主编面对面 | 谈中国心血管创新，《Eur Heart J》杂志主编Filippo Crea教授揭秘心血管研究未来趋势

2025年3月，第二季“中国之声，创新力量——中国原创优秀临床研究展播”活动即将再次起航。本次活动将立足新起点，通过更立体化的传播形式、更国际化的视角，展现中国医务工作者破解临床难题的智慧与担当，助力科研成果转化。为此，我们在研究展播正式开始前，推出“Global Perspectives,  Dialogue with Editors-in-Chief”医学期刊主编面对面环节，以期搭建一架中国学者与权威期刊主编的沟通桥梁。

本期为大家带来《中国医学论坛报》与《欧洲心脏杂志》主编Filippo Crea教授的深度访谈。Prof. Crea为我们介绍了心血管医学领域的研究热点，AI相关研究发表应遵循的5项标准，并对青年中国学者如何在国际期刊上发表高质量研究成果方面给出宝贵建议。

中国原创，世界回响。让我们共同期待这场跨越时空的学术对话，如何点燃临床创新的星星之火，又如何照见人类攻坚心血管系统疾病的共同未来。

Q1 As the Editor-in-Chief of European Heart Journal, you have a unique perspective on transformative trends in cardiovascular science. What key areas of cardiovascular research do you believe will most profoundly reshape the future of cardiology?

作为《欧洲心脏杂志》的主编，您对心血管科学的发展趋势有着独特的见解。您认为，心血管研究中哪些重要领域将重塑心脏病学的未来？

《Eur Heart J》主编Prof. Crea

I think that we have many challenges in front of us. One important challenge is prevention. Traditional risk factors, like diabetes, hypertension, obesity, dyslipidemia, smoking were identified more than 40 years ago. But these traditional risk factors can explain only 50% of cardiovascular disease risk, the remaining 50% is explained by what we call residual risk. And residual risk is mainly related to inflammation and air pollution. I think that we must better characterize cardiovascular risk, including inflammation and air pollution. Current tools are mainly based on traditional risk factors. We must incorporate these new risk factors. And we also need artificial intelligence (AI) to better identify individual risk in the individual patient. Thus, we must include new risk factors and utilize AI in the best possible way. These are two important challenges to address.

我认为我们面临着诸多挑战。其中一个重要挑战是预防。糖尿病、高血压、肥胖、血脂异常、吸烟等传统风险因素早在40多年前就已被确定。但这些传统风险因素只能解释50%的心血管疾病风险，剩余的50%则由我们所称的残余风险来解释。而残余风险主要与炎症和空气污染有关。我认为，我们必须更全面地描述心血管疾病风险，包括炎症和空气污染。目前的风险预测工具主要基于传统风险因素。我们必须将这些新的风险因素纳入考虑。同时，我们还需要利用人工智能（AI）来更好地识别单个患者的个体风险。因此，我们必须纳入新的风险因素，并尽可能最好地利用人工智能。这是我们需要应对的两个重要挑战。

Then another area of development is treatment based on nucleic acids. This is a key development of pharmacotherapy. Nucleic acid-based drugs are the future for the prevention and treatment of cardiovascular diseases. We can utilize different approaches including antisense oligonucleotides, inhibiting RNA and gene editing. All these approaches keep evolving to prevent and treat cardiovascular diseases. One of the advantages offered by nuclei acid-based treatments is that we can treat patients with one injection every six months, rather with a daily administration. And these treatments are very powerful in reducing, for instance, the levels of LDL-C and Lp(a) . And when we come to gene editing, now we have evidence that we can cure cardiac amyloidosis with a single treatment in life. In conclusion, this new potent forms of treatment  represent the future in the treatment of cardiovascular diseases.

另一个发展领域是基于核酸的治疗，这是药物疗法的一个重大发展。核酸类药物是预防和治疗心血管疾病的未来方向。我们可以采用不同的方法，包括反义寡核苷酸、RNA抑制和基因编辑。这些方法也都在不断发展以预防和治疗心血管疾病。核酸类治疗的一个优势是可以降低给药频率，例如患者每6个月只需接受一次注射而无需每日给药。这些治疗方法在降低低密度脂蛋白胆固醇（LDL-C）和脂蛋白(a) [Lp(a)]水平等方面非常有效。在基因编辑方面，现有证据表明，1次治疗即可终身治愈心脏淀粉样变性。总之，这些新型强效治疗方法预示着心血管疾病治疗的未来。

Thus, better prevention, new drugs based on nucleic acid, and the third key area of development is artificial intelligence.

所以，更好的预防以及基于核酸的新药研究都是心血管研究未来的关键领域。至于第三个，当然是AI研究。

Q2 How do you assess the progress of Chinese cardiovascular research in recent years?

您如何看待近年来中国心血管研究的进展？

《Eur Heart J》主编Prof. Crea

The development of cardiovascular research in China in the past few years has been astonishing. I am proud to say that China is the top submitting country to the European Heart journal. The majority of papers we receive come from China. The improvement of the quantity and quality of Chinese cardiovascular research in the past few years has been really outstanding.

过去几年，中国在心血管研究方面的发展令人惊叹。我可以很自豪地说，中国是向《欧洲心脏杂志》投稿最多的国家。我们收到的大多数论文都来自中国。过去几年，中国在心血管研究的数量和质量上的提升确实非常出色。

Q3 Have any research studies from Chinese scholars  particularly caught your attention? Could you share an example and explain why it stands out?

有哪些中国学者的研究特别引起了您的注意？您能跟我们举例分享为什么它们会脱颖而出吗？

《Eur Heart J》主编Prof. Crea

I can provide several examples if I had the time, because China has been extremely productive in several areas. For instance, we published a randomized trial, based on Shensong Yangxin, which is a traditional Chinese medicine. This trial shows that it prevents atrial tachyarrhythmia. Thus, we have trials like this, which are extremely innovative, based on traditional medicines.

如果我有时间的话，我可以举出好几个例子，因为中国在多个领域都取得了极为丰硕的成果。比如，我们发表了一项基于参松养心胶囊（一种传统中药）的随机试验。该试验表明，参松养心胶囊可以预防心房快速性心律失常。我们经常有这样一些基于传统药物的极具创新性的试验。

Then we published several contributions in translational science. Recently, we published a study which was the first to show the presence of an endogenous cholinergic system in the heart. And we published a very interesting study on the adaptive immunity in hypertension.

此外，中国学者在转化科学领域也有多项贡献。最近，我们发表了一项研究，首次揭示了心脏中存在内源性胆碱能系统。我们还有一项关于高血压适应性免疫的研究，也很有意思。

We also published elegant epidemiological studies, which are extremely relevant. For instance, we published recently a study showing that low ambient temperature increases the risk of myocardial infarction without stenosis (MINOCA). Epidemiological studies can inspire new approaches to cardiovascular diseases.

同时，我们也发表了一些非常有意义且设计巧妙的流行病学研究。例如，我们最近发表的一项研究表明，低环境温度会增加无梗阻性冠状动脉心肌梗死（MINOCA）的风险。流行病学研究确实能为心血管疾病的防治提供新思路。

Last but not least, we published excellent contributions in the field of AI. We published a paper 5 years ago, very well cited, about prediction of coronary artery disease by AI-assessed facial recognition. This algorithm which assesses facial features predicts the presence of coronary artery disease better than clinical scores. In conclusion, we published many interesting contributions from China in different fields: trials, translational science, epidemiology and also artificial intelligence.

最后但同样重要的是，中国学者在人工智能领域也发表了一些优秀论文。五年前我们发表了一篇目前已经被广泛引用的论文，探讨了基于人工智能和面部识别技术来预测冠状动脉疾病。该算法能通过面部图片预测冠状动脉疾病的发生部位。可以说，中国学者在临床试验、转化科学、流行病学以及人工智能领域都做出了很多贡献。

Q4 How can emerging tools like AI accelerate solutions to cardiovascular disease burdens, and what role should journals play in curating such research?

人工智能等新兴工具如何加速减轻心血管疾病带来的全球负担，期刊在策划此类研究时应发挥什么作用？

《Eur Heart J》主编Prof. Crea

As we have already discussed, AI is a really important tool which can help in all fields of cardiovascular medicine. For instance，to improve diagnosis, as shown in the Chinese study mentioned before, in which AI-based assessment of the patient face predicted the presence of coronary artery disease. We have studies showing that AI-based reading of a simple electrocardiogram can predict the presence of left ventricular dysfunction or of aortic stenosis. Thus, the role of AI in diagnosis is extremely important.

正如我们已经讨论的，人工智能是一个非常重要的工具，可以在心血管医学的所有领域提供帮助。例如，AI可以改进诊断，之前提到的中国研究就是如此，在该研究中，基于人工智能的患者面部评估可以预测冠心病的存在。我们有研究表明，基于人工智能的简单心电图解读可以预测左心室功能障碍或主动脉狭窄的存在。因此，人工智能在诊断中的作用极为重要。

And also the role of AI in the risk prediction with some elegant study coming from University of Oxford. The prognostic models, AI integrate perivascular adipose tissue(PVAT) information in, can predict cardiovascular risk much better than traditional risk factors. And AI can be extremely useful in predicting the response to treatment. AI is important in all areas of cardiovascular medicine.

此外，如牛津大学的研究所示，人工智能在风险预测方面可以发挥重要作用。将人工智能应用于血管周围脂肪组织（PVAT）的评估，在预测心血管风险方面的效果远优于传统风险因素。最后，人工智能在预测治疗反应方面极具价值。人工智能在心血管医学的所有领域都很重要。

Like other journals，our journal is flooded by papers based on artificial intelligence. We need to be cautious because not all studies and based on artificial intelligence are of top quality. A few months ago, we had published in an editorial in which we identify five quality indicators, which must be really fulfilled to have a top paper in artificial intelligence.

和其他期刊一样，我们的期刊也收到了大量基于人工智能的论文。我们需要保持谨慎，因为并非所有基于人工智能的研究都是高质量的。几个月前，我们发表了一篇特别文章，其中提出了五项质量指标。要发表一篇优秀的人工智能论文，必须满足这些指标。

Quality criterion 1, complete reporting and reproducibility of results. Complete reporting should include the detailed description of all steps of the modelling process.

标准一：结果的完整报告和可重复性。完整的报告应该包括对建模过程所有步骤的详细描述。

Quality criterion 2, clear intended clinical use of the AI-based model. The goal of the study should be clearly indicated and clinically relevant.

标准二：基于人工智能的模型的明确临床用途。研究目标应明确指出，并与临床相关。

Quality criterion 3, rigorous model validation. The algorithm developed in the derivation cohort needs to be validated in an independent validation cohort. 

标准三：严格的模型验证。在推导队列中开发的算法需要在独立的验证队列中进行验证。

Quality criterion 4, sufficient sample size for AI model development and validation. A large sample size is needed for both the derivation and validation cohorts.

标准四：足够的样本量用于人工智能模型的开发和验证。推导队列和验证队列都需要较大的样本量。

Quality criterion 5, openness of data and software. The algorithm on which the study is based must be accessible to allow external validation.

标准五：数据和软件的开放性。研究所依据的算法必须可供访问，以便进行外部验证。

In conclusion, AI is extremely important in the future of cardiovascular medicine but published studies must respect these five quality criteria.

总之，人工智能在未来心血管医学的多个领域都将发挥极其重要的作用，但发表在期刊上的研究必须遵守这五个质量标准。

Q5 What advice would you give to young Chinese  cardiovascular researchers aspiring to publish in top international journals?

对于立志在国际权威期刊上发表论文的中国心血管领域的年轻学者，您会给出怎样的建议？

《Eur Heart J》主编Prof. Crea

There are some important advices I would like to give to young Chinese cardiovascular researchers. The first is to preserve a high level of enthusiasm (even after a rejection of a submitted manuscript): enthusiasm is the fuel. When you are a young researcher, and you submit a paper, the probability of rejection is very high. It happened to me when I started. You must persist going through your learning curve. If you believe in what you do, you shouldn't stop after the rejection of your first papers.

我想给年轻的中国心血管研究人员提供一些重要的建议。第一，要保持高度的热情（即使在稿件被拒之后）：热情是不竭动力。当你还是一名初出茅庐的研究人员时，论文被拒的可能性非常高。我刚开始的时候也这样。你必须坚持自己的学习曲线。如果你相信自己所做的事，就不应该因为最初的几篇论文被拒而停止。

When we come to the content of the manuscript, there are two main criteria we consider for acceptance. First, the methodology must be waterproof. But this is not terribly difficult. More difficult is to be innovative, to produce something which is new and impacting on clinical practice. These are the two criteria for a successful submission: strong methodology and innovation.

在考虑稿件接收时，我们主要考量两个标准。首先，方法必须无懈可击。但这并不是特别困难。更难的是要具有创新性，要产出新颖且对临床实践有影响的研究成果。这是成功投稿的两个标准：方法严谨和创新性。

The mind of a young brilliant researcher is flooded by many questions. The challenge is to identify the questions which are clinically relevant. Not all questions who come to our mind are important. The difficulty is identifying which questions are important, which questions are impactful, and which questions must be addressed in order to change clinical practice.

青年才俊们的脑海中总会涌现出许多问题，他们的挑战在于识别出那些具有临床意义的问题。并非我们想到的所有问题都是重要的，难点在于判断哪些问题至关重要，哪些问题具有影响力，以及哪些问题必须得到解决才能改变临床实践。

Regarding manuscript presentation what is important is to make the manuscript as simple as possible, as straightforward as possible. The perfect manuscript must clarify what is the starting point, what is the current knowledge, and then how the new data presented in the manuscript improve our knowledge and impact on clinical practice.  An excellent manuscript must also identify the new questions generated by the new data. Our knowledge is a continuous progression. We publish studies which introduce elements of novelty and influence the practice, but they also generate new questions. Thus, in a good manuscript, the authors must also define what are the new questions generated by the manuscript they propose. If all this is respected, then the probability of acceptance is really good.

关于稿件的呈现，重要的是要尽量使稿件简洁明了。一篇完美的稿件必须阐明出发点、现有知识，然后说明稿件中提出的新数据如何增进我们的知识并对临床实践产生影响。一篇优秀的稿件还必须指出新数据所引发的新问题。我们的知识是一个不断发展不断深入的过程。我们发表的研究引入了新的元素，影响了实践，但它们也产生了新的问题。因此，在一篇好的稿件中，作者还必须定义他们所提出的稿件引发了哪些新问题。如果所有这些条件都做到了，那么稿件被接受的可能性就非常大。

Q6 What are your expectations or suggestions for the upcoming "Showcase of Outstanding Original Clinical Research in China (Season 2)"?

对于即将举行的第二季中国原创优秀临床研究展播活动，您有哪些期待或建议呢？

《Eur Heart J》主编Prof. Crea

As we discussed before, there are some areas of innovation which are particularly important. I would focus the showcase on one of these rapidly evolving areas. For instance, the showcase might be focused on the application of AI to risk prediction, or the application of AI to diagnosis. Another area might be a focus on nucleic acid-based treatments. There are many new treatments emerging in this direction. I think it is important to focus on these rapidly evolving areas.

如前所述，有些创新领域尤为重要。我愿意将研究展播活动重点放在其中一个迅速发展的领域上。例如，研究展播可以聚焦于人工智能在风险预测中的应用，或人工智能在诊断中的应用。另一个领域可能是聚焦于基于核酸的治疗。这个方向正涌现出许多新的治疗方法。我认为，关注这些迅速发展的领域非常重要。