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Inappropriate shocks in Brugada syndrome: a matter of data capture rather than programming? Brugada综合症中的不当冲击:数据捕获问题而非编程问题?
IF 35.6 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-06 DOI: 10.1093/eurheartj/ehag008
Vincent Probst, Jean Baptiste Gourraud
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引用次数: 0
Programming optimization is crucial for minimizing inappropriate shocks in patients with Brugada syndrome with a subcutaneous implantable cardioverter-defibrillator. 程序优化对于减少Brugada综合征患者皮下植入式心律转复除颤器的不适当电击至关重要。
IF 35.6 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-06 DOI: 10.1093/eurheartj/ehag007
Federico Migliore, Luca Ottaviano, Silvia G Priori
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引用次数: 0
Correction to two articles. 更正两篇文章。
IF 35.6 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-06 DOI: 10.1093/eurheartj/ehag106
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引用次数: 0
Artificial intelligence-enhanced electrocardiograms: building on solid foundations. 人工智能增强心电图:建立在坚实的基础上。
IF 35.6 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-06 DOI: 10.1093/eurheartj/ehaf1008
Fu Siong Ng, Gul Rukh Khattak, Konstantinos Patlatzoglou
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引用次数: 0
The human side of a legendary cardiologist. 传奇心脏病专家人性的一面。
IF 35.6 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-06 DOI: 10.1093/eurheartj/ehag001
Sadananda Bolar Naik
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引用次数: 0
Left bundle branch pacing vs biventricular pacing: back to basics. 左束支起搏vs双心室起搏:回归基础。
IF 35.6 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-06 DOI: 10.1093/eurheartj/ehaf1128
Haran Burri, Brenda R Kwak
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引用次数: 0
Unveiling the future: deep learning redefines strain analysis in paediatric cardiology. 揭示未来:深度学习重新定义儿科心脏病学的应变分析。
IF 35.6 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-06 DOI: 10.1093/eurheartj/ehaf1040
Havard Dalen, Andreas Østvik, Bjørnar Grenne
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引用次数: 0
Pulmonary arterial hypertension: right ventricular phenotyping to improve risk assessment at follow-up. 肺动脉高压:右心室表型改善随访时的风险评估。
IF 35.6 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-06 DOI: 10.1093/eurheartj/ehag023
Stefano Ghio, Roberto Badagliacca, Michele D'Alto, Mauro Acquaro, Pietro Ameri, Paola Argiento, Natale Daniele Brunetti, Gavino Casu, Nadia Cedrone, Marco Confalonieri, Marco Corda, Michele Correale, Carlo D'Agostino, Elisabetta De Tommasi, Domenico Filomena, Giuseppe Galgano, Alessandra Greco, Massimo Grimaldi, Carlo Lombardi, Rosalinda Madonna, Giovanna Manzi, Valentina Mercurio, Massimiliano Mulè, Giuseppe Paciocco, Silvia Papa, Tommaso Recchioni, Antonella Romaniello, Emanuele Romeo, Laura Scelsi, Davide Stolfo, Marco Vatrano, Patrizio Vitulo, Carmine Dario Vizza

Background and aims: The aim of this study was to evaluate whether echocardiography-derived phenotypes describing different degrees of right ventricular (RV) remodelling and dysfunction add prognostic information to that of current risk stratification tools in patients with pulmonary arterial hypertension (PAH) at first follow-up.

Methods: In 11 centres of the Italian Pulmonary Hypertension NETwork (IPHNET), data were prospectively collected from patients with PAH who underwent re-evaluation between 6 and 12 months after diagnosis. Echocardiographic variables were combined a priori to define four phenotypes representing different degrees of RV dilatation and right ventricular-pulmonary arterial (RV-PA) coupling: a mildly dilated right ventricle with preserved RV-PA coupling defined phenotype-1; a mildly dilated right ventricle with poor RV-PA coupling defined phenotype-2; a severely dilated right ventricle with preserved RV-PA coupling defined phenotype-3; a severely dilated right ventricle with poor RV-PA coupling, either with or without tricuspid regurgitation of moderate degree or more, defined phenotype-4. Patients were followed up for all-cause death for a median of 3.7 years.

Results: These echocardiographic phenotypes were present in all European Society of Cardiology/European Respiratory Society or REVEAL 2.0 risk groups except for the high-risk groups, which included only phenotype-3 and phenotype-4. In each risk group, RV phenotype-4 identified patients with a poorer prognosis; RV phenotype-1 identified patients with better survival in intermediate risk groups.

Conclusions: Echocardiography-derived phenotypes describing different degrees of RV remodelling and dysfunction provide prognostic information which is independent of and additional to the clinically defined risk in PAH patients at first follow-up.

背景和目的:本研究的目的是评估超声心动图衍生的表型描述不同程度的右心室(RV)重构和功能障碍是否在首次随访时为肺动脉高压(PAH)患者的当前风险分层工具提供预后信息。方法:在意大利肺动脉高压网络(IPHNET)的11个中心,前瞻性地收集PAH患者的数据,这些患者在诊断后6至12个月内进行了重新评估。超声心动图变量先验地结合定义了四种表型,代表不同程度的右心室扩张和右心室-肺动脉(RV- pa)耦合:轻度扩张的右心室与保留的RV- pa耦合定义表型-1;右心室轻度扩张,RV-PA偶联不良,定义表型2;右心室严重扩张,保留RV-PA偶联定义表型-3;严重扩张的右心室伴RV-PA耦合不良,伴或不伴中度或以上的三尖瓣反流,定义表型-4。对患者进行全因死亡随访,中位随访时间为3.7年。结果:这些超声心动图表型存在于所有欧洲心脏病学会/欧洲呼吸学会或REVEAL 2.0危险组中,但高危组仅包括表型3和表型4。在每个风险组中,RV表型-4鉴定出预后较差的患者;RV表型-1鉴定了中间危险组中生存率较高的患者。结论:超声心动图衍生的表型描述了不同程度的右心室重构和功能障碍,提供了独立于PAH患者首次随访时临床定义风险的预后信息。
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引用次数: 0
Healed plaque and systemic thrombogenicity in patients with chronic coronary syndrome 慢性冠状动脉综合征患者的斑块愈合和全身血栓形成
IF 39.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-05 DOI: 10.1093/eurheartj/ehaf784.1736
T Mito, D Kinoshita, J Goto, T Shikama, Y Otaki, S Kato, T Watanabe, I K Jang, M Watanabe
Background The majority of plaque disruptions are silent, followed by healing, resulting in layered plaque formation. Some plaque disruptions result in occlusive thrombosis and acute myocardial infarction. Purpose This study aimed to test the hypothesis that the patients with layered plaque at culprit lesions would have robust endogenous anti-thrombotic defense mechanisms compared to those without layered plaque. Methods A total of 119 patients with chronic coronary syndrome were enrolled. Target lesions were imaged by optical coherence tomography (OCT). Factor analysis determined four groups of biomarkers, (1) anti-thrombotic factors: plasminogen, anti-thrombin 3, (2) atherogenic factors: low-density lipoprotein-cholesterol (LDL-C), malondialdehyde-modified low-density lipoprotein (MDA-LDL), (3) prothrombotic factors: D-dimer, fibrin degradation products (FDP), and (4) inflammatory factors: fibrinogen, and high-sensitive C reactive protein (hs-CRP). Patients were divided into three groups according to the tertiles of each of those four groups, and their association with a layered plaque was investigated. A layered plaque was defined as one or more layers of different optical densities and a clear demarcation from the underlying tissue. The arc of each layered plaque was assessed at 1-mm cross-section intervals. Layered plaque length is measured from a longitudinal view. The layer index, equivalent to layered plaque volume, is defined as mean layer arc × total layer length. Results The layered plaque was more prevalent in patients with higher levels of anti-thrombotic factor levels (p for trend=0.013) (Figure 1). Similarly, the layer index was higher in patients with higher anti-thrombotic factor levels (p for trend=0.006) (Figure 2). In contrast, other factors had no associations with layered plaque and layer index. In multivariable analysis, only the anti-thrombotic factor was associated with a higher layer index after adjusting for confounders. Conclusions The systemic anti-thrombotic factor levels might be more important determinants for layered plaque formation than atherogenic, prothrombotic, or inflammatory factors.Figure 1 Figure 2
大多数斑块的破坏是沉默的,随后愈合,导致层状斑块的形成。一些斑块破坏导致闭塞性血栓形成和急性心肌梗死。目的本研究旨在验证在罪魁祸首病变处有层状斑块的患者与没有层状斑块的患者相比具有强大的内源性抗血栓防御机制的假设。方法选取119例慢性冠状动脉综合征患者。采用光学相干断层扫描(OCT)对病灶进行成像。因子分析确定了四组生物标志物,(1)抗血栓因子:纤溶酶原,抗凝血酶3,(2)致动脉粥样硬化因子:低密度脂蛋白-胆固醇(LDL-C),丙二醛修饰的低密度脂蛋白(MDA-LDL),(3)血栓形成因子:d -二聚体,纤维蛋白降解产物(FDP),(4)炎症因子:纤维蛋白原,和高敏C反应蛋白(hs-CRP)。根据这四组的每一组的位数将患者分为三组,并研究其与层状斑块的关系。层状斑块被定义为一个或多个不同光密度的层,与底层组织有明确的界限。每隔1mm的横截面间隔评估每层斑块的弧度。层状斑块的长度是从纵向角度测量的。层指数相当于层状斑块体积,定义为平均层弧×总层长。结果层状斑块在抗血栓因子水平较高的患者中更为普遍(趋势p =0.013)(图1)。同样,抗血栓因子水平越高的患者层指数也越高(趋势p =0.006)(图2)。相比之下,其他因素与层状斑块和层指数无关。在多变量分析中,在调整混杂因素后,只有抗血栓因子与较高的层指数相关。结论全身抗血栓因子水平可能是层状斑块形成的重要决定因素,而不是致动脉粥样硬化、血栓前因子或炎症因子。图1图2
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引用次数: 0
Mitral annular disjunction and its arrhythmic risk in mitral valve prolapse: a metanalysis 二尖瓣脱垂的二尖瓣环分离及其心律失常风险:荟萃分析
IF 39.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-05 DOI: 10.1093/eurheartj/ehaf784.2477
L Ordine, D Pacella, S Di Napoli, G Canciello, F Borrelli, R Lombardi, B Napolitano, R Martorano, L Moscano, R Polizzi, A Spinelli, G Esposito, M A Losi
Background Mitral annular disjunction (MAD) is a condition characterized by the abnormal attachment of the posterior mitral leaflet directly to the atrial wall. This condition is particularly prevalent in patients with mitral valve prolapse (MVP). The growing interest in MAD arises from various studies that have indicated its potential arrhythmic role. However, the findings are still controversial, and further research is needed to clarify its implications. Objective To better assess the arrhythmic risk linked to the presence of MAD in patients with MVP. Method We conducted a systematic search of the Medline, Cochrane, and Scopus electronic databases for studies published from their inception through December 2024. Our focus was on studies comparing arrhythmic MAD with non-arrhythmic MAD. Two investigators, L.O. and M.A.L., independently performed the searches using the following terms: mitral annular disjunction, mitral valve disjunction, ventricular arrhythmias, mitral valve prolapse, and sudden cardiac death. The prognostic performance of MAD in predicting major arrhythmias in the MVP population was summarized using pooled estimates for sensitivity, specificity, diagnostic odds ratio (DOR), negative predictive value (NPV), and positive predictive value (PPV). Confidence intervals were calculated using the DerSimonian and Laird method (1986, ref 1). Due to varying thresholds for identifying MAD, moderate heterogeneity was expected, assessed with I-squared and Kendall's Tau. A random-effects model was used when heterogeneity was not extremely low. The summary receiver operating characteristic (sROC) curve and area under the curve (AUC) were computed using a non-parametric summary ROC method, as described by Martinez-Camblor. Statistical analysis was performed with R version 4.4.0. Results After reviewing 66 articles, we identified a total of 7 studies enrolling 1977 patients with MVP. Of these 1171 MVP with MAD and 806 without MAD. MAD was defined as abnormal separation between the mitral valve junction and LV wall with a length of at least 1 mm (5 studies) or 2 mm (2 studies). MAD was assessed with echocardiography (4 studies) or cardiac magnetic resonance (CMR) (3 studies). In patients with MVP, MAD was associated with an increased arrhythmic risk with OR of 2.604 (95% CI: 2.012; 3.371) (Figure, upper panel). MAD resulted as an arrhythmic risk factor in patients with MVP with an AUC of 0.603 (Figure, lower panel). Conclusions While MVP is generally considered a benign condition, a subset of patients may face an elevated risk of life-threatening arrhythmias. Our findings suggest that MAD is a significant risk factor for arrhythmias in patients with MVP, reinforcing the need for careful evaluation and risk stratification in this population. Future studies should focus on refining MAD detection methods and establishing standardized diagnostic thresholds to improve risk prediction and clinical management.
二尖瓣环分离(MAD)是一种以二尖瓣后小叶直接与心房壁异常附着为特征的疾病。这种情况在二尖瓣脱垂(MVP)患者中尤为普遍。越来越多的研究表明,MAD具有潜在的心律失常作用。然而,这些发现仍然存在争议,需要进一步的研究来澄清其含义。目的更好地评估MVP患者与MAD存在相关的心律失常风险。方法我们对Medline、Cochrane和Scopus电子数据库进行了系统的检索,检索从建立到2024年12月发表的研究。我们的重点是比较心律失常与非心律失常的研究。两位研究者,L.O.和M.A.L,独立地使用以下术语进行了搜索:二尖瓣环分离、二尖瓣分离、室性心律失常、二尖瓣脱垂和心源性猝死。通过敏感性、特异性、诊断优势比(DOR)、阴性预测值(NPV)和阳性预测值(PPV)的汇总估计,总结MAD在MVP人群中预测主要心律失常的预后表现。使用DerSimonian和Laird方法(1986,参考文献1)计算置信区间。由于识别MAD的阈值不同,预计中度异质性,用i平方和肯德尔Tau进行评估。当异质性不是极低时,采用随机效应模型。采用Martinez-Camblor描述的非参数汇总ROC方法计算总体受试者工作特征(sROC)曲线和曲线下面积(AUC)。采用R版本4.4.0进行统计分析。结果在回顾了66篇文章后,我们共确定了7项研究,纳入了1977例MVP患者。其中1171个MVP有麦迪,806个MVP没有麦迪。MAD被定义为二尖瓣连接处与左室壁的异常分离,长度至少为1mm(5项研究)或2mm(2项研究)。通过超声心动图(4项研究)或心脏磁共振(CMR)(3项研究)评估MAD。在MVP患者中,MAD与心律失常风险增加相关,OR为2.604 (95% CI: 2.012; 3.371)(图,上面板)。在MVP患者中,MAD是一个心律失常的危险因素,AUC为0.603(图,下面板)。虽然MVP通常被认为是一种良性疾病,但一小部分患者可能面临危及生命的心律失常风险升高。我们的研究结果表明,MAD是MVP患者心律失常的一个重要危险因素,加强了对这一人群进行仔细评估和风险分层的必要性。未来的研究应侧重于完善MAD的检测方法,建立标准化的诊断阈值,以提高风险预测和临床管理。
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European Heart Journal
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