Editors’ highlight picks from 2023 in EHJ Open

EHJ Open has just completed its Volume 3. Since three is the smallest number needed to create a pattern, the EHJ Open Section Editors have now started the process of shaping the journal for both authors and readers. Looking back at 2023, we see a pattern of increasing numbers of submissions and publications and also an escalating interest in the journal’s content. Figure 1 depicts the EHJ Open Volume 3 articles receiving the most attention in 2023, as measured by Altmetric Attention Score. In this editorial, the Section Editors have summarized some of the highlights, and also wanted to thank all Authors, Readers, Associate Editors, and Reviewers for sculpting Volume 3 and leading us into the 4th Volume.

Figure 1

EHJ open publications from 2023 with highest altmetric attention score (data sourced from app.dimensions.ai, accessed 5 February 2024).^1–4

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The section on Epidemiology & Prevention highlights that the distribution of potentially modifiable risk factors differs between high-income European countries (Belgium, France, and England), compared with South Africa and Uganda. The data on the risk score was prospectively collected, and the results reveal that compared to Europe which has more metabolic factors that contribute to the risk score, unhealthy dietary patterns, low physical activity, and a higher waist-hip ratio were more prevalent in South Africa.⁵ Understanding the distribution is key for targeted interventions that can lower future cardiovascular disease for entire populations.⁶

EHJ Open also has a specific section focusing on Cardiovascular Genetics with applicability to all subjects covered in the journal. In this context, Mendelian randomization (MR) adds a causal dimension to studies of cardiovascular risk.⁷ As an example, MR analysis supported that short sleep duration increases peripheral artery disease.⁸ The common paths of Vascular Medicine and Coronary Artery Disease were illustrated in EHJ Open by carotid and coronary atherosclerosis being associated with an estimated 24 h sodium excretion,⁹ for which the underlying mechanisms remain to be fully explored.¹⁰

The latter observations were linked to Hypertension, a subject also dedicated to an EHJ Open section. A study evaluating the prognostic impact of the absence vs. presence of hypertension-mediated organ damage (left ventricular hypertrophy, carotid plaques, and chronic kidney disease) showed that ageing, the magnitude of insulin resistance, antiplatelet therapy, and multiple sites with hypertension-mediated organ damage were associated with future cardiovascular events, whereas a negative association was found with renin–angiotensin system blocker drugs.¹¹ This study extends previous observations¹² and suggests how cardiovascular risk assessment can be improved in clinical practice by using readily available information.

Environmental pollution may alter dietary exposome towards increased cardiovascular risk.¹³ As an example, serum arsenic levels may provide a concentration-dependent link between fish intake and hypertension, for which a causal mechanism was shown in a mouse model.¹⁴ Further Translational Basic Science from Volume 3 reinforced the important role of lipids, showing that very low-density lipoprotein can alter intracellular fatty acid ratio of arachidonic to docosahexaenoic acid (AA/DHA) in C4+ T cells, which promoted Th1-skewing and atherosclerosis.¹⁵ Interestingly, a recent large meta-analysis indicated that plant-based diets lower atherogenic lipoproteins and cardiovascular risk.¹⁶ How diet and its fatty acid content influence T-cell-mediated inflammation and atherosclerotic burden warrants further investigation.

Cardiac amyloidosis (CA), a progressive infiltrative disease caused by the cardiac deposition of amyloid fibrils,¹⁷ has received attention in EHJ Open 2023 across sections. In Valvular Heart Disease, EHJ Open presented a State-of-the-Art review on the association of CA with aortic stenosis, from pathophysiology to treatment.¹⁸ Furthermore, in Arrhythmia & Electrophysiology, Ullah et al. used nationwide health data to conclude that atrial fibrillation ablation was associated with significantly higher net adverse clinical events in patients with CA,¹⁹ albeit atrial fibrillation catheter ablation remains effective to maintain sinus rhythm in patients with CA.²⁰ Finally, novel findings on Vascular & Cardiac Imaging of CA include a suggested novel echocardiographic risk score²¹ and CA prognostic prediction by cardiac magnetic resonance imaging (cMRI).²²

The latter section also includes an article showing that low preoperative left atrial reservoir strain was a risk factor for after coronary artery bypass grafting (CABG) ischaemic stroke in 542 patients over a median follow-up of almost 4 years, independently of the occurrence of postoperative atrial fibrillation (POAF).²³ This work considerably refines the insights from Butt et al.²⁴ about the prognostic value of POAF in CABG patients regarding stroke events. POAF complicates 20–40% of cardiac surgical procedures. Underlying mechanisms are incompletely defined but include intraoperative and postoperative phenomena, such as inflammation, sympathetic activation, and cardiac ischaemia.²⁵ The EHJ Open section on Interventional Cardiology & Cardiac Surgery introduced that the arterial stiffness measure cardio ankle vascular index (CAVI) predicted POAF after surgical aortic valve stenosis replacement.²⁶

Results stemming from a retrospective cohort of 4659 patients who underwent transcatheter aortic valve implantation (TAVI) at two high-volume, early adopter centres, in the United States and in Germany, the main finding was a correlation between right ventricular (RV) stimulation rates and higher risk for all-cause mortality and heart failure-related hospitalizations at 1-year.²⁷ These findings were independent of previously implanted pacemaker, suggesting a direct association between non-physiological ventricular activation and adverse clinical outcomes. The study addressed one of highly debated topics during this past year, namely the clinical impact of pacemaker stimulation in TAVI recipients, adding evidence to extend and confirm similar preliminary findings from a single-centre study, also confirming the previous evidence about the role played by pre-existing right bundle branch block as independent predictor of the need for pacemaker stimulation after TAVI, transposing the association to the rate of RV stimulation.^28,29 Along the same line, they also confirm that implantation depth and post-dilatation of the aortic prosthesis independently predict the need for pacing, supporting the findings from a multidisciplinary research group from Ghent University. In fact, using advanced in-silico modelling, they provided a mechanistic explanation of the impact exerted by the contact pressure generated with self-expandable aortic prostheses and the development of new conduction abnormalities.³⁰

Cardio-oncology represents one of the Special Populations in a dedicated EHJ Open section, in which a prospective cohort study of 47 women with newly diagnosed stage 1–3 human epidermal growth factor receptor (HER) 2-positive breast cancer showed that HER2-directed therapy alone had no major effect on vascular reactivity and vascular biomarkers, but the addition of anthracycline/cyclophosphamide can lead to a deterioration in vascular and cardiac function.³¹ These results fill a part of the gap in knowledge of the emerging problem of vascular effects of cancer therapies.³² Pelosi et al. showed that adults with Adult Congenital Heart Disease (ACHD), especially those with moderate/severe ACHD have an optimistic view of their life-expectancy and clearly more optimistic than their cardiologist.³³ In addition, growing attention is warranted for discussions on end-of-life and patients’ life-expectancy to improve care.³⁴ Takotsubo syndrome (TTS) can be complicated by cardiogenic shock (CS), which represents one of the leading causes of mortality in TTS.³⁵ In a multi-centre observational registry, the use of Heart Failure treatment with intra-aortic balloon counterpulsation was however not associated with lower mortality rates at short- and long-term follow-up in patients with TTS and CS.³⁶

These editors’ highlight picks from 2023 illustrate the breadth of topics covered by EHJ Open. Stay tuned to #EHJOpen for more content. Among the new year’s resolutions, novel research results should soon become available to further promote open and interactive cardiology for an accelerated and global sharing of cardiovascular science.

Data availability

There are no new data associated with this article.

Acknowledgements

The third volume of EHJ Open has been completed with the invaluable help of the following Associate Editors, who have handled submissions during 2023:

Ana Almeida, Athanase Benetos, Marie-Luce Bochaton-Piallat, Mats Börjesson, Ronny Buechel, Juan-Jesus Carrero, Christian de Chillou, Jeremy Fauconnier, Jonas Faxén, Nicolas Girerd, Joerg Herrmann, Annette Schophuus-Jensen, Stefan Koudstaal, John Pernow, Davide Stolfo, Michał Zembala.

All editors of EHJ Open would like to thank those who referee papers for the journal. The peer reviewers who contributed to the Journal in 2023 are as follows.

Editorial board reviewers: Daniel Andersson, Adrian Covic, Kevin Damman, Dipender Gill, Alessia Gimelli, Fabien Hyafil, Bengt Johansson, Patrick Lacolley, Sofia Sederholm Lawesson, Sven-Christian Pawelzik, Arman Postadzhiyan, Veronique Regnault, Željko Reiner, Jane Stubbe, Giuseppe Vergaro.

Reviewers: Ahmed Abdelaziz, Piergiuseppe Agostoni, Anders Ahlsson, Ibrahim Akin, Baravan Al-Kassou, Abdallah Almaghraby, Faisal Amlani, Todd Anderson, Aristides Androulakis, Dimitri Arangalage, Alicja Rudnicka, Vicente Artola Arita, Noel Balrey-Merz, Anna Baritussio, Fotios Barkas, Guillaume Baudry, Alexander E Berezin, Priyadarshini Bhattacharjee, Vanessa Bianconi, Vera Bittner, Robert Bober, Josip Andelo Borovac, Nunzia Borrelli, Ilze Bot, Jacinthe Boulet, Axel Brandes, Ole Breithardt, Ana Briones, Jill Bruneau, Natale Brunetti, Gunilla Burell, Kenneth Caidahl, Paolo Calabrò², Leonardo Calo’, Gianluca Campo, Nicole Carabetta, Marcus Carlsson, Maryanne Caruana, Mariano Casciaro, Edina Cenko, Qingui Chen, Ziying Chen, Jia Ee Chia, Iksung Cho, Stefano Coiro, Bernard Cosyns, Guillaume Coutance, Naima Covassin, Jordi S Dahl, Anna Damlin, Kevin Damman, Gheorghe-Andrei Dan, Undurti N Das, Fabrizio D'Ascenzo, Jennifer Davidson, Guy De Backer, Ole De Backer, Rudolf A. De Boer, Bart De Geest, Sofie De Moudt, Vivian de Waard, Ronak Delewi, Mikael Dellborg, Michael Dismorr, Erwan Donal, Virginie Dufrost, David Duncker, Lydia Dux-Santoy, Jean-Philippe Empana, Johan Engdahl, Etto Eringa, David Erlinge, Andrej Fabjan, Thomas Fink, Ian Ford, Thomas Foret, Nikolaos G. Frangogiannis, Shinichi Fukuhara, Elena Galli, Cosme García-García, Giacomo Gelati, Davide Genovese, Johannes Gho, Emilia Goanta, Guillaume Goudot, K. Lance Gould, Felice Gragnano, Karl-Henrik Grinnemo, Tomasz Grodzicki, Eduard Guasch, Luigina Guasti, Charles Guenancia, Norbert Guettler, Laila Hübbert, Tara Haas, Hajar Habibi, Alison Halliday, Stepan Havranek, Jeroen Hendriks, Christoph Herrmann-Lingen, Helen Huang, Luke Hunter, David Hunter, David Hupin, Tyler Hyungtaek Rim, Ignatios Ikonomidis, Orhan İnce, Riccardo Inciardi, Masanobu Ishii, Frederic Jaisser, Shahnaz Jamil-Copley, Jacob Jentzer, Richmond W. Jeremy, Madeleine Johansson, Christian Jung, Juliane Jurga, Farhan Katchi, Rami Khouzam, Antoine Kimmoun, Roland Klingenberg, Masatake Kobayashi, Takashi Kohno, Emmanuel Koutalas, Adrienne H. Kovacs, Florian Kronenberg, Konstantin Krychtiuk, Jeremy Lagrange, Damien Lanéelle, Isabella Leo, Christian Lewinter, Elisa Liehn, Kai Lin, Valeria Lo Faro, Herbert Loellgen, Mark Luedde, Agneta Månsson Broberg, Teemu Maaniitty, Meena Madhur, Paolo Manca, Antonio Mangieri, Benjamin Marchandot, David Marlevi, Alex Mcconnachie, Luca Monzo, Philip Moons, John Morgan, Daniel A. Morris, Andreea Motoc, Sophia Anastasia Mouratoglou, Theresa Munyombwe, Ramesh Nadarajah, Koki Nakanishi, Ryszard Nosalski, Connor O’Brien, Marish Oerlemans, Adeyemi Olusola, Janine Pöss, Niema Pahlevan, Maria Alexandra Pana, Tunde Peto, J. Geoffrey Pickering, Tomaz Podlesnikar, Arman Postadzhiyan, Marek Postula, Riccardo Proietti, Athanase Protogerou, Neda Rajamand Ekberg, Dimitris Richter, Barbara Riegel, Mario Rienzo, Leena Robinson Vimala, Wolfgang Rottbauer, Massimiliano Ruscica, Lars Rydén, Stefan Söderberg, Manel Sabaté, Pierre Sabouret, Anders Sahlén, Husam Salah, Andrea Salzano, Anna Sannino, Philip Sarajlic, Antti Saraste, Andreas Schuster, Felicia Seemann, Mypinder Sekhon, Jean Marc Sellal, Shantanu Sengupta, Bahira Shahim, Anoop Shetty, Kouji Shirai, Arthur Shiyovich, Moa Simonssonn, Chiara Siracusa, Sara Själander, Markus Skrifvars, Aeron Small, Philipp Sommer, Jonas Spaak, Ivan Stankovic, Stavros Stavrakis, Lasse Steffensen, Konstantinos Stellos, Robert F. Storey, Jane Stubbe, Madhan Sundaram, Per Svenningsen, Andrew Teh, Larisa G. Tereshchenko, Per Tornvall, Gal Tsaban, Grigorios Tsigkas, Jose Tunon, Valtteri Uusitalo, Mani A. Vannan, Manon van der Meer, Niels M.R. van der Sangen, Loek van Heerebeek, Vlad Vasile, Georgios Vavilis, Amit Vora, Håkan Wallén, Jolanda Wentzel, Martin Wilkins, Kevin Willy, Rebecca C. Woodruff, Troels Yndigegn, Shuai Yuan, Paolo Zaffino, Thomas Zegkos, Andreas Zietzer, Marco Zuin.

Finally, the Section Editors gratefully acknowledge the work of the EHJ Open Managing Editor Claudia Welburn.

References

Author notes