AimsHypertension is a well-established heart failure (HF) risk factor, especially in the context of adverse left ventricular (LV) remodelling. We aimed to use myocardial flow reserve (MFR) and global longitudinal strain (GLS), markers of subclinical microvascular and myocardial dysfunction, to refine hypertensive HF risk assessment. Methods and resultsConsecutive patients undergoing symptom-prompted

AimsIn epidemiologic cohorts initiated >30 years ago, inflammatory biomarkers, such as interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hsCRP) were shown to independently predict future cardiovascular events with a magnitude of effect comparable to that of low-density lipoprotein cholesterol (LDLC). Whether aggressive contemporary therapy for atherosclerosis has altered these relationships

AimsIn the DAPA-HF trial, the SGLT2 inhibitor dapagliflozin reduced the risk of worsening heart failure (HF) and death in patients with HF and reduced ejection fraction. We examined whether this benefit was consistent in relation to background HF therapy. Methods and resultsIn this post hoc analysis, we examined the effect of study treatment in the following yes/no subgroups: diuretic, digoxin, mineralocorticoid

AimsThe PARADIGM-HF and PARAGON-HF trials tested sacubitril/valsartan against active controls given renin–angiotensin system inhibitors (RASi) are ethically mandated in heart failure (HF) with reduced ejection fraction and are used in the vast majority of patients with HF with preserved ejection fraction. To estimate the effects of sacubitril/valsartan had it been tested against a placebo control,

This editorial refers to ‘Impact of myocardial fibrosis on left ventricular remodelling, recovery, and outcome after transcatheter aortic valve implantation in different haemodynamic subtypes of severe aortic stenosis’, by M. Puls et al., doi:10.1093/eurheartj/ehaa033.

This commentary refers to ‘The role of implantable cardioverter-defibrillators in New York Heart Class I heart failure patients: do not abandon the asymptomatic just yet’, by A.-L.C.J. van der Lingen and C.P. Allaart, doi:10.1093/eurheartj/ehaa180.

This commentary refers to ‘Short-term e-cigarette vapour exposure causes vascular oxidative stress and dysfunction: evidence for a close connection to brain damage and a key role of the phagocytic NADPH oxidase (NOX-2)’, by M. Kuntic et al., doi:10.1093/eurheartj/ehz772.

This commentary refers to ‘The role of implantable cardioverter-defibrillators and sudden cardiac death prevention: indications, device selection and outcome’, by I. Goldenberg et al., doi:10.1093/eurheartj/ehz788.

This commentary refers to ‘Acrolein exposure from electronic cigarettes’, by B. Mayer, doi: 10.1093/eurheartj/ehaa002.

A 36-year-old woman was transferred to our hospital with dizziness and headache for 10 days and had left-side hemiparesis for 1 day. Head computed tomography suggested multiple intracerebral haemorrhages. Digital subtraction angiography showed that the right internal carotid artery was occluded (Panel A, Video S1). During angiography, a mass in the right lung was observed by accident (Panel B). Chest-enhanced

This editorial refers to ‘Clinical application of the 4th Universal Definition of Myocardial Infarction’, by T.S. Hartikainen et al., doi:10.1093/eurheartj/ehaa035.

AimsWe investigated the relationship between clinically assessed left ventricular ejection fraction (LVEF) and survival in a large, heterogeneous clinical cohort. Methods and resultsPhysician-reported LVEF on 403 977 echocardiograms from 203 135 patients were linked to all-cause mortality using electronic health records (1998–2018) from US regional healthcare system. Cox proportional hazards regression

Ventricular pressure–volume (PV) analysis is the reference method for the study of cardiac mechanics. Advances in calibration algorithms and measuring techniques brought new perspectives for its application in different research and clinical settings. Simultaneous PV measurement in the heart chambers offers unique insights into mechanical cardiac efficiency. Beat to beat invasive PV monitoring can

We present a 47-year-old man with end-stage renal failure on haemodialysis. Four years prior, he underwent coronary artery bypass grafting with the left internal mammary artery to the left anterior descending artery with bioprosthetic surgical aortic valve (SAV) replacement [23 mm Carpentier-Edwards Magna Ease (ME)] for ischaemic heart disease and severe aortic regurgitation from a prolapsed non-coronary

AIMS Cardiac amyloidosis typically manifests as heart failure with preserved left ventricular function due to extracellular plaques comprising aggregated TTR. Despite recent success in halting disease progression with a TTR stabilizer and encouraging preliminary findings with TTR silencers, these agents are not targeting preexisting plaques. Herein, we report the development of a novel monoclonal antibody

This commentary refers to ‘2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association’, by P. Ponikowski et al., doi:10.1093/eurheartj/ehw128.

This editorial refers to ‘A novel monoclonal antibody targeting aggregated transthyretin facilitates its removal and functional recovery in an experimental model’, by J. George et al., doi:10.1093/eurheartj/ehz695.

AIMS Right ventricular dysfunction (RVD) is an important determinant of functional status and survival in various diseases states. Data are sparse on the epidemiology and outcome of patients with severe RVD. This study examined the characteristics, aetiology, and survival of patients with severe RVD. METHODS AND RESULTS Retrospective study of consecutive patients with severe RVD diagnosed by transthoracic

A 33-year-old male patient was admitted to our hospital with fever, diarrhoea, and symptoms of cardiogenic shock after cross-country running. Laboratory data showed an lactate of 4.5 mmol/L, increased troponin t (18 557 ng/L), and creatine phosphokinase levels of 4404 U/I. Coronary angiography demonstrated normal coronary arteries with no electrolytic disturbances. Cardiac index of 1.2 L/min/m2, mean

European Heart Journal – Case Reports (EHJ-Case Reports) is a dedicated open access case reports journal.1 During 2019, the journal received over 600 submissions. Of those accepted, each had an important message about patient care. However, we selected the case by Beekman-van Solkema and colleagues, entitled ‘A rare cause of acute ST-elevation myocardial infarction: case report of native aortic valve

The principle of 'sick individuals vs. sick population', a concept pioneered by Geoffrey Rose 35 years ago, is particularly applicable to heart failure (HF). This perspective article summarizes and expands on the Geoffrey Rose lecture given at the European Society of Cardiology meeting held in conjunction with the World Congress of Cardiology, in Paris, 2019. This article focuses on the fact that,

In a rapid response published online by the British Medical Journal, Sommerstein and Gräni1 pushed forward the hypothesis that angiotensin-converting enzyme (ACE) inhibitors (ACE-Is) could act as a potential risk factor for fatal Corona virus disease 2019 (COVID-19) by up-regulating ACE2. This notion was quickly picked up by the lay press and sparked concerns among physicians and patients regarding

Arrhythmogenic cardiomyopathy (ACM) is a heritable cardiomyopathy characterized by frequent ventricular arrhythmias and progressive ventricular dysfunction. Risk of sudden cardiac death is elevated in ACM patients and can be the presenting symptom particularly in younger individuals and athletes. This review describes current understanding of the genetic architecture of ACM and molecular mechanisms

AimsThis study aims to evaluate the long-term effect of bariatric surgery on cardiovascular outcomes of patients with obesity. Methods and resultsA nested cohort study was carried out within the Clinical Practice Research Datalink. The study cohort included the 3701 patients on the database who had undergone bariatric surgery and 3701 age, gender, and body mass index-matched controls. The primary endpoint

The recent outbreak of coronavirus disease 2019 (COVID-19) provides a further challenge in the battle against outbreaks of novel virus infections and has been declared a public health emergency of international concern. Much has been learnt in the course of preceding epidemics, including severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and H1N1 influenza, and it is

This editorial refers to ‘Echocardiographic phenotype and prognosis in transthyretin cardiac amyloidosis’, by L. Chacko et al., doi:10.1093/eurheartj/ehz905.

Systemic vascular inflammation plays multiple maladaptive roles which contribute to the progression and destabilization of atherosclerotic cardiovascular disease (ASCVD). These roles include: (i) driving atheroprogression in the clinically stable phase of disease; (ii) inciting atheroma destabilization and precipitating acute coronary syndromes (ACS); and (iii) responding to cardiomyocyte necrosis

This editorial refers to ‘Cardiovascular magnetic resonance in immune checkpoint inhibitor-associated myocarditis’, by L. Zhang et al., doi:10.1093/eurheartj/ehaa051.

This editorial refers to ‘Clinical characteristics, diagnosis, and risk stratification of pulmonary hypertension in severe tricuspid regurgitation and implications for transcatheter tricuspid valve repair’, by P. Lurz et al., doi:10.1093/eurheartj/ehaa138.

AimsPatients with pulmonary hypertension (PHT) are often excluded from surgical therapies for tricuspid regurgitation (TR). Transcatheter tricuspid valve repair (TTVR) with the MitraClip™ technique is a novel treatment option for these patients. We aimed to assess the role of PHT in severe TR and its implications for TTVR. Methods and resultsA total of 243 patients underwent TTVR at two centres. One

A 37-year-old male patient was admitted to hospital on 14 January 2020, with chest pain and dyspnoea for 3 days, accompanied by diarrhoea. His blood pressure decreased to 80/50 mmHg. X-ray chest film showed significant enlargement of the heart (Panel A: cardiothoracic ratio 0.70). Chest computed tomography (CT) examination indicated pulmonary infection, enlarged heart, and pleural effusion (Panels

Relates to: ‘Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population: guidance for clinicians to prevent coronary heart disease : Consensus Statement of the European Atherosclerosis Society ’ (https://doi.org/10.1093/eurheartj/eht273)

AIMS The benefit an individual can expect from preventive therapy varies based on risk-factor burden, competing risks, and treatment duration. We developed and validated the LIFEtime-perspective CardioVascular Disease (LIFE-CVD) model for the estimation of individual-level 10 years and lifetime treatment-effects of cholesterol lowering, blood pressure lowering, antithrombotic therapy, and smoking cessation

AimsAnxiety, depression, and reduced quality of life (QoL) are common in patients with implantable cardioverter-defibrillators (ICDs). Treatment options are limited and insufficiently defined. We evaluated the efficacy of a web-based intervention (WBI) vs. usual care (UC) for improving psychosocial well-being in ICD patients with elevated psychosocial distress. Methods and resultsThis multicentre,

This paper was guest edited by Allan Davies

A 46-year-old female patient presented to our hospital for a suspected mass in the right atrium with no complaint of any severe symptoms. The patient had a medical history of hysteromyomectomy 5 years ago. Echocardiography on admission demonstrated a 6.27 cm × 3.49 cm cystic and solid space-occupying lesion swinging front and back in the right heart, resulting in diastolic tricuspid stenosis (Panels

AIMS To quantify the association of combined sleep behaviours and genetic susceptibility with the incidence of cardiovascular disease (CVD). METHODS AND RESULTS This study included 385 292 participants initially free of CVD from UK Biobank. We newly created a healthy sleep score according to five sleep factors and defined the low-risk groups as follows: early chronotype, sleep 7-8 h per day, never/rarely

AIMS We examined the extent to which associations between education and cardiovascular disease (CVD) morbidity and mortality are attributable to income and work stress. METHODS AND RESULTS We included all employed Danish residents aged 30-59 years in 2000. Cardiovascular disease morbidity analyses included 1 638 270 individuals, free of cardiometabolic disease (CVD or diabetes). Mortality analyses

This editorial refers to ‘Contribution of income and job strain to the association between education and cardiovascular disease in 1.6 million Danish employees’††, by E. Framke et al., on page 1164.

A 15-year-old boy was born with cleft lip and palate and congenital aortic valve lesions. The symptoms of chest tightness and dizziness can be relieved after rest. A physical examination revealed slight cyanosis and grade 2/6 systolic murmur in the aortic valve auscultation area. The first echocardiography only found the aortic valve as a four-lobe deformity (PanelA) with moderate to severe regurgitation

Cardiovascular and cerebrovascular diseases constantly rate among the leading global causes or morbidity and mortality worldwide. The last decades have seen a constant and significant decrease in the incidence of these diseases driven by the growing awareness of risk factors and the progressive dissection of pathophysiological mechanisms. Yet, epidemiological studies forecast a rebound effect in the

The patient with a history of dilated cardiomyopathy and severely reduced left ventricular (LV) function presented with severe heart failure. Transthoracic echo showed an LV ejection fraction of 21% and an LV thrombus (Panel A). Severe low-flow-low-gradient stenosis of a bicuspid aortic valve with a mean gradient of 22 mmHg and calculated aortic valve orifice area of 1.0 cm2 (indexed orifice area 0

A 46-year-old man with chronic thromboembolic pulmonary hypertension (CTEPH) was referred to our hospital to undergo pulmonary endarterectomy (PEA). Tc-99m MAA lung perfusion scintigraphy showed multiple perfusion defects in the bilateral lung field (Panel A, arrows). Right heart catheterization including pulmonary angiography revealed pulmonary hypertension (mean PAP 31 mmHg and PVR 5.2 Woods Unit)

A 63-year-old man was hospitalized due to unstable angina and was subsequently implanted with a 4.0 × 28 mm third-generation sirolimus-eluting stent (SES) in the proximal left anterior descending artery (Panels A and B). Twelve months after implantation, he developed chest pain and underwent coronary angiography which revealed in-stent restenosis (ISR) (Panels C–E). Percutaneous coronary intervention

This commentary refers to ‘Real-world risk of cardiovascular outcomes associated with hypertriglyceridaemia among individuals with atherosclerotic cardiovascular disease and potential eligibility for emerging therapies’, by P.R. Lawler et al., doi: 10.1093/eurheartj/ehz767.

This commentary refers to ‘Real-world risk of cardiovascular outcomes associated with hypertriglyceridaemia among individuals with atherosclerotic cardiovascular disease and potential eligibility for emerging therapies’, by P.R. Lawler et al., doi: 10.1093/eurheartj/ehz767.

AimsDespite widely available risk stratification tools, safe and effective anticoagulant options, and guideline recommendations, anticoagulation for stroke prevention in atrial fibrillation (AF) is underprescribed. We created and evaluated an alert-based computerized decision support (CDS) strategy to increase anticoagulation prescription in hospitalized AF patients at high risk for stroke. Methods

This editorial refers to ‘One-year outcomes in atrial fibrillation presenting during infections: a nationwide registry-based study’, by A. Gundlund et al., doi:10.1093/eurheartj/ehz873.

AimsThromboprophylaxis guidelines for patients with concurrent atrial fibrillation (AF) during infections are unclear and not supported by data. We compared 1-year outcomes in patients with infection-related AF and infection without AF. Methods and resultsBy crosslinking Danish nationwide registry data, AF naïve patients admitted with infection (1996–2016) were identified. Those with AF during the

Atrial fibrillation (AF) is the most common cardiac arrhythmia and prevalence is predicted to double over the next 30 years due to changing demographics and the rise in prevalence of risk factors such as hypertension and diabetes. Atrial fibrillation is associated with a five-fold increased stroke risk, but anticoagulation in eligible patients can reduce this risk by around 65%. Many people with AF

A 68-year-old man underwent transcatheter aortic valve implantation with a 29-mm self-expanding valve in 2018. Postoperatively, he developed new left bundle branch block. At discharge, an event monitor was placed, and it did not reveal any high-grade atrioventricular (AV) block episodes. One year later, the patient had a syncopal episode. After regaining consciousness, he immediately used his Apple

A 62-year-old woman was admitted to our hospital due to cardiopulmonary arrest. She had been prescribed flecainide 200 mg a day for paroxysmal atrial fibrillation for 5 years, and garenoxacin 400 mg a day was added because of infectious enteritis. Initially, her monitor electrocardiogram in the ambulance showed a sine-wave-pattern ventricular tachycardia with a cycle length of 320 ms (Panel A), which

A 66-year-old male patient with a history of right-sided pneumonectomy for lung cancer and persistent atrial fibrillation (AF) presented with symptomatic bradycardia–tachycardia episodes. The patient had undergone repeat pulmonary vein isolation and extensive left atrial substrate ablation for treatment of AF-mediated cardiomyopathy. At admission, the patient was in sinus rhythm with narrow QRS complex

The understanding of atrial fibrillation (AF) evolved from a sole rhythm disturbance towards the complex concept of a cardiomyopathy based on arrhythmia substrates. There is evidence that atrial fibrosis can be visualized using late gadolinium enhancement cardiac magnetic resonance imaging and that it is a powerful predictor for the outcome of AF interventions. However, a strategy of an individual

This editorial refers to ‘Alert-based computerized decision support for high-risk hospitalized patients with atrial fibrillation not prescribed anticoagulation: a randomized, controlled trial (AF-ALERT)’††, by G. Piazza et al., on page 1086.

AIMS To evaluate the fracture risk among patients with atrial fibrillation (AF) treated with non-vitamin K antagonist oral anticoagulants (NOACs) or warfarin. METHODS AND RESULTS We conducted a real-world nationwide retrospective cohort study using Taiwan's National Health Insurance Research Database. All adult patients in Taiwan newly diagnosed with AF between 2012 and 2016 who received NOACs or warfarin

AIMS As health systems around the world increasingly look to measure and improve the value of care that they provide to patients, being able to measure the outcomes that matter most to patients is vital. To support the shift towards value-based health care in atrial fibrillation (AF), the International Consortium for Health Outcomes Measurement (ICHOM) assembled an international Working Group (WG)

Cardiac surgery is the current gold standard for repair of mitral valve regurgitation. For high-risk patients, percutaneous repair deducted from the surgical technique of Alfieri has been developed and successfully introduced in the last decade. This procedure involves the transcatheter placement of 1 or more MitraClip® devices (Abbott Inc., Chicago, IL, USA) under echocardiographic and fluoroscopic