Heart最新文献

{"title":"Role of routine surveillance stress testing in patients with or without imaging-guided or physiology-guided PCI.","authors":"Yeonwoo Choi, Do-Yoon Kang, Hoyun Kim, Jinho Lee, Sangyong Jo, Jung-Min Ahn, Nayoung Kim, Yong-Hoon Yoon, Seung-Ho Hur, Cheol Hyun Lee, Won-Jang Kim, Se Hun Kang, Chul-Su Park, Bong-Ki Lee, Jung-Won Suh, Jae Woong Choi, Kee-Sik Kim, Su Nam Lee, Seung-Jung Park, Duk-Woo Park","doi":"10.1136/heartjnl-2025-326402","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326402","url":null,"abstract":"<p><strong>Objective: </strong>The optimal follow-up strategy for high-risk patients who underwent imaging-guided or physiology-guided percutaneous coronary intervention (PCI) remains uncertain. We investigated whether routine surveillance stress testing after PCI provides clinical benefit when the procedure is guided by intravascular ultrasonography (IVUS) or fractional flow reserve (FFR).</p><p><strong>Methods: </strong>In the Pragmatic Trial Comparing Symptom-Oriented vs Routine Stress Testing in High-Risk Patients Undergoing PCI randomised trial, 1706 high-risk patients who underwent PCI were assigned to either routine functional testing at 1 year or standard care alone. In this prespecified subgroup analysis, patients were subsequently categorised according to whether IVUS or FFR was used at the index procedure. The primary outcome was a composite of death, myocardial infarction or hospitalisation for unstable angina over 2 years.</p><p><strong>Results: </strong>Among the randomised population, 74% underwent IVUS-guided intervention and 36% underwent FFR-guided intervention. At 2 years, rates of the primary outcome were similar between routine testing and standard care both in patients treated with IVUS guidance (5.3% vs 6.7%; HR 0.79; 95% CI 0.50 to 1.24) and without IVUS guidance (5.7% vs 3.8%; HR 1.52; 95% CI 0.63 to 3.68; interaction p=0.21). Comparable results were observed in patients with FFR guidance (2.6% vs 3.9%; HR 0.65; 95% CI 0.26 to 1.58) and without FFR guidance (7.0% vs 7.1%; HR 0.99; 95% CI 0.63 to 1.55; interaction p=0.59). Routine functional testing was consistently associated with higher use of invasive coronary angiography and repeat revascularisation, without improvement in clinical outcomes.</p><p><strong>Conclusions: </strong>Among high-risk patients who underwent PCI, routine surveillance stress testing did not reduce the risk of death, myocardial infarction or unstable angina, regardless of the use of IVUS or FFR at the index procedure. Routine functional testing increased downstream invasive procedures without clinical benefit. These findings support guideline recommendations against routine surveillance testing after PCI.</p><p><strong>Trial registration number: </strong>NCT03217877.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225311","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":"Navigating cardiovascular imaging fellowships.","authors":"Puskar Bura, Freya Lodge, Nishat Siddiqi","doi":"10.1136/heartjnl-2025-325997","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-325997","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181982","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":"Trends in burden of atrial fibrillation over three decades: a population-based study.","authors":"Shuyue Yang, Nicole De Kruijf, Fang Zhu, Julie Anne Eni van Oortmerssen, Natasja M S de Groot, Maryam Kavousi","doi":"10.1136/heartjnl-2025-326510","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326510","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is a common sustained cardiac arrhythmia with increasing prevalence and incidence worldwide. However, long-term trends in AF prevalence, incidence, associated risk factors, and the role of comorbidities, including sex-specific differences is limited.</p><p><strong>Methods: </strong>We included 7750, 7675, and 7121 participants from the population-based Rotterdam Study across three epochs over 3 decades (epoch 1990s: 1989-1993; epoch 2000s: 1997-2001; and epoch 2010s: 2009-2014). We examined trends in incidence rates and estimated incidence rate ratios (IRRs) over time, both overall and stratified by sex. Cox regression were applied to evaluate associations between comorbidities and incident AF to derive HRs with 95% CIs. Population attributable fractions (PAFs) were calculated to quantify the contribution of key comorbidities to AF incidence.</p><p><strong>Results: </strong>The mean (SD) of age in three epochs was around 70 years (epoch 1990s: 70.3 (9.6), epoch 2000s: 70.0 (8.7) and epoch 2010s: 70.4 (9.8)). The follow-up for each participant was 5 years. The age and sex-adjusted AF incidence rates in three epochs were 36.1, 27.4 and 52.0 per 1000 person-years. The AF incidence rates were 31.4, 22.9 and 44.1 for women and 45.0, 34.7 and 65.6 for men, respectively. Hypertension was the most important contributor to incident AF in all three epochs (PAFs were epoch 1990s: 36.0% (95% CI 24.3% to 54.2%), epoch 2000s: 35.0% (95% CI 14.0% to 59.5%) and epoch 2010s: 42.7% (95% CI 22.6% to 61.0%)), especially in women (epoch 1990s: 46.6% (95% CI 24.0% to 68.3%), epoch 2000s: 38.60% (95% CI 11.9% to 68.9%) and epoch 2010s: 59.9% (95% CI 40.5% to 82.5%)).</p><p><strong>Conclusion: </strong>The increasing burden of AF over the last three decades for both women and men calls for improved sex-specific AF prevention and management strategies. Hypertension remains to be a principal contributor to the population burden of AF, in particular among women. Effective sex-specific management of hypertension is a promising target in AF prevention strategies.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182052","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":"Accelerometry-defined physical activity and quality of life in hypertrophic cardiomyopathy.","authors":"Stephan A C Schoonvelde, Peter-Paul Zwetsloot, Alexander Hirsch, Arend F L Schinkel, Christian Knackstedt, Tjeerd Germans, Marjon A van Slegtenhorst, Judith M A Verhagen, Rudolf A de Boer, Michelle Michels","doi":"10.1136/heartjnl-2025-326217","DOIUrl":"10.1136/heartjnl-2025-326217","url":null,"abstract":"<p><strong>Background: </strong>Patients with hypertrophic cardiomyopathy (HCM) often reduce their physical activity due to concerns about sudden cardiac death. However, objective data on activity patterns in HCM, particularly in relation to clinical phenotype and quality of life (QoL), remain limited.</p><p><strong>Methods: </strong>We assessed physical activity using 7-day accelerometry in 203 patients with HCM and 37 genotype-positive, phenotype-negative (G+/P-) individuals. Outcomes included daily step counts, time spent in moderate-to-vigorous physical activity (MVPA) and sedentariness. QoL was measured using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the EuroQoL 5-domain 5-level (EQ-5D-5L).</p><p><strong>Results: </strong>HCM patients took fewer steps/day (5254 vs 6573), engaged in less MVPA (3.4% vs 4.5% of the day) and were more often sedentary (61% vs 35% spending >80% of the day sedentary) compared with G+/P- controls (all p<0.01). Symptomatic and obstructive HCM patients showed the lowest activity levels. Notably, asymptomatic obstructive HCM patients demonstrated reduced activity comparable to symptomatic individuals. Obesity and use of cardiac medications were also associated with lower activity. Step counts were positively associated with QoL scores: a 250 steps/day increment corresponded to a 2.15-point higher KCCQ score and a 1000 steps/day increment to a 0.05-point higher EQ-5D-5L score (both p<0.001), remaining significant after adjustment for age and sex. Most HCM patients (62%) recalled receiving exercise guidance, and many (59%) reported reducing their activity as a result.</p><p><strong>Conclusions: </strong>Objectively measured physical activity was significantly lower in HCM patients compared with G+/P- individuals, particularly among those with symptoms, obstruction or obesity. Even modestly higher daily step counts were associated with better QoL, highlighting the relevance of individualised, phenotype-informed exercise counselling in HCM.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144951431","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":"Association between cardiac cachexia and adverse outcomes in patients with heart failure: a meta-analysis of cohort studies.","authors":"Bing Liu, Xinyue Wu, Yuxin Wang, Xinhua Hu","doi":"10.1136/heartjnl-2024-325431","DOIUrl":"10.1136/heartjnl-2024-325431","url":null,"abstract":"<p><strong>Background: </strong>Cardiac cachexia is a condition characterised by unintentional weight loss and muscle wasting in patients with heart failure. However, there is debate about the prognostic value of cardiac cachexia in these patients.</p><p><strong>Objectives: </strong>This meta-analysis aimed to evaluate the prognostic value of cardiac cachexia in patients who had heart failure.</p><p><strong>Methods: </strong>We conducted a thorough literature search of the PubMed, Web of Science and Embase databases until 7 February 2025 to identify studies that examined the prognostic value of cardiac cachexia in patients with heart failure. The outcomes of interest were all-cause mortality and major adverse cardiovascular events (MACEs). The prognostic value of cachexia was determined by pooling the adjusted HR with a 95% CI.</p><p><strong>Results: </strong>Nine studies, including 3821 patients with heart failure, met the inclusion criteria. Depending on the different definitions, the prevalence of cardiac cachexia varied from 11.2% to 37.8% in the included studies. A meta-analysis using a fixed-effects model showed that cardiac cachexia was associated with an increased risk of all-cause mortality (HR 1.59; 95% CI 1.34 to 1.89) and MACEs (HR 2.41; 95% CI 1.50 to 3.85). Subgroup analysis revealed that cardiac cachexia significantly predicted all-cause mortality, regardless of study design, heart failure subtypes, sample sizes, country, patients' age, definitions of cachexia, length of follow-up, baseline body mass index, left ventricular ejection fraction, and whether adjustment for renal function, smoking status, New York Heart Association class or heart failure medications was made.</p><p><strong>Conclusions: </strong>Cardiac cachexia is associated with a higher risk of all-cause mortality and MACEs in patients with heart failure. Assessing cardiac cachexia may provide valuable prognostic information for these patients.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"952-959"},"PeriodicalIF":4.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633850","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":"Cardiac cachexia and sarcopenia in patients with heart failure: need for an integrated approach to patients with chronic cardiovascular diseases.","authors":"Marco Proietti, Giulio Francesco Romiti","doi":"10.1136/heartjnl-2025-325988","DOIUrl":"10.1136/heartjnl-2025-325988","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"943-944"},"PeriodicalIF":4.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784160","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":"Cardiac imaging in oncology: the detection of cardiotoxicity.","authors":"Tomoko Negishi, Sakiko Miyazaki, John Park, Kazuaki Negishi","doi":"10.1136/heartjnl-2024-323864","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-323864","url":null,"abstract":"<p><p>Cardio-oncology has emerged as a rapidly growing subspecialty within both cardiology and oncology, bridging the gap between these two disciplines to address the cardiovascular complications associated with cancer therapies. The development of novel therapies and targeted agents has revolutionised cancer treatment and patient survival. However, these advances have been accompanied by an increase in cardiovascular complications, commonly referred to simply as 'cardiotoxicity', or more recently, as cancer therapy-related cardiovascular toxicity (CTR-CVT). CTR-CVT encompasses a broad spectrum of adverse cardiac effects, ranging from asymptomatic left ventricular systolic dysfunction to life-threatening heart failure, myocarditis, arrhythmias and ischaemic events. Early detection of cardiotoxicity is crucial to prevent irreversible cardiac damage and maintain patients' quality of life. Timely intervention may facilitate modifications in cancer treatment or the implementation of cardioprotective strategies to halt or reverse cardiac damage. Cardiac imaging in general-and echocardiography in particular-plays a pivotal role in achieving this goal by enabling clinicians to monitor, detect and manage cardiac dysfunction in patients with cancer. Improved survival rates have transformed many cancers into manageable chronic conditions. Cardiovascular disease is now a leading cause of morbidity and mortality among cancer survivors, emphasising the need for vigilant cardiovascular monitoring before, during and after cancer treatment. This review will focus on imaging tools and strategies in the detection of cardiotoxicity. We will explore conventional and emerging imaging modalities, highlighting their strengths, limitations and the evolving guidelines that shape clinical practice.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148925","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":"Mineralocorticoid receptor antagonist (MRA) use in UK heart failure care: a national primary care cohort study.","authors":"Rory Maclean, Yang Chen, R Thomas Lumbers, Anoop Dinesh Shah","doi":"10.1136/heartjnl-2024-325132","DOIUrl":"10.1136/heartjnl-2024-325132","url":null,"abstract":"<p><strong>Background and aims: </strong>Mineralocorticoid receptor antagonists (MRAs) reduce mortality and hospitalisation in heart failure with reduced ejection fraction (HFrEF) but are underused, despite recommendation in key guidelines. Identifying the factors contributing to underuse and addressing adherence are key components of a learning health system. We aimed to evaluate MRA prescription in people with HFrEF who would benefit, based on the UK National Institute for Health and Care Excellence (NICE) HFrEF guideline.</p><p><strong>Methods: </strong>We used clinical code lists to identify people with HFrEF in primary care electronic health record (EHR) data from The Health Improvement Network database. For each calendar year 2014-2020, we identified individuals who met the NICE guideline criteria for MRA therapy. We fitted mixed effects logistic regression models to determine the factors contributing to MRA prescription.</p><p><strong>Results: </strong>Among 24 135 people with HFrEF studied between 2014 and 2020, 12 150 person-years were eligible for MRA treatment. The MRA prescription rate increased from 41% to 55%. MRA prescription was inversely associated with age (OR per 1 SD, 95% CI) (0.02 (0.01, 0.03)), increasing glomerular filtration rate (0.37 (0.25, 0.55)), hypertension (0.21 (0.40, 0.78)) and prescription of antihypertensives (0.03 (0.02, 0.07)). MRA prescription was associated with male gender (6.31 (3.20, 12.4)), dilated cardiomyopathy (25.9 (7.48, 89.4)), calendar year (2.17 (1.85, 2.54) per year after study start) and prescription of sacubitril/valsartan (214 (56, 823)).</p><p><strong>Conclusions: </strong>MRAs are underused in people with HFrEF in the UK. Although prescribing increased between 2014 and 2020, half of the cohort still did not receive the therapy. Older age, gender, comorbidities and co-prescriptions were linked to MRA underuse. Understanding the factors contributing to underprescribing at a population level should be used to inform quality improvement strategies.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"976-983"},"PeriodicalIF":4.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969683","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":"Diagnostic accuracy of late gadolinium enhancement cardiac MRI for coronary artery disease in patients with reduced left ventricular ejection fraction.","authors":"Louis-Marie Desroche, Arthur Darmon, Yoan Lavie-Badie, Damien Mandry, Gregory Ducrocq, Thiziri Si-Moussi, Isabelle Durand-Zaleski, Damien Millischer, Olivier Milleron, Olivier Huttin, Mathieu Valla, Lionel Mangin, Bruno Farah, Christelle Diakov, Damien Logeart, Benjamin Safar, Jean-Yves Travers, Jules Mesnier, Alexandra Vappereau, Toni Alfaiate, Charles Burdet, Guillaume Jondeau","doi":"10.1136/heartjnl-2024-325419","DOIUrl":"10.1136/heartjnl-2024-325419","url":null,"abstract":"<p><strong>Background: </strong>Identifying significant coronary artery disease (CAD) in patients with reduced left ventricular ejection fraction (rLVEF) is essential for guiding therapeutic decisions, including medical management, device implantation and potential revascularisation. Prior studies suggested that rest cardiac MRI (CMR) with late gadolinium enhancement (LGE) could reliably detect significant CAD. We aimed to evaluate the diagnostic accuracy of rest LGE-CMR for predicting significant CAD in rLVEF patients.</p><p><strong>Methods: </strong>In this prospective, multicentre cohort study across 10 centres, adults with new-onset rLVEF≤45% without obvious cause were included. All patients underwent rest CMR and coronary angiography. Independent, blinded committees reviewed images. Significant CAD was defined as ≥70% stenosis in major coronary arteries. Ischaemic scars were identified on CMR as subendocardial LGE. The primary outcome was the sensitivity of CMR in detecting significant CAD.</p><p><strong>Results: </strong>Among 380 patients (median age 63 years, 68% male), significant CAD was present in 49 (13%). CMR identified ischaemic scars in 106 (28%). The sensitivity of CMR for detecting significant CAD was 57% (95% CI: 43% to 71%), specificity 76% (95% CI: 72% to 81%), positive predictive value 26% (95% CI: 18% to 35%) and negative predictive value 92% (95% CI: 89% to 95%). A CMR-first strategy would have missed 43% of significant CAD cases, many requiring revascularisation (86% of missed cases).</p><p><strong>Conclusions: </strong>In this large, prospective multicentre study with independent image review, rest LGE-CMR demonstrated limited sensitivity for detecting significant CAD in patients with rLVEF. Relying solely on CMR could lead to missed diagnoses and undertreatment. CMR should be integrated with other diagnostic tools to optimise care in this population.</p><p><strong>Trial registration number: </strong>NCT03231189.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"969-975"},"PeriodicalIF":4.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12505035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728743","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":"Young male with dyspnoea and palpitations.","authors":"Shashank Shekhar Mohanty, Raj Kumar, Faraz Ahmed Farooqui","doi":"10.1136/heartjnl-2025-326399","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326399","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":"111 20","pages":"959-992"},"PeriodicalIF":4.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148912","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}