Pub Date : 2026-01-30DOI: 10.1093/eurheartj/ehaf1125
Francesco Cosentino, Nikolaus Marx, Christopher Paul Cannon
{"title":"The year in cardiovascular medicine 2025: the top 10 papers in diabetes and metabolic disorders.","authors":"Francesco Cosentino, Nikolaus Marx, Christopher Paul Cannon","doi":"10.1093/eurheartj/ehaf1125","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf1125","url":null,"abstract":"","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":" ","pages":""},"PeriodicalIF":35.6,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146092369","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}
Pub Date : 2026-01-30DOI: 10.1093/eurheartj/ehaf1117
Wei-Guo Ma,Yu Chen,Su-Wei Chen,Wei Zhang,Jun Zheng,Qing-Guo Li,Lingeng Lu,Jun-Ming Zhu,Gabriele Piffaretti,John A Elefteriades,Li-Zhong Sun
BACKGROUND AND AIMSThe management of acute type A aortic dissection (ATAAD) has evolved considerably over the decades and a more aggressive approach with extended arch repair has been increasingly adopted in the past 20 years. This study aims to evaluate the early and long-term outcomes of frozen elephant trunk and total arch replacement (FET + TAR) technique in patients with ATAAD.METHODSFrom April 2003 to December 2014, 850 patients with ATAAD (mean age 46.5 ± 10.7 years; 169 women [19.9%]; 136 with malperfusion syndrome [16.0%]) underwent FET + TAR at our center. Aortic root or valve procedures were performed in 456 patients (53.6%). The early and long-term outcomes of FET + TAR were analysed and compared to hemiarch repair in 72 propensity-matched pairs.RESULTSOperative mortality was 8.4% (71/850). Spinal cord injury occurred in 2.5% (21/850), stroke in 3.5% (30/850), re-exploration for bleeding in 5.6% (48/850) and acute kidney injury in 8.7% (74/850). Follow-up was complete in 99.2% (773/779) at mean duration of 12.5 ± 4.0 years (range .2-22.0). There were 153 late deaths and 90 reoperations at median 7.5 and 5.2 years (interquartile range 4.4-9.6 and 1.2-9.7), respectively. Cerebrovascular accident (hazard ratio [HR] 2.34; P = .031) and visceral ischaemia (HR 4.12; P = .005) were risk factors of late death. At 20 years, survival and freedom from reoperation were 70.0% and 85.4% (95% confidence interval [CI], 65.8%-74.0% and 80.1%-89.4%), respectively. In competing risks analysis, the incidences were 25%, 13% and 62% for death, reoperation and reoperation-free survival at 15 years, respectively. Compared to hemiarch repair, FET showed similar operative mortality (6.9% vs 4.2%, P = .719) and lower incidences of late adverse events (LAE), including death, reoperation and distal aortic dilation (16.4% vs 33.8%, P = .048), with significantly higher freedom from LAE at 20 years (78% vs 45.6%; 95% CI, 58.8%-89.0% vs 27.7%-61.8% P = .042).CONCLUSIONSIn this series spanning two decades, the FET + TAR technique achieved satisfactory long-term survival and freedom from reintervention in patients with ATAAD, showing lower risk of late death, reoperation and distal aortic dilation compared to hemiarch repair. These results argue favourably for the use of FET technique in ATAAD repair.
{"title":"Frozen elephant trunk for acute type A aortic dissection: long-term outcomes over two decades.","authors":"Wei-Guo Ma,Yu Chen,Su-Wei Chen,Wei Zhang,Jun Zheng,Qing-Guo Li,Lingeng Lu,Jun-Ming Zhu,Gabriele Piffaretti,John A Elefteriades,Li-Zhong Sun","doi":"10.1093/eurheartj/ehaf1117","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf1117","url":null,"abstract":"BACKGROUND AND AIMSThe management of acute type A aortic dissection (ATAAD) has evolved considerably over the decades and a more aggressive approach with extended arch repair has been increasingly adopted in the past 20 years. This study aims to evaluate the early and long-term outcomes of frozen elephant trunk and total arch replacement (FET + TAR) technique in patients with ATAAD.METHODSFrom April 2003 to December 2014, 850 patients with ATAAD (mean age 46.5 ± 10.7 years; 169 women [19.9%]; 136 with malperfusion syndrome [16.0%]) underwent FET + TAR at our center. Aortic root or valve procedures were performed in 456 patients (53.6%). The early and long-term outcomes of FET + TAR were analysed and compared to hemiarch repair in 72 propensity-matched pairs.RESULTSOperative mortality was 8.4% (71/850). Spinal cord injury occurred in 2.5% (21/850), stroke in 3.5% (30/850), re-exploration for bleeding in 5.6% (48/850) and acute kidney injury in 8.7% (74/850). Follow-up was complete in 99.2% (773/779) at mean duration of 12.5 ± 4.0 years (range .2-22.0). There were 153 late deaths and 90 reoperations at median 7.5 and 5.2 years (interquartile range 4.4-9.6 and 1.2-9.7), respectively. Cerebrovascular accident (hazard ratio [HR] 2.34; P = .031) and visceral ischaemia (HR 4.12; P = .005) were risk factors of late death. At 20 years, survival and freedom from reoperation were 70.0% and 85.4% (95% confidence interval [CI], 65.8%-74.0% and 80.1%-89.4%), respectively. In competing risks analysis, the incidences were 25%, 13% and 62% for death, reoperation and reoperation-free survival at 15 years, respectively. Compared to hemiarch repair, FET showed similar operative mortality (6.9% vs 4.2%, P = .719) and lower incidences of late adverse events (LAE), including death, reoperation and distal aortic dilation (16.4% vs 33.8%, P = .048), with significantly higher freedom from LAE at 20 years (78% vs 45.6%; 95% CI, 58.8%-89.0% vs 27.7%-61.8% P = .042).CONCLUSIONSIn this series spanning two decades, the FET + TAR technique achieved satisfactory long-term survival and freedom from reintervention in patients with ATAAD, showing lower risk of late death, reoperation and distal aortic dilation compared to hemiarch repair. These results argue favourably for the use of FET technique in ATAAD repair.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"54 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146073203","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}
Pub Date : 2026-01-29DOI: 10.1093/eurheartj/ehaf1083
Elena Raffetti
{"title":"Cardiovascular child health in a changing climate.","authors":"Elena Raffetti","doi":"10.1093/eurheartj/ehaf1083","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf1083","url":null,"abstract":"","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"117 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069839","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}
Pub Date : 2026-01-29DOI: 10.1093/eurheartj/ehaf1057
Marco Bacigaluppi,Monica Giannotta,Susanne Wegener
{"title":"DKK2 as a neurovascular modulator in stroke: from mechanisms to translational implications.","authors":"Marco Bacigaluppi,Monica Giannotta,Susanne Wegener","doi":"10.1093/eurheartj/ehaf1057","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf1057","url":null,"abstract":"","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"4 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069830","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}
Myocarditis refers to infiltration of immune cells into the heart causing inflammation and cardiomyocyte damage. Clinically, myocarditis can be acute or chronic. While the clinical and pathological syndrome of myocarditis has been recognized for more than a century, newer aetiologies for myocarditis have emerged in the past decade. These include myocarditis associated with immune checkpoint inhibitors, or myocarditis linked to chronic inflammatory and genetic diseases. With the emergence of immune checkpoint inhibitor-associated myocarditis, the breakdown of T cell tolerance has been recognized as a key mechanism in disease development. The main focus of this review is to integrate existing models of myocarditis into an overarching immunological concept. Through the lens of loss of immune tolerance, this review focuses on diagnosis and treatment of myocarditis. Starting from acute myocarditis as paradigmatic inflammatory condition of the heart, this review outlines future research frontiers for myocardial inflammatory disease including new approaches to diagnosis and treatment.
{"title":"T cells in acute and chronic myocarditis: from diagnosis to treatment.","authors":"Evelyn J Song,Anna Joachimbauer,Sofia Tasca,Richard Baylis,Dörthe Schmidt,Burkhard Ludewig,Javid J Moslehi","doi":"10.1093/eurheartj/ehaf1080","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf1080","url":null,"abstract":"Myocarditis refers to infiltration of immune cells into the heart causing inflammation and cardiomyocyte damage. Clinically, myocarditis can be acute or chronic. While the clinical and pathological syndrome of myocarditis has been recognized for more than a century, newer aetiologies for myocarditis have emerged in the past decade. These include myocarditis associated with immune checkpoint inhibitors, or myocarditis linked to chronic inflammatory and genetic diseases. With the emergence of immune checkpoint inhibitor-associated myocarditis, the breakdown of T cell tolerance has been recognized as a key mechanism in disease development. The main focus of this review is to integrate existing models of myocarditis into an overarching immunological concept. Through the lens of loss of immune tolerance, this review focuses on diagnosis and treatment of myocarditis. Starting from acute myocarditis as paradigmatic inflammatory condition of the heart, this review outlines future research frontiers for myocardial inflammatory disease including new approaches to diagnosis and treatment.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"44 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069836","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}
Pub Date : 2026-01-29DOI: 10.1093/eurheartj/ehaf1075
Colin Berry,Robert A Sykes,Dylan Tan
{"title":"MINOCA: a call for randomized trials.","authors":"Colin Berry,Robert A Sykes,Dylan Tan","doi":"10.1093/eurheartj/ehaf1075","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf1075","url":null,"abstract":"","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"13 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069873","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}
Pub Date : 2026-01-29DOI: 10.1093/eurheartj/ehaf1076
Helmut Baumgartner,Bernard Iung,David Messika-Zeitoun
{"title":"Mitral transcatheter edge-to-edge repair for ventricular secondary mitral regurgitation: do we have enough evidence for its benefit?","authors":"Helmut Baumgartner,Bernard Iung,David Messika-Zeitoun","doi":"10.1093/eurheartj/ehaf1076","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf1076","url":null,"abstract":"","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"33 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069872","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}
BACKGROUND AND AIMSGlucagon-like peptide-1 receptor agonists reduce heart failure (HF) risk in patients with diabetes or obesity. However, the extent to which this reduced risk is dependent on, or extends beyond, glucose control and weight reduction remains unclear.METHODSTwo-sample cis-Mendelian randomization (MR) was used to assess causal effects of GLP-1R activation on HF risk, using glycated haemoglobin (HbA1c) reduction as a surrogate biomarker. The HF outcome was derived from a genome-wide association meta-analysis that included seven original studies and 1 665 481 participants. Primary analyses used inverse variance-weighted (IVW) and MR-robust adjusted profile score (MR-RAPS) methods. Mendelian randomization Bayesian model averaging was used to identify key mediators of the observed effects, while multivariable cis-MR with principal component generalized method of moments and network cis-MR were used to minimize the impact of confounders.RESULTSGenetically proxied GLP-1R activation was associated with reduced HF risk {IVW: odds ratio [OR] [95% confidence interval (CI)] .502 [.339, .743]; MR-RAPS: OR [95% CI] .492 [.320, .756]}. Mendelian randomization Bayesian model averaging identified body mass index (BMI) (marginal inclusion probability 67.2%) and Type 2 diabetes (T2D) (45.0%) as primary mediators. In multivariable cis-MR with principal component generalized method of moments, genetically predicted HbA1c levels from the GLP-1R locus remained significantly associated with HF risk after BMI adjustment, even in instances where BMI effects were non-significant [OR (95% CI) 1.663 (1.087, 2.544) at 99% variance threshold]. Network cis-MR confirmed persistent protection after adjusting for BMI [IVW: OR (95% CI) .587 (.394, .877); MR-RAPS: OR (95% CI) .577 (.375, .887)] or T2D [IVW: OR (95% CI) .508 (.343, .754); MR-RAPS: OR (95% CI) .499 (.327, .762)].CONCLUSIONSGlucagon-like peptide-1 receptor agonist-associated HF risk reduction is primarily mediated by BMI reduction rather than glucose control, but not fully explained by either. Residual effects after BMI and T2D adjustment suggest direct cardioprotective actions, supporting trials in non-obese, non-diabetic HF patients.
背景和目的：胰高血糖素样肽-1受体激动剂可降低糖尿病或肥胖患者心力衰竭（HF）的风险。然而，这种降低的风险在多大程度上依赖于或超出控制血糖和减轻体重的范围仍不清楚。方法采用两样本顺式孟德尔随机化（MR）方法，以糖化血红蛋白（HbA1c）降低作为替代生物标志物，评估GLP-1R激活对HF风险的因果影响。HF结果来自全基因组关联荟萃分析，包括7项原始研究和1665481名参与者。初步分析采用逆方差加权（IVW）和mr稳健调整剖面评分（MR-RAPS）方法。采用孟德尔随机化贝叶斯模型平均来识别观察到的效应的关键中介，而采用主成分广义矩法的多变量顺式磁共振和网络顺式磁共振来最小化混杂因素的影响。结果基因介导的GLP-1R激活与HF风险降低相关{IVW：优势比[OR][95%可信区间（CI）]。502(。339年,.743];Mr-raps：或[95% ci]。492(。320年,.756]}。孟德尔随机化贝叶斯模型平均确定身体质量指数（BMI）（边际纳入概率67.2%）和2型糖尿病（T2D）（45.0%）为主要中介因素。在多变量顺式磁共振主成分广义矩法中，在BMI调整后，遗传预测的GLP-1R位点HbA1c水平与HF风险仍然显著相关，即使在BMI影响不显著的情况下也是如此[OR (95% CI) 1.663(1.087, 2.544)， 99%方差阈值]。网络顺式磁共振证实了BMI调整后的持续保护[IVW: OR (95% CI)]。587(。394年,.877);Mr-raps：或（95% ci）。577(。375年,。[887]或T2D [IVW: or (95% CI)]。508(。343年,.754);Mr-raps：或（95% ci）。499(。327年,.762)]。结论胰高血糖素样肽-1受体激动剂相关的HF风险降低主要是由BMI降低介导的，而不是血糖控制，但两者都不能完全解释。BMI和T2D调整后的残留效应提示有直接的心脏保护作用，支持在非肥胖、非糖尿病性心衰患者中的试验。
{"title":"GLP-1R agonists and heart failure: novel beneficial effects suggested by Mendelian randomization.","authors":"Yiqing Hu,Yongchao Zhao,Neng Dai,You Zhou,Yunqian Yao,Ziang Li,Wufeng Cai,Weidong Xiong,Shuai Song,Xin Deng,Jiasheng Yin,Xin Zhao,Xinyu Weng,Chenguang Li,Aijun Sun,Juying Qian,Hao Lu,Junbo Ge","doi":"10.1093/eurheartj/ehaf1066","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf1066","url":null,"abstract":"BACKGROUND AND AIMSGlucagon-like peptide-1 receptor agonists reduce heart failure (HF) risk in patients with diabetes or obesity. However, the extent to which this reduced risk is dependent on, or extends beyond, glucose control and weight reduction remains unclear.METHODSTwo-sample cis-Mendelian randomization (MR) was used to assess causal effects of GLP-1R activation on HF risk, using glycated haemoglobin (HbA1c) reduction as a surrogate biomarker. The HF outcome was derived from a genome-wide association meta-analysis that included seven original studies and 1 665 481 participants. Primary analyses used inverse variance-weighted (IVW) and MR-robust adjusted profile score (MR-RAPS) methods. Mendelian randomization Bayesian model averaging was used to identify key mediators of the observed effects, while multivariable cis-MR with principal component generalized method of moments and network cis-MR were used to minimize the impact of confounders.RESULTSGenetically proxied GLP-1R activation was associated with reduced HF risk {IVW: odds ratio [OR] [95% confidence interval (CI)] .502 [.339, .743]; MR-RAPS: OR [95% CI] .492 [.320, .756]}. Mendelian randomization Bayesian model averaging identified body mass index (BMI) (marginal inclusion probability 67.2%) and Type 2 diabetes (T2D) (45.0%) as primary mediators. In multivariable cis-MR with principal component generalized method of moments, genetically predicted HbA1c levels from the GLP-1R locus remained significantly associated with HF risk after BMI adjustment, even in instances where BMI effects were non-significant [OR (95% CI) 1.663 (1.087, 2.544) at 99% variance threshold]. Network cis-MR confirmed persistent protection after adjusting for BMI [IVW: OR (95% CI) .587 (.394, .877); MR-RAPS: OR (95% CI) .577 (.375, .887)] or T2D [IVW: OR (95% CI) .508 (.343, .754); MR-RAPS: OR (95% CI) .499 (.327, .762)].CONCLUSIONSGlucagon-like peptide-1 receptor agonist-associated HF risk reduction is primarily mediated by BMI reduction rather than glucose control, but not fully explained by either. Residual effects after BMI and T2D adjustment suggest direct cardioprotective actions, supporting trials in non-obese, non-diabetic HF patients.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"8 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146073042","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}
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