Pub Date : 2022-05-31DOI: 10.1136/heartjnl-2021-320652
R. Citro, K. Chan, M. Miglioranza, C. Laroche, R. Benvenga, S. Furnaz, J. Magne, C. Olmos, B. Paelinck, A. Pasquet, C. Piper, A. Salsano, A. Savouré, S. Park, P. Szymański, P. Tattevin, N. Vallejo Camazón, P. Lancellotti, G. Habib
Aims Purpose of this study is to compare the clinical course and outcome of patients with recurrent versus first-episode infective endocarditis (IE). Methods Patients with recurrent and first-episode IE enrolled in the EUROpean ENDOcarditis (EURO-ENDO) registry including 156 centres were identified and compared using propensity score matching. Recurrent IE was classified as relapse when IE occurred ≤6 months after a previous episode or reinfection when IE occurred >6 months after the prior episode. Results 3106 patients were enrolled: 2839 (91.4%) patients with first-episode IE (mean age 59.4 (±18.1); 68.3% male) and 267 (8.6%) patients with recurrent IE (mean age 58.1 (±17.7); 74.9% male). Among patients with recurrent IE, 13.2% were intravenous drug users (IVDUs), 66.4% had a repaired or replaced valve with the tricuspid valve being more frequently involved compared with patients with first-episode IE (20.3% vs 14.1%; p=0.012). In patients with a first episode of IE, the aortic valve was more frequently involved (45.6% vs 39.5%; p=0.061). Recurrent relapse and reinfection were 20.6% and 79.4%, respectively. Staphylococcus aureus was the microorganism most frequently observed in both groups (p=0.207). There were no differences in in-hospital and post-hospitalisation mortality between recurrent and first-episode IE. In patients with recurrent IE, in-hospital mortality was higher in IVDU patients. Independent predictors of poorer in-hospital and 1-year outcome, including the occurrence of cardiogenic and septic shock, valvular disease severity and failure to undertake surgery when indicated, were similar for recurrent and first-episode IE. Conclusions In-hospital and 1-year mortality was similar in patients with recurrent and first-episode IE who shared similar predictors of poor outcome.
{"title":"Clinical profile and outcome of recurrent infective endocarditis","authors":"R. Citro, K. Chan, M. Miglioranza, C. Laroche, R. Benvenga, S. Furnaz, J. Magne, C. Olmos, B. Paelinck, A. Pasquet, C. Piper, A. Salsano, A. Savouré, S. Park, P. Szymański, P. Tattevin, N. Vallejo Camazón, P. Lancellotti, G. Habib","doi":"10.1136/heartjnl-2021-320652","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-320652","url":null,"abstract":"Aims Purpose of this study is to compare the clinical course and outcome of patients with recurrent versus first-episode infective endocarditis (IE). Methods Patients with recurrent and first-episode IE enrolled in the EUROpean ENDOcarditis (EURO-ENDO) registry including 156 centres were identified and compared using propensity score matching. Recurrent IE was classified as relapse when IE occurred ≤6 months after a previous episode or reinfection when IE occurred >6 months after the prior episode. Results 3106 patients were enrolled: 2839 (91.4%) patients with first-episode IE (mean age 59.4 (±18.1); 68.3% male) and 267 (8.6%) patients with recurrent IE (mean age 58.1 (±17.7); 74.9% male). Among patients with recurrent IE, 13.2% were intravenous drug users (IVDUs), 66.4% had a repaired or replaced valve with the tricuspid valve being more frequently involved compared with patients with first-episode IE (20.3% vs 14.1%; p=0.012). In patients with a first episode of IE, the aortic valve was more frequently involved (45.6% vs 39.5%; p=0.061). Recurrent relapse and reinfection were 20.6% and 79.4%, respectively. Staphylococcus aureus was the microorganism most frequently observed in both groups (p=0.207). There were no differences in in-hospital and post-hospitalisation mortality between recurrent and first-episode IE. In patients with recurrent IE, in-hospital mortality was higher in IVDU patients. Independent predictors of poorer in-hospital and 1-year outcome, including the occurrence of cardiogenic and septic shock, valvular disease severity and failure to undertake surgery when indicated, were similar for recurrent and first-episode IE. Conclusions In-hospital and 1-year mortality was similar in patients with recurrent and first-episode IE who shared similar predictors of poor outcome.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1729 - 1736"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49278776","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 : 2022-05-31DOI: 10.1136/heartjnl-2022-321136
R. Graham
Spontaneous coronary artery dissection (SCAD) is an infrequent but increasingly recognised cause of acute coronary syndrome (ACS) that predominantly affects relatively young women aged 45–52 years and may even occur in association with pregnancy, where it is the most common cause of a myocardial infarction. 2 In contrast to ACS due to atherosclerotic disease, SCAD sufferers have few traditional risk factors apart from hypertension, and the pathophysiology involves impaired coronary flow, not due to plaque rupture, plaque erosion or thrombus formation associated with a calcific nodule, as is the case for atherosclerotic disease, but to the spontaneous formation of an intramural haematoma (IMH) that causes dissection of the vessel wall medial layer. The IHM is likely due to vasa vasorum rupture with or without an intimal tear. As the IMH expands, it compresses the ipsilateral coronary artery wall against the contralateral wall, thereby occluding the coronary lumen and results in ischaemia or infarction of the subtended myocardium. While much has been learnt about the clinical presentation and sequelae of SCAD from studies of retrospective and ambispective registries, metaanalyses and prospective cohorts, major gaps in our understanding of disease mechanisms, management and outcomes persist, with little prospective data from large cohorts and lack of data from randomised control studies. GarciaGuimaraes and colleagues report on the treatment and clinical outcomes of SCAD determined in a cohort of 389 patients assembled from The Spanish Registry on SCAD involving subjects from 34 hospitals. Although the study uses a nonrandomised observational design, particular strengths are its prospective nature, the reasonably large size of the cohort assembled, its careful documentation of SCAD diagnosis by a central angiography reading group and the use of an independent clinical events committee to evaluate adverse outcomes. Moreover, although the study has limitations, as duly acknowledged by the authors, and sheds little new light on the optimal management of SCAD, it does yield important new hypothesisgenerating findings that warranted confirmation in future controlled studies. The study confirms that for those patients who survive to hospital admission, the overall prognosis is favourable, with a survival at discharge of 98%, and 6% suffering a major inhospital adverse cardiovascular event (MAE), mainly driven by reinfarction or unplanned revascularisation and 13% developing a major adverse cardiovascular or cerebrovascular event (MACCE) over a median followup of 2 years. Of course, the outcomes of SCAD sufferers prior to hospitalisation remains unknown, and undoubtedly, some succumb to the disorder. Although the inhospital outcomes reported by GarciaGuimaraes et al are confirmatory, if not better than those reported by others, the MAEs and MACCEs reported did not include the considerable psychosocial burden associated with SCAD, including insomnia, anxiet
{"title":"Adverse events after spontaneous coronary artery dissection","authors":"R. Graham","doi":"10.1136/heartjnl-2022-321136","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321136","url":null,"abstract":"Spontaneous coronary artery dissection (SCAD) is an infrequent but increasingly recognised cause of acute coronary syndrome (ACS) that predominantly affects relatively young women aged 45–52 years and may even occur in association with pregnancy, where it is the most common cause of a myocardial infarction. 2 In contrast to ACS due to atherosclerotic disease, SCAD sufferers have few traditional risk factors apart from hypertension, and the pathophysiology involves impaired coronary flow, not due to plaque rupture, plaque erosion or thrombus formation associated with a calcific nodule, as is the case for atherosclerotic disease, but to the spontaneous formation of an intramural haematoma (IMH) that causes dissection of the vessel wall medial layer. The IHM is likely due to vasa vasorum rupture with or without an intimal tear. As the IMH expands, it compresses the ipsilateral coronary artery wall against the contralateral wall, thereby occluding the coronary lumen and results in ischaemia or infarction of the subtended myocardium. While much has been learnt about the clinical presentation and sequelae of SCAD from studies of retrospective and ambispective registries, metaanalyses and prospective cohorts, major gaps in our understanding of disease mechanisms, management and outcomes persist, with little prospective data from large cohorts and lack of data from randomised control studies. GarciaGuimaraes and colleagues report on the treatment and clinical outcomes of SCAD determined in a cohort of 389 patients assembled from The Spanish Registry on SCAD involving subjects from 34 hospitals. Although the study uses a nonrandomised observational design, particular strengths are its prospective nature, the reasonably large size of the cohort assembled, its careful documentation of SCAD diagnosis by a central angiography reading group and the use of an independent clinical events committee to evaluate adverse outcomes. Moreover, although the study has limitations, as duly acknowledged by the authors, and sheds little new light on the optimal management of SCAD, it does yield important new hypothesisgenerating findings that warranted confirmation in future controlled studies. The study confirms that for those patients who survive to hospital admission, the overall prognosis is favourable, with a survival at discharge of 98%, and 6% suffering a major inhospital adverse cardiovascular event (MAE), mainly driven by reinfarction or unplanned revascularisation and 13% developing a major adverse cardiovascular or cerebrovascular event (MACCE) over a median followup of 2 years. Of course, the outcomes of SCAD sufferers prior to hospitalisation remains unknown, and undoubtedly, some succumb to the disorder. Although the inhospital outcomes reported by GarciaGuimaraes et al are confirmatory, if not better than those reported by others, the MAEs and MACCEs reported did not include the considerable psychosocial burden associated with SCAD, including insomnia, anxiet","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1506 - 1507"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46720459","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 : 2022-05-30DOI: 10.1136/heartjnl-2022-321009
E. Hulten, V. Murthy
Kelion et 1 report a cross- sectional study of the incidence of non- cardiac incidental findings on 4340 clinically indicated coronary CT angiography (CCTA). The first and most significant finding is that 15.8% of CCTA examinations contained an incidental finding, although 23.6% were previously known (12.1% newly recognised incidental findings). A large proportion of these findings, 43%, were pulmonary nodules or cysts of unclear clinical significance. While these incidentals would not otherwise have been diag-nosed by screening criteria, their identification often does impose a burden on patients and medical systems without prognostic benefit. Second, most incidentals, but not all, could be identified on a cardiac field of view (FOV) image, without a need for a wide FOV reconstruction as per routine at many centres. The authors suggest this finding could support a rationale to more expeditiously evaluate only the cardiac FOV dataset in resource- limited settings, given the added time and cost burden of requiring a radiologist to review the full FOV scan for incidentals. Currently, as Kelion et al have noted, the minimum recommendation evaluate the cardiac Society Cardiovascular 1 4 could be detected on limited cardiac FOV vs on wide FOV
{"title":"Thinking outside the box: clinical and economic implications of extracardiac findings on cardiac computed tomography angiography","authors":"E. Hulten, V. Murthy","doi":"10.1136/heartjnl-2022-321009","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321009","url":null,"abstract":"Kelion et 1 report a cross- sectional study of the incidence of non- cardiac incidental findings on 4340 clinically indicated coronary CT angiography (CCTA). The first and most significant finding is that 15.8% of CCTA examinations contained an incidental finding, although 23.6% were previously known (12.1% newly recognised incidental findings). A large proportion of these findings, 43%, were pulmonary nodules or cysts of unclear clinical significance. While these incidentals would not otherwise have been diag-nosed by screening criteria, their identification often does impose a burden on patients and medical systems without prognostic benefit. Second, most incidentals, but not all, could be identified on a cardiac field of view (FOV) image, without a need for a wide FOV reconstruction as per routine at many centres. The authors suggest this finding could support a rationale to more expeditiously evaluate only the cardiac FOV dataset in resource- limited settings, given the added time and cost burden of requiring a radiologist to review the full FOV scan for incidentals. Currently, as Kelion et al have noted, the minimum recommendation evaluate the cardiac Society Cardiovascular 1 4 could be detected on limited cardiac FOV vs on wide FOV","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1426 - 1427"},"PeriodicalIF":0.0,"publicationDate":"2022-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48906950","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 : 2022-05-25DOI: 10.1136/heartjnl-2022-321087
A. Barton, M. Dweck
Aortic stenosis (AS) is characterised both by progressive valve narrowing and the remodelling response of the left ventricle (LV) that occurs secondary to an increased afterload. The latter is of particular importance when considering the development of patient symptoms, adverse clinical events and the need for aortic valve replacement (AVR). The hypertrophic response of the left ventricle is protective for many years, even decades, yet with time it decompensates and patients transition to heart failure. Current wisdom is that valve replacement should be performed in patients with severe stenosis just as that decompensation is starting to occur. Most commonly we use symptom development as our barometer of developing myocardial ill health, however there is increasing interest in more objective markers of LV dysfunction with which to optimise the timing of AVR. These include imaging markers of myocardial fibrosis and early systolic dysfunction as well as serum biomarkers such as highsensitivity troponin and Nterminalprobeta natriuretic peptide (NTproBNP)). 6 It is on this background that Dr Tan and colleagues report a multibiomarker study in 173 patients (55% male, age 69±11 years) with moderatetosevere AS, preserved LV function and New York Heart Association (NYHA) class III symptoms. A range of widely used (highsensitivity troponin T, NTproBNP) and novel (growth differentiation factor, suppression of tumorigenicity2, midregional proadrenomedullin (MRproADM), and MRproatrial natriuretic peptide) biomarkers were obtained from each participant, who were then followed up for a median of 2.7 years. The primary outcome was a composite of allcause mortality, progression to NYHA class IIIIV, and heart failure hospitalisation with the secondary outcome also incorporating syncope and acute coronary syndromes. Impressively, all but one participant had followup data available until either (1) aortic valve replacement was performed, (2) the first outcome of interest was reached, or (3) the date of final followup in those without events. Fiftynine participants fulfilled criteria for the primary outcome (34%) and 66 the secondary outcome (38%). Thirtyfour patients died (20%) with causes being cardiovascular (n=18), respiratory (n=4), sepsis (n=1) and unknown (n=15). There were additionally 28 (16%) heart failure hospitalisations, 10 (6%) syncopal events, 22 (13%) episodes of the acute coronary syndrome and 37 (21%) episodes of symtom progression to NYHA class IIIIV. Across all outcomes, MRproADM emerged as the biomarker with the best prognostic potential, being associated with HRs of 11 and 13 for the primary and secondary outcomes, respectively. The authors also looked at combining multiple biomarkers. Although the strongest dualbiomarker combination was NTproBNP combined with MRproADM, MRproADM remained stronger alone than in any combination. Receiver operating characteristic curve analysis suggested a cutoff level of 0.645 nmol/L was optimal for prediction o
{"title":"Mid-regional pro-adrenomedullin: a new tool in prognosticating asymptomatic severe aortic stenosis?","authors":"A. Barton, M. Dweck","doi":"10.1136/heartjnl-2022-321087","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321087","url":null,"abstract":"Aortic stenosis (AS) is characterised both by progressive valve narrowing and the remodelling response of the left ventricle (LV) that occurs secondary to an increased afterload. The latter is of particular importance when considering the development of patient symptoms, adverse clinical events and the need for aortic valve replacement (AVR). The hypertrophic response of the left ventricle is protective for many years, even decades, yet with time it decompensates and patients transition to heart failure. Current wisdom is that valve replacement should be performed in patients with severe stenosis just as that decompensation is starting to occur. Most commonly we use symptom development as our barometer of developing myocardial ill health, however there is increasing interest in more objective markers of LV dysfunction with which to optimise the timing of AVR. These include imaging markers of myocardial fibrosis and early systolic dysfunction as well as serum biomarkers such as highsensitivity troponin and Nterminalprobeta natriuretic peptide (NTproBNP)). 6 It is on this background that Dr Tan and colleagues report a multibiomarker study in 173 patients (55% male, age 69±11 years) with moderatetosevere AS, preserved LV function and New York Heart Association (NYHA) class III symptoms. A range of widely used (highsensitivity troponin T, NTproBNP) and novel (growth differentiation factor, suppression of tumorigenicity2, midregional proadrenomedullin (MRproADM), and MRproatrial natriuretic peptide) biomarkers were obtained from each participant, who were then followed up for a median of 2.7 years. The primary outcome was a composite of allcause mortality, progression to NYHA class IIIIV, and heart failure hospitalisation with the secondary outcome also incorporating syncope and acute coronary syndromes. Impressively, all but one participant had followup data available until either (1) aortic valve replacement was performed, (2) the first outcome of interest was reached, or (3) the date of final followup in those without events. Fiftynine participants fulfilled criteria for the primary outcome (34%) and 66 the secondary outcome (38%). Thirtyfour patients died (20%) with causes being cardiovascular (n=18), respiratory (n=4), sepsis (n=1) and unknown (n=15). There were additionally 28 (16%) heart failure hospitalisations, 10 (6%) syncopal events, 22 (13%) episodes of the acute coronary syndrome and 37 (21%) episodes of symtom progression to NYHA class IIIIV. Across all outcomes, MRproADM emerged as the biomarker with the best prognostic potential, being associated with HRs of 11 and 13 for the primary and secondary outcomes, respectively. The authors also looked at combining multiple biomarkers. Although the strongest dualbiomarker combination was NTproBNP combined with MRproADM, MRproADM remained stronger alone than in any combination. Receiver operating characteristic curve analysis suggested a cutoff level of 0.645 nmol/L was optimal for prediction o","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1255 - 1256"},"PeriodicalIF":0.0,"publicationDate":"2022-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45445268","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 : 2022-05-25DOI: 10.1136/heartjnl-2022-320910
Akhmetzhan Galimzhanov, Yersyn Sabitov, Erhan Tenekecioglu, Han Naung Tun, Mirvat Alasnag, Mamas A Mamas
Objectives: The nature of the relationship between baseline platelet count and clinical outcomes following percutaneous coronary intervention (PCI) is unclear. We undertook dose-response and pairwise meta-analyses to better describe the prognostic value of the initial platelet count and clinical endpoints in patients after PCI.
Methods: A search of PubMed, Scopus and Web of Science (up to 9 October 2021) was performed to identify studies that evaluated the association between platelet count and clinical outcomes following PCI. The primary outcomes of interest were all-cause mortality, major adverse cardiovascular events (MACE) and major bleeding. We performed random-effects pairwise and one-stage dose-response meta-analyses by calculating HRs and 95% CIs.
Results: The meta-analysis included 19 studies with 217 459 patients. We report a J-shaped relationship between baseline thrombocyte counts and all-cause death, MACE and major bleeding at follow-up. The risk of haemorrhagic events exceeded the risk of thrombotic events at low platelet counts (<175×109/L), while a predominant ischaemic risk was observed at high platelet counts (>250×109/L). Pairwise meta-analyses revealed a robust link between initial platelet counts and the risk of postdischarge all-cause mortality, major bleeding (for thrombocytopenia: HR 1.39, 95% CI 1.30 to 1.49; HR 1.51, 95% CI 1.15 to 2.00, respectively) and future death from any cause and MACE (thrombocytosis: HR 1.60, 95% CI 1.29 to 1.98; HR 1.47, 95% CI 1.22 to 1.78, respectively).
Conclusion: Low platelet counts were associated with the predominant bleeding risk, while high platelet counts were only associated with the ischaemic events.
Prospero registration number: CRD42021283270.
目的:目前尚不清楚经皮冠状动脉介入治疗(PCI)后基线血小板计数与临床预后之间的关系。我们进行了剂量-反应和两两荟萃分析，以更好地描述PCI术后患者初始血小板计数和临床终点的预后价值。方法检索PubMed, Scopus和Web of Science(截至2021年10月9日)，以确定评估血小板计数与PCI术后临床结果之间关系的研究。主要结局为全因死亡率、主要不良心血管事件(MACE)和大出血。我们通过计算hr和95% ci进行了随机效应两两和一期剂量-反应荟萃分析。结果meta分析纳入19项研究，217459例患者。我们报告了基线血小板计数与随访时全因死亡、MACE和大出血之间的j型关系。在低血小板计数(250×109/L)时，出血事件的风险超过血栓形成事件的风险。两两荟萃分析显示，初始血小板计数与出院后全因死亡、大出血(血小板减少:HR 1.39, 95% CI 1.30 ~ 1.49;HR 1.51, 95% CI分别为1.15至2.00)和未来因任何原因死亡和MACE(血小板增多:HR 1.60, 95% CI 1.29至1.98;HR 1.47, 95% CI 1.22 ~ 1.78)。结论血小板计数低与主要出血风险相关，而血小板计数高仅与缺血性事件相关。普洛斯彼罗注册号CRD42021283270。
{"title":"Baseline platelet count in percutaneous coronary intervention: a dose-response meta-analysis.","authors":"Akhmetzhan Galimzhanov, Yersyn Sabitov, Erhan Tenekecioglu, Han Naung Tun, Mirvat Alasnag, Mamas A Mamas","doi":"10.1136/heartjnl-2022-320910","DOIUrl":"10.1136/heartjnl-2022-320910","url":null,"abstract":"<p><strong>Objectives: </strong>The nature of the relationship between baseline platelet count and clinical outcomes following percutaneous coronary intervention (PCI) is unclear. We undertook dose-response and pairwise meta-analyses to better describe the prognostic value of the initial platelet count and clinical endpoints in patients after PCI.</p><p><strong>Methods: </strong>A search of PubMed, Scopus and Web of Science (up to 9 October 2021) was performed to identify studies that evaluated the association between platelet count and clinical outcomes following PCI. The primary outcomes of interest were all-cause mortality, major adverse cardiovascular events (MACE) and major bleeding. We performed random-effects pairwise and one-stage dose-response meta-analyses by calculating HRs and 95% CIs.</p><p><strong>Results: </strong>The meta-analysis included 19 studies with 217 459 patients. We report a J-shaped relationship between baseline thrombocyte counts and all-cause death, MACE and major bleeding at follow-up. The risk of haemorrhagic events exceeded the risk of thrombotic events at low platelet counts (<175×10<sup>9</sup>/L), while a predominant ischaemic risk was observed at high platelet counts (>250×10<sup>9</sup>/L). Pairwise meta-analyses revealed a robust link between initial platelet counts and the risk of postdischarge all-cause mortality, major bleeding (for thrombocytopenia: HR 1.39, 95% CI 1.30 to 1.49; HR 1.51, 95% CI 1.15 to 2.00, respectively) and future death from any cause and MACE (thrombocytosis: HR 1.60, 95% CI 1.29 to 1.98; HR 1.47, 95% CI 1.22 to 1.78, respectively).</p><p><strong>Conclusion: </strong>Low platelet counts were associated with the predominant bleeding risk, while high platelet counts were only associated with the ischaemic events.</p><p><strong>Prospero registration number: </strong>CRD42021283270.</p>","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46120096","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 : 2022-05-25DOI: 10.1136/heartjnl-2022-320799
T. Treibel, A. Kelion, Tom E Ingram, R. Archbold, S. Myerson, L. Menezes, G. Morgan-Hughes, R. Schofield, N. Keenan, S. Clarke, Alan Keys, Bruce Keogh, N. Masani, S. Ray, M. Westwood, K. Pearce, C. Colebourn, R. Bull, J. Greenwood, G. Roditi, G. Lloyd
Heart and circulatory diseases affect more than seven million people in the UK. Non-invasive cardiac imaging is a critical element of contemporary cardiology practice. Progressive improvements in technology over the last 20 years have increased diagnostic accuracy in all modalities and led to the incorporation of non-invasive imaging into many standard cardiac clinical care pathways. Cardiac imaging tests are requested by a variety of healthcare practitioners and performed in a range of settings from the most advanced hospitals to local health centres. Imaging is used to detect the presence and consequences of cardiovascular disease, as well as to monitor the response to therapies. The previous UK national imaging strategy statement which brought together all of the non-invasive imaging modalities was published in 2010. The purpose of this document is to collate contemporary standards developed by the modality-specific professional organisations which make up the British Cardiovascular Society Imaging Council, bringing together common and essential recommendations. The development process has been inclusive and iterative. Imaging societies (representing both cardiology and radiology) reviewed and agreed on the initial structure. The final document therefore represents a position, which has been generated inclusively, presents rigorous standards, is applicable to clinical practice and deliverable. This document will be of value to a variety of healthcare professionals including imaging departments, the National Health Service or other organisations, regulatory bodies, commissioners and other purchasers of services, and service users, i.e., patients, and their relatives.
{"title":"United Kingdom standards for non-invasive cardiac imaging: recommendations from the Imaging Council of the British Cardiovascular Society","authors":"T. Treibel, A. Kelion, Tom E Ingram, R. Archbold, S. Myerson, L. Menezes, G. Morgan-Hughes, R. Schofield, N. Keenan, S. Clarke, Alan Keys, Bruce Keogh, N. Masani, S. Ray, M. Westwood, K. Pearce, C. Colebourn, R. Bull, J. Greenwood, G. Roditi, G. Lloyd","doi":"10.1136/heartjnl-2022-320799","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-320799","url":null,"abstract":"Heart and circulatory diseases affect more than seven million people in the UK. Non-invasive cardiac imaging is a critical element of contemporary cardiology practice. Progressive improvements in technology over the last 20 years have increased diagnostic accuracy in all modalities and led to the incorporation of non-invasive imaging into many standard cardiac clinical care pathways. Cardiac imaging tests are requested by a variety of healthcare practitioners and performed in a range of settings from the most advanced hospitals to local health centres. Imaging is used to detect the presence and consequences of cardiovascular disease, as well as to monitor the response to therapies. The previous UK national imaging strategy statement which brought together all of the non-invasive imaging modalities was published in 2010. The purpose of this document is to collate contemporary standards developed by the modality-specific professional organisations which make up the British Cardiovascular Society Imaging Council, bringing together common and essential recommendations. The development process has been inclusive and iterative. Imaging societies (representing both cardiology and radiology) reviewed and agreed on the initial structure. The final document therefore represents a position, which has been generated inclusively, presents rigorous standards, is applicable to clinical practice and deliverable. This document will be of value to a variety of healthcare professionals including imaging departments, the National Health Service or other organisations, regulatory bodies, commissioners and other purchasers of services, and service users, i.e., patients, and their relatives.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"e7 - e7"},"PeriodicalIF":0.0,"publicationDate":"2022-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42190423","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 : 2022-05-25DOI: 10.1136/heartjnl-2021-320716
Ana-Catarina Pinho-Gomes, Sanne Ae Peters, Nata Nambatingué, Cheryl Carcel, Mark Woodward, Amy Vassallo
{"title":"Did the 'Digital Experience' improve women's representation at the European Society of Cardiology congress?","authors":"Ana-Catarina Pinho-Gomes, Sanne Ae Peters, Nata Nambatingué, Cheryl Carcel, Mark Woodward, Amy Vassallo","doi":"10.1136/heartjnl-2021-320716","DOIUrl":"10.1136/heartjnl-2021-320716","url":null,"abstract":"","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"982-985"},"PeriodicalIF":0.0,"publicationDate":"2022-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9132847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48633980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-24DOI: 10.1136/heartjnl-2022-321262
A. Chang, Arooj R. Khan, Kan Liu
To the Editor We have read the article by Silverio et al regarding betablockers reducing allcause mortality in patients with Takotsubo syndrome (TTS). The beneficial effect of betablockers particularly applies to TTS patients with hypertension or cardiogenic shock. While this exciting finding validates an important risk reduction strategy in TTS survivors at longterm followup, Silverio et al’s results also bring up a seemingly paradoxical therapeutic dilemma in TTS patients with cardiogenic shock. Dynamic left ventricular outflow tract (LVOT) obstruction and worsening mitral regurgitation (MR) play important roles in TTSassociated cardiogenic shock. 3 Preceding myocardial structural abnormalities (hypertensive heart disease and basal septal hypertrophy, etc) may exacerbate LVOT obstruction on top of hyperdynamic motion of basal ventricular walls. There is a growing body of evidence that preexisting myocardial pathologies not only increase adverse haemodynamic events during TTS episodes but also are associated with persistent postTTS diastolic dysfunction and adverse outcomes. 4 5 This signifies the presence of certain specific conditions in some patients with TTS that warrants particular therapeutic strategies for longterm management and secondary prevention. A recent subset analysis of the DOREMI trial showed an outcome improvement in patients with cardiogenic shock who presented with betablockers on admission. Silverio et al’s results further highlight the possible prognostic benefits of early betablockade in TTS patients with cardiogenic shock. Betablockers are traditionally contraindicated in cardiogenic shock. Paradoxically, patients with TTS expected to benefit the most from early β-blockade are not expected to ‘tolerate’ this medication due to concern for worsening haemodynamic instability. In realworld practice, this may also result in an extended medication gap from the immediate hospitalisation period until outpatient followup visits, potentially depriving patients with TTS of the prognostic benefit from appropriate pharmacotherapy in the critical therapeutic window. Uncovering the unique pathophysiology underlying TTS may help solidify timely and effective therapeutic strategies. Brain natriuretic peptide (BNP) release in patients with TTS is usually more prominent than that in patients with acute myocardial infarction. Other than being a prognostic parameter, BNP release also causes natriuresis, vasodilatation and inhibition of the reninaldosterone system, which decreases mean arterial pressure and pulmonary capillary wedge pressure. Natriuresis, when combined with diuresis, may cause patients with TTS to become preload sensitive, precipitating hypotension and reflex tachycardia, resulting in ‘cardiogenic’ shock. In addition, a significant ventricular dilation during TTS episode easily leads to an assumption of pump failure and volume overload. Strict volume restriction or overdiuresis can cause inappropriately low ventricular preload
{"title":"Correspondence on 'Beta-blockers are associated with better long-term survival in patients with Takotsubo syndrome’ by Silverio et al","authors":"A. Chang, Arooj R. Khan, Kan Liu","doi":"10.1136/heartjnl-2022-321262","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321262","url":null,"abstract":"To the Editor We have read the article by Silverio et al regarding betablockers reducing allcause mortality in patients with Takotsubo syndrome (TTS). The beneficial effect of betablockers particularly applies to TTS patients with hypertension or cardiogenic shock. While this exciting finding validates an important risk reduction strategy in TTS survivors at longterm followup, Silverio et al’s results also bring up a seemingly paradoxical therapeutic dilemma in TTS patients with cardiogenic shock. Dynamic left ventricular outflow tract (LVOT) obstruction and worsening mitral regurgitation (MR) play important roles in TTSassociated cardiogenic shock. 3 Preceding myocardial structural abnormalities (hypertensive heart disease and basal septal hypertrophy, etc) may exacerbate LVOT obstruction on top of hyperdynamic motion of basal ventricular walls. There is a growing body of evidence that preexisting myocardial pathologies not only increase adverse haemodynamic events during TTS episodes but also are associated with persistent postTTS diastolic dysfunction and adverse outcomes. 4 5 This signifies the presence of certain specific conditions in some patients with TTS that warrants particular therapeutic strategies for longterm management and secondary prevention. A recent subset analysis of the DOREMI trial showed an outcome improvement in patients with cardiogenic shock who presented with betablockers on admission. Silverio et al’s results further highlight the possible prognostic benefits of early betablockade in TTS patients with cardiogenic shock. Betablockers are traditionally contraindicated in cardiogenic shock. Paradoxically, patients with TTS expected to benefit the most from early β-blockade are not expected to ‘tolerate’ this medication due to concern for worsening haemodynamic instability. In realworld practice, this may also result in an extended medication gap from the immediate hospitalisation period until outpatient followup visits, potentially depriving patients with TTS of the prognostic benefit from appropriate pharmacotherapy in the critical therapeutic window. Uncovering the unique pathophysiology underlying TTS may help solidify timely and effective therapeutic strategies. Brain natriuretic peptide (BNP) release in patients with TTS is usually more prominent than that in patients with acute myocardial infarction. Other than being a prognostic parameter, BNP release also causes natriuresis, vasodilatation and inhibition of the reninaldosterone system, which decreases mean arterial pressure and pulmonary capillary wedge pressure. Natriuresis, when combined with diuresis, may cause patients with TTS to become preload sensitive, precipitating hypotension and reflex tachycardia, resulting in ‘cardiogenic’ shock. In addition, a significant ventricular dilation during TTS episode easily leads to an assumption of pump failure and volume overload. Strict volume restriction or overdiuresis can cause inappropriately low ventricular preload","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1243 - 1244"},"PeriodicalIF":0.0,"publicationDate":"2022-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44185443","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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