Heart, Lung and Circulation最新文献

Background: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are standard-of-care treatment in heart failure (HF). The risk of ketosis in patients with HF is unclear, especially during hospitalisation.

Aim: We aimed to evaluate the normal ketone concentration range in HF patients.

Method: We performed a cross-sectional study of inpatients with acutely decompensated HF and outpatients with stable HF. Ketone concentrations were measured and analysed based on SGLT2i use. Baseline demographic data (age, gender, body mass index [BMI]), time since last meal, HF type, type 2 diabetes status, insulin use, and blood parameters (creatinine, glycosylated haemoglobin A1c [HbA1c] and N-terminal pro-B-type natriuretic peptide) were collected from patients or medical records. The primary outcome was capillary blood ketone concentration in patients with acute decompensated HF and stable chronic HF stratified by SGLT2i use. Multivariate regression was also performed using ketones as the outcome variable, with age, gender, BMI, glucose levels, HbA1c, time since last meal and presence of insulin therapy as predictor variables.

Results: A total of 20 individuals with decompensated HF (n=5 SGLT2i treated) and 47 with stable chronic HF (n=22 SGLT2i treated) were recruited. Median ketone concentrations were similar in all groups irrespective of SGLT2i use and the presence of acute decompensation (0.1 mmol/L, biggest interquartile range 0.2 mmol/L, p=0.49). Apart from time from last meal, multivariate regression analysis showed no association of ketone concentration with SGLT2i use, age, gender, BMI, type 2 diabetes status, insulin use and blood glucose level.

Conclusions: Ketone concentrations were low in individuals with HF regardless of SGLT2i use or the presence of acute decompensation.

Aim: Cox-maze IV is the most effective surgical procedure for atrial fibrillation (AF) treatment to date; however, few studies have compared the outcomes of the different energy sources applied to achieve transmurality. This study aimed to analyse the impact of the different energy sources on Cox-maze IV results in terms of sinus rhythm restoration.

Method: A systematic review and meta-analysis was conducted by including studies reporting rhythm outcomes on biatrial Cox-maze AF ablation with bipolar radio-frequency (BRF), cryoenergy (Cryo), or both (BRF+Cryo). The primary endpoints were the early and late rhythm outcomes of AF ablation using the different energy sources. Late AF recurrences were evaluated through timepoint analysis, and freedom from AF from Kaplan-derived data. Sixty articles including 8,293 patients were selected (3,364 patients Cryo, 1,937 BRF, and 2,992 BRF+Cryo).

Results: At 6 months, AF incidence was significantly lower in the Cryo group at 6.73%; it was 25.52% in the BRF and 16.79% in the BRF+Cryo groups (p=0.0112). At the 4-year timepoint, AF incidence was lower in the Cryo group compared with the BRF and BRF+Cryo: 6.14% vs 51.59% vs 16.09%, respectively (p=0.0392). Freedom from AF was 76.7%±2.2%, 60.9%±2.2%, and 66.3%±1.6% for Cryo, BRF, and BRF+Cryo at 4 years, respectively (p<0.001). At meta-regression, mean left atrial diameter was positively associated with higher AF recurrences (OR 1.04, 95% CI 1.01-1.08; p=0.0159).

Conclusion: When performing this procedure, cryoablation seems to be associated with improved rhythm outcomes when compared with bipolar radiofrequency ablation.

In 2023, a joint National Cardiovascular Workforce Sustainability Summit was convened by the Australian Cardiovascular Alliance (ACvA), the Cardiac Society of Australia and New Zealand, and the National Heart Foundation of Australia, to facilitate a national conversation towards developing a workforce sustainability strategy within the cardiovascular research sector. This initiative stemmed from a previous study conducted by the ACvA which revealed that almost 70% of early and mid-career cardiovascular researchers surveyed had contemplated leaving the sector. Summit attendees reported sector-wide challenges to career progression and retention across three key themes: 1) well-being and career satisfaction, 2) learning and development, and 3) resource allocation. The summit also identified a need for greater collaboration and multidisciplinary approaches to research to foster growth towards a more sustainable sector. Key recommendations from the Summit included: 1) establish metrics to monitor progress towards a more sustainable sector and signpost improvement in workforce sustainability; 2) establish a collective partnership between central bodies for unified advocacy and monitoring of metrics; and 3) develop a collaborative, strategic and targeted approach to guide and facilitate training programs that have been developed by shared sector-wide philosophy.

Background & aim: Individuals with congenital heart disease (CHD) have reduced cardiorespiratory fitness which is associated with poor prognosis and quality of life. Evidence shows that exercise is effective in the management of adults with CHD. However, uncertainties remain about the safety and efficacy of high-intensity interval training (HIIT) in these patients. We performed a systematic review to assess the effects of HIIT on aerobic capacity and quality of life in adults with CHD.

Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane Collaboration Handbook.

Results: As only three studies fitting the inclusion criteria could be included, with a total of 87 adults with CHD, we identified a major need for more studies assessing the effect of HIIT. Although HIIT appeared to improve peak oxygen uptake, other measures were inconclusive due to limited studies.

Conclusion: Available evidence to date suggests that HIIT improves aerobic capacity in adults with CHD with no serious adverse events. However, these data are too limited and are to be viewed with caution, identifying an important need for future studies to determine the direct impact of HIIT and to compare HIIT with other exercise intensity modalities.

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.

Aim: There are few studies that have looked at the long-term outcomes of juvenile mitral stenosis (JMS) following percutaneous transmitral commissurotomy (PTMC). This study sought to analyse the modified history of JMS in children following PTMC.

Method: We describe a longitudinal, observational follow-up study of all children and young adults aged <20 years who underwent PTMC at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India from 2012 to 2021. Children were followed up for progression of mitral stenosis (MS), development of mitral regurgitation (MR), need for repeat interventions (percutaneous or surgical), and mortality.

Results: A total of 114 children and adolescents underwent the procedure. The mean age of children in the study was 15.1±2.5 years. After immediate procedural success, there was a tendency towards restenosis with respect to valve areas and transmitral gradients at follow-up. Severe MR after the procedure was noted in 2.6%. Compliance with penicillin prophylaxis was noted in 42.5%. The Kaplan-Meier survival estimate over 10 years showed a mortality rate of 1.98/100 patient-years and a re-intervention rate (re-do PTMC or surgery) of 5.50/100 patient-years. Additional valvular lesions were noted in 13.1% of children during follow-up. Severe symptomatic status at presentation (New York Heart Association class 4) was predictive of mortality, and children aged <15 years often needed re-intervention.

Conclusions: With a mortality rate of 6.1% and re-do intervention rate of 15.8% during extended follow-up, JMS has considerable healthcare implications in terms of morbidity and mortality in children and young adults.

Background: Coronary assessment is frequently conducted in patients with sustained monomorphic ventricular tachycardia (SMVT); however, its yield and subsequent treatment implications remain unclear. This study aimed to determine the prevalence of coronary artery disease (CAD) in patients presenting with SMVT, factors influencing clinician referral for coronary assessment, and clinical outcomes based on revascularisation or medical management of CAD.

Method: Consecutive patients presenting with acute SMVT requiring inpatient admission between 2017 and 2022 were identified.

Results: A total of 249 individual patients with SMVT were identified, with 140 undergoing coronary assessment. Referral for coronary assessment was driven by chest pain (p<0.001) and increased troponin kinetics (p<0.001). No patient with SMVT had an acute coronary occlusion. Significant CAD was found in 48 (34%) patients, and traditional ischaemic features did not predict significant CAD. Nineteen (40%) patients with significant CAD underwent revascularisation (n=15 percutaneous coronary intervention, n=4 coronary artery bypass grafting). There was no significant difference in time to ventricular tachycardia (VT) recurrence between revascularised and medically managed CAD (hazard ratio 1.670; 95% confidence interval 0.756-3.687; p=0.199). A total of five of six patients who underwent a revascularisation-only strategy (no upfront antiarrhythmic therapy or ablation) had VT recurrence (median time to recurrence 8.9 months).

Conclusions: Despite being frequently performed, coronary assessment in SMVT has only modest yield, with no patients having an acute coronary occlusion. Traditional clinical factors of ischaemia did not improve this yield. Revascularisation alone did not improve freedom from VT.