European Heart Journal Supplements最新文献

The May Measurement Month (MMM) campaign was carried out in Armenia in 2022 with the aim of raising awareness of raised blood pressure (BP). Here, we report on the findings of the campaign. Adults aged ≥18 years were recruited opportunistically in public areas, both indoor and outdoor, as well as in primary and secondary healthcare centres. Three seated BP readings were taken for each participant, along with completion of a questionnaire on demographics, lifestyle factors, and comorbidities. Hypertension was defined as a systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg or being on antihypertensive medication. Controlled BP 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, 11 618 participants were screened, with a mean age of 52.4 (SD 16.5) years and 55.7% of whom were female. Of all participants, 5,999 (51.6%) had hypertension, of whom 3,729 (62.2%) were aware, and 3,203 (53.4%) were on antihypertensive medication. Of those on antihypertensive medication, 1,130 (35.3%) had controlled BP, and of all participants with hypertension, only 18.8% had controlled BP. In total, 4,869 (41.9%) were found to have either untreated or inadequately treated hypertension. The MMM campaign in Armenia identified significant numbers of participants with either untreated or inadequately treated hypertensives. We found that the percentage of hypertensives who are not adequately treated is still substantial in Armenia, which is a vital contributor to the growing burden of non-communicable diseases. May Measurement Month is a pragmatic and reasonably inexpensive tool to improve public awareness of BP in the general population.

The May Measurement Month (MMM) campaign was carried out in Mozambique in 2022 with the aim of raising awareness of raised blood pressure (BP). Here, we report on the findings of the campaign. Adults aged ≥18 years were recruited opportunistically at Zambézia, Sofala, and Maputo city, in Northern, Central, and Southern regions of Mozambique, respectively. Three seated BP readings were taken for each participant, along with completion of a questionnaire on demographics, lifestyle factors, and comorbidities. Hypertension was defined as a systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg or being on antihypertensive medication. Controlled BP 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, 8276 were screened, with a mean age of 36.9 years and 61.6% of whom were female. Of all participants, 2486 (30.0%) had hypertension, of whom 1122 (45.1%) were aware, and 735 (29.6%) were on antihypertensive medication. Of those on antihypertensive medication, 285 (38.8%) had controlled BP, and of all participants with hypertension, 11.5% had controlled BP. In conclusion, the MMM campaign in Mozambique identified significant numbers of participants with either untreated or inadequately treated hypertension, calling attention to the need to improve the overall hypertension care cascade. There is an urgent need to increase awareness, improve access to appropriate antihypertensive medication and better follow up those on treatment.

Acute myocarditis (AM) is an inflammatory injury of the myocardium secondary to infections, systemic autoimmune disorders, medications, or toxic agents. The patient's genetic underground is a likely concurrent aetiology/contributory mechanism recently implicated in a proportion of AM. This review focuses on some critical new concepts of AM, updated indications for endomyocardial biopsy when cardiac magnetic resonance imaging is not sufficient or feasible, and estimation of long-term events after discharge. Furthermore, studies exploring AM as the cause of sudden cardiac death will be examined to assess the characteristics of patients who die due to AM before hospital admission. Managing the most severe clinical presentation, termed fulminant myocarditis (FM) characterized by haemodynamic instability due to ventricular arrhythmias or severe acute pump failure, will be summarized. Specific issues aimed to reduce the high mortality rate of FM, like early recognition, referring these patients from spoke centres to a hub centre, timely temporary mechanical circulatory support when indicated, early endomyocardial biopsy, and eventually immunosuppression, will be briefly discussed. Immune checkpoint inhibitors and desmosomal gene variant-associated AM will be highlighted as paradigmatic new forms of myocarditis.

Periodic breathing is a peculiar ventilatory pattern in patients with heart failure (HF), characterized by cyclic oscillations in minute ventilation. This phenomenon has been observed in awake patients, during sleep, and during exercise. Periodic breathing during exercise, also known as exercise oscillatory ventilation (EOV), is an important marker of clinical and functional status, morbidity, and mortality in HF patients. However, a clear understanding of the meaning, causes, and possible occurrence of different forms of EOV is still currently lacking. This review focuses on what is known, likely known, or unknown about EOV in HF, including topics such as the definition of EOV, pathophysiological mechanisms, EOV phenotypes, treatment modalities, and the prognostic role of EOV in patients with HF. Finally, some perspectives on research opportunities and clinical practice are presented, to increase the knowledge of EOV, and the application of tools for its assessment, which may improve the chances of identifying and treating EOV, with a positive impact on patients with HF.

Atrial fibrillation (AF) is the most common arrhythmia in adults and is associated with an increased risk of embolic stroke. The main prevention strategy for cerebral embolic events is based on the use of oral anticoagulant therapy (OAT). Left atrial appendage occlusion (LAAO) has demonstrated non-inferiority to OAT in clinical trials for prevention of stroke in non-valvular atrial fibrillation (NVAF). Patients with NVAF may still suffer ischemic strokes despite receiving adequate OAT.The physiopathological substrate remains unclear and only few theories can be proposed to explain the phenomenon and the approach to secondary prevention in these 'resistant strokes' remains largely empirical.Several therapeutic strategies have been proposed. Among these, LAAO should be taken into consideration. The procedure requires special planning in well selected patients, but can be performed successfully in most cases.

The first European Society of Cardiology (ESC) guidelines on the management of cardiomyopathies (CMPs), published 1 year ago, remain highly relevant. These guidelines provide a comprehensive framework to manage the complexity of CMPs, consolidating previous approaches. All CMPs are now addressed systematically in one document. The ESC recommends a 'CMP-oriented' approach, emphasizing thorough clinical assessments and phenotype-first categorization into hypertrophic, dilated, arrhythmogenic, restrictive, and non-dilated left ventricular CMP. Despite the utility of this method, certain classifications, such as arrhythmogenic right ventricular CMP and the novel non-dilated left ventricular CMP, raise controversies. Key advances in the guidelines include the use of genetic testing and cardiac magnetic resonance imaging to refine diagnoses and inform treatment, especially for high-risk genotypes. These guidelines advocate for personalized, multidisciplinary care. Overall, they represent a significant step forward but highlight the evolving nature of CMP management as scientific understanding progresses.

Chronic heart failure (HF) is a prevalent condition associated with significant morbidity, mortality, and economic burden worldwide. The pharmacological management of HF has evolved over time with various drug classes demonstrating efficacy in improving patient outcomes. This review examines the pharmacoeconomic aspects of these therapies, including common and newer HF therapies as angiotensin receptor-neprilysin inhibitors, sodium-glucose co-transporter-2 inhibitors, iron supplementation, and vericiguat, a novel soluble guanylate cyclase stimulator. By analysing cost-effectiveness studies and their implications on healthcare resource utilization, this paper aims to inform clinicians and policymakers on HF management optimization from both clinical and economic perspectives.

Coronary computed tomography angiography (CCTA) is the first-line investigation test to 'rule out' significant coronary artery disease in low-risk patients. By performing blood flow simulations using computational fluid dynamics, it is possible to derive fractional flow reserve (FFR) from CCTA (FFRCT) images. Coronary computed tomography angiography and FFRCT are now utilized in higher-risk patients to choose the revascularization mode. Furthermore, new applications of CCTA and FFRCT include a planning tool for percutaneous coronary intervention (PCI), which allows the cardiologist to assess lesion-specific ischaemia, plan stent locations and sizes, and use virtual remodelling of the lumen (virtual stenting) to assess the functional impact of PCI. Moreover, CCTA can assist in planning surgical and percutaneous revascularization by determining the disease complexity, vessel size, lesion length, and tissue composition of the atherosclerotic plaque, as well as the best fluoroscopic viewing angle; it may also help in selecting adjunctive percutaneous devices (e.g. rotational atherectomy) and in determining the best landing zone for stents or bypass grafts. Coronary computed tomography angiography has become also the gold standard for pre-procedural annular assessment, device sizing, risk determination of annular injury, coronary occlusion or left ventricular outflow tract obstruction, calcification visualization and quantification of the target structure, and prediction of a co-planar fluoroscopic angulation for transcatheter interventions in patients with structural heart disease. Coronary computed tomography angiography and cardiac magnetic resonance could be used also in electrophysiology procedures of atrial fibrillation and ventricular arrhythmias ablation (imaging during clinical evaluation and pre-procedural evaluation and intra-procedural live integration). The era of interventional imaging has arrived, and it is based on the cooperation of different figures with specific competences (cardio-imagers, electrophysiologists, cardiac surgeons, and invasive cardiologists).

Hypertrophic cardiomyopathy (HCM) is a genetic condition primarily caused by mutations in sarcomeric proteins, leading to abnormal thickening of the left ventricular wall. Although HCM is the most common genetic cardiovascular disorder, other conditions-such as cardiac amyloidosis, Fabry disease, and mitochondrial myopathies-can mimic its phenotype, complicating diagnosis. Accurate differentiation between HCM and its phenocopies is crucial, as these conditions differ in treatment, prognosis, and inheritance. This paper reviews the clinical, imaging, and laboratory tools essential for diagnosing HCM and its mimics, emphasizing the role of advanced diagnostics like cardiac magnetic resonance, genetic testing, and tissue characterization in guiding personalized management strategies.

Cardiovascular (CV) diseases (CVDs) remain a leading global health issue, causing about one-third of all deaths worldwide. Among modifiable CV risk factors (systolic blood pressure, non-HDL cholesterol, diabetes, body mass index, and smoking), diabetes is a leading one, accounting for established CVDs in 34.8% of diabetic patients, with an increasing prevalence of disease. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), like exenatide, liraglutide, albiglutide, dulaglutide, and semaglutide, initially developed for treatment of Type 2 diabetes, have shown CV benefits, and international guidelines recommend now GLP-1 RAs as preferred drugs for CV prevention in diabetic patients regardless of baseline HbA1c or metformin use. Among GLP-1 RAs, subcutaneous semaglutide has demonstrated cardio-metabolic risk factors reduction and efficacy in CV prevention. Development of oral semaglutide represents the evolution of the molecule. The PIONEER study programme confirmed the efficacy of oral semaglutide in reducing HbA1c, body weight, and cardio-metabolic risk factors as well as CV safety. Notably, independently by route of administration, semaglutide showed early CV benefits, suggesting mechanisms beyond glycaemic control or weight reduction. Semaglutide, combining potent cardio-metabolic effects with oral route, emerges as a pivotal treatment for high-risk Type 2 diabetes patients, offering comprehensive CV protection independent of HbA1c levels.