Heart最新文献

{"title":"Joint British Societies' position statement on cardiology training in the United Kingdom.","authors":"Oliver Ian Brown, Holly Morgan, William John Jenner, Andrew Chapman, Abhishek Joshi, Michael Drozd, Ghulam Andre Ng, John Pierre Greenwood, Mark Westwood, Christian Fielder Camm","doi":"10.1136/heartjnl-2024-325037","DOIUrl":"10.1136/heartjnl-2024-325037","url":null,"abstract":"<p><p>Cardiology training in the UK is facing significant challenges due to a range of factors. Recent curriculum changes have further compounded this issue and significantly risk the ability to produce adequately trained consultants capable of managing patients with increasingly complex cardiovascular disease. The introduction of mandatory dual accreditation in general internal medicine (GIM) alongside cardiology, by design, results in significantly reduced training opportunities, including procedural and subspecialty exposure. Despite prolongation in training duration to mitigate these effects, most trainees now report needing post-certificate of completion of training fellowships to gain the standard competencies required for consultant roles, undermining the curriculum's aim of fostering independent practice. Furthermore, the current training model is misaligned with patient needs, lacking provisions for training in key and expanding services, such as complex structural interventions and inherited cardiac conditions. The increasing complexity of expectations placed on trainees also has the potential to significantly hinder academic training, discouraging research and innovation, thereby risking the future of UK clinical academia. Urgent curriculum reform is not only desirable but also essential and should include limiting GIM training time, improving subspecialty accreditation pathways and revising academic training provisions. If current bodies overseeing cardiology training fail to implement these essential changes, additional options, including an independent regulatory framework for cardiology training, should be considered. Without immediate action, UK cardiology training risks facing a generational crisis of inadequately skilled consultants, which could compromise future patient care.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"e2"},"PeriodicalIF":5.1,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817805","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":"Age of menopause, healthy lifestyle and cardiovascular disease in women: a prospective cohort study.","authors":"Anushriya Pant, Alice A Gibson, Simone Marschner, Lee P Liao, Liliana Laranjo, Clara K Chow, Sarah Zaman","doi":"10.1136/heartjnl-2024-324602","DOIUrl":"10.1136/heartjnl-2024-324602","url":null,"abstract":"<p><strong>Background: </strong>Menopause is a timely opportunity to screen for cardiovascular disease (CVD) and intervene with healthier lifestyles. We investigated the association between premature/early menopause and the likelihood of CVD and whether a healthy lifestyle is associated with a lower likelihood of CVD in menopausal woman.</p><p><strong>Methods: </strong>The Sax Institute's 45 and Up Study prospectively recruited participants aged ≥45 years (n=267 357) between 2005 and 2009 (New South Wales, Australia). Our study included women without prior CVD and reporting menopausal age at baseline. Primary outcome was new-onset CVD (self-reported heart disease/stroke) based on survey data at Wave 2 (2012-2015) and/or Wave 3 (2018-2020). Logistic regression models assessed the associations of premature (age <40 years) and early (age 40-44 years) menopause with CVD, compared with menopause between 50 and 52 years, adjusting for sociodemographic and clinical variables. Healthy lifestyle adherence was assessed using a score of five factors: smoking, physical activity, sitting, sleep and diet.</p><p><strong>Results: </strong>We included 46 238 women (mean age 62.1±8.2 years), with 5416 (11.7%) cases of CVD over 15-year follow-up. After adjustment, the odds of CVD was higher in women with premature menopause (OR 1.36, 95% CIs 1.17 to 1.59; p<0.0001) and early menopause (OR 1.15, 95% CI 1.03 to 1.28; p=0.013) compared with menopause between 50 and 52 years. Among all women, high (score 9-10) versus low (score 0-5) healthy lifestyle adherence led to 23% lower odds of CVD (OR 0.77, 95% CI 0.68 to 0.86; p<0.0001), and in women with premature menopause, led to 52% lower odds of CVD (OR 0.48, 95% CI 0.30 to 0.77, p=0.0022). Lifestyle effect did not significantly differ between menopause categories (interaction, p=0.71).</p><p><strong>Conclusion: </strong>Women with premature/early menopause are at higher likelihood for CVD. Lifestyle modification is associated with consistent reduction of the likelihood of CVD in women and should be encouraged across the life course.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"262-268"},"PeriodicalIF":5.1,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846341","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":"Factors associated with high-intensity physical activity and sudden cardiac death in hypertrophic cardiomyopathy.","authors":"Hyun-Jung Lee, Seo-Yeon Gwak, Kyu Kim, Iksung Cho, Chi Young Shim, Jong-Won Ha, Geu-Ru Hong","doi":"10.1136/heartjnl-2024-324928","DOIUrl":"10.1136/heartjnl-2024-324928","url":null,"abstract":"<p><strong>Background: </strong>High-intensity physical activity has traditionally been discouraged in patients with hypertrophic cardiomyopathy due to concerns about triggering sudden cardiac death. However, current guidelines adopt a more liberal stance, and evidence on risk factors for exercise-related sudden cardiac death remains limited. This study investigated the clinical, morphological and genetic factors associated with high-intensity physical activity-related sudden cardiac death in hypertrophic cardiomyopathy.</p><p><strong>Methods: </strong>This retrospective study included 75 patients with documented sudden cardiac death events from a cohort of 2619 patients with hypertrophic cardiomyopathy evaluated between 2005 and 2023. Physical activity levels at the time of the sudden cardiac death event were classified as high-intensity (≥6 metabolic equivalents) or low-intensity to moderate-intensity. Clinical and imaging characteristics, cardiopulmonary exercise test findings and genetic data were compared between the groups.</p><p><strong>Results: </strong>Among the 75 patients, 15 (20%) experienced sudden cardiac death events during high-intensity activity. These patients were younger than those with events during low-intensity or moderate-intensity activity (median age: 25 (IQR 16-43) years vs 56 (48-64) years, p<0.001). High-intensity activity-related events were associated with higher European Society of Cardiology sudden cardiac death risk scores (median 4.9 vs 2.4, p=0.023) and fewer ventricular arrhythmias during exercise testing. However, there were no differences in the degree of left ventricular hypertrophy, left ventricular outflow tract obstruction, left ventricular systolic or diastolic function or genetic findings between groups. In multivariable analysis, younger age was the only independent risk factor of high-intensity activity-related sudden cardiac death events. Recurrent events in patients who survived initial high-intensity activity-related sudden cardiac death were triggered by subsequent high-intensity activity.</p><p><strong>Conclusions: </strong>High-intensity physical activity-related sudden cardiac death in hypertrophic cardiomyopathy is associated with younger age; however, in this small cohort, no associations were found with traditional risk factors, including left ventricular hypertrophy or obstructive physiology.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"253-261"},"PeriodicalIF":5.1,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028639","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":"Sociodemographic treatment trends for aortic stenosis since the adoption of transcatheter aortic valve intervention.","authors":"Neil Craig, Marc Richard Dweck","doi":"10.1136/heartjnl-2024-325328","DOIUrl":"10.1136/heartjnl-2024-325328","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"239-240"},"PeriodicalIF":5.1,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004096","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":"Statement on long-term cardiovascular consequences of maternal hypertension: call for urgent action.","authors":"Helen Casey, Christian Delles, Ian B Wilkinson","doi":"10.1136/heartjnl-2024-324610","DOIUrl":"10.1136/heartjnl-2024-324610","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"244-245"},"PeriodicalIF":5.1,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004100","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":"Cardiovascular health effects of vaping e-cigarettes: a systematic review and meta-analysis.","authors":"Anasua Kundu, Anna Feore, Sherald Sanchez, Nada Abu-Zarour, Megan Sutton, Kyran Sachdeva, Siddharth Seth, Robert Schwartz, Michael Chaiton","doi":"10.1136/heartjnl-2024-325030","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325030","url":null,"abstract":"<p><strong>Background: </strong>There is substantial interest in the cardiovascular effects of e-cigarette use, highlighting the need to update our knowledge on the subject. We conducted this review to analyse whether e-cigarette use increases cardiovascular health risks and how these risks vary among different populations.</p><p><strong>Methods: </strong>We searched six databases and included peer-reviewed human, animal, cell/in vitro original studies but excluded qualitative studies, which were published between July 2021 and December 2023. Three types of e-cigarette exposure were examined: acute, short-to-medium term and long term. Different risk of bias tools were used for assessing the quality of the included human studies and we conducted meta-analysis when possible.</p><p><strong>Results: </strong>We included 63 studies in the main analysis, 12 studies in the meta-analysis and 32 studies in the sociodemographic factor-based subgroup analysis. Over half of the human studies had low risk of bias. Acute exposure to e-cigarette was associated with increased heart rate (HR) (mean difference (MD) 11.329, p<0.01) and blood pressure (BP) (MD 12.856, p<0.01 for systolic; MD 7.676, p<0.01 for diastolic) compared with non-use. While HR was lower after acute exposure to e-cigarettes compared with cigarettes (MD -5.415, p<0.01), no significant difference in systolic or diastolic BP was observed. Non-smoker current vapers had no significant differences in resting HR and BP compared with non-users but lower resting HR (MD -2.608, p<0.01) and diastolic BP (MD -3.226, p<0.01) compared with non-vaper current smokers. Despite some association between e-cigarette and endothelial dysfunction, short-to-medium-term transition from cigarettes to e-cigarettes may improve blood flow and BP, particularly among females and younger individuals. There is lack of evidence supporting any association of e-cigarette use with cardiovascular diseases and cardiac dysfunction or remodelling.</p><p><strong>Conclusions: </strong>This review highlighted several important cardiovascular impacts of e-cigarette use compared with non-use and cigarette smoking. However, the evidence is still limited and requires future research.</p><p><strong>Prospero registration number: </strong>CRD42023385632.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515416","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":"Balancing the risk of major bleeding against vascular disease risk in people without atherosclerotic disease.","authors":"Imen Hammami, Marion Mafham, Jonathan Emberson, Alison Offer, Jemma C Hopewell, Jane Armitage, Colin Baigent, Sarah Parish","doi":"10.1136/heartjnl-2024-324841","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-324841","url":null,"abstract":"<p><strong>Background and aims: </strong>In the primary prevention setting, low-dose aspirin reduces major vascular events (MVEs) by approximately 11% but increases major bleeding (MB) by 40-50%, implying that net benefit will be most evident when the MVE-to-MB ratio is >4. This study aimed to derive cross-validated risk scores for MB and MVE and use the MVE-to-MB ratio to identify groups who may derive differing net benefits from treatment.</p><p><strong>Methods: </strong>431 167 UK Biobank participants without known atherosclerotic cardiovascular disease at baseline were followed through record linkage for incident MVEs (myocardial infarction, non-haemorrhagic stroke, transient ischaemic attack, arterial revascularisation or vascular death) and MB (gastrointestinal and intracranial bleeds with hospital admission for ≥2 days). Risk scores were derived for MVE and MB using Cox proportional hazards models with cross-validation. Ratios of observed MVE-to-MB rates were calculated across risk categories.</p><p><strong>Results: </strong>During a median follow-up of 12 years, 18 310 participants suffered an MVE and 5352 an MB. MB risk was highest among participants with frailty, prior bleeds, cancer, liver disease or renal dysfunction, with a 4.3-fold difference in risk between the highest and lowest fifths of MB risk (HR 4.3, 95% CI 3.87 to 4.77). The MVE-to-MB ratio was ≤2.6 in the highest MB risk groups and ≥4 in lower MB risk categories.</p><p><strong>Conclusions: </strong>The derived models using routinely available disease history and laboratory measurements improved distinction of the MVE-to-MB ratio compared with using conventional models for MB risk including vascular risk factors. Such models can help identify those with moderate MVE risk but low MB risk who may benefit from low-dose aspirin.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515415","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":"Functional assessment of coronary artery disease in patients with severe aortic stenosis: a review.","authors":"Eron Yones, Julian Gunn, Javaid Iqbal, Paul D Morris","doi":"10.1136/heartjnl-2024-324802","DOIUrl":"10.1136/heartjnl-2024-324802","url":null,"abstract":"<p><p>A significant proportion of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) have concomitant coronary artery disease (CAD). The best way to treat these patients is contentious. Conventional assessments of ischaemia such as fractional flow reserve (FFR) and instantaneous wave-free ratio are not validated in the context of severe AS despite having a Class I European Society of Cardiology indication in patients with isolated coronary disease. A better understanding of how we assess and interpret coronary physiology in these patients is required to optimise treatment pathways. Only one prospective, randomised trial has investigated the routine use of FFR to guide revascularisation in patients undergoing TAVI and several observational cohort studies have measured changes in hyperaemic and resting indices in patients with severe AS as well as before and after TAVI. The purpose of this review article is to provide a summary of the current data regarding the functional assessment of CAD in patients with severe AS and highlight the current best practice in this evolving area.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"246-252"},"PeriodicalIF":5.1,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817804","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":"Surgical and transcatheter aortic valve interventions for aortic stenosis in England: sociodemographic variations in treatment trends and outcome over 20 years.","authors":"Anvesha Singh, Fionna Chalmers, Saadia Aslam, Thomas Bolton, Anna Stevenson, Iain Squire, Kamlesh Khunti, Gerry P McCann, Claire Lawson","doi":"10.1136/heartjnl-2024-324918","DOIUrl":"10.1136/heartjnl-2024-324918","url":null,"abstract":"<p><strong>Background: </strong>Health inequalities in cardiovascular care have been identified in the UK. The sociodemographic characteristics of patients undergoing intervention for aortic stenosis (AS) in England, and the impact of COVID-19, is unknown.</p><p><strong>Methods: </strong>National linked data sets identified all surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) for AS, and post-intervention cardiovascular mortality, between 2000 and 2023.</p><p><strong>Results: </strong>Of 179 645 procedures, there were 139 990 SAVR (mean age 71±10.8 years, 64% male, 96.0% white) and 39 655 TAVI (mean age 81±7.7 years, 57% male, 95.7% white). Rates of SAVR declined during COVID-19 for all groups, but TAVI rates increased steadily. Women were older; ethnic minority groups and those from most deprived areas were younger, with greater comorbidities. Women and more deprived groups had lower rates of SAVR (age-standardised rates per 100 000 in 2020-2023: 17.07 <i>vs</i> 6.65 for men <i>vs</i> women; 9.82 <i>vs</i> 10.10 for Index of Multiple Deprivation (IMD)-1 <i>vs</i> IMD-5) and TAVI (20.20 <i>vs</i> 9.79 for men <i>vs</i> women; 9.55 <i>vs</i> 13.36 for IMD-1 <i>vs</i> IMD-5). These discrepancies widened over time. Ethnic differences were observed for SAVR, with the lowest rates in black patients. Cardiovascular mortality post-intervention was lower in female patients and with decreasing deprivation, with no ethnicity-based differences.</p><p><strong>Conclusions: </strong>There are differences in intervention rates for AS in England, with lower rates in female patients and to a lesser extent, those from the most deprived areas and ethnic minority groups. These variations have widened over time. Post-intervention cardiovascular mortality is lower in women and with decreasing deprivation. Public health measures and research are needed to identify the true prevalence of AS in different populations, and the reasons for potential inequalities.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"278-285"},"PeriodicalIF":5.1,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739245","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":"Giant cardiac mass occupying pericardium.","authors":"Pengfei Yue, Ziqian Xu, Yucheng Chen","doi":"10.1136/heartjnl-2024-325350","DOIUrl":"10.1136/heartjnl-2024-325350","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":"111 6","pages":"252-286"},"PeriodicalIF":5.1,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515419","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}