Heart最新文献

{"title":"Calibration and clarification: atrial fibrillation burden estimated by ECG patch recordings.","authors":"Miriam Tesfamariam, Paulus Kirchhof","doi":"10.1136/heartjnl-2026-328969","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328969","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108894","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":"Plasma heart-type fatty acid-binding protein, omega-3 fatty acids and adverse cardiac events in the general population.","authors":"Jie-Qiong Lyu, Yu-Wen Qian, Zirui Xu, Zhong-Yue Liu, Fei Fang, Meng-Yuan Miao, Li-Qiang Qin, Cheng-Lin Song, Hai-Peng Wang, Guo-Chong Chen","doi":"10.1136/heartjnl-2026-327893","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-327893","url":null,"abstract":"<p><strong>Background: </strong>Heart-type fatty acid-binding protein (H-FABP), a principal intracellular transporter of long-chain fatty acids (FAs), has been investigated as an early diagnostic biomarker for acute myocardial infarction (MI) and acute coronary syndrome. However, evidence regarding its associations with long-term risk of cardiac events and potential interaction with omega-3 FAs remains scarce. Therefore, we aimed to investigate these associations in the general population.</p><p><strong>Methods: </strong>This study included 42 392 participants from the UK Biobank who were free of coronary heart disease (CHD) and heart failure (HF) at baseline. Plasma levels of H-FABP were quantified using the Olink platform. Multivariable Cox regression was used to evaluate the associations of H-FABP with incident CHD and HF, considering potential interaction with omega-3 FAs.</p><p><strong>Results: </strong>Elevated H-FABP levels were consistently associated with a higher risk of CHD (HR _{T3 vs T1}=1.29), MI (HR _{T3 vs T1}=1.54), CHD-related mortality (HR _{T3 vs T1}=2.04) and HF (HR _{T3 vs T1}=1.95) (all P-trend values <0.001). These associations appeared to be modified by plasma levels of omega-3 FAs, especially so for CHD (P-interaction=0.014) and MI (P-interaction=0.003). Comparing the extreme tertiles of H-FABP, HRs (95% CI) of CHD and MI were 1.41 (1.15 to 1.74) and 2.23 (1.57 to 3.15), respectively, among participants with lower omega-3 FAs, and 1.15 (0.96 to 1.38) and 1.11 (0.83 to 1.50), respectively, among those with higher omega-3 FAs.</p><p><strong>Conclusions: </strong>Higher plasma levels of H-FABP were associated with a higher risk of CHD and HF in the general population, predominantly among individuals with low levels of omega-3 FAs.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108823","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":"PreHEART score for emergency medical services triage of chest pain: a randomised trial.","authors":"Dennis C Sagel, Pieter J Vlaar, Duolao Wang, Jesse Demandt, Wybe Nieuwland, Roelof Lettinga, Robert van Barneveld, Edward Jorna, Roelof Kijlstra, Carien van Well, Rick Schram, Ijsbrand Klip, Rutger Anthonio, Louis Bartels, Sjoerd Hofma, Youlan Gu, Marcel Gosselink, Dirk Jan Drenth, Antoinette van Asselt, Peter Van der Meer, Erik Lipsic, Luis Eduardo Juarez Orozco, Pim van der Harst","doi":"10.1136/heartjnl-2026-328924","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328924","url":null,"abstract":"<p><strong>Background: </strong>Triage and support in conveyance decision making of patients with undifferentiated chest pain is the next chapter after validation of the PreHEART score. The PreHEART 3 study tests whether a PreHEART score-guided emergency medical services (EMSs) conveyance is non-inferior to usual care with respect to unexpected serious adverse events in adults attended by EMS for undifferentiated chest pain.</p><p><strong>Methods: </strong>Pragmatic, randomised, open-label, blinded-endpoint non-inferiority trial was conducted in the Netherlands by Emergency Medical Services. 5170 adults attended by EMS for undifferentiated chest pain, randomised 1:1 to a conveyance decision guided by the prehospital PreHEART score versus usual care. Main outcome measures hierarchical composite of unexpected serious adverse events at 3 days, analysed by win ratio (non-inferiority threshold: lower bound of the 95% CI >0.80).</p><p><strong>Results: </strong>PreHEART-guided care was non-inferior (win ratio 1.01; 95% CI 0.89 to 1.16; p<0.001), with no deaths within 3 days among 1526 non-conveyed patients. It increased non-conveyance (34.6% vs 24.5%), reduced 30-day emergency presentations (risk ratio (RR) 0.88) and lowered costs (-€345). In women, acute coronary syndrome (ACS) diagnosis (RR 1.48) and angiography (RR 1.66) increased; multiplicative interactions were nominally significant but not after Holm correction. CONCLUSIONS : PreHEART-guided EMS conveyance was non-inferior to usual care for serious adverse events, reduced emergency department presentations and costs, and was associated with increased ACS detection and coronary angiography in women.</p><p><strong>Trial registration number: </strong>NL-OMON27238.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080477","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":"From task-specific AI to cardiovascular foundation models: a new era of multimodal interpretation.","authors":"Hirotaka Ieki, Paul Cheng, Andrew P Ambrosy, Alan C Kwan, Bryan He, Themistocles L Assimes, James Y Zou, David Ouyang","doi":"10.1136/heartjnl-2026-328835","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328835","url":null,"abstract":"<p><p>Artificial intelligence (AI) is reshaping cardiovascular medicine, evolving from task-specific supervised models towards multitask and foundation models capable of broader, more scalable interpretation. Early AI systems achieved high performance in electrocardiographic interpretation, echocardiographic measurement and disease diagnosis but their dependence on predefined outputs and labelled datasets limits flexibility and confines them to individual tasks. Foundation models address these limitations by learning reusable representations from large-scale data, often through self-supervised or contrastive pretraining, and adapting them to multiple downstream tasks. Emerging models in electrocardiography, echocardiography, chest radiography, cardiac MR and cardiac CT demonstrate capabilities including disease classification, quantitative measurement, segmentation, image-text retrieval, report generation and risk prediction. Generalist and multimodal biomedical foundation models further suggest a future in which cardiovascular AI integrates signals, imaging, clinical text, laboratory data and medical history to support patient-level diagnosis and decision-making. This review synthesises the transition from task-specific AI to cardiovascular foundation models and outlines opportunities for multimodal human-centred implementation.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080454","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":"Unusual ECG of a young male with sudden collapse.","authors":"Fei Ye, Wenjuan Wang, Xiexiong Zhao","doi":"10.1136/heartjnl-2026-328338","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328338","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":"112 20","pages":"1163-1166"},"PeriodicalIF":4.4,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038070","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":"From risk factor to therapeutic target: obesity therapy and cardiovascular outcomes.","authors":"Ronen Arbel, Dror Dicker","doi":"10.1136/heartjnl-2026-327845","DOIUrl":"10.1136/heartjnl-2026-327845","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"1111-1113"},"PeriodicalIF":4.4,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147276176","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":"Survival benefit of guideline-directed medical therapy in older patients with heart failure: a systematic review and meta-analysis.","authors":"Elinor Tan, Chan Meei-Wah, Yao Hao Teo, Li Feng Tan, Vanda Wen Teng Ho, Weiqin Lin, Tiong-Cheng Yeo, Raymond Ching Chiew Wong, Ping Chai, William Kong, Ching-Hui Sia","doi":"10.1136/heartjnl-2025-326305","DOIUrl":"10.1136/heartjnl-2025-326305","url":null,"abstract":"<p><strong>Background: </strong>Heart failure-related mortality in older patients has increased. Guideline-directed medical therapy (GDMT) in heart failure with reduced ejection fraction (HFrEF) remains insufficient in this population. This study assessed the survival benefit of GDMT in elderly patients aged ≥65 years old with HFrEF.</p><p><strong>Methods: </strong>MEDLINE, EMBASE and Cochrane Library were searched from inception to 5 February 2025. Inclusion criteria were age ≥65 years old with HFrEF, GDMT vs no GDMT and reported survival data. Pooled prevalence, HR and risk ratio (RR) with 95% CI were analysed. Heterogeneity was further explored through subgroup analyses. We evaluated potential small-study effects using Begg's rank correlation test, Egger's regression test, funnel plot inspection and trim-and-fill analysis. Publication bias was analysed visually using a funnel plot.</p><p><strong>Results: </strong>34 studies with 92 916 patients from 1994 to 2024 were included. The GDMT group received three of the four main drug classes in three studies, two drug classes in four studies and at least one class in the remaining studies. There were no reported data on the survival benefits of older patients receiving four classes of GDMT. Frail older patients were less likely to receive GDMT (RR 0.63 (0.45-0.89), I2 50%, p=0.009). There was a survival benefit of GDMT in older patients with left ventricular (LV) systolic dysfunction (HR 0.69 (0.64-0.74) p<0.001, Tau² 0.03, I² 71%). Older patients receiving beta-blockers were more likely to develop bradycardia (RR 3.98 (2.72-5.82), p<0.001, I2 0%). There was no difference in hypotension, acute renal impairment and hypoglycaemia between the GDMT and control group.</p><p><strong>Conclusions: </strong>The use of GDMT in older patients with LV systolic dysfunction was associated with a survival benefit. However, the presence of frailty may limit the successful implementation and tolerability of these therapies. High-quality studies are urgently needed to guide the development of novel strategies aimed at optimising the management of older, frail patients with LV systolic function.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"1114-1124"},"PeriodicalIF":4.4,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146164988","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":"Comparing diagnostic tools for heart failure with preserved ejection fraction across community and clinical cohorts.","authors":"Luca Monzo, Olivier Huttin, Biykem Bozkurt, Kévin Duarte, Cecilia Linde, Lars H Lund, Camilla Hage, Erwan Donal, Martin Magnusson, Peter Nilsson, Margret Leosdottir, Erwan Bozec, Guillaume Baudry, Faiez Zannad, Nicolas Girerd","doi":"10.1136/heartjnl-2025-326517","DOIUrl":"10.1136/heartjnl-2025-326517","url":null,"abstract":"<p><strong>Background: </strong>Diagnosing heart failure with preserved ejection fraction (HFpEF) remains challenging, particularly in older adults. While the Heart Failure Association (HFA)-PEFF and H₂FPEF Scores offer structured diagnostic approaches, their clinical utility is still debated. This study aims to compare the diagnostic accuracy of HFpEF Scores versus inclusion criteria used in sodium-glucose cotransporter-2 inhibitors (SGLT2i) trials, age-adjusted N-terminal pro B-type natriuretic peptide (NT-proBNP) thresholds and the universal definition of heart failure (HF).</p><p><strong>Methods: </strong>Diagnostic tools were assessed using sex-weighted and age-weighted propensity score adjustment in individuals aged 60-80 years from two established HFpEF cohorts (MEtabolic Road to DIAstolic Heart Failure (MEDIA), n=297; Karolinska-Rennes (KaRen), n=174) and two community-based cohorts without HF (Suivi Temporaire Annuel Non-Invasif de la Santé des Lorrains Assurés Sociaux (STANISLAS), n=461; Malmö, n=1030).</p><p><strong>Results: </strong>HFA-PEFF and H₂FPEF Scores classified a large proportion of participants in both community-based cohorts (up to 81% in Malmö) and HFpEF cohorts (up to 75% in MEDIA) in the intermediate-likelihood category, requiring further diagnostic evaluation. Their diagnostic discrimination ranged from moderate to good. The universal definition of HF, SGLT2i trial criteria and NT-proBNP age-adjusted thresholds showed diagnostic performance comparable to HFA-PEFF Scores in the HFpEF cohorts and correctly excluded almost all individuals in the community cohorts. The universal definition of HF demonstrated a diagnostic discrimination higher than H₂FPEF and comparable to HFA-PEFF, with the most balanced performance in terms of sensitivity and specificity.</p><p><strong>Conclusions: </strong>Using scores, a substantial proportion of HFpEF individuals fall into the intermediate likelihood category, highlighting diagnostic uncertainty. Simpler tools, such as the universal definition of HF, demonstrate comparable or even superior diagnostic and rule-out performances for HFpEF, emphasising the need for more practical and reliable approaches to HFpEF diagnosis.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"1153-1162"},"PeriodicalIF":4.4,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145540435","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":"Guideline-directed medical therapy in older heart failure patients: survival gains, evidence gaps and the challenge of implementation.","authors":"Umit Yasar Sinan","doi":"10.1136/heartjnl-2026-327799","DOIUrl":"10.1136/heartjnl-2026-327799","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"1109-1110"},"PeriodicalIF":4.4,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147305044","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":"Multisystem comorbidities and shared genetic pathways in calcific aortic stenosis: a phenome-wide and Mendelian randomisation analysis.","authors":"Zihao Zhou, Yidan Zheng, Shiyan Hu, Jingyu Xu, Lifei Luo, Xingyu Qian, Chen Jiang, Yuqi Liu, Fuqiang Tong, Ming Chen, Pengning Fan, Zhe Chen, Da Zhu, Xiangbin Pan, Li Xu, Fei Li","doi":"10.1136/heartjnl-2025-326058","DOIUrl":"10.1136/heartjnl-2025-326058","url":null,"abstract":"<p><strong>Background: </strong>Calcific aortic stenosis (CAS) is frequently accompanied by systemic comorbidities, but their causal relationships and shared genetic architecture remain poorly defined. We aimed to map the multisystem comorbidity network of CAS and clarify underlying genetic mechanisms.</p><p><strong>Methods: </strong>In 467 484 participants from the UK Biobank, observational and polygenic phenome-wide association studies evaluated associations between CAS and 1571 phenotypes, integrating disease-trajectory analyses to visualise temporal patterns. Associations replicated across observational and polygenic analyses were tested using two-sample Mendelian randomisation (MR) based on 22 CAS-related variants from FinnGen. Polygenic risk score (PRS) analyses excluding specific genes assessed their contributions, particularly LPA and plasma lipoprotein(a) (Lp(a)) levels.</p><p><strong>Results: </strong>CAS was associated with higher risks of 42 cardiovascular and non-cardiovascular conditions, most prominently metabolic, endocrine, haematological and respiratory disorders. Temporal analyses showed that circulatory and metabolic diseases typically precede other comorbidities in CAS trajectories. MR findings were consistent with causal effects of CAS on multiple cardiovascular diseases, iron-deficiency anaemia, mental disorders and pleural effusion. When LPA variants were removed from the CAS PRS or plasma Lp(a) concentration was adjusted for, most associations lost significance, indicating a shared LPA/Lp(a)-mediated genetic pathway.</p><p><strong>Conclusions: </strong>CAS is embedded within a broad multisystem comorbidity network, driven largely by genetic variation at LPA and elevated Lp(a). These findings highlight pleiotropic mechanisms linking valvular calcification with systemic disease and support LPA-targeted therapies as a promising avenue for reducing the multisystem burden of CAS.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"1135-1144"},"PeriodicalIF":4.4,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145855460","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}