European heart journal open最新文献

{"title":"Modulation of cell fate by shock wave therapy in ischaemic heart disease.","authors":"Michael Graber, Can Gollmann-Tepeköylü, Victor Schweiger, Jakob Hirsch, Leo Pölzl, Felix Nägele, Daniela Lener, Hubert Hackl, Sieghart Sopper, Elke Kirchmair, Sophia Mair, Jakob Voelkl, Christina Plattner, Felix Eichin, Zlatko Trajanoski, Anne Krogsdam, Jonas Eder, Manuel Fiegl, Dominik Hau, Ivan Tancevski, Michael Grimm, John P Cooke, Johannes Holfeld","doi":"10.1093/ehjopen/oeaf011","DOIUrl":"https://doi.org/10.1093/ehjopen/oeaf011","url":null,"abstract":"<p><strong>Aims: </strong>Cardiac shockwave therapy (SWT) improves left ventricular (LV) function in patients with ischaemic cardiomyopathy. Shockwave therapy activates Toll-like receptor 3 (TLR3), a receptor-inducing chromatin remodelling and nuclear reprogramming of cardiac cells. We hypothesized that mechanical activation of TLR3 facilitates reprogramming of fibroblasts towards endothelial cells restoring myocardial perfusion and function.</p><p><strong>Methods and results: </strong>Human cardiac fibroblasts were treated by mechanical stimulation via SWT or TLR3 agonist Poly(I:C) in the presence of endothelial induction medium. A lineage tracing experiment was performed in a transgenic mouse model of Fsp1-Cre/LacZ mice after coronary occlusion. Left ventricular function and scarring were assessed. Single-cell sequencing including RNA trajectory analysis was performed. Chromatin remodelling and epigenetic plasticity were evaluated via western blot and Assay for Transposase-Accessible Chromatin sequencing. Mechanical stimulation of human fibroblasts with SWT activated TLR3 signalling and enhanced the expression of endothelial genes in a TLR3-dependent fashion. The induced endothelial cells (ECs) resembled genuine ECs in that they produced endothelial nitric oxide and formed tube-like structures in Matrigel. In a lineage tracing experiment in Fsp1-Cre/LacZ mice, shockwave treatment increased LacZ/CD31-positive cells (indicating transdifferentiation) after coronary occlusion. Furthermore, SWT reduced myocardial scar size and improved LV function. Single-cell RNA-seq and RNA trajectory analyses revealed that SWT induced an endothelial fibroblast cluster and mechanical stimulation induced significant changes in chromatin organization, with chromatin being more accessible after both treatments in 1705 genomic regions.</p><p><strong>Conclusion: </strong>Shockwave therapy enhances DNA accessibility via TLR3 activation and facilitates the transdifferentiation of fibroblasts towards endothelial cells in ischaemic myocardium.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 2","pages":"oeaf011"},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11977462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Cardiovascular Disease Journals in Reporting Sex and Gender in Research.","authors":"C Noel Bairey Merz, Robert O Bonow, Mercedes Carnethon, Filippo Crea, Joseph A Hill, Harlan M Krumholz, Roxana Mehran, Erica S Spatz","doi":"10.1093/ehjopen/oeaf029","DOIUrl":"10.1093/ehjopen/oeaf029","url":null,"abstract":"","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 2","pages":"oeaf029"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Edoxaban treatment in routine clinical practice is highly concordant with the 2020 European Society of Cardiology atrial fibrillation guidelines: results from the noninterventional Global ETNA-AF programme.","authors":"Doralisa Morrone, Leon Dinshaw, José Antonio Gordillo de Souza, Cathy Chen, Paulus Kirchhof, Yukihiro Koretsune, Ladislav Pecen, Chun-Chieh Wang, Takeshi Yamashita, Martin Unverdorben, Raffaele De Caterina","doi":"10.1093/ehjopen/oeaf004","DOIUrl":"10.1093/ehjopen/oeaf004","url":null,"abstract":"<p><strong>Aims: </strong>The 2020 European Society of Cardiology (ESC)-atrial fibrillation (AF) guidelines recommend a risk-based approach to oral anticoagulation (OAC) therapy in patients with AF; however, it is unknown if current practice aligns with these recommendations. This study assessed the associated effectiveness and safety of edoxaban in patients with AF according to the 2020 ESC-AF guidelines and the approved label in routine clinical care.</p><p><strong>Methods and results: </strong>The Global ETNA-AF programme is a large prospective, noninterventional programme evaluating safety and effectiveness of edoxaban. Baseline characteristics and 2-year clinical event data were analysed in subgroups, defined by ESC-AF guidelines indication of OAC therapy according to CHA₂DS₂-VASc score [no OAC to be considered, OAC should be considered (2 for females/1 for males), and OAC recommended (≥3 for females/≥2 for males)] and modified HAS-BLED score [(≥3 (bleeding risk high) vs. <3 (bleeding risk low)]. Of 19 960 patients included, 16 912 (84.7%) were categorized as OAC recommended and 2501 (12.5%) as OAC should be considered; 547 (2.7%) were in the no OAC to be considered group. In the OAC recommended group, 12 006 (71.0%) had high bleeding risk. Clinical event rates were <5%/year across all risk groups, even in the OAC recommended and high bleeding risk groups. In the OAC recommended and high bleeding risk groups, patients had low ischaemic stroke and bleeding event rates, regardless of receiving the 30 or 60 mg dose.</p><p><strong>Conclusion: </strong>This study demonstrated that edoxaban use in patients with AF largely aligns with 2020 ESC-AF guidelines, while maintaining low clinical event rates.</p><p><strong>Registration: </strong>Europe (NCT02944019), Japan (UMIN000017011), and Korea/Taiwan (NCT02951039).</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 2","pages":"oeaf004"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insulin-like growth factor binding protein-3 (IGFBP-3): a biomarker of coronary artery disease induced myocardial ischaemia.","authors":"Jacqui A Lee, Jessika Wise, Sara D Raudsepp, Louise N Paton, Jan Powell, Kieran Jina, Sally Aldous, Richard W Troughton, Philip D Adamson, A Mark Richards, W Frank Peacock, James L Januzzi, Noah Erceg, Luca Koechlin, Jasper Boeddinghaus, Pedro Lopez-Ayala, Christian Mueller, Martin P Than, John W Pickering, Chris J Pemberton","doi":"10.1093/ehjopen/oeaf028","DOIUrl":"10.1093/ehjopen/oeaf028","url":null,"abstract":"<p><strong>Aims: </strong>Among individuals presenting to the emergency department (ED) with chest pain, clinical uncertainty surrounds the appropriate identification of non-myocardial infarction (MI) individuals who would most benefit from objective functional/anatomical testing (e.g. imaging). We applied a proteomic biomarker discovery approach to identify novel candidates reflecting coronary artery disease (CAD) induced ischaemia that could translate to measurement in clinical samples.</p><p><strong>Methods and results: </strong>Mass spectroscopy (MS) of perfusate from an isolated rat heart model of cardiac ischaemia identified >100 novel protein biomarkers. A prominent candidate, insulin-like growth factor binding protein (IGFBP-3), was then interrogated for its ability to identify CAD-related ischaemia (e.g. positive cardiac stress test; unstable angina pectoris, UAP; arterial stenosis >70% on angiography) in multiple patient sample sets [cardiac stress testing, <i>n</i> = 12; septal alcohol ablation (SAA), <i>n</i> = 12; ED chest pain, <i>n</i> = 2977]. In cardiac stress testing, a significant delta IGFBP-3 (ΔIGFBP-3) between 0 and 150 min was seen in positive, but not negative, tests (<i>P</i> = 0.03). In SAA, peripheral IGFBP-3 levels did not change over 24 h (<i>P</i> = 0.57). In ED patients, ΔIGFBP-3 between 0 and 2 h (i) identified more 365-day low-risk major adverse cardiac event cases (27-30%), (ii) provided 7% improvement in positive predictive value over a clinical model for the identification of unstable angina (<i>P</i> = 0.01), and (iii) was a significant, independent predictor of >70% stenosis on angiography, improving indeterminate risk prediction by 9% (95% CI 3-15%).</p><p><strong>Conclusion: </strong>Our discovery approach has translated IGFBP-3 as a potential biomarker to identify significant CAD/ischaemia in patients who do not meet diagnostic thresholds for MI.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 2","pages":"oeaf028"},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inhibiting atrial natriuretic peptide clearance reduces myocardial fibrosis and improves cardiac function in diabetic rats.","authors":"Jules Joel Bakhos, Youakim Saliba, Joelle Hajal, Guy Achkouty, Hrag Oskaridjian, Miguel Albuquerque, Chloé Azevedo, Albert Semaan, Nadine Suffee, Elise Balse, Stéphane N Hatem, Nassim Fares","doi":"10.1093/ehjopen/oeaf031","DOIUrl":"https://doi.org/10.1093/ehjopen/oeaf031","url":null,"abstract":"<p><strong>Aims: </strong>Natriuretic peptides (NPs) exert pleiotropic effects through the recruitment of cyclic guanosine monophosphate (cGMP) signalling pathways depending on their bioavailability, which is regulated by clearance receptors and peptidases. Here, we tested the hypothesis that increasing myocardial bioavailability of NP has a beneficial effect on heart failure. We studied the effects of a mutated NP, M-atrial natriuretic peptide (MANP), resistant to neprilysin in a model of diabetic cardiomyopathy characterized by marked myocardial fibrosis.</p><p><strong>Methods and results: </strong>Natriuretic peptides as well as sacubitril were delivered via osmotic mini-pumps to high-fat/streptozotocin-induced Type 2 diabetic (T2D) rats. Cardiac function was evaluated by echocardiography. Myocardial remodelling was studied by histological approaches, collagen phenotype, and atrial natriuretic peptide (ANP)/cGMP concentrations. Live-cell cGMP biosensing was conducted on cultured rat cardiac fibroblasts to investigate the biological effects of NP. Cyclic guanosine monophosphate signalling pathway was studied using multiple antibody arrays and biochemical assays in cardiac tissue and cultured fibroblasts. M-atrial natriuretic peptide exhibits superior efficacy than ANP in reducing left ventricular dysfunction and myocardial fibrosis with less extracellular matrix deposition. <i>In vitro</i>, MANP and ANP similarly generated cGMP and activated the protein kinase G (PKG) signalling pathway in cardiac fibroblasts, attenuating Mothers against decapentaplegic homolog 2 (SMAD) activation, collagen secretion, and cell proliferation. Nevertheless, <i>in vivo</i>, MANP specifically enhanced cardiac cGMP accumulation and was more potent than ANP in activating myocardial cGMP/PKG signalling and inhibiting the profibrotic SMAD, extracellular signal-regulated kinases 1/2, and nuclear factor of activated T cells 3 pathways. Endopeptidase inhibition using sacubitril also led to cardiac ANP/cGMP accumulation and reduced myocardial fibrosis.</p><p><strong>Conclusion: </strong>Myocardial bioavailability of ANP is a major determinant of peptide efficacy in reducing cardiac fibrosis and improving pump function during diabetic cardiomyopathy.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 2","pages":"oeaf031"},"PeriodicalIF":0.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11977460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exercise-based cardiac rehabilitation for patients with atrial fibrillation: a narrative review.","authors":"Benjamin J R Buckley, Liz van Hout, Charlotte Fitzhugh, Gregory Y H Lip, Rod S Taylor, Dick H J Thijssen","doi":"10.1093/ehjopen/oeaf025","DOIUrl":"10.1093/ehjopen/oeaf025","url":null,"abstract":"<p><p>The role of physical activity (i.e. any bodily movement that requires energy expenditure) and exercise (i.e. planned, structured, and repetitive physical activity to improve/maintain fitness) in the primary and secondary prevention of atrial fibrillation (AF) is increasingly recognized. Physical activity has been associated with lower risks to develop AF and associated complications (e.g. stroke, heart failure, and myocardial infarction). Exercise-based cardiac rehabilitation (ExCR) is increasingly examined in the treatment of AF and sometimes combined with rhythm control strategies (e.g. catheter ablation). Nonetheless, several important clinical, practical, and mechanistic questions remain not fully understood. This state-of-the-art review first provides a contemporary update on the evidence base for the clinical effects of ExCR in AF. Despite the ongoing need for high-quality studies, existing randomized controlled trials and cohort studies suggest ExCR reduces AF burden, lowers risks for major adverse cardiovascular events, and improves health-related quality of life. Second, to facilitate implementation of ExCR, we have observed comparable effects of distinct exercise protocols (e.g. type of training and centre-/home-based) and discussed similarity of effectiveness across patient characteristics (e.g. age, sex, and AF subtype). Critically, we have discussed potential barriers that may prohibit the uptake of ExCR for patients with AF, categorized at clinician- (e.g. referral and training), patient- (e.g. motivation, transportation, and psychosocial factors), and system-levels (e.g. insurance and resources). Third, we have summarized the potential mechanisms underlying these effects of ExCR, classified by their potential role in reducing AF burden (e.g. atrial/ventricular function, autonomic balance, and inflammation) and lowering risks for adverse events (e.g. modifiable risk factors, vascular function, and thrombogenesis). Based on the increasing evidence for clinical benefits, e.g. improved health-related quality of life and better clinical outcomes, we advocate stronger focus on regular physical activity and referral to multidisciplinary ExCR for sustainable lifestyle changes within the ESC AF-CARE pathway for the prevention and treatment of AF.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 2","pages":"oeaf025"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of renal denervation therapy in hypertension: a meta-analysis.","authors":"Husam M Salah, Jorge Antonio Gutierrez, Jennifer A Rymer, Hidenori Yaku, Rajesh V Swaminathan, Manesh R Patel, Marat Fudim","doi":"10.1093/ehjopen/oeaf026","DOIUrl":"10.1093/ehjopen/oeaf026","url":null,"abstract":"","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 2","pages":"oeaf026"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rationale and design of the acetazolamide as a chloride sparing diuretic in patients admitted with heart failure (ADA-HF) trial.","authors":"Joseph J Cuthbert, Elton Luo, Aia S M Ahmed, Meenakshy Ajith, Hafiz Butt, Henrietta Pinhol, Felix Baffour Korsah, Jeanne Bulemfu, Sarah Ford, Grant Constable, Leanne Cox, Alan S Rigby, Andrew L Clark","doi":"10.1093/ehjopen/oeaf019","DOIUrl":"10.1093/ehjopen/oeaf019","url":null,"abstract":"<p><strong>Aims: </strong>The Acetazolamide as a chloride-sparing Diuretic in patients Admitted with Heart Failure (ADA-HF) trial will assess the safety and diuretic effect of oral ACZ given alongside a high-dose IV loop diuretic in patients admitted to the hospital with heart failure (HF) and severe fluid retention. Hypochloraemia is common in patients with HF and is associated with worse outcomes, but there are few treatment options available: we will also assess whether ACZ reduces urine chloride loss.</p><p><strong>Methods and results: </strong>The ADA-HF trial is a single centre, open-label, randomized-controlled trial of ACZ 250 mg twice daily plus standard care vs. standard care alone. The trial duration is 4 days. We will recruit 50 patients with severe peripheral oedema due to HF requiring standard care (240 mg of IV furosemide per day given via continuous infusion at 10 mg per hour). The co-primary endpoints are (1) the difference in net fluid loss daily, and over 4 days; and (2) difference in serum chloride concentrations between baseline and day 4. The trial has 80% power to detect a difference in fluid balance of 500-1000 mL per day; and a difference in serum chloride concentration of 1 mmol/L per day. Secondary endpoints include but are not limited to: time to recruit per patient; rate of adverse events; rate of recruitment; and cause-specific rate of drop-out of the study.</p><p><strong>Conclusion: </strong>ACZ may be a useful adjunct to diuretic therapy, but the safety and diuretic efficacy of oral ACZ when used alongside high-dose loop diuretics is unknown. ADA-HF will complement the ADVOR trial and may clarify what role ACZ may have for patients with severe congestion.</p><p><strong>Trial registration: </strong>ISRCTN registry. ISRCTN13060336. Registered on 09/02/2023. URL: https://doi.org/10.1186/ISRCTN13060336.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 2","pages":"oeaf019"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Causes and clinical impact of initial misdiagnosis of acute type A aortic dissection.","authors":"Karl Teurneau-Hermansson, David von Rosen, Jacob Ede, Mårten Larsson, Johan Sjögren, Per Wierup, Shahab Nozohoor, Igor Zindovic","doi":"10.1093/ehjopen/oeaf027","DOIUrl":"10.1093/ehjopen/oeaf027","url":null,"abstract":"<p><strong>Aims: </strong>The high mortality in untreated acute type A aortic dissection (ATAAD) stresses the need for prompt diagnosis and immediate surgical treatment. Our aim was to evaluate the frequency and clinical impact of misdiagnosis and delayed diagnosis of ATAAD.</p><p><strong>Methods and results: </strong>This was a single-centre, retrospective, observational study including all ATAAD patients with available admission charts between 2001 and 2021 in an area of 1.9 million inhabitants in southern Sweden. The primary endpoints were initial misdiagnosis, delayed diagnosis, and 30-day mortality. Surgical treatment was a secondary endpoint. Independent predictors of misdiagnosis and 30-day mortality were identified by multivariable logistic regression and subgroup analyses by severity of clinical presentation were performed. There were 556 patients included in the study (418 surgically treated and 138 non-surgically treated), and 45.3% were initially misdiagnosed. Misdiagnosed patients were more often female (47.6 vs. 35.9%; <i>P</i> = 0.005) and demonstrated significantly lower rates of syncope, hypotensive shock, and malperfusion. Patients without signs of malperfusion subjected to diagnostic delay were less likely offered surgical treatment (74.0 vs. 91.5%; <i>P</i> < 0.001) and had higher 30-day mortality (21.3 vs. 10.8%; <i>P</i> = 0.040). Female sex was an independent predictor of misdiagnosis (OR: 1.748; 95% CI 1.145-2.668; <i>P</i> = 0.010), but neither misdiagnosis nor delayed diagnosis were independent predictors of 30-day mortality.</p><p><strong>Conclusion: </strong>Although misdiagnosis and delayed diagnosis did not influence overall 30-day mortality, delayed diagnosis led to significantly higher 30-day mortality in the large group of patients presenting without signs of malperfusion, likely caused by the observed higher risk of being denied surgical treatment.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 2","pages":"oeaf027"},"PeriodicalIF":0.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11935741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive behavioural therapy targeting cardiac anxiety post-myocardial infarction: results from two sequential pilot studies.","authors":"Amanda Johnsson, Brjánn Ljótsson, Björn E Liliequist, Helga Skúladóttir, Linnea Maurex, Ida Boberg, Eva Ólafsdóttir, Sofia Klavebäck, Frieder Braunschweig, Linda G Mellbin, Josefin Särnholm","doi":"10.1093/ehjopen/oeaf020","DOIUrl":"10.1093/ehjopen/oeaf020","url":null,"abstract":"<p><strong>Aims: </strong>Cardiac anxiety, which is cardiac-related fear and avoidance behaviours, is common following myocardial infarction (MI) and has been associated with increased risk for cardiovascular events. However, there are currently no treatments specifically designed to target cardiac anxiety. The aim of the two pilot studies was to evaluate an exposure-based cognitive behavioural therapy protocol (MI-CBT) targeting cardiac anxiety following MI, assessing feasibility, acceptability, and the intervention's potential for reducing cardiac anxiety and improving health-related quality of life (QoL).</p><p><strong>Methods and results: </strong>A series of two sequential, uncontrolled pilot studies were conducted. In Pilot Study 1 (<i>n</i> = 15), MI-CBT was delivered via face-to-face videoconference, while Pilot Study 2 (<i>n</i> = 23) was delivered online. Patients with a history of MI (≥6 months before assessment, type 1 ST- or non-ST-segment elevation MI, and elevated cardiac anxiety as per clinical interview) were included. The interventions lasted 8 weeks and were therapist-led, with key components including exposure to cardiac-related symptoms and reduction of avoidance behaviours. Participants completed self-rated assessments, including the Cardiac Anxiety Questionnaire (CAQ) and the 12-Item Short Form Health Survey (SF-12), at baseline, post-treatment, and 6-month follow-up. Treatment adherence and satisfaction were high. Cognitive behavioural therapy led to a large reduction in cardiac anxiety, as measured by the CAQ (<i>P</i> < 0.001), and significant improvements in health-related QoL, as measured by the SF-12 (<i>P</i> < 0.001), in both pilot studies.</p><p><strong>Conclusion: </strong>These studies suggest that exposure-based CBT is a feasible, acceptable, and promising approach to reduce cardiac anxiety and improve QoL following MI. A randomized controlled trial should be conducted to evaluate the efficacy of the intervention.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 2","pages":"oeaf020"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}