Heart, Lung and Circulation最新文献

Aim: Acute aortic dissection (AAD) represents a cardiovascular ailment characterised by a notable mortality rate. Chronobiological patterns can offer a predictive framework for anticipating the onset of AAD.

Method: Data were gathered from 1,151 patients diagnosed with AAD at Changhai Hospital in Shanghai, China, spanning 2000-2023. The χ² test was used to assess whether specific periods exhibited significantly different seasonal/weekly distributions compared with others. Fourier models were utilised for the analysis of rhythmicity in monthly/circadian distribution. Publicly available genome-wide association studies datasets were used to establish the causal relationship between chronotype and AAD. Two sets of genetics instruments were used for analysis, derived from publicly available genetic summary data: 75 single-nucleotide polymorphisms (SNPs) significantly associated with chronotype; and SNPs associated with AAD in the FinnGen consortium.

Results: The mean age was 51.5±13.8 years, with 665 patients (57.8%) aged <55 years. Among the 1,151 patients, 80.9% were male. The distribution of DeBakey types was 73.2% (843) for DeBakey I, 21% (242) for DeBakey II, and 5.7% (66) for DeBakey III. Comorbidities included hypertension in 58.5% (673 cases) and diabetes in 7.8% (90 cases). A peak occurred during colder periods (winter/December), and a trough was noted in warmer periods (summer/June). Weekly distribution exhibited no significant variation. Fourier analysis revealed a statistically significant circadian variation (p<0.0001) with a trough between 23:00 and 00:00, a prominent peak from 07:00 to 08:00, and a minor peak between 20:00 and 21:00. Subgroup analyses identified circadian rhythmicity in all subgroups, except for the DeBakey III group and the female group. Using the 75 chronotype-related SNPs, evidence was found of a potential causal effect of chronotype on the risk of AAD, as the inverse-variance weighting analysis showed that self-report chronotype of morningness was associated with a decreased risk of AAD.

Conclusion: The findings substantiate that the initiation of AAD displays noteworthy seasonal, monthly, and circadian patterns. The Mendelian randomisation analysis also indicated that the onset of acute aortic dissection is related to circadian rhythm. These findings offer a fresh perspective, facilitating the identification of triggering factors for AAD and bolstering preventive measures for this catastrophic event.

Aim: Tetralogy of Fallot (TOF) is the most common cyanotic heart disease. This study aimed to demonstrate the effects of preoperative oxygen saturation on the early prognosis of TOF and identify risk factors associated with early complications.

Method: A cohort of 1,138 patients who were diagnosed and underwent one-stage surgical repair in this hospital were retrospectively included in this study. The cohort was divided into three groups according to preoperative oxygen saturation: group 1 (≤75%, n=275), group 2 (75%-85%, n=339), and group 3 (≥85, n=524).

Results: There were 16 early deaths (16 of 1,138) and no late deaths in this study. The total mortality rate was 1.41%, which was not significantly different among the three groups. Major adverse events (MAE)-including death, extracorporeal membrane oxygenation assistance, delayed sternal closure, and re-operation during hospitalisation-were reported in 11.81% of patients in group 1, 7.93% in group 2, and 5.61% in group 3 (p=0.008). Multivariable risk analysis showed that atrial septal defect fenestration (p=0.002), aortic cross-clamp time (p=0.027), and McGoon ratio (p=0.046) were associated with MAE. By propensity score matching, the lower McGoon ratio was significantly related to MAE.

Conclusions: The surgical outcomes were acceptable, with low mortality and MAE rates. The McGoon ratio, not oxygen saturation, presented as a determining factor of MAE.

Background: Unplanned readmissions in patients with acute heart failure generate a substantial burden on healthcare systems and are associated with significant morbidity and mortality. Heart failure admissions are projected to increase over time with the ageing population. Understanding the factors contributing to readmissions after an index admission for heart failure is important, in order to develop strategies to address this phenomenon.

Aim: To understand the patient and organisational factors that contribute to readmissions in patients who are admitted with acute heart failure.

Method: Qualitative content analysis was performed on clinical notes from electronic medical records of all patients readmitted within 30 days after admission with acute heart failure at a single tertiary referral centre, between June 2022 and January 2023. Text related to patient and system-related factors contributing to readmissions were coded and organised into categories and sub-categories. The frequency of codes per patient was generated as a surrogate marker of the relative importance of codes within the dataset.

Results: Overall, 64 patients were readmitted within the study timeframe. Three main categories emerged from the analysis, including patient-related medical factors contributing to readmission, patient-related psychosocial factors, and system-related factors. Patient-related medical factors were the most dominant category, with sub-categories of "non-heart failure causes of readmission", "frailty or functional decline", or "severe underlying cardiac pathology" occurring most frequently within the cohort (60.9%, 48.4%, 42.2%, respectively).

Conclusions: This study explores the patient-related medical, psychosocial, and system-related factors as significant contributors to readmissions in acute heart failure patients. It underscores the need for comprehensive and multi-faceted interventions to improve patient outcomes in this population and reduce healthcare burdens.

Aim: Physician visual assessment (PVA) in invasive coronary angiography (ICA) is clinically used to determine stenosis severity and guide coronary intervention. However, PVA provides limited information regarding the haemodynamic significance of stenosis. This prospective study aimed to develop a model combining visual diameter stenosis (DS_PVA) and quantitative coronary angiography (QCA)-derived parameters to diagnose ischaemic lesions using invasive fractional flow reserve (FFR) with pharmacologically induced maximal hyperaemia as the gold standard.

Methods: A total of 103 patients (148 lesions) who underwent ICA and FFR measurement were included in the study. Quantitative coronary angiography was used to evaluate various parameters, including anatomical parameters such as lesion length (LL), minimal lumen diameter (MLD), and minimal lumen area, along with haemodynamic parameters like LL/MLD⁴ and stenotic flow reserve (SFR). Plaque area, a characteristic parameter of plaque, was also assessed. Lesion-specific ischaemia was defined as invasive FFR ≤0.8.

Results: The LL/MLD⁴ (r= -0.66, p<0.001) and SFR (r=0.66, p<0.001) exhibited inverse and positive correlations, respectively, with invasive FFR. In the multivariable logistic regression analysis, LL/MLD⁴ (≥10.6 mm^-3 vs <10.6 mm^-3; Odds ratio [OR] 10.59, 95% confidence interval [CI] 3.94-28.50; p<0.001) and SFR (≤2.85 vs >2.85; OR 4.38, 95% CI 1.63-11.79; p=0.004) were identified as the optimal dichotomised predictors for discriminating ischaemia. The area under the curve (AUC) was 0.77 using DS_PVA ≥70% as a single predictor. Adding LL/MLD⁴ ≥10.6 mm^-3 and SFR ≤2.85 into the model significantly increased the AUC to 0.87 (p<0.001).

Conclusion: Incorporating QCA-derived haemodynamic parameters provided significant incremental value in the model's discriminatory capability for ischaemic lesions compared with visual diameter assessment alone.

Background: At a global level, regional variation in the management of ST-elevation myocardial infarction (STEMI) is influenced by patient demographics and geography. Rural patients with STEMI are disadvantaged in reaching timely care owing to distance and limited ambulance and healthcare resources. Optimising models of STEMI care is key to overcoming the excess rural vs metropolitan cardiovascular morbidity and mortality. In this descriptive study, we compare patient characteristics and STEMI management in three Local Health Districts (LHDs) across NSW: a rural LHD (Western NSW [WNSWLHD]), a regional LHD (Hunter New England), and a metropolitan site (Sydney LHD).

Method: Data were collected from file audits conducted from 2019 to 2020 in a rural LHD with a single rural 24/7 cardiac catheter laboratory (WNSWLHD), a regional LHD with a part-time rural cardiac catheter laboratory, and a large regional 24/7 cardiac centre (Hunter New England LHD), and a metropolitan site (Sydney LHD), with two 24/7 cardiac centres. Patients with STEMI presenting in the three geographic regions were compared on demographics, differences in presentation, time to reperfusion treatment, time to percutaneous coronary intervention (PCI) centre, distances travelled, proportion of angiograms within 24 hours, and in-hospital mortality.

Results: During 2020, there were 675 recorded STEMI across the three regions. The rural site in WNSWLHD had the highest rate of STEMI per capita, with patients more likely to identify as Indigenous, less likely to call an ambulance, and more likely to present to a non-PCI hospital and to receive thrombolysis. Only 14% of these rural patients received primary PCI (PPCI), with patients presenting a median of 153 km from the PCI centre, vs 69% PPCI in the regional and 89% in metropolitan LHD. Thrombolysis was the main reperfusion treatment in WNSWLHD (76%), and the proportion of patients receiving no treatment was the same in all LHDs at 10%. The percentage of patients receiving angiography within 24 hours in the rural site was 84%. There was no substantial difference in in-hospital mortality among the three LHDs.

Conclusions: We document large differences in the demographic profiles, use of ambulance, and access to PPCI in patients with STEMI across the three NSW centres. Current NSW health and ambulance protocols in a large, sparsely populated rural NSW LHD were able to deliver thrombolysis at the point of contact and facilitate "hot" transfer of patients with STEMI to a PCI centre. Long distances and transfer times mean that PPCI is a limited option in rural NSW, with scope for further improvement in models of care.

Background: Gestational diabetes mellitus (GDM), hypertension during pregnancy (HDP) and/or having small-for-gestational-age (SGA) babies increase cardiovascular disease (CVD) risk. We investigated CVD risk awareness in women with past pregnancy complications and the impact of attending a Women's Heart Clinic (WHC) on this awareness.

Method: Women aged 30-55 years with past GDM, HDP and/or SGA babies were prospectively recruited into a 6-month WHC delivering education and management of CVD risk factors (Melbourne, Australia). A nine-item CVD risk Awareness Survey, consisting of six general/three female-specific questions, was administered at baseline and 6-month follow-up. The primary outcome was a change in overall CVD risk awareness before and after attending a WHC, analysed using a McNemar test. Logistic regression assessed for associations between CVD risk awareness and lifestyle behaviours.

Results: A total of 156 women (mean age 41.0±4.2 years, 3.9±2.9 years postpartum) were recruited with 60.3% past GDM, 23.1% HDP, 13.5% both HDP/GDM and 3.2% SGA babies. The majority were White (68.6%), tertiary-educated (79.5%), and from higher income (84.6%). At baseline, 19.2% (95% confidence interval [CI] 13.0%-25.4%) of women had high overall CVD risk awareness, while 63.5% (95% CI 55.9%-71.0%) had high female-specific CVD risk awareness. At 6-month follow-up, overall CVD risk awareness (19.2%-76.1%, p<0.001) and female-specific CVD risk awareness (63.5%-94.8%; p<0.001) significantly increased. Improvement in CVD risk awareness was not associated with higher physical activity (adjusted odds ratio 0.49; 95% CI 0.04-3.21; p=0.51) or heart-healthy diet (adjusted odds ratio 2.49; 95% CI 0.88-6.93; p=0.08) at 6-month follow-up.

Conclusions: Attendance at a WHC significantly increased women's CVD risk awareness, however, this did not independently associate with lifestyle behaviours.

Background: Lipid-lowering therapy (LLT) is established as a key element in management of patients with coronary artery disease. However, the effect of time of initiation of LLT on outcomes is unclear.

Method: The study compared outcomes of 5,433 patients from Advara HeartCare's Percutaneous Coronary Intervention (PCI) Registry on the basis of timing of LLT initiation classified as pre- or post-PCI admission. The prevalence of acute coronary syndrome (ACS) as the indication for PCI was compared in groups. In patients who underwent PCI for ACS, the incidence of short- (≤30 days) and long-term (>30 days after admission) clinical events (composite of myocardial infarction, cerebrovascular disease, coronary revascularisation, all-cause readmission, and mortality) and first non-fatal cardiovascular events were compared in groups.

Results: At the time of hospitalisation for PCI, 3,982 (73.7%) were on LLT (PRE-LLT), and 1,418 (26.2%) initiated LLT after admission (POST-LLT). Patients on PRE-LLT were significantly less likely to experience ACS before admission for PCI than were those commencing LLT after discharge (PRE-LLT 32.3% vs POST-LLT 56.9%; p<0.001), even after matching for baseline risk factors. Among these patients with ACS, patients on PRE-LLT were older than those on POST-LLT (mean 69.5±9.5 vs 65.0±10.0 years; p<0.001), and had a higher prevalence of cardiovascular risk factors including diabetes (31.5% vs 9.6%; p<0.001), hypertension (79.7% vs 51.7%; p<0.001), and renal failure (7.6% vs 2.0%; p<0.001). No difference was observed between groups in the risk of short- or long-term (median 2.0 years; interquartile range 1.0-3.0) post-PCI cardiovascular (hazard ratio [HR] 1.08; 0.83-1.40; p=0.55) or overall clinical events (HR 1.11; 0.93-1.32; p=0.26).

Conclusions: In patients with coronary artery disease, the risk of ACS is reduced by early initiation of LLT before revascularisation is required. Long-term outcomes of patients at high risk prescribed LLT before admission for ACS PCI may not differ from those of patients at lower risk commencing LLT after PCI for ACS.