首页 > 最新文献

Heart, Lung and Circulation最新文献

英文 中文
Rural and Remote Acute STEMI Diagnosis and Management: Current Status and Future Directions 农村和偏远地区急性STEMI的诊断和管理:现状和未来方向。
IF 2.2 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 DOI: 10.1016/j.hlc.2025.06.1035
Ryan Gadeley BMed , Ruth Arnold FRACP , David Amos FRACP , Stuart Moss FRACP , Alex Elder FRACP , Sameer Karve FRACP , Mark Adams FRACP, PhD , David Brieger FRACP PhD , Harry C. Lowe FRACP, PhD
Current European, American and Australasian guidelines recommend revascularisation for acute ST elevation myocardial infarction (STEMI) by immediate or “primary” percutaneous coronary intervention (pPCI), or if pPCI cannot be performed within 120 minutes, by thrombolysis followed by rescue PCI. This latter approach, despite its limitations, remains a cornerstone of STEMI care in rural and remote settings, where pPCI is not immediately available, and where one-third of the Australian population live.
This review evaluates the current status of thrombolysis and rescue PCI in rural and remote settings, examines the multiple changes that have occurred since its inception, and highlights persisting gaps in knowledge, to provide an up-to-date evaluation of this field, and an outlook for future directions, in this area of ongoing change.
目前欧洲、美国和澳大利亚的指南推荐急性ST段抬高型心肌梗死(STEMI)的血供重建术,即立即或“原发性”经皮冠状动脉介入治疗(pPCI),或者如果pPCI不能在120分钟内进行,则溶栓后再进行抢救性PCI。后一种方法尽管有其局限性,但仍然是农村和偏远地区STEMI护理的基石,这些地区无法立即获得pPCI,而澳大利亚三分之一的人口居住在这些地区。本综述评估了农村和偏远地区溶栓和抢救PCI的现状,检查了自其成立以来发生的多种变化,并强调了持续存在的知识差距,以提供该领域的最新评估,并展望了未来的方向,在这个不断变化的领域。
{"title":"Rural and Remote Acute STEMI Diagnosis and Management: Current Status and Future Directions","authors":"Ryan Gadeley BMed ,&nbsp;Ruth Arnold FRACP ,&nbsp;David Amos FRACP ,&nbsp;Stuart Moss FRACP ,&nbsp;Alex Elder FRACP ,&nbsp;Sameer Karve FRACP ,&nbsp;Mark Adams FRACP, PhD ,&nbsp;David Brieger FRACP PhD ,&nbsp;Harry C. Lowe FRACP, PhD","doi":"10.1016/j.hlc.2025.06.1035","DOIUrl":"10.1016/j.hlc.2025.06.1035","url":null,"abstract":"<div><div>Current European, American and Australasian guidelines recommend revascularisation for acute ST elevation myocardial infarction (STEMI) by immediate or “primary” percutaneous coronary intervention (pPCI), or if pPCI cannot be performed within 120 minutes, by thrombolysis followed by rescue PCI. This latter approach, despite its limitations, remains a cornerstone of STEMI care in rural and remote settings, where pPCI is not immediately available, and where one-third of the Australian population live.</div><div>This review evaluates the current status of thrombolysis and rescue PCI in rural and remote settings, examines the multiple changes that have occurred since its inception, and highlights persisting gaps in knowledge, to provide an up-to-date evaluation of this field, and an outlook for future directions, in this area of ongoing change.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 12","pages":"Pages 1332-1343"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952038","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
Central Obesity: An Emerging Player in Cardiac Remodelling and Dysfunction 中心性肥胖:心脏重构和功能障碍的新参与者。
IF 2.2 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 DOI: 10.1016/j.hlc.2025.05.096
Kylychbek Suiunov MD , Argen Mamazhakypov PhD , Andrey Polupanov MD, PhD , Kyialbek Sakibaev MD, PhD , Meerimgul Sherikbai kyzy MD , Chyngyzbek Asanbaev MD , Akylbek Sydykov MD, PhD , Roman Kalmatov MD, PhD
Abnormal or excessive fat accumulation is defined as obesity. The prevalence of obesity has risen worldwide in the last years. Obesity increases cardiovascular disease risk, affecting cardiac and vascular systems. Accordingly, the health burden related to obesity has been increased. Notably, even individuals with normal body weight can present with excessive accumulation of visceral fat, also known as central obesity. Population-based studies demonstrated associations between central obesity measures, including waist circumference, waist-to-hip ratio, and visceral adipose tissue, and adverse cardiovascular events and increased all-cause mortality. It has been shown that central obesity induces cardiac remodelling and dysfunction. Moreover, central obesity measures proved to be more reliable predictors of cardiac remodelling and dysfunction than traditional obesity measures such as body mass index. This review presents recent evidence of the detrimental effects of central obesity on cardiac function and structure.
异常或过量的脂肪堆积被定义为肥胖。在过去的几年里,肥胖的患病率在全球范围内有所上升。肥胖会增加患心血管疾病的风险,影响心脏和血管系统。因此,与肥胖有关的健康负担也随之增加。值得注意的是,即使是体重正常的人也会出现内脏脂肪的过度积累,也被称为中心性肥胖。基于人群的研究表明,中心性肥胖测量(包括腰围、腰臀比和内脏脂肪组织)与不良心血管事件和全因死亡率增加之间存在关联。研究表明,中心性肥胖可诱导心脏重构和功能障碍。此外,中心性肥胖指标被证明比传统的肥胖指标(如体重指数)更可靠地预测心脏重构和功能障碍。本文综述了中心性肥胖对心脏功能和结构有害影响的最新证据。
{"title":"Central Obesity: An Emerging Player in Cardiac Remodelling and Dysfunction","authors":"Kylychbek Suiunov MD ,&nbsp;Argen Mamazhakypov PhD ,&nbsp;Andrey Polupanov MD, PhD ,&nbsp;Kyialbek Sakibaev MD, PhD ,&nbsp;Meerimgul Sherikbai kyzy MD ,&nbsp;Chyngyzbek Asanbaev MD ,&nbsp;Akylbek Sydykov MD, PhD ,&nbsp;Roman Kalmatov MD, PhD","doi":"10.1016/j.hlc.2025.05.096","DOIUrl":"10.1016/j.hlc.2025.05.096","url":null,"abstract":"<div><div>Abnormal or excessive fat accumulation is defined as obesity. The prevalence of obesity has risen worldwide in the last years. Obesity increases cardiovascular disease risk, affecting cardiac and vascular systems. Accordingly, the health burden related to obesity has been increased. Notably, even individuals with normal body weight can present with excessive accumulation of visceral fat, also known as central obesity. Population-based studies demonstrated associations between central obesity measures, including waist circumference, waist-to-hip ratio, and visceral adipose tissue, and adverse cardiovascular events and increased all-cause mortality. It has been shown that central obesity induces cardiac remodelling and dysfunction. Moreover, central obesity measures proved to be more reliable predictors of cardiac remodelling and dysfunction than traditional obesity measures such as body mass index. This review presents recent evidence of the detrimental effects of central obesity on cardiac function and structure.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 12","pages":"Pages 1344-1361"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145451786","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
Percutaneous Femoral Arterial Closure Following Decannulation of Venoarterial Extracorporeal Membrane Oxygenation Using the MANTA Vascular Closure Device 使用MANTA血管关闭装置在静脉体外膜氧合脱管后经皮股动脉关闭。
IF 2.2 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 DOI: 10.1016/j.hlc.2025.06.006
Riley J. Batchelor FRACP , Arne Diehl FACEM, FCICM , Thodur Vasudevan FRACS , Shane Nanayakkara PhD, FRACP , Nay Htun PhD, FRACP , Vincent Pellegrino FRACP, FCICM , David McGiffin FRACS , Silvana Marasco PhD, FRACS , Carol Hodgson BAppSc, PhD, FACP , David Kaye PhD, FRACP , Dion Stub PhD, FRACP , Antony Walton FRACP

Background

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a life-saving therapy for patients with severe cardiac failure. If patients can be weaned, withdrawal and closure of the large-bore arterial access are required, which historically have been achieved through surgical closure. The MANTA vascular closure device (VCD) is a percutaneous, collagen-based plug device used following large-bore arterial access. We sought to evaluate the efficacy and safety of the MANTA VCD for percutaneous arterial closure following VA-ECMO decannulation.

Method

A non-randomised, open-label pilot study of patients who underwent decannulation from VA-ECMO with percutaneous closure using the MANTA VCD.

Results

Eight patients presenting with cardiogenic shock (mean age 46.5±11.4 years, 37.5% female) underwent percutaneous closure following VA-ECMO decannulation using the 18 Fr MANTA VCD. The mean duration of VA-ECMO support prior to decannulation was 4.8±2.6 days, with arterial cannula sizes ranging from 15 to 19 Fr. There were two major adverse events: one patient had acute limb ischaemia due to superficial femoral artery occlusion, which was detected during percutaneous closure and treated surgically; another patient developed a femoral pseudoaneurysm and infected hematoma that subsequently required surgical repair 17 days after percutaneous closure.

Conclusions

In a centre with immediate access to vascular surgical backup, and in highly selected patients, percutaneous closure following VA-ECMO decannulation using the MANTA VCD is feasible; however, major vascular complications raise concerns regarding safety prior to its adoption as an alternative to up-front surgical closure.
背景:静脉体外膜氧合(VA-ECMO)是一种挽救严重心力衰竭患者生命的治疗方法。如果患者可以断奶,则需要切断和关闭大口径动脉通路,这在历史上是通过手术关闭来实现的。MANTA血管闭合装置(VCD)是一种经皮、基于胶原蛋白的堵塞装置,用于大孔径动脉通路。我们试图评估MANTA VCD在VA-ECMO脱管后经皮动脉闭合的有效性和安全性。方法:一项非随机、开放标签的试点研究,研究对象是使用MANTA VCD进行经皮缝合的VA-ECMO脱管患者。结果:8例心源性休克患者(平均年龄46.5±11.4岁,37.5%为女性)在使用18 Fr MANTA VCD进行VA-ECMO脱管后经皮缝合。脱管前VA-ECMO支持的平均持续时间为4.8±2.6天,动脉插管的大小从15到19 Fr不等。有两个主要不良事件:一名患者因股浅动脉闭塞而出现急性肢体缺血,经皮缝合时发现并手术治疗;另一名患者出现股假性动脉瘤和感染性血肿,在经皮缝合术后17天需要手术修复。结论:在一个可以立即获得血管手术后援的中心,在高度选定的患者中,使用MANTA VCD进行VA-ECMO脱管后经皮闭合是可行的;然而,主要的血管并发症引起对安全性的担忧之前,采用它作为一种替代手术前关闭。
{"title":"Percutaneous Femoral Arterial Closure Following Decannulation of Venoarterial Extracorporeal Membrane Oxygenation Using the MANTA Vascular Closure Device","authors":"Riley J. Batchelor FRACP ,&nbsp;Arne Diehl FACEM, FCICM ,&nbsp;Thodur Vasudevan FRACS ,&nbsp;Shane Nanayakkara PhD, FRACP ,&nbsp;Nay Htun PhD, FRACP ,&nbsp;Vincent Pellegrino FRACP, FCICM ,&nbsp;David McGiffin FRACS ,&nbsp;Silvana Marasco PhD, FRACS ,&nbsp;Carol Hodgson BAppSc, PhD, FACP ,&nbsp;David Kaye PhD, FRACP ,&nbsp;Dion Stub PhD, FRACP ,&nbsp;Antony Walton FRACP","doi":"10.1016/j.hlc.2025.06.006","DOIUrl":"10.1016/j.hlc.2025.06.006","url":null,"abstract":"<div><h3>Background</h3><div>Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a life-saving therapy for patients with severe cardiac failure. If patients can be weaned, withdrawal and closure of the large-bore arterial access are required, which historically have been achieved through surgical closure. The MANTA vascular closure device (VCD) is a percutaneous, collagen-based plug device used following large-bore arterial access. We sought to evaluate the efficacy and safety of the MANTA VCD for percutaneous arterial closure following VA-ECMO decannulation.</div></div><div><h3>Method</h3><div>A non-randomised, open-label pilot study of patients who underwent decannulation from VA-ECMO with percutaneous closure using the MANTA VCD.</div></div><div><h3>Results</h3><div>Eight patients presenting with cardiogenic shock (mean age 46.5±11.4 years, 37.5% female) underwent percutaneous closure following VA-ECMO decannulation using the 18 Fr MANTA VCD. The mean duration of VA-ECMO support prior to decannulation was 4.8±2.6 days, with arterial cannula sizes ranging from 15 to 19 Fr. There were two major adverse events: one patient had acute limb ischaemia due to superficial femoral artery occlusion, which was detected during percutaneous closure and treated surgically; another patient developed a femoral pseudoaneurysm and infected hematoma that subsequently required surgical repair 17 days after percutaneous closure.</div></div><div><h3>Conclusions</h3><div>In a centre with immediate access to vascular surgical backup, and in highly selected patients, percutaneous closure following VA-ECMO decannulation using the MANTA VCD is feasible; however, major vascular complications raise concerns regarding safety prior to its adoption as an alternative to up-front surgical closure.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 12","pages":"Pages 1409-1416"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426808","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
Association Between Ultra-Short-Term Heart Rate Variability and Atrial Fibrillation in Heart Failure Population: A Retrospective Cohort Study 心力衰竭患者超短期心率变异性与心房颤动的相关性:一项回顾性队列研究
IF 2.2 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 DOI: 10.1016/j.hlc.2025.05.089
Xiaodi Tang MD, Rong He MD, PhD

Background

Patients with heart failure are at high risk for atrial fibrillation (AF) due to impaired heart function and sympathetic excitation. Ultra-short-term heart rate variability (usHRV), a parameter that reflects autonomic nervous system activation, has been proposed. However, the association between usHRV and AF has not been investigated in the heart failure with reduced ejection fraction (HFrEF) population.

Objective

This study explored the association between usHRV and AF risk in the HFrEF population.

Method

We conducted a retrospective cohort study involving 2,122 participants from the Critical Care Medical Information Mark-IV (MIMIC-IV) database with 2 years’ observation. We used Cox proportional hazards models, subgroup analysis, interaction effect evaluation and E-value to exclude confounding factors. Furthermore, the Kaplan–Meier curve was used to describe the survival probability in different usHRV quantiles.

Results

During an average follow-up of 1.67 years, 475 participants (22.4%) developed AF. A negative association between usHRV and the risk of AF was evident after adjusting for multiple variables. In the fully adjusted Cox proportional hazard models, for every 1 unit increase, the hazard ratio (HR) for incident AF was 0.84 for log(standard deviation of normal-to-normal RR intervals) (95% confidence intervals [CI] 0.66–1.07), 1.05 for log(standard deviation of successive differences) (95% CI 0.84–1.32), 1.04 for log(root mean square of successive differences) (95% CI 0.83–1.31), 0.88 for log(low frequency [LF]) (95% CI 0.80–0.96), 0.93 for log(high frequency [HF]) (95% CI 0.84–1.04), 0.82 for log(LF/HF) (95% CI 0.70–0.95), 0.79 for log(LF normalised units) (95% CI 0.65–0.97), 2.48 for log(HF normalised units) (95% CI 1.42–4.35), and 0.90 for log(total power) (95% CI 0.80–0.98). The Kaplan–Meier curve shows that the lower the frequency-domain index of usHRV, the higher the risk of AF occurrence in the HFrEF population. Subsequent subgroup analysis and E-value implied the current associations tended to be more stable.

Conclusions

Our study findings suggest that decreased usHRV frequency domain metrics levels may be linked to an increased risk of AF in the HFrEF population.
心衰患者由于心功能和交感神经兴奋受损,心房颤动(AF)的风险较高。超短期心率变异性(usHRV)是一种反映自主神经系统激活的参数。然而,在心力衰竭伴射血分数降低(HFrEF)人群中,usHRV和房颤之间的关系尚未被研究。目的探讨HFrEF人群中usHRV与房颤风险之间的关系。方法采用回顾性队列研究,从重症监护医学信息标记- iv (MIMIC-IV)数据库中纳入2122名参与者,观察2年。采用Cox比例风险模型、亚组分析、交互效应评价和e值等方法排除混杂因素。此外,Kaplan-Meier曲线用于描述不同usHRV分位数的生存概率。结果在1.67年的平均随访期间,475名参与者(22.4%)发生房颤。在调整多个变量后,usHRV与房颤风险呈明显负相关。在完全校正的Cox比例风险模型中,每增加1个单位,事件AF的风险比(HR) log(正态与正态RR区间的标准差)为0.84(95%置信区间[CI] 0.66-1.07), log(连续差异的标准差)为1.05 (95% CI 0.84 - 1.32), log(连续差异的均方根)为1.04 (95% CI 0.83-1.31), log(低频[LF])为0.88 (95% CI 0.80-0.96), log(高频[HF])为0.93 (95% CI 0.84 - 1.04),对数(LF/HF)为0.82 (95% CI 0.70-0.95),对数(LF归一化单位)为0.79 (95% CI 0.65-0.97),对数(HF归一化单位)为2.48 (95% CI 1.42-4.35),对数(总功率)为0.90 (95% CI 0.80-0.98)。Kaplan-Meier曲线显示,usHRV频域指数越低,HFrEF人群发生房颤的风险越高。随后的亚组分析和e值表明,当前的关联倾向于更稳定。研究结果表明,HFrEF人群中usHRV频域指标水平的降低可能与房颤风险的增加有关。
{"title":"Association Between Ultra-Short-Term Heart Rate Variability and Atrial Fibrillation in Heart Failure Population: A Retrospective Cohort Study","authors":"Xiaodi Tang MD,&nbsp;Rong He MD, PhD","doi":"10.1016/j.hlc.2025.05.089","DOIUrl":"10.1016/j.hlc.2025.05.089","url":null,"abstract":"<div><h3>Background</h3><div>Patients with heart failure are at high risk for atrial fibrillation (AF) due to impaired heart function and sympathetic excitation. Ultra-short-term heart rate variability (usHRV), a parameter that reflects autonomic nervous system activation, has been proposed. However, the association between usHRV and AF has not been investigated in the heart failure with reduced ejection fraction (HFrEF) population.</div></div><div><h3>Objective</h3><div>This study explored the association between usHRV and AF risk in the HFrEF population.</div></div><div><h3>Method</h3><div>We conducted a retrospective cohort study involving 2,122 participants from the Critical Care Medical Information Mark-IV (MIMIC-IV) database with 2 years’ observation. We used Cox proportional hazards models, subgroup analysis, interaction effect evaluation and E-value to exclude confounding factors. Furthermore, the Kaplan–Meier curve was used to describe the survival probability in different usHRV quantiles.</div></div><div><h3>Results</h3><div>During an average follow-up of 1.67 years, 475 participants (22.4%) developed AF. A negative association between usHRV and the risk of AF was evident after adjusting for multiple variables. In the fully adjusted Cox proportional hazard models, for every 1 unit increase, the hazard ratio (HR) for incident AF was 0.84 for log(standard deviation of normal-to-normal RR intervals) (95% confidence intervals [CI] 0.66–1.07), 1.05 for log(standard deviation of successive differences) (95% CI 0.84–1.32), 1.04 for log(root mean square of successive differences) (95% CI 0.83–1.31), 0.88 for log(low frequency [LF]) (95% CI 0.80–0.96), 0.93 for log(high frequency [HF]) (95% CI 0.84–1.04), 0.82 for log(LF/HF) (95% CI 0.70–0.95), 0.79 for log(LF normalised units) (95% CI 0.65–0.97), 2.48 for log(HF normalised units) (95% CI 1.42–4.35), and 0.90 for log(total power) (95% CI 0.80–0.98). The Kaplan–Meier curve shows that the lower the frequency-domain index of usHRV, the higher the risk of AF occurrence in the HFrEF population. Subsequent subgroup analysis and E-value implied the current associations tended to be more stable.</div></div><div><h3>Conclusions</h3><div>Our study findings suggest that decreased usHRV frequency domain metrics levels may be linked to an increased risk of AF in the HFrEF population.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 12","pages":"Pages 1439-1448"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145658756","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
A Prospective, Multicentre Randomised Controlled Study of Angiographic and Clinical Outcomes in Total Arterial Coronary Bypass Grafting: The TA Trial Protocol 全动脉冠状动脉旁路移植术的血管造影和临床结果的前瞻性、多中心随机对照研究:TA试验方案。
IF 2.2 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 DOI: 10.1016/j.hlc.2025.06.1018
Alistair Royse AM, MD, FRACS , Justin Ren BBiomedSc , Andrea Bowyer MBBS, PhD , Christopher M. Reid MSc, PhD , Rinaldo Bellomo MD, PhD , Julian A. Smith MBMS, MSurgEd, FRACS , Paul Bannon MBBS, FRACS , David Eccleston MBBS , Michael Vallely PhD, FRACS , Elaine Lui MBBS, MMed , Guy Ludbrook MBBS, PhD, MSc , Sandy Clarke PhD , David H. Tian MD, PhD , Colin Royse MBBS, MD , TA Investigators
<div><h3>Background & Aim</h3><div>Conventional coronary artery bypass grafting (CABG) procedures typically utilise the left internal mammary artery and supplementary saphenous vein grafts (SVGs) to re-establish adequate coronary blood flow to ischaemic territories. However, extensive observational studies have consistently demonstrated that SVGs are prone to accelerated atherosclerosis and progressive failure compared to arterial conduits. These limitations have heightened interest in total arterial revascularisation (TAR) as a potentially superior strategy.</div><div><em>Objective:</em> The Total Arterial (TA) Trial, fully funded through the Medical Research Future Fund Cardiovascular Health Mission, aims to determine the angiographic and clinical outcomes of TAR compared to conventional non-TAR operations.</div></div><div><h3>Method</h3><div><em>Design:</em> This study is an open-label, multicentre, randomised controlled trial including 1,000 CABG patients from multiple cardiac institutions across Australia, with an allocation ratio of 1:1. Randomisation occurs at a standardised perioperative time point via computer-generated sequences with variable block size The trial does not impose specific procedural requirements regarding the type of arterial conduit, revascularisation or reconstruction technique, use of sequential or composite methods, or any perioperative management.</div><div><em>Intervention:</em> Total arterial CABG with no use of SVG.</div><div><em>Control:</em> Non-total-arterial CABG with at least one SVG.</div><div><em>Main outcomes:</em> The primary endpoint will be perfect graft patency at 24 months postoperatively. The secondary endpoints include patency, major adverse cardiac and cerebrovascular events, quality of life, all-cause and cardiac mortality. Clinical follow-up visits will be scheduled at 6-month intervals, and angiographic assessments at 3 months and 24 months. Subgroup analyses by diabetes, sex, age, and conduit types are proposed to examine the potential interactions with treatment effects.</div></div><div><h3>Conclusions</h3><div>The TA Trial is one of the largest multicentre trials in the field of coronary revascularisation research, evaluating the graft status and clinical endpoints of TAR versus non-TAR procedures. The study design will provide valuable insights into whether differences in graft failure of SVG translate into differences in survival and cardiac outcomes. Early postoperative coronary angiography may improve understanding of the impact of competitive flow on graft function. The findings from this study will contribute to an improved understanding and help inform the optimal approach for coronary revascularisation, supporting evidence-based improvements in patient care.</div><div><em>Ethics:</em> Ethical approval has been granted by the Melbourne Health Institutional Review Board (HREC/92839/MH-2023), Australia.</div><div><em>Trial registration:</em> The trial has been registered under the A
背景与目的:传统的冠状动脉旁路移植术(CABG)通常利用左乳腺内动脉和辅助隐静脉移植(SVGs)来重建足够的冠状动脉血流到缺血区域。然而,广泛的观察性研究一致表明,与动脉导管相比,svg容易加速动脉粥样硬化和进行性衰竭。这些局限性提高了人们对全动脉血管重建术(TAR)作为一种潜在的优越策略的兴趣。目的:全动脉(TA)试验由医学研究未来基金心血管健康任务全额资助,旨在确定与传统非TAR手术相比,TAR手术的血管造影和临床结果。设计:本研究是一项开放标签、多中心、随机对照试验,包括来自澳大利亚多家心脏机构的1000例CABG患者,分配比例为1:1。随机化通过计算机生成具有可变块大小的序列在标准化围手术期时间点进行。该试验没有对动脉导管类型、血运重建或重建技术、顺序或复合方法的使用或任何围手术期管理施加特定的程序要求。干预:全动脉冠脉搭桥,不使用SVG。对照组:非全动脉冠脉搭桥且至少有一个SVG。主要结局:主要终点为术后24个月移植物完全通畅。次要终点包括通畅、主要的心脑血管不良事件、生活质量、全因死亡率和心脏死亡率。每隔6个月安排一次临床随访,并在3个月和24个月进行血管造影评估。根据糖尿病、性别、年龄和导管类型进行亚组分析,以检查与治疗效果的潜在相互作用。结论:TA试验是冠状动脉血管重建术研究领域最大的多中心试验之一,评估了TAR与非TAR手术的移植物状态和临床终点。该研究设计将为SVG移植失败的差异是否转化为生存和心脏结局的差异提供有价值的见解。术后早期冠状动脉造影可以提高对竞争血流对移植物功能影响的认识。这项研究的发现将有助于提高对冠状动脉血运重建的理解,并帮助告知最佳方法,支持循证改进患者护理。伦理:已获得澳大利亚墨尔本卫生机构审查委员会(HREC/92839/MH-2023)的伦理批准。试验注册:该试验已在澳大利亚新西兰临床试验注册中心注册(注册号:ACTRN12623000864628)。结果的传播:分析结果将在临床试验完成后发表在同行评议的期刊上。
{"title":"A Prospective, Multicentre Randomised Controlled Study of Angiographic and Clinical Outcomes in Total Arterial Coronary Bypass Grafting: The TA Trial Protocol","authors":"Alistair Royse AM, MD, FRACS ,&nbsp;Justin Ren BBiomedSc ,&nbsp;Andrea Bowyer MBBS, PhD ,&nbsp;Christopher M. Reid MSc, PhD ,&nbsp;Rinaldo Bellomo MD, PhD ,&nbsp;Julian A. Smith MBMS, MSurgEd, FRACS ,&nbsp;Paul Bannon MBBS, FRACS ,&nbsp;David Eccleston MBBS ,&nbsp;Michael Vallely PhD, FRACS ,&nbsp;Elaine Lui MBBS, MMed ,&nbsp;Guy Ludbrook MBBS, PhD, MSc ,&nbsp;Sandy Clarke PhD ,&nbsp;David H. Tian MD, PhD ,&nbsp;Colin Royse MBBS, MD ,&nbsp;TA Investigators","doi":"10.1016/j.hlc.2025.06.1018","DOIUrl":"10.1016/j.hlc.2025.06.1018","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background &amp; Aim&lt;/h3&gt;&lt;div&gt;Conventional coronary artery bypass grafting (CABG) procedures typically utilise the left internal mammary artery and supplementary saphenous vein grafts (SVGs) to re-establish adequate coronary blood flow to ischaemic territories. However, extensive observational studies have consistently demonstrated that SVGs are prone to accelerated atherosclerosis and progressive failure compared to arterial conduits. These limitations have heightened interest in total arterial revascularisation (TAR) as a potentially superior strategy.&lt;/div&gt;&lt;div&gt;&lt;em&gt;Objective:&lt;/em&gt; The Total Arterial (TA) Trial, fully funded through the Medical Research Future Fund Cardiovascular Health Mission, aims to determine the angiographic and clinical outcomes of TAR compared to conventional non-TAR operations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Method&lt;/h3&gt;&lt;div&gt;&lt;em&gt;Design:&lt;/em&gt; This study is an open-label, multicentre, randomised controlled trial including 1,000 CABG patients from multiple cardiac institutions across Australia, with an allocation ratio of 1:1. Randomisation occurs at a standardised perioperative time point via computer-generated sequences with variable block size The trial does not impose specific procedural requirements regarding the type of arterial conduit, revascularisation or reconstruction technique, use of sequential or composite methods, or any perioperative management.&lt;/div&gt;&lt;div&gt;&lt;em&gt;Intervention:&lt;/em&gt; Total arterial CABG with no use of SVG.&lt;/div&gt;&lt;div&gt;&lt;em&gt;Control:&lt;/em&gt; Non-total-arterial CABG with at least one SVG.&lt;/div&gt;&lt;div&gt;&lt;em&gt;Main outcomes:&lt;/em&gt; The primary endpoint will be perfect graft patency at 24 months postoperatively. The secondary endpoints include patency, major adverse cardiac and cerebrovascular events, quality of life, all-cause and cardiac mortality. Clinical follow-up visits will be scheduled at 6-month intervals, and angiographic assessments at 3 months and 24 months. Subgroup analyses by diabetes, sex, age, and conduit types are proposed to examine the potential interactions with treatment effects.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The TA Trial is one of the largest multicentre trials in the field of coronary revascularisation research, evaluating the graft status and clinical endpoints of TAR versus non-TAR procedures. The study design will provide valuable insights into whether differences in graft failure of SVG translate into differences in survival and cardiac outcomes. Early postoperative coronary angiography may improve understanding of the impact of competitive flow on graft function. The findings from this study will contribute to an improved understanding and help inform the optimal approach for coronary revascularisation, supporting evidence-based improvements in patient care.&lt;/div&gt;&lt;div&gt;&lt;em&gt;Ethics:&lt;/em&gt; Ethical approval has been granted by the Melbourne Health Institutional Review Board (HREC/92839/MH-2023), Australia.&lt;/div&gt;&lt;div&gt;&lt;em&gt;Trial registration:&lt;/em&gt; The trial has been registered under the A","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 12","pages":"Pages 1478-1486"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717847","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
Letter to the Editor regarding: “iCARDIO Alliance Global Implementation Guidelines on Heart Failure 2025” by Chopra et al. Heart Lung Circ. 2025;34:e55-e82 关于Chopra等人的《iCARDIO联盟心力衰竭全球实施指南2025》致编辑的信中华心肺杂志2025;34: e55-e82
IF 2.2 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 DOI: 10.1016/j.hlc.2025.09.010
Stefano Perlini MD, PhD
{"title":"Letter to the Editor regarding: “iCARDIO Alliance Global Implementation Guidelines on Heart Failure 2025” by Chopra et al. Heart Lung Circ. 2025;34:e55-e82","authors":"Stefano Perlini MD, PhD","doi":"10.1016/j.hlc.2025.09.010","DOIUrl":"10.1016/j.hlc.2025.09.010","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 12","pages":"Pages e170-e171"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145658570","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
Aeromedical Retrieval of Critically Ill Pulmonary Embolism Patients: A Retrospective Cohort Study of 10 Years in New South Wales 危重肺栓塞患者的航空医学检索:新南威尔士州10年回顾性队列研究
IF 2.2 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 DOI: 10.1016/j.hlc.2025.05.091
Ruan Vlok MBBS , Yousif Rassam FACEM , Christopher Partyka FACEM

Background

Pulmonary embolism (PE) is a common, time-critical condition requiring multidisciplinary care. Interhospital transport is a high-risk period in the patient’s care but offers an opportunity for expedited risk stratification, resuscitation, and transport to definitive care. Patients who require interhospital transfer to specialist centres for PE management have worse outcomes. Despite this, the literature surrounding the interhospital retrieval practice and experience of PE is limited.

Method

A retrospective cohort study was conducted over a 10-year period from January 2014 to June 2024 from the database of a high-volume aeromedical retrieval service in New South Wales, Australia. The study aimed to describe this service’s experience in the care of critically ill patients with PE requiring interhospital transport.

Results

This study included 132 patients in the final analysis, of which 55% were risk stratified as being high risk by European Society of Cardiology criteria. In total, 40% of patients were transferred for specific predetermined advanced PE therapies including extracorporeal support, and 28% of patients received non-thrombolysis advanced PE therapies in the first 24 hours post-transfer. Clinically significant deteriorations in transit occurred in 37% of patients, of which the most common complication was new haemodynamic deterioration (17%).

Conclusions

The population of patients requiring aeromedical retrieval for PE in New South Wales have a high severity of illness, are labour intensive for the retrieval service and frequently deteriorate during transport. Early coordination of care and close collaboration between the retrieval team and the specialist receiving teams offer an opportunity to optimise care.
背景:肺栓塞(PE)是一种常见的、时间紧迫的疾病,需要多学科治疗。医院间转运是患者护理中的高危期,但为加快风险分层、复苏和转移到最终护理提供了机会。需要医院间转移到专业中心进行PE管理的患者预后较差。尽管如此,围绕医院间检索实践和PE经验的文献是有限的。方法:从2014年1月至2024年6月的10年间,从澳大利亚新南威尔士州的大型航空医学检索服务数据库中进行回顾性队列研究。该研究旨在描述该服务在需要医院间转运的PE危重患者护理中的经验。结果:本研究最终纳入132例患者,其中55%根据欧洲心脏病学会的标准被危险分层为高风险。总的来说,40%的患者接受了特定的预先确定的高级PE治疗,包括体外支持,28%的患者在转移后的前24小时接受了非溶栓的高级PE治疗。37%的患者在转运过程中出现临床显著的恶化,其中最常见的并发症是新的血流动力学恶化(17%)。结论:在新南威尔士州,需要空中医疗回收PE的患者群体疾病严重程度高,对回收服务来说是劳动密集型的,并且经常在运输过程中恶化。早期护理协调以及检索小组和专家接收小组之间的密切合作为优化护理提供了机会。
{"title":"Aeromedical Retrieval of Critically Ill Pulmonary Embolism Patients: A Retrospective Cohort Study of 10 Years in New South Wales","authors":"Ruan Vlok MBBS ,&nbsp;Yousif Rassam FACEM ,&nbsp;Christopher Partyka FACEM","doi":"10.1016/j.hlc.2025.05.091","DOIUrl":"10.1016/j.hlc.2025.05.091","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary embolism (PE) is a common, time-critical condition requiring multidisciplinary care. Interhospital transport is a high-risk period in the patient’s care but offers an opportunity for expedited risk stratification, resuscitation, and transport to definitive care. Patients who require interhospital transfer to specialist centres for PE management have worse outcomes. Despite this, the literature surrounding the interhospital retrieval practice and experience of PE is limited.</div></div><div><h3>Method</h3><div>A retrospective cohort study was conducted over a 10-year period from January 2014 to June 2024 from the database of a high-volume aeromedical retrieval service in New South Wales, Australia. The study aimed to describe this service’s experience in the care of critically ill patients with PE requiring interhospital transport.</div></div><div><h3>Results</h3><div>This study included 132 patients in the final analysis, of which 55% were risk stratified as being high risk by European Society of Cardiology criteria. In total, 40% of patients were transferred for specific predetermined advanced PE therapies including extracorporeal support, and 28% of patients received non-thrombolysis advanced PE therapies in the first 24 hours post-transfer. Clinically significant deteriorations in transit occurred in 37% of patients, of which the most common complication was new haemodynamic deterioration (17%).</div></div><div><h3>Conclusions</h3><div>The population of patients requiring aeromedical retrieval for PE in New South Wales have a high severity of illness, are labour intensive for the retrieval service and frequently deteriorate during transport. Early coordination of care and close collaboration between the retrieval team and the specialist receiving teams offer an opportunity to optimise care.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 12","pages":"Pages 1449-1455"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426807","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
An Integrative Analysis of Echocardiographic and Haemodynamic Parameters in Heart Transplant Candidates: Specific Focus on Pulmonary Regurgitation Jet-Derived Mean Pulmonary Artery Pressure and Pulmonary Vascular Resistance 心脏移植候选人超声心动图和血流动力学参数的综合分析:特别关注肺返流射流产生的平均肺动脉压和肺血管阻力。
IF 2.2 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 DOI: 10.1016/j.hlc.2025.08.021
Ayşe İrem Demirtola MD , Anar Mammadli MD , Ozan Oğuz MD , Alican Özkan MD , Burcu Demirkan MD , Kumral Çağlı MD

Background and Aim

Precise haemodynamic assessment is critical in heart transplant candidates with advanced left heart failure. While right heart catheterisation (RHC) is the gold standard for evaluating pulmonary haemodynamics, its invasive nature necessitates non-invasive alternatives. Transthoracic echocardiography provides a non-invasive approach to estimate haemodynamic parameters. This study focused on pulmonary regurgitation (PR) jet-derived mean pulmonary artery pressure (mPAP) and Doppler-based pulmonary vascular resistance (PVR), evaluating their correlation and agreement with RHC-derived measurements in this high-risk population.

Method

This prospective, single-centre study included 51 heart transplant candidates with a median ejection fraction of 15% (interquartile range, 13–20). PR jet-derived mPAP was calculated using the formula mPAP=4(PR peak velocity)2+right atrial pressure, and Doppler-based PVR as tricuspid regurgitation peak velocity/time-velocity integral (right ventricular outflow tract)×10+0.16. Correlation and agreement were assessed using Pearson correlation coefficients and Bland–Altman analysis. Subgroup and covariance analyses were performed, and receiver operating characteristic curves determined diagnostic performance.

Results

PR jet-derived mPAP correlated strongly with RHC (r=0.701; p<0.001), with a mean bias of −1 mmHg and limits of agreement from −14.6 to 12.6 mmHg. Echocardiographic PVR showed moderate correlation (r=0.681; p<0.001) and a mean bias of +0.88 Wood units. Subgroup analysis showed better agreement in patients with dilated cardiomyopathy and New York Heart Association class II, while tricuspid coaptation defects were associated with the lowest PVR correlation (r=0.368). Covariance analysis identified time-velocity integral (right ventricular outflow tract) as the strongest predictor of PVR. Receiver operating characteristic analysis identified optimal cut-offs of ≥26 mmHg for mPAP (area under the curve [AUC]=0.939) and ≥3.99 Wood units for PVR (AUC=0.910).

Conclusions

PR jet-derived mPAP showed good agreement with RHC, while Doppler-based PVR estimations demonstrated moderate correlation. These findings support transthoracic echocardiography as a complementary tool for pulmonary haemodynamic assessment, while emphasising the need for RHC for precise measurements.
背景和目的:精确的血流动力学评估对晚期左心衰竭的心脏移植候选人至关重要。虽然右心导管(RHC)是评估肺血流动力学的金标准,但其侵入性需要非侵入性替代。经胸超声心动图提供了一种评估血流动力学参数的无创方法。本研究的重点是肺反流(PR)射流衍生的平均肺动脉压(mPAP)和基于多普勒的肺血管阻力(PVR),评估它们与高危人群中rhc衍生测量的相关性和一致性。方法:该前瞻性单中心研究纳入51例心脏移植候选者,中位射血分数为15%(四分位数范围13-20)。PR射流衍生的mPAP计算公式为:mPAP=4(PR峰值速度)2+右房压,基于多普勒的PVR计算公式为三尖瓣反流峰值速度/时间-速度积分(右心室流出道)×10+0.16。使用Pearson相关系数和Bland-Altman分析评估相关性和一致性。进行亚组分析和协方差分析,并通过受试者工作特征曲线确定诊断效果。结论:PR射流的mPAP与RHC的相关性较好,而基于多普勒的PVR的相关性较弱。这些发现支持经胸超声心动图作为肺血流动力学评估的补充工具,同时强调了RHC精确测量的必要性。
{"title":"An Integrative Analysis of Echocardiographic and Haemodynamic Parameters in Heart Transplant Candidates: Specific Focus on Pulmonary Regurgitation Jet-Derived Mean Pulmonary Artery Pressure and Pulmonary Vascular Resistance","authors":"Ayşe İrem Demirtola MD ,&nbsp;Anar Mammadli MD ,&nbsp;Ozan Oğuz MD ,&nbsp;Alican Özkan MD ,&nbsp;Burcu Demirkan MD ,&nbsp;Kumral Çağlı MD","doi":"10.1016/j.hlc.2025.08.021","DOIUrl":"10.1016/j.hlc.2025.08.021","url":null,"abstract":"<div><h3>Background and Aim</h3><div>Precise haemodynamic assessment is critical in heart transplant candidates with advanced left heart failure. While right heart catheterisation (RHC) is the gold standard for evaluating pulmonary haemodynamics, its invasive nature necessitates non-invasive alternatives. Transthoracic echocardiography provides a non-invasive approach to estimate haemodynamic parameters. This study focused on pulmonary regurgitation (PR) jet-derived mean pulmonary artery pressure (mPAP) and Doppler-based pulmonary vascular resistance (PVR), evaluating their correlation and agreement with RHC-derived measurements in this high-risk population.</div></div><div><h3>Method</h3><div>This prospective, single-centre study included 51 heart transplant candidates with a median ejection fraction of 15% (interquartile range, 13–20). PR jet-derived mPAP was calculated using the formula mPAP=4(PR peak velocity)<sup>2</sup>+right atrial pressure, and Doppler-based PVR as tricuspid regurgitation peak velocity/time-velocity integral (right ventricular outflow tract)×10+0.16. Correlation and agreement were assessed using Pearson correlation coefficients and Bland–Altman analysis. Subgroup and covariance analyses were performed, and receiver operating characteristic curves determined diagnostic performance.</div></div><div><h3>Results</h3><div>PR jet-derived mPAP correlated strongly with RHC (r=0.701; p&lt;0.001), with a mean bias of −1 mmHg and limits of agreement from −14.6 to 12.6 mmHg. Echocardiographic PVR showed moderate correlation (r=0.681; p&lt;0.001) and a mean bias of +0.88 Wood units. Subgroup analysis showed better agreement in patients with dilated cardiomyopathy and New York Heart Association class II, while tricuspid coaptation defects were associated with the lowest PVR correlation (r=0.368). Covariance analysis identified time-velocity integral (right ventricular outflow tract) as the strongest predictor of PVR. Receiver operating characteristic analysis identified optimal cut-offs of ≥26 mmHg for mPAP (area under the curve [AUC]=0.939) and ≥3.99 Wood units for PVR (AUC=0.910).</div></div><div><h3>Conclusions</h3><div>PR jet-derived mPAP showed good agreement with RHC, while Doppler-based PVR estimations demonstrated moderate correlation. These findings support transthoracic echocardiography as a complementary tool for pulmonary haemodynamic assessment, while emphasising the need for RHC for precise measurements.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 12","pages":"Pages 1399-1408"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148976","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
Paramedic-Delivered Prehospital Thrombolysis Reduces the Time to Reperfusion Therapy in Patients Suffering ST Elevation Myocardial Infarction in Rural and Regional NSW 护理人员提供的院前溶栓减少了新南威尔士州农村和地区ST段抬高心肌梗死患者再灌注治疗的时间。
IF 2.2 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 DOI: 10.1016/j.hlc.2025.05.085
Steven C. Faddy MScMed , Paul W. Stewart AdDipHMgmt , Michael A. McMullen BHSc , Lindsay Savage RN , Peter Fletcher PhD, FRACP

Background

Regionalised systems of care can improve outcomes for patients suffering ST-elevation myocardial infarction (STEMI). Most reports evaluate primary percutaneous intervention programs in metropolitan centres. We report the outcomes of a prehospital thrombolysis program in rural New South Wales (NSW) with particular focus on the impact of paramedic-delivered thrombolysis on total ischaemic time (TIT).

Method

Prospective registry study of patients from rural and regional NSW who were diagnosed with STEMI while in the care of NSW Ambulance paramedics.

Results

Between 2008 and 2020, paramedics treated 2,710 patients diagnosed with STEMI while in their care, and 1,674 (61.9%) received thrombolysis in the field. TIT for patients treated in the field was shorter (94; interquartile range [IQR] 69–141 minutes) compared to the estimated time for those treated after arrival at hospital (172; IQR 124–250 minutes; p<0.0001). Multivariate analysis identified prehospital thrombolysis as the strongest predictor of reduced TIT.

Conclusions

This program has delivered substantial reductions in TIT for STEMI patients in regional and rural NSW. Similar programs should be considered wherever a significant proportion of the population does not have timely access to percutaneous coronary intervention.
背景:区域化的护理系统可以改善st段抬高型心肌梗死(STEMI)患者的预后。大多数报告评价了大城市中心的初级经皮介入治疗方案。我们报告了新南威尔士州农村院前溶栓项目的结果,特别关注护理人员提供的溶栓对总缺血时间(TIT)的影响。方法:前瞻性登记研究来自新南威尔士州农村和地区的患者,他们在新南威尔士州救护车护理人员的护理下被诊断为STEMI。结果:2008年至2020年期间,护理人员治疗了2710名被诊断为STEMI的患者,其中1674名(61.9%)接受了现场溶栓治疗。与到达医院后接受治疗的患者的估计时间(172分钟;四分位间距[IQR] 69-141分钟)相比,在现场接受治疗的患者的TIT更短(94分钟;四分位间距[IQR] 69- 250分钟)。结论:该计划大大减少了NSW地区和农村STEMI患者的TIT。如果有相当比例的人群不能及时获得经皮冠状动脉介入治疗,则应考虑类似的方案。
{"title":"Paramedic-Delivered Prehospital Thrombolysis Reduces the Time to Reperfusion Therapy in Patients Suffering ST Elevation Myocardial Infarction in Rural and Regional NSW","authors":"Steven C. Faddy MScMed ,&nbsp;Paul W. Stewart AdDipHMgmt ,&nbsp;Michael A. McMullen BHSc ,&nbsp;Lindsay Savage RN ,&nbsp;Peter Fletcher PhD, FRACP","doi":"10.1016/j.hlc.2025.05.085","DOIUrl":"10.1016/j.hlc.2025.05.085","url":null,"abstract":"<div><h3>Background</h3><div>Regionalised systems of care can improve outcomes for patients suffering ST-elevation myocardial infarction (STEMI). Most reports evaluate primary percutaneous intervention programs in metropolitan centres. We report the outcomes of a prehospital thrombolysis program in rural New South Wales (NSW) with particular focus on the impact of paramedic-delivered thrombolysis on total ischaemic time (TIT).</div></div><div><h3>Method</h3><div>Prospective registry study of patients from rural and regional NSW who were diagnosed with STEMI while in the care of NSW Ambulance paramedics.</div></div><div><h3>Results</h3><div>Between 2008 and 2020, paramedics treated 2,710 patients diagnosed with STEMI while in their care, and 1,674 (61.9%) received thrombolysis in the field. TIT for patients treated in the field was shorter (94; interquartile range [IQR] 69–141 minutes) compared to the estimated time for those treated after arrival at hospital (172; IQR 124–250 minutes; p&lt;0.0001). Multivariate analysis identified prehospital thrombolysis as the strongest predictor of reduced TIT.</div></div><div><h3>Conclusions</h3><div>This program has delivered substantial reductions in TIT for STEMI patients in regional and rural NSW. Similar programs should be considered wherever a significant proportion of the population does not have timely access to percutaneous coronary intervention.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 12","pages":"Pages 1417-1423"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426825","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
A Fine Balance: Anticoagulation for Non-Valvular Atrial Fibrillation After Cerebral Amyloid Angiopathy–Related Intracranial Haemorrhage 精细平衡:抗凝治疗脑淀粉样血管病相关颅内出血后非瓣膜性房颤。
IF 2.2 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 DOI: 10.1016/j.hlc.2025.06.1027
Dane Turner BPharm, MD, MClinEpi , Kanisha Kamadasala FRACP , Bruce McGarity FRACP
The management of anticoagulation in patients with non-valvular atrial fibrillation at high risk of bleeding complications can be challenging. One such group is elderly patients with previous intracranial haemorrhage secondary to cerebral amyloid angiopathy (CAA-ICH). These patients have a high rate of rebleeding, which can be predicted by features on cerebral magnetic resonance imaging. Common bleeding risk calculators, such as the HAS-BLED score, underestimate the bleeding event rate in patients with CAA-ICH due to poor patient representation in validation studies. Observational studies and subgroup analyses of small randomised controlled trials have failed to show conclusive evidence of benefit or harm with restarting anticoagulation after CAA-ICH. The results of larger, dedicated randomised controlled trials are eagerly awaited. An alternative to anticoagulation in patients with CAA-ICH and concomitant high ischaemic stroke risk is left atrial appendage closure, which has been shown to be effective in this subgroup. This narrative review will use a case to discuss the currently available evidence on this important topic, given our ageing population.
非瓣膜性房颤患者出血并发症高风险的抗凝治疗具有挑战性。其中一组是既往有脑淀粉样血管病(CAA-ICH)继发颅内出血的老年患者。这些患者有较高的再出血率,这可以通过脑磁共振成像特征来预测。常见的出血风险计算方法,如HAS-BLED评分,由于验证研究中患者代表性差,低估了CAA-ICH患者的出血事件发生率。小型随机对照试验的观察性研究和亚组分析未能显示出CAA-ICH后重新开始抗凝治疗的益处或危害的确凿证据。更大规模的、专门的随机对照试验的结果正在热切等待中。对于伴有高缺血性脑卒中风险的CAA-ICH患者,另一种抗凝治疗方法是左心耳关闭,这在该亚组中已被证明是有效的。鉴于我们的人口老龄化,本文将用一个案例来讨论目前关于这一重要主题的现有证据。
{"title":"A Fine Balance: Anticoagulation for Non-Valvular Atrial Fibrillation After Cerebral Amyloid Angiopathy–Related Intracranial Haemorrhage","authors":"Dane Turner BPharm, MD, MClinEpi ,&nbsp;Kanisha Kamadasala FRACP ,&nbsp;Bruce McGarity FRACP","doi":"10.1016/j.hlc.2025.06.1027","DOIUrl":"10.1016/j.hlc.2025.06.1027","url":null,"abstract":"<div><div>The management of anticoagulation in patients with non-valvular atrial fibrillation at high risk of bleeding complications can be challenging. One such group is elderly patients with previous intracranial haemorrhage secondary to cerebral amyloid angiopathy (CAA-ICH). These patients have a high rate of rebleeding, which can be predicted by features on cerebral magnetic resonance imaging. Common bleeding risk calculators, such as the HAS-BLED score, underestimate the bleeding event rate in patients with CAA-ICH due to poor patient representation in validation studies. Observational studies and subgroup analyses of small randomised controlled trials have failed to show conclusive evidence of benefit or harm with restarting anticoagulation after CAA-ICH. The results of larger, dedicated randomised controlled trials are eagerly awaited. An alternative to anticoagulation in patients with CAA-ICH and concomitant high ischaemic stroke risk is left atrial appendage closure, which has been shown to be effective in this subgroup. This narrative review will use a case to discuss the currently available evidence on this important topic, given our ageing population.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 12","pages":"Pages 1313-1318"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145408750","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
期刊
Heart, Lung and Circulation
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1