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The year in cardiovascular medicine 2024: the top 10 papers in ischaemic heart disease.
IF 37.6 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-25 DOI: 10.1093/eurheartj/ehaf078
Diana A Gorog, Ranil de Silva, William E Boden
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引用次数: 0
Metabolic flexibility and reverse remodelling of the failing human heart.
IF 37.6 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-25 DOI: 10.1093/eurheartj/ehaf033
Peregrine G Green, William D Watson, Benjamin M Bussmann, Giovanni Luigi De Maria, Stefan Neubauer, Andrew J M Lewis, Oliver J Rider, Neil Herring

Background and aims: Cardiac resynchronization therapy (CRT) produces long-term reverse remodelling which requires greater adenosine triphosphate delivery to the contractile machinery. Whilst the heart retains some metabolic flexibility in non-ischaemic cardiomyopathy, whether this correlates with reverse remodelling is unknown. This study investigated whether CRT acutely changes cardiac substrate uptake, and whether this translates to favourable reverse remodelling.

Methods: The effect of CRT on cardiac substrate uptake was assessed via direct coronary flow and arteriovenous measurements, with metabolomic/lipidomic analysis on infusions of insulin/glucose and intralipid. Cardiac function was assessed with left ventricular pressure-volume loops during implantation, and cardiac magnetic resonance before and 6 months following CRT, with and without biventricular pacing.

Results: Regardless of substrate infusion, CRT acutely improved stroke work without increasing O2 uptake on both insulin/glucose (by 34%, P = .05) and intralipid (by 36%, P = .03). This was followed by increased fatty acid (FA) uptake on insulin/glucose (R = 0.89, P = .03) and increased β-hydroxybutyrate uptake (R = 0.81, P = .05) during intralipid infusion. After 6 months, there was a 48% (P < .001) reduction in left ventricular end diastolic volume, beyond that achievable by acutely shortening or lengthening QRS duration. Reverse remodelling significantly correlated with increased FA uptake with CRT on insulin/glucose (R = 0.71, P = .05) driven by long and medium chain uptake, and increased ketone uptake with CRT on intralipid (R = 0.79, P = .05).

Conclusions: CRT acutely alters the metabolic phenotype of non-ischaemic cardiomyopathy towards a more physiological picture of FA uptake which correlates with reverse remodelling. Retained metabolic flexibility may therefore be critical for subsequent reverse remodelling.

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引用次数: 0
Autophagy is required for the therapeutic effects of the NAD+ precursor nicotinamide in obesity-related heart failure with preserved ejection fraction.
IF 37.6 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-25 DOI: 10.1093/eurheartj/ehaf062
Mahmoud Abdellatif, Francisco Vasques-Nóvoa, Viktoria Trummer-Herbst, Sylvère Durand, Franziska Koser, Moydul Islam, Jihoon Nah, Eun-Ah Sung, Ruli Feng, Fanny Aprahamian, Andreas Prokesch, Pablo Zardoya-Laguardia, Junichi Sadoshima, Abhinav Diwan, Wolfgang A Linke, João Pedro Ferreira, Guido Kroemer, Simon Sedej
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引用次数: 0
Sex-specific pathways from vascular ageing to cardiac damage: unfavourable pulse pressure trajectories induce atrial fibrillation in women.
IF 37.6 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-24 DOI: 10.1093/eurheartj/ehaf039
Rosa Maria Bruno, Emmanuelle Vidal Petiot
{"title":"Sex-specific pathways from vascular ageing to cardiac damage: unfavourable pulse pressure trajectories induce atrial fibrillation in women.","authors":"Rosa Maria Bruno, Emmanuelle Vidal Petiot","doi":"10.1093/eurheartj/ehaf039","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf039","url":null,"abstract":"","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":" ","pages":""},"PeriodicalIF":37.6,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482505","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}
引用次数: 0
Artificial intelligence applied to electrocardiogram to rule out acute myocardial infarction: the ROMIAE multicentre study.
IF 37.6 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-24 DOI: 10.1093/eurheartj/ehaf004
Min Sung Lee, Tae Gun Shin, Youngjoo Lee, Dong Hoon Kim, Sung Hyuk Choi, Hanjin Cho, Mi Jin Lee, Ki Young Jeong, Won Young Kim, Young Gi Min, Chul Han, Jae Chol Yoon, Eujene Jung, Woo Jeong Kim, Chiwon Ahn, Jeong Yeol Seo, Tae Ho Lim, Jae Seong Kim, Jeff Choi, Joon-Myoung Kwon, Kyuseok Kim

Background and aims: Emerging evidence supports artificial intelligence-enhanced electrocardiogram (AI-ECG) for detecting acute myocardial infarction (AMI), but real-world validation is needed. The aim of this study was to evaluate the performance of AI-ECG in detecting AMI in the emergency department (ED).

Methods: The Rule-Out acute Myocardial Infarction using Artificial intelligence Electrocardiogram analysis (ROMIAE) study is a prospective cohort study conducted in the Republic of Korea from March 2022 to October 2023, involving 18 university-level teaching hospitals. Adult patients presenting to the ED within 24 h of symptom onset concerning for AMI were assessed. Exposure included AI-ECG score, HEART score, GRACE 2.0 score, high-sensitivity troponin level, and Physician AMI score. The primary outcome was diagnosis of AMI during index admission, and the secondary outcome was 30 day major adverse cardiovascular event (MACE).

Results: The study population comprised 8493 adults, of whom 1586 (18.6%) were diagnosed with AMI. The area under the receiver operating characteristic curve for AI-ECG was 0.878 (95% CI, 0.868-0.888), comparable with the HEART score (0.877; 95% CI, 0.869-0.886) and superior to the GRACE 2.0 score, high-sensitivity troponin level, and Physician AMI score. For predicting 30 day MACE, AI-ECG (area under the receiver operating characteristic, 0.866; 95% CI, 0.856-0.877) performed comparably with the HEART score (0.858; 95% CI, 0.848-0.868). The integration of the AI-ECG improved risk stratification and AMI discrimination, with a net reclassification improvement of 19.6% (95% CI, 17.38-21.89) and a C-index of 0.926 (95% CI, 0.919-0.933), compared with the HEART score alone.

Conclusions: In this multicentre prospective study, the AI-ECG demonstrated diagnostic accuracy and predictive power for AMI and 30 day MACE, which was similar to or better than that of traditional risk stratification methods and ED physicians.

背景和目的:新的证据支持人工智能增强心电图(AI-ECG)检测急性心肌梗死(AMI),但还需要实际验证。本研究旨在评估人工智能心电图在急诊科(ED)中检测急性心肌梗死的性能:利用人工智能心电图分析排除急性心肌梗死(Rule-Out acute Myocardial Infarction using Artificial Intelligence Electrocardiogram Analysis,ROMIAE)研究是一项前瞻性队列研究,于 2022 年 3 月至 2023 年 10 月在大韩民国进行,涉及 18 所大学教学医院。研究对象为在急性心肌梗死症状出现后 24 小时内到急诊室就诊的成人患者。暴露指标包括 AI-ECG 评分、HEART 评分、GRACE 2.0 评分、高敏肌钙蛋白水平和医师 AMI 评分。主要结果是入院时诊断为急性心肌梗死,次要结果是 30 天内的主要不良心血管事件(MACE):研究对象包括 8493 名成年人,其中 1586 人(18.6%)被诊断为急性心肌梗死。AI-ECG的接收器操作特征曲线下面积为0.878(95% CI,0.868-0.888),与HEART评分(0.877;95% CI,0.869-0.886)相当,优于GRACE 2.0评分、高敏肌钙蛋白水平和医师AMI评分。在预测 30 天 MACE 方面,AI-ECG(接收器操作特征下面积,0.866;95% CI,0.856-0.877)的表现与 HEART 评分(0.858;95% CI,0.848-0.868)相当。与单独使用 HEART 评分相比,整合 AI-ECG 提高了风险分层和 AMI 鉴别能力,净重新分类率提高了 19.6% (95% CI, 17.38-21.89),C 指数为 0.926 (95% CI, 0.919-0.933):在这项多中心前瞻性研究中,AI-ECG 显示了对 AMI 和 30 天 MACE 的诊断准确性和预测能力,与传统的风险分层方法和急诊室医生的诊断准确性和预测能力相似或更好。
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引用次数: 0
Connecting the dots: the Mediterranean diet, neutrophil count, and atherosclerosis. 连接点:地中海饮食、中性粒细胞计数和动脉粥样硬化。
IF 37.6 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-21 DOI: 10.1093/eurheartj/ehae799
Marta Guasch-Ferré
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引用次数: 0
The hypothesis: a new article type and platform for iconoclasts in medicine. 假设:一个新的文章类型和平台,在医学上打破常规。
IF 37.6 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-21 DOI: 10.1093/eurheartj/ehae770
Milton Packer
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引用次数: 0
Start your day with a morning coffee! 早上喝杯咖啡开始新的一天!
IF 37.6 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-21 DOI: 10.1093/eurheartj/ehae823
Thomas F Lüscher
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引用次数: 0
Correction to: 2024 ESC Guidelines for the management of chronic coronary syndromes: Developed by the task force for the management of chronic coronary syndromes of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS).
IF 37.6 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-21 DOI: 10.1093/eurheartj/ehaf079
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引用次数: 0
Individual patient data meta-analysis of paclitaxel-coated balloons vs. drug-eluting stents for small-vessel coronary artery disease: the ANDROMEDA study.
IF 37.6 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-21 DOI: 10.1093/eurheartj/ehaf002
Simone Fezzi, Daniele Giacoppo, Gregor Fahrni, Azeem Latib, Fernando Alfonso, Antonio Colombo, Felix Mahfoud, Bruno Scheller, Raban Jeger, Bernardo Cortese

Background and aims: In randomized clinical trials of patients undergoing percutaneous coronary intervention (PCI) for de novo small-vessel coronary artery disease (SV-CAD), paclitaxel-coated balloon (PCB) angioplasty showed mid-term angiographic or clinical non-inferiority to drug-eluting stent (DES) implantation. Nevertheless, these trials have sample size limitations, and the relative safety and efficacy beyond the first year remain uncertain.

Methods: The ANDROMEDA study was a collaborative, investigator-initiated, individual patient data meta-analysis comparing 3 year clinical outcomes between PCB angioplasty and DES implantation for the treatment of de novo SV-CAD. Multiple electronic databases (PubMed, Scopus, ScienceDirect, and Web of Science) were searched from May 2010 to June 2024 to identify eligible trials. All the following eligibility criteria were required: (i) random allocations of treatments; (ii) patients with SV-CAD; (iii) treatment with PCB or DES; and (iv) clinical follow-up of at least 36 months. The primary and co-primary endpoints were major adverse cardiac events (MACE) and target lesion failure (TLF), respectively. The protocol was registered with PROSPERO (CRD42023479035).

Results: Individual patient data from three randomized trials, including a total of 1154 patients and 1360 lesions, were combined. At 3 years, PCB was associated with a lower risk of MACE compared with DES [hazard ratio (HR) 0.67, 95% confidence interval (CI) 0.47-0.96], due to a lower risk of myocardial infarction and target vessel revascularization. This benefit persisted after multivariable adjustment (HR 0.75, 95% CI 0.58-0.96), but did not reach statistical significance in the two-stage analysis (HR 0.67, 95% CI 0.43-1.04). At the landmark analysis, the risk of MACE between groups was consistent over time. At 3 years, TLF was not significantly different between PCB and DES groups. Reconstructed time-to-event information from a fourth trial was included in a sensitivity analysis (1384 patients and 1590 lesions), showing consistent results in terms of TLF (HR 0.87, 95% CI 0.63-1.20). The comparison between PCB and second-generation DES did not reveal significant differences in 3 year TLF (HR 1.03, 95% CI 0.70-1.50).

Conclusions: In patients undergoing PCI for de novo SV-CAD, PCB angioplasty is associated with a reduction in MACE and a non-significant difference in TLF at 3 year follow-up compared with DES implantation. The restriction of the comparator group to second-generation DES does not alter the main conclusions. Larger trials comparing contemporary devices at a more prolonged follow-up are warranted to confirm these findings.

{"title":"Individual patient data meta-analysis of paclitaxel-coated balloons vs. drug-eluting stents for small-vessel coronary artery disease: the ANDROMEDA study.","authors":"Simone Fezzi, Daniele Giacoppo, Gregor Fahrni, Azeem Latib, Fernando Alfonso, Antonio Colombo, Felix Mahfoud, Bruno Scheller, Raban Jeger, Bernardo Cortese","doi":"10.1093/eurheartj/ehaf002","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf002","url":null,"abstract":"<p><strong>Background and aims: </strong>In randomized clinical trials of patients undergoing percutaneous coronary intervention (PCI) for de novo small-vessel coronary artery disease (SV-CAD), paclitaxel-coated balloon (PCB) angioplasty showed mid-term angiographic or clinical non-inferiority to drug-eluting stent (DES) implantation. Nevertheless, these trials have sample size limitations, and the relative safety and efficacy beyond the first year remain uncertain.</p><p><strong>Methods: </strong>The ANDROMEDA study was a collaborative, investigator-initiated, individual patient data meta-analysis comparing 3 year clinical outcomes between PCB angioplasty and DES implantation for the treatment of de novo SV-CAD. Multiple electronic databases (PubMed, Scopus, ScienceDirect, and Web of Science) were searched from May 2010 to June 2024 to identify eligible trials. All the following eligibility criteria were required: (i) random allocations of treatments; (ii) patients with SV-CAD; (iii) treatment with PCB or DES; and (iv) clinical follow-up of at least 36 months. The primary and co-primary endpoints were major adverse cardiac events (MACE) and target lesion failure (TLF), respectively. The protocol was registered with PROSPERO (CRD42023479035).</p><p><strong>Results: </strong>Individual patient data from three randomized trials, including a total of 1154 patients and 1360 lesions, were combined. At 3 years, PCB was associated with a lower risk of MACE compared with DES [hazard ratio (HR) 0.67, 95% confidence interval (CI) 0.47-0.96], due to a lower risk of myocardial infarction and target vessel revascularization. This benefit persisted after multivariable adjustment (HR 0.75, 95% CI 0.58-0.96), but did not reach statistical significance in the two-stage analysis (HR 0.67, 95% CI 0.43-1.04). At the landmark analysis, the risk of MACE between groups was consistent over time. At 3 years, TLF was not significantly different between PCB and DES groups. Reconstructed time-to-event information from a fourth trial was included in a sensitivity analysis (1384 patients and 1590 lesions), showing consistent results in terms of TLF (HR 0.87, 95% CI 0.63-1.20). The comparison between PCB and second-generation DES did not reveal significant differences in 3 year TLF (HR 1.03, 95% CI 0.70-1.50).</p><p><strong>Conclusions: </strong>In patients undergoing PCI for de novo SV-CAD, PCB angioplasty is associated with a reduction in MACE and a non-significant difference in TLF at 3 year follow-up compared with DES implantation. The restriction of the comparator group to second-generation DES does not alter the main conclusions. Larger trials comparing contemporary devices at a more prolonged follow-up are warranted to confirm these findings.</p>","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":" ","pages":""},"PeriodicalIF":37.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467396","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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European Heart Journal
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