Heart最新文献

{"title":"Mortality associated with moderate and severe mitral regurgitation in 608 570 men and women undergoing echocardiography.","authors":"David Playford, Simon Stewart, Sarah Ann Harris, Gregory Scalia, David S Celermajer, Liza Thomas, Elizabeth Davida Paratz, Yih-Kai Chan, Geoff Strange","doi":"10.1136/heartjnl-2024-324790","DOIUrl":"10.1136/heartjnl-2024-324790","url":null,"abstract":"<p><strong>Background: </strong>Although the prognostic implications of severe mitral regurgitation (MR) are well recognised, they are less clear in moderate MR. We therefore explored the prognostic impact of both moderate and severe MR within the large National Echocardiography Database Australia cohort.</p><p><strong>Methods: </strong>Echocardiography reports from 608 570 individuals were examined using natural language processing to identify MR severity and leaflet pathology. Atrial (aFMR) or ventricular (vFMR) functional MR was assessed in those without reported leaflet pathology. Using individual data linkage over median 1541 (IQR 820 to 2629) days, we examined the association between MR severity and all-cause (153 612/25.2% events) and cardiovascular-related mortality (47 840/7.9% events).</p><p><strong>Results: </strong>There were 319 808 men and 288 762 women aged 62.1±18.5 years, of whom 456 989 (75.1%), 102 950 (16.9%), 38 504 (6.3%) and 10 127 (1.7%) individuals had no/trivial, mild, moderate and severe MR, respectively, reported on their last echo. Compared with those with no/trivial MR (26.5% had leaflet pathology, 19.2% died), leaflet pathology (51.8% and 78.9%, respectively) and actual 5-year all-cause mortality (54.6% and 67.5%, respectively) increased with MR severity. On an adjusted basis (age, sex and leaflet pathology), long-term mortality was 1.67-fold (95% CI 1.65 to 1.70) and 2.36-fold (95% CI 2.30 to 2.42) higher in moderate and severe MR cases (p<0.001) compared with no/trivial MR. The prognostic pattern for moderate and severe MR persisted for cardiovascular-related mortality and within prespecified subgroups (leaflet pathology, vFMR or aFMR, and age<65 years).</p><p><strong>Conclusions: </strong>Within a large real-world clinical cohort, we confirm that conservatively managed severe MR is associated with a poor prognosis. We further reveal that moderate MR is associated with increased mortality, irrespective of underlying aetiology.</p><p><strong>Trial registration: </strong>Australian New Zealand Clinical Trials Registry (ACTRN12617001387314).</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"327-334"},"PeriodicalIF":5.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871937","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 disease-specific and all-cause mortality across socioeconomic status and lifestyles among patients with established cardiovascular disease in communities of China: data from a national population-based cohort.","authors":"Yunfeng Wang, Ke Peng, Wei Xu, Xin Huang, Xiaoying Liu, Yichong Li, Jiapeng Lu, Yang Yang, Bowang Chen, Yu Shi, Guiyuan Han, Xiaoyan Zhang, Jianlan Cui, Lijuan Song, Aoxi Tian, Wang Runsi, Chunqi Wang, Yuan Tian, Yi Wu, Chunying Lin, Wenyao Peng, Xi Li, Shengshou Hu","doi":"10.1136/heartjnl-2024-324766","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-324766","url":null,"abstract":"<p><strong>Background: </strong>Evidence of socioeconomic status (SES)-related health inequality is scarce in patients with cardiovascular diseases (CVDs) who need both lifestyle change and medical care, particularly in developing countries.</p><p><strong>Methods: </strong>The study employed a nationwide population-based cohort design, covering all 31 provinces of Chinese mainland from September 2014 to March 2021. Participants aged 35-75 years with self-reported CVD diagnoses were included. Information on SES and lifestyle details were collected via a questionnaire, and the unequal mortality across SES groups and the mediating effects of lifestyles were explored.</p><p><strong>Results: </strong>Among the 104 718 participants included, 27 943 (26.7%) were allocated to high SES, 35 802 (34.2%) were allocated to medium SES and 40 973 (39.1%) were allocated to low SES. During a mean follow-up of 48.9±18.9 months, 5010 deaths were recorded. Participants with low SES had a 65% (HR=1.65, 95% CI: 1.50 to 1.80) greater risk of all-cause death and a 95% (HR=1.95, 95% CI: 1.72 to 2.20) greater risk of CVD death in Chinese communities. A low SES with the worst lifestyle was associated with a significant increase in the risk of all-cause mortality by 172% (HR=2.72, 95% CI: 2.37 to 3.12) and CVD mortality by 218% (HR=3.18, 95% CI: 2.64 to 3.83) compared with a high SES with healthy lifestyle. The joint mediating effects of lifestyles on CVD mortality accounted for 19.6% (95%CI: 14.8% to 24.2%) of the excess mortality risk for individuals with low SES, and these effects varied by genders (p for interaction=0.013) and urbanity (p for interaction=0.004). Leisure-time physical activity was the strongest mediator, followed by dietary factors. For all-cause mortality, outcomes were similar to this.</p><p><strong>Conclusions: </strong>Both SES-related health inequalities and lifestyle disparities should be comprehensively considered when caring for this population, and upstream structural interventions that integrate SES and lifestyle factors and are tailored to the target population are urgently needed.</p><p><strong>Trial registration number: </strong>NCT02536456.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624392","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":"Retinal vascular fingerprints predict incident stroke: findings from the UK Biobank cohort study.","authors":"Mayinuer Yusufu, David S Friedman, Mengtian Kang, Ambhruni Padhye, Xianwen Shang, Lei Zhang, Danli Shi, Mingguang He","doi":"10.1136/heartjnl-2024-324705","DOIUrl":"10.1136/heartjnl-2024-324705","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the associations between a comprehensive set of retinal vascular parameters and incident stroke to unveil new associations and explore its predictive power for stroke risk.</p><p><strong>Methods: </strong>Retinal vascular parameters were extracted from the UK Biobank fundus images using the Retina-based Microvascular Health Assessment System. We used Cox regression analysis, adjusted for traditional risk factors, to examine the associations, with false discovery rate adjustment for multiple comparisons. Receiver operating characteristic (ROC) curves were used to assess their predictive values.</p><p><strong>Results: </strong>During a median follow-up of 12.5 years, 749 incident strokes occurred among 45 161 participants. The analysis identified 29 significant parameters associated with stroke risk, with a notable dominance of density parameters (over half). Each SD change in these parameters increased stroke risk by 9.8% to 19.0%. For identified calibre parameters, each SD change was associated with an increased risk (ranging from 10.1% to 14.1%). For identified complexity parameters and arterial inflection count tortuosity, each SD decrease was linked to an increased risk (ranging from 10.4% to 19.5%). The introduction of retinal vascular parameters improved the area under the ROC curve to 0.752, significantly outperforming the model using only traditional risk factors (0.739, p<0.001).</p><p><strong>Conclusions: </strong>Retinal vascular analysis, a non-invasive screening approach for stroke risk assessment, performed better than traditional risk stratification models. The 29 novel retinal indicators identified offer new avenues for stroke pathophysiology research.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"306-313"},"PeriodicalIF":5.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978279","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":"Myocardial infarction with non-obstructive coronary arteries: a journey beyond angiography.","authors":"Giovanni Occhipinti, Salvatore Brugaletta","doi":"10.1136/heartjnl-2024-325412","DOIUrl":"10.1136/heartjnl-2024-325412","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"287-288"},"PeriodicalIF":5.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004039","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":"Outcomes of tricuspid valve surgery in patients with significant tricuspid regurgitation and low to intermediate risk.","authors":"Seo-Yeon Gwak, Kyu Kim, Hyun-Jung Lee, Iksung Cho, Geu-Ru Hong, Jong-Won Ha, Chi Young Shim","doi":"10.1136/heartjnl-2024-324891","DOIUrl":"10.1136/heartjnl-2024-324891","url":null,"abstract":"<p><strong>Background: </strong>In patients with tricuspid regurgitation (TR), delayed surgical intervention is associated with poor outcomes, particularly in advanced stages. This study aimed to assess whether earlier tricuspid valve (TV) surgery provides a survival benefit in patients with moderate to severe TR who are considered at low to intermediate risk of adverse clinical or surgical outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study included 10 016 patients diagnosed with moderate to severe TR between 2008 and 2020. Patients were stratified using the the Tricuspid Regurgitation Impact on Outcomes (TRIO) Score (for general health risk) and TRI-SCORE (for perioperative risk). We focused on patients deemed at low or intermediate risk by these scores, comparing the all-cause mortality of those who underwent TV surgery to those managed medically.</p><p><strong>Results: </strong>Among 8874 patients categorised as low or intermediate risk, 871 (9.8%) underwent TV surgery. Patients in the surgical group were younger and had a higher prevalence of RV enlargement and RV dysfunction compared to those in the medical treatment group. During a mean follow-up of 5.2 years, surgical patients had a lower risk of death (HR 0.38, 95% CI 0.29 to 0.50) compared with medically managed patients after adjusting for confounders. This association persisted in patients who underwent isolated TV surgery. However, the potential for residual confounding in this non-randomised analysis should be considered.</p><p><strong>Conclusions: </strong>TV surgery was associated with higher survival rates in patients with moderate to severe TR and low to intermediate prognostic risk. However, the observational nature of the study means that uncontrolled confounding cannot be excluded. These findings warrant further investigation in randomised studies.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"321-326"},"PeriodicalIF":5.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846447","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":"Pathological findings at invasive assessment in MINOCA: a systematic review and meta-analysis.","authors":"Damiano Fedele, Daniele Cavallo, Francesca Bodega, Nicole Suma, Lisa Canton, Mariachiara Ciarlantini, Khrystyna Ryabenko, Sara Amicone, Virginia Marinelli, Claudio Asta, Giuseppe Pastore, Marcello Casuso Alvarez, Rebecca Belà, Angelo Sansonetti, Francesco Angeli, Matteo Armillotta, Alberto Foà, Luca Bergamaschi, Pasquale Paolisso, Marta Belmonte, Paola Rucci, Emanuele Barbato, Carmine Pizzi","doi":"10.1136/heartjnl-2024-324565","DOIUrl":"10.1136/heartjnl-2024-324565","url":null,"abstract":"<p><strong>Background: </strong>Pathological mechanisms of myocardial infarction with non-obstructive coronary arteries (MINOCA) are heterogeneous, with an unknown impact on prognosis, and often remain unrecognised in clinical practice. This study aimed to evaluate the prevalence and prognostic impact of pathological findings by invasive coronary angiography (ICA), optical coherence tomography (OCT), and coronary function testing in MINOCA.</p><p><strong>Methods: </strong>Studies published until August 2023 were searched on PubMed and SCOPUS and included if reporting the prevalence of patients with non-obstructive coronary arteries (NObs-CA; 1-49% coronary stenosis) versus normal coronary arteries (NCA; 0% coronary stenosis) by ICA, pathological findings by OCT, and/or coronary vasomotor tests in MINOCA. Newcastle-Ottawa Scale was used for quality assessment. The pooled prevalence of pathological findings was estimated with random-effects models. Pooled risk ratios (RRs) with 95% CIs of all-cause death, MI and the composite of both in patients with NObs-CA versus NCA were calculated at short-term (<1 month), 1-year and long-term follow-up (> 1 year).</p><p><strong>Results: </strong>Forty-five studies including 17 539 patients were analysed. The pooled prevalence of NObs-CA at ICA was 53% (95% CI 0.47 to 0.60). OCT showed acute pathological findings in 62% (95% CI 0.44 to 0.78) of patients and coronary vasomotor tests were positive in 49% (95% CI 0.31 to 0.67). NObs-CA compared with NCA was associated with an increased 1-year risk of all-cause death or MI (RR=1.49 (95% CI 1.17 to 1.90)) and MI alone (RR=1.80 (95% CI 1.26 to 2.59)), whereas the risk of all-cause death was comparable. Similar results were seen at long-term, but not at short-term follow-up.</p><p><strong>Conclusions: </strong>Stratification of MINOCA into NObs-CA versus NCA has prognostic value. OCT and vasospasm testing, often informative about the pathological mechanism of MINOCA, should be part of an invasive diagnostic algorithm.</p><p><strong>Prospero registration number: </strong>CRD42023468183.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"291-299"},"PeriodicalIF":5.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846451","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 disease burden and risk factor management in cancer survivors: insights into a multiethnic, socioeconomically deprived urban population.","authors":"Liliana Szabo, Jackie Cooper, Dorina-Gabriela Condurache, Isabel Dostal, Gracia Andriamiadana, Rohini Mathur, Fiona M Walter, Mamas A Mamas, Charlotte H Manisty, Nicholas C Harvey, Stefan Neubauer, Steffen E Petersen, John Robson, Zahra Raisi-Estabragh","doi":"10.1136/heartjnl-2024-325309","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325309","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease (CVD) burden and risk factor management among cancer survivors, especially in socioeconomically deprived, multiethnic populations, remain understudied. This study examines CVD burden and risk factor control in survivors of 20 cancer types within a diverse urban population.</p><p><strong>Methods: </strong>This matched cohort study used electronic health records from 127 urban primary care practices. Cancer survivors were matched to non-cancer comparators at a 1:4 ratio. Cancer and CVD diagnoses were defined using standard clinical code sets. Sociodemographic variables, lifestyle behaviours, blood pressure, cholesterol levels and statin prescriptions were analysed. Multivariable regression evaluated associations between cancer history, CVD prevalence and risk factor control.</p><p><strong>Results: </strong>The cohort included 18 839 cancer survivors (43% men, average age 64±15 years), with high ethnic diversity (48% White, 24% Black, 22% Asian) and high deprivation levels. Cancer survivors had elevated odds of all CVDs considered, independent of shared risk factors. Heart failure was more common in haematological (OR 2.12; 95% CI 1.44 to 3.09) and breast cancer survivors (OR 1.38; 95% CI 1.16 to 1.64). Patients with bladder (OR 1.50; 95% CI 1.20 to 1.87) and lung cancer (OR 1.44; 95% CI 1.09 to 1.87) had higher odds of ischaemic heart disease. Venous thromboembolism risk was highest in ovarian cancer (OR 5.72; 95% CI 3.54 to 9.32). Blood pressure control was slightly better in cancer survivors (OR 0.92; 95% CI 0.87 to 0.97), yet one in three patients did not meet guideline-directed targets. Statin use and cholesterol management were similar between survivors and controls, but disparities were observed within certain ethnic groups.</p><p><strong>Conclusion: </strong>Cancer survivors have an elevated risk of CVD, with variations by cancer type and ethnicity. Despite comparable or slightly better control of major risk factors, a significant proportion of cancer survivors do not achieve guideline-recommended targets, highlighting the need for optimised management strategies, particularly in high-risk subgroups.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624313","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 of incidentally detected mild to moderate ascending aortic dilation and risk factors for rapid progression in a Swedish middle-aged population.","authors":"David Kylhammar, Fredrik Nilsson, Petter Dyverfeldt, Filip Hammaréus, Lena Jonasson, Aleksandra Trzebiatowska-Krzynska, Marcus Lindenberger, Lennart Nilsson, Fredrik Nyström, Chiara Trenti, Jan Engvall, Eva Swahn","doi":"10.1136/heartjnl-2024-325409","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325409","url":null,"abstract":"<p><strong>Background: </strong>Thoracic aortic aneurysm is a life-threatening disease due to the risk for acute aortic syndromes, and subjects with dilated ascending aortas are recommended surveillance imaging to assess the need for preventive surgery. Our objectives were to investigate the progression of dilated ascending aortas and risk factors for rapid progression in a prospectively enrolled general population-based cohort of subjects aged 50-65 years.</p><p><strong>Methods: </strong>From the 5058 subjects prospectively enrolled in the general population-based Swedish CArdioPulmonary bioImage Study (SCAPIS) in Linköping, we followed all 74 subjects (22% female, mean age 59±4 years) with ascending aortic dilation (≥40 mm) identified by CT angiography, thoracic CT or transthoracic echocardiography. Office and home blood pressure (BP), pulse wave velocity, coronary artery calcification and carotid plaques were assessed at baseline. Transthoracic echocardiography was used to follow ascending aortic diameters over time.</p><p><strong>Results: </strong>Three subjects underwent acute or elective aortic repair before the first follow-up examination. Among the remaining subjects, the mean progression rate of ascending aortic diameter was 0.4 mm/year (range 0-1.8 mm/year) during a mean follow-up of 6.1±1.3 years. In 10 (14%) subjects, all men, no progression was seen. In multivariable analysis, higher 7-day home systolic BP was the only factor associated with faster progression rate.</p><p><strong>Conclusions: </strong>Progression of mild to moderate ascending aortic dilation was in general slow. Our findings emphasise the benefit of home BP measurements over office BP and underline the importance of BP control in subjects with a dilated ascending aorta.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624393","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":"Young adult presenting with recurrent dyspnoea.","authors":"Mei Han Ho, Boom Ting Kung, Michael Kang-Yin Lee","doi":"10.1136/heartjnl-2024-325405","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325405","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":"111 7","pages":"305-336"},"PeriodicalIF":5.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624394","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":"Reassessing the role of tricuspid valve surgery in the modern era.","authors":"Erwan Donal, Louis Gegout, Corentin Bourg","doi":"10.1136/heartjnl-2024-325476","DOIUrl":"10.1136/heartjnl-2024-325476","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"289-290"},"PeriodicalIF":5.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004059","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}