Pub Date : 2021-06-01DOI: 10.1136/HEARTJNL-2021-BCS.30
Norildin Al-Refaie, Waqas Jarral, A. Shetye, M. Cassar, J. Newton
hospital stay was not diffirent between the two groups with a mean of days of hospitalization of 27 days . However in-hos-pital mortality rates were higher in culture-negative versus cul-ture-positive patients (15% vs 11% mortality rate) . as for comlication rates Severe sepsis and vascular comlication (stroke , splenic infarction ) were higher in the negative culture group with 7.9 % vs 3.1% in the positive culture groupe p< 0.05. Conclusions Culture-negative endocarditis patients presented with lower levels of C-reactive protein at admission and required less time for hospital admission, however presented a higher rate of in-hospital mortality and complications compared to culture-positive endocarditis patients.
两组患者住院时间差异无统计学意义，平均住院天数为27天。然而，培养阴性患者的住院死亡率高于培养阳性患者(15% vs 11%)。严重脓毒症及血管并发症(脑卒中、脾梗死)发生率阴性培养组为7.9%，阳性培养组为3.1%，p< 0.05。结论培养阴性心内膜炎患者入院时c反应蛋白水平较低，入院时间较短，但与培养阳性心内膜炎患者相比，其住院死亡率和并发症发生率较高。
{"title":"30 Severe aortic stenosis management in a tertiary cardiac centre","authors":"Norildin Al-Refaie, Waqas Jarral, A. Shetye, M. Cassar, J. Newton","doi":"10.1136/HEARTJNL-2021-BCS.30","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2021-BCS.30","url":null,"abstract":"hospital stay was not diffirent between the two groups with a mean of days of hospitalization of 27 days . However in-hos-pital mortality rates were higher in culture-negative versus cul-ture-positive patients (15% vs 11% mortality rate) . as for comlication rates Severe sepsis and vascular comlication (stroke , splenic infarction ) were higher in the negative culture group with 7.9 % vs 3.1% in the positive culture groupe p< 0.05. Conclusions Culture-negative endocarditis patients presented with lower levels of C-reactive protein at admission and required less time for hospital admission, however presented a higher rate of in-hospital mortality and complications compared to culture-positive endocarditis patients.","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"220 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121182372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-01DOI: 10.1136/HEARTJNL-2021-BCS.21
P. Demetriades, R. Oatham, Cheryl Oxley, Timothy Griffiths, Sarah Clews, N. Stokes, G. Heatlie, S. Duckett
Introduction The long-term management of patients following valve replacement is challenging. The fields of percutaneous and surgical valves are expanding rapidly, leading to increased service demands. Most patients in our institution are managed within a dedicated cardiac physiologist' run valve clinic. Initially, follow-up centred around ESC 2012 guidelines on the management of valve disease, which recommended a baseline clinical and echocardiographic assessment after surgery and lifelong annual clinical follow-up. In addition, they recommended annual echocardiogram 5 years for bioprosthetic valves with no specific guidance for mechanical valves. Locally, all patients enrolled into the valve clinic received annual clinical and echocardiographic assessment. In 2019, the BHVS/ BSE published more comprehensive guidance on long-term follow- up of these patients. The Covid-19 pandemic placed pressure on the NHS to reduce outpatient appointments. Prior to service alteration, we conducted an audit to expand our understanding of outcomes in these patients. Methods We retrospectively analysed the data of all patients enrolled in our valve service. We assessed demographics, date and indication for surgery, prosthesis type and position, baseline assessment, frequency of follow-up and significant valverelated complications. Complications constituted: any degree of paravalvular regurgitation, ≥moderate transvalvular regurgitation, raised transvalvular gradients, valve thrombosis, infective endocarditis, new LV dysfunction, need for reintervention, cardiac-related hospital admission and valverelated death. Results We identified 294 patients who underwent valve replacement since clinic establishment in 2010. Patient demographics are shown in table 1. Only 37% of patients had baseline echocardiogram following surgery. Once enrolled into the clinic, 82.7% had yearly clinical and echocardiographic assessment. Table 2 demonstrates the echocardiographic and clinical complications we identified. During follow up 20.7% developed regurgitation, 9.5% developed abnormal gradients and one required re-intervention for re-stenosis. One patient had valve thrombosis and was managed medically. Additionally, 9.2% were diagnosed with new LV dysfunction;four of these required admission with decompensated heart failure and one died. 3.4% developed infective endocarditis;three required redo surgery and four died. Figure 1 provides a schematic of valve-related complications and outcomes. Importantly, all patients who required admission, re-do surgery or that died, presented acutely with symptoms;the complications were not picked-up by the valve clinic. Conclusions Contrast to our expectations, we identified only a small number of valve-related complications. With pressures rising to reduce outpatient footprint, we are now in the process of safely adjusting our practice in line with the BHVS/ BSE recommendations, supported by the evidence generated by our audit. We strongly encoura
{"title":"21 Long term follow-up and outcomes after valve replacement – a 10-year, single-centre experience of the heart valve surveillance clinic","authors":"P. Demetriades, R. Oatham, Cheryl Oxley, Timothy Griffiths, Sarah Clews, N. Stokes, G. Heatlie, S. Duckett","doi":"10.1136/HEARTJNL-2021-BCS.21","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2021-BCS.21","url":null,"abstract":"Introduction The long-term management of patients following valve replacement is challenging. The fields of percutaneous and surgical valves are expanding rapidly, leading to increased service demands. Most patients in our institution are managed within a dedicated cardiac physiologist' run valve clinic. Initially, follow-up centred around ESC 2012 guidelines on the management of valve disease, which recommended a baseline clinical and echocardiographic assessment after surgery and lifelong annual clinical follow-up. In addition, they recommended annual echocardiogram 5 years for bioprosthetic valves with no specific guidance for mechanical valves. Locally, all patients enrolled into the valve clinic received annual clinical and echocardiographic assessment. In 2019, the BHVS/ BSE published more comprehensive guidance on long-term follow- up of these patients. The Covid-19 pandemic placed pressure on the NHS to reduce outpatient appointments. Prior to service alteration, we conducted an audit to expand our understanding of outcomes in these patients. Methods We retrospectively analysed the data of all patients enrolled in our valve service. We assessed demographics, date and indication for surgery, prosthesis type and position, baseline assessment, frequency of follow-up and significant valverelated complications. Complications constituted: any degree of paravalvular regurgitation, ≥moderate transvalvular regurgitation, raised transvalvular gradients, valve thrombosis, infective endocarditis, new LV dysfunction, need for reintervention, cardiac-related hospital admission and valverelated death. Results We identified 294 patients who underwent valve replacement since clinic establishment in 2010. Patient demographics are shown in table 1. Only 37% of patients had baseline echocardiogram following surgery. Once enrolled into the clinic, 82.7% had yearly clinical and echocardiographic assessment. Table 2 demonstrates the echocardiographic and clinical complications we identified. During follow up 20.7% developed regurgitation, 9.5% developed abnormal gradients and one required re-intervention for re-stenosis. One patient had valve thrombosis and was managed medically. Additionally, 9.2% were diagnosed with new LV dysfunction;four of these required admission with decompensated heart failure and one died. 3.4% developed infective endocarditis;three required redo surgery and four died. Figure 1 provides a schematic of valve-related complications and outcomes. Importantly, all patients who required admission, re-do surgery or that died, presented acutely with symptoms;the complications were not picked-up by the valve clinic. Conclusions Contrast to our expectations, we identified only a small number of valve-related complications. With pressures rising to reduce outpatient footprint, we are now in the process of safely adjusting our practice in line with the BHVS/ BSE recommendations, supported by the evidence generated by our audit. We strongly encoura","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127682580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-01DOI: 10.1136/HEARTJNL-2021-BCS.5
Zaid Iskandar, M. Dodd, G. Stuart, Massimo Caputo, T. Clayton, C. Chin, Jack Gibb, Anne H. Child, J. Aragon-Martin, X. Jin, M. Flather, J. Huang, A. Choy
4 Figure 2 Abstracts A4 Heart 2021;107(Suppl 1):A1–A185 on Jne 6, 2021 by gest. P rocted by coright. httpeart.bm jcom / H ert: frst pulished as 10.113artjnl-2021-B C S .5 on 4 Jne 221. D ow nladed fom
A4 Heart 2021;107(增刊1):A1-A185，截止日期为2021年6月6日。P由赖特保护。httpeart。jj.com / H:第一版为10.113artjnl-2021-B C S .5, 221年6月4日。我们从
{"title":"5 Exaggerated elastin turnover in childhood and adolescence in marfan syndrome - correlation with age - new insights from the aims trial","authors":"Zaid Iskandar, M. Dodd, G. Stuart, Massimo Caputo, T. Clayton, C. Chin, Jack Gibb, Anne H. Child, J. Aragon-Martin, X. Jin, M. Flather, J. Huang, A. Choy","doi":"10.1136/HEARTJNL-2021-BCS.5","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2021-BCS.5","url":null,"abstract":"4 Figure 2 Abstracts A4 Heart 2021;107(Suppl 1):A1–A185 on Jne 6, 2021 by gest. P rocted by coright. httpeart.bm jcom / H ert: frst pulished as 10.113artjnl-2021-B C S .5 on 4 Jne 221. D ow nladed fom","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116235231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-01DOI: 10.1136/HEARTJNL-2021-BCS.11
R. Wenlock, E. Thornton, S. Curtis, Michael Lewis, Luke C Holland, R. James
{"title":"11 A 5 year study of infective endocarditis managed by a multidisciplinary team in a regional cardiothoracic centre: trends in referral, infective organisms and outcomes","authors":"R. Wenlock, E. Thornton, S. Curtis, Michael Lewis, Luke C Holland, R. James","doi":"10.1136/HEARTJNL-2021-BCS.11","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2021-BCS.11","url":null,"abstract":"","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130482999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-01DOI: 10.1136/HEARTJNL-2021-BCS.4
H. Sharma, M. Yuan, I. Shakeel, A. Morley-Smith, M. A. Nadir, C. Chue, S. Myerson, R. Steeds, S. Lim
{"title":"4 Impact of left ventricular assist device therapy on severe secondary mitral regurgitation","authors":"H. Sharma, M. Yuan, I. Shakeel, A. Morley-Smith, M. A. Nadir, C. Chue, S. Myerson, R. Steeds, S. Lim","doi":"10.1136/HEARTJNL-2021-BCS.4","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2021-BCS.4","url":null,"abstract":"","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133829975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-01DOI: 10.1136/HEARTJNL-2020-BCS.18
Holly J. Woodward, A. Thomson, Vicky E. Macrae, P. Hadoke
Calcific aortic stenosis (CAS) is the most common valve disease in the Western world and has no effective pharmaceutical treatment options. Stenosis can be caused by a combination of mechanical injury, inflammation, fibrosis and calcification, which eventually leads to left ventricular hypertrophy and heart failure. Males are at greater risk of developing aortic calcification and androgens are a risk factor in this condition. Elucidating the mechanisms underlying male predisposition to aortic stenosis is hampered by the lack of appropriate animal models; particularly valve-injury models which develop stenosis and calcification. This study describes introduction of a murine model for investigation of CAS in male and female mice. Damage was induced in the aortic valve of adult, male and female C57BL/6J mice by inserting a guidewire into the left ventricle under ultrasound guidance and rubbing the valve by rotating the guidewire twenty times. Pilot investigations demonstrated low mortality and weight loss (less than 15% of pre-surgery weight) but no significant changes in aortic or cardiac function (measured by ultrasound) following surgery. H&E staining demonstrated variable thickening of valve cusps (30-140 μM). Cusps displayed fibrosis and stained positive for inflammatory cells (Mac2). No calcification (as determined by alizarin red staining) was observed. These results suggest that wire injury is producing mild damage and non-calcific remodelling in the aortic valve, indicating that greater damage is required to produce haemodynamic changes and aortic stenosis with calcification. Successful development of this model will provide a valuable tool for clarifying the mechanisms that predispose males to CAS. Conflict of Interest none
{"title":"18 Developing a wire-injury model of calcific aortic stenosis","authors":"Holly J. Woodward, A. Thomson, Vicky E. Macrae, P. Hadoke","doi":"10.1136/HEARTJNL-2020-BCS.18","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.18","url":null,"abstract":"Calcific aortic stenosis (CAS) is the most common valve disease in the Western world and has no effective pharmaceutical treatment options. Stenosis can be caused by a combination of mechanical injury, inflammation, fibrosis and calcification, which eventually leads to left ventricular hypertrophy and heart failure. Males are at greater risk of developing aortic calcification and androgens are a risk factor in this condition. Elucidating the mechanisms underlying male predisposition to aortic stenosis is hampered by the lack of appropriate animal models; particularly valve-injury models which develop stenosis and calcification. This study describes introduction of a murine model for investigation of CAS in male and female mice. Damage was induced in the aortic valve of adult, male and female C57BL/6J mice by inserting a guidewire into the left ventricle under ultrasound guidance and rubbing the valve by rotating the guidewire twenty times. Pilot investigations demonstrated low mortality and weight loss (less than 15% of pre-surgery weight) but no significant changes in aortic or cardiac function (measured by ultrasound) following surgery. H&E staining demonstrated variable thickening of valve cusps (30-140 μM). Cusps displayed fibrosis and stained positive for inflammatory cells (Mac2). No calcification (as determined by alizarin red staining) was observed. These results suggest that wire injury is producing mild damage and non-calcific remodelling in the aortic valve, indicating that greater damage is required to produce haemodynamic changes and aortic stenosis with calcification. Successful development of this model will provide a valuable tool for clarifying the mechanisms that predispose males to CAS. Conflict of Interest none","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121492061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-01DOI: 10.1136/HEARTJNL-2020-BCS.14
F. Lodge, C. McAloon, R. Steeds, W. Moody, L. Hudsmith
Introduction Patients with repaired tetralogy of Fallot (RTOF) develop chronic pulmonary regurgitation and require monitoring for right ventricular dilatation. Pulmonary valve replacement can prevent irreversible right ventricular (RV) dilatation and dysfunction and cardiac magnetic resonance (CMR) is used to facilitate its optimal timing. There are however, different techniques published for measuring RV volumes. We sought to determine whether the choice of myocardial contouring technique affects preoperative RV volumetric thresholds for intervention. Methods Consecutive patients (n = 24, age 25.2±15.5 years, 42% male) with RTOF were identified retrospectively, having undergone CMR for clinical surveillance at a Level 1 ACHD surgical referral centre. Volumetric analysis was made by two experienced, independent observers blinded to clinical status. Right ventricular volumes were measured using three contouring techniques: 1) smooth, where the trabeculae were counted as part of the blood volume; 2) detailed, using semi-automated thresholding; 3) detailed, with manual contours. For 2) and 3), trabeculae and sub-valvar apparatus were counted as part of the myocardium. Inter-observer variability (F.L. & C.M.) was assessed blinded in 5 randomly selected patients. Results Right ventricular end-diastolic volume (EDV) was largest for smooth contours compared with thresholding and manual (table), as was end-systolic volume (ESV) (p Conclusions Smooth right ventricular contouring in RTOF creates larger RV volumes than detailed and may result in differences in management strategy. Smooth contouring is more reproducible than detailed methods using thresholding. Manual contouring was the least reproducible in this series. Our results are similar to studies of left ventricular contouring demonstrating larger volumes using smooth compared with detailed methods. The difference in right ventricular volume is accentuated in RTOF due to increased RV trabeculation. Consensus on contouring techniques in RTOF is vital to ensure standardisation of care. Conflict of Interest None
{"title":"14 The effect of different contouring techniques on cardiac magnetic resonance assessment of right ventricular volumes in repaired tetralogy of fallot: implications on preoperative thresholds for intervention","authors":"F. Lodge, C. McAloon, R. Steeds, W. Moody, L. Hudsmith","doi":"10.1136/HEARTJNL-2020-BCS.14","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.14","url":null,"abstract":"Introduction Patients with repaired tetralogy of Fallot (RTOF) develop chronic pulmonary regurgitation and require monitoring for right ventricular dilatation. Pulmonary valve replacement can prevent irreversible right ventricular (RV) dilatation and dysfunction and cardiac magnetic resonance (CMR) is used to facilitate its optimal timing. There are however, different techniques published for measuring RV volumes. We sought to determine whether the choice of myocardial contouring technique affects preoperative RV volumetric thresholds for intervention. Methods Consecutive patients (n = 24, age 25.2±15.5 years, 42% male) with RTOF were identified retrospectively, having undergone CMR for clinical surveillance at a Level 1 ACHD surgical referral centre. Volumetric analysis was made by two experienced, independent observers blinded to clinical status. Right ventricular volumes were measured using three contouring techniques: 1) smooth, where the trabeculae were counted as part of the blood volume; 2) detailed, using semi-automated thresholding; 3) detailed, with manual contours. For 2) and 3), trabeculae and sub-valvar apparatus were counted as part of the myocardium. Inter-observer variability (F.L. & C.M.) was assessed blinded in 5 randomly selected patients. Results Right ventricular end-diastolic volume (EDV) was largest for smooth contours compared with thresholding and manual (table), as was end-systolic volume (ESV) (p Conclusions Smooth right ventricular contouring in RTOF creates larger RV volumes than detailed and may result in differences in management strategy. Smooth contouring is more reproducible than detailed methods using thresholding. Manual contouring was the least reproducible in this series. Our results are similar to studies of left ventricular contouring demonstrating larger volumes using smooth compared with detailed methods. The difference in right ventricular volume is accentuated in RTOF due to increased RV trabeculation. Consensus on contouring techniques in RTOF is vital to ensure standardisation of care. Conflict of Interest None","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115132111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-01DOI: 10.1136/HEARTJNL-2020-BCS.3
U. Tayal, D. Fecht, M. Chadeau, J. Gulliver, J. Ware, S. Cook, S. Prasad
Background Air pollution might contribute to adverse ventricular remodelling in healthy populations. A recent study on a cohort of 500,000 participants (UK Biobank) showed that residential exposure to particulate matter with aerodynamic diameter Dilated cardiomyopathy (DCM) has marked structural and functional phenotypic heterogeneity. The biological basis for this is undefined, but environmental factors are plausible phenotypic modifiers. We sought to evaluate whether air pollution could be an important environmental modifier in DCM. Methods Prospectively recruited patients with DCM underwent advanced phenotyping by cardiac magnetic resonance. Patients were followed up for the primary composite end-point of cardiovascular mortality, major arrhythmic events and major heart failure events. Long-term air pollution exposure estimates prior to the year of DCM diagnosis were assigned to each residential postcode centroid (on average 12 households). Annual average maps were available for NO2 concentrations in 2009 at 200m resolution and PM2.5 in 2010 at 100m resolution. Postcode centroids (x,y locations) were overlaid with each air pollution surface to obtain NO2 and PM2.5 estimates for each postcode and concentrations extrapolated to the year of diagnosis using information from the national air pollution monitoring network. Results From the total cohort of 716 DCM patients enrolled to the study, 678 patients had postcodes which could be assigned a geographical location and air pollutant estimates. The median PM2.5 concentration was 15.4 (14.3 – 16.3) μg/m3 and the median NO2 concentration was 32.4 (24.1 – 40.6) μg/m3. Higher residential exposure to PM2.5 and NO2 was associated with increased left ventricular mass in DCM patients (table 1). Higher residential exposure to NO2 was associated with reduced left ventricular ejection fraction (Table 1). There was no association between exposure to PM2.5 levels or NO2 levels and cardiovascular outcomes (NO2 Hazard ratio 0.99, 95% confidence intervals (CI) 0.98-1.01, p= 0.90; PM2.5 hazard ratio 1.0, 95% CI 0.89-1.25, p= 0.54). Conclusion Fine particulate matter air pollution has an adverse effect on cardiovascular phenotypes amongst patients with DCM suggesting air pollutants could be an environmental modifier of DCM. There was no apparent effect of fine particulate matter on major cardiovascular outcomes in this cohort. Future studies should explore whether air pollution contributes to DCM amongst at risk individuals. Conflict of Interest None
{"title":"3 Residential exposure to fine particulate matter air pollution is associated with impaired cardiac phenotypes in dilated cardiomyopathy","authors":"U. Tayal, D. Fecht, M. Chadeau, J. Gulliver, J. Ware, S. Cook, S. Prasad","doi":"10.1136/HEARTJNL-2020-BCS.3","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.3","url":null,"abstract":"Background Air pollution might contribute to adverse ventricular remodelling in healthy populations. A recent study on a cohort of 500,000 participants (UK Biobank) showed that residential exposure to particulate matter with aerodynamic diameter Dilated cardiomyopathy (DCM) has marked structural and functional phenotypic heterogeneity. The biological basis for this is undefined, but environmental factors are plausible phenotypic modifiers. We sought to evaluate whether air pollution could be an important environmental modifier in DCM. Methods Prospectively recruited patients with DCM underwent advanced phenotyping by cardiac magnetic resonance. Patients were followed up for the primary composite end-point of cardiovascular mortality, major arrhythmic events and major heart failure events. Long-term air pollution exposure estimates prior to the year of DCM diagnosis were assigned to each residential postcode centroid (on average 12 households). Annual average maps were available for NO2 concentrations in 2009 at 200m resolution and PM2.5 in 2010 at 100m resolution. Postcode centroids (x,y locations) were overlaid with each air pollution surface to obtain NO2 and PM2.5 estimates for each postcode and concentrations extrapolated to the year of diagnosis using information from the national air pollution monitoring network. Results From the total cohort of 716 DCM patients enrolled to the study, 678 patients had postcodes which could be assigned a geographical location and air pollutant estimates. The median PM2.5 concentration was 15.4 (14.3 – 16.3) μg/m3 and the median NO2 concentration was 32.4 (24.1 – 40.6) μg/m3. Higher residential exposure to PM2.5 and NO2 was associated with increased left ventricular mass in DCM patients (table 1). Higher residential exposure to NO2 was associated with reduced left ventricular ejection fraction (Table 1). There was no association between exposure to PM2.5 levels or NO2 levels and cardiovascular outcomes (NO2 Hazard ratio 0.99, 95% confidence intervals (CI) 0.98-1.01, p= 0.90; PM2.5 hazard ratio 1.0, 95% CI 0.89-1.25, p= 0.54). Conclusion Fine particulate matter air pollution has an adverse effect on cardiovascular phenotypes amongst patients with DCM suggesting air pollutants could be an environmental modifier of DCM. There was no apparent effect of fine particulate matter on major cardiovascular outcomes in this cohort. Future studies should explore whether air pollution contributes to DCM amongst at risk individuals. Conflict of Interest None","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121492404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-01DOI: 10.1136/HEARTJNL-2020-BCS.6
S. Straw, V. Mishra, W. Baig, R. Gillott, C. Doorn, K. Javangula, J. Sandoe
Introduction Intracardiac abscess complicates both native (NV-IE) and prosthetic valve infective endocarditis (PV-IE). Antibiotics alone rarely achieve source control, and if left untreated abscesses are usually fatal. Uncomplicated abscesses affecting the aortic valve can be treated with aortic valve replacement (AVR) with or without patching of the abscess cavity. With more extensive tissue destruction aortic root replacement (ARR) may be required. The optimal surgical approach is controversial, ARR using homograft valve conduits are reported to have lower re-infection rates and have been favoured in most cases of abscess affecting the aortic root. Aims We aimed to describe the characteristics, surgical technique chosen, complications and outcomes for patients with intracardiac abscess presenting over more than a decade. Methods Consecutive patients assessed between 01 January 2005 and 31 December 2017 were identified from a prospectively collected database used for service evaluation of IE care. We required patients to have Duke definite IE with evidence of intracardiac abscess on imaging or found at operation. We recorded patient demographics, affected structures, microbiology, complications of IE, operative details and outcomes. Results There were 68 episodes of intracardiac abscess occurring in 59 patients, of whom 44 (75%) were male, 10 (17%) were persons who inject drugs (PWID) and the mean age was 55.7 +/- 16.3 years. Affected structures were primarily the aortic (55) and mitral (17) valves. Thirty-one (53%) had NV-IE and 28 (47%) had PV-IE. Multiple aortic cusps were involved in 68%. Bacterial pathogens were mainly Streptococcus (26) and Staphylococcus (18) species, which were associated with NV-IE (p=0.009) and PV-IE (p=0.005) respectively. The most common complications were heart failure (44), heart block (12) and systemic emboli including stroke. Forty-four (75%) patients underwent surgery, 28 had AVR and 14 ARR. The 30-day surgical mortality rate was 10 (23%) and associated with infection with S. aureus (p=0.006) and higher Euroscore II (p=0.03). No other operative factors were associated with survival including the timing of surgery and whether AVR or ARR was undertaken. During long-term follow up there were 9 episodes of re-infection which did not differ between AVR and ARR. The all-cause mortality in operated patients was 34%, 41% and 66% at 1, 5 and 10 years, respectively and the cause of death was due to IE and its complications in 91%. Discussion Abscess formation in IE is associated with high early and late mortality, 25% of patients were not fit for surgery due to prohibitively high preoperative risk. The findings presented here support an individualised approach to surgical technique depending on the results of preoperative imaging and operative findings. A third of patients required complex aortic root surgery, usually in the context of PV-IE. Surgical centres should have the skills and materials to undertake ARR in this h
心内脓肿并发原生瓣膜(NV-IE)和人工瓣膜感染性心内膜炎(PV-IE)。单独使用抗生素很少能控制脓肿的来源，如果不及时治疗，脓肿通常是致命的。无并发症的影响主动脉瓣的脓肿可以用主动脉瓣置换术(AVR)治疗，有或没有修补脓肿腔。对于更广泛的组织破坏，可能需要主动脉根部置换术(ARR)。最佳的手术入路是有争议的，据报道，使用同种移植物瓣膜导管的ARR具有较低的再感染率，并且在大多数影响主动脉根部的脓肿病例中得到青睐。目的我们旨在描述十多年来心内脓肿患者的特征、手术技术选择、并发症和预后。方法从前瞻性收集的用于IE护理服务评估的数据库中筛选2005年1月1日至2017年12月31日期间接受评估的连续患者。我们要求患者在影像学或手术中发现有心内脓肿的证据，并有明确的Duke IE。我们记录了患者的人口统计学、受影响的结构、微生物学、IE并发症、手术细节和结果。结果59例患者发生心内脓肿68次，其中男性44例(75%)，注射吸毒者10例(17%)，平均年龄55.7±16.3岁。受影响的结构主要是主动脉瓣(55)和二尖瓣(17)。31例(53%)有NV-IE, 28例(47%)有PV-IE。累及多个主动脉尖的占68%。病原菌主要为链球菌(26种)和葡萄球菌(18种)，分别与NV-IE (p=0.009)和PV-IE (p=0.005)相关。最常见的并发症是心力衰竭(44例)、心脏传导阻滞(12例)和包括中风在内的全身栓塞。44例(75%)患者接受手术，28例AVR, 14例ARR。30天手术死亡率为10(23%)，与金黄色葡萄球菌感染(p=0.006)和较高的Euroscore II (p=0.03)相关。没有其他手术因素与生存相关，包括手术时间和是否进行AVR或ARR。在长期随访中有9次再感染，AVR和ARR之间没有差异。术后1年、5年和10年全因死亡率分别为34%、41%和66%，91%的死亡原因为IE及其并发症。IE脓肿形成与高早期和晚期死亡率相关，25%的患者由于术前风险过高而不适合手术。本文的研究结果支持根据术前影像学和手术结果对手术技术进行个体化治疗。三分之一的患者需要进行复杂的主动脉根部手术，通常是在PV-IE的情况下。外科中心应具备在这种高风险环境中进行ARR的技能和材料。利益冲突无
{"title":"6 Simple or complex surgery in infective endocarditis complicated by abscess: what is the need and what are the outcomes?","authors":"S. Straw, V. Mishra, W. Baig, R. Gillott, C. Doorn, K. Javangula, J. Sandoe","doi":"10.1136/HEARTJNL-2020-BCS.6","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.6","url":null,"abstract":"Introduction Intracardiac abscess complicates both native (NV-IE) and prosthetic valve infective endocarditis (PV-IE). Antibiotics alone rarely achieve source control, and if left untreated abscesses are usually fatal. Uncomplicated abscesses affecting the aortic valve can be treated with aortic valve replacement (AVR) with or without patching of the abscess cavity. With more extensive tissue destruction aortic root replacement (ARR) may be required. The optimal surgical approach is controversial, ARR using homograft valve conduits are reported to have lower re-infection rates and have been favoured in most cases of abscess affecting the aortic root. Aims We aimed to describe the characteristics, surgical technique chosen, complications and outcomes for patients with intracardiac abscess presenting over more than a decade. Methods Consecutive patients assessed between 01 January 2005 and 31 December 2017 were identified from a prospectively collected database used for service evaluation of IE care. We required patients to have Duke definite IE with evidence of intracardiac abscess on imaging or found at operation. We recorded patient demographics, affected structures, microbiology, complications of IE, operative details and outcomes. Results There were 68 episodes of intracardiac abscess occurring in 59 patients, of whom 44 (75%) were male, 10 (17%) were persons who inject drugs (PWID) and the mean age was 55.7 +/- 16.3 years. Affected structures were primarily the aortic (55) and mitral (17) valves. Thirty-one (53%) had NV-IE and 28 (47%) had PV-IE. Multiple aortic cusps were involved in 68%. Bacterial pathogens were mainly Streptococcus (26) and Staphylococcus (18) species, which were associated with NV-IE (p=0.009) and PV-IE (p=0.005) respectively. The most common complications were heart failure (44), heart block (12) and systemic emboli including stroke. Forty-four (75%) patients underwent surgery, 28 had AVR and 14 ARR. The 30-day surgical mortality rate was 10 (23%) and associated with infection with S. aureus (p=0.006) and higher Euroscore II (p=0.03). No other operative factors were associated with survival including the timing of surgery and whether AVR or ARR was undertaken. During long-term follow up there were 9 episodes of re-infection which did not differ between AVR and ARR. The all-cause mortality in operated patients was 34%, 41% and 66% at 1, 5 and 10 years, respectively and the cause of death was due to IE and its complications in 91%. Discussion Abscess formation in IE is associated with high early and late mortality, 25% of patients were not fit for surgery due to prohibitively high preoperative risk. The findings presented here support an individualised approach to surgical technique depending on the results of preoperative imaging and operative findings. A third of patients required complex aortic root surgery, usually in the context of PV-IE. Surgical centres should have the skills and materials to undertake ARR in this h","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"148 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"113991172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-01DOI: 10.1136/HEARTJNL-2020-BCS.10
G. Norrish
Introduction Sudden cardiac death (SCD) is the most common cause of mortality in childhood hypertrophic cardiomyopathy (HCM). ICDs have been shown to be effective at terminating malignant ventricular arrhythmias but at the expense of a high incidence of complications. The optimal device and programming strategies to reduce complications in this patient group is unknown. To describe the programming strategies and clinical outcomes of ICD implantation in childhood HCM. Methods Anonymised, non-invasive clinical data were collected from a retrospective, longitudinal multi-centre cohort of children ( Results 96 patients (61 male (64%), 6 non-sarcomeric (6%)) underwent ICD implantation at a median age 14yr (IQR 11-16, range 3-16) and weight 52.3 Kg (IQR 34.8-63.1). Indication for ICD was primary prevention in 72 (75%) and secondary 24 (25%). 82 (85%) had an endovascular system, 3 (3%) epicardial and 11 (12%) subcutaneous system. For those with an endovascular system, 14 (15%) had a dual-coil shock lead and 48 (50%) an atrial lead. 61 patients (74%) were receiving one or more cardioactive medications at implantation [B blockers n=56, 70%, disopyramide n=14, 15%, amiodarone n=7, 7%, calcium channel blocker n=7, 9%, other n=5, 6%]. Programming practices varied; all had VF therapies activated (median 220bpm, IQR 212-230), 70 (73%) had a VT zone programmed (median rate 187 bpm, SD 20.9) of which 26 (27%) had therapies activated. 50 patients (61%) had antitachycardia pacing (ATP) activated. Over a median follow up of 53.6 months (IQR 27.3,108.4) 4 patients (4.2%) following arrhythmic events. 25 patients had 53 appropriate therapies (ICD shock n=47, ATP n=8), incidence rate 5.22 (95% CI 3.5-7.8). On univariable analysis, secondary prevention indication for ICD implantation was the only predictor of therapy [16 (64%) vs 8 (11.3%), p value Conclusions In a contemporary cohort of children with HCM, the incidence of inappropriate therapies is lower than previously reported, yet complication rates remain higher than reported in adult patients. No clinical, device or programming strategies were associated with inappropriate therapies or lead complications. Conflict of Interest Nil
心源性猝死(SCD)是儿童肥厚性心肌病(HCM)最常见的死亡原因。icd已被证明在终止恶性室性心律失常方面是有效的，但代价是并发症的发生率很高。在这组患者中，减少并发症的最佳设备和编程策略尚不清楚。目的:探讨儿童HCM植入术的规划策略及临床效果。方法收集回顾性、纵向多中心队列儿童的匿名、无创临床资料(结果96例患者接受ICD植入，其中男性61例(64%)，非肌瘤性6例(6%)，中位年龄14岁(IQR 11-16，范围3-16)，体重52.3 Kg (IQR 34.8-63.1)。ICD的指征为一级预防72例(75%)，二级预防24例(25%)。82例(85%)为血管内系统，3例(3%)为心外膜系统，11例(12%)为皮下系统。对于有血管内系统的患者，14例(15%)有双圈休克导联，48例(50%)有心房导联。61例(74%)患者在植入时接受了一种或多种心脏活性药物[B受体阻滞剂n=56、70%，二丙酰胺n=14、15%，胺碘酮n=7、7%，钙通道阻滞剂n=7、9%，其他n=5、6%]。编程实践多种多样;所有患者均激活了VF治疗(中位数为220bpm, IQR为212-230)，70例(73%)患者的VT区被编程(中位数为187bpm, SD为20.9)，其中26例(27%)患者的治疗被激活。50例(61%)患者有抗心动过速起搏(ATP)激活。中位随访53.6个月(IQR 27.3108.4)， 4例患者(4.2%)出现心律失常事件。25例患者采用53种合适的治疗方法(ICD休克47例，ATP 8例)，发生率5.22 (95% CI 3.5 ~ 7.8)。在单变量分析中，ICD植入的二级预防指征是治疗的唯一预测指标[16 (64%)vs 8 (11.3%)， p值]结论:在当代HCM儿童队列中，不适当治疗的发生率低于先前报道，但并发症发生率仍高于成人患者。没有临床、器械或编程策略与不适当的治疗或导致并发症相关。利益冲突无
{"title":"10 Clinical outcomes and programming strategies of implantable cardioverter defibrillator (ICD) devices during childhood in hypertrophic cardiomyopathy: a UK national cohort study","authors":"G. Norrish","doi":"10.1136/HEARTJNL-2020-BCS.10","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.10","url":null,"abstract":"Introduction Sudden cardiac death (SCD) is the most common cause of mortality in childhood hypertrophic cardiomyopathy (HCM). ICDs have been shown to be effective at terminating malignant ventricular arrhythmias but at the expense of a high incidence of complications. The optimal device and programming strategies to reduce complications in this patient group is unknown. To describe the programming strategies and clinical outcomes of ICD implantation in childhood HCM. Methods Anonymised, non-invasive clinical data were collected from a retrospective, longitudinal multi-centre cohort of children ( Results 96 patients (61 male (64%), 6 non-sarcomeric (6%)) underwent ICD implantation at a median age 14yr (IQR 11-16, range 3-16) and weight 52.3 Kg (IQR 34.8-63.1). Indication for ICD was primary prevention in 72 (75%) and secondary 24 (25%). 82 (85%) had an endovascular system, 3 (3%) epicardial and 11 (12%) subcutaneous system. For those with an endovascular system, 14 (15%) had a dual-coil shock lead and 48 (50%) an atrial lead. 61 patients (74%) were receiving one or more cardioactive medications at implantation [B blockers n=56, 70%, disopyramide n=14, 15%, amiodarone n=7, 7%, calcium channel blocker n=7, 9%, other n=5, 6%]. Programming practices varied; all had VF therapies activated (median 220bpm, IQR 212-230), 70 (73%) had a VT zone programmed (median rate 187 bpm, SD 20.9) of which 26 (27%) had therapies activated. 50 patients (61%) had antitachycardia pacing (ATP) activated. Over a median follow up of 53.6 months (IQR 27.3,108.4) 4 patients (4.2%) following arrhythmic events. 25 patients had 53 appropriate therapies (ICD shock n=47, ATP n=8), incidence rate 5.22 (95% CI 3.5-7.8). On univariable analysis, secondary prevention indication for ICD implantation was the only predictor of therapy [16 (64%) vs 8 (11.3%), p value Conclusions In a contemporary cohort of children with HCM, the incidence of inappropriate therapies is lower than previously reported, yet complication rates remain higher than reported in adult patients. No clinical, device or programming strategies were associated with inappropriate therapies or lead complications. Conflict of Interest Nil","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"272 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116250753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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