European Heart Journal

White matter hyperintensities (WMH) progress with age and hypertension, but the key period of exposure to elevated blood pressure (BP), and the relative role of systolic BP (SBP) vs. diastolic BP (DBP), remains unclear. This study aims to determine the relationship between WMH and concurrent vs. past BP.

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On cerebrotoxicity of antihypertensive therapy and risk factor cosmetics

Franz H Messerli, Chirag Bavishi, Adrian W Messerli, George C M Siontis

doi : 10.1093/eurheartj/ehaa971

European Heart Journal, Volume 42, Issue 7, 14 February 2021, Pages 758–760

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A leucopoietic-arterial axis underlying the link between ambient air pollution and cardiovascular disease in humans

Shady Abohashem, Michael T Osborne, Tawseef Dar, Nicki Naddaf, Taimur Abbasi, Ahmed Ghoneem, Azar Radfar, Tomas Patrich, Blake Oberfeld, Brian Tung, Zahi A Fayad, Sanjay Rajagopalan, Ahmed Tawakol

doi : 10.1093/eurheartj/ehaa982

European Heart Journal, Volume 42, Issue 7, 14 February 2021, Pages 761–772

Air pollution [i.e. particulate matter with diameter <2.5 ?m (PM2.5)] is a risk factor for major adverse cardiovascular events (MACE). While PM2.5 promotes leucopoiesis and atherosclerotic inflammation in experimental models, it is unknown whether this occurs in humans. We tested in humans (a) whether PM2.5 associates with higher leucopoietic tissue activity and arterial inflammation (ArtI), (ii) whether these associations persist after accounting for the effects of potential confounders including socioeconomics, traffic noise, and risk factors, and (iii) whether these tissue effects mediate the association between air pollution and MACE.

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Air pollution triggers inflammation and cardiovascular events: now is the time to act

Baris Gencer, François Mach

doi : 10.1093/eurheartj/ehaa1020

European Heart Journal, Volume 42, Issue 7, 14 February 2021, Pages 773–775

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Prognostic value of peak stress cardiac power in patients with normal ejection fraction undergoing exercise stress echocardiography

Vidhu Anand, Garvan C Kane, Christopher G Scott, Sorin V Pislaru, Rosalyn O Adigun, Robert B McCully, Patricia A Pellikka, Cristina Pislaru

doi : 10.1093/eurheartj/ehaa941

European Heart Journal, Volume 42, Issue 7, 14 February 2021, Pages 776–785

Cardiac power is a measure of cardiac performance that incorporates both pressure and flow components. Prior studies have shown that cardiac power predicts outcomes in patients with reduced left ventricular (LV) ejection fraction (EF). We sought to evaluate the prognostic significance of peak exercise cardiac power and power reserve in patients with normal EF.

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Heart failure and systolic function: time to leave diagnostics based on ejection fraction?

Otto A Smiseth, John M Aalen, Helge Skulstad

doi : 10.1093/eurheartj/ehaa979

European Heart Journal, Volume 42, Issue 7, 14 February 2021, Pages 786–788

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Assessing left ventricular systolic function: from ejection fraction to strain analysis

Brian P Halliday, Roxy Senior, Dudley J Pennell

doi : 10.1093/eurheartj/ehaa587

European Heart Journal, Volume 42, Issue 7, 14 February 2021, Pages 789–797

The measurement of left ventricular ejection fraction (LVEF) is a ubiquitous component of imaging studies used to evaluate patients with cardiac conditions and acts as an arbiter for many management decisions. This follows early trials investigating heart failure therapies which used a binary LVEF cut-off to select patients with the worst prognosis, who may gain the most benefit. Forty years on, the cardiac disease landscape has changed. Left ventricular ejection fraction is now a poor indicator of prognosis for many heart failure patients; specifically, for the half of patients with heart failure and truly preserved ejection fraction (HF-PEF). It is also recognized that LVEF may remain normal amongst patients with valvular heart disease who have significant myocardial dysfunction. This emphasizes the importance of the interaction between LVEF and left ventricular geometry. Guidelines based on LVEF may therefore miss a proportion of patients who would benefit from early intervention to prevent further myocardial decompensation and future adverse outcomes. The assessment of myocardial strain, or intrinsic deformation, holds promise to improve these issues. The measurement of global longitudinal strain (GLS) has consistently been shown to improve the risk stratification of patients with heart failure and identify patients with valvular heart disease who have myocardial decompensation despite preserved LVEF and an increased risk of adverse outcomes. To complete the integration of GLS into routine clinical practice, further studies are required to confirm that such approaches improve therapy selection and accordingly, the outcome for patients.

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