Heart最新文献

{"title":"Allergic vasospastic angina: a systematic review.","authors":"Megan Quetsch, Frank Kette, Rosanna Tavella, John Beltrame","doi":"10.1136/heartjnl-2025-326599","DOIUrl":"10.1136/heartjnl-2025-326599","url":null,"abstract":"<p><strong>Background: </strong>Allergic vasospastic angina (also referred to as Kounis syndrome) is an under-recognised subtype of vasospastic angina in which coronary artery spasm is precipitated by an allergen. This study evaluates the clinical characteristics, mechanisms and management of this intriguing angina subtype.</p><p><strong>Methods: </strong>A systematic review of reported cases of allergic vasospastic angina from 1992 to 2022 was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Each case report was then analysed for patient characteristics, presenting signs/symptoms and both cardiac and allergic investigations.</p><p><strong>Results: </strong>A systematic review of 393 allergic vasospastic angina case reports revealed a median age of 53 years (64% males), 46% had one or more cardiovascular risk factors with 32% having an atopic history. Most patients presented with an acute coronary syndrome (ST-elevation myocardial infarct in 71%) following exposure to a wide array of precipitating allergens (55% prescription medications), with multiple potential allergic mechanisms including immunoglobulin-E (IgE)-mediated mast cell degranulation, eosinophil-mediated allergic response and other non-IgE mediated mast cell activation pathways.</p><p><strong>Conclusion: </strong>Allergic vasospastic angina is an important and under-recognised vasospastic angina subtype, often presenting as an acute coronary syndrome. Diagnosis of this disorder is important since management differs to conventional vasospastic angina with the potential of allergen avoidance and use of allergic response modulating therapies.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"997-1003"},"PeriodicalIF":4.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145458377","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":"Burden of chronic kidney disease and outcomes following hospitalisation for heart failure.","authors":"Tauben Averbuch, Stephen Greene, Tor Biering-Sørensen, Sradha Kotwal, Brandon Zagorski, Harriette G C Van Spall","doi":"10.1136/heartjnl-2025-327053","DOIUrl":"10.1136/heartjnl-2025-327053","url":null,"abstract":"<p><strong>Background: </strong>The epidemiology and long-term healthcare utilisation associated with chronic kidney disease (CKD) among those with heart failure (HF) has not been mapped.</p><p><strong>Methods: </strong>This is a 5-year longitudinal cohort analysis of patients hospitalised for HF and enrolled in the Patient Centered Care Transitions in HF randomised controlled trial. We compared clinical events, healthcare resource utilisation and direct healthcare costs (Canadian dollars, adjusted for inflation) between those with and without a CKD diagnosis at index hospitalisation. Diagnoses and outcomes were determined from linked, administrative databases. Survival was evaluated using Cox-proportional hazards models adjusted for baseline variables.</p><p><strong>Results: </strong>Among 4441 patients hospitalised for HF, 929 (20.9%) had an established CKD diagnosis at index hospitalisation. Patients with CKD at index HF hospitalisation faced a higher adjusted risk of death (adjusted HR 1.55, 95% CI 1.42 to 1.69), poorer survival (mean [SD] 2.2 [1.8] vs 3.0 [1.9] years), more rehospitalisations (mean [SD] 4.5 [12.2] vs 2.5 [6.6] per patient) and more in-hospital days (mean [SD] 43.8 [61.8] vs 22.7 [42.3] per patient) than those without a diagnosis of CKD. Patients with a CKD diagnosis at index hospitalisation received more ambulatory and diagnostic services and were less likely to be dispensed an ACE inhibitor or mineralocorticoid receptor antagonist after adjusting for relevant baseline characteristics. Annual healthcare costs were nearly two times as high in patients with CKD at index hospitalisation than those without (mean [SD] $C128 840 [137 611] vs $C67 937 [104 149] $C/year), largely due to rehospitalisations. Among those without CKD at baseline, at least 83.4% received a CKD diagnosis during the follow-up period.</p><p><strong>Conclusions: </strong>CKD is common at index hospitalisation for HF and is associated with a higher risk of death, shorter lifespan, more rehospitalisations and nearly twice the direct healthcare costs than no CKD. A vast majority of patients without CKD at index hospitalisation for HF are diagnosed with it subsequently.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"1033-1040"},"PeriodicalIF":4.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147348117","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":"Making sense of composite endpoints: efficiency, meaning and clinical relevance in modern cardiovascular trials.","authors":"Bruno R Nascimento, Bárbara C A Marino, Marcos Antonio Marino","doi":"10.1136/heartjnl-2025-327690","DOIUrl":"10.1136/heartjnl-2025-327690","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"995-996"},"PeriodicalIF":4.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018266","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":"Kidney decline: an overlooked driver of mortality and healthcare burden following heart failure hospitalisation.","authors":"Masatake Kobayashi","doi":"10.1136/heartjnl-2025-327647","DOIUrl":"10.1136/heartjnl-2025-327647","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"993-994"},"PeriodicalIF":4.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147348125","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":"Use and misuse of composite endpoints in randomised clinical trials.","authors":"Joan Siquier-Padilla, Rafael Gonzalez-Manzanares, Xavier Rossello","doi":"10.1136/heartjnl-2025-326545","DOIUrl":"10.1136/heartjnl-2025-326545","url":null,"abstract":"<p><p>Composite endpoints are widely used in large randomised cardiovascular outcome trials. They are frequently referred to as major adverse cardiovascular event (MACE), although there is no consensus around this definition. In essence, composite endpoints are single measures of effect encompassing multiple individual events, so that if any of them occurs, the patient is considered to present the composite endpoint. Their popularity has grown because of their methodological advantages, such as statistical efficiency and better ability to capture multiple clinically relevant outcomes. However, its use comes at a cost. Many times, composite endpoints are driven by the less meaningful event, or simply dilute a potential treatment effect by including outcomes that are not affected by the intervention. This and other limitations are often overlooked, therefore having a direct impact on the interpretation of clinical practice-changing trials. This review discusses key aspects related to the definition, interpretation, use and misuse of composite endpoints. Alternatives to composite endpoints are also discussed. Essential concepts are illustrated through examples based on key landmark studies, as well as topical trials. This work aims to help future trialists in the design and reporting of cardiovascular trials, and to assist readers in developing a critical understanding of them.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"1004-1013"},"PeriodicalIF":4.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145855484","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":"Evaluating the use of proactive surveillance and remote patient monitoring to guide the timing of valve intervention in patients with severe asymptomatic aortic stenosis (APRAISE-AS): results of a pilot randomised controlled trial.","authors":"Nazish Khan, Richard P Steeds, Samir Mehta, Yongzhong Sun, Derek Kyte, Larissa Fabritz, Phil Collis, Clive Stubbs, Mary Nulty, James M Cotton","doi":"10.1136/heartjnl-2026-327782","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-327782","url":null,"abstract":"<p><strong>Background: </strong>The insidious nature of aortic stenosis (AS) combined with the advanced age of the affected population results in underreporting of symptoms and underestimation of impact on functional capacity and quality of life. Although guidelines recommend early valve replacement in severe asymptomatic AS when coupled with adverse prognostic features, capacity within healthcare systems may limit translation into clinical practice. The use of remote monitoring and proactive surveillance to inform clinical management of heart valve disease is an underexplored area. APRAISE-AS evaluated the utility of remote monitoring to pre-empt/detect a change in clinical status (incorporating a symptom tracker, frailty assessment and quality of life score) to inform patient management.</p><p><strong>Methods: </strong>12-month open-label, two-arm, parallel group randomised controlled pilot trial conducted in two tertiary cardiac centres. 38/66 participants (≥18 years) with asymptomatic severe AS were randomly assigned (1:1) to standard care or the APRAISE-AS intervention in addition to standard care. The primary aim of the study was to (1) test the trial protocol, (2) determine acceptability of the APRAISE-AS intervention and (3) inform the most appropriate outcome measure(s) and sample size for a full-scale randomised controlled trial.</p><p><strong>Results: </strong>38 participants were assigned to standard care (n=19) or to standard care plus the APRAISE-AS intervention (n=19). Adherence rates were high: 81% for the weekly symptom assessments, 91% for the fortnightly timed up and go tests and 93% for the monthly health-related quality of life assessments using the Kansas City Cardiomyopathy Questionnaire (KCCQ). Clinical review and onward referral for valve replacement were triggered by a change from baseline in symptoms and KCCQ scores.</p><p><strong>Conclusion: </strong>Remote monitoring of severe asymptomatic AS can be safely delivered in practice. Although the pilot did not recruit to target, a digitally enabled clinical pathway to optimise the management of asymptomatic severe AS is acceptable to clinicians and patients.</p><p><strong>Trial registration number: </strong>ISRCTN19413194.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818264","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":"Circulating soluble LOX-1 and patient prognosis after an acute coronary syndrome.","authors":"Alexandru Schiopu, Sara Svedlund, Gayathri Narasimhan, Bi Juin Loong, Troels Yndigegn, Vijayalakshmi Varma, Emily L Ongstad, Isabel Goncalves, Anna Collén, Jan Nilsson, Li-Ming Gan","doi":"10.1136/heartjnl-2025-326315","DOIUrl":"10.1136/heartjnl-2025-326315","url":null,"abstract":"<p><strong>Background: </strong>The lectin-like oxidised low-density lipoprotein receptor-1 (LOX-1) mediates atherosclerotic plaque inflammation and vulnerability. On activation, LOX-1 sheds its extracellular domain into the circulation as soluble LOX-1 (sLOX-1). sLOX-1 is markedly elevated in patients with acute coronary syndrome (ACS).</p><p><strong>Methods: </strong>We prospectively assessed the associations between plasma sLOX-1 and the development of heart failure (HF), major adverse cardiovascular events (MACE) and coronary and left ventricular (LV) dysfunction in two cohorts of patients with ACS. The first cohort comprised 524 patients recruited during the acute index event at the coronary care unit of Skåne University Hospital, Malmö, Sweden. The second cohort included 363 patients with ACS treated with acute percutaneous intervention at Sahlgrenska University Hospital, Gothenburg, Sweden. Additionally, we examined the anti-inflammatory effects of LOX-1 blockade in vitro using human umbilical vein endothelial cells (HUVECs).</p><p><strong>Results: </strong>In the first cohort, acute-phase sLOX-1 was associated with incident HF and MACE independently of cardiovascular risk factors, revascularisation and medication (HR per 1-SD sLOX-1 increase: 1.57 (95% CI: 1.10 to 2.23; p=0.012) for HF and 1.36 (1.08 to 1.71; p=0.009) for MACE). Elevated sLOX-1 was also associated with lower LV ejection fraction and accelerated remodelling, as measured by echocardiography at 1-year post-ACS. In the second cohort, sLOX-1 was negatively associated with left anterior descending coronary artery flow reserve and LV systolic function, and positively correlated with soluble markers of systemic inflammation and cardiac overload at 4 and 16 weeks post-ACS. In vitro, antibody-mediated LOX-1 blockade prevented oxidised low-density lipoprotein-induced HUVEC activation.</p><p><strong>Conclusions: </strong>Elevated plasma sLOX-1 at baseline and during follow-up is associated with incident HF and MACE, as well as cardiac and coronary dysfunction in patients with ACS. As plasma sLOX-1 levels may reflect the intensity of LOX-1 expression on vascular and immune cells, these findings support LOX-1 as a potentially important therapeutic target to improve prognosis in patients with ACS.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":"1014-1021"},"PeriodicalIF":4.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075090","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":"How short is short enough? Reframing dual antiplatelet therapy duration in the contemporary percutaneous coronary intervention era.","authors":"Giampiero Vizzari, Gabriele Carciotto, Antonio Micari","doi":"10.1136/heartjnl-2026-328515","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328515","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812736","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":"Valvular involvement, phenotypic heterogeneity and outcomes in adults with left-to-right shunt congenital heart disease.","authors":"Dongling Luo, Hezhi Li, Xiaoshan Li, Ziyang Yang, Hongwen Fei, Qingshan Geng, Caojin Zhang","doi":"10.1136/heartjnl-2026-328500","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328500","url":null,"abstract":"<p><strong>Background: </strong>In adults with significant left-to-right shunt congenital heart disease (CHD), valvular involvement may represent an additional source of haemodynamic and remodelling burden beyond shunt loading alone, but its distribution, pulmonary haemodynamic correlates, prognostic relevance and multidimensional phenotypic patterns remain insufficiently defined.</p><p><strong>Methods: </strong>Consecutive adults with non-complex, unrepaired left-to-right shunt CHD, pulmonary-to-systemic flow ratio >1.5 on right heart catheterisation and available echocardiographic data were retrospectively studied between 2015 and 2019. Patients were stratified by pre-tricuspid or post-tricuspid shunt location. Left-sided, right-sided and bilateral valvular involvement was evaluated in relation to invasive haemodynamics, cardiac remodelling and survival. Factor analysis of mixed data followed by hierarchical clustering was performed within each subgroup.</p><p><strong>Results: </strong>Among 452 adults, 351 had pre-tricuspid shunts and 101 had post-tricuspid shunts. Left-sided, right-sided and bilateral valvular involvement occurred in 30.2%, 81.8% and 29.1% of pre-tricuspid cases and 28.7%, 42.6% and 16.8% of post-tricuspid cases, respectively. In pre-tricuspid shunts, right-sided involvement was associated with greater pulmonary vascular load and right-heart enlargement, whereas left-sided and bilateral involvement were associated with higher filling pressures, lower estimated mixed venous oxygen saturation and multichamber remodelling. Associations in post-tricuspid shunts were less consistent and mainly involved mixed venous oxygen saturation and chamber enlargement. Left-sided and bilateral involvement was associated with lower survival in pre-tricuspid shunts, whereas no significant survival differences were observed in post-tricuspid shunts. Clustering identified two pre-tricuspid and three post-tricuspid phenotypes. Mortality was higher in the high-burden pre-tricuspid cluster (17.5% vs 4.3%; false discovery rate-adjusted log-rank p<0.001), but did not differ significantly across post-tricuspid clusters (p=0.260).</p><p><strong>Conclusions: </strong>Valvular involvement was common and showed shunt location-specific associations with haemodynamics and cardiac remodelling. Integrated assessment of valve status, chamber remodelling and haemodynamics may enhance phenotypic characterisation beyond shunt magnitude alone, although its prognostic and clinical relevance requires further validation.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792162","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 based multimodal fusion of electronic medical record data and ECG signals for pericarditis prediction: pericarditis calculator (p-Cal) as a screening aid.","authors":"Chadi Ayoub, Jialu Pi, Milagros Pereyra, Juan M Farina, Sherif Ahmed, Owen Crystal, Sushil Allen Luis, Jae K Oh, Reza Arsanjani, Imon Banerjee","doi":"10.1136/heartjnl-2025-327090","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-327090","url":null,"abstract":"<p><strong>Background: </strong>Pericarditis may be associated with significant morbidity and mortality and can be a clinically challenging entity to diagnose. There is a clinical need for automated artificial intelligence (AI) algorithms to act as a screening aid to assist with the early and accurate detection of pericarditis.</p><p><strong>Methods: </strong>We developed p-Cal, a browser-based pericarditis risk calculator that fuses the patient clinical data and 12-lead ECG image to estimate risk for pericarditis. The ECG encoder was designed based on a pretrained MedCLIP Vision Transformer and random forest classifier was used for the clinical tabular data. These two modalities were fused at the decision-level using a meta classifier. Model reasoning for both modalities was assessed using advanced explainable AI techniques-attention maps from the transformer model were used to interpret ECG images, while SHapley Additive exPlanations (SHAP) force plots were applied to analyse the tabular data.</p><p><strong>Results: </strong>A total of 6508 patients (mean age 54.8±16.1 years, 50.9% female) were used for training and internal validation of the AI model, of whom 902 patients had a confirmed diagnosis of pericarditis (13.8%) and the remainder were normal controls. On 1302 hold-out test patients, the Fusion Model demonstrated the best discriminatory performance, achieving an area under the curve (AUC) of 0.89, which surpassed the ECG (AUC = 0.85) and the clinical data only models (AUC = 0.74) performance. On external validation in the Medical Information Mart for Intensive Care (MIMIC) Database, the fusion model achieved an AUC of 0.81.</p><p><strong>Conclusion: </strong>A late fusion AI model integrating tabular clinical electronic medical record data and ECG signal has robust predictive capability for pericarditis as a screening tool.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812731","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}