Heart International最新文献

Background: The development of eHealth has offered a solution to the challenge of effective self-management for patients with heart failure (HF) by facilitating health information exchange, enabling frequent home monitoring, enhancing self-management and promoting patient empowerment. This study aimed to evaluate the effectiveness of eHealth interventions in improving self-management for patients with HF.

Methods: Systematic review and meta-analysis were performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines, by first selecting the relevant publications from the Cochrane Library, EBSCOhost, Epistemonikos, ProQuest, PubMed and Scopus as of 25 February 2025. The quality of the included studies was appraised using Cochrane Risk of Bias 2.0 tool. A meta-analysis of randomized controlled trials was performed using Review Manager software to estimate odds ratios (ORs) and standardized mean differences (SMDs).

Results: We included 37 trials with 13,366 participants. eHealth reduced HF-related admissions (OR: 0.73 [95% confidence interval (CI): 0.62, 0.86; p=0.0002]). All-cause mortality did not differ (OR: 0.93 [95% CI: 0.85, 1.03; p=0.16]). Cardiovascular mortality was not reduced (OR: 0.85 [95% CI: 0.71, 1.01; p=0.07]). Quality of life showed borderline improvement on the Minnesota total score (mean difference: -7.25 [95% CI: -14.81, 0.31; p=0.06]; I²=91%). HF-related knowledge did not differ (SMD: 0.53 [95% CI: -0.12, 1.19; p=0.11]).

Conclusion: This meta-analysis demonstrates that incorporating eHealth interventions, particularly telemedicine, into standard HF care substantially decreases hospital admissions. While broader impacts on mortality, quality of life and knowledge remain inconclusive, the findings underscore the value of standardized eHealth integration as a pragmatic strategy to strengthen HF management and optimize patient outcomes.

Introduction: Guidelines widely recommend exercise training as a complementary therapy for individuals with heart failure. While research highlights the potential of both high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT), a systematic review is required to solidify their effects on improving patients' oxygen uptake, functional capacity, cardiac function and quality of life (QoL).

Objective: This meta-analysis aimed to compare the efficacy of HIIT and MICT on cardiopulmonary fitness, functional capacity, cardiac function and QoL among individuals with heart failure.

Method: This review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in International Prospective Register of Systematic Reviews (PROSPERO; CRD42024602309). We searched PubMed, Cochrane Controlled Register of Trials (CENTRAL), Scopus, Web of Science, ProQuest, Embase, Google Scholar, PubMed Central (PMC), Elton B. Stephens Company (EBSCO) and Wiley. Risk of bias was assessed with the Revised Cochrane for Risk-Of-Bias Tool for Randomized Trials (RoB 2), and analyses were conducted in RStudio version 4.4.1. (Posit PBC, Massachusetts, USA) using the 'meta' package.

Result: A total of 21 randomized controlled trials were included in the analysis. The overall quality assessment showed a low risk of bias. We found that the HIIT group is favourable in terms of cardiac function improvement, represented by left ventricular ejection fraction (LVEF; mean difference [MD]=2.69 [95% confidence interval (CI): 0.01, 5.38; p=0.0495]), peak oxygen uptake (peak VO₂; MD=1.19 [95% CI: 0.43, 1.95; p=0.0021]) and functional capacity, assessed with the six-minute walk test (6MWT; MD=24.87 [95% CI: 11.19, 37.75; p=0.0002]). Furthermore, HIIT showed non-significant trends towards improvement in QoL (MD=1.11 [95% CI: -1.02, 3.24; p=0.31]) and oxygen pulse (MD=1.03 [95% CI: -0.18, 2.24; p=0.095]).

Conclusion: HIIT appears to be more effective than MICT in improving functional capacity, such as LVEF, peak VO₂ and 6MWT, as well as cardiac functional outcome.

Epicardial adipose tissue (EAT), located between the myocardium and visceral pericardium, plays an active role in coronary artery disease (CAD) through local inflammatory and metabolic signalling. This review explores the prognostic significance of EAT volume and attenuation (density) as measured by cardiac computed tomography. While increased EAT volume has been linked to higher plaque burden, coronary artery calcium (CAC) and incident CAD - even in low-CAC populations - attenuation offers additional value by reflecting tissue inflammation and remodelling. Lower EAT density has been independently associated with major adverse cardiac events and vulnerable plaque features, outperforming both volume and CAC score in several cohorts. We also highlight the clinical relevance of these metrics in early disease detection and risk stratification, and their potential for therapeutic modulation. As evidence builds, EAT volume and density may soon serve as practical, imaging-based biomarkers to guide personalized prevention in CAD.

The Evolut Low Risk trial (Transcatheter Aortic Valve Replacement With the Medtronic Transcatheter Aortic Valve Replacement System In Patients at Low Risk for Surgical Aortic Valve Replacement; ClinicalTrials.gov identifier: NCT02701283) provides reassuring evidence that transcatheter aortic valve replacement remains non-inferior to surgery at 5-year follow-up with regard to mortality and disabling stroke in low-risk patients. Valve performance, durability and quality-of-life improvements were excellent in both groups.

Background: The gut microbiome has a crucial role in host metabolism and immune regulation, and there is growing evidence that dysbiosis may be associated with the pathogenesis of cardiovascular disease (CVD). This narrative review provides an overview of the recent literature on mechanistic connections between the gut and heart, as well as on the therapeutic strategies and research gaps in the gut-heart axis.

Methods: We conducted a systematic literature search on PubMed and Embase databases with MeSH and keyword terms: 'gut microbiome', 'cardiovascular disease', 'TMAO', 'short-chain fatty acids', 'probiotics' and 'faecal microbiota transplantation'. We considered human and relevant animal studies focusing on mechanistic pathways or microbiome treatments and excluded editorials, small (less than 10 subjects) case series and articles not published in the English language.

Results: Key microbiota-derived metabolites, trimethylamine N-oxide (TMAO) and short-chain fatty acids (SCFAs), contribute to atherogenesis, blood pressure and myocardial inflammation. Dysbiosis-induced barrier dysfunction and disturbed bile acid signalling also serve as the mediators of cardiac remodelling. Dietary fibre, probiotics/prebiotics, postbiotics and faecal microbiota transplantation are emerging interventions for the modulation of CVD risk. Nevertheless, most result from observational studies, whilst such are heterogeneous in sequencing platforms and too small to draw any definitive conclusions.

Conclusion: The modulation of gut microbiome might be a new target for CVD prevention and treatment. Large-scale, standardized randomized trials with hard cardiovascular endpoints, as well as integrated multi-omics profiling, will be required to validate microbial biomarkers and to optimize microbiome-based interventions.

Drug-coated balloon (DCB)-only angioplasty is a 'leave nothing behind' approach, necessitating a modified percutaneous coronary intervention strategy and mindset to accept coronary dissection during lesion preparation while simultaneously achieving an optimal angiographic outcome. Drawing from the lessons learned during the plain old balloon angioplasty era, it is imperative to re-familiarize ourselves with the strategies of dissection avoidance, recognition and management. With our increasing clinical and research experience in DCB angioplasty, we present our approach to managing dissections, emphasizing the distinction between safe and unsafe dissections, techniques for modifying unsafe or indeterminate dissections into a safe category and the appropriate consideration of bailout stenting (BOS). We provide examples of each dissection category, including those that can be safely left, those requiring BOS and those that necessitate modification through techniques such as further dilatation with specialized balloons (such as non-compliant, scoring and cutting balloons) and prolonged balloon inflation.

Despite strides in cardiovascular disease (CVD) management, dyslipidaemia remains a significant yet underdiagnosed and undertreated risk factor, particularly among women. Sex-based disparities persist in screening, diagnosis and treatment, leading to suboptimal management and increased CVD risk in female populations. This article explores the current literature on sex disparities in dyslipidaemia, analysing screening guidelines, diagnosis trends and treatment gaps. It examines factors influencing lipid metabolism across a woman's lifespan, including hormonal fluctuations, pregnancy, menopause and their impact on CVD risk. The article also highlights barriers to effective lipid management in women, including clinician biases, inadequate screening and lower prescription rates of statin and non-statin therapies. Women are less likely to undergo lipid screening despite having significant CVD risk factors. Even when diagnosed, they receive statin therapy at lower rates than men, and treatment intensification is less frequent. Additionally, clinical trials assessing lipid-lowering therapies often underrepresent women, limiting the applicability of evidence-based recommendations. The lack of sex-specific risk assessment tools further contributes to missed opportunities for prevention and treatment. Addressing disparities in dyslipidaemia management is crucial to reducing the burden of CVD in women. Enhancing awareness among clinicians, improving screening strategies, incorporating sex-specific risk factors into predictive models and increasing female representation in clinical trials are essential steps towards equitable cardiovascular care.

Background: This meta-analysis article aimed to investigate the efficacy of magnesium in preventing new-onset postoperative atrial fibrillation (POAF).

Methods: We searched Medline, Embase, Web of Science and Cochrane Library without any language or publication date restriction up to August 2023. We included randomized controlled trials (RCTs) that enrolled adults undergoing cardiac surgery without a history of atrial fibrillation, exploring the effect of magnesium supplementation in preventing new-onset POAF. We assessed the risk of bias using the Cochrane Risk of Bias 2.0 (RoB 2.0) tool. We conducted a random-effects meta-analysis using R and assessed the certainty of the evidence.

Results: A total of 24 RCTs with 3,373 participants were included. We found that magnesium may reduce the risk of POAF compared to the control group (relative risk [RR]: 0.55; 95% confidence interval [CI]: 0.41, 0.74; low certainty). The subgroup analysis for trials with low/some concerns risk of bias showed that magnesium reduces the risk of new-onset POAF compared to control (RR: 0.70 [95% CI: 0.58, 0.84]; high certainty). Magnesium consumption had no significant effect on all-cause mortality (RR: 1.00 [95% CI: 0.34, 2.90]) or days of hospitalization (mean difference: -0.34 [95% CI: -0.94, 0.26]).

Conclusion: The evidence indicates that magnesium administration reduces the incidence of new-onset POAF.

Transthyretin amyloid cardiomyopathy is a progressive and fatal cardiomyopathy caused by the deposition of misfolded transthyretin in the form of amyloid fibrils in the myocardium. The advent of various highly efficacious transthyretin amyloid-specific disease-modifying therapies has sparked a growing interest in identifying the clinical indicators of disease progression that will be crucial in guiding treatment decisions. Markers of disease progression include changes in commonly measured biomarkers such as the N-terminal pro-B-type natriuretic peptide and the estimated glomerular filtration rate, a decline in the 6-m inute walk test distance, outpatient diuretic intensification, changes in heart failure symptom burden and also changes in various cardiac-imaging parameters. Considering the wide array of markers that can detect disease progression, it is likely that a comprehensive clinical assessment will involve monitoring multiple markers simultaneously. Integrating multiple markers of disease progression offers additional insights beyond individual markers, enabling a refined assessment of disease trajectory and mortality risk. Many of these markers are readily available, simple to measure and universally applicable, making them easy to implement in clinical practice for identifying patients with advancing disease and a heightened risk of mortality.

Introduction: Hypertrophic cardiomyopathy (HCM) is characterised by unusual thickening of the interventricular septum leading to dynamic left ventricular outflow tract obstruction, mitral valve regurgitation, impaired diastolic function and arrhythmias. Mavacamten (MYK-461) is a first-in-class, selective allosteric modulator of cardiac myosin adenosine triphosphatase and received US Food and Drug Administration (FDA) approval on 28 April 2022 to treat symptomatic obstructive HCM (oHCM).

Methods: A systematic search of Medline/PubMed and ClinicalTrials. gov was conducted using advanced search strategies with the terms 'mavacamten/MYK-461' and 'hypertrophic cardiomyopathy/HCM' to identify and include all clinical trials published to date.

Results: The clinical efficacy of mavacamten has been consistently demonstrated in the PIONEER-HCM, MAVERICK-HCM, EXPLORER-HCM, VALOR-HCM, EXPLORER-CN-HCM and HORIZON-HCM clinical trials - there was a notable decrease in the left ventricular outflow tract gradient. Apart from the MAVERICK experiment, which revealed no discernible change in functional class or peak volume of oxygen uptake (pVO₂) in non-oHCM patients, improvements were reported in New York Heart Association functional class, pVO₂ and quality-of-l ife metrics. Except for the PIONEER trial, which didn't report biomarker data such as N-terminal pro B-type natriuretic peptide (NT-proBNP) and troponins, mavacamten significantly reduced biomarkers in all investigations. Additionally, the VALOR trial showed that there was a reduced need for septal reduction therapy. Although systolic dysfunction is a major safety risk that requires careful monitoring, mavacamten was generally well tolerated.

Conclusion: Mavacamten offered a promising, non-invasive pharmacological therapy for patients with symptomatic oHCM, particularly for those who are not candidates for or who have failed conventional treatments.