Heart最新文献

{"title":"Anticoagulants or antiplatelets for secondary prevention of cryptogenic stroke: an updated systematic review and meta-analysis.","authors":"Kuan-Yu Chi, Talal El Zarif, Dimitrios Varrias, Pei-Lun Lee, Yu-Cheng Chang, Junmin Song, Anita Osabutey, Pawel Borkowski, Cho-Han Chiang, Yu Chang, Yu-Shiuan Lin, Michele Nanna, Michael G Nanna","doi":"10.1136/heartjnl-2024-325288","DOIUrl":"10.1136/heartjnl-2024-325288","url":null,"abstract":"<p><strong>Background: </strong>Patients with cryptogenic stroke or embolic stroke of undetermined source (ESUS) face a high risk of recurrent ischaemic stroke, but the optimal antithrombotic strategy remains unclear. This systematic review and meta-analysis compared the effectiveness and safety of oral anticoagulants (OACs) versus antiplatelets in these populations, with a focus on subgroup effects by key clinical characteristics.</p><p><strong>Methods: </strong>Six databases were searched through March 2024 to identify randomised controlled trials (RCTs) comparing OACs and antiplatelets in patients with cryptogenic stroke or ESUS. The primary outcome was recurrent ischaemic stroke. Subgroup analyses evaluated treatment effects based on supracardiac atherosclerosis risk, presence of patent foramen ovale (PFO) and signs or risk factors for atrial cardiopathy. Meta-regression with interaction p values was employed to assess differences in treatment effects between subgroups.</p><p><strong>Results: </strong>Nine RCTs comprising 15 451 participants were included. In the overall population, there was no significant difference in recurrent ischaemic stroke risk between OACs and antiplatelets (relative risk (RR) 0.90, 95% CI 0.79 to 1.02; I²=0%). Subgroup analyses showed that OACs reduced ischaemic stroke risk in patients with low-risk supracardiac atherosclerosis (RR 0.53, 95% CI 0.35 to 0.80; I²=0%) compared with those with high-risk supracardiac atherosclerosis (RR 0.91, 95% CI 0.78 to 1.06; I²=0%) and evidence of supracardiac atherosclerosis (RR 1.13, 95% CI 0.84 to 1.53; I²=0%) (p interaction=0.0002). Similarly, OACs were more effective in patients with signs or risk factors for atrial cardiopathy (RR 0.84, 95% CI 0.70 to 0.99; I²=0%) than in those without atrial cardiopathy (RR 1.05, 95% CI 0.85 to 1.30; I²=0%) (p interaction=0.02). There was no significant interaction by PFO status (p interaction=0.28). While the risk of major bleeding risk was comparable between groups (RR 1.34, 95% CI 0.73 to 2.44; I²=65%), a significantly higher risk of major bleeding other than intracerebral haemorrhage was observed in patients taking OACs compared with antiplatelets (RR 1.69, 95% CI 1.18 to 2.43; I²=0%).</p><p><strong>Conclusions: </strong>OACs are more effective than antiplatelets for preventing ischaemic stroke in patients who had a cryptogenic stroke or ESUS with low-risk supracardiac atherosclerosis or atrial cardiopathy. The findings highlight the need for personalised treatment strategies and further trials in these subgroups.</p><p><strong>Prospero registration number: </strong>CRD42024518903.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"495-505"},"PeriodicalIF":5.1,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12068992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364478","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":"Prognostic impact of albuminuria in early-stage chronic kidney disease on cardiovascular outcomes: a cohort study.","authors":"Khadija Yaqoob, Hafiz Naderi, Ross J Thomson, Dunja Aksentijevic, Magnus T Jensen, Patricia B Munroe, Steffen E Petersen, Nay Aung, Muhammed Magdi Yaqoob","doi":"10.1136/heartjnl-2024-324988","DOIUrl":"10.1136/heartjnl-2024-324988","url":null,"abstract":"<p><strong>Background: </strong>The impact of early-stage chronic kidney disease (CKD) on cardiovascular outcomes, particularly when albuminuria is present, remains unclear. This study examined the associations between early CKD (stages 1 and 2) with and without albuminuria and the incidence of major adverse cardiovascular events (MACEs), heart failure (HF) and all-cause mortality.</p><p><strong>Methods: </strong>A cohort of 456 015 participants from the UK Biobank was categorised by CKD stage using serum creatinine to calculate estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (≥3 mg/mmol) to define albuminuria. Multivariable Cox proportional hazard models were applied to evaluate the associations between CKD stages and cardiovascular outcomes. Additionally, left ventricular mass (LVM), an intermediate cardiovascular risk marker, was assessed in a subset of participants using cardiovascular MRI.</p><p><strong>Results: </strong>Compared with normal kidney function, the risk of adverse outcomes increased progressively with advancing CKD stages, except for stage 2 CKD without albuminuria. Stage 2 CKD with albuminuria was associated with higher risks of MACE (HR 1.32, 95% CI 1.25 to 1.38), HF (HR 1.79, 95% CI 1.67 to 1.92) and all-cause mortality (HR 1.51, 95% CI 1.44 to 1.58), comparable to stage 3A CKD without albuminuria. The presence of albuminuria significantly interacted with the relationships between CKD stages and outcomes. No significant differences in indexed LVM were observed between early-stage CKD with albuminuria and normal renal function.</p><p><strong>Conclusions: </strong>In early-stage CKD, albuminuria is independently associated with increased risks of MACE, HF and mortality. These findings support the use of albuminuria over eGFR decline alone for cardiovascular risk stratification in early CKD.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"506-512"},"PeriodicalIF":5.1,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004058","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":"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":"523-531"},"PeriodicalIF":5.1,"publicationDate":"2025-05-12","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":"Echocardiographic cardiac damage classification and clinical outcomes in atrial functional mitral regurgitation.","authors":"Taiji Okada, Nobuyuki Kagiyama, Tomohiro Kaneko, Masashi Amano, Yukio Sato, Yohei Ohno, Masaru Obokata, Kimi Sato, Kojiro Morita, Tomoko Machino-Ohtsuka, Yukio Abe, Yutaka Furukawa","doi":"10.1136/heartjnl-2024-325240","DOIUrl":"10.1136/heartjnl-2024-325240","url":null,"abstract":"<p><strong>Background: </strong>Atrial functional mitral regurgitation (AFMR) arises from left atrial (LA) dilation, commonly associated with atrial fibrillation, and leads to progressive cardiac damage. This study evaluated the prognostic value of a novel echocardiographic cardiac damage classification system for patients with moderate or severe AFMR.</p><p><strong>Methods: </strong>In a retrospective multicentre study, 1007 patients with AFMR were stratified into four groups based on echocardiographic findings: group 1, LA damage (dilation); group 2, left ventricular damage (reduced ejection fraction and/or dilation); group 3, right heart damage (tricuspid regurgitation and/or pulmonary hypertension); and group 4, combined left and right heart damage. The primary outcome was a composite of all-cause death, heart failure hospitalisations and mitral valve (MV) interventions over a median follow-up of 3.0 years.</p><p><strong>Results: </strong>The cohort's mean age was 78±10 years, with 56% female. Event rates for the primary outcome were progressively higher across groups 1-4 (31.0%, 38.0%, 46.3% and 57.2%, respectively; p<0.001). After multivariable adjustment, group 4 was associated with a significantly higher risk of the primary outcome compared with group 1 (HR 1.65, 95% CI 1.29 to 2.11, p<0.001). This classification consistently stratified risks for individual components of the composite endpoint, particularly in patients without MV intervention.</p><p><strong>Conclusions: </strong>A cardiac damage classification system based on echocardiographic parameters provides prognostic insights in patients with AFMR, identifying subgroups at higher risk of adverse outcomes. Future studies are needed to validate its use in guiding therapeutic decisions.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"532-540"},"PeriodicalIF":5.1,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364489","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":"State-of-the-art analysis of electrocardiogram findings in sudden cardiac death.","authors":"Saori Asada, Hiroshi Morita","doi":"10.1136/heartjnl-2024-324424","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-324424","url":null,"abstract":"<p><p>Sudden cardiac death (SCD) is a significant public health issue, and efforts to prevent it have involved the analysis of various modalities, including echocardiography, cardiac CT, cardiac MRI, genetic testing and ECG. The ECG, invented >100 years ago, is the oldest diagnostic tool among these examinations. Left ventricular hypertrophy and QT prolongation were first identified as risk markers for SCD in the 1960s and 1970s. However, since the beginning of the 21st century, advances in digitalised ECG data have unveiled various additional important findings. In vitro experimental studies have also contributed to the discovery of these new markers. Newly proposed markers include the fragmented QRS complex, the interval between the peak and the end of the T wave and J waves. Many studies have validated the clinical significance of these new ECG markers in predicting SCD risk. Recently, artificial intelligence (AI) has been employed to analyse ECG data to identify the high-risk populations. While the results of AI studies are not yet sufficient for routine clinical practice, ongoing advancements are expected to improve their accuracy in the near future.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997119","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":"Concept and practice in the use of high-dose eicosapentaenoic acid for cardiovascular disease prevention in hypertriglyceridaemia.","authors":"Guillaume Roger, Chris J Packard, Luis Masana, Ulrich Laufs, Alberico L Catapano, Philippe Gabriel Steg","doi":"10.1136/heartjnl-2025-325765","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-325765","url":null,"abstract":"<p><p>Genetic and epidemiological evidence indicates that triglyceride-rich lipoproteins are causal risk factors for atherosclerotic cardiovascular disease (ASCVD). Elevated levels of plasma triglyceride are common in patients who are diabetic or obese and contribute substantially to residual, ongoing risk of an ASCVD event in individuals on low-density lipoprotein (LDL)-lowering treatment. Hypertriglyceridaemia, therefore, presents a target for further intervention. Clinical trials have demonstrated that high-dose eicosapentaenoic acid (EPA) is effective in reducing ASCVD risk in patients on statin therapy, and it is now being incorporated into strategies using combination lipid-regulating treatment to manage aggressively those at highest risk. This review summarises the concepts underpinning the use of high-dose EPA alongside intensive LDL-lowering therapy, especially in the context of post-acute coronary syndrome. A practical implementation algorithm is presented setting out treatment options for combination therapy, and the place of high-dose EPA in ASCVD prevention in hypertriglyceridaemia.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063620","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":"Disparities in prescriptions among Danish heart failure patients: a national longitudinal cohort study.","authors":"Maria Klitgaard Christensen, Vibe Bolvig Hyldgård, Christian Madelaire, Andreas Kristian Pedersen, Jacob Eifer Moller, Rikke Søgaard","doi":"10.1136/heartjnl-2024-325562","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325562","url":null,"abstract":"<p><strong>Background: </strong>Angiotensin receptor-neprilysin inhibitors (ARNi) and sodium-glucose co-transporter 2 inhibitors (SGLT2i) have a Class I indication in the European Society of Cardiology's guidelines for the diagnosis and treatment of acute and chronic heart failure due to benefits in symptom management, rehospitalization rates, and mortality in heart failure. The aim of this study was to investigate demographic, geographic and socioeconomic disparities in prescriptions for ARNi and SGLT2i for heart failure patients in a universal healthcare system.</p><p><strong>Methods: </strong>We used national registers to identify all Danish heart failure patients who were diagnosed on or after the updated clinical guidelines by the European Society of Cardiology (14 July 2016 for ARNi and 27 August 2021 for SGLT2i). Patients were followed until redemption of prescription, emigration, death or censoring on 30 June 2022, whichever came first. The Aalen-Johansen estimator and Cox proportional hazard models were used for individual analysis of ARNi (n=43 625) and SGLT2i (n=2819).</p><p><strong>Results: </strong>The following factors were associated with lack of prescriptions for ARNi and SGLT2i: being women, older age, living alone and being non-native Danish or descendant. HRs ranged from 0.31 (95% CI 0.28 to 0.36) to 0.86 (95% CI 0.80 to 0.93) for ARNi and 0.49 (95% CI 0.41 to 0.58) to 0.93 (95% CI 0.72 to 1.20) for SGLT2i. Prescriptions for both ARNi and SGLT2i showed a social gradient, with the gradient for ARNi being statistically significant.</p><p><strong>Conclusions: </strong>Substantial disparity was found in prescriptions for the potentially life-saving medications, with lack of prescriptions being associated with lower education, lower income and several demographic characteristics.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964960","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":"Outcomes of transcatheter aortic valve replacement in bicuspid versus tricuspid aortic stenosis with severe calcification.","authors":"Yinghao Sun, Changjin Wang, Jie Li, Songyuan Luo, Shengneng Zheng, Bangyuan Yang, Jiaohua Chen, Ruixin Fan, Jianfang Luo","doi":"10.1136/heartjnl-2024-324697","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-324697","url":null,"abstract":"<p><strong>Background: </strong>The comparative outcomes of transcatheter aortic valve replacement (TAVR) in bicuspid versus tricuspid aortic stenosis (AS) with severe calcification remain unclear. This study aimed to compare the safety and efficacy of TAVR in these patient groups.</p><p><strong>Methods: </strong>Using data from the Chinese Cardiovascular Association Database-National Transcatheter Valve Therapeutics Registry, we analysed 870 propensity score matched pairs of patients with severe calcification (≥470 mm³) undergoing TAVR between April 2014 and August 2023. Primary outcome was all-cause mortality at 1 year.</p><p><strong>Results: </strong>No significant differences were observed in technical success (95.1% vs 94.7%), procedural complications or in-hospital outcomes. All-cause mortality at 1 year was similar between bicuspid and tricuspid AS (4.3% vs 5.3%, HR 0.87; log-rank p=0.62). The incidence of stroke (1.5% vs 1.4%), cardiovascular hospitalisation (1.4% vs 1.7%) and moderate-to-severe paravalvular leak (3.5% vs 2.5%) was similar during follow-up. The rate of new permanent pacemaker implantation was higher in bicuspid AS (8.4% vs 5.6%; p=0.03).</p><p><strong>Conclusions: </strong>TAVR was observed to be equally safe and effective in bicuspid and tricuspid AS with severe calcification, though bicuspid AS was associated with a higher rate of permanent pacemaker implantation.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969749","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":"Myocarditis: an increasing global health challenge!","authors":"Massimo Imazio","doi":"10.1136/heartjnl-2025-326105","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326105","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963180","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 morbidity and mortality after radiotherapy for breast cancer: a systematic review and meta-analysis.","authors":"Meng-Xi Yang, Jie-Ke Liu, He-Ping Deng, Jian-Jun Tang, Wen-Ting Xu, Yun-Tao Hu, Wei Diao, Dong Xia, Xi Liu, Lin Yuan, Hong-Bin Luo, Peng Zhou","doi":"10.1136/heartjnl-2024-325179","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325179","url":null,"abstract":"<p><strong>Background: </strong>Radiation exposure of the heart secondary to radiotherapy can lead to potential cardiac injury. However, the hazard ratio (HR) for cardiac morbidity and mortality associated with undergoing breast cancer radiotherapy remains unknown.</p><p><strong>Objectives: </strong>To pool the HRs for cardiovascular risk in patients with breast cancer treated with or without radiotherapy, compare the cardiac risk among irradiated patients divided by the laterality of radiotherapy and further assess the association between the cardiac radiation dose and cardiac morbidity.</p><p><strong>Methods: </strong>A literature search was conducted using MEDLINE, EMBASE and the Cochrane Library from inception to 1 December 2024. Studies that reported HRs with 95% CIs for the associations of interest were included. Pooled effect estimates were obtained using random-effects meta-analysis. Subgroup analyses were carried out to investigate the influence of the treatment period on cardiovascular outcomes. Publication bias was evaluated using the Egger and Begger's tests.</p><p><strong>Results: </strong>Thirty-one studies involving 610 690 participants were ultimately included. Compared with patients who did not receive radiotherapy, patients who underwent radiotherapy experienced increased risks for developing heart failure (HR: 1.37; 95% CI 1.20 to 1.57). Among patients treated with radiotherapy, left-sided radiotherapy increased the risk of subsequent coronary artery disease (HR: 1.11; 95% CI 1.05 to 1.16). There was a linear correlation between the mean heart exposure dose and cardiac morbidity development (HR: 1.12; 95% CI 1.05 to 1.19). When patients were grouped by treatment period, the risk of cardiac mortality in patients treated with left-sided radiotherapy decreased after 1989 (HR: 1.30 vs 1.02, p<0.01*). No evidence of significant publication bias was identified.</p><p><strong>Conclusions: </strong>Radiotherapy for breast cancer was associated with an increased risk of experiencing adverse cardiovascular events, which was highly dependent on the cardiac irradiation dose. With advances in radiation techniques, cardiovascular prognosis is expected to improve further.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988430","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}