Heart最新文献

{"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":"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":"960-968"},"PeriodicalIF":4.4,"publicationDate":"2025-09-25","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":"Defining centres of expertise for minimally invasive mitral valve surgery: a systematic review and volume-outcome meta-analysis.","authors":"Samuel Heuts, Warda Hjij, Michal J Kawczynski, Jules R Olsthoorn, Andrew Tjon Joek Tjien, Sander M J van Kuijk, Jos G Maessen, Peyman Sardari Nia","doi":"10.1136/heartjnl-2024-325048","DOIUrl":"10.1136/heartjnl-2024-325048","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive mitral valve surgery (MIMVS) is increasingly performed, but outcomes such as repair rate, mortality and survival likely depend on expertise. Still, the definition of a high-volume centre varies in the literature and lacks an evidence-based substantiation. Consequently, this study aims to determine the volume-outcome relation in MIMVS in conjunction with a volume threshold, in order to define 'high-volume centres', applying a novel statistical concept.</p><p><strong>Methods: </strong>The study was preregistered in PROSPERO (CRD42022376293, registered 26 November 2022). A systematic search was applied to three databases, including consecutive patients undergoing MIMVS. Studies describing patients undergoing transcatheter procedures were excluded. Restricted cubic spline analyses were applied and the elbow method was used to retrieve the threshold volume. Long-term outcomes were analysed using reconstructed Kaplan-Meier curves and a novel statistical concept to assess the volume-outcome relation for time-to-event outcomes was applied. The primary outcome was early mortality, secondary outcomes were repair rate, stroke, and long-term survival, freedom from reoperation, and freedom from more than moderate mitral regurgitation. Leave-one-out analyses were performed for sensitivity purposes.</p><p><strong>Results: </strong>Data from 68 unique centres were included (n=23 495 patients). Early mortality was 1.3% (95% CI 1.1% to 1.6%), without a statistically significant non-linear relation for this endpoint, nor for stroke. There was a statistically significant volume-outcome relation for mitral valve repair rate (p=0.018). Based on the repair rate, the threshold to define a high-volume centre was 60 cases/year (number needed to treat to prevent a replacement ≤7). A significant volume-outcome relation was observed for long-term outcomes as well, with a threshold of 53 and 54 cases/year for long-term survival and freedom from reoperation, respectively. These results were robust across the sensitivity analyses for the various endpoints.</p><p><strong>Conclusions: </strong>The threshold to define a high-volume centre ranges between 53 and 60 cases/year based on repair rate, long-term survival and freedom-from reoperation. These findings have the potential to facilitate centralisation of MIMVS.PROSPERO registration numberCRD42022376293.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"984-991"},"PeriodicalIF":4.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980494","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 absence of evidence equates to evidence of absence: the case of routine use of cerebral embolic protection devices in transcatheter aortic valve implantation.","authors":"Samuel Heuts, Michal J Kawczynski, Bart Maesen, Pieter A Vriesendorp","doi":"10.1136/heartjnl-2025-326208","DOIUrl":"10.1136/heartjnl-2025-326208","url":null,"abstract":"<p><strong>Objectives: </strong>This updated hierarchical Bayesian meta-analysis aims to integrate the latest randomised controlled trials (RCTs) on the use of cerebral embolic protection (CEP) in transcatheter aortic valve implantation (TAVI) into previously available data, providing a definite answer to the clinical effectiveness of CEP in TAVI patients.</p><p><strong>Methods: </strong>A systematic search was updated on 31 March 2025. RCTs were included when comparing transfemoral TAVI with use of CEP versus transfemoral TAVI without CEP. The primary outcome was all stroke, while the secondary outcome was disabling stroke. A hierarchical Bayesian meta-analysis was performed on the (log) relative risk (RR) scale and transformed to absolute risk differences (ARDs) and numbers needed to treat (NNTs). The threshold for clinical relevance was based on published expert consensus and established on 1.1% ARD (NNT 91).</p><p><strong>Results: </strong>The study was updated with one new RCT, totalling a number of eight RCTs (n=11 590, CEP n=5921 patients, control n=5669 patients). The prevalence of all stroke and disabling stroke was 2.9% and 1.4% in the control group. The median RR for all stroke was 0.94 (95% credible interval (CrI) 0.72-1.25), translating to a mean of -0.17% ARD (NNT 588), and a posterior probability of a clinically relevant CEP effect of <1%. The median RR for disabling stroke was 0.76 (95% CrI 0.44-1.23), translating to a mean of -0.36% ARD (NNT 278), and a posterior probability of a clinically relevant CEP effect of <1%.</p><p><strong>Conclusion: </strong>Current-generation CEP devices are ineffective in reducing periprocedural TAVI-stroke risk to a clinically relevant degree, rendering future trials with these devices futile.</p><p><strong>Prospero registration number: </strong>CRD42023407006.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"947-951"},"PeriodicalIF":4.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274651","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":"60: 'the magic number of greatness' in minimally invasive mitral valve repair?","authors":"Volkmar Falk","doi":"10.1136/heartjnl-2025-326326","DOIUrl":"10.1136/heartjnl-2025-326326","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"945-946"},"PeriodicalIF":4.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336458","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":"AI adoption in cardiology: regulation at a global crossroad.","authors":"Paul Leeson, Kazem Rahimi","doi":"10.1136/heartjnl-2025-326966","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326966","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137284","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":"Acute elevated blood pressure in the inpatient setting.","authors":"Ali Etemadi, Parth Kumar, Timothy S Anderson, Tara I Chang","doi":"10.1136/heartjnl-2025-325845","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-325845","url":null,"abstract":"<p><p>Elevated blood pressure (BP) in the inpatient setting is frequently encountered by most healthcare providers. While there is general consensus on the management of acute BP elevations when associated with end-organ damage, these cases of true hypertensive emergency are relatively infrequent. In contrast, asymptomatic acute BP elevations are considerably more frequent, yet there is little consensus on their appropriate management. Contributing factors include concerns about missing true emergencies, the barriers affecting the accuracy of inpatient BP measurements and a lack of consistent data on the short- and long-term impact of inpatient BP elevations. Practice varies widely, even between departments within the same hospital, and includes observation, intravenous antihypertensives, oral agents and adjustments to existing regimens. Some clinicians also choose to discharge patients on intensified therapy based on inpatient BP values. However, despite the high prevalence of elevated BP in the inpatient setting, evidence remains heterogeneous and fragmented. This review aims to synthesise current knowledge and provide a practical, holistic framework for evaluating and managing elevated BP in the inpatient setting.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080528","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":"Long-term cardiovascular risks after atrial fibrillation diagnosis: a systematic review and meta-analysis.","authors":"Lan Mu, Harriet Larvin, Ramesh Nadarajah, Chris P Gale, Jianhua Wu","doi":"10.1136/heartjnl-2025-326376","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326376","url":null,"abstract":"<p><strong>Background and aims: </strong>Absolute risk estimates of long-term cardiovascular complications after atrial fibrillation (AF) diagnosis from contemporary cohorts are needed to guide clinical care. Quantifying these risks can inform outcome selection in future randomised clinical trials and improve health service delivery. We systematically reviewed and synthesised incidence rates (IRs), risks and temporal trends of adverse cardiovascular events in patients with AF.</p><p><strong>Methods: </strong>Longitudinal cohort studies published from 2015 onwards, reporting cardiovascular events in AF, were included. IRs were pooled using random-effects meta-analyses. Meta-regressions explored the influence of age, CHA_₂DS_₂-VASc Score (a clinical stroke risk assessment tool for patients with AF), geographic region, study period (pre/post-2011) and sex on IRs.</p><p><strong>Results: </strong>80 studies (5 498 857 patients) were identified, of which 73 studies, representing 24 817 465 person-years of follow-up, were included in the primary meta-analyses of IRs. Cardiovascular events in descending frequency were heart failure (IR 2.98 cases per 100 person-years, 95% CI 2.10 to 4.24), ischaemic stroke (IR 1.76 cases per 100 person-years, 95% CI 1.44 to 2.15), cardiovascular death (IR 1.66 cases per 100 person-years, 95% CI 1.24 to 2.23) and myocardial infarction (0.64 cases per 100 person-year, 95% CI 0.41 to 0.98). Except for heart failure (incidence rate ratio (IRR) 0.66, 95% CI 0.33 to 1.34), study outcomes declined over time (ischaemic stroke IRR 0.56, 95% CI 0.40 to 0.80; cardiovascular death IRR 0.52, 95% CI 0.29 to 0.93; myocardial infarction IRR 0.27, 95% CI 0.14 to 0.49). Sex differences appear to have diminished over time and were not found to be statistically significant in more recent studies.</p><p><strong>Conclusions: </strong>In patients with AF, heart failure was the most common and persistent adverse outcome. Despite improvement in stroke prevention, heart failure incidence has not declined, highlighting the need for targeted strategies and guideline focus. Further research is needed to address heart failure prevention and refine the understanding of sex-specific cardiovascular risks.</p><p><strong>Prospero registration number: </strong>CRD42023474268.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080526","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":"Effect of ketone supplementation, a low-carbohydrate diet and a ketogenic diet on heart failure measures and outcomes: a systematic review and meta-analysis.","authors":"Lee P Liao, Lauren Adriel Church, Hannah Melville, Thilini Jayasinghe, Carina Choy, Aileen Zeng, Nikki Barrett, Simone Marschner, Gary Chieh Howe Gan, Liza Thomas, Sarah Zaman","doi":"10.1136/heartjnl-2025-326082","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326082","url":null,"abstract":"<p><strong>Background: </strong>The impact of ketone supplementation, low carbohydrate diets (LCDs) and ketogenic diets (KDs) on heart failure (HF) outcomes is largely unknown. This systematic review and meta-analysis investigated how these dietary changes impacted cardiac function and HF outcomes.</p><p><strong>Method: </strong>A systematic search of MEDLINE, Embase, CINAHL and Web of Science was performed; last search on 19 November 2025. Randomised controlled trials (RCTs) and observational studies in humans receiving ketone supplementation, LCD and KD interventions were included. Studies were eligible if they reported at least one cardiac function/HF measure. Risk of bias was performed using RoB2 and ROBINS-I (Risk Of Bias In Non-randomised Studies of Interventions). Treatment effects were pooled, mean differences and 95% CIs calculated. Subgroup analysis was performed and heterogeneity was assessed.</p><p><strong>Results: </strong>14 studies were included in this systematic review. A meta-analysis was performed on six RCTs. Ketone supplementation increased left ventricular ejection fraction by 3.12% (95% CI 0.95% to 5.30%, p<0.01), with greater improvement in patients with HF with reduced ejection fraction (HFrEF); 4.25% (95% CI 1.99% to 6.51%, p<0.001). In patients with HFrEF, ketone supplementation increased peak systolic annular velocity (0.60% (95% CI 0.17% to 1.02%, p<0.01)) and cardiac output (1.24 L/min (95% CI 0.24 to 2.24, p<0.05)), compared with controls. Due to small cohorts and different treatment durations, assessment of certainty was low to high. Meta-analysis could not be performed on LCD or KD studies, due to low study numbers.</p><p><strong>Conclusions: </strong>Ketone supplementation significantly improved cardiac function compared with controls, especially in people with HFrEF. More research is needed to determine how low carbohydrate and ketogenic diets affect HF outcomes.</p><p><strong>Prospero registration number: </strong>CRD42024615367.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075104","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":"Mammography-an opportunity to optimise women's heart health?","authors":"Gemma A Figtree, Stuart M Grieve","doi":"10.1136/heartjnl-2025-326657","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326657","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075174","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":"Predicting cardiovascular events from routine mammograms using machine learning.","authors":"Jennifer Yvonne Barraclough, Ziba Gandomkar, Robert A Fletcher, Sebastiano Barbieri, Nicholas I-Hsien Kuo, Anthony Rodgers, Kirsty Douglas, Katrina K Poppe, Mark Woodward, Blanca Gallego Luxan, Bruce Neal, Louisa Jorm, Patrick Brennan, Clare Arnott","doi":"10.1136/heartjnl-2025-325705","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-325705","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular risk is underassessed in women. Many women undergo screening mammography in midlife when the risk of cardiovascular disease rises. Mammographic features such as breast arterial calcification and tissue density are associated with cardiovascular risk. We developed and tested a deep learning algorithm for cardiovascular risk prediction based on routine mammography images.</p><p><strong>Methods: </strong>Lifepool is a cohort of women with at least one screening mammogram linked to hospitalisation and death databases. A deep learning model based on DeepSurv architecture was developed to predict major cardiovascular events from mammography images. Model performance was compared against standard risk prediction models using the concordance index, comparative to the Harrells C-statistic.</p><p><strong>Results: </strong>There were 49 196 women included, with a median follow-up of 8.8 years (IQR 7.7-10.6), among whom 3392 experienced a first major cardiovascular event. The DeepSurv model using mammography features and participant age had a concordance index of 0.72 (95% CI 0.71 to 0.73), with similar performance to modern models containing age and clinical variables including the New Zealand 'PREDICT' tool and the American Heart Association 'PREVENT' equations.</p><p><strong>Conclusions: </strong>A deep learning algorithm based on only mammographic features and age predicted cardiovascular risk with performance comparable to traditional cardiovascular risk equations. Risk assessments based on mammography may be a novel opportunity for improving cardiovascular risk screening in women.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075167","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}