Heart, Lung and Circulation最新文献

{"title":"Obesity and Atrial Fibrillation: From Mechanisms to Treatment","authors":"Jenelle K. Dziano BClinExPhys,&nbsp;Jonathan P. Ariyaratnam MB, BChir, PhD,&nbsp;Melissa E. Middeldorp MPH, PhD,&nbsp;Prashanthan Sanders MBBS, PhD,&nbsp;Adrian D. Elliott PhD","doi":"10.1016/j.hlc.2025.08.003","DOIUrl":"10.1016/j.hlc.2025.08.003","url":null,"abstract":"<div><div>By 2050, it is projected that 3.8 billion people worldwide will be overweight or obese. Alongside this growing burden of obesity is a parallel rise in the incidence and prevalence of atrial fibrillation (AF). Obesity promotes the onset of AF through several pathways, including left atrial remodelling, accumulation of epicardial adipose tissue, alterations in cardiac loading, increased inflammation, and renin-angiotensin-aldosterone system activation. In parallel, obesity frequently coexists with and can contribute to comorbidities, including hypertension, type 2 diabetes, and obstructive sleep apnoea. The past decade has seen the introduction of comorbidity and risk factor treatment as the central pillar in the care of patients with AF based on studies showing that weight loss reduces the recurrence of symptomatic AF. As we move deeper into the era of pharmacological treatment for obesity, new opportunities will appear to refine the care of patients living with AF. This review summarises the existing evidence supporting obesity as a major risk factor for AF and discusses the therapeutic options to treat obesity and prevent the growing burden of AF in the community.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 10","pages":"Pages 1021-1032"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000412","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 Clinical Significance of Carotid Plaque Characteristics in Ischaemic Stroke: A Systematic Review and Meta-Analysis","authors":"Shaun Khanna MMed, FRACP ,&nbsp;Dylan Wilson MD ,&nbsp;Sohaib Virk FRACP ,&nbsp;Aditya Bhat PhD, FRACP ,&nbsp;Lauren Houston BPharm, PhD ,&nbsp;Gail Matthews PhD, FRACP ,&nbsp;Nitesh Nerlekar PhD, FRACP ,&nbsp;Clare Arnott PhD, FRACP","doi":"10.1016/j.hlc.2025.08.015","DOIUrl":"10.1016/j.hlc.2025.08.015","url":null,"abstract":"<div><h3>Background</h3><div>There is a growing interest in the assessment of perivascular fat attenuation on cardiac computed tomography as a surrogate of inflammation and vascular risk. Although pericoronary adipose tissue is well-studied, there is a paucity of literature on pericarotid fat and its relationship with ischaemic stroke (IS). This systematic review aimed to characterise carotid plaque, particularly, pericarotid fat attenuation, and its relationship with IS.</div></div><div><h3>Method</h3><div>A systematic literature search of the PubMed, Ovid Medline, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, Scopus, Proquest, and Science Direct databases was performed to identify all relevant studies assessing pericarotid fat attenuation by cardiac computed tomography in adult patients with IS or transient ischaemic attack (TIA) (2000–2025; English only; PROSPERO CRD4202462124). Data for pericarotid fat density was individually extracted and then meta-analysed using random-effects models, with standardised mean difference (SMD) and odds ratios as summary effects.</div></div><div><h3>Results</h3><div>A total of eight studies including a total of 1,041 symptomatic patients (confirmed IS/TIA) and 1,431 asymptomatic patients (exclusion of IS/TIA) were included. Although there was no difference in carotid plaque thickness between the groups (SMD, 0.42; 95% confidence interval [CI] −0.27 to 1.11; p=0.235), symptomatic patients were more likely to have ulcerated plaque (odds ratio 2.27; 95% CI 1.30–3.97; p=0.004) and higher mean pericarotid fat attenuation (SMD, 1.10; 95% CI 0.67–1.53; p&lt;0.001) than asymptomatic patients. Meta-regression analyses identified hypercholesterolaemia as the only significant moderator (coefficient, −0.02; 95% CI −0.04 to −0.01; p=0.04).</div></div><div><h3>Conclusions</h3><div>Populations with IS/TIA have higher mean pericarotid fat attenuation than asymptomatic cohorts. Pericarotid fat attenuation represents a surrogate marker of vessel inflammation, and routine assessment may be able to identify higher risk populations with asymptomatic carotid artery disease.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 10","pages":"Pages 1041-1049"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145052955","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":"From Cushion to Culprit: The Role of Epicardial Adipose Tissue in Cardiovascular Disease","authors":"Shaun Khanna MBBS, MMed, FRACP ,&nbsp;Gurkeerat Mann MD ,&nbsp;Sheran Vasanthakumar MBBS, FRACP ,&nbsp;Clare Arnott MBBS, PhD, FRACP ,&nbsp;Nitesh Nerlekar MBBS, PhD, FRACP","doi":"10.1016/j.hlc.2025.07.010","DOIUrl":"10.1016/j.hlc.2025.07.010","url":null,"abstract":"<div><div>Epicardial adipose tissue (EAT) is the layer of fat located between the visceral pericardium and the myocardium. Emerging research has signified its role in the development of various cardiovascular diseases. The pathogenesis is complex, involving various bioactive compounds that have been implicated in the development of coronary artery disease, heart failure, and arrhythmogenesis. The optimal imaging modality for assessing EAT is cardiac computed tomography, which allows both volumetric and density measurement reflective of the dynamic nature of EAT. EAT can be modulated through lifestyle interventions, pharmacological strategies, and surgical therapies, underscoring its potential as a therapeutic target. This review aims to summarise the contemporary understanding of the physiology, measurement, pathology, and treatment opportunities for EAT.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 10","pages":"Pages 1006-1020"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000474","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":"Coronary Inflammation in Patients With and Without Standard Modifiable Cardiovascular Risk Factors: Insights From a Novel Computed Tomography Imaging Biomarker Pericoronary Adipose Tissue Attenuation","authors":"Seiyon Sivakumar ,&nbsp;Kevin Cheng MBBS ,&nbsp;Andrew Lin MBBS, PhD ,&nbsp;Peter J. Psaltis MBBS, PhD ,&nbsp;Gemma Figtree MBBS, DPhil ,&nbsp;Dennis T.L. Wong BSc (Med), MBBS, MD, PhD","doi":"10.1016/j.hlc.2025.07.014","DOIUrl":"10.1016/j.hlc.2025.07.014","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Significant progress has been made in coronary artery disease (CAD) prevention by targeting standard modifiable cardiovascular risk factors (SMuRFs), which include hypertension, hyperlipidaemia, diabetes mellitus, and smoking. However, there is growing incidence of CAD occurring in the absence of SMuRFs, a phenomenon now termed “SMuRF-less” CAD. Identifying novel biomarkers and mechanisms for SMuRF-less CAD is crucial for new therapeutic strategies in this under-recognised group. The role of inflammation in CAD has been extensively studied and was recently validated as a therapeutic target.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Aims&lt;/h3&gt;&lt;div&gt;This study aimed to assess coronary inflammation in patients without SMuRFs and patients with SMuRFs using pericoronary adipose tissue (PCAT) attenuation, a novel and specific biomarker of coronary inflammation quantified on computed tomography coronary angiography (CTCA). Our secondary aim was to compare the coronary plaque burden and coronary artery stenosis severity between the groups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Method&lt;/h3&gt;&lt;div&gt;We conducted a retrospective single-centre study of 309 consecutive patients who underwent clinically indicated serial CTCAs for suspected stable CAD (2010–2016) at Monash Health, Melbourne, Australia. Patients with a history of CAD were excluded. PCAT&lt;sub&gt;RCA&lt;/sub&gt; attenuation measurement around the proximal right coronary artery (RCA) was performed using semiautomated software. Plaque burden was assessed using the segment involvement score (SIS) and segment stenosis score (SSS). Coronary artery diameter stenosis severity was assessed using the Coronary Artery Disease - Reporting and Data System (CAD-RADS) classification.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In the final study population of 309 patients (median age 57.5 years; 51.8% female), 83 (26.9%) patients were SMuRF-less. Baseline characteristics were similar between patients without SMuRFs and those with SMuRFs, and patients with SMuRFs were more frequently on statins, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and aspirin. Patients without SMuRFs had a similar PCAT&lt;sub&gt;RCA&lt;/sub&gt; mean attenuation (Hounsfield units, HU) compared with patients with SMuRFs (−77.5±9.5 vs −78.4±8.9 HU; p=0.481), despite having a lower coronary plaque burden and stenosis severity. The mean SIS and SSS were 18.7% and 39.5% lower, respectively, in patients without SMuRFs than in those with SMuRFs (SIS: 1.78±2.19 vs 2.72±2.88, p=0.01; SSS: 2.22±3.36 vs 3.67±4.38; p=0.004). Patients with SMuRFs were more likely to have obstructive CAD than patients without SMuRFs (odds ratio 2.8; 95% confidence interval 1.3–5.7; p=0.006).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;In patients undergoing clinically indicated CTCA, patients without SMuRFs exhibited a similar degree of coronary inflammation to those with SMuRFs, despite having a lower plaque burden and stenosis severity. These findings may provide early mechanistic insights i","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 10","pages":"Pages 1098-1108"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058395","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":"Paid MBP advert: ANZSCTS ASM advert","authors":"","doi":"10.1016/S1443-9506(25)01641-5","DOIUrl":"10.1016/S1443-9506(25)01641-5","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 10","pages":"Page 1140"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145227557","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":"Type 2 Diabetes and Acute Myocardial Infarction: Admission Complexity and Readmission Rates","authors":"Momina A. Allahwala MBBS ,&nbsp;Andrew E.C. Booth BCreatArts, MD ,&nbsp;Adam J. Nelson MBBS, PhD, FRACP ,&nbsp;Chinmay S. Marathe MBBS, PhD, FRACP ,&nbsp;Jessica A. Marathe MBBS, PhD, FRACP ,&nbsp;Peter J. Psaltis MBBS, PhD, FRACP","doi":"10.1016/j.hlc.2025.08.013","DOIUrl":"10.1016/j.hlc.2025.08.013","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 10","pages":"Pages e145-e148"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145052935","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 Failure With Preserved Ejection Fraction in Patients With Obesity: A Growing Cardiometabolic Concern","authors":"Andrew P. Sindone BMed, MD ,&nbsp;Walter P. Abhayaratna MBBS, PhD ,&nbsp;Alicia Chan MBBS, PhD ,&nbsp;Melissa Leung MBBS, BSc(med), MBiostat, PhD ,&nbsp;Ingrid Hopper MBBS, BMedSc, PhD ,&nbsp;John Amerena MBBS ,&nbsp;Carmine G. De Pasquale BMBS, PhD ,&nbsp;Christine Burdeniuk BSc, BMBS ,&nbsp;Andrew J.S. Coats MA, MBBChir, DM, DSc ,&nbsp;John J. Atherton MBBS, PhD","doi":"10.1016/j.hlc.2025.08.010","DOIUrl":"10.1016/j.hlc.2025.08.010","url":null,"abstract":"<div><div>Heart failure (HF) affects approximately 2.1% of adult Australians and is associated with substantial morbidity and mortality. Approximately half of all patients with HF have HF with a preserved ejection fraction (HFpEF), which is increasing in incidence driven by an ageing population and an increasing prevalence of obesity and diabetes. Obesity drives HFpEF via multiple mechanisms, with a linear relationship between various anthropometric measures and the risk of developing HFpEF. Heightened diagnostic awareness is required to identify patients with obesity-associated HFpEF, given the availability of therapeutics that have been shown to improve quality of life and clinical outcomes, including sodium-glucose cotransporter 2 inhibitors, mineralocorticoid receptor antagonists, and glucagon-like peptide-1 agonist-based therapies. This review provides an overview of our current understanding of the impact of obesity on the development of HFpEF and outlines an approach to diagnosis and new therapeutic options.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 10","pages":"Pages 1033-1040"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058325","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":"Documenting Cardiovascular-Kidney-Metabolic Risk and Disease Within an Aboriginal Cohort","authors":"Katharine F. Brown PhD ,&nbsp;Natasha J. Howard PhD ,&nbsp;Catherine Paquet PhD ,&nbsp;Melinda J. Carrington PhD ,&nbsp;Alex D.H. Brown MD, PhD","doi":"10.1016/j.hlc.2025.08.016","DOIUrl":"10.1016/j.hlc.2025.08.016","url":null,"abstract":"<div><h3>Aim</h3><div>Aboriginal and Torres Strait Islander people experience high burden of cardiovascular, kidney and metabolic conditions, often manifesting in multimorbidity and contributing to over one third of life expectancy differentials. This article explores cardiovascular-kidney-metabolic (CKM) health within an Aboriginal cohort by documenting the burden of early risk, disease and factors associated with disease progression.</div></div><div><h3>Methods</h3><div>A prospective longitudinal cohort of 601 Aboriginal people living in Central Australia spanning 2008–2016 was utilised. Research was driven by and based on community priorities and partnerships. Baseline data included questionnaires, clinical assessments and primary health care data; follow-up outcomes were derived from primary care clinical review, administrative hospitalisation and mortality datasets.</div></div><div><h3>Results</h3><div>Four percent of participants (mean: 41.3 years; 47% female) had no CKM risk factors (Stage 1 CKM Syndrome or greater) at baseline, 54.6% had established cardiovascular disease, chronic kidney disease, and/or diabetes mellitus. Greater presence of CKM disease and co/multimorbidity was associated with greater socioeconomic disadvantage. After adjusting for age, participants with co/multimorbidity were more likely to die during follow-up (hazard ratio [95% confidence interval]: 2.2 [1.1–4.3]) than participants without clinical disease at baseline. During a mean follow-up period of 6.8 years, 30.4% of participants living with no clinical disease at baseline developed at least one CKM condition, and 25% progressed to co/multimorbidity.</div></div><div><h3>Conclusions</h3><div>This study reveals a higher prevalence of cardiovascular, kidney, and metabolic risk and disease than previously reported and compared to non-Indigenous counterparts. The health sector must recalibrate disease prevention, move beyond single-organ management and implement interdisciplinary care coordination to prevent expansion of inequities.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 10","pages":"Pages 1078-1088"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058343","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":"Clonal Haematopoiesis and Cardiovascular-Kidney-Metabolic Syndrome: Emerging Links","authors":"Savindi Wimalarathne BBiomedSc ,&nbsp;Nick S.R. Lan MBBS, MClinRes (Dist), MSc ,&nbsp;Leon A. Adams MBBS, PhD ,&nbsp;Girish Dwivedi MD, PhD","doi":"10.1016/j.hlc.2025.05.100","DOIUrl":"10.1016/j.hlc.2025.05.100","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 10","pages":"Pages 991-994"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006064","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":"Prevalence of Overweight and Obesity Among Patients Admitted With Acute Coronary Syndromes: Implications for Semaglutide Eligibility to Further Reduce Residual Risk","authors":"Matthew Y. Lim MBBS ,&nbsp;Momina A. Allahwala MBBS ,&nbsp;Andrew E.C. Booth MD ,&nbsp;Shaun Evans MD ,&nbsp;David Jesudason MBBS, PhD ,&nbsp;Jessica A. Marathe MBBS, PhD ,&nbsp;Peter J. Psaltis MBBS, PhD ,&nbsp;Adam J. Nelson MBBS, PhD","doi":"10.1016/j.hlc.2025.07.008","DOIUrl":"10.1016/j.hlc.2025.07.008","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 10","pages":"Pages e149-e151"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952047","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}