Pub Date : 2024-12-01Epub Date: 2024-10-04DOI: 10.1016/j.hlc.2024.07.007
Frazer Kirk, Matthew S Yong, Lavinia Tran, Andrew Newcomb, Cheng He, Andrie Stroebel
Aim: This study aimed to examine contemporary burden and treatment trends of atrial fibrillation (AF) in patients undergoing cardiac surgery in Australia and New Zealand. This allows comparison of contemporary practice with the Society of Thoracic Surgeons guideline recommendations for the surgical treatment of AF in patients undergoing cardiac surgery.
Method: A 10-year retrospective review of the Australian & New Zealand Society of Cardiac & Thoracic Surgeons National Cardiac Surgery Database was performed, examining all adult cardiac surgery patients from 2011 to 2021. Patients were grouped by the presence or absence of AF, and simple descriptive statistical analysis was performed to assess baseline demographics and premorbid condition of the patients. The incidence of AF was analysed by type of surgery. Trends for surgical treatment of AF were then analysed using simple descriptive statistics, examining isolated left atrial appendage ligation, isolated surgical ablation, and combined ligation and ablation.
Results: In the last 10 years, the Australian & New Zealand Society of Cardiac & Thoracic Surgeons database has recorded 140,680 patients who underwent cardiac surgery. Atrial fibrillation (AF) was present in 21,077 patients (14%). Patients with AF were generally older (72.25 vs 66.65 years; p<0.001). Among patients undergoing cardiac surgery, AF was more common in female than in male patients (18% vs 13%, respectively). Patients with AF more often had a higher classification of dyspnoea according to the New York Heart Association and lower ejection fractions compared with their AF-free counterparts. The incidence of AF as a comorbid condition was more frequent in patients undergoing mitral valve surgery or combined coronary artery bypass grafting and valve surgery (aortic, mitral, or both) compared with those undergoing isolated coronary or aortic surgery. Only 11.90% (n=2,509) of patients with AF received a combined ablation and left atrial appendage ligation, and 19.54% (n=693) of those received a Cox-Maze IV ablation.
Conclusions: The burden of concomitant AF in patients undergoing cardiac surgery in Australia is higher than previously reported (14% vs 5%-11%). Despite strong recommendation for the surgical management of AF in patients undergoing cardiac surgery and clear evidence of its benefit, both left atrial appendage ligation and surgical ablation independently or concomitantly remain heavily underutilised in this cohort.
{"title":"Atrial Fibrillation Surgery in Australia: Are We Doing Enough?","authors":"Frazer Kirk, Matthew S Yong, Lavinia Tran, Andrew Newcomb, Cheng He, Andrie Stroebel","doi":"10.1016/j.hlc.2024.07.007","DOIUrl":"10.1016/j.hlc.2024.07.007","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to examine contemporary burden and treatment trends of atrial fibrillation (AF) in patients undergoing cardiac surgery in Australia and New Zealand. This allows comparison of contemporary practice with the Society of Thoracic Surgeons guideline recommendations for the surgical treatment of AF in patients undergoing cardiac surgery.</p><p><strong>Method: </strong>A 10-year retrospective review of the Australian & New Zealand Society of Cardiac & Thoracic Surgeons National Cardiac Surgery Database was performed, examining all adult cardiac surgery patients from 2011 to 2021. Patients were grouped by the presence or absence of AF, and simple descriptive statistical analysis was performed to assess baseline demographics and premorbid condition of the patients. The incidence of AF was analysed by type of surgery. Trends for surgical treatment of AF were then analysed using simple descriptive statistics, examining isolated left atrial appendage ligation, isolated surgical ablation, and combined ligation and ablation.</p><p><strong>Results: </strong>In the last 10 years, the Australian & New Zealand Society of Cardiac & Thoracic Surgeons database has recorded 140,680 patients who underwent cardiac surgery. Atrial fibrillation (AF) was present in 21,077 patients (14%). Patients with AF were generally older (72.25 vs 66.65 years; p<0.001). Among patients undergoing cardiac surgery, AF was more common in female than in male patients (18% vs 13%, respectively). Patients with AF more often had a higher classification of dyspnoea according to the New York Heart Association and lower ejection fractions compared with their AF-free counterparts. The incidence of AF as a comorbid condition was more frequent in patients undergoing mitral valve surgery or combined coronary artery bypass grafting and valve surgery (aortic, mitral, or both) compared with those undergoing isolated coronary or aortic surgery. Only 11.90% (n=2,509) of patients with AF received a combined ablation and left atrial appendage ligation, and 19.54% (n=693) of those received a Cox-Maze IV ablation.</p><p><strong>Conclusions: </strong>The burden of concomitant AF in patients undergoing cardiac surgery in Australia is higher than previously reported (14% vs 5%-11%). Despite strong recommendation for the surgical management of AF in patients undergoing cardiac surgery and clear evidence of its benefit, both left atrial appendage ligation and surgical ablation independently or concomitantly remain heavily underutilised in this cohort.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":"1627-1637"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.hlc.2024.11.009
Adrienne Pacleb, Nicole Lowres, Sue Randall, Lis Neubeck, Robyn Gallagher
{"title":"Retraction notice: Adherence to Cardiac Medications in Patients With Atrial Fibrillation: A Pilot Study: [Heart, Lung and Circulation, Volume 29, Issue 7, July 2020, Pages e131-e139].","authors":"Adrienne Pacleb, Nicole Lowres, Sue Randall, Lis Neubeck, Robyn Gallagher","doi":"10.1016/j.hlc.2024.11.009","DOIUrl":"10.1016/j.hlc.2024.11.009","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"33 12","pages":"R3"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-10-11DOI: 10.1016/j.hlc.2024.07.014
Benjamin K Tong, Seren Ucak, Hasthi Dissanayake, Sanjay Patel, Glenn M Stewart, Kate Sutherland, Brendon J Yee, Usaid Allahwala, Ravinay Bhindi, Philip de Chazal, Peter A Cistulli
Background: Recent neutral randomised clinical trials have created clinical equipoise for treating obstructive sleep apnoea (OSA) for managing cardiovascular risk. The importance of defining the links between OSA and cardiovascular disease is needed with the aim of advancing the robustness of future clinical trials. We aimed to define the clinical correlates and characterise surrogate cardiovascular markers in patients with acute coronary syndrome (ACS) and OSA.
Method: Overall, 66 patients diagnosed with ACS were studied. Patients underwent an unattended polysomnogram after hospital discharge (median [interquartile range] 62 [37-132] days). The Epworth Sleepiness Scale, Berlin, and STOP-BANG questionnaires were administered. Surrogate measures of vascular structure and function, and cardiovascular autonomic function were conducted. Pulse wave amplitude drop was derived from the pulse oximetry signals of the overnight polysomnogram.
Results: OSA (apnoea-hypopnea index [AHI] ≥5) was diagnosed in 94% of patients. Moderate-to-severe OSA (AHI≥15) was observed in 68% of patients. Daytime sleepiness (Epworth Sleepiness Scale ≥10) was reported in 17% of patients. OSA screening questionnaires were inadequate to identify moderate-to-severe OSA, with an area under the receiver operating characteristic curve of approximately 0.64. Arterial stiffness (carotid-femoral pulse wave velocity, 6.1 [5.2-6.8] vs 7.4 [6.6-8.6] m/s, p=0.002) and carotid intima-media thickness (0.8 [0.7-1.0] vs 0.9 [0.8-1.0] mm, p=0.027) was elevated in patients with moderate-to-severe OSA. After adjusting for age, sex and body mass index, these relationships were not statistically significant. No relationships were observed in other surrogate cardiovascular markers.
Conclusions: A high prevalence of OSA in a mostly non-sleepy population with ACS was identified, highlighting a gross underdiagnosis of OSA among cardiovascular patients. The limitations of OSA screening questionnaires highlight the need for new models of OSA screening as part of cardiovascular risk management. A range of inconsistent abnormalities were observed in measures of vascular structure and function, and these appear to be largely explained by confounding factors. Further research is required to elucidate biomarkers for the presence and impact of OSA in ACS patients.
背景:最近的中性随机临床试验为治疗阻塞性睡眠呼吸暂停(OSA)以控制心血管风险提供了临床依据。需要明确 OSA 与心血管疾病之间的联系,以提高未来临床试验的稳健性。我们旨在确定急性冠状动脉综合征(ACS)和 OSA 患者的临床相关性和代用心血管标志物的特征:方法:共对 66 名确诊为急性冠状动脉综合征(ACS)的患者进行了研究。患者在出院后(中位数[四分位间差]62[37-132]天)接受了无人值守的多导睡眠图检查。对患者进行了爱普沃斯嗜睡量表、柏林和 STOP-BANG 问卷调查。对血管结构和功能以及心血管自主神经功能进行了替代测量。脉搏波振幅下降是从通宵多导睡眠图的脉搏血氧仪信号中得出的:94%的患者被诊断为 OSA(呼吸暂停-低通气指数 [AHI] ≥5)。68%的患者被诊断为中重度 OSA(AHI≥15)。17%的患者出现白天嗜睡(埃普沃斯嗜睡量表≥10)。OSA筛查问卷不足以识别中重度OSA,接收者工作特征曲线下面积约为0.64。动脉僵化(颈动脉-股动脉脉搏波速度,6.1 [5.2-6.8] vs 7.4 [6.6-8.6] m/s,p=0.002)和颈动脉内膜厚度(0.8 [0.7-1.0] vs 0.9 [0.8-1.0] mm,p=0.027)在中度至重度 OSA 患者中有所升高。在对年龄、性别和体重指数进行调整后,这些关系没有统计学意义。其他代用心血管标志物也没有发现任何关系:结论:在大多数非睡眠人群中,发现患有 ACS 的 OSA 患病率很高,这表明心血管疾病患者中 OSA 的诊断率严重不足。OSA筛查问卷的局限性凸显了作为心血管风险管理一部分的OSA筛查新模式的必要性。在对血管结构和功能的测量中观察到了一系列不一致的异常,而这些异常似乎在很大程度上是由干扰因素造成的。还需要进一步的研究来阐明 ACS 患者中是否存在 OSA 及其影响的生物标志物。
{"title":"Phenotypic Characterisation of Obstructive Sleep Apnoea in Acute Coronary Syndrome.","authors":"Benjamin K Tong, Seren Ucak, Hasthi Dissanayake, Sanjay Patel, Glenn M Stewart, Kate Sutherland, Brendon J Yee, Usaid Allahwala, Ravinay Bhindi, Philip de Chazal, Peter A Cistulli","doi":"10.1016/j.hlc.2024.07.014","DOIUrl":"10.1016/j.hlc.2024.07.014","url":null,"abstract":"<p><strong>Background: </strong>Recent neutral randomised clinical trials have created clinical equipoise for treating obstructive sleep apnoea (OSA) for managing cardiovascular risk. The importance of defining the links between OSA and cardiovascular disease is needed with the aim of advancing the robustness of future clinical trials. We aimed to define the clinical correlates and characterise surrogate cardiovascular markers in patients with acute coronary syndrome (ACS) and OSA.</p><p><strong>Method: </strong>Overall, 66 patients diagnosed with ACS were studied. Patients underwent an unattended polysomnogram after hospital discharge (median [interquartile range] 62 [37-132] days). The Epworth Sleepiness Scale, Berlin, and STOP-BANG questionnaires were administered. Surrogate measures of vascular structure and function, and cardiovascular autonomic function were conducted. Pulse wave amplitude drop was derived from the pulse oximetry signals of the overnight polysomnogram.</p><p><strong>Results: </strong>OSA (apnoea-hypopnea index [AHI] ≥5) was diagnosed in 94% of patients. Moderate-to-severe OSA (AHI≥15) was observed in 68% of patients. Daytime sleepiness (Epworth Sleepiness Scale ≥10) was reported in 17% of patients. OSA screening questionnaires were inadequate to identify moderate-to-severe OSA, with an area under the receiver operating characteristic curve of approximately 0.64. Arterial stiffness (carotid-femoral pulse wave velocity, 6.1 [5.2-6.8] vs 7.4 [6.6-8.6] m/s, p=0.002) and carotid intima-media thickness (0.8 [0.7-1.0] vs 0.9 [0.8-1.0] mm, p=0.027) was elevated in patients with moderate-to-severe OSA. After adjusting for age, sex and body mass index, these relationships were not statistically significant. No relationships were observed in other surrogate cardiovascular markers.</p><p><strong>Conclusions: </strong>A high prevalence of OSA in a mostly non-sleepy population with ACS was identified, highlighting a gross underdiagnosis of OSA among cardiovascular patients. The limitations of OSA screening questionnaires highlight the need for new models of OSA screening as part of cardiovascular risk management. A range of inconsistent abnormalities were observed in measures of vascular structure and function, and these appear to be largely explained by confounding factors. Further research is required to elucidate biomarkers for the presence and impact of OSA in ACS patients.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":"1648-1658"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-10-18DOI: 10.1016/j.hlc.2024.07.012
William B He, Dylan Jape, Shane Nanayakkara, James A Shaw
Background: Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are novel medications for reducing low-density lipoprotein cholesterol (LDL-C) levels. In 2020, the Australian Pharmaceutical Benefits Scheme (PBS) began subsidising PCSK9 inhibitors for secondary prevention of cardiovascular disease in patients with LDL-C >2.6 mmol/L despite statin and ezetimibe therapy. This criterion was expanded to LDL-C >1.8 mmol/L in 2022.
Method: A retrospective analysis was conducted on patients admitted to a quaternary hospital with acute coronary syndrome (ACS) between 2020-2022. PCSK9 inhibitor eligibility and prescribing patterns were compared between recurrent ACS patients (≥2 events within 5 years) and first-presentation ACS patients. Australian PBS 2020 and 2022 criteria were applied to assess eligibility.
Results: Of 817 ACS patients with LDL-C >1.8 mmol/L, 118 (14.4%) were categorised as recurrent ACS (33.9% female, mean age 67 years, LDL-C 2.9 mmol/L). When compared with first-presentation ACS patients (n=699), recurrent ACS patients had significantly higher proportions already on statin therapy (49.2% vs 6.0%, p<0.001) and ezetimibe (20.3% vs 2.4%, p<0.001). Recurrent ACS patients had significantly higher proportions of 2020 PBS-eligible patients (11.0% vs 1.3%, p<0.001) and 2022 PBS-eligible patients (20.3% vs 2.2%, p<0.001). There were no significant differences in PCSK9 inhibitor prescription rates among eligible patients (four of 13, 30.8% vs four of nine, 44.4%, p=0.51). Univariate binary logistic regression demonstrated that statin intolerance was significantly associated with PCSK9 inhibitor prescription (odds ratio 10; 95% confidence interval 1.3-79.3; p=0.029).
Conclusions: Despite significantly higher eligibility rates, PCSK9 inhibitor uptake remains low in recurrent ACS patients, demonstrating the need to raise further awareness about eligibility criteria and encourage proactive prescription to prevent recurrent cardiovascular events.
{"title":"Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitor Eligibility and Prescription Rates in Patients Presenting With Recurrent Acute Coronary Syndromes.","authors":"William B He, Dylan Jape, Shane Nanayakkara, James A Shaw","doi":"10.1016/j.hlc.2024.07.012","DOIUrl":"10.1016/j.hlc.2024.07.012","url":null,"abstract":"<p><strong>Background: </strong>Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are novel medications for reducing low-density lipoprotein cholesterol (LDL-C) levels. In 2020, the Australian Pharmaceutical Benefits Scheme (PBS) began subsidising PCSK9 inhibitors for secondary prevention of cardiovascular disease in patients with LDL-C >2.6 mmol/L despite statin and ezetimibe therapy. This criterion was expanded to LDL-C >1.8 mmol/L in 2022.</p><p><strong>Method: </strong>A retrospective analysis was conducted on patients admitted to a quaternary hospital with acute coronary syndrome (ACS) between 2020-2022. PCSK9 inhibitor eligibility and prescribing patterns were compared between recurrent ACS patients (≥2 events within 5 years) and first-presentation ACS patients. Australian PBS 2020 and 2022 criteria were applied to assess eligibility.</p><p><strong>Results: </strong>Of 817 ACS patients with LDL-C >1.8 mmol/L, 118 (14.4%) were categorised as recurrent ACS (33.9% female, mean age 67 years, LDL-C 2.9 mmol/L). When compared with first-presentation ACS patients (n=699), recurrent ACS patients had significantly higher proportions already on statin therapy (49.2% vs 6.0%, p<0.001) and ezetimibe (20.3% vs 2.4%, p<0.001). Recurrent ACS patients had significantly higher proportions of 2020 PBS-eligible patients (11.0% vs 1.3%, p<0.001) and 2022 PBS-eligible patients (20.3% vs 2.2%, p<0.001). There were no significant differences in PCSK9 inhibitor prescription rates among eligible patients (four of 13, 30.8% vs four of nine, 44.4%, p=0.51). Univariate binary logistic regression demonstrated that statin intolerance was significantly associated with PCSK9 inhibitor prescription (odds ratio 10; 95% confidence interval 1.3-79.3; p=0.029).</p><p><strong>Conclusions: </strong>Despite significantly higher eligibility rates, PCSK9 inhibitor uptake remains low in recurrent ACS patients, demonstrating the need to raise further awareness about eligibility criteria and encourage proactive prescription to prevent recurrent cardiovascular events.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":"1638-1647"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-10-05DOI: 10.1016/j.hlc.2024.07.010
Johannes Mierke, Thomas Nowack, Frederike Poege, Marie Celine Schuster, Krunoslav Michael Sveric, Stefanie Jellinghaus, Felix J Woitek, Stephan Haussig, Axel Linke, Norman Mangner
Background: The use of microaxial percutaneous left ventricular assist devices (pLVADs) in cardiogenic shock (CS) has increased in recent years, despite limited evidence, and data on sex disparities are particularly scarce. This study aimed to compare short-term outcomes between males and females.
Methods: Data were retrospectively collected from the Dresden Impella Registry, which is a large, prospective, single-centre registry that consecutively enrolled patients who received microaxial pLVAD. Inclusion criteria were CS due to left ventricular failure with serum lactate >4 mM. Patients with pLVAD other than Impella CP were excluded. The primary endpoint was the composite of all-cause mortality at 30 days or requirement of renal replacement therapy (RRT). Secondary endpoints were the components of the primary endpoint alone. Propensity score matched (PSM) analysis was used to adjust for baseline characteristics.
Results: A total of 319 male (69 years; body mass index, 26.7 kg/m2) and 113 female patients (74 years; 27.9 kg/m2) were included in the study. The primary composite endpoint occurred less frequently in female patients in the unmatched analysis (♂ 75.9% [n=239] vs ♀ 64.4% [n=72]; p=0.040) but not in the PSM analysis (♂ 81.1% [n=73] vs ♀ 68.9% [n=42]; p=0.056). However, females less frequently required RRT in both analyses (♂ 48.2% [n=126] vs ♀ 25.9% [n=25]; p=0.001; PSM: ♂ 49.1% [n=36] vs ♀ 23.3% [n=12]; p=0.007). All-cause mortality did not differ between the cohorts.
Conclusions: This study showed no differences in all-cause mortality at 30 days between male and female patients receiving microaxial pLVAD in CS. Larger studies are required to confirm whether female sex is associated with reduced requirement of RRT in CS treated with microaxial pLVAD.
{"title":"Sex-Related Differences in Outcome of Patients Treated With Microaxial Percutaneous Left Ventricular Assist Device for Cardiogenic Shock.","authors":"Johannes Mierke, Thomas Nowack, Frederike Poege, Marie Celine Schuster, Krunoslav Michael Sveric, Stefanie Jellinghaus, Felix J Woitek, Stephan Haussig, Axel Linke, Norman Mangner","doi":"10.1016/j.hlc.2024.07.010","DOIUrl":"10.1016/j.hlc.2024.07.010","url":null,"abstract":"<p><strong>Background: </strong>The use of microaxial percutaneous left ventricular assist devices (pLVADs) in cardiogenic shock (CS) has increased in recent years, despite limited evidence, and data on sex disparities are particularly scarce. This study aimed to compare short-term outcomes between males and females.</p><p><strong>Methods: </strong>Data were retrospectively collected from the Dresden Impella Registry, which is a large, prospective, single-centre registry that consecutively enrolled patients who received microaxial pLVAD. Inclusion criteria were CS due to left ventricular failure with serum lactate >4 mM. Patients with pLVAD other than Impella CP were excluded. The primary endpoint was the composite of all-cause mortality at 30 days or requirement of renal replacement therapy (RRT). Secondary endpoints were the components of the primary endpoint alone. Propensity score matched (PSM) analysis was used to adjust for baseline characteristics.</p><p><strong>Results: </strong>A total of 319 male (69 years; body mass index, 26.7 kg/m<sup>2</sup>) and 113 female patients (74 years; 27.9 kg/m<sup>2</sup>) were included in the study. The primary composite endpoint occurred less frequently in female patients in the unmatched analysis (♂ 75.9% [n=239] vs ♀ 64.4% [n=72]; p=0.040) but not in the PSM analysis (♂ 81.1% [n=73] vs ♀ 68.9% [n=42]; p=0.056). However, females less frequently required RRT in both analyses (♂ 48.2% [n=126] vs ♀ 25.9% [n=25]; p=0.001; PSM: ♂ 49.1% [n=36] vs ♀ 23.3% [n=12]; p=0.007). All-cause mortality did not differ between the cohorts.</p><p><strong>Conclusions: </strong>This study showed no differences in all-cause mortality at 30 days between male and female patients receiving microaxial pLVAD in CS. Larger studies are required to confirm whether female sex is associated with reduced requirement of RRT in CS treated with microaxial pLVAD.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":"1670-1679"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142377815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-10-10DOI: 10.1016/j.hlc.2024.06.1037
Alexander Marschall, Inés Gómez Sánchez, Carmen Dejuán Bitriá, Blanca Coto Morales, Freddy Delgado Calva, David Martí Sánchez
{"title":"Massive Right Atrial Enlargement in an Adult.","authors":"Alexander Marschall, Inés Gómez Sánchez, Carmen Dejuán Bitriá, Blanca Coto Morales, Freddy Delgado Calva, David Martí Sánchez","doi":"10.1016/j.hlc.2024.06.1037","DOIUrl":"10.1016/j.hlc.2024.06.1037","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":"e69-e70"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-28DOI: 10.1016/j.hlc.2024.08.001
Olivia G Deconinck, James E Sharman, Warrick Bishop, Conor F Lees, Luke Dare, Ashutosh Hardikar, Carmel Fenton, Toby Pointon, Gerald F Watts, James A Black
Background: Familial hypercholesterolemia (FH) is an under-recognised but common genetic condition resulting in elevated levels of low-density lipoprotein cholesterol (LDL-C) and a high risk of premature coronary disease. The prevalence of FH among younger patients undergoing coronary bypass surgery is unknown, as is their post-surgical prognosis.
Method: This was a retrospective analysis of younger patients (aged <60 years) undergoing coronary bypass surgery at an Australian tertiary hospital between 2008 and 2022. A Dutch Lipid Clinical Network Score was calculated to determine the presence of underlying FH for each patient. Outcomes were FH prevalence, pre-surgical attainment of guideline-based secondary prevention LDL-C targets and post-surgical major adverse cardiovascular events.
Results: Overall, 590 eligible patients (mean age 53.7 years, 85.6% male) were followed over a median of 7.9 years (interquartile range 4.7-12.1). Eighty (80; 13.6%) patients were categorised as 'FH', 249 (42.2%) 'possible FH' and 261 (44.2%) 'non-FH'. Compared to the non-FH group, patients with FH were less likely to achieve target LDL-C <1.8 mmol/L (15 [18.8%] vs 119 [45.6%]; p<0.001) and had higher rates of adverse cardiovascular events in the years following surgery (adjusted odds ratio 2.52; 95% confidence interval 1.0-6.4; p<0.001).
Conclusions: FH is highly prevalent among younger patients undergoing coronary bypass surgery. These patients are less likely to achieve adequate LDL reduction and are at higher risk of further adverse events. Detection and appropriate treatment of FH prior to bypass surgery should be a clinical priority.
{"title":"Familial Hypercholesterolemia and Cardiovascular Outcomes Amongst Younger Patients Undergoing Coronary Bypass Surgery.","authors":"Olivia G Deconinck, James E Sharman, Warrick Bishop, Conor F Lees, Luke Dare, Ashutosh Hardikar, Carmel Fenton, Toby Pointon, Gerald F Watts, James A Black","doi":"10.1016/j.hlc.2024.08.001","DOIUrl":"https://doi.org/10.1016/j.hlc.2024.08.001","url":null,"abstract":"<p><strong>Background: </strong>Familial hypercholesterolemia (FH) is an under-recognised but common genetic condition resulting in elevated levels of low-density lipoprotein cholesterol (LDL-C) and a high risk of premature coronary disease. The prevalence of FH among younger patients undergoing coronary bypass surgery is unknown, as is their post-surgical prognosis.</p><p><strong>Method: </strong>This was a retrospective analysis of younger patients (aged <60 years) undergoing coronary bypass surgery at an Australian tertiary hospital between 2008 and 2022. A Dutch Lipid Clinical Network Score was calculated to determine the presence of underlying FH for each patient. Outcomes were FH prevalence, pre-surgical attainment of guideline-based secondary prevention LDL-C targets and post-surgical major adverse cardiovascular events.</p><p><strong>Results: </strong>Overall, 590 eligible patients (mean age 53.7 years, 85.6% male) were followed over a median of 7.9 years (interquartile range 4.7-12.1). Eighty (80; 13.6%) patients were categorised as 'FH', 249 (42.2%) 'possible FH' and 261 (44.2%) 'non-FH'. Compared to the non-FH group, patients with FH were less likely to achieve target LDL-C <1.8 mmol/L (15 [18.8%] vs 119 [45.6%]; p<0.001) and had higher rates of adverse cardiovascular events in the years following surgery (adjusted odds ratio 2.52; 95% confidence interval 1.0-6.4; p<0.001).</p><p><strong>Conclusions: </strong>FH is highly prevalent among younger patients undergoing coronary bypass surgery. These patients are less likely to achieve adequate LDL reduction and are at higher risk of further adverse events. Detection and appropriate treatment of FH prior to bypass surgery should be a clinical priority.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-28DOI: 10.1016/j.hlc.2024.07.015
Yi Zhang, Guangguo Fu, Gang Li, Bohao Jian, Rui Wang, Yang Huang, Tongxin Chu, Zhongkai Wu, Zhuoming Zhou, Mengya Liang
Aim: Mitral valve repair (MVr) is associated with more favourable long-term outcomes than mitral valve replacement (MVR) in cases of isolated mitral valve disease suitable for repair. However, there is debate regarding whether the superiority of MVr extends to patients with concomitant aortic and mitral valve disease. Therefore, this meta-analysis was conducted to compare the survival benefits between aortic valve replacement (AVR) plus MVr with a double valve replacement (DVR).
Method: A comprehensive literature search was conducted on PubMed, EMBASE, and Cochrane until 20 October 2022. Studies comparing MVr and MVR in patients undergoing concomitant AVR were included. The primary outcome was long-term survival. The secondary outcomes were early mortality, mitral valve reoperation, and valve-related adverse events.
Results: Sixteen studies with a total of 140,638 patients were included in this analysis. Patients undergoing AVR plus MVr exhibited a favourable trend in long-term survival (HR 0.85; 95% CI 0.71-1.03; p=0.10; I2=58%). The reconstructed Kaplan-Meier curve revealed that the long-term survival at 5, 10, and 15 years was higher in the AVR plus MVr (80.95%, 67.63%, and 51.18%, respectively) than in the DVR group (76.62%, 61.36%, 43.21%, respectively). Aortic valve replacement plus MVr had a lower risk of early mortality (RR 0.67; 95% CI 0.58-0.79; p<0.001; I2=77%), thromboembolic events (RR 0.81; 95% CI 0.67-0.98; p=0.03; I2=5%), and haemorrhagic events (RR 0.87; 95% CI 0.78-0.98; p=0.01; I2=59%). Moreover, both groups displayed comparable rates of mitral valve reoperation (HR 1.73; 95% CI 0.86-3.48; p=0.13; I2=60%) and infective endocarditis (RR 1.60; 95% CI 0.65-3.93; p=0.31; I2=0%). However, the rate of reoperation for AVR plus MVr significantly increased in rheumatic heart disease patients (HR 3.30, 95% CI 1.66-6.59; p<0.0001).
Conclusions: Compared with DVR, AVR plus MVr was associated with favourable long-term survival, reduced early mortality risk, and a lower incidence of thromboembolic and haemorrhagic events without increasing the risk of mitral valve reoperation or infective endocarditis in unselected patients. However, higher reoperation rates were observed in rheumatic heart disease patients undergoing AVR plus MVr.
{"title":"Mitral Valve Repair Versus Replacement in Patients Undergoing Concomitant Aortic Valve Replacement.","authors":"Yi Zhang, Guangguo Fu, Gang Li, Bohao Jian, Rui Wang, Yang Huang, Tongxin Chu, Zhongkai Wu, Zhuoming Zhou, Mengya Liang","doi":"10.1016/j.hlc.2024.07.015","DOIUrl":"https://doi.org/10.1016/j.hlc.2024.07.015","url":null,"abstract":"<p><strong>Aim: </strong>Mitral valve repair (MVr) is associated with more favourable long-term outcomes than mitral valve replacement (MVR) in cases of isolated mitral valve disease suitable for repair. However, there is debate regarding whether the superiority of MVr extends to patients with concomitant aortic and mitral valve disease. Therefore, this meta-analysis was conducted to compare the survival benefits between aortic valve replacement (AVR) plus MVr with a double valve replacement (DVR).</p><p><strong>Method: </strong>A comprehensive literature search was conducted on PubMed, EMBASE, and Cochrane until 20 October 2022. Studies comparing MVr and MVR in patients undergoing concomitant AVR were included. The primary outcome was long-term survival. The secondary outcomes were early mortality, mitral valve reoperation, and valve-related adverse events.</p><p><strong>Results: </strong>Sixteen studies with a total of 140,638 patients were included in this analysis. Patients undergoing AVR plus MVr exhibited a favourable trend in long-term survival (HR 0.85; 95% CI 0.71-1.03; p=0.10; I<sup>2</sup>=58%). The reconstructed Kaplan-Meier curve revealed that the long-term survival at 5, 10, and 15 years was higher in the AVR plus MVr (80.95%, 67.63%, and 51.18%, respectively) than in the DVR group (76.62%, 61.36%, 43.21%, respectively). Aortic valve replacement plus MVr had a lower risk of early mortality (RR 0.67; 95% CI 0.58-0.79; p<0.001; I<sup>2</sup>=77%), thromboembolic events (RR 0.81; 95% CI 0.67-0.98; p=0.03; I<sup>2</sup>=5%), and haemorrhagic events (RR 0.87; 95% CI 0.78-0.98; p=0.01; I<sup>2</sup>=59%). Moreover, both groups displayed comparable rates of mitral valve reoperation (HR 1.73; 95% CI 0.86-3.48; p=0.13; I<sup>2</sup>=60%) and infective endocarditis (RR 1.60; 95% CI 0.65-3.93; p=0.31; I<sup>2</sup>=0%). However, the rate of reoperation for AVR plus MVr significantly increased in rheumatic heart disease patients (HR 3.30, 95% CI 1.66-6.59; p<0.0001).</p><p><strong>Conclusions: </strong>Compared with DVR, AVR plus MVr was associated with favourable long-term survival, reduced early mortality risk, and a lower incidence of thromboembolic and haemorrhagic events without increasing the risk of mitral valve reoperation or infective endocarditis in unselected patients. However, higher reoperation rates were observed in rheumatic heart disease patients undergoing AVR plus MVr.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-25DOI: 10.1016/j.hlc.2024.05.014
Paul Geenty, Nicholas Davidson, Natasha Gorrie, Nicole Bart, Jay Baumwol, Timothy Sutton, Fiona Kwok, James L Hare, Kah Yong Peck, Dariusz Korczyk, Simon D J Gibbs, Liza Thomas
Objective: To estimate the burden of transthyretin cardiac amyloidosis (ATTR-CA) through a cross- sectional 'snapshot' of Australian Amyloidosis Network (AAN) and New Zealand (NZ) specialist amyloidosis clinics.
Design, setting & participants: A prospective survey was performed of seven AAN/ specialist amyloidosis clinics across Australia and NZ. All centres were invited to contribute data; participating centres provided clinical and demographic data for patients with ATTR-CA reviewed in the 2022 calendar year. Patients with new or previously confirmed ATTR-CA reviewed in the 2022 calendar year were included. Diagnosis was established through a positive cardiac scintigraphy scan in the absence of a monoclonal gammopathy or through a cardiac biopsy staining positive with transthyretin (TTR).
Results: A total of 515 patients were reviewed across seven sites. A total of 302/515 (59%) were wild type TTR (ATTRwt), 63/515 (12%) were variant ATTR (ATTRv) and the remaining 150 (29%) had not undergone genetic testing at the time of data collection. A total of 455/515 (88%) patients were male. Compared to ATTRwt, patients with ATTRv had smaller left ventricular (LV) wall thickness (IVSd 14±3 mm vs 16±3mm, p<0.001), and better LV systolic function (LVGLS -15.4±5% vs -11.7±3%, p<0.001). Most patients, 387/515 (75%) were on at least one ATTR specific treatment, including EGCG (157), diflunisal (139), doxycycline (68) and tafamidis (78), acoramidis (33) and gene silencer therapies or monoclonal antibodies (23).
Conclusion: A significant number of patients with ATTR-CA are seen in specialist amyloidosis clinics across Australia and NZ. Most patients received specific amyloidosis therapy, thorough enrollment in clinical trials. With increased recognition of amyloidosis and newer therapies becoming available, the volume of patients seen in these clinics is likely to increase.
目的通过对澳大利亚淀粉样变性网络(AAN)和新西兰淀粉样变性专科诊所的横断面 "快照",估计转甲状腺素心脏淀粉样变性(ATTR-CA)的负担:对澳大利亚和新西兰的七家 AAN/淀粉样变性专科诊所进行了前瞻性调查。所有中心均受邀提供数据;参与调查的中心提供了2022日历年接受复查的ATTR-CA患者的临床和人口统计学数据。在2022年接受复查的新发或既往确诊的ATTR-CA患者均被纳入研究范围。在无单克隆淋巴瘤病的情况下,通过心脏闪烁扫描阳性或心脏活检转甲状腺素(TTR)染色阳性即可确诊:七个医疗中心共对515名患者进行了复查。共有 302/515 例(59%)为野生型 TTR(ATTRwt),63/515 例(12%)为变异型 ATTR(ATTRv),其余 150 例(29%)在数据收集时尚未进行基因检测。共有 455/515 例(88%)患者为男性。与ATTRwt相比,ATTRv患者的左心室壁厚度较小(IVSd 14±3 mm vs 16±3 mm,p):澳大利亚和新西兰的淀粉样变性专科门诊接诊了大量 ATTR-CA 患者。大多数患者都接受了特定的淀粉样变性治疗,并参加了临床试验。随着对淀粉样变性认识的提高和新疗法的出现,在这些诊所就诊的患者人数可能会增加。
{"title":"Transthyretin Cardiac Amyloidosis in Australia and New Zealand-A Multi-Site Snapshot for 2022.","authors":"Paul Geenty, Nicholas Davidson, Natasha Gorrie, Nicole Bart, Jay Baumwol, Timothy Sutton, Fiona Kwok, James L Hare, Kah Yong Peck, Dariusz Korczyk, Simon D J Gibbs, Liza Thomas","doi":"10.1016/j.hlc.2024.05.014","DOIUrl":"https://doi.org/10.1016/j.hlc.2024.05.014","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the burden of transthyretin cardiac amyloidosis (ATTR-CA) through a cross- sectional 'snapshot' of Australian Amyloidosis Network (AAN) and New Zealand (NZ) specialist amyloidosis clinics.</p><p><strong>Design, setting & participants: </strong>A prospective survey was performed of seven AAN/ specialist amyloidosis clinics across Australia and NZ. All centres were invited to contribute data; participating centres provided clinical and demographic data for patients with ATTR-CA reviewed in the 2022 calendar year. Patients with new or previously confirmed ATTR-CA reviewed in the 2022 calendar year were included. Diagnosis was established through a positive cardiac scintigraphy scan in the absence of a monoclonal gammopathy or through a cardiac biopsy staining positive with transthyretin (TTR).</p><p><strong>Results: </strong>A total of 515 patients were reviewed across seven sites. A total of 302/515 (59%) were wild type TTR (ATTRwt), 63/515 (12%) were variant ATTR (ATTRv) and the remaining 150 (29%) had not undergone genetic testing at the time of data collection. A total of 455/515 (88%) patients were male. Compared to ATTRwt, patients with ATTRv had smaller left ventricular (LV) wall thickness (IVSd 14±3 mm vs 16±3mm, p<0.001), and better LV systolic function (LVGLS -15.4±5% vs -11.7±3%, p<0.001). Most patients, 387/515 (75%) were on at least one ATTR specific treatment, including EGCG (157), diflunisal (139), doxycycline (68) and tafamidis (78), acoramidis (33) and gene silencer therapies or monoclonal antibodies (23).</p><p><strong>Conclusion: </strong>A significant number of patients with ATTR-CA are seen in specialist amyloidosis clinics across Australia and NZ. Most patients received specific amyloidosis therapy, thorough enrollment in clinical trials. With increased recognition of amyloidosis and newer therapies becoming available, the volume of patients seen in these clinics is likely to increase.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142728038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}