Herz最新文献

For decades tricuspid valve regurgitation (TR) was considered clinically insignificant and often left untreated. Only with the emergence of catheter-based treatment, particularly tricuspid transcatheter edge-to-edge repair (T-TEER), the condition has gained increasing clinical attention and therapeutic momentum. Concurrently, the surgical treatment has evolved towards minimally invasive endoscopic operations on the beating heart. This article explores the role of the interdisciplinary heart team in the evaluation and execution of T‑TEER or surgical treatment. Based on current guidelines, clinical trial data and echocardiographic selection criteria, it analyses the need for a structured, interdisciplinary decision-making process. Successful TR management requires broad interdisciplinary expertise, including heart failure management, cardiac imaging, interventional cardiology and cardiac surgery. Structured risk assessments using validated tools such as the TRI-score and imaging-based scoring systems enable an objective evaluation of prognosis and anatomical suitability. A key clinical challenge remains the identification of the optimal timing for an intervention, before irreversible deterioration of the right ventricular function or end-organ damage occurs. In conclusion, delivering high-quality, patient-centred care for severe TR is barely achievable without a well-functioning heart team. Early referral, close coordination with outpatient cardiologists, and comprehensive imaging are essential to achieving favourable and sustainable outcomes.

Background: Inflammation is closely associated with various diseases. The platelet-to-high-density lipoprotein cholesterol (HDL-C) ratio (PHR) and the fibrinogen-to-HDL‑C ratio (FHR) are considered important biomarkers for assessing the level of inflammation. This study aimed to investigate the relationship between PHR, FHR, and in-hospital mortality risk in patients with acute myocardial infarction (AMI).

Methods: This retrospective study included patients with first-time AMI at Cangzhou People's Hospital, China, from 2020 to 2021. Multivariable logistic regression analysis was performed to evaluate the association between PHR, FHR, and in-hospital mortality in patients with AMI. Restricted cubic spline (RCS) was used to visualize the dose-response relationship between PHR, FHR, and in-hospital mortality. Receiver operating characteristic (ROC) curve analysis was conducted to determine the predictive value of PHR and FHR for in-hospital mortality. Additionally, subgroup analyses were performed.

Results: In the study, 170 out of 2398 patients with AMI (7.09%) died. In the multivariable logistic regression model, both PHR and FHR were identified as independent predictors of in-hospital mortality in patients with AMI. The adjusted RCS regression analysis indicated that there is no significant nonlinear association between PHR, FHR, and in-hospital mortality. The ROC curve analysis revealed that the area under the curve (AUC) for PHR and FHR was 0.718 (95% CI: 0.700-0.736, p < 0.001) and 0.717 (95% CI: 0.699-0.735, p < 0.001), respectively. In the subgroup analysis, we found that admission route, AMI type, congestive heart failure, and cardiac arrest significantly influenced the relationship between PHR, FHR, and in-hospital mortality (p < 0.05 for interaction).

Conclusion: Both PHR and FHR are independent prognostic factors for in-hospital mortality in patients with AMI. The clinical utility of these inflammatory biomarkers needs to be further validated in studies with larger sample sizes and diverse populations.

The heart team is an important component for guideline-conform treatment of patients with complex coronary artery disease (CAD). Nevertheless, this integrative, multiprofessional approach is not always consistently implemented in clinical practice. This article highlights the role of the heart team, with a particular focus on cardiovascular centers with cardiac surgery on site, presents evidence-based benefits and draws attention to existing structural gaps in daily care, such as the probably widespread use of ad hoc percutaneous coronary intervention (PCI) in multivessel CAD or the lack of interdisciplinary coordination. Numerous studies have shown that consistently implemented heart team decisions and a culture of professional and evidence-based interaction improve patient outcomes. This article appeals to cardiological and cardiac surgery departments to actively shape the heart team process. The presence of both the heart team and cardiac surgery on site paired with modern possibilities of digital communication tools and the wish for individual treatment recommendations should enable faster heart team decisions (practically ad hoc) to improve patient care.

Since the earliest studies on transcatheter aortic valve implantation (TAVI), the heart team concept has been an integral component of treatment planning for patients with aortic valve stenosis (AS). The primary objective is to ensure patient-specific, guideline-based treatment through the structured involvement of all relevant medical disciplines. The TAVI heart team is strongly recommended with a class I indication in both European and US clinical guidelines. A TAVI heart team typically consists of interventional cardiologists, cardiac surgeons, anesthesiologists and cardiac imaging specialists and can be supplemented by additional experts depending on the clinical scenario. The team's responsibilities span the entire continuum of care, from diagnostic assessment and procedural planning to complication management and structured follow-up. The concept of lifetime management is gaining importance, aiming for a long-term strategic approach to valve care throughout the patient's lifespan. Given the evolving age boundaries for intervention, an extension of the heart team approach to all patients with AS is warranted. Clearly defined roles, standardized protocols and defined decision-making processes, supported by a dedicated TAVI coordinator, can substantially enhance both efficiency and quality of care. Looking ahead, digital technologies, artificial intelligence and structured upstream screening strategies for asymptomatic AS patients are expected to play an expanding role.

Cardiac computed tomography (CT) is suitable for use in patients with a low to intermediate pretest probability for risk stratification and for a clear exclusion of coronary heart disease. Furthermore, in addition to a purely anatomical depiction of coronary stenosis it enables the morphological assessment of the underlying plaques and a functional assessment of the hemodynamic relevance. The clinical value of cardiac CT is taken into account in the guidelines of the European Society of Cardiology (ESC) on chronic coronary syndrome with a class 1 recommendation. Cardiac CT therefore has an essential gatekeeper function with respect to the indications for coronary interventions. In the field of structural heart diseases cardiac CT is a core element in the preprocedural planning of heart valve interventions and is the first choice procedure in the postinterventional assessment of unclear findings. Therefore, for interventional heart valve replacement CT-based planning is nowadays the established standard in the clinical diagnostics.

Background: Pulmonary arterial hypertension (PAH) is characterized by vascular remodeling and elevated pulmonary vascular resistance. Aortic compliance indicates vascular stiffness and may be increased in PAH. Inhaled iloprost, a prostacyclin analog, is commonly used for PAH treatment and vasoreactivity testing. Its acute effects on aortic compliance remain unclear. This study evaluated the immediate impact of inhaled iloprost on aortic compliance through aortic pulse wave velocity (aPWV) measurements and pressure parameters in patients with PAH undergoing right heart catheterization.

Methods: This single-center, cross-sectional study enrolled patients with group 1 PAH who underwent right heart catheterization with pulmonary vasoreactivity testing between August 2022 and May 2023. Aortic compliance was measured via aPWV before and after inhaling 20 mcg/mL iloprost. On the basis of the post-iloprost changes, 32 patients were categorized into high-aPWV (n = 4) or low-aPWV (n = 28) groups. Multivariate regression analysis identified significant predictors of impaired aortic stiffness.

Results: The median patient age was 54.5 years (42.2-60.5). No significant differences were found between groups regarding percentage reductions in proximal/distal aortic pressure and pulmonary artery pressure after iloprost administration. The QRS interval was a significant predictor of impaired aortic stiffness (odds ratio: 1.072, 95% confidence interval: 1.002-1.197, p = 0.045). The high-aPWV group demonstrated significantly lower QRS intervals compared to the low-aPWV group (79.0 ms [70.5-84.0] vs. 96.0 ms [85.5-102.0], p = 0.011).

Conclusions: Inhaled iloprost effectively reduced both aortic pressure and pulmonary artery pressure regardless of aortic compliance in patients with group 1 PAH. The QRS interval emerged as an independent predictor of impaired aortic stiffness, offering potential for risk stratification in clinical practice.

Infective endocarditis (IE) is a severe disease with high morbidity and mortality rates. Interdisciplinary endocarditis teams, consisting of specialists in cardiology, cardiac surgery, infectious diseases and microbiology, have been shown to improve patient care. Current guidelines of the European Society of Cardiology (ESC) and the American Heart Association (AHA) explicitly recommend the implementation. Observational studies showed significant reductions in hospital and 1‑year mortality, shorter hospital stays and fewer complications. Such multidisciplinary teams enable faster diagnosis through multimodal imaging, e.g. positron emission tomography (PET) computed tomography (CT), an early and targeted antibiotic therapy and optimized surgical care. A rapid referral to specialized centers with established teams clearly improves the prognosis. Registry data such as European Endocarditis (EURO-ENDO) and the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) also promote quality improvement and standardization. The widespread implementation of the endocarditis team concept is recommended.

Background: Acute chest pain is a common emergency department (ED) presentation requiring rapid risk stratification for major adverse cardiovascular events (MACE; including death, myocardial infarction, and urgent revascularization). While the HEART (History, ECG, Age, Risk factors, Troponin) and GRACE scores are widely used, their comparative predictive accuracy for short-term MACE remains unclear. This study aimed to directly compare the diagnostic performance of HEART and GRACE (Global Registry of Acute Coronary Events) in predicting 30-day MACE among ED patients with acute chest pain.

Methods: We systematically searched PubMed, Embase, Cochrane Library, Scopus, and Web of Science from inception to May 2025 for prospective cohort studies directly comparing HEART and GRACE scores. Included studies applied both scores at ED presentation, reported 30-day MACE (death, myocardial infarction, urgent revascularization), and provided data for 2 × 2 contingency tables. Pooled sensitivity, specificity, likelihood ratios (PLR/NLR), diagnostic odds ratio, and area under the curve (AUC) were calculated using a bivariate random-effects model. Heterogeneity was assessed via I² statistics, and subgroup analyses explored sources of variation.

Results: In total, 19 studies (14,862 patients) were included. The HEART score demonstrated significantly higher sensitivity (0.96, 95% CI: 0.94-0.98 vs. 0.88, 95% CI: 0.85-0.91; ratio: 1.09 [1.05-1.14]) and lower negative likelihood ratio (NLR: 0.08, 95% CI: 0.03-0.17 vs. 0.42, 95% CI: 0.39-0.46) than the GRACE score. Specificity was lower for HEART (0.50, 95% CI: 0.41-0.60) versus GRACE (0.61, 95% CI: 0.58-0.64), while GRACE showed higher specificity. HEART also had superior discriminative power (AUC: 0.80, 95% CI: 0.77-0.84 vs. 0.72, 95% CI: 0.69-0.75; ratio: 1.11 [1.07-1.15]). Subgroup analyses confirmed HEART's advantage in sensitivity across geographic regions and age groups, particularly in Eastern populations (sensitivity ratio: 1.57 [1.27-1.93]).

Conclusion: The HEART score outperforms GRACE in sensitivity and rule-out capability (lower NLR) for 30-day MACE in ED patients with acute chest pain, supporting its utility for safe discharge of low-risk individuals. GRACE's higher specificity may aid in identifying high-risk cases requiring intervention. Standardization of troponin assays and MACE definitions is critical for future implementation.

Objective: The coronary sinus (CS) can reflect the pressure and volume load of the right heart chambers. Idiopathic pulmonary arterial hypertension (IPAH) is a progressive, life-threatening disease in which risk assessment plays a critical role. We aimed to evaluate (a) the correlation between CS diameter and risk assessment parameters in IPAH patients and (b) the utility of CS diameter in predicting mortality and hospitalization.

Methods: This retrospective study included 25 IPAH patients. All patients underwent echocardiographic and laboratory examinations, 6‑minute walk test, and cardiopulmonary exercise test on the same day. The follow-up was 16.8 ± 10.1 months. The primary endpoint was mortality or hospitalization. The relationship between CS diameter, established risk parameters, and prognosis was analyzed.

Results: Six patients (24%) were hospitalized, and three patients (12%) died during the follow-up . The mean CS diameter was 9.9 ± 3.7 mm and showed a moderate positive correlation with age (r = 0.560, p = 0.004) and NT-proBNP levels (r = 0.625, p = 0.001); a weak positive correlation with functional class (r = 0.483, p = 0.017); and moderate negative correlations with 6‑min walking distance (r = -0.553, p = 0.005) and peak oxygen uptake (r = -0.506, p = 0.038). Greater CS diameter was associated with older age, higher NT-proBNP levels, and worse functional class, while reduced exercise capacity and peak VO₂ were accompanied by increased CS diameter. A CS diameter > 9 mm predicted mortality and hospitalization with a sensitivity of 77.8% and specificity of 75.0% (area under the curve [AUC]: 0.788; 95% CI: 0.580-0.996; p = 0.019). The Kaplan-Meier curve showed that as CS diameter increased, mortality and hospitalization rates increased significantly.

Conclusion: The CS diameter is a simple, readily available, noninvasive echocardiographic parameter that may be a valuable adjunct to current risk assessment models in IPAH.

Background: The protective function of the tetrandrine (TET)-mediated transient receptor potential vanilloid 2 (TRPV2) channel in myocardial ischemia/reperfusion injury (MI/RI) has been established in numerous investigations. The objective of the current study was to explain how TRPV2 further modulates downstream factors to influence the progression of MI/RI.

Methods: To this end, an MI/RI model in rats and a hypoxia-reoxygenation (H/R) cell model in H9c2 cells were constructed. Based on western blotting analyses, the effects of TRPV2 on the levels of apoptosis-related proteins as well as calcineurin and nuclear factor of activated T cells (NFAT) were ascertained. Evans blue/triphenyltetrazolium chloride (TTC) double staining and H&E staining were, respectively, used to examine the pathological changes and infarction size of myocardial tissues in rats. Cardiomyocyte apoptosis was assessed with TUNEL assays and flow cytometry. Ca²⁺ concentration and reactive oxygen species (ROS) production were determined using a calcium assay kit and dichlorodihydrofluorescein diacetate (DCFH-DA) staining, respectively.

Results: Downregulated TRPV2 showed a significant ameliorative effect on cardiomyocyte histopathology and infarction area. Cardiomyocyte apoptosis, Ca²⁺ concentration, and ROS amounts were also inhibited when TRPV2 was silenced. Furthermore, results indicated that TET could significantly decrease TRPV2, while knocking down TRPV2 markedly suppressed the expression of calcineurin and NFAT.

Conclusion: These findings shed light on the possible mechanisms behind the TET-mediated TRPV2 channel in MI/RI, indicating that TET has protective functions through downregulation of TRPV2 expression and suppression of the Ca²⁺/calcineurin/NFAT pathway.