Pub Date : 2025-12-01DOI: 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.
{"title":"Rural and Remote Acute STEMI Diagnosis and Management: Current Status and Future Directions","authors":"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","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}
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.
{"title":"Central Obesity: An Emerging Player in Cardiac Remodelling and Dysfunction","authors":"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","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}
Pub Date : 2025-12-01DOI: 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.
{"title":"Percutaneous Femoral Arterial Closure Following Decannulation of Venoarterial Extracorporeal Membrane Oxygenation Using the MANTA Vascular Closure Device","authors":"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","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}
Pub Date : 2025-12-01DOI: 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, 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}
Pub Date : 2025-12-01DOI: 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
{"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 , 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","doi":"10.1016/j.hlc.2025.06.1018","DOIUrl":"10.1016/j.hlc.2025.06.1018","url":null,"abstract":"<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","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}
Pub Date : 2025-12-01DOI: 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}
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.
{"title":"Aeromedical Retrieval of Critically Ill Pulmonary Embolism Patients: A Retrospective Cohort Study of 10 Years in New South Wales","authors":"Ruan Vlok MBBS , Yousif Rassam FACEM , 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}
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.
{"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 , Anar Mammadli MD , Ozan Oğuz MD , Alican Özkan MD , Burcu Demirkan MD , 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<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).</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}
Pub Date : 2025-12-01DOI: 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.
{"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 , Paul W. Stewart AdDipHMgmt , Michael A. McMullen BHSc , Lindsay Savage RN , 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<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}
Pub Date : 2025-12-01DOI: 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.
{"title":"A Fine Balance: Anticoagulation for Non-Valvular Atrial Fibrillation After Cerebral Amyloid Angiopathy–Related Intracranial Haemorrhage","authors":"Dane Turner BPharm, MD, MClinEpi , Kanisha Kamadasala FRACP , 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}
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