Heart最新文献

{"title":"Hearing impairment, psychological distress, and incident heart failure: a prospective cohort study.","authors":"Yu Huang, Yanjun Zhang, Yuanyuan Zhang, Hao Xiang, Ziliang Ye, Sisi Yang, Xiaoqin Gan, Yiting Wu, Yiwei Zhang, Xianhui Qin","doi":"10.1136/heartjnl-2024-325394","DOIUrl":"10.1136/heartjnl-2024-325394","url":null,"abstract":"<p><strong>Background: </strong>The relationship between objectively measured hearing ability and the risk of incident heart failure (HF) remains unclear. This study aimed to assess this association, explore potential modifying factors, and examine whether psychological factors mediate this relationship.</p><p><strong>Methods: </strong>We included 164 431 participants from the UK Biobank without HF at baseline. Speech-in-noise hearing ability was measured using the Digit Triplets Test and quantified by the speech-reception-threshold (SRT). Incident HF was identified through hospital admission and death records. Mediation analyses assessed the role of social isolation, psychological distress, and neuroticism.</p><p><strong>Results: </strong>Over a median follow-up of 11.7 years, 4449 (2.7%) participants developed incident HF. Higher SRT levels were associated with an increased risk of HF (adjusted HR per SD increment 1.05, 95% CI 1.02 to 1.08). Compared with those with normal hearing, participants with insufficient hearing, poor hearing, or hearing aid use had higher HF risks (adjusted HRs 1.15, 1.28, and 1.26, respectively). Psychological distress mediated 16.9% of the association between SRT levels and HF, while social isolation and neuroticism mediated 3.0% and 3.1%, respectively. The association was stronger in participants without coronary heart disease or stroke at baseline.</p><p><strong>Conclusions: </strong>Poor hearing ability is associated with an increased risk of incident HF, with psychological distress playing a notable mediating role. These findings suggest that hearing health and psychological well-being should be considered in cardiovascular risk assessment and prevention strategies.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"877-883"},"PeriodicalIF":4.4,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810688","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":"Contemporary clinical characteristics and management patterns in hypertrophic cardiomyopathy: insights from baseline enrolment data in a nationwide prospective Japanese registry.","authors":"Toru Kubo, Kenta Sugiura, Yukichi Tokita, Hitoshi Takano, Itaru Takamisawa, Morimasa Takayama, Yoshinori L Doi, Yuichiro Minami, Shota Shirotani, Mio Ebato, Miki Tsujiuchi, Takeru Nabeta, Takayuki Inomata, Takao Kato, Ryuji Okamoto, Kaoru Dohi, Yasuyoshi Takei, Taishiro Chikamori, Eiichi Watanabe, Azusa Furugen, Hirosato Doi, Keitaro Akita, Yuichiro Maekawa, Akiyoshi Ogimoto, Norio Tada, Takashi Yokota, Shuntaro Ikeda, Osamu Yamaguchi, Yasuhiro Izumiya, Atsushi Shibata, Seiji Takashio, Kenichi Tsujita, Yasuhiro Maejima, Noboru Fujino, Akihiro Nomura, Yuichi Akasaki, Koji Higuchi, Shuichi Fujita, Masaaki Hoshiga, Yasuyuki Shiraishi, Masaki Ieda, Yuya Miyamoto, Hiroaki Kitaoka","doi":"10.1136/heartjnl-2024-324811","DOIUrl":"10.1136/heartjnl-2024-324811","url":null,"abstract":"<p><strong>Background: </strong>The Japanese Hypertrophic Cardiomyopathy Registry Study was designed to provide comprehensive, real-world insights into the clinical characteristics and management of hypertrophic cardiomyopathy (HCM) in Japan.</p><p><strong>Methods: </strong>This multicentre, prospective study enrolled consecutive patients with HCM from 24 referral hospitals across Japan starting in 2016. The baseline characteristics of 1485 patients enrolled by December 2019 are presented in this analysis.</p><p><strong>Results: </strong>The median ages at registration and diagnosis were 69 and 60 years, respectively, with men accounting for 54% of the cohort. Familial HCM was confirmed in 18% of cases. Of the cohort, 36% had hypertrophic obstructive cardiomyopathy (HOCM), while 8% had mid-ventricular obstruction, 14% had apical HCM and 4% were in the end-stage phase. Atrial fibrillation was observed in 27% of patients, though the majority were asymptomatic or had mild symptoms at registration. Adverse outcomes included prior sustained ventricular tachycardia or fibrillation (6%), heart failure requiring hospitalisation (11%) and embolic events (5%). Defibrillator implantation was performed in 11% of patients. Differences in the defibrillator indications for primary prevention in the current three guidelines and status of defibrillator deployment at registration were clarified: the percentages of class IIa recommendation in the whole cohort and of patients with defibrillator implantation in class IIa were 22% and 19% in the Japanese guidelines, 4% and 39% in the European guidelines and 28% and 22% in the American guidelines, respectively. Beta blockers were prescribed to 90% of patients with HOCM, while 51% received cibenzoline. Septal reduction therapies were performed in 22% of patients with HOCM, with 6% undergoing surgical myectomy.</p><p><strong>Conclusions: </strong>As the first large-scale, prospective HCM registry in Japan, this study provides valuable baseline data on the clinical characteristics and management of HCM. These findings will help address gaps between current practice and guideline recommendations, improving the care of patients with HCM.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"885-892"},"PeriodicalIF":4.4,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556684","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":"Global, regional and national epidemiology of myocarditis: health inequalities, risk factors and forecasted burden based on the Global Burden of Disease Study 2021.","authors":"Changjun Li, Kun Xu, Aijia Du, Ningning Fu, Zhaolong Xu, Qinghua Chang","doi":"10.1136/heartjnl-2024-325523","DOIUrl":"10.1136/heartjnl-2024-325523","url":null,"abstract":"<p><strong>Background: </strong>Myocarditis is a global epidemic that causes various medical conditions associated with an increased incidence and death numbers. This study aimed to investigate the trends in myocarditis-associated incidence, mortality, and disability-adjusted life-years (DALYs) with health inequalities, risk factors, and predict the disease burden, thereby mitigating the health hazards of myocarditis.</p><p><strong>Methods: </strong>This was a modelling study that used data from the Global Burden of Diseases 2021, from which myocarditis was included in the analysis. Incidence, death, DALYs, age-standardised incidence rate (ASIR), age-standardised mortality rate (ASMR), age-standardised DALYs rate (ASDR), cases change, corresponding estimated annual percentage change (EAPC), Slope Inequality of Index (SII) and Concentration Index were analysed.</p><p><strong>Results: </strong>From 1990 to 2021, incidence and death cases increased by 66.88% and 45.94%, respectively. The myocarditis-associated incidence and death cases increased in all five sociodemographic index (SDI) regions. Among the five SDI regions, the High SDI region had the highest myocarditis-associated ASIR with the least ASMR and ASDR in 2021. Regionally, Central Asia had the largest increase in EAPC of ASIR, ASMR and ASDR. Among 204 countries, Japan had the highest ASIR in 2021 and Romania had the highest ASMR and ASDR. Between 1990 and 2021, the SII and Concentration Index for DALYs have shown declining trends. The extreme temperatures were major contributors to the burden of myocarditis during 1990-2021. The projections suggested that the myocarditis-related global number of new cases and death would increase over the next 15 years. There may be upward trends in people of 15+of incidence number and 40+of death and DALYs number.</p><p><strong>Conclusions: </strong>Myocarditis is an increasing global health challenge with rising incidence and death. Management of extreme temperatures remains a major challenge. The number of incidence, death and DALYs in different age groups would continue to grow over the next 15 years. Therefore, measures should be taken to target risk factors and high-risk groups.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"867-876"},"PeriodicalIF":4.4,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985389","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":"Single high-sensitivity troponin levels to assess patients with potential acute coronary syndromes: 1-year outcomes.","authors":"Cara Barnes, Frank M Sanfilippo, Daniel Michael Fatovich, Stephen Macdonald, Richard Alcock, Jon Spiro, Carl Schultz, Tom Briffa, Graham S Hillis","doi":"10.1136/heartjnl-2024-325188","DOIUrl":"10.1136/heartjnl-2024-325188","url":null,"abstract":"<p><strong>Background: </strong>A pathway incorporating an option for early discharge based on a single low level of high-sensitivity cardiac troponin I (hs-cTnI) at presentation increases the proportion of patients presenting with a potential acute coronary syndrome (ACS) that can be discharged directly from the emergency department (ED), reducing length of stay without any increase in adverse events at 30 days. Here, we report the 1-year outcomes of patients managed using this pathway.</p><p><strong>Methods: </strong>We recruited two cohorts of patients with a potential ACS, without high-risk features. The 'standard' cohort was managed according to the Australian national guidelines and the Single Troponin Accelerated Triage ('STAT') cohort was managed using the study pathway. 12-month outcomes were assessed using linked administrative data.</p><p><strong>Results: </strong>Between May 2018 and October 2019, we recruited 2255 patients (1131 standard vs 1124 STAT), mean age 55 years, 53% male. 709 (63%) patients managed using the STAT pathway were discharged directly from ED, compared with 403 (38%) patients using the standard pathway, with a 47 min reduction in median hospital length of stay. At 12 months, there were no significant differences in unadjusted all-cause death (STAT 0.62% vs standard 0.97%, p=0.35) or myocardial infarction (MI) (STAT 0.62% vs standard 1.24%, p=0.13).</p><p><strong>Conclusions: </strong>A clinical pathway which incorporates early discharge based on a single low serum hs-cTnI is associated with an increased proportion of patients with a potential ACS discharged directly from the ED and reduced length of stay, without an increase in death or MI at 1 year.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"847-850"},"PeriodicalIF":4.4,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511739","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":"Myocarditis: an increasing global health challenge!","authors":"Massimo Imazio","doi":"10.1136/heartjnl-2025-326105","DOIUrl":"10.1136/heartjnl-2025-326105","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"845-846"},"PeriodicalIF":4.4,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963180","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":"Transcriptional, proteomic and metabolic drivers of cardiac regeneration.","authors":"Matthew Cook, Sean Lal, Robert D Hume","doi":"10.1136/heartjnl-2024-325442","DOIUrl":"10.1136/heartjnl-2024-325442","url":null,"abstract":"<p><p>Following injury, many organs are capable of rapid regeneration of necrotic tissue to regain normal function. In contrast, the damaged heart typically replaces tissue with a collagen-rich scar, due to the limited regenerative capacity of its functional contractile cardiomyocytes (CMs). However, this regenerative capacity varies dramatically during development and between species. Furthermore, studies have shown that cardiac regeneration can be enhanced to return contractile function to the damaged heart following myocardial infarction (MI). In this review, we outline the proliferative capacity of CMs <i>in utero</i>, postnatally and in adulthood. We also describe the regenerative capacity of the heart following MI injury. Finally, we focus on the various therapeutic strategies that aim to augment cardiac regeneration in preclinical animal models. These include altering transcripts, microRNAs, extracellular matrix proteins and inducing metabolic rewiring. Together, these therapies aim to return function to the damaged heart and potentially improve the lives of the millions of heart failure patients currently suffering worldwide.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"851-858"},"PeriodicalIF":4.4,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556691","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":"Genotype and arrhythmic risk in patients with apical hypertrophic cardiomyopathy.","authors":"Joo Hee Jeong, Hwajung Kim, Sung Ho Hwang, Chang-Ok Seo, Yeji Kim, Hyoung Seok Lee, Yun Gi Kim, Jaemin Shim, Young-Hoon Kim, So Ree Kim, Dong-Hyuk Cho, Mi-Na Kim, Seong-Mi Park, Young Choi, Jong-Il Choi","doi":"10.1136/heartjnl-2024-325218","DOIUrl":"10.1136/heartjnl-2024-325218","url":null,"abstract":"<p><strong>Background: </strong>Apical hypertrophic cardiomyopathy (HCM) is a rare variant of HCM, often considered to have a benign prognosis. This study aimed to compare the clinical characteristics and genetic predisposition of apical HCM with non-apical HCM.</p><p><strong>Methods: </strong>We included 195 patients with HCM who underwent next-generation sequencing at two tertiary centres in South Korea (2017-2024). The primary outcome was a composite of lethal arrhythmic events (LAE), including death, ventricular arrhythmia, implantable cardioverter defibrillator (ICD) implantation and appropriate ICD shock. Secondary outcomes included major adverse cardiovascular events (MACE), such as new-onset atrial fibrillation, ischaemic stroke, heart failure hospitalisation, septal reduction therapy or heart transplant.</p><p><strong>Results: </strong>Of the 195 patients, 67 (34.4%) had apical HCM. Patients with apical HCM were older at diagnosis and had lower maximal left ventricular wall thickness compared with non-apical HCM. Disease-causing variants were less frequent in apical HCM (20.9% vs 46.9%, p<0.001). <i>MYBPC3</i> and <i>MYH7</i> variants were less common in apical HCM (50.0%) than in non-apical HCM (75.0%). MACE occurred less frequently in apical HCM (HR 0.38, 95% CI 0.19 to 0.75), but no difference was observed in LAE (HR 0.62, 95% CI 0.36 to 1.08). The presence of disease-causing variants was independently associated with LAE (adjusted HR 2.50, 95% CI 1.44 to 4.35).</p><p><strong>Conclusions: </strong>Although apical HCM is associated with less hypertrophy and lower genetic yield, it is not entirely benign. The presence of disease-causing variants is an important predictor of arrhythmic risk, underscoring the value of genetic testing in all HCM patients, regardless of phenotype.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"859-866"},"PeriodicalIF":4.4,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803096","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":"Unmasking arrhythmic risk in apical hypertrophic cardiomyopathy: the imperative of genetic stratification.","authors":"Yi Zheng, Tong Liu","doi":"10.1136/heartjnl-2025-325900","DOIUrl":"10.1136/heartjnl-2025-325900","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"843-844"},"PeriodicalIF":4.4,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011234","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":"Phenotyping non-dilated left ventricular cardiomyopathy: just the beginning of the journey.","authors":"Pawel Rubis","doi":"10.1136/heartjnl-2025-326778","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326778","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144951530","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 and prognostic implications of the Valve Academic Research Consortium-High Bleeding Risk criteria in patients undergoing transcatheter aortic valve implantation.","authors":"Davide Cao, Marco Sandri, Philippe Garot, Francesco Pelliccia, Francesco Radico, Vincenzo Pasceri, Samantha Sartori, George D Dangas, Roxana Mehran, Davide Capodanno, Marie-Claude Morice, Italo Porto, Fausto Biancari, Fabrizio D'Ascenzo, Francesco Saia, Giampaolo Luzi, Francesco Bedogni, Ignacio J Amat-Santos, Vincenzo De Marzo, Arnaldo Dimagli, Timo Mäkikallio, Eugenio Stabile, Mario García-Gómez, Luca Testa, Marco Barbanti, Corrado Tamburino, Franco Fabbiocchi, Federico Conrotto, Giuliano Costa, Carmen Spaccarotella, Andrea Macchione, Michele La Torre, Francesco Bendandi, Tatu Juvonen, Wojciech Wanha, Wojtec Wojakowski, Umberto Benedetto, Ciro Indolfi, David Hildick-Smith, Fabio Miraldi, Marco Zimarino, Giulio Stefanini","doi":"10.1136/heartjnl-2025-326043","DOIUrl":"10.1136/heartjnl-2025-326043","url":null,"abstract":"<p><strong>Background: </strong>The Valve Academic Research Consortium (VARC) recently proposed a definition of high bleeding risk (HBR) for patients undergoing transcatheter aortic valve implantation (TAVI). This study aims to evaluate the prevalence and distribution of the VARC-HBR criteria and their ability to predict in-hospital bleeding.</p><p><strong>Methods: </strong>Patients undergoing TAVI at 18 European sites between 2007 and 2022 and included in the Transfusion Requirements in Transcatheter Aortic Valve Implantation (NCT03740425) registry were stratified into low, moderate, high or very high bleeding risk using the VARC-HBR criteria. The primary outcome was in-hospital major or life-threatening bleeding (VARC-2 definition).</p><p><strong>Results: </strong>Among 8464 patients, bleeding risk was very high in 1966 (23.2%), high in 3311 (39.1%), moderate in 2075 (24.5%) and low in 1112 (13.1%). In-hospital bleeding occurred in 11.0% of those at low risk, compared with 17.2%, 20.0% and 22.2% of patients at moderate, high and very high risk (p<0.001). The association between VARC-HBR criteria and bleeding remained significant after adjustment for calendar time. At 2 years, the incidence of major adverse cardiovascular events ranged from 13.8% in low-risk patients to 13.1%, 18.6% and 25.4% among those at moderate, high and very high risk (p<0.001). Mortality was higher after a bleeding event (HR 1.71, 95% CI 1.50 to 1.95), especially within the first 3 months (HR 2.88, 95% CI 2.33 to 3.56).</p><p><strong>Conclusions: </strong>Up to 60% of patients undergoing TAVI are at high or very high bleeding risk. The VARC-HBR criteria identified those at greater risk of adverse events. In-hospital bleeding complications and long-term cardiovascular events increased progressively across VARC-HBR categories.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144845590","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}