British Heart Journal最新文献

{"title":"Sex and outcomes after alcohol septal ablation for patients with hypertrophic obstructive cardiomyopathy","authors":"S. Nagueh","doi":"10.1136/heartjnl-2022-321251","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321251","url":null,"abstract":"Hypertrophic obstructive cardiomyopathy (HOCM) is currently treated with septal reduction therapy in severely symptomatic patients who are not responsive to medical treatment. Since its introduction by Dr Ulrich Sigwart in 1995, alcohol septal ablation (ASA) has been increasingly performed across the globe. In fact, after discussion of risks, benefits and alternatives, many patients elect to undergo ASA. There have been several attempts to identify ASA outcome predictors in this patient population and there are concerns about worse outcomes in female patients. This important question is tackled in this issue of the journal by Lawin et al. The authors report on procedural outcomes at 1–4 days and at 6 months after ASA in 1367 patients with HOCM, stratified by sex. In comparison with men, women were older but had similar prevalence of coronary artery disease. Overall, symptomatic status was worse in women with more frequent syncope, and more severe dyspnoea and angina. Despite these differences, there were no apparent differences in medical therapy prior to ASA. Symptoms were corroborated by a significantly shorter 6minute walking distance (6MWD) in women prior to ASA. However, we are not told whether there was a difference in the doses of the drugs used or the combination of medications (eg, betablockers and disopyramide). Importantly, both resting gradients and exerciseinduced gradients (supine bicycle exercise to workload of 75 W for 5 min) were similar between men and women. While the basal septum was slightly thicker in men (on average for the study sample a difference of 1 mm), when indexed to body surface area (BSA), septum thickness was more in women (average difference: 0.7 mm/ m). This occurred because of the smaller BSA in women. Interestingly, despite the similar number of septal vessels occluded and volume of ethanol used in men and women, infarct size as assessed by peak creatine kinase was significantly higher in men. The magnitude of change at 6 months in basal septal thickness, rest and exerciseinduced gradients, and 6MWD was similar between men and women. Likewise, symptomatic improvement was comparable. Complications were similar, with the exception of highgrade atrioventricular (AV) block, the need for permanent pacemakers and vascular complications which occured more frequently in women, and pulmonary embolism which was more common in men. The study has the strengths of a large data set and coming from an experienced referral centre for ASA. It has several limitations acknowledged by the authors including followup being available in only 65% of women and 74% of men, the absence of baseline ECG findings and the short duration of followup. The absence of ECG findings is particularly relevant to understanding the reasons behind the higher incidence of advanced AV block in women. While the results of 6MWD at followup were included, data on exercise tolerance were not available. In general, the findings are similar to other studies ","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1588 - 1589"},"PeriodicalIF":0.0,"publicationDate":"2022-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44254332","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}

{"title":"Is diastolic dysfunction a red flag sign in moderate aortic stenosis?","authors":"K. Kusunose","doi":"10.1136/heartjnl-2022-321137","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321137","url":null,"abstract":"With rapidly ageing population, aortic stenosis (AS) has become one of the most common valvular heart diseases. Severe AS is clearly associated with increased mortality, and the current American College of Cardiology/American Heart Association guidelines designate a class I or IIa indication for aortic valve surgery in severe patients with AS with symptoms or with low left ventricular (LV) function. Historically, based on the lower risk of sudden death in moderate AS compared with severe AS, watchful observation was recommended to patients with moderate AS. In the last decade, prognostic findings on moderate AS have been gathered (table 1). A large echocardiographic national database study, including 3315 moderate AS with various LV systolic functions, suggested a poor survival rate (5year mortality: 56%). Recently, two academic institutional databases, including 1245 moderate AS, also showed poor prognosis during followup (median followup: 4.3 years; mortality: 45.3%). From a physiological viewpoint, narrowing of the aortic valve area leads to LV systolic/diastolic dysfunction due to LV pressure overloading. In patients with severe AS who particularly underwent transcatheter aortic valve replacement (TAVR), diastolic dysfunction (DD) has been described as an early marker of myocardial damage and an important prognostic information. Thaden et al reported an association between echocardiographic data and outcomes from a retrospective singlecentre study. Over a mean followup period of 7.3 years, increased left atrial pressure based on the American Society of Echocardiography/ European Association of Cardiovascular Imaging criteria remained an independent predictor of mortality after successful aortic valve replacement (AVR) (HR: 1.45; 95% CI 1.16 to 1.81). More recently, Ong et al clearly showed an association between DD grading at baseline and combined cardiovascular death/rehospitalisation at 1 year from the Placement of Aortic Transcatheter Valves (PARTNER) 2 and SAPIEN 3 registry analysed by core laboratories (n=1253). These previous studies described a consistent message of an increased risk of event with worsening grade and stage of DD in severe AS. What about the association of moderate AS with DD? In their Heart article, Stassen et al presented data from a large registry of patients with moderate AS and preserved LV systolic function from three academic institutions between October 2001 and December 2019. Moderate AS was defined as an aortic valve area of between 1.0 cm and 1.5 cm. Finally, 1247 patients with moderate AS were retrospectively included and divided into three groups (normal diastolic function, indeterminate diastolic function and DD) based on the guidelines. The aims of the study were (1) to evaluate the prevalence of DD and (2) to examine the prognostic implications of DD in moderate AS with preserved LV systolic function. The primary outcome was allcause mortality. The secondary outcome was a composite of allcause mortality ","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1340 - 1341"},"PeriodicalIF":0.0,"publicationDate":"2022-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48473981","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}

{"title":"Prognostic implications of left ventricular diastolic dysfunction in moderate aortic stenosis","authors":"J. Stassen, S. Ewe, S. Butcher, MR Ammanullah, K. Hirasawa, G. Singh, Z. Ding, SM Pio, N. Chew, C. Sia, W. Kong, K. Poh, N. Marsan, V. Delgado, Jeroen J. Bax","doi":"10.1136/heartjnl-2022-320886","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-320886","url":null,"abstract":"Objective To investigate the prognostic impact of left ventricular (LV) diastolic dysfunction in patients with moderate aortic stenosis (AS) and preserved LV systolic function. Methods Patients with a first diagnosis of moderate AS (aortic valve area >1.0 and ≤1.5 cm2) and preserved LV systolic function (LV ejection fraction ≥50%) were identified. LV diastolic function was evaluated using echocardiographic criteria according to the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. Clinical outcomes were defined as all-cause mortality and a composite of all-cause mortality and aortic valve replacement (AVR). Results Of 1247 patients (age 74±10 years, 47% men), 535 (43%) had LV diastolic dysfunction at baseline. Patients with LV diastolic dysfunction showed significantly higher mortality rates at 1-year, 3-year and 5-year follow-up (13%, 30% and 41%, respectively) when compared with patients with normal LV diastolic function (6%, 17% and 29%, respectively) (p<0.001). On multivariable analysis, LV diastolic dysfunction was independently associated with all-cause mortality (HR 1.368; 95% CI 1.085 to 1.725; p=0.008) and the composite endpoint of all-cause mortality and AVR (HR 1.241; 95% CI 1.035 to 1.488; p=0.020). Conclusions LV diastolic dysfunction is independently associated with all-cause mortality and the composite endpoint of all-cause mortality and AVR in patients with moderate AS and preserved LV systolic function. Assessment of LV diastolic function therefore contributes significantly to the risk stratification of patients with moderate AS. Future clinical trials are needed to investigate whether patients with moderate AS and LV diastolic dysfunction may benefit from earlier valve intervention.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1401 - 1407"},"PeriodicalIF":0.0,"publicationDate":"2022-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44451136","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}

{"title":"First in-human modified atrial septostomy combining radiofrequency ablation and balloon dilation","authors":"Chaowu Yan, L. Wan, Hua Li, Cheng Wang, Tingting Guo, Hanxu Niu, Shiguo Li, Pingcuo Yundan, Lei Wang, Wei Fang","doi":"10.1136/heartjnl-2022-321212","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321212","url":null,"abstract":"Objective Preclinical research suggests that the combined use of radiofrequency ablation and balloon dilation (CURB) could create stable interatrial communications without device implantation. This study examined the first in-human use of CURB for modified atrial septostomy in patients with severe pulmonary arterial hypertension (PAH). Methods Between July 2018 and October 2021, CURB was performed in 19 patients with severe PAH (age: 31.5±9.1 years; mean pulmonary artery pressure: 73 mm Hg (IQR: 66–92); pulmonary vascular resistance: 18.7 Wood units (IQR: 17.8–23.3)). Under guidance of intracardiac echocardiography and three-dimensional location system, (1) fossae ovalis was reconstructed and ablated point-by-point with radiofrequency; (2) then graded balloon dilation was performed after transseptal puncture and the optimal size was determined according to the level of arterial oxygen saturation (SatO2); (3) radiofrequency ablation was repeated around the rims of the created fenestration. The interatrial fenestrations were followed-up serially. Results After CURB, the immediate fenestration size was 4.4 mm (IQR: 4.1–5.1) with intracardiac echocardiography, systolic aortic pressure increased by 10.2±6.9 mm Hg, cardiac index increased by 0.7±0.3 L/min/m2 and room-air resting SatO2 decreased by 6.2±1.9% (p<0.001). One patient experienced increased pericardiac effusion postoperatively; the others had no complications. On follow-up (median: 15.5 months), all interatrial communications were patent with stable size (intraclass correlation coefficient=0.96, 95%CI:0.89 to 0.99). The WHO functional class increased by 1 (IQR: 1–2) (p<0.001) with improvement of exercise capacity (+159.5 m, P<0.001). Conclusion The interatrial communications created with CURB in patients with severe PAH were stable and the mid-term outcomes were satisfactory. Trial registration number NCT03554330.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1690 - 1698"},"PeriodicalIF":0.0,"publicationDate":"2022-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48303908","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}

{"title":"Heartbeat: sex-based discrepancies in survival from sudden cardiac death","authors":"C. Otto","doi":"10.1136/heartjnl-2022-321429","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321429","url":null,"abstract":"Sudden cardiac death (SCD) is a major cause of death worldwide, with a higher prevalence in men compared with women. To further understand sex differences in SCD presentation and outcomes, Skjelbred and colleagues looked at data on deaths in Denmark in 2010 and found that SCD accounted for 12.7% of all deaths with a male predominant (56% men, 44% women). The average age at SCD was higher in women (79 years) compared with men (71 years), with the greatest sex difference in SCD incidence rates in the age group from 35 to 50 years (incidence rate ratio 3.7, 95% CI 2.8 to 4.8) (figure 1). Women, compared with men, more often died at home (80.5% vs 69.7%, p<0.01) rather than in the hospital (16.8% vs 22.2%, p<0.01). The cause of SCD was coronary artery disease in about 40% of cases. Other causes (each <5%) included cardiac arrhythmias, heart failure, aortic dissection, valve disease and cardiomyopathy. In the accompanying editorial, Tan and Remme suggest that SCD risk relates not only to biological sex differences but also to societal and environmental factors. In men, the cause of SCD usually is coronary artery disease and the initial rhythm typically is ventricular fibrillation. In contrast, the cause of SCD in women more often is ventricular hypertrophy, aortic dissection or myocarditis and the initial rhythm is likely to be pulseless electrical activity or asystole. Women also are more likely to have an unwitnessed event at home, thus, not receiving prompt resuscitation. Even when witnessed, women are less likely to be resuscitated by bystanders; the combination of a longer delay to resuscitation plus the low frequency of a shockable rhythm results in lower survival rates. The authors urge increased research and action to reduce the risk of SCD in both women and men. ‘Clearly, to reduce the societal burden of SCD, we must focus our efforts on earlier recognition of SCA risk. Given the complex underlying causes of SCA and in view of the observation that our ability at early recognition has been stagnant over the last decades, we must adopt a more comprehensive strategy and reap the benefit of relatively new methods which have so far been poorly used in SCA research, for example, artificial intelligencebased analysis of large data sets, genetic analysis and metabolomic analysis. We must also recognise that we should direct our view to the group in society that has so far received insufficient attention in SCA research, that is, individuals who are in the care of their general practitioner and have not (yet) been referred to a cardiologist.’ (figure 2). Another study in this issue of Heart addresses sex (biological) and gender (sociocultural) differences in cardiovascular disease (CVD) risk factors. Based","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"989 - 991"},"PeriodicalIF":0.0,"publicationDate":"2022-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43268536","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}

{"title":"Risk of recurrent infective endocarditis: what do we learn from the Euro-ENDO study?","authors":"Abdallah Al-Mohammad","doi":"10.1136/heartjnl-2022-321135","DOIUrl":"10.1136/heartjnl-2022-321135","url":null,"abstract":"","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43028044","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}

{"title":"An interesting case of fever and left ventricular systolic dysfunction","authors":"A. Ioannou","doi":"10.1136/heartjnl-2022-320831","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-320831","url":null,"abstract":"20 Webb JG, Pate GE, Munt BI. Percutaneous closure of an aortic prosthetic paravalvular leak with an Amplatzer duct occluder. Catheter Cardiovasc Interv 2005;65:69–72. 21 Piéchaud JF. Percutaneous closure of mitral paravalvular leak. J Interv Cardiol 2003;16:153–5. 22 Sorajja P, Cabalka AK, Hagler DJ, et al. Percutaneous repair of paravalvular prosthetic regurgitation: acute and 30day outcomes in 115 patients. Circ Cardiovasc Interv 2011;4:314–21. 23 Ruiz CE, Jelnin V, Kronzon I, et al. Clinical outcomes in patients undergoing percutaneous closure of periprosthetic paravalvular leaks. J Am Coll Cardiol 2011;58:2210–7. 24 Millán X, Bouhout I, Nozza A, et al. Surgery Versus Transcatheter Interventions for Significant Paravalvular Prosthetic Leaks. JACC Cardiovasc Interv 2017;10:1959–69. 25 Sorajja P, Cabalka AK, Hagler DJ, et al. The learning curve in percutaneous repair of paravalvular prosthetic regurgitation: an analysis of 200 cases. JACC Cardiovasc Interv 2014;7:521–9. 26 Lancellotti P, Pibarot P, Chambers J, et al. Recommendations for the imaging assessment of prosthetic heart valves: a report from the European Association of Cardiovascular Imaging endorsed by the Chinese Society of Echocardiography, the InterAmerican Society of Echocardiography, and the Brazilian Department of Cardiovascular Imaging . Eur Heart J Cardiovasc Imaging 2016;17:589–90. 27 Hascoet S, Smolka G, Bagate F, et al. Multimodality imaging guidance for percutaneous paravalvular leak closure: insights from the multicentre FFPP register. Arch Cardiovasc Dis 2018;111:421–31. 28 Lesser JR, Han BK, Newell M, et al. Use of cardiac CT angiography to assist in the diagnosis and treatment of aortic prosthetic paravalvular leak: a practical guide. J Cardiovasc Comput Tomogr 2015;9:159–64. 29 Suh YJ, Hong GR, Han K, et al. Assessment of mitral paravalvular leakage after mitral valve replacement using cardiac computed tomography: comparison with surgical findings. Circ Cardiovasc Imaging 2016;9. 30 de Agustin JA, JimenezQuevedo P, NombelaFranco L, et al. Paravalvular mitral leak closure under EcoXray fusion guidance. Eur Heart J Cardiovasc Imaging 2018;19:586. 31 Faletra FF, Pozzoli A, Agricola E, et al. Echocardiographicfluoroscopic fusion imaging for transcatheter mitral valve repair guidance. Eur Heart J Cardiovasc Imaging 2018;19:715–26. 32 Gafoor S, Steinberg DH, Franke J, et al. Tools and techniques--clinical: paravalvular leak closure. EuroIntervention 2014;9:1359–63. 33 Calvert PA, Northridge DB, Malik IS, et al. Percutaneous device closure of paravalvular leak: combined experience from the United Kingdom and Ireland. Circulation 2016;134:934–44. 34 García E, Arzamendi D, JimenezQuevedo P, et al. Outcomes and predictors of success and complications for paravalvular leak closure: an analysis of the Spanish realworld paravalvular leaks closure (HOLE) registry. EuroIntervention 2017;12:1962–8. 35 AnguloLlanos R, SarnagoCebada F, Rivera AR, et al. Twoyear follow up after surgical","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1011 - 1074"},"PeriodicalIF":0.0,"publicationDate":"2022-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43925789","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}

{"title":"The synergy of myopathic valvular disease","authors":"R. Alharethi, R. A. Butschek, Kismet Rasmusson, B. Whisenant","doi":"10.1136/heartjnl-2022-321214","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321214","url":null,"abstract":"With recent advancements in the treatment of heart failure with reduced ejection fraction (HFrEF) including the addition of angiotensin receptor–neprilysin inhibitor, sodium–glucose cotransporter 2 inhibitors (SGLT2i) and transcatheter edgetoedge mitral valve repair (TEER), the treatment of patients with cardiomyopathy and secondary mitral regurgitation (SMR) has become increasingly complex and can lead to suboptimal utilisation of indicated therapies. Tanaka and colleagues have provided a realworld analysis of guidelinedirected medical therapy (GDMT) among HFREF patients with SMR and managed with TEER. Their findings reinforce the importance of engaging focused heart failure (HF) cardiologists and allied teams to optimise medical therapy before and after TEER. Consistent with the 2021 European Society of Cardiology guideline on HF management, the authors define GDMT as modulation of the renin–angiotensin–aldosterone and sympathetic nervous systems with triple therapy including renin–angiotensin system (RAS) inhibitors, betablockers (BBs) and mineralocorticoid receptor antagonists (MRAs) noting that SGLT2is were approved after study completion. Their results demonstrated the clinical benefits of maintaining triple therapy neuromodulation following TEER. They have thus provided a pragmatic and simple threshold of GDMT that will undoubtedly improve the care of patients with SMR undergoing TEER. Tanaka et al retrospectively divided patients with SMR and left ventricular ejection fraction (LVEF) <50% who underwent TEER into GDMT and nonGDMT cohorts. Local heart teams optimised medical therapy and decided when to perform TEER. As such, this is a realworld population of patients with SMR managed with TEER. GDMT was defined as patients who received triple therapy at the time of discharge with RAS inhibitors, BBs and MRAs of any doses. Nevertheless, among the GDMT cohort, only 21% of patients received target doses of BBs, and only 12% received target doses of RAS inhibitors. NonGDMT patients were prescribed optimal medical therapy per the local heart team consensus including BBs in 84% (16% with target doses), and RAS inhibitors in 60% (12% at target doses). While all GDMT patients were prescribed MRAs, only 22% of nonGDMT patients were prescribed MRAs. Among patients without GDMT, 42% had factors related to ineligibility (ie, systolic blood pressure <100 mm Hg, heart rate <60 bpm or estimated glomerular filtration rate <30 mL/min/m). This underscores the difference between relative ineligibility to a medication and the intolerance to this medication with the inherent complexity of providing detailed reasons for intolerance of GDMT, which were not recorded in this study. We are not sure if the lack of triple therapy in the nonGDMT cohort and the less than target doses of medications in both cohorts represents the absolute maximally tolerated medical therapy. Twoyear mortality was compared between groups after calculating propensity scores and performing ","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1670 - 1671"},"PeriodicalIF":0.0,"publicationDate":"2022-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44168303","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}

{"title":"Guideline-directed medical therapy after transcatheter edge-to-edge mitral valve repair","authors":"Tetsu Tanaka, R. Kavsur, M. Spieker, C. Iliadis, C. Metze, Birthe M Brachtendorf, P. Horn, C. Zachoval, A. Sugiura, M. Kelm, S. Baldus, G. Nickenig, R. Westenfeld, R. Pfister, M. Becher","doi":"10.1136/heartjnl-2022-320826","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-320826","url":null,"abstract":"Objective A sizeable proportion of patients with secondary mitral regurgitation (SMR) do not receive guideline-directed medical therapy (GDMT) for heart failure (HF). We investigated the association between the use of GDMT and mortality in patients with SMR who underwent transcatheter edge-to-edge repair (TEER). Methods We retrospectively analysed patients with SMR and a left ventricular ejection fraction of <50% who underwent TEER at three centres. According to current HF guidelines, GDMT was defined as triple therapy consisting of beta-blockers, renin–angiotensin system (RAS) inhibitors and mineralocorticoid receptor antagonists (MRAs). Patients were divided into two groups: GDMT and non-GDMT groups. We calculated the propensity scores and carried out inverse probability of treatment weighting (IPTW) analyses to compare 2-year mortality between the two groups. Results Of 463 patients, 228 (49.2%) were treated with GDMT upon discharge. IPTW-adjusted Kaplan-Meier curve showed patients with GDMT had a lower incidence of mortality than those without GDMT (19.8% vs 31.1%, p=0.011). In IPTW-adjusted Cox proportional hazards analysis, GDMT was associated with a reduced risk of 2-year mortality (HR: 0.58; 95% CI: 0.35 to 0.95; p=0.030), which was consistent among clinical subgroups. Moreover, patients with GDMT had a higher rate of left ventricular reverse remodelling at 1 year after TEER than those without GDMT. Conclusion GDMT, defined as triple therapy consisting of beta-blockers, RAS inhibitors and MRAs, was associated with a reduced risk of 2-year mortality after TEER for SMR. Optimisation of medical therapy is crucial to improve clinical outcomes in patients undergoing TEER for SMR.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1722 - 1728"},"PeriodicalIF":0.0,"publicationDate":"2022-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48787144","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}

{"title":"Disparities in cardiovascular maternal health","authors":"Janet I Ma, D. Defaria Yeh, Ada C. Stefanescu Schmidt","doi":"10.1136/heartjnl-2022-321056","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321056","url":null,"abstract":"While global maternal mortality has decreased in the last three decades, pregnancyrelated deaths remain prevalent in the USA, even after accounting for possible overreporting based on changes in death certificates. In 2017, approximately 17 US mothers per 100 000 live births died due to complications related to pregnancy or childbirth; in contrast, only 7 UK mothers per 100 000 live births died that year. Up to twothirds of US maternal deaths may have been preventable. Cardiovascular disease has emerged as the driving cause of current maternal mortality rates, causing or related to over onethird of US maternal deaths, with most deaths occurring during or after delivery. Recent studies worldwide have also begun to elucidate the longterm consequences of pregnancyrelated cardiovascular conditions such as gestational hypertension or preeclampsia 6 ; for instance, a largescale population study in the UK found hypertensive disorders of pregnancy increased risk across a multitude of cardiovascular disorders with the impact starting soon after pregnancy. In the USA, preeclampsiarelated deaths have decreased in the last two decades, while deaths associated with or due to chronic hypertension have been increasing. However, one striking difference between the USA and similarly wealthy countries, which may contribute to rising maternal mortality, is its fragmented insurance coverage. Marschner et al give readers a revealing snapshot of the intersection between cardiovascular maternal health and insurance coverage in an important and unique US demographic, pregnant women covered under Medicaid. As the US public insurance programme aimed to improve access to basic healthcare for those otherwise cannot afford it, Medicaid plays a pivotal role in supporting pregnant women living in poverty and currently provides coverage for half of all US births. Marschner et al take a deeper dive into the Medicaid population by exploring pregnancyrelated cardiovascular conditions and early postnatal adverse outcomes among Medicaidinsured pregnant women in three states in the USA between 2015 and 2019. They found that a striking onefourth of these women were diagnosed with a pregnancyrelated cardiometabolic condition, including hypertensive disorders of pregnancy and gestational or preexisting diabetes. Furthermore, between pregnancy and 60 days after delivery, over onetenth of these women were found to have a severe cardiovascular outcome, including heart failure, pulmonary embolism, stroke, cardiac arrest and myocardial infarction. Their study concluded that any type of pregnancyrelated cardiometabolic condition is associated with a threefold higher risk of a severe cardiovascular outcome. Marschner et al point out that current literature suggests the Medicaid population is at much higher risk of pregnancyrelated cardiometabolic conditions compared with those who have private insurance. Their analysis is based on claims data submitted to one Medicaid management company (the m","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1504 - 1505"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41915736","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}