Heart最新文献

{"title":"General practitioners referring for coronary calcium scoring for suspected angina: any CONCRETE evidence?","authors":"Christiaan Vrints, Simon Winther","doi":"10.1136/heartjnl-2026-328613","DOIUrl":"10.1136/heartjnl-2026-328613","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148759002","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":"Fluid restriction in patients with heart failure: a systematic review.","authors":"Job J Herrmann, Rachna van Berlo, Hans-Peter Brunner-La Rocca, Sandra Sanders-Van Wijk, D H Frank Gommans, Roland R J van Kimmenade","doi":"10.1136/heartjnl-2025-326784","DOIUrl":"10.1136/heartjnl-2025-326784","url":null,"abstract":"<p><strong>Background: </strong>Fluid restriction is a commonly prescribed non-pharmacological intervention in the management of heart failure (HF). However, data on its efficacy and safety are scarce. Recent randomised clinical trial (RCT) data prompt reassessment of the available evidence.</p><p><strong>Methods: </strong>CINAHL, EMBASE, PubMed and the Cochrane Library were searched up to 1 May 2025. RCTs were included if adults with HF were randomised to fluid restriction in comparison to a liberal or unrestricted intake, less strict restriction or usual care. Outcomes of interest were mortality, HF hospitalisation, quality of life (QoL), thirst distress, New York Heart Association (NYHA) class and N-terminal pro-Brain Natriuretic Peptide (CRD42022292319). No meta-analysis was performed due to high heterogeneity of the included trials.</p><p><strong>Results: </strong>In total, four RCTs were included, comprising 682 randomised inpatient, recently discharged and stable outpatient patients (ranging from 46 to 504 patients per trial). Only one study had a low risk of bias. None of the four trials found a significant difference in mortality or HF hospitalisations. For QoL, the results are contradictory, but overall, there is no clear benefit for fluid restriction, but it resulted in more thirst distress. No significant differences in NYHA class or (NT-pro)BNP were observed.</p><p><strong>Conclusion: </strong>Studies on fluid restriction in patients with HF are scarce, and most of the available studies are at high risk of bias. Although power is lacking, there is no evidence indicating that fluid restriction affects mortality or HF hospitalisations, but there is a signal of harm in terms of thirst distress. Taken together, the current evidence does not support the routine use of fluid restriction in patients with HF.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"939-945"},"PeriodicalIF":4.4,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145965875","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":"Natural history of the PR interval and risk of cardiac events and mortality: a nationwide study.","authors":"Chaoqun Zheng, Rasmus Frosted, Helle Skovmand Bosselmann, Niels Risum, Christian Jøns, Christoffer Polcwiartek, Helle Collatz Christensen, Kristian Kragholm, Mikkel Porsborg Andersen, Claus Graff, Christian Torp-Pedersen, Henning Bundgaard, Alex Hørby Christensen","doi":"10.1136/heartjnl-2025-327183","DOIUrl":"10.1136/heartjnl-2025-327183","url":null,"abstract":"<p><strong>Background: </strong>The PR interval is a ubiquitous parameter available to all clinicians. Studies on associated risk have been conflicting, often limited by sample sizes and one ECG per individual. The study aimed to investigate the association between the PR interval and its temporal changes with cardiac events in a nationwide cohort.</p><p><strong>Methods: </strong>Nationwide hospital ECGs were linked with Danish national registries. Associations between index-PR interval and absolute temporal changes in PR interval (ΔPR), and cardiac events were modelled with multivariable cause-specific Cox models.</p><p><strong>Results: </strong>A total of 9 020 051 ECGs (n=2 234 492; 53% female) were available, with 1 213 073 patients having >1 ECG. Median follow-up was 7.1 years. Median index-PR interval was 158 ms. PR interval <120 or >200 ms was found in 2.9% and 7.4%, respectively. Prevalence of prolonged PR interval increased with age. Median ΔPR was 10 ms and highest among the oldest. Cox models between the index-PR interval and events showed the following HR patterns: U-shaped for risk of atrial fibrillation/flutter, heart failure and ventricular arrhythmias (HR 1.03-1.24, 1.04-1.11, 1.08-1.16, respectively, p<0.05); stepwise increase at PR interval ≥170 ms for syncope (HR 1.08-1.36, p<0.001); linear increasing at PR intervals >160 ms (HR 1.07-2.11, p<0.05) for high-degree atrioventricular block/cardiac device implantation; J-shaped with moderate and marginal increases among the shortest (HR 1.44, p<0.001) and longest PR intervals (HR 1.03, p<0.001), respectively, for all-cause mortality. Models on ΔPR showed stepwise increases in HR for all events.</p><p><strong>Conclusion: </strong>Prevalence of PR prolongation and temporal PR changes increased with age. Short, long and temporal changes in the PR interval were all associated with increased risk of cardiac events and all-cause mortality.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"957-964"},"PeriodicalIF":4.4,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145714103","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":"Innovations in cardiac device therapy in the era of advanced rhythm management: implantable defibrillators and conduction system pacing.","authors":"Margarida Pujol-Lopez, Roderick Tung, Lluis Mont","doi":"10.1136/heartjnl-2025-325834","DOIUrl":"10.1136/heartjnl-2025-325834","url":null,"abstract":"<p><p>Cardiac device therapy has significantly evolved since the introduction of the first implantable pacemaker and the subsequent development of the implantable cardioverter-defibrillator (ICD). ICDs are highly effective; however, their main weakness lies in lead-related complications. To avoid the need for venous access and the complications associated with transvenous leads, a fully subcutaneous ICD (S-ICD) system was developed. Despite these advancements, the S-ICD system is limited by its inability to provide bradycardia pacing and antitachycardia pacing. This limitation prompted the development of a modular cardiac rhythm management system, integrating a new leadless pacemaker with an S-ICD that uses unidirectional communication to command the pacemaker to deliver antitachycardia pacing.Conduction system pacing, including His bundle pacing and left bundle branch area pacing (LBBAP), has emerged as a physiological alternative to biventricular resynchronisation therapy and conventional pacing, pending results of large clinical trials. LBBAP offers superior electrical parameters and long-term performance compared with His bundle pacing. The capability to provide defibrillation via the same lead used for LBBAP represents an unresolved challenge that is currently under ongoing research.This state-of-the-art review presents the latest developments and innovations in cardiac device therapy, offering a comprehensive overview of current technologies that increasingly enable therapy to be tailored to individual patient needs.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"946-956"},"PeriodicalIF":4.4,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146003355","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":"Heart failure and fluid restriction: time to let go?","authors":"Ryosuke Sato, Constanze Schmidt, Stephan von Haehling","doi":"10.1136/heartjnl-2025-327288","DOIUrl":"10.1136/heartjnl-2025-327288","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"937-938"},"PeriodicalIF":4.4,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145965850","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":"Severe eccentric mitral regurgitation with echocardiography moving in a flail motion.","authors":"Yiren Sun, Qi Tong, Yongjun Qian","doi":"10.1136/heartjnl-2026-328069","DOIUrl":"10.1136/heartjnl-2026-328069","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":"112 17","pages":"991-992"},"PeriodicalIF":4.4,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725031","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":"Progression of valvular heart disease: an academic concept or a clinical imperative?","authors":"Jaroslaw D Kasprzak","doi":"10.1136/heartjnl-2025-327550","DOIUrl":"10.1136/heartjnl-2025-327550","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"935-936"},"PeriodicalIF":4.4,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145958759","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":"Effect of an integrated care model on ST-segment elevation myocardial infarction management in China: a prospective, multicentre, non-randomised controlled study.","authors":"Yong Liu, Jin Liu, Yan Liang, Jianfeng Ye, Yunzhao Hu, Liling Chen, Shaohong Dong, Xiaoyu Huang, Mingcai Song, Ruilin Meng, Xueyan Zheng, Yibo He, Jing Zhang, Xuejun Yin, Shiqun Chen, Ning Tan, Maoyi Tian, Jiyan Chen","doi":"10.1136/heartjnl-2024-324155","DOIUrl":"10.1136/heartjnl-2024-324155","url":null,"abstract":"<p><strong>Background: </strong>Early reperfusion therapy is critical in patients with ST-segment elevation myocardial infarction (STEMI). However, limitations in resources and patient-level and system-level barriers delay the administration of reperfusion therapy. This study evaluated the impact of an integrated care strategy for STEMI management in China.</p><p><strong>Methods: </strong>This prospective, multicentre, non-randomised controlled study consecutively enrolled patients with acute STEMI, who were admitted to eight tertiary hospitals in different regions of China (August 2015-February 2019). An integrated care model was used in four hospitals (intervention). This model mainly included regular community public education, skills training for the diagnosis and treatment of STEMI in percutaneous coronary intervention-incapable centres, referral system improvement and optimal green channel for primary percutaneous coronary intervention-capable centres. In the other four hospitals (control), usual care of acute myocardial infarction public management and medical health service was provided. The primary outcome was the proportion of patients receiving symptom-to-reperfusion within 12 hours.</p><p><strong>Results: </strong>A total of 6817 patients with acute STEMI were analysed (age (mean±SD): 61±13 years; female: n=1242 (18.2%)). Of those, 2452 and 4365 patients were included in the intervention and control groups, respectively. Between 2015 and 2019, the rates of symptom-to-reperfusion within 12 hours and symptom-to-admission within 12 hours increased in the intervention group (from 65.3% to 91.4%; and from 74.2% to 96.4%, respectively; Ptrend=0.015 for both). In addition, there was no significant difference in door-to-balloon time within 90 min observed among the two groups (adjusted relative risk=0.96, 95% CI: 0.89 to 1.02; p=0.18). Moreover, the rates of in-hospital mortality and major adverse cardiac events exhibited a nearly onefold decrease in the intervention group versus the control group (p<0.001).</p><p><strong>Conclusions: </strong>Use of an integrated care model focusing on prehospital delay may increase the rate of timely treatment in areas with limited medical resources in China.</p><p><strong>Trial registration number: </strong>NCT03928119.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"965-973"},"PeriodicalIF":4.4,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032664","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":"Frequency and natural course of American College of Cardiology/American Heart Association valvular heart disease stages in the general population: results from the population-based STAAB cohort study.","authors":"Mengmeng Chen, Floran Sahiti, Vladimir Cejka, Lena Schmidbauer, Stefan Frantz, Götz Gelbrich, Peter U Heuschmann, Stefan Störk, Caroline Morbach","doi":"10.1136/heartjnl-2025-326443","DOIUrl":"10.1136/heartjnl-2025-326443","url":null,"abstract":"<p><strong>Background: </strong>Valvular heart disease (VHD) is described in American guidelines as a progressive disease continuum: stage A (at-risk), stage B (progressive), stage C/D (severe). We aimed to identify frequency and course of VHD stages as well as determinants of VHD progression in the general population.</p><p><strong>Methods: </strong>The STAAB cohort study (Characteristics and Course of Heart Failure STAges A/B and Determinants of Progression) recruited a prestratified, population-based sample of residents (30-79 years) from Würzburg, Germany, without self-reported heart failure. Participants underwent baseline transthoracic echocardiography (2013-2017) with follow-up after 3 years (2017-2021). VHD progression was defined as an increase in stage or valve intervention.</p><p><strong>Results: </strong>Of 4943 participants (mean age 55 years, 53% women) VHD stages were: 24% no VHD, 54% stage A, 21% stage B and 0.3% stage C/D. Prevalence of VHD increased with advancing age. Among 3833 participants who were followed for a median of 34 months, 10% in stage A and 1.3% in stage B progressed. Progression rates were highest in participants aged 60-69 and 70-79 years, at rates of 15% and 25% for stage A and 1.6% and 2.6% for stage B, respectively. In multivariable age-adjusted models, elevated E/e' predicted progression from stage A, while elevated N-terminal pro-brain natriuretic peptide (NT-proBNP) predicted progression from stage B. Continuous analysis of aortic stenosis progression showed associations with older age, higher body mass index, diabetes and baseline peak velocity.</p><p><strong>Conclusion: </strong>In a large community cohort, VHD was common, especially at older ages, and about 11% of individuals progressed within 3 years. Echocardiographic indices (E/e') and the biomarker NT-proBNP emerged as stage-specific predictors, supporting their potential role, along with age and metabolic factors, in identifying individuals at higher risk for progression.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"982-990"},"PeriodicalIF":4.4,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145714147","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":"Renal denervation for hypertension management in the UK: a Delphi expert consensus.","authors":"Peter Alexander John Haworth, Clare Bent, Neil Chapman, Rasha Kadem Al-Lamee, Indranil Dasgupta, Terry McCormack, Kazem Rahimi","doi":"10.1136/heartjnl-2025-327110","DOIUrl":"10.1136/heartjnl-2025-327110","url":null,"abstract":"<p><strong>Background: </strong>Renal denervation (RDN) has emerged as a guideline-recommended therapeutic option in hypertension management with several high-quality, randomised, placebo-controlled trials demonstrating efficacy and safety. However, the lack of expert consensus on patient selection for RDN in the UK has led to debate regarding its use. This study aimed to establish a multidisciplinary consensus to provide clinicians and commissioners with guidance on the appropriate use of RDN in hypertension management within the UK.</p><p><strong>Methods: </strong>The project used a modified Delphi method. A steering group (SG) of seven clinicians in cardiology, clinical pharmacology, radiology, nephrology and general practice, all experienced in managing patients with hypertension, convened in June 2024. The SG aligned on 40 consensus statements covering key topics (patient identification and selection, multidisciplinary team collaboration, commissioning and guidelines, training and education and awareness of RDN). The statements were distributed as an online survey to UK clinicians involved in hypertension management. Respondents assessed their level of agreement using a four-point Likert scale. Consensus was predefined as 75% agreement. The surveys were collated anonymously and independently analysed. The results were shared with the SG in November and December 2024.</p><p><strong>Results: </strong>A total of 125 responses were received from interventional cardiologists and radiologists, cardiologists, clinical pharmacologists and nephrologists across various regions of the UK.Consensus was achieved for 37 out of 40 statements (93%). Based on the consensus scores, 11 key recommendations were developed by the SG regarding patient selection, multidisciplinary collaboration, clinician training and commissioning for RDN.</p><p><strong>Conclusions: </strong>This expert consensus defines patient selection criteria for RDN and provides 11 recommendations to support its use. RDN should be considered for resistant hypertension or intolerance to medications, using a multidisciplinary approach. Implementation of these recommendations could guide clinical practice, inform commissioning and support National Institute for Health and Care Excellence reviews, ultimately improving patient access across the UK.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"974-981"},"PeriodicalIF":4.4,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145540423","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}