Transcatheter aortic valve replacement (TAVR) has increasingly emerged as one of the primary treatments for patients with severe bicuspid aortic valve (BAV) stenosis. Nevertheless, these patients encounter multiple procedural challenges.
\nTo develop a machine learning (ML) model for assessing the risk of periprocedural adverse events (PAEs) in TAVR population with BAV.
\nThis multicentre study retrospectively enrolled 1266 patients with BAV stenosis. Clinical characteristics and imaging data of the patients were collected, and an ML prediction model was developed. PAE was collectively defined as all-cause death, disabling stroke, life-threatening haemorrhage, acute kidney injury (≥stage 3), major vascular complications, valve-related dysfunction necessitating reoperation and other major complications that occurred prior to discharge.
\nThe average age was 72.6±6.3 years, and 58.3% (n=738) of male. In the derivation dataset, five predictive factors were identified: Type 0 BAV, aortic root calcification volume, horizontal aorta, annular ellipticity and previous atrial fibrillation. A robust risk scoring model was thereby established (area under the curve=0.801 95% CI 0.768 to 0.832). A graded relationship was observed between the quartiles of the score and PAE (0.6%, 1.7%, 3.2% and 9.6%; overall p<0.001). A nomogram was constructed to enable calculation of individual scores and the corresponding PAE probabilities. Additionally, similar results were observed in the validation dataset.
\nThe ML model developed in this study could predict the PAEs occurrence of TAVR in patients with BAV stenosis. This is conducive to individualised procedural planning and in-hospital management.
\nWomen with angina due to suspected ischaemia referred for coronary angiography often have no obstructive coronary artery disease (ANOCA/INOCA).
\nTo determine if intensive medical treatment (IMT) reduces major ischaemic events (major adverse cardiovascular event, MACE) among women with suspected ANOCA/INOCA.
\nRandomised, prospective, blinded-outcomes evaluation.
\n71 sites in the USA.
\n2476 women with suspected ANOCA/INOCA.
\nIMT-high intensity statin, ACE inhibitor (ACEi) or angiotensin receptor blocker (ARB) and aspirin versus usual care (UC).
\nPrimary: all cause death, myocardial infarction, stroke/transient ischaemic attack, hospitalisation for angina or heart failure (MACE). Secondary: components of the primary, quality of life and win ratio.
\nRecruitment was lower than planned (n=2476), yielding an aged population (mean, 64 years) with well-controlled blood pressure and low-density lipoprotein cholesterol at baseline, and relatively high rates of statin and ACEI/ARB use. At 2.5 years, 421 events occurred (221 in IMT, 200 in UC) with no difference in the primary outcome (HR=1.13 (95% CI 0.94 to 1.37) for IMT vs UC, p=0.20) or secondary outcomes. Hospitalisations for angina were the dominant contributor to MACE. Sensitivity analysis of contamination provided an estimated HR for IMT versus UC of 0.74 95% CI (0.352 to 1.558), p=0.43.
\nAmong women with suspected ANOCA/INOCA, outcomes were dominated by chest pain and IMT did not improve outcomes, although limited power precludes concluding that it may not be helpful. The findings support the need for more investigation in this population with high burden of angina hospitalisation, health resource consumption and poor quality of life.
\nIn cardiovascular medicine, claims of ‘mortality reduction’ are widely used to summarise the benefits of contemporary therapies. The phrase carries a powerful and intuitive meaning, suggesting that deaths have been prevented and lives have been saved. However, a closer examination of many cardiovascular outcome trials shows that this conclusion often reflects an interpretative shortcut rather than a fundamental difference in outcomes.
\nMost trials rely on time-to-event analyses that demonstrate differences in the timing of death within a limited follow-up period. These findings are frequently translated into statements of reduced mortality, even when the observed effect primarily represents a modest extension of survival rather than the prevention of death. Although statistically correct within the predefined time horizon, this framing may overstate clinical benefit and obscure the time-dependent nature of survival outcomes.
\nThis Viewpoint examines the conceptual distinction between delaying death and preventing it, and explores how this distinction is often blurred in trial reporting, abstracts, guideline summaries and clinical communication. By converting time gained into categorical claims of deaths avoided, survival benefits may acquire a clinical and moral weight that exceeds their absolute magnitude, influencing therapeutic expectations, guideline recommendations and patient decision-making.
\nThe aim is not to question the validity of survival analysis but to highlight the importance of interpretative precision once statistical results are translated into clinical language. Greater clarity in distinguishing survival extension from mortality reduction would support more transparent communication of benefit, facilitate shared decision-making and better align reported outcomes with what patients ultimately experience and value.
\nIn an era of increasingly complex cardiovascular interventions, precision in how benefits are described is a necessary component of high-quality, patient-centred care.
"},{"url":"https://hartvaat.nl/2026/04/10/risicostratificatie-bij-longembolie-hoe-bruikbaar-zijn-de-huidige-instrumenten/","doi":"http://heart.bmj.com/cgi/content/short/112/9/480?rss=1","title_en":"","journal":"Heart","source_date":"2026-04-10","abstract_original":"Currently, most international guidelines advocate for risk stratification of acute pulmonary embolism (PE) as a framework to guide treatment decisions. Key prognostic factors for patients with PE include clinical presentation, comorbidities, (imaging) biomarkers and haemodynamic status. The most widely used risk stratification algorithm, outlined in the 2019 European Society of Cardiology/European Respiratory Society guidelines, classifies patients with PE into high-risk (massive), (high or low) intermediate-risk (submassive) and low-risk (nonmassive) categories. It is well established that the risk of adverse outcomes, including mortality, increases with each escalating risk level. However, substantial variation remains among leading international guidelines regarding risk stratification and corresponding treatment recommendations. This inconsistency stems from a lack of grade/level 1A evidence (i.e. strong recommendation based on high-quality evidence) to guide treatment decisions"},{"url":"https://hartvaat.nl/2026/04/09/sekseverschillen-in-secundaire-preventie-na-acs-vrouwen-halen-minder-vaak-hun-ld/","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e003856?rss=1","title_en":"","journal":"Open Heart","source_date":"2026-04-09","abstract_original":" Poor adherence to risk factor control and life-saving medications is a key factor affecting long-term patient prognosis. Evidence indicates that sex plays a significant role in the uptake of both pharmacological and non-pharmacological interventions, ultimately influencing long-term outcomes. This study aimed to quantify sex differences in risk factor management and medication adherence following acute coronary syndrome (ACS). This is a secondary analysis of the TEXTMEDS randomised clinical trial - a single-blind, multicentre randomised controlled trial of patients post-ACS. We compared sex differences in achieving clinical and lifestyle targets for secondary prevention, namely blood pressure control (<140/90 mm Hg), low-density lipoprotein cholesterol (LDL-C) (<1.8 mmol/L), healthy body mass index (BMI) (<25 kg/m²), regular physical activity (Global Physical Activity Questionnaire score ≥600), smoking status and adherence to cardioprotective medications (aspirin, beta blockers, ACE/angiotensin receptor blockers, statins, antiplatelets), using adjusted logistic regression models. Medication adherence was defined as taking ≥80% of prescribed doses in the month prior to follow-up, across all five drug classes, unless contraindicated. Of 1379 patients (mean age 58.5±10.7 years; 1095 (79.4%) male), females were less likely than men to achieve LDL-C targets (adjusted OR (aOR): 0.61, 95% CI 0.45 to 0.82) and engage in regular physical activity (aOR: 0.61, CI 0.47 to 0.80), but more likely to achieve a healthy BMI (aOR: 1.47, CI 1.04 to 2.06). Female patients are less likely to adhere to their medication compared with male counterparts (aOR: 0.68, CI 0.50 to 0.92). However, this association weakened and lost statistical significance after further adjustment for socio-economic factors (aOR: 0.71, CI 0.50 to 1.03). There were no significant interactions between sociodemographic or clinical factors and sex in relation to overall medication adherence (P-interactions >0.05). This study reveals that female patients are less likely to achieve LDL-C targets and engage in physical activity but more likely to maintain a healthy BMI. Although females showed lower medication adherence, this association weakened after adjusting for socio-economic factors. These findings highlight the importance of sex-sensitive strategies focusing on risk factor control and medication adherence for improving cardiovascular health outcomes. ACTRN12613000793718. Current risk scores inadequately predict long-term mortality after transcatheter aortic valve replacement (TAVR), limiting their ability to guide decisions around procedural futility. We aimed to develop and externally validate a machine learning (ML) model using only preprocedural variables to predict 1-year all-cause mortality. An ML model was trained on a retrospective cohort of 1025 TAVR patients using 52 clinical and echocardiographic variables. Feature selection and model tuning were performed via a multiobjective evolutionary algorithm to optimise predictive performance and model simplicity. The final model used 13 preprocedural variables and was externally validated in an independent cohort of 270 patients. Performance was compared with European System for Cardiac Operative Risk Evaluation II (EuroSCORE II), FRANCE-2 and TAVI2-SCORE using the area under the curve (AUC), calibration and net reclassification improvem"},{"url":"https://hartvaat.nl/2026/04/09/grootschalige-proteomics-van-bloeddruk-en-hypertensie-wijst-nherf2-aan-als-mogel/","doi":"https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.26407","title_en":"Integrative Proteomic Profiling of Blood Pressure and Hypertension","journal":"Hypertension","source_date":"2026-04-09","abstract_original":"Hypertension, Volume 83, Issue 6, Page e26407, June 1, 2026. BACKGROUND:Hypertension affects one-third of adults worldwide and is largely idiopathic. Identifying protein biomarkers of hypertension may reveal underlying mechanisms and potential treatments.METHODS:We examined associations between 2922 plasma proteins and blood pressure (BP) traits (systolic BP [SBP] and diastolic BP [DBP], and prevalent hypertension) in 45 991 UK Biobank participants with validation in 5759 FHS (Framingham Heart Study) participants. Analysis of new-onset hypertension was performed in 3995 UK Biobank participants and validated in 3073 FHS participants. Functional enrichment analysis linked proteins to biological functions and diseases. Mendelian randomization assessed causal relations between proteins usingcis-protein quantitative trait loci as exposures and BP traits as outcomes.RESULTS:In the UK Biobank, 342 proteins were associated (false discovery rate knockoff <0.1) with SBP, 276 with DBP, and 200 with prevalent hypertension (N=24 724). In the FHS, 115 proteins were validated (Bonferroni-correctedP<0.05) for SBP, 108 for DBP, and 102 for hypertension. New-onset hypertension was associated with 60 (17 validated) proteins. Mendelian randomization analyses revealed significant associations for 206, 210, and 82 proteins with SBP, DBP, and hypertension, respectively. Several of these proteins are involved in blood vessel and cardiac muscle morphogenesis, vasoconstriction, and inflammation. BP-related proteins are enriched for atherosclerotic cardiovascular, liver, and kidney diseases. NHERF2 (Na+/H+exchange regulatory cofactor 2) demonstrated putatively causal associations with SBP, DBP, and with prevalent and new-onset hypertension.CONCLUSIONS:This large-scale proteomic study revealed protein signatures of BP traits and hypertension risk, highlighting inflammation and cardiac and vascular remodeling processes; NHERF2 and several other proteins emerged as promising therapeutic targets."},{"url":"https://hartvaat.nl/2026/04/15/mitralisklepreparatie-bij-endocarditis-geeft-betere-langetermijnoverleving-dan-k/","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e004008?rss=1","title_en":"","journal":"Open Heart","source_date":"2026-04-15","abstract_original":" The optimal surgical strategy for mitral valve (MV) infective endocarditis (IE) remains uncertain. Although valve repair is increasingly advocated, MV replacement is frequently performed, and robust data comparing long-term outcomes between approaches are limited. We evaluated long-term survival following MV repair vs replacement in patients with IE-related mitral regurgitation. We retrospectively analysed 88 consecutive patients who underwent MV surgery for IE-associated mitral regurgitation at St George’s Hospital NHS Foundation Trust, UK, between June 2011 and May 2025. Long-term all-cause mortality was assessed using Kaplan-Meier survival analysis. Multivariable logistic regression identified independent predictors of mortality, and model discrimination was evaluated using the area under the receiver operating characteristic (AUROC) curve. The cohort comprised 65% men with a median age of 57 years (IQR 44.0–64.8). MV replacement was performed in 51.1% of patients who were older than those undergoing repair (median age 62 vs 51 years). In-hospital mortality was 4.5% and long-term all-cause mortality was 14.8%. No in-hospital deaths occurred in the repair group. In age-adjusted and sex-adjusted analyses among replacement patients, increasing age (OR 1.1; 95% CI 1.0 to 1.1; p=0.03) and diabetes mellitus (OR 7.8; 95% CI 1.3 to 48.8; p=0.02) independently predicted long-term mortality. The model demonstrated good discrimination (AUROC 0.83; 95% CI 0.69 to 0.97). Mean survival was significantly longer following repair than replacement (161.0 vs 129.9 months; p=0.008). MV repair for infective endocarditis is safe and associated with superior long-term survival compared with replacement. Diabetes mellitus is a strong independent predictor of mortality in the MV replacement group, highlighting the importance of risk stratification in surgical decision-making. Rapid access chest pain (RACP) clinics are designed to expedite cardiac assessment, but current pathways cause delays due to sequential consultations and testing. This pilot evaluated a novel direct-to-CT coronary angiography (CTCA) pathway to test the hypothesis that a ‘test-first’ model would reduce the time to diagnosis and clinic utilisation. This was a prospective single-centre pilot of consecutive primary care referrals to an RACP service (June 2024–January 2025). Eligible patients with suspected anginal symptoms, no known coronary artery disease (CAD) and no contraindications to CTCA were offered an opt-in to a direct-to-CTCA pathway. CTCA was performed using a prospective single-heartbeat acquisition. The primary outcome was referral-to-diagnosis interval. Secondary outcomes included need for face-to-face consultation, further investigations, incidental findings and theoretical cost savings. 149 patients (mean age 57±9 years, 34% female) underwent CTCA. Median referral-to-diagnosis interval was 29 days (IQR 21–41) vs 88 days (IQR 84–101) in the conventional pathway. CTCA revealed no or mild CAD in 104 (70%) patients; only 47 (32%) required subsequent face-to-face review. Follow-up testing included exercise ECG (17%), echocardiography (8%) and invasive coronary angiography (7%). Incidental findings were uncovered in 30%, with 3% leading to specialty referral. An estimated 102 outpatient visits were avoided, with a cost avoidance estimate of £32 620 per year. A direct-to-CTCA pathway for patients with suspected cardiac chest pain is feasible, reduces time to diagnosis and aligns with National Institute for Health and Care Excellence guidelines. The pathway enables early CAD exclusion in most patients, reduces unnecessary clinic visits and optimises resource use without compromising diagnostic quality. In aortic valve disease, several interventions are available. In young people who are still growing, or considering the risks of long-term anticoagulation, the Ross procedure remains an alternative for aortic valve replacement. This procedure entails the transposition of the patient’s pulmonary valve to the aortic position, with placement of a homograft in the pulmonary position. However, long-term prognosis remains largely unknown. The Swedish national registry of congenital heart disease was searched for adult patients with a history of Ross operation. 82 patients (mean age 40.4±15.8 years) were identified, with a mean age at the time of the Ross procedure of 23.6±14.7 years. After a mean follow-up of 16.8±5.5 years, 24.4% of patients underwent a first reoperation involving either the neoaortic valve or the pulmonary homograft, at a mean age of 32.0±13.9 years. The cumulative incidence of reoperation was approximately 15% at 10 years and 30% at 20 years post-Ross procedure. Among the 20 reinterventions, 17 (85.0%) involved the pulmonary valve and 8 the neoaortic valve; five patients underwent procedures on both valves. Two patients (2.3%) died during follow-up. Forty-eight patients in the cohort had undergone primary Ross surgery. This subgroup was older at the time of data extraction (mean age 46.7±15.7 years) compared with those who underwent secondary Ross surgery (mean age 31.3±10.7 years), that is, typically following previous interventions. The secondary Ross group demonstrated better left ventricular function, with ejection fraction >50% in 91.7% of cases, compared with 69.8% in the primary group (p=0.041). One in four patients undergoing the Ross procedure requires a reintervention, commonly involving the pulmonary valve. Long-term mortality was low. In selected patients, the Ross procedure remains a viable option; however, late morbidity must be considered. Our findings suggest that secondary Ross surgery is associated with better long-term outcomes, particularly regarding left ventricular function, although the underlying mechanisms remain unclear. Women with pre-eclampsia are at increased risk of later-life cardiovascular disease (CVD). Despite suggestions that women affected by pre-eclampsia should undergo routine CVD screening, uniform recommendations are lacking. Subclinical atherosclerosis provides a window of opportunity to identify and treat those at risk of CVD. Coronary artery calcium scoring (CAC), carotid intima–media thickness (CIMT) and ankle brachial index (ABI) are effective methods of detecting subclinical atherosclerosis. This systematic review sought to explore associations between timing of measurement and presence of subclinical atherosclerosis in women with a history of pre-eclampsia. We searched the MEDLINE, EMBASE and CINAHL databases for all studies which reported subclinical atherosclerosis in women with a history of pre-eclampsia. Common and random effects models were used to examine the associations between pre-eclampsia and subclinic"},{"url":"https://hartvaat.nl/2026/04/10/proteomics-onthult-vier-subgroepen-van-acuut-hfpef-met-eigen-biologische-routes-/","doi":"http://heart.bmj.com/cgi/content/short/112/9/504?rss=1","title_en":"","journal":"Heart","source_date":"2026-04-10","abstract_original":" Heterogeneity of heart failure with preserved ejection fraction (HFpEF) results in significant challenges for treatment development. Identifying and characterising distinct HFpEF phenogroups may aid in tailoring therapeutic strategies for these patients. The objective of this study was to assess proteomic patterns of HFpEF phenogroups identified through a machine-learning-based clustering model, with the aim of uncovering specific biological pathways associated with each phenogroup. This study represents a post-hoc analysis of the ongoing Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with preserved Ejection Fraction (PURSUIT-HFpEF) study, which is a multicentre prospective observational study of hospitalised patients with acute decompensated HFpEF. Of the overall cohort (N=1238), this study analysed 198 patients with HFpEF with available proteomics data. These patients were classified into four"},{"url":"https://hartvaat.nl/2026/04/10/tweelingzwangerschap-bij-vrouwen-met-een-hartaandoening-geeft-een-hoog-risico-op/","doi":"http://heart.bmj.com/cgi/content/short/112/9/514?rss=1","title_en":"","journal":"Heart","source_date":"2026-04-10","abstract_original":" Cardiovascular adaptation to pregnancy is more marked in twin than singleton pregnancies and may result in a higher rate of adverse cardiac events in women with heart disease. The objective was to test the hypothesis that women with heart disease and a twin pregnancy have a higher rate of adverse cardiac events. Registry Of Pregnancy And Cardiac disease (ROPAC) is a prospective (2007–2018), global registry of pregnant women with heart disease. Pregnancy outcomes in twin (n=96) were compared with 5643 women with singleton pregnancies. At baseline, twin mothers were older (32.1 vs 29.5 years, p<0.001) and had fewer prior cardiac interventions (43% vs 55.5%, p=0.02). Cardiac diagnosis, New York Heart Association class, modified WHO class, country of origin, prior hypertension, diabetes mellitus, atrial fibrillation and signs of heart failure were similar. The risk of heart failure was significantly higher"},{"url":"https://hartvaat.nl/2026/04/17/verhoogd-crp-voorspelt-hartfalen-bij-kankeroverlevenden-uk-biobank/","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e003513?rss=1","title_en":"","journal":"Open Heart","source_date":"2026-04-17","abstract_original":" Cancer survivors often face the risk of developing heart failure (HF) as a result of their previous cancer therapy. However, the availability of early predictors for such complications remains limited. Recent studies have highlighted the potential link between chronic low-grade inflammation and the development of both cancer and HF. Despite this knowledge, there is a paucity of research specifically investigating the association between C reactive protein (CRP) and the risk of HF among cancer survivors. This study aims to analyse this association. In this study, we analysed data from the UK Biobank, including 20 244 participants (7108 males), with a mean age of 60 years who had cancer at baseline. The primary endpoint of the study was incident HF. Competing risk regression with Cox proportional-hazard models was performed to estimate association between CRP levels and risk of incident HF in cancer survivors. A total of 401 cancer survivors (2.0 per 100) experienced a HF event over a median follow-up of 10.5±1.2 years. Competing risk regression analysis, with adjustment for sociodemographic, lifestyle and clinical variables, revealed that CRP >2 mg/L was associated with a 53% increased risk of incident HF in cancer survivors (sHR 1.53, 95% CI 1.24 to 1.88, p<0.001). Subgroup analyses validated the consistent trend of chronic low-grade inflammation with an increased risk of HF in cancer survivors. Furthermore, cancer type-stratified analyses indicated that the association between inflammation and HF risk was most pronounced among survivors of cutaneous malignancies. This study provides important insights into the relationship between CRP levels and the risk of incident HF in cancer survivors. Future research should investigate whether interventions focused on reduction of inflammation could potentially decrease risk of HF in cancer survivors. The restrictive filling pattern of transmitral inflow has been shown to be associated with a poor prognosis in patients with heart failure (HF) with reduced ejection fraction or myocardial infarction. We aimed to investigate the significance of restrictive filling pattern in patients with HF with preserved ejection fraction (HFpEF). Among 4056 patients with acute decompensated HF in the Kyoto Congestive Heart Failure registry, we analysed 830 patients with HFpEF who had transmitral inflow data available in echocardiography. Patients whose early to late diastolic transmitral flow velocity (E/A ratio) ≥2 were classified as having a restrictive filling pattern of transmitral inflow. The main outcome measures were all-cause death and HF hospitalisation at 1 year. Among 830 patients, a restrictive filling pattern was observed in 144 (17.3%) patients, who had higher prevalence of a history of atrial fibrillation and supranormal left ventricular ejection fraction (>65%), and higher brain natriuretic peptide level at discharge. The cumulative 1-year incidence of HF hospitalisation was significantly higher in patients with restrictive filling pattern than those without (31.0% vs 18.1%, p<0.001), while the cumulative 1-year incidence of all-cause death was not different between the two groups (14.2% vs 14.4%, p=0.93). After adjusting for confounding factors, the excess risk of restrictive filling pattern relative to non-restrictive filling pattern remained significant for HF hospitalisation (HR=1.58, 95% CI 1.10 to 2.27, p=0.01), but not for all-cause death (HR=0.92, 95% CI 0.60 to 1.42, p=0.70). A restrictive filling pattern of transmitral inflow was associated with an increased risk for HF hospitalisation, but not for all-cause death, in patients with acute decompensated HFpEF. Patients with angina and no obstructive coronary artery disease (ANOCA) frequently receive empirical antianginal therapy that fails to target underlying pathophysiological mechanisms. Whether stress perfusion cardiac magnetic resonance (CMR)-guided endotyping and stratified medical therapy improves treatment satisfaction and appropriate medication prescribing in this population is uncertain. In the Coronary Microvascular Angina CMR Imaging Trial, 250 patients with suspected ANOCA, who had undergone invasive coronary angiography demonstrating no obstructive disease, were enrolled and underwent stress perfusion CMR with quantification of myocardial blood flow. Participants were randomised 1:1 to CMR-guided management (intervention) or angiography-guided management (control). Treatment satisfaction was assessed using the validated Treatment Satisfaction Questionnaire for Medication (TSQM-9) at baseline, 6 months and 12 months. Medication prescriptions were documented at these time points. Stress CMR imaging led to diagnostic reclassification in 53.0% of patients, with microvascular angina diagnosed in 51.0%. At 12 months, global treatment satisfaction was significantly higher in the intervention group compared with controls (adjusted difference, 19.30 units (95% CI 13.89 to 24.71); p<0.001), with consistent improvements across the effectiveness and convenience domains. CMR-guided management was associated with more appropriate prescribing, including higher use of preventive therapies (85.5% vs 67.5%; p=0.001), and more targeted antianginal prescribing, including calcium channel blockers (43.5% vs 27.0%; p=0.008) and long-acting nitrates (56.5% vs 32.5%; p<0.001). In patients with ANOCA, non-invasive CMR-guided endotyping substantially improves treatment satisfaction and enables more appropriate, mechanism-targeted pharmacotherapy compared with angiography-guided care. ClinicalTrials.gov ID NCT04805814. A clear definition of delayed and missed coronary artery disease (CAD) diagnosis is lacking, hampering research on the epidemiology and determinants of delayed and missed CAD diagnosis. We engaged healthcare professionals, patients and healthy citizens to develop a consensus-based definition of delayed and missed diagnosis in two CAD domains: acute coronary syndrome (ACS) and chronic coronary syndrome (CCS). Modified Delphi method. Primary and secondary care. The study was conducted among an expert panel consisting of cardiologists (n=19), general practitioners (n=35), patients (n=55) and healthy citizens (n=34). 42 definitions for delayed and missed ACS and 30 definitions for delayed and missed CCS were developed during the first 2 Delphi rounds. The expert panel graded these definitions in rounds 3 and 4 by Likert scale (from 1 (strongly disagree) to 5 (strongly agree)). Useful definitions for research purposes were recommended based on predefined criteria: (1) IQR to assess consensus, (2) median to evaluate the level of support for the definition and (3) convergence of the group to assess stability of opinions across rounds. For delayed ACS, 2 definitions were classified as highly recommended, 13 as recommended and 6 as considerable. For missed ACS, none met the threshold for highly recommended; 5 were recommended and 12 were classified as considerable. For CCS, 2 definitions for delayed diagnosis were highly recommended, 13 recommended and 7 considerable. For missed CCS, 1 definition was highly recommended, 6 were recommended and 7 were considerable. We were unable to establish a one-size-fits-all definition for delayed and missed ACS/CCS diagnosis, reflecting the complexity and context-dependency of CAD diagnostic pathways. However, the developed consensus-based framework and recommended definitions provide a valuable basis for future research, enabling study comparisons across different diagnostic settings. This will ultimately enhance understanding of delayed and missed ACS/CCS diagnosis. Syndromic conditions are frequently associated with congenital heart disease (CHD). Their distribution, recognition and prognostic impact in adults with CHD (ACHD) remain poorly characterised due to limited assessment beyond childhood. We retrospectively analysed 9826 patients with ACHD from a tertiary ACHD centre. Syndromic conditions were identified from clinical records and categorised as chromosomal, single-gene or other syndromes. Clinical characteristics, comorbidities and CHD complexity were compared between syndromic and non-syndromic patients. Multivariable Cox regression was used to evaluate associations with all-cause mortality. Of 9826 patients, 1069 (10.9%) had a syndromic diagnosis. Marfan syndrome (4.1%) and Down syndrome (3.6%) were the most common, followed by Noonan syndrome (0.7%) and 22q11.2 deletion syndrome (0.7%). Syndromic patients were younger (median 34 vs 39 years), had higher rates of pulmonary arterial hypertension (15% vs 5.9%) and sleep apnoea (7.4% vs 2.8%), but fewer traditional cardiovascular risk factors. Down syndrome clustered with atrioventricular septal defect and 22q11.2 deletion with conotruncal defects. In Tetralogy of Fallot, 4.3% had 22q11.2 deletion, mostly diagnosed in childhood; among those without prior diagnosis, most were neither clinically suspected nor tested in adulthood, suggesting under-recognition compared with paediatric cohorts. A syndromic diagnosis was independently associated with higher all-cause mortality (HR 2.06, 95% CI 1.76 to 2.42, p<0.001). We present herewith our institutional ACHD data showing that approximately 1 in 10 patients had a syndromic condition, which was clinically relevant in many respects, cardiovascular or other, including overall mortality. We submit that improved recognition and expanded access to genetic screening may provide additional information relevant to risk stratification and long-term outcome in this growing patient population. Native aortic valve endocarditis continues to present significant operative challenges, often complicated by heart failure, peri-annular extension and conduction disturbances. This study aimed to evaluate temporal trends, outcomes and predictors of mortality following surgery within a nationwide cohort. A retrospective analysis was performed using data from the UK National Institute for Cardiovascular Outcomes Research registry. All patients undergoing aortic valve replacement (AVR) for infective endocarditis between 1996 and 2019 were included. The primary endpoint was in-hospital mortality. Univariate and multivariable logistic regression analyses were conducted to identify independent predictors of adverse outcomes, with bootstrap validation across 500 datasets. A total of 3694 patients underwent AVR for native valve endocarditis between 1996 and 2019. Mean age was 58.0 years (IQR 45.9–68.2) and 21.9% (n=809) were female. Biological prostheses were most frequently implanted (55.7%). In-hospital mortality was 7.8% (n=290). Non-survivors were significantly older and more likely to have chronic kidney disease, diabetes, pulmonary disease, cardiogenic shock and poor preoperative ventricular function. On multivariable analysis, operative urgency (OR 2.49, 95% CI 1.98 to 3.14) and preoperative inotropic support (OR 2.24, 95% CI 1.42 to 3.52) were the most powerful predictors of mortality. Other risk factors included New York Heart Association class III–IV (OR 1.73–1.94), advanced age (OR 1.02/year), chronic kidney disease (OR 1.53) and preoperative atrial fibrillation (OR 1.58). Later years of surgery conferred improved survival (OR 0.96, 95% CI 0.94 to 0.99). Surgery for native aortic valve endocarditis remains high risk, though outcomes have improved over time. Operative urgency and preoperative inotropic requirement are the most powerful predictors of mortality. Despite growing interest in male–female differences in cardiovascular disease, evidence in infective endocarditis (IE) is limited and contradictory. This prospective study included all patients with definite or possible valvular IE discussed by the endocarditis team from 2016 to 2025. Baseline characteristics, diagnostics, treatment and outcomes were compared between sexes. A Cox model was conducted to assess survival adjusted for baseline characteristics, IE type and treatment. The cohort included 791 patients with definite or possible IE (72.8% males, 27.2% females). Age was not different (male: 67 (IQR 56–75), female: 71 (IQR 55–78) years, p=0.07). Females more often had hypertension (46.0% vs 35.2%, p=0.07) and mitral valve IE (45.6% vs 32.3%, p<0.001). Males had more predisposing conditions (71.5% vs 60.5%, p=0.004) and more aortic valve IE (71.0% vs 62.3%, p=0.02) and Cutibacterium species (5.7% vs 1.4%, p=0.007). There was no difference in indication for surgery. However, males were more often treated surgically (41.1% vs 29.3%, p=0.002), and females with an indication for surgery were more often treated conservatively (22.5% vs 37.0%, p=0.006). After a median follow-up of 2.1 (IQR 0.4–4.4) years, females had higher mortality (adjusted HR (aHR) 1.39 (95% CI 1.03 to 1.89), p=0.03). Surgery was associated with higher mortality in males (aHR 1.32 (95% CI 0.90 to 1.94) vs aHR 0.62 (95% CI 0.32 to 1.20), p value for interaction=0.03). Differences were observed in baseline characteristics, IE type and survival. Females had worse overall adjusted survival, suggesting a less favourable overall prognosis. In terms of surgical decision-making, surgery was withheld more often in females despite surgical indication, and after excluding these patients, surgery appeared more protective in females than in males. These findings may reflect sex differences in surgical selection. Cardiac amyloidosis (CA) is underdiagnosed due to non-specific clinical and echocardiographic features. This systematic review and meta-analysis evaluated the diagnostic accuracy of the left ventricular relative apical sparing (RELAPS) pattern on speckle-tracking echocardiography. A literature search of PubMed, Scopus and Cochrane was conducted through August 2025. RELAPS was defined as the average apical longitudinal strain divided by the sum of average basal and average middle left ventricular longitudinal strains. Diagnostic accuracy was assessed using a bivariate random-effects model. Subgroup analyses by CA subtype and echocardiogram software, and meta-regression for clinical variables, were performed. Optimal cut-offs were determined by maximising the Youden index. Analyses were conducted in R V.4.4.1. Forty-one studies (3473 CA; 4525 comparators) were included. Pooled analysis yielded an area under the receiver operating characteristic curve (AUC-ROC) of 0.818, with sensitivity 65.9% (95% CIs 59.2% to 72.0%) and specificity 83.1% (CI 78.5% to 86.8%). The diagnostic oods ratio (DOR) was 9.54 (CI 7.41 to 12.10). In subtype analyses, immunoglobulin light chains (AL-CA) showed AUC-ROC 0.876, sensitivity 59.8% (CI 41.1% to 76.0%) and specificity 92.7% (CI 83.6% to 96.9%); transthyretin (ATTR-CA) showed AUC-ROC 0.822, sensitivity 63.8% (CI 51.2% to 74.8%) and specificity 84.4% (CI 76.7% to 89.9%), with no significant differences between subtypes (sensitivity p=0.760; specificity p=0.172). Three echocardiography software systems were evaluated. GE EchoPAC (26 studies) achieved an AUC-ROC of 0.822 (sensitivity 70.4% (CI 64.1% to 76.0%), specificity 81.2% (CI 75.7% to 85.7%)). Philips QLAB (four studies) performed comparably (AUC-ROC 0.904; sensitivity 67.6% (CI 31.2% to 90.6%), specificity 92.7% (CI 73.6% to 98.3%)). In contrast, TomTec (four studies) had an AUC-ROC of 0.806, but its sensitivity (31.1% (CI 9.4% to 66.3%)) was significantly lower than GE EchoPAC’s (p<0.001), despite a similar specificity (93.6% (CI 78.8% to 98.3%)). RELAPS provides moderate diagnostic accuracy for identifying CA, with good specificity and modest sensitivity. Performance varies by analysis software and threshold, underscoring the need for standardised measurement and prespecified cut-offs. To investigate whether achieving minimum clinically important difference in anxiety and depression is associated with meeting minimum clinically important difference in walking fitness following cardiac rehabilitation. This retrospective observational study analysed routinely collected data from the UK National Audit of Cardiac Rehabilitation. Univariate analyses were employed to investigate the baseline characteristics associated with walking fitness. Then, a logistic regression analysis was conducted to examine whether achieving the minimum clinically important difference in anxiety and depression (defined as >1.7 score improvement in the Hospital Anxiety and Depression Scale) was associated with achieving the minimum clinically important difference in walking fitness (defined as >70 m improvement in the incremental shuttle walk test) following cardiac rehabilitation. A total of 4585 acute coronary syndrome patients at the National Audit of Cardiac Rehabilitation underwent valid incremental shuttle walk test and the Hospital Anxiety and Depression Scale assessments before and after cardiac rehabilitation between 1 January 2021 and 30 June 2024. Patients who achieved the minimum clinically important difference for depression had 23% higher odds of meeting the minimum clinically important difference for walking fitness (OR 1.23, 95% CI 1.01 to 1.49). Compared with home-based programmes, centre-based group programmes and hybrid programmes (combining centre-based and home-based components) were associated with higher odds of achieving clinically meaningful improvement in walking fitness. Factors such as older age, female sex, physical inactivity, obesity and longer waiting times to commence cardiac rehabilitation were associated with a lower likelihood of achieving minimum clinically important difference in walking fitness, adjusting for baseline anxiety, depression and incremental shuttle walk test scores. Clinically meaningful improvement in depressive symptoms was associated with clinically meaningful improvement in walking fitness, underscoring the relevance of addressing depression within cardiac rehabilitation. Conduction system pacing (CSP) has emerged as an alternative to right ventricular pacing (RVP) for atrioventricular block (AVB) aiming to avoid ventricular dyssynchrony and adverse heart failure outcomes yet clinical adoption remains limited due to insufficient randomised evidence. This study aimed to assess the clinical outcomes of CSP versus RVP in patients with AVB based exclusively on randomised controlled trials (RCTs). MEDLINE, Embase and Cochrane were searched from inception to October 2025. Clinical outcomes comparing CSP and RVP were analysed using HR, risk ratio (RR) and mean difference with 95% CIs. Heterogeneity was assessed with I2 and robustness tested by sensitivity analyses. Outcomes included heart failure hospitalisation (HFH), all-cause mortality (ACM), composite endpoint and key cardiac parameters. Data from five RCTs involving 985 patients with AVB were analysed. In the pooled analysis, the composite endpoint is significantly improved in the intervention pacing (HR=0.54; 95% CI 0.31 to 0.95; p=0.03), similarly with markedly reduced risk for HFH (RR=0.30; 95% CI 0.17 to 0.54; p<0.0001). However, no significant difference was observed between CSP and RVP in ACM (RR=0.69; 95% CI 0.36 to 1.30; p=0.25). Secondary outcomes significantly favoured the CSP group, as the change in left ventricular ejection fraction (LVEF) was significantly increased (p=0.008) and the QRS duration was significantly shorter (p=0.002) compared with RVP. In patients with AVB, CSP provides enhanced cardiac and clinical benefit compared with RVP driven by reduced HFH, improved LVEF and shorter QRS, while evidence regarding its influence on overall mortality remains uncertain. Secondary tricuspid regurgitation (TR) often develops or persists following left-sided valve surgery. However, its impact on outcomes and the optimal timing of intervention is unclear. This study examined the association between isolated postoperative secondary TR and outcomes in patients with a history of mitral or aortic valve surgery. This observational single-centre cohort study included patients with left-sided valve surgery and less than moderate preoperative TR who underwent follow-up echocardiography between 2002 and 2024. The presence of isolated postoperative secondary TR was evaluated in relation to clinical outcomes. The primary endpoint was a composite of all-cause death and heart failure hospitalisations (HFH). The cohort consisted of 2487 patients with a mean age of 68 years and a median follow-up time of 3 years. All-cause mortality and HFH increased with the grade of postoperative TR (p<0.001). Postoperative TR was associated with the composite endpoint independent of cardiovascular risk factors and baseline comorbidities (adjusted HR 1.29; 95% CI 1.18 to 1.41; p<0.001). The association between postoperative TR and the primary endpoint remained significant after adjustment for right ventricular (RV) remodelling and moderate mitral regurgitation (adjusted HR 1.40; 95% CI 1.28 to 1.53; p<0.001). An increase in TR by at least two grades from the preoperative assessment was observed in 12.5% of patients and was associated with the composite endpoint (p<0.001). Age, sex, myocardial infarction, coronary artery bypass grafting, atrial fibrillation and RV remodelling were factors associated with TR progression (p<0.01). In patients following left-sided valve surgery, isolated postoperative secondary TR is independently associated with mortality and HFH independent of RV size, function and baseline comorbidities. An increase in TR severity by at least two grades from the preoperative assessment is associated with adverse outcomes. Patients with adult congenital heart disease (ACHD) frequently develop late complications despite early surgical repair, including ventricular dysfunction and arrhythmias. In conditions with predominant right-sided pathology such as atrial septal defect (ASD), pulmonary stenosis (PS) and Tetralogy of Fallot (ToF), leading to right ventricular dilatation or systolic/diastolic dysfunction, ventricular interdependence may result in impaired left ventricular filling and left atrial (LA) dysfunction, despite the absence of primary left-sided disease. LA strain (LAS) has demonstrated prognostic value in acquired heart disease but its role in ACHD remains incompletely defined. To evaluate the prognostic significance of LAS in adults with repaired right-sided CHD. This single-centre longitudinal study includes patients with ACHD such as ASD, PS and ToF from the Quality of Life study at the Erasmus Medical Center. All patients underwent surgical repair during childhood between 1968 and 1980. Detailed cardiological evaluation, including STE-derived assessment of LA reservoir (LASr), conduit and contractile (LASct) function, was performed in 2012. Clinical outcomes were collected over a 10-year follow-up period, including mortality, reinterventions, heart failure and symptomatic tachyarrhythmias (supraventricular or ventricular) requiring treatment. A total of 195 patients were included (ASD=78 (40%); PS=45 (23%); ToF=72 (37%)), with a mean age of 40.7±5.2 years at the time of evaluation. Patients with ToF exhibited more frequent interventricular conduction abnormalities at baseline and had 2.7-fold higher odds of reaching the composite endpoint compared with patients with ASD. In Cox regression analyses, LASr and LASct were independently associated with symptomatic tachyarrhythmias (LASr: HR=0.952, p=0.013; LASct: HR=0.936, p=0.046), and these associations remained significant after adjustment for left ventricular ejection fraction, LA volume index or N-terminal pro B-type natriuretic peptide. LAS provides independent prognostic information after surgical repair of right-sided CHD, particularly for predicting symptomatic tachyarrhythmias. Impaired LA deformation identifies patients at increased risk, underscoring the clinical relevance of LA mechanics in ACHD follow-up. To quantify ethnic disparities in mortality after acute coronary syndrome (ACS) by comparing outcomes in Black, Asian and hite population groups. We conducted a systematic review and meta-analysis of observational studies reporting mortality after ACS by ethnicity. Embase, Global Health, Ovid MEDLINE and Web of Science were searched through to March 2026 for English-language studies of adults with ST-elevation myocardial infarction (STEMI), non-STEMI or unstable angina. Two reviewers independently screened records, extracted data and assessed risk of bias using the Newcastle-Ottawa Scale. The primary outcome was all-cause mortality. Risk ratios (RRs), ORs and HRs were pooled as relative risk (RRs) with 95% CIs using random-effects models. Heterogeneity was quantified with I² and explored using prespecified subgroup analyses and meta-regression. Forty cohort and registry studies from the USA, UK and Canada including 14 million patients met the inclusion criteria. Overall mortality was similar in black versus white patients (RR 0.99, 95% CI 0.94 to 1.03) and Asian versus white patients (RR 1.06, 95% CI 0.95 to 1.17); however, restriction to US-based studies demonstrated higher mortality in Asian patients (RR 1.14, 95% CI 1.03 to 1.27). Subgroup analyses showed higher mortality in black patients following STEMI (RR 1.09, 95% CI 1.02 to 1.17). Meta-regression showed age-dependent effect modification in black versus white comparisons, with differences attenuating in older populations. The pooled risk of major bleeding was similar between groups. Black patients had higher mortality than white patients following STEMI, and Asian patients demonstrated higher mortality in US-based studies. Overall post-ACS mortality was otherwise similar across ethnic groups. These findings suggest disparities persist in specific contexts and may be more pronounced in younger populations, but should be interpreted with caution due to substantial heterogeneity. The Heavy, Hypertensive, Atrial fibrillation, Pulmonary hypertension, Elder, Filling pressure (H2FPEF) score is a widely used diagnostic tool for heart failure with preserved ejection fraction (HFpEF). Angina symptoms are common in patients with HFpEF but are not included in the score. We aimed to determine whether incorporating angina into the H2FPEF score improves its diagnostic performance sex-specifically, given the well-known sex differences in both HFpEF and angina presentation. We included 515 individuals from the UHFO-DM cohort with suspected HFpEF. Participants underwent standardised symptom collection, including angina using WHO questionnaires, and expert-panel adjudication of HFpEF. Following evaluation of H2FPEF, we assessed the association of angina with HFpEF independent of H2FPEF using logistic regression. By adding angina to H2FPEF, we developed a modified algorithm and evaluated it by the area under the receiver operating characteristic curve (AUC), calibration, reclassification and decision curve analysis. All analyses were stratified by sex. We also included another 751 individuals with suspected HFpEF from a Combination cohort of UHFO-COPD (n=136), STRETCH (n=331) and TREE (n=284) for regression analysis. In the UHFO-DM cohort, HFpEF prevalence was 24%. Overall H2FPEF discrimination (AUC) was 0.72, with 0.69 in women and 0.74 in men. Angina was independently associated with HFpEF in women (OR 3.96, 95% CI 1.72 to 9.11, p=0.001) but not in men (1.90, 0.88 to 4.10, 0.102). Adding one point for angina in a modified H2FPEF score in women improved AUC from 0.69 to 0.71 (DeLong p=0.030), increased sensitivity (0.53 to 0.60) and negative predictive value (0.80 to 0.82) and yielded a continuous net reclassification improvement of 0.449, with preserved calibration and higher net clinical benefit on decision curves. No performance gain was observed with the same modification in men. In the Combination cohort, angina was also independently associated with HFpEF only in women (women, 2.13, 1.14 to 3.97, 0.018; men, 0.85, 0.44 to 1.66, 0.638). In women with suspected HFpEF, the presence of angina provides diagnostic information independent of H2FPEF to uncover HFpEF. A simple sex-specific modification of H2FPEF, adding one point for angina in women, may slightly improve discrimination and rule-out performance in women. Both Takotsubo syndrome (TS) and ST-elevation myocardial infarction (STEMI) are conditions characterised by the acute onset of left ventricular (LV) dysfunction. While LV thrombus is a known complication of LV dysfunction, its epidemiology in these two patient groups remains poorly understood. We used data from the Stunning in Takotsubo versus Acute Myocardial Infarction (STAMI) study, which prospectively enrolled patients with TS and STEMI at Sahlgrenska University Hospital. Serial echocardiography was performed on admission and on days 1, 2, 3, 7, 14 and 30. Predictors of LV thrombus were identified using Cox regression analyses. 314 patients were included; 68 with TS, 148 with anterior STEMI and 98 with non-anterior STEMI. Mean LV ejection fraction (LVEF) at admission was 39% (95% CI 35.8 to 42.2) in TS, 46.7% (95% CI 43.3 to 50.1) in anterior STEMI and 52.8% (95% CI 48.9 to 56.7) in non-anterior STEMI. LV thrombus occurred in 20 of 246 (8.1%) STEMI patients but in none of the TS patients. All but one LV thrombus was found in anterior STEMI. All LV thrombi in anterior STEMI were detected within 7 days, while the single non-anterior LV thrombus was found on day 30. All patients with LV thrombi received anticoagulation. Predictors of LV thrombus included lower LVEF and higher troponin levels. Despite more severe LV dysfunction in TS compared with STEMI, LV thrombus was exclusively found in STEMI patients. Almost all LV thrombi were found in anterior STEMI within the first week and showed a high-resolution rate at 30 days. Our findings highlight pathophysiological differences between these two conditions, warranting further investigation and implications for differing surveillance needs after TS and STEMI. Myocarditis is a potentially severe adverse event after COVID-19 messenger RNA (mRNA) vaccination. Validation of reported cases is essential. We aimed to determine the occurrence, clinical characteristics and short-term outcomes of vaccine-associated myocarditis (VAM) in Norway. In this nationwide, population-based validation study, we used national health registry data and hospital electronic medical records from 27 December 2020 to 30 April 2022. We identified all Norwegian residents who received at least one dose of BNT162b2 or mRNA-1273. By cross-linking registries, we identified myocarditis within 90 days after vaccination. Diagnoses were validated through individual chart review using Brighton Collaboration criteria. VAM was defined as myocarditis without a more likely alternative cause. Among 4.1 million vaccinated individuals who received 10.9 million doses, we identified 367 potential myocarditis cases. Of 349 cases reviewed, 177 (51%) were validated as VAM, corresponding to 4.5 cases per 100 000 vaccinated individuals. In total, 110 (62%) cases occurred after the second dose. Of validated cases, 139 (79%) occurred in men. Median age was 30 (IQR 24–50) years for men and 54 (IQR 32–65) years for women. Three (2%) cases were under 18 years. The median hospital stay was 4 (IQR 3–5) days, and the median ejection fraction was 55% (IQR 53%–60%). Seven (4%) patients required intensive care and two (1%) older patients died. No patient required mechanical circulatory support or heart transplantation. VAM occurred in 4.5 per 100 000 vaccinated individuals, based on validation of about half of registry-identified myocarditis cases. The acute clinical course was generally mild. National surveillance and systematic validation are essential for reliable estimates of vaccine-associated adverse events. Heart pumping weakness occurs progressively in all patients with Duchenne muscular dystrophy (DMD), but symptoms only occur very late in the process. Regular imaging assessments of heart function are needed to see how the heart is ‘doing’ and how well it is responding to treatment with heart drugs. Echocardiography (echo) has been the standard type of imaging used for these assessments in the UK. It is widely available but has limitations. Cardiac MRI (CMR), although less readily available and more expensive, is better able to detect tissue changes in the heart before there is any reduction of heart pump function and retains accuracy in all measures even as DMD progresses. An expert panel of cardiologists, muscle specialists and patient representatives was set up to review evidence and provide expert guidance on how to use both echo and CMR best to the benefit of patients with DMD, Becker muscular dystrophy (BMD) and females affected by DMD-gene abnormalities (‘female gene carriers’). The working group concluded that echo should remain the predominant method used in heart checks for patients with DMD in the UK. However, wider use of CMR, performed at times individualised to key decision points after about the age of 10 years, would allow earlier detection of those heart changes prompting the introduction and changes in heart therapies. Similarly, greater use of CMR could contribute to improving cardiac management of males with BMD and females with DMD-gene variations. _______________________ To provide guidance on the use of cardiac MRI (CMR) in the UK in paediatric and adult patients with Duchenne muscular dystrophy (DMD) or Becker muscular dystrophy (BMD) as well as recommendations for screening and monitoring females with dystrophin-gene variations. Specifically, to examine the ‘added value’ of CMR over echocardiography at selected time points in the assessment of individuals with or at risk of developing cardiac dystrophinopathy. Initiated by an expert working group of UK-based and US-based imaging cardiologists, neuromuscular clinicians and DMD-patient representatives, draft guidelines were created based on published evidence, current practice and expert opinion. After wider consultation with UK cardiologists, consensus was reached on the optimal use of CMR in clinical decision-making about therapy. Echocardiography should remain the predominant modality for cardiac surveillance and to guide therapy for patients with DMD in the UK. However, when tolerated, wider use of CMR at key stages in patients with DMD, older than age 10 years, and for males with BMD and females with DMD-gene variations would allow earlier detection of those with cardiac involvement and inform the earlier initiation of regimes of cardiac medications. In this way, greater use of CMR could contribute to improving cardiac health in each of these patient groups. To investigate the prevalence of diastolic dysfunction and associated risk factors in pre-diabetes and diabetes in the general population. Diastolic function was assessed by transthoracic echocardiography in a cross-sectional sample of 3840 men and women aged 50–64 years from the Swedish CArdioPulmonary bioImage Study. Anthropometry, medical history, blood pressure, biochemistry and coronary atherosclerosis assessed by CT were recorded. Population-specific reference ranges were applied. Diastolic function was compared across glycaemic groups and analysed in relation to risk factors. Normoglycaemia was present in 82%, pre-diabetes in 12% and diabetes in 6%. Diastolic function was impaired (p<0.001) in pre-diabetes and diabetes, with higher prevalence of abnormal diastolic variables in pre-diabetes (30%) and diabetes (33%) than in normoglycaemia (21%). Among participants with pre-diabetes/diabetes, diastolic dysfunction was associated with hypertension and more severe coronary atherosclerosis (p<0.001). In multivariable analyses, waist circumference (OR 1.034, 95% CI 1.013 to 1.054) and high Coronary Artery Calcium Score (OR 2.897, 95% CI 1.373 to 6.113) were independently associated with diastolic dysfunction, also after exclusion of subjects with ischaemic heart disease. In those without coronary atherosclerosis and hypertension, systolic blood pressure was the only independent risk factor (OR 1.027, 95% CI 1.002 to 1.053). Diastolic dysfunction was as common in pre-diabetes as in diabetes and was mainly associated with central adiposity, hypertension and coronary atherosclerosis. In individuals without coronary atherosclerosis or hypertension, systolic blood pressure was still the only independent predictor. These findings challenge the concept of a clinically relevant isolated diabetic cardiomyopathy and highlight the importance of early and comprehensive cardiometabolic risk factor control to prevent heart failure with preserved ejection fraction. Aortic stenosis (AS) leads to left ventricular (LV) remodelling and fibrosis. Myocardial fibrosis can be focal and irreversible, associated with poor prognosis, or diffuse and potentially reversible after surgery. Cardiac magnetic resonance imaging (CMR) shows promise in quantifying diffuse myocardial fibrosis (DMF), but methods vary in precision. The aim of this study was to investigate the presence and distribution of DMF from myocardial biopsies and CMR tissue characteristics in severe AS. Secondarily, explore the association between DMF and LV function. Forty-three patients with severe AS underwent CMR and transthoracic echocardiography within 1 week before surgical aortic valve replacement. CMR included balanced steady-state free-precession cine images, T1 relaxometry with Modified Look-Locker Inversion recovery and extracellular volume calculations. Endomyocardial biopsies were sampled. Histological analysis of 192 biopsies showed a median LV collagen volume fraction (CVF) of 19%, peaking in segment 1, according to the segment model recommended by the American Heart Association (AHA). There were significant moderate correlations between CVF and extracellular volume in AHA segments 1 (r² = 0.54, p<0.01) and 16 (r² = 0.44, p=0.03), where the DMF had the highest prevalence. Functional assessments demonstrated correlations between CVF and global circumferential and radial strain (r2 0.31, p=0.04 respectively r2–0.33, p=0.03), as well as LV ejection fraction (r2–0.34, p=0.03). T1 relaxation time correlated with GLS (r2 0.42, p<0.01), mitral annular plane systolic excursion (r2–0.39, p=0.01) and mean S’ LV (r2–0.45, p<0.01) from transthoracic echocardiography. CVF varied across LV segments and was significantly highest at the base of the heart, suggesting the start location for fibrosis. Systolic functional data correlated with CVF and T1 relaxation time. Serum chloride has been recently recognised as a predictor of short-term mortality in patients hospitalised with acute heart failure (AHF). However, data from developing nations such as Vietnam remain limited. We conducted a cross-sectional study at Can Tho Central General Hospital, Vietnam, from May to December 2024. Adult patients aged ≥18 years, hospitalised with AHF and NT-proBNP levels ≥300 pg/mL, were included after providing informed consent. Exclusions were made for patients lacking 24-hour electrolyte panels, those transferred or deceased before blood collection and individuals with end-stage renal disease, on renal replacement therapy or with active malignancies. Postdischarge survivors were followed up via phone interviews for 30 days. The primary endpoint was all-cause mortality. Given the low in-hospital event rate (5%), logistic regression was used to estimate ORs, while modified Poisson regression with robust variance estimation was applied for 30-day mortality, where the event rate exceeded 10% and OR would overestimate true risk. The final cohort included 423 patients (mean age 69.7±12.7 years; 48% male). During hospitalisation, 21 (5.0%) patients died and 402 were discharged alive. Of the discharged patients, 252 (62.7%) completed a 30-days follow-up, with 43 deaths (17.1% mortality rate). After adjusting for age, sex, coronary artery disease, chronic heart failure, left ventricular ejection fraction and serum sodium, hypochloraemia was an independent predictor of in-hospital mortality (adjusted OR 4.9; 95% CI 1.3 to 18.5) and 30-days mortality (adjusted RR 1.9; 95% CI 1.1 to 3.6). Additionally, each 1 mmol/L increase of chloride was associated with a 5% lower risk of 30-day death (RR per unit change 0.95; 95% CI 0.91 to 0.99; p=0.007). Admission serum chloride levels independently predicted both in-hospital and 30-days all-cause mortality in Vietnamese patients with AHF. Including this biomarker in risk-stratification tools could enhance short-term prognostication, while its longer-term predictive value warrants further investigation. Infective endocarditis following transcatheter aortic valve implantation (TAVI-IE) is an uncommon but clinically devastating complication. We aimed to identify risk factors for TAVI-IE and to estimate its association with all-cause mortality. We conducted a case-control study including patients who underwent TAVI at Haukeland University Hospital, Norway, between 2012 and 2023. Patients who developed TAVI-IE (n=71) were compared with age-matched and sex-matched controls without IE (n=213; 1:3 ratio). Death was treated as a competing event in analyses of IE, and we estimated the subdistribution HRs (SHR) for IE using Fine-Gray competing risk regression. Cox regression models with IE as a time-dependent covariate assessed the impact of infection on mortality. The incidence of TAVI-IE was 1.2% per patient-year with a median time from TAVI to infection of 13 months (IQR 4–29). In multivariable competing risk analysis, diabetes mellitus remained an independent predictor of TAVI-IE (SHR 2.08, 95% CI 1.19 to 3.65, p=0.010). Obesity (27% vs 15%, p=0.019) and balloon-expandable valve use (28% vs 13%, p=0.003) were more often observed in patients with TAVI-IE. Enterococcus faecalis was the most frequent pathogen (30%). TAVI-IE was associated with an approximately twofold increase in all-cause mortality (adjusted HR 2.13, 95% CI 1.48 to 3.07, p<0.001) with the highest risk in early infections. TAVI-IE is an infrequent but severe complication associated with excess mortality. Diabetes mellitus was the dominant independent risk factor and E. faecalis the leading pathogen. These findings may help target monitoring and prevention in patients at the highest risk. The interplay between genetic susceptibility and clinical risk for incident atrial fibrillation (AF) is unclear. We used a case-cohort study design and included AF cases and a randomly drawn subcohort of 4040 participants from the Danish Diet, Cancer and Health cohort. The simplified version of the Future Innovations in Novel Detection of Atrial Fibrillation (FIND-AF) risk score was used to quantify individual participant clinical risk of incident AF as low (0–3 points), high (4–6 points) and very high risk (7–14 points). We calculated individual participant Genetic Risk Scores (GRS) from 142 variants to categorise participants as low (quintile 1), intermediate (quintile 2–4) or high (quintile 5) genetic risk of AF. We used weighted Cox proportional hazards regression to quantify risk of incident AF according to FIND-AF risk and GRS and assessed the relative excess risk due to interaction (RERI) for interaction on an additive scale. During a median follow-up of 12.9 years, 3094 participants developed AF. Compared with individuals with low FIND-AF risk score and low GRS, the multivariable-adjusted HR for AF was 3.47 (95% CI 2.64 to 4.55) for those with high FIND-AF risk score and high GRS and 12.76 (95% CI 5.07 to 32.11) for those with very high FIND-AF risk score and high GRS. The RERI was 0.56 (95% CI 0.43 to 0.70), indicating a positive additive interaction between GRS and FIND-AF risk score. Genetic susceptibility and clinical risk interacted on an additive scale to elevate AF risk. These results highlight the need for future research on prevention and screening among individuals with both high genetic and clinical risk for AF. The current guideline recommends a peak tricuspid regurgitation velocity (TRV) ≥2.9 m/s on echocardiography for pulmonary hypertension (PH) screening; however, this threshold was based on the previous PH definition (mean pulmonary arterial pressure (mPAP) ≥25 mm Hg) and derived largely from PH referral centres. We retrospectively analysed 755 patients who underwent both transthoracic echocardiography and right heart catheterisation at two general hospitals. The discrimination of peak TRV and estimated right atrial pressure (eRAP), derived from inferior vena cava diameter and respiratory variation, for screening for PH was assessed by receiver operating characteristic curve analysis. Optimal cut-off values were determined with the Youden Index. The c-statistic for peak TRV in detecting PH was 0.82 (95% CI 0.79 to 0.85). An optimal cut-off of 2.7 m/s provided higher sensitivity (72%) than the conventional 2.9 m/s threshold (60%) while maintaining high specificity (82%). In 681 patients with available TRV and eRAP data, adding eRAP improved discrimination compared with TRV alone (c-statistic 0.83 vs 0.80; net reclassification improvement=0.14, p=0.002). eRAP ≥5 mm Hg was associated with a higher risk of PH, and the combination of elevated TRV and eRAP yielded the strongest association. For screening under the revised PH definition, a peak TRV of 2.7 m/s is suggested as the optimal cut-off. Although TRV alone showed good discriminative performance, combining it with eRAP further improved diagnostic accuracy using simple echocardiographic measures. Fractional flow reserve derived from CT (FFR-CT) enables non-invasive functional assessment of coronary stenoses in patients with suspected or known coronary artery disease, but evidence regarding its prognostic value remains fragmented. We conducted a systematic review and meta-analysis to quantify the association between abnormal FFR-CT and major adverse cardiovascular events (MACE), updating the 2022 meta-analysis by Nørgaard et al We searched PubMed, Embase and Scopus through December 2025 for studies comparing outcomes in patients with suspected or known coronary artery disease with FFR-CT ≤0.80 versus >0.80 (PROSPERO: CRD420261276897). Random-effects meta-analysis with Hartung-Knapp-Sidik-Jonkman adjustment was performed. Subgroup analyses examined FFR-CT technology, geography and follow-up duration. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool and certainty of evidence using Grading of Recommendations, Assessment, Development and Evaluations (GRADE) method. Twenty-two studies with 20 067 patients were included, representing a fourfold increase from the prior meta-analysis. Follow-up ranged from 12 to 120 months. Patients with FFR-CT ≤0.80 had significantly higher MACE risk (HR 3.94; 95% CI 2.92 to 5.31; p<0.0001) with substantial heterogeneity (I²=79.9%). However, restricting to hard endpoints (death/myocardial infarction; k=6) yielded HR 3.28 (95% CI 2.25 to 4.79) with zero heterogeneity (I²=0%). No significant differences emerged across FFR-CT technologies (p=0.812), including HeartFlow, machine learning and deep learning algorithms. Trim-and-fill analysis suggested possible publication bias, with adjusted HR 2.35. GRADE certainty was moderate. Abnormal FFR-CT is associated with nearly fourfold increased risk of MACE in patients with suspected or known coronary artery disease, with consistent prognostic value across technologies. The absence of heterogeneity for hard endpoints supports FFR-CT as a reliable prognostic marker. These findings address the evidence gap identified by current guidelines regarding FFR-CT prognostic utility. CRD420261276897. Not applicable (as this is a Systematic Review and Meta-Analysis and not a Clinical Trial). The primary aim of this study was to describe physical fitness in a large real-world cohort of patients entering exercise-based cardiac rehabilitation (EBCR) after first-time myocardial infarction (MI). The secondary aim was to compare the results with clinical reference values. This registry-based cohort study used data from the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) post-MI registry between 2016 and 2019. Patients with first-time MI who underwent physiotherapist-led assessments of physical fitness at EBCR entry were included. Exercise capacity was evaluated by a symptom-limited cycle ergometer test and muscular endurance by a unilateral heel-rise test. Results were compared with age-stratified and sex-stratified clinical reference values. Reference values for exercise capacity were based on the Swedish Kalmar dataset, the national standard reference in Sweden since 2014, and reference values for heel-rise performance were based on a Swedish normative dataset of healthy adults. A total of 15 105 patients (mean age 62.5±9.1 years, 78.4% men) were included. Exercise capacity (Watt max from the exercise test) was higher in men than women across age groups, and muscular endurance declined with age, with a steeper age-related decline in women’s heel rise performance. The mean exercise capacity of the study population corresponded to 64.7±27.4% of predicted values in men and 68.4±18.9% in women. Muscular endurance averaged 78.4%±51.0% of reference values in men and 61.7%±43.2% in women. At EBCR entry after a first-time MI, both exercise capacity and muscular endurance were substantially below age-specific and sex-specific reference values. These results underscore the importance of systematic baseline assessments and tailored rehabilitation interventions targeting both exercise capacity and muscular endurance. Cardiovascular diseases often occur together, but little is known about what increases the risk of developing cardiovascular multimorbidity (CVM), particularly in women. This study investigated the associations of cardiovascular risk factors with CVM incidence in UK women. 1.3 million women aged 50–64 years were recruited into the Million Women Study in 1996–2001. Women reported information on demographic and cardiovascular risk factors (weight, height, smoking, alcohol consumption, physical activity and treatment for high blood pressure, diabetes and high blood cholesterol) at baseline. Using linked hospital admission and death records, each participant was followed for 19 subtypes of incident cardiovascular disease. Outcomes were CVM (having ≥2 of 19 selected cardiovascular disease diagnoses), complex CVM (having ≥4 diagnoses), and pairs of the four most common individual cardiovascular diseases. In multivariable adjusted models, obesity, current smoking and treatment for diabetes or hypertension were each independently associated with a 2–3 times higher risk of incident CVM. Severe obesity, heavy smoking and diabetes were associated with 3–4 times higher risks of complex CVM and most CVM pairs. The strongest relationships were for severe obesity, which was associated with a fivefold higher risk of developing both atrial fibrillation and heart failure together (compared with healthy body mass index), and for diabetes, which was associated with a fivefold higher risk of developing both ischaemic heart disease and heart failure together. There was little evidence of strong associations of alcohol consumption or physical activity with most CVM outcomes. In middle-aged women, known cardiovascular risk factors including smoking and obesity were associated with substantially higher risks of CVM, with stronger associations for severe obesity, heavy smoking and diabetes, and certain combinations of cardiovascular disease subtypes. Targeted management of these risk factors for secondary prevention may reduce progression to CVM, potentially with greater benefits in those at risk for complex CVM. Congenital heart disease surgery includes intricate structures that are perhaps hard to completely understand by traditional two-dimensional shapes. Individualised, centre-based three-dimensional (3D) heart models may enhance structural imaging and surgical preparation, while data on their medical effect continue to be unpredictable and uneven. This systematic review and meta-analysis assessed the impact of 3D heart simulations on surgical preparation and outcomes in congenital cardiac disease. To assess the successful outcomes of patient-centred 3D cardiac simulations in medical preparation, intraoperative execution and surgical results in patients experiencing operation for congenital cardiac disease. To evaluate the impact of patient-specific 3D heart models on surgical planning precision and preoperative outcomes in congenital heart disease surgery. A systematic review and meta-analysis were performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 standards and prospectively registered in PROSPERO (CRD42024211985). PubMed, Embase, Scopus and Cochrane CENTRAL were searched through March 2025 for comparative studies evaluating 3D-printed or virtual heart models versus conventional imaging. Outcomes were harmonised and pooled as risk ratios (RRs), mean differences (MDs) or standardised MDs (SMDs) with 95% CIs using random-effects models. 32 studies (n=1842) met inclusion criteria. The use of 3D models was associated with more frequent surgical plan modification (RR 1.42; 95% CI 1.21 to 1.67), reduced operative time (MD –18.4 min; 95% CI –27.6 to –9.2), lower postoperative complications (RR 0.74; 95% CI 0.56 to 0.98) and reduced re-operation (RR 0.52; 95% CI 0.31 to 0.86). Hospital stay was shortened (MD: 1.8 days; 95% CI –3.0 to –0.6), and surgeon confidence improved (SMD 0.88; 95% CI 0.60 to 1.15). The confidence of indication extended from modest to small because of non-experimental research and variability. Individualised-centred 3D heart stimulation improves structural imaging and medical preparation in congenital cardiac disease, chiefly for intricate lacerations and can increase preoperative competence, while statistics for conclusive diagnosis results continue to be restricted and mainly experiential. Upcoming potential, large-scale investigator-led research with consistent result events are required to ratify their medical success. Recurrent pericardial effusion remains a diagnostic and therapeutic challenge due to high recurrence rates. Laparoscopic pericardioperitoneal window represents an understudied method in the management of pericardial effusion and is a minimally invasive technique that allows continuous drainage, achieving symptomatic improvement with minimal recurrence. We conducted a single-centre prospective study between 2022 and 2024, including patients with recurrent pericardial effusion requiring surgical intervention. A pericardioperitoneal window was created via laparoscopy for all patients. Clinical outcomes, complications and recurrence rates were assessed over a 12-month follow-up period. 24 patients were included, and all patients tolerated the surgical procedure well. The surgery was technically successful in all patients, resulted in direct symptomatic improvement and none experienced postoperative complications. Postoperative drainage was not needed, and patients were discharged the next day. 12-month follow-up revealed no clinical or radiological signs of recurrence. Laparoscopic pericardioperitoneal window appears to be a safe, effective and durable alternative for patients with recurrent pericardial effusion. However, larger randomised controlled trials are required for further assessment of safety and long-term outcomes. Elevated blood pressure (BP) in the inpatient setting is frequently encountered by most healthcare providers. While there is general consensus on the management of acute BP elevations when associated with end-organ damage, these cases of true hypertensive emergency are relatively infrequent. In contrast, asymptomatic acute BP elevations are considerably more frequent, yet there is little consensus on their appropriate management. Contributing factors include concerns about missing true emergencies, the barriers affecting the accuracy of inpatient BP measurements and a lack of consistent data on the short- and long-term impact of inpatient BP elevations. Practice varies widely, even between departments within the same hospital, and includes observation, intravenous antihypertensives, oral agents and adjustments to existing regimens. Some clinicians also choose to discharge patients on intensified therapy based on inpatient BP values. However, despite the high prevalence of elevated BP in the inpatient setting, evidence remains heterogeneous and fragmented. This review aims to synthesise current knowledge and provide a practical, holistic framework for evaluating and managing elevated BP in the inpatient setting. The 12-lead ECG is a simple, inexpensive clinical tool with a key role in the assessment of patients with hypertrophic cardiomyopathy (HCM). The aims of this single centre, retrospective cohort study were to characterise ECG findings and to identify potential ECG predictors of major adverse cardiovascular events (MACE—cardiovascular mortality, resuscitated cardiac arrest, ventricular arrhythmias with haemodynamic compromise, appropriate implantable cardioverter defibrillator therapy or heart failure hospitalisation) in children with RASopathy-associated HCM (RAS-HCM). The resting 12-lead ECGs of 84 children with RAS-HCM were compared with those from 113 patients with sarcomeric HCM (s-HCM). A significant proportion of ECGs in RAS-HCM had superior axis deviation (29.8% vs 2.5%, p value<0.001) and voltage criteria for right ventricular hypertrophy (52.4% vs 28.3%, p value<0.001), and a significantly lower prevalence of pathological Q waves (27.4% vs 47.8%, p value<0.001). Over a median follow-up period of 6.8 years (3.1–9.7), 19 patients (22.6%) with RAS-HCM suffered an MACE. Right atrial enlargement and ST segment changes>2 mm correlated with MACE on univariate analysis, with the latter remaining significant after adjustment in a multivariate model (adjusted relative risk (RR) 2.33, 95% CI 1.12 to 4.86, p value 0.024). These findings suggest that the 12-lead ECG may be a useful screening tool to distinguish RAS-HCM from s-HCM in everyday practice and could have potential implications for prediction of adverse outcomes. There is limited contemporary data available on the subject of left ventricular thrombus (LVT) recurrence. This study aimed to evaluate the incidence, outcomes and predictors of patients with LVT recurrence after resolution. This was a retrospective cohort study involving 346 patients with resolved LVT at baseline, derived from an echocardiography database at a tertiary medical centre, from March 2011 to January 2021. Patients were stratified based on the presence of LVT recurrence during follow-up, with subgroup analysis performed for patients who developed LVT post-acute myocardial infarction (AMI) over a median follow-up duration of 4.4 years. The incidence of LVT recurrence was 11.8% (n=41/346) among all resolved LVT (mean age of 59.9±11.6 years, 86.4% male), and 12.0% (n=23/192) in patients with post-AMI resolved LVT. On multivariable regression analyses accounting for competing risks (all-cause mortality), active or previous malignancy was associated with LVT recurrence in both all (adjusted subdistribution HR (aSHR) 5.59, 95% CI 2.02 to 15.5, p<0.001) and patients with post-AMI (aSHR 13.9, 95% CI 4.05 to 47.7, p<0.001) resolved LVT. Initial LVT characteristics such as size (per cm) (aSHR 1.42, 95% CI 1.02 to 1.96, p=0.036) and protrusion (aSHR 5.46, 95% CI 1.38 to 21.6, p=0.016) were associated with recurrence in all and patients with post-AMI, respectively. On multivariable Cox regression analyses, LVT recurrence was associated with increased composite outcomes (comprising AMI, acute ischaemic stroke, acute decompensated heart failure, all-cause mortality) in all patients with resolved LVT (adjusted HR (aHR) 3.04, 95% CI 1.70 to 5.44, p<0.001), and in the post-AMI subgroup (aHR 2.77, 95% CI 1.21 to 6.32, p=0.016). Active or previous malignancy, and initial LVT imaging characteristics were associated with recurrent LVT. LVT recurrence was a marker of poor prognosis in terms of adverse composite outcomes in patients with resolved LVT. Recent cardiovascular risk equations from the USA and United Kingdom use routinely collected electronic medical records (EMRs), while current equations used in Australia (AusCVDRisk) have not been validated locally. We assessed the feasibility and performance of using routinely collected EMRs from Australian primary care software systems to predict absolute risk of cardiovascular disease (CVD). We used primary care EMR data from the New South Wales Health Lumos programme, covering 680 general practices, linked with hospital and death records. Individuals aged 30–74 years on 1 January 2017 with no prior CVD history and at least one record for an anthropometric measurement or pathology test were included. Sex-specific Cox proportional hazards models were used to estimate 5-year risk of a fatal or non-fatal CVD event. Predictors included demographics, smoking, chronic conditions, clinical variables and medications. Modelling used a 5x2 cross-validation approach. Discrimination, calibration and reclassification performance were assessed. Over a mean follow-up of 4.91 years, 33 578 CVD events were recorded in 850 216 patients. Full models with 28 predictors had Harrell’s C of 0.803 (95% CI 0.801 to 0.804) for females and 0.772 (95% CI 0.770 to 0.773) for males. Least absolute shrinkage and selection operator models with 12–15 predictors performed similarly. Models were well calibrated across age, socioeconomic and smoking strata. Geographic (internal–external) validation across 10 Primary Health Networks confirmed consistent discrimination (C-index range 0.747–0.788 for males; 0.772–0.827 for females). Percentile-based net reclassification improvement showed enhanced event detection compared with a model based on AusCVDRisk variables (event-Net Reclassification Improvement up to 0.185). CVD risk equations based on routine Australian primary care data performed strongly and generalised well across diverse settings. These models offer potential for automated integration into general practice software to support real-time CVD risk assessment. The natural history of asymptomatic moderate or severe aortic regurgitation (AR) remains uncertain, with conflicting reports about its progression and surgical timing. We aimed to quantify adverse outcomes under conservative management and evaluate the association of aortic valve replacement/repair (AVR) with mortality. Systematic searches (inception–July 2025) identified cohort studies of asymptomatic moderate/severe AR. Random-effects models estimated pooled incidence rates of adverse events; fixed-effects models were used for hazard ratios (HRs) of AVR vs conservative management. Twenty-seven studies (4720 patients; mean age 49 years; mean follow-up 3.9 years) were included. Pooled incidence rates per 100 person-years were 1.75 (95% CI 1.27 to 2.41) for all-cause mortality, 1.29 for cardiac death, 0.29 for sudden death, 4.30 for new symptoms and 7.01 for AVR. Asymptomatic low left ventricular ejection fraction occurred in only 0.9 per 100 person-years. Mortality rates were more than double those of the general population across age groups—2.45 (1.90 to 3.18) per 100 person-years for cohorts with mean age ≥50 years versus 0.59 (0.29 to 1.21) for younger cohorts. Early AVR was associated with lower mortality (pooled HR 0.33; 95% CI 0.30 to 0.37). Asymptomatic moderate/severe AR carries significant excess mortality irrespective of age, contradicting its historically benign reputation. Given the rarity of asymptomatic LV dysfunction, earlier intervention guided by more sensitive markers of LV damage may improve outcomes, although heterogeneity and study quality warrant cautious interpretation. CRD42024522683. False-positive (FP) alerts from implantable loop recorders increase clinical workload and may delay appropriate intervention. AccuRhythm AI, a cloud-based filtering algorithm, is designed to reduce these alerts in Reveal LINQ and LINQ II devices. This study assessed the algorithm’s effect on FP and clinician burden reduction, with a focus on the influence of R-wave sensing amplitude. This multicentre, retrospective study included 800 patients with either Reveal LINQ or LINQ II. We analysed automated artificial intelligence (AI) reports and compared FP rates and transmission burden before and after software-based AI activation in the subset of Reveal LINQ patients to assess patient-level changes. The relationship between R-wave amplitude and FP incidence was also evaluated. AI-based filtering, by AccuRhythm AI automatic analysis, reduced false pause alerts by 62% and false atrial fibrillation alerts by 33%, saving 210 clinician hours over 6 months. Patient level analysis, among 465 Reveal LINQ patients, showed FP+ patients (patients with ≥1 false-positive transmission) reduction from 55.5% to 15.1% post-AI (p<0.001), translating to 1128 hours saved. All residual false alerts occurred in patients with R-wave amplitudes <0.4 mV. Use of AccuRhythm AI was associated with a significant reduction in FPs and clinician workload while preserving diagnostic accuracy. R-wave amplitude remained a key factor influencing alert specificity, emphasising the continued importance of optimal device implantation and signal quality. The safety of internal thoracic artery (ITA) grafting in patients undergoing coronary artery bypass grafting (CABG) with prior mediastinal radiation remains controversial due to concerns regarding compromised sternal perfusion and radiation-induced injury. This study evaluated whether prior mediastinal radiation is associated with adverse perioperative outcomes in patients undergoing CABG with ITA grafting. We conducted a retrospective cohort study using the Maryland Cardiac Surgery Quality Initiative (MCSQI) database. A total of 29 206 patients who underwent CABG with ITA use between 1 July 2011 and 31 March 2023 were analysed. Patients with and without prior mediastinal radiation were propensity-matched (1:10) using the nearest neighbour method. The primary outcome was the composite of operative mortality and deep sternal wound infection (DSWI). Secondary outcomes included other infectious complications, major morbiditie"},{"url":"https://hartvaat.nl/2026/04/09/thuis-bloeddruk-time-in-target-range-hoger-percentage-in-doel-geassocieerd-met-m/","doi":"https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.26519","title_en":"IoT-Based Home Blood Pressure Time in Target Range and Brain Lesions on MRI","journal":"Hypertension","source_date":"2026-04-09","abstract_original":"BACKGROUND:Time in target range (TTR) reflects the proportion of time that blood pressure (BP) stays within guideline-recommended levels. However, the distribution of home BP TTR and its association with subclinical cerebrovascular disease in community-based populations remain unclear.METHODS:We investigated annual and seasonal TTR of Internet of Things-based home BP and its association with brain lesions on magnetic resonance imaging in a community-based cohort. Home BP was measured twice daily (morning and evening). Weekly mean BP was calculated from ≥3 valid daily readings, and TTR was defined in those with ≥2 valid weeks/season as the percentage of weeks meeting guideline-based targets (systolic and diastolic BP <135 and <85 mm Hg, respectively, for participants not receiving antihypertensive medication; <125 and <75 mm Hg, respectively, for those receiving medication). Brain lesions included ≥1 magnetic resonance imaging-detected lacunar infarct, white matter hyperintensities, cerebral microbleeds, or intracranial artery stenosis.RESULTS:Among 306 participants (mean age, 56 years; 57% women), median annual TTR was 100% (interquartile range, 92.6%–100%) in participants not receiving antihypertensive medication and 1.9% (0%–19.2%) in those receiving medication. TTR tended to be lower in winter than in summer. In Poisson regression with robust variance, adjusted for demographic, lifestyle, and clinical factors, higher TTR was associated with a lower prevalence of brain lesions (prevalence ratio per 10% higher, 0.85 [95% CI, 0.79–0.91]). The association was stronger among participants not receiving antihypertensive medication (interactionP=0.047), with no heterogeneity across seasons (interactionP=0.958).CONCLUSIONS:Home BP TTR may help characterize longitudinal BP control and provide complementary information regarding cerebrovascular health."},{"url":"https://hartvaat.nl/2026/05/22/il-6-sterker-met-hart-en-vaatziekte-geassocieerd-dan-ldl-lp-a-en-crp/","doi":"10.1016/j.pcad.2026.05.005","title_en":"Comparative associations of LDL-C, Lp(a), hsCRP, and IL-6 with cardiovascular risk: Insights from the UK Biobank and MESA.","journal":"Progress in cardiovascular diseases","source_date":"2026-05-22","abstract_original":"INTRODUCTION: Low-density lipoprotein-cholesterol (LDL-C) is a well-established causal risk factor for atherosclerosis and remains the cornerstone of primary prevention. Lipoprotein(a) [Lp(a)] and high-sensitivity C-reactive protein (hsCRP) are considered risk-enhancing factors in current guidelines. Interleukin-6 (IL-6), a pro-inflammatory cytokine upstream of CRP, has recently emerged as a potential therapeutic target. We sought to compare the longitudinal associations of LDL-C, Lp(a), hsCRP, and IL-6, both individually and in relation to one another, with atherosclerotic cardiovascular disease (ASCVD) events in two large, contemporary primary prevention cohorts. METHODS: Participants with baseline measurements of LDL-C, Lp(a), hsCRP, and IL-6 from the United Kingdom (UK) Biobank and the Multi-Ethnic Study of Atherosclerosis (MESA) were included in this study. The primary endpoint was incident ASCVD (defined as composite of myocardial infarction, stroke, or cardiovascular death). Cox proportional hazards models were used to calculate hazard ratios across biomarker quartiles, adjusting for traditional risk factors and other biomarkers. RESULTS: The mean age (SD) was 56.8 (8.1) years in UK Biobank and 62.2 (10.2) years in MESA. In fully adjusted models including all covariates, the HRs for ASCVD comparing top vs bottom quartiles in UK Biobank were: LDL-C 1.10 (95% CI: 0.97-1.25), Lp(a) 1.15 (1.03-1.29), hsCRP 1.19 (1.04-1.37), and IL-6 1.67 (1.44-1.93). In MESA, corresponding HRs were: LDL-C 1.26 (1.02-1.56), Lp(a) 1.23 (0.99-1.53), hsCRP 1.13 (0.88-1.44), and IL-6 1.60 (1.24-2.07). CONCLUSION: In two large primary prevention cohorts, IL-6 demonstrated the strongest association with ASCVD, independent of LDL-C, Lp(a), and hsCRP when mutually adjusted. These data suggest that IL-6 may be a key driver of ASCVD, with potential implications for risk prediction and therapeutic targeting for prevention of ASCVD."},{"url":"https://hartvaat.nl/2026/04/29/de-secretoire-pcsk-familie-van-moleculaire-schakelaars-tot-doelwit-voor-cardiova/","doi":"https://www.atherosclerosis-journal.com/article/S0021-9150(26)00082-1/fulltext","title_en":"The secretory PCSK family in cardiovascular disease and beyond","journal":"Atherosclerosis","source_date":"2026-04-29","abstract_original":"It took >20 years to discover the family of proteases implicated in the activation and/or regulation of the activity of secretory proteins, including polypeptide hormones, growth factors and receptors. From 1990 to 2003 the 9 members of the proprotein convertase (PC) family were identified and shown to be phylogenetically ancient serine proteases related to bacterial subtilases and to yeast Kexin, now called Proprotein Convertases related to Subtilsin and Kexin (PCSK1-PCSK9). Because many growth factors, receptors, adhesion molecules, metalloproteinases, cytokines, etc., are produced as inactive precursors, PCSKs are critical “master switches” that regulate when and where these proteins become active."},{"url":"https://hartvaat.nl/2026/05/14/bloeddrukvariabiliteit-sprint-accord-ipd-meta-even-prognostisch-als-gemiddelde-b/","doi":"10.1093/eurheartj/ehag330","title_en":"","journal":"European Heart Journal","source_date":"2026-05-14","abstract_original":"Background and Aims: Blood pressure variability (BPV) is associated with cardiovascular risk and has been shown to confer prognostic information independent of mean blood pressure. However, the consistency of its incremental predictive value across different clinical settings and populations warrants further investigation. A patient-level pooled analysis of two large randomized trials (SPRINT and ACCORD) was conducted to clarify the association between BPV and major cardiovascular events. Methods: Visit-to-visit BPV was calculated from Month 3 onwards using multiple metrics (including variation independent of mean, VIM) in participants with ≥3 visits. Associations between BPV and major cardiovascular events (MCEs: myocardial infarction, stroke, or cardiovascular death) were assessed using Cox regression and restricted cubic splines. Results: Among 18,415 participants (median 12 BP measurements, 3.6-year follow-up), 1,244 (6.8%) experienced MCEs. After multivariable adjustment, higher SBP-VIM (highest vs lowest tertile) was associated with a greater risk of MCEs (HR 1.15, 95% CI 1.00–1.32), with similar associations for myocardial infarction and cardiovascular death. Restricted cubic spline analyses revealed a J-shaped relationship between SBP-VIM and cardiovascular outcomes (all p<0.05). The prognostic value of SBP-VIM was comparable to mean SBP. Findings were consistent across alternative BPV metrics and intensified with extended follow-up. Conclusions: Visit-to-visit BP variability carries prognostic information comparable in magnitude to mean BP in high-risk individuals, supporting routine recording of BP variability as a meaningful add-on to mean-BP-only risk models."},{"url":"https://hartvaat.nl/2026/05/13/aha-scientific-statement-2026-secundaire-preventie-na-coronaire-bypassoperatie-e/","doi":"10.1161/CIR.0000000000001434","title_en":"","journal":"Circulation","source_date":"2026-05-13","abstract_original":"Coronary artery bypass grafting is a well-established, durable, and safe surgical intervention. However, coronary artery disease continues to progress after the procedure. Patients who have undergone bypass surgery present unique challenges in terms of secondary prevention resulting from the often severe and diffuse nature of their coronary disease, the complexities of their postoperative recovery, the burden of their comorbid conditions, and the importance of ensuring long-term graft patency and preventing further disease progression. New evidence and advances in secondary prevention strategies in the post–coronary bypass grafting population have emerged since the American Heart Association's 2015 scientific statement on this topic. This 2026 update revisits lipid lowering, antiplatelet/anticoagulation strategies, blood-pressure targets, diabetes and CKM management, cardiac rehabilitation, and post-discharge follow-up structures, with an emphasis on what is evidence-based and what is consensus-driven. Secondary prevention strongly correlates with improved outcomes after bypass surgery, providing the rationale and urgency for this updated scientific statement to promote evidence-based practical considerations and to improve their use."},{"url":"https://hartvaat.nl/2026/05/13/wereldwijde-hf-registry-fev1-is-een-onafhankelijke-prognostische-factor-pleidooi/","doi":"10.1093/eschf/xvag128","title_en":"","journal":"ESC Heart Failure","source_date":"2026-05-13","abstract_original":"Aims: Pulmonary abnormalities are common in HF and may have prognostic implications. Current evidence is largely limited to high-income countries. We examined the relationship between forced expiratory volume in 1 second (FEV1), HF burden and long-term clinical outcomes in a diverse multinational HF cohort. Methods: Sub-study within the multinational Global Congestive Heart Failure registry, which collected clinical data including spirometry from HF participants in 28 high-, middle- and low-income countries; followed for median 3.8 years (IQR 2.1–5.0). Baseline FEV1 was transformed into z-scores standardised for age, sex, and height. The association between baseline FEV1 with all-cause mortality, cardiovascular (CV) deaths and all-cause hospitalisations were examined. Results: 3,359 HF participants (mean age 61.9 [SD 14.1] years, 66.4% males). Participants with lower FEV1 z-scores even within the normal range (z >-2) showed increasing HF burden, cardiac structural and functional impairment, and lower health-related quality of life. FEV1 z-score ≤-2 was independently associated with higher risks of all-cause mortality (HR 2.20; 95% CI 1.61–3.01), CV mortality (HR 2.45; 95% CI 1.64–3.66) and hospitalisations (HR 1.40; 95% CI 1.12–1.74). Effect sizes were comparable to other major prognostic factors. Associations were consistent across populations from diverse socio-economic development, HF aetiology and HF type. Conclusions: FEV1 is a major, independent prognostic factor in HF across global populations. Routine spirometry deserves a place in the HF workup alongside conventional risk stratification."},{"url":"https://hartvaat.nl/2026/05/13/uk-biobank-na-ischemisch-cva-of-tia-is-het-risico-op-hartfalen-groter-dan-dat-op/","doi":"10.1093/eschf/xvag123","title_en":"","journal":"ESC Heart Failure","source_date":"2026-05-13","abstract_original":"Aims: To define incident heart failure (HF) risk in ischaemic stroke/TIA survivors. Secondary aims: to define the association of HF with all-cause mortality in stroke survivors and to describe their cardiac magnetic resonance findings. Methods: Prospective cohort study using the UK Biobank cohort (aged 40–69 years), excluding individuals with prior HF. Participants were stratified by history of ischaemic stroke/TIA. Main outcome: incident HF as defined by hospital admissions coded for HF. Secondary outcomes: all-cause mortality, myocardial infarction and CMR findings. Results: 405,406 individuals were included (mean age 56.5 years, 45.6% males). Over 13.7 years of follow-up, 15,565 individuals developed incident HF. Stroke/TIA survivors had a crude HR 3.6 (95% CI 3.3–3.8; p<0.0001) for HF hospitalization, attenuated to adjusted HR 1.4 (95% CI 1.3–1.5; p<0.0001). The risk of HF hospitalization exceeded the risk of MI (12.6% vs 5.4%). Stroke survivors with subsequent HF had lower LVEF and higher LV mass on CMR than those without HF. Incident HF after stroke was associated with HR 1.8 (95% CI 1.6–1.9) for mortality. Conclusions: Incident HF is common in stroke survivors and strongly associates with mortality. The risk of HF exceeds the risk of subsequent MI — a counter-intuitive finding that argues for systematic cardiac follow-up of stroke survivors with structured HF risk assessment."},{"url":"https://hartvaat.nl/2026/05/13/verisec-vericiguat-in-de-praktijk-halveert-hartfalen-decompensaties-bij-hfref-sp/","doi":"10.1093/eschf/xvag138","title_en":"","journal":"ESC Heart Failure","source_date":"2026-05-13","abstract_original":"Aims: To evaluate the effectiveness and safety of vericiguat in patients with heart failure and reduced ejection fraction (HFrEF) following recent decompensation in routine clinical practice in Spain. Methods: VERISEC is a prospective, multicenter registry of 835 consecutive patients initiating vericiguat at 41 centers in Spain. Functional class, biochemical markers, ventricular function, and clinical events were analyzed during 1-year follow-up. Results: Patients (age 71.3 years [SD 11.2], 78.9% male) received highly optimized baseline therapy: 91.5% SGLT2i, 90.7% beta-blockers, 85.4% RAASi, and 79.8% MRAs. Quadruple therapy remained stable (61.7% baseline to 63.0% at 12 months; p=0.526). At 1-year follow-up, significant improvements were observed: NT-proBNP decreased from 3,532 to 2,292 pg/mL (p<0.001) and LVEF increased from 30.3% to 35.4% (p<0.001). NYHA class improved, with class II patients increasing from 55.6% to 62.2% (p<0.001). Mean HF decompensations requiring intravenous diuretics decreased from 1.34/year pre-treatment to 0.65/year during follow-up (≈51% reduction). Non-HF cardiovascular hospitalizations decreased from 0.98 to 0.39 per year. Vericiguat was discontinued in 13.4% of patients, primarily due to symptomatic hypotension (49.4% of discontinuations). Higher baseline NT-proBNP independently predicted discontinuation (OR 1.06 per 1,000-pg/mL increase; 95% CI 1.03–1.08; p<0.001). Conclusions: In a large real-world Spanish cohort initiating vericiguat after HF decompensation, treatment was associated with improved biomarkers, LV function and functional class, and a halving of HF decompensations — confirming and extending the VICTORIA trial in routine practice."},{"url":"https://hartvaat.nl/2026/05/11/ehj-editorial-cleland-wereldwijde-hartfalenprevalentie-overschrijdt-600-miljoen-/","doi":"10.1093/eurheartj/ehag331","title_en":"","journal":"European Heart Journal","source_date":"2026-05-11","abstract_original":"Editorial reviewing recent population-level evidence on heart failure (HF) prevalence and projecting that the global HF population may now exceed 600 million when broader, contemporary definitions are applied. Historical figures of 60 million reflect symptomatic HF in registries; population-based echocardiography studies including stage A/B HF, HFpEF and structural/functional abnormalities consistently identify 8–12% of older adults, implying a far larger denominator. The authors argue for international consensus on case definitions, routine inclusion of natriuretic peptides and echocardiography in primary-care screening of high-risk patients, and integration of HF prevalence reporting into national cardiovascular registries. Implications: HF should be treated as a population-health emergency, not a sub-specialty problem, and resource allocation needs to scale accordingly."},{"url":"https://hartvaat.nl/2026/05/11/finearts-hf-subanalyse-virale-luchtweginfecties-triggeren-hartfalen-verslechteri/","doi":"10.1093/eurheartj/ehag384","title_en":"","journal":"European Heart Journal","source_date":"2026-05-11","abstract_original":"Sub-analysis of the FINEARTS-HF trial (finerenone in HF with mildly reduced or preserved ejection fraction, n=6001) examining the incidence, predictors and outcomes of viral respiratory tract infections (RTIs) over the trial follow-up. RTIs were associated with subsequent worsening heart failure events and excess mortality, with the absolute event rate higher in patients with more severe HF symptoms at baseline. Finerenone did not modify the rate of RTI episodes, but the relative benefit of finerenone on the primary outcome was preserved across patients with and without intercurrent RTI. The findings position respiratory infection as a recognisable trigger of HF decompensation in HFmrEF/HFpEF — relevant for vaccination policy and acute-illness pathway planning — and confirm that finerenone benefit is robust to this common clinical event."},{"url":"https://hartvaat.nl/2026/05/12/aha-scientific-statement-evaluatie-en-behandeling-van-het-kind-met-acuut-gedecom/","doi":"10.1161/CIR.0000000000001428","title_en":"","journal":"Circulation","source_date":"2026-05-12","abstract_original":"Nationally, there has been a rise in the number of children and adolescents with congenital and acquired heart disease presenting with acute decompensated heart failure. Compared with adults, these children have increased morbidity and mortality and use significantly more health care resources once admitted. Currently, there is little guidance on how to assess, manage, and create successful discharge plans for children presenting with acute decompensated heart failure. Given that this population represents an intersection among emergency medicine, cardiology, surgery, critical care, and psychology, a guidance document for the comprehensive management of this high-risk population is needed. This scientific statement reflects the state of current evidence and highlights important knowledge gaps in this domain. Key recommendations cover triage and risk stratification, diagnostic workup, initial stabilization, inotrope and diuretic choice, mechanical support thresholds, transition to chronic therapy, discharge planning, and post-discharge psychosocial follow-up."},{"url":"https://hartvaat.nl/2026/05/12/massieve-lvh-bij-pediatrische-hcm-vroeger-diagnose-vaker-sarcomere-variant-driev/","doi":"10.1161/CIRCULATIONAHA.126.078843","title_en":"","journal":"Circulation","source_date":"2026-05-12","abstract_original":"BACKGROUND: Massive left ventricular hypertrophy (LVH) is a risk factor for sudden cardiac death in children with hypertrophic cardiomyopathy (HCM), but little is understood about its natural history. METHODS: Patients with pediatric-onset HCM identified from two registries (SHaRe [Sarcomeric Human Cardiomyopathy Registry] and IPHCC [International Paediatric Hypertrophic Cardiomyopathy Consortium]) with or without massive LVH were compared. Massive LVH was defined as absolute maximal left ventricular wall thickness ≥30 mm or MLVWT z-score ≥+20 at age <18. Data from SHaRe and IPHCC include encounters from January 1960 through March 2024 and January 1970 through March 2024 respectively. Demographic, clinical, and serial MLVWT data were collected. RESULTS: 587 patients were identified (54 female [30%]; 186 with massive LVH). Children with massive LVH were diagnosed younger (median 9.2 years [IQR 2.1–13.1] vs 13.6 [9.7–15.5]; p<0.001), more often had sarcomeric variants (72% vs 61%; p=0.034), and showed higher HCM-related mortality (unadjusted HR 3.3; 95% CI 1.2–9.7; p=0.026). Major ventricular arrhythmia events and HF events were also significantly more frequent. CONCLUSIONS: Massive LVH in pediatric HCM is associated with earlier diagnosis, more sarcomeric variants, and a markedly worse prognosis — supporting earlier intervention and more intensive surveillance in this subgroup."},{"url":"https://hartvaat.nl/2026/05/11/hcmr-nhlbi-multidimensionele-risicovoorspelling-beter-dan-scd-gefocuste-richtlij/","doi":"10.1001/jama.2026.5633","title_en":"","journal":"JAMA","source_date":"2026-05-11","abstract_original":"Importance: Current risk prediction guidelines for hypertrophic cardiomyopathy predict only sudden cardiac death and are imperfect, leading to avoidable deaths and unnecessary implantable cardioverter defibrillators. Objective: To combine prospectively collected clinical history, imaging, genetic, and biomarker data to improve risk prediction of adverse events in hypertrophic cardiomyopathy. Design, Setting, and Participants: A total of 2,750 patients with hypertrophic cardiomyopathy were prospectively enrolled in the registry-based study from 44 sites in North America and Europe with expertise in hypertrophic cardiomyopathy and cardiac magnetic resonance (CMR) imaging. Participants were enrolled from April 1, 2014, to April 7, 2017. Mean follow-up exceeded 7 years. Exposures: Patients underwent a health history questionnaire, blood sampling for biomarkers and genotyping, and contrast-enhanced CMR. Main Outcomes and Measures: The predefined composite adjudicated primary end point was time to first event for hypertrophic cardiomyopathy–related deaths; nonfatal sustained ventricular arrhythmias requiring cardioversion or defibrillation; and left ventricular assist device implant or heart transplant. A secondary end point was a composite of sudden cardiac death and nonfatal VA events. The elastic-net method identified the most important predictors. Cox proportional hazards regression assessed associations with time to the first end point. Results: Of the 2,750 prospectively enrolled patients, 2,698 (98%) had analyzable data; 1,919 (71%) were male, mean age 50 years. The integrated multidimensional model outperformed traditional risk prediction restricted to sudden cardiac death, identifying patients at risk for HF events, heart transplant, and ventricular arrhythmias that were previously under-recognized. Conclusions: A multidimensional risk prediction model combining clinical, imaging, genetic and biomarker data provides more comprehensive risk stratification in hypertrophic cardiomyopathy than the current SCD-focused frameworks."},{"url":"https://hartvaat.nl/2026/05/12/cadence-sotatercept-verlaagt-pulmonale-vaatweerstand-bij-gecombineerde-pre-postc/","doi":"10.1161/CIRCULATIONAHA.126.079918","title_en":"","journal":"Circulation","source_date":"2026-05-12","abstract_original":"BACKGROUND: Combined post- and pre-capillary pulmonary hypertension in heart failure with preserved ejection fraction (CpcPH-HFpEF) involves remodeling in both the heart and pulmonary vasculature. Despite significant mortality, there are no proven therapies. METHODS: In this multicenter, randomized, placebo-controlled, phase 2 trial, adults received sotatercept (0.3 or 0.7 mg/kg) or placebo every 3 weeks. The primary end point was change in pulmonary vascular resistance at week 24. Hodges-Lehmann shift estimates described placebo-adjusted changes. RESULTS: 164 patients were randomized 54:55:55 to sotatercept 0.3 mg/kg, 0.7 mg/kg, and placebo (mean age 75, 70% women). Baseline median pulmonary vascular resistance was 5.2 (IQR 4.0–6.9) Wood units. The Hodges-Lehmann shift in pulmonary vascular resistance was −1.02 Wood units (95% CI −1.81 to −0.23; P=0.004) for 0.3 mg/kg and −0.75 (95% CI −1.52 to 0.03; P=0.024) for 0.7 mg/kg sotatercept. Mean pulmonary arterial pressure dropped by ~9 mmHg in both sotatercept groups, with reductions in pulmonary arterial wedge pressure of 3 and 2.5 mmHg. 6-minute walk distance improved 20.3 m at 0.3 mg/kg (95% CI 1.5–39.1) and 5.8 m at 0.7 mg/kg. Most common adverse events were increased haemoglobin and diarrhea. CONCLUSIONS: These findings provide proof of concept for improved pulmonary vascular and cardiac hemodynamics following activin signalling inhibition with sotatercept in patients with CpcPH-HFpEF. The 0.3 mg/kg dose had the most attractive efficacy-safety profile for phase 3 development."},{"url":"https://hartvaat.nl/2026/05/10/paradise-gelijktijdig-acuut-hartfalen-plus-luchtweginfectie-verhoogt-sterfte-tij/","doi":"10.1093/ejhf/xuag160","title_en":"","journal":"European Journal of Heart Failure","source_date":"2026-05-10","abstract_original":"Background: Acute heart failure (AHF) and respiratory infection (RI) frequently coexist, with the latter commonly regarded as a trigger of AHF decompensation. However, the independent and combined prognostic impact of these conditions on survival is not well studied. We assessed the association of AHF and RI, both separately and in combination, with subsequent mortality. Methods: Patients discharged with diagnoses of AHF, RI, or both were identified from the PARADISE study, a large French cohort of patients hospitalised for acute dyspnoea (2010–2019). Associations with in-hospital and post-discharge mortality were assessed using multivariable binomial logistic regression and Cox proportional hazards models, respectively. Results: Among 11,679 patients, 4,349 (37%) had AHF alone, 5,091 (44%) had RI alone, and 2,239 (19%) had both AHF and RI. In-hospital mortality was highest in patients with concomitant AHF and RI (21.9%), whereas post-discharge mortality was highest among those with AHF (55.2% at 5 years). After multivariable adjustment, AHF+RI together had higher in-hospital mortality than AHF alone (aOR 1.62; 95% CI 1.33–1.98; p<0.001), but not higher post-discharge mortality (aHR 0.99; 95% CI 0.88–1.11; p=0.9). RI alone was not associated with higher mortality, either in-hospital (aOR 1.11; p=0.3) or post-discharge (aHR 1.07; p=0.2). Conclusions: Patients with concomitant AHF and RI face increased in-hospital risk but no excess post-discharge risk compared with AHF alone, whereas RI alone is not associated with increased mortality. Concomitant RI is a marker for in-hospital severity, but long-term prognosis is governed by AHF itself."},{"url":"https://hartvaat.nl/2026/05/10/hartfalen-en-infarct-verdrievoudigen-het-risico-op-kanker-vooral-hematologisch/","doi":"10.1093/ejhf/xuag061","title_en":"","journal":"European Journal of Heart Failure","source_date":"2026-05-10","abstract_original":"Aims: Heart failure (HF) and acute myocardial infarction (AMI) may contribute to cancer development through shared and disease-related pathophysiological pathways. We investigated the mid-term risk of incident cancer in patients with HF or AMI using a large, real-world dataset. Methods: Adults with a first hospitalization for acute HF or AMI between October 2015 and October 2024 were included from the TriNetX Global Collaborative Research Network. Patients with prior or concurrent cancer were excluded. Each cohort was matched 1:1 with controls without HF or AMI using propensity score matching. The primary end-point was any new cancer diagnosis occurring during follow-up, starting 6 months after the index hospitalization. Results: After matching, 120,783 patients with HF and 7,896 patients with AMI were included. Over a median follow-up of 13 months in the HF cohort and 16 months in the AMI cohort (after the 6-month landmark), both groups showed a higher incidence of cancer compared with controls (HF: HR 2.80, 95% CI 2.69–2.91; AMI: HR 2.02, 95% CI 1.71–2.39; both p<0.001). In both cohorts, the excess risk was more pronounced for haematologic than for solid malignancies (HF: HR 6.78 vs 2.53; AMI: HR 4.45 vs 1.77). HFpEF was associated with a slightly higher cancer incidence than HFrEF/HFmrEF (HR 1.10; 95% CI 1.04–1.17; p=0.002), whereas no difference was observed between ST and non-ST segment elevation AMI. Conclusions: In this large, real-world cohort, both HF and AMI were associated with an increased incidence of cancer, particularly haematologic malignancies. HF was associated with a greater excess risk than AMI. These findings are hypothesis-generating and warrant further investigation into shared pathways and screening implications."},{"url":"https://hartvaat.nl/2026/05/10/porthos-nt-probnp-afkapwaarden-onbetrouwbaar-bij-obese-patienten-risico-op-gemis/","doi":"10.1093/ejhf/xuag154","title_en":"","journal":"European Journal of Heart Failure","source_date":"2026-05-10","abstract_original":"Background: Obesity is linked to heart failure, particularly with preserved ejection fraction, but is associated with lower natriuretic peptide levels, potentially leading to underdiagnosis. Aims: To examine the association between adiposity measures — body mass index, waist circumference, and waist-to-height ratio — and N-terminal pro-B-type natriuretic peptide levels, and to determine if lower cut-offs should be used to rule out heart failure in individuals with obesity. Methods: PORTHOS is a 2023 population-based study in Portugal including adults aged 50 years or older. Participants underwent NT-proBNP screening, followed by clinical and echocardiographic assessment in those with levels ≥125 pg/mL, self-reported heart failure, or a 5% random sample with levels <125 pg/mL. Results: Among 2,498 participants, obesity prevalence ranged from 25% using body mass index ≥30 kg/m² to >70% using waist-to-height ratio ≥0.6. Body mass index showed a strong inverse association with NT-proBNP, with approximately 50 pg/mL lower levels per 5 kg/m² increase. Individuals with obesity and NT-proBNP <125 pg/mL had higher odds of heart-failure symptoms (OR 1.97, 95% CI 1.15–3.38) and echocardiographic abnormalities (OR 3.63, 95% CI 1.27–10.4) than lean participants with NT-proBNP ≥125 pg/mL — despite being 9 years younger and having fourfold lower median NT-proBNP (59 vs 235 pg/mL). Conclusions: Obesity is associated with lower NT-proBNP levels despite a higher burden of symptoms and structural abnormalities. Fixed cut-offs do not reliably exclude heart failure in individuals with obesity."},{"url":"https://hartvaat.nl/2026/05/10/poseidon-4-op-10-patienten-met-hartfalen-wereldwijd-heeft-inflammatoir-verhoogd-/","doi":"10.1093/ejhf/xuag155","title_en":"","journal":"European Journal of Heart Failure","source_date":"2026-05-10","abstract_original":"Aims: Inflammation contributes to the pathophysiology of heart failure (HF), yet the global prevalence of elevated high-sensitivity C-reactive protein (hsCRP) in patients with HF across the ejection fraction (EF) spectrum remains unclear. We sought to characterize the prevalence and clinical correlates of high inflammatory risk (hsCRP ≥2 mg/L) in a global real-world HF cohort across the EF spectrum. Methods and Results: POSEIDON prospectively enrolled 18,904 individuals across 317 sites in 18 countries (2023–2025) at routine visits, including 11,809 with HF and available hsCRP (3714 with HFpEF, 2176 with HFmrEF, 5919 with HFrEF), and excluding those with recent infections. Elevated hsCRP (≥2 mg/L) was found in 1442 (38.8%) patients with HFpEF, 830 (38.1%) with HFmrEF, and 2263 (38.2%) with HFrEF. Within each HF subtype, patients with elevated hsCRP were more likely to be female and to have chronic kidney disease, obesity, worse functional class, and higher NT-proBNP levels. Independent predictors of elevated hsCRP included smoking, rheumatic/autoimmune/inflammatory disease, obesity, reduced eGFR, dyslipidaemia and worse NYHA class — consistent across HF subtypes (interaction p>0.05), except body-mass index which was more strongly associated with hsCRP in HFpEF (interaction p=0.001). Interleukin-6 correlated moderately with hsCRP across all HF subtypes. Conclusions: In a global HF population, high inflammatory risk is present in approximately 4 in 10 patients and is associated with more severe HF and a cardio-kidney-metabolic phenotype, consistently across HF subtypes."},{"url":"https://hartvaat.nl/2026/05/09/uf-care-ultrafiltratie-bij-type-2-cardiorenaal-syndroom-mist-primair-eindpunt-in/","doi":"10.1093/eschf/xvag133","title_en":"","journal":"ESC Heart Failure","source_date":"2026-05-09","abstract_original":"Background: Type 2 cardiorenal syndrome (CRS), characterized by chronic heart failure (HF) leading to chronic kidney disease (CKD), is associated with high morbidity and mortality. In patients with refractory congestive HF, extrarenal fluid removal techniques can be proposed. We aimed to evaluate whether adding ultrafiltration through peritoneal dialysis (PD), haemodialysis (HD) or isolated ultrafiltration (IUF) improves clinical outcomes compared with optimized medical therapy alone. Methods: UF-CARE was a multicentre, randomized, controlled, open-label trial conducted in 15 French centres. Adults with severe HF, persistent or recurrent congestion despite high-dose diuretics and guideline-directed medical therapy, and mild to severe CKD were randomized to optimized medical therapy alone (Control group) or optimized medical therapy plus ultrafiltration (Ultrafiltration group), through PD, HD or IUF, according to clinical judgment, patient characteristics and preferences, and availability in each centre. The primary outcome was a composite of all-cause mortality or unplanned hospitalization for acute HF within 12 months. Results: Among 108 screened patients, 46 were randomized (24 Control group, 22 Ultrafiltration group). After a median follow-up of 262 days, the primary outcome occurred in 63% of patients in the Ultrafiltration group and 87% in the Control group (p=0.144). Quality-of-life scores seemed to improve over time in both groups, with a slightly more sustained improvement in the ultrafiltration group. One death related to the technique was reported. Conclusion: In patients with type 2 CRS and refractory congestive HF, adding ultrafiltration through PD, HD or IUF did not significantly reduce mortality or HF-related hospitalizations at 12 months compared with optimized medical therapy alone."},{"url":"https://hartvaat.nl/2026/05/09/subcut-hf-ii-subcutane-furosemide-thuis-verlaagt-opnameduur-met-5-5-dagen-na-har/","doi":"https://www.prnewswire.com/news-releases/results-of-the-randomized-controlled-trial-of-at-home-subcutaneous-diuretic-therapy-for-heart-failure-associated-edema-to-be-presented-at-heart-failure-2026-302760746.html","title_en":"","journal":"Heart Failure 2026 (Late-Breaking Science)","source_date":"2026-05-09","abstract_original":"BACKGROUND: Persistent congestion at discharge in patients hospitalised with heart failure (HF) is associated with worse outcomes; inpatient intravenous diuretic therapy is often prolonged because at-home parenteral options are limited. SUBCUT HF II evaluated whether a novel subcutaneous furosemide formulation (Lasix ONYU; 80 mg infused over 5 hours via patch-pump) administered at home is non-inferior — and operationally superior — to inpatient intravenous furosemide. METHODS: Investigator-sponsored, multicentre, open-label, randomised controlled trial across 20 UK National Health Service hospitals. 170 patients admitted for HF and requiring ongoing intravenous loop diuretic therapy were randomised 1:1 to (a) early discharge with at-home subcutaneous furosemide via Lasix ONYU or (b) continued inpatient intravenous furosemide. The primary endpoint was days alive and out of hospital (DAOH) at 30 days. RESULTS: Patients randomised to at-home subcutaneous furosemide had 4 more days alive and out of hospital at 30 days than the inpatient comparator (p<0.001), with index-hospitalization length of stay reduced by 5.5 days (p<0.001). The DAOH benefit was sustained at 60 days. Safety and key secondary endpoints supported equivalence to in-hospital treatment. CONCLUSIONS: At-home subcutaneous furosemide via Lasix ONYU is an effective and safe alternative to inpatient intravenous diuresis in patients with HF-associated edema, materially shortening hospitalization without compromising safety or efficacy. Lasix ONYU received FDA approval in October 2025; SUBCUT HF II provides the supporting randomised evidence. Results presented at Heart Failure 2026 (Barcelona, 9 May 2026). Peer-reviewed publication forthcoming."},{"url":"https://hartvaat.nl/2026/04/24/astma-geassocieerd-met-verhoogd-risico-op-degeneratieve-hartklepziekte-uk-bioban/","doi":"http://heart.bmj.com/cgi/content/short/112/10/576?rss=1","title_en":"","journal":"Heart","source_date":"2026-04-24","abstract_original":" Asthma has been associated with the development and progression of various cardiovascular diseases but its relationship with degenerative valvular heart disease (VHD) remains unclear. This study investigated the association between asthma and incident degenerative VHD, including aortic stenosis (AS), aortic regurgitation (AR), mitral regurgitation (MR) and pulmonary regurgitation (PR). We analysed 483 735 participants from the UK Biobank (median age 56.5 years; 45.2% male) who were free of VHD at baseline. Asthma status was self-reported at recruitment. Incident VHD was ascertained through hospital admission and mortality records using International Classification of Diseases, Tenth Revision codes. Cox proportional hazards models were used to estimate HRs and 95% CIs for each VHD subtype, adjusting for demographic, lifestyle and clinical covariates. Sensitivity analyses accounted for asthma medications, duration of asthma "},{"url":"https://hartvaat.nl/2026/04/24/cardiovasculaire-ziekte-bij-sikkelcelziekte-ondergediagnosticeerde-drijver-van-m/","doi":"http://heart.bmj.com/cgi/content/short/112/10/539?rss=1","title_en":"","journal":"Heart","source_date":"2026-04-24","abstract_original":" Cardiovascular complications are increasingly recognised as a major driver of morbidity and early mortality in patients with sickle cell disease (SCD), yet they remain underdiagnosed and underappreciated. This contemporary review synthesises current knowledge across a spectrum of cardiovascular manifestations—including myocardial dysfunction, pulmonary hypertension, cardiac iron overload, arrhythmias, myocardial infarction, stroke and sudden death—with emphasis on their unique pathophysiological mechanisms in SCD. We highlight emerging diagnostic tools such as cardiac magnetic resonance with T2* mapping and extracellular volume sequences, speckle-tracking echocardiography and invasive exercise testing, which can revealing a distinct phenotype combining restrictive cardiomyopathy and high-output heart failure. Practical algorithms for risk stratification and disease monitoring are presented alongside evidence-based and SCD-specific management approaches, including the rol"},{"url":"https://hartvaat.nl/2026/04/23/aha-statement-kinderen-met-cardiomyopathie-mogen-meer-bewegen/","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIR.0000000000001431","title_en":"","journal":"Circulation","source_date":"2026-04-23","abstract_original":"Circulation, Volume 153, Issue 21, Page e1344-e1358, May 26, 2026. Physical activity (PA) is essential for the cardiovascular, emotional, and social health of all children and adolescents. However, for pediatric patients with cardiomyopathy, decades of risk-averse clinical guidance have resulted in widespread PA restriction due to fears of sudden cardiac death and disease progression. This has contributed to sedentary behavior, poor cardiorespiratory fitness, and increased risk of secondary cardiometabolic conditions in this population. However, emerging data challenge this restrictive paradigm, showing that the risk of sudden cardiac death may not be higher in some patients with cardiomyopathy who exercise than in those who are less active, and that participation in PA may also have a positive effect on reverse remodeling. This American Heart Association scientific statement provides an evidence-based framework for the promotion of PA in pediatric patients with hypertrophic cardiomyopathy, dilated cardiomyopathy, restrictive cardiomyopathy, or arrhythmogenic cardiomyopathy, as well as those with implantable cardioverter defibrillators; outlines the physical, social, and emotional benefits of PA for these children and adolescents; and provides updated risk stratification strategies, including the use of advanced imaging, exercise testing, and genotype-specific data. This scientific statement underscores the importance of shared decision-making tailored to developmental maturity and family goals and emphasizes the need for longitudinal surveillance as clinical phenotypes evolve. With individualized assessment and informed shared decision-making, most children and adolescents with cardiomyopathy can safely engage in PA, with important implications for long-term cardiometabolic and psychologic health."},{"url":"https://hartvaat.nl/2026/05/09/telesat-prior-hf-telemonitoring-na-hartfalenopname-verbonden-met-46-lagere-morta/","doi":"10.1093/ejhf/xuag146","title_en":"","journal":"European Journal of Heart Failure","source_date":"2026-05-09","abstract_original":"Aims: Patients recently hospitalized for heart failure (HF) face a high risk of readmission and mortality. Remote monitoring programs (RMPs) may offer a scalable, non-invasive strategy to improve outcomes in this vulnerable population. Methods: This prespecified sub-analysis of the TELESAT-HF study included HF patients with at least one HF-related hospitalization in the year preceding study entry. Patients enrolled in the RMP and controls were identified from the French national health database. Controls were weighted to create a group comparable to the RMP group. The primary endpoint was all-cause mortality; secondary endpoints included HF rehospitalizations and cumulative days spent in hospital. Healthcare costs were also explored. Results: After weighting, ~1258 patients managed with RMP (mean age 73 years, 33% women) and ~2321 controls were included. Compared with standard of care, RMP was associated with a lower risk of all-cause mortality (23.5% vs. 39.6%; HR 0.54, 95%CI 0.47-0.63; p<.001), a lower rate of HF rehospitalizations (rate ratio 0.85; p=0.002), fewer admissions via emergency departments (-32%), reduced need of intensive care (-35%), and fewer cumulative days spent in hospital (estimated absolute difference -1.77 days; p<.001). Mean total healthcare costs did not differ significantly between groups at 6, 12, or 24 months. Subgroup analyses showed consistent associations across age, sex, RMP modality, and number of prior HF hospitalizations. Conclusion: Among patients recently hospitalized for HF, participation in a non-invasive RMP was associated with lower mortality, fewer HF rehospitalizations, and fewer hospital days, without increasing total healthcare costs."},{"url":"https://hartvaat.nl/2026/05/10/delta-hf-thoracale-duct-lymfedecongestie-via-elym-systeem-haalbaar-bij-acute-har/","doi":"10.1093/ejhf/xuag157","title_en":"","journal":"European Journal of Heart Failure","source_date":"2026-05-10","abstract_original":"Background: Persistent congestion at discharge is associated with worse outcomes in acute decompensated heart failure (ADHF), with impaired lymphatic function contributing to difficult-to-target tissue and organ congestion. Methods: The safety and effectiveness of the eLym System in ADHF was evaluated in the multicenter, single-arm DELTA-HF trial. A localized reduced-pressure zone at the venous angle was created in 40 patients using an endovenous axial pump to support lymph drainage through the thoracic duct. Results: Forty patients with ADHF (32.5% female, 71±11 years) received therapy. Patients had a median of 2 hospitalizations in the prior 6 months and were on home daily loop diuretic dose equivalent to ≥80 mg furosemide. Device deployment was successful in all cases (therapy time: 23.1±7.3 hours). Weight decreased by 3.6±2.4 kg during eLym therapy and by 6.8±3.4 kg at discharge. Median modified EVEREST Clinical Congestion Score improved from 5.0 to 2.0 after treatment and to 0 by discharge, remaining stable through 6 months (p<0.0001). Serum creatinine remained stable acutely and through 6 months. Freedom from device- or procedure-related serious adverse events was 95%. One patient had a vascular complication causing mediastinal hematoma and death; another required inotropes due to hypotension. At 6 months, two patients experienced three HF hospitalizations and five patients died (four cardiovascular, one urosepsis). Conclusions: eLym therapy in ADHF appeared to be safe, with early data suggesting effective, durable decongestion and a low 6-month rehospitalization rate. Randomized controlled trials are warranted."},{"url":"https://hartvaat.nl/2026/05/10/dig-rhd-digoxine-verlaagt-sterfte-en-hartfalen-bij-symptomatische-reumatische-ha/","doi":"10.1001/jama.2026.7335","title_en":"","journal":"JAMA","source_date":"2026-05-10","abstract_original":"Importance: Heart failure is the most common cause of death in patients with rheumatic heart disease. The efficacy and safety of digoxin in this population are not known. Objective: To determine if digoxin, compared with placebo, improves the composite of death or new-onset or worsening heart failure in patients with symptomatic rheumatic heart disease. Design, Setting, and Participants: Multicenter, randomized, placebo-controlled trial enrolling patients with rheumatic heart disease who additionally had heart failure or atrial fibrillation or were already taking digoxin at 12 tertiary care hospitals in India between February 25, 2022, and August 31, 2024; median follow-up was 2.1 years (until December 15, 2025). Interventions: Patients were randomized 1:1, stratified by baseline rhythm, to receive oral digoxin 0.125 to 0.25 mg once daily (n=885) or matching placebo (n=884). Main Outcomes and Measures: The primary outcome was a composite of all-cause death or new-onset or worsening heart failure within 36 months of follow-up or until study end, whichever occurred first. Results: Of 1769 enrolled patients, 1759 took at least 1 dose. Mean age was 46 years and 72% were female. Most (81.5%) had mixed lesions involving multiple valves, with 85% having moderate to severe mitral stenosis. Atrial fibrillation was present in 70%, and 90% were in NYHA class II-IV. The primary composite outcome occurred in 276 patients (31.4%) receiving digoxin and 312 (35.5%) receiving placebo (hazard ratio 0.82; 95% CI 0.69-0.96). Conclusions: In patients with symptomatic rheumatic heart disease, digoxin reduced the composite of death or new-onset or worsening heart failure compared with placebo."},{"url":"https://hartvaat.nl/2026/05/09/meta-analyse-decision-digit-hf-dig-digitalisglycosiden-reduceren-verslechterende/","doi":"10.1093/eurheartj/ehag387","title_en":"","journal":"European Heart Journal","source_date":"2026-05-09","abstract_original":"Background: Whether digitalis glycosides retain a role in heart failure with reduced or mildly reduced ejection fraction (HF(m)rEF) on top of contemporary guideline-directed medical therapy is debated. Methods: This study-level meta-analysis combined the DECISION (n=1001), DIGIT-HF (~1240) and DIG (n=6800) trials, totalling 9013 patients with HF(m)rEF assigned to digoxin, digitoxin or placebo. The primary outcome was a composite of cardiovascular death or first worsening heart failure event. Secondary analyses examined time to first worsening heart failure event and pre-specified interaction with guideline-recommended medical therapy use across the RALES, EMPHASIS-HF, PARADIGM-HF and DAPA-HF backbones. Results: Compared with placebo, digitalis glycosides significantly reduced the primary composite (HR 0.85; 95% CI 0.80–0.90; p<0.001) and the time to first worsening heart failure event (HR 0.75; 95% CI 0.69–0.81; p<0.001). The benefit was consistent across trials and was maintained in patients already on contemporary guideline-recommended HF therapy, with no heterogeneity by trial type or glycoside variant. Conclusions: At the population level, digitalis glycosides reduce worsening heart failure events on top of contemporary guideline-directed therapy, supporting reconsideration of their place in HF(m)rEF treatment."},{"url":"https://hartvaat.nl/2026/05/10/decision-onttrekkingssubstudie-stoppen-van-digoxine-na-lange-behandeling-leidt-t/","doi":"10.1093/eurheartj/ehag385","title_en":"","journal":"European Heart Journal","source_date":"2026-05-10","abstract_original":"Background and aims: Whether digoxin withdrawal is safe in patients with heart failure (HF) optimized on contemporary guideline-recommended medical therapy remains unknown. This prespecified analysis of the DECISION trial evaluated outcomes following blinded withdrawal of digoxin or placebo. Methods: In DECISION, 1001 patients were randomized to low-dose digoxin or placebo and treated for a median of 36.5 months. At the end of the study, 587 patients on active treatment (digoxin 288, placebo 299) underwent blinded withdrawal with an in-person follow-up visit at six weeks. All events were adjudicated. Results: During the pre-withdrawal phase (100 days), incidence rates of cardiovascular (CV) death or worsening HF events were 5.7 versus 6.5 events per 100 patient-years in the digoxin versus placebo group; rate ratio 0.88 (95%CI 0.24-3.10). Following withdrawal, the incidence rate increased markedly in patients withdrawn from digoxin but not placebo (42.8 vs. 5.9 events per 100 patient-years; time period-by-treatment interaction, P=0.036). Fourteen events (12 hospitalizations and 2 urgent HF visits) occurred in the digoxin withdrawal arm versus two (one HF hospitalization and one CV death) in the placebo withdrawal arm (RR 7.37, 95% CI 1.56–34.88; P=0.012). Withdrawal of digoxin was accompanied by an increase in heart rate (p=0.003), reduction in systolic blood pressure (p=0.014) and rise in NT-proBNP (p=0.002). Conclusions: Discontinuation of digoxin after long-term treatment is associated with clinical deterioration in patients with HF and a reduced or mildly reduced ejection fraction. These findings warrant caution when stopping digoxin."},{"url":"https://hartvaat.nl/2026/05/10/decision-lage-dosis-digoxine-mist-primair-eindpunt-bij-hf-m-ref-maar-suggereert-/","doi":"10.1038/s41591-026-04406-6","title_en":"","journal":"Nature Medicine","source_date":"2026-05-10","abstract_original":"BACKGROUND: The benefit of low-dose digoxin in contemporary patients with heart failure with reduced or mildly reduced ejection fraction (HF(m)rEF) treated according to current guidelines is unclear. METHODS: DECISION was a double-blind, randomized, placebo-controlled outcome trial conducted at 43 Dutch sites enrolling 1001 patients with symptomatic mild-to-moderate HF(m)rEF (LVEF ≤50%). Mean age was 73 years, 28% were women, and 29% had atrial fibrillation. Patients were randomized 1:1 to low-dose digoxin (target serum concentration 0.5–0.9 ng/mL) or matching placebo on top of guideline-directed medical therapy. The primary endpoint was a composite of total worsening heart failure events (hospitalizations or urgent visits) and cardiovascular mortality. Median follow-up was 36.5 months. RESULTS: The primary endpoint occurred 238 times in 131 of 500 digoxin patients versus 291 times in 152 of 501 placebo patients (rate ratio 0.81; 95% CI 0.61–1.07; p=0.133). Total worsening heart failure events were lower in the digoxin group (RR 0.76; 95% CI 0.54–1.05). Cardiovascular mortality was similar (HR 0.93; 95% CI 0.69–1.26). Low-dose digoxin was generally well tolerated and safe. CONCLUSIONS: Low-dose digoxin did not significantly reduce the composite of worsening heart failure events and cardiovascular mortality in contemporary HF(m)rEF, although directional benefit on worsening heart failure events was observed."},{"url":"https://hartvaat.nl/2026/05/10/hf-revert-antisense-mirna-remmer-cdr132l-mist-primair-eindpunt-na-infarct-met-ve/","doi":"10.1038/s41591-026-04408-4","title_en":"","journal":"Nature Medicine","source_date":"2026-05-10","abstract_original":"MicroRNA-132 (miR-132) is a central regulator of adverse cardiac remodeling. Here we evaluated CDR132L, a synthetic antisense oligonucleotide miR-132 inhibitor, in a multinational, randomized, double-blind, placebo-controlled phase 2 trial (HF-REVERT) in patients with recent myocardial infarction (MI) and left ventricular (LV) systolic dysfunction. Within 3–14 days after MI, 294 patients were randomized to receive CDR132L 5 mg/kg, CDR132L 10 mg/kg or placebo as three intravenous doses at 4-week intervals plus guideline-directed therapy. In total, 280 patients (245 men and 35 women) who received at least one dose of the study drug were included in the modified intention-to-treat population. CDR132L was well tolerated, with no hepatic, renal, hematologic or cardiac toxicity signals. The primary endpoint—the percentage change in LV end-systolic volume index at 6 months—improved in all groups but did not differ significantly between the CDR132L groups (5 mg/kg and 10 mg/kg) and the placebo group. Secondary endpoints, including LV ejection fraction, global longitudinal strain and N-terminal pro B-type natriuretic peptide, were also not significantly different between the CDR132L and placebo groups. Prespecified exploratory analyses suggested potential benefits of CDR132L treatment in patients with advanced adverse remodeling at baseline, supporting further evaluation of CDR132L, including in chronic heart failure conditions. ClinicalTrials.gov: NCT05350969."},{"url":"https://hartvaat.nl/2026/05/09/praise-mr-sacubitril-valsartan-verbetert-inspanningshemodynamiek-bij-hfpef-met-a/","doi":"10.1161/CIRCULATIONAHA.126.080833","title_en":"","journal":"Circulation","source_date":"2026-05-09","abstract_original":"Background: Atrial functional mitral regurgitation (AFMR) characterizes a high-risk phenotype in heart failure with preserved ejection fraction (HFpEF). Although sacubitril/valsartan reduces functional MR in HF with reduced EF (HFrEF), its impact on exercise hemodynamics and the dynamic burden of AFMR in HFpEF remains to be elucidated. Methods: This multicenter, randomized, open-label trial with blinded primary endpoint assessment assigned 84 patients with symptomatic HFpEF and ≥moderate AFMR within the previous year to sacubitril/valsartan (n=41) or standard-of-care (SOC; n=43). The primary outcome was the 6-month change in the exercise mean pulmonary arterial pressure to cardiac output (mPAP/CO) slope, assessed using cardiopulmonary exercise testing with simultaneous echocardiography (CPETecho). Secondary outcomes included changes in peak oxygen consumption (peak VO2), Kansas City Cardiomyopathy Questionnaire (KCCQ), NT-proBNP levels, LA volume and function, and AFMR severity in rest and during stress. Results: At 6 months, sacubitril/valsartan significantly improved the mPAP/CO slope compared to SOC (adjusted between-group difference in change: -0.93 mmHg/L/min; 95%CI: -1.80 to -0.07; p=0.035). This hemodynamic benefit was accompanied by improvements in peak VO2 (+0.9 vs. -0.6 mL/kg/min; p=0.002) and KCCQ (median increase: 10 vs. 2 points; p=0.002). Significant reductions in NT-proBNP and LA volume were observed, alongside attenuation of AFMR severity at rest and during exercise. Conclusions: In symptomatic HFpEF with secondary AFMR, sacubitril/valsartan improved exercise hemodynamics, exercise capacity, quality of life, and biomarker and structural endpoints over six months."},{"url":"https://hartvaat.nl/2026/04/24/bij-metabool-syndroom-zonder-diabetes-of-hypertensie-bloeddruk-en-triglyceriden-/","doi":"10.1136/bmjopen-2025-105379","title_en":"","journal":"BMJ open","source_date":"2026-04-24","abstract_original":"OBJECTIVES: To examine the metabolic syndrome (MetS) and its components as risk factors for a cardiovascular (CV) event, in individuals without diabetes and/or hypertension, and to explore which of the risk factors are the most predictive for cardiovascular disease (CVD) and whether the assessment of risk could be simplified. DESIGN: A longitudinal, cross-sectional study. SETTING: A randomly selected population. PARTICIPANTS: In 2002-2005, 2816 randomly selected residents of Skaraborg, Sweden, underwent physical examinations and blood tests as part of the Skaraborg Project. Exclusion of individuals with diabetes mellitus and/or hypertension at baseline left 2328 persons for analyses. OUTCOME MEASURES: CV events were assessed in 2011 using national Swedish registers. RESULTS: A total of 293 (13%) were defined as having the MetS according to the National Cholesterol Education Programme (NCEP) and 292 according to the International Diabetes Federation (IDF) definition, whereof 27 had a CV event after a mean follow-up time of 9.7 years. The MetS according to NCEP was significantly predictive of a CVD with an HR 2.4 (95% CI 1.4 to 3.9) but not according to the IDF definition. Blood pressure was significantly predictive according to both definitions (HR 1.77, 95% CI 1.06 to 2.97). Also, triglycerides (Tg) were significantly predictive for a CV event (HR 2.05, 95% CI 1.17 to 3.59). Neither waist circumference, high-density lipoprotein nor fasting plasma glucose was predictive for a CV event. Combining a blood pressure ≥125/≥80 mm Hg with Tg ≥1.5 mmol/L was predictive for CVD (HR 2.1, 95% CI 1.3 to 3.6) with a sensitivity of 32.5% and numbers needed to examine (NNE) 7.1. Lowering the cut-off for Tg to ≥1.2 mmol/L (HR 2.1, 95% CI 1.3 to 3.4) increased sensitivity to 44.9% and NNE became 8. CONCLUSIONS: Using blood pressure combined with Tg was shown to be an equally good predictor for CVD as the complete MetS in individuals without diagnosed diabetes or hypertension. Therefore, healthcare personnel should pay attention to individuals with a borderline blood pressure, and if equivalent to or equal to 125/85, continue with measuring Tg for a discussion concerning lifestyle."},{"url":"https://hartvaat.nl/2026/04/24/grote-ziekenhuisvariatie-in-mcs-gebruik-bij-myocardinfarct-met-cardiogene-shock/","doi":"http://heart.bmj.com/cgi/content/short/112/10/563?rss=1","title_en":"","journal":"Heart","source_date":"2026-04-24","abstract_original":" Cardiogenic shock (CS) is a leading cause of mortality following acute myocardial infarction (AMI). Some patients may require intra-aortic balloon pump (IABP) or percutaneous ventricular assist device (PVAD) placement; however, there is a paucity of standardised algorithms to guide the deployment of each device. The present study evaluated interhospital variation in the use of IABP and PVAD for AMI CS and identified institutional factors associated with hospital-level device preference. All non-elective adult hospitalisations entailing AMI and CS were identified within the 2019 Nationwide Readmissions Database. Patients were grouped into IABP, PVAD and non-mechanical circulatory support cohorts. The primary aim was to quantify the degree of interhospital variation in the use of IABP and PVAD. Escalation to extracorporeal membrane oxygenation (ECMO), left ventricular assist device (LVAD) implantation, length of stay and hos"},{"url":"https://hartvaat.nl/2026/04/24/bayesiaanse-netwerkmeta-analyse-vergelijkt-revascularisatie-bij-stabiele-ischemi/","doi":"http://heart.bmj.com/cgi/content/short/112/10/530?rss=1","title_en":"","journal":"Heart","source_date":"2026-04-24","abstract_original":" Contemporary guidelines by the European Society for Cardiology and American College of Cardiology/American Heart Association for the treatment of non-acute myocardial ischaemic syndromes dispute the value of revascularisation and differ in their recommendation to perform revascularisation. A Bayesian network meta-analysis was performed, evaluating the strength of evidence for the comparative incremental effectiveness of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) over medical therapy on long-term outcomes. A hierarchical Bayesian network meta-analysis was designed (PROSPERO CRD42024541215, date 20 May 2024), including randomised controlled trials (RCTs) published between 2005 and 10 June 2025, which consisted of three initial treatment modalities: optimal medical therapy (OMT), PCI+OMT and CABG+OMT. The primary outcome was all-cause mortality at maximum follow-up; secondary outcom"},{"url":"https://hartvaat.nl/2026/04/24/crt-bij-volwassenen-met-systemische-rechterventrikel-gemengde-uitkomsten-in-inte/","doi":"http://heart.bmj.com/cgi/content/short/112/10/549?rss=1","title_en":"","journal":"Heart","source_date":"2026-04-24","abstract_original":" Cardiac resynchronisation therapy (CRT) is a key treatment for heart failure (HF) in acquired heart disease, but its benefits in adults with congenital heart disease and a systemic right ventricle (sRV) remain unclear. This study aimed to assess whether CRT improves outcomes in patients with sRV. This is an international, retrospective study including patients >18 years from 33 centres with transposition of the great arteries (TGA) following atrial switch operation and congenitally corrected TGA. The primary endpoint included overall survival and survival free from HF. The secondary endpoint was a composite of death, hospitalisation for HF, heart transplant, mechanical support and ventricular tachycardia/implantable cardioverter-defibrillator therapies. We identified 105 out of 1721 patients (3.5%) who underwent CRT. Median follow-up after CRT implant was 4.6 (1.6–8) years. QRS "},{"url":"https://hartvaat.nl/2026/04/27/genen-voor-bloeddruk-in-de-kindertijd-voorspellen-cardiometabool-risico-op-later/","doi":"10.1093/eurheartj/ehag313","title_en":"","journal":"European heart journal","source_date":"2026-04-27","abstract_original":"BACKGROUND AND AIMS: To elucidate the genetic architecture of blood pressure (BP) and heart rate (HR) during early life and assess their potential relevance to adult health outcomes. METHODS: The largest genome-wide association study (GWAS) meta-analyses to date of childhood systolic BP, diastolic BP, pulse pressure, and mean arterial pressure (n = 28 425) and HR (n = 22 565) were conducted in children of European ancestry aged 4-17 years. Follow-up analyses included comparisons with adult GWAS results, polygenic risk score (PRS) analyses in independent cohorts of diverse ancestries, and a phenome-wide association study in the UK Biobank. RESULTS: Eight genome-wide significant loci were identified for childhood BP (KIAA2013, CACNB2, PLCE1, PAX2, COL4A2, RP11-236L14.1, CFDP1, TPX2) and three loci for childhood HR (CCDC141, ACHE, MYH6); all novel in children but previously reported in adults. Childhood PRSs explained up to 1.6% of BP variance and 5.2% of HR variance among children of European ancestry. Genetic correlations between childhood and adulthood BP traits were moderate (rg = 0.4-0.7), suggesting age-specific genetic effects on BP. In the UK Biobank, higher childhood BP PRS levels were significantly associated with a broad range of adult health outcomes, particularly cardiometabolic outcomes such as hypertension, angina, myocardial infarction, and cardiovascular disease-related mortality. CONCLUSIONS: These findings advance the understanding of the genetic architecture of childhood BP and HR and provide compelling genetic evidence linking childhood BP to a broad spectrum of adult health outcomes-particularly cardiometabolic conditions-which may inform targeted prevention strategies from a young age."},{"url":"https://hartvaat.nl/2026/04/25/praetorian-dft-defibrillatietest-bij-subcutane-icd-veilig-achterwege-te-laten/","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.126.080638","title_en":"","journal":"Circulation","source_date":"2026-04-25","abstract_original":"Background: To improve survival in patients at risk of sudden cardiac death, subcutaneous ICDs (S-ICDs) require optimal implant positioning for effective shocks. Defibrillation (DF) testing is recommended but carries serious risks. The PRAETORIAN score predicts defibrillation outcomes based on chest X-rays. The PRAETORIAN-DFT trial evaluated whether omission of DF testing guided by the PRAETORIAN score is non-inferior for first-shock efficacy.Methods: In this multinational trial, S-ICD patients from 37 centers were randomized to DF testing or no DF testing. In the No-DF testing group, the PRAETORIAN score was evaluated before discharge. The primary endpoint was failed first shock for spontaneous ventricular arrhythmias, as a surrogate for defibrillation success, tested for non-inferiority with a 3% absolute risk margin. Secondary endpoints included mortality, potential DF testing-related complications, and S-ICD revisions.Results: The included 965 patients (No-DF testing, n=483;DF testing, n=482) were followed for a median of 41 months. Failed first shock for spontaneous ventricular arrhythmia occurred in 1.7% of the No-DF testing group versus 2.3% of the DF testing group (–0.6%, 95% CI [ –2.6 to 1.4]; p<0.001). There were no significant differences in all-cause mortality (HR 0.9 [95% CI 0.6–1.4]) or arrhythmic death (HR 0.4 [95% CI 0.04–3.4]). Potential DF testing-related complications occurred in 1.7% in the DF testing group. Postoperative S-ICD revisions due to inadequate positioning were identical between groups (n=2 each).Conclusions: PRAETORIAN score–guided omission of DF testing- after S-ICD implantation did not increase the risk of failed first shocks for spontaneous ventricular arrhythmias and reduced procedural risk without increasing S-ICD revisions. (Funded by Boston Scientific; PRAETORIAN-DFT)."},{"url":"https://hartvaat.nl/2026/04/24/santorini-uk-ldl-doel-onbereikt-bij-meerderheid-van-hoogrisicopatienten-na-1-jaa/","doi":"10.1136/bmjopen-2025-114031","title_en":"","journal":"BMJ open","source_date":"2026-04-24","abstract_original":"OBJECTIVES: This real-world study investigated the changes of lipid lowering therapy (LLT) usage in patients with high or very high cardiovascular (CV) risk in the UK and the group of all other European countries in the SANTORINI study up to 1 year from baseline and the impact this treatment had on the attainment of low-density lipoprotein cholesterol (LDL-C) risk-adjusted goals set by the National Institute for Health and Care Excellence (NICE) and those in the 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) dyslipidaemia guidelines. DESIGN: Secondary analysis of the SANTORINI dataset (an international, prospective, observational, non-interventional study (NCT04271280)). SETTING: Primary and secondary care centres in the UK and the group of other European countries (Austria, Belgium, Denmark, Finland, France, Germany, Ireland, Italy, the Netherlands, Portugal, Spain, Sweden and Switzerland). PARTICIPANTS: 663 UK patients with high and very high CV risk were included in this analysis and 8502 from the group of other European countries. Of these, 380 UK patients and 6830 from the group of other European countries had LDL-C information available at baseline and 1-year follow-up. PRIMARY OUTCOME MEASURES: The primary objectives were to describe patients' lipid management, LDL-C levels at 1-year follow-up and their attainment of 2023 NICE (≤2.0 mmol/L) and 2019 ESC/EAS LDL-C 2019 guideline-recommended LDL-C goals (<1.4 mmol/L for very high-risk patients and <1.8 mmol/L for high-risk patients) within this time frame. RESULTS: Over the course of 1-year follow-up, the overall proportion of UK patients on no LLT reduced from 20.4% at baseline to 7.1%, similar to that observed in the group of other European countries (baseline-20.9%, 1 year-3.0%). The proportion of UK patients receiving LLT monotherapy increased from 74.8% at baseline to 84.9%, higher at both time points than that observed for the group of other European countries (baseline: 52.0%, 1 year: 55.0%). The use of any combination therapy increased slightly from baseline to 1 year in the UK overall cohort (4.9% vs 7.1%) and overall in the group of all other European countries, the cohort increased from baseline (27.1%) to 1 year (40.2%). Overall, mean (SD) LDL-C levels in the UK were 2.5 (1.2) mmol/L at baseline and 2.1 (1.0) mmol/L at 1 year and for the group of other European countries were 2.4 (1.2) mmol/L at baseline and 2.0 (0.9) mmol/L at 1 year. The overall proportions of UK patients achieving the UK NICE treatment goal and ESC/EAS 2019 guidelines at baseline versus 1-year follow-up were 40.3% vs 52.6% and 22.9% vs 32.9%, respectively; 21.1% and 30.9% of patients in the group of other European countries achieved the ESC/EAS 2019 guidelines at baseline and 1-year follow-up, respectively. CONCLUSIONS: In this UK-focused analysis of the SANTORINI study, use of LLT increased modestly over 1 year, accompanied by a reduction in average LDL-C levels. However, mean LDL-C remained above the NICE goal, and attainment of both NICE and ESC/EAS LDL-C thresholds remained suboptimal. The findings highlight continued opportunities to optimise lipid management in UK clinical practice, including the potential for broader use of combination therapies."},{"url":"https://hartvaat.nl/2026/04/24/verminderde-nierfunctie-verhoogt-hartfalenrisico-bij-ouderen-aspree-cohort/","doi":"http://heart.bmj.com/cgi/content/short/112/10/569?rss=1","title_en":"","journal":"Heart","source_date":"2026-04-24","abstract_original":" We examined whether impaired kidney function, identified through elevated levels of urine albumin to creatinine ratio (UACR) or reduced estimated glomerular filtration rate (eGFR), is associated with hospitalisation or death due to heart failure (HF) in a large community-based cohort of older adults. We included 17 834 participants from the ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial and follow-up ASPREE eXTension observational study with complete baseline data on albuminuria and eGFR. HRs for hospitalisation due to HF (HHF), HF death, a composite outcome of HHF and HF death, and HF re-admission were calculated using Cox models adjusting for potential confounders. Over a median follow-up of 8.6 years, 354 (1.98%) participants had a first hospitalisation for HF and 147 (0.82%) died due to HF. Participants with albuminuria (UACR ≥3.0 mg/mmol; 11.3%) had higher risk"},{"url":"https://hartvaat.nl/2026/04/01/noac-s-onder-de-65-jaar-apixaban-heeft-het-gunstigste-baten-risicoprofiel/","doi":"10.1001/jamanetworkopen.2026.9082","title_en":"","journal":"JAMA network open","source_date":"2026-04-01","abstract_original":"IMPORTANCE: A study using Medicare data concluded that among patients aged 65 years or older, rivaroxaban had a less favorable benefit-harm profile compared with other non-vitamin K oral anticoagulants (NOACs); however, it is unclear whether this finding persists in younger users. OBJECTIVE: To compare major extracranial bleeding (MEB), gastrointestinal bleeding (GIB), intracranial hemorrhage (ICH), and thromboembolic stroke in individuals aged younger than 65 years using non-vitamin K oral anticoagulants (NOAC users) for nonvalvular atrial fibrillation (NVAF). DESIGN, SETTING, AND PARTICIPANTS: This cohort study using health care claims data between October 2010 and February 2022 in the FDA Sentinel System included standard dose NOAC (rivaroxaban, apixaban, and dabigatran) users with NVAF aged 21 to 64 years. Analyses conducted between December 2022 and August 2023. MAIN OUTCOMES AND MEASURES: Hazard ratios (HRs) and 95% CIs were estimated for each outcome (MEB, GIB, ICH, and thromboembolic stroke) in inverse probability of treatment-weighted pairwise comparisons: rivaroxaban vs apixaban, rivaroxaban vs dabigatran, and dabigatran vs apixaban. RESULTS: A total of more than 173 000 patients (mean [SD] age, 56.6 [7.23] years; 27.5% female; 72.5% male) were included across the 3 exposure cohorts. The number of NOAC users for each pairwise comparison were rivaroxaban (57 932) vs apixaban (96 057), rivaroxaban (57 399) vs dabigatran (20 188), and dabigatran (20 163) vs apixaban (96 668). Rivaroxaban was associated with higher risks of MEB and GIB compared with apixaban (MEB: HR, 1.91; 95% CI, 1.56-2.34; GIB: HR, 1.92, 95% CI, 1.54-2.39), while differences in thromboembolic stroke prevention were not significant (HR, 1.05; 95% CI, 0.77-1.44). Dabigatran was associated with higher thromboembolic stroke risk (rivaroxaban vs dabigatran: HR, 0.61; 95% CI, 0.39-0.94; dabigatran vs apixaban: HR, 1.74; 95% CI, 1.13-2.68). CONCLUSIONS AND RELEVANCE: These findings suggest that for patients aged younger than 65 years treated with NOACs for NVAF, apixaban was associated with the most favorable benefit-harm profile. While the results suggest that rivaroxaban may have provided greater stroke prevention than dabigatran, it was associated with higher bleeding risks than apixaban without additional stroke prevention. The higher thromboembolic stroke risks observed with dabigatran in younger patients suggest important age-related differences in effectiveness that warrant further investigation."},{"url":"https://hartvaat.nl/2026/04/24/nkf-consensus-standaardiseer-urine-afname-om-albuminurie-betrouwbaar-te-meten/","doi":"10.1093/ndt/gfag083","title_en":"","journal":"Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association","source_date":"2026-04-24","abstract_original":"Albuminuria and proteinuria are key biomarkers for diagnosing, staging, and monitoring of chronic kidney disease. Both are also strongly associated with renal and cardiovascular risk. Given their important diagnostic role, reliable measurement of urinary albumin and protein is essential for clinical practice and trials. However, variability in the methodology presently used to collect, store and prepare urine samples may influence assay performance and contribute to inconsistent results. In response to a call for harmonization, the United States of America National Kidney Foundation organized a workshop in April 2025 to define optimal methods and practices for measuring albuminuria and proteinuria. As part of this initiative, the available evidence on pre-analytical factors affecting urinary albumin and protein measurements was discussed. For this purpose, a narrative literature review was conducted to identify relevant studies focusing on urine collection strategies, including 24-hour versus single-void samples, timing of sample collection, the need for repeated measurements, clinical conditions that may cause false-positive results, and the effects of sample storage and handling under various temperature conditions. Given heterogeneity in study designs and outcome measures, findings were synthesized qualitatively. This consensus report summarizes the findings of this literature review and the resulting discussion. It highlights the importance of standardized urine collection and handling procedures to minimize biological and analytical variability. In addition, it provides practical recommendations."},{"url":"https://hartvaat.nl/2026/05/05/verminderde-rv-vrijewandstrain-voorspelt-mcs-behoefte-bij-cardiogene-shock/","doi":"10.1093/eschf/xvag116","title_en":"","journal":"ESC heart failure","source_date":"2026-05-05","abstract_original":"INTRODUCTION: Early identification of patients with cardiogenic shock (CS) who will require temporary mechanical circulatory support (MCS) remains challenging. Right ventricular (RV) dysfunction is common in CS and affects haemodynamic stability. RV free wall longitudinal strain (RV FWLS) is a sensitive marker of myocardial dysfunction, but its role in predicting MCS escalation in CS remains unclear. METHODS: In this single-centre retrospective study, patients admitted with CS between January 2023 and December 2025 were screened. Inclusion required transthoracic echocardiography within 24 h of CS diagnosis and prior to MCS implantation. RV FWLS was measured using commercially available software. Primary outcome was temporary MCS implantation during hospitalization. Secondary outcomes included in-hospital mortality and intensive care and hospital length of stay. RESULTS: Ninety-two patients were included; 31 (34%) required temporary MCS. Severe RV FWLS impairment (<11%) was strongly associated with temporary MCS use (OR 10.49, 95% CI 3.72-29.59). Tricuspid annular plane systolic excursion and fractional area change were not significantly associated with temporary MCS. Severe RV FWLS was linked to longer intensive care stay (21 vs 8 days, P = .003) and hospital stay (25 vs 14 days, P = .003), but not mortality. RV FWLS demonstrated moderate discrimination (area under the curve, AUC 0.74), improving with left ventricular ejection fraction (LVEF) and Sequential Organ Failure Assessment (SOFA) score (AUC 0.82). A classification and regression tree -derived algorithm using RV FWLS, SOFA score, and LVEF stratified patients into distinct risk groups with 78% overall accuracy and 95% specificity. CONCLUSION: Integration of RV FWLS with clinical parameters may improve early risk stratification in CS."},{"url":"https://hartvaat.nl/2026/04/24/gecombineerde-mitraal-en-tricuspidalis-teer-verbetert-overleving-bij-multivalvul/","doi":"10.1093/eurheartj/ehag186","title_en":"","journal":"European heart journal","source_date":"2026-04-24","abstract_original":"BACKGROUND AND AIMS: The coexistence of moderate mitral regurgitation (MR) and severe tricuspid regurgitation (TR) is common, yet evidence guiding optimal management remains limited. Transcatheter edge-to-edge repair (TEER) of both valves-performed either sequentially or in combination-has emerged as a potential therapeutic strategy. This study aimed to assess the prognostic impact of moderate MR in patients undergoing tricuspid TEER (T-TEER) for severe TR and to evaluate whether concomitant mitral TEER (M-TEER) improves clinical outcomes. METHODS: Data from the EuroTR registry (2016-25) were analysed, including patients with severe TR treated with T-TEER. Outcomes were compared between patients with untreated moderate MR and those who underwent concomitant M-TEER using propensity score matching (PSM). The primary endpoint was all-cause mortality at 2 years. Secondary endpoints included New York Heart Association (NYHA) class, 6 min walk distance (6MWD), TR severity, and heart failure rehospitalizations. RESULTS: Among 3100 patients, 30% had moderate MR, which was associated with higher 2-year mortality (23% vs 37%, p<0.0001). After PSM, 217 matched patients treated with concomitant M-TEER had greater TR reduction (-1.9 vs -1.6 grades, P = .001), better NYHA improvement, and increased 6MWD at follow-up. Survival was higher in the combined treatment group (87% vs 76% at 1 year; 81% vs 70% at 2 years, P = .005). In a multivariable analysis, moderate MR predicted increased mortality [hazard ratio (HR) 1.81, P = .005), while combined M-TEER predicted better survival (HR 0.46, P < .0001). CONCLUSIONS: Moderate MR predicts impaired prognosis in patients undergoing T-TEER for treatment of severe TR. Concomitant M-TEER is associated with improved survival and functional outcomes in this population with multivalve disease. These findings are hypothesis-generating and need to be tested in a dedicated randomized controlled trial."},{"url":"https://hartvaat.nl/2026/05/06/circulerend-mir-10b-5p-voorspelt-af-recidief-na-ablatie/","doi":"10.1093/europace/euag097","title_en":"","journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","source_date":"2026-05-06","abstract_original":"AIMS: The identification of reliable biomarkers for atrial fibrillation (AF) recurrence post-catheter ablation remains a clinical challenge. This study aimed to identify circulating microRNAs (miRNAs) associated with post-ablation AF recurrence and examine their underlying molecular pathways using an integrative translational approach. METHODS AND RESULTS: This two-phase study included a discovery case-control phase (n = 29) followed by a prospective validation cohort (n = 126). In the discovery phase, 84 miRNAs were quantified via real-time PCR, and candidates were selected using differential expression analysis and machine learning. In the validation phase, five candidate miRNAs (hsa-miR-342-3p, hsa-miR-424-5p, hsa-miR-486-5p, hsa-miR-10b-5p, and hsa-let-7d-5p) were further evaluated to assess their prognostic performance. Pathway enrichment analysis was performed for the most predictive miRNA. Differential expression analysis identified 14 miRNAs to be significantly associated with AF recurrence. In the validation cohort, hsa-miR-10b-5p showed the highest discriminative performance (AUC = 0.96, P < 0.001). Multivariable logistic regression confirmed that lower expression of hsa-miR-10b-5p was an independent predictor of recurrence (OR = 0.06, P < 0.001), significantly improving the baseline clinical model (ΔR = 63.3%). Pathway analysis linked hsa-miR-10b-5p to FOXO signalling, p53 signalling, circadian rhythm and cellular senescence, pathophysiologic mechanisms that are critical to atrial remodelling, and fibrotic persistence. CONCLUSION: Down-regulation of circulating hsa-miR-10b-5p was independently associated with AF recurrence after catheter ablation and improved risk discrimination beyond clinical variables. These findings support its potential role as a prognostic biomarker, although further multicentre validation is required before clinical application."},{"url":"https://hartvaat.nl/2026/04/01/risicofactoren-voor-cardiovasculaire-events-bij-heterozygote-familiaire-hypercho/","doi":"10.1016/j.atherosclerosis.2026.120650","title_en":"","journal":"Atherosclerosis","source_date":"2026-04-01","abstract_original":"BACKGROUND AND AIMS: Familial hypercholesterolemia (FH) is a highly prevalent monogenic disorder characterized by elevated low-density lipoprotein-cholesterol (LDL-C) levels and premature atherosclerotic cardiovascular disease (ASCVD). The risk factors associated with cardiovascular events in this population vary considerably among studies. This systematic review aims to identify the key risk factors predicting cardiovascular events in patients with a confirmed genetic diagnosis of heterozygous FH (PROSPERO, CRD42022304273). METHODS AND ANALYSIS: Cochrane Library, Embase, MEDLINE, Scopus, UpToDate and other literature databases were searched from inception to June 2023. Records were eligible if they included studies reporting risk factors for ASCVD endpoints in adult patients with a genetic diagnosis of FH. A meta-analysis was performed using MetaEasy. RESULTS: A total of 21 studies were identified, involving 23,613 individual participants and 3489 prevalent cardiovascular events. The sex distribution was 47.2% male and 52.8% female. Most of the studies were conducted in European populations, representing 90.5% of the total. The meta-analysis found associations between ASCVD and hypertension (effect size 0.414; 95% CI: 0.346-0.482), male sex (0.334; 0.213-0.456), smoking (0.324; 0.203-0.445), lipoprotein(a) (0.219; 0.127-0.312), age (0.212; 0.161-0.264), body mass index (0.108; 0.028-0.188), triglycerides (0.084; 0.057-0.111) and LDL-C (0.015; 0.002-0.028). CONCLUSIONS: This is the first systematic review and meta-analysis demonstrating that hypertension, male sex, smoking, lipoprotein(a), age, body mass index, triglycerides and LDL-C are significantly and independently associated with ASCVD in genetically confirmed patients with heterozygous FH. These data can inform risk stratification models and optimise therapy in such patients."},{"url":"https://hartvaat.nl/2026/04/22/maternale-auto-immuunziekte-verhoogt-cardiovasculair-risico-bij-nakomelingen/","doi":"10.1093/eurheartj/ehag316","title_en":"","journal":"European heart journal","source_date":"2026-04-22","abstract_original":"BACKGROUND AND AIMS: Maternal autoimmune diseases (AIDs) have been linked to adverse birth outcomes that may potentially increase cardiovascular disease (CVD) risk in offspring. However, whether maternal AIDs is associated with offspring CVD remains largely unexplored. This study aimed to examine whether intrauterine exposure to maternal AIDs is associated with offspring CVD up to early adulthood. METHODS: This nationwide population-based cohort study included 1 455 645 live singleton births during 2001-2014 in Sweden and followed them to 31 December 2023. Associations between maternal AIDs and offspring CVD were evaluated using Cox proportional hazard models. Cousin analyses and analyses with paternal AID were conducted to assess shared genetic and familial environmental confounding. RESULTS: During a median follow-up of 15.2 years (range, 0-23.7 years), 90 046 (6.2%) participants were exposed to maternal AIDs and 40 260 (2.8%) were diagnosed with CVD. Intrauterine exposure to maternal AIDs was associated with an increased risk of any CVD in offspring (hazard ratio 1.19, 95% confidence interval 1.14-1.24). Elevated CVD risks in offspring were observed across maternal AID categories. Paternal AIDs had a weaker association with offspring CVD than maternal AIDs; the associations in the cousin analyses persisted, though they were somewhat weaker than those in the main analyses. CONCLUSIONS: Maternal AIDs is associated with a moderately increased risk of CVD in childhood and early adulthood in offspring. These findings need to be interpreted with caution, as shared familial factors may partly contribute to the observed associations, and further studies are needed to clarify the mechanisms underlying the observed associations."},{"url":"https://hartvaat.nl/2026/04/19/fh-vrouwen-verliezen-mediaan-2-9-jaar-lipidenverlagende-behandeling-rond-elke-ki/","doi":"10.1016/j.atherosclerosis.2026.120668","title_en":"","journal":"Atherosclerosis","source_date":"2026-04-19","abstract_original":"BACKGROUND AND AIMS: Women with familial hypercholesterolaemia (FH) lose substantial treatment time during their reproductive years as most lipid-lowering therapies are contraindicated from the preconception through the end of breastfeeding. We examined the duration of real-life pregnancy-related off-treatment time in 27 women with FH in Norway. METHODS: Women with FH in Norway who had completed the ongoing FH-FEMINA study (ClinicalTrials.gov ID NCT05367310) were included. Women were followed from 36th week of gestation and until one year after delivery or until end of breastfeeding. Information on use of medication before, during and after the current and previous pregnancies was collected. Pregnancy-related off-treatment time was calculated from discontinuation of lipid-lowering therapy when planning pregnancy, throughout pregnancy, and after delivery. RESULTS: The total duration of pregnancy-related off-treatment time after all childbirths (median 1, range 1-3) per woman was a median of 2.9 years (25th-75th percentile; 1.6-4.0), ranging from 0.8 to 12 years. The pregnancy itself accounted for median of 42.1% of the pregnancy-related off-treatment time, whereas the time before and after pregnancy accounted for a median of 57.9% (range 11.4% to 91.2%). When including untreated years in childhood and/or prior to diagnosis, the lifelong off-treatment time represented a median of 66.3% (range 41.9 to 100%) of lifetime without treatment. CONCLUSION: Early diagnosis and initiation of treatment is essential in girls with FH to compensate for pregnancy-related off-treatment time later in life. To minimize these pregnancy-related off-treatment periods, healthcare professionals should support women with FH to resume lipid-lowering therapy immediately after breastfeeding and between pregnancies. In addition, more knowledge on the potential effects of statin use during pregnancy and breastfeeding on maternal and offspring health is urgently needed."},{"url":"https://hartvaat.nl/2026/04/22/obesitas-en-primair-aldosteronisme-oorzaak-gevolg-of-beide/","doi":"https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.126.26227","title_en":"","journal":"Hypertension","source_date":"2026-04-22","abstract_original":"Hypertension, Volume 83, Issue 6, Page e26227, June 1, 2026. Obesity has been shown to correlate directly with circulating aldosterone levels and urinary aldosterone excretion in normotensive and hypertensive individuals without primary aldosteronism (PA). This relationship may be bi-directional, though it is probably not symmetrical. Activation of the mineralocorticoid receptor in adipocytes may cause expansion of visceral fat mass. Conversely, adipocytes have been shown to augment the adrenal production of aldosterone by their release of aldosterone secretagogues—leptin, C1q/TNF-related proteins 1, and resistin—into the circulation. Patients with PA are more obese (idiopathic hyperaldosteronism>aldosterone-producing adenoma) than those with essential or no hypertension (women>men). The stronger association of obesity with idiopathic hyperaldosteronism than with the more metabolically severe unilateral PA, and the reductions in aldosterone levels after weight loss, suggest a substantive role for adipocytes in circulating aldosterone levels. A 2-sample Mendelian randomization analysis suggested that peri-renal adipose tissue, a form of visceral adipose tissue encompassing the adrenal glands, was causally linked to idiopathic hyperaldosteronism but not to other forms of hypertension. These observations support the speculation that at least a portion of idiopathic hyperaldosteronism cases represent adipocyte-driven hyperaldosteronism that might be effectively treated by weight loss. This review will provide the trans-disciplinary rationale for the hypothesis supporting a causal relationship between obesity and idiopathic hyperaldosteronism. This unproven hypothesis is eminently testable given the powerful pharmacological and surgical weight loss strategies currently available."},{"url":"https://hartvaat.nl/2026/04/22/angptl3-remmers-verlagen-breed-lipidenspectrum-vooral-remnant-en-triglyceriden/","doi":"10.1093/eurjpc/zwag230","title_en":"","journal":"European journal of preventive cardiology","source_date":"2026-04-22","abstract_original":"AIMS: Inhibition of angiopoietin-like protein 3 (ANGPTL3) has been proposed as a promising approach to reduce residual cardiovascular risk. We conducted a meta-analysis of randomized controlled trials (RCTs) to provide a comprehensive evaluation of the metabolic effects of ANGPTL3 inhibitors. METHODS: Databases (PubMed, EMBASE, Web of Science, CENTRAL, ClinicalTrials.gov) were searched from inception to July 2025. Eligible studies were RCTs comparing ANGPTL3 inhibitors against placebo. Outcomes included triglycerides (TG), LDL-C, apolipoprotein B (ApoB), non-high-density lipoprotein cholesterol (non-HDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), very-low-density lipoprotein cholesterol (VLDL-C), apolipoprotein A1 (ApoA1), apolipoprotein C3 (ApoC3), lipoprotein(a) (Lp(a)), remnant cholesterol (RC), ANGPTL3 and C-reactive protein (CRP). Pooled estimates of percentage change from baseline were obtained using fixed- and random-effects models. Subgroup analysis was performed based on the mechanism of action: monoclonal antibodies (mAbs, evinacumab), antisense oligonucleotides (ASOs, vupanorsen), and small interfering RNAs (siRNA, zodasiran and solbinsiran). RESULTS: Nine RCTs (1,254 participants) were included. ANGPTL3 inhibition significantly reduced TG (-47.1%), LDL-C (-21.6%), ApoB (-19.9%), non-HDL-C (-31.5%), TC (-32.8%), VLDL-C (-40.6%), and RC (-72.7%). Modest but consistent reductions were also observed in Lp(a) (-11.5%), ApoA1 (-18.3%), and ApoE (-16.4%). ANGPTL3 inhibitors markedly reduced circulating ANGPTL3 protein (-70.7%), with no significant effect on high-sensitivity CRP. Subgroup analyses demonstrated greater reductions in LDL-C, ApoB, non-HDL-C, and TC with evinacumab compared to the other groups, whereas small interfering RNAs produced more pronounced VLDL-C lowering compared with vupanorsen. CONCLUSIONS: ANGPTL3 inhibition offers broad lipid-lowering benefits, with particularly marked reductions in TG-rich lipoproteins."},{"url":"https://hartvaat.nl/2026/04/28/geen-sekseverschillen-in-werkzaamheid-van-hartfalenmedicatie-meta-analyse-van-13/","doi":"10.1093/eurheartj/ehag311","title_en":"","journal":"European heart journal","source_date":"2026-04-28","abstract_original":"BACKGROUND AND AIMS: Women remain underrepresented in heart failure (HF) trials, raising concerns about potential undetected sex-specific differences in treatment efficacy. This study assesses sex differences in the primary efficacy endpoint of HF treatments and examines whether the proportion of women enrolled in a trial influences (variations in) treatment effect estimates. METHODS: A systematic search was conducted up to 21 March 2025, including randomized controlled trials (RCTs) (≥100 patients) evaluating pharmacological HF treatments vs. placebo or usual care, with clinical events as the primary outcome. Sex differences in the primary outcome were assessed using a random-effects meta-analysis of the reported relative effect measures (REM) and pooled estimates. For key clinical outcomes, meta-regression analyses were performed to examine the association between the proportion of women enrolled and sex differences in REMs, as well as the overall REMs without separating sex. RESULTS: Of 5749 screened publications, 139 RCTs met inclusion criteria, with 292 027 patients (28.1% women). Based on 78 RCTs that reported sex-stratified treatment effects, pooled analysis showed no difference in treatment efficacy between women and men (delta ln[REM] 0.00; 95% confidence interval (CI) -0.04 to 0.03; P = .85; I2 = 4.1%). Meta-regression found no association between the proportion of women and sex differences in REM (78 RCTs, P = .25), overall efficacy (139 RCTs, P = .24), or other clinical outcomes. CONCLUSIONS: These findings suggest that pharmacological efficacy in HF does not differ by sex and that historical female underrepresentation in trials is unlikely to have masked important sex differences. Nonetheless, improving sex balance in HF trials remains essential for societal and ethical reasons."},{"url":"https://hartvaat.nl/2026/04/25/preoperatieve-pcsk9-remming-associeert-met-minder-postoperatieve-mace-dan-statin/","doi":"10.1016/j.atherosclerosis.2026.120760","title_en":"","journal":"Atherosclerosis","source_date":"2026-04-25","abstract_original":"BACKGROUND AND AIMS: Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors achieve substantial reductions in low-density lipoprotein cholesterol, yet their effectiveness and safety in the perioperative setting have not been fully delineated. The present study evaluated postoperative adverse events among patients treated with preoperative PCSK9 inhibitors versus statins. METHODS: We conducted a 1:1 propensity score-matched, active-comparator cohort study using the TriNetX research database, including adults with hyperlipidemia who underwent surgery at U.S. medical institutions between July 1, 2015, and June 30, 2025, and who received either PCSK9 inhibitors or statins within 90 days before surgery. The primary outcome was 30-day postoperative major adverse cardiovascular events (MACEs). Secondary outcomes included all-cause mortality, acute kidney injury (AKI), respiratory infections, and other complications. RESULTS: Among the 35,923 matched pairs, PCSK9 inhibitor use was associated with significantly lower risks of 30-day MACEs [6.4% vs. 9.6%; number needed to treat: 31; relative risk (RR): 0.67, 95% confidence interval (CI): 0.63-0.70], all-cause mortality (RR: 0.45: 95% CI: 0.35-0.58), AKI (RR: 0.45: 95% CI: 0.41-0.49), and respiratory infections (RR: 0.77: 95% CI: 0.71-0.83; all p < 0.0001). These associations remained consistent across postoperative time intervals and therapy duration strata. Furthermore, PCSK9 inhibitor use was associated with reduced risks of delirium (RR: 0.41: 95% CI: 0.28-0.60) and elevated liver enzymes (RR: 0.58: 95% CI: 0.48-0.70). CONCLUSIONS: Preoperative PCSK9 inhibitor therapy was associated with more favorable perioperative outcomes and a better safety profile compared with statins. Randomized controlled trials are warranted to confirm these results."},{"url":"https://hartvaat.nl/2026/04/27/routinematige-urine-natriummeting-drijft-agressievere-diurese-bij-acuut-hartfale/","doi":"10.1093/eschf/xvag119","title_en":"","journal":"ESC heart failure","source_date":"2026-04-27","abstract_original":"BACKGROUND AND AIMS: Natriuresis-guided diuresis has been investigated in prospective trials for acute heart failure (HF), but its impact on diuretic prescribing in clinical practice is uncertain. METHODS: From September 2021, routine urine sodium measurement was implemented for all patients admitted with acute HF to our intensive cardiac care unit. We compared diuretic prescribing in 160 prospective post-implementation patients (up to April 2023) with 206 historical controls (from January 2020). Multivariable logistic regression evaluated the odds of aggressive diuretic use, defined as the upper tertile of total furosemide dose administered within the first 72 hours (≥340 mg). Propensity score matching on prespecified covariates created a balanced cohort for sensitivity analysis. RESULTS: The median age was 71 (IQR 60-80), with 252 (69%) men. Post-implementation, patients received higher median total furosemide dose at 72 hours (340 [180-525] mg vs. 220 [120-320] mg; p < 0.001), and were more likely to receive aggressive diuresis (adjusted OR 4.8, 95% CI 2.86-8.25; p<0.001). Propensity score matching of 264 patients yielded consistent results (adjusted OR 5.2, 95% CI 3.004-9.46; p<0.001). At 72 hours, the post-implementation group had higher cumulative urine output (6,250 mL vs. 4,873 mL; p<0.001) and more frequent resolution of jugular venous distension (25% vs. 5%; p<0.001) and peripheral edema (14% vs. 5%; p=0.009), with no difference in pleural effusion (7% vs. 5%; p=0.550). CONCLUSIONS: Routine urine sodium measurement in acute HF patients in intensive care settings was associated with more aggressive diuretic use, increased diuresis, and more rapid improvement in congestion markers."},{"url":"https://hartvaat.nl/2026/04/01/doorgaan-met-dezelfde-doac-na-breakthrough-beroerte-even-goed-als-wisselen/","doi":"10.1001/jamanetworkopen.2026.9584","title_en":"","journal":"JAMA network open","source_date":"2026-04-01","abstract_original":"IMPORTANCE: Management after an ischemic stroke occurring despite direct oral anticoagulant (DOAC) therapy for atrial fibrillation (AF) varies widely. Switching anticoagulation is common in clinical practice, although evidence supporting this strategy is limited. OBJECTIVE: To evaluate whether continuation of treatment with the same DOAC was noninferior to switching oral anticoagulant therapy with respect to 90-day clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS: This multicenter registry-based cohort study with an emulated target trial design included consecutive adult patients with AF who experienced a breakthrough ischemic stroke while receiving uninterrupted DOAC therapy and resumed anticoagulation therapy thereafter. Patients were enrolled between February 2020 and February 2025, across 35 stroke centers in 9 countries in Europe and North Africa, with a standardized 90-day follow-up. The dataset was locked on September 1, 2025. A noninferiority comparison of switching vs continuation strategies was performed. Baseline confounding was addressed using inverse probability of treatment weighting (IPTW). The primary noninferiority margin was an absolute risk difference of 3.0 percentage points in 90-day net clinical benefit. EXPOSURE: The intervention group switched to treatment with a different DOAC or vitamin K antagonist; the comparator group continued therapy with the prestroke DOAC. MAIN OUTCOMES AND MEASURES: The primary outcome was 90-day net clinical benefit, defined as recurrent ischemic stroke and moderate to severe bleeding. Secondary outcomes included recurrent ischemic events, symptomatic intracerebral hemorrhage, moderate to severe extracranial bleeding, all-cause mortality, and vascular death. RESULTS: Among 1006 patients included in the analysis (median age, 80.4 [IQR, 73.4-85.4] years; 503 female [50.0%] and 503 [50.0%] male), 463 (46.0%) continued the same DOAC therapy and 543 (54.0%) switched therapy. After IPTW adjustment, the 90-day net clinical benefit was 4.9% with switching and 5.1% with continuation, corresponding to a risk difference of -0.3 percentage points (90% CI, -2.7 to 2.1 percentage points), meeting the prespecified noninferiority criterion. For recurrent ischemic events and bleeding outcomes, the absolute differences were within the predefined noninferiority margins. Noninferiority was not demonstrated for all-cause or vascular mortality. CONCLUSIONS AND RELEVANCE: In patients with breakthrough ischemic stroke during DOAC therapy, switching anticoagulation treatment was not associated with clinically meaningful short-term benefit compared with continuation. These findings suggest that switching does not provide additional benefit compared with continuing treatment with the same DOAC. Randomized clinical trials are needed to identify strategies to improve secondary prevention after a breakthrough ischemic stroke."},{"url":"https://hartvaat.nl/2026/04/22/cardiovasculair-polygeen-risico-voorspelt-witte-stof-hyperintensiteiten-in-uk-bi/","doi":"https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.26388","title_en":"","journal":"Hypertension","source_date":"2026-04-22","abstract_original":"BACKGROUNDS:White matter hyperintensities (WMH), a marker of cerebral small vessel disease, are associated with cardiovascular risk factors and disease. However, the extent to which these associations are driven by shared genetic architecture remains unclear.METHODS:Using data from 44 996 UK Biobank participants, we evaluated associations between WMH subtypes (total WMH, deep WMH, and periventricular WMH) and polygenic risk scores (PRSs) for 35 diseases and traits. Associations were tested using χ2and multivariable linear regression models. Cox models assessed whether WMH burden modified cardiovascular risk across genetic risk strata. Multiomics data were examined to identify biomarkers jointly associated with WMH and disease-specific PRSs.RESULTS:Higher WMH burden was associated with increased PRSs for cardiovascular disease (CVD), hypertension, ischemic stroke, and blood pressure, with the strongest associations observed for total WMH. WMH burden was prospectively associated with higher CVD incidence among individuals with high CVD PRS (hazard ratio, 2.54 [95% CI, 1.44–4.45]), but not among those with low PRS. For hypertension, WMH burden was associated with increased risk in both PRS strata, with stronger associations in individuals with high hypertension PRS, indicating additive contributions of genetic susceptibility and WMH burden. Lifestyle influences varied by genetic background: longer sleep duration and lower body mass index were protective only with low CVD PRS. Multiomics analyses identified 46 circulating biomarkers jointly associated with WMH and CVD PRSs, predominantly related to lipid metabolism.CONCLUSIONS:The association between WMH burden and cardiovascular-related disease risk is influenced by genetic background, supporting precision risk stratification and prevention in clinical practice."},{"url":"https://hartvaat.nl/2026/05/06/dronedaron-na-af-ablatie-gelijke-werkzaamheid-minder-bijwerkingen-dan-amiodaron/","doi":"10.1093/europace/euag095","title_en":"","journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","source_date":"2026-05-06","abstract_original":"AIMS: The high recurrence rate after catheter ablation for atrial fibrillation (AF) remains a challenge. Short-term antiarrhythmic drugs are commonly used during the 3-month blanking period, but the choice between amiodarone and dronedarone is unclear. OBJECTIVES: This trial directly compared the effectiveness and safety of dronedarone vs. amiodarone administered during the blanking period post-ablation in AF. METHODS AND RESULTS: In this open-label, randomized controlled trial, 280 patients undergoing AF ablation were assigned to receive 12 weeks of treatment with either dronedarone or amiodarone, which was discontinued upon completion of this treatment phase as per protocol. The primary endpoint was atrial tachyarrhythmia recurrence (>30 s) after the blanking period. A total of 280 participants were enrolled, of whom 273 were included in the modified intention-to-treat (mITT) analysis. In the mITT analysis, recurrence rates were not significantly different between the dronedarone and amiodarone groups (23.4% vs. 16.9%, P = 0.184). Secondary efficacy endpoints also showed no significant differences. However, the dronedarone group had a significantly lower incidence of side effects (40.9% vs. 64.0%, P < 0.001), primarily due to fewer cases of QTc-interval prolongation (5.8% vs. 15.4%, P = 0.01) and hypothyroidism (8.8% vs. 26.5%, P < 0.001). The intention-to-treat analysis, which included all enrolled participants, yielded results consistent with those of the mITT analysis. CONCLUSION: Therapy with dronedarone during the blanking period after AF ablation was associated with a similar recurrence rate but a superior safety profile compared to amiodarone."},{"url":"https://hartvaat.nl/2026/04/28/viborg-screeningsprogramma-verlaagt-5-jaarssterfte-bij-67-jarigen/","doi":"10.1093/eurheartj/ehag309","title_en":"","journal":"European heart journal","source_date":"2026-04-28","abstract_original":"BACKGROUND AND AIMS: Cardiovascular screening has been shown to reduce mortality in trials involving men. This study evaluated the effect of cardiovascular screening in both sexes, with all-cause mortality as the primary outcome. METHODS: The Viborg Screening Program, a prospective, population-based study in Denmark, in which the intervention consisted of inviting all 67-year olds to screening for carotid plaque, lower extremity artery disease, abdominal aortic aneurysm, hypertension, cardiac arrhythmia/ischaemia, and diabetes mellitus. This cohort included invitees from the first 5 years (2014-2019). Controls were 67-year olds without screening access. Effects were evaluated using propensity score matching (1:3 ratio, nearest-neighbour matching) and analysed using Cox proportional hazards models under the intention-to-invite principle. Sex-stratified analyses of all-cause mortality were conducted post hoc. RESULTS: Among 5505 invitees, three died before inclusion and 4602 participated (83.6%). Ninety individuals lacked registry information. After matching, 5412 invitees and 16 236 controls were included. During a median follow-up of 5.8 years, 372 (6.9%) invitees and 1444 (8.9%) controls died [hazard ratio (HR) 0.76, 95% confidence interval (CI) 0.68-0.85; P < .001]. The number needed to invite to save one life was 49. The HR for cardiovascular mortality was 0.76 (95% CI 0.56-1.03), for major adverse cardiovascular events 1.10 (95% CI 1.01-1.19), and for major adverse limb events 0.70 (95% CI 0.50-0.98). All-cause mortality HRs were 0.73 (95% CI 0.63-0.84) for men, 0.82 (95% CI 0.68-0.98) for women, 0.70 (95% CI 0.61-0.80) for those without prior cardiovascular disease (CVD), and 0.97 (95% CI 0.78-1.21) for those with prior CVD. CONCLUSIONS: Multi-modality non-invasive cardiovascular screening reduced 5-year all-cause mortality among 67-year olds, also when stratified by sex. Prioritizing individuals without known CVD may enhance population-level impact."},{"url":"https://hartvaat.nl/2026/04/27/mexicaanse-hypertensieprevalentie-daalt-over-twee-decennia-behandelingsgaten-bli/","doi":"https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.25807","title_en":"","journal":"Hypertension","source_date":"2026-04-27","abstract_original":"BACKGROUND:Systemic arterial hypertension is a public health concern, and timely diagnosis and management are critical to mitigate long-term effects. Here, we evaluated prevalence trends and determinants of hypertension phenotypes in the Mexican population over 2 decades.METHODS:We analyzed cross-sectional Mexican Health and Nutrition Surveys (2000–2024), including 146 904 adults aged ≥20 years. Hypertension was defined as self-reported diagnosis or blood pressure ≥140/90 mm Hg; undiagnosed hypertension (UDH) as blood pressure ≥140/90 mm Hg without prior diagnosis; and untreated hypertension as a prior diagnosis without treatment. UDH was classified as isolated systolic, isolated diastolic, or systolic-diastolic hypertension. We assessed trends with Poisson models and determinants of UDH and untreated hypertension with logistic models.RESULTS:We observed an overall decrease in hypertension prevalence from 33.1% in 2000 to 26.0% in 2024, concurrently with increases in diagnosed (12.3%–19.3%) and decreases in undiagnosed (20.7%–6.7%) hypertension. Isolated diastolic hypertension and systolic-diastolic hypertension declined over time, while isolated systolic hypertension increased, particularly among older adults. Among diagnosed cases, treatment percentage increased (69%–80%) and blood pressure control improved (40.5%–81.1%). Despite these trends, by 2024, ≈5 million Mexican adults still had UDH (25.9% of all hypertension cases), 2.9 million remained untreated, and 2.7 million were uncontrolled. Lack of diagnosis and treatment were more likely among men, individuals with unhealthy lifestyles, and those with social disadvantage.CONCLUSIONS:Results highlight evolving trends in hypertension diagnosis, treatment, and control in Mexico, with persistent challenges in UDH and untreated hypertension. Strengthening screening, treatment access, and equity is crucial to reduce hypertension-related cardiovascular risk."},{"url":"https://hartvaat.nl/2026/04/20/raas-blokkade-in-de-levenscyclus-van-de-nier-actuele-behandelstandaard/","doi":"10.1093/ndt/gfag090","title_en":"","journal":"Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association","source_date":"2026-04-20","abstract_original":"The renin-angiotensin-aldosterone system (RAAS) plays a central role in regulating renal hemodynamics, sodium and water balance, and cardiovascular homeostasis. Chronic RAAS activation contributes to hypertension, proteinuria, inflammation, fluid overload, and fibrosis, making RAAS blockade (RAASb) a cornerstone therapy across the kidney life cycle. Over the past decades, ACE inhibitors, angiotensin receptor blockers, direct renin inhibitors, and mineralocorticoid receptor antagonists have demonstrated substantial benefits in slowing chronic kidney disease (CKD) progression, reducing proteinuria, and lowering cardiovascular risk. However, the efficacy and safety of RAASb vary according to the kidney life cycle. Evidence supports its use in proteinuric CKD and even in advanced stages, whereas the benefit in non-proteinuric disease remains limited. Novel non-steroidal mineralocorticoid receptor antagonists such as finerenone further enhance renal and cardiovascular protection, particularly in persons with diabetes and CKD. In dialysis populations, RAASb may preserve residual kidney function improve cardiac structure/function, although the benefit of steroidal MRAs remains uncertain. In kidney transplantation, RAASb appears safe and may improve long-term graft and patient survival, particularly when initiated early. The emergence of SGLT2 inhibitors and GLP-1 receptor agonists has reshaped therapeutic strategies, with accumulating evidence supporting complementary rather than competing roles with RAASb. This review synthesizes current evidence on RAAS modulation across the kidney life cycle from primary prevention to advanced CKD, dialysis, and transplantation, highlighting both established benefits and areas of current clinical uncertainty."},{"url":"https://hartvaat.nl/2026/04/01/lp-a-verlaging-vergelijkbaar-tussen-alle-pcsk9-gerichte-middelen/","doi":"10.1016/j.jacl.2026.03.019","title_en":"","journal":"Journal of clinical lipidology","source_date":"2026-04-01","abstract_original":"BACKGROUND AND AIMS: Lipoprotein(a) [Lp(a)] is a causal contributor to atherosclerotic cardiovascular disease (ASCVD). While no therapies are currently approved solely for lowering Lp(a), subgroup analyses suggest that individuals with elevated Lp(a) may gain added benefit from intensive lipid-lowering strategies. No prior meta-analysis has compared evolocumab, alirocumab, inclisiran, lerodalcibep, and enlicitide in their Lp(a)-lowering efficacy. We aimed to determine whether PCSK9-targeted therapies differ significantly in Lp(a) reduction, or whether agent selection can be guided primarily by other factors such as dosing frequency, cost, and patient preference. SOURCES OF MATERIAL: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) reporting percent change in Lp(a) following treatment with the five PCSK9-targeted agents. A random-effects model calculated pooled estimates of percentage Lp(a) change, and mixed-effects meta-regression assessed differences between agents. ABSTRACT OF FINDINGS: Thirty-one RCTs were included. PCSK9 inhibitors and inclisiran reduced Lp(a) by a pooled mean of -25.76% versus control (95% CI -29.54 to -21.99; P < .0001). Meta-regression revealed no significant differences between agents (alirocumab vs evolocumab: +3.3%, 95% CI -1.40 to 8.07, P = .16; inclisiran vs evolocumab: +4.9%, 95% CI -2.31 to 12.16, P = .18; inclisiran vs alirocumab: +1.6%, 95% CI -5.38 to 8.55, P = .65). Lerodalcibep and enlicitide demonstrated similar approximate 25% reductions; however, insufficient trial numbers precluded a powered head-to-head comparison. CONCLUSIONS: No statistically significant differences in Lp(a) reduction were observed between currently available PCSK9-targeting medications. Agent selection may reasonably be based on non-efficacy factors, including administration frequency, cost, and patient preference."},{"url":"https://hartvaat.nl/2026/04/23/large-language-models-in-de-hypertensiezorg-kansen-en-grenzen/","doi":"https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.126.27004","title_en":"","journal":"Hypertension","source_date":"2026-04-23","abstract_original":"Large language models have emerged as potential tools to support hypertension care, including diagnosis, treatment decision-making, and patient education. However, evidence regarding their validity, performance, and clinical applicability remains limited. The objective is to map current applications of large language models in hypertension care, with emphasis on model optimization strategies, evaluation approaches, and reported limitations. We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews–compliant scoping review of primary studies published between 2023 and 2025 evaluating large language models in hypertension. Thirty-three studies were included. Data were charted on clinical use cases, model optimization techniques, evaluation metrics, data sets, and limitations. Applications were categorized into clinical decision support systems, patient education, medical education, research support, and administrative functions. GPT-based models predominated (82%). Model optimization was limited: 89% relied exclusively on prompt engineering. Most applications focused on patient education (52%) and clinical decision support systems (24%). In clinical decision support systems, reported accuracy ranged from 65% to 100%, reaching 87% to 91% for ambulatory blood pressure monitoring interpretation. Patient education applications showed accuracy between 80% and 90%, but frequent issues included excessive language complexity and occasional unsafe outputs. Across domains, evaluation methods were heterogeneous, reproducibility was inconsistently assessed, and safety concerns, including hallucinations and outdated knowledge, were commonly reported. Current evidence suggests that large language models may support selected tasks in hypertension care; however, their clinical reliability remains uncertain. The limited methodological rigor, minimal use of advanced optimization techniques, and narrow scope of evaluated applications preclude conclusions regarding routine clinical use. Further rigorously designed studies are required before broader implementation can be considered."},{"url":"https://hartvaat.nl/2026/05/05/hfa-consensus-gestructureerde-aanpak-van-recent-ontstane-cardiomyopathie/","doi":"10.1093/eschf/xvag115","title_en":"","journal":"ESC heart failure","source_date":"2026-05-05","abstract_original":"Recent-onset cardiomyopathy represents a clinically dynamic and potentially reversible clinical framework of non-ischaemic cardiomyopathy, characterized by high variability in left ventricular (LV) function and arrhythmic risk. This clinical consensus statement provides a structured diagnostic and therapeutic approach based on two prognostic axes: the potential for LV reverse remodelling (LVRR) and the risk of sudden cardiac death (SCD). We operationalize four trajectories in the LV evolution, ranging from recovered LV ejection fraction (LVEF) to persistently reduced LVEF. Multimodal stratification including echocardiography, cardiac magnetic resonance, genetic profiling, biomarkers, and early treatment response allows tailored decision-making on pharmacological and device-based therapies. We propose a unified management algorithm emphasizing early initiation of guideline-directed medical therapy, structured reassessment at 3 and 6 months, and individualized consideration of defibrillators, resynchronization therapy, arrhythmia ablation, transcatheter valve leaflet edge-to-edge repair, and advanced heart failure assessment. This document aims to support clinicians in risk stratification and timely management or referrals."},{"url":"https://hartvaat.nl/2026/04/20/stopstorm-stereotactische-bestraling-reduceert-refractaire-vt-met-80/","doi":"10.1093/eurheartj/ehag338","title_en":"","journal":"European heart journal","source_date":"2026-04-20","abstract_original":"BACKGROUND AND AIMS: Stereotactic arrhythmia radioablation (STAR) is increasingly used for refractory ventricular tachycardia (VT), yet prospective multicentre outcome data remain limited. Here, the planned interim analysis of the prospective Standardized Treatment and Outcome Platform for Stereotactic Therapy Of Re-entrant tachycardia by a Multidisciplinary (STOPSTORM) registry is reported. METHODS: STOPSTORM is a European prospective, international, multicentre registry of patients treated with STAR. The primary efficacy endpoint was the change in sustained VT episode burden comparing the 6 months before versus the 6 months after STAR. The primary safety endpoint was the occurrence of serious adverse events (SAEs) adjudicated as possibly or probably treatment-related. Overall survival was assessed using time-to-event methods. RESULTS: Across 28 centres, 193 patients were included (mean age 68±9 years; 88% male; 53% non-ischaemic cardiomyopathy). Median follow-up was 19 months. Among 107 evaluable patients with ≥6-month follow-up, the median VT episode burden was reduced by 80% after STAR. Among patients surviving ≥6 months, 72% were free from implantable cardioverter-defibrillator (ICD) shock. In the full cohort, 12 SAEs were adjudicated as possibly or probably treatment-related, including pericardial effusion, coronary events, and early post-treatment ventricular arrhythmia. Overall survival probability was 77% at 12 months. CONCLUSIONS: In the largest prospective multicentre cohort reported to date, STAR was associated with a substantial reduction in VT burden and ICD shocks, with a low frequency of possibly or probably treatment-related SAEs."},{"url":"https://hartvaat.nl/2026/05/01/jama-cardiology-missie-en-visie/","doi":"https://jamanetwork.com/journals/jamacardiology/fullarticle/2849186","title_en":"JAMA Cardiology","journal":"JAMA Cardiology","source_date":"2026-05-01","abstract_original":"Mission Statement: JAMA Cardiology is positioned at the nexus of clinical investigation, actionable clinical science, and clinical practice, with emphasis on traditional cardiovascular medicine, evolving cardiovascular science, and evidence-based health policy. Health equity, especially when supported by original science, is a leading editorial priority."},{"url":"https://hartvaat.nl/2026/04/01/verhoogd-lp-a-hangt-samen-met-mitralisring-calcificatie-maar-niet-met-mitralisin/","doi":"10.1016/j.jacl.2026.03.022","title_en":"","journal":"Journal of clinical lipidology","source_date":"2026-04-01","abstract_original":"BACKGROUND: Lipoprotein(a) [Lp(a)] is a genetically determined cardiovascular risk factor increasingly linked to calcific valvular disease. Although its role in aortic stenosis is well established, the association between Lp(a) and mitral valve pathology, particularly mitral annular calcification (MAC), mitral stenosis (MS), and mitral regurgitation (MR), remains uncertain. OBJECTIVE: To evaluate the association between elevated Lp(a) levels and mitral valve disease in a large, real-world cohort. METHODS: We conducted a retrospective observational analysis using the TriNetX research network, including over 130,000 adults with available Lp(a) measurements. Patients with Lp(a) >50 mg/dL were propensity score matched 1:1 to those with Lp(a) <50 mg/dL across 54 demographic, clinical, and treatment variables. Valvular outcomes were defined using administrative codes. Kaplan-Meier survival estimates and log-rank tests were calculated in the matched cohorts. The primary outcome was MAC, with MR, MS, and mitral valve prolapse (MVP) as secondary outcomes. AS served as a positive control. RESULTS: Each matched cohort included 66,292 patients. Elevated Lp(a) was significantly associated with the primary outcome of MAC (hazard ratio [HR] 1.330, 95% CI 1.172-1.509, P < .001). The positive control outcome of AS(Aortic stenosis) was also significant (HR 1.313, 95% CI 1.175-1.466, P < .001). No significant associations were observed for the secondary outcomes of MR (HR 1.006, 95% CI 0.940-1.077, P = .856), MS (HR 1.178, 95% CI 0.875-1.587, P = .280), or MVP (HR 1.035, 95% CI 0.863-1.241, P = .710). CONCLUSION: In this large multicenter propensity-matched cohort, elevated Lp(a) was independently associated with MAC but not with MS, MR, or mitral valve prolapse. These findings support a potential role of Lp(a) in mitral annular calcification and highlight the need for prospective studies to clarify causality and clinical implications."},{"url":"https://hartvaat.nl/2026/03/30/leadless-atriaal-pacen-geeft-minder-complicaties-dan-transveneus-1-jaars-medicar/","doi":"10.1093/europace/euag072","title_en":"","journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","source_date":"2026-03-30","abstract_original":"BACKGROUND AND AIMS: Leadless pacing was developed to avoid complications inherent to transvenous (TV) pacemakers. Among patients with sinus node dysfunction (SND) without atrioventricular block (AVB), TV systems remain standard therapy. Real-world data have shown favourable safety profiles for leadless vs. TV pacemakers. This study aimed to compare 30-day complications and 1-year outcomes-including complications, device-reinterventions, and all-cause mortality-between AVEIR AR leadless pacemakers (LP) and dual-chamber (DCTV) or right-atrial (RATV) TV pacemakers. METHODS: Medicare fee-for-service claims were analysed to identify patients undergoing de novo AVEIR AR LP or TV pacemaker implantation from January 2024 to March 2025, with ≥1 year of prior and ≥30 days of post-implant continuous enrolment. The DCTV cohort included patients with SND without permanent atrial fibrillation or AVB; the RATV and LP cohorts included all respective recipients. Outcomes included 30-day and 1-year complications, device-reinterventions, and mortality. Comparisons were adjusted using propensity score derived overlap weights. RESULTS: A total of 428 AVEIR AR, 39 881 DCTV, and 389 RATV patients were included. Thirty-day complications were lower with AVEIR AR compared with DCTV (adjusted 6.7% vs. 9.4%; OR = 0.7) and similar to RATV (6.9% vs. 6.7%). At 1 year, overall complications remained lower in AVEIR AR than DCTV (3.6% vs. 8.5%; HR = 0.4) and RATV (3.3% vs. 7.5%; HR = 0.4) cohorts. Device-related complications were reduced vs. DCTV, and reinterventions were reduced vs. both DCTV and RATV. Mortality was comparable across all groups. CONCLUSION: AVEIR AR was associated with fewer long-term complications and reinterventions compared with DCTV and RATV, while 1-year mortality remained similar."},{"url":"https://hartvaat.nl/2026/04/23/triple-pill-verlaagt-risico-op-terugkerende-beroerte-na-hersenbloeding/","doi":"10.1056/NEJMoa2515043","title_en":"","journal":"The New England journal of medicine","source_date":"2026-04-23","abstract_original":"BACKGROUND: Blood-pressure reduction is the only proven treatment to prevent stroke. Whether a single pill that combines three antihypertensive drugs at low doses, in addition to standard antihypertensive treatment, can lower blood pressure more than standard care alone and reduce the risk of recurrent stroke after intracerebral hemorrhage is uncertain. METHODS: We conducted a multinational, double-blind, randomized, placebo-controlled trial involving patients with a history of intracerebral hemorrhage. Patients were eligible for the trial if they had a systolic blood pressure of 130 to 160 mm Hg at baseline and were in clinically stable condition. After a 2-week active run-in phase during which all the patients received a once-daily pill containing three antihypertensive agents at low doses (telmisartan at 20 mg, amlodipine at 2.5 mg, and indapamide at 1.25 mg; the triple pill), the patients were randomly assigned to continue receiving the triple pill or to receive matching placebo. The primary outcome was the first recurrent stroke. Secondary outcomes included blood-pressure control, major cardiovascular events, death from cardiovascular causes, and safety. RESULTS: Of 1670 patients who underwent randomization, 833 were assigned to receive the triple pill and 837 to receive placebo. The mean age of the patients was 58 years. At a median follow-up of 2.5 years, recurrent stroke had occurred in 38 patients (4.6%) in the triple-pill group and 62 (7.4%) in the placebo group (hazard ratio, 0.61; 95% confidence interval [CI], 0.41 to 0.92; P = 0.02). The mean systolic blood pressure during follow-up was 127 mm Hg and 138 mm Hg, respectively. The incidence of major cardiovascular events was lower with the triple pill than with placebo (6.6% vs. 9.8%; P = 0.04). Serious adverse events occurred in 23.2% of the patients in the triple-pill group and 26.0% of those in the placebo group. Early discontinuation of the trial regimen due to an adverse event occurred in 13.6% and 6.0%, respectively. The most common adverse event leading to discontinuation was an increase of 20% or more in the serum creatinine level. CONCLUSIONS: Among patients with intracerebral hemorrhage, treatment with a combination of three low-dose antihypertensive agents in a single pill, in addition to standard care, was associated with a lower incidence of recurrent stroke and major cardiovascular events than placebo. (Funded by the National Health and Medical Research Council of Australia and the Brazilian Ministry of Health; TRIDENT ClinicalTrials.gov number, NCT02699645; Australian New Zealand Clinical Trials Registry number, ACTRN12616000327482.)."},{"url":"https://hartvaat.nl/2026/03/30/adapt-cec-adaptief-ai-algoritme-voor-cardiovasculaire-event-adjudicatie-in-klini/","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.126.080072","title_en":"","journal":"Circulation","source_date":"2026-03-30","abstract_original":"Background: Clinical endpoint classification (CEC) is the gold standard for cardiovascular endpoint measurement in clinical trials, but adds time and cost. We developed and validated an artificial intelligence (AI) algorithm (ADAPT-CEC) that adjudicates multiple cardiovascular endpoints and adapts to new definitions.Methods: ADAPT-CEC was derived on myocardial infarction (MI), stroke, and heart failure from the ODYSSEY OUTCOMES trial and externally validated on MI, stroke, bleeding and CV death from the EUCLID trial after adaptation with 20 EUCLID suspected events per endpoint. ADAPT-CEC was compared via F1 score with direct generative pretrained transformer (GPT) 4.0 adjudication and a hybrid approach where the 30% of suspected events with the lowest AI prediction certainty used human adjudication. The EUCLID primary endpoint of CV death, MI, or stroke was re-estimated for all three adjudication strategies.Results: Amongst 13,885 suspected EUCLID primary endpoint events, ADAPT CEC, hybrid, and GPT 4.0 strategies correctly classified 86.4%, 95.6%, and 76.3% of all endpoints and 99.4%, 99.6%, and 99.8% of all non-endpoints compared with human adjudication, respectively. Hybrid adjudication F1 metrics were the highest [CV death (0.94, 95% CI 0.92 – 0.96), MI (0.80, 95% CI 0.77 – 0.82), stroke (0.82; 95% CI 0.78 – 0.86), bleeding (0.83, 95% CI 0.82 – 0.85)]. ADAPT-CEC F1 metrics were lower for CV death, MI, and stroke but similar to GPT 4.0 while bleeding (0.78, 95% CI 0.77 – 0.79) was superior to GPT 4.0. The EUCLID primary treatment effect was similar by human adjudication (HR 1.02, 95% CI 0.93 – 1.13), hybrid (HR 1.04; 95% CI 0.94 – 1.15) ADAPT-CEC (HR 0.98, 95% CI 0.88 – 1.09) and GPT 4.0 (1.06, 95% CI 0.95 – 1.19) adjudication.Conclusions: After brief adaptation, a single trial derived AI algorithm can adjudicate similar (MI and stroke) and new endpoints (CV death and bleeding) in a second trial and replicate the EUCLID primary outcome treatment effect. A hybrid approach with humans adjudicating those suspected events with the lowest 30% of ADAPT-CEC prediction certainty was superior to ADAPT-CEC alone or GPT 4.0 alone and replicated the EUCLID primary outcome treatment effect. Prospective studies of adaptive AI adjudication are needed to determine future trial implementation."},{"url":"https://hartvaat.nl/2026/04/06/aha-scientific-statement-acute-decompensatie-bij-hartfalen-in-het-kind-integraal/","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIR.0000000000001428","title_en":"","journal":"Circulation","source_date":"2026-04-06","abstract_original":"Nationally, there has been a rise in the number of children and adolescents with congenital and acquired heart disease presenting with acute decompensated heart failure. Compared with adults, these children have increased morbidity and mortality and use significantly more health care resources once admitted. Currently, there is little guidance on how to assess, manage, and create successful discharge plans for children presenting with acute decompensated heart failure. Given that this population represents an intersection among emergency medicine, cardiology, surgery, critical care, and psychology, a guidance document for the comprehensive management of this high-risk population is needed. This scientific statement reflects the state of current evidence and highlights important knowledge gaps in this domain."},{"url":"https://hartvaat.nl/2026/03/16/the-lancet-commentaar-vroege-atheroma-preventie-als-kosteneffectieve-route-naar-/","doi":"https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00419-8/fulltext","title_en":"","journal":"The Lancet","source_date":"2026-03-16","abstract_original":"As the global population ages, older adults with atherosclerotic cardiovascular disease (ASCVD) are projected to drive a growing proportion of morbidity, mortality, and health-care spending in the coming years.1,2 Annual deaths from ASCVD are projected to rise substantially, from 20·5 million deaths in 2025 to 35·6 million in 2050.3,4 As an emerging generation of clinicians caring for an increasingly complex aging population, we see an opportunity to re-examine primary prevention with a focus on lifelong healthy cardiovascular aging."},{"url":"https://hartvaat.nl/2026/03/25/fontan-outcomes-network-eerste-bevindingen-uit-noord-amerikaans-register-van-1-1/","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.125.078152","title_en":"","journal":"Circulation","source_date":"2026-03-25","abstract_original":"BACKGROUND:Survival after Fontan palliation for single ventricle heart disease has improved substantially, yet the long-term trajectory remains poorly defined. The Fontan Outcomes Network, a learning health network of 38 congenital heart centers in the United States and Canada, was established to address this gap. We report baseline characteristics and early findings from the first 1121 participants enrolled in this prospective clinical registry.METHODS:We performed a cross-sectional analysis of individuals who had undergone Fontan palliation enrolled in the Fontan Outcomes Network from August 2022 through August 2024. Demographic, clinical, imaging, procedural, and medication data were analyzed descriptively, overall and by age group (<12, 12 to <18, and ≥18 years).RESULTS:A total of 1121 participants were enrolled (mean age, 16.3±10.2 years; 471 [42%] female). Hypoplastic left heart syndrome (n=431 [38.5%]) and right ventricular–dominant anatomy (n=615 [54.9%]) were the"},{"url":"https://hartvaat.nl/2026/03/25/lvad-ondersteuning-activeert-microvasculair-herstel-in-het-falende-hart-mechanis/","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.125.078996","title_en":"","journal":"Circulation","source_date":"2026-03-25","abstract_original":"BACKGROUND:Heart failure (HF) is a significant global health problem. Left ventricular assist device (LVAD) implantation serves as a bridge for patients awaiting heart transplantation. Intriguingly, LVAD support often improves cardiac histology and function, sometimes enough to avoid transplantation after LVAD removal. However, the cellular programs underlying this recovery remain unclear.METHODS:Myocardial tissues were obtained from patients with HF at the time of LVAD implantation (pre LVAD) and explantation (post LVAD) for histological analysis and single-nucleus RNA sequencing. A murine model of HF recovery, combined with lineage tracing studies, was employed to define cellular sources of vascular repair. Cardiac function, fibrosis, and vascular density were assessed using echocardiography, histology, and fluorescent microsphere perfusion. A patient-derived cardiac nonmyocyte culture system was established to interrogate mechanisms of cell fate regulation.RESULTS:Post-LVAD myocardial tissues exhibited reduced fibrosis and increased capillary density compared with pre-LVAD samples. Across samples, fibroblast abundance was inversely correlated with endothelial cell abundance, consistent with enhanced angiogenesis during recovery. Single-nucleus RNA sequencing identified a fibroblast subset predisposed to undergo mesenchymal-to-endothelial transition, acquiring an endothelial cell identity. Additionally, nonmyocytes from pre-LVAD hearts proliferated poorly and failed to form vascular structures, whereas nonmyocytes from post-LVAD hearts displayed greater proliferation and angiogenesis capacity, forming vessel-like structures, reinforcing the association of HF recovery with angiogenic reprogramming. Mechanistically, knockdown of c-Myc (cellular myelocytomatosis oncogene) by small interfering RNA shifted post-LVAD nonmyocytes to a pre-LVAD–like state, while c-Myc overexpression by mRNA in pre-LVAD cells induced a post-LVAD–like phenotype, implicating c-Myc as 1 contributor to this fate switch. A model of HF recovery in mice mimicked the histological and functional changes in patients, with physiological evidence of increased microvascular perfusion, associated with a fibroblast-to-endothelial transition, documented by lineage tracing.CONCLUSIONS:HF recovery involves reduced fibrosis and enhanced microvascularization, partly driven by fibroblast-to-endothelial cell fate transition. c-Myc functions as 1 regulator of this transition, offering a mechanistic entry point to develop regenerative therapies in HF."},{"url":"https://hartvaat.nl/2026/03/28/echofocus-chd-ai-model-detecteert-20-aangeboren-hartafwijkingen-op-standaard-ech/","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.126.079781","title_en":"","journal":"Circulation","source_date":"2026-03-28","abstract_original":"BACKGROUND:Delayed or missed diagnosis of congenital heart disease (CHD) contributes to excess pediatric mortality worldwide. Echocardiography (echo) is central to diagnosing and triaging CHD, yet expert interpretation remains a scarce and maldistributed global resource. Artificial intelligence offers the potential to democratize diagnostics and to extend expert-level interpretation beyond large academic centers, but its application in CHD remains underexplored.METHODS:We developed EchoFocus-CHD, an artificial intelligence–enabled model for automated detection of 12 critical and 8 noncritical CHD lesions, individually and as composites. The composite critical CHD outcome was the primary end point. The model expands on a multitask, view-agnostic architecture (PanEcho) with a transformer encoder to improve focus on relevant echo views. The model was internally trained (80%) and tested (20%) on the first echo per patient from Boston Children’s Hospital, with further evaluation on a referral cohort of echo studies performed at external US and international centers.RESULTS:The internal and referral cohorts included 3.4 million videos from 54 727 echos (median age at echo, 7.1 years [interquartile range, 0.2–15.0 years]; 5.8% critical CHD, 23.6% noncritical CHD) and 167 484 videos from 3356 echos (median age at echo, 2.5 years [interquartile range, 0.3–9.4 years]; 29.4% critical CHD, 45.6% noncritical CHD), respectively. EchoFocus-CHD showed excellent internal ability to detect the composite critical CHD outcome (area under the receiver-operating curve [AUROC], 0.94; positive likelihood ratio, 7.50; negative likelihood ratio, 0.14) and individual critical lesions (AUROC, 0.83–1.00), as well as composite noncritical CHD (AUROC, 0.90; positive likelihood ratio, 5.00; negative likelihood ratio, 0.23) and individual noncritical lesions (AUROC, 0.70–0.96). Performance declined during evaluation on the referral cohort to detect critical CHD (AUROC, 0.77), coinciding with greater expert disagreement on referral cases (κ=0.72 versus 0.82 for internal cases). Explainability analyses demonstrated that the model prioritized the same clinically relevant views (parasternal long axis, parasternal short axis, subxiphoid long axis, apical) across internal and referral cohorts, whereas uniform manifold approximation and projection analysis revealed a domain shift between cohorts. Retraining on all available US patients attenuated domain shift effects, improving international critical CHD detection (AUROC, 0.87) and calibration.CONCLUSIONS:EchoFocus-CHD shows promise for automated CHD detection to advance equitable global cardiovascular care and highlights the need to address domain shift and to establish external validation before real-world deployment."},{"url":"https://hartvaat.nl/2026/03/31/mr-proadm-voorspelt-mortaliteit-en-hf-events-bij-attr-cardiale-amyloidose/","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.125.077833","title_en":"","journal":"Circulation","source_date":"2026-03-31","abstract_original":"BACKGROUND:With the increasing diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CM) at earlier stages and new therapies, there is a rising demand for tools to stratify risk and prognosis. We evaluated the prognostic value of multiple circulating biomarkers for predicting outcomes in ATTR-CM.METHODS:We evaluated 12 different circulating biomarkers (N-terminal pro-B-type natriuretic peptide [NT-proBNP], high-sensitivity troponin I [hsTnI], mid-regional pro-adrenomedullin [MR-proADM], carbohydrate antigen 125 [CA125], soluble suppressor of tumorigenicity 2 [sST2], cluster of differentiation antigen 146 [CD146], growth/differentiation factor-15 [GDF-15], alpha-klotho, fibroblast growth factor 23 [FGF-23], galectin-3, insulin-like growth factor-binding protein 7 [IGFBP-7], and estimated glomerular filtration rate [eGFR]) in 337 ATTR-CM patients from Spain. Cox models were employed to determine their predictive abilities. Findings were validated in 2 independent external cohorts of 21"},{"url":"https://hartvaat.nl/2026/04/01/zwangerschap-als-stresstest-consensus-over-langetermijn-cardiovasculair-risico-b/","doi":"https://jamanetwork.com/journals/jamacardiology/fullarticle/2845161","title_en":"","journal":"JAMA Cardiology","source_date":"2026-04-01","abstract_original":"Pregnancy is well recognized as a critical period in a woman’s life course when physiologic changes intended to support the growing fetus can have adverse sequelae for long-term cardiovascular health. Adverse pregnancy outcomes are rising in prevalence, complicate nearly 1 in 5 pregnancies in the US, and include hypertensive disorders of pregnancy, gestational diabetes, preterm birth, and having a small-for-gestational-age infant. Ample observational data demonstrate that these adverse pregnancy outcomes are associated with increased maternal risk of cardiovascular disease (CVD) in the short and long term. As a result, pregnancy is commonly referred to as a stress test, which provides a window to future cardiovascular health for women. This knowledge has led to growing calls by national and international professional societies to recognize pregnancy and the postpartum period as opportunistic moments for CVD risk assessment and cardiovascular health counseling. This recognition of the i"},{"url":"https://hartvaat.nl/2026/03/26/aha-scientific-statement-niet-optimale-omgevingstemperatuur-als-cardiovasculaire/","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIR.0000000000001419","title_en":"","journal":"Circulation","source_date":"2026-03-26","abstract_original":"Ambient temperature is a key environmental driver of cardiovascular health. With rising global temperatures and increasing frequency, intensity, and duration of extreme temperature events, understanding the cardiovascular impacts of nonoptimal temperature is more urgent than ever. Short-term exposures to both heat and cold increase the risk of cardiovascular events, including myocardial infarction, stroke, heart failure decompensation, arrhythmias, and sudden cardiac death. Climate, built environment, socioeconomic variables, physiological vulnerability, and systemic inequities exacerbate these risks. There is also a growing appreciation of the importance of contextual factors such as geographic location, housing, occupation, and individual-level exposure. A range of biological mechanisms, including autonomic and neurohormonal activation, endothelial dysfunction, inflammation, hemoconcentration, and impaired thermoregulation, mediate temperature-related cardiovascular risk. Nonoptimal "},{"url":"https://hartvaat.nl/2026/03/18/systematische-review-welke-factoren-voorspellen-langetermijnrisico-op-beroerte-n/","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.125.078763","title_en":"","journal":"Circulation","source_date":"2026-03-18","abstract_original":"BACKGROUND:Patients with a transient ischemic attack (TIA) or minor stroke have an increased risk of subsequent stroke that persists for at least 10 years. We aimed to identify prognostic factors associated with long-term risk of stroke in this patient group and estimate their population attributable fraction (PAF).METHODS:A systematic review was performed of MEDLINE, Embase, and Web of Science for cohort studies including patients with TIA or minor stroke that evaluated factors for subsequent stroke over a follow-up period of ≥1 year. We pooled hazard ratios adjusted for relevant confounders using random-effect meta-analysis and determined the PAF of factors based on their pooled prevalence and adjusted hazard ratio. We assessed certainty of evidence using the grading of recommendations, assessment, development, and evaluation approach. The study is registered in PROSPERO (CRD42023476551).RESULTS:From 14 732 identified citations, we included 28 cohort studies comprising 86 810 patient"},{"url":"https://hartvaat.nl/2026/03/30/crt-zonder-atriale-lead-tweeledig-crt-dx-systeem-non-inferieur-aan-klassieke-dri/","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.126.079859","title_en":"","journal":"Circulation","source_date":"2026-03-30","abstract_original":"Background: The role of atrial pacing support is unclear in cardiac resynchronization therapy-defibrillator (CRT-D) patients without sinus node dysfunction.Methods: We conducted a randomized, parallel-group, non-inferiority trial to evaluate whether a two-lead CRT-DX system capable of atrial sensing (but no pacing) via a floating dipole on the right ventricular lead is not inferior to a three-lead CRT-D with conventional atrial lead. Between October 17, 2018, and March 5, 2024, 636 patients (68 ± 10 years old, 28.6% females) with standard CRT-D indication, optimized medical therapy, and resting sinus rate ≥45 beats/min were randomized 1:1 to CRT-DX (VDD 35 beats/min) or CRT-D (DDD 50 beats/min) at 23 Italian sites. A centralized block randomization procedure stratified by site was used, with patients and primary outcome assessors blinded to treatment assignment. The primary endpoint was a 1-year composite of all-cause mortality, cardiovascular hospitalization, and lead-related complications (loss of functionality not correctable by device reprogramming). Key secondary endpoints were each component, echocardiographic reverse remodeling, and 6-minute walk test distance at 12 months.Results: The primary endpoint occurred in 41 (13.1%) patients in the CRT-DX group and 47 (15.6%) patients in the CRT-D group, corresponding to a hazard ratio of 0.82 (95% CI, 0.54–1.25). This confirmed non-inferiority (pre-specified relative margin of 1.20) in both the per-protocol (p=0.039) and intention-to-treat (p=0.044) analyses. Individual components showed no significant differences, except for lead complications related to right atrial functionality (4 [1.3% ] patients in the CRT-DX group vs. 13 [4.2%] patients in the CRT-D group; p=0.040). Reverse remodeling responders were 203 (77.5% of 262) CRT-DX patients and 190 (76.3% of 249) CRT-D patients (p=0.83). Walking distance did not differ between two study arms (404 vs. 398 m; p=0.62). After median follow-up of 2.4 years, only one CRT-DX patient required implantation of a standard atrial lead.Conclusions: Two-lead CRT-DX system without atrial pacing is non-inferior to conventional three-lead CRT-D, with fewer atrial lead-related complications."},{"url":"https://hartvaat.nl/2026/03/29/cadence-sotatercept-verlaagt-pulmonale-vaatweerstand-bij-gecombineerde-pulmonale/","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.126.079918","title_en":"","journal":"Circulation","source_date":"2026-03-29","abstract_original":"Background: Combined post- and pre-capillary pulmonary hypertension in heart failure with preserved ejection fraction (CpcPH–HFpEF) involves remodeling in both the heart and pulmonary vasculature. Despite significant mortality, there are no proven therapies.Methods: In this multicenter, randomized, placebo-controlled, phase 2 trial, adults received sotatercept (0.3 or 0.7 mg/kg) or placebo every 3 weeks. The primary end point was change in pulmonary vascular resistance at week 24. Hodges–Lehmann shift estimates described placebo-adjusted changes.Results: 164 patients were randomized 54:55:55 to sotatercept 0.3 mg/kg, 0.7 mg/kg, and placebo, and baseline median pulmonary vascular resistance was 5.2 (interquartile range [IQR] 4.0–6.9) Wood units. The median change from baseline in pulmonary vascular resistance at week 24 was –0.67 Wood units in the sotatercept 0.3 mg/kg group, –0.33 Wood units in the sotatercept 0.7 mg/kg group, and 0.26 Wood units in the placebo group. The Hodges–Lehman"},{"url":"https://hartvaat.nl/2026/04/01/aric-ckm-syndroom-stadiering-voorspelt-hartfalen-risico-bij-ouderen-ook-met-subk/","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.125.077894","title_en":"","journal":"Circulation","source_date":"2026-04-01","abstract_original":"BACKGROUND:Suboptimal cardiovascular–kidney–metabolic (CKM) health is highly prevalent in the United States, especially among older adults, but whether the CKM syndrome staging framework is predictive of incident heart failure (HF) in this population remains uncertain.METHODS:Participants from the ARIC Study (Atherosclerosis Risk in Communities; visit 5, 2011–2013) who underwent echocardiography were categorized according to the American Heart Association CKM syndrome staging framework, which is based on excess or dysfunctional adiposity, metabolic risk factors, kidney disease, subclinical cardiovascular disease (CVD), and clinical CVD. We evaluated the association between CKM stage and prevalence and progression of cardiac remodeling and longitudinal risk of incident HF.RESULTS:Of the 5646 participants who had data available for CKM staging (age range, 66 to 90 years; 3271 women [57.9%]), 24 (0.4%) were stage 0 (optimal CKM health), 104 (1.8%) stage 1, 460 (8.1%) stage 2, 3197 (56.0%)"},{"url":"https://hartvaat.nl/2026/04/01/conduction-system-pacing-versus-biventriculaire-pacing-twee-trials-vergelijken-b/","doi":"https://jamanetwork.com/journals/jamacardiology/fullarticle/2845804","title_en":"","journal":"JAMA Cardiology","source_date":"2026-04-01","abstract_original":"Cardiac resynchronization therapy (CRT) with biventricular pacing (BiVP) remains a cornerstone treatment for patients with heart failure with reduced ejection fraction and left bundle-branch block (LBBB), supported by decades of randomized evidence demonstrating reductions in mortality and heart failure hospitalization. In parallel, conduction system pacing (CSP), most commonly delivered as left bundle-branch area pacing (LBBAP), has emerged as a physiologically appealing alternative, aiming to directly recruit the His-Purkinje system. Because early observational studies and small randomized trials reported superior electrical resynchronization and larger improvements in left ventricular ejection fraction (LVEF) with CSP than with BiVP, CSP is becoming increasingly popular for CRT in patients who have a strong indication for BiVP."},{"url":"https://hartvaat.nl/2026/03/31/aha-scientific-statement-2026-nieuwe-voedingsleidraad-voor-cardiovasculaire-gezo/","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIR.0000000000001435","title_en":"","journal":"Circulation","source_date":"2026-03-31","abstract_original":"Poor diet quality is strongly associated with elevated cardiovascular disease morbidity and mortality risk. This American Heart Association scientific statement for food-based cardiovascular health optimization and cardiovascular disease risk reduction guidance summarizes available evidence and provides contextual guidance for the key features of heart-healthy dietary patterns. It enumerates collateral benefits of adopting a heart-healthy dietary pattern in terms of nutrient intake adequacy and compatibility with other chronic disease risk reduction guidance. The features of a heart-healthy dietary pattern include (1) adjusting energy intake and expenditure to achieve and maintain a healthy body weight; (2) eating plenty of vegetables and fruits and choosing a wide variety; (3) choosing foods made mostly with whole grains rather than refined grains; (4) choosing healthy sources of protein; (5) choosing sources of unsaturated fats in place of sources of saturated fat; (6) choosing minim"},{"url":"https://hartvaat.nl/2026/03/28/minoca-oorzaken-bij-vrouwen-en-mannen-in-beeld-gebracht-met-oct-en-cmr/","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.126.080234","title_en":"","journal":"Circulation","source_date":"2026-03-28","abstract_original":"BACKGROUND:Myocardial infarction with nonobstructive coronary arteries (MINOCA) has several underlying causes, including mimicking conditions in some cases. Imaging is recommended to identify MINOCA etiologies, but it remains unclear which patients are most likely to have abnormal findings. We characterized MINOCA mechanisms, analyzed predictors of imaging abnormalities, and explored sex differences.METHODS:We enrolled patients with clinical diagnosis of myocardial infarction in an international, prospective, diagnostic study at 28 sites in the United States, Canada and United Kingdom. After a women-only phase, we included both sexes. Individuals with ≥50% diameter stenosis or coronary dissection on angiography, or alternate causes for the clinical presentation, were excluded. Participants had multivessel coronary optical coherence tomography (OCT) during index coronary angiography and cardiac magnetic resonance imaging (CMR) within 1 week. Independent core laboratories interpreted imaging, blinded to other results.RESULTS:Among 754 patients enrolled, 389 had MINOCA, and 336 with MINOCA underwent OCT (270 women and 66 men); CMR was completed in 284 (85%). An OCT-defined culprit lesion was identified in 45% (116 of 270 women [43%] and 35 of 66 men [53%],P=0.18). CMR demonstrated an ischemic pattern in 114 of 284 (40%), similar by sex (96 of 225 women [43%] versus 18 of 59 men [31%],P=0.12). A nonischemic pattern was observed in 23% (23% of women, 25% of men,P=0.78). We identified a cause of the clinical presentation in 79% of patients with both tests completed; 59% had an ischemic cause of MINOCA, and 20% had a non-ischemic mimicking condition. OCT alone found a MINOCA etiology in 151 of 336 (45%) and CMR alone in 180 of 284 (63%). Predictors of an OCT culprit lesion included age, abnormal angiogram, and number of vessels imaged, but 27% of normal angiograms harbored a culprit lesion. Predictors of abnormal CMR were peak troponin, shorter time to CMR, and non-Asian race, but CMR was abnormal in 40% when troponin was <4-fold above the upper reference limit.CONCLUSIONS:The combination of multivessel coronary OCT and CMR in patients with a clinical diagnosis of MINOCA confirmed myocardial infarction in 59% and identified an alternate cause (MINOCA mimic) in 20%. Clinical factors had limited usefulness to predict imaging abnormalities. No sex differences in imaging results were detected.REGISTRATION:URL:https://www.clinicaltrials.gov; Unique identifier: NCT02905357."},{"url":"https://hartvaat.nl/2026/04/01/franse-multicentertrial-lage-dosis-rivaroxaban-verlaagt-linkerventrikeltrombus-n/","doi":"https://jamanetwork.com/journals/jamacardiology/fullarticle/2845590","title_en":"","journal":"JAMA Cardiology","source_date":"2026-04-01","abstract_original":"This multicenter randomized clinical trial conducted in France determines whether the addition of low-dose rivaroxaban to dual antiplatelet therapy reduces the incidence of left ventricular thrombus at 1 month in patients with anterior ST-segment elevation myocardial infarction."},{"url":"https://hartvaat.nl/2026/03/30/essence-timi-73b-apoc3-remmer-olezarsen-reduceert-niet-verkalkte-coronairplaque-/","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.126.080012","title_en":"","journal":"Circulation","source_date":"2026-03-30","abstract_original":"Background: Whether lowering triglyceride-rich lipoproteins and remnant cholesterol favorably modifies coronary atherosclerosis is unclear. Olezarsen, an antisense oligonucleotide that targets apolipoprotein C-III, reduces triglycerides by ~60% and remnant cholesterol by ~70%, has a neutral effect on LDL cholesterol (LDL-C), and reduces apolipoprotein B (apoB) by ~15% in moderate hypertriglyceridemia. We investigated the effect of olezarsen on coronary plaque in adults with largely moderate hypertriglyceridemia.Methods: We conducted a coronary computed tomography angiography (CCTA) study within Essence-TIMI 73b, a randomized, placebo-controlled trial of olezarsen vs. placebo that enrolled patients between November 2022 and February 2024. Inclusion criteria were triglycerides ≥150 mg/dL (2.26 mmol/L), presence or high risk for cardiovascular disease, and non-calcified plaque on baseline CCTA. The primary endpoint was percent change from baseline to 12 months in non-calcified plaque volu"},{"url":"https://hartvaat.nl/2026/03/19/memantine-remt-premature-atriumcontracties-in-fase-2-trial-nieuw-aangrijpingspun/","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.125.079023","title_en":"","journal":"Circulation","source_date":"2026-03-19","abstract_original":"BACKGROUND:Premature atrial contractions (PACs) are independently associated with atrial fibrillation, stroke, and heart failure, yet no pharmacological therapy is approved for PAC suppression. Experimental studies have identified a functional cardiac glutamatergic system in which N-methyl-D-aspartate receptors regulate atrial electrophysiology. Preclinical studies show that pharmacological antagonism of N-methyl-D-aspartate receptors with memantine suppresses atrial arrhythmias.METHODS:We conducted an investigator-initiated, phase 2, multicenter, randomized, double-blind, placebo-controlled trial. Symptomatic adults with frequent PACs (≥1000/24 h) were randomly assigned to receive memantine or placebo for 6 weeks. The primary end point was the percentage change in mean 24-hour PAC count from baseline to the end of treatment. The primary analysis was performed in the intention-to-treat population. Prespecified secondary end points included the responder rate (≥50% PAC reduction), perce"},{"url":"https://hartvaat.nl/2026/03/30/heparin-stemi-prehospitale-heparine-vergroot-vroege-doorstroming-bij-stemi-zonde/","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.126.079839","title_en":"","journal":"Circulation","source_date":"2026-03-30","abstract_original":"Background: Primary PCI is the preferred reperfusion strategy in patients with ST-elevation myocardial infarction (STEMI). We investigated benefits and safety of pretreatment with unfractioned heparin (UFH) in STEMI referred to primary PCI.Methods: Our single-center, open-label, randomized controlled trial assigned STEMI with ≤6 hours of symptom duration either to 70-100 IE/kg bolus of UFH at first prehospital medical contact (FMC) plus supplemental dose before PCI adjusted to activated clothing time ≥250 seconds or to control group undergoing standard UFH at the time of PCI. Primary efficacy endpoint was TIMI 2-3 flow in infarct related artery (IRA) at initial coronary angiography. Primary safety endpoint was BARC 3-5 bleeding during the index hospital stay.Results: From March 2022 to February 2025, 298 patients were randomized to UFH pretreatment and 295 to the control group. Both groups were comparable in age, gender, risk factors, previous cardiovascular events and median delay fro"},{"url":"https://hartvaat.nl/2026/03/13/2026-acc-aha-richtlijn-dyslipidemie-lagere-doelen-meer-rol-voor-non-hdl-lp-a-en-/","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIR.0000000000001423","title_en":"","journal":"Circulation","source_date":"2026-03-13","abstract_original":"Circulation, Volume 153, Issue 17, Page e1154-e1276, April 28, 2026. AIMThe “2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia” retires and replaces the “2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol.”METHODSA comprehensive literature search was conducted from October 2024 to December 2024 to identify clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline.STRUCTUREThe focus of this clinical practice guideline is to address the evaluation, management, and monitoring of individuals with dyslipidemias, including high blood cholesterol, hypertriglyceridemia, and elevated lipoprotein(a)."},{"url":"https://hartvaat.nl/2026/03/25/ehj-review-wearables-in-de-cardiovasculaire-praktijk-hoe-ver-zijn-we/","doi":"10.1093/eurheartj/ehag189","title_en":"","journal":"European heart journal","source_date":"2026-03-25","abstract_original":"Wearable devices are transforming cardiovascular medicine by enabling continuous monitoring of physiologic and behavioural measures outside of traditional clinical settings. Smartwatches and activity trackers, the most widely used wearables, employ motion and biometric sensors to measure physical activity, sleep quality, heart rate, and rhythm. By converting health goals into objective, quantifiable measures, wearable devices empower patients to assume a more active role in their health while providing clinicians with novel opportunities for longitudinal, real-world assessment. Clinical applications span the cardiovascular continuum from lifestyle interventions targeting physical activity and sleep to the remote management of chronic conditions such as heart failure. Widespread clinical adoption of wearables remains limited by challenges, such as variability in device methodology, data outputs, validation, and intended use; incompatibility with existing electronic health records; and the lack of standardized, evidence-based workflows for clinicians to efficiently interpret and act upon wearable data. This review summarizes the current landscape of wearable technologies in cardiovascular medicine by highlighting key clinical applications, evidence gaps in the existing literature, the role of artificial intelligence, and barriers to implementation. We discuss strategies to enhance clinical integration and strengthen the current evidence base while also providing practical guidance to help clinicians navigate commonly encountered clinical scenarios."},{"url":"https://hartvaat.nl/2026/03/23/clorotic-subanalyse-acute-egfr-daling-door-thiaziden-bij-acuut-hf-is-geen-progno/","doi":"10.1093/ndt/gfag070","title_en":"","journal":"Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association","source_date":"2026-03-23","abstract_original":"BACKGROUND AND HYPOTHESIS: The association between acute declines in estimated glomerular filtration rate (eGFR) among individuals admitted for acute decompensated heart failure (ADHF) and cardiovascular outcomes has been inconsistent. Our objective was to examine whether eGFR decline, and the timing of these declines, are associated with mortality and a composite outcome of mortality or heart failure (HF) hospitalization. METHODS: We used data from the CLOROTIC Trial, which randomized patients admitted for ADHF to thiazide versus placebo. We examined %eGFR change at 2-days (n = 225) and at 4-days (n = 218) after randomization. Multivariable Cox models were used to evaluate the association between % eGFR change and a primary outcome of mortality and secondary outcome of composite of mortality or HF hospitalization. RESULTS: Median %eGFR change was -9.7% (IQR -22.1, 5.4) and -14.4% (-25.1, 7.8) in the thiazide arm at 2-days and 4-days respectively, compared to -0.3% (-7.5, 10.1) and 0% (-10.0, 16.2) in the placebo arm at 2-days and 4-days, respectively. Over a median 3-month follow-up, of those with 2-day eGFR change available, 41 (18%) patients died and 98 (44%) met the composite outcome, and of those with 4-day eGFR change available, 38 (17.4%) died and 95 (43.6%) met the composite outcome. The eGFR decline at 2-days was not associated with risk of mortality (HR = 0.96 [95% CI 0.47, 1.97] and HR = 0.89 [0.37, 2.10] per 30% eGFR decline in the thiazide and placebo arms, respectively). The eGFR decline at 4-days was not associated with risk of mortality in the thiazide arm (HR = 0.86 [0.48, 1.55] per 30% eGFR decline) nor in the placebo (HR = 1.63 [0.82, 3.26] per 30% eGFR decline). Associations were similar for the composite outcome. CONCLUSIONS: Among patients admitted for ADHF and randomized to thiazide vs placebo, early acute declines in eGFR had no association with increased risk of cardiovascular outcomes. REGISTRATION: Clinicaltrials.gov: NCT01647932; EudraCT Number: 2013-001852-36."},{"url":"https://hartvaat.nl/2026/03/24/myocardiale-brug-praktische-gids-voor-diagnose-en-behandeling-in-het-ccta-tijdpe/","doi":"10.1093/eurheartj/ehaf1038","title_en":"","journal":"European heart journal","source_date":"2026-03-24","abstract_original":"Myocardial bridging is the most common congenital coronary anomaly, characterized by an intramyocardial course of a segment of an epicardial coronary artery, with considerable variability in its depth and length. In most cases, MB is a benign anatomical variant without clinical significance, often asymptomatic and not requiring treatment. However, with the increasing use of coronary computed tomography angiography for coronary assessment, myocardial bridging is now more frequently identified during non-invasive imaging. It can also be diagnosed via invasive coronary angiography, where it appears as a dynamic systolic compression of the tunnelled artery segment, and further anatomical characterization can be enhanced by intravascular ultrasound or optical coherence tomography. Growing recognition of myocardial bridging's role in ischaemia with non-obstructive coronary arteries has heightened clinical interest in its prevalence, diagnostic strategies, and management approaches. As such, this narrative review provides clinicians with an updated, evidence-based guide to the diagnosis and therapeutic management of myocardial bridging, while also addressing ongoing controversies and areas of uncertainty."},{"url":"https://hartvaat.nl/2026/03/03/tien-jaar-real-world-sacubitril-valsartan-mortaliteitsreductie-bevestigd-maar-sl/","doi":"10.1093/eschf/xvag095","title_en":"","journal":"ESC heart failure","source_date":"2026-03-03","abstract_original":"INTRODUCTION: Sacubitril/valsartan (Sac/Val) represents a cornerstone of heart failure (HF) with reduced ejection fraction (HFrEF) management. This systematic review provides a comprehensive overview of real-world evidence (RWE) regarding the implementation, clinical effectiveness, and safety of Sac/Val in patients with HFrEF. METHODS: A systematic literature search of PubMed was conducted through March 2024 following PRISMA guidelines. RESULTS: The review included 45 manuscripts from 30 different studies, primarily from Europe (44%) and the US (30%). RWE confirmed that Sac/Val was associated with a lower risk of cardiovascular mortality (10%-16%), HF hospitalization (10%-38%), and all-cause mortality (10%-25%). Sac/Val was significantly associated with cardiac reverse remodeling and lower-grade mitral regurgitation. Despite these benefits, implementation gaps persist, with only 15%-25% of patients achieving target doses in clinical practice. The most common reported adverse event with Sac/Val was hypotension (up to 17.6%), though severe hyperkalaemia and renal decline were similar when compared with traditional renin angiotensin system inhibitors. CONCLUSION: Real-world data mirror the efficacy and safety profiles seen in randomized controlled trials, establishing Sac/Val as a cornerstone of HFrEF therapy. However, significant barriers remain, including delayed initiation and suboptimal dose titration. Enhancing clinician and patient awareness is needed to bridge these implementation gaps and fully realize the drug's potential to reduce the global healthcare burden of HF."},{"url":"https://hartvaat.nl/2026/03/25/mendeliaanse-randomisatie-lp-a-verhoogt-coronarialijden-onafhankelijk-van-ldl-c-/","doi":"10.1016/j.jacadv.2026.102697","title_en":"","journal":"JACC. Advances","source_date":"2026-03-25","abstract_original":"BACKGROUND: Mendelian randomization studies suggest a causal effect of lipoprotein(a) (Lp(a)) on atherosclerotic cardiovascular disease. Noncardiovascular effects (eg, diabetes risk) are inadequately investigated. OBJECTIVES: In this noninterventional phenome-wide association study designed to better understand the potential causal role of Lp(a), direct causal phenotypic effects of exposure to Lp(a) were estimated. Also, the association between LPA null allele rs41272114 with type 2 diabetes was assessed, and ancestry-specific Lp(a) thresholds were determined. METHODS: In the UK Biobank (n = 425,677 adults, 55% female), we studied 1,456 phenotypes spanning 18 classes using 4 ancestry-specific polygenic risk scores and false discovery rate multiple testing correction. Network deconvolution Mendelian randomization was leveraged to separate direct from indirect (ie, associations via mediating variables) causal phenotypic effects and account for confounding, reverse causation, and bidirectionality. RESULTS: Lp(a) was significantly associated with 80 phenotypes across 7 classes. Higher Lp(a) exposure had significant direct causal effects, independent of low-density lipoprotein cholesterol, on coronary artery disease (OR: 1.36; 95% CI: 1.21-1.54) and glycated hemoglobin (HbA1c; β = 0.099; 95% CI: 0.051-0.15) only. Very low Lp(a) exposure was not associated with type 2 diabetes (OR: 0.92; 95% CI: 0.64-1.31) or HbA1c (β = -0.016; 95% CI: -0.062 to 0.030). Among European and African ancestries, 86 (77th percentile) and 93 (59th percentile) nmol/L optimally discriminated myocardial infarction risk, respectively. CONCLUSIONS: Increasing Lp(a) exposure had direct, independent causal effects on coronary artery disease and HbA1c only; very low Lp(a) exposure is suggested to not be causally associated with type 2 diabetes. The optimal European and African ancestry threshold to stratify cardiovascular risk is comparable, and below 125/105 nmol/L in current U.S./European medical professional society guidelines."},{"url":"https://hartvaat.nl/2026/03/17/athena-register-pulsed-field-ablatie-voor-atriumfibrilleren-ook-effectief-bij-ha/","doi":"10.1093/europace/euag049","title_en":"","journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","source_date":"2026-03-17","abstract_original":"BACKGROUND: Data on pulsed-field ablation (PFA) for atrial fibrillation (AF) in patients with heart failure (HF) are limited. OBJECTIVE: To evaluate clinical outcomes of PFA in patients with AF and HF, stratified by HF subtype. METHODS: Consecutive patients undergoing first-time pentaspline PFA within the ATHENA registry were analyzed. Patients were stratified into three groups: no HF, HF with preserved ejection fraction (HFpEF, LVEF ≥50%), and HF with mildly reduced or reduced EF (HFmrEF/rEF, LVEF <50%). The primary endpoint was freedom from documented atrial arrhythmias >30 seconds after a 2-month blanking period. AAD use was left to physician discretion. RESULTS: Among 1,224 patients included (68.5% with paroxysmal AF and 31.5% with persistent AF), 176 (14.4%) had HF: 40 (3.3%) with HFpEF and 136 (11.1%) with HFmrEF/rEF. The Kaplan-Meier estimated freedom from any atrial arrhythmias at 1-year follow-up was 79.9%, with higher rate in the no-HF group (81.0%) vs the HF group (73.3%, HR=1.5, 95%CI: 1.1-2.1, p=0.0133). Considering separately paroxysmal and persistent AF form, paroxysmal AF patients with no sign of HF showed significantly higher freedom from atrial arrhythmias (82.2%) than patients with HF (68.6%, 2.0, 1.3-3.1, p=0.0028), while no differences were found in patients with persistent AF (77.9% vs 76.4%, 1.1, 0.7-1.7, p=0.7065). CONCLUSION: PFA with the pentaspline catheter appears to be an effective treatment for AF in patients with HF. Freedom from AF and atrial arrhythmias post-PFA was highest in patients with paroxysmal AF and no history of HF, with no significant differences observed in persistent AF patients."},{"url":"https://hartvaat.nl/2026/03/28/gestandaardiseerd-stappenplan-voor-tricuspidalisinsufficientie-van-verwijzing-to/","doi":"10.1093/eurheartj/ehag214","title_en":"","journal":"European heart journal","source_date":"2026-03-28","abstract_original":"Tricuspid regurgitation (TR) is a common yet historically neglected condition associated with poor outcomes. Traditionally managed conservatively, TR has recently gained renewed attention, thanks to advances in surgical and transcatheter interventions. Selecting the optimal therapy, however, requires an integrated and systematic approach considering TR aetiology, stage of the disease, comorbidities, operative risk, and anatomical feasibility. This review describes a standardized stepwise work-up for patients with TR from the referral centre to the expert heart valve centre (HVC). It provides practical algorithms and structured protocols covering clinical and biological assessment, multimodality imaging (echocardiography, computed tomography, cardiac magnetic resonance), and invasive haemodynamic evaluation. The document highlights the importance of multidisciplinary collaboration, involving imagers, heart failure specialists, interventional cardiologists, electrophysiologists, and surgeons, in line with the new recommendations of the 2025 ESC/EACTS Guidelines for the Management of Valvular Heart Disease. By harmonizing diagnostic standards and promoting a structured approach to patient assessment within HVCs, this review aims to facilitate timely referral and ensure consistent evaluation and management of patients with this complex and often underestimated condition."},{"url":"https://hartvaat.nl/2026/03/20/hokuriku-plus-genetische-diagnose-bij-familiaire-hypercholesterolemie-verlaagt-m/","doi":"10.1253/circj.CJ-25-1189","title_en":"","journal":"Circulation journal : official journal of the Japanese Circulation Society","source_date":"2026-03-20","abstract_original":"BACKGROUND: We aimed to clarify the impact of genetic testing on major adverse cardiovascular events (MACE) among patients with heterozygous familial hypercholesterolemia (HeFH) using data from the Hokuriku-plus FH Registry (UMIN000038210). METHODS AND RESULTS: In all, 431 patients were enrolled in the study, with a median follow-up of 3.9 years. The primary outcome was time to first MACE, defined as cardiovascular death, non-fatal myocardial infarction, coronary revascularization, or non-fatal stroke. Using Cox proportional hazards regression models, we examined whether undergoing genetic testing was associated with a reduced risk of MACE. Among the 431 patients, sufficient data were available for 386 with HeFH, of whom 202 (52.3%) underwent genetic testing. Low-density lipoprotein cholesterol (LDL-C) levels at follow-up were significantly lower in group that underwent genetic testing than in the group that did not (median 102 vs. 130 mg/dL, respectively; P<0.001). During follow-up, 23 MACE occurred (18 in the non-testing group and 5 in the genetic testing group). Notably, undergoing genetic testing was significantly associated with a reduced risk of MACE, even after adjusting for LDL-C levels (hazard ratio 0.66; 95% confidence interval 0.20-0.92; P=0.033). CONCLUSIONS: Genetic testing in patients with HeFH was associated with a reduced risk of MACE independent of LDL-C. Randomized controlled trials will be needed to clarify whether providing genetic testing can reduce MACE among patients with HeFH."},{"url":"https://hartvaat.nl/2026/03/30/linear-trial-lattice-tip-katheter-verslaat-standaard-irrigatie-bij-cti-ablatie-v/","doi":"10.1093/europace/euag046","title_en":"","journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","source_date":"2026-03-30","abstract_original":"AIMS: Cavotricuspid isthmus (CTI) ablation is a cornerstone therapy for typical atrial flutter (AFl) and is commonly performed during atrial fibrillation (AF) ablation. In this multicentre randomized trial, we compared a lattice-tip catheter with an irrigated focal-tip catheter for radiofrequency CTI ablation (LINEAR study-ClinicalTrials.gov NCT07078760). METHODS AND RESULTS: Patients were randomized to a lattice-tip, dual-energy catheter (lattice-tip group) or to a standard 3.5-mm irrigated radiofrequency catheter (standard group) in two centres. In the lattice-tip group, only radiofrequency was utilized. The primary endpoint was the achievement and persistence of bidirectional CTI block after a 60-minute waiting period, confirmed by high-density electroanatomical mapping and adenosine testing. Secondary endpoints included the rate of first-pass block, the number of lesions, and the ablation time. Procedural complications were recorded. In total, 102 patients were randomized. The primary endpoint was achieved in significantly more patients in the lattice-tip as compared to the standard group (94.1% vs. 68.6%, P = 0.002). The lattice-tip catheter resulted in a significantly higher rate of first-pass block (90.2% vs. 60.8%, P = 0.001). CTI block required significantly shorter ablation time (41.3 ± 12.1 vs. 245.3 ± 91.3 s, P < 0.001) and a significantly lower number of lesions (8.3 ± 2.4 vs. 13.4 ± 4.5, P < 0.001) in the lattice-tip as compared to the standard group. No procedural complications were documented. CONCLUSION: The lattice tip catheter resulted in higher acute procedural success for radiofrequency CTI ablation compared to the standard irrigated focal-tip catheter. Future studies are needed to assess long-term efficacy and clinical outcomes."},{"url":"https://hartvaat.nl/2026/03/26/fine-heart-vrouwen-met-cardiovasculair-renaal-metabool-syndroom-worden-systemati/","doi":"10.1093/eurheartj/ehag162","title_en":"","journal":"European heart journal","source_date":"2026-03-26","abstract_original":"BACKGROUND AND AIMS: While the prevalence, drivers, and impact of cardiometabolic risk factors are known to differ between women and men, less is known about sex differences in the cardiovascular-kidney-metabolic (CKM) syndrome. METHODS: In this prespecified analysis, individual participant-level data were pooled from two trials of chronic kidney disease and type 2 diabetes (FIDELIO-DKD and FIGARO-DKD) and a trial of heart failure (HF) with mildly reduced or preserved ejection fraction (FINEARTS-HF). The risk of first HF hospitalization, cardiovascular death, major adverse cardiovascular events, kidney composite outcome, and all-cause death, was compared between men and women using adjusted Cox regression models. Treatment effect heterogeneity in response to finerenone was evaluated using interaction analyses. RESULTS: Of the 18 991 participants in FINE-HEART, 6664 (35%) were women. Compared with men, women were slightly older (69 vs 67 years) and had a lower median urine albumin-to-creatinine ratio (183 vs 337 mg/g). Women were more likely to have Stage 4 CKM syndrome but less likely to receive medical therapies commonly indicated for the management of CKM conditions at baseline, such as aspirin, statins, renin-angiotensin system inhibitors, sodium-glucose co-transporter 2 inhibitors, and glucagon-like peptide-1 receptor agonists. During a median follow-up of 2.9 years, both women and men had similarly high rates of HF hospitalization or cardiovascular death (4.8 vs 3.9 per 100 patient-years, adjusted hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.89-1.06, P = .52) but lower risk of all-cause mortality (adjusted HR 0.83, 95% CI 0.76-0.91, P < .001) compared with men. There was no evidence of treatment heterogeneity by sex with finerenone in reducing cardiovascular, kidney, and mortality outcomes (all Pinteraction >.05). CONCLUSIONS: In this pooled analysis of individuals with advanced CKM syndrome, women had a higher burden of multimorbidity and were less likely to receive commonly indicated CKM therapies than men. Finerenone conferred consistent benefits in women and men, reinforcing its use while underscoring persistent sex-based treatment disparities in CKM care. REGISTRATION: PROSPERO identifier: CRD42024570467."},{"url":"https://hartvaat.nl/2026/03/28/lp-a-verhoogt-risico-op-veneuze-trombo-embolie-bij-premenopauzale-vrouwen-en-hor/","doi":"10.1093/eurheartj/ehag252","title_en":"","journal":"European heart journal","source_date":"2026-03-28","abstract_original":"BACKGROUND AND AIMS: Elevated lipoprotein(a) [Lp(a)] levels are an established risk factor for atherosclerotic cardiovascular disease, but the association between Lp(a) and venous thromboembolism (VTE) remains unclear. Sex and hormonal status may modify the relationship between Lp(a) and VTE. METHODS: The present study included participants from the UK Biobank with available baseline Lp(a) data. Individuals with a history of VTE or cancer, as well as those using anticoagulants, were excluded. Multivariable-adjusted Cox models were used to assess the association between Lp(a) levels ≥ 125 nmol/L and incident VTE in premenopausal women, postmenopausal women, and men. Subgroup analyses stratified premenopausal women by oral contraceptive (OCP) use and postmenopausal women by menopausal hormone therapy (MHT) use. RESULTS: Among 55 302 premenopausal women, 129 045 postmenopausal women, and 189 013 men, the proportions with Lp(a) ≥ 125 nmol/L were 14.0%, 19.0%, and 15.0%, respectively. Over a median (interquartile range) follow-up of 13.6 (12.9-14.4) years, 8186 VTE events occurred (cumulative incidence 2.2%). Lp(a) ≥ 125 nmol/L was associated with incident VTE in premenopausal women [adjusted hazard ratio (aHR) 1.32; 95% confidence interval (CI) 1.04-1.66; P = 0.02] but not in postmenopausal women (aHR 1.03; 95% CI 0.94-1.13; P = 0.47; Pinteraction = 0.03) or men (aHR 1.00; 95% CI 0.92-1.08; P = 0.94). OCP use did not modify the Lp(a)-VTE association among premenopausal women (Pinteraction = 0.61). However, among postmenopausal MHT users, Lp(a) ≥ 125 nmol/L was associated with higher VTE risk (aHR 1.48; 95% CI 1.03-2.12; P = 0.03; Pinteraction = 0.04). CONCLUSIONS: Elevated Lp(a) was associated with VTE in premenopausal women and in postmenopausal MHT users, suggesting that hormonal context may influence Lp(a)- associated thrombotic risk."},{"url":"https://hartvaat.nl/2026/03/25/meta-analyse-glp-1-agonisten-voorkomen-hartfalen-in-type-2-diabetes-sterkste-eff/","doi":"10.1093/eschf/xvag091","title_en":"","journal":"ESC heart failure","source_date":"2026-03-25","abstract_original":"BACKGROUND AND AIMS: Heart failure (HF) is a common sequela of diabetes and obesity. Glucagon-like peptide-1 (GLP-1) receptor agonists may prevent HF events. This meta-analysis estimates absolute risk reduction (ARR) and number needed to treat (NNT) for GLP-1 receptor agonists to prevent one HF event in patients with type 2 diabetes and/or obesity, including in those without baseline HF. METHODS: The Medline, Embase, and Cochrane Central databases were searched to 04 April 2025 for placebo-controlled randomised controlled trials (RCTs) of GLP-1 receptor agonists in a type 2 diabetes and/or obesity indication with a prespecified heart failure event endpoint. Random effects meta-analysis using the Mantel-Haenszel Method was performed to synthesise risk ratios (RR), ARRs, and NNTs with 95% confidence intervals (CI). RESULTS: Twelve placebo-controlled RCTs involving 95 023 patients were included. GLP-1 receptor agonists reduced HF events by 12% (RR 0.88, 95% CI 0.82-0.95; ARR 0.42%, 95% CI 0.17%-0.62%; NNT 238, 95% CI 161-588), and, in those without baseline HF, by 19% (RR 0.81, 95% CI 0.72-0.90; ARR 0.60%, 95% CI 0.32%-0.89%; NNT 167, 95% CI 113-313). Semaglutide reduced the risk of HF events by 16% (RR 0.84, 95% CI 0.74-0.95; ARR 0.62%, 95% CI 0.19%-1.00%; NNT 161, 95% CI 100-526), and by 31% in those without baseline HF (RR 0.69, 95% CI 0.55-0.88; ARR 1.25%, 95% CI 0.48%-1.82%; NNT 80, 95% CI 55-208). CONCLUSIONS: GLP-1 receptor agonists have limited absolute benefit for preventing HF events in patients with type 2 diabetes and/or obesity, including in those without baseline HF. SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD420251074882."},{"url":"https://hartvaat.nl/2026/03/29/confidence-analyse-acute-egfr-daling-bij-empagliflozin-finerenone-is-reversibel-/","doi":"10.1681/ASN.0000001071","title_en":"","journal":"Journal of the American Society of Nephrology : JASN","source_date":"2026-03-29","abstract_original":"KEY POINTS: We investigated the effect of empagliflozin, finerenone, and their combination on eGFR decline in people with type 2 diabetes and albuminuria. Acute declines in eGFR occurred more in those on combination therapy, on diuretics, and with higher eGFR; eGFR changes were reversible. Finerenone's additive effect to empagliflozin on urinary albumin-to-creatinine ratio lowering is nonhemodynamic; empagliflozin lowers urinary albumin-to-creatinine ratio in part driven by eGFR change. BACKGROUND: eGFR decline is common with sodium-glucose cotransporter 2 inhibitors and renin-angiotensin system inhibitors, often prompting treatment interruption or cessation, limiting cardiorenal benefits. This mostly prespecified COmbinatioN effect of FInerenone anD EmpaglifloziN in participants with chronic kidney disease and type 2 diabetes using a UACR Endpoint (CONFIDENCE) trial analysis investigated the effect of empagliflozin, finerenone, and their combination on change from baseline in eGFR and its determinants and the relationship of change in eGFR with albuminuria reduction in people with type 2 diabetes and CKD. METHODS: Evaluable participants (N=790) with type 2 diabetes, CKD, and albuminuria, receiving stable doses of renin-angiotensin system inhibitors, were randomized 1:1:1 to empagliflozin, finerenone, or both. The primary outcome was urinary albumin-to-creatinine ratio (UACR) change from baseline to day 180. We assessed mean eGFR change from baseline at day 14 (acute), determinants of acute eGFR decline, and acute eGFR change from baseline as a mediator of UACR reduction at day 180. RESULTS: The mean acute eGFR decline was greater with combination therapy (-6.6 ml/min per 1.73 m2) than with finerenone (-2.1 ml/min per 1.73 m2) or empagliflozin (-4.8 ml/min per 1.73 m2) monotherapy; P < 0.001. Acute decline in eGFR was significantly more pronounced among participants with higher baseline eGFR and in those receiving diuretics at baseline (P < 0.001 for both factors). Baseline values for systolic BP and UACR had no statistically significant effect on acute eGFR decline. Exploratory analysis showed that acute eGFR change mediated 28% of the effect of adding empagliflozin to finerenone on UACR reduction at day 180 but only 5.2% of the effect when adding finerenone to empagliflozin. AKI was uncommon in all treatment groups. CONCLUSIONS: Acute eGFR decline was significantly associated with combination therapy, higher baseline eGFR, and diuretic use at baseline. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER: ClinicalTrials.gov, NCT05254002."},{"url":"https://hartvaat.nl/2026/03/29/uk-biobank-hogere-intensiteit-van-beweging-belangrijker-dan-totale-tijd-voor-car/","doi":"10.1093/eurheartj/ehag168","title_en":"","journal":"European heart journal","source_date":"2026-03-29","abstract_original":"BACKGROUND AND AIMS: While vigorous physical activity (VPA) is known to provide greater health benefits per unit time than moderate activity, the spectrum of these benefits across different chronic diseases and the relative importance of physical activity (PA) intensity vs volume remain unclear. This study examined associations between the proportion of VPA (%VPA) relative to total volume of PA and the incidence of multiple chronic disease outcomes. METHODS: This prospective population-based cohort study included 96,408 participants (mean age 61.9 years, women: 56.3%) with device-measured data (wrist-worn accelerometers) and 375,730 participants (mean age 56.2 years, women: 52.2%) with self-reported PA data (IPAQ) from the UK Biobank. Main outcomes included incidence of eight chronic diseases: major adverse cardiovascular events (MACE), atrial fibrillation (AFib), type 2 diabetes (T2D), immune-mediated inflammatory diseases, metabolic dysfunction-associated steatotic liver disease (MASLD), chronic respiratory diseases (CRD), chronic kidney disease (CKD), and dementia, as well as all-cause mortality. Cox proportional hazards models were used to estimate adjusted hazard ratios and 95% confidence interval. RESULTS: In the device-measured data, non-linear inverse dose-response relationships were observed between %VPA and all outcomes (all P < .001), and these patterns remained consistent across strata of total PA volume. In multivariable models adjusted for total PA volume, participants with >4% VPA had 29%-61% lower risks of these outcomes compared with those with 0% VPA. Joint analyses and population attributable fraction revealed distinct disease-specific patterns: immune-mediated inflammatory diseases showed very strong intensity-dependence with minimal contribution from PA volume (20.3% for intensity vs 1.0% for volume), while MACE (17.8% vs 6.0%), AFib (16.2% vs 5.0%), CRD (21.4% vs 5.6%), and dementia (32.3% vs 8.1%) demonstrated intensity predominance with modest contribution from PA volume, and T2D (26.6% vs 17.7%), MASLD (22.1% vs 16.6%), CKD (23.0% vs 15.3%), and all-cause mortality (31.4% vs 14.2%) showed more balanced contributions from both intensity and volume. CONCLUSIONS: A higher %VPA, independent of total activity volume, is inversely associated with eight major chronic diseases and all-cause mortality. Intensity consistently demonstrated a higher preventive potential than total PA volume. These findings support, whenever possible, prioritizing higher-intensity activities in clinical and public health interventions aimed at preventing non-communicable diseases."},{"url":"https://hartvaat.nl/2026/03/28/vesalius-cv-subgroep-jama-evolocumab-beschermt-ook-diabeten-zonder-vastgestelde-/","doi":"10.1001/jama.2026.3277","title_en":"","journal":"JAMA","source_date":"2026-03-28","abstract_original":"IMPORTANCE: Intensive lowering of low-density lipoprotein cholesterol (LDL-C) levels with PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors for cardiovascular event reduction has largely been reserved for patients with significant atherosclerosis. OBJECTIVE: To investigate whether evolocumab could prevent a first major cardiovascular event (MACE) in patients without known significant atherosclerosis. DESIGN, SETTING, AND PARTICIPANTS: VESALIUS-CV was a randomized, double-blind, placebo-controlled trial of evolocumab conducted across 774 sites in 33 countries and enrolling 12 257 patients with no prior myocardial infarction or stroke, LDL-C level 90 mg/dL or greater, and qualifying atherosclerosis or high-risk diabetes. This prespecified subgroup analysis examined outcomes in patients without known significant atherosclerosis (none of the following: prior arterial revascularization, arterial stenosis ≥50%, or coronary artery calcium score ≥100 Agatston units), all of whom had diabetes. Enrollment started in June 2019 and the last patient visit was July 2025, with a median follow-up of 4.8 years. INTERVENTION: Patients were randomized in a 1:1 ratio to subcutaneous administration of either evolocumab (140 mg every 2 weeks) or matching placebo added to optimally tolerated statin therapy. MAIN OUTCOMES AND MEASURES: The dual primary end points were composites of coronary heart disease death, myocardial infarction, or ischemic stroke (3-P MACE) and 3-P MACE plus ischemia-driven arterial revascularization (4-P MACE). Secondary end points included all-cause mortality. RESULTS: This predefined subgroup included 3655 patients (1849 in the evolocumab group and 1806 in the placebo group) with a median age of 65 years (57% female). Among those in the lipid substudy, the median LDL-C level at 48 weeks was 52 mg/dL in the evolocumab group vs 111 mg/dL in the placebo group (P < .001). A 3-P MACE event occurred in 83 patients (5-year Kaplan-Meier estimate, 5.0%) in the evolocumab group compared with 117 patients (5-year Kaplan-Meier estimate, 7.1%) in the placebo group (hazard ratio [HR], 0.69 [95% CI, 0.52-0.91]; P = .009; between-group difference, 2.1% [95% CI, 0.4%-3.8%]). A 4-P MACE event occurred in 127 patients (5-year Kaplan-Meier estimate, 7.6%) in the evolocumab group compared with 178 patients (5-year Kaplan-Meier estimate, 10.5%) in the placebo group (HR, 0.69 [95% CI, 0.55-0.86]; P = .001; between-group difference, 2.9% [95% CI, 0.9%-4.9%]). There were 136 deaths (5-year Kaplan-Meier estimate, 7.8%) in the evolocumab group compared with 172 deaths (5-year Kaplan-Meier estimate, 10.1%) in the placebo group (HR, 0.76 [95% CI, 0.61-0.95]). CONCLUSIONS AND RELEVANCE: In high-risk patients without known significant atherosclerosis and with diabetes, evolocumab reduced the risk of a first major cardiovascular event. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03872401."},{"url":"https://hartvaat.nl/2026/03/03/prasugrel-vs-clopidogrel-invloed-van-patientkenmerken-op-trombocytenremming-bij-/","doi":"10.5551/jat.66056","title_en":"","journal":"Journal of atherosclerosis and thrombosis","source_date":"2026-03-03","abstract_original":"AIM: To explore whether the antiplatelet effects of prasugrel and clopidogrel vary according to patient background factors in the ACUTE-PRAS study. METHODS: This was a post hoc, hypothesis-generating, exploratory analysis of the multicenter, open-label, randomized controlled ACUTE-PRAS study, in which 176 patients with acute atherothrombotic stroke or high-risk TIA received prasugrel or clopidogrel within 48 h of symptom onset. High platelet reactivity (HPR; platelet reaction units [PRU] ＞208) and absolute PRU were assessed on Day 5 in subgroups stratified by ABCD-GENE score, age, body mass index (BMI), chronic kidney disease (CKD), diabetes mellitus (DM), hypertension, dyslipidemia, time from stroke onset to treatment, National Institutes of Health Stroke Scale (NIHSS) score, and prior ischemic stroke. RESULTS: Patients with prasugrel had numerically lower rates of HPR than those with clopidogrel in the high-risk stratum of ABCD-GENE score ≥ 10 (OR 2.73, p = 0.076), and favorable trends in prasugrel were also observed for CKD (8.06, p = 0.012), age ＞75 years (5.02, p = 0.025), BMI ＜25 kg/m² (4.61, p = 0.012), dyslipidemia (4.73, p = 0.009), DM (3.86, p = 0.038), treatment initiation ≤ 24 h (3.31, p = 0.010), and NIHSS ≤ 3 (2.77, p = 0.036) or ≥ 4 (9.00, p = 0.025). Prasugrel also reduced PRU numerically more than clopidogrel across most subgroups, except in patients with BMI ≥ 25 kg/m2, treatment initiation ＞24 hours, or prior ischemic stroke, where only numerical differences were observed. CONCLUSIONS: Prasugrel provided favorable early platelet inhibition, particularly in subgroups characterized by advanced age, CKD, low BMI, metabolic comorbidities, or very early treatment start."},{"url":"https://hartvaat.nl/2026/03/05/trem-1-remming-vermindert-in-stent-neoatherosclerose-in-diermodel/","doi":"https://www.atherosclerosis-journal.com/article/S0021-9150(26)00067-5/fulltext","title_en":"","journal":"Atherosclerosis","source_date":"2026-03-05","abstract_original":"In-stent neoatherosclerosis (ISNA) contributes significantly to late stent thrombosis and in-stent restenosis. Triggering receptor expressed on myeloid cells-1 (TREM-1) is a key amplifier of inflammation; however, its role in ISNA pathogenesis remains unexplored. In this study, we investigated the effects of pharmacologically inhibiting TREM-1 with a novel clinical agent LR12 (nangibotide) on ISNA development in an experimental model."},{"url":"https://hartvaat.nl/2026/02/27/smoothened-signalering-bevordert-nierfibrose-via-autofagieremming/","doi":"https://www.kidney-international.org/article/S0085-2538(26)00140-7/fulltext","title_en":"","journal":"Kidney International","source_date":"2026-02-27","abstract_original":"Kidney fibrosis progressively induces kidney function loss, leading to kidney failure. Myofibroblast transition from fibroblast is significantly involved in the development of kidney fibrosis. Previous studies revealed that sonic hedgehog (Shh), the upstream ligand of Smoothened (Smo) receptor signaling, contributes to kidney fibrosis. However, the role of Smo in fibroblast activation remains unclear."},{"url":"https://hartvaat.nl/2026/02/27/pdgf-b-uit-tubulusepitheel-drijft-nierfibrose-aan/","doi":"https://www.kidney-international.org/article/S0085-2538(26)00141-9/fulltext","title_en":"","journal":"Kidney International","source_date":"2026-02-27","abstract_original":"Kidney fibrosis is the underlying pathological process of chronic kidney disease, a major global medical challenge. In most diseases, fibrosis-initiating injury affects epithelial cells. However, the fibrosis-executing cells are interstitial mesenchymal cells, particularly fibroblasts, expressing the platelet-derived growth factor (PDGF) receptor β (PDGFR-β). Here, we analyzed the cell-specific functional relevance of the PDGFR-β ligand, PDGF-B, in the cellular crosstalk in kidney fibrosis."},{"url":"https://hartvaat.nl/2026/03/04/ivus-segmentatiemethoden-vergeleken-in-de-pacman-ami-trial/","doi":"10.1253/circj.CJ-25-0590","title_en":"","journal":"Circulation journal : official journal of the Japanese Circulation Society","source_date":"2026-03-04","abstract_original":"BACKGROUND: This study compared changes in percentage atheroma volume (PAV) using an end-diastolic (ED) intravascular ultrasound (IVUS) segmentation approach vs. the conventional 1-mm interval analysis in serial IVUS data from the PACMAN-AMI trial. METHODS AND RESULTS: IVUS data from the PACMAN-AMI study were analyzed by 2 core laboratories: one with 1-mm segmentation and the other with an ED-based approach. The same arterial segments were assessed at baseline and at the 52-week follow-up in patients receiving alirocumab or placebo. Changes in segment length, lumen, vessel, total atheroma volume (TAV), and PAV between baseline and follow-up were compared between methods. Biomarkers associated with atherosclerotic progression were measured and correlated with TAV and PAV changes. In all, 387 segments were analyzed. Agreement between conventional and ED volumetric analysis was excellent (intraclass coefficient >0.891, P<0.001). TAV and PAV were larger in both groups in the ED analysis than with the conventional approach; however, changes between treatment arms were similar for the conventional and ED analyses (TAV: 14.34 vs. 14.64 mm3, respectively [P=0.823]; PAV: 1.29% vs. 1.25%, respectively [P=0.911]). Biomarker correlations with TAV and PAV changes did not differ between approaches. CONCLUSIONS: ED- and 1-mm-based analyses demonstrated comparable treatment effects of alirocumab on plaque regression in PACMAN-AMI. These findings support the use of the less time-consuming 1-mm segmentation method in serial IVUS studies."},{"url":"https://hartvaat.nl/2025/01/01/kwaliteit-van-hartfalenzorg-bij-aziatische-patienten-in-de-vs/","doi":"https://www.sciencedirect.com/science/article/pii/S0735109725101526?dgcid=rss_sd_all","title_en":"","journal":"JACC","source_date":"2025-01-01","abstract_original":"Publication date: 3 March 2026Source: JACC, Volume 87, Issue 8"},{"url":"https://hartvaat.nl/2025/01/01/voedingskwaliteit-en-plantaardige-voeding-centraal-voor-cardiovasculaire-gezondh/","doi":"https://www.sciencedirect.com/science/article/pii/S0735109726003013?dgcid=rss_sd_all","title_en":"","journal":"JACC","source_date":"2025-01-01","abstract_original":"Publication date: 26 May 2026Source: JACC, Volume 87, Issue 20"},{"url":"https://hartvaat.nl/2026/03/03/cardiovasculaire-mortaliteit-bij-chronische-nierziekte-en-dialyse-een-tweestappe/","doi":"10.5551/jat.RV22048","title_en":"","journal":"Journal of atherosclerosis and thrombosis","source_date":"2026-03-03","abstract_original":"Patients with chronic kidney disease (CKD) face a markedly elevated risk of death from cardiovascular disease (CVD); in particular, those requiring hemodialysis have a 10- to 30-fold higher risk than the general population. This extremely increased risk of CVD death reflects the coexistence of multiple traditional and nontraditional risk factors. The present narrative review considers two distinct steps: first, the occurrence of a CVD event, and second, death resulting from an inability to recover from the CVD event. Patients undergoing hemodialysis are at an increased risk for both of these steps, accounting for the dramatically higher risk of CVD death in this population. High risk for the second step-death following a CVD event-may be driven by conditions called decreased physical resilience and increased frailty. Studies of patients on hemodialysis show that predictors for death at this stage include key components of malnutrition-inflammation-atherosclerosis syndrome-also called the malnutrition-inflammation-complex-syndrome or protein-energy wasting-such as lower body mass index, lower serum albumin, and higher C-reactive protein. Other important contributors include higher age, longer dialysis duration, diabetic kidney disease, phosphate, calcium, serum calcification propensity (T50), and insulin-like growth factor 1 levels. Notably, some of these factors also predict death following infection, suggesting that the risk predictors for the second step are shared between CVD and infection. Recognizing these steps may facilitate prevention and greater preparedness for CVD, infection, and other stressful events among patients with CKD."},{"url":"https://hartvaat.nl/2026/03/06/sociaaleconomische-status-en-cardiovasculaire-ziekte-wereldwijde-meta-analyse/","doi":"https://www.atherosclerosis-journal.com/article/S0021-9150(26)00063-8/fulltext","title_en":"","journal":"Atherosclerosis","source_date":"2026-03-06","abstract_original":"While socioeconomic status (SES) is recognized as a significant determinant of cardiovascular disease (CVD), the strength and direction of this association vary across studies and with stages of societal development. This meta-analysis of global data aimed to evaluate the relationship between SES domains and CVD outcome while examining the influence of measures on country-level for social development."},{"url":"https://hartvaat.nl/2026/03/03/evolocumab-naast-empagliflozine-verandert-ldl-subdeeltjes-bij-type-2-diabetes/","doi":"https://www.atherosclerosis-journal.com/article/S0021-9150(26)00052-3/fulltext","title_en":"","journal":"Atherosclerosis","source_date":"2026-03-03","abstract_original":"Sodium–glucose cotransporter-2 inhibitors (SGLT2i) and proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) reduce cardiovascular risk in type 2 diabetes. Whether these benefits are partly mediated by modifications in low-density lipoprotein (LDL) phenotype, beyond changes in LDL-cholesterol levels, remains unknown."},{"url":"https://hartvaat.nl/2026/03/05/ai-echocardiografie-door-niet-specialisten-kosteneffectiviteitsanalyse-uit-singa/","doi":"10.1093/eschf/xvag069","title_en":"","journal":"ESC heart failure","source_date":"2026-03-05","abstract_original":"BACKGROUND: Accurate assessment of left ventricular ejection fraction (LVEF) is crucial for heart failure (HF) diagnosis but requires skilled sonographers. Artificial intelligence-enabled point-of-care (AI-POC) devices may enable novices to assess LVEF, potentially reducing healthcare costs. We conducted a cost-minimization analysis comparing conventional sonographer-performed echocardiography versus novice-operated AI-POC devices. METHODS: Using a decision tree model, we compared the costs of diagnosing LVEF <50% in patients with suspected heart failure across two pathways: novice-operated AI-POC devices versus standard transthoracic echocardiogram (TTE) performed by sonographers. The model incorporated LVEF<50% prevalence, diagnostic accuracy metrics, and comprehensive cost data for both approaches. We conducted a probabilistic sensitivity analysis to test the robustness of our findings under varying assumptions. RESULTS: The AI-POC pathway demonstrated substantial cost savings, averaging S$1,185 [US$1,422] per patient compared to S$1,403 [US$1,684] for conventional TTE. In a single tertiary referral centre in Singapore, implementing AI-POC devices for LVEF assessment in 100 patients resulted in savings of S$21,669 [US$26,013]. Probabilistic sensitivity analysis suggested a 99.9% probability that the AI-POC approach would be cost-saving compared to standard TTE. CONCLUSION: This study provides economic evidence that task-shifting echocardiographic assessment of LVEF to novices using AI-POC devices is likely cost-saving compared to standard TTE. This task-shifting strategy offers a cost-saving alternative to conventional sonographer-led TTE."},{"url":"https://hartvaat.nl/2026/03/03/darmmicrobioom-bevordert-atriumfibrilleren-bij-chronische-nierziekte-via-nlrp3-i/","doi":"10.1093/europace/euag037","title_en":"","journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","source_date":"2026-03-03","abstract_original":"BACKGROUND: Chronic kidney disease (CKD) significantly increases the risk of atrial fibrillation (AF). Although alterations in the gut microbiota have been linked to CKD progression, its exact involvement in CKD-associated AF remians unclear. We amis to investigate the role of gut microbiota in the development of CKD-associated AF, and to uncover potential mechanisms that could serve as effective targets for prevention and treatment. METHODS AND RESULTS: A rat model of CKD was induced by an adenine-enriched diet. 16S rRNA sequencing and fecal microbiota transplantation (FMT) were utilized to study the involvement of gut microbiota. AST-120, gut barrier protectants and mono-colonization experiments were performed to investigate potential mechanism. CKD rats exhibited gut microbiota dysbiosis and a significantly increased susceptibility to AF. FMT from CKD rats transferred this heightened AF susceptibility to healthy recipient rats, linked to the activation of the NLRP3 inflammasome. Mechanistically, gut dysbiosis in CKD patients leads to elevated IS levels, causing gut barrier dysfunction and increased circulating lipopolysaccharide (LPS). Elevated LPS activates atrial TLR4 receptors, triggering NLRP3 inflammasome activation, which contributes to AF pathogenesis. Treatment with the IS scavenger AST-120 or gut barrier protectants successfully prevented CKD-associated AF. Furthermore, supplementation with Lactobacillus gasseri reduced circulating IS levels and mitigated AF susceptibility in CKD rats. CONCLUSION: This study demonstrates that gut dysbiosis-driven elevation of IS and subsequent activation of the atrial NLRP3 inflammasome are key mechanisms in CKD-associated AF. Modulating the gut microbiota could provide a new therapeutic strategy for CKD-associated AF."},{"url":"https://hartvaat.nl/2026/03/01/non-hdl-hdl-ratio-als-voorspeller-van-cardiovasculaire-ziekte-bij-ckm-syndroom/","doi":"10.1111/jch.70221","title_en":"","journal":"Journal of clinical hypertension (Greenwich, Conn.)","source_date":"2026-03-01","abstract_original":"The American Heart Association recently proposed the concept of Cardiovascular-kidney-metabolic (CKM) syndrome, emphasizing the interconnections among cardiovascular disease (CVD), chronic kidney disease (CKD), and metabolic disorders. The ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (NHHR) has emerged as a novel lipid marker associated with CVD, but its relevance in individuals with CKM syndrome remains unclear. This study aimed to examine the association between NHHR and incident CVD among adults with CKM stages 0-3 using data from the China Health and Retirement Longitudinal Study (CHARLS). CVD events were defined as self-reported heart disease or stroke. Cox proportional hazards models and restricted cubic spline (RCS) analyses were applied to assess associations, and receiver operating characteristic (ROC) curves evaluated predictive performance. Among 7445 participants (mean follow-up: 80 months), 1476 developed CVD. Each one-unit increase in NHHR was associated with a 4% higher risk of CVD (95% CI: 1.00-1.08). Participants in the highest quartile (Q4) had a 23% higher risk compared with Q1 (HR = 1.23, 95% CI: 1.03-1.47). RCS analysis showed a significant positive linear relationship (P overall = 0.018). NHHR demonstrated the strongest predictive ability for CVD, with consistent results across subgroups. Higher NHHR levels were independently linked to increased CVD risk among individuals with CKM stages 0-3, suggesting NHHR may serve as a simple marker to identify high-risk populations."},{"url":"https://hartvaat.nl/2026/02/28/epic-hiv-trial-pcsk9-remming-ter-cardiovasculaire-preventie-bij-hiv-patienten/","doi":"10.1016/j.ahj.2026.107400","title_en":"","journal":"American heart journal","source_date":"2026-02-28","abstract_original":"RATIONALE: People with HIV (PWH) are at increased risk of cardiovascular disease. Moderate lipid lowering with statins has been demonstrated to reduce cardiovascular risk among PWH. Accordingly, evaluation of more potent lipid lowering strategies for prevention are needed, especially for PWH at higher risk. Prior research suggests that proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors safely lower low density lipoprotein cholesterol by 60% among people with HIV, but the impact of PCSK9 inhibitors on arterial inflammation, endothelial function, coronary plaque, or markers of immune dysfunction among PWH remains unknown. METHODS: The Effect of PCSK9 Inhibition on Cardiovascular Risk in Treated HIV Infection (EPIC-HIV) Study is a randomized, placebo-controlled, double-blinded clinical trial. Adults at least 40 years old with treated and virally suppressed HIV and at least one cardiovascular risk factor (primary prevention) or a prior cardiovascular event (secondary prevention) are randomized in a 2:1 ratio to alirocumab or matching placebo injected subcutaneously. 18F-FDG PET/CT, coronary computed tomographic angiography (CCTA), and flow-mediated dilation of the brachial artery are conducted at baseline and after one year of treatment. The primary study outcome is change in arterial inflammation assessed using the target-to-background ratio of the most diseased arterial segment on PET/CT from baseline to 1 year, and key secondary endpoints will include change in noncalcified coronary plaque on CCTA, change in endothelial function, and safety according to the intention-to-treat principle. ENROLLMENT: 118 participants were randomized. Mean age was 59.5 years and 6% were female. CONCLUSIONS: The EPIC-HIV Study will provide evidence regarding the mechanisms by which potent lipid lowering with PCSK9 inhibitors may alter the pathogenesis of atherosclerosis among PWH. ETHICS, FUNDING DISSEMINATION: This investigator-initiated study was funded by the National Heart, Lung, and Blood Institute (R61/R33 HL141047). Study drug and placebo were provided by the manufacturer. The work of IS was supported by the intramural research program of NIH. The contributions of the NIH authors are considered Works of the United States Government. The findings and conclusions presented in this paper are those of the authors and do not necessarily reflect the views of the NIH or the U.S. Department of Health and Human Services. The study protocol was approved by the Institutional Review Board at the University of California San Francisco. Written informed consent was obtained from all study participants. The funders will have no role in the decision to submit the manuscript for publication in a peer-reviewed journal. TRIAL REGISTRATION: https://clinicaltrials.gov/study/NCT03207945."},{"url":"https://hartvaat.nl/2026/02/26/ai-clustering-identificeert-functionele-risicofenotypen-bij-hartfalen/","doi":"10.1136/openhrt-2025-003530","title_en":"","journal":"Open heart","source_date":"2026-02-26","abstract_original":"BACKGROUND: Patients with heart failure (HF) frequently suffer from undetected declines in cardiorespiratory fitness (CRF), which significantly increases their risk of poor outcomes. However, current clinical practice lacks effective tools for early CRF risk stratification. METHODS: We conducted an artificial intelligence (AI)-driven unsupervised clustering analysis based on 15 multimodal clinical variables-including metabolic, inflammatory and body composition indicators-in 505 patients with HF. The associations between clustering-derived phenotypes and CRF impairment (maximal oxygen uptake (VO2 max) ≤20 mL/kg/min) were evaluated using multivariable logistic regression and five supervised machine learning models. SHapley Additive exPlanations analysis was applied for model interpretability. External validation was performed in an independent cohort of 201 patients. RESULTS: Three distinct phenotypes were identified: balanced, inflammatory-sarcopenic and metabolically dysregulated. Compared with the balanced phenotype, both non-balanced phenotypes showed significantly higher odds of impaired VO₂ max. In the derivation cohort test set, random forest (area under the curve (AUC)=0.75; 95% CI 0.62 to 0.87) and XGBoost (AUC=0.74; 95% CI 0.62 to 0.87) demonstrated the best discriminative performance. In the external validation cohort, the highest discrimination was observed for Naive Bayes (AUC=0.75; 95% CI 0.67 to 0.83), followed by random forest (AUC=0.74; 95% CI 0.58 to 0.91). CONCLUSION: By integrating multimodal clinical data with AI-driven clustering and machine learning, this study identified novel CRF risk phenotypes in patients with HF and established a highly interpretable and generalisable risk stratification model. These findings offer a valuable framework for early functional assessment and pave the way for precision rehabilitation strategies in HF management."},{"url":"https://hartvaat.nl/2026/02/26/fluoroscopieminimalisatie-bij-svt-ablatie-door-vrouwelijke-elektrofysiologen/","doi":"10.1093/europace/euag030","title_en":"","journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","source_date":"2026-02-26","abstract_original":"BACKGROUND AND AIMS: Occupational exposure to ionizing radiation in electrophysiology may significantly affect the careers of women of reproductive age. The aim of the STOOP registry was to quantify the estimated yearly occupational radiation exposure of female electrophysiologists of reproductive age performing consecutive radiofrequency catheter ablation (RFCA) for supraventricular tachycardia (SVT) adopting a fluoroscopy-minimization strategy. METHODS: Twelve European centers participated. All procedures were performed with a fluoroscopy-minimization strategy, guided by 3D mapping systems and following the ALARA (As Low As Reasonably Achievable) principles. RESULTS: 710 RFCA procedures were performed by 32 operators (mean age38±7 years). Mean procedure time was 80±35 min, with a mean fluoroscopy time of 51±153 s. The mean operator annual dose-area product (DAP) was 46.7±79.5 Gycm², corresponding to an estimated mean annual effective dose of 9.34±15.9 µSV. In no case did the yearly effective dose reach the 1 mSv occupational limit for pregnancy. The mean DAP did not differ among operators, and was unaffected by operator experience or annual procedure volume. CONCLUSIONS: Performing SVT ablation with a fluoroscopy-minimization strategy results in operator radiation exposure far below the 1 mSv fetal dose constraint applicable once pregnancy is declared, irrespective of operator experience or case volume. These findings support the safety of continuing electrophysiology activity for women of reproductive age under modern fluoroscopy-free workflows."},{"url":"https://hartvaat.nl/2026/03/04/veroudering-immuundysfunctie-en-nierfibrose-kip-of-ei/","doi":"https://www.kidney-international.org/article/S0085-2538(25)00950-0/fulltext","title_en":"","journal":"Kidney International","source_date":"2026-03-04","abstract_original":"Aging is a significant risk factor for the development of chronic kidney disease (CKD), an incurable condition that can progress despite current “standard of care” treatments. Multiple transcriptional and histologic changes are shared by “normal aged” and CKD kidneys. These include increased myofibroblast number, interstitial collagen deposition, chronic immune infiltrates, and increased levels of renal epithelial senescence (senescent cells [SCs], permanently growth-arrested cells with altered behavior, and secretory phenotypes) compared with healthy young kidneys."},{"url":"https://hartvaat.nl/2026/03/04/winterhypertensie-koude-als-cardiovasculaire-risicofactor/","doi":"https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.26518","title_en":"","journal":"Hypertension","source_date":"2026-03-04","abstract_original":"Hypertension, Volume 83, Issue 6, Page e26518, June 1, 2026. An increase in the rate of cardiovascular events (eg, myocardial infarction, stroke, heart failure) during the winter season has been reported worldwide, including Japan. As 1 contributor to the increase in cardiovascular risk during the colder months, winter hypertension likely reflects an interaction between environmental factors and human physiological responses. In particular, the prognostically important morning blood pressure (BP) surge is accentuated in winter versus other seasons, as is BP variability. Some individuals may exhibit more marked changes in BP in response to cold exposure, referred to as thermosensitive hypertension. During winter mornings, sympathetic activation due to cold stress and the arousal response overlap, producing a synergistic effect that raises baseline BP, amplifies BP variability, and augments the morning BP surge simultaneously. These mechanisms help explain why cardiovascular event risk peaks during the early morning hours in winter. Approaches to optimizing the living environment and lifestyle during winter to help reduce cold-induced increases in BP are discussed, with a focus on Japan. Incorporation of home BP monitoring and newer approaches, such as digital therapeutics are also important. Overall, winter BP management should consider BP variability, time of day (chronobiology), and the environment, rather than focusing solely on absolute BP levels. The period immediately after awakening represents the most dangerous time window, during which cold exposure, low indoor temperature, awakening-related sympathetic activation, and initiation of physical activity converge. Effective management for individual cardiovascular risk reduction requires a comprehensive approach that optimizes living conditions, lifestyle factors, BP monitoring, and hypertension pharmacotherapy."},{"url":"https://hartvaat.nl/2026/02/27/gerichte-immunotherapie-bij-nierziekten-b-cel-targeting-en-car-t/","doi":"https://www.kidney-international.org/article/S0085-2538(26)00145-6/fulltext","title_en":"","journal":"Kidney International","source_date":"2026-02-27","abstract_original":"Recent advances in immunotherapy targeting B cells have ushered in a new era for disease treatment. The effectiveness of targeted approaches such as T-cell engagers or B cell–directed chimeric antigen receptor (CAR)-T-cell therapy in treating autoimmune diseases has been demonstrated so far only in uncontrolled, investigator-initiated trials. Several case series in patients with therapy-resistant systemic lupus erythematosus showed efficacy and safety of CD19+ CAR-T cells, showing depletion of autoreactive B cells and full clinical remission."},{"url":"https://hartvaat.nl/2026/02/26/ai-model-voorspelt-nachtelijke-hypertensie-bij-chronische-nierziekte/","doi":"https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.126.26706","title_en":"","journal":"Hypertension","source_date":"2026-02-26","abstract_original":"Hypertension, Volume 83, Issue 4, Page e26706, April 1, 2026. BACKGROUND:Ambulatory blood pressure monitoring is indispensable for diagnosing nocturnal hypertension (NH) among patients with chronic kidney disease, but it is costly and time-consuming. Screening tools for predicting high-risk NH are urgently needed.METHODS:A large cohort of 5769 patients with nondialysis chronic kidney disease were enrolled (hospital A: 4565; hospital B: 1204). Patients from hospital A were split 8:2 into training/internal test sets; hospital B served as the external test set. A total of 1006 patients with at least 2 valid ambulatory blood pressure monitoring recordings were used for secondary validation. We proposed a table-value diffusion model by incorporating generative modeling concepts to map distributions between clinical variables and predict NH. The predicted probabilities for NH were stratified and validated according to patients’ true adverse renal/cardiovascular prognoses.RESULTS:Through a ri"},{"url":"https://hartvaat.nl/2026/03/05/nucleair-ago2-verergert-hfpef-via-myocardiale-ketogenese/","doi":"10.1093/eurheartj/ehag067","title_en":"","journal":"European heart journal","source_date":"2026-03-05","abstract_original":"BACKGROUND AND AIMS: With the prevalence of Western-style high-fat diet (HFD), the incidence of heart failure with preserved ejection fraction (HFpEF) is gradually increasing. Recent studies suggested that microRNAs (miRNAs) located in different subcellular organelles could regulate lipid metabolism and cardiac function. However, the functional property of subcellular argonaute 2 (AGO2), the core member of miRNA machinery, remained elusive in HFD-related HFpEF. METHODS: The causal role of nuclear AGO2 in inducing cardiac dysfunction was revealed with a recombinant adeno-associated virus (serotype 9) vector. The underlying mechanisms were explored with echocardiography, catheter manometer system, proteomics analyses, chromatin immunoprecipitation assays, luciferase assays, Western blotting, immunofluorescence, seahorse assays, β-hydroxybutyrate (β-OHB), and ATP measurements. RESULTS: Knockdown of AGO2 attenuated HFD-induced cardiac dysfunction. Mechanistically, AGO2 could activate the transcription of HMGCS2. Knockdown of either cardiac AGO2 or HMGCS2 protected against HFD-induced cardiac dysfunction. Subsequent high-through profiling further identified ATP5MG and UQCR10 as the key downstream targets for AGO2/HMGCS2 mediated β-OHB over-production, and a feed forward loop involving lipo-toxicity and ketone-toxicity was discovered. Furthermore, a PKCα-ERK-EGR1-AGO2-HMGCS2 axis in the initiation of fatty acid-induced cardiomyocyte dysfunction was revealed. Importantly, overexpressing of nuclear AGO2 rather than cytosolic AGO2 exacerbated the HFD-induced cardiac dysfunction in mice. CONCLUSIONS: These findings uncover that long-term Western-style HFD treatment captures some critical characteristics of HFpEF, characterized by diastolic dysfunction with left ventricular ejection fraction >50%. AGO2/HMGCS2 pathway links lipo-toxicity to ketone-toxicity in the heart, which provides new mechanistic insights and suggests a potential strategy to develop treatments against metabolism disorder-related HFpEF."},{"url":"https://hartvaat.nl/2026/04/01/kosteneffectiviteit-van-cascadescreening-voor-familiaire-hypercholesterolemie-ti/","doi":"10.1016/j.atherosclerosis.2025.120416","title_en":"TEMPORARY REMOVAL: Cost-effectiveness of alternative cascade screening strategies for familial hypercholesterolemia with realistic cascade screening acceptance rates and use of novel treatment","journal":"Atherosclerosis","source_date":"2026-04-01","abstract_original":"BACKGROUND AND AIMS: Cascade screening (CS) for familial hypercholesterolemia (FH) has been found to be cost-effective in many published studies. However, most existing studies (i) ignored or overstated first-degree relative (FDR) participation rate (as 60-100 %), (ii) did not consider novel and expensive therapies, e.g. PCSK9 inhibitors (PCSK9i), and (iii) were conducted outside of Asia. This study, conducted in Singapore, where FDR participation rate is about 25 % among probands who have known pathogenic variants, aims to identify drivers of cost-effectiveness of CS protocols for FH. METHODS: Four CS protocols, which vary in the application of genetic tests, were examined using a hybrid decision tree-Markov model. Sensitivity analyses were conducted to identify drivers of cost-effectiveness. RESULTS: Cascade acceptance rates are key drivers of cost-effectiveness. Other drivers include age of proband, prevalence of FH among probands, health-related quality of life loss with cardiovascular disease, timeliness of starting treatment post-screening, treatment effectiveness, cost of PCSK9i and discount rate for cost and QALY. With cascade acceptance rates observed in Singapore, among various screening protocols examined, probabilities of being cost-effective ranged from 86 % to 95 % when no access to PCSK9i and ranged from 75 % to 98 % when PCSK9i are provided. The most cost-effective protocol differs depending on cascade acceptance rates and whether PCSK9i is provided. CONCLUSION: For better cost-effectiveness of CS for FH, health systems need to look for ways to improve proband's willingness to share contact of their relatives and relatives' willingness to be screened and to lower the cost of novel treatment. Other ways to improve cost-effectiveness include to select age groups for proband screening, improve screening detection rate among probands, and start timely treatment post-screening."},{"url":"https://hartvaat.nl/2026/03/02/senescente-p16-cellen-verergeren-hartremodellering-na-ischemie-via-cytotoxische-/","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.125.077172","title_en":"","journal":"Circulation","source_date":"2026-03-02","abstract_original":"BACKGROUND:Ischemic heart disease remains a leading cause of mortality worldwide, with adverse remodeling after myocardial infarction driven by inflammation and cardiomyocyte loss. Although cytotoxic lymphocytes exacerbate myocardial injury and P16 marks cellular senescence in diseased hearts, the cell type–specific functions of P16+populations remain unclear.METHODS:Usingp16-CreER;R26-tdTreporter mice, we mapped P16+cell heterogeneity after myocardial infarction. Senolytic effects were assessed with combined dasatinib and quercetin treatment. Transcriptomic profiling (bulk and single-cell RNA sequencing) of sorted P16+cells identified secreted factors, validated through in silico predictions and quantitative polymerase chain reaction. Intercellular communication was analyzed using CellChat. Functional relevance was tested through CCL8 (cytokine [C-C motif] ligand 8) neutralization,Ccl8deletion in P16+cells, lymphocyte depletion, and intersectional genetic ablation of P16+fibroblasts o"},{"url":"https://hartvaat.nl/2026/03/02/extracellulaire-vesikels-medieren-adipocyt-cardiomyocytcommunicatie-bij-diabetis/","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.125.076372","title_en":"","journal":"Circulation","source_date":"2026-03-02","abstract_original":"BACKGROUND:Mortality from acute myocardial infarction (MI) has declined significantly in the past decade for nondiabetic patients. However, both morbidity and mobility of ischemic heart failure (IHF) persistently escalate in the diabetic population via incompletely understood mechanisms. Recent studies demonstrated that small extracellular vesicles (sEVs) released from nondiabetic and diabetic adipocytes (ADps) exert opposite effects on acute myocardial ischemia and reperfusion (MI/R) injury. However, whether and how ADp sEVs may protect against post-MI remodeling and IHF, and more important, whether and how diabetes may impair this protective effect, remain unknown.METHODS:sEVs were isolated from epididymal fat pads of nondiabetic animals and intramyocardially injected in nondiabetic or diabetic hearts subjected to MI (90 minutes of MI per 4 weeks of reperfusion).RESULTS:sEV treatment significantly attenuated post-MI cardiac remodeling and improved cardiac function in nondiabetic mice"},{"url":"https://hartvaat.nl/2026/02/28/clopidogrel-versus-aspirine-bij-coronairlijden-kanttekeningen-bij-meta-analyse/","doi":"https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)02643-1/fulltext","title_en":"","journal":"The Lancet","source_date":"2026-02-28","abstract_original":"We read with interest the systematic review and meta-analysis on clopidogrel versus aspirin for secondary prevention of coronary artery disease by Marco Valgimigli and colleagues.1 This review included seven randomised trials with individual patient data from 28 982 patients and found a lower incidence of major adverse cardiovascular or cerebrovascular events (MACCE) with clopidogrel (929 events; 2·61 per 100 patient-years) compared with aspirin (1062 events; 2·99 per 100 patient-years).1 Most trials were open-label and industry-funded, yet all were judged as having a low risk of bias."},{"url":"https://hartvaat.nl/2026/03/31/titine-cardiomyopathie-meestal-dcm-of-linksdominante-acm-met-blijvend-ritmestoor/","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e003750?rss=1","title_en":"Genotype-phenotype correlations in patients with pathogenic/likely pathogenic titin variants from the Swiss Arrhythmogenic Cardiomyopathy Registry","journal":"Open Heart","source_date":"2026-03-31","abstract_original":" Truncating variants in the titin gene (TTNtv) are associated with cardiomyopathy, mainly dilated cardiomyopathy (DCM). The clinical presentation and outcomes of arrhythmogenic phenotypes in these patients are scarcely studied. This was a retrospective Swiss national study including 46 cardiomyopathy patients with pathogenic/likely pathogenic (P/LP) TTNtv. 63% were male and median age at diagnosis was 47 years. At baseline, 89% patients formally fulfilled current DCM criteria and 17% the 2024 revised Padua criteria for diagnosis of ACM, of which all were of the left-dominant phenotype (arrhythmogenic left ventricular cardiomyopathy). No patient fulfilled arrhythmogenic right ventricular cardiomyopathy (ARVC) criteria. Most TTNtv were located on the A-band (74%). Median time to last follow-up (FU) was 63 months. Ventricular arrhythmia (VA) events in the primary prevention group significantly increased over time; although, under optimal guideline-directed medical therapy, mean left ventricular ejection fraction and right ventricular function significantly improved during time to last FU. At the time to last FU, 50% fulfilled DCM criteria, whereas 27% fulfilled the criteria for left-dominant ACM. Late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) was most commonly in the basal septum, but no patient had higher degree atrioventricular block (AVB). LGE on CMR was not associated with higher rates of VAs. Patients with P/LP TTNtv most frequently present as DCM or left-dominant ACM, whereas TTN is not a classical ARVC-causing gene. The risk of VA remains high despite favourable remodelling. Left ventricular LGE is frequent and often involves the septum. In contrast to sarcoidosis, high degree AVB seems not to be a typical feature of TTN cardiomyopathy. International guidelines emphasise the role of heart valve centres (HVC) and specialist heart valve clinics (SHVC) to deliver optimal care to patients with heart valve disease (HVD). We sought to determine whether we could reaffirm the importance of SHVCs in our centre. A total of 3731 consecutive non-SHVC (N-SHVC) patients were reviewed over 18 months. Patients (134) with a primary diagnosis of HVD were compared with 173 consecutive SHVC attendees based on international guidelines. Concordance was defined as adherence to recommended frequency of follow-up, investigations, timing of surgery and valve care advice, and discordance as any deviation from this. Of 134 N-SHVC patients (4.5%) with HVD, 89 (66.4%) had native valve disease and 45 (33.6%) prior heart valve surgery compared with 123 (71.1%) and 50 (28.9%) of SHVC patients, respectively, in the SHVC cohort. In symptomatic patients, the relationship to HVD was not documented in 31.5% of N-SHVC patients versus 5.7% of SHVC patients (p<0.001). Exercise testing was used infrequently in N-SHVCs compared with SHVCs (3.4% vs 32%, p<0.001) and surgical referral was lower (3.4% vs 26.8%, p<0.001). No N-SHVC patients with prior valve surgery received endocarditis prevention advice compared with 100% of SHVC patients. Overall, 34 (38.2%) of N-SHVC patients with native valve disease and 34 (84.4%) with prior cardiac surgery had discordant management compared with 4 (3.3%) and 2 (4%) of SHVC patients respectively. Almost 5% of patients with valve disease are still seen in an N-SHVC setting despite the availability of an SHVC within the same institute and receive suboptimal care. Ventricular septal defect (VSD) is the most common congenital heart defect. Much remains unclear about the long-term prognosis for VSD patients. This study aimed to investigate the all-cause and cardiovascular mortality in patients with VSD compared with controls without congenital heart disease in Sweden. Swedish National Patient Register was used to identify all VSD patients born between 1970 and 2017. Mortality data were collected from the Swedish National Cause of Death register. Patients with associated complex congenital heart disease or non-congenital VSD were excluded. The VSD cases were matched by age and sex with 10 controls without congenital heart disease for each case. A total of 22 855 VSD patients were included. The hazard of death for the entire VSD cohort, including patients with syndromes and associated non-complex congenital cardiac lesions, was increased compared with matched controls without congenital heart disease, with a HR of 6.8 (95% CI 6.1 to 7.6) for ages 0–17 years and HR of 3.1 (95% CI 2.5 to 4.0) for ages >18 years, during a mean follow-up of 14.3 years (±11.1). In isolated, non-syndromic VSD, the hazard of death was still elevated compared with controls, regardless of whether the VSD had been repaired in childhood or not. The HR for death for unrepaired VSDs was 4.8 (95% CI 4.1 to 5.6) for ages 0–17 years and 2.1 (95% CI 1.5 to 3.0) for ages >18 years and for VSDs repaired before 18 years of age HR for death was 2.9 (95% CI 1.2 to 7.1) for ages 0–17 years and 8.2 (95% CI 2.2 to 30.4) for ages >18 years. Mortality rates were three times higher in adult VSD patients compared with matched controls. Mortality risk was highest in VSD cohorts that included patients with syndromes and congenital valvular lesions, highlighting VSD patients at extra risk of adverse outcomes. Time to reperfusion is a predictor of long-term outcomes in ST-segment elevation myocardial infarction (STEMI). Timely primary percutaneous coronary intervention (PCI) is the preferred strategy recommended by guidelines. Fibrinolysis is recommended in patients in whom timely primary PCI is not feasible, though concerns persist about underutilisation of this approach. We examined long-term survival outcomes in STEMI patients according to treatment strategy received in a national STEMI registry in Ireland. This was an observational, nationwide, population-based study. We identified all STEMI cases from January 2013 to March 2018. After exclusion of patients with missing data, we divided patients into three groups as per reperfusion strategy—fibrinolysis, delayed primary PCI (>120 min of diagnosis) and timely primary PCI (<120 min of diagnosis)—and analysed mortality through to 3 years follow-up. A multivariate Cox proportional hazards model was used, with a propensity score matching analysis performed as a sensitivity analysis. Of the 4156 patients included in this analysis, 202 (4.9%) were treated with fibrinolysis, 1075 (25.8%) were treated with delayed primary PCI and 2879 (69.3%) were treated with timely primary PCI. At follow-up, delayed primary PCI was associated with an increased risk of mortality through to 3 years in comparison to fibrinolysis (HRadjusted, 1.36; 95% CI 1.02 to 1.83, p=0.04). Timely primary PCI was associated with a comparable risk of mortality through to 3 years in comparison to fibrinolysis (HRadjusted, 1.10; 95% CI 0.81 to 1.49, p=0.53). A sizeable proportion of STEMI patients continue to receive treatment with delayed primary PCI. This is associated with an increased risk of mortality through 3 years in comparison to fibrinolysis. Cardiac sarcoidosis (CS) creates complex treatment challenges, especially for patients who fail to respond to immunosuppressive drugs, including second-line tumour necrosis factor inhibitors. These refractory cases frequently lead to serious complications and worse prognosis, prompting exploration of new therapies like Janus kinase (JAK) inhibitors. This study included eight patients with refractory CS or probable CS treated with the JAK inhibitor tofacitinib at the University Hospital Zurich from 2020 to 2024. Treatment outcomes were assessed through changes in myocardial as well as nodal and pulmonary inflammation via 18-F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) scans, left ventricular ejection fraction (LVEF), corticosteroid use and blood neopterin levels. Seven out of eight patients (87.5%) who received tofacitinib achieved inactive or remitting disease as assessed by repeat myocardial 18F-FDG PET/CT, with a decrease in both standardised uptake value (SUVmax and cardiac metabolic activity. In the treated patients, LVEF stabilised or improved, and the corticosteroid dose was substantially reduced, with the average daily prednisone dose dropping from 5.94 mg to 2.5 mg. Blood neopterin levels, indicative of macrophage activation, as well as extra cardiac SUVmax (nodal and pulmonal) as assessed by repeat 18F-FDG PET/CT also decreased in a majority of the treated patients. Tofacitinib shows promising results in managing treatment-refractory CS, with seven out of eight patients achieving significant reduction in myocardial inflammation and corticosteroid dependency. However, further studies with larger prospective cohorts are essential to solidify these findings and assess the drug’s efficacy and safety profile in this complex patient group. In patients with dextro-transposition of the great arteries, cardiovascular interventions and complications are common after the arterial switch operation (ASO). While complex anatomy—typically defined by ventricular septal defects (VSDs)—is often linked to these outcomes, the independent role of aortic coarctation (CoA) remains unclear. We analysed 502 adults from the EPOCH (European collaboration for Prospective Outcome research in Congenital Heart disease)-ASO multicentre registry (median age 25.5 years). The primary outcome was time to first right ventricular outflow tract (RVOT)-related intervention. Secondary outcomes included left ventricular outflow tract (LVOT)-related interventions and cardiovascular complications. Associations were assessed using adjusted Cox regression and Andersen-Gill models. CoA emerged as the strongest independent predictor of RVOT interventio"},{"url":"https://hartvaat.nl/2026/03/25/geleidelijk-afbouwen-van-rilonacept-bij-recidiverende-pericarditis-voorkomt-vake/","doi":"http://heart.bmj.com/cgi/content/short/112/8/454?rss=1","title_en":"Comparative analysis of recurrence rates following various cessation strategies for rilonacept in recurrent pericarditis","journal":"Heart","source_date":"2026-03-25","abstract_original":" Rilonacept (RI), an interleukin (IL)-1α/β cytokine trap, is a biological treatment to prevent recurrence in recurrent pericarditis (RP). Discontinuation of RI in patients after 18 months with RP has been associated with a higher rate of RP. We aimed to propose a preliminary strategy for stopping Rl in select patients and evaluate their long-term outcomes. We conducted a retrospective cohort study at the pericardial disease centre at Cleveland Clinic, Ohio. Adults included had RP refractory to first-line therapies, receiving Rl for at least 12 months (median duration 24 months) with improvement in symptoms and late gadolinium enhancement on cardiac MRI. The primary outcome was recurrence of RP post abrupt Rl discontinuation versus slow taper (gradual decrease in Rl frequency from weekly, to bimonthly, to monthly and then cessation). We also evaluated the effects of colchicine prophylaxis at the end of "},{"url":"https://hartvaat.nl/2026/03/25/kinderen-van-een-hypertensieve-zwangerschap-hebben-later-vaker-hoge-bloeddruk-en/","doi":"https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.25834","title_en":"Heritability and Cardiovascular Disease in Adult Offspring of Hypertensive Disorder of Pregnancy: A Systematic Review and Meta-Analysis","journal":"Hypertension","source_date":"2026-03-25","abstract_original":"Hypertension, Volume 83, Issue 6, Page e25834, June 1, 2026. The heritability of hypertensive disorders of pregnancy (HDP) and HDP’s association with cardiovascular disease in adult offspring were explored through a systematic review and meta-analysis. MEDLINE and EMBASE were searched independently by 2 reviewers (inception to February 18, 2025). Maternal chronic hypertension, antenatal complications, and pediatric cardiovascular disease were excluded. The Critical Appraisal Skills Program checklist was used for critical appraisal. Random-effects meta-analysis was conducted using a generic inverse variance method. Narrative synthesis and pooled results were expressed as odds ratios with 95% CIs. Of 225 studies screened, 11 studies (n=59 185; 48.3% women) assessed cardiovascular disease, and 9 studies (n=58 512) assessed HDP. Offspring age ranged from 19 to 55 years. There were 11 good- and 9 fair-quality studies. Fifteen studies were included in the meta-analysis (n=266 244). Adult offspring exposed to HDP had systolic and diastolic blood pressure that was 3.40 mm Hg (95% CI, 2.44–4.37; I2=40%) and 2.19 mm Hg higher (95% CI, 1.40–2.98; I2=51%). Higher odds of hypertension were observed (odds ratio, 1.50 [95% CI, 1.18–1.91]; I2=66%). Female offspring exhibited 72% increased odds of HDP (OR, 1.72 [95% CI, 1.41–2.09]; I2=81%) and 90% increased odds of preeclampsia (odds ratio, 1.90 [95% CI, 1.47–2.46]; I2=36%) following exposure to the same disorders. Increased odds of premature acute coronary syndrome and higher stroke risk were observed following HDP and severe preeclampsia exposure, respectively. In adult offspring, heritability of HDP was high. HDP were associated with hypertension, acute coronary syndrome, and stroke. Lifestyle modifications, cardiovascular disease monitoring, and prevention are paramount."},{"url":"https://hartvaat.nl/2026/03/25/glp-1-agonisten-en-sglt2-remmers-in-de-praktijk-bescherming-van-hart-en-nieren-v/","doi":"http://heart.bmj.com/cgi/content/short/112/8/422?rss=1","title_en":"Managing glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors in clinical practice","journal":"Heart","source_date":"2026-03-25","abstract_original":" The obesity epidemic has significantly heightened the impact of cardiometabolic risk factors on the global burden of cardiovascular and kidney diseases. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is), originally developed for type 2 diabetes treatment, have demonstrated in randomised controlled trials their ability to reduce the risk of cardiovascular and kidney diseases. This has led to substantial improvements in patient outcomes. SGLT2i, in particular, are the first class of drugs proven to improve the prognosis of patients with heart failure with preserved ejection fraction, and evidence is accumulating to suggest that also GLP-1RA might be beneficial in these patients. Remarkably, the benefits of GLP-1RA and SGLT2i are independent of type 2 diabetes status or baseline renal function. The critical role of these drug classes in managing high cardiovascular risk patients is increasingly acknowledged in guidelines, which"},{"url":"https://hartvaat.nl/2026/03/25/sekseverschillen-in-hartremodellering-bij-primair-aldosteronisme-vrouwen-hebben-/","doi":"https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.26213","title_en":"Sex Differences in Cardiac Remodeling and Dysfunction in Primary Aldosteronism","journal":"Hypertension","source_date":"2026-03-25","abstract_original":"Hypertension, Volume 83, Issue 5, Page e26213, May 1, 2026. BACKGROUND:Sex differences influence cardiovascular risk assessment and management; however, their role in aldosterone-mediated cardiac remodeling in primary aldosteronism remains incompletely understood.METHODS:We conducted a retrospective study of 547 patients with primary aldosteronism, including 249 men and 298 women. Clinical and echocardiographic data were collected at baseline and 1 year following aldosterone-targeted therapies.RESULTS:The mean age was 53.8 years in men and 54.6 years in women. At baseline, men had a higher left ventricular mass index (LVMI), whereas women had a higher prevalence of left ventricular (LV) hypertrophy and worse diastolic function, as indicated by a higher ratio of early diastolic transmitral to mitral annular velocity (E/e′) and left atrial volume index. In multivariable analyses, plasma aldosterone concentration (PAC) was associated with baseline LVMI in both sexes. Associations between "},{"url":"https://hartvaat.nl/2026/03/25/vrouwen-krijgen-een-type-a-aortadissectie-bij-een-kleinere-aortadiameter-door-hu/","doi":"http://heart.bmj.com/cgi/content/short/112/8/462?rss=1","title_en":"Sex differences in ascending aortic diameter at the time of acute type A aortic dissection","journal":"Heart","source_date":"2026-03-25","abstract_original":" Guideline size criteria for prophylactic repair of ascending aortic aneurysm do not account for sex, although some evidence suggests women may experience acute type A aortic dissection (ATAAD) at smaller diameters. We examined sex differences in ascending aortic diameter among patients with ATAAD. We performed a single-centre, retrospective study including consecutive adult patients undergoing repair of spontaneous ATAAD (2011–2023). Maximal ascending aortic diameter was measured on index CT. Maximum diameter and diameter indexed to height and body surface area (BSA) were compared by sex. Multivariable linear regression, accounting for sex, age and comorbidities, predicted aortic diameter at time of ATAAD. Height and BSA were separately added to the model to evaluate how associations changed with body size. Among 413 included patients, 146 (35.4%) were female. Women were older (65 "},{"url":"https://hartvaat.nl/2026/03/25/waarom-de-sterfte-na-een-hartinfarct-daalde-15-jaar-nationale-data-uit-engeland-/","doi":"http://heart.bmj.com/cgi/content/short/112/8/446?rss=1","title_en":"Drivers of 1-year mortality decline after acute myocardial infarction in England and Wales: a 15-year national cohort study","journal":"Heart","source_date":"2026-03-25","abstract_original":" One-year mortality following acute myocardial infarction (AMI) has declined over time, yet the reasons for this improvement remain unclear. Understanding the drivers of these changes is essential for informing clinical strategies and health policy. We analysed 852 914 adult patients admitted with AMI across England and Wales between 2005 and 2019 using national registry data. We examined changes in 1-year all-cause mortality and quantified the contribution of clinical, treatment and demographic factors to this trend using decomposition analysis. Between 2005 and 2019, 1-year all-cause mortality declined from 22.8% (95% CI 22.4% to 23.2%) to 14.2% (95% CI 13.7% to 14.7%), an absolute reduction of 8.6 percentage points. Approximately 68.2% of this decline was explained by measured factors. The greatest contributor was increased use of evidence-based pharmacological therapies—includin"},{"url":"https://hartvaat.nl/2026/03/25/vier-klinische-fenotypes-bij-coronairlijden-met-sterk-verschillend-risico-op-nie/","doi":"http://heart.bmj.com/cgi/content/short/112/8/431?rss=1","title_en":"Identifying clinical phenotype clusters in patients with coronary artery disease","journal":"Heart","source_date":"2026-03-25","abstract_original":" Guideline recommendations for the prevention of cardiovascular (CV) events in patients with coronary artery disease (CAD) are predominantly one-size-fits-all. Clinically identifiable phenotypes needing specific considerations might exist. The purpose of this study is to identify such clinical phenotypic clusters in patients with CAD and assess their relationship with the risk of recurrent CV events. Unsupervised machine learning through latent class analysis was performed in patients with CAD from the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) registry (n=88 894) and Utrecht Cardiovascular Cohort-Second Manifestations of Arterial Disease (UCC-SMART) cohort (n=5506). Characteristics for clustering were based on availability, missingness and clinical relevance. Clustering was performed in SWEDEHEART and validated in UCC-"},{"url":"https://hartvaat.nl/2026/03/25/hoe-bouw-je-il-1-remmers-af-bij-recidiverende-pericarditis-strategieen-voor-afbo/","doi":"http://heart.bmj.com/cgi/content/short/112/8/413?rss=1","title_en":"Strategies for optimising tapering and withdrawal of interleukin-1 blockers in recurrent pericarditis","journal":"Heart","source_date":"2026-03-25","abstract_original":" Interleukin-1 (IL-1) blockers were first introduced into clinical practice approximately 15 years ago for the treatment of patients with glucocorticoid-dependent and colchicine-resistant (GD-CR) recurrent pericarditis. This marked a significant advancement that has radically changed the clinical landscape for this subgroup of patients. GD-CR affects approximately 5%–10% of patients with recurrent pericarditis. The paradox of recurrent pericarditis lies in the fact that its challenges do not exclusively stem from the "},{"url":"https://hartvaat.nl/2026/03/25/inspanningsecho-identificeert-hcm-patienten-die-baat-hebben-bij-mavacamten/","doi":"10.1093/eschf/xvag087","title_en":"Role of Provocation and Exercise Imaging for the Identification of Candidates for Cardiac Myosin Inhibitors","journal":"ESC heart failure","source_date":"2026-03-25","abstract_original":"AIMS: Left ventricular outflow tract obstruction (LVOTO) drives symptoms and functional limitation in obstructive hypertrophic cardiomyopathy (oHCM). Some patients may only show treatment-qualifying obstruction during exercise echocardiography, yet their clinical profile and response to cardiac myosin inhibition are not well defined. This study compared the characteristics and therapeutic response of patients requiring exercise echocardiography to establish eligibility for mavacamten versus those meeting criteria at rest or during Valsalva. METHODS AND RESULTS: A single-center retrospective cohort of 56 symptomatic oHCM patients treated with mavacamten was evaluated. LVOTO was assessed at rest, with Valsalva, and during exercise; patients were classified as \"exercise\" or \"non-exercise\" LVOTO based on the provocation maneuver eliciting a qualifying gradient (≥50 mmHg). Hemodynamic (Valsalva LVOT gradient) and symptomatic (NYHA class) response were assessed at 12 and 24 weeks. A total of 42.9% qualified for mavacamten exclusively during exercise echocardiography. Although resting and Valsalva gradients were lower by definition, these patients showed similar baseline functional limitation and exercise capacity (pVO2; 17.9±7.4 vs. 16.8±5.5 mL/kg/min, p=0.550). By 24 weeks, most patients in both groups achieved non-obstructive gradients (<30 mmHg; 92.3% vs. 100.0%, p=0.371) and NYHA class improvement (77.3% vs. 92.3%, p=0.377), without significant between-group differences. CONCLUSION: Patients requiring exercise echocardiography to document qualifying LVOTO do not exhibit a milder disease phenotype and derive similar treatment benefits from mavacamten compared to those with resting or Valsalva-provoked obstruction. Exercise echocardiography identifies a substantial proportion of symptomatic HCM patients with significant LVOTO missed by resting assessment and is essential for guiding treatment eligibility."},{"url":"https://hartvaat.nl/2026/03/25/bmi-en-prognose-bij-acuut-hartfalen-verschillen-per-fenotype-en-geslacht/","doi":"10.1093/eschf/xvag050","title_en":"Sex- and Phenotype-Specific Prognostic Implications of Body Mass Index in Acute Heart Failure","journal":"ESC heart failure","source_date":"2026-03-25","abstract_original":"AIMS: This study aimed to determine whether the prognostic implications of body mass index (BMI) differ according to heart failure (HF) phenotype and sex. METHODS: From the Korean HF III registry (n = 7,351), we analyzed 5,271 patients hospitalized for acute heart failure (AHF) with available data. BMI was categorized as low (<18.5 kg/m²), normal (18.5-24.9), or high (≥25.0) using cut-off values consistent with Asia-Pacific criteria. The primary outcome was a composite of 2-year all-cause mortality or heart transplantation. Kaplan-Meier analyses and multivariable Cox proportional hazards models, including interaction terms for BMI, sex, and HF phenotype, were performed. RESULTS: In HF with reduced ejection fraction (HFrEF), lower BMI was consistently associated with worse outcomes in both men and women. In contrast, in HF with preserved ejection fraction (HFpEF), BMI was prognostic in women but not in men: survival differed by BMI category in Kaplan-Meier analyses for all subgroups except men with HFpEF. In multivariable analyses, higher BMI was independently associated with lower risk in women with HFrEF (hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.45-0.96, p = 0.032), whereas lower BMI in women with HFpEF showed a borderline association with higher risk (HR 1.56, 95% CI 0.99-2.47, p = 0.057). CONCLUSION: The prognostic implications of BMI in AHF differ according to HF phenotype and sex. Lower BMI is a consistent adverse marker in HFrEF in both sexes and shows a borderline adverse association in women with HFpEF, whereas BMI is not prognostic in men with HFpEF. These findings highlight the importance of sex- and phenotype-specific interpretation of BMI in risk assessment."},{"url":"https://hartvaat.nl/2026/03/25/cardiale-betrokkenheid-bij-parasitaire-infecties/","doi":"10.1093/eurheartj/ehag173","title_en":"","journal":"European heart journal","source_date":"2026-03-25","abstract_original":"Parasitic infections are an underrecognized but important cause of cardiovascular disease, primarily in endemic regions and increasingly in non-endemic settings as a consequence of global migration and travel. Cardiac involvement may result from direct parasitic invasion or, more commonly, from immune-mediated and inflammatory mechanisms, with predominant effects on the myocardium and pericardium. Clinical manifestations include acute myocarditis, dilated or restrictive cardiomyopathy, pericardial effusion, tamponade, constrictive pericarditis, and occasionally cystic lesions identified on cardiac imaging. Parasitic aetiologies should be considered in patients with unexplained myocardial or pericardial disease, particularly in those with relevant epidemiological exposure, immunosuppression, fever, or eosinophilia. This narrative review offers an updated overview of cardiac involvement in parasitic infections, integrating current evidence on epidemiology, clinical manifestations, diagnosis, and management of parasitic cardiac disease, providing practical, clinically oriented guidance supported by figures, algorithms, and summary tables designed to enhance clinical applicability."},{"url":"https://hartvaat.nl/2026/03/25/hart-en-vaatziekten-in-china-epidemiologische-evolutie-19902021/","doi":"10.1093/eurheartj/ehaf1121","title_en":"","journal":"European heart journal","source_date":"2026-03-25","abstract_original":"Cardiovascular disease (CVD) has remained a predominant cause of mortality in China for several decades, experiencing notable epidemiological transitions. Numerous recent studies have provided valuable observational data on the evolution of CVD epidemiology across various dimensions. However, there is a paucity of comprehensive reviews that synthesize these findings and analyse their interrelationships. To address this gap, this review summarizes the key features from complex data presented in various literature reports and additional analyses of available databases. The impact of the primary drivers of these changed features and their intricate interconnections on total CVD and major subtypes, including ischaemic heart disease (IHD), ischaemic stroke (IS), and haemorrhagic stroke (HS), was quantitatively evaluated across different periods from 1990 to 2021. Four prominent transitional features of CVD mortality and the impact of underlying drivers elucidate not only new challenges for CVD prevention and control but also highlight the hidden effects of national efforts on CVD prevention. The analysis also indicated that despite a similar pattern in age-specific mortality for HS, IS, and IHD over the past decade, only the decline in HS mortality was largely attributed to the benefits of primary CVD prevention. In contrast, the declining age-specific IHD and IS mortality was due to reduced fatal events from improved medical care. The implications of these evolving features of CVD over time for further decision-making in CVD prevention strategies are discussed in depth."},{"url":"https://hartvaat.nl/2026/03/25/palliatieve-zorg-in-de-cardiologie-een-state-of-the-art-overzicht/","doi":"10.1093/eurheartj/ehag219","title_en":"","journal":"European heart journal","source_date":"2026-03-25","abstract_original":"Cardiovascular disease remains the leading global cause of morbidity and mortality. Although advances in prevention, diagnostics, and disease-modifying therapies have prolonged survival, many individuals now live longer with high symptom burden, functional decline, and complex decisional needs. Palliative care (PC) for adults with advanced cardiovascular disease can improve quality of life, support caregivers, and align treatments with patient values and goals. Core elements include symptom management, effective communication, shared decision-making, advance care planning, and integration of psychosocial and spiritual support across the disease trajectory and different care settings. Current evidence demonstrates that early PC intervention can improve symptom control, enhance quality of life, reduce psychological distress, and decrease high-intensity yet low-value care near the end of life. Nevertheless, outside of heart failure populations, gaps in widespread PC implementation across populations supported with cardiac devices as well as across diverse cultural and health systems remain. This state-of-the-art review (i) synthesizes conceptual foundations, referral triggers, and delivery models for PC in cardiovascular medicine; (ii) reviews disease-specific considerations across heart failure, valvular disease, pulmonary hypertension, arrhythmias, and congenital heart disease; (iii) outlines ethical and legal issues including advance directives and device deactivation; (iv) provides practical guidance for symptom management and communication frameworks; and (v) proposes a pragmatic algorithm to support clinical integration of PC into cardiovascular medicine."},{"url":"https://hartvaat.nl/2025/01/01/medicamenteuze-therapie-bij-niet-obstructieve-hcm-nieuwe-perspectieven/","doi":"https://www.sciencedirect.com/science/article/pii/S0735109725104361?dgcid=rss_sd_all","title_en":"Drug Therapy in Nonobstructive Hypertrophic Cardiomyopathy: Out of the Darkness Into the Light","journal":"JACC","source_date":"2025-01-01","abstract_original":"Publication date: 3 March 2026Source: JACC, Volume 87, Issue 8"},{"url":"https://hartvaat.nl/2025/01/01/troponine-i-t-ratio-bij-myocardschade-nieuwe-inzichten-uit-bekende-biomarkers/","doi":"https://www.sciencedirect.com/science/article/pii/S0735109726002238?dgcid=rss_sd_all","title_en":"High-Sensitivity Troponin I-to-High-Sensitivity Troponin T Ratio in Myocardial Injury: Old Dogs, New Tricks","journal":"JACC","source_date":"2025-01-01","abstract_original":"Publication date: Available online 4 March 2026Source: JACC"},{"url":"https://hartvaat.nl/2025/01/01/innovatie-in-longemboliebehandeling-loopt-de-praktijk-voor-op-het-bewijs/","doi":"https://www.sciencedirect.com/science/article/pii/S0735109726002378?dgcid=rss_sd_all","title_en":"Innovation and Evidence in Pulmonary Embolism Management: Putting the Cart Before the Horse","journal":"JACC","source_date":"2025-01-01","abstract_original":"Publication date: Available online 4 March 2026Source: JACC"},{"url":"https://hartvaat.nl/2026/03/24/triglyceride-glucose-index-voorspelt-sterfte-bij-kritiek-zieke-patienten-met-ckm/","doi":"10.1186/s12933-025-03061-4","title_en":"Triglyceride-glucose index and mortality in critically ill patients with cardiovascular-kidney-metabolic syndrome stage 4","journal":"Cardiovascular diabetology","source_date":"2026-03-24","abstract_original":"The triglyceride-glucose (TyG) index is a well-established surrogate marker of insulin resistance (IR). Previous studies have linked higher TyG levels to an increased risk of cardiovascular events in individuals with early-stage (0-3) Cardiovascular-Kidney-Metabolic Syndrome (CKM). However, its prognostic value in critically ill patients with CKM stage 4 remains unclear. In this retrospective study, we analyzed clinical data from critically ill CKM stage 4 patients in the MIMIC-IV database. The TyG index was calculated and patients were categorized into tertiles. Cox proportional hazards models and restricted cubic spline (RCS) analyses were used to evaluate the association between the TyG index and all-cause mortality. A total of 3,125 patients were included, of whom 65.22% were male.= The 1-year all-cause mortality was 34.18% overall (28.79% in Q1, 35.06% in Q2, and 38.68% in Q3; P < 0.05). In multivariable Cox regression, each 1-standard deviation increase in the TyG index was associated with a 23% higher risk of 1-year mortality (HR = 1.23, 95% CI 1.09-1.39). Compared with the Q1 group, patients in Q3 had a 30% higher 1-year mortality risk (HR = 1.30, 95% CI 1.08-1.55). RCS analysis showed a linear positive relationship between the TyG index and mortality (P for non-linearity > 0.05). These findings indicate that higher TyG levels are independently associated with increased short- and long-term mortality in critically ill patients with CKM stage 4. The TyG index may provide a simple indicator of acute metabolic disturbances and could support early risk stratification in this population. However, its role in clinical decision-making and potential utility in guiding interventions require confirmation in prospective studies."},{"url":"https://hartvaat.nl/2026/03/24/cascadescreening-op-verhoogd-lp-a-via-kinderen-opbrengst-in-de-praktijk-amsterda/","doi":"10.1093/eurjpc/zwag161","title_en":"Cascade screening for elevated Lp(a) in relatives of children who visited the pediatric lipid clinic: yield of daily clinical practice","journal":"European journal of preventive cardiology","source_date":"2026-03-24","abstract_original":"AIMS: Cascade screening can identify individuals with elevated lipoprotein(a) [Lp(a)], a causal risk factor for atherosclerotic cardiovascular disease (ASCVD). The aim of this study is to explore the effectiveness of cascade screening with asymptomatic children as index cases to identify family members with elevated Lp(a). METHODS: In this retrospective study we used our database consisting of all children referred for a tentative diagnosis of hereditary dyslipidemia to the Amsterdam University Medical Centers pediatric lipid clinic (1989-2023). Elevated Lp(a) was defined as ≥30 mg/dL or ≥75 nmol/L. We evaluated two cascade screening approaches (opportunistic and systematic), calculated the number needed to screen (NNS) and repeated the analysis exclusively in children with FH as subgroup with particularly high cardiovascular risk. RESULTS: A total of 1,931 children were included (732 indexes, mean age (SD) 11.7 (4.5) years; 1,199 relatives, mean age (SD) 10.1 (4.4) years). In total, 480 (25%) of all children had elevated Lp(a) concentrations (≥30 mg/dL or ≥75 nmol/L). Both opportunistic (732 indexes) and systematic (316 indexes) cascade screening identified relatives with elevated Lp(a). The NNS was of 3.7 (95% CI 3.3-4.3) for the systematic approach and 4.1 (95% CI 3.8-4.6) for the opportunistic approach. In the FH subgroup, NNS were 3.9 (95% CI 3.4-4.5) and 4.3 (95% CI 3.9-4.8), respectively. CONCLUSION: Our findings suggest that cascade screening using children as index cases is an effective strategy to identify asymptomatic relatives at risk. Cardiovascular risk assessment should include Lp(a), especially in patients with FH who face an even higher cardiovascular risk. Until effective therapies become available, management should focus on modifiable risk factors."},{"url":"https://hartvaat.nl/2026/03/16/coronaire-calciumscore-blijft-bruikbaar-bij-verhoogd-lp-a-multicohort-studie-met/","doi":"10.1016/j.jacc.2026.02.5067","title_en":"Use of Coronary Artery Calcium Scoring in Individuals With Elevated Lipoprotein(a): A Multicohort Study","journal":"Journal of the American College of Cardiology","source_date":"2026-03-16","abstract_original":"BACKGROUND: The utility of coronary artery calcium (CAC) scoring in individuals with elevated lipoprotein(a) [Lp(a)] for atherosclerotic cardiovascular disease (ASCVD) risk assessment is currently unclear given the propensity of Lp(a) toward noncalcified plaque. OBJECTIVES: The authors aimed to evaluate the interaction between elevated Lp(a) (>50 mg/dL) and CAC score, and the association of Lp(a) with ASCVD risk across strata of CAC. METHODS: A pooled cohort of participants without known ASCVD from 4 U.S.-based prospective cohort studies with baseline Lp(a) and CAC measurements was used. The association between elevated Lp(a) across CAC strata and incident ASCVD (myocardial infarction, stroke, coronary revascularization) was evaluated in multivariable Cox regression models. RESULTS: The study included 11,319 participants (mean age 56 years, 54% women) with 1,569 incident ASCVD events over 14.8 year mean follow-up. Lp(a) >50 mg/dL (HR: 1.24; 95% CI: 1.09-1.41) and CAC >0 (HR: 2.44; 95% CI: 2.14-2.77) were independently associated with ASCVD risk (P interaction = 0.80). Among individuals with CAC = 0, ASCVD incidence rates were low overall, but higher with Lp(a) >50 mg/dL vs ≤50 mg/dL (4.9 vs 3.8/1,000 person-years, HR: 1.28; 95% CI: 1.01-1.60). Among those with CAC >0, increased risk was again noted with elevated Lp(a) (21.2 vs 18.2/1,000 person-years, HR: 3.03; 95% CI: 2.52-3.64). Similar results were observed when examining further CAC strata with the greatest risk noted with both CAC ≥300 and Lp(a) >50 mg/dL (HR: 6.12; 95% CI: 4.80-7.81). Consistent results were noted by age and sex with greater absolute risk in general among individuals >50 years of age and men. CONCLUSIONS: Elevated Lp(a) is associated with higher relative risk across CAC strata, including CAC of 0. Among individuals with CAC of 0, absolute event rates remain low even when Lp(a) is elevated. CAC scoring remains a powerful tool for risk assessment among individuals with elevated Lp(a)."},{"url":"https://hartvaat.nl/2026/03/13/nieuwe-acc-aha-richtlijn-dyslipidemie-2026-lagere-ldl-streefwaarden-en-lp-a-meti/","doi":"10.1016/j.jacc.2025.11.016","title_en":"2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines","journal":"Journal of the American College of Cardiology","source_date":"2026-03-13","abstract_original":"AIM: The \"2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia\" retires and replaces the \"2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol.\" METHODS: A comprehensive literature search was conducted from October 2024 to December 2024 to identify clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE: The focus of this clinical practice guideline is to address the evaluation, management, and monitoring of individuals with dyslipidemias, including high blood cholesterol, hypertriglyceridemia, and elevated lipoprotein(a)."},{"url":"https://hartvaat.nl/2026/03/24/systemische-inflammatie-en-recidief-na-een-af-gerelateerd-herseninfarct/","doi":"10.1212/WNL.0000000000214701","title_en":"Systemic Inflammation and Recurrence After Atrial Fibrillation-Related Stroke: An Individual Participant Data Meta-Analysis.","journal":"Neurology","source_date":"2026-03-24","abstract_original":"BACKGROUND AND OBJECTIVES: The residual recurrence risk after atrial fibrillation (AF)-related stroke is high despite anticoagulation, thereby necessitating new therapies. The importance of inflammation in AF is increasingly recognized. However, patients with AF-related stroke were excluded from recent trials of anti-inflammatory therapies. It is uncertain whether associations between IL-6/high-sensitivity C-reactive protein (hsCRP) and poststroke recurrence are modified by AF status. In this study, we aimed to analyze the association between IL-6/hsCRP and recurrence according to AF history. METHODS: We leveraged individual participant data from studies identified by systematic review. We analyzed associations between IL-6/hsCRP and recurrent stroke/major adverse cardiovascular events (MACEs) (defined as fatal or nonfatal recurrent stroke or major coronary events) using multivariable Cox regression analyses (conditional logistic regression for 1 study) adjusted for age, sex, index event, cardiovascular risk factors, and medication use, stratified by AF status. RESULTS: Data from 11 prospective studies with 10,080 patients (2,134 with AF, mean age 70 years, 59.3% male) were included. During 21,080 person-years of follow-up, 1,677 patients had MACEs and 1,342 had recurrent stroke. Inflammatory markers were higher in patients with AF, irrespective of stroke severity and timing of measurement, with elevated levels persisting well beyond the acute phase. hsCRP was associated with recurrent MACEs in patients with AF (adjusted risk ratio [aRR] 1.14, 95% CI 1.04-1.25, per loge-unit increase) and without AF (aRR 1.08, 1.03-1.13) (Pinteraction 0.30). There were similar associations on per-quarter analysis in patients with AF (aRR 1.51, 1.04-2.18) and without AF (aRR 1.32, 1.10-1.59) (Q4 vs Q1). No association was observed between hsCRP and recurrent stroke in either group. For IL-6, there was no evidence of interaction according to AF status for MACEs (Pinteraction 0.57) or recurrent stroke (Pinteraction 0.82). The aRR per loge unit for MACE was 1.17 (1.07-1.27) in patients without AF and 1.10 (0.91-1.34) in those with AF. The corresponding aRR for recurrent stroke was 1.15 (1.05-1.25) and 1.12 (0.91-1.37) in patients without and with AF, respectively. DISCUSSION: These data highlight the importance of inflammatory mechanisms in vascular recurrence irrespective of AF, provide rationale for the inclusion of patients with AF in trials of anti-inflammatory therapy, and support a selection approach in future trials based on elevated inflammatory marker levels, rather than stroke etiology alone."},{"url":"https://hartvaat.nl/2025/01/01/vroege-heropnames-na-chirurgische-aortaklepvervanging-beinvloeden-trial-eindpunt/","doi":"https://www.sciencedirect.com/science/article/pii/S0735109726002159?dgcid=rss_sd_all","title_en":"Surgical Aortic Valve Replacement: Early Rehospitalizations and Their Implication for Trial Endpoints","journal":"JACC","source_date":"2025-01-01","abstract_original":"Publication date: Available online 4 March 2026Source: JACC"},{"url":"https://hartvaat.nl/2025/01/01/ai-analyse-van-ecg-als-digitale-biomarker-voor-hartfalen/","doi":"https://www.sciencedirect.com/science/article/pii/S0735109725103446?dgcid=rss_sd_all","title_en":"The Emerging Role of ECG-AI as a Digital Risk Biomarker for Incident Heart Failure","journal":"JACC","source_date":"2025-01-01","abstract_original":"Publication date: 3 March 2026Source: JACC, Volume 87, Issue 8"},{"url":"https://hartvaat.nl/2025/01/01/wat-betekent-verbetering-bij-hypertrofische-cardiomyopathie/","doi":"https://www.sciencedirect.com/science/article/pii/S0735109726002093?dgcid=rss_sd_all","title_en":"What Does Improvement Mean?: Interpreting Progress and Evidence in Hypertrophic Cardiomyopathy","journal":"JACC","source_date":"2025-01-01","abstract_original":"Publication date: 3 March 2026Source: JACC, Volume 87, Issue 8"},{"url":"https://hartvaat.nl/2026/03/23/transapicale-tavi-met-de-j-valve-bij-ernstige-aortaklepinsufficientie-vergelijkb/","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e003969?rss=1","title_en":"Comparing TA-TAVR and SAVR in severe aortic regurgitation: outcomes and valve haemodynamics","journal":"Open Heart","source_date":"2026-03-23","abstract_original":" Transcatheter aortic valve replacement (TAVR) has already been recommended for some high-risk patients with aortic valve regurgitation, but there is still a lack of evidence regarding its early-term and medium-term safety and effectiveness compared with surgical aortic valve replacement (SAVR). This retrospective study included patients who underwent bioprosthetic aortic valve replacement for severe aortic regurgitation (AR) at a single centre between January 2018 and December 2023. All patients in the TAVR group received the J-Valve system via transapical (TA) approach. Propensity score matching (PSM) was used to balance the groups. The primary endpoint was 2-year all-cause mortality. Secondary endpoints included other clinical events, left ventricular (LV) function recovery and prosthesis haemodynamics, assessed by transthoracic echocardiography. A total of 369 patients (median age 68 years, 26.6% female) were enrolled. Of these, 256 underwent TA-TAVR and 113 underwent SAVR. After 1:1 PSM, 76 matched pairs were included. There were no statistical differences between the groups in all-cause mortality, cardiovascular mortality, stroke, heart failure rehospitalisation, permanent pacemaker implantation or moderate to severe paravalvular leakage at 30 days or 2 years. Before PSM, left ventricular ejection fraction (LVEF) improved in the TAVR group (57% (IQR: 45–63%) vs 61% (IQR: 55–65%), p<0.001), with no significant change in the SAVR group (61% (IQR: 55–65%) vs 62% (IQR: 59–66%), p>0.05). After PSM, LVEF improvement was comparable between groups (+4.0% (IQR: –1.5 to 10.0) vs +2.0% (IQR: –3.0 to 9.5), p=0.430). Haemodynamics was superior in the TAVR group (p<0.001), while regression of LV dimensions was greater in the SAVR group. In patients with severe AR, using the J-Valve for TA-TAVR showed comparable outcomes to SAVR regarding mortality and other clinical events. TAVR provided superior valve haemodynamics and was an effective treatment that significantly improved LV function, especially in high-risk patients. Iron deficiency (ID) is common in patients with heart failure (HF). Current guidelines define ID based on serum ferritin and transferrin saturation (TSAT) rather than soluble transferrin receptor (STFR) or ratios such as iron/STFR or TSAT/STFR. We investigated the associations between these biomarkers and prognosis in patients with new-onset HF with reduced ejection fraction (HFrEF). All patients hospitalised in 2016–2020 at Sahlgrenska University Hospital with new-onset HFrEF who had iron biomarkers measured within 6 months of discharge were included, with follow-up from the date of the iron biomarker test until 31 December 2021. The primary composite event of interest was first re-hospitalisation for HF (HHF) or all-cause mortality. The associations between ID biomarkers and endpoints were analysed using Cox regression adjusted for age, sex, previous HF, left ventricular ejection fraction, HF medications and comorbidity. Bonferroni-Holm correction was applied for multiple testing. Of 325 patients included (median age 68 (57–76) years, 70.2% men), 168 (52%) had ID using current guideline criteria and STFR was available for 224 (69%) patients. Median follow-up was 2.2 years. In the prespecified analysis plan, biomarkers of ID were not statistically significantly associated with the primary composite endpoint, although each SD increase in TSAT was associated with 56% lower risk of HHF (0.44 [0.27–0.71]) as were increased ratios of iron/STFR (0.58 [0.40–0.86]) and TSAT/STFR (0.55 [0.37–0.83]). However, in a post hoc sensitivity analysis in which patients with extreme values were excluded, each increase in SD of TSAT was associated with 47% lower risk of the primary composite endpoint (0.53 [0.35–0.79]). Lower TSAT is associated with a greater risk of clinical events in patients with new-onset HF, as were the ratios of iron/STFR and TSAT/STFR. However, neither ratio appeared to offer a substantial advantage compared with TSAT alone. Pericardium is considered electrically inert, but diffuse ST-elevation is an electrocardiographic marker of acute pericarditis. We hypothesised that ST-elevation in acute pericarditis may reflect underlying myocardial involvement. Accordingly, this study aimed to assess the association between ST-elevation and myocardial involvement in pericarditis patients and to further characterise the clinical features and long-term outcomes of myopericarditis compared with isolated pericarditis. This longitudinal multicentre study included 351 pericarditis patients (328 recurrent; 180 females), 70/351 with myopericarditis, defined by troponin elevation and/or suggestive cardiac MRI. 121 patients had ST-elevation (34.5%); they were younger: 38 years (23–53) vs 47 (31–58) (median (IQR)) (p<0.001), more often male: 63.6% (77/121) vs 40.9% (94/230) (p<0.001) and had higher C reactive protein values: 92.0 (35–170) vs 58.4 mg/L (15.8–137.5) (median (IQR)) (p=0.002) and less frequent pericardial effusions: 71.1% (86/121) vs 83.5% (192/230) (p=0.004). Myocardial involvement was diagnosed in 70/351 (19.9%) patients, occurring more frequently among those with ST-elevation: 26.4% (32/121), compared with those without: 16.5% (38/230) (p=0.035). ST-elevation predicted myocardial involvement with an OR of 1.82 (95% CI 1.07 to 3.10). Compared with isolated pericarditis, patients with myopericarditis were more frequently male: 61.4% (43/70) vs 45.6% (128/281) (p=0.023) and had a higher prevalence of transient systolic dysfunction: 13.5% (7/52) vs 2.1% (3/141) (p=0.004). During follow-up, myopericarditis patients had a lower remission rate: 18.5% (12/65) vs 31.2% (82/263) (p=0.047) and a higher annual hospitalisation rate (median 0.5 vs 0.4/year, p=0.010), while recurrence rates and disease duration were similar. Treatment strategies, including use of corticosteroids and interleukin 1 blockers, were also comparable. ST-segment elevation in acute pericarditis was associated with myocardial involvement, supporting the concept that the pericardium is electrically inert. Myopericarditis was associated with lower remission rates and slightly higher hospitalisation needs compared to isolated pericarditis, despite otherwise comparable recurrence rates and treatment strategies. To analyse comorbidity measures in relation to cardiovascular disease risk, using data from Swedish healthcare registries. The aim was to evaluate the performance of different indices in predicting incidences of four outcomes: coronary heart disease (CHD), myocardial infarction (MI), heart failure (HF) and stroke. Study population: All individuals in Sweden born between 1936 and 1975, with a look-back for diagnosis data 2010–2014 and followed-up for outcomes from 2024 to 2019, n=4 454 895 individuals. Two age groups: 40–64 and 65–79 years old were studied. We used the area under the receiver operating characteristic curves (AUROC) of age-and-sex, the Nordic Multimorbidity Index (NMI), a set of five cardiovascular risk factors as indicator variables (CV-IV) and explored measures based on inpatient care and numbers of filled prescriptions. In the age group 40–64 years, the AUROCs for age-and-sex alone were higher than those for the indices alone in all analyses: CHD (0.739); MI (0.736); HF (0.730) and stroke (0.685). CV-IV alone showed a higher AUROC for HF (0.694; 95% CI 0.690 to 0.697) than that for NMI (0.643; 95% CI 0.639 to 0.647), and for numbers of filled prescriptions (0.671; 95% CI 0.667 to 0.675). Highest AUROC was observed for HF, when taking age-and-sex into account, for CV-IV (0.781; 95% CI 0.778 to 0.784) followed by numbers of filled prescriptions (0.776; 95% CI 0.773 to 0.780) and NMI (0.771; 95% CI 0.768 to 0.774). Furthermore, AUROC was higher for CV-IV, when taking age-and-sex into account, than that of age-and-sex alone for all outcomes in both age groups. AUROC for age-and-sex alone was higher than that for any other single measure alone for all outcomes. The highest AUROC observed was for CV-IV adjusted for age-and-sex for HF. Thus, simple indicators measuring a few well-established cardiovascular risk factors outperformed a complex index such as the NMI. Similar results were obtained for numbers of filled prescriptions implying possible use as a proxy measure for comorbidity. Metabolic-associated steatotic liver disease (MASLD) is a prevalent chronic liver disease affecting approximately a third of the global population. Early identification is critical for timely intervention, yet effective screening tools remain limited. The American Heart Association’s Life’s Simple 7 (LS7), originally developed to assess cardiovascular health, captures several metabolic domains that overlap with the diagnostic criteria of MASLD. Consequently, observed associations between LS7 and MASLD are expected to partly reflect shared metabolic components rather than independent risk prediction. We analysed data from 3204 participants undergoing screening colonoscopy in the Salzburg Colon Cancer Prevention Initiative (Sakkopi). LS7 was derived from seven modifiable lifestyle factors (smoking, body mass index, blood pressure, cholesterol, fasting glucose, physical activity and diet). MASLD was assessed using abdominal ultrasonography, while liver fibrosis was evaluated through non-invasive markers (Aspartate Aminotransferase to Platelet Ratio Index and transient elastography). Poisson regression with robust SEs was used to estimate risk ratios (RRs) for MASLD and liver fibrosis across LS7 categories (poor: 0–4, intermediate: 5–9, ideal: 10–14), adjusting for age, sex and socioeconomic status. MASLD prevalence was highest in individuals with poor LS7 (82%) compared with those with intermediate (47%) and ideal (16%) scores. Higher LS7 was significantly associated with a lower risk of MASLD (RR 0.80; 95% CI 0.79 to 0.82; p<0.001) and liver fibrosis after adjustment for confounders. LS7 showed a strong association with MASLD and hepatic steatosis, while associations with non-invasive fibrosis markers were weaker and marker-dependent, underscoring the close interplay between cardiometabolic health and liver disease. Future studies should evaluate whether changes in LS7 over time are associated with longitudinal changes in hepatic steatosis and fibrosis-related outcomes. Preprocedural risk prediction of 30-day all-cause mortality after percutaneous coronary intervention (PCI) aids in clinical decision-making and benchmarking hospital performance. This study aimed to identify preprocedural factors to predict the risk of 30-day all-cause mortality post-PCI using machine learning (ML) approaches. The study analysed 93 055 consecutive PCI procedures recorded in the Victorian Cardiac Outcomes Registry in Australia. The Boruta feature selection method was used to identify key predictive variables. Seven ML algorithms were employed for models’ development and validation. Models’ performance was assessed using standard metrics for validation data set. SHapley Additive exPlanations method was used to explain leading predictive variables. Among the seven ML algorithms, the Extreme Gradient Boosting (XGB) model had the better performance across most metrics, such as accuracy (86.7%), root mean square error (36.5%), specificity (82.5%), precision (54.0%), F1 score (52.7%) and Brier score (13.3%). The XGB model also demonstrated strong discriminatory power, achieving a receiver operating characteristics-area under the curve of 85.5% (95% CI 83.5% to 87.4%). The XGB model identified left ventricular ejection fraction, acute coronary syndrome, estimated glomerular filtration rate, age and complex lesions as the five leading factors associated with 30-day mortality post-PCI. Other factors, in order, were cardiogenic shock, body mass index, intubated out-of-hospital cardiac arrest, lesion location, mechanical ventricular support, gender and peripheral vascular disease. The XGB model demonstrated the best performance in predicting 30-day all-cause mortality post-PCI, identified most influential predictors such as severely reduced ejection fraction, ST-elevation myocardial infarction presentation, severe renal impairment, age 80 years and older and complex lesion. These factors from the XGB model could support individualised risk assessment, informed clinical decision-making, improved patient care or efficient resource utilisation for an Australian population. Further external validation is essential to confirm the model’s generalisability across different populations. The PRECISE study demonstrated that the Prospective multicentre imaging study for evaluation of chest pain (PROMISE) Minimal risk score (PMRS) can identify patients with recent onset stable chest pain who could safely be reassured and discharged without further testing. Despite this observation, the PMRS is not in widespread use. The aim of this analysis was therefore to retrospectively evaluate the performance of the PMRS had it been applied as a decision tool in a real-world population. We performed a retrospective cohort analysis of all stable chest pain referrals from 03 April 2023 to 30 August 2024. All elements of the PMRS were measured, along with key patient outcomes including subsequent investigations and cardiovascular events (myocardial infarction (MI) and all-cause mortality). Statistical analyses were conducted in accordance with the data type and distribution. The cohort was split into the minimal risk cohort (PMRS >0.46) and the remainder of the cohort (PMRS ≤0.46). A Kaplan-Meier curve, with log rank analysis, was created to compare the incidence of death/MI between the minimal risk and the remainder of the cohort. This analysis included 3983 patients with a median age of 64 years (IQR 55–75 years) and 49.5% female. The median PMRS was 0.102 (IQR 0.041–0.257) with 10.9% (436) categorised as minimal risk (PMRS >0.46). In the minimal risk group, there were three CT coronary angiographies (0.7%) that demonstrated obstructive coronary disease. At a median follow-up of 306 days (IQR 177–428) there were no MI or deaths recorded in the minimal risk group. These data demonstrate that a PMRS >0.46 is associated with a very low frequency of significant coronary artery disease and MI or death. This proof of concept suggests that PMRS could be safely instituted into clinical practice to defer those patients at minimal risk from further investigations which would result in significant resource savings for healthcare services. Japanese guidelines recommend a corticosteroid maintenance dose of 5–10 mg/day for cardiac sarcoidosis (CS); however, the optimal dose remains unclear. This study aimed to evaluate the impact of maintenance dose and corticosteroid re-escalation on prognosis in patients with CS. This multicentre retrospective cohort study used data from a Japanese nationwide CS registry. A total of 352 patients diagnosed according to the Japanese Circulation Society 2016 guideline and treated with oral corticosteroids were included. Patients were grouped by maintenance dose: low (<5.0 mg/day), recommended (5.0–10.0 mg/day) and high (>10.0 mg/day). Clinical outcomes were analysed. The main outcome was all-cause mortality. The low-dose, recommended-dose and high-dose groups comprised 11% (n=40), 78% (n=276) and 10% (n=36) of patients, with mean maintenance doses of 2.2 mg/day, 6.7 mg/day and 16.2 mg/day, respectively. During a median follow-up of 5.12 years, 39 patients (11%) died. Kaplan-Meier survival analysis showed statistically better survival in the recommended dose group, with the high-dose group showing statistically significantly worse outcomes (log-rank p=0.012). Corticosteroid re-escalation occurred in 19% of patients (9% before and 11% after achieving maintenance dose). All-cause mortality was 8% in the recommended-dose group versus 25% in the low-dose and 17% in the high-dose groups. In univariable analyses, re-escalation after achieving maintenance was associated with mortality in the high-dose group (HR 4.34, 95% CI 1.24 to 98.3), whereas re-escalation before achieving maintenance was associated with mortality in the low-dose group (HR 19.41, 95% CI 2.71 to 138.5). A recommended maintenance dose of corticosteroids was associated with better prognosis in patients with CS. Achieving and maintaining this dose appears critically important in clinical management. To develop diagnostic models to predict initial heart failure (HF) hospitalisation in patients with unstable angina (UA) and prognostic models to predict rehospitalisation for recurrent or new-onset HF after discharge, aiming to enhance early identification and patient care strategies. We retrospectively analysed data from 12 857 acute coronary syndrome patients (January 2015 to March 2023). After screening, 7092 UA patients were included and randomly divided into a training cohort (4964) and a validation cohort (2128). Logistic regression and least absolute shrinkage and selection operator (LASSO) regression identified risk factors. Diagnostic models were developed and evaluated using receiver operating characteristic curves. Using the same predictors, prognostic models predicted rehospitalisation at 1, 2 and 6 months postdischarge. The lambda.1se criterion in LASSO regression identified three key risk factors: left ventricular diameter, N-terminal pro–B-type natriuretic peptide and ischaemic cardiomyopathy. The diagnostic model’s area under the curve (AUC) was 0.938 (95% CI 0.909 to 0.955) in the training cohort and 0.931 (95% CI 0.901 to 0.956) in the validation cohort, showing consistent and reliable performance. Prognostic models for 1, 2 and 6 months postdischarge had AUC values of 0.770, 0.794 and 0.751, respectively, supporting their utility in prognostic evaluations. The UA diagnostic and prognostic HF model was developed and validated. These models can quickly identify high-risk patients, enabling prompt and tailored interventions. Cardiovascular disease (CVD) is the leading cause of mortality worldwide, while depression is highly prevalent in this patient population and has long been regarded as an independent risk factor for increased mortality. However, recent evidence suggests that this association may be influenced by symptom overlap and residual confounding that has not been fully accounted for. This study aimed to evaluate the association between clinically significant depressive symptoms and the risk of all-cause, cardiovascular and non-cardiovascular mortality in adults with CVD. We conducted a secondary analysis of 2064 adults with a history of CVD using data from the National Health and Nutrition Examination Survey 2011–2018 linked with the National Death Index. Depression was defined using the Patient Health Questionnaire-9 with a cut-off score of 10 or higher. Primary outcomes were all-cause, cardiovascular and non-cardiovascular mortality. Statistical analyses were performed using R software. We employed multivariable Cox regression models as well as propensity score matching and inverse probability weighting to control for potential confounders. Over a median follow-up of 4.67 years, 403 deaths were recorded. In an adjusted multivariable Cox model controlling for age, sex and race, depression was associated with an increased risk of all-cause mortality (HR 1.33; 95% CI 1.02 to 1.75) and non-cardiovascular mortality (HR 1.46; 95% CI 1.04 to 2.05). However, after applying propensity score matching and inverse probability weighting, these associations were no longer statistically significant for any mortality outcome. After rigorous adjustment for confounders and comorbidities, depression was no longer identified as an independent risk factor for mortality among patients with CVD. To evaluate sex differences in perioperative characteristics, in-hospital outcomes and long-term survival following coronary artery bypass grafting (CABG). Prospective data were collected for all patients undergoing isolated CABG at a single centre during 2001–2021. Baseline characteristics were adjusted between females and males using 1:1 propensity score matching (nearest-neighbour, without replacement). Kaplan-Meier analysis assessed long-term survival. A predefined sub-analysis assessed risk mitigation associated with using off-pump CABG (OPCABG) in females in the matched cohort. Prematching, 11 563 males and 2573 females were included. Females were older with higher prevalences of class III–IV angina, hypertension and diabetes. After matching, 2573 patients per group were analysed, with standardised mean differences <0.1 for all covariates. Females had fewer left internal mammary artery (LIMA) grafts (84% vs 88%, p<0.001), fewer total grafts (median 2 vs 3, p<0.001), higher in-hospital mortality (2.2% vs 1.3%, OR 1.74, 95% CI 1.14 to 2.71, p=0.011) and longer hospital stays (median 7 days vs 6 days, beta 0.51, 95% CI 0.12 to 0.90, p=0.01). Long-term survival was similar (stratified log-rank p=0.79). OPCABG mitigated the risk of in-hospital mortality in females (1.1% males vs 1.6% females, OR 0.69, 95% CI 0.33 to 1.43, p=0.32; 1.6% OPCABG females vs 3.0% on-pump females, OR 0.53, 95% CI 0.31 to 0.91, p=0.021). Females suffer higher in-hospital mortality and receive fewer LIMA and total number of grafts than males; however, 20-year survival is similar. OPCABG protects females from in-hospital mortality. A new female-tailored peri-operative care approach is warranted for females undergoing CABG. Patients with heart failure (HF) frequently suffer from undetected declines in cardiorespiratory fitness (CRF), which significantly increases their risk of poor outcomes. However, current clinical practice lacks effective tools for early CRF risk stratification. We conducted an artificial intelligence (AI)-driven unsupervised clustering analysis based on 15 multimodal clinical variables—including metabolic, inflammatory and body composition indicators—in 505 patients with HF. The associations between clustering-derived phenotypes and CRF impairment (maximal oxygen uptake (VO2 max) ≤20 mL/kg/min) were evaluated using multivariable logistic regression and five supervised machine learning models. SHapley Additive exPlanations analysis was applied for model interpretability. External validation was performed in an independent cohort of 201 patients. Three distinct phenotypes were identified: balanced, inflammatory-sarcopenic and metabolically dysregulated. Compared with the balanced phenotype, both non-balanced phenotypes showed significantly higher odds of impaired VO2 max. In the derivation cohort test set, random forest (area under the curve (AUC)=0.75; 95% CI 0.62 to 0.87) and XGBoost (AUC=0.74; 95% CI 0.62 to 0.87) demonstrated the best discriminative performance. In the external validation cohort, the highest discrimination was observed for Naive Bayes (AUC=0.75; 95% CI 0.67 to 0.83), followed by random forest (AUC=0.74; 95% CI 0.58 to 0.91). By integrating multimodal clinical data with AI-driven clustering and machine learning, this study identified novel CRF risk phenotypes in patients with HF and established a highly interpretable and generalisable risk stratification model. These findings offer a valuable framework for early functional assessment and pave the way for precision rehabilitation strategies in HF management. Cascade-tested relatives of individuals with pathogenic genetic variants in sarcomere genes causing hypertrophic cardiomyopathy are recommended. Little is known about the outcomes in cascade-identified relatives. We aimed to characterise the endpoints for these individuals. A retrospective cohort case note evaluation of 64 families reviewed by NHS Tayside Clinical Genetics between January 2010 and December 2018 was conducted, identifying 280 patients. The primary endpoint of the study was the composite endpoint of the onset of a repeat major adverse cardiac event (MACE). Analysis of covariance was used to model marginal mean estimates for baseline interventricular size. Cox proportional hazards model was used to depict time to MACEs. Asymmetrical septal hypertrophy fulfilling diagnostic criteria on echocardiography was noted in 35.4% of cascade-tested individuals. Adjusted interventricular septal size for cascade-tested individuals with a positive genotype (13.9 mm; 95% CI (12.1 to 15.8)) was lower than that of probands with a pathogenic variant (22.1 mm; 95% CI (19.7 to 24.4); p<0.001) but higher than that of cascade-tested individuals with no genotype (12.3 mm; 95% CI (10.2 to 14.4); p<0.001). Adjusted multivariate event analysis demonstrated decreased risk of adverse cardiac events in cascade-identified individuals compared with probands with a genotype (HR 4.0; 95% CI (1.9 to 8.5); p<0.001) and increased risk compared with cascade-identified relatives without a genotype (HR 3.3 (1.2 to 9.1); p<0.001). Our results demonstrate that cascade-tested individuals carrying a pathogenic sarcomere variant retain a degree of complication justifying their identification and follow-up. People living with HIV (PWH) are at increased risk of cardiovascular disease; however, evidence from Asian populations remains limited. We evaluated the prevalence and characteristics of carotid plaques among PWH and people without HIV (PWoH) in China to examine the impact of HIV infection on subclinical atherosclerosis. In this cross-sectional study conducted at the Shanghai Public Health Clinical Center, China, we enrolled 1390 PWH and 1390 age-frequency and sex-frequency matched PWoH aged 40 years or older. Carotid ultrasonography was used to assess the presence, number and echogenicity of carotid plaques. The prevalence of carotid plaques was significantly higher in PWH than in PWoH (45.3% vs 37.5%, p<0.001), and the prevalence of echo-lucent plaques was also higher (21.1% vs 18.0%, p=0.045). Among participants with carotid plaques, PWH were more likely to have three or more plaques (35.8% vs 21.2%, p<0.001) and a greater maximum plaque thickness (2.0 mm vs 1.9 mm; p=0.026). After adjustment for age, sex and dyslipidaemia, HIV infection remained independently associated with increased odds of carotid plaques (adjusted OR (aOR)=1.45; 95% CI 1.23 to 1.70) and echo-lucent plaques (aOR=1.24; 95% CI 1.02 to 1.50). Associations were strongest among men and younger participants. No HIV-related clinical factors were significantly associated with carotid plaque presence. HIV infection is independently associated with an increased carotid plaque burden and echo-lucent plaque features, suggesting accelerated atherosclerosis beyond traditional risk factors. These findings support routine cardiovascular risk assessment and early preventive strategies in PWH. Estimates of long-term atrial fibrillation (AF) incidence in individuals with sinus rhythm are limited. This study investigated age-stratified and sex-stratified long-term incidence of AF in individuals with baseline sinus rhythm and no history of AF, and examined associations between AF, ischaemic stroke and overall cardiovascular disease (CVD). Participants were recruited to the population-based Interplay Between Genetic Susceptibility and External Factors cohort, initiated in western Sweden (2001–2004). Follow-up of incident diagnoses and mortality continued through national registers until 31 December 2022. Cumulative incidence of AF was calculated accounting for the competing risk of death. Cox regression models assessed associations between AF as a time-varying exposure, incident ischaemic stroke and overall CVD, adjusting for confounding. 2967 AF-free participants were included (mean age 50.7±13.4 years; 52.9% female). During 53 447 person-years of follow-up (median 20.1 years), 356 (12.0%) developed AF (incidence rate 6.66 per 1000 person-years). At 20 years, the cumulative incidence of AF accounting for competing risk of death was 2.1% (<45 years at baseline), 13.3% (45–65 years) and 29.5% (>65 years). Men had a higher incidence than women in all age groups. Incident AF was associated with ischaemic stroke (HR 1.80, 95% CI 1.19 to 2.72) and overall CVD (HR 2.07, 95% CI 1.60 to 2.68). AF was a common long-term outcome, particularly among older adults and men, and was associated with subsequent stroke and CVD. Age-specific and sex-specific risk stratification may inform targeted follow-up and early AF detection. Worse prognosis in cardiac sarcoidosis (CS) is likely associated with diagnostic delay and cardiac involvement as first sarcoidosis (de novo) presentation, but data are limited. We retrospectively investigated 95 patients with CS diagnosed 2003–2024. Using electronic health records, the date of first CS symptoms/signs, immunosuppressant therapy and follow-up data including left ventricular ejection fraction (LVEF), biomarkers and cardiac device therapy were extracted. Median time from first symptoms/signs to CS diagnosis (9 months) was used to define delayed diagnosis. Implantation of cardiac resynchronisation therapy defibrillator was more likely in patients with diagnostic delay (p=0.01). No difference was observed in time to diagnosis between patients with de novo CS (n=49) and those with prior extracardiac sarcoidosis (ECS) (n=46). Severe symptoms at disease onset were more common in de novo CS. At a median of 46 months from diagnosis, de novo patients more often had reduced LVEF (p=0.006) and an implantable cardioverter defibrillator (p<0.05) than those with prior ECS despite receiving more immunosuppressant therapy. De novo patients with diagnostic delay more often had reduced LVEF at CS presentation. Symptom presentation is likely associated with diagnostic delay, but the disease presentation and course seem more severe in de novo CS and may not be altered by immunosuppressants, or demand more aggressive therapy. Invasive coronary function testing (CFT) is indicated in patients with refractory angina with non-obstructed coronary arteries (ANOCA). Despite this, questions remain regarding patient selection for testing, safety and integration of CFT within clinical pathways and the impact that endotyping has on long term management of these patients. This study aims to investigate the safety of CFT in patients presenting with anginal chest pain, the prevalence of ANOCA endotypes in the tested population, and the impact of CFT on prescribed medical therapy and secondary care resource utilisation. A retrospective analysis of electronic case records of 159 consecutive patients who underwent complete invasive CFT at two UK centres between June 2022 and December 2024 was performed. All patients were tested for endothelium-independent coronary microvascular dysfunction (CMD) and coronary vasospasm (vasospastic angina (VSA)). 44 patients (27.6%) also underwent endothelial function assessment. The median length of follow-up was 9 months (IQR 4–16). An ANOCA endotype was identified in 101 patients (63.5%) (CFT+ve). Of those, 24 (23.8%) were diagnosed with isolated CMD, 53 (52.4%) with isolated VSA and 24 (23.8%) with a mixed endotype. Five (3.1%) experienced intraprocedural adverse events. In 123 patients (77.3%), CFT led to a change in medical therapy. Re-hospitalisation for recurrent chest pain occurred in 21.7% of CFT+ve and 13.7% of CFT–ve patients, with the majority re-presenting within 6 months of CFT. VSA was linked to higher re-hospitalisation odds (OR 2.64 (1.10–6.33), p=0.03), and patients with VSA tended to re-present earlier than others (p=0.017). Higher antianginal therapy prescription and prior emergency presentations were also predictive of risk of re-presentation (OR 1.61, p=0.02 and OR 4.18, p=0.001, respectively). CFT testing had low intraprocedural risk and influenced onward management. Hospitalisation for chest pain post CFT testing was common. Further refinement of clinical pathways, including early follow-up for medical optimisation, is suggested. The integration of artificial intelligence (AI) and machine learning (ML) into cardiology represents one of the most profound opportunities to transform patient care. Automated diagnostics, predictive analytics and prescriptive treatment recommendations promise to reshape workflows, improve efficiency and get us closer to the much-heralded precision cardiovascular medicine. Yet, as the scoping review by Hussain et al Within just the past few years, nearly 300 AI-driven medical devices have been cleared by the United States Food and Drug Administation (FDA) for clinical use in cardiology and this number will almost certainly grow rapidly in the future. A woman in her 30s was admitted to our hospital with palpitations and shortness of breath for 2 years. Auscultation revealed a grade 2–3/6 midsystolic murmur with a wide and fixed splitting S2. ECG indicated sinus tachycardia. Transthoracic echocardiography revealed a well-defined, fluid-filled, round cystic mass with a size of 40x50 mm near the criss-cross atrioventricular connection ( Transthoracic echocardiogram. (A) The cystic mass in the end-diastolic phase, (B) the cystic mass in the end-systolic phase and (C) the secundum atrial septal defect. Patients with hypertrophic cardiomyopathy (HCM) often reduce their physical activity due to concerns about sudden cardiac death. However, objective data on activity patterns in HCM, particularly in relation to clinical phenotype and quality of life (QoL), remain limited. We assessed physical activity using 7-day accelerometry in 203 patients with HCM and 37 genotype-positive, phenotype-negative (G+/P–) individuals. Outcomes included daily step counts, time spent in moderate-to-vigorous physical activity (MVPA) and sedentariness. QoL was measured using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the EuroQoL 5-domain 5-level (EQ-5D-5L). HCM patients took fewer steps/day (5254 vs 6573), engaged in less MVPA (3.4% vs 4.5% of the day) and were more often sedentary (61% vs 35% spending >80% of the day sedentary) compared with G+/P– controls (all p<0.01). Symptomat"},{"url":"https://hartvaat.nl/2026/02/23/biologische-versus-mechanische-prothesen-bij-aortaklepvervanging-op-middelbare-l/","doi":"http://heart.bmj.com/cgi/content/short/112/6/341?rss=1","title_en":"Comparative evaluation of biological and mechanical prostheses for aortic valve replacement in a middle-aged population: a population-based cohort study","journal":"Heart","source_date":"2026-02-23","abstract_original":" Current guidelines for aortic valve replacement (AVR) lack consensus on prosthesis selection in middle-aged patients. This study aimed to provide a comprehensive comparison of long-term outcomes following AVR with mechanical versus biological prostheses among middle-aged patients in an Asian population. This retrospective cohort study used Taiwan’s national claims database, including patients aged 45–64 years who underwent AVR between 2006 and 2021 across 46 hospitals. Propensity score matching was applied to achieve covariate balance. Risks of all-cause mortality and major adverse prosthesis-related events (major bleeding, ischaemic stroke, aortic valve reoperation, endocarditis and sudden cardiac death) were compared using restricted mean survival time (RMST) and subdistribution HRs (sHRs) to account for competing risks. Subgroup analyses were performed for patients aged 45–54 and 55–64 years. Electrocardiographic imaging (ECGI) is a non-invasive technique that combines patient-specific cardiac anatomy with numerous body-surface potentials to gain insight into the in vivo electrical epicardial activity across the whole heart. This review summarises some of the latest hardware developments for ECGI data acquisition as well as innovative software solutions to address the inverse problem of electrocardiography. It delves into some of the successful clinical applications of ECGI while highlighting the hurdles that still stand in the way of its more widespread roll-out to healthcare. As well as serving as a powerful tool for electrophysiological research, ECGI promises to play an increasingly valuable role in the personalised diagnosis and management of cardiac arrhythmias. Composite outcomes in cardiovascular trials often group events of unequal clinical importance, and conventional analyses may obscure treatment trade-offs. Generalised pairwise comparisons (GPC), expressed as a win ratio (WR), allow for hierarchical ranking of events and incorporation of recurrent outcomes, providing a potentially more intuitive assessment of benefit–risk. In a prespecified exploratory analysis of the 2x2 factorial, randomised CLEAR (Colchicine and Spironolactone in Patients with Myocardial Infarction) trial (7062 patients within 72 hours of acute myocardial infarction (MI) and percutaneous coronary intervention), we applied both time-to-first and recurrent-event GPC to reassess low-dose colchicine (0.5 mg daily) and spironolactone (25 mg daily) versus placebo. For the colchicine comparison, the hierarchical benefit–risk outcome included all-cause death, strok"},{"url":"https://hartvaat.nl/2026/02/23/luchtvervuiling-en-multimorbiditeit-verhogen-het-risico-op-atriumfibrilleren/","doi":"http://heart.bmj.com/cgi/content/short/112/6/318?rss=1","title_en":"Impact of air pollution and multimorbidity on the risk of incident atrial fibrillation","journal":"Heart","source_date":"2026-02-23","abstract_original":" Emerging evidence suggests associations between air pollution, multimorbidity, and atrial fibrillation (AF), but their interplay remains unclear. We evaluated these relationships in a prospective cohort. We retrieved a total of 480 344 individuals from the UK Biobank. The quantification of air pollutants (particulate matter with a diameter ≤2.5 μm (PM2.5), particulate matter with a diameter ≤10 μm (PM10), nitrogen oxides (NOx) and nitrogen dioxide (NO2)) was conducted at the geocoded residential locations of each participant. Multimorbidity clusters were determined using latent class analysis using 35 long-term conditions (LTCsc. Three latent classes were identified: non-cardiovascular disease (non-CVD) multimorbidity, mental health multimorbidity and cardiometabolic multimorbidity. These were compared with no LTCs and singular LTCs. Cox models examined the effects of"},{"url":"https://hartvaat.nl/2026/02/23/regulering-van-ai-in-de-cardiologie-door-de-fda-een-scoping-review/","doi":"http://heart.bmj.com/cgi/content/short/112/6/300?rss=1","title_en":"Is the FDA regulation of cardiology AI devices supporting cardiovascular innovation: a scoping review","journal":"Heart","source_date":"2026-02-23","abstract_original":" Artificial intelligence (AI) and machine learning (ML) have shown immense potential in cardiology, leveraging data-driven insights to enhance diagnosis, treatment planning and patient care. This study presents a comprehensive evaluation of US Food and Drug Administration (FDA)-approved AI/ML devices in cardiology, analysing trends in clinical applications, regulatory pathways and evidence transparency. FDA clearance summaries from the AI/ML medical device database were reviewed to identify cardiology-specific applications. Devices were categorised using the descriptive, diagnostic, predictive and prescriptive framework. Regulatory pathways, AI technologies and validation data were critically assessed. Of 1016 FDA-approved AI/ML devices, 277 (27.3%) had cardiology applications, predominantly for imaging (65.3%) and diagnostics (64.3%). Predictive and prescriptive tools constituted only 5."},{"url":"https://hartvaat.nl/2026/02/23/nierbescherming-na-harttransplantatie-risicoreductie-en-therapeutische-mogelijkh/","doi":"10.1161/CIRCHEARTFAILURE.125.013747","title_en":"Mitigating Risk of Kidney Dysfunction After Heart Transplantation and Therapeutic Approaches.","journal":"Circulation. Heart failure","source_date":"2026-02-23","abstract_original":"Kidney dysfunction after heart transplantation (HT) is associated with significant morbidity and mortality. Recipient and perioperative factors may all influence the risk of kidney injury. Furthermore, data suggest that the incidence of kidney dysfunction, both acute and chronic, is increasing after the implementation of the United States' 2018 allocation system due to increasing use of temporary mechanical circulatory support and changing recipient characteristics. While data are robust regarding nephroprotective therapies such as renin-angiotensin-aldosterone system inhibition and SGLT2 (sodium-glucose cotransporter 2) inhibitors to minimize the progression of chronic kidney disease in patients with heart failure, data in HT recipients are beginning to emerge. This state-of-the-art review will critically examine the existing literature regarding the epidemiology of kidney dysfunction after HT, mitigation strategies for acute kidney injury and chronic kidney disease, including pharmacotherapeutics, the need for kidney transplantation after HT, and practical next steps for the larger HT community."},{"url":"https://hartvaat.nl/2026/02/23/diabetes-verhoogt-het-risico-op-hartfalen-bij-myocarditis/","doi":"10.1093/eschf/xvag064","title_en":"Diabetes Increases the Risk of Heart Failure in Myocarditis: A Propensity-Matched Nationwide Database Analysis.","journal":"ESC heart failure","source_date":"2026-02-23","abstract_original":"BACKGROUND: The impact of diabetes on non-atherosclerotic cardiac disease has not been studied extensively. We aimed to assess the in-hospital and long-term effects of diabetes in patients hospitalized for myocarditis. METHODS: The Nationwide Readmissions Database (2016-2020) was used to identify adults hospitalized with a primary diagnosis of myocarditis. Patients were stratified by the presence of diabetes, and those discharged alive were followed for a calendar year. The primary outcome was in-hospital mortality. Secondary outcomes included in-hospital ventricular fibrillation, ventricular tachycardia, acute renal failure, cardiogenic shock, heart failure, and one-year all-cause readmission, readmission for heart failure, and mortality. Multivariable logistic and Cox regression models were applied, and propensity score matching was performed as a sensitivity analysis. RESULTS: Among 8,826 adults with myocarditis, 951 (11%) had diabetes. Compared with patients without diabetes, those with diabetes were older, had a higher prevalence of comorbidities, and showed an increased adjusted risk of in-hospital acute renal failure [aOR=1.74 (95% CI: 1.42-2.12)], heart failure [aOR=1.62 (95% CI: 1.37-1.91)], cardiogenic shock [aOR=1.36 (95% CI: 1.04-1.78)], but not of mortality, ventricular fibrillation, and ventricular tachycardia. In one year, diabetes was not associated with higher adjusted risks of all-cause readmission or mortality [aHR=0.81 (95% CI: 0.41-1.60) and aHR=0.81 (95% CI: 0.68-0.97), respectively]. However, it was associated with a higher risk of readmission for heart failure [aHR=1.16 (95% CI: 1.02-1.31)]. These associations remained consistent in propensity score-matched analyses. CONCLUSION: Diabetes independently increases the risk of in-hospital and one-year heart failure in patients with myocarditis."},{"url":"https://hartvaat.nl/2026/02/23/verhoogd-activine-a-bij-peripartum-cardiomyopathie-en-tijdens-lv-herstel/","doi":"10.1093/eschf/xvag062","title_en":"Elevated Activin-A serum levels in patients with acute peripartum cardiomyopathy and during left ventricular recovery.","journal":"ESC heart failure","source_date":"2026-02-23","abstract_original":"AIM: Peripartum cardiomyopathy (PPCM) is an idiopatic form of heart failure occuring in the peripartum phase. Elevated circulating levels of the senescence-associated-secretory-phenotype (SASP) factor Activin-A have been associated with heart failure severity in acute PPCM patients at baseline diagnosis. Here, we investigated Activin-A serum levels in the German PPCM registry in acute PPCM and during left ventricular (LV) recovery. METHODS AND RESULTS: Clinical data including LV ejection fraction (LVEF) and Activin-A serum levels were assessed at initial diagnosis (baseline [BL], ) and during follow-up (FU) at 3 months (M) and 6M in PPCM patients from the German PPCM Registry (n=151, mean age 33±5 years) compared to postpartum healthy controls (n=27, mean age 32±5 years). Activin-A serum levels at BL were elevated (404pg/ml; interquartile range [IQR]: 197-815, n=151) compared to healthy postpartum controls (240 pg/ml, IQR:148-446, n=27; P<0.01) and remained persistently elevated above postpartum healthy controls at 3M (418 pg/ml, IQR: 169-806, n=100) and 6M-FU (520 pg/ml, IQR: 214-1131, n=104). Activin-A levels at BL did not correlate with LVEF (Spearman r=0.10, p=0.2416, n=139), NT-proBNP (r=0.096, p=0.2766, n=131), CRP (r=-0.0008, p= 0.9933; n=110) or PPCM biomarker plasminogen-activator-inhibitor-1 (PAI-1) (r=0.095, p=0.3273, n=109). The majority of PPCM patients showed LV recovery 6M after initial diagnosis, indicated by improved LVEF (PPCM BL: 25%, IQR: 20-33, n=152; 6M-FU: 52% IQR: 45-56, n=128, P<0.0001). Activin-A levels did not differ between full or incomplete LV recovery, or between patients with hypertensive pregnancy disorders. CONCLUSIONS: In PPCM patients from the German PPCM registry Activin-A serum levels were elevated at diagnosis, remained persistently high after 3M- and 6M-FU but were not associated with LV recovery."},{"url":"https://hartvaat.nl/2026/02/23/pathfinder-trial-betere-naleving-van-hartfalenrichtlijnen-in-de-huisartsenprakti/","doi":"10.1093/eschf/xvag061","title_en":"Primary care Adherence To Heart failure guidelines in post-Discharge, Evaluation & Routine management (PATHFINDER): a randomised controlled trial.","journal":"ESC heart failure","source_date":"2026-02-23","abstract_original":"BACKGROUND AND AIMS: Heart failure (HF) management guidelines offer evidence-based recommendations but can be difficult to implement in primary care. This randomised controlled trial evaluated a multifaceted intervention to improve adherence to pharmacological and non-pharmacological HF management guidelines in primary care. METHODS AND RESULTS: Patients hospitalised with HF were randomised 1:1 to an intervention or control group. The intervention group received guideline-based inpatient education, a post-discharge plan including referral to cardiac rehabilitation (CR) and scheduled general practitioner follow-ups at 1 and 4 weeks, and 3 months, supported by a cardiologist-approved medication titration plan. The control group received usual care. The primary outcome, measured at 6 months, was adherence to five recommended treatments: i) ACEI/ARB/ARNI ≥50% target dose, ii) beta blocker ≥50% target dose, iii) MRA at any dose, iv) anticoagulation for atrial fibrillation, and v) CR referral. Adherence was compared using Chi-squared tests and logistic regression.Of 225 participants (25% female), a greater proportion in the intervention group achieved the primary outcome (61.8% vs. 28.7%; p<0.01). The unadjusted odds ratio showed that the intervention group was 6.27 times more likely to achieve the outcome compared to the control group (95% CI, 3.35-11.76, p<0.01). This difference was driven by higher prescription rates of ACEI/ARB/ARNI and beta blocker, and higher referral rates to CR. CONCLUSION: Hospital-based support for HF-management in primary care improved adherence to pharmacological and non-pharmacological components of guideline-recommended care. Greater implementation of transitional care processes of this nature has the potential to improve clinical outcomes for patients with HF."},{"url":"https://hartvaat.nl/2026/02/23/hartfalen-app-verbetert-ziektekennis-bij-patienten-een-gerandomiseerde-pilotstud/","doi":"10.2196/83022","title_en":"Impact of the Cardio-Meds Mobile App on Heart Failure Knowledge and Medication Adherence: Pilot Randomized Controlled Trial.","journal":"JMIR cardio","source_date":"2026-02-23","abstract_original":"BACKGROUND: Heart failure (HF) is a prevalent chronic condition for which optimal management depends not only on guideline-directed medical therapy but also on patients' understanding of their disease, recognition of warning signs, and sustained medication adherence, which remains challenging in routine care. Mobile health interventions may support therapeutic education and self-management; however, many available apps lack validated content and local relevance. Cardio-Meds is a mobile app developed at Geneva University Hospitals to support HF self-management through structured educational content, interactive quizzes, medication lists with reminders, and tools for monitoring weight and vital signs. OBJECTIVE: This study aims to evaluate the impact of a 30-day Cardio-Meds intervention on HF knowledge and medication adherence in patients with HF with reduced or mildly reduced ejection fraction. METHODS: We conducted a single-center, pilot randomized controlled trial in patients followed at the outpatient HF clinic or enrolled in cardiac rehabilitation at Geneva University Hospitals in 2024. Eligible participants had HF with a left ventricular ejection fraction less than 50%, were receiving HF-specific pharmacotherapy, speak French, and owned a smartphone. Participants were recruited by phone and randomized to Cardio-Meds use for 30 days, a self-guided intervention with a single standardized technical support call. Outcomes were self-assessed using standardized questionnaires: HF knowledge and self-management using the Dutch Heart Failure Knowledge Scale (DHFKS; score range 0-15); medication adherence using the Basel Assessment of Adherence to Immunosuppressive Medication Scale, covering initiation, implementation, and persistence; and usability in the intervention group using the System Usability Scale (score range 0-100). Between-group differences in DHFKS scores were analyzed using analysis of covariance adjusted for baseline values. RESULTS: A total of 49 participants were included (25 intervention, 24 control); 78% (n=38) were male, and the mean age was 62 (SD 11.4) years. In the intervention group, median app usage was 123 (IQR 74-273) minutes, with a median of 43 (IQR 19-85) logins. Mean baseline DHFKS scores were similar between groups (intervention 11.1, SD 2.4 vs control 10.5, SD 2.9). At 30 days, mean scores increased significantly in the intervention group (12.4, SD 2.4; mean change +1.3; P<.001) and remained stable in the control group (10.4, SD 3; mean change -0.1; P=.82), with a significant adjusted between-group difference of +1.3 points (P<.001). No significant between-group differences were observed for medication adherence. Usability was high, with a mean score of 84.3 (SD 15), and 64% (16/25) of intervention participants reported that they would continue using the app. CONCLUSIONS: In a stable ambulatory HF population, the Cardio-Meds intervention demonstrated short-term improvement in HF knowledge, while no effect was observed on medication adherence within the 30-day follow-up period. The app showed high usability and acceptability. Larger multicenter studies with longer follow-up are needed to assess clinical impact."},{"url":"https://hartvaat.nl/2026/02/23/arni-verbetert-kwaliteit-van-leven-en-vermindert-ziekenhuisopnames-bij-hartfalen/","doi":"10.1136/bmjopen-2025-111865","title_en":"Association between angiotensin receptor-neprilysin inhibitor use and clinical outcomes in patients with heart failure: a 1-year prospective cohort study from Jordan.","journal":"BMJ open","source_date":"2026-02-23","abstract_original":"OBJECTIVES: Heart failure (HF) is associated with complex symptoms and frequent hospitalisation that reduce patients' quality of life (QoL). This study aims to assess the association between angiotensin receptor-neprilysin inhibitor (ARNI) use and changes in QoL and disease-related outcomes among patients with HF in Jordan. DESIGN: Prospective observational cohort study. SETTING AND PARTICIPANTS: The study was conducted among patients with HF attending the outpatient cardiology clinics at Jordan University Hospital, a tertiary care centre in Amman, Jordan. Patients either initiated on ARNI or receiving angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) were included in the study at a 1:2 ratio. All participants were followed up for up to 1 year after recruitment. The study period was from 4 February 2024 to 29 May 2025. PRIMARY AND SECONDARY OUTCOME MEASURES: Data on QoL, New York Heart Association (NYHA) functional class and left ventricular ejection fraction (LVEF) were collected at baseline and after 3 months of treatment. Hospitalisation data were collected for the preceding year and the year following participants' recruitment. Medication adherence and ARNI side effects were assessed after 3-month of follow-up period. RESULTS: A total of 227 patients with HF were included; 74 were initiated on ARNI, and 153 were receiving ACEIs/ARBs. At baseline, significantly lower QoL scores and LVEF were observed in the ARNI group compared with the ACEIs/ARBs group. After 3-month, the ARNI group showed improvements in all QoL scores, NYHA functional class and LVEF (p<0.05). Worsened QoL scores (symptom stability, symptom burden, self-efficacy domains and clinical summary score) were detected within the ACEIs/ARBs group (p<0.05). One-year post-recruitment a significant reduction in cardiovascular and all-cause hospitalisations (p<0.05) was observed in the ARNI group compared with the ACEIs/ARBs group. Adherence levels assessed after 3 months of treatment were shown to be high in both study groups (p=0.558). The main ARNI side effect was hypotension. CONCLUSIONS: ARNI use was associated with favourable QoL, NYHA class, and LVEF as well as lower hospitalisation rates among patients with HF in Jordan. The safety profile was consistent with previous studies."},{"url":"https://hartvaat.nl/2026/02/23/lichamelijke-activiteit-op-het-werk-en-bloeddruk-sekseverschillen-en-de-rol-van-/","doi":"10.3346/jkms.2026.41.e94","title_en":"Occupational Physical Activity and Blood Pressure: The Role of Leisure Time Physical Activity and Sex Differences.","journal":"Journal of Korean medical science","source_date":"2026-02-23","abstract_original":"BACKGROUND: This study examined the association between occupational physical activity (OPA) and blood pressure (BP), with particular emphasis on sex differences and the moderating role of leisure-time physical activity (LTPA). Elucidating these relationships may support the development of tailored BP management strategies within occupational health contexts. METHODS: A total of 3,909 adults from the Korea National Health and Nutrition Examination Survey were included in the analysis. Propensity score matching was employed to balance covariates between groups. Linear regression analyses were conducted to examine interactions between OPA and both systolic and diastolic BP, accounting for sex differences and LTPA levels. RESULTS: Among males with insufficient LTPA, OPA was significantly associated with higher systolic BP (β = 1.944, P = 0.004). In contrast, no significant association was observed in males with sufficient LTPA. Among females, OPA was significantly associated with lower systolic BP (β = -1.133, P = 0.048), regardless of LTPA status. No significant associations were found between OPA and diastolic BP in either sex. CONCLUSION: The findings reveal sex-specific associations between OPA and BP. In males, OPA was linked to elevated systolic BP in the absence of sufficient LTPA, whereas in females, OPA was associated with lower systolic BP irrespective of LTPA levels. These results suggest a potential protective effect of OPA on systolic BP in females and underscore the need to consider sex, OPA, and LTPA collectively when developing BP management strategies."},{"url":"https://hartvaat.nl/2026/02/23/analytische-validatie-van-een-directe-lp-a-cholesterolbepaling/","doi":"10.1016/j.jlr.2026.101008","title_en":"Analytical Validation of Direct Lipoprotein(a)-Cholesterol Assay.","journal":"Journal of lipid research","source_date":"2026-02-23","abstract_original":"Accurate measurement of lipoprotein(a) cholesterol [Lp(a)-C] may be useful in interpreting the traditional lipid panel, particularly in patients with high Lp(a). We developed and analytically validated in a CLIA certified laboratory a direct immunocapture ELISA for quantifying Lp(a)-C in human plasma using an apolipoprotein(a)-specific monoclonal antibody (LPA4) coupled to magnetic beads. The linearity of the assay was found to be excellent (R2=1.00), with % Bias ranging from 0.3% (upper limit of quantification) to 16.1% (low limit of quantification) and %CV ranging from 3.4% to 16.2%. The analytical measuring range was 0.78 mg/dL to 40.0 mg/dL and the limit of Blank and limit of Detection were 0.02 mg/dL and 0.05 mg/dL, respectively. The intra- and inter-assay coefficients of variation determined on four quality control samples, ranged from 4.9% to 7.6% and from 12.6% to 15.0%, respectively. No interference was observed from hemolysis (up to 0.71 g/dL), bilirubin (up to 10.1 mg/dL), or triglycerides (up to 1082 mg/dL. Lp(a)-C was stable for at least 3 months at -70 °C and through two freeze-thaw cycles. Direct Lp(a)-C correlated strongly with Lp(a) molar (r=0.93, p<0.001) concentration. This study reports the results of the first analytical validation of a direct method to quantify Lp(a)-C, enabling standardized quantification of Lp(a)-C suitable for research studies and clinical trials; additional clinical outcome validation will be required prior to routine clinical implementation."},{"url":"https://hartvaat.nl/2026/02/23/pcsk9-remmers-bij-cardiaal-syndroom-x-nieuw-perspectief-op-microvasculaire-angin/","doi":"10.1016/j.mvr.2026.104925","title_en":"The possible role of PCSK9 inhibitors in cardiac syndrome X: Bridging microvascular dysfunction, endothelial pathobiology, and molecular pharmacotherapy.","journal":"Microvascular research","source_date":"2026-02-23","abstract_original":"Cardiac syndrome X (CSX), historically used to describe angina with normal coronary angiography and now largely encompassed within microvascular angina and INOCA, is an ischemic disorder characterized by angina pectoris without narrowing of coronary arteries. CSX, which primarily affects postmenopausal women, is driven by coronary micro-vascular dysfunction, endothelial impairment, oxidative stress, and chronic low-grade inflammation. Notably, the Conventional anti-anginal therapies often yield limited symptom relief, underscoring the need for novel mechanism-based approaches. Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) has emerged as a pivotal mediator linking dyslipidemia to endothelial dysfunction, oxidative injury, and vascular inflammation. Elevated PCSK9 suppresses endothelial nitric oxide synthase, enhances reactive oxygen species generation, promotes cytokines such as IL-6 and TNF-α, and increases platelet activation. Therefore, PCSK9 inhibitors such as alirocumab, evolocumab, and inclisiran, have been shown to improve endothelial function, reduce arterial stiffness, and attenuate oxidative and inflammatory stress. Consequently, PCSK9 inhibition may be a promising therapeutic strategy for CSX. Thus, this review aimed to discuss and explain the potential role of PCSK9 in the pathogenesis of CSX, and how PCSK9 inhibitors could be effective in managing patients with CSX."},{"url":"https://hartvaat.nl/2026/02/22/bloeddrukcontrole-bij-hypertensie-in-gezondheidscentra-in-shenzhen/","doi":"10.1136/bmjopen-2025-105830","title_en":"Blood pressure control rates among hypertensive patients managed in community health centres in Shenzhen, China: a megacity population-based observational study.","journal":"BMJ open","source_date":"2026-02-22","abstract_original":"BACKGROUND: Hypertension represents a major public health challenge globally, with a rising prevalence in China. This study aims to explore the factors shaping blood pressure (BP) control among hypertensive patients managed in community health centres (CHCs), with a particular emphasis on the association with age. METHODS: This was a population-based, observational study that used healthcare records from CHC in Shenzhen, covering the period from 1 January 2000 to 8 October 2024. Univariate and multivariate logistic regression analyses were employed to assess the independent associations of various factors with BP control rate. Additionally, the study evaluated the relationship between age and BP control across six distinct age subgroups. RESULTS: The study included 1 073 914 participants who met the eligibility criteria, with 955 415 (88.97%) patients achieving BP control. The median baseline age was 55.9 (IQR 18-109) years. Individuals aged 45 years and above demonstrated better BP control rates (46-55, OR 1.053, 95% CI 1.020 to 1.087; 56-65, OR 1.246, 95% CI 1.205 to 1.289; 66-75, OR 2.183, 95% CI 2.103 to 2.265; >75, OR 2.159, 95% CI 2.060 to 2.262). Among young adults aged 18-35 years, increasing age was consistently associated with poorer BP control across most subgroups. For the middle-aged groups (36-45 and 46-65 years), age had little impact on BP control. In the 66-75 years age range, older age was linked to better BP control in some groups. CONCLUSION: The association between age and BP control varied across age groups. Hypertension management strategies should be tailored to address the unique needs of different age groups, geographical regions and targeted populations."},{"url":"https://hartvaat.nl/2026/02/22/liposomaal-bupivacaine-peng-blok-tegen-diepveneuze-trombose-bij-heupfracturen/","doi":"10.1136/bmjopen-2025-111579","title_en":"Effect of preoperative liposomal bupivacaine single-injection pericapsular nerve group (PENG) block on lower extremity deep vein thrombosis in elderly patients with hip fractures: a randomised controlled, double-blind, prospective clinical study protocol.","journal":"BMJ open","source_date":"2026-02-22","abstract_original":"INTRODUCTION: Deep vein thrombosis (DVT) of the lower limbs has a significantly higher incidence among elderly populations than that observed in other types of fractures, prolonged immobilisation and the systemic inflammatory response triggered by preoperative pain are the main risk factors. Liposomal bupivacaine (LB) single-injection pericapsular nerve group (PENG) block has demonstrated effective analgesia both before and after surgery, while preserving motor function in patients with hip fracture. Although regional nerve block is a well-established component of preoperative multimodal analgesia, its potential role and underlying mechanisms in the prevention of DVT in elderly patients with hip fracture remain largely unexplored. METHODS AND ANALYSIS: This study will be conducted as a double-blind, randomised, sham-controlled, prospective clinical trial. On admission, a total of 132 participants will be randomly assigned using block randomisation to receive either treatment group (LB single-injection PENG block) or sham group (saline solution single-injection PENG block). The primary outcome was the incidence of DVT, while secondary outcomes included perioperative inflammatory and immune-related stress levels and functional-based pain scores. ETHICS AND DISSEMINATION: This study protocol complies with the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2013 guidelines and has been approved by the Ethics Committee of Shunde Hospital, Guangzhou University of Traditional Chinese Medicine (Approval No KY-2025005). The raw data are planned to be made publicly available on the ResMan raw data-sharing platform (IPD sharing platform) of the Chinese Clinical Trial Registry in December 2027 and can be accessed at http://www.medresman.org.cn. TRIAL REGISTRATION NUMBER: ChiCTR2500100799."},{"url":"https://hartvaat.nl/2026/02/22/kosteneffectiviteit-van-sglt2-remmers-en-glp-1-agonisten-bij-hoog-cardiovasculai/","doi":"10.1503/cmaj.250591","title_en":"Cost-effectiveness of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists for patients with high cardiovascular risk and type 2 diabetes in Canada.","journal":"CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne","source_date":"2026-02-22","abstract_original":"BACKGROUND: Diabetes Canada and the Canadian Cardiovascular Society recommend that patients with type 2 diabetes and cardiovascular disease, renal disease, or multiple cardiovascular risk factors begin glucagon-like peptide-1 receptor agonists (GLP-1 RA) or sodium-glucose cotransporter 2 inhibitors (SGLT2i). We assessed cost-effectiveness in patients meeting these criteria in Canada. METHODS: Our patient-level simulation estimated lifetime costs, clinical events, and quality-adjusted life-years (QALYs) for patients initiating SGLT2i or GLP-1 RA or remaining on \"baseline treatment\"; i.e., other standard-of-care medications. We based initial laboratory values and characteristics on 216 patients from a Quebec clinic focused on initiating guideline-directed diabetes therapies from 2022 to 2025. We calibrated risk equations and treatment effects to end points from placebo-controlled cardiovascular outcome trials. We estimated cost-effectiveness over a patient lifetime horizon from a Canadian health care payer perspective using a 1.5% annual discount rate. We performed probabilistic sensitivity analysis. RESULTS: Compared with baseline treatment, SGLT2i and GLP-1 RA reduced lifetime rates of cardiovascular and renal events and produced higher net present QALYs (+0.24 SGLT2i; +0.23 GLP-1 RA ), but at a higher net present cost (+$5000 SGLT2i; +$27 000 GLP-1 RA [2023 Canadian $]). Sodium-glucose cotransporter 2 inhibitors cost $21 400 per QALY gained and were consistently cost-effective in sensitivity analyses. In 62% of probabilistic sensitivity analysis iterations, GLP-1 RA were dominated, producing fewer QALYs at a higher cost than SGLT2i. INTERPRETATION: Sodium-glucose cotransporter 2 inhibitors provided more QALYs at a lower price than GLP-1 RA and were cost-effective at current prices. Glucagon-like peptide-1 RA cost-effectiveness may improve if outcomes beyond typical diabetes complications are considered and if generic GLP-1 RA become available."},{"url":"https://hartvaat.nl/2026/02/22/genetische-voorspelling-van-lp-a-spiegels-in-diverse-populaties/","doi":"10.64898/2026.02.20.26346738","title_en":"Genetic Prediction of Circulating Lipoprotein(a) Levels in Diverse Populations.","journal":"medRxiv : the preprint server for health sciences","source_date":"2026-02-22","abstract_original":"BACKGROUND: Circulating lipoprotein(a) [Lp(a)] levels are highly heritable and linked to atherosclerotic cardiovascular disease, yet clinical measurement rates remain low (<1%) in the United States. The high heritability of Lp(a) across populations makes genetic prediction an attractive approach for closing this testing gap, but existing polygenic scores transfer poorly across populations. Haplotype-based prediction models, which use standard genome-wide genotype data to capture common-, rare-, and structural-variation at the LPA locus, could bridge this gap, enabling opportunistic identification of individuals with elevated Lp(a) levels across diverse populations within existing large, genotyped cohorts. OBJECTIVES: This study sought to develop and validate a haplotype-based prediction model using genome-wide genotype data to identify individuals with elevated Lp(a) levels across diverse populations. METHODS: We developed an LPA -haplotype model using data from the All of Us Research Program and validated it in the Penn Medicine BioBank (PMBB), Mass General Brigham Biobank (MGBB), and Mount Sinai BioMe cohorts. Primary outcomes included model performance for predicting continuous Lp(a) concentrations (r²) and identifying elevated Lp(a) levels (>125 nmol/L) through positive predictive value (PPV) and number needed to test (NNT). RESULTS: Among PMBB (n = 1856), MGBB (n = 1401), and BioMe (n = 1686) participants with available genotype and Lp(a) measurements, average age was 60 years, and 51% were female. Overall r² of the haplotype model was 0.46 (95% Credible Interval [CrI] 0.32 to 0.6), with similar performance across genetically inferred ancestries and cohorts. For identifying elevated Lp(a) levels >125 nmol/L the overall PPV was 0.81 (95% CrI 0.6 to 0.89), corresponding to a NNT of 1.2 (95% CrI 1.1 to 1.7) individuals predicted to have elevated levels needing to undergo clinical testing to identify one true elevation. In the full PMBB cohort (n = 49310), the haplotype model identified elevated Lp(a) at a rate of 128 per 1000 (95% CrI 125 to 130), corresponding to an estimated 14.4-fold improvement (95% CrI 13.1 to 15.9; P(improvement) = 1) in identification rate compared with the existing rate of clinical assessment. CONCLUSIONS: A haplotype-based genetic model effectively identified individuals with elevated Lp(a) levels across diverse populations, with potential utility for opportunistic screening among cohorts where genotype data is available, but Lp(a) testing rates are low."},{"url":"https://hartvaat.nl/2026/02/21/erratum-sapien-3-versus-myval-bij-tavi-compare-tavi-1/","doi":"https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00315-6/fulltext","title_en":"Department of Error","journal":"The Lancet","source_date":"2026-02-21","abstract_original":"Terkelsen CJ, Freeman P, Dahl JS, et al. SAPIEN 3 versus Myval transcatheter heart valves for transcatheter aortic valve implantation (COMPARE-TAVI 1): a multicentre, randomised, non-inferiority trial. Lancet 2025; 405: 1362–72—In this Article, the authors identified an error in the dataset that resulted in four patients being misclassified as having moderate or severe transcatheter heart valve (THV) deterioration. This misclassification does not affect the overall conclusions of the Article. Additionally, “upper CI” has been corrected to “lower CI” throughout the paper to reflect the negative risk difference."},{"url":"https://hartvaat.nl/2026/02/21/barrieres-en-facilitatoren-voor-mhealth-programma-diabetes-en-hypertensie-in-gha/","doi":"10.1186/s12913-026-14175-0","title_en":"Barriers and Facilitators to the implementation and scale-up of a mHealth integrated care program for diabetes and hypertension in Ghana: a qualitative study of the Akoma Pa program.","journal":"BMC health services research","source_date":"2026-02-21","abstract_original":"OBJECTIVE: To determine the barriers and facilitators to the implementation and scale-up of the Akoma Pa mHealth-based integrated care program for diabetes and hypertension in Ghana. METHODS: 30 implementation managers and healthcare providers (Akoma Pa champions) were interviewed in-depth based on their experience and ability to provide information on implementing and scaling-up the Akoma Pa program in February 2024. Participants were selected from the Christian Health Association Ghana healthcare facilities across Ghana. Thematic qualitative content analysis based on Kuckartz was used to identify recurring themes and categories, guided by the mHealth Predisposing Characteristics, Needs, and Enabling Resources (PNE) Framework. RESULTS: Participants identified 47 factors influencing the implementation and scale-up of the intervention, categorized into provider- and patient-level contextual factors. Findings were organized according to perceived usefulness and perceived ease of use, reflecting assessments of value, feasibility, and scale-up potential. Key enablers included mobile phone accessibility, provider engagement, and integration with the National Health Insurance Scheme. Reported barriers included digital infrastructure gaps, policy misalignment, lack of data protection policies and workforce limitations. Although the SPICE app, central to the Akoma Pa digital health program, enhanced patient tracking and care coordination, it still required ongoing support to ensure interoperability and scalability. Evidence-based practices and personalized care improved patient management and outcomes. CONCLUSION: Integrated mHealth programs such as Akoma Pa hold promise for strengthening chronic disease management in low-resource settings. Addressing infrastructural and long-term funding barriers is critical to sustaining and scaling these interventions. Findings offer insights to inform future digital health policy and program design in sub-Saharan Africa."},{"url":"https://hartvaat.nl/2026/02/21/driedimensionale-echocardiografie-bij-kleplijden-klinische-implicaties/","doi":"10.1093/eurheartj/ehaf1127","title_en":"Three-dimensional echocardiography for valvular heart disease: clinical implications.","journal":"European heart journal","source_date":"2026-02-21","abstract_original":"Three-dimensional (3D) echocardiography has become an essential tool in the evaluation and management of valvular heart disease (VHD), offering superior accuracy and detailed visualization when used with the transthoracic and transoesophageal approaches. The rise of transcatheter valve interventions, particularly for high-risk or inoperable patients, has underscored the importance of 3D imaging in guiding these procedures. 3D echocardiography allows for precise assessment of valvular anatomy, quantification of regurgitation, and visualization of complex lesions, contributing to better procedural planning and outcomes. These advancements have enhanced the ability to guide transcatheter interventions with greater accuracy, improving the overall safety and success of procedures. This review highlights the growing role of 3D echocardiography in the management of VHD, emphasizing its evolving technology and applications in diagnostic precision and procedural guidance."},{"url":"https://hartvaat.nl/2026/02/21/aspirine-lipoproteine-a-en-aortaklepstenose-de-mesa-studie/","doi":"10.1093/eurheartj/ehag018","title_en":"Aspirin use, lipoprotein(a), and calcific aortic valve disease: the Multi-ethnic Study of Atherosclerosis.","journal":"European heart journal","source_date":"2026-02-21","abstract_original":"BACKGROUND AND AIMS: Lipoprotein(a) [Lp(a)] and LDL cholesterol (LDL-C) are causally linked to aortic valve calcium (AVC) and aortic stenosis (AS). Lipoprotein(a) has anti-fibrinolytic properties; therefore, aspirin may reduce cardiovascular disease risk among individuals with high Lp(a). This analysis sought to determine the association of aspirin with incident AVC and AS across Lp(a) and LDL-C levels. METHODS: This observational study included up to 6598 participants in the Multi-Ethnic Study of Atherosclerosis. Aortic valve calcium was measured on non-contrast cardiac computed tomography. Multivariable Cox hazards regression assessed the association of self-reported regular aspirin use (≥3 days/week) with incident AVC and severe AS, stratified by Lp(a) and LDL-C. Aortic valve calcium and Lp(a) values were not reported to participants. RESULTS: Mean age was 62 years, 53% were women, 23% reported regular aspirin use, 8% developed AVC (median 8.9 years), and 1% developed severe AS (median 16.7 years). Among individuals with elevated Lp(a), regular aspirin use was associated with a lower risk of incident AVC (Lp(a) ≥75 mg/dL: hazard ratio (HR) .42, 95% confidence interval (CI) .19-.93; Lp(a) ≥100 mg/dL: HR .17, 95% CI .04-.67) and severe AS (Lp(a) ≥50 mg/dL: HR .13, 95% CI: .04-.47; Lp(a) ≥75 mg/dL: HR .02, 95% CI .001-.29). For participants with elevated LDL-C, there was no association of regular aspirin use with incident AVC (LDL-C ≥130 mg/dL: HR 1.02, 95% CI .66-1.58; LDL-C ≥160 mg/dL: HR 1.51, 95% CI .53-4.28) or severe AS (LDL-C ≥100 mg/dL: HR .70, 95% CI .39-1.26; LDL-C ≥130 mg/dL: HR .46, 95% CI .14-1.47). CONCLUSIONS: In this exploratory analysis of prospective observational cohort data, regular aspirin use was associated with a lower risk of AVC and severe AS in persons with high Lp(a), but not high LDL-C. Confirmatory studies are required to determine the role of aspirin in the prevention of AVC and AS for persons with high Lp(a)."},{"url":"https://hartvaat.nl/2026/02/21/pelacarsen-vermindert-de-behoefte-aan-lipoproteine-a-aferese-lp-a-frontiers-aphe/","doi":"10.1093/eurheartj/ehag073","title_en":"Pelacarsen and lipoprotein(a) apheresis in secondary prevention: the Lp(a)FRONTIERS APHERESIS trial.","journal":"European heart journal","source_date":"2026-02-21","abstract_original":"BACKGROUND AND AIMS: Lipoprotein apheresis (LA) is the only approved treatment for patients with elevated lipoprotein(a) [Lp(a)]. The Lp(a)FRONTIERS APHERESIS trial investigated whether pelacarsen reduces the need for LA in patients from Germany with elevated Lp(a) and established cardiovascular disease (CVD). METHODS: Adult patients with Lp(a) levels >60 mg/dl who had undergone ≥35 LA sessions in the prior year were randomized to receive pelacarsen 80 mg or placebo every 4 weeks for 52 weeks. Weekly LA sessions were performed if the Lp(a) measurement from the prior visit was >60 mg/dL. The primary endpoint was the rate of performed LA sessions normalized to the weekly LA schedule (the number of actual LA sessions divided by the number of planned LA sessions during the 52-week period). Secondary endpoints were time to LA avoidance (for ≥24 consecutive weeks) and total LA avoidance from week 12 to week 52. RESULTS: Fifty-one patients were randomized (mean age 61.7 years, mean Lp(a) at baseline 85.4 mg/dL, and mean 44.0 LA sessions in the past 12 months), with 25 of 26 (96.2%) in the pelacarsen arm and 23 of 25 (92.0%) in the placebo arm completing the study. Baseline characteristics were generally balanced between treatment arms. Pelacarsen reduced the mean rates of LA (0.16 vs 0.93 in placebo, odds ratio 0.006, 95% confidence interval [CI] 0.003, 0.013; P < .0001) and substantially increased the hazard of achieving LA avoidance (hazard ratio: 88.3; P = .0014; median time to achieve LA avoidance: 6.1 weeks) and total LA avoidance (odds ratio: 163.2; P = .0005). The placebo-adjusted Lp(a) change from baseline at week 52 was -72% (95% CI: -79%, -61%; P < .0001). Treatment emergent adverse events were similar between arms, except for mostly mild injection site erythema (pelacarsen 38.5%; placebo 0%). CONCLUSIONS: Pelacarsen is a highly effective and well-tolerated Lp(a)-targeted therapy that substantially reduces the need for LA in patients with elevated Lp(a) and established CVD. CLINICALTRIALS.GOV, IDENTIFIER: NCT05305664."},{"url":"https://hartvaat.nl/2026/02/20/kosteneffectiviteit-van-mavacamten-bij-obstructieve-hcm-gezondheidswinst-maar-ee/","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e003914?rss=1","title_en":"Cost-effectiveness analysis of mavacamten for obstructive hypertrophic cardiomyopathy: a perspective from the Chinese healthcare system","journal":"Open Heart","source_date":"2026-02-20","abstract_original":" The clinical management of Obstructive Hypertrophic Cardiomyopathy remains challenging, and the phase III EXPLORER-HCM trial has demonstrated that the novel cardiac myosin inhibitor Mavacamten can significantly improve patients’ symptomatic and functional status. This study aimed to evaluate the cost-effectiveness of the MBC regimen (Mavacamten plus a β-blocker or a calcium-channel blocker) versus the PBC regimen (placebo plus a β-blocker or a calcium-channel blocker) for treating Obstructive Hypertrophic Cardiomyopathy from the perspective of the Chinese Healthcare System. A Markov model was constructed using data from the EXPLORER-HCM clinical trial. Cost and utility inputs were sourced from public databases and published literature. Total costs, life-years (LY), quality-adjusted life years (QALY) and the incremental cost-effectiveness ratio (ICER) were assessed. One-way deterministic sensitivity analysis and probabilistic sensitivity analysis were conducted to examine the robustness of the model. Compared with the PBC regimen, Mavacamten treatment yielded an ICER of US$50 587.23/QALY. Its incremental cost was US$106 221.41, providing 2.1 additional QALY and 3.15 LY. Sensitivity analyses indicated that the drug price was the key driver influencing changes in the ICER value. This study confirms that Mavacamten provides substantial health benefits to patients, but its relatively high ICER exceeds the commonly accepted willingness to pay. Delays in performing urgent coronary artery bypass graft (CABG) surgery are increasing across the UK, with national wait times now exceeding guideline targets. Prolonged preoperative admissions contribute to hospital bed pressures, increased costs and negative psychosocial effects for patients. Virtual wards using remote patient monitoring (RPM) may enable safe early discharge for clinically stable patients awaiting surgery. To evaluate the feasibility, safety and outcomes of a virtual ward pathway using RPM for patients awaiting urgent CABG surgery. A prospective, multicentre, single-arm study was conducted across three UK cardiac centres (December 2022–May 2025). Eligible patients were discharged home with daily symptom reporting via a digital platform and structured clinician review. The primary outcome was preoperative major adverse cardiovascular events (MACE). Secondary outcomes included 30-day mortality, resternotomy, time to surgery, postoperative stay, readmissions and patient experience. 128 patients were enrolled (mean age 61 years; 87% male). No preoperative MACE occurred (0%; 95% CI 0.0% to 2.3%). 30-day mortality was 0% (95% CI 0.0% to 2.9%), and resternotomy occurred in 2.3%, comparable to national rates. Median time from discharge to surgery was 10 days, saving an estimated 1152 inpatient bed-days. Postoperative length of stay was 7.0 days compared with a national average of 8.0 (p=0.084). Patient experience was favourable: 95% felt safe at home, and 89% found the platform easy to use. A virtual ward pathway with remote monitoring for selected patients awaiting urgent CABG was safe, feasible and associated with high patient acceptability and major reductions in inpatient utilisation. These findings support this model as a scalable approach to managing urgent surgical pathways while preserving safety and surgical timelines. Cardiovascular diseases (CVD) remain the leading cause of mortality globally, necessitating early risk identification to improve prevention and management strategies. Traditional risk prediction models, such as the Framingham Cardiovascular Risk Score and the Systematic Coronary Risk Evaluation, often fall short due to their reliance on classical statistical methods and limited variable scope. This study harnessed machine learning (ML) techniques to develop and validate a comprehensive CVD risk prediction model using data from the UK Biobank cohort. Our approach incorporated genetic scores, clinical parameters and lifestyle factors to create separate models for overall CVD, cerebrovascular diseases, thrombotic diseases and other cardiovascular conditions. We used a diverse set of ML algorithms, including Ridge Regression, Logistic Regression, Support Vector Machines, Random Forest, XGBoost, Multilayer Perceptron and Stacking, with rigorous cross-validation procedures to ensure robustness. From an initial cohort of 502 407 individuals, 240 644 participants were included in the final analysis. The integrated model, combining clinical, lifestyle and genetic data, achieved the highest predictive performance with an area under the curve (AUC) of 0.85. Models based solely on clinical data, lifestyle data and polygenic risk scores showed lower predictive power. Stratified analysis revealed variable performance across CVD subtypes, with the highest AUC of 0.83 for other cardiovascular diseases. Key predictors included age, systolic blood pressure, cystatin C levels and waist circumference. The integration of clinical, lifestyle and genetic data substantially enhances the predictive accuracy of ML models for CVD risk. Our model demonstrates robust performance, with an improvement of 0.12 in AUC over the Framingham Cardiovascular Risk Score, highlighting its potential utility in clinical settings for early risk identification and personalised intervention strategies. Future research should focus on refining the model by incorporating additional predictors and validating its applicability across diverse populations. Secondary prevention is critical for patients with established atherosclerotic cardiovascular diseases (ASCVD). The SMART2 model predicts recurrent ASCVD risk but does not account for psychiatric disorders, socioeconomic deprivation or ethnicity. We aimed to evaluate SMART2 model performance overall and in subgroups defined by these factors. SMART2 was externally validated using electronic health records of patients aged 40–80 in the Leiden-The Hague region. Patients hospitalised for cardiovascular disease or coronary interventions between 1 January 2010 and 31 December 2021 were included. Model performance was assessed using discrimination (10-year area under ROC curve (AUC)) and calibration (observed/expected (OE) ratios and plots, adjusted for competing risks), both overall and in subgroups defined by three factors: psychiatric history, socioeconomic status (SES) and ethnicity. Among 15 528 patients (66% male, mean age 65) with established ASCVD, median follow-up was 6.0 years. Recurrent cardiovascular events occurred in 2220 patients, and 1820 had competing events. Overall AUC was 0.63 (95% CI 0.61 to 0.65). OE ratio was 0.96 (95% CI 0.92 to 1.00). The model underestimated risk in patients with low SES (OE 1.09, 95% CI 1.02 to 1.17) and in non-Western patients (OE 1.16, 95% CI 1.02 to 1.31). Calibration was adequate in patients with psychiatric history, but the model was substantially underestimating for patients with multiple vulnerabilities—combinations of low SES, non-Western ethnicity and psychiatric history—with OE ranging from 1.19 to 1.29, depending on the combination. The SMART2 model is well-calibrated in the general population but underestimates risk, especially in subgroups with multiple vulnerabilities. Patients in these vulnerable subgroups may require intensified monitoring. Clinicians should consider social, ethnic and psychiatric factors when interpreting risk estimates. Non-ST-segment-elevation myocardial infarction (NSTEMI) accounts for the majority of acute coronary syndrome presentations. Invasive coronary angiography (ICA) is recommended but challenging to deliver within guideline-recommended timeframes and unnecessary in patients without obstructive disease. CT coronary angiography (CTCA) offers a non-invasive alternative for lower-risk patients that may reduce procedural-related complications and optimise resource use by avoiding unnecessary ICA. We conducted a systematic review and meta-analysis following Cochrane standards. Four databases were searched from January 2005 to March 2025. Eligible studies included adult patients with NSTEMI undergoing CTCA to guide management, with comparators of standard care (ICA-first strategies). Primary outcomes were ICA utilisation, composite cardiovascular events (myocardial infarction, cardiovascular and all-cause death) and diagnostic accuracy of CTCA versus ICA. From 12 058 records, eight studies met inclusion criteria; three randomised controlled trial (RCT) studies and five observational cohorts; total n2700. Across two RCTs, a CTCA-first strategy did not significantly reduce ICA use (pooled relative risk (RR)=0.82 (0.55–1.22)). Evidence for composite clinical outcomes was heterogeneous: The Rapid Assessment of Potential Ischaemic Heart Disease with CTCA trial reported no difference in death or MI, whereas the trial, Computed Tomography Cardiac Angiography Before Invasive Coronary Angiography in Patients with Previous Bypass Surgery, observed reduced events at 1 year (RR=0.63 (0.43–0.94)). Pooled diagnostic accuracy for >50% stenosis from observational studies demonstrated high sensitivity (96.3%) and moderate specificity (79.6%), with high heterogeneity. Length of stay and patient satisfaction were similar or improved with CTCA-first strategies, though cost-effectiveness data were limited. Overall evidence quality ranged from moderate (RCTs) to low (observational studies). CTCA demonstrates excellent diagnostic accuracy and may reduce complications while maintaining clinical outcomes in patients with NSTEMI. Current evidence does not show consistent reductions in ICA use or major adverse events. Larger trials are needed to clarify its role in NSTEMI management pathways. CRD420251003903 Although exercise stress testing (EST) is commonly used for risk stratification in coronary artery disease (CAD), it yields inconclusive results in up to 20% of patients. Stress perfusion cardiac magnetic resonance (CMR) is a comprehensive and accurate tool for evaluating CAD, but data on its use in patients with inconclusive EST results are limited. Therefore, this study aimed to assess the prognostic value of stress perfusion CMR in patients with inconclusive EST results. Consecutive patients with known or suspected CAD and inconclusive EST results who were referred for stress perfusion CMR between 2009 and 2022 were studied. Patients were divided into two groups based on the presence or absence of inducible myocardial ischaemia, as determined by CMR. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, acute coronary syndrome, hospitalisation for heart failure, and ischaemic stroke. A total of 414 patients (mean age 63±9 years, 48% male) were included, of whom 69 had myocardial ischaemia. Over a median follow-up of 6.9 years (IQR 4.5–9.9), 32 patients (7.7%) experienced MACE. Patients with myocardial ischaemia had a significantly higher annualised MACE rate than those without ischaemia (2.8 vs 0.8 per 100 patient-years, p<0.001). On multivariable analysis, myocardial ischaemia was an independent predictor of MACE (HR 4.03, 95% CI 1.94 to 8.38, p<0.001), along with atrial fibrillation (HR 5.83, 95% CI 1.69 to 20.09, p=0.005) and resting systolic blood pressure (HR 1.02, 95% CI 1.005 to 1.04, p=0.01). Subgroup analysis demonstrated a consistent association between myocardial ischaemia and increased MACE risk across most subgroups (all p for interaction >0.05). Stress perfusion CMR demonstrated prognostic value and effectively stratified risk in patients with known or suspected CAD who had inconclusive EST results. Stress perfusion CMR represents a valuable tool for this patient population. Patients with heart failure (HF) and severe mitral regurgitation (MR) have poor outcomes. Early identification could allow physicians to consider interventions that may improve outcomes. We identified factors associated with progression to severe MR in patients with HF. A total of 11 521 patients with HF and MR were screened, out of which we identified 7391 patients with a clinical diagnosis of HF and at least two echocardiograms at least 6 months apart. We excluded patients without a documented severity of MR at initial (n=1840) or follow-up (n=960) echocardiogram and those with severe MR at initial echocardiogram (n=450). We evaluated factors associated with the development of either moderate to severe or severe MR using multivariable logistic regression analysis. A total of 7391 patients were included in the study, 4173 (56.5%) male, and median age 75 (IQR (IQR) 64–83). In total, 357 (4.8%) patients developed severe MR on the follow-up echocardiogram at a median of 1.4 years (IQR 0.9–2.4). In addition to baseline MR severity, atrial fibrillation (adjusted OR (aOR)1.52), ischaemic heart disease (aOR 1.44), hypertension (aOR 1.35) and higher left ventricular end-diastolic dimension (aOR 1.36 per 1 cm) were associated with increased progression to severe MR. Beta-blocker prescription was associated with reduced progression to severe MR (aOR 0.74). We identified several factors associated with the progression to severe MR in patients with HF. This information could be used by clinicians to identify patients who require closer echocardiographic follow-up and access to appropriate early interventions. Ischaemic heart disease (IHD) remains a leading cause of morbidity and mortality worldwide and poses an increasing public health challenge in India. The rising incidence of myocardial infarction, especially among younger individuals, is concerning. To compare cardiovascular risk factors, clinical presentation, angiographic patterns and reperfusion characteristics between younger and older adults presenting with ST-segment elevation myocardial infarction (STEMI). A cross-sectional analytical study was conducted among 260 patients admitted to a tertiary care hospital in South India with a first episode of STEMI. Participants were selected using convenience sampling and included 65 younger adults (≤45 years) and 195 older adults (>45 years) in a 1:3 ratio. Data were obtained through structured interviews and review of the medical records. Continuous variables were analysed using the Independent Student’s t-test or Mann-Whitney U test, while categorical variables were assessed using the 2 or Fisher’s exact test. Univariate and multivariate logistic regression analyses were performed with results reported as ORs and adjusted ORs with 95% CIs. The mean age was 40.14±15.79 years in the younger group and 60.84±8.25 years in the older group. Younger patients had a significantly higher male predominance, greater alcohol consumption, positive family history of premature cardiovascular disease, shorter sleep duration and higher anxiety scores. In contrast, older adults have a significantly higher prevalence of hypertension and diabetes mellitus. Multiple logistic regression revealed an increase in average sleep duration was associated with a 0.57-unit increase in the log-odds of being aged >45 years. On the contrary, the anxiety score was inversely associated with older adults (β=–0.10; AOR=0.90; 95% CI 0.82 to 0.99). Younger patients with acute STEMI exhibited an increased burden of modifiable lifestyle and psychosocial risk factors, emphasising the need for age-specific preventive interventions. Heart failure (HF) often coexists with chronic kidney disease (CKD), impacting prognosis. This study aims to evaluate renal function trajectories and their impact on major clinical outcomes in a cohort of patients hospitalised for ‘de novo’ HF with reduced ejection fraction (HFrEF). This is a prospective cohort study that included patients hospitalised for ‘de novo’ HFrEF at two university hospitals. Renal function was assessed using the CKD-Epidemiology Collaboration formula. Total mortality and the combined total mortality and HF readmissions were evaluated during follow-up. Of 370 patients, 306 were eligible. At discharge, 24.6% had estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2. Higher eGFR at discharge was associated with better outcomes. During follow-up, 79.1% showed eGFR ≥45 mL/min/1.73 m2. Patients with stable or improved eGFR had lower total mortality and HF readmission rates. Factors associated with renal function improvement or stabilisation included less prior CKD, hypertension and younger age, higher eGFR values at discharge and more use of quadruple therapy at the end of uptitration period. In patients with ‘de novo’ HFrEF, renal function deterioration at discharge correlated with poorer outcomes. However, stabilisation or improvement during follow-up was linked to better prognosis. Routine renal function assessment is crucial in HFrEF management, guiding personalised treatment strategies to mitigate renal function decline and improve patient care. Guidelines permit up to 360 J for synchronised biphasic electrical cardioversion (ECV) in atrial fibrillation (AF) lasting >48 hours. The CHESS randomised trial reported higher first-shock success with fixed 360J versus a low-escalation 125–150–200J sequence. Much of this evidence used adhesive pads without manual pressure and anterior–posterior positioning. We evaluated a 200 J-first, fixed-escalation biphasic ECV protocol delivered with a standardised technique in an emergency department (ED). Single-centre retrospective observational study of consecutive adults undergoing elective ECV for symptomatic AF >48hours (2019–2021). Procedures used hand-held paddles with firm chest pressure in the anterolateral (AL) position under deep sedation. The predefined sequence was 200->300->360J if needed. The primary outcome was restoration of sinus rhythm (SR) documented on a 12-lead ECG within 120 min. Secondary outcomes were first shock success at 200 J, cumulative efficacy, SR to discharge without post-ECV antiarrhythmics, adverse events and subgroup efficacy. Results were contrasted descriptively with 360 J-first cohorts (CHESS). Of 451 ECV procedures identified, 374 were eligible. The primary outcome was achieved in 97.3% (364/374; 95% CI 95.5 to 98.7). First-shock success with 200 J was 88.0% (329/374; 95% CI 84.3 to 90.9). Escalation to 300 J and 360 J was required in 44 and 15 patients. SR was maintained to discharge in converted patients. Two minor adverse events occurred (2/374, 0.5%) and no serious adverse events were recorded. A 200 J-first, fixed-escalation biphasic protocol with a standardised technique (manual paddles, firm pressure, AL placement) achieved high first-shock and excellent cumulative efficacy for AF>48 hours in real-world ED care without routine pharmacologic adjuncts. Findings support considering a 200 J-first approach and motivate pragmatic multicentre randomised controlled trials directly comparing 200 J-first versus 360 J-first under harmonised technique with objective safety endpoints. Persistent atrial fibrillation (AF) remains challenging to treat with catheter ablation. The left atrial posterior wall (PW) may represent an important non-pulmonary vein (PV) substrate; however, randomised trials have not demonstrated improved outcomes with adjunctive PW isolation (PWI), potentially reflecting technical limitations of thermal ablation rather than a lack of mechanistic relevance. Pulsed-field ablation (PFA) is a non-thermal ablation modality that selectively targets myocardial tissue and may enable safer and more consistent PWI. We compared real-world outcomes of PFA and radiofrequency ablation (RFA) for combined PV isolation and PWI in patients with persistent AF. 200 consecutive patients (100 PFA and 100 RFA) undergoing combined PVI and PWI were retrospectively followed for up to 12 months. Baseline characteristics were broadly similar; however, PFA patients had lower left ventricular ejection fraction (LVEF) (43.5% (35.5–55.5%) vs 47% (40–58), p=0.01) and higher CHA2DS2-VA risk score (3 (2–4) vs 2 (1–3), p=0.01). Primary outcomes were acute procedural success and freedom from recurrent atrial tachyarrhythmia (AT) at 6 and 12 months. PFA achieved near-universal PWI compared with RFA (99% vs RFA: 65%, p<0.005), with shorter procedure duration (106 vs 143.5 min, p<0.005), reduced left atrial dwell time (62 vs 98 min, p<0.005), and faster time to PVI and PWI (all p<0.005). Major non-vascular complications were uncommon (1.5%) and similar between groups. At 12 months, freedom from recurrent AT was higher with PFA (70% vs RFA 54%, p=0.03), with lower odds of first detected AT recurrence in adjusted time-to-event analysis (OR 0.46 (0.26–0.82), p=0.009). In this real-world cohort, PFA was associated with a higher rate of acute PWI and greater freedom from AT compared with RFA, without a signal of increased complications. Prospective randomised studies are needed to define the role of PWI delivered with PFA in patients with persistent AF, including those with reduced LVEF. Early graft failure within 90 postoperative days is the leading cause of mortality after heart transplantation. Existing risk scores, based on linear regression, often struggle to capture the complex, multifactorial biological interactions necessary for personalised donor–recipient matching. This study utilised explainable machine learning (ML) to identify robust predictors of 90-day graft failure and developed a clinically interpretable, ML-informed nomogram designed specifically for cross-population generalisability. Using the UNOS registry (2008–2020; n=25 200), XGBoost/Random Forest models identified 90-day graft failure predictors from 32 donor–recipient variables. Explainable AI (SHapley Additive exPlanations) analysis revealed key predictors and their non-linear interactions, which were translated into a clinically applicable nomogram. External validation was performed on a large, single-centre Chinese cohort (Wuhan Union Hospital ; 2018–2023; n=563), assessing performance via area under the curve (AUC), calibration and decision curve analysis (DCA). The final model incorporated eight predictors: recipient factors (prior cardiac surgery, age, bilirubin, body mass index (BMI)), donor factors (age, gender, BMI) and cold ischaemia time. The XGBoost-derived nomogram demonstrated consistent discrimination (AUC 0.67, 95% CI 0.64 to 0.70) and calibration. Patients stratified into the high-risk group (top quantile by nomogram score) had a 2.4-fold increased hazard of graft failure (HR 2.42, 95% CI 2.11 to 2.78). DCA confirmed the model’s clinical utility across a wide range of risk thresholds (0.0–0.4). External validation in the Chinese cohort affirmed its generalisability (AUC 0.67). This study introduces an ML-informed nomogram for 90-day graft failure, validated across USA and Chinese populations. By translating ML insights into a clinically interpretable tool using routinely available pretransplant variables, it bridges a key translational gap in transplant risk prediction. This tool can aid in optimising donor–recipient matching and personalising post-transplant management, with the potential to help address geographic disparities in heart transplant outcomes. Low socioeconomic status (SES) is linked to increased cardiovascular risk, but its association with carotid atherosclerosis in the general population is less well studied. We examined associations between individual-level and area-level SES and carotid plaque burden and explored potential sex differences. In this cross-sectional analysis from the Akershus Cardiac Examination 1950 Study, individual-level SES was defined by educational attainment, and area-level SES by urban versus rural residence and median household income of municipality. Carotid ultrasound was used to quantify plaque burden with a plaque score (0–3 per segment; maximum 24), where >3 indicates elevated cardiovascular risk. Associations between SES and plaque score were estimated using Poisson regression in crude and adjusted models. We included 3673 participants (48.8% women; mean age 63.9 years). The prevalence of elevated plaque score (>3) was 23.3% in tertiary, 28.2% in secondary and 31.4% in primary education groups (p for trend <0.001). Women and men with primary education had 32% and 24% higher plaque scores than those with tertiary education (p<0.001). After adjustment for cardiovascular risk factors, excess atherosclerotic burden remained 22% in women and 12% in men (p<0.001). No significant associations were observed for area-level SES, and no sex interactions were detected. Lower educational attainment is associated with higher carotid atherosclerotic burden in both sexes, independent of cardiovascular risk factors, while area-level SES shows no clear association. These findings suggest that educational disparities contribute to atherosclerotic disease burden and merit further investigation in longitudinal studies. Persistent atrial fibrillation (PersAF) presents a significant clinical and economic burden and is associated with poorer outcomes after catheter ablation compared with paroxysmal atrial fibrillation (AF). Pulsed field ablation (PFA) has emerged as a new form of energy modality for AF treatment. Sphere-9 is a novel dual-energy large-focal lattice tip (LFLT) catheter that is also capable of high-density mapping. The study aims to evaluate the cost-effectiveness of Sphere-9 catheter versus conventional radiofrequency (RF ablation for the treatment of PersAF in the English National Health Service (NHS) setting. Individual patient data from the SPHERE Per-AF randomised controlled trial were used to estimate efficacy, safety and resource utilisation parameters in symptomatic PersAF patients. The cost-effectiveness model consisted of a hybrid decision tree (1-year time horizon) and a Markov model with 3-month cycle length (lifetime time horizon, 40 years) and was developed from the perspective of the English NHS. Unit costs were derived from the National Institute for Health and Care Excellence (NICE) clinical guideline for AF diagnosis and management (NG196) and NHS national cost collection data. Health benefits were expressed in quality-adjusted life years (QALYs), and all benefits and costs were discounted at 3.5% per year in line with NICE requirements. LFLT ablation was found to be dominant compared with RF, since it was less costly and it produced greater health outcomes. LFLT was associated with an average cost of £15 433 and 8.26 QALYs per patient, compared with £20 861 and 8.20 QALYs for RF ablation. Results remained robust across all sensitivity and scenario analyses. The Sphere-9 catheter is a cost-saving strategy for treating patients with PersAF compared with conventional RF ablation. Given the growing burden of AF and limited healthcare resources, Sphere-9 presents a valuable option for improving patient outcomes while optimising NHS resource allocation. To compare the efficacy and safety of off-label low-dose versus standard-dose antiplatelet agents in coronary heart disease (CHD) patients, focusing on the evidence gap in comparisons of low-dose versus standard-dose ticagrelor and prasugrel. PubMed, Embase, the Cochrane Library, ClinicalTrials.gov, China National Knowledge Infrastructure and Wanfang databases were searched up to 11 May 2025 for randomised controlled trials. Study quality was assessed using the Cochrane Risk of Bias 2.0 tool. A meta-analysis was performed, with relative risk (RR) and 95% CI as the effect estimates. Subgroup analyses were performed stratified by antiplatelet agent type, ethnic region, treatment duration and CHD subtype. A total of 22 randomised controlled trials, involving 7486 patients, met the study criteria. Among them, 92.09% were Asian, and 63.63% of the included studies exclusively enrolled acute coronary syndrome patients. All patients received the dual antiplatelet therapy (aspirin combined with a low or standard dose of P2Y12 receptor antagonist), mainly with low-dose prasugrel and ticagrelor. Off-label low-dose antiplatelet agents significantly reduced myocardial infarction (MI) (RR 0.75, 95% CI 0.58 to 0.97) and minimal bleeding risks (RR 0.64, 95% CI 0.50 to 0.82) compared with standard doses, with comparable risks for other ischaemic and bleeding events. Compared with standard-dose clopidogrel, they significantly reduced MI risk (RR 0.71, 95% CI 0.54 to 0.93) but increased overall (RR 1.40, 95% CI 1.11 to 1.77) and minor bleeding risks (RR 1.86, 95% CI 1.02 to 3.38). Compared with standard-dose prasugrel or ticagrelor, they demonstrated comparable ischaemic risks and significantly reduced overall and minimal bleeding risks. All other subgroup analyses were consistent with the overall findings. Off-label low-dose antiplatelet therapy reduces the risks of MI and minimal bleeding. It surpassed standard-dose clopidogrel and offered lower bleeding risks than prasugrel or ticagrelor, thus representing an effective secondary prevention strategy for Asian CHD. CRD42023438376. The obesity paradox has been described in different cardiovascular conditions. Data on the association between obesity and outcomes in patients with Takotsubo syndrome (TTS) are lacking. The aim of this study was to determine the relationship between body weight and mortality in TTS patients. Patients enrolled in the International Takotsubo Registry from January 2011 to July 2021 and with available data on body mass index (BMI) were included in the analysis. Patients were stratified according to BMI (underweight, <18.5 kg/m2; normal weight, 18.5–24.9 kg/m2; overweight, 25.0–29.9 kg/m2; obese, 30.0–34.9 kg/m2; and very obese, ≥35.0 kg/m2). The primary endpoint was mortality at 1 year. Of the 2707 patients, 222 (8.2%) were underweight, 1340 (49.5%) of normal weight, 759 (28.0%) overweight, 268 (9.9%) obese and 118 (4.4%) very obese (p=0.02). Rates of mortality at 1 year were 11.3%, 6.9%, 5.5%, 4.9% and 9.3% in underweight, normal weight, overweight, obese and very obese patients (p=0.02). Being overweight or obese was significantly associated with a lower mortality rate at 1 year (HR 0.70, 95% CI 0.51 to 0.96, p=0.03), and this association remained significant after multivariable adjustments (adjusted HR 0.67, 95% CI 0.46 to 0.97, p=0.03). A U-shaped mortality curve across BMI categories was observed in TTS patients, with the highest mortality rates observed in underweight and the lowest rates observed in obese patients. These observations provide the first evidence for the existence of the obesity paradox in TTS. Mechanical compression from the ascending aorta on the left atrial anterior wall (LAAW) can cause low voltage areas (LVAs), which are associated with a higher risk of atrial fibrillation (AF) recurrence after catheter ablation. This study investigates the AF recurrence rate post-LAAW complex fractionated atrial electrograms (CFAE) ablation or LAAW linear ablation in AF patients with aortic encroachment. We retrospectively analysed AF patients who underwent first-time ablation between 2019 and 2023 in our department and had preablation cardiac CT scans. The impact of LAAW-LVAs and different LAAW ablation strategies on AF recurrence within 1-year postprocedure was evaluated. In total, 267 patients had both aortic encroachment and LAAW-LVAs. In the absence of LAAW ablation, patients with aortic encroachment had a significantly higher risk of AF recurrence compared with those without (adjusted HR (aHR): 2.29, 95% CI: 1.27 to 4.15, p=0.006). Patients receiving LAAW CFAE ablation had a higher recurrence rate than those receiving LAAW linear ablation (aHR: 3.29, 95% CI 1.42 to 7.63, p=0.006). Multivariable analysis identified that LAAW linear ablation was a strong independent predictor of reduced AF recurrence (HR: 0.13, 95% CI 0.06 to 0.28, p<0.001). Aortic encroachment is a common and significant risk factor for AF recurrence after ablation. When LAAW-LVAs are present, performing LAAW linear ablation might be a highly effective strategy to reduce postablation AF recurrence. Multidisciplinary team (MDT) meetings are central to treatment decisions in aortic stenosis (AS), particularly for borderline or high-risk patients. This study evaluates long-term, real-world outcomes according to MDT-selected management strategy within routine clinical practice in this clinically important patient group. We conducted a retrospective cohort study of all patients with severe AS discussed at a transcatheter aortic valve implantation (TAVI) MDT at a tertiary UK centre between January 2014 and December 2016. Patients were categorised as TAVI or non-TAVI (conservatively managed). Demographic, clinical and frailty data were collected, including Charlson Comorbidity Index, Clinical Frailty Scale (CFS) and number of prescribed medications. Survival was analysed using Kaplan-Meier estimates and Cox proportional hazards modelling adjusted for age, sex, frailty, comorbidity burden and medication count. A total of 373 patients were included (TAVI=178; non-TAVI=195). Patients undergoing TAVI were younger (81.3 years vs 83.5 years; p=0.01) and less frail (CFS 3.9 vs 4.9; p<0.01). Survival at 1 year, 2 years and 5 years was significantly higher following TAVI (87.6%, 74.7%, 44.9%) compared with conservative management (60.8%, 44.2%, 12.1%; p<0.001). Median survival was 53 months after TAVI versus 20 months without intervention. On multivariable analysis, TAVI was independently associated with reduced mortality (HR 0.38, 95% CI 0.28 to 0.50; p<0.001). In patients with severe AS discussed at MDT, TAVI was associated with a substantial and durable survival advantage compared with conservative management. These findings highlight the poor prognosis of untreated severe AS and support systematic inclusion of conservatively managed patients in interventional registries to better inform MDT deliberation and shared decision-making. There is a lack of contemporary data describing patients with left ventricular (LV) systolic dysfunction post myocardial infarction (MI) in terms of symptom burden and secondary prevention measures. The aim of this study was to describe patients with various degrees of LV systolic dysfunction after a first MI, their symptom burden, quality of life and adherence to recommended secondary prevention measures in a nationwide patient material. Patients (n=49 564) registered in the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease registry between 2011 and 2018, diagnosed with a first acute MI, discharged alive and with no previous heart failure, were stratified by degree of LV systolic dysfunction. Compared with patients with normal ejection fraction (EF≥50%), patients with a reduced EF (<30%) more often experienced shortness of breath (32.3% vs 5.6%, adjusted OR (95% CI): 7.45 (6.22 to 8.92)), had more often been readmitted (48.1% vs 31.2%, 1.87 (1.61 to 2.19)) and were more often on sick leave (26.6% vs 9.5%, 3.35 (2.45 to 4.58)), whereas there were no significant differences regarding chest pain and quality of life at the follow-up visit after 11–13 months. Patients with EF <30% had participated in education programme (44.9% vs 55.5%, 0.70 (0.60 to 0.81)) and physical therapy (11.3% vs 14.9%, 0.68 (0.58 to 0.79)) and have been physically active at least 30 min per day for at least 5 days per week (35.5% vs 40.2%, 0.86 (0.73 to 1.01)) to a lesser extent. Contemporary representative data show that LV systolic dysfunction after MI is associated with a very high symptom burden and worse secondary prevention after 11–13 months. To evaluate if an intervention to improve health literacy, using the risk communication tool ‘Your Heart Forecast’ and informative e-mails, can lower patients’ blood pressure (BP) and total cholesterol to high-density lipoprotein ratio (TC/HDL). A cluster randomised controlled trial. The intervention took place in 17 Danish general practice clinics randomised to either control or intervention at clinic level after invitation of each 25 hypertensive patients by birthdate. Men and women were eligible for inclusion if 35–75 years old, without prior cardiovascular disease (CVD). The final population consisted of 255 patients, 142 intervention and 113 control. The 146 men and 109 women were included between April 2019 and May 2021. The trial ended in March 2022. The intervention consisted of the CVD-risk communication tool ‘Your Heart Forecast’ at the annual BP consultations plus 1 monthly educational e-mail on lifestyle for 12 months. The control group received the usual care, defined as the annual CVD risk management consultation. Main outcome measures, BP and TC/HDL, were measured at baseline and follow-up after 10–18 months. Patients were divided into groups based on baseline levels and a paired t-test was performed on a pseudorandomised dataset by a blinded statistician. Both groups’ most dysregulated patients decreased their BP (p<0.0001, p=0.0002), and the BP decrease in the intervention group was larger. Additionally, the intervention patients with moderately raised BP also decreased their BP significantly (p=0.0133). Both groups saw an increase in BP in the most well-regulated patients. TC/HDL decreased only for the intervention patients with the highest baseline levels (p<0.0001) and increased for all with the lowest ratio (p<0.0001). The intervention lowered BP and TC/HDL in comparison to usual care for patients with dysregulated BP and/or TC/HDL above 4. NCT04058847; Clinicaltrials.gov, registered on 16 August 2019. The benefits of minimally invasive mitral valve surgery (MIMVS) compared with conventional approaches (CMVS, conventional mitral valve surgery) remain controversial. We conducted a systematic review and meta-analysis to evaluate the short-term benefits between these approaches. To evaluate the short-term benefits of MIMVS versus CMVS in adults. We searched PubMed/MEDLINE, EMBASE, Cochrane Library, LILACS, SciELO, clinical trial registries and grey literature using MeSH terms, without date or language restrictions. Randomised clinical trials (RCTs) comparing MIMVS and CMVS in adults (≥18 years) were included. Robotic, endovascular and redo procedures were excluded. Two reviewers independently extracted data following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Risk of bias was assessed with the Cochrane tool, and certainty of evidence with Grading of Recommendations, Assessment, Development and Evaluation. Meta-analyses used random-effects models. Primary outcomes were mortality, acute kidney injury (AKI) and wound infection. Nine studies (1248 patients) from eight RCTs were included (686 CMVS, 562 MIMVS). MIMVS showed no significant difference in mortality or AKI compared with CMVS. There was a trend towards fewer wound infections (risk ratio=0.47; 95% CI=0.22 to 1.00) and shorter intensive care unit (ICU) stay (mean difference=–0.71 days; 95% CI=–1.47 to 0.04). MIMVS reduced reoperation for bleeding (RR=0.24; 95% CI=0.06 to 0.92) and hospital stay (mean difference=–1.83 days; 95% CI=–3.03 to –0.64). Operative times were longer with MIMVS, but without clinical impact. Stroke, myocardial infarction, mechanical ventilation time and transfusion rates were similar. Most studies had low risk of bias, with moderate to high certainty of evidence. No heterogeneity was detected for primary outcomes. MIMVS enhances postoperative recovery through shorter hospital stays, fewer reoperations for bleeding and a trend towards fewer wound infections and shorter ICU stays compared with CMVS. Despite longer operative times, key safety is comparable between techniques. The overall certainty of evidence is high for most outcomes, supporting strong clinical recommendations in favour of MIMVS. CRD42022321939. Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) carries high mortality. Early revascularisation improves survival, but the effect of structured multidisciplinary care on outcomes remains underexplored. ACT-SHOCK is a service evaluation at a UK tertiary cardiac centre. Between May 2023 and May 2024, 82 patients with AMI-related CS requiring emergent percutaneous coronary intervention (PCI) were identified using protocolised physiological criteria and managed by an Advanced Cardiogenic-Shock Team (ACT). The ACT comprised interventional cardiologists, intensivists, anaesthetists, critical care staff and cardiac physiologists, coordinating PCI and ongoing care. Outcomes were compared with 83 historical controls from the year preceding ACT roll-out, who received standard care without ACT activation. Primary endpoints were 30-day and 1-year all-cause mortality; secondary outcomes included predictors of 30-day mortality. Within the ACT cohort, elevated lactate, critical care admission, invasive ventilation, out-of-hospital cardiac arrest and Society for Cardiovascular Angiography and Interventions (SCAI) Shock Stage E at first medical contact predicted 1-year mortality. Adjusted analyses showed ACT management was associated with lower 1-year mortality compared with standard care (HR 0.53, 95% CI 0.30 to 0.92; p=0.026). Although 30-day mortality was lower in the ACT group, this did not reach statistical significance (HR 0.71, 95% CI 0.39 to 1.29; p=0.26). Escalation from coronary care to critical care during the recovery phase occurred more promptly in the ACT group (9.7% vs 2.4%, p=0.09). At 24 hours, a smaller proportion of ACT patients remained in SCAI stages D/E compared with standard care (42% vs 48%; p=0.003). Implementation of physiological criteria to identify CS and activation of a multidisciplinary ACT in a UK tertiary centre was associated with earlier detection and improved 1-year survival in AMI-related CS. These pilot data support further study across multiple UK centres to inform national policy and standardise care pathways. Aortic dimensions are critical for assessing the risk of acute aortic complications and guiding surgical interventions. Current guidelines define absolute diameter thresholds based largely on Western cohorts, while data on Indian patients remain limited. To address this gap, our study provides a direct, large-scale comparison of aortic diameters between Indian and Dutch individuals to determine whether existing geometry-based surgical guidelines are equally applicable across populations. In this retrospective cohort study, we analysed all consecutive patients who underwent CT imaging between January and December 2022 at SIMS Hospital (India) and Amsterdam University Medical Center (Netherlands). Aortic diameters were measured at five predefined anatomical locations: aortic root, ascending aorta, aortic arch, descending aorta and abdominal aorta. Multivariable linear regression models were used, adjusting for age, sex, height and comorbidities. A total of 3692 patients were included (2000 Indian and 1692 Dutch). Indian patients had a larger aortic root (33.9 ± 4.6 mm vs 31.5 ± 5.4 mm; p<0.001), whereas Dutch patients had significantly larger diameters of the ascending aorta (33.1 ± 5.4 mm vs 30.5 ± 4.3 mm; p<0.001), aortic arch (29.8 ± 4.5 mm vs 26.4 ± 3.7 mm; p<0.001), descending aorta (26.7 ± 4.2 mm vs 23.0 ± 3.9 mm; p<0.001) and abdominal aorta (23.1 ± 5.0 mm vs 21.3 ± 3.4 mm; p<0.001). These differences persisted after adjustment for age, sex, height and comorbidities. In this first global comparison of ascending aortic dimensions between Indian and Dutch patients, we demonstrate substantial geographic heterogeneity. These findings highlight concerns about applying current surgical thresholds to Indian patients with aortopathy and emphasise the need for individualised risk assessment and treatment strategies in this population. Future guidelines should consider population-specific differences in India and incorporate indexed measurements to optimise personalised surgical decision-making. Inherited cardiac conditions, including dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM), may have a monogenic cause identified through genetic testing (GT). Confirmation of pathogenic gene variants can have important implications for the patient and their relatives. The UK National Genomic Test Directory (NGTD) provides strict criteria on the indications for GT; however, the European Society of Cardiology (ESC) recommends wider GT. We reviewed the prevalence of pathogenic genotypes in patients undergoing GT who did not meet the NGTD criteria. We conducted a retrospective analysis of patients who underwent GT with a confirmed diagnosis of HCM or DCM attending the Essex Inherited Cardiac Conditions Clinic between January 2023 and January 2025. 257 patients were included in the analysis, with 136 patients with DCM (52.9%) and 121 patients with HCM (47.1%). The diagnostic yield of GT was 19.9% in DCM and 17.4% in HCM. 14.8% of gene-positive patients with DCM and 14.3% of gene-positive patients with HCM did not meet current UK testing criteria, predominantly due to age of onset. All gene-positive patients in the DCM subgroup not meeting current NGTD criteria for testing had evidence of myocardial fibrosis. A significant minority of patients (1 in 7) with cardiomyopathy and a pathogenic genotype did not meet current UK testing criteria; each patient has an average of 4 first-degree relatives at risk who will benefit from predictive GT. We propose the adoption of the wider ESC guidance, removing the strict age-related cut-offs and being guided more by the severity of the phenotype, particularly involving myocardial scarring. Fibrocalcific aortic valve sclerosis (AVSc), the earliest manifestation of aortic stenosis (AS), is increasingly recognised as a marker of systemic vascular damage and adverse cardiovascular outcomes. While a subset of AVSc patients progresses to AS, reported rates vary widely. We conducted a systematic review and meta-analysis to better define the natural history of AVSc progression. Following Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, we searched PubMed, Scopus and Web of Science through July 2025 for observational studies reporting AS development in AVSc patients. Primary outcomes were progression to any degree of AS and to severe AS. Pooled event rates were calculated using a random-effects model. Heterogeneity and publication bias were assessed using standard statistical methods. Meta-regression explored associations with clinical and demographic variables. Eight studies (n=12 388 patients) reported on the progression of AVSc patients to any AS stage, and nine studies (n=19 486 patients) on the progression to severe AS. Over a median follow-up of 4.0 years, 14.1% of AVSc patients progressed to any AS stage (effect size: 0.14; 95% CI 0.02 to 0.53), and 2.0% to severe AS (effect size: 0.02; 95% CI 0.003 to 0.094). Heterogeneity was high, but no publication bias was detected. Meta-regression found no significant predictors of progression. Approximately one in six AVSc patients progresses to AS within 4 years, and 2% develop a severe disease. These findings underscore the importance of structured echocardiographic surveillance and support AVSc as a clinically relevant marker of systemic cardiovascular risk. Biomarkers could improve risk stratification in patients with acute ST-segment elevation myocardial infarction (STEMI), beyond left ventricular ejection fraction (LVEF). Our study evaluated the association between N-terminal pro-B-type natriuretic peptide (NT-proBNP), C reactive protein (CRP) and mortality in a cohort of patients with acute STEMI. This prospective, observational cohort study included patients with reperfused acute STEMI admitted to a tertiary cardiovascular disease centre between July 2020 and October 2023. All patients underwent NT-proBNP and CRP testing. The association between NT-proBNP, CRP and all-cause mortality was evaluated in relation to predischarge LVEF. The cohort included 566 patients with a mean age of 63 years. After a median follow-up of 39 months, postdischarge all-cause mortality reached 13.4%. NT-proBNP was associated with mortality irrespective of LVEF (HR 2.34 per SD increment in log NT-proBNP; p<0.001 at LVEF <50% and HR 2.36; p=0.004 at LVEF ≥50%), but the association between CRP and mortality was significant only in patients with LVEF <50% (HR 1.55, p=0.003). Across the cohort, NT-proBNP remained associated with death after adjustment for age, sex, diabetes, baseline high-sensitivity cardiac troponin T (hs-cTnT), CRP, final Thrombolysis in myocardial infarction (TIMI) flow grade and reduced LVEF (HR 1.45, p=0.03). In patients with preserved LVEF, routine NT-proBNP testing (area under the curve (AUC) 0.753 (0.642–0.863), p<0.001) improved risk stratification compared with isolated LVEF assessment (AUC 0.592 (0.453–0.730), p=0.18). In a cohort of stabilised acute STEMI survivors, NT-proBNP was associated with all-cause mid-term mortality independent of hs-cTnT and LVEF. The association between CRP and mortality was significant only in patients with LVEF <50%. Patients with severe aortic stenosis (AS) are at high risk of mortality, regardless of symptom status. Despite this, aortic valve replacement rates remain low for patients with severe AS due to challenges in identifying clinically significant AS in time. This has prompted the need to develop and investigate novel diagnostic modalities. The objective of this study was to develop and validate novel, non-invasive diagnostic algorithm leveraging seismocardiography (SCG) data to detect severe AS. A device capable of collecting a single-lead ECG and a three-dimensional SCG signal using a microelectromechanical-based accelerometer was used to collect sensor data. Phase 1 data were collected for training and validation of an algorithm for AS detection. Phase 2 data were collected as a blinded independent test set with age-matched and sex-matched patients as controls. In phase 1 of the study, 115 subjects (n=56 AS patients and n=59 controls; mean age 73.8±10.4 years) were collected for training and validation of an algorithm for AS detection. Once model development was complete, the frozen model was then evaluated in a fully independent, single blinded phase 2 cohort of 99 subjects (n=50 AS patients and n=49 controls; mean age 76.8±6.4 years) for final analysis. The algorithm accurately classified 89 out of 99 patients, with four true AS cases misclassified as controls and six true control cases misclassified as AS. The sensitivity, specificity and area under the curve of the model were 92% (95% CI 84.5% to 99.5%), 87.8% (95% CI 78.6% to 96.9%), and 96% (95% CI 91.9% to 99.9%), respectively. This SCG-based algorithm to detect severe AS demonstrated high sensitivity and specificity when tested in a blinded, age-matched and sex-matched cohort. These findings suggest that this technology may hold potential as a low-cost diagnostic tool for the detection of AS. While female sex has historically been associated with worse outcomes following surgical aortic valve replacement, the evidence regarding sex-related differences after transcatheter aortic valve implantation (TAVI) remains inconclusive. Given that women are more frequently referred for TAVI, clarifying the role of sex in procedural outcomes is clinically relevant. To systematically evaluate and summarise randomised clinical trial (RCT) evidence comparing TAVI outcomes between women and men. A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in PROSPERO (CRD42024510202). PubMed, EMBASE and Web of Science were searched for English-language RCTs up to 1 July 2024. Studies comparing TAVI outcomes by sex were included. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular mortality, stroke or transient ischaemic attack (TIA), major bleeding and permanent pacemaker implantation (PPI). Pooled ORs were calculated using Mantel-Haenszel random-effects models. 14 RCTs with a total of 15 225 participants were included. No overall difference in all-cause mortality was observed between sexes (OR: 0.83; 95% CI 0.65 to 1.06), though a significant protective effect for female sex was found among intermediate-risk patients (OR: 0.64; 95% CI 0.49 to 0.84; I²=0%). Women had a significantly higher risk of major bleeding (OR: 1.35; 95% CI 1.21 to 1.52; I²=15%). No significant sex-based differences were identified in cardiovascular mortality (OR: 0.98), stroke/TIA (OR: 0.96) or PPI (OR: 1.05). Female sex was associated with a lower all-cause mortality among intermediate-risk patients undergoing TAVI, but also with a higher overall risk of major bleeding. These findings suggest the need for further investigation into sex-related anatomical and procedural factors. CRD42024510202. Heart failure (HF) is common with high associated morbidity and mortality. UK National Institute for Health and Clinical Excellence (NICE) Guidelines suggest prioritising assessment by natriuretic peptide (NP) level, with patients with high NP levels assessed within 2 weeks. We evaluated adherence to NICE guidelines in the post-COVID-19 era. We conducted a retrospective audit of consecutive referrals to a HF diagnostic pathway across seven hospitals in the West of Scotland (between 5January and 2June2022). Patients were categorised by NP level according to NICE Guidelines: NT-proBNP 400–2000 ng/L (echocardiogram within 6 weeks) or >2000 ng/L (echocardiogram within 2 weeks). Time-to-echocardiogram was recorded, and 1-year outcomes (HF hospitalisation, death) were obtained from electronic records. Of the 899 patients (median age 79 years, 56% female) referred for echocardiography on the HF diagnostic pathway, 264 (29%) and 635 (71%) had an NT-proBNP >2000 ng/L and 400–2000 ng/L, respectively. Only 20 (8%) patients with NT-proBNP >2000 ng/L and 51 (8%) patients with NT-proBNP 400–2000 ng/L received an echocardiogram within the recommended timeframe. 252 (28%) patients were diagnosed with HF, 110 (42%) and 142 (22%) in the NT-proBNP >2000 ng/L and 400–2000 ng/L groups, respectively, p<0.001. One-year mortality was 12% and was higher in the >2000 ng/L NT-proBNP group at 21% compared with 9% in the 400–2000 ng/L group. High NP levels identified a high-risk group who are more likely to have HF and a higher risk of mortality. Few patients received echocardiography within the NICE Guideline-recommended timeframe. Patients with high NP levels should be investigated with the same urgency as suspected cancer. The epidemiology of native valve infective endocarditis (IE) has shifted toward older adults with substantial comorbidity burdens, yet contemporary nationwide data on outcomes and surgical impact remain limited. We conducted an 18-year nationwide cohort study of adults hospitalised with native valve IE in Korea (2006–2023). Outcomes included in-hospital and 5-year all-cause mortality, IE relapse and a composite of death or relapse. Temporal trends, mortality predictors and surgical associations across age strata were evaluated using multivariable Cox models and stratified survival analyses. Among 18 402 patients (mean age 63.7 years), incidence declined in individuals <45 years but increased in those ≥65 years. In-hospital mortality was 25.5%, and 5-year mortality exceeded 50% overall. Advanced age, dialysis dependence, cancer and major complications predicted mortality. Valve surgery, performed in 29.1% of patients, was consistently associated with lower short- and long-term mortality across age groups, with no evidence of age-by-treatment interaction. Both early (≤7 days) and late (>7 days) surgery showed reduced mortality versus medical therapy. IE relapse was more frequent in older adults, and surgery was associated with a lower relapse risk. In the composite outcome of death or relapse, older adults had a higher event burden, whereas surgery remained associated with fewer composite events. Native valve IE in Korea has shifted toward an elderly, multimorbid population with persistently high mortality. Despite declining utilisation, the survival benefit of surgery was preserved across the age spectrum, supporting operative consideration in appropriately selected older adults. To evaluate the potential mediating role of left ventricular ejection fraction (LVEF) in the relationship between replacement fibrosis (assessed by late gadolinium enhancement (LGE)) and sudden cardiac death (SCD) post-myocardial infarction (MI) and also to assess this mediation effect in subgroups based on LVEF ≤ 35% and > 35% according to implantable cardioverter-defibrillator (ICD) selection criterion. A retrospective analysis was conducted on 917 post-MI patients (mean age: 56.3±11.0 years, 88.8% male) who underwent cardiac MR from January 2017 to August 2021. The endpoint for SCDs included SCD, aborted SCD and appropriate ICD discharges. The association of LGE with LVEF was quantified using linear regression models. The associations of LGE and LVEF with SCDs were evaluated using competing risk models. Mediation analysis was then used to decompose the total effect of LGE on SCDs into direct and indirect (mediated through LVEF) effects using accelerated failure time models. Over a median follow-up of 63.3 (IQR, 43.6 to 76.6) months, 65 patients (7.1%) experienced SCDs. In all patients, LGE was significantly associated with lower LVEF (β=-0.35, p<0.001). Both LGE and LVEF independently predicted SCDs (subdistribution hazard ratio (sHR)=1.06, p<0.001; sHR=0.95, p=0.03, respectively). Mediation analysis showed that LVEF accounted for 19.7% of the total effect of LGE on SCDs (p<0.001). This mediation effect was 40.4% in patients with LVEF > 35% (p = 0.02), while no mediation was observed in patients with LVEF ≤ 35% (p = 0.08). LVEF partially mediated the effect of LGE on the SCD, accounting for less than one-fifth of the total effect. LVEF alone inadequately captured the whole SCD risk, irrespective of whether LVEF is greater than 35% or 35% or less. Annually, 4% of the global population undergoes non-cardiac surgery, with 30% of those patients having at least one cardiovascular risk factor. It is estimated that the 30-day mortality is between 0.5% and 2%. The main objective of this study is to develop a traditional machine learning (ML) model that provides a cardiovascular risk score for patients older than 50 years undergoing non-cardiac surgery, calculating the risk from the date of surgery until 30 days post surgery, with specific emphasis on interpretability and explainability of the model’s decision-making process. The NSQIP 2022 dataset was used to build the model. It consisted of a total of 4 97 011 patients after data cleaning. The primary clinical endpoint was death, myocardial infarction, cardiac arrest or stroke at 30 days postoperatively, which occurred in 1.44% of the patients. Different preprocessing techniques were performed for data cleaning and feature selection. The cleaned data were then used to model the selected learning algorithms, including Logistic Regression, Naive Bayes, Random Forest and boosting Decision Tree algorithms (CatBoost, AdaBoost, Light Gradient Boosting Machine (LightGBM, XGBoost, Gradient Boosting). These models were evaluated in terms of the area under the receiver operating characteristic curve (AUROC) and their corresponding 95% CI. For classification, the trained models were evaluated using AUROC on the test set. LightGBM achieved the highest AUROC of 0.9009 with a 95% CI of 0.8889 to 0.9126. The model consisted of six data elements: type of surgery, American Society of Anesthesiology classification, Blood Urea Nitrogen (BUN), sepsis, emergent surgery and mechanical ventilation. In our study, LightGBM classifier proved to be the best model for cardiovascular risk scoring, demonstrating a strong balance between prediction accuracy and generalisation. Ruling out myocardial infarction (MI) in patients with an initial indeterminate (detectable to mildly elevated) troponin measure is challenging. Myocardial-Ischaemic-Injury Index (MI3) is a machine-learning algorithm designed to diagnose MI, but its utility in patients with indeterminate troponins is unclear. This study seeks to evaluate its diagnostic performance in patients with an initial indeterminate troponin. We conducted a secondary analysis of a cohort (Cardiovascular Magnetic Resonance-Invasive-based Strategies in Patients with Chest Pain and Detectable to Mildly Elevated Serum Troponin) of adult patients with symptoms suggestive of acute coronary syndrome and an initial clinical contemporary troponin of 0.006–1.0 ng/mL across four US hospitals. Patients with initial and 3-hour high-sensitivity cardiac troponin I (Abbott Laboratories) measures were classified by MI3 into low-risk, intermediate-risk and high-risk groups. The primary outcome was adjudicated MI at 30 days. The sensitivity, specificity and negative likelihood ratio (–LR) of MI3 for MI at 30 days were calculated and reported with 95% CIs. A receiver operator characteristics curve for MI at 30 days was created and area under the curve (AUC) for MI3 was calculated. Among 207 patients, 34.3% (71/207) were female with a mean age of 61±11 years. MI at 30 days occurred in 43.5% (90/207). The AUC for MI3 for the detection of MI at 30 days was 0.882 (95% CI 0.833 to 0.932). MI3 classified 34.8% (72/207) of patients as low-risk, of which 8.3% (6/72) had MI at 30 days, yielding a sensitivity of 93.3% (95% CI 86.1 to 97.5%) and –LR of 0.12 (95% CI 0.05 to 0.26). Among the 47.3% (98/207) classified as intermediate-risk, MI at 30 days occurred in 48.0% (47/98). MI3 classified 17.9% (37/207) as high-risk, among which 100% (37/37) had MI at 30 days, yielding a specificity of 100% (95% CI 96.9% to 100%). Among emergency department patients with an initial indeterminate troponin measure, the MI3 machine-learning algorithm had high AUC and specificity for 30-day MI. Differentiating type 1 myocardial infarctions (T1MI) from type 2 myocardial infarctions (T2MI) can be challenging based on clinical variables alone. This review aimed to explore the utility of novel and traditional biomarkers to discriminate between these entities and potentially provide additional prognostic information. A systematic review of observational studies and randomised controlled trials that examined the discriminatory or prognostic roles of either traditional cardiac biomarkers (troponin, creatine kinase or b-type natriuretic peptide) or non-traditional biomarkers. Data sources included PubMed, SCOPUS, Web of Science, EMBASE and clinicaltrials.gov and were last searched on 15 November 2024. The diagnostic accuracy of biomarkers and prognostic utility of identified biomarkers are narratively reported. 31 studies with 16 111 individuals with a T2MI were included. Most studies (97%) demonstrated moderate or severe risk of bias. Of studies that examined traditional cardiac biomarkers (n=13), the ability to discriminate between T2MI and T1MI ranged from an area under the curve (AUC) of 0.61–0.71. Studies that added traditional cardiac biomarkers to clinical variables (n=4) demonstrated a diagnostic accuracy AUC 0.71–0.82. Studies exploring non-traditional biomarkers, metabolic and proteomic profiles (n=14) demonstrated a wide range of diagnostic accuracy (AUC 0.50–0.77). Traditional cardiac biomarkers inconsistently demonstrated a correlation with subsequent cardiovascular events. The prognostic utility of non-traditional biomarkers was infrequently assessed. The role of biomarkers, metabolic and proteomic profiles in the diagnosis and prognostication of T2MI remains unclear. Higher quality studies and refining the classification of T2MI may improve this further. CRD42023418095.