搜索结果：European heart journal supplements : journal of the European Society of Cardiology

The population of adult patients with congenital heart disease (ACHD) is rapidly growing thanks to advances in diagnostics and therapeutics. However, these patients now encounter new clinical and healthcare challenges. The 'New perspectives in ACHD management' session at the ACHD 2025 Congress highlighted the key areas of innovation aimed at improving prognosis and quality of life. The aging ACHD population places substantial demands on geriatric medicine, with significant implications for the healthcare system. Similarly, the increasing arrhythmic burden, in particular atrial fibrillation, requires specific preventive and therapeutic strategies, including ablation procedures tailored to the anatomical peculiarities of ACHD patients. Pulmonary hypertension is a major contributor to morbidity and mortality in ACHD, requiring precision medicine approaches, dedicated risk stratification, and multidisciplinary approach. A central role is played by adequate prevention of acquired cardiovascular diseases, whose incidence is higher and occur earlier than in the general population. Specific risk stratification tools and an integrated approach of lifestyle modification and innovative pharmacological therapy are necessary. Telemedicine offers new opportunities for remote monitoring, access to specialized expertise, and comprehensive support, particularly for frail patients or those living in remote areas. Lastly, emerging technologies such as 3D printing, virtual reality, computational modelling, and artificial intelligence are transforming treatment planning and enabling personalized care. A multidisciplinary and technologically advanced approach is essential for shifting the focus from merely prolonging survival to truly improving the quality of life of ACHD patients.

Tricuspid regurgitation (TR) affects approximately 4% of individuals over 75 years of age and is associated with substantial morbidity due to heart failure symptoms and frequent hospitalization. In Europe, TR prevalence is expected to rise with an ageing population, contributing to a growing burden on heart failure services. Surgical repair or replacement for isolated TR has been historically underutilized because of high operative risk, however, recent advancements in transcatheter technology have shifted the treatment paradigm. Having once been labelled the forgotten valve, the European interventional cardiology community was suddenly confronted with a number of different devices, all designed to target TR. Having the intrahospital mortality for isolated tricuspid valve surgery in mind, ranging from 8.0% to 12.3%, the initial results of transcatheter therapies with an all-cause mortality of 3.7% at 30 days were promising, although procedural success was achieved in only 62% and cardiac and cerebrovascular major adverse events were as high as 26%. Already, T-TEER constituted the majority of interventions, although miskeyed M-TEER devices were used off-label. Other systems, such as Trialign, TriCinch, FORMA, Cardioband, NaviGate, and caval valve implantation were used distinctively less often.

Hypertrophic cardiomyopathy (HCM) is a non-rare genetic cardiomyopathy, with an estimated prevalence of 1:500, characterized by an increase in the left ventricular wall thickness in the absence of increased loading conditions. The hypertrophy is mostly asymmetric and predominantly affects the basal septum and anterior wall. Left ventricular outflow tract obstruction, at rest or after provocative tests, is detected in many patients and represents the primary cause of reduced functional capacity, as well as an independent predictor of sudden cardiac death and advanced heart failure. Until ∼1 year ago, symptomatic patients despite maximal therapy with β-blockers or calcium channel blockers plus disopyramide had only basal septal reduction therapy through myectomy or septal alcoholization as additional therapeutic options. Today, a new class of drugs that inhibit cardiac myosin activity is available for patients with obstructive HCM. In light of the new treatment perspectives, the correct clinical-therapeutic classification of affected patients becomes of fundamental importance for the cardiologist. The aim of this position paper is to increase the knowledge of cardiologists in the field of HCM, defining its epidemiological, genetic, and pathological characteristics, identifying the diagnostic criteria and instrumental methods capable of stratifying the risk profile, with the aim of an optimal therapy tailored on the single patient.

Heart failure is the leading cardiovascular cause of hospitalization with an increasing prevalence, especially in older patients. About 50% of patients with heart failure have preserved ventricular function, a form of heart failure that, until a few years ago, was orphaned by pharmacological treatments effective in reducing hospitalization and mortality. New trials, which have tested the use of gliflozins in patients with heart failure with preserved ejection fraction (HFpEF), have for the first time demonstrated their effectiveness in changing the natural history of this insidious and frequent form of heart failure. Therefore, diagnosing those patients early is crucial to provide the best treatment. Moreover, the diagnosis is influenced by the patient's comorbidities, and some HFpEF patients have symptoms common to other rare diseases that, if unrecognized, develop an unfavourable prognosis. This position paper aims to provide the clinician with a useful tool for diagnosing and treating patients with HFpEF, guiding the clinician towards the most appropriate diagnostic and therapeutic pathway.

Tricuspid regurgitation (TR), once considered a passive marker of advanced cardiac disease, is increasingly recognized as an independent contributor to morbidity, mortality, and healthcare burden. Recent evidence, including the pivotal TRILUMINATE trial and Tri-FR, together with supporting cost-effectiveness models, suggest that the correction of TR with T-TEER systems may improve patient outcomes and offer good value for money in European healthcare settings. This article explores the clinical rationale and economic imperative for considering TR as a modifiable and actionable target in modern cardiology ([Adamo M, Chioncel O, Pagnesi M, Bayes-Genis A, Abdelhamid M, Anker SD et al. Epidemiology, pathophysiology, diagnosis and management of chronic right-sided heart failure and tricuspid regurgitation. A clinical consensus statement of the Heart Failure Association (HFA) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC. Eur J Heart Fail 2024;26:18-33.]).

The May Measurement Month (MMM) campaign was carried out in Thailand in 2022 with the aim of raising awareness of raised blood pressure (BP). Here, we report on the findings of the campaign. Adults aged &#x2265;18 years were recruited opportunistically at hospitals and co-working spaces in all regions of Thailand. Three seated BP readings were taken for each participant, along with the completion of a questionnaire on demographics, lifestyle factors, and comorbidities. Hypertension was defined as a systolic BP &#x2265; 140&#x2005;mmHg and/or diastolic BP &#x2265; 90&#x2005;mmHg or being on antihypertensive medication. Controlled BP was defined as being on antihypertensive medication with a BP < 140/90&#x2005;mmHg. Multiple imputation was used to estimate any missing BP readings. In total, 10 562 were screened, with a mean age of 50.4 years and 60.8% of whom were female. Of all participants, 4670 (44.2%) had hypertension, of whom 3416 (73.1%) were aware, and 3240 (69.4%) were on antihypertensive medication. Of those on antihypertensive medication, 1957 (60.4%) had controlled BP, and of all participants with hypertension, 41.9% had controlled BP. The MMM campaign in Thailand identified significant numbers of participants with either untreated or inadequately treated hypertension. Appropriate intervention after BP screening together with prescribing suitable BP-lowering regimens should be implemented to enhance BP control.

In recent years, remarkable advancements in paediatric cardiology and surgical techniques have dramatically increased the survival of patients with congenital heart disease. As a result, adults with congenital heart disease (ACHD) are now living longer, and many, despite having residual lesions and sequelae, may have near-normal life expectancy. Adults with congenital heart disease patients should no longer be viewed merely as survivors; instead, medical care should shift its focus from simply prolonging life to enhancing quality of life and overall well-being. Moreover, as ACHD population ages, they are increasingly exposed to a burden of acquired cardiovascular and extracardiac disease, making early intervention on modifiable risk factors a key priority. Herewith, we provide an overview of the multiple aspects that should be considered in this holistic approach to guide everyday issues of ACHD patients, including nutrition, physical activity, sexual health, cancer prevention, respiratory disease, and infective endocarditis.

Hypertension remains a major public health challenge with inadequate control globally. The May Measurement Month (MMM) global survey initiated by the International Society of Hypertension was implemented in Greece in 2022 aiming to raise hypertension awareness and control. Adult volunteers were recruited through opportunistic screening in 11 urban areas. Information on medical history and three sitting blood pressure (BP) measurements were obtained using validated automated upper-arm devices, and the data were submitted online through a custom-designed app of the global MMM survey. Hypertension was defined as average systolic BP at least 140&#x2005;mmHg and/or diastolic 90&#x2005;mmHg, and/or self-reported use of drugs for hypertension. A total of 6353 individuals were included (mean age 54.8 &#xb1; 16.2 years, 49% men, 30.5% current smokers, 11.5% had diabetes, 5.1% cardiovascular disease). The prevalence of hypertension (42.6%) was higher in men (48.8%) and in older individuals (74%). Among individuals with hypertension, 27.5% were unaware of their diagnosis, 22.2% were treated but uncontrolled (&#x2265;140&#x2005;mmHg systolic and/or &#x2265;90&#x2005;mmHg diastolic BP), and 47.9% were treated and controlled. Among treated hypertensives, 58.2% were on monotherapy and at least one-third of them were uncontrolled. The prevalence of hypertension in Greece seems to be high and is often undiagnosed, untreated, and uncontrolled. Public health initiatives and campaigns aiming at improving hypertension diagnosis and control need to be implemented.

Cardiogenic shock (CS) is a life-threatening condition defined by the heart's inability to adequately pump blood to meet metabolic demands, leading to systemic hypoperfusion and insufficient tissue oxygenation. Despite treatment advancements, CS continues to carry high morbidity and mortality rates, especially when it follows acute myocardial infarction. Various expert groups and scientific societies have proposed recommendations and management pathways, each contributing unique insights yet sometimes overlooking important clinical considerations. This mini-review provides an updated, integrated overview of distinct CS scenarios, including ischaemic, non-ischaemic, and post-cardiotomy categories, and their respective treatment strategies. Additionally, this review explores management approaches that underscore the importance of early detection of inflammatory markers in non-ischaemic CS and targeted therapeutic interventions for each CS subtype. Specifically, the role of pharmacological treatments is examined alongside the relevance and timing of mechanical circulatory support devices. A deeper understanding of the pathophysiology and tailored management pathways for each CS type may enable clinicians to improve interventions and enhance survival and recovery in patients with CS.

2025 ESC/EACTS guidelines for valvular heart disease reflect the rapid evolution of transcatheter technologies and multidisciplinary care. In primary mitral regurgitation, surgical repair remains the gold standard, with a new Class I recommendation for asymptomatic patients and refined timing incorporating indexed left ventricular end-systolic dimension. Transcatheter edge-to-edge repair (TEER) is upgraded to Class IIa for symptomatic high-risk patients. In secondary mitral regurgitation (SMR), the guidelines distinguish between atrial and ventricular phenotypes. Transcatheter edge-to-edge repair has now a Class I [Level of Evidence (LOE) A] recommendation for very selected patients with ventricular SMR symptomatic despite guideline-directed medical therapy. For atrial SMR, surgery-often involving concomitant atrial fibrillation ablation-is preferred in suitable candidates, while TEER is reserved to high-risk patients. Regarding tricuspid regurgitation, the guidelines emphasize early referral and structured evaluation of right ventricular function and pulmonary pressures (Class I). Transcatheter tricuspid valve interventions are upgraded to Class IIa (LOE A) for symptomatic high-risk patients, provided severe right ventricular dysfunction or precapillary pulmonary hypertension are absent. These updates redefine atrio-ventricular valve management by promoting earlier and personalized intervention. They solidify the role of transcatheter therapies as evidence-based, outcome-modifying options within a Heart Valve Centre framework, while precisely delineating the continued priority of surgery in lower-risk populations and complex anatomies.

Patients with a systemic right ventricle (sRV)-including those with transposition of the great arteries (TGA) following atrial switch repair (Mustard or Senning procedures) and congenitally corrected TGA-represent one of the greatest challenges in the management of adults with congenital heart disease (ACHD). The right ventricle is not anatomically designed to sustain systemic pressure over a lifetime. As a result, sRV failure is almost inevitable and follows a progressive, multifactorial process that initiates with maladaptive functional and structural changes. In later stages, arrhythmias, conduction delays, and pacing-induced dyssynchrony emerge, accelerating deterioration. Finally, lifestyle and environmental factors such as inactivity, obesity, or pregnancy may trigger clinical decompensation. Recognizing where a patient lies along this continuum and identifying those at highest risk is essential to anticipate deterioration and implement timely interventions. Despite significant advances in the management of ACHD, important gaps in knowledge and research remain regarding the sRV, particularly in understanding its long-term adaptation, predictors of failure, optimal medical therapy, prevention of dyssynchrony, and timing for transplant. We herewith summarize latest evidences on prognostic determinants, multimodality imaging, heart failure therapy, electrical therapy for heart failure, mechanical circulatory systems, and heart transplant in sRV.

Since the first operation performed in 1968, the worldwide population of patients living with Fontan circulation is dramatically growing, with 40% reaching adulthood in the current era. Despite this remarkable improvement in survival, some patients struggle with Fontan-related complications including heart failure, arrhythmias, end-organ dysfunction, and premature death. This review aims at describing common complications of the Fontan circulation, proposing a clinical and mortality risk score to better stratify this complex population as well as exploring the current state of art in catheter interventions and transplant.

Arrhythmic sudden cardiac death (SCD) remains a major cause of late mortality in adults with congenital heart disease (ACHD), second only to heart failure. Risk prediction is challenging due to the heterogeneity of underlying defects and surgical histories. This review summarizes contemporary evidence on arrhythmic SCD prevention in ACHD, focusing on lesion-specific risk stratification, device-based therapies, and emerging technologies. Traditional markers-ventricular dysfunction, QRS prolongation, and prior arrhythmias-show limited predictive value. Recent models such as PREVENTION-ACHD and the Spanish ACHD Network score offer structured but evolving approaches to individualized risk assessment. Cardiac MRI-derived fibrosis quantification, electro-anatomical mapping, and machine-learning-based tools hold promise for refined prediction. Implantable cardioverter-defibrillators (ICDs) remain the cornerstone of secondary prevention, while subcutaneous ICDs and emerging extravascular systems mitigate lead-related complications. The wearable cardioverter-defibrillator offers a temporary protective option in high-risk patients awaiting definitive therapy. Catheter ablation-particularly in repaired Tetralogy of Fallot-can modify arrhythmic substrates, whereas bradyarrhythmias require vigilant monitoring and timely pacing interventions. In conclusion, effective prevention of arrhythmic SCD in ACHD demands a multidisciplinary, lesion-specific approach integrating advanced imaging, device innovation, and personalized risk modelling. Ongoing refinement of predictive tools and interventional strategies will be crucial to reduce mortality in this growing population.

Tricuspid regurgitation is a frequent and undertreated condition associated with poor outcomes. Over the past decade, transcatheter tricuspid valve interventions have emerged as a valuable alternative for high-risk patients. Edge-to-edge repair is the most widely adopted approach, while replacement technologies are advancing rapidly and offer the potential for near-complete elimination of regurgitation. In parallel, annuloplasty, spacers, and caval devices are broadening the therapeutic spectrum across diverse anatomies. This review outlines the expanding device armamentarium and the key opportunities and challenges in this evolving field.

Recent advances in congenital heart disease management reflect a paradigm shift towards less invasive, physiology-preserving, and durable interventions. Transcatheter pulmonary valve implantation has become an established therapy for right ventricular outflow tract dysfunction, supported by multiple valve systems tailored to increasingly complex anatomies. These devices have demonstrated high procedural success and sustained hemodynamic performance, although infective endocarditis and arrhythmic complications remain clinical concerns. In parallel, transcatheter edge-to-edge repair for atrioventricular valve regurgitation (AVVR) has expanded from acquired disease to congenital populations, particularly in patients with single-ventricle physiology or systemic AVVR where surgical risk is prohibitive. Early experiences with devices such as MitraClip&#x2122;, TriClip&#x2122;, and Pascal have shown promising results in improving valve competence and functional status. From a surgical perspective, the Ross procedure continues to offer a unique, physiological alternative for aortic valve replacement in selected young adults, achieving excellent long-term outcomes when performed in high-volume centres with reinforcement strategies to prevent autograft dilation. Similarly, percutaneous correction of sinus venosus atrial septal defect using covered stents has emerged as a safe and effective alternative to conventional repair, providing anatomical reconstruction with low complication rates. The modern Fontan circulation exemplifies the evolution of single-ventricle palliation, emphasizing conduit optimization, pro-active re-intervention, and individualized surgical planning to sustain function over time. Collectively, these innovations underscore the growing integration of transcatheter and surgical therapies, re-defining long-term management paradigms and improving survival and quality of life in patients with congenital heart disease.

Tricuspid regurgitation (TR) has historically been under-recognized in clinical practice, yet growing evidence highlights its significant impact on prognosis, particularly in its severe forms. Severe TR is indeed associated with increased mortality and heart failure hospitalizations, with prognostic deterioration further stratified by emerging classifications such as 'massive' and 'torrential' TR. Accurate assessment of TR severity is essential for timely referral and management decisions. Traditional echocardiographic parameters-such as tricuspid annular plane systolic excursion and right ventricular (RV) fractional area change-are limited by their load-dependence, prompting growing interest in advanced imaging modalities such as strain imaging and cardiac magnetic resonance for more precise evaluation of RV function. In this setting, medical management remains only supportive, with diuretics and neurohormonal modulation forming the cornerstone of therapy, especially in patients with heart failure. However, evidence for pharmacological interventions specific to TR is limited. Surgical treatment is indicated in select patients, though associated with high perioperative risk, necessitating careful patient selection. In recent years, transcatheter tricuspid valve interventions have emerged as promising alternatives for high-risk patients, including edge-to-edge repair (T-TEER) and orthotopic tricuspid valve replacement, and also caval valve implantation is being explored for anatomically complex or high-risk cases. Early recognition, comprehensive risk assessment, and individualized therapeutic planning-including consideration of timely intervention-are crucial to improving outcomes in this often-neglected valvular condition.

Functional/Secondary tricuspid regurgitation (STR) accounts for over 85% of clinically significant tricuspid regurgitation (TR) and is associated with adverse prognosis and impaired quality of life. Advances in percutaneous tricuspid valve (TV) interventions underscore the need to differentiate TR aetiologies, mechanisms, and phenotypes. STR is subdivided into atrial (A-STR), caused by right atrial dilation and tricuspid annular enlargement without significant leaflet tethering, and ventricular (V-STR), resulting from right ventricular dilation/dysfunction with leaflet tethering. A-STR, increasingly prevalent with ageing and atrial fibrillation, typically presents with preserved right ventricular function, whereas V-STR reflects more advanced disease, is associated with RV dysfunction and, often, left ventricular systolic dysfunction and remodelling and/or left-sided valve disease, carrying higher mortality, compared with A-STR. Cardiac implantable electronic device (CIED) related TR is emerging as a distinct entity, while organic-TR arises from intrinsic structural abnormalities of the valve apparatus. Echocardiography, particularly three-dimensional imaging, is essential for accurate phenotyping and helps in procedural planning. Medical therapy remains primarily symptomatic, with diuretics as first-line therapy and targeted treatment of underlying cardiac pathology. In A-STR, rhythm control strategies, including catheter ablation for atrial fibrillation, may reverse annular remodelling. Surgical repair, preferably annuloplasty, is recommended in selected patients, often when concomitant left-sided surgery is needed. Transcatheter edge-to-edge repair offers a safe and increasingly used alternative, providing symptomatic improvement. The effects on outcomes are likely dependent on the time of intervention and the STR phenotype.

Only recently, pathophysiology and relevance of tricuspid regurgitation (TR) has been acknowledged but remains still poorly understood. The rising interest in this valve disease has also fuelled the efforts to define and improve imaging modalities. Vice versa, understanding tricuspid disease initiation and progress, validation, and quantification as well as choice and monitoring of treatment critically rely on reproducible and sensitive imaging capabilities. The latter is dominated by ever improving ultrasound-based analysis applied from the outside, the oesophagus or within the heart. The increasing appreciation of the relevance of TR and the rapid evolution of catheter-based treatment options has stimulated engineers and industry to swiftly improve established methodologies as well as to provide novel tools including three-dimensional intra-cardiac echocardiography and fusion imaging. Ultrasound is necessarily complemented by MRI and CT in the tricuspid space urging the cardiologist to gain also expertise in these modalities. In this review, we will focus on the quantitative and reproducible measurements to quantify TR and concomitant left and right heart anatomy, function, and haemodynamics before, during and after treatment. In addition, we will share insights on adjunct and future technologies.

Advances in paediatric cardiology and surgery have transformed congenital heart disease from a fatal condition into a chronic, lifelong one. As a result, the adult congenital heart disease (ACHD) population is rapidly expanding and aging, with rising medical complexity and growing workforce shortages. The ACHD patient of tomorrow will present with diverse needs-ranging from management of complex congenital repairs and heart failure (HF) to acquired comorbidities typical of aging populations. This shift necessitates a reimagined model of care emphasizing accessibility, precision, and patient partnership. Telemedicine, remote monitoring, and digital health platforms will decentralize ACHD care, improving follow-up and reducing disparities. Precision medicine, integrating genomics, proteomics, metabolomics, and microbiomics, will enable individualized diagnosis and therapy. Artificial intelligence (AI) will enhance early detection, risk prediction, and surgical planning while supporting patient education and engagement. Future ACHD patients will be empowered participants in shared decision-making, supported by AI-driven tools and online communities. Personalized strategies for HF management, especially in Fontan circulation and systemic right ventricles, along with advances in transcatheter interventions, will minimize surgical trauma and improve quality of life. Equally, mental health and social integration will be central to holistic care. Ultimately, tomorrow's ACHD care will merge technology and humanity-leveraging innovation to deliver compassionate, individualized treatment across a patient's lifespan.