Pub Date : 2022-05-11DOI: 10.1136/heartjnl-2022-321248
C. Otto
genetic diagnosis of in in
in的基因诊断
{"title":"Heartbeat: can cardiogenetics reduce adverse events due to catecholaminergic polymorphic ventricular tachycardia?","authors":"C. Otto","doi":"10.1136/heartjnl-2022-321248","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321248","url":null,"abstract":"genetic diagnosis of in in","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"816 - 818"},"PeriodicalIF":0.0,"publicationDate":"2022-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45575115","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 : 2022-05-11DOI: 10.1136/heartjnl-2022-321317
G. Ng
{"title":"The British Cardiovascular Society Centenary Conference, 6–8 June 2022: the Vice President’s message","authors":"G. Ng","doi":"10.1136/heartjnl-2022-321317","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321317","url":null,"abstract":"","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"813 - 815"},"PeriodicalIF":0.0,"publicationDate":"2022-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63983865","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 : 2022-05-11DOI: 10.1136/heartjnl-2022-320808
Dinkar Bhasin, Rahul Kumar, S. Bansal
ryanodine receptor mutationcarrying relatives. Circ Arrhythm Electrophysiol 2012;5:748–56. 13 Sumitomo N, Harada K, Nagashima M, et al. Catecholaminergic polymorphic ventricular tachycardia: electrocardiographic characteristics and optimal therapeutic strategies to prevent sudden death. Heart 2003;89:66–70. 14 Ohno S, Hasegawa K, Horie M. Gender differences in the inheritance mode of RyR2 mutations in catecholaminergic polymorphic ventricular tachycardia patients. PLoS One 2015;10:e0131517. 15 Ackerman MJ, Priori SG, Willems S, et al. HRS/EHRA expert consensus statement on the state of genetic testing for the channelopathies and cardiomyopathies this document was developed as a partnership between the heart rhythm Society (HRS) and the European heart rhythm association (EHRA). Heart Rhythm 2011;8:1308–39. 16 Schwartz PJ. Cascades or waterfalls, the cataracts of genetic screening are being opened on clinical cardiology. J Am Coll Cardiol 2010;55:2577–9. 17 Richards S, Aziz N, Bale S, et al. Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of medical genetics and genomics and the association for molecular pathology. Genet Med 2015;17:405–24. 18 Kawata H, Ohno S, Aiba T, et al. Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT) Associated With Ryanodine Receptor (RyR2) Gene Mutations LongTerm Prognosis After Initiation of Medical Treatment. Circ J 2016;80:1907–15. 19 Rijnbeek PR, Witsenburg M, Schrama E, et al. New normal limits for the paediatric electrocardiogram. Eur Heart J 2001;22:702–11. 20 Rijnbeek PR, van Herpen G, Bots ML, et al. Normal values of the electrocardiogram for ages 1690 years. J Electrocardiol 2014;47:914–21. 21 Priori SG, Napolitano C, Memmi M, et al. Clinical and molecular characterization of patients with catecholaminergic polymorphic ventricular tachycardia. Circulation 2002;106:69–74. 22 Priori SG, Chen SRW. Inherited dysfunction of sarcoplasmic reticulum Ca2+ handling and arrhythmogenesis. Circ Res 2011;108:871–83. 23 MedeirosDomingo A, Bhuiyan ZA, Tester DJ, et al. The RYR2encoded ryanodine receptor/calcium release channel in patients diagnosed previously with either catecholaminergic polymorphic ventricular tachycardia or genotype negative, exerciseinduced long QT syndrome: a comprehensive open reading frame mutational analysis. J Am Coll Cardiol 2009;54:2065–74. 24 Kanda Y. Investigation of the freely available easytouse software ’EZR’ for medical statistics. Bone Marrow Transplant 2013;48:452–8. 25 Leinonen JT, Crotti L, Djupsjöbacka A, et al. The genetics underlying idiopathic ventricular fibrillation: a special role for catecholaminergic polymorphic ventricular tachycardia? Int J Cardiol 2018;250:139–45. 26 Nesta AV, Tafur D, Beck CR. Hotspots of human mutation. Trends Genet 2021;37:30276–6. 27 Roston TM, Vinocur JM, Maginot KR, et al. Catecholaminergic polymorphic ventricular tachycardia in children: analysis of therapeutic strat
{"title":"Man with recent myocardial infarction and heart failure","authors":"Dinkar Bhasin, Rahul Kumar, S. Bansal","doi":"10.1136/heartjnl-2022-320808","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-320808","url":null,"abstract":"ryanodine receptor mutationcarrying relatives. Circ Arrhythm Electrophysiol 2012;5:748–56. 13 Sumitomo N, Harada K, Nagashima M, et al. Catecholaminergic polymorphic ventricular tachycardia: electrocardiographic characteristics and optimal therapeutic strategies to prevent sudden death. Heart 2003;89:66–70. 14 Ohno S, Hasegawa K, Horie M. Gender differences in the inheritance mode of RyR2 mutations in catecholaminergic polymorphic ventricular tachycardia patients. PLoS One 2015;10:e0131517. 15 Ackerman MJ, Priori SG, Willems S, et al. HRS/EHRA expert consensus statement on the state of genetic testing for the channelopathies and cardiomyopathies this document was developed as a partnership between the heart rhythm Society (HRS) and the European heart rhythm association (EHRA). Heart Rhythm 2011;8:1308–39. 16 Schwartz PJ. Cascades or waterfalls, the cataracts of genetic screening are being opened on clinical cardiology. J Am Coll Cardiol 2010;55:2577–9. 17 Richards S, Aziz N, Bale S, et al. Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of medical genetics and genomics and the association for molecular pathology. Genet Med 2015;17:405–24. 18 Kawata H, Ohno S, Aiba T, et al. Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT) Associated With Ryanodine Receptor (RyR2) Gene Mutations LongTerm Prognosis After Initiation of Medical Treatment. Circ J 2016;80:1907–15. 19 Rijnbeek PR, Witsenburg M, Schrama E, et al. New normal limits for the paediatric electrocardiogram. Eur Heart J 2001;22:702–11. 20 Rijnbeek PR, van Herpen G, Bots ML, et al. Normal values of the electrocardiogram for ages 1690 years. J Electrocardiol 2014;47:914–21. 21 Priori SG, Napolitano C, Memmi M, et al. Clinical and molecular characterization of patients with catecholaminergic polymorphic ventricular tachycardia. Circulation 2002;106:69–74. 22 Priori SG, Chen SRW. Inherited dysfunction of sarcoplasmic reticulum Ca2+ handling and arrhythmogenesis. Circ Res 2011;108:871–83. 23 MedeirosDomingo A, Bhuiyan ZA, Tester DJ, et al. The RYR2encoded ryanodine receptor/calcium release channel in patients diagnosed previously with either catecholaminergic polymorphic ventricular tachycardia or genotype negative, exerciseinduced long QT syndrome: a comprehensive open reading frame mutational analysis. J Am Coll Cardiol 2009;54:2065–74. 24 Kanda Y. Investigation of the freely available easytouse software ’EZR’ for medical statistics. Bone Marrow Transplant 2013;48:452–8. 25 Leinonen JT, Crotti L, Djupsjöbacka A, et al. The genetics underlying idiopathic ventricular fibrillation: a special role for catecholaminergic polymorphic ventricular tachycardia? Int J Cardiol 2018;250:139–45. 26 Nesta AV, Tafur D, Beck CR. Hotspots of human mutation. Trends Genet 2021;37:30276–6. 27 Roston TM, Vinocur JM, Maginot KR, et al. Catecholaminergic polymorphic ventricular tachycardia in children: analysis of therapeutic strat","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"847 - 898"},"PeriodicalIF":0.0,"publicationDate":"2022-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41381924","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 : 2022-05-09DOI: 10.1136/heartjnl-2022-321181
M. Garbi, Alfredo Mariani
We read with interest the response of Armoiry and Connock to our editorial and to the Cohen et al paper it referred to. This response demonstrates the wide interest on costeffectiveness of transcatheter edgetoedge repair (TEER) in secondary mitral regurgitation. Armoiry and Connock generously conclude that the paper by Cohen et al ‘represents a valuable contribution’, although criticising it throughout the text. Regarding our editorial, we are sorry that Armoiry and Connock disagree with our statement that costeffectiveness of TEER in secondary mitral regurgitation does not need confirmation. Yet, our statement refers strictly to the UK NHS and is underpinned by the costeffectiveness analyses that informed the National Institute for Health and Care Excellence (NICE) guidelines recommendation: the NICE MitraClip model and Shore 2020. Although Armoiry and Connock state that in the UK ‘costeffectiveness is a key criterion to judge recommendation’ and although at current device cost, in the UK NHS, the incremental cost per qualityadjusted lifeyear (QALY) gained for TEER in secondary mitral regurgitation was significantly above the £20 000 threshold in both NICE analysis and Shore 2020, the NICE guidelines do recommend TEER in secondary mitral regurgitation; the recommendation (‘consider TEER’) is of similar strength with the European and American guidelines recommendation (class II). The NICE incremental cost per QALY gained threshold refers to a strong recommendation (‘offer TEER’), equivalent with a European and American recommendation class I. However, the existent clinical effectiveness evidence prevents all guidelines from making a strong recommendation. Further costeffectiveness confirmation would only be needed in case of new clinical effectiveness evidence supportive of a strong recommendation and of reduction of device cost in the UK NHS.
{"title":"Response to: Correspondence on 'Cost-effectiveness of transcatheter edge-to-edge repair in secondary mitral regurgitation does need confirmation' by Armoiry and Connock","authors":"M. Garbi, Alfredo Mariani","doi":"10.1136/heartjnl-2022-321181","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321181","url":null,"abstract":"We read with interest the response of Armoiry and Connock to our editorial and to the Cohen et al paper it referred to. This response demonstrates the wide interest on costeffectiveness of transcatheter edgetoedge repair (TEER) in secondary mitral regurgitation. Armoiry and Connock generously conclude that the paper by Cohen et al ‘represents a valuable contribution’, although criticising it throughout the text. Regarding our editorial, we are sorry that Armoiry and Connock disagree with our statement that costeffectiveness of TEER in secondary mitral regurgitation does not need confirmation. Yet, our statement refers strictly to the UK NHS and is underpinned by the costeffectiveness analyses that informed the National Institute for Health and Care Excellence (NICE) guidelines recommendation: the NICE MitraClip model and Shore 2020. Although Armoiry and Connock state that in the UK ‘costeffectiveness is a key criterion to judge recommendation’ and although at current device cost, in the UK NHS, the incremental cost per qualityadjusted lifeyear (QALY) gained for TEER in secondary mitral regurgitation was significantly above the £20 000 threshold in both NICE analysis and Shore 2020, the NICE guidelines do recommend TEER in secondary mitral regurgitation; the recommendation (‘consider TEER’) is of similar strength with the European and American guidelines recommendation (class II). The NICE incremental cost per QALY gained threshold refers to a strong recommendation (‘offer TEER’), equivalent with a European and American recommendation class I. However, the existent clinical effectiveness evidence prevents all guidelines from making a strong recommendation. Further costeffectiveness confirmation would only be needed in case of new clinical effectiveness evidence supportive of a strong recommendation and of reduction of device cost in the UK NHS.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1073 - 1073"},"PeriodicalIF":0.0,"publicationDate":"2022-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45624687","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 : 2022-05-09DOI: 10.1136/heartjnl-2022-321179
X. Armoiry, M. Connock
To the Editor: we have read with considerable interest the paper by Cohen et al estimating the costeffectiveness of the Mitraclip system in patients with secondary mitral regurgitation (SMR). Like other published works that adopted different healthcare perspectives, including the one by Baron et al, the costeffectiveness analysis conducted by Cohen et al was based on 2year data from the Coapt randomised controlled trial (RCT). Generating lifetime estimates of survival gain (1.57 years here) from the 2year data of Coapt requires extensive extrapolation of about 13 years beyond observed data and >95% of benefit reported in the percutaneous repair (PR) arm accrues in the extrapolation phase rather than the observation phase. The observed source data used for extrapolation can therefore exert a profound influence on estimation of gained benefit from PR. We were surprised that Cohen et al chose not to consider in their economic model the 3year data from Coapt which were released as oral presentation in 2019 and fully published in late 2020. Indeed, the 3year allcause mortality curve for the Mitraclip arm of Coapt reported by Mack et al 5 indicates a doubling in mean mortality rate in years 2–3 relative to years 1–2 (estimated using area under the curve as is done in costeffectiveness analysis). The upturn in mortality during years 2–3 in the PR arm is similarly reflected in the cumulative percentage mortality reported at years 1, 2 and 3 of 19%, 28.2% and 42.8%, respectively, that translates to a crude estimate of annual mortality rates of 19% over the first year, 9.2% over years 1–2, and 14.6% over years 2–3; an increase of 59% in rate for years 2–3 relative to years 1–2. It is therefore evident that using 3year mortality data instead of 2year will considerably influence estimated survival gains accrued in economic models. Consequently, we believe that the lifetime extrapolation beyond the observed 2year data is highly optimistic in the work by Cohen et al, particularly for the intervention arm, and that this has potential to impact the costeffectiveness in favour of the intervention. As a general principle, it would be expected that using longer rather than shorter followup results from trials is likely to reduce uncertainty in costeffectiveness estimates. This can optimise decisionmaking in territories such as the UK where costeffectiveness is a key criterion to judge recommendation of new technologies. In consequence, in our opinion, the 2year mortality data from Stone et al are likely to be unsuitable for reliable costeffectiveness analysis. Further prespecified analyses from Coapt at 4 and 5 years are eagerly awaited. Additionally, the generalisability of Cohen et al findings using US Coapt population as source of clinical inputs may be questionable since, as acknowledged by authors in the Limitation section, the inputs from the MitraFr RCT (undertaken in a French population and showing no advantage of PR relative to medical treatment alone) wer
{"title":"Correspondence on 'Cost-effectiveness of transcatheter edge-to-edge repair in secondary mitral regurgitation does need confirmation' by Cohen et al","authors":"X. Armoiry, M. Connock","doi":"10.1136/heartjnl-2022-321179","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321179","url":null,"abstract":"To the Editor: we have read with considerable interest the paper by Cohen et al estimating the costeffectiveness of the Mitraclip system in patients with secondary mitral regurgitation (SMR). Like other published works that adopted different healthcare perspectives, including the one by Baron et al, the costeffectiveness analysis conducted by Cohen et al was based on 2year data from the Coapt randomised controlled trial (RCT). Generating lifetime estimates of survival gain (1.57 years here) from the 2year data of Coapt requires extensive extrapolation of about 13 years beyond observed data and >95% of benefit reported in the percutaneous repair (PR) arm accrues in the extrapolation phase rather than the observation phase. The observed source data used for extrapolation can therefore exert a profound influence on estimation of gained benefit from PR. We were surprised that Cohen et al chose not to consider in their economic model the 3year data from Coapt which were released as oral presentation in 2019 and fully published in late 2020. Indeed, the 3year allcause mortality curve for the Mitraclip arm of Coapt reported by Mack et al 5 indicates a doubling in mean mortality rate in years 2–3 relative to years 1–2 (estimated using area under the curve as is done in costeffectiveness analysis). The upturn in mortality during years 2–3 in the PR arm is similarly reflected in the cumulative percentage mortality reported at years 1, 2 and 3 of 19%, 28.2% and 42.8%, respectively, that translates to a crude estimate of annual mortality rates of 19% over the first year, 9.2% over years 1–2, and 14.6% over years 2–3; an increase of 59% in rate for years 2–3 relative to years 1–2. It is therefore evident that using 3year mortality data instead of 2year will considerably influence estimated survival gains accrued in economic models. Consequently, we believe that the lifetime extrapolation beyond the observed 2year data is highly optimistic in the work by Cohen et al, particularly for the intervention arm, and that this has potential to impact the costeffectiveness in favour of the intervention. As a general principle, it would be expected that using longer rather than shorter followup results from trials is likely to reduce uncertainty in costeffectiveness estimates. This can optimise decisionmaking in territories such as the UK where costeffectiveness is a key criterion to judge recommendation of new technologies. In consequence, in our opinion, the 2year mortality data from Stone et al are likely to be unsuitable for reliable costeffectiveness analysis. Further prespecified analyses from Coapt at 4 and 5 years are eagerly awaited. Additionally, the generalisability of Cohen et al findings using US Coapt population as source of clinical inputs may be questionable since, as acknowledged by authors in the Limitation section, the inputs from the MitraFr RCT (undertaken in a French population and showing no advantage of PR relative to medical treatment alone) wer","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1071 - 1071"},"PeriodicalIF":0.0,"publicationDate":"2022-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44480985","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 : 2022-05-09DOI: 10.1136/heartjnl-2022-320970
Juan A Quintero-Martinez, Joya-Rita Hindy, Said El Zein, Hector I Michelena, Vuyisile T Nkomo, Daniel C DeSimone, Larry M Baddour
Objective: Non-bacterial thrombotic endocarditis (NBTE) is a syndrome characterised by cardiac valve vegetations and/or thickening due to non-infective mechanisms. Nowadays, a premortem diagnosis of NBTE is possible based on echocardiographic findings. Therefore, to better characterise this disease, we performed a contemporary review of the epidemiology, demographics, diagnosis and clinical outcomes of these patients.
Methods: Adults with a diagnosis of NBTE seen within the Mayo Clinic Enterprise from December 2014 to December 2021 were included. NBTE diagnosis was identified by clinicians representing at least two specialties including cardiology, infectious diseases, rheumatology and oncology. Patients with positive blood cultures, infective endocarditis, culture-negative endocarditis and denial of research authorisation were excluded. All patients had a 1-year follow-up.
Results: Forty-eight cases were identified; mean age was 60.0±13.8 years, 75% were female. The most prevalent comorbidities were malignancy (52.1%) and connective tissue disease (37.5%). Valvular abnormalities included 41 (85.4%) patients with vegetations, 43 (89.6%) patients with thickening and 26 (54.2%) with moderate to severe regurgitation. Thirty-eight (79.2%) patients had an embolic event (stroke in 26 (54.2%) patients) within 1 month of NBTE diagnosis and 16 (33.3%) patients died within 1 year of NBTE diagnosis. Metastatic tumours and lung cancer were associated with 1-year all-cause mortality (p=0.0017 and p=0.0004, respectively).
Conclusions: NBTE was more prevalent in females and embolic complications were the most frequent clinical finding. Overall, patients with NBTE had a poor prognosis, particularly in those with lung cancer or metastatic tumours. Further studies in patients with NBTE are needed given its morbidity and mortality.
{"title":"Contemporary demographics, diagnostics and outcomes in non-bacterial thrombotic endocarditis.","authors":"Juan A Quintero-Martinez, Joya-Rita Hindy, Said El Zein, Hector I Michelena, Vuyisile T Nkomo, Daniel C DeSimone, Larry M Baddour","doi":"10.1136/heartjnl-2022-320970","DOIUrl":"10.1136/heartjnl-2022-320970","url":null,"abstract":"<p><strong>Objective: </strong>Non-bacterial thrombotic endocarditis (NBTE) is a syndrome characterised by cardiac valve vegetations and/or thickening due to non-infective mechanisms. Nowadays, a premortem diagnosis of NBTE is possible based on echocardiographic findings. Therefore, to better characterise this disease, we performed a contemporary review of the epidemiology, demographics, diagnosis and clinical outcomes of these patients.</p><p><strong>Methods: </strong>Adults with a diagnosis of NBTE seen within the Mayo Clinic Enterprise from December 2014 to December 2021 were included. NBTE diagnosis was identified by clinicians representing at least two specialties including cardiology, infectious diseases, rheumatology and oncology. Patients with positive blood cultures, infective endocarditis, culture-negative endocarditis and denial of research authorisation were excluded. All patients had a 1-year follow-up.</p><p><strong>Results: </strong>Forty-eight cases were identified; mean age was 60.0±13.8 years, 75% were female. The most prevalent comorbidities were malignancy (52.1%) and connective tissue disease (37.5%). Valvular abnormalities included 41 (85.4%) patients with vegetations, 43 (89.6%) patients with thickening and 26 (54.2%) with moderate to severe regurgitation. Thirty-eight (79.2%) patients had an embolic event (stroke in 26 (54.2%) patients) within 1 month of NBTE diagnosis and 16 (33.3%) patients died within 1 year of NBTE diagnosis. Metastatic tumours and lung cancer were associated with 1-year all-cause mortality (p=0.0017 and p=0.0004, respectively).</p><p><strong>Conclusions: </strong>NBTE was more prevalent in females and embolic complications were the most frequent clinical finding. Overall, patients with NBTE had a poor prognosis, particularly in those with lung cancer or metastatic tumours. Further studies in patients with NBTE are needed given its morbidity and mortality.</p>","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48960331","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 : 2022-05-09DOI: 10.1136/heartjnl-2022-321180
D. Cohen, E. Magnuson, G. Stone, J. Cleland
{"title":"Response to: Correspondence on 'Cost-effectiveness of transcatheter edge-to-edge repair in secondary mitral regurgitation does need confirmation' by Armoiry and Connock","authors":"D. Cohen, E. Magnuson, G. Stone, J. Cleland","doi":"10.1136/heartjnl-2022-321180","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321180","url":null,"abstract":"","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1072 - 1072"},"PeriodicalIF":0.0,"publicationDate":"2022-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48364165","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 : 2022-05-06DOI: 10.1136/heartjnl-2021-320443
M. Imazio, Gabriele Barberi Squarotti, A. Andreis, A. Agosti, M. Millesimo, S. Frea, C. Giustetto, G. Deferrari
Objective The ECG has been traditionally used to support the diagnosis of pericarditis. However, the pericardium is electrically silent and ECG changes may imply concurrent myocardial involvement rather than simple pericarditis. The aim of the present paper is to analyse the frequency, type and clinical implication of ECG changes in patients with pericarditis compared with those with myocarditis. Methods Consecutive patients with pericarditis and/or myocarditis were included in a prospective cohort study from January 2017 to December 2020. A clinical and echocardiographic follow-up was performed at 1, 3, 6 months and then every 6 months. Cardiac magnetic resonance was used to diagnose concurrent myocarditis. Results 166 patients (median age 47 years, 95% CI 44 to 51) with 66 men (39.8%) were included: 110 cases with pericarditis (mean age 47.7 years, 29.1% male) and 56 cases with myocarditis (mean age 44.8, 60.7% male). ECG changes were reported in 61 of 166 (36.7%) patients: 27 of 110 (24.5%) among those with pericarditis and 34 of 56 (60.7%) among those with myocarditis (p<0.0001). In multivariate logistic regression analysis, ECG changes were associated with troponin elevation (risk ratio 1.97; 95% CI 1.13 to 3.43), suggesting myocardial involvement. ECG changes were not associated with increased risk of adverse events. Conclusions ECG changes, mainly widespread ST-segment elevation, can be recorded in about one-quarter of patients with pericarditis, and were not associated with a worse prognosis. These changes may reflect concurrent myocarditis that should be ruled out.
目的心电图历来被用于心包炎的诊断。然而，心包电性无影，心电图改变可能提示并发心肌受累，而不是单纯的心包炎。本文的目的是分析心包炎患者与心肌炎患者心电图变化的频率、类型及其临床意义。方法将2017年1月至2020年12月期间心包炎和/或心肌炎患者纳入前瞻性队列研究。分别于1、3、6个月及以后每6个月进行临床及超声心动图随访。应用心脏磁共振诊断并发性心肌炎。结果纳入166例患者(中位年龄47岁，95% CI 44 ~ 51)，其中男性66例(39.8%):心包炎110例(平均年龄47.7岁，男性29.1%)，心肌炎56例(平均年龄44.8岁，男性60.7%)。166例患者中有61例(36.7%)出现心电图改变，110例心包炎患者中有27例(24.5%)出现心电图改变，56例心肌炎患者中有34例(60.7%)出现心电图改变(p<0.0001)。多因素logistic回归分析显示，心电图变化与肌钙蛋白升高相关(危险比1.97;95% CI 1.13 ~ 3.43)，提示心肌受累。心电图变化与不良事件风险增加无关。结论约1 / 4的心包炎患者可出现心电图改变，主要表现为广泛的st段抬高，与预后不相关。这些变化可能反映并发心肌炎，应予以排除。
{"title":"Diagnostic and prognostic role of the electrocardiogram in patients with pericarditis","authors":"M. Imazio, Gabriele Barberi Squarotti, A. Andreis, A. Agosti, M. Millesimo, S. Frea, C. Giustetto, G. Deferrari","doi":"10.1136/heartjnl-2021-320443","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-320443","url":null,"abstract":"Objective The ECG has been traditionally used to support the diagnosis of pericarditis. However, the pericardium is electrically silent and ECG changes may imply concurrent myocardial involvement rather than simple pericarditis. The aim of the present paper is to analyse the frequency, type and clinical implication of ECG changes in patients with pericarditis compared with those with myocarditis. Methods Consecutive patients with pericarditis and/or myocarditis were included in a prospective cohort study from January 2017 to December 2020. A clinical and echocardiographic follow-up was performed at 1, 3, 6 months and then every 6 months. Cardiac magnetic resonance was used to diagnose concurrent myocarditis. Results 166 patients (median age 47 years, 95% CI 44 to 51) with 66 men (39.8%) were included: 110 cases with pericarditis (mean age 47.7 years, 29.1% male) and 56 cases with myocarditis (mean age 44.8, 60.7% male). ECG changes were reported in 61 of 166 (36.7%) patients: 27 of 110 (24.5%) among those with pericarditis and 34 of 56 (60.7%) among those with myocarditis (p<0.0001). In multivariate logistic regression analysis, ECG changes were associated with troponin elevation (risk ratio 1.97; 95% CI 1.13 to 3.43), suggesting myocardial involvement. ECG changes were not associated with increased risk of adverse events. Conclusions ECG changes, mainly widespread ST-segment elevation, can be recorded in about one-quarter of patients with pericarditis, and were not associated with a worse prognosis. These changes may reflect concurrent myocarditis that should be ruled out.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1474 - 1478"},"PeriodicalIF":0.0,"publicationDate":"2022-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44411703","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 : 2022-05-05DOI: 10.1136/heartjnl-2021-320483
Christine Mansour, Nooshin Beygui, M. Mamas, P. Parwani
{"title":"Utilizing social media for cardiovascular education","authors":"Christine Mansour, Nooshin Beygui, M. Mamas, P. Parwani","doi":"10.1136/heartjnl-2021-320483","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-320483","url":null,"abstract":"","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1240 - 1241"},"PeriodicalIF":0.0,"publicationDate":"2022-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43181076","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 : 2022-05-05DOI: 10.1136/heartjnl-2021-319229corr1
{"title":"Correction: Heart failure medication dosage and survival in women and men seen at outpatient clinics","authors":"","doi":"10.1136/heartjnl-2021-319229corr1","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-319229corr1","url":null,"abstract":"","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"e4 - e4"},"PeriodicalIF":0.0,"publicationDate":"2022-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46807324","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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