European heart journal open最新文献

{"title":"Unmasking flawed exposure attribution in nicotine and cardiovascular risk.","authors":"Red Thaddeus D Miguel, Isabella Steffensen","doi":"10.1093/ehjopen/oeag059","DOIUrl":"10.1093/ehjopen/oeag059","url":null,"abstract":"","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 3","pages":"oeag059"},"PeriodicalIF":4.3,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13183172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147978166","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":"Left bundle branch area pacing: anatomical and physiological features made easy.","authors":"Guram Imnadze, Amr Abdin, Mauro Biffi, José-Ángel Cabrera, Óscar Cano, Jan De Pooter, Maxim Didenko, Marek Jastrzebski, Wilfried Mullens, Kevin Vernooy, Pugazhendhi Vijayaraman, Haran Burri","doi":"10.1093/ehjopen/oeag081","DOIUrl":"10.1093/ehjopen/oeag081","url":null,"abstract":"<p><p>Left bundle branch area pacing is being increasingly adopted in routine clinical practice as a more physiological alternative to right ventricular and biventricular pacing. Understanding the concepts of this pacing modality may be a hurdle for the non-electrophysiologist and specialists alike. This review article aims to explain in a didactic manner the anatomical and electrophysiological principles underlying left bundle branch area pacing.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 3","pages":"oeag081"},"PeriodicalIF":4.3,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13403281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148611290","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":"Nicotine as a cardiovascular drug: haemodynamic stress, oxidative injury, and the regulatory failure to protect the heart.","authors":"Thomas Münzel, Filippo Crea, Sanjay Rajagopalan, Thomas F Lüscher","doi":"10.1093/ehjopen/oeag065","DOIUrl":"10.1093/ehjopen/oeag065","url":null,"abstract":"","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 3","pages":"oeag065"},"PeriodicalIF":4.3,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13183173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147978100","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":"Asymptomatic and symptomatic cardiac toxicity associated with immune checkpoint inhibitors: insights from a Japanese registry.","authors":"Yudai Tamura, Yuichi Tamura, Hiroshi Ohtsu, Shiro Nakamori, Kazuaki Maruyama, Nao Muraoka, Masaaki Shoji, Kazuko Tajiri, Hirofumi Tomita, Yoshitaka Iso, Koichiro Sugimura, Hirotsugu Yamada, Koichiro Kinugawa, Ryota Morimoto, Hiroshi Akazawa, Kazumasa Harada, Shintaro Nakano, Kenichi Tsujita, Tadahiro Gunji, Toshihiro Tsuruda, Akihiro Nakamura, Michiro Maruyama, Yuichi Miyake, Kunihiko Hatanaka, Hiroaki Kawano, Wakana Sato, Shingo Yano, Kyoko Imanaka-Yoshida, Issei Komuro","doi":"10.1093/ehjopen/oeag079","DOIUrl":"10.1093/ehjopen/oeag079","url":null,"abstract":"<p><strong>Aims: </strong>Immune checkpoint inhibitors (ICIs) are a cornerstone of cancer therapy; however, immune-related adverse events, including myocarditis, pose significant challenges. Furthermore, limited data exist on the pathology of mild or asymptomatic cases. This study aimed to characterize the clinical, biomarker, and pathological features of ICI-associated cardiac toxicity, comparing symptomatic and asymptomatic cases within a Japanese multicentre registry.</p><p><strong>Methods and results: </strong>A nationwide, retrospective registry collected data from 90 patients across 23 hospitals between 2020 and 2022. Patients were classified according to the American Society of Clinical Oncology Clinical Practice Guidelines: Grade 1 (asymptomatic) and Grades 2-4 (symptomatic). Endomyocardial biopsy was performed in 24 patients (<i>n</i> = 19 symptomatic, <i>n</i> = 5 asymptomatic). Among the enrolled patients (mean age: 68 years; 76.7% male), 41.1% were classified as Grade 1, whereas 58.9% were symptomatic (Grades 2-4). Symptomatic cases exhibited significantly higher troponin I and creatine kinase levels at onset. Pathological analysis revealed more extensive lymphocytic infiltration (CD3+ T cells) in symptomatic cases, particularly with higher CD8+ and CD68+ cell counts. Continuation of ICI therapy was more frequent in the asymptomatic group, and only one patient experienced recurrence. In contrast, all seven myocarditis-related deaths occurred in symptomatic patients.</p><p><strong>Conclusion: </strong>This study provides one of the largest pathological and biomarker-based comparisons of symptomatic and asymptomatic ICI-associated cardiac toxicity. Our findings suggest that asymptomatic cases may represent a distinct, less aggressive inflammatory phenotype, characterized by lower CD8+ infiltration and limited myocardial damage.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 3","pages":"oeag079"},"PeriodicalIF":4.3,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229838","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":"Pathology-validated prevalence and clinical characteristics of coronary medial arterial calcification.","authors":"Yuki Matsumoto, Sho Torii, Kazuki Aihara, Yuto Ono, Yu Sato, Norihito Nakamura, Manabu Shiozaki, Tsukasa Kato, Masataka Nakano, Tomoya Onodera, Yuki Egawa, Shingo Ito, Kaho Hashimoto, Ryosuke Omura, Daiki Suzuki, Yohei Masugi, Yoshihiro Morino, Yuji Ikari, Gaku Nakazawa","doi":"10.1093/ehjopen/oeag076","DOIUrl":"10.1093/ehjopen/oeag076","url":null,"abstract":"<p><strong>Aims: </strong>Medial arterial calcification (MAC) is well characterized in peripheral arteries, but its pathology-validated prevalence in the coronary circulation remains uncertain. Because intravascular imaging cannot routinely delineate the elastic laminae in advanced atherosclerotic lesions, deep intimal calcification (DIC) accumulating adjacent to the internal elastic lamina (IEL) may fundamentally mimic MAC. This study aimed to determine the strict pathology-validated prevalence of true coronary MAC and morphologically characterize DIC as a potential imaging mimic using a large-scale autopsy registry.</p><p><strong>Methods and results: </strong>We evaluated 4508 histologic sections from 327 coronary arteries in 112 autopsy cases. To ensure accurate layer-specific differentiation, the IEL and external elastic lamina were precisely identified using Movat Pentachrome and EVG stains. The cohort was high-risk, featuring 85% cardiac deaths. Pathology-confirmed MAC was remarkably rare, present in only 1.0% of sections and 3.6% of patients. Strikingly, coronary MAC presented in two distinct morphological phenotypes. Three patients exhibited nodular MAC strictly co-existing with intimal nodules in severely stenotic segments, representing secondary mechanical protrusion from the intima. Conversely, only one patient exhibited isolated medial sheet calcification with minimal intimal narrowing, representing true primary medial disease. Notably, the IEL-overriding pattern occasionally seen in peripheral MAC was entirely absent. Meanwhile, DIC was significantly more prevalent, identified in 35.7% of patients.</p><p><strong>Conclusion: </strong>True primary coronary MAC is exceptionally rare. Because dense acoustic shadowing clinically conceals secondary medial nodular protrusions <i>in vivo</i>, imaging-reported coronary 'MAC' almost exclusively represents DIC. Recognizing three distinct phenotypes-DIC, secondary nodular protrusion, and the rare true Mönckeberg-type MAC-is essential to accurately interpret clinical imaging findings.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 4","pages":"oeag076"},"PeriodicalIF":4.3,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414129","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":"First quinquennium completed: highlights from <i>EHJ Open</i> 2025.","authors":"Magnus Bäck, Maciej Banach, Frieder Braunschweig, Salvatore De Rosa, Frank A Flachskampf, Thomas Kahan, Daniel F J Ketelhuth, Patrizio Lancellotti, Susanna C Larsson, Linda Mellbin, Gianluigi Savarese, Annette Schophuus Jensen, Karolina Szummer, Denis Wahl","doi":"10.1093/ehjopen/oeag074","DOIUrl":"10.1093/ehjopen/oeag074","url":null,"abstract":"","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 2","pages":"oeag074"},"PeriodicalIF":4.3,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13176770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147966116","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":"Design and rationale of the RISC-trial: multicentre <i>R</i>CT to assess <i>i</i>mmediate discharge of <i>s</i>yncope patients admitted to the (<i>c</i>ardiac) emergency room.","authors":"Thomas T Boel, Suzanne Y G Peeters, Anouk P van Alem, Mark J Boogers, Marianne Bootsma, Marinus A van den Dorpel, Mehran Firouzi, Jan G J Groothuis, Martin E W Hemels, Jaco H Houtgraaf, Ward P J Jansen, Jelle S Y de Jong, Monica Jongenotter, Evert C A Kaal, Egbert M Koomen, Susan E Langerak, Gideon Mairuhu, Nieke E Mullaart, Johannes B van Rees, Mariam Samim, Eric Wierda, Steven van Zanten, Arthur van Zoelen, Marit van Barreveld, Philip M Croon, Marcel G W Dijkgraaf, Jan G P Tijssen, Joris R De Groot, Frederik J de Lange","doi":"10.1093/ehjopen/oeag078","DOIUrl":"10.1093/ehjopen/oeag078","url":null,"abstract":"<p><strong>Aims: </strong>Syncope is responsible for 1-3% of emergency department presentations. The European Society of Cardiology guidelines on syncope recommend a structured initial evaluation to diagnose syncope patients. If the cause of the syncopal event remains unexplained, risk-stratification is applied to distinguish between patients at high risk of serious cardiovascular events and low-risk patients, who can be safely discharged. However, there is a group of patients in whom this risk can currently not be adequately determined, hereafter called intermediate risk. In clinical practice, these patients are either immediately discharged or admitted for 24 h in-hospital cardiac rhythm monitoring. Due to the high cost of admission, immediate discharge could lower healthcare costs, hospital bed utilization, and patient burden. To our knowledge, there is no sufficient scientific basis for the superiority of either. The RISC trial aims to resolve this knowledge gap.</p><p><strong>Study design: </strong>The RISC trial is an investigator-initiated multicentre prospective randomized controlled trial. A total of 640 predefined low- and intermediate-risk syncope patients are randomized to either immediate discharge or discharge after 24 h in-hospital rhythm monitoring (1:1). The trial is powered to claim non-inferiority of immediate discharge with respect to (non-)fatal composite safety endpoints, which entail arrhythmic disorders, syncope recurrence, and (cardiovascular)death. Furthermore, healthcare costs and quality of life will be evaluated.</p><p><strong>Conclusion: </strong>The RISC trial is a multicentre RCT that aims to gather scientific evidence for immediate discharge of the ESC guideline-based pre-defined low- and intermediate-risk syncope patients in the emergency department. Primary endpoints entail cardiovascular events such as arrhythmias, syncope, and death. This trial is registered at ClinicalTrials.gov with trial-ID: NCT06472375.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 3","pages":"oeag078"},"PeriodicalIF":4.3,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229829","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":"Finerenone vs. spironolactone to reduce adverse outcomes in patients with cardiac-kidney-metabolic syndrome complicated by atrial fibrillation: findings from the Tianjin atrial fibrillation project.","authors":"Xu Tian, Xueguang Liu, Jinhua Zhao, Xuyao Han, Tianshu Gu, Kang-Yin Chen, Panagiotis Korantzopoulos, Gregory Y H Lip, Tong Liu","doi":"10.1093/ehjopen/oeag077","DOIUrl":"10.1093/ehjopen/oeag077","url":null,"abstract":"","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 3","pages":"oeag077"},"PeriodicalIF":4.3,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229218","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":"Sex differences in circulating microRNA profiles in heart failure with preserved and reduced ejection fraction.","authors":"Genri Numata, Shun Nakamura, Hiroyuki Tokiwa, Akashi Taguchi, Masayuki Toyoda, Takashi Kohno, Hisataka Maki, Yasuyuki Shiraishi, Shinsuke Takeuchi, Ayumi Goda, Kyohei Daigo, Natsuko Yamamoto, Yusuke Adachi, Kosuke Yabe, Takao Kato, Yukio Hiroi, Norihiro Kato, Takuya Kawahara, Kazutaka Ueda, Eisuke Amiya, Masaru Hatano, Hideo Fujita, Masaki Ieda, Tetsuo Sasano, Norihiko Takeda, Takahide Kohro, Yasushi Hirota, Issei Komuro, Youichiro Wada, Eiki Takimoto","doi":"10.1093/ehjopen/oeag073","DOIUrl":"10.1093/ehjopen/oeag073","url":null,"abstract":"<p><strong>Aims: </strong>Circulating microRNAs (miRNAs) are informative markers of heart failure (HF); however, sex differences in HF-associated miRNA changes remain unclear. We performed sex-stratified analyses to assess whether HF-associated circulating miRNA changes differ by sex in HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF).</p><p><strong>Methods and results: </strong>In this prospective multicentre cohort study in Japan, we analysed 235 participants, including 82 controls (41 males and 41 females), 76 patients with HFpEF (39 males and 37 females), and 77 patients with HFrEF (54 males and 23 females). Unbiased whole-blood miRNA sequencing detected 1767 unique miRNAs, of which 229 were retained for the primary analysis after abundance filtering. Age- and body mass index (BMI)-adjusted differential-expression analyses identified 50 miRNAs in males with HFpEF and 59 miRNAs in males with HFrEF, whereas no miRNAs reached statistical significance in females with either HF phenotype. Importantly, HF-associated log2 fold changes in males and females were positively correlated for both HF phenotypes, although the absolute magnitudes of change were greater in males than in females, indicating partly shared directions of change between sexes. Age- and BMI-adjusted permutational multivariate analysis of variance revealed more pronounced phenotype-associated differences in global miRNA profiles in males than in females; these findings were consistent across alternative abundance filters.</p><p><strong>Conclusion: </strong>Sex-stratified analyses of circulating miRNAs in HFpEF and HFrEF showed that HF-associated expression changes were consistently more pronounced in males than in females. These findings highlight the importance of sex stratification when interpreting circulating miRNA alterations in HF.</p><p><strong>Trial registration number: </strong>UMIN000052673 (UMIN Clinical Trials Registry; observational study).</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 3","pages":"oeag073"},"PeriodicalIF":4.3,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229745","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":"Definitions and outcomes reported in studies investigating the management of new onset atrial fibrillation in acutely unwell patients admitted to the intensive care unit: a scoping review.","authors":"Brian W Johnston, Joby Mathew, Calum Voller, Ruaraidh A Hill, Bronagh Blackwood, Karen Williams, Angela Hall, Keith Wilson, Trudie H Lobban, Gregory Y H Lip, Ingeborg D Welters","doi":"10.1093/ehjopen/oeag075","DOIUrl":"10.1093/ehjopen/oeag075","url":null,"abstract":"<p><p>New-onset atrial fibrillation (NOAF) frequently occurs in critically ill patients admitted to intensive care units (ICUs), yet definitions and outcome reporting remain inconsistent across clinical studies. This heterogeneity impedes evidence synthesis and limits the development of standardized management strategies. A scoping review was conducted following the Arksey and O'Malley framework and reported using PRISMA-ScR guidelines. Electronic databases were searched from 1990 to 2024 for randomized controlled trials and observational studies reporting on NOAF in acutely unwell ICU patients. Data on arrhythmia definitions and reported outcomes were extracted and categorized using the ISPOR framework. This is the first study to systematically examine and compare diagnostic criteria for NOAF in ICU-based research. Out of 8477 records, 44 studies (4 RCTs, 12 prospective, and 28 retrospective observational studies) met inclusion criteria. Significant heterogeneity was found in how NOAF was defined, including arrhythmia duration thresholds, diagnostic criteria, and heart rate cut-offs. Outcomes were primarily clinician-reported (<i>n</i> = 101), followed by observer-reported (<i>n</i> = 74), biomarker (<i>n</i> = 25), and patient-reported outcomes (<i>n</i> = 4), with no performance outcomes identified. Common outcomes included rhythm and heart rate control, arrhythmia recurrence, mortality, and length of stay, though definitions and timeframes varied considerably across studies. This review identifies substantial methodological variation in both the definition and measurement of NOAF in ICU research. The findings are immediately applicable to clinical practice, enabling ICU teams to benchmark diagnostic and monitoring approaches, align practice with guideline-based definitions, and identify patients who may benefit from structured post-discharge follow-up. They also provide evidence for the importance of the development a Core Outcome Set for NOAF.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 3","pages":"oeag075"},"PeriodicalIF":4.3,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229815","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}