Heart最新文献

{"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}

{"title":"Optical coherence tomography-guided percutaneous coronary intervention in multivessel coronary disease with complex lesions.","authors":"In Tae Jin, Seung-Jun Lee, Jong-Young Lee, Sang-Min Kim, Seung-Ho Hur, Jung Ho Heo, Ji-Yong Jang, Jin-Sin Koh, Hoyoun Won, Jun-Won Lee, Soon Jun Hong, Dong-Kie Kim, Jeong Cheon Choe, Jin Bae Lee, Tae-Hyun Yang, Jung-Hee Lee, Young Joon Hong, Jong-Hwa Ahn, Sang-Hyup Lee, Yong-Joon Lee, Sung-Jin Hong, Chul-Min Ahn, Jung-Sun Kim, Myeong-Ki Hong, Yangsoo Jang, Jin Won Kim, Byeong-Keuk Kim","doi":"10.1136/heartjnl-2026-328499","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328499","url":null,"abstract":"<p><strong>Background: </strong>Optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) improves clinical outcomes through enhanced stent optimisation; however, whether these benefits extend to patients with multivessel disease (MVD), characterised by greater anatomical complexity and high ischaemic burden, remains unclear. Therefore, this study aimed to evaluate whether OCT guidance improves clinical outcomes in patients with MVD undergoing PCI.</p><p><strong>Methods: </strong>We conducted a post hoc subgroup analysis of the OCCUPI trial, focusing on patients with MVD (diameter stenosis ≥50% in ≥2 major epicardial coronary arteries) with at least one complex lesion. The primary outcome was major adverse cardiac event (MACE), a composite of cardiac death, myocardial infarction, stent thrombosis or ischaemia-driven target-vessel revascularisation over 1 year.</p><p><strong>Results: </strong>Among the as-treated population in the OCCUPI trial (n=1604), 985 (61.4%) patients had MVD and 575 had single-vessel disease. In patients with MVD, OCT-guided PCI (n=515) was associated with a lower risk of 1-year MACE than angiography-guided PCI (n=470) (4.7% vs 8.9%; HR 0.51, 95% CI 0.31 to 0.85; p=0.008), with consistent treatment effects observed across disease extent (p for interaction=0.202). Among the OCT-guided patients, 355 (70.2%) achieved the prespecified OCCUPI optimisation criteria, whereas 151 (29.8%) did not. Stent optimisation was associated with significantly lower MACE rates (3.1% vs 8.6%; p=0.011) and consistent benefits were observed across MVD and single-vessel disease (p for interaction=0.521).</p><p><strong>Conclusions: </strong>In patients with MVD and complex lesions, OCT-guided PCI was associated with a lower risk of 1-year MACE than angiography-guided PCI particularly when stent optimisation on OCT was achieved.</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":"148827647","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":"Palpitations and progressive left ventricular dysfunction in a young woman.","authors":"Tiange Li, Yabo Wang, Yunfei Ling","doi":"10.1136/heartjnl-2026-328255","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328255","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":"112 18","pages":"1049-1050"},"PeriodicalIF":4.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818272","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":"Economic evaluation of the TriageHF Plus clinical pathway for device-based remote monitoring in heart failure.","authors":"Fozia Z Ahmed, Rachel Harwood, David Lanctin, Catherine Leonard, Sarah Medland, Daniela Afonso, Stuart Mealing, Toni Weldon, Callum Blunt, Niall G Campbell, Joanne K Taylor","doi":"10.1136/heartjnl-2025-326702","DOIUrl":"10.1136/heartjnl-2025-326702","url":null,"abstract":"<p><strong>Background: </strong>In 2024, the UK National Institute of Health and Care Excellence (NICE) recommended TriageHF alerts as an option for remote monitoring of patients with heart failure (HF) and a compatible cardiac implantable electronic device (CIED). Data on the cost-effectiveness of this approach has not been published. This research evaluates the cost-effectiveness of TriageHF Plus in public hospital settings, using data from the TriageHF Plus multicentre study (758 participants, NCT04177199).</p><p><strong>Methods: </strong>An economic model was developed to capture the lifetime cost and benefits of TriageHF Plus versus usual care, based on a site of 300 eligible patients. Analysis on individual patient-level data informed model efficacy and resource use parameters. EuroQol five-dimensional questionnaire data and unit costs were obtained from published, peer-reviewed literature and national databases respectively. Costs and benefits were discounted at 3.5% per annum to adjust future costs and benefits to present value.</p><p><strong>Results: </strong>In a site size of 300, TriageHF Plus was predicted to prevent 384 (363-405) hospitalisations over 5 years. In total, TriageHF Plus saved £3989 (£1812-£5563) per person-lifetime versus usual care and was more effective and cost-saving in 99.4% of simulations. Results were robust to changes in key input parameters. Modelling showed that to avoid one hospitalisation, 1.7 people would need lifetime access to TriageHF Plus.</p><p><strong>Conclusion: </strong>The TriageHF Plus pathway is cost-effective for the remote monitoring of HF in patients with CIEDs.</p><p><strong>Trial registration number: </strong>NCT04177199.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"1022-1032"},"PeriodicalIF":4.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774192","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":"Practice patterns and outcomes of cardiac implantable electronic device removal in patients with non-surgically managed infective endocarditis.","authors":"Amna Alhakak, Lauge Østergaard, Niels Eske Bruun, Anne-Christine Ruwald, Berit Thornvig Philbert, Michael Vinther, Peter Godsk Jørgensen, Eva Havers-Borgersen, Kasper Høtoft Bengtsen, Louise Kruse Jensen, Jonas Agerlund Povlsen, Jens Cosedis Nielsen, Jens Brock Johansen, Marianne Voldstedlund, Claus Moser, Henning Bundgaard, Lars Køber, Emil Loldrup Fosbøl","doi":"10.1136/heartjnl-2025-327223","DOIUrl":"10.1136/heartjnl-2025-327223","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines recommend complete removal of a cardiac implantable electronic device (CIED) in patients with infective endocarditis (IE), although these recommendations are largely based on expert opinion (level of evidence C). We aimed to examine outcomes stratified by CIED removal status in patients with IE.</p><p><strong>Methods: </strong>Using Danish nationwide registries (2010-2021), we identified patients aged ≥18 years with first-time IE, who were alive at discharge, managed without valve surgery and had a CIED. Patients who underwent CIED removal during IE admission were compared with those without removal. The study outcomes were IE readmission, recurrent bacteraemia (including IE with the same microbial aetiology) and all-cause mortality within 6 months after discharge.</p><p><strong>Results: </strong>The study population comprised 1040 patients with non-surgically managed IE and a CIED, and among these, 596 (57.3%) underwent CIED removal during admission. Patients who underwent removal were younger and less frail than those without removal. In the removal versus non-removal group, the 6-month cumulative incidences were 2.5% (95% CI 1.4% to 4.1%) vs 7.1% (95% CI 4.9% to 9.9%) for IE readmission (p value <0.001), 2.1% (95% CI 1.1% to 3.5%) vs 5.2% (95% CI 3.4% to 7.6%) for recurrent bacteraemia (p value=0.005) and 11.5% (95% CI 9.1% to 14.3%) vs 20.0% (95% CI 16.4% to 23.9%) for all-cause mortality (p value <0.001). In multivariable Cox regression models, CIED removal was associated with lower 6-month rates of IE readmission (HR 0.39 (95% CI 0.19 to 0.79)) and all-cause mortality (HR 0.70 (95% CI 0.49 to 0.996)), compared with no removal.</p><p><strong>Conclusions: </strong>In this nationwide study of patients with non-surgically managed IE and a CIED, CIED removal was associated with significantly lower 6-month rates of IE readmission, recurrent bacteraemia and mortality compared with no removal, supporting current guideline recommendations. However, randomised clinical trials are warranted to determine the most effective treatment strategy.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"1041-1048"},"PeriodicalIF":4.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767912","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 imaging: how should we assess patients with aortic stenosis?","authors":"Lojien Moharram, Sean Coffey","doi":"10.1136/heartjnl-2026-328687","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328687","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818226","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":"Distinct relationships of compartment-specific fat distribution profiles with cardiovascular ageing and future cardiovascular events.","authors":"Cynthia Maldonado-Garcia, Ahmed M Salih, Stefan Neubauer, Steffen E Petersen, Zahra Raisi-Estabragh","doi":"10.1136/heartjnl-2026-327946","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-327946","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a major contributor to cardiovascular disease (CVD). Different fat depots may have distinct effects on cardiac ageing and cardiovascular risk. We examined associations of imaging-defined obesity phenotypes with biological heart ageing and incident CVD and evaluated whether they provide additional information beyond anthropometric measures.</p><p><strong>Methods: </strong>This study included UK Biobank participants without CVD, with cardiac and abdominal MRI and linked health records. Biological heart age was estimated using machine learning from 56 cardiac MRI phenotypes. Abdominal visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue (ASAT) and pericardial adipose tissue (PAT) were clustered via K-means to identify distinct adiposity phenotypes. Mediation analysis quantified the contribution of individual fat compartments to incident CVD through biological heart ageing. Findings were compared with anthropometric measures. Analyses were sex-stratified.</p><p><strong>Results: </strong>The analysis included 34 496 participants (55%, n=18 978 females) with an average age of 63.5 years. Median body mass index (BMI) was 25.7 kg/m², with 58.4% classed as overweight or obese. Imaging-defined adiposity clustering identified a high-risk phenotype (comprising higher VAT, ASAT and PAT levels) associated with greater heart ageing and a lower-risk phenotype linked with reduced ageing. Imaging-defined adiposity clusters outperformed BMI categories in their association with biological heart age. In mediation analyses, VAT explained 14% of its association with incident CVD through accelerated heart ageing, the strongest mediation effect across all fat depots. PAT showed similar mediation (10.7%), but this fell to <1% after adjustment for VAT. Associations were more pronounced among males.</p><p><strong>Conclusion: </strong>Among the adiposity compartments studied, VAT showed the strongest relationships with cardiovascular ageing and incident CVD. While PAT showed initial associations, these were not independent of VAT. Imaging-defined adiposity phenotypes can allow more precise definition of cardiovascular risk and may enhance mechanistic understanding of obesity-related CVD, including sex-specific susceptibilities.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818301","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":"Allergic vasospastic angina: a systematic review.","authors":"Megan Quetsch, Frank Kette, Rosanna Tavella, John Beltrame","doi":"10.1136/heartjnl-2025-326599","DOIUrl":"10.1136/heartjnl-2025-326599","url":null,"abstract":"<p><strong>Background: </strong>Allergic vasospastic angina (also referred to as Kounis syndrome) is an under-recognised subtype of vasospastic angina in which coronary artery spasm is precipitated by an allergen. This study evaluates the clinical characteristics, mechanisms and management of this intriguing angina subtype.</p><p><strong>Methods: </strong>A systematic review of reported cases of allergic vasospastic angina from 1992 to 2022 was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Each case report was then analysed for patient characteristics, presenting signs/symptoms and both cardiac and allergic investigations.</p><p><strong>Results: </strong>A systematic review of 393 allergic vasospastic angina case reports revealed a median age of 53 years (64% males), 46% had one or more cardiovascular risk factors with 32% having an atopic history. Most patients presented with an acute coronary syndrome (ST-elevation myocardial infarct in 71%) following exposure to a wide array of precipitating allergens (55% prescription medications), with multiple potential allergic mechanisms including immunoglobulin-E (IgE)-mediated mast cell degranulation, eosinophil-mediated allergic response and other non-IgE mediated mast cell activation pathways.</p><p><strong>Conclusion: </strong>Allergic vasospastic angina is an important and under-recognised vasospastic angina subtype, often presenting as an acute coronary syndrome. Diagnosis of this disorder is important since management differs to conventional vasospastic angina with the potential of allergen avoidance and use of allergic response modulating therapies.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"997-1003"},"PeriodicalIF":4.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145458377","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":"Burden of chronic kidney disease and outcomes following hospitalisation for heart failure.","authors":"Tauben Averbuch, Stephen Greene, Tor Biering-Sørensen, Sradha Kotwal, Brandon Zagorski, Harriette G C Van Spall","doi":"10.1136/heartjnl-2025-327053","DOIUrl":"10.1136/heartjnl-2025-327053","url":null,"abstract":"<p><strong>Background: </strong>The epidemiology and long-term healthcare utilisation associated with chronic kidney disease (CKD) among those with heart failure (HF) has not been mapped.</p><p><strong>Methods: </strong>This is a 5-year longitudinal cohort analysis of patients hospitalised for HF and enrolled in the Patient Centered Care Transitions in HF randomised controlled trial. We compared clinical events, healthcare resource utilisation and direct healthcare costs (Canadian dollars, adjusted for inflation) between those with and without a CKD diagnosis at index hospitalisation. Diagnoses and outcomes were determined from linked, administrative databases. Survival was evaluated using Cox-proportional hazards models adjusted for baseline variables.</p><p><strong>Results: </strong>Among 4441 patients hospitalised for HF, 929 (20.9%) had an established CKD diagnosis at index hospitalisation. Patients with CKD at index HF hospitalisation faced a higher adjusted risk of death (adjusted HR 1.55, 95% CI 1.42 to 1.69), poorer survival (mean [SD] 2.2 [1.8] vs 3.0 [1.9] years), more rehospitalisations (mean [SD] 4.5 [12.2] vs 2.5 [6.6] per patient) and more in-hospital days (mean [SD] 43.8 [61.8] vs 22.7 [42.3] per patient) than those without a diagnosis of CKD. Patients with a CKD diagnosis at index hospitalisation received more ambulatory and diagnostic services and were less likely to be dispensed an ACE inhibitor or mineralocorticoid receptor antagonist after adjusting for relevant baseline characteristics. Annual healthcare costs were nearly two times as high in patients with CKD at index hospitalisation than those without (mean [SD] $C128 840 [137 611] vs $C67 937 [104 149] $C/year), largely due to rehospitalisations. Among those without CKD at baseline, at least 83.4% received a CKD diagnosis during the follow-up period.</p><p><strong>Conclusions: </strong>CKD is common at index hospitalisation for HF and is associated with a higher risk of death, shorter lifespan, more rehospitalisations and nearly twice the direct healthcare costs than no CKD. A vast majority of patients without CKD at index hospitalisation for HF are diagnosed with it subsequently.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"1033-1040"},"PeriodicalIF":4.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147348117","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":"Making sense of composite endpoints: efficiency, meaning and clinical relevance in modern cardiovascular trials.","authors":"Bruno R Nascimento, Bárbara C A Marino, Marcos Antonio Marino","doi":"10.1136/heartjnl-2025-327690","DOIUrl":"10.1136/heartjnl-2025-327690","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"995-996"},"PeriodicalIF":4.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018266","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}