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Transthyretin (TTR) amyloidosis is a progressive and fatal disease caused by the deposition of TTR amyloid fibrils in multiple organs and tissues. The HELIOS-B trial (a phase three, randomized, double-blind, placebo-controlled, multicenter study) tested the safety and efficacy of vutrisiran, a subcutaneous gene silencer, in patients with wild-type or inherited TTR cardiomyopathy. The two primary endpoints were a composite of all-cause mortality and recurrent cardiovascular (CV) events (CV hospitalizations and urgent heart failure visits) assessed in the overall population and the monotherapy group. Secondary endpoints included all-cause mortality up to 42 months and 30-month change in functional capacity, health status, and quality of life. A total of 655 patients were enrolled in the study (vutrisiran, n = 326; placebo, n = 329). The mean age was 77 years, and 40% received tafamidis at baseline. Treatment with vutrisiran resulted in a reduction in all-cause and CV mortality events, as well as preservation of functional capacity, quality of life, and health status in patients with TTR cardiomyopathy.

The May Measurement Month (MMM) campaign was carried out in Kazakhstan in 2022 with the aim of raising awareness of raised blood pressure (BP). Here, we report on the findings of the campaign. Adults aged ≥18 years were recruited opportunistically at hypermarkets in Almaty. 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 ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg or being on antihypertensive medication. Controlled BP was defined as being on antihypertensive medication with a BP < 140/90 mmHg. Multiple imputation was used to estimate any missing BP readings. In total, 2133 adults were screened, with a mean age of 46.5 years and 49.8% were female. Of all participants, 843 (39.5%) had hypertension, of whom 469 (55.6%) were aware, and 396 (47.0%) were on antihypertensive medication. Of those on antihypertensive medication, 172 (43.4%) had controlled BP, and of all participants with hypertension, 20.4% had controlled BP. In total, 671 (31.5%) were found to have either untreated or inadequately treated hypertension. The MMM campaign in Kazakhstan identified significant numbers of participants with either untreated or inadequately treated hypertension. The findings highlight the urgent need for improved screening, treatment, and management strategies for hypertension in Kazakhstan. Strengthening public health initiatives and increasing awareness can significantly reduce the burden of cardiovascular disease and improve population health outcomes.

May Measurement Month (MMM) is a global campaign initiated by the International Society of Hypertension aimed at raising awareness of high blood pressure (BP) and to act as a temporary solution to the lack of screening programmes worldwide. We provide the results of the MMM 2022 (MMM22) campaign in Mauritius. Adults aged ≥18 years were recruited opportunistically at workplaces and community centres, in both rural and urban areas across Mauritius. Three seated BP readings were taken for each participant, along with completion of a questionnaire on demographics, lifestyle factors, and comorbidities. Hypertension was defined as a systolic BP ≥140 mmHg and/or a diastolic BP ≥90 mmHg or being on antihypertensive medication. Controlled BP was defined as being on antihypertensive medication with a BP <140/90 mmHg. Multiple imputation was used to estimate any missing BP readings. In total, 8953 were screened, with a mean age of 43.6 years and 62.2% of whom were female. Out of 8953 participants, 2024 participants (22.6%) had hypertension, of whom 1066 (52.7%) were aware, and 884 (43.7%) were on antihypertensive medication. Of those on antihypertensive medication, 550 (62.2%) had controlled BP, and of all participants with hypertension, 550 (27.2%) had controlled BP. The MMM campaign in Mauritius identified significant numbers of participants with either untreated or inadequately treated hypertension. May Measurement Month 2022 was the largest BP screening campaign undertaken in Mauritius. These results suggest that MMM22 was useful in the identification of patients with raised BP for further investigation and follow-up.

Cardiac pacemakers have revolutionized the management of heart rhythm disorders since their introduction in the mid-20th century. They have played a crucial role in the management of several clinical conditions, from symptomatic bradyarrhythmia to electrical and/or mechanical dyssynchrony. Conventional cardiac pacemakers have significantly evolved over the last several decades. However, a critical limitation has been the presence of a generator pocket and endovascular leads connecting the pulse generator to cardiac tissue. While leads are essential to the pacemaker system by transmitting electrical impulses, they impose several significant risks that include venous thrombosis, device-associated endocarditis, and lead malfunction (mainly due to lead fracture, insulation failure, and macro- or micro-dislodgement), whereas the generator pocket can be the origin of a systemic device infection. The development of leadless pacemakers inaugurated a new era in cardiac pacing, eliminating many of the risks associated with traditional transvenous pacemakers. Leadless pacemakers are small, self-contained devices, which are fundamentally able to pace the heart without the need for a pocket and endovascular leads.

Leadless pacemakers (LPs) are increasingly being used to treat bradyarrhythmias, and end of service (EOS) management decisions are becoming increasingly important given finite battery lifespans. Two strategies have been adopted for device EOS: LP abandonment and LP removal. Certain scenarios including high degree of LP encapsulation and 'last expected' pacing devices favour LP abandonment, while other LP complications may necessitate device removal. When abandoning LP, clinicians must understand design, performance, and safety considerations for devices left in place. When removing LP, specialized tools and techniques have been developed, each varying by device manufacturer and model. Case reports and series on LP removal have elucidated how to overcome challenges that may arise during removal. Despite best practice techniques, complications can arise before and after removal. Current studies on LP EOS management are limited, and further studies are needed to help understand predictors of successful device removal and long-term sequelae of both strategies. The aim of this state-of-the-art review is to help clinicians understand current strategies and considerations for both LP abandonment and removal.

Leadless pacemakers' (LPs) main advantage over the traditional transvenous permanent pacemakers (TV-PPMs) is the absence of leads and subcutaneous pocket. These intracardiac pacemakers have been shown in observational studies to reduce long-term complications as compared with TV-PPM mainly by reducing the need for re-intervention. Two major advantages of this technology are the lower rate of infection (absence of pocket and lower rate of bacterial seeding) and lead-related complications (dislodgment). Hence, these advantages are more accentuated after transcutaneous valve replacement or valve surgery and clinical situations where it is important to reduce systemic infections and endocarditis. In this review, we highlight the role of LP in patients after transcutaneous and surgical valve replacements.

Leadless pacemakers are being used with increased frequency due to improvements in the technologies, and the recognition of the substantial benefits over traditional transvenous devices. Current information shows a substantial reduction in morbidity with leadless devices which has resulted in a significant expansion in the indication for these devices. Patient selection now includes a younger population as well as those commonly excluded from consideration. Understanding these new applications will allow a larger group of patients to benefit from the significant advantages of leadless devices while not compromising quality and effective pacing. Further improvements in this technology will result in even more availability of these transformative devices.

Leadless pacing has been established as an effective and safe therapy. The majority of published data relates to an older population. However, this therapy may be particularly attractive for a younger (<40 years) population where the complications of transvenous devices can be enhanced. These include having leads in the vasculature for a longer period of time and the need for more generator changes over a longer time frame that may increase the rate of complications, e.g. infection. There is increasing evidence that leadless pacing is safe and effective in a younger population that may include specific patient groups such as those that require infrequent pacing, e.g. cardioinhibitory vasovagal syncope. Additionally, leadless pacing may be particularly suited to patients with adult congenital heart disease where conventional access with transvenous devices may be challenging. There are also some other groups such as neuromuscular disorders associated with conduction system disease that may benefit. The paediatric population is a further group that offers many challenges for pacing and so may be considered for leadless pacing. There is an increasing evidence base for the use of a superior jugular approach in this population rather than the conventional femoral approach. Further evidence to support leadless pacing would be enhanced with prospective randomized controlled studies in the population under the age of 40 years.

Pacemakers are a lifesaving and mature technology. The past decade has seen a revolution in pacemaker technology with the development of leadless pacemakers. There is growing evidence for the value of leadless pacemakers in the management of a variety of patients.