Heart最新文献

{"title":"From pattern recognition to clinical suspicion: can multimodal artificial intelligence help uncover pericarditis?","authors":"Massimo Imazio","doi":"10.1136/heartjnl-2026-328703","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328703","url":null,"abstract":"","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":"148812666","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 and exploratory neurohormonal correlates of hypochloraemia in heart failure: a multicentre cohort study.","authors":"Kohei Inukai, Mikito Takefuji, Shingo Kazama, Ryota Ito, Hiroaki Hiraiwa, Toru Kondo, Ryota Morimoto, Shouji Matsushima, Keisuke Kida, Toshiharu Ninomiya, Nobuyuki Enzan, Masataka Ikeda, Takeshi Kitai, Tatsunori Taniguchi, Takeshi Tohyama, Hiroyuki Tsutsui, Yuya Matsue, Toyoaki Murohara, Takahiro Okumura","doi":"10.1136/heartjnl-2026-328053","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328053","url":null,"abstract":"<p><strong>Background: </strong>Hypochloraemia has emerged as a prognostic marker in heart failure, although the mechanisms underlying chloride dysregulation remain incompletely understood. We evaluated the prognostic significance of serum chloride levels and explored clinical and biochemical correlates of hypochloraemia including circulating urocortin 2 (UCN2).</p><p><strong>Methods: </strong>This multicentre prospective cohort study included 3941 patients discharged after hospitalisation for acute or worsening heart failure with available serum chloride measurements. Patients were categorised according to discharge chloride levels as hypochloraemia, normochloraemia or hyperchloraemia. Associations between chloride status and 2-year outcomes were assessed using multivariable Cox proportional hazards and competing risk models. Exploratory analyses of circulating UCN2 concentrations were performed in a predefined subset of 499 patients.</p><p><strong>Results: </strong>Hypochloraemia was independently associated with adverse outcomes after multivariable adjustment, including all-cause mortality (adjusted HR, 2.09; 95% CI 1.64 to 2.67; p<0.001), cardiovascular mortality (adjusted HR, 2.29; 95% CI 1.64 to 3.20; p<0.001), heart failure rehospitalisation (adjusted HR, 1.30; 95% CI 1.02 to 1.67; p=0.04) and the composite outcome (adjusted HR, 1.46; 95% CI 1.20 to 1.78; p<0.001). Competing risk analyses demonstrated that the excess mortality risk associated with hypochloraemia was predominantly cardiovascular. In models including both serum chloride and sodium, chloride remained independently associated with all-cause mortality whereas sodium did not. In exploratory analyses, circulating UCN2 concentrations showed a modest inverse association with serum chloride levels after adjustment for sodium, renal function, nutritional status and clinical severity (B=-0.37; 95% CI -0.72 to -0.02; p=0.04).</p><p><strong>Conclusions: </strong>Hypochloraemia identified patients with heart failure at substantially increased cardiovascular risk independent of established prognostic markers. Exploratory analyses suggested a potential association between circulating UCN2 and chloride homeostasis that warrants mechanistic investigation.</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":"148812748","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":"Peer review without the expert: artificial intelligence-assisted reviewing and the cost to science.","authors":"Shishir Rao, Kazem Rahimi","doi":"10.1136/heartjnl-2026-328603","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328603","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792232","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":"Diagnosis is not enough: the missing step in acute aortic dissection care.","authors":"Farhin Holia, Christoph Nienaber, Aung Oo","doi":"10.1136/heartjnl-2026-328216","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328216","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792145","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":"Lamin A/C cardiomyopathy and heart transplantation: reassuring outcomes, higher stakes in electrical storm.","authors":"Rodrigue Garcia","doi":"10.1136/heartjnl-2026-328574","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328574","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792159","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":"NT-proBNP in relation to clinical characteristics and cardiovascular outcomes in non-anticoagulated patients with atrial fibrillation.","authors":"Maria Tomasdottir, Jonas Oldgren, Johan Lindbäck, Alexander Benz, John W Eikelboom, Agneta Siegbahn, Lars Wallentin, Ziad Hijazi","doi":"10.1136/heartjnl-2026-328033","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328033","url":null,"abstract":"<p><strong>Background: </strong>N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a well-established biomarker for cardiovascular risk; however, its prognostic value in patients with atrial fibrillation (AF) who are not receiving anticoagulation therapy has not been well established. We investigated the association between NT-proBNP levels, clinical characteristics and cardiovascular outcomes in non-anticoagulated patients with AF and assessed whether baseline heart rhythm modified these associations.</p><p><strong>Methods: </strong>Plasma samples were obtained at baseline in two multicentre clinical trials involving 3183 patients with AF randomised to aspirin with a median follow-up of 18 months. NT-proBNP was analysed using the Elecsys immunoassay. Associations between NT-proBNP and clinical characteristics were assessed by multivariable linear regression. Associations with clinical outcomes were evaluated using Cox regression models. The prognostic value of NT-proBNP was evaluated with C-statistics.</p><p><strong>Results: </strong>AF on the baseline ECG was the clinical factor most strongly associated with NT-proBNP levels, with concentrations 4.2 times higher in AF than in sinus rhythm. NT-proBNP was independently associated with ischaemic stroke (the third sample quartile compared with the first, HR 2.07, 95% CI 1.46 to 2.94), heart failure hospitalisation (HR 2.16, 95% CI 1.59 to 2.92), cardiovascular death (HR 2.43, 95% CI 1.79 to 3.30) and all-cause death (HR 2.09, 95% CI 1.65 to 2.65) during follow-up. There was no interaction between heart rhythm and the associations between NT-proBNP and outcomes (all p values ≥0.07).</p><p><strong>Conclusions: </strong>In non-anticoagulated patients with a diagnosis of AF, NT-proBNP levels were significantly associated with the risk of clinical outcomes. Baseline AF rhythm was the clinical factor most strongly associated with NT-proBNP levels. However, the associations between NT-proBNP and outcomes remained consistent regardless of baseline rhythm.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792172","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":"Temporal trends in characteristics, management and prognosis of patients with acute heart failure through two repeated snapshots.","authors":"Damien Logeart, Benjamin Alos, Damien Legallois, Clerfond Guillaume, Jerome Costa, Etienne Puymirat, Guillaume Turlotte, Christophe Thuaire, François Picard, Guillaume Jondeau, Jean-Noel Trochu, Erwan Donal, Pascal De Groote, Diane Bodez, Clément Delmas, Muriel Salvat, Louise Legrand, Maxime Doublet, Claire Bouleti","doi":"10.1136/heartjnl-2025-327454","DOIUrl":"10.1136/heartjnl-2025-327454","url":null,"abstract":"<p><strong>Background: </strong>Real-life data is very useful for gaining a better understanding of care in practice and identifying areas for improvement. This study aimed to assess changes in the clinical characteristics, care and outcomes of patients hospitalised with acute heart failure (HF).</p><p><strong>Methods: </strong>Two multicentre snapshot surveys were conducted in 2009 and 2021 following the same methodology and enrolled 1658 and 1513 patients, respectively. Clinical characteristics, hospitalisation pathways, in-hospital management and short-term outcomes during a 6-month follow-up were collected.</p><p><strong>Results: </strong>While the age of patients and the proportion in each left ventricular ejection fraction (LVEF) category remained largely unchanged (76 years and 53% with reduced LVEF in the two surveys), there was a rise in the prevalence of most comorbidities. Emergency department was the predominant and increasing route for hospitalisation (64-71%), and admission to critical care units remained frequent and stable (40%). In patients with reduced LVEF, the prescription rate of ACE inhibitors, angiotensin receptor blockers or angiotensin receptor-neprilysin inhibitors (ARNis) decreased from 77.8% to 70.6%, while the use of beta-blockers and mineralocorticoid receptor antagonists increased (67.7-74.2% and 26.6-35.5%, respectively) at discharge. Mortality at 1 and 6 months declined from 8.9% to 7.6% and from 24.7% to 21.3%, respectively. This difference was also significant after matching the two cohorts (HR 0.78 (0.66-0.94)). This improvement in mortality was observed in most patients except in the most elderly and those with preserved LVEF.</p><p><strong>Conclusions: </strong>A comparison of two cross-sectional surveys of acute HF, conducted 12 years apart, reveals an increasing burden of comorbidities, as well as a lack of dedicated admission pathways and a significant shortcoming in the prescription of evidence-based HF drugs on discharge. However, there has been a significant decrease in short-term mortality.</p><p><strong>Trial registration number: </strong>NCT01080937 and NCT05232058.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147928591","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":"COVID-19 outcomes and persistent symptoms in patients with hypertrophic cardiomyopathy: association with pre-existing cardiovascular magnetic resonance phenotype.","authors":"Archit Singhal, Ellen Appleby, Owen Agnel, Paul Kolm, Brian C Case, Ryan L Wallace, Sarahfaye F Dolman, Nancy Geller, Dong-Yun Kim, Patrice Desvigne-Nickens, William Weintraub, Milind Y Desai, Raymond Y Kwong, John DiMarco, Carolyn Ho, Hugh Watkins, Christopher M Kramer, Stefan Neubauer, Betty Raman","doi":"10.1136/heartjnl-2025-327169","DOIUrl":"10.1136/heartjnl-2025-327169","url":null,"abstract":"<p><strong>Background: </strong>The impact of COVID-19 in hypertrophic cardiomyopathy (HCM), particularly in the post-vaccine era, remains incompletely understood. We evaluated whether pre-existing cardiovascular magnetic resonance (CMR) phenotypes are associated with COVID-19 outcomes and recovery.</p><p><strong>Methods: </strong>In 1704 participants from the international HCM Registry with prior CMR phenotyping, COVID-19 infection and outcomes were assessed using patient-reported questionnaires. Associations between baseline CMR features and hospitalisation or impaired recovery (≥3 months) were evaluated using multivariable logistic regression.</p><p><strong>Results: </strong>Among 767 participants with reported COVID-19 infection (mean age 49±11 years), 4% required hospitalisation, 19% reported impaired recovery at ≥3 months and 2 (0.26%) non-cardiac deaths occurred. Persistent symptoms were common particularly fatigue (67%) and dyspnoea (33%). After adjustment, adverse CMR features, including hypertrophy, fibrosis (late gadolinium enhancement) and extracellular volume, were not associated with hospitalisation or impaired recovery. Female sex and younger age were associated with persistent symptoms.</p><p><strong>Conclusions: </strong>In this large HCM cohort, COVID-19 was associated with a substantial burden of persistent symptoms, but pre-existing CMR phenotype was not associated with adverse outcomes. These findings suggest that baseline structural disease severity may not identify patients at higher risk of post-COVID-19 complications, although results should be interpreted in the context of self-reported outcomes and limited event rates.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148054182","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":"Coronary calcium scoring in the evaluation of stable chest pain in general practice: a cluster-randomised trial.","authors":"Moniek Y Koopman, Thom E J Severijn, Jorn J W Reijnders, Grigory Sidorenkov, Marcel Van Tuinen, Carine J M Doggen, Geert Jan Dinant, Mathijs O Versteylen, Jan-Willem C Gratama, Richard Braam, Bastiaan Kietselaer, Rykel Van Bruggen, Robert Willemsen, Pim van der Harst, Rozemarijn Vliegenthart","doi":"10.1136/heartjnl-2025-327687","DOIUrl":"10.1136/heartjnl-2025-327687","url":null,"abstract":"<p><strong>Background: </strong>General practitioners (GPs) have limited tools for chest pain patients to identify (non-)obstructive coronary artery disease (OCAD). This trial evaluates whether GP access to the coronary artery calcium score (CACS) improves diagnostic efficiency and cardiovascular risk management (CVRM).</p><p><strong>Methods: </strong>COroNary Calcium scoring as fiRst-linE Test to dEtect and exclude coronary artery disease in GP patients with stable chest pain (CONCRETE) is a pragmatic, non-blinded implementation study that cluster-randomised 101 Dutch GP offices into CACS or standard of care (SOC). Patients aged ≥40 (men) or ≥45 (women) years, without known CAD, with possible cardiac or non-cardiac chest pain were included. The primary outcome was the proportional 2-year increase in CVRM registrations at GP office level. Patient-level secondary outcomes included cardiologist referral rate, OCAD diagnosis and CVRM enrolment.</p><p><strong>Results: </strong>At GP office level, no significant difference in CVRM registration increase was seen for CACS versus SOC (46 CACS practices: +0.3%, 45 SOC practices: +0.2%, p=0.77). Per protocol analysis for patient-level outcomes included 583 patients (57.5% women, mean age 60.6±9.1 years) (CACS arm: 466; SOC arm: 117), recruited between January 2019 and October 2023. The CACS arm showed 47.1% relative reduction in cardiologist referrals compared with SOC (42.5% vs 80.3%; modelled difference 31.3% (95% CI 14.8% to 47.8%)). OCAD detection rates were not significantly different (CACS: 4.9, SOC: 7.7%, p=0.14). Patients with higher CACS had a higher probability of cardiologist referral (from 8.4% for CACS 0 to 94.2% for CACS ≥400, difference +85.7% (95% CI 79.4% to 91.9%)) and of OCAD diagnosis (0% for CACS 0 to 21.2% for CACS ≥400, OR 9.08 (95% CI 4.20 to 19.67)). Compared with SOC, more CACS patients were enrolled in CVRM (36.3% vs 17.0%, p<0.01).</p><p><strong>Conclusions: </strong>In this pragmatic, primary-care implementation and proof-of-concept trial, CACS was an effective diagnostic test for stable chest pain patients with (very) low likelihood of OCAD. CACS reduced unnecessary cardiology referrals and enhanced individual preventive care, without demonstrable practice-level impact on CVRM registrations.</p><p><strong>Registration: </strong>The CONCRETE study is registered under CCMO Register NL66821.042.18 and closed for enrolment.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148759540","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 contemporary cardiology: physiological insights, novel applications and evolving algorithms.","authors":"Marco Guazzi","doi":"10.1136/heartjnl-2025-327739","DOIUrl":"10.1136/heartjnl-2025-327739","url":null,"abstract":"<p><p>Cardiopulmonary exercise testing (CPET) allows for the study of the pathophysiology of exercise intolerance through assessment of exercise integrative physiology of the pulmonary, cardiovascular, muscular and cellular oxidative systems. Over the years, key gas exchange variables have shown a role in the interpretative translation of physiology to clinical decision making. CPET is a standard when approaching all forms of exercise intolerance, with a predominant evidence for heart failure and hypertrophic cardiomyopathy. As impaired cardiac output and peripheral oxygen diffusion are the main determinants of the abnormal functional response in patients with cardiac issues, invasive CPET (iCPET) has been gaining popularity, especially in confirming the diagnosis of heart failure with preserved ejection fraction (HFpEF) and exercise-induced pulmonary hypertension. Impactful advancements come from the application of CPET combined with echocardiography, or CPET imaging, which shows less accuracy in the left and right haemodynamic assessment compared with iCPET but adds information on atrial and biventricular cardiac valve functional perturbations. While gas exchange classifications and scores are predominant for heart failure with reduced ejection fraction, algorithms are growing on refining exercise unexplained dyspnoea categorisation in HFpEF. The implementation of wearable systems and artificial intelligence to estimate peak oxygen consumption is part of the novel applications. This review focuses on CPET use and perspectives focusing on the most modern advancements in cardiology.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147503540","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}