Heart最新文献

{"title":"Pulse pressure and aortic valve peak velocity as new predictors of heart failure in patients post-myocardial infarction.","authors":"Sukrit Trewaree, Alena Shantsila, Gregory Y H Lip","doi":"10.1136/heartjnl-2024-325513","DOIUrl":"10.1136/heartjnl-2024-325513","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"339-340"},"PeriodicalIF":5.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364506","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":"Long-term benefits of atorvastatin on the incidence of cardiovascular events: the ASCOT-Legacy 20-year follow-up.","authors":"Peter S Sever, Somayeh Rostamian, William Whiteley, Cono Ariti, Thomas Godec, Ajay Gupta, Judith Mackay, Andrew Whitehouse, Neil R Poulter","doi":"10.1136/heartjnl-2024-325104","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325104","url":null,"abstract":"<p><strong>Aims: </strong>Cardiovascular (CV) deaths were reduced by atorvastatin during a 16-year follow-up of participants in the Anglo-Scandinavian Cardiac Outcomes Trial-lipid-lowering arm. We now extend these observations over 20 years and report both non-fatal and fatal CV outcomes.</p><p><strong>Methods: </strong>A cohort of 4605 UK hypertensive participants with total cholesterol <6.5 mmol/L (2317 atorvastatin vs 2288 placebo) was followed for up to 21 years (IQR 9.1-19.3). Cox proportional hazard models assessed HRs for non-fatal and fatal CV events. At the end of the original trial (3.3 years), all participants were offered atorvastatin. Lipid profiles were obtained from all subjects 2 years later and from subgroups approximately 9 years post-trial.</p><p><strong>Results: </strong>Patients allocated to atorvastatin had a significant reduction in non-fatal myocardial infarction (MI) and fatal coronary heart disease (CHD) events (HR (95% CI) 0.81 (0.69 to 0.94, p=0.006)), total coronary events (0.88 (0.80 to 0.98, p=0.017)) and CV deaths (0.86 (0.74 to 0.99, p=0.048)). No significant reduction in heart failure (HF), strokes, total CV events and all-cause mortality was observed.In participants assigned atorvastatin in the trial, 3-year mean low-density lipoprotein-cholesterol was strongly associated with long-term CV outcomes. The HRs per 1 mmol/L decrease were for non-fatal MI and fatal CHD (0.69 (0.57 to 0.85, p<0.001)), total coronary events (0.70 (0.61 to 0.79, p<0.001)), non-fatal and fatal HF (0.68 (0.57 to 0.81, p<0.001)), non-fatal and fatal stroke (0.74 (0.59 to 0.92, p=0.006)), total CV events and procedures (0.74 (0.66 to 0.81, p<0.001)), CV mortality (0.66 (0.55 to 0.81, p<0.001)) and all-cause mortality (0.81 (0.71 to 0.90, p<0.001)).Two years after the trial, approximately two-thirds of subjects in each arm were taking atorvastatin. At this time point and approximately 9 years post-trial, lipid profiles were similar between those formerly assigned atorvastatin or placebo.</p><p><strong>Conclusions: </strong>These observations provide further evidence for the long-term legacy effects of statins and have implications for the early introduction of statins to prevent CV events and mortality.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729752","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":"Inflammation in coronary atherosclerosis: diagnosis and treatment.","authors":"Giovanni Occhipinti, Salvatore Brugaletta, Antonio Abbate, Daniela Pedicino, Marco Giuseppe Del Buono, Ramona Vinci, Giuseppe Biondi Zoccai, Manel Sabate, Dominick Angiolillo, Giovanna Liuzzo","doi":"10.1136/heartjnl-2024-325408","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325408","url":null,"abstract":"<p><p>Coronary atherosclerosis is a chronic condition characterised by the development of an atherosclerotic plaque in the inner layer of the coronary artery, mainly associated with cholesterol accumulation and favoured by endothelial dysfunction related to other cardiovascular risk factors, such as smoking, diabetes and hypertension. A key actor in this process is the systemic inflammatory response, which can make plaques either grow slowly over the course of years (like a 'mountain'), obstructing coronary flow, and causing stable coronary artery disease, or make them explode (like a 'volcano') with subsequent abrupt thrombosis causing an acute coronary syndrome. This central role of inflammation in coronary atherosclerosis has led to its consideration as a modifiable cardiovascular risk factor and a therapeutic target. Classic anti-inflammatory drugs have been tested in clinical trials with some encouraging results, and new drugs specifically designed to tackle inflammation are currently being under investigation in ongoing trials. The objectives of this review are to (1) summarise the role of inflammatory biomarkers and imaging techniques to detect inflammation at each stage of plaque progression, and (2) explore currently available and upcoming anti-inflammatory therapies.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729562","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":"Legacy effects in extension studies: standing the test of time.","authors":"Natalia Fabin, Xavier Rossello","doi":"10.1136/heartjnl-2025-325897","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-325897","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729748","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":"Artificial intelligence in cardiac telemetry.","authors":"Jiaying Lu, Ran Xiao, Xiao Hu, Duc H Do","doi":"10.1136/heartjnl-2024-323947","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-323947","url":null,"abstract":"<p><p>Cardiac telemetry has evolved into a vital tool for continuous cardiac monitoring and early detection of cardiac abnormalities. In recent years, artificial intelligence (AI) has become increasingly integrated into cardiac telemetry, making a shift from traditional statistical machine learning models to more advanced deep neural networks. These modern AI models have demonstrated superior accuracy and the ability to detect complex patterns in telemetry data, enhancing real-time monitoring, predictive analytics and personalised cardiac care. In our review, we examine the current state of AI in cardiac telemetry, focusing on deep learning techniques, their clinical applications, the challenges and limitations faced by these models, and potential future directions in this promising field.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691850","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":"Cardiac disease monitoring measures in patients with transthyretin amyloid cardiomyopathy treated with tafamidis.","authors":"Dimitrios Bampatsias, Abdirahman Wardhere, Lawrence Zeldin, Alfonsina Mirabal-Santos, Ariel Y Weinsaft, Juliana C Levy, Dia Smiley, Sergio L Teruya, Mathew S Maurer","doi":"10.1136/heartjnl-2024-324826","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-324826","url":null,"abstract":"<p><strong>Background: </strong>Patients with transthyretin amyloid cardiomyopathy (ATTR-CM) often experience worsening cardiac disease (WCD) despite disease-modifying treatment. However, a strict definition is lacking. Recent studies have shown that N-terminal pro-B-natriuretic peptide (NT-proBNP increase), or intensification of oral diuretics, is associated with increased mortality risk.</p><p><strong>Aim: </strong>To describe the pattern of WCD at 1 year in patients with ATTR-CM on tafamidis and explore the association with mortality and cardiovascular (CV) hospitalisation.</p><p><strong>Methods: </strong>Patients diagnosed with ATTR-CM at Columbia University after 2018 who were treated with tafamidis were enrolled in the study. WCD was defined as: increase in NT-proBNP >700 pg/mL and >30% from baseline or oral diuretic intensification (ODI) or both. Survival and CV hospitalisation risk analysis was performed using Kaplan-Meier curves, Cox regression and competing risk regression adjusted for age, genotype and disease severity by the National Amyloidosis Centre (NAC) stage.</p><p><strong>Results: </strong>A total of 238 patients were enrolled, 100 (42%) of whom showed WCD at 1 year. WCD was associated with increased mortality risk (log rank, p<0.0001, HR=1.91 (1.10-3.32), p=0.023, after adjustment for age, genotype and baseline NAC stage). In competing risk analysis, WCD was associated with increased risk for CV-related hospitalisation (HR=1.8 (1.17-2.99, p=0.009)) after adjustment for age, genotype and baseline NAC stage.</p><p><strong>Conclusions: </strong>NT-proBNP increase and ODI can serve as markers of WCD and predict mortality and CV hospitalisations in a cohort of patients taking tafamidis.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691963","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":"Identification and management of non-obstructive high-risk coronary artery plaque.","authors":"Craig Balmforth, Michael McDermott, Phyo Khaing, Marc Richard Dweck, David E Newby","doi":"10.1136/heartjnl-2024-324858","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-324858","url":null,"abstract":"<p><p>Despite advances in its understanding and treatment, coronary heart disease remains the leading cause of death worldwide. Acute coronary syndromes most commonly result as a consequence of the rupture of non-flow-limiting, high-risk coronary artery plaques. Advances in multimodality imaging have allowed the detailed assessment of the high-risk plaque including the assessment of plaque burden, high-risk plaque features, plaque activity and thrombosis. This in turn may help identify those patients at greatest risk, and thus benefit from intensification of pharmacotherapies or from local preventative strategies including coronary revascularisation. However, the optimal management of high-risk plaques and the prevention of consequent adverse coronary events have yet to be established. Further development and observational studies are required to determine how best to apply high-risk plaque metrics into clinical practice. Nevertheless, a new era of precision medicine is upon us, with advanced plaque imaging allowing enhanced risk stratification and targeting of the growing armamentarium of atherosclerotic therapies to the highest risk patients.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691999","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":"Prognostic impact of neutrophil-to-lymphocyte ratio in patients with and without diabetes mellitus undergoing percutaneous coronary intervention.","authors":"Francesca Maria Di Muro, Samantha Sartori, Birgit Vogel, Sydney Lupo, Angelo Oliva, Mauro Gitto, Prakash Krishnan, Benjamin Bay, Kenneth Smith, Joseph Sweeny, Pedro Moreno, Pier Pasquale Leone, Parasuram Melarcode Krishnamoorthy, George D Dangas, Annapoorna S Kini, Samin K Sharma, Roxana Mehran","doi":"10.1136/heartjnl-2024-325396","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325396","url":null,"abstract":"<p><strong>Background: </strong>The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation associated with adverse cardiovascular outcomes. However, limited evidence exists regarding its prognostic role in patients with diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI), which we sought to explore in this analysis.</p><p><strong>Methods: </strong>We retrospectively evaluated all patients undergoing PCI at a large tertiary centre between 2012 and 2022. Patients were stratified according to the presence of DM, and NLR quartiles were derived in each subgroup. The primary endpoint was major adverse cardiovascular events (MACE), consisting of all-cause mortality, spontaneous myocardial infarction (MI) or stroke. Secondary endpoints were each single MACE component, target vessel revascularisation, bleeding and postprocedural acute kidney injury. A multivariable Cox regression model, adjusted for relevant baseline characteristics, was computed.</p><p><strong>Results: </strong>A total of 9427 patients were included (48.5% with DM). DM patients had more comorbidities and higher baseline high-sensitivity C reactive protein levels, while patients with elevated NLR in both subgroups exhibited multivessel disease with moderate/severe calcification. DM patients in the upper NLR quartile had the highest rates of MACE (15.7%) than any other subgroup. An independent association of elevated NLR with MACE was observed in both patients with and without DM, and was confirmed after multivariable adjustment. This was primarily driven by all-cause mortality rates in both subgroups and by MI incidence in DM patients only.</p><p><strong>Conclusions: </strong>Patients undergoing PCI with a higher NLR had worse clinical outcomes, regardless of DM status. The combination of DM and elevated NLR revealed the most unfavourable prognosis.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673169","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 between cardiac cachexia and adverse outcomes in patients with heart failure: a meta-analysis of cohort studies.","authors":"Bing Liu, Xinyue Wu, Yuxin Wang, Xinhua Hu","doi":"10.1136/heartjnl-2024-325431","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325431","url":null,"abstract":"<p><strong>Background: </strong>Cardiac cachexia is a condition characterised by unintentional weight loss and muscle wasting in patients with heart failure. However, there is debate about the prognostic value of cardiac cachexia in these patients.</p><p><strong>Objectives: </strong>This meta-analysis aimed to evaluate the prognostic value of cardiac cachexia in patients who had heart failure.</p><p><strong>Methods: </strong>We conducted a thorough literature search of the PubMed, Web of Science and Embase databases until 7 February 2025 to identify studies that examined the prognostic value of cardiac cachexia in patients with heart failure. The outcomes of interest were all-cause mortality and major adverse cardiovascular events (MACEs). The prognostic value of cachexia was determined by pooling the adjusted HR with a 95% CI.</p><p><strong>Results: </strong>Nine studies, including 3821 patients with heart failure, met the inclusion criteria. Depending on the different definitions, the prevalence of cardiac cachexia varied from 11.2% to 37.8% in the included studies. A meta-analysis using a fixed-effects model showed that cardiac cachexia was associated with an increased risk of all-cause mortality (HR 1.59; 95% CI 1.34 to 1.89) and MACEs (HR 2.41; 95% CI 1.50 to 3.85). Subgroup analysis revealed that cardiac cachexia significantly predicted all-cause mortality, regardless of study design, heart failure subtypes, sample sizes, country, patients' age, definitions of cachexia, length of follow-up, baseline body mass index, left ventricular ejection fraction, and whether adjustment for renal function, smoking status, New York Heart Association class or heart failure medications was made.</p><p><strong>Conclusions: </strong>Cardiac cachexia is associated with a higher risk of all-cause mortality and MACEs in patients with heart failure. Assessing cardiac cachexia may provide valuable prognostic information for these patients.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633850","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":"Influence of depression trajectories in heart failure patients with preserved ejection fractions: a secondary analysis of adverse outcomes in the TOPCAT trial.","authors":"Fuwei Xing, Min Gao, Yuzhong Wu, Weihao Liang, Jingzhou Jiang, Yu-Gang Dong, Yi Li, Bin Dong, Chen Liu","doi":"10.1136/heartjnl-2024-324505","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-324505","url":null,"abstract":"<p><strong>Background: </strong>Long-term patterns of depressive symptoms among patients with heart failure, specifically those with a preserved ejection fraction (HFpEF), and their relationship with prognoses are not well studied.</p><p><strong>Methods: </strong>This analysis included 609 participants from the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) at baseline and at 1-year, 2-year and 3-year intervals. Individual trajectory patterns based on PHQ-9 scores during the first 3 years were identified using latent class trajectory models, and their associations with clinical outcomes were evaluated using Cox regression models.</p><p><strong>Results: </strong>Among the 609 participants, 316 (51.9%) were female, with a median age of 74 years (IQR: 66, 80). Four distinct depression trajectory patterns were identified: low (consistently low scores; 349, 57.3%), mild (sustained mild elevation; 110, 18.1%), high (sustained moderate-severe elevation; 52, 8.5%) and recurrent deterioration (high baseline scores, remission, then escalation; 98, 16.1%). According to the multivariate Cox model, recurrent deterioration was associated with a significantly greater risk of all-cause mortality (HR: 2.05; 95% CI 1.16, 3.64) than the low trajectory pattern. No significant differences were found among the low, mild and high trajectory groups.</p><p><strong>Conclusions: </strong>Four distinct depression trajectory patterns were identified among patients with HFpEF. Notably, patients who experienced a recurrent deterioration trajectory presented a significantly increased risk of all-cause mortality. Our findings highlight the importance of monitoring patients' depressive symptoms over time rather than focusing on a single timepoint.</p><p><strong>Trial registration number: </strong>NCT00094302.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633994","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}