Heart最新文献

{"title":"N-terminal pro-B-type natriuretic peptide in atrial fibrillation: time to look beyond clinical risk scores, or not?","authors":"Thomas Salmon, Garry McDowell, Gregory Y H Lip","doi":"10.1136/heartjnl-2026-328868","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328868","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":"149001723","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":"Gut-brain-heart axis in congenital heart disease: emerging roles of the microbiome in cardiac physiology and neurodevelopment.","authors":"Sean T Kelleher, Dhrati Patangia, R Paul Ross, Adam James, Catherine Stanton, Colin J McMahon","doi":"10.1136/heartjnl-2026-328544","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328544","url":null,"abstract":"<p><p>Congenital heart disease (CHD) is increasingly recognised as a multisystem condition extending beyond structural cardiac abnormalities to include gastrointestinal, immunological and neurodevelopmental consequences. Although advances in surgical and intensive care have significantly improved survival, children with CHD remain at heightened risk for adverse neurodevelopmental outcomes, systemic inflammation and gastrointestinal morbidity. The gut microbiome plays a central role in immune regulation, metabolic homeostasis and brain development particularly during early life. Perturbations of the microbiome are common in infants with CHD due to altered gut perfusion, antibiotic exposure, feeding disruption and cardiopulmonary bypass (CPB). These changes may influence both cardiac recovery and neurodevelopment through interconnected gut-heart-brain signalling pathways. This review synthesises current evidence linking the gut microbiome to cardiac physiology and brain development in children with CHD, with particular emphasis on early-life vulnerability, perioperative factors and emerging translational insights. Understanding these interactions may inform future strategies to optimise long-term outcomes in this high-risk population.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982534","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":"Reframing transthyretin amyloidosis cardiomyopathy in the context of heart failure.","authors":"Jarred J Iacovelli, D W Wray, Spencer J Carter","doi":"10.1136/heartjnl-2026-328728","DOIUrl":"10.1136/heartjnl-2026-328728","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982563","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":"Discordance between N-terminal pro-B-type natriuretic peptide and left ventricular end-diastolic pressure in suspected heart failure with a preserved ejection fraction: implications for diagnosis and prognosis.","authors":"Gülmisal Güder, Stefan Störk, Stefan Frantz, Floran Sahiti, Assad Haneya, Katharina Huenges, Christine Friedrich, Oliver Riedel, Julia Buschenhenke, Simone Schulze, Jörg Strotmann","doi":"10.1136/heartjnl-2026-328688","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328688","url":null,"abstract":"<p><strong>Background: </strong>Diagnosing heart failure with preserved ejection fraction (HFpEF) remains challenging, as natriuretic peptides and resting haemodynamic measurements reflect complementary but incomplete aspects of myocardial stress and filling pressure.</p><p><strong>Methods: </strong>In this prospective all-comer cohort (UKSH-Trial registration number AZ-D412-/21), adults undergoing elective left heart catheterisation underwent simultaneous invasive left ventricular end-diastolic pressure (LVEDP) measurement and N-terminal pro-B-type natriuretic peptide (NT-proBNP) sampling. The H₂FPEF score was calculated in patients with preserved ejection fraction (≥50%), and those with intermediate or high probability were included. Patients were classified using guideline-recommended NT-proBNP thresholds and LVEDP ≥16 mm Hg into four groups: normal (Group 1), isolated LVEDP elevation (Group 2), isolated NT-proBNP elevation (Group 3) and combined elevation (Group 4). The primary endpoint was all-cause mortality, analysed using multivariable Cox models, including age, sex, renal dysfunction and H2FPEF risk category.</p><p><strong>Results: </strong>Among 514 participants (mean age 70 years, 49% women), group distribution was 29%, 14%, 28% and 29%. Discordance was common (42%). Clinical profiles aligned more closely with NT-proBNP than LVEDP. Compared with Group 1, adjusted mortality was not significantly higher in Group 2 (HR 1.34, 95% CI 0.45 to 4.02), whereas it was significantly higher in Group 3 (HR 2.26, 95% CI 1.02 to 5.01) and Group 4 (HR 3.33, 95% CI 1.54 to 7.20).</p><p><strong>Conclusions: </strong>NT-proBNP and LVEDP are frequently discordant and provide complementary prognostic information in suspected HFpEF. Mortality risk was highest when both were elevated and was also increased with isolated NT-proBNP elevation, whereas isolated LVEDP elevation was not associated with excess mortality. These findings support integrated biomarker-haemodynamic assessment and warrant prospective validation.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976703","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":"Elusive benefit of mineralocorticoid receptor antagonists in transthyretin cardiac amyloidosis: where do we stand?","authors":"Matteo Serenelli, Anna Cantone","doi":"10.1136/heartjnl-2026-328899","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328899","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976717","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":"Haemodynamic response to exercise in patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction.","authors":"Helga Lillian Gudmundsdottir, Anna Axelsson Raja, Kasper Rossing, Hanne Rasmusen, Martin Snoer, Lars Juul Andersen, Rikke Gottlieb, Alex Hørby Christensen, Henning Bundgaard, Emil Wolsk, Christian Hassager, Finn Gustafsson, Jens Jakob Thune","doi":"10.1136/heartjnl-2025-326193","DOIUrl":"10.1136/heartjnl-2025-326193","url":null,"abstract":"<p><strong>Background: </strong>Dyspnoea and reduced exercise capacity are common features in hypertrophic cardiomyopathy (HCM) without left ventricular outflow tract (LVOT) obstruction, yet the haemodynamic mechanisms contributing to these symptoms are poorly described. This study aimed to characterise the haemodynamic response to exercise in patients with HCM without LVOT obstruction.</p><p><strong>Methods: </strong>In this observational study, 121 subjects underwent right heart catheterisation with haemodynamic measurements during rest and supine incremental exercise: 59 patients with HCM without LVOT obstruction (58±12 years) and 62 healthy controls (49±17 years). Left ventricular (LV) filling pressure was assessed as pulmonary capillary wedge pressure (PCWP) and compared with diagnostic thresholds (rest: <15 mm Hg; exercise: <25 mm Hg). Group comparisons were performed using Student's t-tests or Wilcoxon rank-sum tests, as appropriate RESULTS: At rest, patients had higher PCWP than controls (14±6 vs 9±2 mm Hg, p<0.001), while other haemodynamic parameters were similar. Already at mild exercise (25 W), patients showed elevated PCWP (27±7 vs 16±7 mm Hg, p<0.001), mean arterial pressure (100±18 vs 93±13 mm Hg, p=0.02), central venous pressure (12±6 vs 9±4 mm Hg, p<0.001) and mean pulmonary artery pressure (38±11 vs 26±8 mm Hg, p<0.001). At peak exercise, patients exhibited higher PCWP (32±8 vs 18±8 mm Hg, p<0.001), with lower cardiac index (6.4±1.8 vs 8.9±1.4 L/min/m², p<0.001), heart rate (114±21 vs 132±19 bpm, p<0.001) and arteriovenous oxygen difference (58±13 vs 64±6%, p=0.004). Peak exercise capacity (119±50 vs 149±40 W, p<0.001) and peak oxygen consumption (21±7 vs 35±8 mL/kg/min, p<0.001) were lower in patients. Abnormal PCWP was found in 68% of patients at mild exercise and 85% at peak, compared with 6% of controls at mild exercise and 24% at peak. PCWP at mild exercise was inversely correlated with peak oxygen consumption in patients (r=-0.61; 95% CI -0.7 to -0.4; p<0.001).</p><p><strong>Conclusion: </strong>Patients with HCM without LVOT obstruction exhibited significant haemodynamic impairments during exercise. Abnormally elevated LV filling pressures were present even at low workloads and were correlated with reduced exercise capacity.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"1098-1106"},"PeriodicalIF":4.4,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760706","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":"Puzzling oscillating electrocardiogram in a patient with dyspnoea.","authors":"Massimo Mapelli, Martina Virili, Matteo Marchese","doi":"10.1136/heartjnl-2026-328406","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328406","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":"112 19","pages":"1107-1108"},"PeriodicalIF":4.4,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944680","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":"Association of high-sensitivity cardiac troponin I levels below the sex-specific 99th percentile with late-life dementia: the Perth Longitudinal Study of Ageing Women.","authors":"Carlos J Toro-Huamanchumo, Abadi Kahsu Gebre, Tiago Pecanha, Craig Sale, Wai Lim, Elizabeth Byrnes, Ee Mun Lim, Simon Laws, Kun Zhu, Carl Schultz, Richard L Prince, Blossom Cm Stephan, Mario Siervo, Joshua R Lewis, Marc Sim","doi":"10.1136/heartjnl-2025-326066","DOIUrl":"10.1136/heartjnl-2025-326066","url":null,"abstract":"<p><strong>Background: </strong>Elevated high-sensitivity cardiac troponin (hs-cTn) levels are linked with cardiovascular disease and cognitive impairment, both of which are strong risk factors for late-life dementia (LLD). This study examined the association between hs-cTnI levels below the sex-specific 99th percentile for myocardial injury and the incidence of LLD in older women.</p><p><strong>Methods: </strong>986 community-dwelling women aged ≥70 years without prior LLD and with hs-cTnI <15.6 ng/L (stratified into quartiles) were included from the Perth Longitudinal Study of Ageing Women. The primary outcome was incident LLD events, including LLD hospitalisation or death, over 14.5 years obtained from linked health records. Associations between hs-cTnI and LLD outcomes were explored using multivariable-adjusted Cox models, as part of restricted cubic splines.</p><p><strong>Results: </strong>At baseline, participants' mean (±SD) age was 75.2±2.7 years. Over 14.5 years of follow-up, LLD events (n=174, 17.7%), hospitalisations (n=155, 15.7%) and deaths (n=68, 6.9%) were recorded. Compared with those in the lowest quartile (Q1, median 3.1 ng/L), women in the highest quartile of hs-cTnI (Q4, median 7.3 ng/L) had a greater risk of developing LLD-related events (adjusted HR: 1.88, 95% CI: 1.22 to 2.91), hospitalisation (adjusted HR: 1.65, 95% CI: 1.04 to 2.64) and death (adjusted HR: 2.27, 95% CI: 1.13 to 4.59), after adjusting for established cardiovascular and dementia risk factors, including apolipoprotein E (<i>APOE</i>) genotype.</p><p><strong>Conclusion: </strong>Among older women, hs-cTnI levels below the sex-specific 99th percentile for myocardial injury were associated with an increased risk of LLD events over 14.5 years. These findings suggest that hs-cTnI may identify older women at higher risk of LLD, capturing both cardiovascular and brain health vulnerability in older age.</p><p><strong>Trial registration number: </strong>ACTRN12617000640303.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"1081-1087"},"PeriodicalIF":4.4,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882796","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":"Prehospital risk stratification in suspected non-ST-segment elevation acute coronary syndrome with point-of-care troponin: an individual patient data meta-analysis.","authors":"Jesse Demandt, Dennis Sagel, Cyril Camaro, Veerle A E van Hattem, Simon A Mahler, Jamie Cooper, Rudolf Tolsma, Marion Fokkert, Aysun Cetinyurek-Yavuz, Anna C Snavely, Lorna A A Donaldson, Pim van der Harst, Arnoud van 't Hof, Niels van Royen, Marcel van 't Veer, Pieter J Vlaar","doi":"10.1136/heartjnl-2025-326922","DOIUrl":"10.1136/heartjnl-2025-326922","url":null,"abstract":"<p><strong>Background: </strong>Emergency Medical Services (EMS) patients with chest pain are often suspected of having non-ST-elevation acute coronary syndrome (NSTE-ACS). Current risk stratification protocols for NSTE-ACS have limitations, leading to a lack of a well-organised prehospital diagnostic pathway. Recent studies have demonstrated that using clinical risk scores (CRS) including point-of-care (POC)-troponin in the EMS can improve prehospital diagnostic pathways for suspected NSTE-ACS. The primary aim of this systematic review and individual patient data meta-analysis was to assess safety of low-risk stratification for suspected NSTE-ACS patients in the prehospital setting.</p><p><strong>Methods: </strong>Prospective studies using CRS or POC-troponin for risk stratification in suspected NSTE-ACS patients within the EMS setting were included. Safety was assessed using sensitivity and negative predictive value (NPV) for patients identified as low risk, based on CRS or POC-troponin measurement, for three different endpoints within 30 days: (1) all-cause mortality, (2) composite of mortality and/or acute myocardial infarction (AMI), (3) major adverse cardiac events (MACE).</p><p><strong>Results: </strong>Of 1526 articles screened, 6 were included, comprising 5.239 patients, and all utilised CRS derived from the History, ECG, Age, Risk-factor and Troponin (HEART) score. The summary of low-risk CRS diagnostic performance predicted all-cause mortality with a sensitivity of 93.2% (83.5-98.1) and NPV of 99.8% (99.5-99.9); mortality and/or AMI with a sensitivity of 91.8% (83.0-96.2) and an NPV of 97.3% (89.9-99.3); and MACE with a sensitivity of 92.8% (88.7-95.5) and an NPV of 97.2% (92.1-99.0). Lowering the CRS cut-off value for identifying low-risk patients increased sensitivity and NPV but decreased the proportion of patients classified as low risk.</p><p><strong>Conclusion: </strong>In well-trained EMS systems, where prompt and accurate follow-up of low-risk patients is possible, HEART-derived CRS effectively identify patients with a very low risk of 30-day mortality and MACE. However, implementation in other healthcare systems requires additional validation, given the variations in healthcare structure, risk stratification processes and follow-up capabilities.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"1055-1062"},"PeriodicalIF":4.4,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892340","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":"Comprehensive risk factor analysis of sick sinus syndrome: a genetic, sociodemographic, clinical and laboratory investigation using the UK Biobank data.","authors":"Hong-Ju Kim, Pil-Sung Yang, Hanjin Park, Daehoon Kim, Han-Joon Bae, Chan-Hee Lee, Jang-Won Son, Ung Kim, Boyoung Joung","doi":"10.1136/heartjnl-2025-327272","DOIUrl":"10.1136/heartjnl-2025-327272","url":null,"abstract":"<p><strong>Background: </strong>Sinoatrial node dysfunction and atrial fibrillation (AF) often coexist, and each potentially initiates or perpetuates the other. Consequently, genetic risk factors for AF may be associated with sick sinus syndrome (SSS). This study evaluated clinical, sociodemographic, laboratory and genetic factors in predicting the SSS incidence by using a polygenic risk score (PRS) for AF, given the absence of a dedicated PRS for SSS.</p><p><strong>Methods: </strong>A total of 502 421 individuals aged 38-73 years across 22 centres from 2006 to 2010 were enrolled in the UK Biobank. After those with incomplete data, prior AF or valvular disease were excluded, 405 869 participants (median age 58.0 (IQR, 50.0-64.0) years; 213 684 (45.2%) male) were analysed. AF PRS categorised the participants into low (first quintile), intermediate (middle three quintiles) and high (fifth quintile) risks. SSS incidence was recorded, and associations were evaluated using Cox regression with sociodemographic, clinical, laboratory and genetic variables.</p><p><strong>Results: </strong>During the median follow-up of 11.9 years, 769 SSS events occurred. Their incidence increased with age (HR 1.52, 95% CI 1.43 to 1.62 per 5 years), male sex (HR 1.39, 95% CI 1.03 to 1.88), prior myocardial infarction (HR 1.54, 95% CI 1.08 to 2.21) and hypertension (HR 1.21, 95% CI 1.02 to 1.42). The high-PRS and intermediate-PRS groups were related to 82% (HR 1.82, 95% CI 1.45 to 2.29) and 32% (HR 1.32, 95% CI 1.07 to 1.62) higher SSS risks, respectively. Cystatin C (HR 1.71, 95% CI 1.33 to 2.22) was also associated with the increased risk. The model's C-index was 0.752 with sociodemographic and clinical variables, but it increased to 0.760 with genetic and biomarker data.</p><p><strong>Conclusion: </strong>In addition to sociodemographic and clinical risk factors, AF PRS and cystatin C were linked to the SSS incidence. Although their inclusion modestly improved prediction, these findings highlighted the potential of integrating genetic and biomarker information for comprehensive SSS risk assessments.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":"112 19","pages":"1074-1080"},"PeriodicalIF":4.4,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944738","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}