Heart最新文献

{"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":"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":"904-909"},"PeriodicalIF":4.4,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12505057/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benefit-risk of colchicine and spironolactone in acute myocardial infarction: a prespecified generalised pairwise comparisons analysis of the CLEAR trial.","authors":"Marc-André d'Entremont, Sanjit S Jolly, Faisal Alharthi, Binita Shah, David Austin, Quilong Yi, Robert F Storey, Matthias Bossard, Jan Cornel, Jeroen Jaspers Focks, Sasko Kedev, Valon Asani, Goran Stankovic, Michael Tsang, Nicholas Valettas, Jessica Tyrwhitt, Jackie Betz, Shun Fu Lee, Rajibul Mian, Johanne Silvain, Farzin Beygui, Andrew Czarnecki, Payam Dehghani, Warren Cantor, Shahar Lavi, James C Spratt, Emilie P Belley-Côté, John W Eikelboom","doi":"10.1136/heartjnl-2025-326218","DOIUrl":"10.1136/heartjnl-2025-326218","url":null,"abstract":"<p><strong>Background: </strong>Composite outcomes in cardiovascular trials often group events of unequal clinical importance, and conventional analyses may obscure treatment trade-offs. Generalised pairwise comparisons (GPC), expressed as a win ratio (WR), allow for hierarchical ranking of events and incorporation of recurrent outcomes, providing a potentially more intuitive assessment of benefit-risk.</p><p><strong>Methods: </strong>In a prespecified exploratory analysis of the 2×2 factorial, randomised CLEAR (Colchicine and Spironolactone in Patients with Myocardial Infarction) trial (7062 patients within 72 hours of acute myocardial infarction (MI) and percutaneous coronary intervention), we applied both time-to-first and recurrent-event GPC to reassess low-dose colchicine (0.5 mg daily) and spironolactone (25 mg daily) versus placebo. For the colchicine comparison, the hierarchical benefit-risk outcome included all-cause death, stroke, recurrent MI, unplanned ischaemia-driven revascularisation, serious infection or diarrhoea. For the spironolactone comparison, the outcome included all-cause death, stroke, MI, new or worsening heart failure, significant ventricular arrhythmia, hyperkalaemia or gynaecomastia/gynaecodynia. GPC results were compared with Cox, logistic and Andersen-Gill models.</p><p><strong>Results: </strong>For colchicine, the time-to-first event GPC showed a 12% lower proportional win rate compared with placebo (WR 0.88, 95% CI 0.79 to 0.98; win difference -2.10%, 95% CI -3.84 to -0.37), driven largely by excess diarrhoea. For spironolactone, patients experienced a 14% lower win rate (WR 0.86, 95% CI 0.75 to 0.99; win difference -1.46%, 95% CI -2.84% to -0.08%), largely attributable to gynaecomastia and hyperkalaemia. Conventional statistical approaches yielded concordant results. Across both interventions, higher-order efficacy outcomes (death, MI, stroke, heart failure) showed no benefit.</p><p><strong>Conclusions: </strong>In patients with post-MI, both low-dose colchicine and spironolactone demonstrated disadvantageous benefit-risk profiles, reinforcing that neither agent should be used routinely. This prespecified application of GPC provided results consistent with traditional methods but offered a clinically intuitive framework for interpreting composite outcomes.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000476","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":"Vascular endothelial growth factor inhibitor-induced cardiotoxicity: prospective multimodality assessment incorporating cardiovascular magnetic resonance imaging.","authors":"Stephen J H Dobbin, Kenneth Mangion, Colin Berry, Giles Roditi, Susmita Basak, John D McClure, Katriona Brooksbank, Piotr Sonecki, Steven Sourbron, Jeff Evans, Jeff White, Paul Welsh, Elaine Butler, Balaji Venugopal, Rhian M Touyz, Robert J Jones, Mark C Petrie, Ninian N Lang","doi":"10.1136/heartjnl-2024-325535","DOIUrl":"10.1136/heartjnl-2024-325535","url":null,"abstract":"<p><strong>Background: </strong>Vascular endothelial growth factor inhibitors (VEGFIs) are effective anticancer agents, but are associated with cancer therapy-related cardiac dysfunction (CTRCD) and hypertension. The timing, frequency and magnitude of these toxicities are poorly defined. The objective of this study is therefore to investigate the incidence, time course and mechanisms of VEGFI-associated CTRCD and hypertension.</p><p><strong>Methods: </strong>Patients commencing VEGFI underwent blood pressure (BP) monitoring, echocardiography and cardiac biomarker measurement at baseline and prospectively over 24 weeks. Serial adenosine stress perfusion cardiovascular MRI (CMR) was performed in a substudy. CTRCD was defined as left ventricular ejection fraction (LVEF) decline by ≥10 percentage points from baseline to a value <50%.</p><p><strong>Results: </strong>78 patients participated (68% men; age 63±11 years). 15 patients (19%) developed CTRCD, and it was evident at 4 weeks in 93% of cases. Overall, LVEF was 4.2% (95% CI: -6.2% to -2.3%, p<0.001) lower than baseline at 4 weeks. At 4 weeks, N-terminal pro-brain natriuretic peptide, but not troponin, was higher in patients with CTRCD. 62 (77%) patients developed hypertension. Home systolic and diastolic BP increased by 7.2 mm Hg (4.7-9.8, p<0.001) and 4.8 mm Hg (3.1-6.5, p<0.001), respectively, at 1 week. There was no association between change in LVEF and BP.CMR-derived LVEF, T1 relaxation times and resting myocardial blood flow (n=46) were 5.2% (-7.3% to -3.1%, p<0.001), 27 ms (-40 to -14, p<0.001) and 14.7 mL/100mL/min (-24.2 to -5.1, p=0.004), respectively, lower at 4 weeks.</p><p><strong>Conclusion: </strong>VEGFI-associated CTRCD is frequent and occurs early. This finding has implications for prioritising early cardiac imaging follow-up after commencing treatment. Underlying mechanisms include myocardial and microvascular effects that are at least partly independent of hypertension.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"925-932"},"PeriodicalIF":4.4,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12505041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779747","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 12-lead ECG and outcomes in acute coronary syndrome.","authors":"Timothy John Driscoll, Sarah Black, Glenn Davies, Chris P Gale, Lucia Gavalova, Mary Halter, Chelsey Hughes, Scott Munro, Nigel Rees, Andy Rosser, Helen Snooks, Alan Watkins, Clive Weston, Tom Quinn","doi":"10.1136/heartjnl-2025-325780","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-325780","url":null,"abstract":"<p><strong>Importance/background: </strong>The 12-lead ECG is recommended in clinical guidelines for prehospital assessment of patients with suspected acute coronary syndrome (ACS) presenting to Emergency Medical Services (EMS).</p><p><strong>Objectives: </strong>To determine prehospital ECG (PHECG) utilisation since UK national rollout of primary percutaneous coronary intervention, and whether this is associated with clinical outcomes in patients with ACS.</p><p><strong>Design: </strong>Population-based, linked cohort study using Myocardial Ischaemia National Audit Project data from 1 January 2010 to 31 December 2017, related to patients with ACS conveyed by the EMS to hospital in England and Wales.</p><p><strong>Exposure: </strong>PHECG administration.</p><p><strong>Outcomes: </strong>Proportion of patients where PHECG was recorded, 30-day and 1 year all-cause mortality, use of reperfusion.</p><p><strong>Results: </strong>Of 330 713 eligible patients transferred by EMS, 263 420 patients (79.7%) had PHECG recorded, steadily increasing from 74.2% in 2010 to 85.0% in 2017. Patients who received PHECG were generally younger than those who did not (median age: 70 years vs 75 years), less likely to be female (32.8% vs 41.9%) or to have comorbidities such as diabetes (20.8% vs 24.7%) or peripheral vascular disease (4.1% vs 4.8%). Patients who received PHECG had lower mortality at 30 days (7.1% vs 10.9%), with adjusted OR 0.77 (95% CI 0.75 to 0.80), and at 1 year (14.2% vs 23.2%), with adjusted OR 0.69 (95% CI 0.68 to 0.71). Adjustment accommodated demographic characteristics, comorbidities and medical history. Reperfusion was more frequent in patients with ST-elevation myocardial infarction (STEMI) receiving PHECG (84.5% vs 54.7%) with adjusted OR 4.37 (95% CI 4.20 to 4.54), with similar adjustment.</p><p><strong>Conclusions: </strong>Use of PHECG by EMS for patients with ACS is associated with lower short-term mortality and higher odds of receiving reperfusion for STEMI patients. Administration of PHECG increased steadily over time, but at the end of the study, still 15% of eligible patients did not receive a PHECG.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033092","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":"Individual hearts: computational models for improved management of cardiovascular disease.","authors":"Nick van Osta, Tim van Loon, Joost Lumens","doi":"10.1136/heartjnl-2024-324177","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-324177","url":null,"abstract":"<p><p>Cardiovascular disease remains a leading cause of morbidity and mortality worldwide, with conventional management often applying standardised approaches that struggle to address individual variability in increasingly complex patient populations. Computational models, both knowledge-driven and data-driven, have the potential to reshape cardiovascular medicine by offering innovative tools that integrate patient-specific information with physiological understanding or statistical inference to generate insights beyond conventional diagnostics. This review traces how computational modelling has evolved from theoretical research tools into clinical decision support systems that enable personalised cardiovascular care. We examine this evolution across three key domains: enhancing diagnostic accuracy through improved measurement techniques, deepening mechanistic insights into cardiovascular pathophysiology and enabling precision medicine through patient-specific simulations. The review covers the complementary strengths of data-driven approaches, which identify patterns in large clinical datasets, and knowledge-driven models, which simulate cardiovascular processes based on established biophysical principles. Applications range from artificial intelligence-guided measurements and model-informed diagnostics to digital twins that enable in silico testing of therapeutic interventions in the digital replicas of individual hearts. This review outlines the main types of cardiovascular modelling, highlighting their strengths, limitations and complementary potential through current clinical and research applications. We also discuss future directions, emphasising the need for interdisciplinary collaboration, pragmatic model design and integration of hybrid approaches. While progress is promising, challenges remain in validation, regulatory approval and clinical workflow integration. With continued development and thoughtful implementation, computational models hold the potential to enable more informed decision-making and advance truly personalised cardiovascular care.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032639","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":"Off-label underdosing of edoxaban antithrombotic therapy for patients with atrial fibrillation and stable coronary artery disease: findings from the EPIC-CAD trial.","authors":"Min Soo Cho, Do-Yoon Kang, Jung-Bok Lee, Yong-Seog Oh, Chang Hoon Lee, Eue-Keun Choi, Ji Hyun Lee, Chang Hee Kwon, Gyung-Min Park, Hyung Oh Choi, Kyoung-Ha Park, Kyoung-Min Park, Jongmin Hwang, Ki-Dong Yoo, Young Rak Cho, Ji-Hyun Kim, Ki Won Hwang, Eun Sun Jin, Osung Kwon, Ki-Hun Kim, Duk-Woo Park, Gi-Byoung Nam","doi":"10.1136/heartjnl-2025-326646","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326646","url":null,"abstract":"<p><strong>Objective: </strong>The impact of off-label underdosing of direct oral anticoagulants (DOACs) on clinical outcomes in patients with atrial fibrillation (AF) and stable coronary artery disease (CAD) remains unclear.</p><p><strong>Methods: </strong>The EPIC-CAD trial (Edoxaban vs Edoxaban with antiPlatelet agent In patients with atrial fibrillation and Chronic stable Coronary Artery Disease) randomised patients with AF and stable CAD to receive either edoxaban monotherapy or dual antithrombotic therapy (edoxaban plus single antiplatelet agent). Off-label underdosing was defined as low-dose edoxaban (30 mg once daily) without standard criteria for dose reduction. The primary outcome was a composite of death, myocardial infarction, stroke, systemic embolism, unplanned revascularisation and major or clinically relevant non-major bleeding at 12 months.</p><p><strong>Results: </strong>Among the 1040 randomised patients, 694 patients (66.7%) without dose-reduction criteria were included; of whom, 121 patients (17.4%) received edoxaban underdosing. At 12 months, the incidence of primary outcome was similar between standard-dose and under-dose edoxaban groups (10.5% vs 9.2%, adjusted HR 0.77, 95% CI 0.39 to 1.54). There was no significant difference in major ischaemic events (1.4% vs 1.7%, HR 1.14, 95% CI 0.22 to 5.91) and major or clinically relevant non-major bleeding (9.0% vs 8.4%, HR 0.87, 95% CI 0.42 to 1.78). Regardless of edoxaban underdosing, edoxaban monotherapy was associated with lower risk of primary net-clinical outcomes and bleeding compared with dual antithrombotic therapy.</p><p><strong>Conclusions: </strong>In patients with AF and stable CAD, there was no significant difference in the rate of primary outcome between off-label underdose and standard-dose edoxaban. The benefit of edoxaban monotherapy over dual antithrombotic therapy was consistent regardless of edoxaban underdosing. However, given the analyses were underpowered and the CI was wide, the results cannot be considered clinically directive.</p><p><strong>Trial registration number: </strong>URL: https://www.</p><p><strong>Clinicaltrials: </strong>gov; unique identifiers: NCT03718559.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032973","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":"Effect of an integrated care model on ST-segment elevation myocardial infarction management in China: a prospective, multicentre, non-randomised controlled study.","authors":"Yong Liu, Jin Liu, Yan Liang, Jianfeng Ye, Yunzhao Hu, Liling Chen, Shaohong Dong, Xiaoyu Huang, Mingcai Song, Ruilin Meng, Xueyan Zheng, Yibo He, Jing Zhang, Xuejun Yin, Shiqun Chen, Ning Tan, Maoyi Tian, Jiyan Chen","doi":"10.1136/heartjnl-2024-324155","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-324155","url":null,"abstract":"<p><strong>Background: </strong>Early reperfusion therapy is critical in patients with ST-segment elevation myocardial infarction (STEMI). However, limitations in resources and patient-level and system-level barriers delay the administration of reperfusion therapy. This study evaluated the impact of an integrated care strategy for STEMI management in China.</p><p><strong>Methods: </strong>This prospective, multicentre, non-randomised controlled study consecutively enrolled patients with acute STEMI, who were admitted to eight tertiary hospitals in different regions of China (August 2015-February 2019). An integrated care model was used in four hospitals (intervention). This model mainly included regular community public education, skills training for the diagnosis and treatment of STEMI in percutaneous coronary intervention-incapable centres, referral system improvement and optimal green channel for primary percutaneous coronary intervention-capable centres. In the other four hospitals (control), usual care of acute myocardial infarction public management and medical health service was provided. The primary outcome was the proportion of patients receiving symptom-to-reperfusion within 12 hours.</p><p><strong>Results: </strong>A total of 6817 patients with acute STEMI were analysed (age (mean±SD): 61±13 years; female: n=1242 (18.2%)). Of those, 2452 and 4365 patients were included in the intervention and control groups, respectively. Between 2015 and 2019, the rates of symptom-to-reperfusion within 12 hours and symptom-to-admission within 12 hours increased in the intervention group (from 65.3% to 91.4%; and from 74.2% to 96.4%, respectively; Ptrend=0.015 for both). In addition, there was no significant difference in door-to-balloon time within 90 min observed among the two groups (adjusted relative risk=0.96, 95% CI: 0.89 to 1.02; p=0.18). Moreover, the rates of in-hospital mortality and major adverse cardiac events exhibited a nearly onefold decrease in the intervention group versus the control group (p<0.001).</p><p><strong>Conclusions: </strong>Use of an integrated care model focusing on prehospital delay may increase the rate of timely treatment in areas with limited medical resources in China.</p><p><strong>Trial registration number: </strong>NCT03928119.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032664","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":"Severity of mobility limitation and adverse outcomes in heart failure.","authors":"Kotaro Iwatsu, Kensuke Takabayashi, Tomoyuki Hamada, Toru Kubo, Tsutomu Ikeda, Shoji Kitaguchi, Tetsuhisa Kitamura, Takeshi Kimura, Hiroaki Kitaoka, Ryuji Nohara","doi":"10.1136/heartjnl-2024-325120","DOIUrl":"10.1136/heartjnl-2024-325120","url":null,"abstract":"<p><strong>Background: </strong>Mobility limitation is prevalent in patients with heart failure (HF), but the dose-response relationship between its severity and adverse outcomes remains unquantified.</p><p><strong>Methods: </strong>We conducted a patient-level pooled analysis of two prospective Japanese cohort studies, including 2103 hospitalised patients with HF with no exclusion criteria. Mobility limitation at discharge was categorised into four levels: category I (independent outdoor walking), category II (indoor independence but requiring outdoor assistance), category III (requiring indoor assistance) and category IV (unable to walk). The primary endpoint was a 2-year composite of HF rehospitalisation or all-cause mortality. Adjusted analyses accounted for age, sex, comorbidities, biomarkers and medications.</p><p><strong>Results: </strong>Among 2820.7 person-years of follow-up, 998 composite outcomes occurred. Incidence rates per 100 person-years for the primary outcome increased with mobility limitation severity: 24.9 (category I), 47.0 (II), 59.3 (III) and 84.8 (IV) (p for trend <0.001). Adjusted HRs (95% CI) using category I as reference were 1.22 (95% CI 1.04 to 1.45) for II, 1.39 (95% CI 1.11 to 1.73) for III and 1.71 (95% CI 1.34 to 2.20) for IV. While the graded association was clear for mortality, it was less evident for HF rehospitalisation alone, likely reflecting competing mortality risks.</p><p><strong>Conclusions: </strong>This study demonstrates a strong and graded association between mobility limitation severity and adverse outcomes in HF, suggesting its utility for refined risk stratification.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325308","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":"Prognostic value of leaflet coaptation gap in transcatheter edge-to-edge repair for functional mitral regurgitation.","authors":"Naoki Nishiura, Shunsuke Kubo, Sachiyo Ono, Kazunori Mushiake, Kohei Osakada, Takeshi Maruo, Kazushige Kadota, Masanori Yamamoto, Mike Saji, Yuki Izumi, Masahiko Asami, Yusuke Enta, Shinichi Shirai, Masaki Izumo, Shingo Mizuno, Yusuke Watanabe, Makoto Amaki, Kazuhisa Kodama, Junichi Yamaguchi, Toru Naganuma, Hiroki Bota, Yohei Ohno, Daisuke Hachinohe, Masahiro Yamawaki, Hiroshi Ueno, Kazuki Mizutani, Toshiaki Otsuka, Kentaro Hayashida","doi":"10.1136/heartjnl-2024-325585","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325585","url":null,"abstract":"<p><strong>Background: </strong>Coaptation gap (CG) is one of the challenging anatomies of mitral transcatheter edge-to-edge repair (TEER), but its impact on patient outcomes is unclear. This study aimed to evaluate the impact of CG on procedural and clinical outcomes in patients with functional mitral regurgitation (MR).</p><p><strong>Methods: </strong>Data from 2140 patients undergoing TEER for functional MR were analysed, focusing on the presence of CG, which is a missing leaflet coaptation between the anterior and posterior leaflets during systole. The primary outcome was a composite of death, heart failure hospitalisation and mitral valve reintervention.</p><p><strong>Results: </strong>Of the 2140 patients, 219 (10%) had CG and 1921 (90%) did not, as assessed by baseline transoesophageal echocardiography. In patients with CG, baseline MR grade and New York Heart Association (NYHA) functional class were more severe, and long/wide clip types were used more frequently. Post-TEER, patients with CG had significantly lower achievement of MR grade ≤2+ (93%) and ≤1+ (65%) compared with patients without CG (97%, p<0.01; 82%, p<0.01, respectively). NYHA functional class at 1 year was similar in both groups. The cumulative incidence of the primary outcome was comparable between CG and non-CG groups (51% vs 53% at 3 years, p=0.71). While residual MR grade 2+ was associated with the higher primary outcome incidence compared with ≤1+ in patients without CG (p<0.01), no significant difference was found in patients with CG (p=0.51).</p><p><strong>Conclusion: </strong>CG was associated with less MR reduction but with no clear difference in adverse clinical outcomes after TEER. Similar outcomes between residual MR grade 2+ and ≤1+ in CG patients highlight the importance of procedural endpoint in anatomically challenging cases.</p><p><strong>Trial registration number: </strong>UMIN000023653.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023190","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":"Clinical predictors and prognostic impact of left ventricular thrombus recurrence.","authors":"Aloysius Sheng-Ting Leow, Christopher Junyan Low, Fang-Qin Goh, Andre Wen-Jie Seah, Benjamin Yong-Qiang Tan, William K F Kong, Kian-Keong Poh, Mark Y Chan, Leonard L L Yeo, Ping Chai, Tiong-Cheng Yeo, Xin Zhou, Gregory Y H Lip, Ching-Hui Sia","doi":"10.1136/heartjnl-2025-326486","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326486","url":null,"abstract":"<p><strong>Background: </strong>There is limited contemporary data available on the subject of left ventricular thrombus (LVT) recurrence. This study aimed to evaluate the incidence, outcomes and predictors of patients with LVT recurrence after resolution.</p><p><strong>Methods: </strong>This was a retrospective cohort study involving 346 patients with resolved LVT at baseline, derived from an echocardiography database at a tertiary medical centre, from March 2011 to January 2021. Patients were stratified based on the presence of LVT recurrence during follow-up, with subgroup analysis performed for patients who developed LVT post-acute myocardial infarction (AMI) over a median follow-up duration of 4.4 years.</p><p><strong>Results: </strong>The incidence of LVT recurrence was 11.8% (n=41/346) among all resolved LVT (mean age of 59.9±11.6 years, 86.4% male), and 12.0% (n=23/192) in patients with post-AMI resolved LVT. On multivariable regression analyses accounting for competing risks (all-cause mortality), active or previous malignancy was associated with LVT recurrence in both all (adjusted subdistribution HR (aSHR) 5.59, 95% CI 2.02 to 15.5, p<0.001) and patients with post-AMI (aSHR 13.9, 95% CI 4.05 to 47.7, p<0.001) resolved LVT. Initial LVT characteristics such as size (per cm) (aSHR 1.42, 95% CI 1.02 to 1.96, p=0.036) and protrusion (aSHR 5.46, 95% CI 1.38 to 21.6, p=0.016) were associated with recurrence in all and patients with post-AMI, respectively. On multivariable Cox regression analyses, LVT recurrence was associated with increased composite outcomes (comprising AMI, acute ischaemic stroke, acute decompensated heart failure, all-cause mortality) in all patients with resolved LVT (adjusted HR (aHR) 3.04, 95% CI 1.70 to 5.44, p<0.001), and in the post-AMI subgroup (aHR 2.77, 95% CI 1.21 to 6.32, p=0.016).</p><p><strong>Conclusions: </strong>Active or previous malignancy, and initial LVT imaging characteristics were associated with recurrent LVT. LVT recurrence was a marker of poor prognosis in terms of adverse composite outcomes in patients with resolved LVT.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023181","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}