Herz最新文献

Noninvasive cardiac imaging using cardiac computed tomography (CCT) and cardiac magnetic resonance imaging (CMRI) has become established as an indispensable diagnostic instrument in modern cardiology for the assessment of cardiovascular diseases. Both techniques are complementary in their diagnostic potential and enable an individualized clinical care, including diagnostic confirmation, prognosis estimation and treatment planning. The use of CCT enables a precise visualization of the coronary vessels, including the detection and quantification of luminal stenosis and additional plaque characterization. It is particularly suitable for the noninvasive clarification of coronary artery disease (CAD) in patients with a low to moderate pretest probability and for procedural planning in cardiology. The high negative predictive value of CCT enables its use as a gatekeeper for unnecessary invasive diagnostics of CAD. The use of CMRI provides a combination of functional morphological diagnostics with a precise myocardial tissue characterization, which are helpful for the assessment of CAD, inflammatory heart diseases and cardiomyopathies. Due to the possibility to quantify myocardial damage, CMRI has a high prognostic value. The combination of both non-invasive techniques in the present-day modern cardiac diagnostics is essential for guideline-compliant and patient-centered care by the coverage of the broad spectrum of cardiac diseases and the supplementary methods.

Background: Palliative care is a crucial part of the holistic management of advanced heart failure; however, it remains unclear how palliative care is currently provided in the outpatient sector in Germany.

Methods: We conducted a survey among office-based cardiologists and general practitioners (GPs) in Germany on the current provision of palliative care for people with advanced heart failure. The survey was developed by a multiprofessional project group of the German Cardiac Society (DGK e. V.) and administered online by the National Association of Office-Based Cardiologists (BNK e.V.).

Results: A total of 235 individuals participated in the study. The majority of respondents reported frequently or always discussing goals of care with patients with advanced heart failure. The GPs reported significantly more often than cardiologists that they always or frequently address primary palliative care needs. None of the surveyed office-based cardiologists but 35.1% of GPs stated that they frequently or always prescribe specialized outpatient palliative care (SAPV) for patients with advanced heart failure. Over 90% of the cardiologists reported that they rarely or never continue to care for patients when they cannot come to the practice themselves.

Conclusion: Only few office-based physicians in Germany regularly refer patients with advanced heart failure to specialized palliative care services. Primary palliative care and the involvement of SAPV are significantly more often managed by GPs than by office-based cardiologists.

Background: In this study, we compared the incidence of short-term outcomes between two groups of patients based on the occurrence of intra-procedural slow-flow/no-reflow phenomenon (SF/NR) and identified predictors of short-term outcomes. This study enrolled a consecutive series of patients diagnosed with ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI).

Methods: The patients were divided into two groups based on the presence or absence of SF/NR, and the incidence of short-term major adverse cardiovascular events (MACE) was compared between the two groups. Furthermore, the study aimed to identify predictors of short-term mortality in these patients. A total of 2582 patients were included, of whom 79.1% (n=2042) were male.

Results: The average age of the patients was 55.7 ± 11.2 years. Intra-procedural SF/NR was observed in 21.7% (560) of the patients. During median short-term follow-up of 180 days (144-205), patients with SF/NR exhibited a higher incidence of all-cause mortality (23.6% vs. 12.3%; p < 0.001) and MACE (30.4% vs. 16.9%; p < 0.001), with a hazard ratio of 1.82 (1.46-2.27; p < 0.001) and 1.69 (1.39-2.05; p < 0.001), respectively. Among patients with SF/NR, the following were found to be independent predictors of short-term mortality (adjusted odds ratios): total ischemic time, 1.04 (1.00-1.07; p = 0.041); random blood sugar levels, 1.01 (1.00-1.01; p < 0.001); intubation status, 2.79 (1.26-6.18; p = 0.011); post-procedural sub-optimal flow, 1.76 (1.04-2.98; p = 0.034); and intra-procedural arrhythmias, 5.48 (2.03-14.79; p < 0.001).

Conclusion: The presence of intra-procedural SF/NR has significant prognostic implications. Patients with intra-procedural SF/NR face a significantly higher risk of short-term adverse outcomes.

The treatment of valvular heart disease plays an important role in cardiovascular medicine. The 2025 European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) guidelines for the management of valvular heart disease set new standards for diagnostics and treatment based on scientific evidence with the aim to avoid both undertreatment and overtreatment. Recommendations for interventional treatment of valvular diseases are given greater importance compared to the 2021 guidelines. At the same time, surgical expertise remains indispensable, especially in younger patients and those with complex anatomy. Particular emphasis is placed on precise diagnostics using multimodal imaging, the recommendation for treatment of patients in high-volume centers (Heart Valve Centers) and an optimal patient selection by the multidisciplinary heart team. The ESC/EACTS guidelines advocate individualized, multidisciplinary treatment decisions based on the best available evidence. In practice, this can only be achieved by more intensive cooperation between the individual institutions of outpatient and inpatient care as well as specialized centers.

The 2025 European Society of Cardiology (ESC) Guidelines on cardiovascular disease in pregnancy represents the second revision of the guideline versions published in 2011 and 2018. The new version aims to incorporate the most up-to-date evidence and update the resulting recommendations for clinical practice. The experts appointed by the ESC constitute a new task force compared with the first two versions. However, the thematic focus does not differ fundamentally from the 2018 guidelines. In view of the expanding evidence base, several chapters have become substantially more precise, for example those on risk stratification in women with pre-existing cardiovascular disease; the need for structured, obligatory postpartum follow-up in the event of complications during pregnancy; and the recommended measures for pre-pregnancy screening and counselling. The recommendations continue to be based predominantly on level C evidence, i.e., on expert opinion and consensus. Since the thalidomide scandal in 1962, there have been very few prospective randomized trials including pregnant women. Explicit presentation of level C evidence is therefore particularly important, as individual physicians are only rarely involved in the care of pregnant women. This task is demanding, because both the pregnant woman and the fetus require individual consideration. This should, however, not be discouraging but rather viewed as a positive challenge. This work is substantially supported by the establishment of the institution of a "Pregnancy Heart Team." These teams, usually available 24/7 in larger centers, ensure interdisciplinary collaboration among multiple specialties and professions in order to arrive at the best possible decisions for both mother and child. The 2025 guidelines devote an expanded chapter to this topic.

The new guidelines for myocarditis and pericarditis from the European Society of Cardiology (ESC) are the first guidelines for myocarditis and for the first time they also combine the two entities. A key aspect is the introduction of the term inflammatory myopericardial syndrome (IMPS), an umbrella term that covers the spectrum of both diseases and enables uniform diagnostics and treatment but in particular draws attention to the fact that there are overlapping causes, diagnostic approaches and treatment options. Other major aspects relate to noninvasive diagnostics using multimodal imaging. There is a paradigm shift that enables the definitive diagnosis of myocarditis also using cardiovascular magnetic resonance imaging. An etiologically oriented treatment mostly requires an endomyocardial biopsy in pericardial effusion cytological work-up is instrumental. Furthermore, an intuitive risk stratification is introduced, which influences both the treatment and follow-up examinations and involves abandoning fixed waiting periods with respect to resuming sports and work. Diagnostic algorithms are based on the initial symptoms, such as chest pain, heart failure and arrhythmia and integrate the risk stratification into the treatment process. For pericarditis, innovative treatment approaches using interleukin‑1 antagonists are coming to the fore. Another focus is the consideration of genetic factors, which are particularly relevant in recurrent forms.

The 2025 update of the European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines on dyslipidemia introduce important innovations based on new evidence. The risk assessment is now conducted using the systematic coronary risk evaluation 2 (SCORE2) and SCORE2-OP (older persons), which enable improved stratification, particularly in older individuals. In addition, risk modifiers, such as family history, ethnicity, comorbidities and the biomarkers elevated highly sensitive C‑reactive protein (hs-CRP) or lipoprotein(a) (Lpa), have been introduced. Risk categories have been refined while low-density lipoprotein cholesterol (LDL-C) target values and the principle of stepwise treatment remain unchanged. A major focus is on the acute coronary syndrome: the immediate initiation of high-intensity statin treatment, mostly in combination with ezetimibe is recommended. Increasingly more important are elevated Lp(a) levels and special subgroups: in people with human immunodeficiency virus (HIV), statin treatment is recommended over the age of 40 years regardless of the LDL‑C as well as in high-risk patients undergoing anthracycline treatment. The use of dietary supplements and vitamins for prevention, however, are discouraged. The update reinforces the principle of risk-adapted LDL‑C target values, expands the treatment options and emphasizes the need for early, consistent lipid-lowering with practical recommendations.

The negative impact of psychological factors on the development and course of cardiovascular disease is impressively documented in the European Society of Cardiology (ESC) 2025 Clinical Consensus Statement on mental health and cardiovascular disease (ESC-CCS-2025), which cites a total of 687 references. In particular, chronic stress, depression, anxiety disorders, and post-traumatic stress disorder can increase the cardiovascular risk by up to twofold, and these factors are often associated with an unhealthy lifestyle (smoking, unhealthy diet, physical inactivity, obesity). Conversely, due to their often existentially threatening nature, cardiovascular diseases can secondarily lead to significant psychological distress. Based on this broad body of evidence, readers are encouraged to apply this knowledge in clinical practice as directly and extensively as possible. As there are several barriers to implementing these recommendations, the ACTIVE principles propose guidance on how structures can be improved or newly created in order to enhance the diagnosis and treatment of psychological distress and mental disorders in patients with cardiovascular disease. To this end, establishment of a "Psycho-Cardio team" and expansion of a stepped-care model are recommended. The statement also emphasizes that caregiving relatives of patients may themselves experience severe emotional distress and often require support. Furthermore, the situation of patients with a primary, severe mental disorder is highlighted, as their cardiovascular care is frequently characterized by stigma and undertreatment. In our view, the ESC-CCS-2025 represents a milestone in psychocardiology, calling on all of us to translate this knowledge into practice and to create or expand effective structures of care.

Electrophysiological procedures in Germany have traditionally required inpatient admission with overnight stay. However, technological advances have led to increased success rates, shorter procedure times and lower complication rates, making same-day discharge (SDD) feasible for most electrophysiological and cardiac implantable electronic device procedures. Implementing safe outpatient electrophysiological procedures requires careful patient selection and standardized workflows addressing pre-, intra- and post-procedural care. Current evidence from European and American studies demonstrate that outpatient procedures achieve complication rates comparable to impatient care while improving patient satisfaction. This paradigm shift ist becoming essential, particularly with the upcoming implementation of the hybrid diagnosis-related groups (DRG) reimbursement system.