Heart最新文献

{"title":"Circulating soluble LOX-1 and patient prognosis after an acute coronary syndrome.","authors":"Alexandru Schiopu, Sara Svedlund, Gayathri Narasimhan, Bi Juin Loong, Troels Yndigegn, Vijayalakshmi Varma, Emily L Ongstad, Isabel Goncalves, Anna Collén, Jan Nilsson, Li-Ming Gan","doi":"10.1136/heartjnl-2025-326315","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326315","url":null,"abstract":"<p><strong>Background: </strong>The lectin-like oxidised low-density lipoprotein receptor-1 (LOX-1) mediates atherosclerotic plaque inflammation and vulnerability. On activation, LOX-1 sheds its extracellular domain into the circulation as soluble LOX-1 (sLOX-1). sLOX-1 is markedly elevated in patients with acute coronary syndrome (ACS).</p><p><strong>Methods: </strong>We prospectively assessed the associations between plasma sLOX-1 and the development of heart failure (HF), major adverse cardiovascular events (MACE) and coronary and left ventricular (LV) dysfunction in two cohorts of patients with ACS. The first cohort comprised 524 patients recruited during the acute index event at the coronary care unit of Skåne University Hospital, Malmö, Sweden. The second cohort included 363 patients with ACS treated with acute percutaneous intervention at Sahlgrenska University Hospital, Gothenburg, Sweden. Additionally, we examined the anti-inflammatory effects of LOX-1 blockade in vitro using human umbilical vein endothelial cells (HUVECs).</p><p><strong>Results: </strong>In the first cohort, acute-phase sLOX-1 was associated with incident HF and MACE independently of cardiovascular risk factors, revascularisation and medication (HR per 1-SD sLOX-1 increase: 1.57 (95% CI: 1.10 to 2.23; p=0.012) for HF and 1.36 (1.08 to 1.71; p=0.009) for MACE). Elevated sLOX-1 was also associated with lower LV ejection fraction and accelerated remodelling, as measured by echocardiography at 1-year post-ACS. In the second cohort, sLOX-1 was negatively associated with left anterior descending coronary artery flow reserve and LV systolic function, and positively correlated with soluble markers of systemic inflammation and cardiac overload at 4 and 16 weeks post-ACS. In vitro, antibody-mediated LOX-1 blockade prevented oxidised low-density lipoprotein-induced HUVEC activation.</p><p><strong>Conclusions: </strong>Elevated plasma sLOX-1 at baseline and during follow-up is associated with incident HF and MACE, as well as cardiac and coronary dysfunction in patients with ACS. As plasma sLOX-1 levels may reflect the intensity of LOX-1 expression on vascular and immune cells, these findings support LOX-1 as a potentially important therapeutic target to improve prognosis in patients with ACS.</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":"145075090","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":"On the role of guideline-directed medical therapy in current generation PCI.","authors":"Claudio Laudani","doi":"10.1136/heartjnl-2025-326823","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326823","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064512","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":"Revascularisation strategies for non-acute myocardial ischaemic syndromes.","authors":"Michal J Kawczynski, Fabio Barili, James M Brophy, Raffaele De Caterina, Giuseppe Biondi Zoccai, Amedeo Anselmi, William E Boden, Alessandro Parolari, Samuel Heuts","doi":"10.1136/heartjnl-2025-326101","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326101","url":null,"abstract":"<p><strong>Background: </strong>Contemporary guidelines by the European Society for Cardiology and American College of Cardiology/American Heart Association for the treatment of non-acute myocardial ischaemic syndromes dispute the value of revascularisation and differ in their recommendation to perform revascularisation. A Bayesian network meta-analysis was performed, evaluating the strength of evidence for the comparative incremental effectiveness of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) over medical therapy on long-term outcomes.</p><p><strong>Methods: </strong>A hierarchical Bayesian network meta-analysis was designed (PROSPERO CRD42024541215, date 20 May 2024), including randomised controlled trials (RCTs) published between 2005 and 10 June 2025, which consisted of three initial treatment modalities: optimal medical therapy (OMT), PCI+OMT and CABG+OMT. The primary outcome was all-cause mortality at maximum follow-up; secondary outcomes were trates of the rates of myocardial infarction, stroke and re-revascularisation at maximum follow-up, expressed in HRs and 95% credible intervals (CrIs), accompanied by surface under the cumulative ranking curve (SUCRA) scores.</p><p><strong>Results: </strong>10 RCTs, comprising 10 742 patients, were included. For all-cause mortality, the estimated median HR of CABG+OMT versus OMT was 0.84 (95% CrI 0.68-1.07); the HR of PCI+OMT versus OMT was 0.93 (0.79-1.16); and the HR of CABG+OMT versus PCI+OMT was 0.91 (0.71-1.13). The SUCRAs of a CABG+OMT strategy ranking as the optimal revascularisation treatment regarding mortality, myocardial infarction, stroke and re-revascularisation were 88.1%, 99.7%, 17.5% and 99.5%, respectively. Results were consistent across sensitivity analyses, including in the node-splitting models.</p><p><strong>Conclusions: </strong>This Bayesian network meta-analysis found that an initial CABG (+OMT) revascularisation strategy was associated with higher probabilities of optimal outcomes, with the exception of stroke, compared with an initial PCI (+OMT) revascularisation strategy, although CrIs overlapped, suggesting that some uncertainty remains.</p><p><strong>Prospero registration number: </strong>CRD42024541215.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064544","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 outcomes of intravascular ultrasound-guided percutaneous coronary intervention versus coronary artery bypass grafting for multivessel coronary artery disease.","authors":"Jinho Lee, Jung-Min Ahn, Hoyun Kim, Yeonwoo Choi, Sangyong Jo, Do-Yoon Kang, Min-Ju Kim, Seung Ho Hur, Hun-Jun Park, Damras Tresukosol, Woong Chol Kang, Hyuck Moon Kwon, Seung-Woon Rha, Do-Sun Lim, Myung-Ho Jeong, Bong-Ki Lee, He Huang, Young-Hyo Lim, Jang Ho Bae, Byung Ok Kim, Tiong Kiam Ong, Sung Gyun Ahn, Cheol-Hyun Chung, Duk-Woo Park, Seung-Jung Park","doi":"10.1136/heartjnl-2024-325107","DOIUrl":"10.1136/heartjnl-2024-325107","url":null,"abstract":"<p><strong>Background: </strong>Intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) has been shown to improve outcomes in complex coronary artery disease compared with angiography-guided PCI. However, long-term comparisons between IVUS-guided PCI and coronary artery bypass grafting (CABG) for multivessel disease (MVD) remain limited.</p><p><strong>Methods: </strong>This post hoc analysis of the Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment Extended Follow-up study included 880 patients with MVD, excluding 15 patients who received medical therapy. Patients were categorised into IVUS-guided PCI (n=333), angiography-guided PCI (n=131) and CABG (n=401). The primary endpoint was the composite of death, myocardial infarction (MI) or target-vessel revascularisation over a median follow-up of 11.8 years.</p><p><strong>Results: </strong>The IVUS-guided PCI group showed no difference in the primary endpoint compared with CABG (adjusted HR 1.013; 95% CI 0.747 to 1.374; p=0.93). In contrast, angiography-guided PCI was associated with a higher risk of clinical events (adjusted HR 2.231; 95% CI 1.582 to 3.145; p<0.001). The safety endpoint (composite of death, MI and stroke) did not differ between IVUS-guided PCI and CABG (adjusted HR 0.845; 95% CI 0.605 to 1.181; p=0.324), while angiography-guided PCI was associated with a higher risk (adjusted HR 2.016; 95% CI 1.405 to 2.895; p<0.001). Both PCI groups had higher rates of repeat revascularisation compared with CABG.</p><p><strong>Conclusions: </strong>IVUS-guided PCI demonstrated comparable long-term outcomes to CABG in terms of mortality and safety endpoints, supporting its use in the treatment of MVD. These findings highlight the potential benefits of IVUS guidance in complex PCI procedures.</p><p><strong>Trial registration numbers: </strong>NCT05125367 and NCT00997828.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"918-924"},"PeriodicalIF":4.4,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077632","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":"Percutaneous intramyocardial septal radiofrequency ablation: a novel treatment for drug-refractory non-obstructive hypertrophic cardiomyopathy with severe septal hypertrophy.","authors":"Huiyi Wang, Jing Li, David H Hsi, Wenxia Li, Shengjun Ta, Yiyu Jiao, Bo Shan, Lingxiao Chang, Xumei Ou, Lu Yao, Bo Wang, Jing Wang, Changhui Lei, Liwen Liu","doi":"10.1136/heartjnl-2024-325334","DOIUrl":"10.1136/heartjnl-2024-325334","url":null,"abstract":"<p><strong>Background: </strong>Patients with drug-refractory non-obstructive hypertrophic cardiomyopathy (NOHCM) lack effective invasive treatment options. This study aimed to evaluate the safety and effectiveness of percutaneous intramyocardial septal radiofrequency ablation (PIMSRA, Liwen procedure) in patients with NOHCM and severe septal hypertrophy (≥28 mm).</p><p><strong>Method: </strong>This single-arm, open-label, prospective study enrolled 20 adult patients with drug-refractory NOHCM between June 2017 and June 2023. Patients underwent PIMSRA and were followed for a median of 15 months. Outcomes included changes in septal thickness, quality of life (Kansas City Cardiomyopathy Questionnaire-12, KCCQ-12) and myocardial function.</p><p><strong>Results: </strong>No major adverse clinical events occurred within 30 days after the procedure. The maximum interventricular septal thickness decreased significantly from 31.3 mm to 17.4 mm (mean difference: -13.9 mm; 95% CI -15.92 to -11.88). Left atrial volume index and left ventricular mass index also decreased significantly. Improvements in global longitudinal strain and global radial strain were observed, indicating possibly enhanced myocardial performance. KCCQ-12 scores improved from 65.6 to 84.4 (mean difference: 18.78; 95% CI 11.62 to 25.93). Patients after PIMSRA were not found to have an increased risk of arrhythmias such as atrial fibrillation, high-grade conduction block or non-sustained ventricular tachycardia during the follow-up.</p><p><strong>Conclusions: </strong>PIMSRA was associated with a reduction of myocardial septal thickness and improvement in functional status in patients with NOHCM. The absence of major adverse events is also encouraging, but larger studies with a control arm are needed to confirm long-term safety.</p><p><strong>Trial registration number: </strong>ChiCTR1900020530.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"933-940"},"PeriodicalIF":4.4,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12505089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584843","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":"Artificial intelligence in cardiac telemetry.","authors":"Jiaying Lu, Ran Xiao, Xiao Hu, Duc H Do","doi":"10.1136/heartjnl-2024-323947","DOIUrl":"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":"897-903"},"PeriodicalIF":4.4,"publicationDate":"2025-09-11","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":"Synergistic effects of female-specific conditions and genetic risk on cardiometabolic disease: a cohort study.","authors":"Jiayu Yin, Tingting Li, Zongliang Yu, Lingchan Yu, Liyan Bian, Boyang Xiang, Xiaosong Gu","doi":"10.1136/heartjnl-2024-325355","DOIUrl":"10.1136/heartjnl-2024-325355","url":null,"abstract":"<p><strong>Background: </strong>The role of female-specific factors in the occurrence and progression of cardiometabolic disease (CMD) across different genetic risks remains incompletely clear. This study aimed to comprehensively assess the association of female-specific factors with the occurrence and progression of CMD.</p><p><strong>Methods: </strong>This was a prospective cohort study of 150 413 female individuals from the UK Biobank. The female-specific factors in this study included premature menopause, adverse pregnancy outcomes, early or late menarche, multiparity, infertility, use of oral contraceptive or hormone therapy and autoimmune diseases, and a weighted female-specific risk score (FSRS, ranging from 0 to 6) was constructed. We analysed the association of female-specific factors with the occurrence and progression of CMD across genetic risks.</p><p><strong>Results: </strong>A total of 16 636 CMD events were documented after a median follow-up of 13.7 years. A one-point increase in FSRS was associated with a 24% higher risk of incident CMD, with persistent association with progression to first CMD, cardiometabolic multimorbidity and mortality. Female-specific factors and genetic susceptibility were synergistically associated with a higher risk of CMD (p_Interaction<0.001). Compared with the group with low female-specific and genetic risks, the group with high female-specific and genetic risk had a 243% increased risk of CMD. FSRS had a relatively high predictive value for CMD, especially in the group with higher genetic risks, and modestly improved the performance of two recommended cardiovascular algorithms. Phenotypic ageing, inflammation, metabolic factors, renal function and oestradiol collectively explained 21.6% of the association between FSRS and CMD.</p><p><strong>Conclusions: </strong>Female-specific health factors significantly contribute to CMD risk and interact with genetic susceptibility. Incorporating these factors into risk assessment models could enhance predictive accuracy, particularly for women with high genetic risk.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"910-917"},"PeriodicalIF":4.4,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729754","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":"Evolving insights into VEGFI cardiotoxicity: past challenges, present findings and future opportunities.","authors":"Kenya Kusunose","doi":"10.1136/heartjnl-2025-326107","DOIUrl":"10.1136/heartjnl-2025-326107","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"895-896"},"PeriodicalIF":4.4,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980496","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":"Follow-up visit of an incidentally detected ventricular septal defect.","authors":"Saurav Banerjee, Deepanjan Bhattacharya, Sanjeev S Mukherjee","doi":"10.1136/heartjnl-2025-326310","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326310","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":"111 19","pages":"903-942"},"PeriodicalIF":4.4,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040007","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":"Can PCI match CABG for multivessel disease? Here is how.","authors":"Alexander Levy, Gregg W Stone","doi":"10.1136/heartjnl-2025-326361","DOIUrl":"10.1136/heartjnl-2025-326361","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"893-894"},"PeriodicalIF":4.4,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215680","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}