Heart最新文献

{"title":"Pathological findings at invasive assessment in MINOCA: a systematic review and meta-analysis.","authors":"Damiano Fedele, Daniele Cavallo, Francesca Bodega, Nicole Suma, Lisa Canton, Mariachiara Ciarlantini, Khrystyna Ryabenko, Sara Amicone, Virginia Marinelli, Claudio Asta, Giuseppe Pastore, Marcello Casuso Alvarez, Rebecca Belà, Angelo Sansonetti, Francesco Angeli, Matteo Armillotta, Alberto Foà, Luca Bergamaschi, Pasquale Paolisso, Marta Belmonte, Paola Rucci, Emanuele Barbato, Carmine Pizzi","doi":"10.1136/heartjnl-2024-324565","DOIUrl":"10.1136/heartjnl-2024-324565","url":null,"abstract":"<p><strong>Background: </strong>Pathological mechanisms of myocardial infarction with non-obstructive coronary arteries (MINOCA) are heterogeneous, with an unknown impact on prognosis, and often remain unrecognised in clinical practice. This study aimed to evaluate the prevalence and prognostic impact of pathological findings by invasive coronary angiography (ICA), optical coherence tomography (OCT), and coronary function testing in MINOCA.</p><p><strong>Methods: </strong>Studies published until August 2023 were searched on PubMed and SCOPUS and included if reporting the prevalence of patients with non-obstructive coronary arteries (NObs-CA; 1-49% coronary stenosis) versus normal coronary arteries (NCA; 0% coronary stenosis) by ICA, pathological findings by OCT, and/or coronary vasomotor tests in MINOCA. Newcastle-Ottawa Scale was used for quality assessment. The pooled prevalence of pathological findings was estimated with random-effects models. Pooled risk ratios (RRs) with 95% CIs of all-cause death, MI and the composite of both in patients with NObs-CA versus NCA were calculated at short-term (<1 month), 1-year and long-term follow-up (> 1 year).</p><p><strong>Results: </strong>Forty-five studies including 17 539 patients were analysed. The pooled prevalence of NObs-CA at ICA was 53% (95% CI 0.47 to 0.60). OCT showed acute pathological findings in 62% (95% CI 0.44 to 0.78) of patients and coronary vasomotor tests were positive in 49% (95% CI 0.31 to 0.67). NObs-CA compared with NCA was associated with an increased 1-year risk of all-cause death or MI (RR=1.49 (95% CI 1.17 to 1.90)) and MI alone (RR=1.80 (95% CI 1.26 to 2.59)), whereas the risk of all-cause death was comparable. Similar results were seen at long-term, but not at short-term follow-up.</p><p><strong>Conclusions: </strong>Stratification of MINOCA into NObs-CA versus NCA has prognostic value. OCT and vasospasm testing, often informative about the pathological mechanism of MINOCA, should be part of an invasive diagnostic algorithm.</p><p><strong>Prospero registration number: </strong>CRD42023468183.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"291-299"},"PeriodicalIF":5.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846451","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":"Reassessing the role of tricuspid valve surgery in the modern era.","authors":"Erwan Donal, Louis Gegout, Corentin Bourg","doi":"10.1136/heartjnl-2024-325476","DOIUrl":"10.1136/heartjnl-2024-325476","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"289-290"},"PeriodicalIF":5.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004059","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-stratified effects of intravenous ferric derisomaltose in heart failure with iron deficiency: insights from the IRONMAN trial.","authors":"Shirley Sze, Iain Squire, Paul R Kalra, John G Cleland, Mark C Petrie, Philip A Kalra, Fozia Ahmed, Prithwish Banerjee, Christopher J Boos, Callum Chapman, Peter James Cowburn, Lana Dixon, Simon Duckett, Rebecca Lane, Paul Foley, Ninian N Lang, Kristopher Lyons, Robin Ray, Rebekah Schiff, Elizabeth A Thomson, Michele Robertson, Ian Ford","doi":"10.1136/heartjnl-2024-324908","DOIUrl":"10.1136/heartjnl-2024-324908","url":null,"abstract":"<p><strong>Background: </strong>Intravenous iron therapy with ferric derisomaltose (FDI) has been shown to improve outcomes in patients with heart failure with reduced ejection fraction (HFrEF) and iron deficiency. However, its effects across different age groups remain unclear. This analysis of the Effectiveness of Intravenous Iron Treatment versus Standard Care in Patients with Heart Failure and Iron Deficiency (IRONMAN) trial explored the efficacy and safety of FDI across age groups.</p><p><strong>Methods: </strong>The IRONMAN trial was a prospective, open-label, blinded end point randomised controlled trial enrolling patients with HFrEF and iron deficiency. This prespecified analysis stratified the population into four quarters by age group: <67 years, 67-73 years, 74-79 years, >79 years. The primary outcome was a composite of recurrent heart failure hospitalisations and cardiovascular death. Secondary outcomes included changes in haemoglobin and quality of life. Clinical outcomes comparing FDI versus usual care in each age subgroup were analysed by the method of Lin <i>et al</i> for recurrent events and Cox proportional hazards model for time to first event. Interactions between age and treatment effects were explored.</p><p><strong>Results: </strong>Among 1137 randomised patients (median age 73 years), the primary outcome rate ratio (FDI vs usual care) was 0.87 (95% CI 0.61 to 1.23) in patients <67 years, 0.93 (95% CI 0.66 to 1.32) in those aged 67-73 years, 0.88 (95% CI 0.59 to 1.33) in those aged 74-79 years and 0.66 (95% CI 0.45 to 0.96) in those aged >79 years (p-interaction=0.38). Improvements in haemoglobin and quality of life scores at 4 months did not differ statistically across age groups (p-interaction=0.92 and 0.64, respectively). Older patients were more symptomatic at baseline, with higher N-terminal-pro B-type natriuretic peptide levels and poorer renal function, but safety outcomes did not differ across age groups.</p><p><strong>Conclusions: </strong>We found no evidence that the effects of FDI on heart failure hospitalisations, cardiovascular death, haemoglobin and quality of life differed by age. These findings support its use in patients with HFrEF and iron deficiency, including older adults.</p><p><strong>Trial registration number: </strong>NCT02642562.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143407114","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":"Percutaneous intramyocardial septal radiofrequency ablation: a novel treatment for drug-refractory non-obstructive hypertrophic cardiomyopathy with severe septal hypertrophy.","authors":"Huiyi Wang, Jing Li, David H Hsi, Wenxia Li, Shengjun Ta, Yiyu Jiao, Bo Shan, Lingxiao Chang, Xumei Ou, Lu Yao, Bo Wang, Jing Wang, Changhui Lei, Liwen Liu","doi":"10.1136/heartjnl-2024-325334","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325334","url":null,"abstract":"<p><strong>Background: </strong>Patients with drug-refractory non-obstructive hypertrophic cardiomyopathy (NOHCM) lack effective invasive treatment options. This study aimed to evaluate the safety and effectiveness of percutaneous intramyocardial septal radiofrequency ablation (PIMSRA, Liwen procedure) in patients with NOHCM and severe septal hypertrophy (≥28 mm).</p><p><strong>Method: </strong>This single-arm, open-label, prospective study enrolled 20 adult patients with drug-refractory NOHCM between June 2017 and June 2023. Patients underwent PIMSRA and were followed for a median of 15 months. Outcomes included changes in septal thickness, quality of life (Kansas City Cardiomyopathy Questionnaire-12, KCCQ-12) and myocardial function.</p><p><strong>Results: </strong>No major adverse clinical events occurred within 30 days after the procedure. The maximum interventricular septal thickness decreased significantly from 31.3 mm to 17.4 mm (mean difference: -13.9 mm; 95% CI -15.92 to -11.88). Left atrial volume index and left ventricular mass index also decreased significantly. Improvements in global longitudinal strain and global radial strain were observed, indicating possibly enhanced myocardial performance. KCCQ-12 scores improved from 65.6 to 84.4 (mean difference: 18.78; 95% CI 11.62 to 25.93). Patients after PIMSRA were not found to have an increased risk of arrhythmias such as atrial fibrillation, high-grade conduction block or non-sustained ventricular tachycardia during the follow-up.</p><p><strong>Conclusions: </strong>PIMSRA was associated with a reduction of myocardial septal thickness and improvement in functional status in patients with NOHCM. The absence of major adverse events is also encouraging, but larger studies with a control arm are needed to confirm long-term safety.</p><p><strong>Trial registration number: </strong>ChiCTR1900020530.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584843","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":"Missed opportunities to manage complex comorbidity of heart failure, type 2 diabetes mellitus and chronic kidney disease: a retrospective cohort study.","authors":"Laura Pasea, Mohamed Mohamed, Ashkan Dashtban, Anish Bhuva, Mehrdad A Mizani, Sarah Ali, Thomas Oates, Mamas A Mamas, Tamsin Morris, Gao He, Jil Billy Mamza, Amitava Banerjee","doi":"10.1136/heartjnl-2024-325046","DOIUrl":"10.1136/heartjnl-2024-325046","url":null,"abstract":"<p><strong>Background: </strong>Effective management of coexisting heart failure (HF), chronic kidney disease (CKD) and type 2 diabetes mellitus (T2D) is critical, yet evidence of adherence to guideline-recommended standards in routine care remains unclear. We aimed to assess primary care adherence to guideline-recommended standards for patients with overlapping HF, CKD and T2D in England.</p><p><strong>Methods: </strong>Using UK Clinical Practice Research Datalink (1998-2020), we evaluated care adherence across 161 529 individuals with HF, CKD or T2D before and after developing a second of these conditions. We analysed disease investigation rates, medication use and predictors of guideline adherence.</p><p><strong>Results: </strong>We identified 161 529 patients with CKD followed by HF (CKD+HF, 40%), CKD+T2D (51.3%) and HF+T2D (8.6%) with a median of 3.1 years follow-up after the second diagnosis. In CKD+HF, CKD+T2D and HF+T2D groups, prescription rates of renin-angiotensin system inhibitors (71%, 64.1% and 74.4%), beta-blockers (53.1%,36.2% and 55.1%), antiplatelets (56.2%, 45.2% and 54.4%) and statins (56.7%, 68.5% and 72%) were suboptimal. Advanced age, female sex, peripheral arterial disease and cancer were associated with a lower likelihood of checking blood pressure, creatinine and glycated haemoglobin (HbA1C) after HF, CKD and T2D diagnoses, respectively. The first diagnosis of HF was associated with reduced odds of having HbA1C measured after T2D diagnosis (OR 0.79, 95% CI 0.72 to 0.86), compared with CKD as the first diagnosis.</p><p><strong>Conclusions: </strong>In overlapping HF, CKD and T2D, guideline-recommended care is suboptimal, with inequalities by age, sex, disease on first presentation and comorbidities. Quality improvement requires linked data collection, monitoring and action across diseases.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556688","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":"Epicardial adipose tissue, myocardial remodelling and adverse outcomes in asymptomatic aortic stenosis: a post hoc analysis of a randomised controlled trial.","authors":"Jolien Geers, Nipun Manral, Aryabod Razipour, Caroline Park, Guadalupe Flores Tomasino, Emily Xing, Kajetan Grodecki, Jacek Kwiecinski, Tania Pawade, Mhairi K Doris, Rong Bing, Audrey C White, Steven Droogmans, Bernard Cosyns, Piotr J Slomka, David E Newby, Marc R Dweck, Damini Dey","doi":"10.1136/heartjnl-2024-324925","DOIUrl":"10.1136/heartjnl-2024-324925","url":null,"abstract":"<p><strong>Background: </strong>Epicardial adipose tissue represents a metabolically active visceral fat depot that is in direct contact with the left ventricular myocardium. While it is associated with coronary artery disease, little is known regarding its role in aortic stenosis. We sought to investigate the association of epicardial adipose tissue with aortic stenosis severity and progression, myocardial remodelling and function, and mortality in asymptomatic patients with aortic stenosis.</p><p><strong>Methods: </strong>In a post hoc analysis of 124 patients with asymptomatic mild-to-severe aortic stenosis participating in a prospective clinical trial, baseline epicardial adipose tissue was quantified on CT angiography using fully automated deep learning-enabled software. Aortic stenosis disease severity was assessed at baseline and 1 year. The primary endpoint was all-cause mortality.</p><p><strong>Results: </strong>Neither epicardial adipose tissue volume nor attenuation correlated with aortic stenosis severity or subsequent disease progression as assessed by echocardiography or CT (p>0.05 for all). Epicardial adipose tissue volume correlated with plasma cardiac troponin concentration (r=0.23, p=0.009), left ventricular mass (r=0.46, p<0.001), ejection fraction (r=-0.28, p=0.002), global longitudinal strain (r=0.28, p=0.017), and left atrial volume (r=0.39, p<0.001). During the median follow-up of 48 (IQR 26-73) months, a total of 23 (18%) patients died. In multivariable analysis, both epicardial adipose tissue volume (HR 1.82, 95% CI 1.10 to 3.03; p=0.021) and plasma cardiac troponin concentration (HR 1.47, 95% CI 1.13 to 1.90; p=0.004) were associated with all-cause mortality, after adjustment for age, body mass index and left ventricular ejection fraction. Patients with epicardial adipose tissue volume >90 mm³ had 3-4 times higher risk of death (adjusted HR 3.74, 95% CI 1.08 to 12.96; p=0.037).</p><p><strong>Conclusions: </strong>Epicardial adipose tissue volume does not associate with aortic stenosis severity or its progression but does correlate with blood and imaging biomarkers of impaired myocardial health. The latter may explain the association of epicardial adipose tissue volume with an increased risk of all-cause mortality in patients with asymptomatic aortic stenosis.</p><p><strong>Clinicaltrials: </strong>gov (NCT02132026).</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572800","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":"Terminal renal failure as a contributor to high-sensitivity cardiac troponin T elevations: insights from patients undergoing renal transplantation.","authors":"Androniki Papachristou, Christian Puelacher, Noemi Glarner, Ivo Strebel, Ibrahim Schaefer, Georgiana Virant, Juerg Steiger, Matthias Diebold, Giovanna LuratiBuse, Daniel Bolliger, Luzius Steiner, Lorenz Guerke, Thomas Wolff, Edin Mujagic, Danielle Menosi Gualandro, Christian Müller, Tobias Breidthardt","doi":"10.1136/heartjnl-2024-324686","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-324686","url":null,"abstract":"<p><strong>Background: </strong>False cardiac troponin (cTn) elevations from non-cardiac causes are a major concern. We aimed to assess terminal renal failure as a possible non-cardiac cause of elevated high-sensitivity cTnT (hs-cTnT) concentrations using renal transplantation as an in vivo model of rapid restoration of renal function.</p><p><strong>Methods: </strong>We analysed consecutive patients with end-stage renal disease (ESRD) undergoing renal transplantation at a single centre. Patients with perioperative myocardial infarction or injury were excluded. Changes in hs-cTnT and creatinine were measured pretransplant and at four post-transplant intervals (day 1, days 2-5 and days 14-180). A decrease of ≥25% in hs-cTnT within 24 hours post-transplant was deemed evidence of renal clearance recovery.</p><p><strong>Results: </strong>Among 45 patients (median age 67 years, 31% women), the median pretransplant plasma creatinine concentration was 608 μmol/L (IQR 482-830), and fell to 425 μmol/L (IQR 337-619) on day 1, 289 μmol/L (IQR 201-492) on days 2-5 and 126 μmol/L (IQR 103-191) on days 14-180 (p<0.001, p<0.001 and p=0.003, respectively). The median pretransplant hs-cTnT concentration was 48 ng/L (IQR 34-70). It fell to 26 ng/L (IQR 15-38; geometric mean of relative change 36%) on day 1 (p<0.001) and then remained constant on days 2-5 (26 ng/L (IQR 18-35)) and days 14-180 (25 ng/L (IQR 20-30), p=ns).</p><p><strong>Conclusion: </strong>Terminal renal failure is a non-cardiac cause of elevated circulating hs-cTnT concentrations, contributing more than one-third in this cohort, while the remaining two-thirds seem related to chronic cardiomyocyte injury.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572801","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":"Advancing clinical management of left ventricular thrombosis: prevention, detection and treatment modalities in the modern era.","authors":"Qian Zhang, Haikuo Zheng, Zhongfan Zhang, Yuanzhen Xu, Wenqi Zhang","doi":"10.1136/heartjnl-2024-324605","DOIUrl":"10.1136/heartjnl-2024-324605","url":null,"abstract":"<p><p>Heightened interest in left ventricular thrombus (LVT) stems from the consistent association of subsequent stroke and systemic embolism after LVT, and many aspects of its management still exist in a grey area of evidence. The current delay in intervention is likely related to a limited understanding of the disease pathophysiology, along with an underestimation of LVT by standard imaging modalities. With the rapid development of antithrombotic regimens consisting of direct oral anticoagulants (OACs), which have shown early safety and efficacy, there is a growing need to understand and accurately diagnose the LVT process in order to determine appropriate management solutions. This educational review will oversee LVT pathophysiology, current status of the guidelines-recommended echocardiographic approach and the role of multimodality imaging, as well as prevention and treatment modalities in the modern era. Meanwhile, the review proposes an algorithm for the prevention and treatment of LVT based on current guidelines and expert consensus, and highlights the need for more investigations to identify risk stratification methods for individual patients, and lastly, discusses the potential of direct OACs in the management of LVT.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143407113","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":"Contemporary clinical characteristics and management patterns in hypertrophic cardiomyopathy: insights from baseline enrolment data in a nationwide prospective Japanese registry.","authors":"Toru Kubo, Kenta Sugiura, Yukichi Tokita, Hitoshi Takano, Itaru Takamisawa, Morimasa Takayama, Yoshinori L Doi, Yuichiro Minami, Shota Shirotani, Mio Ebato, Miki Tsujiuchi, Takeru Nabeta, Takayuki Inomata, Takao Kato, Ryuji Okamoto, Kaoru Dohi, Yasuyoshi Takei, Taishiro Chikamori, Eiichi Watanabe, Azusa Furugen, Hirosato Doi, Keitaro Akita, Yuichiro Maekawa, Akiyoshi Ogimoto, Norio Tada, Takashi Yokota, Shuntaro Ikeda, Osamu Yamaguchi, Yasuhiro Izumiya, Atsushi Shibata, Seiji Takashio, Kenichi Tsujita, Yasuhiro Maejima, Noboru Fujino, Akihiro Nomura, Yuichi Akasaki, Koji Higuchi, Shuichi Fujita, Masaaki Hoshiga, Yasuyuki Shiraishi, Masaki Ieda, Yuya Miyamoto, Hiroaki Kitaoka","doi":"10.1136/heartjnl-2024-324811","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-324811","url":null,"abstract":"<p><strong>Background: </strong>The Japanese Hypertrophic Cardiomyopathy Registry Study was designed to provide comprehensive, real-world insights into the clinical characteristics and management of hypertrophic cardiomyopathy (HCM) in Japan.</p><p><strong>Methods: </strong>This multicentre, prospective study enrolled consecutive patients with HCM from 24 referral hospitals across Japan starting in 2016. The baseline characteristics of 1485 patients enrolled by December 2019 are presented in this analysis.</p><p><strong>Results: </strong>The median ages at registration and diagnosis were 69 and 60 years, respectively, with men accounting for 54% of the cohort. Familial HCM was confirmed in 18% of cases. Of the cohort, 36% had hypertrophic obstructive cardiomyopathy (HOCM), while 8% had mid-ventricular obstruction, 14% had apical HCM and 4% were in the end-stage phase. Atrial fibrillation was observed in 27% of patients, though the majority were asymptomatic or had mild symptoms at registration. Adverse outcomes included prior sustained ventricular tachycardia or fibrillation (6%), heart failure requiring hospitalisation (11%) and embolic events (5%). Defibrillator implantation was performed in 11% of patients. Differences in the defibrillator indications for primary prevention in the current three guidelines and status of defibrillator deployment at registration were clarified: the percentages of class IIa recommendation in the whole cohort and of patients with defibrillator implantation in class IIa were 22% and 19% in the Japanese guidelines, 4% and 39% in the European guidelines and 28% and 22% in the American guidelines, respectively. Beta blockers were prescribed to 90% of patients with HOCM, while 51% received cibenzoline. Septal reduction therapies were performed in 22% of patients with HOCM, with 6% undergoing surgical myectomy.</p><p><strong>Conclusions: </strong>As the first large-scale, prospective HCM registry in Japan, this study provides valuable baseline data on the clinical characteristics and management of HCM. These findings will help address gaps between current practice and guideline recommendations, improving the care of patients with HCM.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556684","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":"Evolution of coronary stents: innovations, antithrombotic strategies and future directions.","authors":"William A E Parker","doi":"10.1136/heartjnl-2024-324744","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-324744","url":null,"abstract":"<p><p>Implantation of drug-eluting stents (DESs) remains central to percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS) and chronic coronary syndromes (CCS). DES platforms, polymers and drugs have evolved significantly to improve deliverability and safety, now being typically thin-strut with a compact layer of biocompatible or bioresorbable polymer, or no polymer at all. Ultra-thin-strut DESs push this concept further, and in some studies perform better than conventional DES, but may recoil in challenging settings such as chronic total occlusion PCI. Stent implantation has also progressed, with greater attention to lesion preparation and poststenting optimisation, increased use of intracoronary imaging helping to recognise and remedy issues. In parallel, antithrombotic therapy for patients undergoing PCI has advanced considerably, with reliable P2Y₁₂ inhibition now possible with the newest agents. As well as progress in controlling other thrombotic risk factors such as hyperlipidaemia, hypertension and diabetes, these developments have contributed to reducing thrombotic risk. As well as preventing stent thrombosis, antithrombotic therapy can reduce the risk of non-PCI-related thrombotic events, not only in the coronary tree but also in the cerebral and peripheral circulation, however it increases bleeding risk. Twelve months of dual antiplatelet therapy (DAPT) after PCI for ACS (and 6 months after PCI for CCS) remains the default recommended strategy, but given reliable P2Y₁₂ inhibition, good control of ischaemic risk factors and a minimally thrombogenic stent design and deployment, it is rational that earlier de-escalation to monotherapy, particularly with ticagrelor, is often appropriate, reserving longer-duration DAPT for those with highest ischaemic risk but where bleeding risk is not high. A body of trial evidence now supports this. As well as earlier de-escalation of DAPT, future developments in PCI might include increased use of 'leave nothing behind' strategies and further pharmacological options for optimisation of ischaemic risk factors.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556685","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}