Heart, Lung and Circulation最新文献

Background: Hypoxia is a common complication seen in people with COVID-19 and can often be the presenting symptom.

Methods: Using a multi-centre observational database, we analysed 3,624 hospitalised COVID-19 PCR-positive patients at Methodist Health System, Dallas, Texas, USA from March 2020 to December 2020. We compared in-hospital death or hospice referral rates and major adverse cardiovascular events (MACE) between patients with four levels of oxygen (O₂) requirements (0-1 L/min, 2-10 L/min, 11-20 L/min, 21-100 L/min). MACE included congestive heart failure (CHF) exacerbations, myocardial infarctions (MI), strokes, pulmonary embolism (PE) / deep venous thrombosis (DVT), and shock. Logistic regression analysis was used to determine comorbidities and demographics associated with mortality. Multinomial regression analysis was used to find which of these variables were associated with hypoxia.

Results: Patients who arrived needing 0-1 L/min of O₂ had reduced risk of mortality compared to those requiring 2-10 L/min (OR=1.54, 95% CI=1.207-1.976, p<0.0001), 11-20 L/min (OR=4.55, 95% CI=3.169-6.547, p<0.0001), or 21-100 L/min (OR=12.06, 95% CI=8.548-17.016, p<0.0001). In addition, patients who arrived needing 0-1 L/min of O₂ showed reduced risk of MACE compared to those requiring 2-10 L/min (OR=1.20, 95% CI=1.029-1.409, p<0.0001), 11-20 L/min (OR=2.76, 95% CI 2.06-3.696, p<0.0001), or 21-100 L/min (OR=6.74, 95% CI 4.966-9.155, p<0.0001).

Conclusion: Hypoxia on arrival is associated with a significantly increased risk of mortality and MACE among hospitalised patients with COVID-19. This data will promote better prognostication and help reduce negative outcomes in an inpatient setting.

Aim: Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are simple biomarkers that reflect systemic inflammation and are associated with adverse cardiovascular disease outcomes. The utility of NLR and PLR for risk prediction following transcatheter aortic valve implantation (TAVI) is not clear.

Method: We retrospectively analysed a prospectively maintained database of patients who underwent TAVI at a tertiary hospital from 2009 to 2022. Baseline demographics, NLR, PLR and Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) scores were obtained. The 30-day and 1-year survival rates were analysed using a logistic regression model while overall survival was analysed using the Kaplan-Meier method. Predictors of survival were calculated using a Cox-hazards regression model and presented as odds ratio (OR) with 95% confidence interval (CI).

Results: Overall, 367 patients were included in this study (mean age 84 years, 51% male). Median follow-up was 19 months (interquartile range 8.8-40 months) with a median survival of 7.2 years (interquartile range 3.5-10.3 years). NLR was associated with 30-day mortality (OR 1.75; 95% CI 1.25-2.68; p<0.01). PLRs marginally predicted 1-year mortality (OR 1.01; 95% CI 1.00-1.02). However, only the STS-PROM score significantly predicted overall survival (hazard ratio 1.07; 95% CI 1.02-1.12; p=0.03) after adjustment for NLR and PLR.

Conclusions: NLR is associated with 30-day mortality following TAVI. PLR was not a clinically significant predictor of mortality after TAVI. Only the STS-PROM score remained a significant predictor of overall survival.

Background & aim: SARS-CoV-2 infection is associated with increased cardiovascular (CV) morbidity and mortality, manifesting as increased adverse outcomes in the first 30 days, extending to 12 months. This study aimed to investigate trends in sudden unexpected deaths between 2018 and 2022, with a focus on CV deaths.

Method: A retrospective analysis was performed on autopsy reports (n=9,330) obtained from New South Wales Coroners Court, Australia, specifically targeting cases of unexplained deaths that occurred between 2018 and 2022. Statistical analysis was conducted using chi-square tests and a post hoc analysis with Bonferroni correction, as well as analysis of variance with multiple comparisons.

Results: There were 349 (18.3%) CV deaths in 2018, 346 (18.0%) in 2019, 338 (17.5%) in 2020, 395 (21.9%) in 2021, and (23.4%) 413 in 2022 (p=0.0002). Among CV deaths, the number of deaths from sudden arrhythmic death syndrome were 25 (7.2%) in 2018, 26 (7.5%) in 2019, 18 (5.3%) in 2020, 52 (13.2%) in 2021, and 80 (19.4%) in 2022 (p=0.0001). Atherosclerosis was the most common cause of death among all CV categories; there were 196 (56.2%) atherosclerosis deaths in 2018, 207 (59.8%) in 2019, 192 (56.8%) in 2020, 221 (56.0%) in 2021, and 197 (47.7%) in 2022 (p=0.43). The average age of death from sudden arrhythmic death syndrome (42.8±19.1 years) across 2018-2022 was younger than atherosclerosis (56.2±12.4 years) and total groups (53.1±15.1 years) (p<0.001). Males comprised 76% of all CV deaths from 2018 to 2022 (p<0.0001).

Conclusions: Compared with pre-pandemic data, a noteworthy increase in CV deaths was observed in occurrence with the escalation in COVID-19 cases in Australia. This may be attributed to direct or indirect factors, such as lifestyle modifications, disrupted access to routine cardiac care, or COVID-19 infection-triggered CV deaths.

Background: Prompt recognition of symptoms and response to acute coronary syndrome (ACS) are crucial for reducing pre-hospital delay. This study compares culturally and linguistically diverse (CALD) and non-CALD Australian populations in terms of their (i) ACS symptom knowledge and (ii) intention to call emergency medical services (EMS) for ACS.

Method: This cross-sectional study used data from HeartWatch, an online survey collected by the National Heart Foundation of Australia between 2018 and 2020 for Australian adults aged ≥18 years. CALD respondents were defined as non-Indigenous individuals who reported speaking a language other than English at home. Characteristics associated with ACS symptom knowledge and EMS calling intentions were analysed using multivariable logistic regression.

Results: Of 31,919 respondents, 16.3% were from CALD backgrounds (n=5,212). Compared with non-CALD, CALD respondents were less likely to name any ACS symptom (63.0% vs 76.0%; adjusted odds ratio [AOR] 0.66; 95% confidence interval [CI] 0.61-0.70) and were less likely to state that they would call an ambulance for ACS (50.2% vs 72.1%; AOR 0.53; 95% CI 0.50-0.57). Almost one-quarter (23.0%) of CALD respondents reported not knowing what they would do. In both groups, males, individuals aged ≤60 years, and those with diabetes were less likely to name an ACS symptom and had lower intention to call an ambulance. Those unable to list a single ACS symptom also had a lower intention to call an ambulance.

Conclusions: Knowledge of ACS symptoms and intention to call an ambulance were lower among CALD respondents. The demographics of those with low ACS symptom knowledge and EMS calling intention were similar in the two groups. Future education efforts in Australia should focus on promoting ACS symptom knowledge and EMS use and should target these groups.

Septal artery perforations are an uncommon complication of percutaneous coronary intervention. Unlike epicardial vessels, septal perforations do not result in pericardial effusions but rather produce septal haematomas. While most can be managed expectantly, a small proportion requires active management to prevent rapid haematoma expansion resulting in compromise of right ventricular filling and 'dry tamponade'. We present two cases of septal artery perforation during percutaneous coronary intervention and propose a management approach that takes into account the unique haemodynamic consequences of this complication.