Herz最新文献

{"title":"Retrospective analysis of serum low-density lipoprotein cholesterol goal attainment and cardiovascular outcomes in coronary heart disease.","authors":"Ying Nie, Li Chu, Xianyu Lv","doi":"10.1007/s00059-026-05390-w","DOIUrl":"https://doi.org/10.1007/s00059-026-05390-w","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to evaluate the association of low-density lipoprotein cholesterol (LDL-C) goal attainment and continuous LDL‑C levels with major adverse cardiovascular events (MACE) risk in real-world coronary heart disease (CHD) patients, and to support secondary prevention lipid management.</p><p><strong>Methods: </strong>This single-center retrospective cohort study enrolled CHD patients at a tertiary hospital (2021-2024) with complete lipid and follow-up data. Baseline LDL‑C was recorded; patients were stratified by guideline-recommended targets based on cardiovascular risk (very high risk: < 1.4 mmol/L; others: < 1.8 mmol/L). Goal attainment was defined as baseline LDL‑C below the assigned target. The primary outcome was first MACE (cardiovascular death, nonfatal myocardial infarction, nonfatal ischemic stroke, or repeat revascularization). Median follow-up was 2.3 years. Kaplan-Meier, Cox regression (stepwise adjustment), propensity score matching, and restricted cubic splines were used.</p><p><strong>Results: </strong>Among 2476 patients (872 achievers, 1604 non-achievers), 382 MACE occurred. Achievers had significantly lower MACE incidence. Multivariable Cox regression showed goal attainment was associated with reduced MACE risk, an association that remained stable after adjusting for comorbidities, lipids, and therapy intensity. Propensity score matching confirmed the findings. Restricted cubic splines revealed a nonlinear dose-response relationship: MACE risk progressively increased with higher LDL‑C, especially at elevated concentrations.</p><p><strong>Conclusion: </strong>In real-world CHD patients, achieving guideline-recommended LDL‑C targets was significantly associated with lower MACE risk, with a nonlinear LDL-C-event relationship. The findings support intensive LDL‑C management in secondary prevention; however, the retrospective design limits conclusions about causality.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148548752","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 applications of artificial intelligence in hypertension management: current evidence and future perspectives.","authors":"Ehsan Shahverdi, Amin Shahverdi, Shadi Kamali, Lars Roman Herda","doi":"10.1007/s00059-026-05389-3","DOIUrl":"https://doi.org/10.1007/s00059-026-05389-3","url":null,"abstract":"<p><strong>Background: </strong>Hypertension remains the leading modifiable risk factor for cardiovascular morbidity and mortality worldwide, with persistently inadequate blood pressure control despite guideline-directed therapy. The rapid expansion of digital health data and computational capacity has positioned artificial intelligence (AI) as a promising tool for improving hypertension management through enhanced risk prediction, phenotyping, and individualized care. However, important challenges related to external validation, interpretability, implementation, and real-world clinical benefit remain unresolved.</p><p><strong>Methods: </strong>We conducted a structured narrative review with a systematic literature search across PubMed/MEDLINE, Embase, and Scopus for studies published between January 2015 and December 2025. Eligible studies evaluated clinically relevant applications of AI in hypertension, including screening, diagnosis, cardiovascular risk stratification, treatment optimization, clinical decision support, and remote monitoring. Findings were synthesized qualitatively because of substantial heterogeneity in study design, AI methodology, and reported outcomes.</p><p><strong>Results: </strong>AI-based models demonstrated favorable performance in predicting incident hypertension and cardiovascular risk using electronic health records, wearable technologies, and multimodal clinical datasets. Machine learning approaches frequently outperformed conventional risk prediction models, with reported area under the curve values generally ranging from approximately 0.75 to 0.90 across representative studies. AI-supported systems also showed potential for personalized antihypertensive therapy, resistant hypertension identification, and continuous blood pressure monitoring. However, most available evidence remains based on retrospective or internally validated datasets, and relatively few studies have demonstrated robust external validation or improvements in hard clinical outcomes such as cardiovascular events or mortality.</p><p><strong>Challenges: </strong>Major barriers to implementation include data heterogeneity, algorithmic bias, limited interpretability, insufficient external validation, infrastructure and cost requirements, regulatory uncertainty, and concerns regarding patient trust and data privacy. In addition, evidence supporting widespread clinical implementation remains limited by the scarcity of large prospective randomized trials.</p><p><strong>Conclusion: </strong>AI has the potential to substantially transform hypertension management by enabling more precise, proactive, and personalized care. Nevertheless, rigorous prospective validation, improved transparency, equitable implementation strategies, and seamless integration into clinical workflows will be essential before widespread clinical adoption can be achieved.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470242","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":"T-TEER-interventional repair of tricuspid regurgitation.","authors":"Dominik Berliner, Sven Schallhorn, Johann Bauersachs","doi":"10.1007/s00059-026-05373-x","DOIUrl":"10.1007/s00059-026-05373-x","url":null,"abstract":"<p><p>Severe tricuspid regurgitation (TR) is a common right-sided valvular disease associated with a substantially increased risk of morbidity, hospitalization, and mortality. Transcatheter tricuspid edge-to-edge repair (T-TEER) is a minimally invasive therapy for patients with severe, symptomatic TR at high surgical risk. By approximating the valve leaflets, T‑TEER reduces regurgitant volume, improves right heart hemodynamics, and interrupts the progressive cycle of right ventricular dilation and worsening TR. Studies and registry data show that approximately 81-88% of patients treated with T‑TEER achieve a reduction of TR to moderate or less, accompanied by sustained improvements in functional status, quality of life, right heart remodeling, and reductions in heart failure-related hospitalizations. Early analyses also suggest beneficial effects on renal and hepatic function. Therefore, T‑TEER represents a safe and effective treatment option for patients with severe TR who previously had limited therapeutic options.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"184-191"},"PeriodicalIF":1.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147305001","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":"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":"222-229"},"PeriodicalIF":1.6,"publicationDate":"2026-06-01","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":"Contemporary insights and evolving clinical pathways in transcatheter tricuspid valve replacement.","authors":"J G da Rocha E Silva, L Stolz, H Kempton, L T Weckbach, T J Stocker, P Doldi, J Novotny, M Näbauer, Jörg Hausleiter","doi":"10.1007/s00059-026-05371-z","DOIUrl":"10.1007/s00059-026-05371-z","url":null,"abstract":"<p><p>Transcatheter tricuspid valve replacement (TTVR) has emerged as an important therapeutic option for patients with severe tricuspid regurgitation (TR), particularly those with high surgical risk and complex anatomy. This review summarizes the current state of orthotopic TTVR, including patient selection, procedural considerations, and post-procedural care. Recent data demonstrate that TTVR provides consistent results and effective TR elimination, promotes reverse right ventricular (RV) remodeling, and improves symptoms and quality of life. In patients with massive or torrential baseline TR, TTVR has also been associated with reduced heart failure hospitalizations. Key challenges include conduction disturbances, bleeding complications, risk of afterload mismatch, and the need for long-term anticoagulation. As multiple devices become available, careful multidisciplinary evaluation, incorporating valve anatomy, RV function, pulmonary pressures, imaging quality, and comorbid conditions, remains essential for optimal therapy selection.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"192-201"},"PeriodicalIF":1.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147344068","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":"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":"204-221"},"PeriodicalIF":1.6,"publicationDate":"2026-06-01","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":"M-TEER-interventional repair of mitral valve regurgitation.","authors":"Christos Iliadis, Stephan Baldus","doi":"10.1007/s00059-026-05372-y","DOIUrl":"10.1007/s00059-026-05372-y","url":null,"abstract":"<p><p>Mitral valve transcatheter edge-to-edge repair (M-TEER) has emerged as an alternative therapy for mitral regurgitation (MR), addressing the unmet clinical need for patients with high surgical risk. Previous large randomized controlled trials (RCTs), including EVEREST II, COAPT, and MITRA-FR, have established the safety and efficacy of M‑TEER for both etiologies of MR: primary (PMR) and secondary MR (SMR). The field of SMR treatment has been updated by the recent RCTs RESHAPE-HF2 and MATTERHORN, which have expanded the recommendations of M‑TEER in the current European guidelines. This article summarizes key evidence from pivotal trials, discusses patient selection, and presents ongoing studies in the field of M‑TEER.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"163-170"},"PeriodicalIF":1.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147283430","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":"Interventional treatment of atrioventricular valves.","authors":"Johann Bauersachs, Ralf Zahn","doi":"10.1007/s00059-026-05376-8","DOIUrl":"10.1007/s00059-026-05376-8","url":null,"abstract":"","PeriodicalId":12863,"journal":{"name":"Herz","volume":"51 3","pages":"161-162"},"PeriodicalIF":1.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148143258","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":"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":"230-238"},"PeriodicalIF":1.6,"publicationDate":"2026-06-01","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":"[Cardiovascular pharmacotherapy in the era of RNA-based precision medicine].","authors":"Anselm A Derda, Anna Hohneck","doi":"10.1007/s00059-026-05375-9","DOIUrl":"10.1007/s00059-026-05375-9","url":null,"abstract":"<p><p>In the pharmacotherapy of heart failure with reduced ejection fraction (HFrEF) in addition to the \"fantastic four\", a potential fifth pillar is emerging with low-dose digitoxin, while finerenone broadens the spectrum of mineralocorticoid receptor antagonists, particularly in HF with mildly reduced EF (HFmrEF)/HF with preserved EF (HFpEF). For HFpEF sodium-glucose linked transporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists are coming to the foreground through gains in morbidity and quality of life. Further innovations include myosin inhibitors in hypertrophic cardiomyopathy, de-escalated dual antiplatelet therapy (DAPT) regimens after acute coronary syndrome (ACS) and factor XI inhibitors as a potentially safer option regarding the risk of bleeding. In prevention, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition including small interfering RNA (siRNA)-based approaches targeting lipoprotein (a) as well as RNA-based and aldosterone synthase-based hypertension therapy and microRNA targeting mark the path towards individualized cardiovascular precision medicine.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"239-248"},"PeriodicalIF":1.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147633373","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}