Herz最新文献

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.

In October 2025 the current resuscitation guidelines of the European Resuscitation Council (ERC) were published in Resuscitation and translated into the German language by the German Resuscitation Council (GRC). This article focuses specifically on the main aspects and changes to the recommendations on basic life support, adult advanced life support and postresuscitation care. It should be emphasized that dispatchers will be involved earlier than before in the process of cardiopulmonary resuscitation in the form of assisted telephone resuscitation. Furthermore, in the event of persistent ventricular fibrillation, a so-called vector change should be considered. Probably the biggest change is that the previous targeted temperature management is no longer recommended and that only temperature control should be attempted.

In recent years telemonitoring for heart failure (TmHi) has transitioned from project-based pilot applications to a structured and fully reimbursed component of routine outpatient care in Germany. This development is supported by robust evidence from randomized controlled trials and meta-analyses demonstrating consistent reductions in mortality and hospitalizations, improved treatment adherence and enhanced continuity of care. Both noninvasive and implant-based monitoring strategies enable early detection of pathophysiological deterioration and facilitate proactive therapeutic adjustments through telemedicine centers (TMZ) in close collaboration with primary physicians. The implementation of TmHi in Germany relies on clear legal, technical and organizational standards, although current practice across centers remains heterogeneous and reveals potential for improvement in workflow standardization, interoperability, staffing and reimbursement management. In addition to the proven clinical benefits, in the context of the demographic changes TmHi is gaining in importance economically and in the healthcare system. Telemonitoring is thus poised to evolve from a specialized adjunct service into a cornerstone of predictive, digitally integrated care of heart failure.

Cardiac magnetic resonance imaging (CMR) provides decisive advantages, particularly in coronary heart disease, myocarditis and cardiomyopathy. It accurately detects ischemia, scarring, edema and microvascular disorders, enables reliable risk stratification and supports treatment decisions such as revascularization or medication adjustments. Modern quantitative perfusion methods and artificial intelligence (AI)-based analyses further increase the diagnostic accuracy. In inflammatory myocardial and pericardial diseases, CMR using mapping techniques and late gadolinium enhancement (LGE) forms the basis for differentiated diagnostics and estimation of the prognosis. It also enables a precise etiological classification and provides prognostically relevant parameters in cases of hypertrophic, dilated, arrhythmogenic and restrictive cardiomyopathies. In the diagnostics of valvular diseases and the planning of interventional procedures and cardiac tumors, CMR provides essential additional information and demonstrates a high sensitivity and specificity. New techniques such as quantitative 4‑dimensional (4D) flow measurements, high-resolution 3D imaging and electrocardiograph (ECG)-independent scans will further increase its value. Due to the increasing number of CMR examinations, standardized procedures, qualified personnel and structured training programs are essential to ensure a high quality of care in the long term.

Artificial intelligence (AI) in cardiology has evolved from rule-based expert systems to data-driven, learning models that can support diagnostic and therapeutic decision-making in acute coronary syndrome (ACS). At their core, these are statistical prediction models that infer conditional probabilities for clinical events from data and are therefore, in principle, ideally suited for risk-based decision making. This review article focuses on risk stratification in ACS, with particular emphasis on the detection of type 1 or occlusive myocardial infarction (MI). Models based on clinical variables and high-sensitivity troponin measurements use continuous troponin values in combination with patient characteristics to estimate individual probabilities of MI instead of relying on fixed troponin thresholds. In retrospective studies, they reduce the "observe zone", enable faster and safer rule-out decisions, and have the potential to relieve pressure on emergency departments. However, they remain dependent on laboratory assays and currently lack prospective evidence of improvements in patient relevant outcomes. Electrocardiogram (ECG)-based approaches promise greater clinical impact: classical machine learning (ML) on preselected ECG features already yields interpretable models that quantify ischemic patterns and can detect occlusive MI even in the absence of ST-segment elevation. Deep learning models applied directly to raw ECG signals additionally exploit subtle spatiotemporal changes and have outperformed conventional ECG interpretation in early studies. Prospective data on the detection of ST segment elevation myocardial infarction (STEMI) indicate that this can shorten the time to reperfusion.

Background: Heart failure with preserved ejection fraction (HFpEF) represents approximately half of all heart failure cases, and its prevalence is rising with an aging population and increasing comorbidities. Diagnosis is challenging due to heterogeneous clinical features and nonspecific symptoms. To improve diagnostic accuracy, scores such as the HFA-PEFF (Heart Failure Association Pre-test Assessment, Echocardiography & Natriuretic Peptide, Functional Testing, Final Etiology) and H2FPEF have been proposed. Oncostatin M (OSM), a cytokine of the interleukin‑6 family, is involved in cardiac inflammation, fibrosis, and remodeling, but its diagnostic role in HFpEF remains unclear.

Methods: This single-center, cross-sectional study enrolled 71 patients with suspected HF symptoms (dyspnea, fatigue, edema) and a left ventricular ejection fraction ≥ 50%. Demographic, laboratory, and echocardiographic data were recorded. HFpEF likelihood was assessed using the HFA-PEFF and H2FPEF scores. Serum OSM levels were measured, and patients were classified into low-intermediate- and high-risk groups.

Results: Mean patient age was 67.0 years (63.4% female). In the high-risk H2FPEF group, only hypertension showed a significant association (p = 0.032). By contrast, the high-risk HFA-PEFF group showed higher left atrial volume index, left ventricular mass index, and E/e' ratio; NT-proBNP and OSM levels were also significantly increased (51.3 vs. 14.4 pg/mL; p < 0.001). Receiver operating characteristic analysis showed that OSM had strong discriminatory power for the HFA-PEFF but not the H2FPEF score.

Conclusion: Serum OSM levels correlated more strongly with the HFA-PEFF score, which incorporates structural and functional cardiac parameters. Thus, OSM may serve as a complementary biomarker to improve HFpEF diagnosis when used with the HFA-PEFF scoring system.

Background: Coronary artery disease (CAD) is a significant global health burden, warranting pragmatic, low-cost biomarkers for effective risk stratification. The atherogenic index of plasma (AIP), calculated as log(TG/HDL-C), is a lipid-derived indicator of cardiometabolic risk. We evaluated AIP as an associative marker for CAD and compared its diagnostic performance with commonly used biomarkers.

Methods: In a hospital-based, angiography-confirmed case-control cohort (n = 340; 211 cases, 129 controls), we assessed AIP alongside uric acid, creatinine, neutrophil-to-lymphocyte ratio (NLR), TG/HDL‑C, HbA1c, and ejection fraction. Group characteristics were summarized using descriptive statistics, chi-square tests, and ANOVA. Associations with CAD were examined using multivariable logistic regression adjusted for age, sex, body mass index, diabetes, hypertension, smoking status, and statin use. Discriminative performance was evaluated via receiver operating characteristic (ROC) analysis, with pairwise comparisons conducted using DeLong's test.

Results: Values of AIP (OR 1.42, 95% CI 1.18-1.69; p = 0.012), uric acid (OR 1.20, 95% CI 1.02-1.42; p = 0.032), and creatinine (OR 1.69, 95% CI 1.03-2.76; p = 0.038) were independently associated with CAD. HbA1c, TG/HDL‑C, NLR, and ejection fraction were not significantly associated in multivariable models. Values of AIP increased with greater angiographic severity. In ROC analysis, AIP showed superior discriminatory ability to uric acid, creatinine, NLR, and HbA1c (all p < 0.05, DeLong test), and performed comparably to TG/HDL‑C, consistent with AIP being its log transformation.

Conclusion: Readily available AIP offers incremental prognostic value in symptomatic patients with suspected CAD. These findings are hypothesis-generating; thus, thresholds should be interpreted cautiously pending prospective, multicenter studies.

Background: Oral anticoagulation is a cornerstone of stroke prevention in patients with atrial fibrillation (AF) and elevated thromboembolic risk. However, evidence regarding the association between co-use of direct oral anticoagulants (DOACs) and non-dihydropyridine calcium-channel blockers (CCBs) and bleeding risk remains controversial.

Methods: We systematically searched PubMed, Embase, and the Cochrane Library for randomized clinical trials, cohort, and case-control studies evaluating bleeding risk associated with DOAC + CCB co-use in patients with AF. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for binary outcomes.

Results: Nine studies met inclusion criteria, comprising 408,276 patients overall, of whom 67,359 were using DOACs + CCBs. Meta-analysis showed a significantly higher incidence of major bleeding with DOAC + CCB co-use compared with DOAC alone (OR 1.21 [95% CI 1.18-1.43]; p < 0.001; I² = 21%). By contrast, there was no significant difference in any bleeding events between groups (OR 1.21 [95% CI 0.83-1.77]; p = 0.31; I² = 77%).

Conclusion: Co-use of DOACs and non-dihydropyridine CCBs is associated with an increased risk of major bleeding, whereas the overall risk of any bleeding does not differ significantly. Large randomized controlled trials are warranted to confirm these findings and to further evaluate the safety of this combination.