Heart最新文献

{"title":"Midterm outcomes of rheumatic mitral valve repair versus replacement in a dual-centre retrospective study.","authors":"Songhao Jia, Peiyi Liu, Maozhou Wang, Xiaohan Zhong, Meili Wang, Wei Luo, Yuyong Liu, Hongyu Ye, Hongjia Zhang, Wenjian Jiang","doi":"10.1136/heartjnl-2025-326323","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326323","url":null,"abstract":"<p><strong>Background: </strong>Rheumatic mitral valve disease remains a major global health challenge. Determining optimal surgical approaches is critical. This study aimed to identify key repairability factors and compare midterm outcomes of mitral repair versus replacement.</p><p><strong>Methods: </strong>This retrospective cohort study consecutively enrolled rheumatic mitral valve surgery patients from two centres, excluding those with missing imaging or clinical data. CT angiography and echocardiogram was used to quantitatively assess factors affecting repairability. Inverse probability weighting was applied to balance baseline characteristics between groups, and mid-term outcomes were compared. Independent risk factors for prognosis were also explored.</p><p><strong>Results: </strong>Among 972 patients, 621 (63.9%) successfully underwent mitral valve repair. Body mass index, diabetes, left atrial diameter, posterior leaflet calcification, anterior leaflet clear zone calcification and annular calcification were identified as independent factors affecting repairability. At a median follow-up of 3.51 years (IQR 1.62-5.14), the repair group demonstrated more favourable outcomes, with significantly reduced mortality and stroke rates compared with the replacement group, while maintaining comparable reoperation rates. Prior percutaneous mitral commissurotomy did not reduce valve repairability (OR=0.588, 95% CI 0.342 to 1.010; p=0.054) but emerged as an independent predictor of reoperation following repair (OR=7.496, 95% CI 1.325 to 42.404; p=0.023).</p><p><strong>Conclusions: </strong>In well-selected patients, rheumatic mitral valve repair was associated with lower mortality and stroke rates compared with replacement, with comparable reoperation rates. However, patients with a history of percutaneous mitral commissurotomy have a higher risk of reoperation after repair and should be carefully evaluated.</p><p><strong>Trial registration number: </strong>ChiCTR2200067151.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006008","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":"Accelerated biological ageing and cardiovascular disease trajectories: a multistate analysis.","authors":"Weiling Yang, Lihui Zhou, Mengjing Zhu, Yanchun Chen, Dun Li, Li Sun, Yaogang Wang","doi":"10.1136/heartjnl-2025-325881","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-325881","url":null,"abstract":"<p><strong>Background: </strong>Accelerated biological ageing has been linked to elevated risks of hypertension (HTN) and cardiovascular diseases (CVDs), yet its role in shaping the dynamic progression from health to HTN, to CVDs, and ultimately to mortality remains poorly understood. We aimed to investigate these transitions using biological ageing measures and to assess the mediating role of intermediate disease states.</p><p><strong>Methods: </strong>We analysed data from 136 614 UK Biobank participants aged 38-73 years, all free of HTN and CVDs at baseline. Accelerated biological ageing was assessed using phenotypical age (PhenoAge) and the Klemera-Doubal Method Biological Age (KDM-BA). Multistate models were used to evaluate the impact of accelerated biological ageing on disease progression, and mediation analyses assessed the role of intermediate diseases in these transitions.</p><p><strong>Results: </strong>Over a median follow-up of 13.52 years, 8068 participants developed HTN, 11 795 developed CVDs and 6225 died. Each SD increase in PhenoAge acceleration was associated with higher risk of transitioning from healthy to HTN (HR 1.14, 95% CI 1.12 to 1.17), to CVDs (HR 1.14, 95% CI 1.11 to 1.16), and from HTN to CVDs (HR 1.06, 95% CI 1.02 to 1.10). Similarly, KDM-BA acceleration was associated with increased risk for these transitions: HRs of 1.28 (1.25-1.31), 1.12 (1.10-1.15) and 1.06 (1.01-1.11), respectively. Accelerated biological ageing was also significantly associated with higher risk of mortality from healthy, HTN and CVD states. Intermediate diseases were identified as important pathways through which biological ageing influenced disease progression.</p><p><strong>Conclusions: </strong>Accelerated biological ageing is a strong predictor of cardiovascular health trajectories. It offers a valuable framework for forecasting cardiovascular ageing, supporting subclinical CVD prevention and identifying opportunities for early intervention.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000487","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":"Beyond hypertension: quantifying the full risk landscape for heart failure in women.","authors":"Kazem Rahimi, Eva Gerdts","doi":"10.1136/heartjnl-2025-326874","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326874","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992365","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":"ECG algorithms for localisation of outflow tract ventricular arrhythmias: is there a winner?","authors":"Bruno Wilnes, Beatriz Castello-Branco, Pasquale Santangeli","doi":"10.1136/heartjnl-2025-326550","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326550","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992329","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":"Carbohydrate antigen 125: promising diagnostic biomarker in heart failure with preserved ejection fraction.","authors":"Alexander Berezin","doi":"10.1136/heartjnl-2025-326900","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326900","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144951411","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":"Analysis and prediction of cardiovascular research hotspots, trends and interdisciplinarity.","authors":"Zeye Liu, Ziping Li, Hong Jiang, Guangyu Pan, Wenchao Li, Fengwen Zhang, Wen-Bin Ou-Yang, Shouzheng Wang, Cheng Wang, Xuanqi An, Anlin Dai, Ruibing Xia, Yakun Li, Xiaochun Sun, Yi Shi, Chengliang Yin, Xiang-Bin Pan","doi":"10.1136/heartjnl-2025-325877","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-325877","url":null,"abstract":"<p><strong>Objective: </strong>Comprehensive data and analyses on cardiovascular research could clarify recent research trends for the academic community and facilitate policy development. We examined publications and reference data to identify research topics, trends and interdisciplinarity for cardiovascular disease (CVD).</p><p><strong>Methods: </strong>We extracted and clustered text fragments from the titles and abstracts of 2 512 445 publications using artificial intelligence techniques, including natural language processing (NLP) for semantic analysis. Cardiovascular experts identified topics and document clusters based on the output of those semiautomatic methods. We also applied machine learning algorithms to predict the trends over the next 5 years in each field. We examined the crossover between the two cluster groups using citation relationships in the documents.</p><p><strong>Results: </strong>Research in clinical studies showed the most notable increase; that was followed by research in population and basic studies. The research hotspots were minimally invasive treatments for valve disease, circulatory haemodynamics, and prevention and control of hypertension. The fastest-growing topics were health monitoring, evidence-based medicine and immunotherapy. We found extensive crossover relationships among document clusters for the periods of 2017-2018 and 2020-2021.</p><p><strong>Conclusions: </strong>This study provides valuable insights into the research hotspots for cardiovascular research, including an increasing emphasis on early disease detection and prevention, exploration of minimally invasive treatments and assessment of risk factors. The research landscape demonstrates signs of interdisciplinarity and integration as reflected in citation relationships. These findings suggest practical implications for optimising resource allocation in healthcare systems, guiding clinical guideline updates and informing policy-making to prioritise high-impact research areas aligned with evolving CVD challenges. Given the evolving global burden of CVD, continuous research and innovation are imperative, with interdisciplinary collaboration assuming a pivotal role in advancing scientific knowledge.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144951413","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":"Evaluation of carbohydrate antigen 125 in heart failure with preserved ejection fraction diagnosis.","authors":"Javier de Juan Bagudá, Andrea Severo Sánchez, Rafael de la Espriella, María Jesús Valero-Masa, David García-Vega, Marta de Antonio Ferrer, Teresa Segura de la Cal, Anna Mollar, María Dolores García-Cosío Carmena, Luis Martínez-Dolz, Javier de la Cruz, José R González-Juanatey, Manuel Martínez-Sellés, Julio Núñez, Juan F Delgado Jiménez","doi":"10.1136/heartjnl-2025-326053","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326053","url":null,"abstract":"<p><strong>Background: </strong>Current evidence supports the role of circulating carbohydrate antigen 125 (CA125) in risk assessment, disease monitoring and therapeutic guidance in heart failure (HF). However, there is limited data on its diagnostic applicability. This study aimed to assess the diagnostic performance of CA125 in identifying HF with preserved ejection fraction (HFpEF) in an outpatient population.</p><p><strong>Methods: </strong>This was a prospective, multicentre study involving 246 consecutive patients with clinically suspected HF. Patients with a left ventricular ejection fraction <50% (n=8) and those with a history of malignancy (n=22) were excluded. The final study cohort comprised 210 patients. The diagnosis of HFpEF was confirmed by a trained cardiologist blinded to the biomarker levels.</p><p><strong>Results: </strong>The mean age of the study cohort was 69.7±15 years, and 69% were women. Median levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and CA125 were 125 pg/mL (IQR: 51-332) and 11 U/mL (IQR: 8-17), respectively. HFpEF was diagnosed in 65 (31%) patients. For HFpEF diagnosis, NT-proBNP and CA125 levels demonstrated comparable areas under the receiver operating characteristic curves 0.765 (95% CI: 0.686 to 0.843) vs 0.715 (95% CI: 0.636 to 0.793), respectively (p=0.323). Optimal cut points were identified as 12.2 U/mL for CA125 (sensitivity: 0.69; specificity: 0.68) and 243 pg/mL for NT-proBNP (sensitivity: 0.65; specificity: 0.83). Elevated CA125 levels (>23 U/mL, 12.4% of the sample) exhibited high specificity (0.97), a positive predictive value of 80.8% and correctly classified 77.1% of cases as HFpEF. Conversely, CA125 levels<9 U/mL were associated with a high negative predictive value (85.7%).</p><p><strong>Conclusion: </strong>In an ambulatory setting, CA125 exhibits acceptable diagnostic performance for identifying HFpEF and may complement NT-proBNP in clinical practice.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144951527","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":"Optimising implantable loop recorder alerts with artificial intelligence: role of R-wave amplitude and workload reduction.","authors":"Luigi Cocchiara, Benedetta Brescia, Procolo Marchese, Stefano Nardi, Gianmarco Arabia, Alfonsomaria Salucci, Francesca Gennaro, Giovanni Mazzotta, Lucio Addeo, Emiliano Calvi, Gianfranco Mitacchione, Teresa Strisciuglio, Pasquale Vergara, Giovanni Esposito, Antonio Rapacciuolo","doi":"10.1136/heartjnl-2025-326430","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326430","url":null,"abstract":"<p><strong>Background: </strong>False-positive (FP) alerts from implantable loop recorders increase clinical workload and may delay appropriate intervention. AccuRhythm AI, a cloud-based filtering algorithm, is designed to reduce these alerts in Reveal LINQ and LINQ II devices. This study assessed the algorithm's effect on FP and clinician burden reduction, with a focus on the influence of R-wave sensing amplitude.</p><p><strong>Methods: </strong>This multicentre, retrospective study included 800 patients with either Reveal LINQ or LINQ II. We analysed automated artificial intelligence (AI) reports and compared FP rates and transmission burden before and after software-based AI activation in the subset of Reveal LINQ patients to assess patient-level changes. The relationship between R-wave amplitude and FP incidence was also evaluated.</p><p><strong>Results: </strong>AI-based filtering, by AccuRhythm AI automatic analysis, reduced false pause alerts by 62% and false atrial fibrillation alerts by 33%, saving 210 clinician hours over 6 months. Patient level analysis, among 465 Reveal LINQ patients, showed FP+ patients (patients with ≥1 false-positive transmission) reduction from 55.5% to 15.1% post-AI (p<0.001), translating to 1128 hours saved. All residual false alerts occurred in patients with R-wave amplitudes <0.4 mV.</p><p><strong>Conclusion: </strong>Use of AccuRhythm AI was associated with a significant reduction in FPs and clinician workload while preserving diagnostic accuracy. R-wave amplitude remained a key factor influencing alert specificity, emphasising the continued importance of optimal device implantation and signal quality.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144951576","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":"Diagnostic performance of exercise stress testing findings and coronary microvascular dysfunction in patients with angina with non-obstructive coronary artery disease.","authors":"Tsung-Ying Tsai, Ali Aldujeli, Ayman Haq, Paddy Murphy, Ramunas Unikas, Diana Žaliaduonytė-Pekšienė, Rima Braukyliene, Thomas John Kiernan, Pruthvi C Revaiah, Kotaro Miyashita, Akihiro Tobe, Asahi Oshima, Jelena Celeutkiene, Faisal Sharif, Scot Garg, Vacis Tatarunas, Yoshinobu Onuma, Patrick W Serruys","doi":"10.1136/heartjnl-2025-325769","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-325769","url":null,"abstract":"<p><strong>Background: </strong>Coronary microvascular dysfunction (CMD) is common among patients with angina with non-obstructive coronary artery disease (ANOCA) and leads to poorer clinical outcomes. Exercise stress testing (EST) was shown to have a high specificity for detecting CMD. However, the relationship between diagnosing CMD using different invasive physiological parameters and thresholds and the association between EST findings and the endotype of CMD remains unknown.</p><p><strong>Methods: </strong>This multicentre, prospective cohort study enrolled 117 patients with ANOCA who underwent EST prior to invasive coronary angiography with functional assessment to measure coronary flow reserve (CFR), the index of microvascular resistance (IMR) and microvascular resistance reserve (MRR)=(CFR/FFR)×(P_{a rest}/P_{a hyper}). CMD was classified using multiple criteria, including MRR <3.0, CFR <2.5 and CFR <2.0 or IMR ≥25. Diagnostic sensitivity and specificity and the accuracy of EST findings (exercise-induced chest discomfort, ischaemic ECG changes and exercise intolerance) for diagnosing CMD were assessed.</p><p><strong>Results: </strong>The prevalence of CMD was similar under all three definitions. However, structural CMD was more common using MRR <3.0. Ischaemic ECG changes during EST showed an excellent diagnostic accuracy of 86.3% (78.7-92.0%) for detecting CMD, with a sensitivity and specificity of 86.2% (68.3-96.1%) and 86.4% (77.4-92.8%), respectively. Exercise-induced chest discomfort also had a good diagnostic accuracy of 76.1% (95% CI 67.3% to 83.5%); however, it offered no additional value when added to ischaemic ECG changes. EST preferentially identified structural CMD, while functional CMD was more frequently missed.</p><p><strong>Conclusions: </strong>Ischaemic ECG changes during EST performed immediately before invasive functional assessment demonstrated excellent diagnostic accuracy for identifying patients with CMD, particularly the structural endotype.</p><p><strong>Trial registration number: </strong>NCT05841485.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144951389","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":"Electrocardiogram abnormalities and cardiovascular risk prediction in older Chinese: the Guangzhou Biobank Cohort Study.","authors":"Wen Bo Tian, Wei Sen Zhang, Chao Qiang Jiang, Xiang Yi Liu, Ya Li Jin, Tai Hing Lam, Kar Keung Cheng, Lin Xu","doi":"10.1136/heartjnl-2024-325553","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325553","url":null,"abstract":"<p><strong>Background: </strong>Evidence on the associations of multiple minor ECG abnormalities (EA) with cardiovascular disease (CVD) and mortality in older populations is limited, particularly whether a weighted EA score better predicts CVD risk than a single EA severity.</p><p><strong>Methods: </strong>We analysed 26 846 Chinese aged 50+ years from Guangzhou Biobank Cohort Study (GBCS), without CVD at baseline. Minor and major EAs were classified based on the Minnesota Code Manual. EA severity was defined as normal, one minor, two or more minor and major abnormalities. Cox regression with backward stepwise selection was conducted to develop EA score. Cox regression was used to examine the associations of EA (severity/score) with incident CVD events, all-cause mortality and CVD mortality. C-index and Net Reclassification Index (NRI) were used to assess the improvement in CVD risk prediction after adding EA (severity/score) to the GBCS model variables.</p><p><strong>Results: </strong>During an average follow-up of 15.3 (SD=3.5) years, 6232 CVD events and 5960 deaths occurred. Compared with normal ECG, one minor (adjusted HR 1.12, 95% CI 1.05 to 1.19), two or more minor (1.20, 95% CI 1.11 to 1.29) and major abnormalities (1.46, 95% CI 1.31 to 1.63) were associated with a higher risk of incident CVD events. The EA score showed a strong dose-response relationship (0 point as reference): 1-29 points (1.12, 95% CI 1.05 to 1.19), 30-59 points (1.56, 95% CI 1.38 to 1.77), ≥60 points (3.16, 95% CI 2.56 to 3.91) (p value for trend <0.001). Similar findings were observed for all-cause and CVD mortality. Adding EA score improved the C-index for incident CVD events, but the improvement diminished over time (change in C-index: 0.011 (95% CI 0.002 to 0.022) at 3 years to 0.003 (95% CI 0.002 to 0.004) at 15 years). The NRI for 10-year risk was 0.016 (95% CI 0.007 to 0.024), indicating limited utility.</p><p><strong>Conclusions: </strong>Major EA and multiple minor EAs were associated with higher risks of CVD events and mortality, but the value in improving CVD risk prediction is limited.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144951442","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}