Herz最新文献

{"title":"Renal denervation plus cardiac ablation vs. cardiac ablation alone for patients with atrial fibrillation and uncontrolled arterial hypertension : A systematic review and updated meta-analysis of randomized controlled trials.","authors":"Ocílio Ribeiro Gonçalves, Altair Pereira de Melo Neto, Maria Antonia Oliveira Machado Pereira, Victor Arthur Ohannesian, Matheus Augusto Nepomuceno Fernandes, Clara Rocha Dantas, Maria Tereza Camarotti, João Victor Araújo de Oliveira, Gustavo José Silva Sanchez, Carlos Eduardo Batista de Lima, Avelar Alves da Silva","doi":"10.1007/s00059-025-05302-4","DOIUrl":"https://doi.org/10.1007/s00059-025-05302-4","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is a complex arrhythmia often worsened by hypertension (HTN). Pharmacological treatments frequently underperform, and the best approach, particularly combining renal denervation (RDN) with cardiac ablation (CA), remains unclear.</p><p><strong>Objective: </strong>We conducted an updated meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of RDN combined with CA versus CA alone in patients with AF and uncontrolled HTN.</p><p><strong>Methods: </strong>We performed a systematic review and meta-analysis of RCTs retrieved from PubMed, Embase, and the Cochrane Library up to July 2024. Primary outcomes included AF recurrence, periprocedural complications, blood pressure changes, and estimated glomerular filtration rate (eGFR). Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were computed using a random-effects model.</p><p><strong>Results: </strong>Eight RCTs were included, involving 689 patients (37% female). Of these, 355 underwent RDN + CA, and 334 underwent CA alone, with a mean follow-up of at least 12 months. The RDN + CA group exhibited a significant reduction in AF recurrence (RR: 0.77; 95% CI: 0.61-0.97). There were no significant differences in periprocedural complications (RR: 1.06; 95% CI: 0.60-1.89), systolic blood pressure (MD: -6.79; 95% CI: -14.71-1.14), diastolic blood pressure (MD: -2.47; 95% CI: -8.13-3.20), or eGFR (MD: 1.14; 95% CI: -11.95-14.23).</p><p><strong>Conclusion: </strong>Our findings show that RDN combined with CA significantly reduces AF recurrence compared to CA alone, presenting a promising approach for patients with resistant HTN and AF.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017214","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":"Obesity and heart failure-the role of GLP-1 receptor agonists.","authors":"Gregor Simonis, Ulrike Schatz","doi":"10.1007/s00059-025-05312-2","DOIUrl":"https://doi.org/10.1007/s00059-025-05312-2","url":null,"abstract":"<p><p>Patients with obesity-driven heart failure with preserved ejection fraction (HFpEF) often suffer from symptoms despite guideline-recommended treatment with diuretics, sodium glucose cotransporter 2 (SGLT2) inhibition, and mineralocorticoid antagonists. Obesity by itself drives heart failure via multiple pathophysiological mechanisms. This review summarizes current data on glucagon-like peptide‑1 (GLP-1) receptor agonists and the dual GIP/GLP‑1 agonist tirzepatide, including symptoms and outcomes in patients with obesity-driven HFpEF with or without diabetes.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763893","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: 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/s00059-024-05283-w","DOIUrl":"10.1007/s00059-024-05283-w","url":null,"abstract":"","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"148"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545123","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":"Precision medicine in the management of cardiac arrhythmias.","authors":"Felix Wiedmann, Constanze Schmidt","doi":"10.1007/s00059-025-05298-x","DOIUrl":"10.1007/s00059-025-05298-x","url":null,"abstract":"<p><p>Precision medicine in cardiac electrophysiology tailors diagnosis, treatment, and prevention by integrating genetic, environmental, and lifestyle factors. Unlike traditional, generalized strategies, precision medicine focuses on individual patient characteristics to enhance care. Significant progress has been made, especially in managing channelopathies, where genetic insights now already drive personalized therapies. Identifying specific mutations has clarified molecular mechanisms and enabled targeted interventions, improving outcomes in conditions such as long QT syndrome. The integration of big data from clinical records, omics datasets, and biosignals from devices such as cardiac implantable electronic devices (CIEDs) or wearables may be on the verge of revolutionizing the diagnosis of cardiac arrhythmias once again. Progress is also expected in the field of human-induced pluripotent stem cells (hiPSCs) and in silico modeling, which may overcome the limitations of traditional expression systems for the functional evaluation of patient-specific mutations. Genome-wide association studies (GWAS) and polygenic risk scores (PRS) provide deeper insights into complex arrhythmogenic disorders, aiding in risk stratification and targeted treatment strategies. Finally, emerging technologies such as CRISPR/Cas9 promise gene editing for inherited and acquired arrhythmias. In summary, precision medicine offers the potential for individualized treatment of cardiac arrhythmias.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"88-95"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582281","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":"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":"122-134"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","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":"[Vaccination and cardiovascular diseases].","authors":"Markus Therre, Mert Tokcan, Philipp Markwirth, Michael Böhm","doi":"10.1007/s00059-024-05291-w","DOIUrl":"10.1007/s00059-024-05291-w","url":null,"abstract":"<p><p>Respiratory tract infections with influenza, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and respiratory syncytial (RS) viruses and pneumococci as well as endogenous reactivation of varicella zoster viruses presenting as herpes zoster, are associated with adverse cardiovascular outcomes, such as myocardial infarction or hospitalization for heart failure. Effective prevention of these events, particularly through influenza and pneumococcal vaccination, is well established and cost-effective. Despite guideline recommendations to vaccinate older patients and people at risk, vaccination rates in these population groups remain suboptimal and below average in international comparison. This article sheds light on the association of vaccine preventable diseases with cardiovascular complications and demonstrates the protective effect of the respective vaccinations. Additionally, recommendations on the practical approach to vaccinating high-risk patients are given.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"149-158"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978283","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":"[Perspectives on cardiovascular precision medicine - from prevention to intervention].","authors":"Ulf Landmesser","doi":"10.1007/s00059-025-05300-6","DOIUrl":"https://doi.org/10.1007/s00059-025-05300-6","url":null,"abstract":"","PeriodicalId":12863,"journal":{"name":"Herz","volume":"50 2","pages":"77-78"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718777","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 role of peak VO₂ for short- and long-term major adverse cardiac events in patients with high cardiovascular risk.","authors":"Selin Cilli Hayıroğlu, Mehmet Uzun","doi":"10.1007/s00059-024-05276-9","DOIUrl":"10.1007/s00059-024-05276-9","url":null,"abstract":"<p><strong>Background: </strong>The objective of this study was to assess the accuracy of VO₂ measurements in predicting long-term major adverse cardiac events (MACEs) in patients with high cardiovascular risk.</p><p><strong>Methods: </strong>Based on a 10-year atherosclerotic cardiovascular disease risk score, 333 patients with high cardiovascular risk were included in this retrospective analysis. The study endpoint was MACEs, comprising all-cause mortality, cardiovascular mortality, non-fatal myocardial infarction or stroke, and coronary revascularization. The study cohort was divided into two groups according to the frequency of MACE occurrence. Measurements of VO₂ were assessed for the prediction of MACEs.</p><p><strong>Results: </strong>The best predictive accuracy for 1‑year MACEs was determined to be a VO₂ max value of ≥ 20.3 mL/kg/min, with 60% specificity and 60% sensitivity (area under the curve [AUC]: 0.61; 95% confidence interval [CI]: 0.51-0.71; p < 0.001), and for 5‑year MACEs it was ≥ 19.9 mL/kg/min, with 69% specificity and 64% sensitivity (AUC: 0.69; 95% CI: 0.62-0.76; p < 0.001). Multivariable Cox regression analysis, after adjusting for univariable factors, showed that VO₂ max was independently associated with both short- and long-term MACEs in patients at high cardiovascular risk (hazard ratio [HR]: 0.900, 95% CI: 0.858-0.943, p < 0.001).</p><p><strong>Conclusion: </strong>According to the results of this pilot study, VO₂ max can predict both short- and long-term MACEs in patients at high cardiovascular risk.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"142-147"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463341","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":"Precision medicine in the management of valvular heart disease.","authors":"Felix S Nettersheim, Stephan Baldus","doi":"10.1007/s00059-025-05299-w","DOIUrl":"10.1007/s00059-025-05299-w","url":null,"abstract":"<p><p>The management of valvular heart disease has undergone a remarkable transformation over the past two decades, which was driven by the advent of catheter-based treatment methods. Whereas medical therapy was the only available treatment option for many older patients deemed unsuitable for conventional surgery until the early 2000s, a wide range of interventional therapies is now available. Transcatheter aortic valve replacement and mitral valve transcatheter edge-to-edge repair evidently provide prognostic advantages over medical therapy for inoperable patients with severe aortic stenosis and secondary mitral regurgitation, and they have been demonstrated to be non-inferior to conventional surgery in certain operable patient groups. Although catheter-based therapies of aortic and tricuspid regurgitation have not yet been proven to provide prognostic benefits, these approaches enable substantial and sustainable improvements in symptoms as well as quality of life while demonstrating a favorable safety profile. Given the multitude of available options for the treatment of valvular heart diseases, determining the appropriate indication and selecting the optimal therapeutic approach often pose significant challenges. This review article highlights the latest advancements in valvular heart disease management and explores the patient-centered application of available therapies within the framework of an approach toward precision medicine.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"103-112"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541017","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":"135-141"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","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}