Heart最新文献

{"title":"Updated evidence on selection and implementation of an invasive treatment strategy for older patients with non-ST-segment elevation myocardial infarction.","authors":"Kieran Gill, Vijay Kunadian","doi":"10.1136/heartjnl-2024-325157","DOIUrl":"10.1136/heartjnl-2024-325157","url":null,"abstract":"<p><p>Non-ST-segment elevation myocardial infarction (NSTEMI) is the most common acute coronary syndrome diagnosis in older patients. In the UK, there are ~20 000 NSTEMI cases annually in patients aged ≥75 years. Despite therapeutic advances in pharmacological and invasive management, studies show that older patients with NSTEMI experience worse in-hospital and long-term outcomes than younger patients, suggesting a clear need for robust evidence in this cohort.The European Society of Cardiology guidelines recommend that invasive management should be considered holistically with no specified age cut-offs. However, older patients are less likely to receive invasive management due to a paucity of evidence from trials that represent contemporary clinical characteristics of older adults. Recruiting older patients realistic of those encountered in clinical practice is hugely challenging. Chronological age alone does not reflect the heterogeneity of the older population; ~30% of older patients with NSTEMI are frail, ~65% are cognitively impaired and most live with at least two additional comorbidities that can influence risk. Weighing the risk of an NSTEMI in an older adult against competing risks attributable to underlying frailty, comorbidities and cognitive impairment poses a key challenge.Recently, the SENIOR-RITA trial showed that invasive management in older patients with NSTEMI is safe and reduces non-fatal myocardial infarction and subsequent revascularisation but does not improve mortality. Individualised risk assessment and shared decision-making is necessary to guide these nuanced decisions. This review discusses the latest evidence regarding invasive management in the older population with NSTEMI, including the impact of geriatric syndromes on clinical outcomes.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"546-556"},"PeriodicalIF":5.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143407115","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":"AF-CARE in the elderly: complex but of increasing importance.","authors":"Stijn P G Van Vugt, Martin E W Hemels","doi":"10.1136/heartjnl-2024-325614","DOIUrl":"10.1136/heartjnl-2024-325614","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"544-545"},"PeriodicalIF":5.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440528","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 incidence of implantable cardioverter-defibrillator therapy in patients with hypertrophic cardiomyopathy: analysis of appropriate and inappropriate interventions.","authors":"Emma Basse Christensen, Christoffer Rasmus Vissing, Elvira Silajdzija, Helen Lamiokor Mills, Jens Jakob Thune, Charlotte Larroudé, Helle Skovmand Bosselmann, Berit Thornvig Philbert, Anna Axelsson Raja, Alex Hørby Christensen, Henning Bundgaard","doi":"10.1136/heartjnl-2024-325020","DOIUrl":"10.1136/heartjnl-2024-325020","url":null,"abstract":"<p><strong>Background: </strong>Treatment with implantable cardioverter-defibrillators (ICDs) effectively prevents sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM). Identifying patients most likely to benefit from a primary prevention ICD remains challenging. We aimed to investigate the long-term incidence of ICD therapy in patients with HCM according to SCD-risk at baseline.</p><p><strong>Methods: </strong>The study retrospectively included all patients with HCM treated with an ICD for primary or secondary prevention between 1995 and 2022 in Eastern Denmark. Medical records for each patient were evaluated. Patients were stratified into risk groups according to the European Society of Cardiology HCM Risk-SCD score.</p><p><strong>Results: </strong>We included 208 patients (66% male) with HCM and an ICD for primary (78%) or secondary prevention (22%). During a median 10-year follow-up, 66 patients (32%) received appropriate ICD therapy (antitachycardia pacing and/or shock), while 20 (10%) received inappropriate therapy. Patients with an ICD implanted for secondary prevention were almost twice as likely to receive appropriate therapy compared with patients with an ICD implanted for primary prevention (47% vs 28%, p=0.02). The 5-year cumulative incidences of appropriate shock therapy were 17% in patients with a high HCM Risk-SCD score, 16% in patients with an intermediate-risk score and 6% in patients with a low-risk score. A high-risk score was associated with higher cumulative incidence of appropriate shock therapy (p=0.012).</p><p><strong>Conclusion: </strong>One-third of patients with HCM treated with an ICD experienced appropriate ICD therapy. The HCM-Risk SCD score adequately distinguished between low-risk and high-risk patients among those who underwent ICD implantation. Further improvements of risk-tools are needed to identify a larger proportion of the two-thirds of patients who did not benefit from ICD implantation after 10 years of observation.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"575-582"},"PeriodicalIF":5.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004449","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":"Safety and effectiveness of anticoagulation therapy in older people with atrial fibrillation during exposed and unexposed treatment periods.","authors":"Anneka Mitchell, Margaret C Watson, Tomas J Welsh, Anita McGrogan","doi":"10.1136/heartjnl-2024-324763","DOIUrl":"10.1136/heartjnl-2024-324763","url":null,"abstract":"<p><strong>Background: </strong>Anticoagulation therapy reduces stroke risk in patients with atrial fibrillation (AF), but it is often underused in older populations due to concerns about bleeding. This study aimed to compare the safety and effectiveness of anticoagulation during periods of exposure and non-exposure and across different anticoagulants in people with AF aged ≥75 years.</p><p><strong>Methods: </strong>Using UK primary care data from the Clinical Practice Research Datalink (2013-2017), a retrospective cohort study was conducted on patients newly prescribed oral anticoagulants (warfarin or direct oral anticoagulants). Exposure to anticoagulation was mapped using prescription data. Cox regression models were used to estimate adjusted HRs for stroke, bleeding, myocardial infarction, and death during periods of exposure and non-exposure and for different anticoagulants.</p><p><strong>Results: </strong>Among 20 167 patients (median age 81 years), non-exposure to anticoagulation was associated with higher risks of stroke (HR 3.07, 95% CI 2.39 to 3.93), myocardial infarction (HR 1.85, 95% CI 1.34 to 2.56) and death (HR 2.87, 95% CI 2.63 to 3.12) compared with exposure. Compared with warfarin, apixaban was associated with lower risks of non-major bleeding (HR 0.73, 95% CI 0.64 to 0.85), whereas rivaroxaban was associated with higher risks of major (HR 1.33, 95% CI 1.15 to 1.55) and non-major (HR 1.29, 95% CI 1.16 to 1.44) bleeding.</p><p><strong>Conclusions: </strong>Non-exposure to anticoagulation increases the risks of stroke, myocardial infarction and death in older patients with AF. Clinicians should carefully weigh the risks of discontinuing anticoagulation and provide shared decision-making support to patients, especially when considering deprescription.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"565-574"},"PeriodicalIF":5.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440655","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":"Rare case of marked left ventricular hypertrophy.","authors":"Michiyo Yamano, Aya Miyagawa-Hayashino, Natsuya Keira","doi":"10.1136/heartjnl-2024-325645","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325645","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":"111 12","pages":"556-594"},"PeriodicalIF":5.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132295","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":"Updating the Scottish national cardiovascular risk score: ASSIGN version 2.0.","authors":"Paul Welsh, Dorien M Kimenai, Mark Woodward","doi":"10.1136/heartjnl-2024-324852","DOIUrl":"10.1136/heartjnl-2024-324852","url":null,"abstract":"<p><strong>Background: </strong>The Assessing cardiovascular risk using Scottish Intercollegiate Guidelines Network (ASSIGN) risk score, developed in 2006, is used in Scotland for estimating the 10-year risk of first atherosclerotic cardiovascular disease (ASCVD). Rates of ASCVD are decreasing, and an update is required. This study aimed to recalibrate ASSIGN (V.2.0) using contemporary data and to compare recalibration with other potential approaches for updating the risk score.</p><p><strong>Methods: </strong>Data from Scotland-resident participants from UK Biobank (2006-2010) and the Generation Scotland Scottish Family Health Study (2006-2010), aged 40-69 and without previous ASCVD, were used for the derivation of scores. External evaluation was conducted on UK Biobank participants who were not residents of Scotland. The original ASSIGN predictor variables and weights formed the basis of the new sex-specific risk equation to predict the 10-year risk of ASCVD. Different approaches for updating ASSIGN (recalibration, rederivation and regression adjustment) were tested in the evaluation cohort.</p><p><strong>Results: </strong>The original ASSIGN score overestimated ASCVD risk in the evaluation cohort, with median predicted 10-year risks of 10.6% for females and 15.1% for males, compared with observed risks of 6% and 11.4%, respectively. The derivation cohort included 44 947 (57% females and a mean age of 55) participants. The recalibrated score, ASSIGN V.2.0, improved model fit in the evaluation cohort, predicting median 10-year risk of 4% for females and 8.9% for males. Similar improvements were achieved using the regression-adjusted model. Rederivation of ASSIGN using new beta coefficients offered only modest improvements in calibration and discrimination beyond simple recalibration. At the current risk threshold of20% 10-year risk, the original ASSIGN equation yielded a positive predictive value (PPV) of 16.3% and a negative predictive value (NPV) of 94.4%. Recalibrated ASSIGN V.2.0 showed similar performance at a 10% threshold, with a PPV of 16.8% and an NPV of 94.6%.</p><p><strong>Conclusions: </strong>The recalibrated ASSIGN V.2.0 will give a more accurate estimation of contemporary ASCVD risk in Scotland.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"557-564"},"PeriodicalIF":5.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004117","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":"Moving towards precision medicine for older adults with non-ST-segment elevation myocardial infarction.","authors":"Armin Nouri, Michael G Nanna","doi":"10.1136/heartjnl-2025-325817","DOIUrl":"10.1136/heartjnl-2025-325817","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"541-543"},"PeriodicalIF":5.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556689","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":"Pulmonary haemodynamics and right heart function during exercise at high versus low altitude in patients with pulmonary vascular disease: a randomised crossover trial.","authors":"Julian Müller, Laura Mayer, Simon Raphael Schneider, Meret Bauer, Michael Furian, Konrad E Bloch, Esther I Schwarz, Mona Lichtblau, Ulrich Silvia","doi":"10.1136/heartjnl-2024-325605","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325605","url":null,"abstract":"<p><strong>Background: </strong>Patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension (PAH/CTEPH) may experience physiological stress at high altitude. We investigated pulmonary haemodynamics and right heart function during incremental (IET) and constant work-rate exercise tests (CWRET) at high (2500 m) vs low altitude (470 m).</p><p><strong>Methods: </strong>In this randomised crossover trial, patients with stable PAH/CTEPH without resting hypoxaemia performed IET and CWRET at both altitudes. Systolic pulmonary arterial pressure (sPAP) and right ventricular (RV) arterial coupling (tricuspid annular plane systolic excursion/sPAP) were assessed by echocardiography.</p><p><strong>Results: </strong>Among 27 patients (44% women, 61±14 years), sPAP was higher at rest at 2500 m vs 470 m (mean difference: 14 mm Hg, 95% CI 7 to 23), but increased linearly during exercise with similar slopes at each altitude (7.9 vs 9.7 mm Hg/min, respectively). RV arterial coupling was lower at high altitude at rest (difference: -0.13 mm/mm Hg, 95% CI -0.26 to -0.04) but decreased comparably during exercise. During CWRET, sPAP rose steeply in the first 3 min, plateauing thereafter, with no altitude-dependent differences in pressure-flow slope. Oxygen delivery was reduced at high altitude.</p><p><strong>Conclusion: </strong>Despite higher baseline sPAP and reduced RV coupling at rest, exercise-induced haemodynamic changes were similar at both high and low altitudes, suggesting short-term altitude exposure does not exacerbate cardiopulmonary stress during exercise in stable PAH/CTEPH. The exercise protocol (IET vs CWRET) alters haemodynamic trajectories more than altitude.</p><p><strong>Trial registration number: </strong>NCT05107700.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127371","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":"Applying the 2024 European Society of Cardiology Guidelines for the management of elevated blood pressure and hypertension to a Norwegian general population cohort from age 40: data from the Akershus Cardiac Examination 1950 study.","authors":"Håkon Ihle-Hansen, Marte Meyer Walle-Hansen, Guri Hagberg, Trygve Berge, Hege Ihle-Hansen, Peter Selmer Rønningen, Inger Ariansen, Torbjørn Omland, Helge Rosjo, Arnljot Tveit, Magnus Nakrem Lyngbakken","doi":"10.1136/heartjnl-2025-325770","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-325770","url":null,"abstract":"<p><strong>Background: </strong>The 2024 European Society of Cardiology (ESC) Guidelines for hypertension introduced the 'elevated BP' (eBP) category (120-139/70-89 mm Hg). Individuals with persistent eBP (130-139/80-89 mm Hg), despite lifestyle intervention, may be recommended pharmacological treatment in case of concomitant elevated cardiovascular (CV) risk. We aimed to assess the impact of these updated recommendations on treatment eligibility at ages 40 and 62-65 and to examine the CV event rates over 30 years of follow-up, focusing on those with eBP (130-139/80-89 mm Hg) eligible for pharmacological treatment.</p><p><strong>Methods: </strong>Data from individuals born in 1950 who participated in the Age 40 Programme and the Akershus Cardiac Examination 1950 Study was linked to national health registries. These data include BP measurements at age 40 (1990-1991) and 62-65 (2012-2015), assessment of elevated CV risk based on Systematic Coronary Risk Evaluation 2 (SCORE2) and outcomes of major adverse cardiovascular events (MACEs) tracked through 2022.</p><p><strong>Results: </strong>At age 40, 854 (32%) of 2688 individuals had eBP (130-139/80-89 mm Hg), but only 4 had elevated CV risk warranting pharmacological treatment. At age 62-65, 1657 (61%) were on BP-lowering medication or had a BP ≥140/90, while 64 (8%) out of 851 with eBP were eligible for drug treatment. Based on BP values at age 40, only 2 of the 93 MACEs in the eBP (130-139/80-89 mm Hg) category occurred among those eligible for pharmacological treatment.</p><p><strong>Conclusions: </strong>A single BP measurement at age 40 identified eBP (130-139/80-89 mm Hg) among one-third of the individuals, yet MACE cases within the eBP category occurred primarily in individuals who were not eligible for medical treatment.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127369","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":"Catheter ablation versus medical rate control for persistent atrial fibrillation in older heart failure patients with reduced ejection fraction.","authors":"Ziliang Song, Shi-Yi Wang, Zheng Qidong, Nannan Chen, Yu Zhang, Weifeng Jiang, Shao Hui Wu, Kai Xu, Yang Liu, Xu Liu, Xumin Hou, Mu Qin","doi":"10.1136/heartjnl-2024-324668","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-324668","url":null,"abstract":"<p><strong>Background: </strong>Patients with heart failure with reduced ejection fraction (HFrEF) and atrial fibrillation are mostly elderly patients, and persistent atrial fibrillation (PerAF) with multiple comorbidities tends to have a worse clinical prognosis. However, there is a lack of randomised trial to investigate the impact of catheter ablation (CA) on outcomes in older PerAF combined with HFrEF.</p><p><strong>Objective: </strong>This study aims to compare the effects of CA versus medical rate control (MRC) on severity indicators of HFrEF.</p><p><strong>Methods: </strong>Older patients with PerAF and HFrEF underwent transthoracic echocardiography and were randomly assigned to receive either AF ablation or MRC. The primary outcome was changes in left ventricular ejection fraction (LVEF).</p><p><strong>Results: </strong>A total of 89 patients (mean age 69.5±3.9 years) were randomly allocated to the CA group (n=45) and MRC group (n=44). Baseline characteristics were similar between the two groups. After 12 months, worsening heart failure requiring unplanned hospitalisation occurred less frequently in the CA group (p=0.019). In CA group, LVEF (from baseline 36.1%±2.7% to 48.9%±7.1%; p<0.00 L) improved higher compared with the MRC group (8.7 (5.9 to 11.5)), p<0.001. Compared with baseline, New York Heart Association functional class and AF burden also showed improvement in CA group than MR group. At a follow-up period of 12 months, sinus rhythm rate was higher in CA group than MRC group, 51.1% versus 20.4%.</p><p><strong>Conclusion: </strong>This limited small-scale randomised study showed that CA in older patients with PerAF and HFrEF was associated with a lower likelihood of unplanned hospitalisations due to worsening heart failure with improvement in LVEF and lower AF burden.</p><p><strong>Trial registration number: </strong>NCT05827172.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110529","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}