Herz最新文献

{"title":"Guideline-endorsed follow-up after percutaneous valve therapies-non-attendance of TAVI and MitraClip patients.","authors":"Frank Patrick Schmidt, Martin Geyer, Efthymios Sotiriou, Yasemin Ardic, Pantea Sadegh, Eberhard Schulz, Thomas Münzel, Ralph Stephan von Bardeleben","doi":"10.1007/s00059-024-05245-2","DOIUrl":"10.1007/s00059-024-05245-2","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous valve therapies (PVT) are performed on a large number of patients. With increasing procedural volume, the need for follow-up has also increased. Follow-up in the heart valve clinic is endorsed by recent guidelines but utilization is unknown, making resource allocation in the clinic difficult. Central follow-up in valve centers may not be feasible for all patients in the future.</p><p><strong>Methods: </strong>In our center, follow-up for PVT patients is scheduled at 1 month and 12 months after the index procedure. Patients are reminded of their appointment by invitation letters or phone calls. We analyzed 150 consecutive patients who underwent transcutaneous aortic valve implantation (TAVI) and MitraClip implantation (n = 300) at our center.</p><p><strong>Results: </strong>At 1 month, 72.7% of patients attended their follow-up, while at 12 months the rate dropped to 58%. Patients who underwent TAVI were older than the MitraClip patients (82.7 vs. 76.1 years) but had lower mean logEuroSCORE (22.6% vs. 25.9%). There was no significant difference in 1‑year mortality between TAVI and MitraClip patients (20% vs. 17.3%). By contrast, the rate of missed follow-up visits was higher for TAVI compared to MitraClip patients (52% vs. 33.3%; p = 0.002). Female patients less frequently attended follow-up (p = 0.005), whereas age, EuroSCORE, NYHA class, ejection fraction, and health status (EQ-5DVAS) were not predictors of attendance in multivariable analysis. Although the result of the EQ-5D assessment was not associated with mortality or attendance, completing the questionnaire was associated with overall survival (p < 0.001).</p><p><strong>Conclusion: </strong>In our heart valve clinic, we observed a high percentage of missed follow-up appointments (42% at 12 months) despite a structured follow-up plan. Factors significantly associated with non-attendance in multivariable analysis were female gender and having a TAVI rather than MitraClip. Future follow-up concepts should take such findings into account, and decentralized approaches need to be explored.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"371-377"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140922041","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":"[Healthcare 4.0-Medicine in transition].","authors":"Steffen Roßkopf, Benjamin Meder","doi":"10.1007/s00059-024-05267-w","DOIUrl":"10.1007/s00059-024-05267-w","url":null,"abstract":"<p><p>Healthcare 4.0 describes the future transformation of the healthcare sector driven by the combination of digital technologies, such as artificial intelligence (AI), big data and the Internet of Medical Things, enabling the advancement of precision medicine. This overview article addresses various areas such as large language models (LLM), diagnostics and robotics, shedding light on the positive aspects of Healthcare 4.0 and showcasing exciting methods and application examples in cardiology. It delves into the broad knowledge base and enormous potential of LLMs, highlighting their immediate benefits as digital assistants or for administrative tasks. In diagnostics, the increasing usefulness of wearables is emphasized and an AI for predicting heart filling pressures based on cardiac magnetic resonance imaging (MRI) is introduced. Additionally, it discusses the revolutionary methodology of a digital simulation of the physical heart (digital twin). Finally, it addresses both regulatory frameworks and a brief vision of data-driven healthcare delivery, explaining the need for investments in technical personnel and infrastructure to achieve a more effective medicine.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"350-354"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901460","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":"Artificial intelligence in cardiovascular imaging and intervention.","authors":"Sandy Engelhardt, Salman Ul Hussan Dar, Lalith Sharan, Florian André, Eike Nagel, Sarina Thomas","doi":"10.1007/s00059-024-05264-z","DOIUrl":"10.1007/s00059-024-05264-z","url":null,"abstract":"<p><p>Recent progress in artificial intelligence (AI) includes generative models, multimodal foundation models, and federated learning, which enable a wide spectrum of novel exciting applications and scenarios for cardiac image analysis and cardiovascular interventions. The disruptive nature of these novel technologies enables concurrent text and image analysis by so-called vision-language transformer models. They not only allow for automatic derivation of image reports, synthesis of novel images conditioned on certain textual properties, and visual questioning and answering in an oral or written dialogue style, but also for the retrieval of medical images from a large database based on a description of the pathology or specifics of the dataset of interest. Federated learning is an additional ingredient in these novel developments, facilitating multi-centric collaborative training of AI approaches and therefore access to large clinical cohorts. In this review paper, we provide an overview of the recent developments in the field of cardiovascular imaging and intervention and offer a future outlook.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"327-334"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906414","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":"[Telemedical care concepts for heart failure: status and future].","authors":"F Koehler, M Hiddemann, M Koehler, K Koehler, S Spethmann, T Kaas, B Zippel-Schultz, T M Helms","doi":"10.1007/s00059-024-05266-x","DOIUrl":"10.1007/s00059-024-05266-x","url":null,"abstract":"<p><p>Telemedical care concepts provide opportunities to improve the care of patients with chronic heart failure (CHF). The current state of telemedical technologies enables the effective monitoring of the disease. Germany is one of the first European countries with an entitlement to telemedical supporting care for CHF patients. The decision of the German Federal Joint Committee in 2020 to introduce telemedical supporting care for CHF patients marks a milestone. For the first time, a digital care procedure was included in the benefits catalogue of the statutory health insurance funds due to its proven benefits in terms of morbidity and mortality. Privately insured CHF patients have been entitled to these benefits since January 2024. Future developments, particularly with respect to artificial intelligence procedures in telemedicine, are promising but require more evidence. Further research, technological innovation and supportive policy frameworks are needed to realize the full potential of these approaches. Continued collaboration between healthcare professionals, technology developers and policy makers will be crucial in sustainably improving the care of heart failure patients with telemedicine.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"342-349"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080026","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":"[eHealth: digital bridges in the healthcare system].","authors":"Simon Glück, Christian Perings","doi":"10.1007/s00059-024-05265-y","DOIUrl":"10.1007/s00059-024-05265-y","url":null,"abstract":"<p><p>Healthcare in Germany is divided into various service sectors, which differ in terms of outpatient and inpatient care as well as the legal and financial bases. The resulting breaks in consecutive patient care are to be overcome by integrating services into cross-sectoral processes (integrated care). Digitalization and the associated use of information and communication technology (ICT) play a decisive role in this. To derive implications and benefits it is necessary to classify the technical possibilities. For this purpose, eHealth is the basic generic term for all process support and direct patient applications that are based on the electronic exchange of data. A distinction can be made between technology for process support and technology for direct application on the patient. Applications in all categories are suitable for ensuring that interfaces in the flow of information between those involved in healthcare processes are adequately managed by eHealth. Furthermore, the allocation of specialized medicine through eHealth is independent of location and sector. New possibilities for generating and using structured data for evidence development and care research are realized through eHealth and the development of existing and new care models will be promoted.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"335-341"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142106744","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":"[Lifelong learning in cardiology: success through innovation : Use of e-learning in further education and training].","authors":"A A Derda, A Hohneck","doi":"10.1007/s00059-024-05263-0","DOIUrl":"10.1007/s00059-024-05263-0","url":null,"abstract":"<p><p>Lifelong learning in cardiology is essential, as treatment standards, technologies and drug treatment are constantly evolving. In this respect e‑learning plays a central role, enabling doctors to flexibly and efficiently expand their knowledge. There are various offerings, from medical students and specialist training to highly specialised expert knowledge. The e‑learning platforms have become an indispensable tool in specialist training. Another concept is the combination of face-to-face teaching and e‑learning, known as blended learning. This is particularly effective in medical training. These models enable flexible preparation and follow-up and appeal to different types of learners. Overall, e‑learning offers a valuable resource for flexibly and efficiently acquiring knowledge and keeping up to date.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"321-326"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142106745","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":"Erratum to: Artificial intelligence in cardiovascular imaging and intervention.","authors":"Sandy Engelhardt, Salman Ul Hussan Dar, Lalith Sharan, Florian André, Eike Nagel, Sarina Thomas","doi":"10.1007/s00059-024-05271-0","DOIUrl":"10.1007/s00059-024-05271-0","url":null,"abstract":"","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"393"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142106746","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":"Cannabinoids and the heart-a psychiatrist's perspective.","authors":"Johannes Kramer, Gabi Koller, Oliver Pogarell","doi":"10.1007/s00059-024-05273-y","DOIUrl":"https://doi.org/10.1007/s00059-024-05273-y","url":null,"abstract":"<p><p>The partial legalization of cannabis in Germany in 2024 will affect both medical and recreational use of cannabis. Tetrahydrocannabinol (THC), the main psychoactive component of the cannabis plant, influences heart rate and blood pressure through the endocannabinoid system. Acute and chronic use can pose cardiovascular risks. There is evidence of a link between cannabis use and cardiovascular events such as stroke and myocardial infarction, although studies show conflicting results. The non-psychoactive cannabidiol (CBD) could have anti-inflammatory and antioxidant effects. Smoking cannabis poses additional cardiovascular risks similar to tobacco. Given these risks, cardiologists should routinely ask their patients about possible cannabis use and inform them about the potential cardiovascular dangers. The article also highlights the psychiatric risks of cannabis use, including dependence and psychosis, and emphasizes the need for interdisciplinary collaboration between cardiologists and psychiatrists to effectively manage cannabis-related health problems.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142345171","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":"Acute atrial infarction: a relatively neglected and under-recognized entity in clinical practice.","authors":"Chengye Di, Haijiang Wang, Mingming Wang, Qun Wang, Yanxi Wu, Longyu Li, Yan Zhang, Wenhua Lin","doi":"10.1007/s00059-024-05272-z","DOIUrl":"https://doi.org/10.1007/s00059-024-05272-z","url":null,"abstract":"<p><strong>Background: </strong>Electrocardiograms (ECGs) and angiographic features indicative of acute atrial infarction (AAI) often go unnoticed and are under-recognized in clinical practice.</p><p><strong>Methods: </strong>In this retrospective observational study, we analyzed the data of 3981 out of 9803 patients (40.61%) who were referred to our hospital for angiography and/or percutaneous coronary intervention due to acute coronary syndrome (ACS). These patients were diagnosed with acute ST segment elevation myocardial infarction (AMI) affecting the inferior, posterior, and/or right ventricular regions.</p><p><strong>Results: </strong>Of the 3981 patients, 270 (6.78%) had involvement of the main coronary atrial branch meeting the angiographic criteria for AAI. Among the 270 patients identified, the right coronary artery was diagnosed as the infarct-related artery (IRA) in 187 patients (group R), while the left circumflex artery was the IRA in 83 patients (group L). The incidence of PR-segment deviation was similar between the two groups (65.2% in group R vs. 66.3% in group L, p = 0.870), as was occurrence of atrial tachyarrhythmia (67.4% vs. 55.4%, p = 0.059). The prevalence of P wave morphology abnormalities (29.9% vs. 49.4%, p = 0.005) and sinus bradycardia or arrest (25.1% vs. 66.3%, p < 0.001) was significantly lower in Group R than in Group L.</p><p><strong>Conclusion: </strong>Acute atrial infarction represents a distinct yet frequently overlooked clinical entity. Clinicians should consider the potential for atrial arrhythmias, thromboembolism, hemodynamic instability, and atrial rupture when diagnosing AAI.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307541","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":"Efficacy of sacubitril-valsartan vs. angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in preventing atrial fibrillation recurrence after catheter ablation: a systematic review and meta-analysis.","authors":"Fernando Baía Bezerra, Luis Eduardo Rodrigues Sobreira, Vitor Kendi Tsuchiya Sano, Artur de Oliveira Macena Lôbo, Jorge Henrique Cavalcanti Orestes Cardoso, Francinny Alves Kelly, Francisco Cezar Aquino de Moraes, Fernanda Marciano Consolim-Colombo","doi":"10.1007/s00059-024-05275-w","DOIUrl":"10.1007/s00059-024-05275-w","url":null,"abstract":"<p><strong>Background: </strong>Patients who have undergone catheter ablation for atrial fibrillation (AF) may experience recurrence of this condition. The efficacy of sacubitril-valsartan (S/V) in preventing AF recurrence compared with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) is not established. This meta-analysis aimed to establish the best therapeutic choice for preventing AF recurrence after catheter ablation.</p><p><strong>Method: </strong>A systematic search of the PubMed, Embase, and Cochrane databases was conducted for randomized controlled trials (RCTs) and observational studies comparing the use of S/V with ACEI/ARB in patients who underwent catheter ablation. Results are presented as mean difference (MD) with 95% confidence interval (CI). Heterogeneity was assessed with the I² statistic, and outcomes are expressed as relative risk (RR). R software version 4.2.3 was used for the analysis.</p><p><strong>Results: </strong>Three RCTs and one cohort study, comprising 642 patients with 319 patients in the S/V group and 323 in the control group, were included. Follow-up ranged from 6 to 36 months, with mean ages ranging from 58.9 to 65.8 years. A significant reduction in persistent AF occurrence was demonstrated favoring the S/V group (RR: 0.54; 95% CI: [0.41, 0.70]; p = 0.000004; I²: 80%) over the ACEI/ARB group. There was no significant difference in left ventricular ejection fraction with S/V use (MD: 1.23; 95% CI: [-0.12, 2.60]; p = 0.076; I²: 0%) compared with ACEI/ARB. The analysis also showed a significant reduction in left atrial volume index (MD: -5.33; 95% CI: [-8.76, -1.90]; p = 0.002; I²: 57%) in the S/V group compared with the ACEI/ARB group.</p><p><strong>Conclusion: </strong>This meta-analysis demonstrated the efficacy of S/V in reducing the incidence of AF in patients undergoing catheter ablation compared with the use of ACEI/ARB. However, more RCTs are needed for a comprehensive evaluation of its efficacy in reducing AF recurrence after catheter ablation in clinical practice.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307522","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}