Heart最新文献

{"title":"Myocarditis: an increasing global health challenge!","authors":"Massimo Imazio","doi":"10.1136/heartjnl-2025-326105","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-326105","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-10","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":"Cardiovascular morbidity and mortality after radiotherapy for breast cancer: a systematic review and meta-analysis.","authors":"Meng-Xi Yang, Jie-Ke Liu, He-Ping Deng, Jian-Jun Tang, Wen-Ting Xu, Yun-Tao Hu, Wei Diao, Dong Xia, Xi Liu, Lin Yuan, Hong-Bin Luo, Peng Zhou","doi":"10.1136/heartjnl-2024-325179","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325179","url":null,"abstract":"<p><strong>Background: </strong>Radiation exposure of the heart secondary to radiotherapy can lead to potential cardiac injury. However, the hazard ratio (HR) for cardiac morbidity and mortality associated with undergoing breast cancer radiotherapy remains unknown.</p><p><strong>Objectives: </strong>To pool the HRs for cardiovascular risk in patients with breast cancer treated with or without radiotherapy, compare the cardiac risk among irradiated patients divided by the laterality of radiotherapy and further assess the association between the cardiac radiation dose and cardiac morbidity.</p><p><strong>Methods: </strong>A literature search was conducted using MEDLINE, EMBASE and the Cochrane Library from inception to 1 December 2024. Studies that reported HRs with 95% CIs for the associations of interest were included. Pooled effect estimates were obtained using random-effects meta-analysis. Subgroup analyses were carried out to investigate the influence of the treatment period on cardiovascular outcomes. Publication bias was evaluated using the Egger and Begger's tests.</p><p><strong>Results: </strong>Thirty-one studies involving 610 690 participants were ultimately included. Compared with patients who did not receive radiotherapy, patients who underwent radiotherapy experienced increased risks for developing heart failure (HR: 1.37; 95% CI 1.20 to 1.57). Among patients treated with radiotherapy, left-sided radiotherapy increased the risk of subsequent coronary artery disease (HR: 1.11; 95% CI 1.05 to 1.16). There was a linear correlation between the mean heart exposure dose and cardiac morbidity development (HR: 1.12; 95% CI 1.05 to 1.19). When patients were grouped by treatment period, the risk of cardiac mortality in patients treated with left-sided radiotherapy decreased after 1989 (HR: 1.30 vs 1.02, p<0.01*). No evidence of significant publication bias was identified.</p><p><strong>Conclusions: </strong>Radiotherapy for breast cancer was associated with an increased risk of experiencing adverse cardiovascular events, which was highly dependent on the cardiac irradiation dose. With advances in radiation techniques, cardiovascular prognosis is expected to improve further.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988430","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":"Defining centres of expertise for minimally invasive mitral valve surgery: a systematic review and volume-outcome meta-analysis.","authors":"Samuel Heuts, Warda Hjij, Michal J Kawczynski, Jules R Olsthoorn, Andrew Tjon Joek Tjien, Sander M J van Kuijk, Jos G Maessen, Peyman Sardari Nia","doi":"10.1136/heartjnl-2024-325048","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325048","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive mitral valve surgery (MIMVS) is increasingly performed, but outcomes such as repair rate, mortality and survival likely depend on expertise. Still, the definition of a high-volume centre varies in the literature and lacks an evidence-based substantiation. Consequently, this study aims to determine the volume-outcome relation in MIMVS in conjunction with a volume threshold, in order to define 'high-volume centres', applying a novel statistical concept.</p><p><strong>Methods: </strong>The study was preregistered in PROSPERO (CRD42022376293, registered 26 November 2022). A systematic search was applied to three databases, including consecutive patients undergoing MIMVS. Studies describing patients undergoing transcatheter procedures were excluded. Restricted cubic spline analyses were applied and the elbow method was used to retrieve the threshold volume. Long-term outcomes were analysed using reconstructed Kaplan-Meier curves and a novel statistical concept to assess the volume-outcome relation for time-to-event outcomes was applied. The primary outcome was early mortality, secondary outcomes were repair rate, stroke, and long-term survival, freedom from reoperation, and freedom from more than moderate mitral regurgitation. Leave-one-out analyses were performed for sensitivity purposes.</p><p><strong>Results: </strong>Data from 68 unique centres were included (n=23 495 patients). Early mortality was 1.3% (95% CI 1.1% to 1.6%), without a statistically significant non-linear relation for this endpoint, nor for stroke. There was a statistically significant volume-outcome relation for mitral valve repair rate (p=0.018). Based on the repair rate, the threshold to define a high-volume centre was 60 cases/year (number needed to treat to prevent a replacement ≤7). A significant volume-outcome relation was observed for long-term outcomes as well, with a threshold of 53 and 54 cases/year for long-term survival and freedom from reoperation, respectively. These results were robust across the sensitivity analyses for the various endpoints.</p><p><strong>Conclusions: </strong>The threshold to define a high-volume centre ranges between 53 and 60 cases/year based on repair rate, long-term survival and freedom-from reoperation. These findings have the potential to facilitate centralisation of MIMVS.PROSPERO registration numberCRD42022376293.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980494","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":"Incidence, predictors and clinical impact of upper gastrointestinal bleeding after transcatheter aortic valve replacement.","authors":"Masaaki Nakase, Dominik F Draxler, Daijiro Tomii, Dik Heg, Taishi Okuno, Daryoush Samim, Jonas Lanz, Stefan Stortecky, David Reineke, Stephan Windecker, Thomas Pilgrim","doi":"10.1136/heartjnl-2024-325359","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325359","url":null,"abstract":"<p><strong>Background: </strong>Upper gastrointestinal (GI) bleeding following transcatheter aortic valve replacement (TAVR) is common in patients with aortic stenosis due to the combination of acquired type 2A von Willebrand disease and aspirin-based antiplatelet therapy. We aimed to investigate the incidence, predictors and clinical outcomes of late upper GI bleeding in patients undergoing TAVR.</p><p><strong>Methods: </strong>In a prospective TAVR registry, patients were stratified according to upper GI bleeding within 1 year of discharge.</p><p><strong>Results: </strong>Among the 3144 eligible patients, 54 (1.7%) experienced upper GI bleeding after discharge. Of these, 40 patients had major or life-threatening bleeding, while 14 had minor bleeding events. The presence of atrial fibrillation or atrial flutter (HR_adjusted 2.98; 95% CI 1.65 to 5.38) and previous upper GI bleeding (HR_adjusted 3.51; 95% CI 1.51 to 8.19) were independent predictors of upper GI bleeding, while the use of proton pump inhibitors at discharge (HR_adjusted 0.49; 95% CI 0.27 to 0.89) and higher haemoglobin levels (1 g/dL increase) (HR_adjusted 0.73; 95% CI 0.62 to 0.87) were protective. Patients who experienced major or life-threatening upper GI bleeding had a higher all-cause (73.7% vs 11.4%, HR 5.84; 95% CI 3.41 to 10.02) and cardiovascular mortality (31.6% vs 7.3%, HR 3.87; 95% CI 1.72 to 8.70) compared with those without upper GI bleeding.</p><p><strong>Conclusions: </strong>Among patients who underwent TAVR, 1.7% of patients experienced upper GI bleeding within 1 year of discharge. Major or life-threatening upper GI bleeding was associated with an increased risk of all-cause and cardiovascular mortality.</p><p><strong>Trial registration number: </strong>NCT01368250.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962256","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":"The <i>ICAM1</i> p.K56M variant and risk of heart failure in chronic kidney disease: the Chronic Renal Insufficiency Cohort study.","authors":"Kasen Culler, Leila R Zelnick, Rupal C Mehta, Giselle R de Sosa, Mayank Kansal, Panduranga S Rao, Zeenat Bhat, Jonathan Taliercio, Edward Horwitz, Jing Chen, Jiang He, Sanjiv J Shah, Tamara Isakova, Ravi B Patel","doi":"10.1136/heartjnl-2024-325205","DOIUrl":"10.1136/heartjnl-2024-325205","url":null,"abstract":"<p><strong>Background: </strong>Intercellular adhesion molecule-1 (ICAM-1) is a cell-surface protein that facilitates inflammation through leucocyte adhesion. Approximately 35% of Black individuals carry at least one copy of an <i>ICAM1</i> missense variant (rs5491; p.K56M), which has been associated with increased risk of heart failure (HF) with preserved ejection fraction (HFpEF). Whether the risk of HFpEF conferred by rs5491 extends to individuals with chronic kidney disease (CKD), a cohort at high risk for HF, is unknown.</p><p><strong>Aims: </strong>We investigated the association between rs5491 and the incidence of HF in CKD.</p><p><strong>Methods: </strong>We estimated associations of rs5491 with incident HF and HF subtypes among Black individuals who were free from HF at baseline in the Chronic Renal Insufficiency Cohort (CRIC). The CRIC study recruited individuals who were 21-74 years old with estimated glomerular filtration rate (eGFR) of 20-70 mL/min/1.73 m² at baseline.</p><p><strong>Results: </strong>Among 1267 Black participants (mean age 57±11 years, 51% female, mean eGFR 45±15 mL/min/1.73 m²), 464 (37%) had at least one copy of rs5491. During a median follow-up of 10.3 years (IQR: 4.7-15.0 years), there were 309 incident overall HF hospitalisations (160 HFpEF, 111 HF with reduced ejection fraction (HFrEF) and 38 HF with unknown ejection fraction). Each additional rs5491 allele was significantly associated with incident HFpEF (HR 1.35, 95% CI 1.03 to 1.76, p=0.029). The rs5491 variant was not associated with incident overall HF (HR 1.14, 95% CI 0.93 to 1.39, p=0.20) or incident HFrEF (HR 0.76, 95% CI 0.53 to 1.10, p=0.15).</p><p><strong>Conclusion: </strong>The <i>ICAM1</i> p.K56M variant is specifically associated with increased risk of incident HFpEF among individuals with CKD.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"441-444"},"PeriodicalIF":5.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12048245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364457","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":"Weight changes in obesity: the obesity paradox revisited.","authors":"Salvatore Carbone, Carl J Lavie, Ian J Neeland","doi":"10.1136/heartjnl-2024-325611","DOIUrl":"10.1136/heartjnl-2024-325611","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"437-438"},"PeriodicalIF":5.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585260","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":"Transitioning to high-sensitivity troponin: 1-year mortality outcomes in patients with suspected acute coronary syndrome presenting to emergency departments.","authors":"Siobhan Hickling, Frank M Sanfilippo, Louise Cullen, Derek P Chew, Graham S Hillis, Daniel M Fatovich, Jonathon Karnon, Jamie Rankin, Lee Nedkoff, Samuel Scanlan, Peter E Hickman, Stuart Stapleton, Matthew Knuiman, William Parsonage, Biswadev Mitra, Hans G Schneider, Garry Wilkes, Teagan Robinson, Tom Briffa","doi":"10.1136/heartjnl-2024-324959","DOIUrl":"10.1136/heartjnl-2024-324959","url":null,"abstract":"<p><strong>Background: </strong>Switching from a conventional to a high-sensitivity cardiac troponin (hs-cTn) assay enables detection of smaller amounts of myocardial damage, but the clinical benefit is unclear. We investigated whether switching to a hs-cTnI assay with a sex-specific 99th centile diagnostic threshold was associated with lower 1-year death or new myocardial infarction (MI) in patients with suspected acute coronary syndrome (ACS).</p><p><strong>Methods: </strong>This pre-post study included nine tertiary hospitals in Australia. During the pre-hs-cTn period, all hospitals used conventional troponin assays, and during the postperiod, four switched to using hs-cTnI. Participants were ≥20 years old and presenting to emergency departments (EDs) with suspected ACS between March 2011 and November 2015. Outcomes were determined using linked administrative data and compared using Kaplan-Meier and Cox regression analyses.</p><p><strong>Results: </strong>We identified 179 681 consecutive patients (62 (SD 19) years, 47% women), 87 019 (48%) during the preperiod, and 92 662 (52%) during the postperiod. Following the switch to hs-TnI, the proportion of patients diagnosed with new MI was not significantly different (3.9% postperiod vs 4.2% preperiod; p=0.08) while diagnoses of unstable angina were lower (1.5% postperiod vs 2.5% preperiod; p<0.0001). In non-switching jurisdictions, rates of new MI remained stable, while diagnoses of unstable angina increased. Switching to hs-cTnI assay was associated with lower mortality at 30 days (adjusted HR 0.88 (0.82, 0.95)) and 1 year (aHR 0.90 (0.85, 0.94)). The corresponding aHRs for non-switching jurisdictions were not statistically different.</p><p><strong>Conclusion: </strong>The use of an hs-cTnI assay in an ED population with suspected ACS was associated with lower mortality at 1 year.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"471-479"},"PeriodicalIF":5.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004103","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":"High-sensitivity troponin assays: the proof of the pudding is in the eating.","authors":"Paul O Collinson","doi":"10.1136/heartjnl-2024-325613","DOIUrl":"10.1136/heartjnl-2024-325613","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"439-440"},"PeriodicalIF":5.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440653","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":"Association of self-reported and accelerometer-based walking pace with incident cardiac arrhythmias: a prospective cohort study using UK Biobank.","authors":"Pei Qin, Frederick K Ho, Carlos A Celis-Morales, Stewart G Trost, Jill P Pell","doi":"10.1136/heartjnl-2024-325004","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325004","url":null,"abstract":"<p><strong>Objectives: </strong>Dedicated studies aimed at investigating the relationship between walking pace and arrhythmia are limited. This study assessed associations between self-reported and accelerometer measured walking pace and incident cardiac arrhythmias, overall and by subtype, and explored metabolic and inflammatory markers as possible mediators.</p><p><strong>Methods: </strong>Self-reported average walking pace was available for 420 925 UK Biobank participants, and accelerometer measured time spent walking at different paces was available for 81 956 participants. Outcomes were incident cardiac arrhythmias: all, atrial fibrillation (AF), other (including bradyarrhythmias and ventricular arrhythmias), bradyarrhythmias and ventricular arrhythmias. Cox proportional regression models were used to investigate the associations.</p><p><strong>Results: </strong>Compared with slow walking pace, average and brisk walking pace were associated with significantly lower risks of all cardiac arrhythmias (hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.62 to 0.68; HR 0.57, 95% CI 0.54 to 0.60), AF (HR 0.62, 95% CI 0.58 to 0.65; HR 0.54, 95% CI 0.50 to 0.57) and other arrhythmias (HR 0.69, 95% CI 0.64 to 0.73; HR 0.61, 95% CI 0.57 to 0.65). Overall, 36.0% of the association between walking pace and all arrhythmias was mediated via metabolic and inflammatory markers. The associations were stronger in women, in those aged <60 years, in those with a body mass index <30, in those who had hypertension and in those with ≥2 long term conditions.</p><p><strong>Conclusions: </strong>Average and brisk self-reported walking pace and time spent walking at moderate and brisk pace were associated with a decreased risk of cardiac arrhythmias, in part mediated via metabolic and inflammatory pathways. Our findings suggest brisk walking may be a safe and effective exercise to reduce arrhythmias, especially for higher risk groups.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005509","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":"Association of weight change with cardiovascular events and all-cause mortality in obese participants with cardiovascular disease: a prospective cohort study.","authors":"Jufen Zhang, Rudolph Schutte, Barbara Pierscionek","doi":"10.1136/heartjnl-2024-324383","DOIUrl":"10.1136/heartjnl-2024-324383","url":null,"abstract":"<p><strong>Background: </strong>Studies have examined the association between weight change and risk of cardiovascular (CV) outcomes in the general population. However, very few literature reported the association among obese people with established CV disease (CVD) and the factors associated with weight change are not clear. We sought to investigate this using the UK Biobank data.</p><p><strong>Methods: </strong>In this large prospective population-based cohort study, absolute interval change scores in weight were calculated between weight measurements at baseline and the follow-up. The estimated HRs with 95% CIs were obtained from the Cox regression models to assess the association between weight change and the risk of CV death, cerebrovascular and ischaemic heart diseases and all-cause mortality.</p><p><strong>Results: </strong>Of the 8297 obese participants who had CVD with repeated weight measurements, 43.1% were female. The mean age was 56.6 (SD: 7.2) years. The overall median follow-up of the study was 13.9 (IQR: 13.1-14.6) years. 52.7% of the participants had stable weight change (weight loss or gain<5 kg), 14.2% had large weight loss (≥10 kg) and 5.1% had large weight gain (≥10 kg). Compared with stable weight, only large weight gain was associated with an increased risk of CV death and all-cause mortality (fully adjusted HR (95% CI): 3.05 (1.40 to 6.67) for CV death and 1.93 (1.15 to 3.26) for all-cause mortality).</p><p><strong>Conclusions: </strong>Among obese individuals with CVD, large weight gain is associated with a higher risk of CV death and all-cause mortality. Further studies are needed to understand the exact mechanisms underlying the associations between weight loss or weight gain and mortality.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"454-461"},"PeriodicalIF":5.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004423","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}