Heart最新文献

{"title":"ABCDE of complex pericarditis cases.","authors":"Michele Marchetta, Luigi Adamo, Aldo Bonaventura, Michael Garshick, Brittany N Weber, Antonio Abbate","doi":"10.1136/heartjnl-2026-328058","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328058","url":null,"abstract":"<p><p>Pericarditis is the most frequent manifestation of pericardial disease and accounts for up to 5% of emergency department visits for chest pain. Although traditionally considered a benign and self-limited condition, it is a heterogeneous syndrome with a broad aetiological spectrum and potentially significant morbidity. While mortality is low, the burden of complications like recurrent disease, cardiac tamponade or constrictive pericarditis, and the frequent need for hospitalisation underscore its clinical relevance. The growing availability of multimodality imaging and the publication of updated international guidelines in 2025 have recently renewed attention to pericardial diseases, refining diagnostic criteria, risk stratification and therapeutic approaches. In high-income settings, idiopathic or presumed viral pericarditis remains the most common presentation. However, a substantial proportion of patients harbour alternative aetiologies that carry distinct prognostic implications and require tailored diagnostic and management strategies. In this review, we use the ABCDE mnemonic as a pragmatic framework to highlight five clinically important and often under-recognised forms of pericardial disease. Pericarditis associated with <i>autoimmune and systemic inflammatory diseases</i> is typically characterised by recurrent or refractory inflammatory courses and frequent extracardiac involvement. <i>Bacterial pericarditis</i>, although rare, represents a life-threatening condition requiring rapid aetiological identification and aggressive therapy. <i>Cancer-related</i> pericardial disease often presents with large pericardial effusions or cardiac tamponade and is associated with a poor prognosis largely determined by the underlying malignancy. <i>Damage-related and drug-related</i> pericarditis encompasses postcardiac injury syndromes and pharmacological toxicity. Finally, <i>endocrine and metabolic</i> disorders, including uraemia, hypothyroidism and infiltrative conditions such as amyloidosis, are associated with pericardial disease that manifests with atypical features and effusion. Early recognition of these entities is critical, as management extends beyond standard anti-inflammatory therapy and often requires correction of the underlying cause and close multidisciplinary collaboration. This ABCDE approach can aid clinicians in identifying these uncommon high-risk forms of pericarditis and optimising patient-centred care.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147769935","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":"When a patent foramen ovale becomes pathological.","authors":"Mike Saji, Hiroshi Ohara","doi":"10.1136/heartjnl-2026-328040","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328040","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147769730","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":"Emergency department visits among non-Western and Western women with no obstructive coronary artery disease: results from a nationwide cohort.","authors":"Nikoline Fredsøe, Anne Mark Sørensen, Jane Lange Dalsgaard, Michael Skov Hansen, Morten Sodemann, Chalotte Willemann Stecher, Lisette Okkels Jensen, Britt Borregaard","doi":"10.1136/heartjnl-2025-326747","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326747","url":null,"abstract":"<p><strong>Background: </strong>More than half of women experiencing angina pectoris or non-specific chest pain are diagnosed with non-obstructive coronary artery disease (CAD), with a higher proportion being non-Western. The study aimed to describe emergency department (ED) visits among non-Western and Western women with chest pain but no obstructive CAD and to investigate the association between ethnicity and ED visits within 3 years following the diagnosis.</p><p><strong>Methods: </strong>A substudy to the Danish nationwide register-based WOMen with symptoms of Angina or non-specific chest pain but NO obstructive CAD (WOMANOCA) cohort with non-Western and Western women. The women were divided into two groups: symptoms of angina or non-specific chest pain. All women underwent diagnostic assessment with either coronary angiography or cardiac CT. The association between ethnicity and ED visits was investigated using multivariable Cox proportional hazard models adjusted for age, Charlson Comorbidity Index, body mass index and educational level. Results were reported as HRs with 95% CIs.</p><p><strong>Results: </strong>In total, 60 666 women were included in the two groups (angina n=17 835, non-specific chest pain n=42 831) with 8% and 9% being non-Western in the angina group and the non-specific chest pain group, respectively (n=1484 and n=3644). In both symptom groups, non-Western women more commonly presented to the ED following diagnosis compared with Western women (angina, adjusted HR 1.42, 95% CI 1.28 to 1.56, non-specific, adjusted HR 1.25, 95% CI 1.18 to 1.33).</p><p><strong>Conclusions: </strong>Ethnicity was associated with ED visits, with non-Western women having significantly more visits regardless of whether the underlying chest pain was related to angina or non-specific symptoms.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147769354","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":"What is in a name? Name bias and tackling health disparities.","authors":"Mo Al-Haddad, Dipesh Gopal, Mala Rao","doi":"10.1136/heartjnl-2026-327965","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-327965","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147769397","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 cardiomyopathy and systemic organ crosstalk: from mechanisms to clinical implications.","authors":"Nick Laurens van Vreeswijk, Andreas Meert, Oliver Bundgaard Vad, Isabelle C van Gelder, Yuri Blaauw, Michiel Rienstra","doi":"10.1136/heartjnl-2025-327563","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-327563","url":null,"abstract":"<p><p>Atrial cardiomyopathy (ACMP) encompasses structural, electrical and functional atrial abnormalities that have been associated with ischaemic stroke, heart failure and mortality, independent of atrial fibrillation (AF). Increasing evidence suggests that AF, stroke and other adverse outcomes may represent parallel manifestations of ACMP. In the present narrative review, we synthesise current experimental and clinical evidence on the risk factors, pathophysiology, diagnosis and stages of ACMP, and summarise its bidirectional interactions with affected organs, including the left ventricle, lungs, brain, kidneys and gut.ACMP can be considered as an upstream disease process driven by fibrosis, inflammation, oxidative stress, hypercoagulability, metabolic stress and adipose tissue. Through haemodynamic, neurohormonal, inflammatory and thrombotic pathways, ACMP both contributes to and results from dysfunction in other organs, forming self-perpetuating cycles. ACMP can be characterised using complementary electrical, structural, functional and biomarker-based measures, although no single diagnostic standard exists. Disease progression appears staged, with earlier phases potentially reversible and advanced stages dominated by more permanent structural remodelling.Collectively, the evidence supports considering ACMP as a multiorgan disease, highlighting the need for an atrium-centred, integrated approach to risk stratification, preventive and therapeutic strategies.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147769866","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":"Clinical impact of Takotsubo syndrome in patients with stroke.","authors":"SeonHo Sunny Jang, Luciano Sposato, Jan F Scheitz, Yun-Hee Choi, Amir Geressu, Nikolaos Tzemos, Diana Ayan, Mamas A Mamas, Rodrigo Bagur","doi":"10.1136/heartjnl-2025-327188","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-327188","url":null,"abstract":"<p><strong>Background: </strong>Data on outcomes of patients complicating with Takotsubo syndrome (TTS) following stroke, contributing factors and prognosis significance have not been well characterised.</p><p><strong>Objective: </strong>To assess the incidence, factors and prognosis of TTS-complicated stroke, and to determine the 30-day unplanned readmission rates with TTS and its prognosis among stroke survivors without initial TTS.</p><p><strong>Methods: </strong>The US Nationwide Readmission Database was queried using International Classification of Disease codes to gather information on individuals hospitalised with primary diagnosis of stroke between January 2010 and November 2021. Incidence, factors and prognosis associated with TTS-complicated stroke and 30-day unplanned readmissions with new TTS were assessed. The primary outcome was the occurrence of death during index admission for stroke as well as during readmission episode with TTS. Incidence, factors and prognosis associated with TTS-complicated stroke and 30-day unplanned readmissions with new TTS were assessed.</p><p><strong>Results: </strong>Of 3 376 606 patients admitted with primary diagnosis of stroke, 6119 (0.18%) developed TTS secondary to stroke. Patients with TTS were more likely to be women (79% vs 50%, p<0.001), younger (median 67 vs 70 years), present with haemorrhagic (as opposed to ischaemic stroke, p<0.001) and have a higher comorbidity burden. The mortality rate was significantly higher in those who had TTS-complicated stroke (21% vs 7.8%, p<0.001). Of patients who were discharged without having TTS during the index admission, 217 745 (6.5%) patients had 30-day unplanned readmission, among these, 214 (0.1%) were readmitted with the new diagnosis of TTS. Patients who were readmitted with TTS were more likely to be women (79% vs 50%), had higher comorbidity burden and experienced higher mortality rate during readmission compared with those without TTS (13% vs 6.5%, p=0.008).</p><p><strong>Conclusion: </strong>Although rare, TTS secondary to stroke is highly fatal. Female sex, presentation with haemorrhagic stroke and pre-existing health conditions were strong factors associated with TTS-complicated stroke. Early recognition and management of TTS-complicated stroke are of paramount importance to prevent serious consequences.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147769946","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":"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":"539-548"},"PeriodicalIF":4.4,"publicationDate":"2026-04-24","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":"Pulmonary hypertension after atrial septal defect repair.","authors":"Yuyan Cai, Hong Tang, Xin Wei","doi":"10.1136/heartjnl-2025-327583","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-327583","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":"112 10","pages":"583-584"},"PeriodicalIF":4.4,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147769707","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":"Variation in mechanical circulatory support use for acute myocardial infarction cardiogenic shock.","authors":"Arjun Verma, Nikhil L Chervu, Justin J Kim, Saad Mallick, Boback Ziaeian, Peyman Benharash","doi":"10.1136/heartjnl-2024-325413","DOIUrl":"10.1136/heartjnl-2024-325413","url":null,"abstract":"<p><strong>Background: </strong>Cardiogenic shock (CS) is a leading cause of mortality following acute myocardial infarction (AMI). Some patients may require intra-aortic balloon pump (IABP) or percutaneous ventricular assist device (PVAD) placement; however, there is a paucity of standardised algorithms to guide the deployment of each device. The present study evaluated interhospital variation in the use of IABP and PVAD for AMI CS and identified institutional factors associated with hospital-level device preference.</p><p><strong>Methods: </strong>All non-elective adult hospitalisations entailing AMI and CS were identified within the 2019 Nationwide Readmissions Database. Patients were grouped into IABP, PVAD and non-mechanical circulatory support cohorts. The primary aim was to quantify the degree of interhospital variation in the use of IABP and PVAD. Escalation to extracorporeal membrane oxygenation (ECMO), left ventricular assist device (LVAD) implantation, length of stay and hospitalisation costs were secondarily assessed. Hospital factors, such as percutaneous coronary intervention (PCI) volume and safety net status, were also analysed.</p><p><strong>Results: </strong>Among 53 903 patients, 23.4% received IABP, and 12.5% received PVAD. After adjustment for patient factors, approximately 13% (11-14%) of variation in IABP use and 18% (15-20%) of PVAD use were attributable to centre-level differences. High-PVAD hospitals had higher annual PCI volume (257 (185-369) vs 204 (148-276) cases/year, p=0.032) and were more commonly safety net institutions (27.4% vs 11.3%, p=0.023), compared to high-IABP hospitals. Patients treated at high-IABP and high-PVAD hospitals faced similar length of stay (β -0.16, 95% CI -1.82 to 1.49) and costs (β -$3500, 95% CI -16 600 to 9600). Those at high-PVAD hospitals had lower adjusted risk of escalation to ECMO (0.52, 95% CI 0.29 to 0.95) and LVAD implantation (0.28, 95% CI 0.08 to 0.94).</p><p><strong>Conclusions: </strong>The present study identified wide interhospital variation in the use of IABP and PVAD for AMI CS. Although the likelihood of escalation to ECMO or LVAD differed between hospital types, resource utilisation was similar.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"563-568"},"PeriodicalIF":4.4,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144951498","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":"Surprising and essential answer to the 'Left-Right Question' in complex congenital heart disease.","authors":"Michael S Lloyd","doi":"10.1136/heartjnl-2025-327094","DOIUrl":"10.1136/heartjnl-2025-327094","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"527"},"PeriodicalIF":4.4,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145458380","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}