Intervention, improved prevention, imaging, inflammation, and innovation: the five I's cardiovascular highlights in EHJ Open 2024

Intervention, Improved prevention, Imaging, Inflammation, and Innovation are highlights of some major insights from European Heart Journal Open 2024. Those I's also put spotlight on five of the future perspectives in cardiology trajectories towards optimization of diagnosis, interventions, and treatments, as well as novel innovative targets and methods. To balance potent P2Y12 inhibitors after percutaneous coronary intervention (PCI), a guided selection of P2Y12 inhibiting therapy has been associated with the most favourable balance between efficacy and adverse bleeding effects in a meta-analysis.1 In the case of co-morbidities requiring both anti-coagulation and anti-platelet therapy, such as concomitant atrial fibrillation and PCI, a large nation-wide registry study showed a lower ischaemic risk without increased bleeding with ticagrelor or prasugrel over clopidogrel,2 which aligns with the real-world PERSEO registry3 and supports an individualized choice of P2Y12 inhibitors. Beyond optimizing post-intervention care, novel interventional cardiology technologies also emphasize pre-intervention patient selection to improve treatment success. Mitral valve transcatheter edge-to-edge repair (TEER) significantly reduced the combined endpoint of heart failure hospitalizations and mortality compared with medical therapy in the RESHAPE-HF2 (Transcatheter Valve Repair in Heart Failure with Moderate to Severe Mitral Regurgitation) trial.4 The results highlight possible need for a reconsidered severity threshold for secondary mitral regurgitation intervention as well as an integrated approach including also left ventricular remodelling for optimizing patient selection and TEER success.5 Successful prevention, both before and after an optimized intervention, relies on life-style modifications and pharmacological interventions. Although recent evidence suggests electronic cigarettes as a potential addition to counselling for quitting regular smoking,6 a contemporary meta-analysis showed that electronic cigarettes containing nicotine are not without risks and affect the cardiovascular system acutely similar to regular combustible cigarettes.7 In addition to life-style changes, polypills may facilitate the attainment of guideline-recommended prevention linked to better outcomes, less side effects, and being cost saving compared with other therapeutic options.8 Those results support and extend other findings on the use of polypill in secondary prevention in patients with coronary artery disease.9 Lipoprotein(a) [Lp(a)] is emerging in prevention, for risk prediction10 and with therapeutic potential.11 Although Lp(a) levels are predominantly genetically determined, temporal-related changes in Lp(a) variability suggests that repeat Lp(a) measures allow more precise cardiovascular risk prediction.12 Prevention with available lipid-lowering is also challenging in some special populations, such as the need for establishing safety and efficacy of dyslipidaemia treatment during pregnancy.13 Finally, improved prevention through lipid lowering also comprises novel targets and potential personalized medicine approaches. A drug-target Mendelian randomization analysis supports lowering plasma ANGPTL3, ANGPTL4, and APOC3 levels as promising novel strategies for reducing cardiovascular disease risk.14 Extracellular volume (ECV), a marker of myocardial fibrosis and other conditions, traditionally assessed via cardiac magnetic resonance, can also be evaluated using coronary computed tomography angiography (CTA).15 In a study retrospectively evaluating 874 patients who underwent CTA for the evaluation of coronary artery disease myocardial ECV fraction was obtained from the CTA data.16 The results detected 12% of patients with an ECV fraction >35%, which was associated with several pathologic conditions, among which cardiac amyloidosis was diagnosed in 15 patients.16 This cohort is considerably larger than all studies combined from a recent meta-analysis15 and points to ECV fraction as a clinically meaningful parameter extractable from clinically indicated CTA. Chronic inflammation is well-established as a residual risk for atherosclerotic cardiovascular disease.17 Among the currently implemented anti-inflammatory targets, colchicine inhibits cytoskeletal microtubule formation leading to decreased vesicle transport and secretion, but its use may be limited by adverse effects.18 Despite previous outcome trials reporting significantly reduced cardiovascular events with low-dose colchicine19 and new ESC recommendations for colchicine in chronic coronary syndromes,20 its use remains limited. The most recent results from the CLEAR trial however showed that treatment with colchicine after myocardial infarction for a median of 3 years did not reduce the incidence of the composite primary cardiovascular outcome.21 Nevertheless, colchicine decreased CRP compared with placebo,21 pointing to decreased inflammation. Colchicine's potential effects on lower-extremity peripheral artery disease (PAD) evaluated in emulation of target trials using a real-world sample of patients with PAD and gout, did not conclude that colchicine decreased the cardiovascular or limb events,22 and the ongoing randomized clinical trial LEADER-PAD (NCT04774159) is evaluating the effects of colchicine in PAD.23 Among other anti-inflammatory targets, IL-6's broad effects has made it an attractive target for anti-inflammatory cardiovascular risk reduction,24 which is currently evaluated in an ongoing trial of the monoclonal anti-IL-6 ziltivekimab (NCT05021835).19 Importantly, myeloid-specific IL-6 has been shown to significantly impact vascular function25 and to be linked to a newly identified population of monocyte-derived lipid-laden pro-inflammatory macrophages that can accelerate atherosclerosis.26 These findings suggest that not only the secreted IL-6 protein but also the cells overexpressing it should be considered for future anti-inflammatory cardiovascular therapies. Among machine learning methods that enable novel and innovative approaches, spectral regression learning is emerging as a promising technique for advanced data analysis applicable to measures of aortic stiffness, which represents structural changes of the arterial system and associates with future cardiovascular events and mortality.27 Wave separation analysis is a tool for decomposing the components of blood pressure waveform, but the need for concurrent measurements of pressure and flow limits its applicability. A recent study introduced a spectral regression learning method for pressure-only wave separation analysis using data from the Framingham Heart Study to evaluate the accuracy of pressure-only estimates, and their association with aortic stiffness, assessed by carotid-femoral pulse wave velocity (cf-PWV).28 After adjustments for potential confounders, the results suggested that the pressure-only evaluations of wave separation parameters predicted cf-PWV, with forward wave amplitude being the only significant factor. The authors propose that aortic stiffness estimated through this spectral regression learning and single pressure waveform measurements outperform methods used in previous studies29 and provide a valuable non-invasive tool for cardiovascular assessment. In summary, the 5 I's put forward here highlights European Heart Journal Open as an open access forum for providing important insights into the recent development of cardiovascular medicine and surgery. We encourage you to explore the journal's full content, which is freely available, and welcome submissions that contribute to a continued open and interactive cardiovascular forum with global sharing of science. Section Editors gratefully acknowledge the work of the EHJ Open Managing Editor Claudia Welburn. Volume 4 of EHJ Open has been completed with the invaluable help of the following Associate Editors, who have handled submissions during 2024: Ana Almeida Athanase Benetos Marie-Luce Bochaton-Piallat Mats Börjesson Ronny Buechel Christian de Chillou Jérémy Fauconnier Dipender Gill Nicolas Girerd Joerg Herrmann Stefan Koudstaal Seth Martin Edit Nagy Jens Cosedis Nielsen John Pernow Davide Stolfo Giuseppe Vergaro Faiez Zannad Michal Zembala All editors of EHJ Open would like to thank those who reviewed papers for the journal. The peer reviewers who contributed to the Journal in 2024 are as follows. Adrian Covic Bruna Gigante Daniel Andersson Gustavs Latkovskis Jane Stubbe Michael Shapiro Nailin Li Niki Katsiki Patrick Lacolley Sven-Christian Pawelzik Wael Jaber Yury Lopatin Elisabetta Abruzzese Maurizio Acampa Lina Adwan Arian Aghilinejad Vibhor Agrawal Malik Takreem Ahmad Alberto Aimo Noor Albakaa Joakim Alfredsson Baravan Al-Kassou Abdallah Almaghraby Saed Alnaimat Till Althoff Ali Ambreen Rafael Amorim Belo Nunes Oskar Angerås Luca Arcari Albert Ariza-Solé Vicente Artola Arita Alice Assinger Camillo Autore Tariq Azam Luca Baldetti Noel Balrey-Merz Anna Baritussio Fotios Barkas Ozcan Basaran Frederico Bastos Gonçalves Benedikt N. Beer Ronen Beeri Alexander E. Berezin Jutta Bergler-Klein Marco Bernardi Kunal Bhatt Francesco Bianco Luigi Biasco Elias Björnson Hanne Boen Giuseppe Boriani Josip Andelo Borovac Athenais Boucly Selim Bozkurt Anna Brand Axel Brandes Michele Brignole Jonas Brinck Ana Briones Natale Brunetti Rosa Maria Bruno Antonio Cannata Blase Anthony Carabello Nicole Carabetta Andreina Carbone Lombardi Carlo Mario Vincenzo Castiglione Anwar Chahal Ari Chaouat Emmanouil Charitakis Qingui Chen Jia Ee Chia Jacob J. Christensen Ruxandra Christodorescu Sumeet S. Chugh Thomas R. Cimato Giovanni Cimmino Marc J. Claeys Alberto Clemente Paul Collinson Alberto Cordero Madalena Costa Elaine Coutinho Inês Coutinho dos Santos Naima Covassin Mohamed Dafaalla Fabrizio D'Ascenzo Tim A.C. de Vries Emilia D'Elia Louis Dell'Italia Borislav Dinov Erwan Donal Stavros Drakos Iryna Dykun Lars Eckardt Betty Eipper Johan Engdahl Artur Evangelista Morten Fagerland Francesca Fasolo Laurent Fauchier Jonas Faxén Abdallah Fayssoil Gudrun M. Feuchtner Thomas Fink Elena Fortin Eloi Gagnon Elena Galli Luna Gargani Johannes Gho Federico Giacobbe Daniele Giacoppo Angelina Gideon Robert Giugliano Diona Gjermeni Emilia Goanta Andrew Michael Goldsweig Rafael González-Manzanares Shinya Goto Guillaume Goudot Felice Gragnano Karl-Henrik Grinnemo Tomasz Grodzicki Luigina Guasti Diana Ruxandra Hădăreanu Sigrun Halvorsen Kristina Hambraeus Pamela Harding Mark Haykowsky Jeroen Hendriks Alexander Hirsch Vibeke Hjortdal Katarzyna Holcman John Horowitz Amin Hossein David Hupin Ignatios Ikonomidis Masanobu Ishii Hideki Itoh Vikash Jaiswal Hong Jin Madeleine Johansson Elizabeth Jones Jens Jordan Christian Jung Wayne Kaesemeyer Nobuyuki Kagiyama Sergio Kaiser Farhan Katchi Cormac Kennedy Yulia Khodneva Kye Hun Kim Masatake Kobayashi Petri Kovanen Konstantin Krychtiuk Jeremy Lagrange Stefan Lange Alf Inge Larsen Chu-Pak Lau Seung-Yul Lee Georges Leftheriotis Anthony Leicht Daniel Lenihan Isabella Leo Thorsten Leucker Christian Lewinter Hoong Sern Lim Herbert Loellgen Cristina Madaudo Meena Madhur Ange Maguy Koon-Hou Mak Michael Makover Daniel Malone Paolo Manca Benjamin Marchandot Nassir Marrouche Antoni Martínez-Rubio Yuya Matsue John W. McEvoy Felix G. Meinel Thomas Meyer Dimitri P. Mikhailidis Emanuele Monda Luca Monzo Sara Moscatelli Andreea Motoc Marion Mußbacher Maria Lorenza Muiesan Toshiyuki Nagai Bernd Niemann George Ntaios W. Charles O’Neill Marish Oerlemans Evangelos Oikonomou Elmir Omerovic Ariela R. Orkaby Giuseppe Panuccio Konstatinos Papadopoulos Valeria Paradies Manan Pareek Claudio Passino Mubarak Patel Francesco Pelliccia Peter Penson Carl J. Pepine Gabriele Pesarini Aurélie Philippe Indu G. Poornima Athanase Protogerou Nicola Pugliese Juan Carlos Quijano-Campos Anjali Rao Vijay Rao Fabrizio Ricci David Ripley Benoit Robaye Bianca Rocca Alfredo Rodriguez Marco Roffi Nathalie Rosenblatt-Vein Joy Roy Eleonora Ruscio Manel Sabate Pierre Sabouret Akinori Sairaku John Sanderson Anna Sandström Ciro Santoro Carmine Savoia Marco Schiavone Christian Schulze Andreas Schuster Paolo Sciarrone Jean Marc Sellal Bahira Shahim Arthur Shiyovich Anwar Siddiqui Johanne Silvaine Moa Simonsson Tomasz Skowerski Matthew Solomon Philipp Sommer Jonas Spaak Lasse Steffensen Phyllis K. Stein Konstantinos Stellos Lee Sterling Christian Sticherling Alexander Sullivan Toru Suzuki Emma Svennberg Sebastian Szmit Felix Tanner Giuseppe Tarantini Jean-Claude Tardif Konsta Teppo Ulf Thilén Per Tornvall Mileen van de Kar Erik Van Iterson Gregoire Vandecasteele Mani Vannan Renu Virmani Niels Voigt Miao Wang Liansheng Wang Samuel Watson Troels Yndigegn Shuai Yuan Sergio Zacà Emmanuel Zavalis Hongsong Zhang Liang Zhong Andreas Zietzer Christopher Zörner Ermir Zulfaj There are no new data associated with this article.