Heart最新文献

{"title":"Non-malignant gynaecological disease and risk of cardiovascular or cerebrovascular disease: a systematic review and meta-analysis.","authors":"Giorgia Elisabeth Colombo, Yahya Mahamat-Saleh, Mike Armour, Kedar Madan, Angelo Sabag, Marina Kvaskoff, Stacey A Missmer, George Condous, Faraz Pathan, Mathew Leonardi","doi":"10.1136/heartjnl-2024-324675","DOIUrl":"10.1136/heartjnl-2024-324675","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease is the leading cause of death globally. Non-malignant gynaecological diseases (NMGD) significantly affect patient health and well-being and may be associated with cardiovascular or cerebrovascular disease (C/CVD).</p><p><strong>Methods: </strong>Seven databases were searched for relevant studies up to 21 April 2024. Observational studies reporting risk estimates and 95% CIs for the association between NMGD and C/CVD were included. Data were extracted by two independent reviewers. Random effects models were used to calculate summary relative risk (SRR) with 95% CI. Composite C/CVD outcome was defined as a combination of ischaemic heart disease, cerebrovascular disease, heart failure, and peripheral vascular disease. The ROBINS-I tool defined study quality and risk of bias.</p><p><strong>Results: </strong>We screened 6639 studies, of which 59 were eligible for full-text review and 28 were included in our analysis, comprising a total of 3 271 242 individuals. The majority (53.5%) of the studies were scored as having a 'serious'/'critical' risk of bias. Overall, individuals with an NMGD had a significantly greater risk of composite C/CVD with low heterogeneity among contributing studies (SRR 1.28, 95% CI 1.20 to 1.37; n=16 studies, I²=65.3%), ischaemic heart disease (SRR 1.41, 95% CI 1.31 to 1.51; n=21 studies, I²=73.7%), and cerebrovascular disease (SRR 1.33, 95% CI 1.18 to 1.51; n=16 studies, I²=91.5%). In NMGD-specific analyses, the risk of C/CVD and its components was greater among those with a history of endometriosis or polycystic ovary syndrome.</p><p><strong>Conclusions: </strong>We found an overall association between NMGD and C/CVD across all studies. However, estimates from individual studies varied substantially.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491769","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":"AF-CARE in the elderly: complex but of increasing importance.","authors":"Stijn P G Van Vugt, Martin E W Hemels","doi":"10.1136/heartjnl-2024-325614","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325614","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440528","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":"https://doi.org/10.1136/heartjnl-2024-325613","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-02-17","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":"Safety and effectiveness of anticoagulation therapy in older people with atrial fibrillation during exposed and unexposed treatment periods.","authors":"Anneka Mitchell, Margaret C Watson, Tomas J Welsh, Anita McGrogan","doi":"10.1136/heartjnl-2024-324763","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-324763","url":null,"abstract":"<p><strong>Background: </strong>Anticoagulation therapy reduces stroke risk in patients with atrial fibrillation (AF), but it is often underused in older populations due to concerns about bleeding. This study aimed to compare the safety and effectiveness of anticoagulation during periods of exposure and non-exposure and across different anticoagulants in people with AF aged ≥75 years.</p><p><strong>Methods: </strong>Using UK primary care data from the Clinical Practice Research Datalink (2013-2017), a retrospective cohort study was conducted on patients newly prescribed oral anticoagulants (warfarin or direct oral anticoagulants). Exposure to anticoagulation was mapped using prescription data. Cox regression models were used to estimate adjusted HRs for stroke, bleeding, myocardial infarction, and death during periods of exposure and non-exposure and for different anticoagulants.</p><p><strong>Results: </strong>Among 20 167 patients (median age 81 years), non-exposure to anticoagulation was associated with higher risks of stroke (HR 3.07, 95% CI 2.39 to 3.93), myocardial infarction (HR 1.85, 95% CI 1.34 to 2.56) and death (HR 2.87, 95% CI 2.63 to 3.12) compared with exposure. Compared with warfarin, apixaban was associated with lower risks of non-major bleeding (HR 0.73, 95% CI 0.64 to 0.85), whereas rivaroxaban was associated with higher risks of major (HR 1.33, 95% CI 1.15 to 1.55) and non-major (HR 1.29, 95% CI 1.16 to 1.44) bleeding.</p><p><strong>Conclusions: </strong>Non-exposure to anticoagulation increases the risks of stroke, myocardial infarction and death in older patients with AF. Clinicians should carefully weigh the risks of discontinuing anticoagulation and provide shared decision-making support to patients, especially when considering deprescription.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440655","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":"Cardiologists and recognition of iron deficiency in patients with heart failure.","authors":"Iain Squire, Paul R Kalra","doi":"10.1136/heartjnl-2024-325383","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325383","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440651","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":"Assessing diagnostic accuracy of intravascular imaging for functionally significant coronary stenosis: updated findings from a meta-analysis.","authors":"Fabrizio D'Ascenzo, Riccardo Improta, Federico Giacobbe, Gianluca Di Pietro, Daniela Zugna, Stefano Siliano, Marco Gatti, Francesco Bruno, Tsunekazu Kakuta, Seung-Jea Tahk, Tomasz Pawlowski, Francesco Burzotta, Riccardo Faletti, Gennaro Sardella, Gaetano Maria Deferrari, Massimo Mancone, Ovidio De Filippo","doi":"10.1136/heartjnl-2024-324499","DOIUrl":"10.1136/heartjnl-2024-324499","url":null,"abstract":"<p><strong>Background: </strong>Accurate discrimination of functionally significant coronary stenosis using intravascular imaging remains uncertain, particularly with regard to vessel size. This meta-analysis evaluates the diagnostic performance of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) for identifying functionally significant coronary stenosis as confirmed by fractional flow reserve (FFR).</p><p><strong>Methods: </strong>A systematic search of PubMed, Scopus and Google Scholar identified studies that assessed the diagnostic accuracy of IVUS and OCT by minimal luminal area (MLA) with FFR as the reference standard. Sensitivity and specificity were analysed across different vessel diameters including left main coronary artery (LM) lesions. Hierarchical models estimated the summary receiver operating characteristic curve, sensitivity and specificity.</p><p><strong>Results: </strong>31 studies involving 4039 patients and 4413 lesions were analysed. For IVUS, a median MLA threshold of 2.9 mm² (IQR: 2.6-3.2) predicted significant lesions, yielding an area under the curve (AUC) of 0.76. In vessels≥3 mm, this threshold increased to 3.0 mm² (IQR: 2.7-3.1) with an AUC of 0.76 while in smaller vessels it decreased to 2.6 mm² (IQR: 2.4-2.7) with an AUC of 0.79. For LM lesions, the median threshold was 6.0 mm² (IQR: 4.9-6.2) with an AUC of 0.88. OCT demonstrated a median threshold of 2.0 mm² (IQR: 1.7-2.3) and an AUC of 0.82 with better performance in larger vessels (≥3 mm, median 3.0 mm², AUC 0.87) than in smaller ones (<3 mm, median 1.8 mm², AUC 0.75).</p><p><strong>Conclusions: </strong>IVUS and OCT show moderate diagnostic accuracy for identifying functionally significant coronary stenosis with OCT providing improved accuracy in vessels≥3 mm. IVUS is more accurate in assessing LM lesions, suggesting that vessel size should guide modality selection.</p><p><strong>Prospero registration number: </strong>CRD 42024514538.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"195-204"},"PeriodicalIF":5.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846349","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":"Updated evidence on selection and implementation of an invasive treatment strategy for older patients with non-ST-segment elevation myocardial infarction.","authors":"Kieran Gill, Vijay Kunadian","doi":"10.1136/heartjnl-2024-325157","DOIUrl":"https://doi.org/10.1136/heartjnl-2024-325157","url":null,"abstract":"<p><p>Non-ST-segment elevation myocardial infarction (NSTEMI) is the most common acute coronary syndrome diagnosis in older patients. In the UK, there are ~20 000 NSTEMI cases annually in patients aged ≥75 years. Despite therapeutic advances in pharmacological and invasive management, studies show that older patients with NSTEMI experience worse in-hospital and long-term outcomes than younger patients, suggesting a clear need for robust evidence in this cohort.The European Society of Cardiology guidelines recommend that invasive management should be considered holistically with no specified age cut-offs. However, older patients are less likely to receive invasive management due to a paucity of evidence from trials that represent contemporary clinical characteristics of older adults. Recruiting older patients realistic of those encountered in clinical practice is hugely challenging. Chronological age alone does not reflect the heterogeneity of the older population; ~30% of older patients with NSTEMI are frail, ~65% are cognitively impaired and most live with at least two additional comorbidities that can influence risk. Weighing the risk of an NSTEMI in an older adult against competing risks attributable to underlying frailty, comorbidities and cognitive impairment poses a key challenge.Recently, the SENIOR-RITA trial showed that invasive management in older patients with NSTEMI is safe and reduces non-fatal myocardial infarction and subsequent revascularisation but does not improve mortality. Individualised risk assessment and shared decision-making is necessary to guide these nuanced decisions. This review discusses the latest evidence regarding invasive management in the older population with NSTEMI, including the impact of geriatric syndromes on clinical outcomes.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143407115","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":"Atrial arrhythmia and heart failure in adult patients with congenital heart disease: a retrospective cohort study.","authors":"Charlotte Lauwers, Els Troost, Pieter De Meester, Philip Moons, Bert Vandenberk, Joris Ector, Peter Haemers, Werner Budts, Alexander Van De Bruaene","doi":"10.1136/heartjnl-2024-324417","DOIUrl":"10.1136/heartjnl-2024-324417","url":null,"abstract":"<p><strong>Background: </strong>Atrial arrhythmias (AA) and heart failure (HF) are major causes of hospitalisation in adult congenital heart disease (ACHD). This study aimed to evaluate the temporal relationship between AA and HF onset, the association between HF and the success of radiofrequency ablation (RFA), and how HF influences outcomes in patients with AA.</p><p><strong>Methods: </strong>In this single-centre retrospective cohort study, data from 3995 patients with ACHD were analysed. Dates of first AA and HF presentations were documented, and outcomes of RFA, including acute and long-term success, were assessed. All-cause mortality was compared between patients with AA and those with both AA and HF.</p><p><strong>Results: </strong>The median age at last follow-up was 33 years (IQR 26-42). AA was observed in 348 patients (8.7%), and HF in 256 (6.4%). Among patients who developed both AA and HF (n=130), AA preceded HF in 79% of cases, with a median interval of 6 years (IQR 2-13) before HF diagnosis. In the remaining cases, AA occurred after HF diagnosis (median 2 years, IQR 1-6). RFA was performed in 119 patients (34.2%), 45 of whom had HF. Two years after RFA, 72% of patients were free from AA recurrence. Patients without HF had higher acute success rates (98% vs 90%) and lower recurrence rates (48% vs 76%) than those with HF. Patients with AA with HF had worse overall survival compared with those without HF.</p><p><strong>Conclusions: </strong>In patients with ACHD, AA frequently precedes HF by several years. RFA can be an effective treatment for AA, but acute success is lower and recurrence rate higher when HF is present.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"212-220"},"PeriodicalIF":5.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618737","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":"Cardiopulmonary exercise testing in Fabry disease: is it an early marker of cardiomyopathy?","authors":"Justin McNair Canada, Cory Ross Trankle","doi":"10.1136/heartjnl-2024-325300","DOIUrl":"10.1136/heartjnl-2024-325300","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"193-194"},"PeriodicalIF":5.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11821428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004424","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":"Forecasting cardiovascular disease risk and burden in China from 2020 to 2030: a simulation study based on a nationwide cohort.","authors":"Runsi Wang, Yunfeng Wang, Jiapeng Lu, Yichong Li, Chaoqun Wu, Yang Yang, Jianlan Cui, Wei Xu, Lijuan Song, Hao Yang, Wenyan He, Yan Zhang, Xingyi Zhang, Xi Li, Shengshou Hu","doi":"10.1136/heartjnl-2024-324650","DOIUrl":"10.1136/heartjnl-2024-324650","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease (CVD) remains a significant public health challenge in China. This study aimed to project the burden of CVD from 2020 to 2030 using a nationwide cohort and to simulate the potential impact of various control measures on morbidity and mortality.</p><p><strong>Methods: </strong>An agent-based model was employed to simulate annual CVD incidence and mortality from 2021 to 2030. The effects of different prevention and treatment interventions, modelled on international strategies, were also explored.</p><p><strong>Results: </strong>The study included 106 259 participants. The annual CVD incidence rate is projected to increase from 0.74% in 2021 to 0.97% by 2030, with age-standardised and sex-standardised rates rising from 0.71% to 0.96%. CVD mortality is expected to rise from 0.39% in 2021 to 0.46% in 2024, after which it will stabilise at 0.44% by 2030. Community-based interventions and improved access to inpatient care are predicted to reduce the projected burden of CVD significantly.</p><p><strong>Conclusions: </strong>The incidence of CVD in China is projected to increase steadily over the next decade, while mortality will plateau after 2024. Comprehensive interventions, including community-based screenings and enhanced healthcare access, could significantly mitigate the CVD burden.</p><p><strong>Trial registration number: </strong>NCT02536456.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"205-211"},"PeriodicalIF":5.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784677","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}