Herz最新文献

{"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}

{"title":"Mechanism of action of aloperine in the treatment of pulmonary arterial hypertension based on network pharmacology and molecular docking methods.","authors":"Yanrong Wang, Baolan Yan, Pengsheng Ma, Ru Zhou, Fang Zhao","doi":"10.1007/s00059-025-05295-0","DOIUrl":"https://doi.org/10.1007/s00059-025-05295-0","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary arterial hypertension is a severe pulmonary vascular disease, marked by high mortality and substantial treatment costs, underscoring the urgent need for the exploration of traditional Chinese medicine as a potential therapeutic strategy for pulmonary hypertension. This study aimed to investigate the underlying mechanisms of aloperine in treating PAH through network pharmacology and molecular docking approaches.</p><p><strong>Methods: </strong>The Swiss Target Prediction database was employed to predict molecular targets of aloperine, while Cytoscape was used to construct the \"active component-target\" network. Disease-associated targets were identified through the GeneCards and OMIM databases and cross-referenced with drug targets to determine effective targets of aloperine for PAH treatment. Analysis of protein-protein interaction (PPI) was conducted using the STRING database. Furthermore, gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were carried out via the Metascape platform.</p><p><strong>Results: </strong>Following screening, 42 molecular targets of aloperine, 1264 disease-related targets, and 23 effective targets of aloperine in treating PAH were identified. The PPI analysis revealed that aloperine targets SLC6A2, ADRA1B, CYP2D6, CCR5, and JAK2, all of which play a therapeutic role in PAH. The GO and KEGG pathway analyses identified relevant biological functions, such as membrane raft organization, G protein-coupled amine receptor activity, and regulation of tube diameter, as well as ten pathways including neuroactive ligand-receptor interaction, the cGMP-PKG signaling pathway, calcium signaling, and vascular smooth muscle contraction. Molecular docking results confirmed the interaction between aloperine and its key targets, with a high docking affinity observed between aloperine and the core target ADRA1A.</p><p><strong>Conclusion: </strong>Network pharmacology analysis demonstrated that aloperine exerts its therapeutic effects in PAH primarily through multi-target and multi-pathway mechanisms, providing a novel direction and foundation for PAH treatment.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585285","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":"Outcome of edge-to-edge vs. surgical repair in patients with functional mitral regurgitation and reduced left ventricular function.","authors":"Daniel Silva, Peter Wohlmuth, Friedrich-C Rieß, Joachim Schofer","doi":"10.1007/s00059-025-05294-1","DOIUrl":"https://doi.org/10.1007/s00059-025-05294-1","url":null,"abstract":"<p><strong>Background: </strong>This study aims to compare the midterm outcome of percutaneous edge-to-edge repair (TEER) using the first-generation MitraClip system (Abbott Vascular, Santa Clara, CA) with surgical repair, in patients with severe functional mitral regurgitation (fMR) and reduced left ventricular function (LVEF).</p><p><strong>Methods: </strong>The data of consecutive patients with severe fMR and LVEF ≤ 45%, who underwent either isolated surgical repair or MitraClip implantation between January 2007 and December 2015, were retrospectively analyzed. Clinical and echocardiographic follow-up data after 12 and 24 months were obtained in both groups. A propensity score matching analysis was performed to adjust for intergroup differences in baseline characteristics.</p><p><strong>Results: </strong>A total of 167 patients with significant fMR and LVEF ≤ 45% were identified, who underwent either isolated surgical mitral valve repair (n = 83, 49.7%) or MitraClip (n = 84, 50.3%) implantation. Because the two groups had very different risk profiles, propensity scores were calculated for age, sex, EuroSCORE, LVEF, and coronary artery disease, which reduced the number of patients to 74 (38 in the clip group and 36 in the surgical group). There was no significant difference between the two groups in terms of survival, number of reinterventions, heart failure symptoms according to New York Heart Association (NYHA) class, degree of mitral regurgitation, and LVEF.</p><p><strong>Conclusion: </strong>In this retrospective analysis of patients with severe fMR and LVEF ≤ 45%, the comparison between surgical repair, edge-to-edge repair and a first-generation MitraClip device showed similar midterm outcomes in terms of survival, number of reinterventions, NYHA class, degree of mitral regurgitation, and LVEF.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467819","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":"Life's Essential 8 and mortality among adults with early-onset cardiovascular diseases : A prospective community-based study.","authors":"Jing Yang, Xiao Chen, Yaqi Li, Shuohua Chen, Xiang Gao, Shouling Wu","doi":"10.1007/s00059-025-05293-2","DOIUrl":"https://doi.org/10.1007/s00059-025-05293-2","url":null,"abstract":"<p><strong>Background: </strong>Information regarding the association between cardiovascular health (CVH) as assessed using Life's Essential 8 (LE8) approach and all-cause mortality in adults with early-onset cardiovascular diseases (CVDs) is limited.</p><p><strong>Objective: </strong>In this study, we aimed to assess the association between CVH constructed by the LE8 metrics and all-cause mortality in Chinese individuals with early-onset CVDs, including myocardial infarction, heart failure, atrial fibrillation, ischemic stroke, and hemorrhagic stroke as well as in those who had undergone coronary artery bypass surgery or coronary intervention.</p><p><strong>Methods: </strong>Data of 3454 participants who were first diagnosed with early-onset CVDs (men aged < 55 years and women aged < 65 years with CVDs) in the Kailuan study from 1 January 2006 to 31 December 2020 were analyzed. Assessment of CVH (score ranging from 0 to 100 points) was made using the LE8 metrics (including diet, physical activity, nicotine exposure, sleep duration, body mass index [BMI], lipid, blood glucose, and blood pressure). All-cause mortality information was collected from provincial vital statistics offices. Cox proportional hazard regression models and restricted cubic splines were utilized to examine associations between the CVH scores and all-cause mortality in adults with early-onset CVDs.</p><p><strong>Results: </strong>During a mean follow-up of 6.78 years (interquartile range [IQR]: 3.36-10.5 years), 460 deaths were documented. After controlling for demographic variables, lifestyles, and major clinical factors, higher CVH scores were associated with lower risks of all-cause mortality among participants with early-onset CVDs. The corresponding hazard ratios (HRs) with 95% confidence intervals (CIs) were 0.64 (0.49, 0.82) comparing two extreme quartiles of CVH scores and 0.85 (0.77, 0.82) for each 10-point increment in CVH score (p _trend = 0.001). Specifically, significant inverse associations were observed among participants with hemorrhagic stroke (HR _{Q4 vs. Q1} = 0.46, 0.23-0.93) and heart disease (HR _{Q4 vs. Q1} = 0.59, 0.41-0.87).</p><p><strong>Conclusion: </strong>Our findings supported the beneficial role of higher CVH scores in all-cause mortality among adults with early-onset CVD.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467738","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":"[2024 ESC guidelines: What is new? What is of particular importance?]","authors":"Rolf Dörr, Bernhard Maisch","doi":"10.1007/s00059-024-05290-x","DOIUrl":"https://doi.org/10.1007/s00059-024-05290-x","url":null,"abstract":"","PeriodicalId":12863,"journal":{"name":"Herz","volume":"50 1","pages":"1-2"},"PeriodicalIF":1.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052218","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":"[What is new in the management of peripheral arterial occlusive disease and diseases of the aorta? : Highlights of the ESC guidelines 2024].","authors":"Heike Schulze-Bauer, Moritz Staudacher, Sabine Steiner, Oliver Schlager","doi":"10.1007/s00059-024-05286-7","DOIUrl":"10.1007/s00059-024-05286-7","url":null,"abstract":"<p><p>The European Society of Cardiology (ESC) guidelines on peripheral arterial disease (PAD) and diseases of the aorta published in September 2024 for the first time combine recommendations for both diseases in a joint guideline document. The consolidation of PAD and aorta guidelines follows a holistic approach, which underlines the entirety of the arterial vascular system. This aim is underlined by a specifically introduced recommendation to take the entirety of the circulatory system into account in patients with vascular diseases. The focus in the current ESC guideline document is on a multidisciplinary, patient-centered management of PAD and diseases of the aorta, whereby the prevention and follow-up of patients after therapeutic interventions are emphasized. In PAD the document highlights exercise training and the procedure for patients with chronic wounds as well as risk stratification and hereditary diseases of the aorta.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"25-33"},"PeriodicalIF":1.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Management of acute coronary syndrome].","authors":"Maria Buske, Hans-Josef Feistritzer, Alexander Jobs, Holger Thiele","doi":"10.1007/s00059-024-05284-9","DOIUrl":"10.1007/s00059-024-05284-9","url":null,"abstract":"<p><p>Coronary artery disease (CAD) is the leading cause of death worldwide. Acute coronary syndrome (ACS) encompasses a spectrum of diagnoses ranging from unstable angina pectoris to myocardial infarction with and without ST-segment elevation and frequently presents as the first clinical manifestation. It is crucial in this scenario to perform a timely and comprehensive assessment of patients by evaluating the clinical presentation, electrocardiogram and laboratory diagnostics using highly sensitivity cardiac troponin in order to initiate a timely and risk-adapted continuing treatment with immediate or early invasive coronary angiography. In addition to revascularization, the subsequent antithrombotic and lipid-lowering treatment plays a major role in the further secondary prevention of CAD. The choice and duration of medication over time should be tailored to the individual risk profile of the patient. Furthermore, appropriate patient education regarding risk factor management is of paramount importance.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"66-76"},"PeriodicalIF":1.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946915","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}