Pub Date : 2022-05-24DOI: 10.1136/heartjnl-2022-321263
A. Silverio, M. Bellino, G. Galasso, E. Bossone, R. Citro
The Authors’ reply We appreciate the interest of Dr Chang and Dr Liu in our study. Cardiogenic shock (CS) complicates the inhospital course of patients with takotsubo syndrome (TTS) in 6%–20% of cases and is the main cause of inhospital mortality. Treatment of CS in TTS is a clinical challenge and, due to the complexity of investigating this subject in dedicated randomised controlled trials, current evidence is limited to case reports or retrospective observational studies. The use of catecholamines in TTS complicated by CS is still debated since the administration of exogenous catecholamines might reexacerbate the acute phase and increase the risk of inhospital adverse events. In this scenario, previous case series have suggested the use of the Ca sensitiser levosimendan as a safe and feasible nonadrenergic alternative to common inotropic agents in TTS. Owing to the key role of catecholamine overstimulation in TTS pathophysiology, the use of betablockers has been proposed to mitigate the sympathetic drive and the effects of further catecholamine surges during the acute phase. In a monkey model of epinephrineinduced TTS, metoprolol improved left ventricular dysfunction, diminished the catecholamineinduced cardiomyocytolysis and modified the expression of heart failurerelated genes. However, in a recent propensity score matching analysis including 2110 Japanese patients with TTS, the early use of betablockers (started on hospitalisation day 1 or 2) did not influence patient 30day mortality. One interpretation of these conflicting results may be that the expected benefit of betablockers during the acute phase depends on the correct identification of the patient most likely to benefit. In TTS scenario, the early identification of patients at high risk of developing CS or with initial signs of haemodynamic instability constitutes the first step of an individualised patienttailored therapy. In a study from the INTERTAK Registry including 2078 patients with TTS, 198 (9.5%) developed CS. Some parameters easily detectable on admission including apical TTS, physical stress, lower left ventricular ejection fraction, diabetes mellitus and atrial fibrillation were associated with the risk of CS, hence emphasising their early detection for the identification of patients more prone to develop CS. We concur with Dr Chang and Dr Liu that betablockers should be considered in all patients after clinical stabilisation and before discharge, even in those who did not tolerate their early use. This certainly includes patients who developed CS during the acute phase, who have a significantly higher risk of developing adverse events compared with those without CS over the long term. 7 In our study, the prescription of betablockers at discharge was associated with a lower risk of mortality at longterm followup, particularly in patients with TTS who developed CS during the hospitalisation. This finding suggests that these patients may constitute a particular TTS phenotype
{"title":"Response to: Correspondence on ‘Beta-blockers are associated with better long-term survival in patients with Takotsubo syndrome’ by Chang et al","authors":"A. Silverio, M. Bellino, G. Galasso, E. Bossone, R. Citro","doi":"10.1136/heartjnl-2022-321263","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321263","url":null,"abstract":"The Authors’ reply We appreciate the interest of Dr Chang and Dr Liu in our study. Cardiogenic shock (CS) complicates the inhospital course of patients with takotsubo syndrome (TTS) in 6%–20% of cases and is the main cause of inhospital mortality. Treatment of CS in TTS is a clinical challenge and, due to the complexity of investigating this subject in dedicated randomised controlled trials, current evidence is limited to case reports or retrospective observational studies. The use of catecholamines in TTS complicated by CS is still debated since the administration of exogenous catecholamines might reexacerbate the acute phase and increase the risk of inhospital adverse events. In this scenario, previous case series have suggested the use of the Ca sensitiser levosimendan as a safe and feasible nonadrenergic alternative to common inotropic agents in TTS. Owing to the key role of catecholamine overstimulation in TTS pathophysiology, the use of betablockers has been proposed to mitigate the sympathetic drive and the effects of further catecholamine surges during the acute phase. In a monkey model of epinephrineinduced TTS, metoprolol improved left ventricular dysfunction, diminished the catecholamineinduced cardiomyocytolysis and modified the expression of heart failurerelated genes. However, in a recent propensity score matching analysis including 2110 Japanese patients with TTS, the early use of betablockers (started on hospitalisation day 1 or 2) did not influence patient 30day mortality. One interpretation of these conflicting results may be that the expected benefit of betablockers during the acute phase depends on the correct identification of the patient most likely to benefit. In TTS scenario, the early identification of patients at high risk of developing CS or with initial signs of haemodynamic instability constitutes the first step of an individualised patienttailored therapy. In a study from the INTERTAK Registry including 2078 patients with TTS, 198 (9.5%) developed CS. Some parameters easily detectable on admission including apical TTS, physical stress, lower left ventricular ejection fraction, diabetes mellitus and atrial fibrillation were associated with the risk of CS, hence emphasising their early detection for the identification of patients more prone to develop CS. We concur with Dr Chang and Dr Liu that betablockers should be considered in all patients after clinical stabilisation and before discharge, even in those who did not tolerate their early use. This certainly includes patients who developed CS during the acute phase, who have a significantly higher risk of developing adverse events compared with those without CS over the long term. 7 In our study, the prescription of betablockers at discharge was associated with a lower risk of mortality at longterm followup, particularly in patients with TTS who developed CS during the hospitalisation. This finding suggests that these patients may constitute a particular TTS phenotype","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1244 - 1245"},"PeriodicalIF":0.0,"publicationDate":"2022-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43713689","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 : 2022-05-24DOI: 10.1136/heartjnl-2022-321223
Matthew C Langston, Chad. J. Zack, E. Fender
Sterile vegetations of the cardiac valves were first identified in 1888 by Zeigler, with case reports described eponymously in 1924 by Libman and Sacks. 2 These and subsequent early accounts identified an association between noninfectious endocarditis and a variety of diseases, specifically malignancy and rheumatological conditions such as systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (AAS). Autopsy cases predominated the early literature; however, after the advent of echocardiography, many case series relied on noninvasive diagnosis (table 1). 4 These studies found a strong association with cancers, with a higher prevalence and greater mortality in patients with metastatic disease. Up to 31 per cent of cases are in fact culturenegative endocarditis rather than nonbacterial thrombotic endocarditis (NBTE). Therefore, a diagnosis of NBTE requires obtaining extended blood cultures to ensure infection is fully excluded. Currently, the diagnosis remains challenging as there are no pathognomonic echocardiographic or clinical features, and because the disease is associated with a variety of concomitant disorders. In Heart, QuinteroMartinez and colleagues provide an update on the epidemiology and conditions associated with NBTE. This singlecentre retrospective analysis included 48 patients defined by specialist consensus as having NBTE following an extensive echocardiographic and microbiological investigation. The study population was predominantly female (75%) with a median age of 60 years. Transoesophageal echocardiography (TOE) was the preferred initial imaging technique and was completed in 91.7% of the study population, with 54.2% of patients also undergoing transthoracic echocardiographic (TTE) imaging. Associated clinical conditions including connective tissue diseases (37.5%) and malignancies (52.1%) were defined. The authors observed many patients had echocardiographic evidence of a vegetation (85.4%) and/or valve thickening (89.6%) resulting in moderate to severe regurgitation in 54.2%. The mitral valve was most frequently affected (mitral vegetation in 54.2% and thickening in 70.8%), followed by the aortic valve (aortic vegetation in 41.7% and thickening in 56.3%). Twenty seven per cent of patients had evidence of multivalvular involvement. Based on their observation that TOE had superior diagnostic sensitivity when compared with TTE, the authors propose a diagnostic pathway which emphasises the role of TOE. The authors found that 79% of subjects suffered an embolic event (ischaemic stroke, peripheral ischaemic event, transient ischaemic attack or any combination thereof). This is in line with, if not increased, from similar postmortem reports. Anticoagulation was initiated in 91.7% of the study population, most commonly with low molecular weight heparin (45.8%) or warfarin (39.6%). Overall mortality was 33% at 1 year, which is unsurprising considering the strong association of NBTE with malignancy, particularly lun
{"title":"Non-bacterial thrombotic endocarditis: manifestations and diagnosis in the age of echocardiography","authors":"Matthew C Langston, Chad. J. Zack, E. Fender","doi":"10.1136/heartjnl-2022-321223","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321223","url":null,"abstract":"Sterile vegetations of the cardiac valves were first identified in 1888 by Zeigler, with case reports described eponymously in 1924 by Libman and Sacks. 2 These and subsequent early accounts identified an association between noninfectious endocarditis and a variety of diseases, specifically malignancy and rheumatological conditions such as systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (AAS). Autopsy cases predominated the early literature; however, after the advent of echocardiography, many case series relied on noninvasive diagnosis (table 1). 4 These studies found a strong association with cancers, with a higher prevalence and greater mortality in patients with metastatic disease. Up to 31 per cent of cases are in fact culturenegative endocarditis rather than nonbacterial thrombotic endocarditis (NBTE). Therefore, a diagnosis of NBTE requires obtaining extended blood cultures to ensure infection is fully excluded. Currently, the diagnosis remains challenging as there are no pathognomonic echocardiographic or clinical features, and because the disease is associated with a variety of concomitant disorders. In Heart, QuinteroMartinez and colleagues provide an update on the epidemiology and conditions associated with NBTE. This singlecentre retrospective analysis included 48 patients defined by specialist consensus as having NBTE following an extensive echocardiographic and microbiological investigation. The study population was predominantly female (75%) with a median age of 60 years. Transoesophageal echocardiography (TOE) was the preferred initial imaging technique and was completed in 91.7% of the study population, with 54.2% of patients also undergoing transthoracic echocardiographic (TTE) imaging. Associated clinical conditions including connective tissue diseases (37.5%) and malignancies (52.1%) were defined. The authors observed many patients had echocardiographic evidence of a vegetation (85.4%) and/or valve thickening (89.6%) resulting in moderate to severe regurgitation in 54.2%. The mitral valve was most frequently affected (mitral vegetation in 54.2% and thickening in 70.8%), followed by the aortic valve (aortic vegetation in 41.7% and thickening in 56.3%). Twenty seven per cent of patients had evidence of multivalvular involvement. Based on their observation that TOE had superior diagnostic sensitivity when compared with TTE, the authors propose a diagnostic pathway which emphasises the role of TOE. The authors found that 79% of subjects suffered an embolic event (ischaemic stroke, peripheral ischaemic event, transient ischaemic attack or any combination thereof). This is in line with, if not increased, from similar postmortem reports. Anticoagulation was initiated in 91.7% of the study population, most commonly with low molecular weight heparin (45.8%) or warfarin (39.6%). Overall mortality was 33% at 1 year, which is unsurprising considering the strong association of NBTE with malignancy, particularly lun","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1590 - 1591"},"PeriodicalIF":0.0,"publicationDate":"2022-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44476671","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 : 2022-05-23DOI: 10.1136/heartjnl-2021-320686
J. Devgun, Tharwat Nasser, James Lee
16 Elze MC, Gregson J, Baber U, et al. Comparison of propensity score methods and covariate adjustment: evaluation in 4 cardiovascular studies. J Am Coll Cardiol 2017;69:345–57. 17 Cases in the UK | coronavirus in the UK. Available: https://coronavirus.data.gov.uk/ details/cases [Accessed 30 Jun 2021]. 18 Dofferhoff ASM, Piscaer I, Schurgers LJ. Reduced vitamin K status as a potentially modifiable risk factor of severe coronavirus disease 2019. Clin Infect Dis 2020. 19 NICE. Atrial fibrillation: management | guidance | NICE, 2014. Available: https://www. nice.org.uk/guidance/cg180 [Accessed 22 Jun 2021]. 20 NHS Digital. QOF 201920 | NHS digital. Available: https://qof.digital.nhs.uk/ [Accessed 30 Jun 2021]. 21 Curtis HJ, MacKenna B, Walker AJ. OpenSAFELY: impact of national guidance on switching from warfarin to direct oral anticoagulants (DOACs) in early phase of COVID19 pandemic in England. medRxiv 2020:2020.12.03.20243535. 22 NHS England. Specialty guides for patient management during the coronavirus pandemic Clinical guide for the management of anticoagulant services during the coronavirus pandemic, 2020. Available: https://www.england.nhs.uk/coronavirus/ publication/specialty-guides/%0Ahttps://www.england.nhs.uk/coronavirus/wpcontent/uploads/sites/52/2020/03/C0077-Specialty-guide_Anticoagulant-servicesand-coronavirus-v1-31-March.pdf [Accessed 30 Jun 2021]. 23 Dalgaard F, Mulder H, Wojdyla DM, et al. Patients with atrial fibrillation taking nonsteroidal antiinflammatory drugs and oral anticoagulants in the ARISTOTLE trial. Circulation 2020;141:10–20. 24 Søgaard KK, HorváthPuhó E, Grønbaek H, et al. Risk of venous thromboembolism in patients with liver disease: a nationwide populationbased casecontrol study. Am J Gastroenterol 2009;104:96–101. 25 Qamar A, Vaduganathan M, Greenberger NJ, et al. Oral anticoagulation in patients with liver disease. J Am Coll Cardiol 2018;71:2162–75. 26 Lee SR, Lee HJ, Choi EK, et al. Direct oral anticoagulants in patients with atrial fibrillation and liver disease. J Am Coll Cardiol 2019;73:3295–308. 27 Donzé J, Clair C, Hug B, et al. Risk of falls and major bleeds in patients on oral anticoagulation therapy. Am J Med 2012;125:773–8. 28 Williamson EJ, Walker AJ, Bhaskaran K, et al. Factors associated with COVID19related death using OpenSAFELY. Nature 2020;584:430–6. 29 Marmot M, Bell R. Fair society, healthy lives. Public Health 2012;126 Suppl 1:S4. 30 Fauvel C, Weizman O, Trimaille A, et al. Pulmonary embolism in COVID19 patients: a French multicentre cohort study. Eur Heart J 2020;41:3058–68.
{"title":"Pulmonary vein Doppler flow in a patient with fatigue and dyspnoea","authors":"J. Devgun, Tharwat Nasser, James Lee","doi":"10.1136/heartjnl-2021-320686","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-320686","url":null,"abstract":"16 Elze MC, Gregson J, Baber U, et al. Comparison of propensity score methods and covariate adjustment: evaluation in 4 cardiovascular studies. J Am Coll Cardiol 2017;69:345–57. 17 Cases in the UK | coronavirus in the UK. Available: https://coronavirus.data.gov.uk/ details/cases [Accessed 30 Jun 2021]. 18 Dofferhoff ASM, Piscaer I, Schurgers LJ. Reduced vitamin K status as a potentially modifiable risk factor of severe coronavirus disease 2019. Clin Infect Dis 2020. 19 NICE. Atrial fibrillation: management | guidance | NICE, 2014. Available: https://www. nice.org.uk/guidance/cg180 [Accessed 22 Jun 2021]. 20 NHS Digital. QOF 201920 | NHS digital. Available: https://qof.digital.nhs.uk/ [Accessed 30 Jun 2021]. 21 Curtis HJ, MacKenna B, Walker AJ. OpenSAFELY: impact of national guidance on switching from warfarin to direct oral anticoagulants (DOACs) in early phase of COVID19 pandemic in England. medRxiv 2020:2020.12.03.20243535. 22 NHS England. Specialty guides for patient management during the coronavirus pandemic Clinical guide for the management of anticoagulant services during the coronavirus pandemic, 2020. Available: https://www.england.nhs.uk/coronavirus/ publication/specialty-guides/%0Ahttps://www.england.nhs.uk/coronavirus/wpcontent/uploads/sites/52/2020/03/C0077-Specialty-guide_Anticoagulant-servicesand-coronavirus-v1-31-March.pdf [Accessed 30 Jun 2021]. 23 Dalgaard F, Mulder H, Wojdyla DM, et al. Patients with atrial fibrillation taking nonsteroidal antiinflammatory drugs and oral anticoagulants in the ARISTOTLE trial. Circulation 2020;141:10–20. 24 Søgaard KK, HorváthPuhó E, Grønbaek H, et al. Risk of venous thromboembolism in patients with liver disease: a nationwide populationbased casecontrol study. Am J Gastroenterol 2009;104:96–101. 25 Qamar A, Vaduganathan M, Greenberger NJ, et al. Oral anticoagulation in patients with liver disease. J Am Coll Cardiol 2018;71:2162–75. 26 Lee SR, Lee HJ, Choi EK, et al. Direct oral anticoagulants in patients with atrial fibrillation and liver disease. J Am Coll Cardiol 2019;73:3295–308. 27 Donzé J, Clair C, Hug B, et al. Risk of falls and major bleeds in patients on oral anticoagulation therapy. Am J Med 2012;125:773–8. 28 Williamson EJ, Walker AJ, Bhaskaran K, et al. Factors associated with COVID19related death using OpenSAFELY. Nature 2020;584:430–6. 29 Marmot M, Bell R. Fair society, healthy lives. Public Health 2012;126 Suppl 1:S4. 30 Fauvel C, Weizman O, Trimaille A, et al. Pulmonary embolism in COVID19 patients: a French multicentre cohort study. Eur Heart J 2020;41:3058–68.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"931 - 988"},"PeriodicalIF":0.0,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41731229","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 : 2022-05-23DOI: 10.1136/heartjnl-2022-321278
R. Citro, A. Silverio, M. Bellino, G. Parodi, E. Bossone
To the Editor I enjoyed reading the article by Silverio et al, pertaining to the longterm (median followup of 24.0 months) effects of β-blocker therapy in patients with takotsubo syndrome (TTS). The authors employed a consecutive patient database of 825, studied over a 12year period, mostly female in their early 60s to late 70s from the Takotsubo Italian Network (TIN) registry, about 60% of whom were discharged on β-blockers, while the balance of patients did not receive such therapy, focusing on allcause mortality, TTS recurrence, and cardiac and noncardiac mortality as outcomes. While β-blockers did not influence TTS recurrence or cardiac mortality, they led to a reduction of allcause mortality, particularly for patients with hypertension and those who developed cardiogenic shock during the acute phase of TTS. The results reinforce the current belief that β-blockers do not have a specific effect in patients who have suffered TTS, in terms of prevention of its recurrence; also, it is not surprising that there was a beneficial effect of β-blockers in patients with hypertension and cardiogenic shock, considering the established indications for β-blocker therapy for patients with history of hypertension, coronary artery disease and heart failure. Considering the interest among Italian and other investigators on the effect of ACE inhibitors/ angiotensin receptor blockers, alone or in combination with β-blockers, on mortality and the recurrence of TTS, I would like to ask the authors if they have any information on the above for the patients in the TIN registry, and whether they recommend the use of ACE inhibitors/angiotensin receptor blockers, with or without β-blockers, for patients discharged after an index admission with TTS, as done by others. Also, since the TIN registry constitutes a multicentre (16 Italian hospitals) study of consecutive patients with TTS prospectively collected, fairly representative of the Italian population, it would be of interest to compare the observed prevalence of diabetes mellitus (DM) (11.9%) noted in the TIN registry with the prevalence of DM in the general Italian population, particularly in women in their early 60s to late 70s, considering previous work showing a low prevalence of DM in patients with TTS.
{"title":"Response to: Correspondence on ‘Beta-blockers are associated with better long-term survival in patients with Takotsubo syndrome’ by John E Madias","authors":"R. Citro, A. Silverio, M. Bellino, G. Parodi, E. Bossone","doi":"10.1136/heartjnl-2022-321278","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321278","url":null,"abstract":"To the Editor I enjoyed reading the article by Silverio et al, pertaining to the longterm (median followup of 24.0 months) effects of β-blocker therapy in patients with takotsubo syndrome (TTS). The authors employed a consecutive patient database of 825, studied over a 12year period, mostly female in their early 60s to late 70s from the Takotsubo Italian Network (TIN) registry, about 60% of whom were discharged on β-blockers, while the balance of patients did not receive such therapy, focusing on allcause mortality, TTS recurrence, and cardiac and noncardiac mortality as outcomes. While β-blockers did not influence TTS recurrence or cardiac mortality, they led to a reduction of allcause mortality, particularly for patients with hypertension and those who developed cardiogenic shock during the acute phase of TTS. The results reinforce the current belief that β-blockers do not have a specific effect in patients who have suffered TTS, in terms of prevention of its recurrence; also, it is not surprising that there was a beneficial effect of β-blockers in patients with hypertension and cardiogenic shock, considering the established indications for β-blocker therapy for patients with history of hypertension, coronary artery disease and heart failure. Considering the interest among Italian and other investigators on the effect of ACE inhibitors/ angiotensin receptor blockers, alone or in combination with β-blockers, on mortality and the recurrence of TTS, I would like to ask the authors if they have any information on the above for the patients in the TIN registry, and whether they recommend the use of ACE inhibitors/angiotensin receptor blockers, with or without β-blockers, for patients discharged after an index admission with TTS, as done by others. Also, since the TIN registry constitutes a multicentre (16 Italian hospitals) study of consecutive patients with TTS prospectively collected, fairly representative of the Italian population, it would be of interest to compare the observed prevalence of diabetes mellitus (DM) (11.9%) noted in the TIN registry with the prevalence of DM in the general Italian population, particularly in women in their early 60s to late 70s, considering previous work showing a low prevalence of DM in patients with TTS.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1242 - 1243"},"PeriodicalIF":0.0,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44164136","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 : 2022-05-23DOI: 10.1136/heartjnl-2022-320823
A. Zaidi
{"title":"Response to: Correspondence on “Tetralogy of Fallot: management of residual hemodynamic and electrophysiological abnormalities” by Yalta et al","authors":"A. Zaidi","doi":"10.1136/heartjnl-2022-320823","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-320823","url":null,"abstract":"","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1157 - 1158"},"PeriodicalIF":0.0,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46522147","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 : 2022-05-23DOI: 10.1136/heartjnl-2022-321203
J. Madias
To the Editor I enjoyed reading the article by Silverio et al, pertaining to the longterm (median followup of 24.0 months) effects of β-blocker therapy in patients with takotsubo syndrome (TTS). The authors employed a consecutive patient database of 825, studied over a 12year period, mostly female in their early 60s to late 70s from the Takotsubo Italian Network (TIN) registry, about 60% of whom were discharged on β-blockers, while the balance of patients did not receive such therapy, focusing on allcause mortality, TTS recurrence, and cardiac and noncardiac mortality as outcomes. While β-blockers did not influence TTS recurrence or cardiac mortality, they led to a reduction of allcause mortality, particularly for patients with hypertension and those who developed cardiogenic shock during the acute phase of TTS. The results reinforce the current belief that β-blockers do not have a specific effect in patients who have suffered TTS, in terms of prevention of its recurrence; also, it is not surprising that there was a beneficial effect of β-blockers in patients with hypertension and cardiogenic shock, considering the established indications for β-blocker therapy for patients with history of hypertension, coronary artery disease and heart failure. Considering the interest among Italian and other investigators on the effect of ACE inhibitors/ angiotensin receptor blockers, alone or in combination with β-blockers, on mortality and the recurrence of TTS, I would like to ask the authors if they have any information on the above for the patients in the TIN registry, and whether they recommend the use of ACE inhibitors/angiotensin receptor blockers, with or without β-blockers, for patients discharged after an index admission with TTS, as done by others. Also, since the TIN registry constitutes a multicentre (16 Italian hospitals) study of consecutive patients with TTS prospectively collected, fairly representative of the Italian population, it would be of interest to compare the observed prevalence of diabetes mellitus (DM) (11.9%) noted in the TIN registry with the prevalence of DM in the general Italian population, particularly in women in their early 60s to late 70s, considering previous work showing a low prevalence of DM in patients with TTS.
{"title":"Correspondence on ‘Beta-blockers are associated with better long-term survival in patients with Takotsubo syndrome’ by Silverio et al","authors":"J. Madias","doi":"10.1136/heartjnl-2022-321203","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321203","url":null,"abstract":"To the Editor I enjoyed reading the article by Silverio et al, pertaining to the longterm (median followup of 24.0 months) effects of β-blocker therapy in patients with takotsubo syndrome (TTS). The authors employed a consecutive patient database of 825, studied over a 12year period, mostly female in their early 60s to late 70s from the Takotsubo Italian Network (TIN) registry, about 60% of whom were discharged on β-blockers, while the balance of patients did not receive such therapy, focusing on allcause mortality, TTS recurrence, and cardiac and noncardiac mortality as outcomes. While β-blockers did not influence TTS recurrence or cardiac mortality, they led to a reduction of allcause mortality, particularly for patients with hypertension and those who developed cardiogenic shock during the acute phase of TTS. The results reinforce the current belief that β-blockers do not have a specific effect in patients who have suffered TTS, in terms of prevention of its recurrence; also, it is not surprising that there was a beneficial effect of β-blockers in patients with hypertension and cardiogenic shock, considering the established indications for β-blocker therapy for patients with history of hypertension, coronary artery disease and heart failure. Considering the interest among Italian and other investigators on the effect of ACE inhibitors/ angiotensin receptor blockers, alone or in combination with β-blockers, on mortality and the recurrence of TTS, I would like to ask the authors if they have any information on the above for the patients in the TIN registry, and whether they recommend the use of ACE inhibitors/angiotensin receptor blockers, with or without β-blockers, for patients discharged after an index admission with TTS, as done by others. Also, since the TIN registry constitutes a multicentre (16 Italian hospitals) study of consecutive patients with TTS prospectively collected, fairly representative of the Italian population, it would be of interest to compare the observed prevalence of diabetes mellitus (DM) (11.9%) noted in the TIN registry with the prevalence of DM in the general Italian population, particularly in women in their early 60s to late 70s, considering previous work showing a low prevalence of DM in patients with TTS.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1242 - 1242"},"PeriodicalIF":0.0,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47517497","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 : 2022-05-23DOI: 10.1136/heartjnl-2022-321376
C. Otto
Calcific aortic stenosis (AS) is characterised at the tissue level by inflammation, lipid deposition and calcification of the valve leaflets. Yet, the potential role of dietary calcium supplements in the development or progression of AS is not clear. In this issue of Heart, Kassis and colleagues report the association between dietary calcium supplementation and cardiovascular (CV) outcomes in a retrospective longitudinal study of 2657 patients age 60 years or older with mildtomoderate AS. In the 39% of patients taking calcium supplements, with or without vitamin D supplementation, there was a higher risk of allcause mortality (absolute rate (AR)=43.0/1000 personyears; HR=1.31, 95% CI (1.07 to 1.62); p=0.009), CV mortality (AR=13.7/1000 personyears; HR=2.0, 95% CI (1.31 to 3.07); p=0.001) and aortic valve replacement (AVR) (AR=88.2/1000 personyears; HR=1.48, 95% CI (1.24 to 1.78); p<0.001), compared with those not on calcium supplementation (figure 1). However, there was no association between calcium supplementation and echocardiographic changes in transaortic pressure gradient or valve area. In the accompanying editorial BerglerKlein points out that, compared with calcium supplements, dietary calcium has little influence on serum calcium availability. Importantly, ‘vitamin D supplementation alone remained neutral with respect to AVR and was not linked to any mortality increase in multivariable analyses, so that the assumed beneficial effects concerning osteoporosis and bone metabolism are maintained in patients with AS.’ Hopefully, future osteoporosis studies will focus both on benefits due to improved bone strength and risks related to adverse cardiovascular outcomes (figure 2). For now, ‘In patients with calcific AS and highrisk CV, the present study strongly adds to the evidence that longterm continuous calcium supplementation should be avoided if not mandatory.’ Another important study in this issue of Heart evaluated whether outcomes with
钙化性主动脉瓣狭窄(AS)在组织水平上表现为炎症、脂质沉积和瓣叶钙化。然而，膳食钙补充剂在AS发生或进展中的潜在作用尚不清楚。在这一期《心脏》杂志上，Kassis及其同事报道了一项对2657名60岁及以上轻至中度AS患者进行的回顾性纵向研究中，膳食钙补充与心血管(CV)结局之间的关系。在39%服用钙补充剂的患者中，无论是否补充维生素D，全因死亡率(绝对死亡率(AR)= 40.3 /1000人年;HR=1.31, 95% CI (1.07 ~ 1.62);p=0.009)， CV死亡率(AR=13.7/1000人年;HR=2.0, 95% CI (1.31 ~ 3.07);p=0.001)和主动脉瓣置换术(AVR) (AR=88.2/1000人年;HR=1.48, 95% CI (1.24 ~ 1.78);p<0.001)，与未补钙的患者相比(图1)。然而，补钙与经主动脉压力梯度或瓣膜面积的超声心动图变化之间没有关联。在随后的社论中，BerglerKlein指出，与钙补充剂相比，膳食钙对血清钙利用率的影响很小。重要的是，在多变量分析中，单独补充维生素D对AVR保持中性，与任何死亡率增加无关，因此，假设的有关骨质疏松症和骨代谢的有益作用在AS患者中得以维持。希望未来的骨质疏松症研究能同时关注骨质强度提高带来的益处和与心血管不良后果相关的风险(图2)。目前，“在钙化AS和高风险CV患者中，本研究有力地证明，如果不是强制性的，应避免长期持续补钙。”这期《心脏》杂志上的另一项重要研究评估了
{"title":"Heartbeat: calcium belongs in bones not hearts","authors":"C. Otto","doi":"10.1136/heartjnl-2022-321376","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321376","url":null,"abstract":"Calcific aortic stenosis (AS) is characterised at the tissue level by inflammation, lipid deposition and calcification of the valve leaflets. Yet, the potential role of dietary calcium supplements in the development or progression of AS is not clear. In this issue of Heart, Kassis and colleagues report the association between dietary calcium supplementation and cardiovascular (CV) outcomes in a retrospective longitudinal study of 2657 patients age 60 years or older with mildtomoderate AS. In the 39% of patients taking calcium supplements, with or without vitamin D supplementation, there was a higher risk of allcause mortality (absolute rate (AR)=43.0/1000 personyears; HR=1.31, 95% CI (1.07 to 1.62); p=0.009), CV mortality (AR=13.7/1000 personyears; HR=2.0, 95% CI (1.31 to 3.07); p=0.001) and aortic valve replacement (AVR) (AR=88.2/1000 personyears; HR=1.48, 95% CI (1.24 to 1.78); p<0.001), compared with those not on calcium supplementation (figure 1). However, there was no association between calcium supplementation and echocardiographic changes in transaortic pressure gradient or valve area. In the accompanying editorial BerglerKlein points out that, compared with calcium supplements, dietary calcium has little influence on serum calcium availability. Importantly, ‘vitamin D supplementation alone remained neutral with respect to AVR and was not linked to any mortality increase in multivariable analyses, so that the assumed beneficial effects concerning osteoporosis and bone metabolism are maintained in patients with AS.’ Hopefully, future osteoporosis studies will focus both on benefits due to improved bone strength and risks related to adverse cardiovascular outcomes (figure 2). For now, ‘In patients with calcific AS and highrisk CV, the present study strongly adds to the evidence that longterm continuous calcium supplementation should be avoided if not mandatory.’ Another important study in this issue of Heart evaluated whether outcomes with","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"899 - 901"},"PeriodicalIF":0.0,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46426726","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 : 2022-05-23DOI: 10.1136/heartjnl-2022-321143
M. D'alto, R. Badagliacca
The major determinant of symptoms and outcome in patients with pulmonary arterial hypertension (PAH) is right ventricle (RV) function and its coupling to the pulmonary circulation. To preserve a suffi-cient cardiac output, the RV adapts to increased afterload by increased contrac-tility (homeometric adaptation) and, when this mechanism becomes exhausted, by increased volumes (heterometric adaptation).Recent evidence 1 has shown that PAH progression is characterised by changes in RV dimension and function (increased volumes and decreased ejection frac-tion), even in apparently stable patients, highlighting the importance of RV in determining the prognosis. The study from Goh and colleagues 2 underscores the relevance of RV remodelling in PAH. The authors analysed a large cohort of 505 patients from the ASPIRE (Assessing the Spectrum of Pulmonary hypertension Identified at a REferral centre) registry. Cardiac magnetic resonance allowed to identify four different RV adaptation clusters according to its volume and mass. Patients with a favourable adaptive remodelling (low volume and low mass) had the best prognosis. Interestingly, these patients showed the highest cardiac index, mixed venous oxygen saturation, RV ejection fraction and RV- pulmonary arterial coupling, the lowest mean pulmonary artery pressure and pulmonary vascular resistance (PVR), and the smallest right atrium area. All these prognostic indicators are associated with better RV function. On the contrary, patients with a maladaptive remodelling (high- volume- low- mass) the worst prognosis. study important clin-ical implications.RV reverse remodelling an excellent long- term survival and quality of life, it by For an reverse
{"title":"The importance of right ventricular remodelling in pulmonary arterial hypertension","authors":"M. D'alto, R. Badagliacca","doi":"10.1136/heartjnl-2022-321143","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321143","url":null,"abstract":"The major determinant of symptoms and outcome in patients with pulmonary arterial hypertension (PAH) is right ventricle (RV) function and its coupling to the pulmonary circulation. To preserve a suffi-cient cardiac output, the RV adapts to increased afterload by increased contrac-tility (homeometric adaptation) and, when this mechanism becomes exhausted, by increased volumes (heterometric adaptation).Recent evidence 1 has shown that PAH progression is characterised by changes in RV dimension and function (increased volumes and decreased ejection frac-tion), even in apparently stable patients, highlighting the importance of RV in determining the prognosis. The study from Goh and colleagues 2 underscores the relevance of RV remodelling in PAH. The authors analysed a large cohort of 505 patients from the ASPIRE (Assessing the Spectrum of Pulmonary hypertension Identified at a REferral centre) registry. Cardiac magnetic resonance allowed to identify four different RV adaptation clusters according to its volume and mass. Patients with a favourable adaptive remodelling (low volume and low mass) had the best prognosis. Interestingly, these patients showed the highest cardiac index, mixed venous oxygen saturation, RV ejection fraction and RV- pulmonary arterial coupling, the lowest mean pulmonary artery pressure and pulmonary vascular resistance (PVR), and the smallest right atrium area. All these prognostic indicators are associated with better RV function. On the contrary, patients with a maladaptive remodelling (high- volume- low- mass) the worst prognosis. study important clin-ical implications.RV reverse remodelling an excellent long- term survival and quality of life, it by For an reverse","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1338 - 1339"},"PeriodicalIF":0.0,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42070333","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 : 2022-05-23DOI: 10.1136/heartjnl-2022-320821
K. Yalta, T. Yalta, Cihan Ozturk
To the Editor In clinical practice, tetralogy of Fallot (TOF) has been a specific form of cyanotic congenital heart disease particularly requiring a lifelong followup. The recently published article by Zaidi has focused on residual abnormalities in the setting of repaired tetralogy of Fallot (rTOF). In this context, functional tricuspid regurgitation (TR) and its management might also have important implications in patients with rTOF requiring pulmonary valve replacement (PVR). It is well known that functional TR might potentially follow a progressive course after cardiac surgeries performed for leftsided valvular pathologies with pulmonary hypertension (despite a transient postoperative improvement in TR severity) largely due to the ongoing structural changes of tricuspid annulus. 3 As expected, this most likely occurs in patients with significant degrees of preoperative TR and/or tricuspid annular dilatation potentially mandating concomitant tricuspid and leftsided valve interventions in these patients. 3 These notions 3 might also apply to the setting of rTOF with a significant pulmonary infundibular or valvular pathology (associated with right ventricular (RV) pressure or volume overload) requiring reintervention. In the recently reported largest study comprising 542 subjects with rTOF or pulmonary stenosis requiring PVR, concomitant tricuspid valve intervention (TVI) led to an additional 2.3fold decrease in TR severity without any significant increases in length of hospital stay and early adverse outcomes. The authors particularly suggested concomitant TVI as an efficient and safe option that might further improve TR grade beyond the favourable impact of RV offloading obtained with PVR in isolation. In this context, patients with preoperative significant TR or tricuspid annulus diameter of >40 mm or those with structural leaflet pathologies including leaflet entrapment, leadrelated injury and congenital anomalies have been suggested to be particularly eligible for combined TVI and PVR. Based on the abovementioned notions, functional TR with highrisk features (including increased annulus diameter) might also be labelled as an important residual haemodynamic abnormality usually emerging in association with pulmonary regurgitation and/or infundibular restenosis in patients with rTOF. Importantly, this form of TR might have the potential to hamper RV reverse remodelling, and might even lead to endstage right heart failure (even after successful PVR) potentially mandating TVI at the time of PVR in this specific group of relatively young patients.
{"title":"Correspondence on \"Tetralogy of Fallot: management of residual hemodynamic and electrophysiological abnormalities\" by Zaidi","authors":"K. Yalta, T. Yalta, Cihan Ozturk","doi":"10.1136/heartjnl-2022-320821","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-320821","url":null,"abstract":"To the Editor In clinical practice, tetralogy of Fallot (TOF) has been a specific form of cyanotic congenital heart disease particularly requiring a lifelong followup. The recently published article by Zaidi has focused on residual abnormalities in the setting of repaired tetralogy of Fallot (rTOF). In this context, functional tricuspid regurgitation (TR) and its management might also have important implications in patients with rTOF requiring pulmonary valve replacement (PVR). It is well known that functional TR might potentially follow a progressive course after cardiac surgeries performed for leftsided valvular pathologies with pulmonary hypertension (despite a transient postoperative improvement in TR severity) largely due to the ongoing structural changes of tricuspid annulus. 3 As expected, this most likely occurs in patients with significant degrees of preoperative TR and/or tricuspid annular dilatation potentially mandating concomitant tricuspid and leftsided valve interventions in these patients. 3 These notions 3 might also apply to the setting of rTOF with a significant pulmonary infundibular or valvular pathology (associated with right ventricular (RV) pressure or volume overload) requiring reintervention. In the recently reported largest study comprising 542 subjects with rTOF or pulmonary stenosis requiring PVR, concomitant tricuspid valve intervention (TVI) led to an additional 2.3fold decrease in TR severity without any significant increases in length of hospital stay and early adverse outcomes. The authors particularly suggested concomitant TVI as an efficient and safe option that might further improve TR grade beyond the favourable impact of RV offloading obtained with PVR in isolation. In this context, patients with preoperative significant TR or tricuspid annulus diameter of >40 mm or those with structural leaflet pathologies including leaflet entrapment, leadrelated injury and congenital anomalies have been suggested to be particularly eligible for combined TVI and PVR. Based on the abovementioned notions, functional TR with highrisk features (including increased annulus diameter) might also be labelled as an important residual haemodynamic abnormality usually emerging in association with pulmonary regurgitation and/or infundibular restenosis in patients with rTOF. Importantly, this form of TR might have the potential to hamper RV reverse remodelling, and might even lead to endstage right heart failure (even after successful PVR) potentially mandating TVI at the time of PVR in this specific group of relatively young patients.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1157 - 1157"},"PeriodicalIF":0.0,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46061017","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 : 2022-05-19DOI: 10.1136/heartjnl-2022-321030
Josef Madrigal, Shannon Richardson, Joseph Hadaya, Arjun Verma, Zachary Tran, Yas Sanaiha, Peyman Benharash
Objective: Although kidney transplant (KTx) recipients are at significant risk for cardiovascular disease, outcomes following cardiac operations have been examined in limited series. The present study thus aimed to assess the impact of KTx on in-hospital perioperative outcomes and readmissions in a nationally representative cohort.
Methods: All adults undergoing elective coronary artery bypass grafting, valve repair/replacement or a combination thereof were identified from the 2010-2018 Nationwide Readmissions Database. Patients were stratified by history of KTx. Transplant-capable centres were defined as hospitals performing at least one KTx annually. To perform risk-adjustment in assessing outcomes, multivariable regression models were developed.
Results: Of an estimated 1 407 351 patients included for analysis, 0.2% (n=2849) were KTx recipients. Compared with the general cardiac surgical population, patients with prior KTx experienced higher adjusted odds of in-hospital mortality (adjusted OR (AOR) 2.44, 95% CI 1.72 to 3.47, p<0.001) and perioperative complication (AOR 1.67, 95% CI 1.44 to 1.94, p<0.001). Additionally, KTx was independently associated with greater readmission rates within 30 days (AOR 1.96, 95% CI 1.65 to 2.34, p<0.001) with kidney injury contributing significantly to the burden of rehospitalisation (4.6 vs 1.8%, p=0.005). In a subpopulation comprised of only KTx recipients, treatment at a transplant-capable centre reduced odds of kidney injury with non-transplant hospitals as reference (AOR 0.65, 95% CI 0.43 to 0.98, p=0.037).
Conclusions: Kidney transplant recipients undergoing cardiac operations encounter significant risks compared with the general surgical population. Referral to transplant-capable centres should be explored to improve outcomes and to preserve allograft function in this population.
虽然肾移植(KTx)受者患心血管疾病的风险很大，但心脏手术后的结果已经在有限的系列中进行了研究。因此，本研究旨在评估KTx对全国代表性队列住院围手术期结局和再入院的影响。方法从2010-2018年全国再入院数据库中确定所有接受择期冠状动脉旁路移植术、瓣膜修复/置换术或两者结合的成年人。根据KTx病史对患者进行分层。有移植能力的中心被定义为每年至少进行一次KTx手术的医院。为了在评估结果时进行风险调整，我们开发了多变量回归模型。结果在纳入分析的1 407 351例患者中，0.2% (n=2849)为KTx受体。与一般心脏手术人群相比，既往有KTx的患者有更高的住院死亡率(调整OR (AOR) 2.44, 95% CI 1.72至3.47,p<0.001)和围手术期并发症(AOR 1.67, 95% CI 1.44至1.94,p<0.001)。此外，KTx与30天内更高的再入院率独立相关(AOR 1.96, 95% CI 1.65至2.34,p<0.001)，肾损伤显著增加再入院负担(4.6 vs 1.8%， p=0.005)。在仅由KTx受体组成的亚群中，以非移植医院为参照，在具有移植能力的中心接受治疗降低了肾损伤的几率(AOR 0.65, 95% CI 0.43至0.98,p=0.037)。结论:与普通外科人群相比，接受心脏手术的肾移植受者存在显著的风险。转诊到有移植能力的中心应探讨，以改善结果和保持同种异体移植功能在这一人群。
{"title":"Perioperative outcomes and readmissions following cardiac operations in kidney transplant recipients.","authors":"Josef Madrigal, Shannon Richardson, Joseph Hadaya, Arjun Verma, Zachary Tran, Yas Sanaiha, Peyman Benharash","doi":"10.1136/heartjnl-2022-321030","DOIUrl":"10.1136/heartjnl-2022-321030","url":null,"abstract":"<p><strong>Objective: </strong>Although kidney transplant (KTx) recipients are at significant risk for cardiovascular disease, outcomes following cardiac operations have been examined in limited series. The present study thus aimed to assess the impact of KTx on in-hospital perioperative outcomes and readmissions in a nationally representative cohort.</p><p><strong>Methods: </strong>All adults undergoing elective coronary artery bypass grafting, valve repair/replacement or a combination thereof were identified from the 2010-2018 Nationwide Readmissions Database. Patients were stratified by history of KTx. Transplant-capable centres were defined as hospitals performing at least one KTx annually. To perform risk-adjustment in assessing outcomes, multivariable regression models were developed.</p><p><strong>Results: </strong>Of an estimated 1 407 351 patients included for analysis, 0.2% (n=2849) were KTx recipients. Compared with the general cardiac surgical population, patients with prior KTx experienced higher adjusted odds of in-hospital mortality (adjusted OR (AOR) 2.44, 95% CI 1.72 to 3.47, p<0.001) and perioperative complication (AOR 1.67, 95% CI 1.44 to 1.94, p<0.001). Additionally, KTx was independently associated with greater readmission rates within 30 days (AOR 1.96, 95% CI 1.65 to 2.34, p<0.001) with kidney injury contributing significantly to the burden of rehospitalisation (4.6 vs 1.8%, p=0.005). In a subpopulation comprised of only KTx recipients, treatment at a transplant-capable centre reduced odds of kidney injury with non-transplant hospitals as reference (AOR 0.65, 95% CI 0.43 to 0.98, p=0.037).</p><p><strong>Conclusions: </strong>Kidney transplant recipients undergoing cardiac operations encounter significant risks compared with the general surgical population. Referral to transplant-capable centres should be explored to improve outcomes and to preserve allograft function in this population.</p>","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44555593","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：