Heart, Lung and Circulation最新文献

英文中文

Postural Orthostatic Tachycardia Syndrome: A State-of-the-Art Review 体位性站立性心动过速综合征：最新研究综述。

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2026-02-01 DOI: 10.1016/j.hlc.2025.09.004

Dennis H. Lau MBBS, PhD , Artur Fedorowski MD, PhD , Satish R. Raj MD, MSCI , Caelum Schild BAppSc , Laura A. Pace MD, PhD , Svetlana Blitshteyn MD , Vidya Raj MB ChB , Jeffrey R. Boris MD , Lesley Kavi MBChB , Marie-Claire Seeley RN, PhD , Celine Gallagher RN, PhD

Postural orthostatic tachycardia syndrome (POTS) is a complex disorder mainly of orthostatic intolerance, often accompanied by a spectrum of symptoms related to autonomic nervous system dysfunction. Although the diagnostic criteria require an orthostatic challenge test, the associated symptom burden can be broad and is often missed by treating healthcare professionals, resulting in significant diagnostic delay. Treatment of this highly heterogenous condition is nuanced and consists of non-pharmacologic and pharmacologic approaches. Availability of POTS care is limited, with a dearth of medical specialists or general practitioners specialising in autonomic medicine. The complexity of care for those with POTS necessitates a multidisciplinary approach due to the need for extended appointment times and frequent follow-ups to monitor therapeutic response and progress. This should include a primary team consisting of a general practitioner and trained autonomic physicians with specialist nurses, allied health professionals, and any other specialists required to manage the affected systems. This state-of-the-art review aims to cover the key aspects of diagnosing and managing POTS, including special neurological, gastroenterological, psychological, and paediatric considerations. There is an urgent need to provide services that meet the needs of the growing POTS population.

体位性体位性心动过速综合征（POTS）是一种以体位不耐受为主的复杂疾病，常伴有与自主神经系统功能障碍相关的一系列症状。虽然诊断标准要求进行直立性挑战测试，但相关的症状负担可能很广泛，并且经常被治疗保健专业人员遗漏，从而导致严重的诊断延迟。治疗这种高度异质性的条件是微妙的，包括非药物和药物的方法。由于缺乏专门从事自主医学的医学专家或全科医生，POTS护理的可用性有限。由于需要延长预约时间和频繁随访以监测治疗反应和进展，POTS患者护理的复杂性需要多学科方法。这应该包括一个由全科医生和训练有素的自主医生与专科护士、联合卫生专业人员和管理受影响系统所需的任何其他专家组成的初级团队。这篇最新的综述旨在涵盖诊断和治疗POTS的关键方面，包括特殊的神经学、胃肠病学、心理学和儿科方面的考虑。迫切需要提供服务，以满足不断增长的POTS人口的需求。

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引用次数: 0

Shifting the Paradigm: Bringing Personalised Approaches to Coronary Artery Disease 转变范式：为冠状动脉疾病带来个性化方法。

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2026-02-01 DOI: 10.1016/j.hlc.2025.08.030

Sina Fathieh MBBS, PhD , Michael P. Gray MPH , Gemma A. Figtree AM, MBBS DPhil, FRACP FAHA

引用次数: 0

Securing Long-Term Heart Health for Australians: Understanding How Funding Structures in Cardiac Rehabilitation Influence Cardiovascular Inequities 确保澳大利亚人的长期心脏健康：了解心脏康复的资金结构如何影响心血管不公平。

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2026-02-01 DOI: 10.1016/j.hlc.2025.07.016

Sarah Gauci PhD , Lan Gao PhD , Robyn Gallagher PhD , Julie Redfern PhD , Susie Cartledge PhD , Adrienne O’Neil PhD

引用次数: 0

Safety of Early Coronary Surgery in Antiplatelet Non-Responders: A Retrospective Cohort Study 抗血小板无应答者早期冠状动脉手术的安全性：一项回顾性队列研究。

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2026-02-01 DOI: 10.1016/j.hlc.2025.06.1028

John D.L. Brookes MBBS, MSc, PGDipAnat , Shazhad Sadiqi MBBS, PhD, MSc , Manoras Chengalath MBBS, MS, MCh , Henry Ring MD , Christopher Morley BSc, Dip Perf , Kyri Hogan MSc, Dip Perf , Cheng-Hon Yap MS, FRACS , Michael Seitz BMedSc, FRACS

Background

Dual antiplatelet therapy (DAPT) is frequently prescribed to patients with acute coronary syndromes on presentation. If these patients require inpatient surgical revascularisation, current guidelines suggest they await several days’ DAPT washout prior to proceeding to operation. However, the rate of non-response to DAPT is significant, and there is minimal research available to assess if patients who are non-responders can safely proceed to surgery without waiting for washout.

Method

A retrospective cohort study of prospectively collected data was undertaken, examining patients who proceeded to surgery before the guideline-recommended washout time compared to those with no DAPT exposure.

Results

One hundred patients had Thromboelastogram (TEG) assessment of response to DAPT. There was a high rate of DAPT non- and low-response, 56% (n=56). Thirty-five non- and low-response patients proceeded to theatre prior to the guideline-recommended waiting time following DAPT. There was no statistically significant increase in bleeding or transfusion requirements (any transfusion, p=0.79), and no difference in morbidity and mortality (p=0.46). Non-responders proceeding early to surgery had a significantly shorter length of stay - non-responder 8.8±3.3 vs no DAPT 10.7±4.7 vs awaited washout 12.1±4.7 days (p<0.01).

Conclusions

There is a high rate of non-/low-response to DAPT, particularly clopidogrel. Non-responder patients do not have significant increase in overall morbidity and mortality, bleeding outcomes or transfusion requirements, and have the advantage of a significantly shorter length of hospital stay.

背景：双重抗血小板治疗（DAPT）常用于急性冠状动脉综合征患者。如果这些患者需要住院手术血运重建，目前的指南建议他们等待几天的DAPT冲洗后再进行手术。然而，对DAPT无反应的比率是显著的，并且很少有可用的研究来评估无反应的患者是否可以安全地进行手术而无需等待冲洗。方法：对前瞻性收集的数据进行回顾性队列研究，将在指南推荐的洗脱时间之前进行手术的患者与未接受DAPT治疗的患者进行比较。结果：100例患者采用血栓弹性图（TEG）评估DAPT的疗效。DAPT无应答率高，低应答率56% （n=56）。35例无反应和低反应患者在指南推荐的DAPT等待时间之前进入了手术室。出血或输血需求没有统计学上的显著增加（任何输血，p=0.79），发病率和死亡率也没有差异（p=0.46）。无反应者早期手术的住院时间明显缩短——无反应者8.8±3.3天vs无DAPT者10.7±4.7天vs等待洗脱期12.1±4.7天(结论：DAPT无反应/低反应率高，尤其是氯吡格雷。无应答患者在总体发病率和死亡率、出血结局或输血需求方面没有显著增加，并且具有住院时间明显缩短的优势。

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引用次数: 0

A Heart of Stone: A Rare Finding in Multimodality Imaging 石之心：多模态成像的罕见发现。

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2026-02-01 DOI: 10.1016/j.hlc.2025.08.032

Mariana Pereira Santos MD , David Sá Couto MD , Sónia Magalhães MD , Patrícia Rodrigues MD, PhD

引用次数: 0

Cardiac Society of Australia and New Zealand 澳大利亚和新西兰心脏学会

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2026-02-01 DOI: 10.1016/S1443-9506(26)00027-2

引用次数: 0

Heart Smart From the Start: The Strength of Childhood Fitness 心脏从一开始就聪明：儿童健康的力量

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2026-02-01 DOI: 10.1016/j.hlc.2026.01.001

引用次数: 0

Ethanol Infusion in the Vein of Marshall during Atrial Fibrillation Ablation: A Systematic Review and Meta-Analysis. 心房颤动消融期间Marshall静脉乙醇输注：系统回顾和荟萃分析。

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2026-01-30 DOI: 10.1016/j.hlc.2025.10.014

Giovana Guedes Mendonça, Geovana Almeida Spies, Maria Clara Ramos Miranda, Charles Karel Martins Santos, Gabriel Alves Barbosa, Vinicius Martins Rodrigues Oliveira, Silvia Marçal Botelho, Antônio da Silva Menezes Júnior

Background: Ethanol infusion into the vein of Marshall (EIVOM) is proposed to improve atrial fibrillation (AF) ablation outcomes, though its efficacy is uncertain. This study reviews EIVOM's effect on AF catheter ablation.

Method: Systematic searches in PubMed, Embase, and Scopus identified studies comparing EIVOM with radiofrequency (RF) ablation. A random-effects model pooled mean differences with 95% confidence intervals (CIs), and heterogeneity was assessed with the I² statistic. R 4.2.3 was used for statistical analyses, including leave-one-out sensitivity analyses and Baujat plots to assess heterogeneity and study influence.

Results: We included 15 studies (four randomised controlled trials and 11 cohort studies) comprising 3,507 patients (mean age 64.07±9.57 years), of whom 73.25% were men and 1,536 were treated with EIVOM. This technique was associated with improved mitral isthmus (MI) block rates (relative risk [RR] 1.33; 95% CI 1.13-1.57; p<0.001) and reduced AF/atrial tachycardia (AT) recurrence (RR 0.65; 95% CI 0.52-0.80; p<0.001). No significant differences were found in MI reconnections (RR 0.65; 95% CI 0.31-1.34; p=0.240) while fluoroscopy (standardised mean difference [SMD] 0.25; 95% CI -0.86 to 1.37; p=0.656) and procedure times were longer in the EIVOM group (SMD 11.70 minutes; 95% CI -1.67 to 25.16; p=0.088). In the subgroup analyses, ethanol volumes >5 mL enhanced MI block and AF/AT recurrence.

Conclusion: EIVOM and RF are associated with a reduced MI block rates and recurrence of AF and AT when compared with RF only.

背景：马歇尔静脉灌注乙醇（EIVOM）被认为可以改善房颤（AF）消融结果，但其疗效尚不确定。本研究回顾了EIVOM在房颤导管消融中的作用。方法：在PubMed、Embase和Scopus中进行系统检索，确定了将EIVOM与射频消融进行比较的研究。随机效应模型以95%置信区间（ci）合并平均差异，并使用I2统计量评估异质性。采用r4.2.3进行统计分析，包括遗漏敏感性分析和Baujat图来评估异质性和研究影响。结果：我们纳入了15项研究（4项随机对照试验和11项队列研究），包括3507例患者（平均年龄64.07±9.57岁），其中73.25%为男性，1536例患者接受了EIVOM治疗。该技术可改善二尖瓣峡部（MI）阻滞率（相对危险度[RR] 1.33; 95% CI 1.13-1.57； p5 mL可增强MI阻滞和AF/AT复发）。结论：与单纯RF相比，EIVOM和RF与心肌梗死阻滞率和AF和AT复发率降低有关。

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引用次数: 0

TAVR in Bicuspid Aortic Valve Disease: A Meta-Analysis of Surgical Comparison and Anatomic Predictors. 二尖瓣主动脉瓣疾病的TAVR：手术比较和解剖学预测因素的荟萃分析。

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2026-01-30 DOI: 10.1016/j.hlc.2025.11.014

Shanmukh Sai Pavan Lingamsetty, Harshith Thyagaturu, Sahas Reddy Jitta, Kesar Prajapati, Ademola Ajibade, Waleed Alruwaili, Hassan Muntazir, Irfan Zeb

Background: Despite the proven efficacy of transcatheter aortic valve replacement (TAVR) in treating tricuspid aortic valve stenosis, the bicuspid aortic valve (BAV) population has been excluded from most of the landmark trials.

Aim: This study aimed to assess the outcomes of TAVR compared with those of surgical aortic valve replacement (SAVR) and examine the impact of BAV type, aortopathy, excess leaflet calcification, and raphe calcification on BAV TAVR outcomes.

Method: We searched PubMed/MEDLINE, Embase, and Cochrane Library for studies that assessed the outcomes of TAVR in the BAV population. We also included studies of patients with BAV undergoing TAVR and SAVR, and those assessing anatomical predictors of TAVR outcomes. Random-effects models were used to calculate the pooled risk ratios, mean differences, and hazard ratios.

Results: Patients with BAV who underwent TAVR showed significantly lower risks of major bleeding and acute kidney injury, and shorter hospital stays than those who underwent SAVR. However, BAV TAVR had a higher pacemaker implantation rate. Among the BAV types, Type 0 showed a higher risk of coronary obstruction, whereas Type 1 had a lower risk of pacemaker implantation following BAV TAVR. Additionally, BAV TAVR had a higher risk of long-term mortality in patients with aortopathy (ascending aortic diameter >4.5 cm) and excessive leaflet calcification.

Conclusions: Compared with SAVR, TAVR in BAV is associated with favourable in-hospital outcomes. Anatomical features, such as BAV type, aortopathy, excess leaflet calcification, and calcified raphe, significantly influence the outcomes of TAVR in the BAV population.

背景：尽管经导管主动脉瓣置换术（TAVR）治疗三尖瓣主动脉瓣狭窄的疗效已被证实，但大多数具有里程碑意义的试验都将二尖瓣主动脉瓣（BAV）人群排除在外。目的：本研究旨在评估TAVR与外科主动脉瓣置换术（SAVR）的结果，并研究BAV类型、主动脉病变、过度小叶钙化和中叶钙化对BAV TAVR结果的影响。方法：我们检索PubMed/MEDLINE， Embase和Cochrane图书馆，以评估BAV人群中TAVR的结果。我们还纳入了BAV患者接受TAVR和SAVR的研究，以及评估TAVR结果的解剖学预测因素的研究。随机效应模型用于计算合并风险比、平均差异和风险比。结果：BAV患者行TAVR的大出血和急性肾损伤风险明显低于行SAVR的患者，住院时间明显缩短。而BAV TAVR起搏器植入率较高。在BAV类型中，0型患者冠脉阻塞的风险较高，而1型患者BAV TAVR后起搏器植入的风险较低。此外，BAV TAVR在主动脉病变（升主动脉直径4.5 cm）和小叶钙化过度的患者中具有更高的长期死亡风险。结论：与SAVR相比，BAV患者的TAVR与良好的住院预后相关。解剖特征，如BAV类型、主动脉病变、过度小叶钙化和裂口钙化，显著影响BAV人群TAVR的预后。

{"title":"TAVR in Bicuspid Aortic Valve Disease: A Meta-Analysis of Surgical Comparison and Anatomic Predictors.","authors":"Shanmukh Sai Pavan Lingamsetty, Harshith Thyagaturu, Sahas Reddy Jitta, Kesar Prajapati, Ademola Ajibade, Waleed Alruwaili, Hassan Muntazir, Irfan Zeb","doi":"10.1016/j.hlc.2025.11.014","DOIUrl":"https://doi.org/10.1016/j.hlc.2025.11.014","url":null,"abstract":"<p><strong>Background: </strong>Despite the proven efficacy of transcatheter aortic valve replacement (TAVR) in treating tricuspid aortic valve stenosis, the bicuspid aortic valve (BAV) population has been excluded from most of the landmark trials.</p><p><strong>Aim: </strong>This study aimed to assess the outcomes of TAVR compared with those of surgical aortic valve replacement (SAVR) and examine the impact of BAV type, aortopathy, excess leaflet calcification, and raphe calcification on BAV TAVR outcomes.</p><p><strong>Method: </strong>We searched PubMed/MEDLINE, Embase, and Cochrane Library for studies that assessed the outcomes of TAVR in the BAV population. We also included studies of patients with BAV undergoing TAVR and SAVR, and those assessing anatomical predictors of TAVR outcomes. Random-effects models were used to calculate the pooled risk ratios, mean differences, and hazard ratios.</p><p><strong>Results: </strong>Patients with BAV who underwent TAVR showed significantly lower risks of major bleeding and acute kidney injury, and shorter hospital stays than those who underwent SAVR. However, BAV TAVR had a higher pacemaker implantation rate. Among the BAV types, Type 0 showed a higher risk of coronary obstruction, whereas Type 1 had a lower risk of pacemaker implantation following BAV TAVR. Additionally, BAV TAVR had a higher risk of long-term mortality in patients with aortopathy (ascending aortic diameter >4.5 cm) and excessive leaflet calcification.</p><p><strong>Conclusions: </strong>Compared with SAVR, TAVR in BAV is associated with favourable in-hospital outcomes. Anatomical features, such as BAV type, aortopathy, excess leaflet calcification, and calcified raphe, significantly influence the outcomes of TAVR in the BAV population.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096973","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}

引用次数: 0

Left Main Coronary Atresia Presenting as Severe Mitral Valve Regurgitation in an Infant. 婴儿左主干冠状动脉闭锁表现为严重的二尖瓣返流。

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2026-01-29 DOI: 10.1016/j.hlc.2025.08.034

Amit Kumar Pandey, Navaneetha Sasikumar, Raman Krishna Kumar

引用次数: 0

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