Heart最新文献

{"title":"Role of routine surveillance stress testing in patients with or without imaging-guided or physiology-guided PCI.","authors":"Yeonwoo Choi, Do-Yoon Kang, Hoyun Kim, Jinho Lee, Sangyong Jo, Jung-Min Ahn, Nayoung Kim, Yong-Hoon Yoon, Seung-Ho Hur, Cheol Hyun Lee, Won-Jang Kim, Se Hun Kang, Chul-Su Park, Bong-Ki Lee, Jung-Won Suh, Jae Woong Choi, Kee-Sik Kim, Su Nam Lee, Seung-Jung Park, Duk-Woo Park","doi":"10.1136/heartjnl-2025-326402","DOIUrl":"10.1136/heartjnl-2025-326402","url":null,"abstract":"<p><strong>Objective: </strong>The optimal follow-up strategy for high-risk patients who underwent imaging-guided or physiology-guided percutaneous coronary intervention (PCI) remains uncertain. We investigated whether routine surveillance stress testing after PCI provides clinical benefit when the procedure is guided by intravascular ultrasonography (IVUS) or fractional flow reserve (FFR).</p><p><strong>Methods: </strong>In the Pragmatic Trial Comparing Symptom-Oriented vs Routine Stress Testing in High-Risk Patients Undergoing PCI randomised trial, 1706 high-risk patients who underwent PCI were assigned to either routine functional testing at 1 year or standard care alone. In this prespecified subgroup analysis, patients were subsequently categorised according to whether IVUS or FFR was used at the index procedure. The primary outcome was a composite of death, myocardial infarction or hospitalisation for unstable angina over 2 years.</p><p><strong>Results: </strong>Among the randomised population, 74% underwent IVUS-guided intervention and 36% underwent FFR-guided intervention. At 2 years, rates of the primary outcome were similar between routine testing and standard care both in patients treated with IVUS guidance (5.3% vs 6.7%; HR 0.79; 95% CI 0.50 to 1.24) and without IVUS guidance (5.7% vs 3.8%; HR 1.52; 95% CI 0.63 to 3.68; interaction p=0.21). Comparable results were observed in patients with FFR guidance (2.6% vs 3.9%; HR 0.65; 95% CI 0.26 to 1.58) and without FFR guidance (7.0% vs 7.1%; HR 0.99; 95% CI 0.63 to 1.55; interaction p=0.59). Routine functional testing was consistently associated with higher use of invasive coronary angiography and repeat revascularisation, without improvement in clinical outcomes.</p><p><strong>Conclusions: </strong>Among high-risk patients who underwent PCI, routine surveillance stress testing did not reduce the risk of death, myocardial infarction or unstable angina, regardless of the use of IVUS or FFR at the index procedure. Routine functional testing increased downstream invasive procedures without clinical benefit. These findings support guideline recommendations against routine surveillance testing after PCI.</p><p><strong>Trial registration number: </strong>NCT03217877.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"1088-1097"},"PeriodicalIF":4.4,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225311","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":"Risk factors for the development of sick sinus syndrome: another manifestation of atrial cardiomyopathy?","authors":"Joost C Beusekamp, Alexander H Maass","doi":"10.1136/heartjnl-2026-327790","DOIUrl":"10.1136/heartjnl-2026-327790","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"1053-1054"},"PeriodicalIF":4.4,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147304668","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":"Taking assessment to the patient: can we break the emergency department gridlock?","authors":"Paul O Collinson","doi":"10.1136/heartjnl-2025-327714","DOIUrl":"10.1136/heartjnl-2025-327714","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"1051-1052"},"PeriodicalIF":4.4,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147276215","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":"Primordial prevention: a life-course approach to global cardiovascular health.","authors":"Hooi Min Lim, Darwin R Labarthe","doi":"10.1136/heartjnl-2025-326752","DOIUrl":"10.1136/heartjnl-2025-326752","url":null,"abstract":"<p><p>Primordial prevention is the strategy of preventing occurrence of cardiovascular risk factors from early life and promoting favourable life course trajectories of cardiovascular health. While the term 'primordial prevention' was introduced by Strasser in 1978, representing a society-wide strategy to prevent epidemics of cardiovascular risk factors, the concept has been implemented far less to date than is needed to reduce the global cardiovascular burden. The primary purpose of this review is to increase understanding of the concept and strategy of primordial prevention for reducing the burden of cardiovascular disease and its relation to cardiovascular health. We discuss the influence of upstream adverse social and structural determinants on the development of traditional cardiovascular risk throughout the life course. We summarise recent trial evidence of intervention effectiveness and highlight policy and practice opportunities that can achieve the potential of primordial prevention as a sustainable and equitable strategy for promoting cardiovascular health across the life course.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"1063-1073"},"PeriodicalIF":4.4,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165003","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 Asian and Caucasian patients with type A aortic intramural haematoma: a multicentre registry analysis.","authors":"Jung-Min Ahn, Harleen K Sandhu, Shuichiro Kaji, Tadashi Kitamura, Simon Chi-Ying Chow, Jong-Seon Park, Thomas Van Brakel, Gijs van Steenbergen, Frederik M Zimmermann, Carlos Ferrera, Ji Sung Lee, Isidre Vilacosta, Anthony L Estrera, Jae-Kwan Song","doi":"10.1136/heartjnl-2026-328023","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328023","url":null,"abstract":"<p><strong>Background: </strong>Outcomes of aortic intramural haematoma (IMH) have shown disparities between Asian and Caucasian patients. We evaluated the heterogeneity of treatment effects in Asian and Caucasian patients with type A IMH.</p><p><strong>Methods: </strong>This multicentre registry included individual patient data from 485 patients with type A IMH, collected from eight institutions (five Asian and three Western). Overall mortality was the primary outcome.</p><p><strong>Results: </strong>Compared with their Asian counterparts, Caucasian patients (n=147) were older (69.3 vs 66.8 years) and had a higher prevalence of bicuspid aortic valve (4.1% vs 0.6%), visceral ischaemia (6.1% vs 1.5%), limb ischaemia (3.4% vs 0.3%) and shock (21.1% vs 6.8%), thicker haematoma (12.5±4.8 vs 10.5±5.2 mm) and larger ascending aortas (51.5±7.8 vs 47.7±7.2 mm). Urgent surgery was performed in 129 patients (26.6%), while 356 patients (73.4%) received medical treatment. Initial medical treatment was more common in Asian patients (85.5% vs 45.6%). During follow-up (median, 6.9 years), 121 deaths occurred. After adjustment for potential confounding factors, there was no significant difference regarding long-term mortality between Asian and Caucasian (HR, 1.38; 95% CI 0.73 to 2.60; p=0.32). Age (HR 1.42; 95% CI 1.17 to 1.72; p<0.001), ascending aorta diameter (HR 1.05; 95% CI 1.02 to 1.09; p<0.001) and medical treatment due to prohibitive surgical risk (HR 3.00; 95% CI 1.45 to 6.22; p<0.003) were independent predictors for long-term mortality.</p><p><strong>Conclusions: </strong>In patients with type A IMH, race was not associated with long-term mortality. The initial clinical presentation and imaging characteristics were the primary determinants of clinical outcomes.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919138","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":"Direct transfer to primary percutaneous coronary intervention centres following out-of-hospital cardiac arrest: longer term outcomes and influences on survival.","authors":"Alexander Hunt, Steven Scholfield, Joseph Morris, Nicholas Lim, Adam Darnley, Justin Chiong, Yahya Al-Najjar, Farzin Fath-Ordoubadi","doi":"10.1136/heartjnl-2026-328408","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328408","url":null,"abstract":"<p><strong>Objective: </strong>Myocardial infarction is a leading cause of out-of-hospital cardiac arrest (OHCA). In patients with OHCA due to suspected acute coronary occlusion, direct transfer to a centre capable of primary percutaneous coronary intervention (PPCI) has been shown to improve short-term outcomes. However, practice remains heterogeneous and the impact on longer-term survival is unclear. We evaluated whether direct transfer of OHCA patients with ST-elevation was associated with improved short-term, medium-term and long-term survival compared with indirect transfer via a non-PPCI hospital.</p><p><strong>Methods: </strong>This retrospective cohort study collected data from a national myocardial infarction registry within a regional emergency service network. Adults with OHCA, return of spontaneous circulation and ST-elevation on post-arrest ECG were included between April 2015 and September 2022. Patients were categorised according to direct transfer to a PPCI centre or indirect transfer via a non-PPCI hospital. The primary outcome was all-cause mortality at 3 years, with landmark analyses at 30 days and 1 year. Survival was analysed using adjusted FPSMs, with covariates including age, sex, witnessed event, presenting rhythm and time to emergency response.</p><p><strong>Results: </strong>613 patients were included; 359 (59%) were transferred directly and 254 (41%) indirectly. Call-to-balloon time was shorter following direct transfer (134 min vs 222 min) and survival to discharge was higher (81% vs 68%). Following adjustment, indirect transfer was associated with higher mortality at 30 days (adjusted HR 2.48, 95% CI 1.08 to 5.73), with excess risk attenuating thereafter and stabilising after approximately 6 months. Cumulative incidence of death at 3 years was 27.9% versus 41.3%, an absolute risk difference of 13.5%.</p><p><strong>Conclusion: </strong>In patients with OHCA and ST-elevation, direct transfer to PPCI centres was associated with improved survival up to 3 years. This advantage appears driven predominantly by early in-hospital outcomes, supporting direct triage for rapid reperfusion and optimised post-resuscitation care.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906160","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":"Weight loss as a marker of successful decongestion during acute heart failure hospitalisation.","authors":"Mikael Erhardsson, Lars H Lund, Lina Benson, Gianluigi Savarese, Giulia Ferrannini, Ulrika Ljung Faxén, Ulf Dahlström, Camilla Hage","doi":"10.1136/heartjnl-2026-328175","DOIUrl":"10.1136/heartjnl-2026-328175","url":null,"abstract":"<p><strong>Background: </strong>Effective decongestion is a key therapeutic goal during hospitalisation for acute heart failure (HF), but the clinical significance of intravenous loop diuretic-induced weight loss and its relationship with biomarker changes remain uncertain.</p><p><strong>Methods: </strong>We included patients hospitalised for HF in the nationwide Swedish Heart Failure Registry (2017-2021) who received intravenous loop diuretics, survived to discharge and had body weight recorded at admission and discharge. Weight loss was defined as ≥2 kg between admission and discharge. Associations between weight loss, changes in biomarkers (estimated glomerular filtration rate (eGFR), N-terminal pro-B-type natriuretic peptides (NT-proBNP), haemoglobin, sodium and potassium) and outcomes were evaluated. The primary outcome was rehospitalisation for HF (re-HHF); the secondary outcome was the composite of cardiovascular death or re-HHF at 30 days and 1 year.</p><p><strong>Results: </strong>Among 4979 patients (median age 80 years; 57% male), median weight change during hospitalisation was -2.5 kg and 2949 (59%) achieved weight loss ≥2 kg. Male sex, atrial fibrillation, obesity, higher admission NT-proBNP and mineralocorticoid receptor antagonist use were independently associated with weight loss. Weight change showed no meaningful association with change in eGFR. Weight loss was independently associated with a lower risk of re-HHF (HR 0.59, 95% CI 0.53 to 0.67) and the composite of cardiovascular death or re-HHF (HR 0.76, 95% CI 0.69 to 0.84) within 30 days but not thereafter. These associations were consistent irrespective of biomarker changes, including worsening renal function.</p><p><strong>Conclusions: </strong>In this nationwide cohort of patients hospitalised for HF and treated with intravenous loop diuretics, diuretic-induced weight loss, a pragmatic marker of decongestion, was associated with improved short-term clinical outcomes without an accompanying decline in renal function and irrespective of biomarker changes, including worsening renal function.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818247","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":"Biological uncertainty cannot be eliminated by diagnostic certainty: the Heisenberg problem of occlusive myocardial infarction.","authors":"Emre Aslanger","doi":"10.1136/heartjnl-2026-328887","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328887","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864643","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":"Geographic variation in long-term health outcomes following myocardial infarction in England.","authors":"Charlotte Sturley, Tamara Del Toro, Jonathan A Batty, Eleanor Booth, Marlous Hall","doi":"10.1136/heartjnl-2025-327671","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-327671","url":null,"abstract":"<p><strong>Background: </strong>Nationwide studies report the high incidence of major health outcomes following myocardial infarction (MI). This cohort study investigates variation in incidence of health outcomes following MI between health commissioning areas within England.</p><p><strong>Methods: </strong>All adults ≥18 years of age with index MI admitted to hospital within all 106 integrated care board (ICB) subpopulations in England were included (2008-2017). The cumulative incidence of all-cause mortality and non-fatal health outcomes (subsequent MI and first hospitalisation for heart failure, atrial fibrillation, cerebrovascular disease, peripheral arterial disease, severe bleeding, renal failure, diabetes mellitus and depression) within 9 years of follow-up was calculated from flexible parametric survival models adjusted for age, sex, year of MI and deprivation. Choropleth maps and funnel plots were used to visualise the degree of variation in incidence of outcomes by ICB subpopulation. The intraclass correlation coefficient (ICC) was used to determine the degree of variation explained at the area versus patient level.</p><p><strong>Results: </strong>A total of 381 518 individuals with MI (n=2 807 195 hospital admissions) were included in the study. The crude incidence of post-MI health outcomes varied between areas, including heart failure (range 20.2%-47.9%), severe bleeding (14.3%-34.6%), renal failure (23.7%-38.0%) and all-cause mortality (34.3%-47.7%). The incidence of each major health outcome following MI fell within expected range (between 95% control limits) after adjusting for patient demographics with the exception of two sub-ICBs in Lancashire and South Cumbria, where rates were higher than expected. Overall, variation observed was predominantly explained by region-specific patient demographic profiles rather than at the ICB subpopulation level (ICC <5% for all outcomes).</p><p><strong>Conclusions: </strong>This research provides region-specific data for the incidence of 10 major health outcomes following MI in England. The findings can support commissioners to target resources to those areas with populations at greatest risk of major health outcomes following MI.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864566","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":"Prevalence, burden and manifestation of atrial fibrillation: a large-scale analysis of cardiac patch monitors.","authors":"Sophie Sigfstead, David Newman, Isabelle Nault, David Gladstone, Anthony Tang, Laurent Macle, Jeffrey S Healey, Jason G Andrade, Riyaz A Kaba, Christopher C Cheung","doi":"10.1136/heartjnl-2026-328587","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328587","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is frequently paroxysmal and asymptomatic, making its detection and burden quantification challenging. The distribution of AF burden across clinically monitored populations remains poorly characterised. We sought to describe the distribution of AF burden and its variation by monitoring indication, symptomatology, arrhythmia characteristics and geography.</p><p><strong>Methods: </strong>This study analysed cardiac patch monitor reports collected between May 2017 and July 2023. Analyses were stratified by monitoring indication, AF burden grouping and geography. AF burden subgroups were defined based on the burden detected during recording, and divided into four subgroups: (1) no AF (AF burden=0%); (2) low burden AF (>0 to ≤10%); (3) moderate burden AF (>10% to <100%); and (4) continuous AF (100%).</p><p><strong>Results: </strong>Across 142 346 monitoring reports, AF was detected in 15 678 cases (11.17%), with a median AF burden of 100% (IQR 4.67-100.00). When stratified by monitoring indication, AF was detected in 28.2% of monitors indicated due to suspected or history of AF, 4.5% for stroke/transient ischaemic attack (TIA), 6.5% for syncope/pre-syncope and 4.9% for palpitations. In the stroke/TIA monitoring population, AF detection was time-dependent, with 58.8% of cases identified within 24 hours, increasing to 88.0% identified at 7 days. Among all patients with AF detected, patients with continuous AF (100% AF burden) exhibited lower heart rates and symptom burden compared with those with low (≤10%) and moderate (10% to <100%) AF burden. AF detection was higher in the UK than Canada (12.2% vs 10.9%), as was median burden among detected cases (100.0 vs 55.0%), despite shorter prescribed monitoring durations in the UK (median 48.00 hours (IQR 24.00-168.00) vs 168.00 hours (IQR 168.00-336.00)).</p><p><strong>Conclusions: </strong>In patients undergoing clinically indicated patch monitoring, AF burden varied by monitoring indication, symptomatology and geography, identifying potentially distinct AF subgroups. Characterising AF burden can inform the development and evaluation of AF monitoring and treatment strategies.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148827578","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}