Herz最新文献

{"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}

{"title":"Evaluation of the acute effects of inhaled iloprost on aortic compliance in pulmonary arterial hypertension using invasive methods.","authors":"Alkım Ateşli Yazıcı, Kadriye Memiç Sancar, Serkan Kahraman, Ümit Bulut, Begüm Uygur, Batuhan Yazıcı, Şükrü Hakan Gündüz, Mustafa Yıldız","doi":"10.1007/s00059-025-05315-z","DOIUrl":"10.1007/s00059-025-05315-z","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary arterial hypertension (PAH) is characterized by vascular remodeling and elevated pulmonary vascular resistance. Aortic compliance indicates vascular stiffness and may be increased in PAH. Inhaled iloprost, a prostacyclin analog, is commonly used for PAH treatment and vasoreactivity testing. Its acute effects on aortic compliance remain unclear. This study evaluated the immediate impact of inhaled iloprost on aortic compliance through aortic pulse wave velocity (aPWV) measurements and pressure parameters in patients with PAH undergoing right heart catheterization.</p><p><strong>Methods: </strong>This single-center, cross-sectional study enrolled patients with group 1 PAH who underwent right heart catheterization with pulmonary vasoreactivity testing between August 2022 and May 2023. Aortic compliance was measured via aPWV before and after inhaling 20 mcg/mL iloprost. On the basis of the post-iloprost changes, 32 patients were categorized into high-aPWV (n = 4) or low-aPWV (n = 28) groups. Multivariate regression analysis identified significant predictors of impaired aortic stiffness.</p><p><strong>Results: </strong>The median patient age was 54.5 years (42.2-60.5). No significant differences were found between groups regarding percentage reductions in proximal/distal aortic pressure and pulmonary artery pressure after iloprost administration. The QRS interval was a significant predictor of impaired aortic stiffness (odds ratio: 1.072, 95% confidence interval: 1.002-1.197, p = 0.045). The high-aPWV group demonstrated significantly lower QRS intervals compared to the low-aPWV group (79.0 ms [70.5-84.0] vs. 96.0 ms [85.5-102.0], p = 0.011).</p><p><strong>Conclusions: </strong>Inhaled iloprost effectively reduced both aortic pressure and pulmonary artery pressure regardless of aortic compliance in patients with group 1 PAH. The QRS interval emerged as an independent predictor of impaired aortic stiffness, offering potential for risk stratification in clinical practice.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"385-394"},"PeriodicalIF":0.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752394","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":"[Clinical application of cardiac computed tomography : Current recommendations].","authors":"Christian Tesche, Mohamed Marwan, Michaela Hell, Axel Schmermund, Dirk Loßnitzer, Stefan Möhlenkamp, Dieter Ropers, Stefan Achenbach, Grigorios Korosoglou","doi":"10.1007/s00059-025-05310-4","DOIUrl":"10.1007/s00059-025-05310-4","url":null,"abstract":"<p><p>Cardiac computed tomography (CT) is suitable for use in patients with a low to intermediate pretest probability for risk stratification and for a clear exclusion of coronary heart disease. Furthermore, in addition to a purely anatomical depiction of coronary stenosis it enables the morphological assessment of the underlying plaques and a functional assessment of the hemodynamic relevance. The clinical value of cardiac CT is taken into account in the guidelines of the European Society of Cardiology (ESC) on chronic coronary syndrome with a class 1 recommendation. Cardiac CT therefore has an essential gatekeeper function with respect to the indications for coronary interventions. In the field of structural heart diseases cardiac CT is a core element in the preprocedural planning of heart valve interventions and is the first choice procedure in the postinterventional assessment of unclear findings. Therefore, for interventional heart valve replacement CT-based planning is nowadays the established standard in the clinical diagnostics.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"362-373"},"PeriodicalIF":0.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709581","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 TAVI heart team].","authors":"Oliver Dumpies, Marik Urbschat, Thilo Noack, Mohamed Abdel-Wahab","doi":"10.1007/s00059-025-05331-z","DOIUrl":"10.1007/s00059-025-05331-z","url":null,"abstract":"<p><p>Since the earliest studies on transcatheter aortic valve implantation (TAVI), the heart team concept has been an integral component of treatment planning for patients with aortic valve stenosis (AS). The primary objective is to ensure patient-specific, guideline-based treatment through the structured involvement of all relevant medical disciplines. The TAVI heart team is strongly recommended with a class I indication in both European and US clinical guidelines. A TAVI heart team typically consists of interventional cardiologists, cardiac surgeons, anesthesiologists and cardiac imaging specialists and can be supplemented by additional experts depending on the clinical scenario. The team's responsibilities span the entire continuum of care, from diagnostic assessment and procedural planning to complication management and structured follow-up. The concept of lifetime management is gaining importance, aiming for a long-term strategic approach to valve care throughout the patient's lifespan. Given the evolving age boundaries for intervention, an extension of the heart team approach to all patients with AS is warranted. Clearly defined roles, standardized protocols and defined decision-making processes, supported by a dedicated TAVI coordinator, can substantially enhance both efficiency and quality of care. Looking ahead, digital technologies, artificial intelligence and structured upstream screening strategies for asymptomatic AS patients are expected to play an expanding role.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"309-318"},"PeriodicalIF":0.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023187","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 endocarditis team : Structure, evidence and clinical benefit].","authors":"Carolyn Weber, Norma Jung, Stephan Baldus, Lenard Conradi, Maria Isabel Körber","doi":"10.1007/s00059-025-05333-x","DOIUrl":"10.1007/s00059-025-05333-x","url":null,"abstract":"<p><p>Infective endocarditis (IE) is a severe disease with high morbidity and mortality rates. Interdisciplinary endocarditis teams, consisting of specialists in cardiology, cardiac surgery, infectious diseases and microbiology, have been shown to improve patient care. Current guidelines of the European Society of Cardiology (ESC) and the American Heart Association (AHA) explicitly recommend the implementation. Observational studies showed significant reductions in hospital and 1‑year mortality, shorter hospital stays and fewer complications. Such multidisciplinary teams enable faster diagnosis through multimodal imaging, e.g. positron emission tomography (PET) computed tomography (CT), an early and targeted antibiotic therapy and optimized surgical care. A rapid referral to specialized centers with established teams clearly improves the prognosis. Registry data such as European Endocarditis (EURO-ENDO) and the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) also promote quality improvement and standardization. The widespread implementation of the endocarditis team concept is recommended.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"344-348"},"PeriodicalIF":0.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144951547","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":"HEART vs. GRACE scores for 30-day cardiovascular outcomes in acute chest pain : A systematic review and meta-analysis.","authors":"Peng-Fei Nie, Jun Chen, Huan-Tong Li","doi":"10.1007/s00059-025-05340-y","DOIUrl":"https://doi.org/10.1007/s00059-025-05340-y","url":null,"abstract":"<p><strong>Background: </strong>Acute chest pain is a common emergency department (ED) presentation requiring rapid risk stratification for major adverse cardiovascular events (MACE; including death, myocardial infarction, and urgent revascularization). While the HEART (History, ECG, Age, Risk factors, Troponin) and GRACE scores are widely used, their comparative predictive accuracy for short-term MACE remains unclear. This study aimed to directly compare the diagnostic performance of HEART and GRACE (Global Registry of Acute Coronary Events) in predicting 30-day MACE among ED patients with acute chest pain.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, Cochrane Library, Scopus, and Web of Science from inception to May 2025 for prospective cohort studies directly comparing HEART and GRACE scores. Included studies applied both scores at ED presentation, reported 30-day MACE (death, myocardial infarction, urgent revascularization), and provided data for 2 × 2 contingency tables. Pooled sensitivity, specificity, likelihood ratios (PLR/NLR), diagnostic odds ratio, and area under the curve (AUC) were calculated using a bivariate random-effects model. Heterogeneity was assessed via I² statistics, and subgroup analyses explored sources of variation.</p><p><strong>Results: </strong>In total, 19 studies (14,862 patients) were included. The HEART score demonstrated significantly higher sensitivity (0.96, 95% CI: 0.94-0.98 vs. 0.88, 95% CI: 0.85-0.91; ratio: 1.09 [1.05-1.14]) and lower negative likelihood ratio (NLR: 0.08, 95% CI: 0.03-0.17 vs. 0.42, 95% CI: 0.39-0.46) than the GRACE score. Specificity was lower for HEART (0.50, 95% CI: 0.41-0.60) versus GRACE (0.61, 95% CI: 0.58-0.64), while GRACE showed higher specificity. HEART also had superior discriminative power (AUC: 0.80, 95% CI: 0.77-0.84 vs. 0.72, 95% CI: 0.69-0.75; ratio: 1.11 [1.07-1.15]). Subgroup analyses confirmed HEART's advantage in sensitivity across geographic regions and age groups, particularly in Eastern populations (sensitivity ratio: 1.57 [1.27-1.93]).</p><p><strong>Conclusion: </strong>The HEART score outperforms GRACE in sensitivity and rule-out capability (lower NLR) for 30-day MACE in ED patients with acute chest pain, supporting its utility for safe discharge of low-risk individuals. GRACE's higher specificity may aid in identifying high-risk cases requiring intervention. Standardization of troponin assays and MACE definitions is critical for future implementation.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148905","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":"[Deactivation of implantable cardioverter defibrillators (ICD) at the end of life].","authors":"Karl-Heinz Ladwig, Bernd Lemke, Andreas Goette, Karoline Lukaschek","doi":"10.1007/s00059-025-05342-w","DOIUrl":"https://doi.org/10.1007/s00059-025-05342-w","url":null,"abstract":"<p><p>Up to one third of patients with an implantable cardioverter defibrillator (ICD) experience shock discharges in the last 24 h before death, which no longer have any therapeutic benefit. Even in patients who have a living will (do not resuscitate, DNR, directive), the shock function of the ICD is activated in over 50% of those affected 24 h before death. A significant subgroup of ICD wearers must therefore experience painful, significantly stressful and unnecessary ICD shocks at the hour of their death. All available position papers on this topic call for patients to be informed about this issue in good time; however, in reality such a conversation almost never takes place. This paper outlines the legal basis that helps doctors to deactivate the ICD in the final stage of life and the specific conditions that must be met. This paper advocates repeatedly addressing the issue during the course of the illness and to involve relatives. The actual conversation about deactivation at the end of life should be proactively initiated by the responsible attending physician and should take the form of a structured, patient-centered dialogue in the spirit of good dialogue.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137243","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":"Role of the coronary sinus in risk stratification and prognostic evaluation of idiopathic pulmonary arterial hypertension.","authors":"Begum Uygur, Kadriye Memiç Sancar, Ümit Bulut, Serkan Kahraman, Alkım Ateşli Yazıcı, Ali Rıza Demir, Hicaz Zencirkıran Ağuş, Gizemnur Coşkun, Mehmet Erturk, Mustafa Yıldız","doi":"10.1007/s00059-025-05341-x","DOIUrl":"https://doi.org/10.1007/s00059-025-05341-x","url":null,"abstract":"<p><strong>Objective: </strong>The coronary sinus (CS) can reflect the pressure and volume load of the right heart chambers. Idiopathic pulmonary arterial hypertension (IPAH) is a progressive, life-threatening disease in which risk assessment plays a critical role. We aimed to evaluate (a) the correlation between CS diameter and risk assessment parameters in IPAH patients and (b) the utility of CS diameter in predicting mortality and hospitalization.</p><p><strong>Methods: </strong>This retrospective study included 25 IPAH patients. All patients underwent echocardiographic and laboratory examinations, 6‑minute walk test, and cardiopulmonary exercise test on the same day. The follow-up was 16.8 ± 10.1 months. The primary endpoint was mortality or hospitalization. The relationship between CS diameter, established risk parameters, and prognosis was analyzed.</p><p><strong>Results: </strong>Six patients (24%) were hospitalized, and three patients (12%) died during the follow-up . The mean CS diameter was 9.9 ± 3.7 mm and showed a moderate positive correlation with age (r = 0.560, p = 0.004) and NT-proBNP levels (r = 0.625, p = 0.001); a weak positive correlation with functional class (r = 0.483, p = 0.017); and moderate negative correlations with 6‑min walking distance (r = -0.553, p = 0.005) and peak oxygen uptake (r = -0.506, p = 0.038). Greater CS diameter was associated with older age, higher NT-proBNP levels, and worse functional class, while reduced exercise capacity and peak VO₂ were accompanied by increased CS diameter. A CS diameter > 9 mm predicted mortality and hospitalization with a sensitivity of 77.8% and specificity of 75.0% (area under the curve [AUC]: 0.788; 95% CI: 0.580-0.996; p = 0.019). The Kaplan-Meier curve showed that as CS diameter increased, mortality and hospitalization rates increased significantly.</p><p><strong>Conclusion: </strong>The CS diameter is a simple, readily available, noninvasive echocardiographic parameter that may be a valuable adjunct to current risk assessment models in IPAH.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112921","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":"[Leadless atrial pacemaker : New perspectives in cardiac pacemaker treatment].","authors":"Elia von Felten, Alexander Breitenstein, Daniel Hofer","doi":"10.1007/s00059-025-05337-7","DOIUrl":"10.1007/s00059-025-05337-7","url":null,"abstract":"<p><p>Previous leadless pacemaker systems were confined to the right ventricle, thus limiting the clinical applications. With the introduction of the first leadless atrial cardiac pacemaker, new perspectives in antibradycardia treatment were introduced. This device enables leadless atrial stimulation and electrical atrial sensing with the potential to reduce complications of cardiac pacemaker treatment. The atrial leadless atrial pacemaker is implanted transvenously with a delivery catheter via the femoral vein into the base of the right atrial appendage. In combination with a ventricular leadless pacemaker, a complete dual chamber pacemaker system can be created through galvanically coupled intracorporeal communication. This can be created as an upgrade from an already implanted ventricular or atrial leadless cardiac pacemaker or the system can be implanted directly (de novo). The possibility of an upgrade enables a flexible treatment adapted to the individual progression of the underlying disease. Current limitations for wider clinical use include economic considerations, limited battery capacity and insufficient data concerning retrievability after the battery is exhausted.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069473","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":"[First cardioverter defibrillator (ICD) shock : Diagnostic and therapeutic procedure].","authors":"Thomas Kleemann, Ralf Zahn","doi":"10.1007/s00059-025-05338-6","DOIUrl":"https://doi.org/10.1007/s00059-025-05338-6","url":null,"abstract":"<p><p>Patients with an implantable cardioverter defibrillator (ICD) who receive an appropriate ICD shock are known to subsequently have a worse prognosis. Despite the knowledge about the poorer prognosis, in the guidelines there are no clear instructions on how to proceed after the occurrence of an adequate ICD shock. The ToVAMI concept represents a treatment regimen for patients with first appropriate ICD shock after ventricular tachycardia (VT) or ventricular fibrillation (VF) and consists of three steps: 1) To = trigger optimization with the following triggers summarized under the acronym ICD-STEMi (ischemia, compliance, decompensation, stress, technical issue, electrolyte/endocrinological disorder and medication intoxication), 2) VA = ventricular arrhythmia treatment and 3) MI = medicinal and interventional prognostic heart failure treatment. The treatment after the first ICD shock consists not only of ablation or antiarrhythmic treatment but also encompasses a comprehensive suite of diagnostic and therapeutic measures, which require a systematic approach. The systematic application of this regimen can increase the detection rate of trigger factors for VT/VF and essentially contributes to an optimized medicinal and interventional prognostic heart failure treatment. Approximately 10% of patients have no clinical symptoms of worsening heart failure or ischemia during the first ICD shock, despite objective evidence of progressive heart failure or ischemia. In these patients, the first VT/VF shock is the sole warning signal for worsening of the cardiac status. This underscores the need for a systematic diagnostic work-up and treatment after the first ICD shock.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033113","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}