Heart最新文献

{"title":"Legacy effects in extension studies: standing the test of time.","authors":"Natalia Fabin, Xavier Rossello","doi":"10.1136/heartjnl-2025-325897","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-325897","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729748","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":"Artificial intelligence in cardiac telemetry.","authors":"Jiaying Lu, Ran Xiao, Xiao Hu, Duc H Do","doi":"10.1136/heartjnl-2024-323947","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-323947","url":null,"abstract":"<p><p>Cardiac telemetry has evolved into a vital tool for continuous cardiac monitoring and early detection of cardiac abnormalities. In recent years, artificial intelligence (AI) has become increasingly integrated into cardiac telemetry, making a shift from traditional statistical machine learning models to more advanced deep neural networks. These modern AI models have demonstrated superior accuracy and the ability to detect complex patterns in telemetry data, enhancing real-time monitoring, predictive analytics and personalised cardiac care. In our review, we examine the current state of AI in cardiac telemetry, focusing on deep learning techniques, their clinical applications, the challenges and limitations faced by these models, and potential future directions in this promising field.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691850","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":"Bacteraemia and infective endocarditis after transcatheter aortic valve replacement: prevention is the key.","authors":"Bleri Celmeta, Antonio Miceli","doi":"10.1136/heartjnl-2024-325410","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325410","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691852","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 disease monitoring measures in patients with transthyretin amyloid cardiomyopathy treated with tafamidis.","authors":"Dimitrios Bampatsias, Abdirahman Wardhere, Lawrence Zeldin, Alfonsina Mirabal-Santos, Ariel Y Weinsaft, Juliana C Levy, Dia Smiley, Sergio L Teruya, Mathew S Maurer","doi":"10.1136/heartjnl-2024-324826","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-324826","url":null,"abstract":"<p><strong>Background: </strong>Patients with transthyretin amyloid cardiomyopathy (ATTR-CM) often experience worsening cardiac disease (WCD) despite disease-modifying treatment. However, a strict definition is lacking. Recent studies have shown that N-terminal pro-B-natriuretic peptide (NT-proBNP increase), or intensification of oral diuretics, is associated with increased mortality risk.</p><p><strong>Aim: </strong>To describe the pattern of WCD at 1 year in patients with ATTR-CM on tafamidis and explore the association with mortality and cardiovascular (CV) hospitalisation.</p><p><strong>Methods: </strong>Patients diagnosed with ATTR-CM at Columbia University after 2018 who were treated with tafamidis were enrolled in the study. WCD was defined as: increase in NT-proBNP >700 pg/mL and >30% from baseline or oral diuretic intensification (ODI) or both. Survival and CV hospitalisation risk analysis was performed using Kaplan-Meier curves, Cox regression and competing risk regression adjusted for age, genotype and disease severity by the National Amyloidosis Centre (NAC) stage.</p><p><strong>Results: </strong>A total of 238 patients were enrolled, 100 (42%) of whom showed WCD at 1 year. WCD was associated with increased mortality risk (log rank, p<0.0001, HR=1.91 (1.10-3.32), p=0.023, after adjustment for age, genotype and baseline NAC stage). In competing risk analysis, WCD was associated with increased risk for CV-related hospitalisation (HR=1.8 (1.17-2.99, p=0.009)) after adjustment for age, genotype and baseline NAC stage.</p><p><strong>Conclusions: </strong>NT-proBNP increase and ODI can serve as markers of WCD and predict mortality and CV hospitalisations in a cohort of patients taking tafamidis.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691963","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":"Identification and management of non-obstructive high-risk coronary artery plaque.","authors":"Craig Balmforth, Michael McDermott, Phyo Khaing, Marc Richard Dweck, David E Newby","doi":"10.1136/heartjnl-2024-324858","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-324858","url":null,"abstract":"<p><p>Despite advances in its understanding and treatment, coronary heart disease remains the leading cause of death worldwide. Acute coronary syndromes most commonly result as a consequence of the rupture of non-flow-limiting, high-risk coronary artery plaques. Advances in multimodality imaging have allowed the detailed assessment of the high-risk plaque including the assessment of plaque burden, high-risk plaque features, plaque activity and thrombosis. This in turn may help identify those patients at greatest risk, and thus benefit from intensification of pharmacotherapies or from local preventative strategies including coronary revascularisation. However, the optimal management of high-risk plaques and the prevention of consequent adverse coronary events have yet to be established. Further development and observational studies are required to determine how best to apply high-risk plaque metrics into clinical practice. Nevertheless, a new era of precision medicine is upon us, with advanced plaque imaging allowing enhanced risk stratification and targeting of the growing armamentarium of atherosclerotic therapies to the highest risk patients.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691999","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":"Prognostic impact of neutrophil-to-lymphocyte ratio in patients with and without diabetes mellitus undergoing percutaneous coronary intervention.","authors":"Francesca Maria Di Muro, Samantha Sartori, Birgit Vogel, Sydney Lupo, Angelo Oliva, Mauro Gitto, Prakash Krishnan, Benjamin Bay, Kenneth Smith, Joseph Sweeny, Pedro Moreno, Pier Pasquale Leone, Parasuram Melarcode Krishnamoorthy, George D Dangas, Annapoorna S Kini, Samin K Sharma, Roxana Mehran","doi":"10.1136/heartjnl-2024-325396","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325396","url":null,"abstract":"<p><strong>Background: </strong>The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation associated with adverse cardiovascular outcomes. However, limited evidence exists regarding its prognostic role in patients with diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI), which we sought to explore in this analysis.</p><p><strong>Methods: </strong>We retrospectively evaluated all patients undergoing PCI at a large tertiary centre between 2012 and 2022. Patients were stratified according to the presence of DM, and NLR quartiles were derived in each subgroup. The primary endpoint was major adverse cardiovascular events (MACE), consisting of all-cause mortality, spontaneous myocardial infarction (MI) or stroke. Secondary endpoints were each single MACE component, target vessel revascularisation, bleeding and postprocedural acute kidney injury. A multivariable Cox regression model, adjusted for relevant baseline characteristics, was computed.</p><p><strong>Results: </strong>A total of 9427 patients were included (48.5% with DM). DM patients had more comorbidities and higher baseline high-sensitivity C reactive protein levels, while patients with elevated NLR in both subgroups exhibited multivessel disease with moderate/severe calcification. DM patients in the upper NLR quartile had the highest rates of MACE (15.7%) than any other subgroup. An independent association of elevated NLR with MACE was observed in both patients with and without DM, and was confirmed after multivariable adjustment. This was primarily driven by all-cause mortality rates in both subgroups and by MI incidence in DM patients only.</p><p><strong>Conclusions: </strong>Patients undergoing PCI with a higher NLR had worse clinical outcomes, regardless of DM status. The combination of DM and elevated NLR revealed the most unfavourable prognosis.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673169","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":"https://doi.org/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":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-15","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":"Influence of depression trajectories in heart failure patients with preserved ejection fractions: a secondary analysis of adverse outcomes in the TOPCAT trial.","authors":"Fuwei Xing, Min Gao, Yuzhong Wu, Weihao Liang, Jingzhou Jiang, Yu-Gang Dong, Yi Li, Bin Dong, Chen Liu","doi":"10.1136/heartjnl-2024-324505","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-324505","url":null,"abstract":"<p><strong>Background: </strong>Long-term patterns of depressive symptoms among patients with heart failure, specifically those with a preserved ejection fraction (HFpEF), and their relationship with prognoses are not well studied.</p><p><strong>Methods: </strong>This analysis included 609 participants from the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) at baseline and at 1-year, 2-year and 3-year intervals. Individual trajectory patterns based on PHQ-9 scores during the first 3 years were identified using latent class trajectory models, and their associations with clinical outcomes were evaluated using Cox regression models.</p><p><strong>Results: </strong>Among the 609 participants, 316 (51.9%) were female, with a median age of 74 years (IQR: 66, 80). Four distinct depression trajectory patterns were identified: low (consistently low scores; 349, 57.3%), mild (sustained mild elevation; 110, 18.1%), high (sustained moderate-severe elevation; 52, 8.5%) and recurrent deterioration (high baseline scores, remission, then escalation; 98, 16.1%). According to the multivariate Cox model, recurrent deterioration was associated with a significantly greater risk of all-cause mortality (HR: 2.05; 95% CI 1.16, 3.64) than the low trajectory pattern. No significant differences were found among the low, mild and high trajectory groups.</p><p><strong>Conclusions: </strong>Four distinct depression trajectory patterns were identified among patients with HFpEF. Notably, patients who experienced a recurrent deterioration trajectory presented a significantly increased risk of all-cause mortality. Our findings highlight the importance of monitoring patients' depressive symptoms over time rather than focusing on a single timepoint.</p><p><strong>Trial registration number: </strong>NCT00094302.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633994","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":"Estimated sodium intake and premature ventricular complexes: data from the population-based Swedish CArdioPulmonary bioImage Study.","authors":"Johan Economou Lundeberg, Jonas Wuopio, Andrew Mente, Alexandra Måneheim, Magdalena Okrajni, Jeffrey S Healey, Johan Sundström, Johan Ärnlöv, Gunnar Engström, Linda S B Johnson","doi":"10.1136/heartjnl-2024-324391","DOIUrl":"10.1136/heartjnl-2024-324391","url":null,"abstract":"<p><strong>Background: </strong>Premature ventricular complexes (PVCs) predict coronary heart disease, heart failure, atrial fibrillation and death, all of which are also related to sodium intake. We studied estimated sodium intake and PVC frequency in the randomly selected population-based Swedish CArdioPulmonary bioImage Study cohort.</p><p><strong>Methods: </strong>In our cross-sectional study, we included 5636 individuals with 24-hour ECG registration and fasting morning urine sampling. Sodium intake was estimated using the Kawasaki formula, and the association between sodium intake and PVC frequency was modelled using multivariable negative binomial regression, adjusted for age, sex, body mass index, level of education, height, physical activity and smoking status, across prespecified strata of sodium intake: <2 g/day, 2-2.99 g/day, 3-3.99 g/day (reference category), 4-4.99 g/day and ≥5 g/day.</p><p><strong>Results: </strong>The median age was 57.6 years, and 51.9% were female. The median daily PVC count was 8 (IQR 3-41); 5.9% had ≥500 PVCs/24 hours. The mean estimated sodium intake was 3.3 g/day. There was a U-shaped association between sodium intake and PVCs. Compared with the reference of 3-3.99 g/day (28% of participants), sodium intakes <2 g/day (15% of participants) and ≥5 g/day (10% of participants) were associated with 26% (95% CI 6% to 49%) and 52% (95% CI 26% to 84%, p<0.01) increases in PVC frequency, respectively, but intakes of 2-2.99 g/day and 4-4.99 g/day were not (5% (95% CI -8% to 20%) and 4% (95% CI -11% to 22%) increase, respectively).</p><p><strong>Conclusion: </strong>There was a U-shaped association between sodium intake and PVC frequency, with both low and high sodium intake associated with higher PVC frequency.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"300-305"},"PeriodicalIF":5.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440652","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":"Leucocyte telomere length and conduction system ageing.","authors":"Stefan van Duijvenboden, Christopher P Nelson, Zahra Raisi-Estabragh, Julia Ramirez, Michele Orini, Qingning Wang, Nay Aung, Veryan Codd, Svetlana Stoma, Elias Allara, Angela M Wood, Emanuele Di Angelantonio, John Danesh, Nicholas C Harvey, Steffen E Petersen, Patricia B Munroe, Nilesh J Samani","doi":"10.1136/heartjnl-2024-324875","DOIUrl":"10.1136/heartjnl-2024-324875","url":null,"abstract":"<p><strong>Background: </strong>Deterioration of the cardiac conduction system is an important manifestation of cardiac ageing. Cellular ageing is accompanied by telomere shortening and telomere length (TL) is often regarded as a marker of biological ageing, potentially adding information regarding conduction disease over and above chronological age. We therefore sought to evaluate the association between leucocyte telomere length (LTL) on two related, but distinct aspects of the cardiac conduction system: ECG measures of conduction (PR interval and QRS duration) and incident pacemaker implantation in a large population-based cohort.</p><p><strong>Methods: </strong>In the UK Biobank, we measured PR interval and QRS duration from signal-averaged ECG waveforms in 59 868 and 62 266 participants, respectively. Incident pacemaker implantation was ascertained using hospital episode data from 420 071 participants. Associations with LTL were evaluated in (Cox) multivariable regression analyses adjusted for potential confounders. Putative causal effects of LTL were investigated by mendelian randomisation (MR).</p><p><strong>Results: </strong>Mean PR interval and QRS duration were 144.2 ms (± 20.4) and 92.3 ms (± 7.8), respectively, and there were 7169 (1.7%) incident pacemaker implantations, during a median follow-up period of 13.6 (IQR 1.5) years. LTL was significantly associated with PR interval (0.19 ms (95% CI: 0.03 to 0.35), per 1 SD shorter LTL, p=0.021), but not QRS duration. After adjusting for age, sex and cardiovascular risk factors, shorter LTL remained associated with an increased risk for incident pacemaker implantation (HR per SD decrease in LTL: 1.03 (95% CI: 1.01 to 1.06), p=0.012). MR analysis showed a trend towards an association of shorter LTL with longer PR interval and higher risk of pacemaker implantation but was likely to be underpowered.</p><p><strong>Conclusions: </strong>Shorter LTL was significantly, and possibly causally, associated with prolongation of atrioventricular conduction and pacemaker implantation, independent of traditional cardiovascular risk factors. Our findings support further research to explore the role of ageing on cardiac conduction beyond chronological age.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"314-320"},"PeriodicalIF":5.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846445","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}