Herz最新文献

{"title":"[Subcutaneous defibrillator (S-ICD)].","authors":"Jürgen Kuschyk, Fabian Fastenrath, Katherine Sattler, Ibrahim Akin, Daniel Duerschmied, Boris Rudic","doi":"10.1007/s00059-025-05344-8","DOIUrl":"https://doi.org/10.1007/s00059-025-05344-8","url":null,"abstract":"<p><p>Defibrillator treatment should adhere to the guidelines to effectively prevent sudden cardiac death while minimizing all complications. As an entirely extrathoracic system, the subcutaneous implantable cardioverter defibrillator (S-ICD) eliminates the need for intracardiac leads, thus reducing procedural and lead-related complications as well as systemic infections. The evidence across > 5000 participants in randomized trials and registries demonstrates approximately 98% shock conversion with low complication rates. The PRAETORIAN study demonstrated that the S‑ICD is not inferior to the transvenous ICD (TV-ICD), long-term and secondary analyses indicate fewer severe, particularly lead-related, complications with S‑ICD treatment. Studies such as UNTOUCHED, EFFORTLESS, and PAS confirm its shock effectiveness and safety profile in routine clinical care, while the ATLAS study reports significantly fewer perioperative lead-related complications in younger patients. The procedure has been streamlined and standardized, incorporating best practices such as preoperative vector screening, a two-incision technique, intermuscular/submuscular pocket creation, and dual-zone programming with morphology/high-pass filtering. In the absence of indications for bradypacing, cardiac resynchronization therapy (CRT) or antitachycardia pacing (ATP), the S‑ICD should be considered a routine option in the clinical routine, especially for younger patients, those prone to infections, those with limited venous access and individuals with hereditary arrhythmia syndromes.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrical-mechanical dyssynchrony in pre-capillary pulmonary hypertension.","authors":"Bing-Yang Liu, En-Ci Hu, Lin Xue, Wei-Chun Wu, Yi-Cheng Yang, Bei-Lan Yang, Yan-Ru Liang, Qi-Xian Zeng, Tao Yang, Qing Zhao, Qin Luo, Zhi-Hui Zhao, Zhi-Hong Liu, Chang-Ming Xiong","doi":"10.1007/s00059-025-05343-9","DOIUrl":"https://doi.org/10.1007/s00059-025-05343-9","url":null,"abstract":"<p><strong>Background: </strong>This study focused on exploring the correlation between the electrical and mechanical dyssynchrony of the right ventricle (RV) in patients with pre-capillary pulmonary hypertension (PcPH). It also aimed to compare the predictive capabilities of these dyssynchronies for risk stratification.</p><p><strong>Methods: </strong>From April 2017 to March 2018, PcPH patients at Fuwai Hospital were consecutively enrolled. They were divided into low-risk and non-low-risk groups according to the 2015 European Society of Cardiology Guidelines. Off-line software (GE EchoPAC version 201) was used to measure RV mechanical dyssynchrony (standard deviation of the time from QRS onset to peak strain for the six RV segments [RV-SD6]), while QRS duration representing electrical dyssynchrony was measured manually.</p><p><strong>Results: </strong>In total, 66 PcPH patients (average 35 years, 19 males and 47 females) were enrolled, 37 in the low-risk group and 29 in the non-low-risk group. QRS duration was significantly correlated with RV-SD6 (r = 0.25, p = 0.047). Both RV-SD6 and QRS duration were significantly correlated with N‑terminal pro-brain natriuretic peptide levels (r = 0.44, p < 0.001 vs. r = 0.26, p = 0.039). Furthermore, RV-SD6 (area under the curve [AUC]: 0.75, 95% confidence interval [CI]: 0.64-0.87, p < 0.001) and QRS duration (AUC: 0.65, 95% CI: 0.52-0.78, p = 0.036) had the potential to predict non-low-risk stratification. Multivariate logistic regression analyses identified RV-SD6 (odds ratio [OR]: 1.02, 95% CI: 1.01-1.03, p = 0.009) and QRS duration (OR: 1.07, 95% CI: 1.00-1.15, p = 0.045) as independent predictors of non-low-risk PcPH.</p><p><strong>Conclusion: </strong>Mechanical dyssynchrony presented by RV-SD6 correlates with QRS duration and better predicts risk stratification in PcPH patients without complete bundle branch block.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The multidisciplinary Heart Team in mitral valve transcatheter edge-to-edge repair.","authors":"Christoph S Mueller, Christian Hagl, Jörg Hausleiter, Thomas J Stocker","doi":"10.1007/s00059-025-05328-8","DOIUrl":"10.1007/s00059-025-05328-8","url":null,"abstract":"<p><p>Treatment options for mitral regurgitation (MR) have markedly evolved over the past few decades, with mitral valve transcatheter edge-to-edge repair (M-TEER) expanding the clinical armamentarium of guideline-directed medical therapy and surgical techniques. However, the variety of mitral valve anatomies, the presence of heart failure (HF), and consideration of the individual patient risk require a multidisciplinary Heart Team approach to identify the optimal treatment for MR for each patient. Despite the growing field of transcatheter mitral interventions and the longstanding availability of surgical mitral valve repair and replacement, evidence from randomized clinical trials comparing intervention with surgery remains scarce. In the meantime, the increasing safety and experience of surgical and interventional procedures have shifted the perspective on mitral valve disease in terms of when and how to treat it. Therefore, the multidisciplinary Heart Team discussion has become of paramount importance in the evaluation and treatment decisions for patients with mitral valve disease.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"319-325"},"PeriodicalIF":0.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144951589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The heart team in coronary artery disease-perspectives from centers without institutional cardiac surgery].","authors":"M Winhard, M Krane, S Hakmi, J Mehilli, A Ghanem","doi":"10.1007/s00059-025-05332-y","DOIUrl":"10.1007/s00059-025-05332-y","url":null,"abstract":"<p><p>The management of coronary artery disease (CAD) has become more demanding due to evolving therapeutic options and more complex patient profiles. In this context, the heart team has become established: a structured, interdisciplinary decision-making process that brings together the specialist knowledge from cardiology, cardiac surgery, anesthesia and other specialist fields to enable individual and evidence-based treatment recommendations. While this model is well-established in university medical centers, its implementation in nonuniversity hospitals lacking in-house cardiac surgery presents unique challenges. This article explores practical strategies for successfully establishing heart teams in such institutions, including the formation of a stable organized core team for case coordination, formal cooperation with external cardiac surgery centers (often via telemedicine), integration of experienced cardiac anesthesiologists and the establishment of clear internal processes for communication and documentation. Particular attention is given to the technical infrastructure required to support hybrid or virtual conferencing formats.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"356-361"},"PeriodicalIF":0.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144951653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The heart team in heart failure].","authors":"Joanna Jozwiak-Nozdrzykowska, Marcus Sandri, Maja Hanuna, Sotirios Nedios, Alexey Dashkevich","doi":"10.1007/s00059-025-05330-0","DOIUrl":"10.1007/s00059-025-05330-0","url":null,"abstract":"<p><p>In recent years the treatment for heart failure (HF) has become much more complex. This development has highlighted the importance of a multidisciplinary HF team to ensure the best possible individually adapted treatment decisions, taking the patient's personal wishes into account and to achieve optimal results. In Germany, specialized HF practices, clinics and tertiary bespoke HF unit centers were established to ensure qualified care for HF patients. These institutions fulfil defined standards and quality features for outpatient and inpatient treatment and cooperate closely in the framework of HF networks. The interdisciplinary HF team should be involved in the treatment from the initial step of correct diagnosis through availability for changes of the clinical status up to HF-related hospitalization due to acute or advanced HF. The core team encompasses cardiologists, skilled HF nursing personnel, cardiac surgeons and coordinators for heart transplantation and ventricular assist devices and is complimented by other specialists depending on the patient's specific etiology and severity of HF as well as relevant comorbidities. The quality of treatment is also enhanced by personal HF additional qualifications. One of the most essential goals of this multidisciplinary collaboration is patient-centered team-based recommendations and decision making, which aim to improve the prognosis of patients, reduce hospitalization rates and improve the quality of life.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"337-343"},"PeriodicalIF":0.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Diagnosis and treatment of heart failure with preserved ejection fraction].","authors":"Samira Soltani, Johann Bauersachs","doi":"10.1007/s00059-025-05327-9","DOIUrl":"10.1007/s00059-025-05327-9","url":null,"abstract":"<p><p>The treatment of heart failure with preserved ejection fraction (HFpEF) involves symptomatic management of congestion with diuretics (class I recommendation) and treatment with sodium-glucose linked transporter 2 (SGLT2) inhibitors for improvement of the prognosis, which have a class I recommendation across the entire spectrum of left ventricular ejection fraction (LVEF) in the current guidelines. The data supporting the recommendation of SGLT2 inhibitors in HFpEF come from the EMPEROR-Preserved and DELIVER studies. The FINEARTS-HF study showed positive effects on cardiovascular death/heart failure hospitalization of the treatment of HFpEF patients with finerenone, a nonsteroidal mineralocorticoid receptor antagonist. The STEP-HFpEF (2023) and SUMMIT (2024) studies investigated the treatment with glucagon-like peptide 1 (GLP-1) analogs in patients with HFpEF and obesity and showed positive outcomes regarding quality of life and, in the latter study, positive effects on heart failure events. The treatment of severe mitral and tricuspid valve regurgitation impacts not only the symptom burden but also hospitalization and overall prognosis in HFpEF patients.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"395-404"},"PeriodicalIF":0.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144951504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The heart team: overemphasized benefit or mandatory requirement?]","authors":"Michael A Borger, Holger Thiele","doi":"10.1007/s00059-025-05335-9","DOIUrl":"https://doi.org/10.1007/s00059-025-05335-9","url":null,"abstract":"","PeriodicalId":12863,"journal":{"name":"Herz","volume":"50 5","pages":"305-308"},"PeriodicalIF":0.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Interdisciplinary management of tricuspid valve regurgitation].","authors":"Marc Adrian Rogmann, Edoardo Zancanaro, Hendrik Treede, Philipp Lurz, Karl-Patrik Kresoja","doi":"10.1007/s00059-025-05329-7","DOIUrl":"10.1007/s00059-025-05329-7","url":null,"abstract":"<p><p>For decades tricuspid valve regurgitation (TR) was considered clinically insignificant and often left untreated. Only with the emergence of catheter-based treatment, particularly tricuspid transcatheter edge-to-edge repair (T-TEER), the condition has gained increasing clinical attention and therapeutic momentum. Concurrently, the surgical treatment has evolved towards minimally invasive endoscopic operations on the beating heart. This article explores the role of the interdisciplinary heart team in the evaluation and execution of T‑TEER or surgical treatment. Based on current guidelines, clinical trial data and echocardiographic selection criteria, it analyses the need for a structured, interdisciplinary decision-making process. Successful TR management requires broad interdisciplinary expertise, including heart failure management, cardiac imaging, interventional cardiology and cardiac surgery. Structured risk assessments using validated tools such as the TRI-score and imaging-based scoring systems enable an objective evaluation of prognosis and anatomical suitability. A key clinical challenge remains the identification of the optimal timing for an intervention, before irreversible deterioration of the right ventricular function or end-organ damage occurs. In conclusion, delivering high-quality, patient-centred care for severe TR is barely achievable without a well-functioning heart team. Early referral, close coordination with outpatient cardiologists, and comprehensive imaging are essential to achieving favourable and sustainable outcomes.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"326-336"},"PeriodicalIF":0.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144951637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive value of PHR and FHR for in-hospital mortality risk in patients with acute myocardial infarction.","authors":"Yazhao Sun, Lingxiao Zhang, Yuanyuan Zuo, Xiaochen Liu","doi":"10.1007/s00059-025-05304-2","DOIUrl":"10.1007/s00059-025-05304-2","url":null,"abstract":"<p><strong>Background: </strong>Inflammation is closely associated with various diseases. The platelet-to-high-density lipoprotein cholesterol (HDL-C) ratio (PHR) and the fibrinogen-to-HDL‑C ratio (FHR) are considered important biomarkers for assessing the level of inflammation. This study aimed to investigate the relationship between PHR, FHR, and in-hospital mortality risk in patients with acute myocardial infarction (AMI).</p><p><strong>Methods: </strong>This retrospective study included patients with first-time AMI at Cangzhou People's Hospital, China, from 2020 to 2021. Multivariable logistic regression analysis was performed to evaluate the association between PHR, FHR, and in-hospital mortality in patients with AMI. Restricted cubic spline (RCS) was used to visualize the dose-response relationship between PHR, FHR, and in-hospital mortality. Receiver operating characteristic (ROC) curve analysis was conducted to determine the predictive value of PHR and FHR for in-hospital mortality. Additionally, subgroup analyses were performed.</p><p><strong>Results: </strong>In the study, 170 out of 2398 patients with AMI (7.09%) died. In the multivariable logistic regression model, both PHR and FHR were identified as independent predictors of in-hospital mortality in patients with AMI. The adjusted RCS regression analysis indicated that there is no significant nonlinear association between PHR, FHR, and in-hospital mortality. The ROC curve analysis revealed that the area under the curve (AUC) for PHR and FHR was 0.718 (95% CI: 0.700-0.736, p < 0.001) and 0.717 (95% CI: 0.699-0.735, p < 0.001), respectively. In the subgroup analysis, we found that admission route, AMI type, congestive heart failure, and cardiac arrest significantly influenced the relationship between PHR, FHR, and in-hospital mortality (p < 0.05 for interaction).</p><p><strong>Conclusion: </strong>Both PHR and FHR are independent prognostic factors for in-hospital mortality in patients with AMI. The clinical utility of these inflammatory biomarkers needs to be further validated in studies with larger sample sizes and diverse populations.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"374-384"},"PeriodicalIF":0.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The heart team for coronary artery disease: perspectives from centers with heart surgery on site].","authors":"Philine Fleckenstein, Torsten Doenst, Marcus Franz","doi":"10.1007/s00059-025-05336-8","DOIUrl":"10.1007/s00059-025-05336-8","url":null,"abstract":"<p><p>The heart team is an important component for guideline-conform treatment of patients with complex coronary artery disease (CAD). Nevertheless, this integrative, multiprofessional approach is not always consistently implemented in clinical practice. This article highlights the role of the heart team, with a particular focus on cardiovascular centers with cardiac surgery on site, presents evidence-based benefits and draws attention to existing structural gaps in daily care, such as the probably widespread use of ad hoc percutaneous coronary intervention (PCI) in multivessel CAD or the lack of interdisciplinary coordination. Numerous studies have shown that consistently implemented heart team decisions and a culture of professional and evidence-based interaction improve patient outcomes. This article appeals to cardiological and cardiac surgery departments to actively shape the heart team process. The presence of both the heart team and cardiac surgery on site paired with modern possibilities of digital communication tools and the wish for individual treatment recommendations should enable faster heart team decisions (practically ad hoc) to improve patient care.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"349-355"},"PeriodicalIF":0.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}