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: Cardiac rehabilitation (CR) under-attendance presents a global challenge. The Queensland Cardiac Outcomes Registry is a comprehensive clinical registry that routinely collects point-of-care CR data. We aimed to determine whether demographic, clinical, psychosocial, and behavioural characteristics of the population vary between those who (i) declined, (ii) commenced but did not complete, and (iii) completed CR.

Methods: The cohort comprised 33,055 patients referred to one of 56 Queensland CR services extracted from the Queensland Cardiac Outcomes Registry (2020-2022). Bivariate and multivariable logistic regression analyses were used to identify factors associated with CR non-attendance and non-completion.

Results: Over the study period, 12,152 patients (37%) declined CR, 11,621 (35%) initiated but did not complete CR, and 9,282 (28%) completed CR. Significant predictors of CR non-attendance were aged ≥75 years (adjusted odds ratio [aOR] 1.51; 95% confidence interval [CI] 1.42-1.61), Indigenous status (aOR 1.65; 95% CI 1.50-1.81), living regionally (aOR 1.76; 95% CI 1.65-1.87) or remotely (aOR 2.33; 95% CI 1.92-2.82), and having arrhythmia (aOR 2.38; 95% CI 2.07-2.73), heart failure (aOR 1.54; 95% CI 1.37-1.74), non-ST-elevation myocardial infarction (aOR 1.30; 95% CI 1.21-1.40) or unstable angina (aOR 1.24; 95% CI 1.1.13-1.37). Significant predictors of CR non-completion were age <55 years (aOR 1.55; 95% CI 1.37-1.75), Indigenous status (aOR 1.60; 95% CI 1.29-1.98), living regionally (aOR 1.29; 95% CI 1.12-1.48), obesity (aOR 1.14; 95% CI 1.01-1.28), being a current (aOR 1.97; 95% CI 1.70-2.27) or former smoker (aOR:1.22, 95% CI 1.11-1.33) and having low social support (aOR 1.58; 95% CI 1.24-2.02).

Conclusion: As one of the largest studies of CR participation to date, these findings can now be applied to develop targeted, co-designed initiatives to enhance CR participation, especially among First Nations populations, smokers, those with limited social support, people living regionally/remotely, patients with arrhythmia and heart failure, and those in varying age groups.

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: 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.

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.