European Heart Journal Supplements最新文献

Over the past three decades, ischaemia research has been the cornerstone of the management and treatment of patients with atherosclerotic CAD. A robust body of evidence, including non-randomized and randomized trials, has supported the use of invasive and non-invasive coronary function tests to guide coronary revascularization. However, more recent data have questioned the clinical benefits of adopting this approach, especially in patients admitted with acute myocardial infarction. The increasing use of intracoronary imaging has identified the morphological features of plaques at higher risk of causing subsequent acute coronary events, despite the fact that they were not obstructive at the time of the index investigation. However, although functional assessment does not appear to have the same potential for identifying high-risk plaques as imaging modalities, it offers the simplicity and reproducibility of plaque assessment as a unique advantage. Furthermore, the ideal approach for the treatment of the so-called vulnerable plaques is still far from being identified, while a robust body of evidence supports the role of functionally guided revascularization, especially in stable patients. Overall, ischaemia research still provides non-negligible information that contributes to a personalized approach to improve patient outcomes.

Electrocardiogram (ECG) may play a crucial role in the diagnosis of left-sided variants of desmosomal arrhythmogenic cardiomyopathies. This article discusses the most common ECG changes, such as T-wave inversion and low QRS voltages, and new ECG signs such as Q-waves, low voltages in specific leads, posterior fascicle block, and R/S ratio ≥ 0.5 in V1. In addition, ventricular arrhythmias have peculiar features in these patients. Electrocardiogram may be an early marker of this insidious cardiomyopathy and allow to avoid sudden cardiac death often in young people. Electrocardiogram abnormalities may also be indicators of disease evolution over time.

The newly proposed classification of cardiomyopathies, referred to as 'the Padua Classification', is based on both pathobiological basis (genetics, molecular biology, and pathology) and clinical features (morpho-functional and structural ventricular remodelling as evidenced by cardiac magnetic resonance). Cardiomyopathies are grouped into tree main categories and characterized by a designation combining both 'anatomical' and 'functional' features: hypertrophic/restrictive, dilated/hypokinetic, and scarring/arrhythmogenic; each cardiomyopathy group includes either genetic or non-genetic aetiologic variants. This novel approach aims to enhance the diagnostic accuracy and to support 'disease-specific' therapeutic strategies, with the objective to improve patient management and outcome.

Pulsed field ablation (PFA) offers a novel approach to treating atrial fibrillation, demonstrating promising efficacy and safety. Unlike traditional thermal ablation techniques like radiofrequency or cryoablation, PFA uses non-thermal irreversible electroporation to selectively target myocardial tissue, minimizing damage to surrounding structures such as the oesophagus, phrenic nerve, and coronary arteries. Initial studies indicate that PFA is effective in achieving durable pulmonary vein isolation and posterior wall isolation, with a low incidence of serious complications. However, more long-term clinical data are needed to further confirm its efficacy.

Advances in understanding the genetic architecture and novel imaging techniques have profoundly impacted research on arrhythmogenic right ventricular cardiomyopathy (ARVC). As knowledge of ARVC has evolved, so has its classification: originally termed "arrhythmogenic right ventricular dysplasia", it was later broadened to "arrhythmogenic cardiomyopathy" (ACM) to include left ventricular forms. However, the 2023 European Society of Cardiology guidelines advocate reintroducing ARVC for fibro-fatty right ventricular disease and adopting "non-dilated left ventricular cardiomyopathy" for left-sided phenotypes previously labelled as ACM variants. Genetic testing has become critical in ARVC diagnosis, particularly for identifying mutations in desmosomal genes (e.g., PKP2, PKP2, PKP2, PKP2, PKP2), which are the primary genetic contributors to ARVC and inform family screening and diagnostic decisions. Recent expert consensus confirmed that only PKP2, PKP2, and PKP2 gene mutations among non-desmosomal genes had sufficient evidence to suggest a causative relationship. While genotype-specific risk assessment models are being developed, at present, genetic background does not represent an independent risk factor for patients with ARVC. Novel gene therapies, particularly AAV-mediated PKP2 gene replacement, have recently been demonstrated to be useful in reversing ARVC phenotypes in preclinical models. FDA-approved trials are currently evaluating PKP2-targeted therapies, and CRISPR/Cas9 methods are being explored for PKP2-R14del mutations. Overall, current evidence supports distinct gene-specific manifestations within ARVC, aligning clinical phenotypes with specific genetic variants. This progress points to a future in which risk stratification and management are personalized through gene- and mutation-specific approaches, advancing the potential for precision medicine in ARVC care.

The use of implantable cardiac monitors (ICMs) has gradually entered clinical practice in various fields. In addition to the consolidated indications in the study of syncope, cryptogenic stroke and in the management of patients with arrhythmias (suspected or defined), today a possible role for these devices in patients with heart failure (HF) is emerging. The rationale for the use of these devices in HF can be identified in three key areas: (i) identification of silent atrial fibrillation and reduction of the risk of stroke, (ii) stratification of the risk of brady-tachy arrhythmias and consequent reduction of the risk of sudden death, and (iii) identification of patients at risk of imminent exacerbation of HF and their early management with reduction of hospitalizations and episodes of clinical deterioration. For each of these areas, there are conflicting data regarding the real usefulness of ICMs; however, it is reasonable to hypothesize that the use of these devices, under certain conditions, may be useful in patients with HF. The adequate selection of patients to be candidates for this strategy is important. The choice of tools and the availability of an organization that allows the possibility of managing these patients remotely also play an essential role. In any case, case-control studies are needed to establish whether this tool can be truly useful in HF.

Subclinical atrial fibrillation (AF) and atrial high-rate episodes (AHREs) are often detected incidentally through cardiac implantable electronic devices or wearables, especially in asymptomatic patients. These episodes pose a clinical challenge as they are associated with an increased risk of stroke, albeit at a lower rate compared with clinical AF. This review discusses the evolving understanding of AHRE, highlighting the uncertainties regarding optimal management, particularly the use of oral anticoagulants. Two key trials, ARTESiA and NOAH-AFNET 6, investigated anticoagulation in patients with device-detected AHRE. ARTESiA found that apixaban significantly reduced stroke or systemic embolism, but with an increased risk of major bleeding. In contrast, NOAH-AFNET 6, which tested edoxaban, did not demonstrate a significant benefit in reducing cardiovascular events but also observed higher bleeding rates. A meta-analysis of these trials confirmed the efficacy of oral anticoagulants in lowering ischaemic stroke risk, though with an elevated bleeding risk. Given these findings, clinical decision-making in patients with AHRE must be individualized, taking into account stroke risk, bleeding risk, and patient preferences. Shared decision-making is crucial to balance the benefits and risks of anticoagulation, especially in the context of progression to clinical AF and its associated stroke risk. Moreover, it is essential to educate patients about the risk of bleeding complications and emphasize the importance of close monitoring. Future research may further clarify optimal anticoagulation strategies and better define high-risk subgroups that would most benefit from therapy.

The May Measurement Month (MMM) campaign was carried out in Nigeria in 2022 to raise awareness of high blood pressure (BP). Here, we report on the campaign's findings. Adults aged ≥18 years were recruited opportunistically at public and private areas, pharmacies, clinics, and hospitals across the six geopolitical zones of Nigeria. Three seated BP readings were taken for each participant, and a questionnaire on demographics, lifestyle factors, and comorbidities was completed. Hypertension was defined as a systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg or being on antihypertensive medication. Controlled hypertension was defined as being on antihypertensive medication with a BP < 140/90 mmHg. Multiple imputation was used to estimate any missing BP readings. In total, 5798 were screened, with a mean age of 44.2 years, and 54.8% were female. Of all participants, 2330 (40.2%) had hypertension, of whom 1362 (58.5%) were aware, and 1241 (53.3%) were on antihypertensive medication. Of those on antihypertensive medication, 522 (42.1%) had controlled BP, and of all participants with hypertension, 22.4% had controlled BP. The MMM campaign in Nigeria identified significant numbers of participants with either untreated or inadequately treated hypertension. There is a poor awareness and unacceptably high burden of hypertension among the Nigerian population. Urgent actions are required to improve the awareness of hypertension and reduce its associated health burden in Nigeria.

Cardiovascular diseases (CVDs) remain a major cause of morbidity and mortality worldwide. The European Society of Cardiology Guidelines encourage the use of risk prediction models to enhance an adequate management of cardiovascular risk factors and the implementation of healthy behaviours. In primary prevention, estimating CVD risk is used to identify patients at high risk in order to enhance preventive strategies and decrease the incidence of unfavourable events and pre-mature cardiovascular deaths. Risk models integrate information on several conventional risk factors and estimate individual risk over a 10-year period. In addition to conventional risk factors, emerging non-traditional markers should be considered and mentioned in risk stratification. In secondary prevention, optimal management of patients include evaluation of residual CVD risk. The 10-year risk of recurrent events is not the same for all patients. The identification of high-risk patients is mandatory to prevent recurrent events and to allow to engage intensive treatments and follow-up strategies, representing an opportunity for major public health gain. This review provides a guide to evaluate which CVD risk score is appropriate for use in different settings in clinical practice.

Telling story of myocarditis is characterized by discoveries and inventions. The invention of the microscope opened new avenues in medicine, with the observation of myocardial inflammation by Carl Ludwig Alfred Fiedler. Rudolph Virchow discovered that cells are the elementary units. Karl Albert Ludwig Aschoff first reported rheumatic pancarditis. Gilbert Dallford found enterovirus in the faeces of children, who died suddenly in the village of Coxsackie. Werner Forssmann entered in his own right ventricle with a urologic catheter via the left radial vein. Endomyocardial biopsy, via the femoral or jugular veins, made possible to take away myocardial samples in vivo, for diagnosis of myocarditis or cardiac rejection of transplanted heart. The invention of polymerase chain reaction by Kary Mullis allowed to achieve diagnosis of concealed infections and genetically determined cardiomyopathies. Myocarditis, a significant cause of sudden death, was found to be frequently ascribed to viruses. Cytotoxicity of Coxsackievirus B was proved to consist on released protease 2, encoded by virus genome and cleaving dystrophin. RNA (Coxsackie) and DNA (adenovirus) viruses share a common receptor. Cardiac magnetic resonance revealed to be sensitive and specific in the diagnosis of myocarditis by detecting myocardial oedema. However, it is unable to establish the histotype. The onset of myocarditis may be fulminant; however, extracorporeal membrane oxygenation, invented by Robert Bartlett, allows heart rest, while replacing cardiac contractility. High rates of survival have been achieved, probably because of mild myocardial damage.