Herz最新文献

{"title":"[Sex-specific diagnostics and treatment of cardiovascular diseases].","authors":"Verena Stangl, Anna Brand","doi":"10.1007/s00059-025-05303-3","DOIUrl":"10.1007/s00059-025-05303-3","url":null,"abstract":"<p><p>There are relevant sex-specific differences for coronary heart disease, heart failure, takotsubo syndrome and atrial fibrillation. The underrepresentation of women in clinical studies and the fact that sex-specific aspects and analyses are still insufficiently taken into consideration in preclinical and clinical research raises questions on the transferability of research results to women and strongly contrasts with the generally agreed requirements of evidence-based medicine. Sex-specific aspects are not always adequately addressed even in guidelines. Less than half of 24 ESC guidelines from 2018-2023 contain a corresponding section. In more recent recommendations, such as the guidelines on hypertension from 2024, sex-specific considerations are discussed, also with regards to the \"gaps of evidence\". In this context, in addition to the demands for more prospective sex-specific studies and data on epidemiology, risk factors, pathophysiology and outcomes, the importance of providing evidence with respect to sex-specific optimal dosages, effects and undesired side effects of drugs are also the subjects of discussion.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"113-121"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673452","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":"https://doi.org/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":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","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":"[Quality assurance with routine data : Expectations and reality from a physician's perspective].","authors":"Susanne Macher-Heidrich","doi":"10.1007/s00059-025-05313-1","DOIUrl":"https://doi.org/10.1007/s00059-025-05313-1","url":null,"abstract":"<p><p>An effective quality assurance concept with essential benefits for all patients concerned and without bureaucratic overload can only be achieved with all stakeholders working closely together with the inclusion of clinical medical expertise. The calculation of quality results based on routine data alone is not sufficient to reach this goal.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752390","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":"[Update on cardiovascular prevention 2025].","authors":"Harm Wienbergen, Ulrich Hanses, Hatim Kerniss, Rainer Hambrecht","doi":"10.1007/s00059-025-05305-1","DOIUrl":"https://doi.org/10.1007/s00059-025-05305-1","url":null,"abstract":"<p><p>Despite an expensive healthcare system Germany performs poorly with respect to life-expectancy compared to other countries, for which cardiovascular diseases and deficits in cardiovascular prevention in particular are responsible. The basis of cardiovascular prevention is a healthy lifestyle with regular physical exercise, a predominantly plant-based diet, nonsmoking, good sleep and mental health. In many cases additional lipid-lowering, antidiabetic and antihypertensive medications are necessary. Recent studies have proven the prognostic effects of different groups of medications, such as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, sodium-glucose transporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists, in the appropriate indication areas. To improve the cardiovascular prevention in Germany, intensified public efforts are crucial. In addition, individual support of patients is effective for long-term preventive measures. To achieve this healthcare professionals must be trained (physicians, cardiovascular prevention assistants), who can sustainably support patients in lifestyle modifications and medicinal prevention.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735726","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":"https://doi.org/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":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-25","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":"Diabetes, obesity, and cardiovascular disease-what is the impact of lifestyle modification?","authors":"Celina Seth, Veronika Schmid, Stephan Mueller, Mark Haykowsky, Stephen J Foulkes, Martin Halle, Simon Wernhart","doi":"10.1007/s00059-025-05309-x","DOIUrl":"https://doi.org/10.1007/s00059-025-05309-x","url":null,"abstract":"<p><p>Diabetes, obesity, and cardiovascular disease (CVD) represent an escalating global health challenge, contributing significantly to morbidity, mortality, and healthcare costs. Evidence from large cohort studies and clinical trials underscores the impact of diabetes and obesity as major risk factors for CVD, causing systemic inflammation, insulin resistance, and neurohormonal activation. Frequently, a sedentary lifestyle and unbalanced dietary habits are associated with these risk factors. Physical activity and exercise training interventions, a Mediterranean and plant-based diet, smoking cessation, and reduction of alcohol have shown promise in mitigating these risks. The implementation of lifestyle and pharmacotherapy have emerged as new pillars of preventive medicine. This review discusses the evidence of lifestyle interventions to reduce the burden of diabetes, obesity, and CVD. It is highlighted that only a multifaceted, sustained approach integrating lifestyle interventions and pharmacological strategies can reduce the burden of disease and improve long-term outcomes.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630322","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":"[Quality assurance in cardiology with routine data : Requirement and reality].","authors":"Volker Schächinger","doi":"10.1007/s00059-025-05306-0","DOIUrl":"https://doi.org/10.1007/s00059-025-05306-0","url":null,"abstract":"<p><p>Routine data are very helpful as an instrument for health services research. In German hospitals the input data of the statutory quality assurance (in cardiology: left heart catheterization, cardiac implantable electronic devices and transcatheter aortic valve implantation, TAVI), the data according to § 21 of the Hospital Remuneration Act and mandatory quality assurance reports of hospitals are available. In addition, the health insurance companies also have social data at their disposal. The very restrictive interpretation of data safety in Germany as well as a partition of the data according to the private or statutory health insurance status, outpatient and inpatient forms of treatment and two different remuneration sources exacerbate in the current reality an effective central use of routine data, as is possible in other countries, e.g., Sweden. Routine data are a powerful tool for quality assurance in terms of critical self-reflection and as a basis for peer review by colleagues; however, public reporting of routine data (publication of the results of individual hospitals) is questionable due to methodological limitations, such as data quality and risk adjustment, as it puts hospitals in the pillory without any chance to critically reflect on the validity of the data. Consequently, risk-avoiding behavior in medical services could compromise patient care. The current development of healthcare policies with a structural reform of the hospital landscape and the recommendations of the government committee will increase the demands on the quality assessment based on routine data. Simplified data acquisition, methodological improvements as well as new aspects, such as the quality of indications, assessment of nursing services and patient orientation will be added. In future, a quality-oriented remuneration based on routine data is intended to help control the healthcare system.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623890","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":"[Quality evaluation in cardiovascular medicine : Legal frameworks, practical implementation and challenges].","authors":"Sebastian von Podewils","doi":"10.1007/s00059-025-05308-y","DOIUrl":"https://doi.org/10.1007/s00059-025-05308-y","url":null,"abstract":"<p><p>The quality assurance procedure for coronary surgery and heart valve interventions (QS KCHK) is designed to systematically evaluate and enhance the quality of complex cardiological interventional and cardiac surgical procedures. In this respect, the inclusion of indicators based on routine data facilitates the efficient and standardized analysis of the long-term quality of treatment; however, experiences from the first feedback procedures show that the use of social data is associated with challenges. For example, for the rehospitalization rates due to heart failure nonspecific exclusions and the lack of a differentiation between comorbidities and primary complications lead to distortions. The situation is similar for the 1‑year mortality. In this case, due to the long follow-up period of 365 days a sufficient association between the quality characteristic and the service provider carrying out the index procedure is often not possible to establish using social data. In addition, documentation problems, such as discrepancies between operative data and social data make a precise assessment more difficult. Nevertheless, the QS procedure KCHK makes a substantial contribution to quality assurance by creating transparency and comparability between service providers. In order to enhance the strength of the indicators methodological refinements, such as the harmonization of data standards and the improvement of the validity of the individual indicators, are essential for the documentation of a quality characteristic.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624252","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":"[Mortality in patients with ST-segment elevation myocardial infarction in Germany : Comparison of routine data vs. quality assurance vs. registry].","authors":"Uwe Zeymer, Steffen Schneider, Susanne Stolpe, Ralf Zahn","doi":"10.1007/s00059-025-05307-z","DOIUrl":"https://doi.org/10.1007/s00059-025-05307-z","url":null,"abstract":"<p><p>The recording of mortality after acute myocardial infarction can be based on different data, some of which yield very different results. These differences are due to a number of factors, including the definition of acute myocardial infarction, patient selection and the methods used to determine mortality. While routine data are primarily used for billing purposes, procedural data for coronary angiography and percutaneous coronary intervention (PCI) are used for external quality assurance and therefore only include patients who undergo invasive diagnostic procedures. Registries include patients with a disease, e.g., ST-segment elevation myocardial infarction, according to defined criteria. The mortality data published for Germany differ considerably depending on the source of the data. The manuscript discusses the problems of recording the mortality of myocardial infarction in Germany and attempts to propose solutions for improving data quality in order to be able to evaluate possibilities for optimizing treatment.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614652","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":"https://doi.org/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":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-11","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}