当前期刊: European Heart Journal Go to current issue    加入关注   
显示样式:        排序: 导出
我的关注
我的收藏
您暂时未登录!
登录
  • Echocardiographic phenotype and prognosis in transthyretin cardiac amyloidosis
    Eur. Heart J. (IF 23.239) Pub Date : 2020-01-17
    Chacko L, Martone R, Bandera F, et al.

    AimsTransthyretin amyloidosis cardiomyopathy (ATTR-CM) is an increasingly recognized cause of heart failure. We sought to characterize the structural and functional echocardiographic phenotype across the spectrum of wild-type (wtATTR-CM) and hereditary (hATTR-CM) transthyretin cardiomyopathy and the echocardiographic features predicting prognosis. Methods and resultsWe studied 1240 patients with ATTR-CM who underwent prospective protocolized evaluations comprising full echocardiographic assessment and survival between 2000 and 2019, comprising 766 with wtATTR-CM and 474 with hATTR-CM, of whom 314 had the V122I variant and 127 the T60A variant. At diagnosis, patients with V122I-hATTR-CM had the most severe degree of systolic and diastolic dysfunction across all echocardiographic parameters and patients with T60AhATTR-CM the least; patients with wtATTR-CM had intermediate features. Stroke volume index, right atrial area index, longitudinal strain, and E/e’ were all independently associated with mortality (P < 0.05 for all). Severe aortic stenosis (AS) was also independently associated with prognosis, conferring a significantly shorter survival (median survival 22 vs. 53 months, P = 0.001). ConclusionThe three distinct genotypes present with varying degrees of severity. Echocardiography indicates a complex pathophysiology in which both systolic and diastolic function are independently associated with mortality. The presence of severe AS was independently associated with significantly reduced patient survival.

    更新日期:2020-01-17
  • Nickel allergy impacts decision-making in secondary prevention of systemic embolism in patients with patent foramen ovale
    Eur. Heart J. (IF 23.239) Pub Date : 2020-01-14
    Bartel T, Müller S.

    The comment refers to ‘European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism’, by C. Pristipino et al., 2019;40:3182–3195.

    更新日期:2020-01-14
  • Long-term outcomes of chronic coronary syndrome worldwide: insights from the international CLARIFY registry.
    Eur. Heart J. (IF 23.239) Pub Date : 2019-09-11
    Emmanuel Sorbets,Kim M Fox,Yedid Elbez,Nicolas Danchin,Paul Dorian,Roberto Ferrari,Ian Ford,Nicola Greenlaw,Paul R Kalra,Zofia Parma,Svetlana Shalnova,Jean-Claude Tardif,Michal Tendera,José Luis Zamorano,Emmanuelle Vidal-Petiot,Philippe Gabriel Steg

    AIMS Over the last decades, the profile of chronic coronary syndrome has changed substantially. We aimed to determine characteristics and management of patients with chronic coronary syndrome in the contemporary era, as well as outcomes and their determinants. METHODS AND RESULTS Data from 32 703 patients (45 countries) with chronic coronary syndrome enrolled in the prospective observational CLARIFY registry (November 2009 to June 2010) with a 5-year follow-up, were analysed. The primary outcome [cardiovascular death or non-fatal myocardial infarction (MI)] 5-year rate was 8.0% [95% confidence interval (CI) 7.7-8.3] overall [male 8.1% (7.8-8.5); female 7.6% (7.0-8.3)]. A cox proportional hazards model showed that the main independent predictors of the primary outcome were prior hospitalization for heart failure, current smoking, atrial fibrillation, living in Central/South America, prior MI, prior stroke, diabetes, current angina, and peripheral artery disease. There was an interaction between angina and prior MI (P = 0.0016); among patients with prior MI, angina was associated with a higher primary event rate [11.8% (95% CI 10.9-12.9) vs. 8.2% (95% CI 7.8-8.7) in patients with no angina, P < 0.001], whereas among patients without prior MI, event rates were similar for patients with [6.3% (95% CI 5.4-7.3)] or without angina [6.4% (95% CI 5.9-7.0)], P > 0.99. Prescription rates of evidence-based secondary prevention therapies were high. CONCLUSION This description of the spectrum of chronic coronary syndrome patients shows that, despite high rates of prescription of evidence-based therapies, patients with both angina and prior MI are an easily identifiable high-risk group who may deserve intensive treatment. CLINICAL REGISTRY ISRCTN43070564.

    更新日期:2020-01-14
  • 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromesThe Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC)
    Eur. Heart J. (IF 23.239) Pub Date : 2019-08-31
    Knuuti J, Wijns W, Saraste A, et al.

    Guidelineschronic coronary syndromesangina pectorismyocardial ischaemiacoronary artery diseasediagnostic testingimagingrisk assessmentlifestyle modificationsanti-ischaemic drugsantithrombotic therapylipid-lowering drugsmyocardial revascularizationmicrovascular anginavasospastic anginascreening

    更新日期:2020-01-14
  • Corrigendum to: Relationship between coronary plaque morphology of the left anterior descending artery and 12 months clinical outcome: the CLIMA study
    Eur. Heart J. (IF 23.239) Pub Date : 2019-08-29

    Corrigendum to: Relationship between coronary plaque morphology of the left anterior descending artery and 12 months clinical outcome: the CLIMA study [Eur Heart J 2020;41:383–391].

    更新日期:2020-01-14
  • Relationship between coronary plaque morphology of the left anterior descending artery and 12 months clinical outcome: the CLIMA study
    Eur. Heart J. (IF 23.239) Pub Date : 2019-08-06
    Prati F, , Romagnoli E, et al.

    AimsThe CLIMA study, on the relationship between coronary plaque morphology of the left anterior descending artery and twelve months clinical outcome, was designed to explore the predictive value of multiple high-risk plaque features in the same coronary lesion [minimum lumen area (MLA), fibrous cap thickness (FCT), lipid arc circumferential extension, and presence of optical coherence tomography (OCT)-defined macrophages] as detected by OCT. Composite of cardiac death and target segment myocardial infarction was the primary clinical endpoint. Methods and resultsFrom January 2013 to December 2016, 1003 patients undergoing OCT evaluation of the untreated proximal left anterior descending coronary artery in the context of clinically indicated coronary angiogram were prospectively enrolled at 11 independent centres (clinicaltrial.gov identifier NCT02883088). At 1-year, the primary clinical endpoint was observed in 37 patients (3.7%). In a total of 1776 lipid plaques, presence of MLA <3.5 mm2 [hazard ratio (HR) 2.1, 95% confidence interval (CI) 1.1–4.0], FCT <75 µm (HR 4.7, 95% CI 2.4–9.0), lipid arc circumferential extension >180° (HR 2.4, 95% CI 1.2–4.8), and OCT-defined macrophages (HR 2.7, 95% CI 1.2–6.1) were all associated with increased risk of the primary endpoint. The pre-specified combination of plaque features (simultaneous presence of the four OCT criteria in the same plaque) was observed in 18.9% of patients experiencing the primary endpoint and was an independent predictor of events (HR 7.54, 95% CI 3.1–18.6). ConclusionThe simultaneous presence of four high-risk OCT plaque features was found to be associated with a higher risk of major coronary events.

    更新日期:2020-01-14
  • Risky lipids: refining the ceramide score that measures cardiovascular health
    Eur. Heart J. (IF 23.239) Pub Date : 2019-08-01
    Poss A, Holland W, Summers S.

    This editorial refers to ‘Development and validation of a ceramide- and phospholipid-based cardiovascular risk estimation score for coronary artery disease patients’††, by M. Hilvo et al., on page 371.

    更新日期:2020-01-14
  • Development and validation of a ceramide- and phospholipid-based cardiovascular risk estimation score for coronary artery disease patients
    Eur. Heart J. (IF 23.239) Pub Date : 2019-06-18
    Hilvo M, Meikle P, Pedersen E, et al.

    AimsDistinct ceramide lipids have been shown to predict the risk for cardiovascular disease (CVD) events, especially cardiovascular death. As phospholipids have also been linked with CVD risk, we investigated whether the combination of ceramides with phosphatidylcholines (PCs) would be synergistic in the prediction of CVD events in patients with atherosclerotic coronary heart disease in three independent cohort studies. Methods and resultsCeramides and PCs were analysed using liquid chromatography–mass spectrometry (LC-MS) in three studies: WECAC (The Western Norway Coronary Angiography Cohort) (N = 3789), LIPID (Long-Term Intervention with Pravastatin in Ischaemic Disease) trial (N = 5991), and KAROLA (Langzeiterfolge der KARdiOLogischen Anschlussheilbehandlung) (N = 1023). A simple risk score, based on the ceramides and PCs showing the best prognostic features, was developed in the WECAC study and validated in the two other cohorts. This score was highly significant in predicting CVD mortality [multiadjusted hazard ratios (HRs; 95% confidence interval) per standard deviation were 1.44 (1.28–1.63) in WECAC, 1.47 (1.34–1.61) in the LIPID trial, and 1.69 (1.31–2.17) in KAROLA]. In addition, a combination of the risk score with high-sensitivity troponin T increased the HRs to 1.63 (1.44–1.85) and 2.04 (1.57–2.64) in WECAC and KAROLA cohorts, respectively. The C-statistics in WECAC for the risk score combined with sex and age was 0.76 for CVD death. The ceramide-phospholipid risk score showed comparable and synergistic predictive performance with previously published CVD risk models for secondary prevention. ConclusionA simple ceramide- and phospholipid-based risk score can efficiently predict residual CVD event risk in patients with coronary artery disease.

    更新日期:2020-01-14
  • Intravascular lithotripsy for treatment of stent underexpansion secondary to severe coronary calcification
    Eur. Heart J. (IF 23.239) Pub Date : 2018-11-19
    Ali Z, McEntegart M, Hill J, et al.

    A 73-year old man was found to have proximal left anterior descending (LAD) in-stent stenosis (ISS) secondary to stent underexpansion as a cause of limiting angina. Despite serial dilations, including 3.5 mm OPN NC® High-Pressure PTCA (SIS Medical AG; Switzerland) to >40 atm, percutaneous coronary intervention (PCI) was unsuccessful on multiple occasions (Panel A). In September 2018, the patient re-presented with recurrent angina, and angiography identified a high-grade proximal LAD lesion (Panel B, Supplementary material onlineSupplementary material online, Video S1). Optical coherence tomography (OCT) confirmed severe ISS with minimal stent area (MSA) 1.09 mm2 secondary to stent underexpansion due to concentric severe coronary calcification (Panel C–F, Supplementary material onlineSupplementary material online, Video S2). A C2 4.0 × 12 mm Shockwave (Fremont, CA, USA) intravascular lithotripsy (IVL) balloon was advanced across the lesion and inflated to 4 atm. During the second round of 10 pulses, the balloon fully expanded (Panel G, Supplementary material onlineSupplementary material online, Video S3). Angiography confirmed successful PCI with minimal residual diameter stenosis (Panel H, Supplementary material onlineSupplementary material online, Video S4). Repeat OCT showed multiple calcium fractures at the site of ISS, with post-IVL stent area of 6.47 mm2 (Panel I–L, Supplementary material onlineSupplementary material online, Video S5). The procedure was completed using a 4.0 × 15 mm drug-eluting balloon (SeQuent, B Braun) without additional DES placement and a final stent area of 6.55 mm2 at the site of previous MSA. IVL is a new technology, in which multiple lithotripsy emitters mounted on a traditional catheter platform deliver localized pulsatile sonic pressure waves liberating extreme bursts of energy. We illustrate treatment of high-grade ISS secondary to severe coronary calcification with IVL for the first time, where historically there have been limited treatment options.

    更新日期:2020-01-14
  • Aspirin desensitization procedures in aspirin intolerant patients: a neglected topic in the ESC 2019 Chronic Coronary Syndrome guidelines
    Eur. Heart J. (IF 23.239) Pub Date : 2019-12-23
    Bianco M, Rossini R, Cerrato E, et al.

    This commentary refers to ‘2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes’, by J. Knuuti et al., on page 407.

    更新日期:2020-01-14
  • Intolerance to aspirin in patients undergoing percutaneous coronary intervention in the setting of chronic coronary syndromes: perspectives from the ESC 2019 Chronic Coronary Syndromes guidelines
    Eur. Heart J. (IF 23.239) Pub Date : 2019-12-23
    Storey R, Valgimigli M, Cuisset T, et al.

    This commentary refers to ‘Aspirin desensitization procedures in aspirin intolerant patients: a neglected topic in the ESC 2019 Chronic Coronary Syndrome guidelines’, by M. Bianco et al., on page 482.

    更新日期:2020-01-14
  • Solving coronary risk: time to feed machines some calcium (score) supplements
    Eur. Heart J. (IF 23.239) Pub Date : 2019-10-11
    Sengupta P, Shrestha S, Zeb I.

    This editorial refers to ‘Machine learning of clinical variables and coronary artery calcium scoring for the prediction of obstructive coronary artery disease on coronary computed tomography angiography: analysis from the CONFIRM registry’††, by S.J. Al’Aref et al., on page 359.

    更新日期:2020-01-14
  • Pursuit for the detection of vulnerable plaque
    Eur. Heart J. (IF 23.239) Pub Date : 2019-09-24
    Jang I.

    This editorial refers to ‘Relationship between coronary plaque morphology of the left anterior descending artery and 12 months clinical outcome: the CLIMA study’††, by F. Prati et al., on page 383.

    更新日期:2020-01-14
  • Machine learning of clinical variables and coronary artery calcium scoring for the prediction of obstructive coronary artery disease on coronary computed tomography angiography: analysis from the CONFIRM registry
    Eur. Heart J. (IF 23.239) Pub Date : 2019-09-12
    Al’Aref S, Maliakal G, Singh G, et al.

    AimsSymptom-based pretest probability scores that estimate the likelihood of obstructive coronary artery disease (CAD) in stable chest pain have moderate accuracy. We sought to develop a machine learning (ML) model, utilizing clinical factors and the coronary artery calcium score (CACS), to predict the presence of obstructive CAD on coronary computed tomography angiography (CCTA). Methods and resultsThe study screened 35 281 participants enrolled in the CONFIRM registry, who underwent ≥64 detector row CCTA evaluation because of either suspected or previously established CAD. A boosted ensemble algorithm (XGBoost) was used, with data split into a training set (80%) on which 10-fold cross-validation was done and a test set (20%). Performance was assessed of the (1) ML model (using 25 clinical and demographic features), (2) ML + CACS, (3) CAD consortium clinical score, (4) CAD consortium clinical score + CACS, and (5) updated Diamond-Forrester (UDF) score. The study population comprised of 13 054 patients, of whom 2380 (18.2%) had obstructive CAD (≥50% stenosis). Machine learning with CACS produced the best performance [area under the curve (AUC) of 0.881] compared with ML alone (AUC of 0.773), CAD consortium clinical score (AUC of 0.734), and with CACS (AUC of 0.866) and UDF (AUC of 0.682), P < 0.05 for all comparisons. CACS, age, and gender were the highest ranking features. ConclusionA ML model incorporating clinical features in addition to CACS can accurately estimate the pretest likelihood of obstructive CAD on CCTA. In clinical practice, the utilization of such an approach could improve risk stratification and help guide downstream management.

    更新日期:2020-01-14
  • Anti-ischaemic medication must be adapted to each patient’s characteristics and preferences in patients with chronic coronary syndromes
    Eur. Heart J. (IF 23.239) Pub Date : 2019-12-28
    Knuuti J, Wijns W, Funck-Brentano C.

    This commentary refers to ‘Beta blockers, calcium channel blockers, and long-acting nitrates for patients with stable angina and low blood pressure levels: should this recommendation be reconsidered?’, by M.S. Kallistratos et al., on page 479.

    更新日期:2020-01-14
  • Beta blockers, calcium channel blockers, and long-acting nitrates for patients with stable angina and low blood pressure levels: should this recommendation be reconsidered?
    Eur. Heart J. (IF 23.239) Pub Date : 2019-12-28
    Kallistratos M, Poulimenos L, Manolis A.

    This commentary refers to ‘2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes’, by J. Knuuti et al., on page 407.

    更新日期:2020-01-14
  • 更新日期:2020-01-14
  • Mechanistic insights into the superior clinical efficacy of prasugrel over ticagrelor
    Eur. Heart J. (IF 23.239) Pub Date : 2020-01-13
    Schüpke S, Kastrati A.

    This editorial refers to ‘Effects of clopidogrel vs. prasugrel vs. ticagrelor on endothelial function, inflammatory parameters, and platelet function in patients with acute coronary syndrome undergoing coronary artery stenting: a randomized, blinded, parallel study’, by B. Schnorbus et al., doi:10.1093/eurheartj/ehz917.

    更新日期:2020-01-13
  • Durability of transcatheter bioprosthetic aortic valves
    Eur. Heart J. (IF 23.239) Pub Date : 2020-01-06
    Sondergaard L.

    This editorial refers to ‘Long-term clinical outcome and performance of transcatheter aortic valve replacement with a self-expandable bioprostheses’, by L. Testa et al., doi: 10.1093/eurheartj/ehz925.

    更新日期:2020-01-10
  • Long-term clinical outcome and performance of transcatheter aortic valve replacement with a self-expandable bioprosthesis
    Eur. Heart J. (IF 23.239) Pub Date : 2020-01-06
    Testa L, Latib A, Brambilla N, et al.

    Aims In the last decade, transcatheter aortic valve (TAV) replacement determined a paradigm shift in the treatment of patients with severe symptomatic aortic stenosis. Data on long-term TAV performance are still limited. We sought to evaluate the clinical and haemodynamic outcomes of the CoreValve self-expandable valve up to 8-year follow-up (FU). Methods and results Nine hundred and ninety inoperable or high-risk patients were treated with the CoreValve TAV in eight Italian Centres from June 2007 to December 2011. The median FU was 4.4 years (interquartile range 1.4–6.7 years). Longest FU reached 11 years. A total of 728 died within 8-year FU (78.3% mortality from Kaplan–Meier curve analysis). A significant functional improvement was observed in the majority of patients and maintained over time, with 79.3% of surviving patients still classified New York Heart Association class ≤ II at 8 years. Echocardiographic data showed that the mean transprosthetic aortic gradient remained substantially unchanged (9 ± 4 mmHg at discharge, 9 ± 5 mmHg at 8 years, P = 0.495). The rate of Grade 0/1 paravalvular leak was consistent during FU with no significant change from post-procedure to FU ≥5 years in paired analysis (P = 0.164). Structural valve deterioration (SVD) and late bioprosthetic valve failure (BVF) were defined according to a modification of the 2017 EAPCI/ESC/EACTS criteria. In cumulative incidence functions at 8 years, moderate and severe SVD were 3.0% [95% confidence interval (CI) 2.1–4.3%] and 1.6% (95% CI 0.6–3.9%), respectively, while late BVF was 2.5% (95% CI 1.2–5%). Conclusion While TAVs are questioned about long-term performance and durability, the results of the present research provide reassuring 8-year evidence on the CoreValve first-generation self-expandable bioprosthesis.

    更新日期:2020-01-10
  • BNP level and post-transcatheter aortic valve replacement outcome: an intriguing J-shaped relationship
    Eur. Heart J. (IF 23.239) Pub Date : 2020-01-06
    Rubattu S, Volpe M.

    This editorial refers to ‘Low and elevated B-type natriuretic peptide levels are associated with increased mortality in patients with preserved ejection fraction undergoing transcatheter aortic valve replacement: an analysis of the PARTNER II trial and registry’, by S. Chen et al., doi:10.1093/eurheartj/ehz892.

    更新日期:2020-01-10
  • How much can acute heart failure patients with low basic blood pressure (systolic blood pressure 90–100 mmHg) benefit from the use of vasodilators?
    Eur. Heart J. (IF 23.239) Pub Date : 2020-01-10
    Zhou Y, Wen J, Nie J.

    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.

    更新日期:2020-01-10
  • Machine learning-based mortality prediction of patients undergoing cardiac resynchronization therapy: the SEMMELWEIS-CRT score
    Eur. Heart J. (IF 23.239) Pub Date : 2020-01-10
    Tokodi M, Schwertner W, Kovács A, et al.

    AimsOur aim was to develop a machine learning (ML)-based risk stratification system to predict 1-, 2-, 3-, 4-, and 5-year all-cause mortality from pre-implant parameters of patients undergoing cardiac resynchronization therapy (CRT). Methods and resultsMultiple ML models were trained on a retrospective database of 1510 patients undergoing CRT implantation to predict 1- to 5-year all-cause mortality. Thirty-three pre-implant clinical features were selected to train the models. The best performing model [SEMMELWEIS-CRT score (perSonalizEd assessMent of estiMatEd risk of mortaLity With machinE learnIng in patientS undergoing CRT implantation)], along with pre-existing scores (Seattle Heart Failure Model, VALID-CRT, EAARN, ScREEN, and CRT-score), was tested on an independent cohort of 158 patients. There were 805 (53%) deaths in the training cohort and 80 (51%) deaths in the test cohort during the 5-year follow-up period. Among the trained classifiers, random forest demonstrated the best performance. For the prediction of 1-, 2-, 3-, 4-, and 5-year mortality, the areas under the receiver operating characteristic curves of the SEMMELWEIS-CRT score were 0.768 (95% CI: 0.674–0.861; P < 0.001), 0.793 (95% CI: 0.718–0.867; P < 0.001), 0.785 (95% CI: 0.711–0.859; P < 0.001), 0.776 (95% CI: 0.703–0.849; P < 0.001), and 0.803 (95% CI: 0.733–0.872; P < 0.001), respectively. The discriminative ability of our model was superior to other evaluated scores. ConclusionThe SEMMELWEIS-CRT score (available at semmelweiscrtscore.com) exhibited good discriminative capabilities for the prediction of all-cause death in CRT patients and outperformed the already existing risk scores. By capturing the non-linear association of predictors, the utilization of ML approaches may facilitate optimal candidate selection and prognostication of patients undergoing CRT implantation.

    更新日期:2020-01-10
  • Resting heart rate and cardiovascular outcomes in diabetic and non-diabetic individuals at high cardiovascular risk analysis from the ONTARGET/TRANSCEND trials
    Eur. Heart J. (IF 23.239) Pub Date : 2018-12-24
    Böhm M, Schumacher H, Teo K, et al.

    AimsResting heart rate (RHR) has been shown to be associated with cardiovascular outcomes in various conditions. It is unknown whether different levels of RHR and different associations with cardiovascular outcomes occur in patients with or without diabetes, because the impact of autonomic neuropathy on vascular vulnerability might be stronger in diabetes. Methods and resultsWe examined 30 937 patients aged 55 years or older with a history of or at high risk for cardiovascular disease and after myocardial infarction, stroke, or with proven peripheral vascular disease from the ONTARGET and TRANSCEND trials investigating ramipril, telmisartan, and their combination followed for a median of 56 months. We analysed the association of mean achieved RHR on-treatment with the primary composite outcome of cardiovascular death, myocardial infarction, stroke, hospitalization for heart failure, the components of the composite primary outcome, and all-cause death as continuous and categorical variables. Data were analysed by Cox regression analysis, ANOVA, and χ2 test. These trials were registered with ClinicalTrials.gov.number NCT00153101. Patients were recruited from 733 centres in 40 countries between 1 December 2001 and 31 July 2008 (ONTARGET) and 1 November 2001 until 30 May 2004 (TRANSCEND). In total, 19 450 patients without diabetes and 11 487 patients with diabetes were stratified by mean RHR. Patients with diabetes compared to no diabetes had higher RHRs (71.8 ± 9.0 vs. 67.9 ± 8.8, P < 0.0001). In the categories of <60 bpm, 60 ≤ 65 bpm, 65 ≤ 70 bpm, 70 ≤ 75 bpm, 75 ≤ 80 bpm and ≥80 bpm, non-diabetic patients had an increased hazard of the primary outcome with mean RHR of 75 ≤ 80 bpm (adjusted hazard ratio [HR] 1.17 (1.01–1.36)) compared to RHR 60 ≤ 65 bpm. For patients with in-trial RHR ≥80 bpm the hazard ratios were highest (diabetes: 1.96 (1.64–2.34), no diabetes: 1.73 (1.49–2.00), For cardiovascular death hazards were also clearly increased at RHR ≥80 bpm (diabetes [1.99, (1.53–2.58)], no diabetes [1.73 (1.38–2.16)]. Similar results were obtained for hospitalization for heart failure and all-cause death while the effect of RHR on myocardial infarction and stroke was less pronounced. Results were robust after adjusting for various risk indicators including beta-blocker use and atrial fibrillation. No significant association to harm was observed at lower RHR. ConclusionMean RHR above 75–80 b.p.m. was associated with increased risk for cardiovascular outcomes except for stroke. Since in diabetes, high RHR is associated with higher absolute event numbers and patients have higher RHRs, this association might be of particular clinical importance in diabetes. These data suggest that RHR lowering in patients with RHRs above 75–80 b.p.m. needs to be studied in prospective trials to determine if it will reduce outcomes in diabetic and non-diabetic patients at high cardiovascular risk. Clinical Trial registrationhttp://clinicaltrials.gov.Unique identifier: NCT00153101.

    更新日期:2020-01-07
  • Response to ‘The possible role of insulin and glucagon in patients with heart failure and Type 2 diabetes’
    Eur. Heart J. (IF 23.239) Pub Date : 2019-04-28
    Bertero E, Sequeira V, Heymans S, et al.

    This commentary refers to ‘The possible role of insulin and glucagon in patients with heart failure and Type 2 diabetes’, by M. Skelin et al., on page 325.

    更新日期:2020-01-07
  • The possible role of insulin and glucagon in patients with heart failure and Type 2 diabetes
    Eur. Heart J. (IF 23.239) Pub Date : 2019-04-28
    Skelin M, Lucijanic M, Javor E.

    This commentary refers to ‘Heart failure and diabetes: metabolic alterations and therapeutic interventions: a state-of-the-art review from the Translational Research Committee of the Heart Failure Association–European Society of Cardiology’, by C. Maack et al., 2018;39:4243–4254.

    更新日期:2020-01-07
  • Body mass index and body composition in relation to 14 cardiovascular conditions in UK Biobank: a Mendelian randomization study
    Eur. Heart J. (IF 23.239) Pub Date : 2019-06-13
    Larsson S, Bäck M, Rees J, et al.

    AimsThe causal role of adiposity for several cardiovascular diseases (CVDs) is unclear. Our primary aim was to apply the Mendelian randomization design to investigate the associations of body mass index (BMI) with 13 CVDs and arterial hypertension. We also assessed the roles of fat mass and fat-free mass on the same outcomes. Methods and resultsSingle-nucleotide polymorphisms associated with BMI and fat mass and fat-free mass indices were used as instrumental variables to estimate the associations with the cardiovascular conditions among 367 703 UK Biobank participants. After correcting for multiple testing, genetically predicted BMI was significantly positively associated with eight outcomes, including and with decreasing magnitude of association: aortic valve stenosis, heart failure, deep vein thrombosis, arterial hypertension, peripheral artery disease, coronary artery disease, atrial fibrillation, and pulmonary embolism. The odds ratio (OR) per 1 kg/m2 increase in BMI ranged from 1.06 [95% confidence interval (CI) 1.02–1.11; P=2.6 × 10−3] for pulmonary embolism to 1.13 (95% CI 1.05–1.21; P=1.2 × 10−3) for aortic valve stenosis. There was suggestive evidence of positive associations of genetically predicted fat mass index with nine outcomes (P<0.05). The strongest magnitude of association was with aortic valve stenosis (OR per 1 kg/m2 increase in fat mass index 1.46, 95% CI 1.13–1.88; P=3.9 × 10−3). There was suggestive evidence of inverse associations of fat-free mass index with atrial fibrillation, ischaemic stroke, and abdominal aortic aneurysm. ConclusionThis study provides evidence that higher BMI and particularly fat mass index are associated with increased risk of aortic valve stenosis and most other cardiovascular conditions.

    更新日期:2020-01-07
  • Cyclase-associated protein 1 is a binding partner of proprotein convertase subtilisin/kexin type-9 and is required for the degradation of low-density lipoprotein receptors by proprotein convertase subtilisin/kexin type-9
    Eur. Heart J. (IF 23.239) Pub Date : 2019-08-16
    Jang H, Lee S, Yang J, et al.

    AimsProprotein convertase subtilisin/kexin type-9 (PCSK9), a molecular determinant of low-density lipoprotein (LDL) receptor (LDLR) fate, has emerged as a promising therapeutic target for atherosclerotic cardiovascular diseases. However, the precise mechanism by which PCSK9 regulates the internalization and lysosomal degradation of LDLR is unknown. Recently, we identified adenylyl cyclase-associated protein 1 (CAP1) as a receptor for human resistin whose globular C-terminus is structurally similar to the C-terminal cysteine-rich domain (CRD) of PCSK9. Herein, we investigated the role of CAP1 in PCSK9-mediated lysosomal degradation of LDLR and plasma LDL cholesterol (LDL-C) levels. Methods and resultsThe direct binding between PCSK9 and CAP1 was confirmed by immunoprecipitation assay, far-western blot, biomolecular fluorescence complementation, and surface plasmon resonance assay. Fine mapping revealed that the CRD of PCSK9 binds with the Src homology 3 binding domain (SH3BD) of CAP1. Two loss-of-function polymorphisms found in human PCSK9 (S668R and G670E in CRD) were attributed to a defective interaction with CAP1. siRNA against CAP1 reduced the PCSK9-mediated degradation of LDLR in vitro. We generated CAP1 knock-out mice and found that the viable heterozygous CAP1 knock-out mice had higher protein levels of LDLR and lower LDL-C levels in the liver and plasma, respectively, than the control mice. Mechanistic analysis revealed that PCSK9-induced endocytosis and lysosomal degradation of LDLR were mediated by caveolin but not by clathrin, and they were dependent on binding between CAP1 and caveolin-1. ConclusionWe identified CAP1 as a new binding partner of PCSK9 and a key mediator of caveolae-dependent endocytosis and lysosomal degradation of LDLR.

    更新日期:2020-01-07
  • Relationship between hypoglycaemia, cardiovascular outcomes, and empagliflozin treatment in the EMPA-REG OUTCOME® trial.
    Eur. Heart J. (IF 23.239) Pub Date : 2019-09-11
    David Fitchett,Silvio E Inzucchi,Christoph Wanner,Michaela Mattheus,Jyothis T George,Ola Vedin,Bernard Zinman,Odd Erik Johansen

    AIMS Hypoglycaemia, in patients with Type 2 diabetes (T2D) is associated with an increased risk for cardiovascular (CV) events. In EMPA-REG OUTCOME, the sodium-glucose co-transporter-2 inhibitor empagliflozin reduced the risk of CV death by 38% and heart failure hospitalization (HHF) by 35%, while decreasing glycated haemoglobin (HbA1c) without increasing hypoglycaemia. We investigated CV outcomes in patients with hypoglycaemia during the trial and the impact of hypoglycaemia on the treatment effect of empagliflozin. METHODS AND RESULTS About 7020 patients with T2D (HbA1c 7-10%) were treated with empagliflozin 10 or 25 mg, or placebo and followed for median 3.1 years. The relationship between on-trial hypoglycaemia and CV outcomes, and effects of empagliflozin on outcomes by incident hypoglycaemia [HYPO-broad: symptomatic hypoglycaemia with plasma glucose (PG) ≤70 mg/dL, any hypoglycaemia with PG <54 mg/dL, or severe hypoglycaemia, and HYPO-strict: hypoglycaemia with PG <54 mg/dL, or severe hypoglycaemia] was investigated using adjusted Cox regression models with time-varying covariates for hypoglycaemia and interaction with treatment. HYPO-broad occurred in 28% in each group and HYPO-strict in 19%. In the placebo group, hypoglycaemia was associated with an increased risk of HHF for both HYPO-broad [hazard ratio (HR, 95% confidence interval, CI) 1.91 (1.25-2.93)] and HYPO-strict [1.72 (1.06-2.78)]. HYPO-broad (but not HYPO-strict) was associated with an increased risk of myocardial infarction (MI) [HR 1.56 (1.06-2.29)]. Empagliflozin improved CV outcomes, regardless of occurrence of hypoglycaemia (P-for interactions >0.05). CONCLUSION In this post hoc exploratory analysis, hypoglycaemia was associated with an increased risk of HHF and MI. Hypoglycaemia risk was not increased with empagliflozin and incident hypoglycaemia did not attenuate its cardio-protective effects.

    更新日期:2020-01-07
  • 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASDThe Task Force for diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD)
    Eur. Heart J. (IF 23.239) Pub Date : 2019-08-31
    Cosentino F, Grant P, Aboyans V, et al.

    Guidelinesdiabetes mellitusimpaired glucose tolerancecardiovascular diseasesepidemiologyrisk factorspreventioncardiovascular risk assessmentpatient managementpharmacological treatmentrevascularizationpatient-centred care

    更新日期:2020-01-07
  • Treatment algorithm in patients with type 2 diabetes and atherosclerotic cardiovascular disease or high/very high cardiovascular risk
    Eur. Heart J. (IF 23.239) Pub Date : 2019-12-04
    Targher G, Byrne C.

    This commentary refers to ‘2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD’, by F. Cosentino et al., on page 255.

    更新日期:2020-01-07
  • Amphetamine-induced coronary artery dissection and massive aortic valve thrombus
    Eur. Heart J. (IF 23.239) Pub Date : 2019-11-25
    Eberhard M, Hermann M, Stähli B, et al.

    A 29-year-old woman presented at her local hospital with acute chest pain 2 days after she went to a techno party. Transthoracic echocardiography revealed left ventricular hypokinesia of the apical segments with normal ejection fraction. Cardiac valves were unremarkable (Supplementary material online, S1). After ruling-out pulmonary embolism and pneumothorax with computed tomography (CT), she was admitted to our hospital on the same day for coronary catheterization because of elevated cardiac enzymes (hs-troponin-T levels: 1599 ng/mL, myoglobin: 373 µg/L, creatine kinase: 1601 U/L). Catheter coronary angiography was highly suspicious of a spontaneous coronary artery dissection (type III, focal stenosis) in the mid-left anterior descending coronary artery (Panel A), being compatible with the echocardiography wall motion abnormalities. Since the flow distal to the dissection was normal [thrombolysis in myocardial infarction (TIMI) grade flow 3], no intervention was performed. The right coronary artery was normal. Toxicology screening showed positive urinary levels for amphetamine, benzodiazepine, and cannabis.

    更新日期:2020-01-07
  • Complete regression of coronary atherosclerosis
    Eur. Heart J. (IF 23.239) Pub Date : 2019-11-07
    Lee H, Chang M, Piccinelli M, et al.

    A 44-year-old woman without any cardiovascular risk factors, presented with effort angina for 2 months. Coronary computed tomographic angiography (CCTA) showed 70% stenosis of the proximal left anterior descending (LAD) artery by non-calcified plaque, and N-13 ammonia positron emission tomography (PET) demonstrated the reversible perfusion defect in the LAD territory (Panels B and C). Invasive coronary angiography revealed diffuse intermediate stenosis in the LAD. Fractional flow reserve (FFR) was 0.73, and the gradual increase of FFR was observed during pull-back pressure tracing under hyperaemia (Panel A, yellow line). Intravascular ultrasound revealed diffuse plaque in left main and LAD with negative remodelling. The minimal lumen area was 3.0 mm2 with plaque burden of 55%. Based on the lesion characteristics and the patient’s preference, revascularization was deferred and medical treatment with aspirin, ezetimibe/simvastatin, and diltiazem was maintained.

    更新日期:2020-01-07
  • Cardiology care delivered to cancer patientsThe results of a questionnaire survey by the Council for Cardio Oncology and Council for Cardiology Practice of the European Society of Cardiology
    Eur. Heart J. (IF 23.239) Pub Date : 2020-01-07
    Asteggiano R, Aboyans V, Lee G, et al.

    Survival of patients with cancer has increased substantially nowadays, thanks to the progress in treatments. As a result, patients can then exhibit some long-term cardiovascular (CV) system effects from their oncology treatments.

    更新日期:2020-01-07
  • Comments on the 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases
    Eur. Heart J. (IF 23.239) Pub Date : 2019-12-05
    Jorsal A, Persson F, Bruun J.

    This commentary refers to ‘2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD’, by F. Cosentino et al., on page 255.

    更新日期:2020-01-07
  • Compelling evidence for SGLT2 inhibitors and GLP-1 receptor agonists as first-line therapy in patients with diabetes at very high/high cardiovascular risk
    Eur. Heart J. (IF 23.239) Pub Date : 2019-12-04
    Marx N, Grant P, Cosentino F.

    This commentary refers to ‘Comments on the 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases’, by A. Jorsal et al., on page 328.

    更新日期:2020-01-07
  • IRIS courses for cardiologyIRIS courses are available in 2020 which are designed for building a research career in cardiology
    Eur. Heart J. (IF 23.239) Pub Date : 2020-01-07
    Bacharova L, Komarova D, Böhm A.

    The International Research Interdisciplinary School (IRIS), originally named the International Scientific Summer School (ISSS), provides an interdisciplinary international environment for training skills required for preparing research study protocols and scientific manuscripts and for international collaboration especially in the field of cardiovascular biomedicine. It is a common initiative of several scientific journals aiming to provide support for young researchers in their research career, in preparing their research projects and succeeding in publications.

    更新日期:2020-01-07
  • The Fourth European-South African Cardiovascular Research WorkshopStrengthening cardiovascular research networking between the southern and northern hemispheres
    Eur. Heart J. (IF 23.239) Pub Date : 2020-01-07
    Lecour S, Hausenloy D, Madonna R.

    The 4th European-South African Cardiovascular Research Workshop, jointly hosted by the South African Society for Cardiovascular Research (SASCAR) and the European Society of Cardiology Working Group on Cellular Biology of the Heart, was held in Stellenbosch, South Africa, in April 2019. The aim of these joint meetings, initiated by Prof. Sandrine Lecour (Hatter Institute, Cape Town) and Prof. Derek Hausenloy (Hatter Institute, London) in 2010, is to encourage fruitful cardiovascular research collaborations between Europe and South Africa.1,2 It not only promotes the establishment of north–south collaborations but provides a platform for interaction between promising young cardiovascular scientists and senior researchers. In science, networking has been proven to be an important tool for future job opportunities.

    更新日期:2020-01-07
  • Clinical impact of conduction disturbances in transcatheter aortic valve replacement recipients: a systematic review and meta-analysis
    Eur. Heart J. (IF 23.239) Pub Date : 2020-01-03
    Faroux L, Chen S, Muntané-Carol G, et al.

    AimsThe clinical impact of new-onset persistent left bundle branch block (NOP-LBBB) and permanent pacemaker implantation (PPI) on transcatheter aortic valve replacement (TAVR) recipients remains controversial. We aimed to evaluate the impact of (i) periprocedural NOP-LBBB and PPI post-TAVR on 1-year all-cause death, cardiac death, and heart failure hospitalization and (ii) NOP-LBBB on the need for PPI at 1-year follow-up. Methods and resultsWe performed a systematic search from PubMed and EMBASE databases for studies reporting raw data on 1-year clinical impact of NOP-LBBB or periprocedural PPI post-TAVR. Data from 30 studies, including 7792 patients (12 studies) and 42 927 patients (21 studies) for the evaluation of the impact of NOP-LBBB and PPI after TAVR were sourced, respectively. NOP-LBBB was associated with an increased risk of all-cause death [risk ratio (RR) 1.32, 95% confidence interval (CI) 1.17–1.49; P<0.001], cardiac death (RR 1.46, 95% CI 1.20–1.78; P<0.001), heart failure hospitalization (RR 1.35, 95% CI 1.05–1.72; P=0.02), and PPI (RR 1.89, 95% CI 1.58–2.27; P<0.001) at 1-year follow-up. Periprocedural PPI after TAVR was associated with a higher risk of all-cause death (RR 1.17, 95% CI 1.11–1.25; P<0.001) and heart failure hospitalization (RR 1.18, 95% CI 1.03–1.36; P=0.02). Permanent pacemaker implantation was not associated with an increased risk of cardiac death (RR 0.84, 95% CI 0.67–1.05; P=0.13). ConclusionNOP-LBBB and PPI after TAVR are associated with an increased risk of all-cause death and heart failure hospitalization at 1-year follow-up. Periprocedural NOP-LBBB also increased the risk of cardiac death and PPI within the year following the procedure. Further studies are urgently warranted to enhance preventive measures and optimize the management of conduction disturbances post-TAVR.

    更新日期:2020-01-07
  • Effects of clopidogrel vs. prasugrel vs. ticagrelor on endothelial function, inflammatory parameters, and platelet function in patients with acute coronary syndrome undergoing coronary artery stenting: a randomized, blinded, parallel study
    Eur. Heart J. (IF 23.239) Pub Date : 2020-01-03
    Schnorbus B, Daiber A, Jurk K, et al.

    AimsIn a randomized, parallel, blinded study, we investigate the impact of clopidogrel, prasugrel, or ticagrelor on peripheral endothelial function in patients undergoing stenting for an acute coronary syndrome. Methods and resultsThe primary endpoint of the study was the change in endothelium-dependent flow-mediated dilation (FMD) following stenting. A total of 90 patients (age 62 ± 9 years, 81 males, 22 diabetics, 49 non-ST elevation myocardial infarctions) were enrolled. There were no significant differences among groups in any clinical parameter. Acutely before stenting, all three drugs improved FMD without differences between groups (P = 0.73). Stenting blunted FMD in the clopidogrel and ticagrelor group (both P < 0.01), but not in the prasugrel group. During follow-up, prasugrel was superior to clopidogrel [mean difference 2.13, 95% confidence interval (CI) 0.68–3.58; P = 0.0047] and ticagrelor (mean difference 1.57, 95% CI 0.31–2.83; P = 0.0155), but this difference was limited to patients who received the study therapy 2 h before stenting. Ticagrelor was not significantly superior to clopidogrel (mean difference 0.55, 95% CI −0.73 to 1.82; P = 0.39). No significant differences were seen among groups for low-flow-mediated dilation. Plasma interleukin (IL)-6 (P = 0.02 and P = 0.01, respectively) and platelet aggregation reactivity in response to adenosine diphosphate (P = 0.002 and P = 0.035) were lower in the prasugrel compared to clopidogrel and ticagrelor group. ConclusionAs compared to ticagrelor and clopidogrel, therapy with prasugrel in patients undergoing stenting for an acute coronary syndrome is associated with improved endothelial function, stronger platelet inhibition, and reduced IL-6 levels, all of which may have prognostic implications. This effect was lost in patients who received the study medication immediately after stenting. EUDRACT-No2011-005305-73

    更新日期:2020-01-06
  • Complete revascularization reduces cardiovascular death in patients with ST-segment elevation myocardial infarction and multivessel disease: systematic review and meta-analysis of randomized clinical trials
    Eur. Heart J. (IF 23.239) Pub Date : 2019-12-31
    Pavasini R, Biscaglia S, Barbato E, et al.

    AimsThe aim of this work was to investigate the prognostic impact of revascularization of non-culprit lesions in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease by performing a meta-analysis of available randomized clinical trials (RCTs). Methods and resultsData from six RCTs comparing complete vs. culprit-only revascularization in STEMI patients with multivessel disease were analysed with random effect generic inverse variance method meta-analysis. The endpoints were expressed as hazard ratio (HR) with 95% confidence interval (CI). The primary outcome was cardiovascular death. Main secondary outcomes of interest were all-cause death, myocardial infarction (MI), and repeated coronary revascularization. Overall, 6528 patients were included (3139 complete group, 3389 culprit-only group). After a follow-up ranging between 1 and 3 years (median 2 years), cardiovascular death was significantly reduced in the group receiving complete revascularization (HR 0.62, 95% CI 0.39–0.97, I2 = 29%). The number needed to treat to prevent one cardiovascular death was 70 (95% CI 36–150). The secondary endpoints MI and revascularization were also significantly reduced (HR 0.68, 95% CI 0.55–0.84, I2 = 0% and HR 0.29, 95% CI 0.22–0.38, I2 = 36%, respectively). Needed to treats were 45 (95% CI 37–55) for MI and 8 (95% CI 5–13) for revascularization. All-cause death (HR 0.81, 95% CI 0.56–1.16, I2 = 27%) was not affected by the revascularization strategy. ConclusionIn a selected study population of STEMI patients with multivessel disease, a complete revascularization strategy is associated with a reduction in cardiovascular death. This reduction is concomitant with that of MI and the need of repeated revascularization.

    更新日期:2020-01-04
  • The Dapagliflozin And Prevention of Adverse outcomes in Heart Failure trial (DAPA-HF) in context
    Eur. Heart J. (IF 23.239) Pub Date : 2020-01-03
    McMurray J, Solomon S, Docherty K, et al.

    The recently reported Dapagliflozin And Prevention of Adverse outcomes in Heart Failure trial (DAPA-HF) showed the sodium-glucose cotransporter 2 (SGLT2) inhibitor dapagliflozin reduced the risk of hospital admission for worsening heart failure, increased survival and improved symptoms in patients with heart failure with reduced ejection fraction (HFrEF).1–3 Although SGLT2 inhibitors had been developed as glucose-lowering treatments for patients with type 2 diabetes, approximately half the patients in DAPA-HF did not have type 2 diabetes.1–3 The benefits of dapagliflozin in DAPA-HF were of a similar magnitude in participants without diabetes to the benefits obtained in individuals with diabetes. Importantly, in both groups of patients, dapagliflozin in patients with HFrEF were observed when dapagliflozin was added to excellent background disease-modifying therapy for heart failure.

    更新日期:2020-01-04
  • ‘Stadium wave-like’ ventricular contraction due to extreme conduction delay in tricyclic antidepressant intoxication
    Eur. Heart J. (IF 23.239) Pub Date : 2020-01-03
    Bouwmeester S, van Nunen L, van de Berg P.

    A 39-year-old man was transferred to the emergency department by ambulance due to loss of consciousness and hypotension (70/40 mmHg). The patient had a medical history of depression, for which he was taking nortriptyline [tricyclic antidepressant (TCA)]. The electrocardiogram (Panel A) showed several features consistent with TCA intoxication, i.e. tachycardia, QRS prolongation, a pronounced terminal R wave in lead aVR, and rightward shift of the terminal QRS vector. This shift typically occurs because of an intraventricular and interventricular conduction delay resulting in delayed right ventricular activation. Transthoracic echocardiography (Supplementary material onlineSupplementary material online, Videos SA and SB) revealed a severe contraction dyssynchrony, caused by extreme conduction delay. The interventricular septum contracted in a ‘stadium wave-like pattern’ (Panels B–D). Toxicological analysis confirmed the diagnosis of severe TCA intoxication.

    更新日期:2020-01-04
  • Low-grade endotoxaemia enhances artery thrombus growth via Toll-like receptor 4: implication for myocardial infarction
    Eur. Heart J. (IF 23.239) Pub Date : 2020-01-03
    Carnevale R, Sciarretta S, Valenti V, et al.

    AimsLow-grade endotoxaemia is detectable in human circulation but its role in thrombosis is still unclear. Methods and resultsWe measured serum lipopolysaccharide (LPS) concentration, soluble P-selectin (sP-selectin), a marker of platelet activation, and zonulin, a marker of gut permeability, in peripheral circulation, coronary thrombi, and intracoronary blood of patients with ST-elevation myocardial infarction (STEMI, n = 50) and stable angina (SA) (n = 50), respectively, and in controls (n = 50). Experimental study was carried out in mice to assess if Escherichia coli-LPS (E. coli-LPS) possess thrombotic property. Coronary thrombi from STEMI showed higher concentrations of LPS, sP-selectin vs. intracoronary blood of SA and peripheral blood of controls (P < 0.001). Zonulin was higher in STEMI compared to the other two groups [4.57 (3.34–5.22); 2.56 (0.41–4.36); 1.95 (1.22–2.65) ng/mL; P < 0.001] and correlated with LPS (Rs = 0.585; P < 0.001). Escherichia coli DNA was positive in 34% of STEMI vs. 12% of SA and 4% of controls (P < 0.001). In a subgroup of 12 STEMI, immunohistochemical analysis of coronary thrombi showed positivity for leucocyte Toll-like receptor 4 (TLR4), cathepsin G, and LPS from E. coli in 100%, 80%, and 25% of samples, respectively. E. coli-LPS injected in mice to reach LPS concentrations like those detected in coronary thrombi was associated with enhanced artery thrombosis and platelet activation, an effect blunted by TLR4 inhibitor co-administration. In vitro study demonstrated that LPS from E. coli enhanced platelet aggregation via TLR4-mediated leucocyte cathepsin G activation. ConclusionST-elevation myocardial infarction patients disclose an enhanced gut permeability that results in LPS translocation in human circulation and eventually thrombus growth at site of artery lesion via leucocyte–platelet interaction.

    更新日期:2020-01-04
  • Chronic infarct size after spontaneous coronary artery dissection: implications for pathophysiology and clinical management
    Eur. Heart J. (IF 23.239) Pub Date : 2020-01-03
    Al-Hussaini A, Abdelaty A, Gulsin G, et al.

    AimsTo report the extent and distribution of myocardial injury and its impact on left ventricular systolic function with cardiac magnetic resonance imaging (CMR) following spontaneous coronary artery dissection (SCAD) and to investigate predictors of myocardial injury. Methods and resultsOne hundred and fifty-eight angiographically confirmed SCAD-survivors (98% female) were phenotyped by CMR and compared in a case–control study with 59 (97% female) healthy controls (44.5 ± 8.4 vs. 45.0 ± 9.1 years). Spontaneous coronary artery dissection presentation was with non-ST-elevation myocardial infarction in 95 (60.3%), ST-elevation myocardial infarction (STEMI) in 52 (32.7%), and cardiac arrest in 11 (6.9%). Left ventricular function in SCAD-survivors was generally well preserved with small reductions in ejection fraction (57 ± 7.2% vs. 60 ± 4.9%, P < 0.01) and increases in left ventricular dimensions (end-diastolic volume: 85 ± 14 mL/m2 vs. 80 ± 11 mL/m2, P < 0.05; end-systolic volume: 37 ± 11 mL/m2 vs. 32 ± 7 mL/m2, P <0.01) compared to healthy controls. Infarcts were small with few large infarcts (median 4.06%; range 0–30.9%) and 39% having no detectable late gadolinium enhancement (LGE). Female SCAD patients presenting with STEMI had similar sized infarcts to female Type-1 STEMI patients age <75 years. Multivariate modelling demonstrated STEMI at presentation, initial TIMI 0/1 flow, multivessel SCAD, and a Beighton score >4 were associated with larger infarcts [>10% left ventricular (LV) mass]. ConclusionThe majority of patients presenting with SCAD have no or small infarctions and preserved ejection fraction. Patients presenting with STEMI, TIMI 0/1 flow, multivessel SCAD and those with features of connective tissue disorders are more likely to have larger infarcts.

    更新日期:2020-01-04
  • Senescence-induced inflammation: an important player and key therapeutic target in atherosclerosis
    Eur. Heart J. (IF 23.239) Pub Date : 2020-01-03
    Stojanović S, Fiedler J, Bauersachs J, et al.

    Inflammation is a hallmark and potent driver of pathological vascular remodelling in atherosclerosis. However, current anti-inflammatory therapeutic strategies have shown mixed results. As an alternative perspective on the conundrum of chronic inflammation emerging evidence points towards a small subset of senescent cells as a critical player and central node driving atherosclerosis. Senescent cells belonging to various cell types are a dominant and chronic source of a large array of pro-inflammatory cytokines and various additional plaque destabilizing factors, being involved with various aspects of atherosclerosis pathogenesis. Antagonizing these key agitators of local chronic inflammation and plaque instability may provide a causative and multi-purpose therapeutic strategy to treat atherosclerosis. Anti-senescence treatment options with translational potential are currently in development. However, several questions and challenges remain to be addressed before these novel treatment approaches may enter the clinical setting.

    更新日期:2020-01-04
  • A rare case of persistent left superior vena cava with absent right superior vena cava
    Eur. Heart J. (IF 23.239) Pub Date : 2019-06-29
    Raisi-Estabragh Z, Khanji M.

    A 28-year-old man underwent transthoracic echocardiography (TTE) following an abnormal electrocardiogram. Parasternal long-axis images revealed a dilated coronary sinus measuring 15 mm × 25 mm (Panel A), raising the possibility of a persistent left superior vena cava (SVC). Bubble contrast TTE using agitated saline injected from the left antecubital vein resulted in opacification of the coronary sinus (*) before filling of the right atrium (Panels B and C, Supplementary materialSupplementary material online, Video S1). This confirmed the presence of a persistent left SVC with drainage into the coronary sinus. Agitated saline injected from the right antecubital vein, unexpectedly, also resulted in filling of the coronary sinus prior to opacification of the right atrium, indicating absence of the right SVC with drainage of the entire upper body venous return to the right atrium via the coronary sinus (Panels D and E, Supplementary materialSupplementary material online, Videos S2 and S3).

    更新日期:2020-01-01
  • 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular riskThe Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS)
    Eur. Heart J. (IF 23.239) Pub Date : 2019-08-31
    Mach F, Baigent C, Catapano A, et al.

    Guidelinesdyslipidaemiascholesteroltriglycerideslow-density lipoproteinshigh-density lipoproteinsapolipoprotein Blipoprotein(a)lipoprotein remnantstotal cardiovascular risktreatment (lifestyle)treatment (drugs)treatment (adherence)very low-density lipoproteinsfamilial hypercholesterolaemia

    更新日期:2020-01-01
  • Clinical review on triglycerides
    Eur. Heart J. (IF 23.239) Pub Date : 2019-11-25
    Laufs U, Parhofer K, Ginsberg H, et al.

    Hypertriglyceridaemia is a common clinical problem. Epidemiologic and genetic studies have established that triglyceride-rich lipoproteins (TRL) and their remnants as important contributors to ASCVD while severe hypertriglyceridaemia raises risk of pancreatitis. While low-density lipoprotein is the primary treatment target for lipid lowering therapy, secondary targets that reflect the contribution of TRL such as apoB and non-HDL-C are recommended in the current guidelines. Reduction of severely elevated triglycerides is important to avert or reduce the risk of pancreatitis. Here we discuss interventions for hypertriglyceridaemia, including diet and lifestyle, established treatments such as fibrates and omega-3 fatty acid preparations and emerging therapies, including various biological agents.

    更新日期:2020-01-01
  • Real-world risk of cardiovascular outcomes associated with hypertriglyceridaemia among individuals with atherosclerotic cardiovascular disease and potential eligibility for emerging therapies
    Eur. Heart J. (IF 23.239) Pub Date : 2019-11-16
    Lawler P, Kotrri G, Koh M, et al.

    AimsHypertriglyceridaemia in patients with atherosclerotic cardiovascular disease (ASCVD) has been in focus following the REDUCE-IT trial showing benefit with icosapent ethyl. Among individuals with prevalent ASCVD, we sought to quantify the contemporary, real-world risk of ASCVD events associated with hypertriglyceridaemia, as well as estimate icosapent ethyl eligibility and compare trial participants with REDUCE-IT-like individuals in the population. Methods and resultsWe examined data from 2 424 865 adults with lipid panels in the Ontario population. Among those with prevalent ASCVD, we examined adjusted associations between triglyceride (TG) and ASCVD events (first occurrence of myocardial infarction, unstable angina, stroke or transient ischaemic attack, coronary revascularization, or cardiovascular death). The proportion of patients with ASCVD potentially eligible for icosapent ethyl was estimated as those with TG 135–499 mg/dL (1.52–5.63 mmol/L) and low-density lipoprotein cholesterol (LDLc) 41–100 mg/dL (1.06–2.59 mmol/L), similar to the lipid cut-offs in REDUCE-IT, and their demographics and event rates examined. Among 196 717 individuals with ASCVD, median age was 69 years and 30% were female. A total of 24 097 composite ASCVD events occurred over a mean (standard deviation) 2.9 (0.5) years of follow-up. Increasing TG was associated with a graded, progressively higher hazard of ASCVD events. Twenty-five percent (49 886) of individuals with ASCVD had hypertriglyceridaemia and controlled LDLc; these patients were demographically similar to those in REDUCE-IT with comparable event rates. ConclusionsAmong patients with ASCVD, hypertriglyceridaemia is common, and is associated with higher ASCVD risk across a range of TG. It is possible that as many as one in four patients with ASCVD may be candidates for emerging therapies.

    更新日期:2020-01-01
  • Statins and Lp(a): do not make perfect the enemy of excellent
    Eur. Heart J. (IF 23.239) Pub Date : 2019-11-14
    Banach M, Penson P.

    This commentary refers to ‘Statin therapy increases lipoprotein(a) levels’, by S. Tsimikas et al., doi: 10.1093/eurheartj/ehz310.

    更新日期:2020-01-01
  • Statins and increases in Lp(a): an inconvenient truth that needs attention
    Eur. Heart J. (IF 23.239) Pub Date : 2019-11-14
    Tsimikas S, Gordts P, Nora C, et al.

    This commentary refers to ‘Statins and Lp(a): do not make perfect the enemy of excellent', by M. Banach and P.E. Penson, on pages 190–191.

    更新日期:2020-01-01
  • More consideration of β-cell function and PCSK9/LDLR axis
    Eur. Heart J. (IF 23.239) Pub Date : 2019-09-20
    Yang X, Mao Y, Wang D.

    This commentary refers to ‘PCSK9 deficiency reduces insulin secretion and promotes glucose intolerance: the role of the low-density lipoprotein receptor’, by L. Da Dalt et al., Eur Heart J2019;40:357–368.

    更新日期:2020-01-01
  • Flattening the hierarchies in academic medicine: the importance of diversity in leadership, contribution, and thoughtThe authors present a rationale for team-based leadership in medicine, shifting away from traditional hierarchical leadership models of today
    Eur. Heart J. (IF 23.239) Pub Date : 2020-01-01
    Whitelaw S, Kalra A, Van Spall H.

    The redistribution of several oil portraits of physician leaders from an auditorium at Brigham and Women’s Hospital to other locations has been the source of much debate on social media. Such portraits—ubiquitous in academic medical institutions—speak of pride, achievement, and institutional history, but to some, represent a lack of gender and racial diversity in academic leadership. To others, the portraiture represents the hierarchical structures in academic medicine that disproportionately reward physician leaders and leave the diverse contributions of the healthcare workforce under-recognized.

    更新日期:2020-01-01
  • European Society of Cardiology: Cardiovascular Disease Statistics 2019
    Eur. Heart J. (IF 23.239) Pub Date : 2019-12-10
    Timmis A, Townsend N, Gale C, et al.

    AimsThe 2019 report from the European Society of Cardiology (ESC) Atlas provides a contemporary analysis of cardiovascular disease (CVD) statistics across 56 member countries, with particular emphasis on international inequalities in disease burden and healthcare delivery together with estimates of progress towards meeting 2025 World Health Organization (WHO) non-communicable disease targets. Methods and resultsIn this report, contemporary CVD statistics are presented for member countries of the ESC. The statistics are drawn from the ESC Atlas which is a repository of CVD data from a variety of sources including the WHO, the Institute for Health Metrics and Evaluation, and the World Bank. The Atlas also includes novel ESC sponsored data on human and capital infrastructure and cardiovascular healthcare delivery obtained by annual survey of the national societies of ESC member countries. Across ESC member countries, the prevalence of obesity (body mass index ≥30 kg/m2) and diabetes has increased two- to three-fold during the last 30 years making the WHO 2025 target to halt rises in these risk factors unlikely to be achieved. More encouraging have been variable declines in hypertension, smoking, and alcohol consumption but on current trends only the reduction in smoking from 28% to 21% during the last 20 years appears sufficient for the WHO target to be achieved. The median age-standardized prevalence of major risk factors was higher in middle-income compared with high-income ESC member countries for hypertension {23.8% [interquartile range (IQR) 22.5–23.1%] vs. 15.7% (IQR 14.5–21.1%)}, diabetes [7.7% (IQR 7.1–10.1%) vs. 5.6% (IQR 4.8–7.0%)], and among males smoking [43.8% (IQR 37.4–48.0%) vs. 26.0% (IQR 20.9–31.7%)] although among females smoking was less common in middle-income countries [8.7% (IQR 3.0–10.8) vs. 16.7% (IQR 13.9–19.7%)]. There were associated inequalities in disease burden with disability-adjusted life years per 100 000 people due to CVD over three times as high in middle-income [7160 (IQR 5655–8115)] compared with high-income [2235 (IQR 1896–3602)] countries. Cardiovascular disease mortality was also higher in middle-income countries where it accounted for a greater proportion of potential years of life lost compared with high-income countries in both females (43% vs. 28%) and males (39% vs. 28%). Despite the inequalities in disease burden across ESC member countries, survey data from the National Cardiac Societies of the ESC showed that middle-income member countries remain severely under-resourced compared with high-income countries in terms of cardiological person-power and technological infrastructure. Under-resourcing in middle-income countries is associated with a severe procedural deficit compared with high-income countries in terms of coronary intervention, device implantation and cardiac surgical procedures. ConclusionA seemingly inexorable rise in the prevalence of obesity and diabetes currently provides the greatest challenge to achieving further reductions in CVD burden across ESC member countries. Additional challenges are provided by inequalities in disease burden that now require intensification of policy initiatives in order to reduce population risk and prioritize cardiovascular healthcare delivery, particularly in the middle-income countries of the ESC where need is greatest.

    更新日期:2020-01-01
  • Circulating stem cells and cardiovascular outcomes: from basic science to the clinic
    Eur. Heart J. (IF 23.239) Pub Date : 2019-12-31
    Fadini G, Mehta A, Dhindsa D, et al.

    The cardiovascular and haematopoietic systems have fundamental inter-relationships during development, as well as in health and disease of the adult organism. Although haematopoietic stem cells (HSCs) emerge from a specialized haemogenic endothelium in the embryo, persistence of haemangioblasts in adulthood is debated. Rather, the vast majority of circulating stem cells (CSCs) is composed of bone marrow-derived HSCs and the downstream haematopoietic stem/progenitors (HSPCs). A fraction of these cells, known as endothelial progenitor cells (EPCs), has endothelial specification and vascular tropism. In general, the levels of HSCs, HSPCs, and EPCs are considered indicative of the endogenous regenerative capacity of the organism as a whole and, particularly, of the cardiovascular system. In the last two decades, the research on CSCs has focused on their physiologic role in tissue/organ homoeostasis, their potential application in cell therapies, and their use as clinical biomarkers. In this review, we provide background information on the biology of CSCs and discuss in detail the clinical implications of changing CSC levels in patients with cardiovascular risk factors or established cardiovascular disease. Of particular interest is the mounting evidence available in the literature on the close relationships between reduced levels of CSCs and adverse cardiovascular outcomes in different cohorts of patients. We also discuss potential mechanisms that explain this association. Beyond CSCs’ ability to participate in cardiovascular repair, levels of CSCs need to be interpreted in the context of the broader connections between haematopoiesis and cardiovascular function, including the role of clonal haematopoiesis and inflammatory myelopoiesis.

    更新日期:2019-12-31
  • Fractional flow reserve in clinical practice: from wire-based invasive measurement to image-based computation
    Eur. Heart J. (IF 23.239) Pub Date : 2019-12-30
    Tu S, Westra J, Adjedj J, et al.

    Fractional flow reserve (FFR) and instantaneous wave-free ratio are the present standard diagnostic methods for invasive assessment of the functional significance of epicardial coronary stenosis. Despite the overall trend towards more physiology-guided revascularization, there remains a gap between guideline recommendations and the clinical adoption of functional evaluation of stenosis severity. A number of image-based approaches have been proposed to compute FFR without the use of pressure wire and induced hyperaemia. In order to better understand these emerging technologies, we sought to highlight the principles, diagnostic performance, clinical applications, practical aspects, and current challenges of computational physiology in the catheterization laboratory. Computational FFR has the potential to expand and facilitate the use of physiology for diagnosis, procedural guidance, and evaluation of therapies, with anticipated impact on resource utilization and patient outcomes.

    更新日期:2019-12-30
  • How low should we go on low-carbohydrate diets?
    Eur. Heart J. (IF 23.239) Pub Date : 2019-12-28
    Sequeira V, Bertero E, Maack C.

    This commentary refers to ‘Lower carbohydrate diets and all-cause and cause-specific mortality: a population-based cohort study and pooling of prospective studies’, M. Mazidi et al., doi: 10.1093/eurheartj/ehz174.

    更新日期:2019-12-29
  • Low and elevated B-type natriuretic peptide levels are associated with increased mortality in patients with preserved ejection fraction undergoing transcatheter aortic valve replacement: an analysis of the PARTNER II trial and registry
    Eur. Heart J. (IF 23.239) Pub Date : 2019-12-28
    Chen S, Redfors B, O’Neill B, et al.

    AimsB-type natriuretic peptide (BNP) is a cardiac neurohormone that is secreted in response to ventricular volume expansion and pressure overload. There are conflicting data regarding the association between BNP levels and outcomes after transcatheter aortic valve replacement (TAVR). We therefore sought to assess the association between baseline BNP and adverse outcomes in patients with symptomatic, severe aortic stenosis (AS), and left ventricular ejection fraction (LVEF) ≥50%, undergoing TAVR in the PARTNER 2 Trial and Registry. Methods and resultsA total of 1782 patients were included in the analysis, and BNP was evaluated both as a continuous log-transformed value and by a priori categories: low (<50 pg/mL), normal (≥50 and <100 pg/mL), moderately elevated (≥100 and <400 pg/mL), or markedly elevated (≥400 pg/mL). Clinical outcomes from discharge to 2 years were compared between patients according to their baseline BNP level, using Kaplan–Meier event rates and multivariable Cox proportional hazards regression models. After adjustment, spline curves revealed a non-linear association between log-transformed BNP and all-cause and cardiovascular mortality in which both the lowest and highest values were associated with increased mortality. Two-year all-cause mortality rates for those with low (n = 86), normal (n = 202), moderately elevated (n = 885), and markedly elevated (n = 609) baseline BNP were 20.0%, 9.8%, 17.7%, and 26.1%, respectively. In adjusted models, compared to a normal baseline BNP, low [adjusted hazard ratio (HR) 2.6, 95% confidence interval (CI) 1.3–5.0, P-value 0.005], moderately elevated (adjusted HR 1.6, 95% CI 1.0–2.6, P-value 0.06), and markedly elevated (adjusted HR 2.1, 95% CI 1.3–3.5, P-value 0.003) BNP were associated with increased all-cause mortality, driven by cardiovascular mortality. ConclusionsIn a large cohort of patients with severe symptomatic AS and preserved LVEF undergoing TAVR, all-cause and cardiovascular mortality rates at 2 years were higher in patients with low and markedly elevated BNP levels. Clinical Trial Registrationhttps://clinicaltrials.gov/ unique identifier #NCT01314313, #NCT02184442, #NCT03222128, and #NCT03222141.

    更新日期:2019-12-29
  • Low-carbohydrate diet: forget restriction, replace with balance!
    Eur. Heart J. (IF 23.239) Pub Date : 2019-12-28
    Banach M, Mikhailidis D, Mazidi M.

    This commentary refers to ‘How low should we go on low-carbohydrate diets?’, by V. Sequeira et al., doi: 10.1093/eurheartj/ehz926.

    更新日期:2019-12-29
Contents have been reproduced by permission of the publishers.
导出
全部期刊列表>>
2020新春特辑
限时免费阅读临床医学内容
ACS材料视界
科学报告最新纳米科学与技术研究
清华大学化学系段昊泓
自然科研论文编辑服务
中国科学院大学楚甲祥
中国科学院微生物研究所潘国辉
中国科学院化学研究所
课题组网站
X-MOL
北京大学分子工程苏南研究院
华东师范大学分子机器及功能材料
中山大学化学工程与技术学院
试剂库存
天合科研
down
wechat
bug