Nature Reviews Cardiology最新文献

Access to digital health technologies: personalized framework and global perspectives 获取数字卫生技术：个性化框架和全球视角

IF 49.6 1区医学

Nature Reviews Cardiology Pub Date : 2025-07-16 DOI: 10.1038/s41569-025-01184-5

Sanjiv M. Narayan, Mina K. Chung, Demilade Adedinsewo, Luisa C. C. Brant, Leslie L. Davis, David Duncker, Jennifer L. Hall, Janet K. Han, Carolyn S. P. Lam, Eldrin Lewis, Joseph Loscalzo, Manlio F. Márquez, Vasiliki Rahimzadeh, Fatima Rodriguez, Prashanthan Sanders, Emma Svennberg, Kenneth Stein, Mintu Turakhia, Clyde Yancy, Antonis A. Armoundas

{"title":"Access to digital health technologies: personalized framework and global perspectives","authors":"Sanjiv M. Narayan, Mina K. Chung, Demilade Adedinsewo, Luisa C. C. Brant, Leslie L. Davis, David Duncker, Jennifer L. Hall, Janet K. Han, Carolyn S. P. Lam, Eldrin Lewis, Joseph Loscalzo, Manlio F. Márquez, Vasiliki Rahimzadeh, Fatima Rodriguez, Prashanthan Sanders, Emma Svennberg, Kenneth Stein, Mintu Turakhia, Clyde Yancy, Antonis A. Armoundas","doi":"10.1038/s41569-025-01184-5","DOIUrl":"https://doi.org/10.1038/s41569-025-01184-5","url":null,"abstract":"The emergence and rapid adoption of digital health technologies (DHT) present unprecedented opportunities to democratize and reduce disparities in health care by monitoring health and disease at the point of care in all patients. However, limited access to DHT is becoming a major obstacle to realizing these goals. Access to DHT is influenced not only by well-recognized social determinants of health, but also by digital determinants of health, such as digital literacy and the need for broad access to digital infrastructure, as well as commercial and economic factors. Addressing these challenges and designing unbiased systems of care are essential to enable broad access to DHT and to benefit diverse and under-represented communities. Doing so will fill gaps in the clinical evidence base and avoid perpetuating historical biases. In this Review, we propose a personalized framework to improve access to DHT, addressing determinants of access at the individual, interpersonal, community, society, government and industry levels. We frame these issues globally, highlighting how the challenges to DHT access and potential solutions might differ between continents while also emphasizing common themes. We provide perspectives from partners across the spectrum of health care, including clinicians, clinical trialists, and experts from digital health and industry.","PeriodicalId":18976,"journal":{"name":"Nature Reviews Cardiology","volume":"29 1","pages":""},"PeriodicalIF":49.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Publisher Correction: Wearable blood pressure sensors for cardiovascular monitoring and machine learning algorithms for blood pressure estimation. 发布者更正：用于心血管监测的可穿戴血压传感器和用于血压估计的机器学习算法。

IF 41.7 1区医学

Nature Reviews Cardiology Pub Date : 2025-07-04 DOI: 10.1038/s41569-025-01189-0

Seongwook Min, Jaehun An, Jae Hee Lee, Ji Hoon Kim, Daniel J Joe, Soo Hwan Eom, Chang D Yoo, Hyo-Suk Ahn, Jin-Young Hwang, Sheng Xu, John A Rogers, Keon Jae Lee

引用次数: 0

Tailored therapeutics for cardiomyopathies 针对心肌病的量身定制疗法

IF 49.6 1区医学

Nature Reviews Cardiology Pub Date : 2025-06-27 DOI: 10.1038/s41569-025-01183-6

Athanasios Bakalakos, Emanuele Monda, Perry Mark Elliott

{"title":"Tailored therapeutics for cardiomyopathies","authors":"Athanasios Bakalakos, Emanuele Monda, Perry Mark Elliott","doi":"10.1038/s41569-025-01183-6","DOIUrl":"https://doi.org/10.1038/s41569-025-01183-6","url":null,"abstract":"The term cardiomyopathy is used to describe a large family of complex heart muscle disorders of diverse aetiology and pathophysiology. For decades, the management of individual cardiomyopathy subtypes has focused primarily on the management of symptoms and the prevention of disease-related complications, such as heart failure and sudden cardiac death. Treatment of progressive myocardial dysfunction has relied on conventional evidence-based heart failure therapies, with variable success. In contrast to other areas of medicine, cardiology is characterized by few aetiology-targeted therapies, but cardiomyopathies offer an ideal model for innovation because, in many individuals, the disorder has a monogenic cause, the expression of which is modified by complex genetic mechanisms, comorbidities and lifestyle. Elucidation of the complex cellular and molecular pathways that result in downstream tissue phenotypes has led to the investigation of new or repurposed pharmacological agents and, in parallel, therapies that modify or mitigate the effects of causative genetic variants, offering the prospect of targeting the disease at its source. In this Review, we describe some of the most promising therapeutic approaches in cardiomyopathy and discuss their potential effect on the lives of patients and relatives.","PeriodicalId":18976,"journal":{"name":"Nature Reviews Cardiology","volume":"27 1","pages":""},"PeriodicalIF":49.6,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144500613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Challenges and opportunities in assessing right ventricular structure and function: a Roadmap for standardization, clinical implementation and research 评估右心室结构和功能的挑战和机遇：标准化、临床实施和研究的路线图

IF 49.6 1区医学

Nature Reviews Cardiology Pub Date : 2025-06-25 DOI: 10.1038/s41569-025-01180-9

Attila Kovács, Harry Magunia, Alina Nicoara, David Oxborough, Marius Keller, Daniel X. Augustine, Dick Thijssen, Arie van Dijk, Andre Denault, Francois Haddad, Elena Surkova

{"title":"Challenges and opportunities in assessing right ventricular structure and function: a Roadmap for standardization, clinical implementation and research","authors":"Attila Kovács, Harry Magunia, Alina Nicoara, David Oxborough, Marius Keller, Daniel X. Augustine, Dick Thijssen, Arie van Dijk, Andre Denault, Francois Haddad, Elena Surkova","doi":"10.1038/s41569-025-01180-9","DOIUrl":"https://doi.org/10.1038/s41569-025-01180-9","url":null,"abstract":"Given its crucial role in determining patient symptoms and outcomes in various cardiopulmonary diseases, the thorough and accurate assessment of right ventricular function is essential for both diagnosis and ongoing patient monitoring. In the era of precision medicine, a more detailed characterization of patients with cardiopulmonary diseases is needed, especially with the emergence of novel pharmacological and device-based therapies, such as transcatheter tricuspid valve intervention, gene therapy in patients with cardiomyopathy and anti-obesity interventions for patients with heart failure. Precise and reproducible quantification of right ventricular morphology and function are crucial for risk stratification, the selection of different therapies for the appropriate patients and the evaluation of treatment outcomes. As our understanding of right ventricular pathophysiology expands, the need for sensitive markers of functional deterioration, reliable prognostic indicators and more precise surrogates for clinical trials becomes increasingly important. In this Roadmap, we address current challenges in the standardization of image acquisition, analysis and interpretation across different modalities. We explore the factors limiting the clinical adoption of more advanced approaches and provide expert recommendations to overcome these barriers. Additionally, we outline potential next steps for incorporating parameters of right ventricular function as surrogate end points in multicentre clinical trials of new drugs or devices, and highlight new research opportunities, including the integration of artificial intelligence technologies. Finally, we issue a call for international collaboration on selected priority areas.","PeriodicalId":18976,"journal":{"name":"Nature Reviews Cardiology","volume":"45 1","pages":""},"PeriodicalIF":49.6,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144479041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Endothelial cell necroptosis induces haemolysis and microangiopathy 内皮细胞坏死导致溶血和微血管病变

IF 49.6 1区医学

Nature Reviews Cardiology Pub Date : 2025-06-23 DOI: 10.1038/s41569-025-01185-4

Gregory B. Lim

引用次数: 0

Mechano-energetic uncoupling in heart failure 心力衰竭的机械-能量解耦

IF 49.6 1区医学

Nature Reviews Cardiology Pub Date : 2025-06-22 DOI: 10.1038/s41569-025-01167-6

Dunja Aksentijevic, Simon Sedej, Jeremy Fauconnier, Melanie Paillard, Mahmoud Abdellatif, Katrin Streckfuss-Bömeke, Renée Ventura-Clapier, Jolanda van der Velden, Rudolf A. de Boer, Edoardo Bertero, Jan Dudek, Vasco Sequeira, Christoph Maack

{"title":"Mechano-energetic uncoupling in heart failure","authors":"Dunja Aksentijevic, Simon Sedej, Jeremy Fauconnier, Melanie Paillard, Mahmoud Abdellatif, Katrin Streckfuss-Bömeke, Renée Ventura-Clapier, Jolanda van der Velden, Rudolf A. de Boer, Edoardo Bertero, Jan Dudek, Vasco Sequeira, Christoph Maack","doi":"10.1038/s41569-025-01167-6","DOIUrl":"https://doi.org/10.1038/s41569-025-01167-6","url":null,"abstract":"Heart failure (HF) is a major global and life-threatening disease. Despite advances in therapies, the prevalence of HF is increasing owing to an ageing population and the pervasive pandemic of obesity and metabolic disorders, which have transformed the pathophysiology of HF. Changes in cardiac energy metabolism and the related energy deficit crucially contribute to the severity and type of HF. Furthermore, perturbations in excitation–contraction coupling, mitochondrial function and oxidative stress are characteristic features of HF. In this Review, we focus on the close interaction between cardiac mechanics and mitochondrial energetics, and decipher how this mechano-energetic coupling is disturbed in various acquired and hereditary forms of HF. In HF with reduced ejection fraction, defects in excitation–contraction coupling are key drivers of mechano-energetic uncoupling, whereas in HF with preserved ejection fraction, increased preload and afterload imposed by obesity, hypertension and age-dependent vascular stiffness increase mechanical workload, which is insufficiently matched by mitochondrial tricarboxylic acid cycle activity and ATP supply. In both scenarios, oxidative stress results from depletion of the antioxidative capacity and contributes to maladaptive cardiac remodelling and dysfunction. Several established and emerging treatments for HF target this mechano-energetic uncoupling, and a greater understanding of the underlying mechanisms will open new therapeutic opportunities to alleviate the burden of HF.","PeriodicalId":18976,"journal":{"name":"Nature Reviews Cardiology","volume":"15 1","pages":""},"PeriodicalIF":49.6,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cardiac intermediary metabolism in heart failure: substrate use, signalling roles and therapeutic targets. 心力衰竭的心脏中间代谢：底物使用，信号作用和治疗靶点。

IF 49.6 1区医学

Nature Reviews Cardiology Pub Date : 2025-06-22 DOI: 10.1038/s41569-025-01166-7

Mathias Mericskay,Coert J Zuurbier,Lisa C Heather,Anja Karlstaedt,Javier Inserte,Luc Bertrand,Georgios Kararigas,Marisol Ruiz-Meana,Christoph Maack,Gabriele G Schiattarella

{"title":"Cardiac intermediary metabolism in heart failure: substrate use, signalling roles and therapeutic targets.","authors":"Mathias Mericskay,Coert J Zuurbier,Lisa C Heather,Anja Karlstaedt,Javier Inserte,Luc Bertrand,Georgios Kararigas,Marisol Ruiz-Meana,Christoph Maack,Gabriele G Schiattarella","doi":"10.1038/s41569-025-01166-7","DOIUrl":"https://doi.org/10.1038/s41569-025-01166-7","url":null,"abstract":"The number of patients with heart failure is expected to rise sharply owing to ageing populations, poor dietary habits, unhealthy lifestyles and improved survival rates from conditions such as hypertension and myocardial infarction. Heart failure is classified into two main types: heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). These forms fundamentally differ, especially in how metabolism is regulated, but they also have shared features such as mitochondrial dysfunction. HFrEF is typically driven by neuroendocrine activation and mechanical strain, which demands a higher ATP production to sustain cardiac contraction. However, the primary energy source in a healthy heart (fatty acid β-oxidation) is often suppressed in HFrEF. Although glucose uptake increases in HFrEF, mitochondrial dysfunction disrupts glucose oxidation, and glycolysis and ketone oxidation only partially compensate for this imbalance. Conversely, HFpEF, particularly in individuals with metabolic diseases, such as obesity or type 2 diabetes mellitus, results from both mechanical and metabolic overload. Elevated glucose and lipid levels overwhelm normal metabolic pathways, leading to an accumulation of harmful metabolic byproducts that impair mitochondrial and cellular function. In this Review, we explore how disruptions in cardiac metabolism are not only markers of heart failure but also key drivers of disease progression. We also examine how metabolic intermediates influence signalling pathways that modify proteins and regulate gene expression in the heart. The growing recognition of the role of metabolic alterations in heart failure has led to groundbreaking treatments that target these metabolic disruptions, offering new hope for these patients.","PeriodicalId":18976,"journal":{"name":"Nature Reviews Cardiology","volume":"8 1","pages":""},"PeriodicalIF":49.6,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Metabolic alterations in heart failure 心力衰竭的代谢改变

IF 49.6 1区医学

Nature Reviews Cardiology Pub Date : 2025-06-22 DOI: 10.1038/s41569-025-01181-8

Christoph Maack

引用次数: 0

Immunometabolism in heart failure 心力衰竭的免疫代谢

IF 49.6 1区医学

Nature Reviews Cardiology Pub Date : 2025-06-22 DOI: 10.1038/s41569-025-01165-8

Ioanna Andreadou, Alessandra Ghigo, Panagiota-Efstathia Nikolaou, Filip K. Swirski, James T. Thackeray, Gerd Heusch, Gemma Vilahur

{"title":"Immunometabolism in heart failure","authors":"Ioanna Andreadou, Alessandra Ghigo, Panagiota-Efstathia Nikolaou, Filip K. Swirski, James T. Thackeray, Gerd Heusch, Gemma Vilahur","doi":"10.1038/s41569-025-01165-8","DOIUrl":"https://doi.org/10.1038/s41569-025-01165-8","url":null,"abstract":"The interaction between inflammation and metabolism (immunometabolism) is a crucial factor in the pathophysiology of heart failure, whether the cardiac failure originates from ischaemic injury or systemic metabolic disorders, and whether it is associated with reduced or preserved ejection fraction. Ischaemia, metabolic stress and comorbidity-driven systemic inflammation attract innate and adaptive immune cells to the myocardium and induce their polarization towards pro-inflammatory or anti-inflammatory phenotypes through cell-intrinsic metabolic shifts involving oxidative phosphorylation and anaerobic glycolysis. These infiltrating immune cells modulate cardiac and systemic metabolism. The bidirectional metabolic crosstalk between immune cells and parenchymal and stromal cardiac cells contributes to adverse cardiac remodelling. In turn, ischaemic injury and deregulated metabolism stimulate bone marrow and extramedullary myelopoiesis, which increases immune cell recruitment and perpetuates a non-resolving chronic inflammatory state. Pharmacological interventions targeting metabolism have shown promise for improving outcomes in patients with heart failure, but immunomodulatory approaches face multiple challenges. Understanding the complex metabolic pathways and cell–cell interactions that regulate immunometabolism in heart failure is essential to identify new therapies that shift the balance from maladaptive to cardioprotective immune responses. In this Review, we provide a comprehensive overview of the intricate cellular and molecular mechanisms that govern immunometabolism in heart failure and discuss potential approaches to non-invasively monitor and treat patients with heart failure.","PeriodicalId":18976,"journal":{"name":"Nature Reviews Cardiology","volume":"17 1","pages":""},"PeriodicalIF":49.6,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Vascular (dys)function in the failing heart. 衰竭心脏的血管功能。

IF 49.6 1区医学

Nature Reviews Cardiology Pub Date : 2025-06-22 DOI: 10.1038/s41569-025-01163-w

Luca Liberale,Dirk Jan Duncker,Derek John Hausenloy,Simon Kraler,Hans Erik Bøtker,Bruno Karl Podesser,Gerd Heusch,Petra Kleinbongard

{"title":"Vascular (dys)function in the failing heart.","authors":"Luca Liberale,Dirk Jan Duncker,Derek John Hausenloy,Simon Kraler,Hans Erik Bøtker,Bruno Karl Podesser,Gerd Heusch,Petra Kleinbongard","doi":"10.1038/s41569-025-01163-w","DOIUrl":"https://doi.org/10.1038/s41569-025-01163-w","url":null,"abstract":"Heart failure (HF) is not confined to contractile failure of cardiomyocytes or myocardial fibrosis. Coronary and systemic vascular dysfunction contributes to the initiation and progression of HF with or without reduced ejection fraction. Furthermore, HF compromises vascular function, creating and sustaining a vicious cycle with deranging effects on coronary blood flow, cardiac metabolism and cardiac function. In HF, systemic arterial dysfunction, characterized by increased arterial stiffness and resistance, raises cardiac afterload and impedes myocardial contractile function. Reduced coronary blood flow impairs myocardial oxygen delivery and consequently cardiomyocyte metabolism and function. Coronary microvascular dysfunction is heterogeneous in its pathogenesis and manifestations, complicating the diagnosis and management across different HF phenotypes. Understanding the alterations in function in different segments of the vasculature, from the aorta to the capillary level, offers mechanistic insights into disease drivers and therapeutic interventions. Interventional approaches can improve vascular haemodynamics, whereas established and emerging pharmacotherapies target the neurohumoral axis and reduce extravascular compression, inflammation, and oxidative stress, thereby improving vascular function and HF-related outcomes. In this Review, we provide a mechanistic framework of vascular dysfunction in the pathogenesis of HF with or without reduced ejection fraction, pointing towards integrated therapies that consider the vascular implications of contemporary HF management across HF phenotypes.","PeriodicalId":18976,"journal":{"name":"Nature Reviews Cardiology","volume":"20 1","pages":""},"PeriodicalIF":49.6,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0