p<0.01) and sustained until the third year (adjusted HR: 0.65, 95% CI: 0.50 to 0.85; p<0.01), compared with the non-GDMT group.</p><p><strong>Conclusions: </strong>In patients who achieved FCR, the benefit of good adherence to GDMT remained significant, starting from the second year and continuing up to 3 years.</p><p><strong>Trial registration number: </strong>NCT03656848.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803965","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":"Surgical ablation in non-mitral valve cardiac surgeries: a meta-analysis of early outcomes.","authors":"Gabriel Scarpioni Barbosa, Eric Shih Katsuyama, Christian Ken Fukunaga, Julia M Fernandes, Ana Carolina C Coan, Yoana Palatianos, Ronaldo Correa Fabiano, Luciana Gioli-Pereira, Hristo Kirov, Torsten Doenst, Túlio Caldonazo","doi":"10.1136/heartjnl-2025-326299","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326299","url":null,"abstract":"<p><strong>Background: </strong>Surgical ablation (SA) is a key treatment for atrial fibrillation (AF) patients undergoing heart surgery. However, direct comparisons between SA and non-mitral valve (non-MV) surgery alone are lacking. We performed a systematic review and meta-analysis comparing concomitant SA to isolated non-MV surgery in AF patients.</p><p><strong>Methods: </strong>MEDLINE, Embase and Cochrane were searched. Outcomes of interest were: (1) postoperative AF (POAF); (2) early all-cause mortality; (3) postoperative pacemaker implantation and (4) stroke. Additionally, a subgroup analysis comparing randomised controlled trials (RCTs) and propensity score-matched studies (PSM) was conducted. Risk ratios (RRs) and their respective 95% CI were calculated using a random effects model.</p><p><strong>Results: </strong>After screening 6423 citations, we included 2 RCTs and 5 PSM studies encompassing 39 348 AF patients undergoing non-MV surgery, of whom 18 394 (46.7%) underwent SA. Compared with isolated non-MV surgery, SA was associated with significant POAF reduction (RR: 0.73; 95% CI: 0.67 to 0.79; I²=0%) and higher risk of postoperative pacemaker implantation (RR: 1.34; 95% CI: 1.14 to 1.57, I²=0%) compared with surgery alone. No differences were found in early all-cause mortality (RR: 0.96; 95% CI: 0.76 to 1.22; I²=65%) and postoperative stroke (RR: 1.06; 95% CI: 0.89 to 1.26; I²=0%). The subgroup analysis comparing RCTs and PSM showed significant consistency among the different designs.</p><p><strong>Conclusions: </strong>In this meta-analysis, SA was associated with POAF reduction in non-MV surgery. In terms of safety, it was suggested that although no difference in early mortality and postoperative stroke was observed, SA had a higher risk of pacemaker implantation than isolated non-MV surgery.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803966","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":"Surveillance of left ventricular function among cancer survivors.","authors":"Cheng Hwee Soh, Thomas H Marwick","doi":"10.1136/heartjnl-2025-326282","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326282","url":null,"abstract":"<p><strong>Background: </strong>Cancer survivors have an increased risk of heart failure, but this is balanced by the risk of death from other causes. The results of this balance impact on the optimal time for guideline-recommended surveillance for cardiac dysfunction. This study aimed to investigate the association between cancer history and cardiac function at various times during follow-up.</p><p><strong>Methods: </strong>This cross-sectional study included participants with documented cancer history from cancer registries and matched with non-cancer controls using propensity scoring based on age, sex, diabetes and blood pressure. Cardiac function, primarily left ventricular ejection fraction (LVEF), was assessed using cardiac magnetic resonance (CMR). Multivariable binomial regression analyses were conducted to analyse the association between cancer and cardiac function.</p><p><strong>Results: </strong>Of 23 854 cancer survivors (aged 61.0±6.8 years, 60.9% female) and an equal number of matched controls, 1051 survivors and 1538 controls underwent CMR. Survivors from breast or haematological malignancies demonstrated minor differences in LVEF (59.5±6.4 vs 60.1±6.4, p<0.001) and global circumferential strain (-22.4±3.5 vs -22.6±3.5, p<0.001) compared with controls. Analysis stratified by time since cancer diagnosis revealed that both LVEF (p=0.014) and global circumferential strain (p=0.045) were less likely to be impaired with increasing time from diagnosis. Cancer survivors (prevalence ratio (PR)=1.19 (95% CI 1.05 to 1.35), p=0.006), particularly breast cancer (PR=1.39 (95% CI 1.18 to 1.64), p<0.001), were associated with low LVEF (≤55%) after adjusting for age, sex, years since cancer diagnoses and blood pressure medication.</p><p><strong>Conclusions: </strong>Compared with people without cancer, cancer survivors have a higher risk of subclinical cardiac dysfunction. However, dysfunction is less common with increasing time since cancer diagnosis. These findings suggest prioritising cardiac monitoring early in survivorship, especially in breast cancer survivors.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788901","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":"Atrial fibrillation and the risk of sudden cardiac death: incidence, impact and implications.","authors":"Jani Rankinen, Jussi Hernesniemi, Juho Taneli Tynkkynen","doi":"10.1136/heartjnl-2025-326003","DOIUrl":"10.1136/heartjnl-2025-326003","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation(AF) may be linked to increased sudden cardiac death (SCD) risk, but patients with AF are often neglected in studies on ECG risk factors for SCD. We aimed to clarify the long-term SCD incidence in AF among patients undergoing coronary angiography.</p><p><strong>Methods: </strong>SCD incidence was retrospectively assessed between 2007 and 2018 in patients with suspected or known coronary artery disease referred for elective angiography and in patients with acute coronary syndrome (ACS). Follow-up extended until 31 December 2022. SCD (defined per American Heart Association/American College of Cardiology/Heart Rhythm Society/European Society of Cardiology guidelines) and SCD-equivalent events occurring during follow-up were identified through in-depth review of medical records, including accounts of circumstances leading to deaths. History of AF was identified through review of medical records, while AF at baseline and during follow-up was detected using the GE HealthCare Marquette 12SL algorithm.</p><p><strong>Results: </strong>9622 ACS and 11 799 elective patients were included, with 955 SCD events during follow-up. The 10-year SCD incidence among patients with AF was 7.7% in ACS and 6.4% in elective patients, compared with 4.5% and 3.2% in those without AF. In competing risk models adjusted for baseline risk factors including left ventricular ejection fraction, AF was associated with SCD (ACS: subdistribution hazard 1.33 (95% CI 1.05 to 1.67); elective: 1.37 (95% CI 1.10 to 1.71)), but this was no longer evident in the elective cohort after adjusting for incident heart failure hospitalisations, which AF preceded in 57.5% by an average of 1.4 years. Overall, 33% of SCD cases occurred in patients with known AF (paroxysmal, persistent or permanent), and 21% of SCD victims had AF on their last ECG.</p><p><strong>Conclusions: </strong>A significant proportion of SCDs occur in patients with AF, but the risk appears mediated by heart failure hospitalisations rather than AF itself.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642380","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}