Heart最新文献

{"title":"Cannabis use among young adults with acute coronary syndrome: impact on initial presentation and long-term prognosis.","authors":"Nicolas Martin, Christophe Beyls, Michel Zeitouni, Yohann Bohbot, Valentin Stracchi, Sofiane Sroutta-Paillusseau, Geneviève Jarry, Sandra Bodeau, Fabio Noé, Julien Hudelo, Alexandre Fournier, Dorothée Malaquin, Paul Gabrion, Thomas Landemaine, Agathe Vernier, Maciej Kubala, Laurent Leborgne, Alexis Hermida","doi":"10.1136/heartjnl-2025-326777","DOIUrl":"10.1136/heartjnl-2025-326777","url":null,"abstract":"<p><strong>Background: </strong>Cannabis consumption has increased among young adults, but its long-term cardiovascular impact remains unclear. This study assessed the association between cannabis use at admission for acute coronary syndrome (ACS) and long-term prognosis.</p><p><strong>Methods: </strong>A retrospective, single-centre cohort included patients under the age of 45 years admitted for ACS between 1 January 2010 and 1 March 2025, all of whom reported current tobacco use at admission. Based on urinary testing at admission, patients were classified as cannabis users or non-users. The primary endpoint was major adverse cardiovascular events (MACE), a composite of death, stroke, recurrent myocardial infarction, arrhythmia or heart failure-related events. A propensity-weighted analysis adjusted for socioeconomic and cardiovascular risk factors was conducted. Weighted survival curves were plotted, and a Cox model truncated at 6 years was used to estimate the HR for MACE associated with cannabis use.</p><p><strong>Results: </strong>Among 188 included patients, 77 (41.0%) were cannabis users and 111 (59.0%) non-users. The median follow-up was 2.93 (0.45-5.53) years. Weighted Kaplan-Meier curves differed significantly (Fleming-Harrington p=0.002), with a higher cumulative incidence of MACE among cannabis users. In the inverse probability of treatment weighting Cox model, cannabis use was associated with a higher hazard of MACE (HR 2.52, 95% CI 1.05 to 6.02; p=0.04). Cannabis users also had higher peak troponin levels, higher leucocyte counts and a greater use of postprocedural anticoagulation (all p<0.05).</p><p><strong>Conclusions: </strong>Cannabis use in young adults with ACS was associated with a 2.5-fold higher hazard of MACE over 6 years, highlighting the need to take cannabis use into account in cardiovascular care pathways.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"1145-1152"},"PeriodicalIF":4.4,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426840","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":"Cardiovascular benefits of obesity therapies: an overview of obesity medicines and metabolic bariatric surgery.","authors":"Itxaso K Villelabeitia, Ricardo Cohen, Carel W le Roux","doi":"10.1136/heartjnl-2025-326812","DOIUrl":"10.1136/heartjnl-2025-326812","url":null,"abstract":"<p><p>Obesity is an independent driver of cardiovascular disease (CVD), mediated through adverse haemodynamic loading, insulin resistance, systemic inflammation, endothelial dysfunction and prothrombotic pathways. Contemporary obesity therapies show cardiovascular (CV) benefits beyond improvements in traditional risk factors. Across large CV outcome trials, glucagon-like peptide 1 receptor agonists consistently reduce three-point major adverse CV events (MACE) in patients with overweight, obesity and established CVD with and without diabetes. In obesity-related heart failure of preserved ejection fraction, semaglutide and tirzepatide improve symptoms and functional capacity and reduce worsening heart failure events, while effects on CV mortality remain uncertain. In contrast, evidence for metabolic bariatric surgery is dominated by large observational cohorts and meta-analyses, which are associated with durable weight loss and lower observed rates of MACE, heart failure and all-cause mortality compared with non-surgical care, though causal inference is constrained by residual confounding. Data support that sustained weight loss of at least 10% is more likely to translate into CVD event reduction, alongside other organ specific mechanisms that impact CV health independent from weight reduction. Obesity treatments offer a safe and effective method to lose weight with varying CV benefits, with current evidence still in early stages to establish robust clinical recommendations.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"1125-1134"},"PeriodicalIF":4.4,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147276182","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":"Atrial fibrillation and coronary artery disease: interactions, outcomes and evolving management strategies.","authors":"Ashley Verburg, Dominik Linz, Tasnim Mohaissen, Jurriën Ten Berg","doi":"10.1136/heartjnl-2026-328218","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328218","url":null,"abstract":"<p><p>Atrial fibrillation (AF) and coronary artery disease (CAD) are prevalent cardiovascular disorders that increasingly coexist as populations age and cardiometabolic comorbidities rise. Their intersection creates a high-risk phenotype, with substantially higher rates of stroke, acute coronary syndromes, heart failure and mortality than either condition alone. This excess risk reflects shared comorbidities and complex bidirectional interactions whereby AF exacerbates myocardial ischaemia and endothelial dysfunction and CAD promotes atrial remodelling and arrhythmogenesis.Despite advances in antithrombotic and rhythm management strategies, care for patients with coexisting AF and CAD remains challenging. Diagnostic evaluation is often obscured by overlapping symptoms and confounding biomarker and imaging findings. Therapeutic decisions require careful integration of ischaemic and arrhythmic risk, particularly when determining antithrombotic intensity, selecting rate or rhythm control and managing ischaemia in AF-related haemodynamics. The evidence base has evolved rapidly, with short- and long-term antithrombotic studies and rhythm-control trials reshaping practice, prompting re-evaluation of management strategies.This Review synthesises current knowledge on epidemiology, pathophysiology and diagnostic challenges of AF-CAD coexistence and provides an updated integrated framework for therapeutic decision-making. We discuss contemporary antithrombotic strategies, rate and rhythm control, ischaemia management and clinical outcomes as well as highlight emerging evidence and practical considerations.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038081","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 metabolomics uncovers key metabolites and enhances prediction of aortic stenosis: insights from prospective cohort and Mendelian randomisation studies.","authors":"Hao Xiang, Yanjun Zhang, Yuanyuan Zhang, Ziliang Ye, Sisi Yang, Xiaoqin Gan, Yu Huang, Yiting Wu, Yiwei Zhang, Xianhui Qin","doi":"10.1136/heartjnl-2025-326161","DOIUrl":"10.1136/heartjnl-2025-326161","url":null,"abstract":"<p><strong>Objective: </strong>To examine the association between nuclear magnetic resonance (NMR)-based metabolomics and aortic stenosis (AS) risk, and determine whether metabolomic profiling can enhance AS prediction beyond conventional clinical risk factors.</p><p><strong>Methods: </strong>We included 168 metabolites in our study. The primary outcome of interest was incident AS. The secondary outcome of interest was incident AS-related interventions or deaths. Prospective and two-sample Mendelian randomisation (MR) analyses were used to investigate the relationship between metabolites and AS risk. Harrell's C index, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were employed to assess whether adding metabolites could improve risk discrimination and reclassification for AS prediction beyond clinical risk factors.</p><p><strong>Results: </strong>During a median follow-up of 13.7 years, 2562 AS events, along with 1039 AS-related interventions or deaths, were recorded. In observational analyses, 77 of 168 metabolites were significantly associated with AS risk after adjusting for covariates and correcting for multiple testing. In MR analyses, 39 metabolites, including apolipoprotein B, apolipoprotein B-containing lipoprotein particles and lipid constituents within lipoprotein subclasses, remained causally associated with AS risk. Besides, all of the 39 metabolites were associated with incident AS-related interventions or deaths. Using LASSO (least absolute shrinkage and selection operator) regression, we identified 12 metabolites in the training set (n=146 252). Adding the 12 metabolites to clinical risk factors-based Cox regression model significantly improved AS risk prediction. The C index improved from 0.780 to 0.791 in the testing set (n=62 678) and from 0.764 to 0.786 in the external validation cohort (n=21 546). The NRI and IDI were also significantly improved.</p><p><strong>Conclusions: </strong>Our study identified 39 metabolites with causal associations with AS risk, particularly apolipoprotein B-containing lipoproteins. The derived 12-metabolite panel significantly improved AS risk prediction, demonstrating the potential of NMR-based metabolomics to enhance AS risk stratification and targeted prevention.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784069","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":"Permanent pacemaker implantation after cardiac surgery and long-term outcome.","authors":"Laura Alice David, Amar Taha, Sigurdur Thorleifsson, J Gustav Smith, Anders Jeppsson, Andreas Martinsson","doi":"10.1136/heartjnl-2026-328361","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328361","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing cardiac surgery are at risk of perioperative conduction system damage leading to permanent placement of a cardiac electronic implantable device (CIED) which is a common complication following cardiac surgery. Studies evaluating the long-term outcomes following permanent pacemaker implantation in cardiac surgery patients are contradictory and inconsistent. The current study aimed to evaluate the long-term outcome across the spectrum of cardiac surgery in a nationwide contemporary setting.</p><p><strong>Methods: </strong>All adult patients in Sweden, without previous CIED who had cardiac surgery between 2006 and 2020 were included. Data was obtained from nationwide registries. Cox proportional hazards models were used to account for comorbid conditions and perioperative characteristics and to evaluate the association between permanent pacemaker or implantable cardioverter defibrillator (ICD) implantation and the risk of all-cause mortality, cardiovascular mortality and heart failure hospitalisation.</p><p><strong>Results: </strong>Among 76 223 patients (mean age 67.8 years, 25% female), 2150 (2.8%) received a permanent pacemaker and 348 (0.5%) received an ICD within 30 days after surgery. During a mean follow-up of 6.8 years (SD 10.7), pacemaker implantation was associated with a higher risk of all-cause mortality (adjusted HR (aHR) 1.09, 95% CI 1.01 to 1.19) and heart failure hospitalisation (aHR 1.36, 95% CI 1.22 to 1.52). Cardiovascular mortality showed a similar but statistically non-significant trend. ICD implantation was not associated with all-cause mortality but was associated with increased risks of heart failure hospitalisation and cardiovascular mortality. Subgroup analyses did not show any significant interactions between comorbid conditions and outcomes.</p><p><strong>Conclusion: </strong>Permanent pacemaker implantation after cardiac surgery was associated with a higher risk of all-cause mortality and heart failure hospitalisation. These findings were consistent across cardiac surgical subtypes and underscore the need for careful long-term surveillance for these patients.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016773","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":"Post-heart transplantation immunosuppression and rejection: what the general cardiologist needs to know.","authors":"Rashmi Jain, Michelle M Kittleson","doi":"10.1136/heartjnl-2026-328009","DOIUrl":"10.1136/heartjnl-2026-328009","url":null,"abstract":"<p><p>While heart transplantation (HT) is the optimal therapy for end-stage heart failure patients, longevity of HT recipients continues to be limited by rejection and its sequelae. In this review, we provide an overview of current immunosuppressive principles and the prevention, diagnosis and treatment of rejection in HT. All HT recipients are maintained on immunosuppression to prevent rejection and undergo regular surveillance testing to identify rejection episodes that may require treatment. Risk of rejection is highest in the first year-post-HT and so during that period, immunosuppression is maintained at the highest levels and surveillance testing is done most frequently. The current standard triple-drug immunosuppressive regimen for HT consists of tacrolimus, a calcineurin inhibitor, mycophenolate mofetil, an antimetabolite agent and steroids. This regimen, with a calcineurin inhibitor as its cornerstone, has led to significantly decreased rates of rejection, particularly acute cellular rejection (ACR) in the current day compared with the early days of HT. The endomyocardial biopsy is currently the standard for rejection surveillance, but newer technologies such as donor-derived cell-free DNA measurements are changing surveillance practices in the field. While rates of ACR have decreased with current management strategies, antibody-mediated rejection (AMR) continues to pose a challenge. Newer immunosuppressive therapies that more effectively target the humoral and innate immune systems aim to better prevent and treat AMR in HT recipients. Furthermore, ongoing advancements in rejection surveillance strategy offer higher sensitivity and diagnostic accuracy for AMR compared with just histopathology on the endomyocardial biopsy. Ongoing advancements in immunosuppression and rejection surveillance will lead to continued improvement in longevity of HT recipients.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016768","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":"Prospective evaluation of a self-report-guided strategy for targeted coronary artery calcium imaging.","authors":"Eva Hagberg, Elias Björnson, Martin Adiels, Bledar Daka, Louise H Fornander, Josefin Kjelldahl, David Molnar, Carlo Pirazzi, Ulf Strömberg, Gustav Kjellsson, Carl Bonander, Mikael Svensson, Anders Gummessson, Göran Bergström","doi":"10.1136/heartjnl-2026-328767","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328767","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery calcium (CAC) imaging directly assesses subclinical calcified coronary atherosclerosis but population-wide imaging is not recommended. Simple prescreening may help identify individuals most likely to benefit from CAC imaging. We previously developed a self-report-based model to estimate the probability of CAC ≥100. This study prospectively evaluated a strategy based on this model to select individuals for CAC imaging. We assessed agreement between model-predicted probability and observed prevalence of CAC ≥100 among participants undergoing CT imaging and examined patterns of preventive lipid-lowering therapy.</p><p><strong>Methods: </strong>The PRedict and Identify cOronary atherosclerosis-Now (PRIO-Now) study applied a prospective, two-step, population-based screening approach. Individuals aged 59-60 years were invited to complete a self-report questionnaire. Eligible respondents without previous ischaemic heart disease whose model-predicted probability of CAC ≥100 exceeded the predefined threshold were invited to clinical assessment and non-contrast coronary CT imaging. The primary analysis assessed agreement between model-predicted probabilities and the observed prevalence of CAC ≥100 among CT completers.</p><p><strong>Results: </strong>Of 8000 invited individuals, 2588 (32%) completed the questionnaire. Of 2375 eligible respondents, 814 were classified as high risk and 563 underwent CT imaging. Among CT completers, the mean predicted probability of CAC ≥100 was 28.3% (95% CI 27.2 to 29.3), compared with an observed prevalence of 28.4% (95% CI 24.8 to 32.4), corresponding to an expected/observed ratio of 0.99 and a Brier score of 0.19. Among participants with CAC ≥100, 64% were not receiving lipid-lowering therapy and 11% had low-density lipoprotein cholesterol ≤1.8 mmol/L.</p><p><strong>Conclusions: </strong>A self-report-guided strategy enabled targeted CAC imaging in a model-selected cohort. Among participants completing CT imaging, the observed prevalence of CAC ≥100 was comparable with the mean model-predicted probability. These findings suggest that self-report data may support preselection for CAC imaging and help identify opportunities for preventive treatment among individuals with elevated CAC.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016750","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":"Sex differences in early ventricular fibrillation among patients with fulminant myocarditis in a nationwide registry.","authors":"Keishi Moriwaki, Koshiro Kanaoka, Kenji Onoue, Yoshihiko Saito, Kaoru Dohi","doi":"10.1136/heartjnl-2026-328039","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328039","url":null,"abstract":"<p><strong>Background: </strong>Fulminant myocarditis is a rare but life-threatening condition frequently complicated by malignant ventricular arrhythmias. Data on sex differences in early ventricular fibrillation (VF) in fulminant presentation are limited.</p><p><strong>Methods: </strong>We conducted a retrospective nationwide multicentre cohort study using the Japanese Registry of Fulminant Myocarditis between 2012 and 2017. Fulminant presentation was defined as prodromal symptoms within 4 weeks and the need for catecholamines and/or mechanical circulatory support within 14 days of admission. The primary endpoint was VF within 30 days after admission. We estimated the 30-day cumulative incidence of VF and used Fine-Gray competing-risk regression (death as the competing event) to evaluate the association with sex.</p><p><strong>Results: </strong>Among 696 patients (40% female), VF within 30 days occurred in 120 (17%). Female patients had a higher 30-day incidence of VF than male patients (22% vs 14%; p=0.006). In multivariable complete-case analysis adjusting for age, left ventricular ejection fraction on admission, estimated glomerular filtration rate and peak creatine kinase, female sex was associated with 30-day VF (subdistribution HR, 1.58; 95% CI 1.09 to WHAT IS ALREADY KNOWN ON THIS TOPIC2.28; p=0.016). Ninety-day all-cause mortality was 36% in female patients and 34% in male patients (p=0.732).</p><p><strong>Conclusions: </strong>In a nationwide registry of fulminant myocarditis, female sex was associated with a higher risk of early VF, whereas there was no clear evidence of a sex difference in 90-day all-cause mortality. Incorporating sex into early risk assessment may help tailor acute monitoring and management strategies in this high-risk condition.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016776","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":"Women are not just lighter men: excess weight weighs heavier on the female heart.","authors":"Dominik Linz, Thomas Jespersen","doi":"10.1136/heartjnl-2026-328516","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328516","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001798","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":"European Infective Endocarditis (EURO-ENDO) score for predicting 30-day mortality in left-sided infective endocarditis.","authors":"Antonia Sambola, Jordi Lozano-Torres, Eric Boersma, Claudia Escabias, Lluis Admella, Chiara Pidone, Arwa Mehmood-Wahid, Victoria Delgado, Pau Rello, Eduard Ródenas-Alsina, Carmen Olmos, Julien Ternacle, Christophe Tribouilloy, Vlatka Reskovic Luksic, Jadranka Separovic-Hanzevacki, Seung-Woo Park, Sebastiaan C A M Bekkers, Kwan-Leung Chan, Abdallah Almaghraby, Bernard Iung, Patrizio Lancellotti, Gilbert Habib","doi":"10.1136/heartjnl-2026-328064","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328064","url":null,"abstract":"<p><strong>Background: </strong>A major challenge in managing left-sided infective endocarditis (LSIE) is identifying patients who will benefit from surgery including those with prohibitive operative risk. However, no widely validated models are currently available to estimate 30-day mortality early after the initial diagnostic evaluation in the broader LSIE population including patients managed without surgery. We aimed to develop and externally validate the European Infective Endocarditis (EURO-ENDO) risk score for predicting 30-day mortality in patients with LSIE.</p><p><strong>Methods: </strong>The prospective, multicentre European Society of Cardiology (ESC)-EURObservational Research Programme EURO-ENDO registry included 2171 patients with LSIE diagnosed according to ESC 2015 criteria. Clinical, biological, microbiological and imaging variables were analysed and a multivariable logistic regression model was developed. Internal validation was performed using bootstrap resampling. External validation was conducted in an independent temporal cohort of 377 consecutive patients with LSIE from two tertiary centres in Barcelona, Spain, recruited between 2019 and 2024.</p><p><strong>Results: </strong>Among 2140 registry patients included in the final analysis, 254 (11.9%) died within 30 days. Eleven variables were independently associated with 30-day mortality and included in the EURO-ENDO prediction model: previous stroke or transient ischaemic attack, previous cardiac surgery, heart failure or cardiogenic shock, creatinine >2 mg/dL, vegetations >10 mm, severe regurgitation, abscess, negative blood cultures, <i>Staphylococcus aureus</i> infection, absence of surgical indication and surgical indication without intention to operate. The model showed good discrimination and calibration (area under the receiver operating characteristic (AUROC) 0.763; Hosmer-Lemeshow p=0.825; Brier score 0.09). In the external validation cohort, 48/377 patients (12.7%) died; discrimination remained excellent (AUROC 0.799; 95% CI 0.730 to 0.868) with good calibration (slope 1.017; expected-to-observed ratio 1.124).</p><p><strong>Conclusions: </strong>The EURO-ENDO risk score, incorporating 11 variables available during the initial diagnostic evaluation, accurately predicts individualised 30-day mortality in patients with LSIE and showed consistent performance in both internal and external validation cohorts. This tool may support early risk stratification, multidisciplinary endocarditis team discussions and clinical decision-making (https://scoreei.web.app/score).</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001710","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}