Pub Date : 2024-11-01DOI: 10.1016/j.hlc.2024.05.012
Alicia Chan FRACP, PhD, FCSANZ , Suzanne M. Cosh MPsych(Clin), PhD , Phillip J. Tully MPsych(Clin), PhD
{"title":"Heart Failure Admissions in Women With a History of Gender-Based Violence","authors":"Alicia Chan FRACP, PhD, FCSANZ , Suzanne M. Cosh MPsych(Clin), PhD , Phillip J. Tully MPsych(Clin), PhD","doi":"10.1016/j.hlc.2024.05.012","DOIUrl":"10.1016/j.hlc.2024.05.012","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"33 11","pages":"Pages e59-e60"},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619086","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 : 2024-11-01DOI: 10.1016/j.hlc.2024.09.001
Andre La Gerche , Elizabeth D. Paratz , Janet E. Bray , Garry Jennings , Greg Page , Susan Timbs , Jamie I. Vandenberg , Walter Abhayaratna , Clara K. Chow , Mark Dennis , Gemma A. Figtree , Jason C. Kovacic , Jessica Maris , Ziad Nehme , Sarah Parsons , Andreas Pflaumer , Rajesh Puranik , Dion Stub , Edwin Freitas , Robert Zecchin , Jodie Ingles
Sudden cardiac arrest (SCA) represents a major cause of premature mortality globally, with enormous impact and financial cost to victims, families, and communities. SCA prevention should be considered a health priority in Australia. National Cardiac Arrest Summits were held in June 2022 and March 2023, with inclusion from multi-faceted endeavours related to SCA prevention. It was agreed to establish a multidisciplinary Australian Sudden Cardiac Arrest Alliance (AuSCAA) working group charged with developing a national unified strategy, with clear and measurable quality indicators and standardised outcome measures, to amplify the goal of SCA prevention throughout Australia.
A multi-faceted prevention strategy will include i) endeavours to progress community awareness, ii) improved fundamental mechanistic understanding, iii) implementation of best-practice resuscitation strategies for all demographics and locations, iv) secondary risk assessment directed to family members, and v) development of (near) real-time registry of cardiac arrest cases to inform areas of need and effectiveness of interventions. Together, we can and should reduce the impact of SCA in Australia.
{"title":"A Call to Action to Improve Cardiac Arrest Outcomes: A Report From the National Summit for Cardiac Arrest","authors":"Andre La Gerche , Elizabeth D. Paratz , Janet E. Bray , Garry Jennings , Greg Page , Susan Timbs , Jamie I. Vandenberg , Walter Abhayaratna , Clara K. Chow , Mark Dennis , Gemma A. Figtree , Jason C. Kovacic , Jessica Maris , Ziad Nehme , Sarah Parsons , Andreas Pflaumer , Rajesh Puranik , Dion Stub , Edwin Freitas , Robert Zecchin , Jodie Ingles","doi":"10.1016/j.hlc.2024.09.001","DOIUrl":"10.1016/j.hlc.2024.09.001","url":null,"abstract":"<div><div>Sudden cardiac arrest (SCA) represents a major cause of premature mortality globally, with enormous impact and financial cost to victims, families, and communities. SCA prevention should be considered a health priority in Australia. National Cardiac Arrest Summits were held in June 2022 and March 2023, with inclusion from multi-faceted endeavours related to SCA prevention. It was agreed to establish a multidisciplinary Australian Sudden Cardiac Arrest Alliance (AuSCAA) working group charged with developing a national unified strategy, with clear and measurable quality indicators and standardised outcome measures, to amplify the goal of SCA prevention throughout Australia.</div><div>A multi-faceted prevention strategy will include i) endeavours to progress community awareness, ii) improved fundamental mechanistic understanding, iii) implementation of best-practice resuscitation strategies for all demographics and locations, iv) secondary risk assessment directed to family members, and v) development of (near) real-time registry of cardiac arrest cases to inform areas of need and effectiveness of interventions. Together, we can and should reduce the impact of SCA in Australia.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"33 11","pages":"Pages 1507-1522"},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142285973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.hlc.2024.10.003
Ankit Agrawal MD, Umesh Bhagat MD, Aro Daniela Arockiam MD, Elio Haroun MD, Tom Kai Ming Wang MBChB, MD
{"title":"Reply to Letter to the Editor: “Risk Factors Associated With Fatal Thrombosis in COVID-19” regarding: “Improving Risk Analysis for Fatal Thrombosis in COVID-19: A Call for Targeted Anticoagulation”","authors":"Ankit Agrawal MD, Umesh Bhagat MD, Aro Daniela Arockiam MD, Elio Haroun MD, Tom Kai Ming Wang MBChB, MD","doi":"10.1016/j.hlc.2024.10.003","DOIUrl":"10.1016/j.hlc.2024.10.003","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"33 11","pages":"Pages e63-e65"},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619093","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 : 2024-11-01DOI: 10.1016/j.hlc.2024.04.167
Ankit Agrawal MD , Suryansh Bajaj MD , Umesh Bhagat MD , Sanya Chandna MD , Aro Daniela Arockiam MD , Joseph El Dahdah MD , Elio Haroun MD , Rahul Gupta MD , Shashank Shekhar MD , Kavin Raj MD , Divya Nayar MD , Divyansh Bajaj MD , Pulkit Chaudhury MD , Brian P. Griffin MD , Tom Kai Ming Wang MBChB, MD
Background
Coronavirus disease 2019 (COVID-19) is known to increase the risk of venous thromboembolism (VTE) and arterial thromboembolism (ATE). However, the incidence, predictors, and outcomes of clinical thrombosis for inpatients with COVID-19 are not well known. This study aimed to enhance our understanding of clinical thrombosis in COVID-19, its associated factors, and mortality outcomes.
Method
Hospitalised adult (≥18 years of age) patients with COVID-19 in 2020 were retrospectively identified from the US National Inpatient Sample database. Clinical characteristics, incident VTE, ATE, and in-hospital mortality outcomes were recorded. Multivariable logistic regression was performed to identify clinical factors associated with thrombosis and in-hospital mortality in COVID-19 inpatients.
Results
A total of 1,583,135 adult patients with COVID-19 in the year 2020 were identified from the National Inpatient Sample database; patients with thrombosis were 41% females with a mean age of 65.4 (65.1–65.6) years. The incidence of thrombosis was 6.1% (97,185), including VTE at 4.8% (76,125), ATE at 3.0% (47,790), and the in-hospital mortality rate was 13.4% (212,785). Patients with thrombosis were more likely to have respiratory symptoms of COVID-19 (76.7% vs 75%, p<0.001) compared with patients without thrombosis. The main factors associated with overall thrombosis, VTE, and ATE were paralysis, ventilation, solid tumours without metastasis, metastatic cancer, and acute liver failure. Although all thrombosis categories were associated with higher in-hospital mortality for COVID-19 inpatients in univariable analyses (p<0.001), they were not in multivariable analyses—thrombosis (odds ratio [OR] 1.24; 95% confidence interval [CI] 0.90–1.70; p=0.19), VTE (OR 0.70; 95% CI 0.52–1.00; p=0.05), and ATE (OR 1.07; 95% CI 0.92–1.25; p=0.36).
Conclusions
The association of COVID-19 with thrombosis and VTE increases with increasing severity of the COVID-19 disease. Risk stratification of thrombosis is crucial in COVID-19 patients to determine the necessity of thromboprophylaxis.
{"title":"Incidence, Predictors, and Outcomes of Venous and Arterial Thrombosis in COVID-19: A Nationwide Inpatient Analysis","authors":"Ankit Agrawal MD , Suryansh Bajaj MD , Umesh Bhagat MD , Sanya Chandna MD , Aro Daniela Arockiam MD , Joseph El Dahdah MD , Elio Haroun MD , Rahul Gupta MD , Shashank Shekhar MD , Kavin Raj MD , Divya Nayar MD , Divyansh Bajaj MD , Pulkit Chaudhury MD , Brian P. Griffin MD , Tom Kai Ming Wang MBChB, MD","doi":"10.1016/j.hlc.2024.04.167","DOIUrl":"10.1016/j.hlc.2024.04.167","url":null,"abstract":"<div><h3>Background</h3><div><span>Coronavirus disease 2019 (COVID-19) is known to increase the risk of </span>venous thromboembolism<span> (VTE) and arterial thromboembolism (ATE). However, the incidence, predictors, and outcomes of clinical thrombosis for inpatients with COVID-19 are not well known. This study aimed to enhance our understanding of clinical thrombosis in COVID-19, its associated factors, and mortality outcomes.</span></div></div><div><h3>Method</h3><div>Hospitalised adult (≥18 years of age) patients with COVID-19 in 2020 were retrospectively identified from the US National Inpatient Sample database. Clinical characteristics, incident VTE, ATE, and in-hospital mortality outcomes were recorded. Multivariable logistic regression was performed to identify clinical factors associated with thrombosis and in-hospital mortality in COVID-19 inpatients.</div></div><div><h3>Results</h3><div><span>A total of 1,583,135 adult patients with COVID-19 in the year 2020 were identified from the National Inpatient Sample database; patients with thrombosis were 41% females with a mean age of 65.4 (65.1–65.6) years. The incidence of thrombosis was 6.1% (97,185), including VTE at 4.8% (76,125), ATE at 3.0% (47,790), and the in-hospital mortality rate was 13.4% (212,785). Patients with thrombosis were more likely to have respiratory symptoms of COVID-19 (76.7% vs 75%, p<0.001) compared with patients without thrombosis. The main factors associated with overall thrombosis, VTE, and ATE were paralysis, ventilation, </span>solid tumours<span><span> without metastasis, metastatic cancer, and </span>acute liver failure. Although all thrombosis categories were associated with higher in-hospital mortality for COVID-19 inpatients in univariable analyses (p<0.001), they were not in multivariable analyses—thrombosis (odds ratio [OR] 1.24; 95% confidence interval [CI] 0.90–1.70; p=0.19), VTE (OR 0.70; 95% CI 0.52–1.00; p=0.05), and ATE (OR 1.07; 95% CI 0.92–1.25; p=0.36).</span></div></div><div><h3>Conclusions</h3><div><span>The association of COVID-19 with thrombosis and VTE increases with increasing severity of the COVID-19 disease. Risk stratification of thrombosis is crucial in COVID-19 patients to determine the necessity of </span>thromboprophylaxis.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"33 11","pages":"Pages 1563-1573"},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141467608","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 : 2024-11-01DOI: 10.1016/j.hlc.2024.03.011
Wei Xiong MD, PhD , He Du MD , Yong Luo MD , Yi Cheng MD, PhD , Mei Xu MD , Xuejun Guo MD, PhD , Yunfeng Zhao MD, PhD
Background
Occurrence of chronic thromboembolic disease (CTED) after 3 or 6 months of standard and effective anticoagulation is not uncommon in patients with acute pulmonary embolism (PE). To date, there has been no scoring model for the prediction of CTED occurrence.
Methods
A Prediction Rule for CTED (PRC) was established in the establishment cohort (n=1,124) and then validated in the validation cohort (n=211). Both original and simplified versions of the PRC score were provided by using different scoring and cut-offs.
Results
The PRC score included 10 items: active cancer (3.641; 2.338–4.944; p<0.001), autoimmune diseases (2.218; 1.545–2.891; p=0.001), body mass index >30 kg/m2 (2.186; 1.573–2.799; p=0.001), chronic immobility (2.135; 1.741–2.529; p=0.001), D-dimer >2,000 ng/mL (1.618; 1.274–1.962; p=0.005), PE with deep vein thrombosis (3.199; 2.356–4.042; p<0.001), previous venous thromboembolism (VTE) history (5.268; 3.472–7.064; p<0.001), thromboembolism besides VTE (4.954; 3.150–6.758; p<0.001), thrombophilia (3.438; 2.573–4.303; p<0.001), and unprovoked VTE (2.227; 1.471–2.983; p=0.001). In the establishment cohort, the sensitivity, specificity, Youden index (YI), and C-index were 85.5%, 79.7%, 0.652, and 0.821 (0.732–0.909) when using the original PRC score, whereas they were 87.9%, 74.6%, 0.625, and 0.807 (0.718–0.897) when using the simplified one, respectively (Kappa coefficient 0.819, p-value of McNemar’s test 0.786). In the validation cohort, the sensitivity, specificity, YI, and C-index were 86.3%, 76.3%, 0.626, and 0.815 (0.707–0.923) when using the original PRC score, whereas they were 85.0%, 78.6%, 0.636, and 0.818 (0.725–0.911) when using the simplified one, respectively (Kappa coefficient 0.912, p-value of McNemar’s test 0.937); both were better than that of the DASH score (72.5%, 69.5%, 0.420, and 0.621 [0.532–0.710]).
Conclusions
A prediction score for CTED occurrence, termed PRC, predicted the likelihood of CTED occurrence after 3 or 6 months of standard anticoagulation in hospitalised patients with a diagnosis of acute PE.
{"title":"A Prediction Rule for Occurrence of Chronic Thromboembolic Disease After Acute Pulmonary Embolism","authors":"Wei Xiong MD, PhD , He Du MD , Yong Luo MD , Yi Cheng MD, PhD , Mei Xu MD , Xuejun Guo MD, PhD , Yunfeng Zhao MD, PhD","doi":"10.1016/j.hlc.2024.03.011","DOIUrl":"10.1016/j.hlc.2024.03.011","url":null,"abstract":"<div><h3>Background</h3><div>Occurrence of chronic thromboembolic disease (CTED) after 3 or 6 months of standard and effective anticoagulation is not uncommon in patients with acute pulmonary embolism (PE). To date, there has been no scoring model for the prediction of CTED occurrence.</div></div><div><h3>Methods</h3><div>A Prediction Rule for CTED (PRC) was established in the establishment cohort (n=1,124) and then validated in the validation cohort (n=211). Both original and simplified versions of the PRC score were provided by using different scoring and cut-offs.</div></div><div><h3>Results</h3><div>The PRC score included 10 items: active cancer (3.641; 2.338–4.944; p<0.001), autoimmune diseases (2.218; 1.545–2.891; p=0.001), body mass index >30 kg/m<sup>2</sup> (2.186; 1.573–2.799; p=0.001), chronic immobility (2.135; 1.741–2.529; p=0.001), D-dimer >2,000 ng/mL (1.618; 1.274–1.962; p=0.005), PE with deep vein thrombosis (3.199; 2.356–4.042; p<0.001), previous venous thromboembolism (VTE) history (5.268; 3.472–7.064; p<0.001), thromboembolism besides VTE (4.954; 3.150–6.758; p<0.001), thrombophilia (3.438; 2.573–4.303; p<0.001), and unprovoked VTE (2.227; 1.471–2.983; p=0.001). In the establishment cohort, the sensitivity, specificity, Youden index (YI), and C-index were 85.5%, 79.7%, 0.652, and 0.821 (0.732–0.909) when using the original PRC score, whereas they were 87.9%, 74.6%, 0.625, and 0.807 (0.718–0.897) when using the simplified one, respectively (Kappa coefficient 0.819, p-value of McNemar’s test 0.786). In the validation cohort, the sensitivity, specificity, YI, and C-index were 86.3%, 76.3%, 0.626, and 0.815 (0.707–0.923) when using the original PRC score, whereas they were 85.0%, 78.6%, 0.636, and 0.818 (0.725–0.911) when using the simplified one, respectively (Kappa coefficient 0.912, p-value of McNemar’s test 0.937); both were better than that of the DASH score (72.5%, 69.5%, 0.420, and 0.621 [0.532–0.710]).</div></div><div><h3>Conclusions</h3><div>A prediction score for CTED occurrence, termed PRC, predicted the likelihood of CTED occurrence after 3 or 6 months of standard anticoagulation in hospitalised patients with a diagnosis of acute PE.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"33 11","pages":"Pages 1551-1562"},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141320813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.hlc.2024.08.008
Adrian D. Elliott , Melissa E. Middeldorp , Julie R. McMullen , Diane Fatkin , Liza Thomas , Kylie Gwynne , Adam P. Hill , Catherine Shang , Meng-Ping Hsu , Jamie I. Vandenberg , Jonathan M. Kalman , Prashanthan Sanders
Atrial fibrillation (AF) is highly prevalent in the Australian community, ranking amongst the highest globally. The consequences of AF are significant. Stroke, dementia and heart failure risk are increased substantially, hospitalisations are amongst the highest for all cardiovascular causes, and Australians living with AF suffer from substantial symptoms that impact quality of life. Australian research has made a significant impact at the global level in advancing the care of patients living with AF. However, new strategies are required to reduce the growing incidence of AF and its associated healthcare demand. The Australian Cardiovascular Alliance (ACvA) has led the development of an arrhythmia clinical theme with the objective of tackling major research priorities to achieve a reduction in AF burden across Australia. In this summary, we highlight these research priorities with particular focus on the strengths of Australian research and the strategies needed to move forward in reducing incident AF and improving outcomes for those who live with this chronic condition.
{"title":"Research Priorities for Atrial Fibrillation in Australia: A Statement From the Australian Cardiovascular Alliance Clinical Arrhythmia Theme","authors":"Adrian D. Elliott , Melissa E. Middeldorp , Julie R. McMullen , Diane Fatkin , Liza Thomas , Kylie Gwynne , Adam P. Hill , Catherine Shang , Meng-Ping Hsu , Jamie I. Vandenberg , Jonathan M. Kalman , Prashanthan Sanders","doi":"10.1016/j.hlc.2024.08.008","DOIUrl":"10.1016/j.hlc.2024.08.008","url":null,"abstract":"<div><div>Atrial fibrillation (AF) is highly prevalent in the Australian community, ranking amongst the highest globally. The consequences of AF are significant. Stroke, dementia and heart failure risk are increased substantially, hospitalisations are amongst the highest for all cardiovascular causes, and Australians living with AF suffer from substantial symptoms that impact quality of life. Australian research has made a significant impact at the global level in advancing the care of patients living with AF. However, new strategies are required to reduce the growing incidence of AF and its associated healthcare demand. The Australian Cardiovascular Alliance (ACvA) has led the development of an arrhythmia clinical theme with the objective of tackling major research priorities to achieve a reduction in AF burden across Australia. In this summary, we highlight these research priorities with particular focus on the strengths of Australian research and the strategies needed to move forward in reducing incident AF and improving outcomes for those who live with this chronic condition.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"33 11","pages":"Pages 1523-1532"},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Unilateral chronic thromboembolism pulmonary disease (CTEPD) is very rare. There is limited information on the safety and efficacy of pulmonary endarterectomy (PEA) in this population. This study investigated the effectiveness of PEA in this unique disease.
Methods
This multicentre study included patients with unilateral CTEPD from three referral centres in the United States, Turkey, and Iran. The patients’ demographic information, 6-minute walk test distance (6MWD), New York Heart Association (NYHA) functional class, and haemodynamics were evaluated.
Result
Of the 1,031 patients who had undergone PEA, 39 patients (3.7%) had pure unilateral involvement, of whom 28 were female (71.8%). There was a significant improvement in the mean pulmonary artery pressure (mPAP, 26 mmHg vs 21 mmHg; p=0.011) and pulmonary vascular resistance (PVR, 202 vs 136 dynes∗sec1∗cm-5; p=0.014). There was also a significant improvement in NYHA functional class (p<0.001) and 6MWD (360 vs 409 m; p<0.001). In the nine patients with normal haemodynamic parameters at rest, there was no significant change in median 6MWD (448.5 vs 449 m; p=0.208), mPAP (19 mmHg vs 16.5 mmHg; p=0.397), and PVR (129 vs 84.5 dynes∗sec1∗cm-5; p=0.128). The most common postoperative complication was ipsilateral pleural effusion. One patient needed extracorporeal membrane oxygenation support. No patient died within the 1-year follow up.
Conclusion
Pulmonary endarterectomy is a safe and effective procedure for improving the symptoms and haemodynamic parameters of patients with unilateral CTEPH. Symptomatic patients with unilateral chronic thromboembolic disease are suitable for PEA.
背景：单侧慢性血栓栓塞性肺病（CTEPD）非常罕见：单侧慢性血栓栓塞性肺病（CTEPD）非常罕见。关于肺动脉内膜剥脱术（PEA）在这一人群中的安全性和有效性的信息非常有限。本研究探讨了肺动脉内膜剥脱术（PEA）在这种特殊疾病中的有效性：这项多中心研究纳入了来自美国、土耳其和伊朗三个转诊中心的单侧 CTEPD 患者。对患者的人口统计学信息、6 分钟步行测试距离（6MWD）、纽约心脏协会（NYHA）功能分级和血液动力学进行了评估：在 1031 名接受过 PEA 的患者中，39 名患者（3.7%）为纯粹的单侧受累，其中 28 名为女性（71.8%）。平均肺动脉压（mPAP，26 mmHg vs 21 mmHg；P=0.011）和肺血管阻力（PVR，202 vs 136 dynes∗sec1∗cm-5；P=0.014）均有明显改善。NYHA 功能分级也有明显改善（p1∗cm-5；p=0.128）。最常见的术后并发症是同侧胸腔积液。一名患者需要体外膜氧合支持。在一年的随访中，没有患者死亡：肺动脉内膜剥脱术是一种安全有效的手术，可改善单侧 CTEPH 患者的症状和血流动力学参数。有症状的单侧慢性血栓栓塞性疾病患者适合接受肺动脉内膜剥脱术。
{"title":"Unilateral Chronic Thromboembolic Pulmonary Disease: Do Patients Benefit From Thromboendarterectomy? Case Series From Three CTEPH Centres","authors":"Farid Rashidi MD , Bedrettin Yıldızeli MD , Rezayat Parvizi MD , Serpil Taş MD , Şehnaz Olgun Yıldızeli MD , Bülent Mutlu MD , Eisa Bilehjani MD , Babak Mahmoudian MD , Hooman Bakhshandeh MD, PhD , Seyed Ali Mousavi-Aghdas MD , Gustavo A. Heresi MD, MS","doi":"10.1016/j.hlc.2024.06.049","DOIUrl":"10.1016/j.hlc.2024.06.049","url":null,"abstract":"<div><h3>Background</h3><div>Unilateral chronic thromboembolism pulmonary disease (CTEPD) is very rare. There is limited information on the safety and efficacy of pulmonary endarterectomy (PEA) in this population. This study investigated the effectiveness of PEA in this unique disease.</div></div><div><h3>Methods</h3><div>This multicentre study included patients with unilateral CTEPD from three referral centres in the United States, Turkey, and Iran. The patients’ demographic information, 6-minute walk test distance (6MWD), New York Heart Association (NYHA) functional class, and haemodynamics were evaluated.</div></div><div><h3>Result</h3><div>Of the 1,031 patients who had undergone PEA, 39 patients (3.7%) had pure unilateral involvement, of whom 28 were female (71.8%). There was a significant improvement in the mean pulmonary artery pressure (mPAP, 26 mmHg vs 21 mmHg; p=0.011) and pulmonary vascular resistance (PVR, 202 vs 136 dynes∗sec<sup>1</sup>∗cm<sup>-5</sup>; p=0.014). There was also a significant improvement in NYHA functional class (p<0.001) and 6MWD (360 vs 409 m; p<0.001). In the nine patients with normal haemodynamic parameters at rest, there was no significant change in median 6MWD (448.5 vs 449 m; p=0.208), mPAP (19 mmHg vs 16.5 mmHg; p=0.397), and PVR (129 vs 84.5 dynes∗sec<sup>1</sup>∗cm<sup>-5</sup>; p=0.128). The most common postoperative complication was ipsilateral pleural effusion. One patient needed extracorporeal membrane oxygenation support. No patient died within the 1-year follow up.</div></div><div><h3>Conclusion</h3><div>Pulmonary endarterectomy is a safe and effective procedure for improving the symptoms and haemodynamic parameters of patients with unilateral CTEPH. Symptomatic patients with unilateral chronic thromboembolic disease are suitable for PEA.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"33 11","pages":"Pages 1574-1581"},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142285976","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 : 2024-11-01DOI: 10.1016/j.hlc.2024.10.001
{"title":"It’s Time: A new International Research Challenge to Tackle Critical Knowledge Gaps in Women’s Cardiovascular Health","authors":"","doi":"10.1016/j.hlc.2024.10.001","DOIUrl":"10.1016/j.hlc.2024.10.001","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"33 11","pages":"Page 1605"},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142660463","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 : 2024-11-01DOI: 10.1016/j.hlc.2024.03.014
Hayley Robinson FCICM , Matthew Anstey MPH, FCICM , Edward Litton PhD, FCICM , Kwok M. Ho PhD, FCICM , Angela Jacques M.Biostat , Kaushalendra Rathore FRACS , Timothy Yap MBBS , Monique Lucas MBBS , Laura Worthy MBBS , Jo-Lynn Tan MBBS , Matthew Yeoh MBBS , Ho-Cing Yau MBBS, BMedSc , Kieran Robinson MBBS , Jess Mudie MD , Gavin Hennelly MBCH, MRCPI , Bradley Wibrow MSc, FCICM
Aim
Acute pulmonary embolism (PE) is a significant cause of mortality in the hospital setting. The objective of this study was to outline the long-term outcomes after surgical and non-surgical management for patients with massive and submassive PE.
Methods
Population cohort observational study evaluating all patients who presented to three tertiary hospitals in the state of Western Australia with access to cardiothoracic services over 5 years (2013–2018). Reviewed notes of all patients as well as radiology, linked mortality data and all available echocardiography studies at the primary hospital.
Results
In total, 245 patients were identified, of which 41 received surgical management and 204 non-surgical management; demographic data was similar. Clinically, the surgical group had higher rates of shock requiring vasopressors, severe bradycardia, or cardiopulmonary resuscitation prior to intervention. The 28-day mortality was not statistically significantly different between the surgical embolectomy group (2/41 [4.2%]) and the non-surgical group (17/201 [8.3%]) (p=0.382). There was no difference in 12-month mortality, including when this was adjusted for vasopressors, right ventricular (RV) strain, troponin, and brain natriuretic peptide. In the massive PE sub-group, 28-day mortality was not significantly different: 2/29 (6.9%) surgical group vs 7/34 (20.2%) non-surgical group (p=0.064). Higher rates of severe RV impairment and dilatation were present in the surgical group. All patients with available echocardiography studies at outpatient follow-up returned to normal or mild RV impairment.
Conclusion
Patients who presented with massive or submassive PE had similar outcomes whether treated with surgical or non-surgical management. Surgical embolectomy is a safe option in a cardiothoracic centre setting.
{"title":"Long-Term Echocardiographic and Clinical Outcomes After Invasive and Non-Invasive Therapies for Sub-Massive and Massive Acute Pulmonary Embolism","authors":"Hayley Robinson FCICM , Matthew Anstey MPH, FCICM , Edward Litton PhD, FCICM , Kwok M. Ho PhD, FCICM , Angela Jacques M.Biostat , Kaushalendra Rathore FRACS , Timothy Yap MBBS , Monique Lucas MBBS , Laura Worthy MBBS , Jo-Lynn Tan MBBS , Matthew Yeoh MBBS , Ho-Cing Yau MBBS, BMedSc , Kieran Robinson MBBS , Jess Mudie MD , Gavin Hennelly MBCH, MRCPI , Bradley Wibrow MSc, FCICM","doi":"10.1016/j.hlc.2024.03.014","DOIUrl":"10.1016/j.hlc.2024.03.014","url":null,"abstract":"<div><h3>Aim</h3><div><span>Acute pulmonary embolism (PE) is a significant cause of mortality in the hospital setting. The objective of this study was to outline the long-term outcomes after surgical and non-surgical management for patients with massive and submassive </span>PE.</div></div><div><h3>Methods</h3><div><span><span>Population cohort observational study evaluating all patients who presented to three tertiary hospitals in the state of Western Australia with access to cardiothoracic services over 5 years (2013–2018). Reviewed notes of all patients as well as </span>radiology, linked mortality data and all available </span>echocardiography studies at the primary hospital.</div></div><div><h3>Results</h3><div>In total, 245 patients were identified, of which 41 received surgical management and 204 non-surgical management; demographic data was similar. Clinically, the surgical group had higher rates of shock<span><span><span> requiring vasopressors, severe bradycardia, or cardiopulmonary resuscitation prior to intervention. The 28-day mortality was not statistically significantly different between the surgical embolectomy group (2/41 [4.2%]) and the non-surgical group (17/201 [8.3%]) (p=0.382). There was no difference in 12-month mortality, including when this was adjusted for vasopressors, right ventricular (RV) strain, </span>troponin, and </span>brain natriuretic peptide. In the massive PE sub-group, 28-day mortality was not significantly different: 2/29 (6.9%) surgical group vs 7/34 (20.2%) non-surgical group (p=0.064). Higher rates of severe RV impairment and dilatation were present in the surgical group. All patients with available echocardiography studies at outpatient follow-up returned to normal or mild RV impairment.</span></div></div><div><h3>Conclusion</h3><div>Patients who presented with massive or submassive PE had similar outcomes whether treated with surgical or non-surgical management. Surgical embolectomy is a safe option in a cardiothoracic centre setting.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"33 11","pages":"Pages 1543-1550"},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141467609","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}
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