Pub Date : 2022-05-01DOI: 10.1136/heartjnl-2021-320144
Rebecca Dobson, Sarah C Clarke
{"title":"Women in cardiology: narrowing the gender gap.","authors":"Rebecca Dobson, Sarah C Clarke","doi":"10.1136/heartjnl-2021-320144","DOIUrl":"10.1136/heartjnl-2021-320144","url":null,"abstract":"","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"757-759"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9046733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43485917","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 : 2022-04-28DOI: 10.1136/heartjnl-2022-320950
T. Isogai, Ken-ichi Kato
Takotsubo syndrome (TTS) has gained more awareness and attention in clinical practice in the last decade. Prior studies revealed important insights into the patient characteristics and outcomes of TTS. 2 One of the most notable facts is that the prognosis of TTS is not as benign as initially expected and is comparable to acute coronary syndrome. 2 Therefore, it is no surprise that physicians and researchers investigate a potential treatment option to improve the prognosis of TTS. Although the pathophysiology of TTS remains to be fully elucidated, catecholamines appear to play a critical role, as evidenced by the fact that TTS is frequently triggered by acute emotional or physical stress along with excess plasma catecholamine levels. 3 As a result, β-blockers (BBs) have been empirically considered a reasonable therapy for TTS in the absence of randomised clinical trials. In the current issue of Heart, Silverio et al examined the association between BBs and longterm survival using 825 patients in the Takotsubo Italian Network registry. The authors demonstrated that BB prescription at discharge was significantly associated with lower allcause mortality after TTS (6.8% vs 13.6%; adjusted hazard ratio (aHR)=0.563, 95% confidence interval (CI)=0.356 to 0.889, p=0.014) during a median followup of 24 months, particularly with lower noncardiac mortality (4.9% vs 10.7%; aHR=0.525, 95% CI=0.309 to 0.893, p=0.018) rather than cardiac mortality (1.8% vs 3.0%; aHR=0.699, 95% CI=0.284 to 1.722, p=0.436). Also, the effect modification was observed in patients with hypertension and those who developed cardiogenic shock during the acute phase (p for interaction <0.05). Meanwhile, there was no significant association between BB prescription and TTS recurrence. The authors are to be congratulated on their contribution to current literature on the topic. Nonetheless, several discussions need to be raised about the results and potential limitations of the study. One may expect that BBs theoretically have potential in reducing cardiac mortality after TTS (maybe through the facilitated recovery from cardiac dysfunction or the prevention of fatal ventricular arrhythmia or other cardiac events), but not noncardiac mortality. However, contrary to this expectation, Silverio et al demonstrated that BB prescription at discharge was significantly associated with lower noncardiac mortality, but not cardiac mortality. The statistically insignificant association between BB prescription and cardiac mortality may be at least partly due to the low cardiac mortality rate (2.3%), as Silverio et al discussed. Notably, however, their data revealed that the estimated risk reduction in allcause mortality by BB use was driven largely by the reduction in noncardiac mortality. How could BB use be strongly associated with lower (nearly half) noncardiac mortality after TTS? As Silverio et al speculated, there might be several possible mechanisms for it. Meanwhile, it might also be due to resid
近十年来，Takotsubo综合征(TTS)在临床实践中得到了越来越多的认识和重视。先前的研究揭示了对TTS患者特征和结果的重要见解。最值得注意的事实之一是，TTS的预后不像最初预期的那样良性，与急性冠状动脉综合征相当。因此，医生和研究人员研究一种改善TTS预后的潜在治疗方案也就不足为奇了。虽然TTS的病理生理机制尚不完全清楚，但儿茶酚胺似乎起着关键作用，这一事实证明，TTS经常由急性情绪或身体压力以及血浆儿茶酚胺水平过高引发。因此，在缺乏随机临床试验的情况下，β受体阻滞剂(BBs)在经验上被认为是TTS的合理治疗方法。在最新一期的《心脏》杂志上，Silverio等人在Takotsubo意大利网络注册的825名患者中研究了BBs与长期生存之间的关系。作者证明，出院时BB处方与TTS后较低的全因死亡率显著相关(6.8% vs 13.6%;校正风险比(aHR)=0.563, 95%可信区间(CI)=0.356 ~ 0.889, p=0.014)，中位随访24个月，特别是非心脏死亡率较低(4.9% vs 10.7%;aHR=0.525, 95% CI=0.309 ~ 0.893, p=0.018)，而不是心脏死亡率(1.8% vs 3.0%;aHR=0.699, 95% CI=0.284 ~ 1.722, p=0.436)。此外，在高血压患者和急性期发生心源性休克的患者(p为相互作用200)中观察到关于使用BB进行TTS的效果改变6-11总结于表1。所有研究均为非随机研究。其中，两项研究关注的是院内预后，均显示BB使用与更好的预后之间无显著关联。其余6项研究考察了BB对长期随访结果的有效性，结果不一致。4 8-11除了观察性设计之外，这些研究还需要承认一些局限性和注意事项(表2):(1)入院前服用者(即入院前已经服用过BBs的患者)和新服用者(即入院后开始服用BBs的患者)对TTS的影响可能不同;(2) BB的影响可能不是“类效应”，而是在BB子类之间存在差异;(3)持续/停药和依从性可改变BBs对预后的影响;(4)考虑到TTS患者的高年龄，需要权衡BBs的有效性及其潜在的不良反应(如心动过缓、低血压或相关的损伤或住院);(5) TTS是否合并左室流出道梗阻(发生率为10%-25%)可能是一个关键因素，特别是在评估急性期预后时，因为BBs似乎有效地降低了流出道的梯度;(6)最后但并非最不重要的是，在老年人群中，患者的一般情况(如虚弱)可能是结果评估的混杂因素，因此应该进行调整，以便在BB使用者和非使用者之间进行公平比较，除非是随机比较。在这些背景下，表2中的所有8项研究似乎都缺乏一些可以作为效果调节因子或未测量混杂因素的基本数据，这表明它们应该被视为假设生成。在结局方面，Silverio等的研究中，非心源性死亡占随访期间所有死亡的76%(60/79)，与RETAKO研究的72%(39/54)相当。这一发现表明，在经历TTS的患者中，大多数死亡是非心脏性的。此外，在大多数情况下，TTS表现出心功能障碍在发病后几天到几周内迅速恢复。因此，尽管TTS被认为是一种模仿急性冠状动脉综合征的急性心力衰竭综合征，但可能值得探索一种治疗策略来降低TTS患者的非心脏死亡率。如果我们调查诸如BBs之类的心血管药物的有效性，可能合理地将重点放在患者身上，美国俄亥俄州克利夫兰克利夫兰诊所心脏血管与心胸研究所心血管医学系，日本千叶大学医学院心血管医学系
{"title":"β-blockers and outcomes of Takotsubo syndrome: need more clinical data","authors":"T. Isogai, Ken-ichi Kato","doi":"10.1136/heartjnl-2022-320950","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-320950","url":null,"abstract":"Takotsubo syndrome (TTS) has gained more awareness and attention in clinical practice in the last decade. Prior studies revealed important insights into the patient characteristics and outcomes of TTS. 2 One of the most notable facts is that the prognosis of TTS is not as benign as initially expected and is comparable to acute coronary syndrome. 2 Therefore, it is no surprise that physicians and researchers investigate a potential treatment option to improve the prognosis of TTS. Although the pathophysiology of TTS remains to be fully elucidated, catecholamines appear to play a critical role, as evidenced by the fact that TTS is frequently triggered by acute emotional or physical stress along with excess plasma catecholamine levels. 3 As a result, β-blockers (BBs) have been empirically considered a reasonable therapy for TTS in the absence of randomised clinical trials. In the current issue of Heart, Silverio et al examined the association between BBs and longterm survival using 825 patients in the Takotsubo Italian Network registry. The authors demonstrated that BB prescription at discharge was significantly associated with lower allcause mortality after TTS (6.8% vs 13.6%; adjusted hazard ratio (aHR)=0.563, 95% confidence interval (CI)=0.356 to 0.889, p=0.014) during a median followup of 24 months, particularly with lower noncardiac mortality (4.9% vs 10.7%; aHR=0.525, 95% CI=0.309 to 0.893, p=0.018) rather than cardiac mortality (1.8% vs 3.0%; aHR=0.699, 95% CI=0.284 to 1.722, p=0.436). Also, the effect modification was observed in patients with hypertension and those who developed cardiogenic shock during the acute phase (p for interaction <0.05). Meanwhile, there was no significant association between BB prescription and TTS recurrence. The authors are to be congratulated on their contribution to current literature on the topic. Nonetheless, several discussions need to be raised about the results and potential limitations of the study. One may expect that BBs theoretically have potential in reducing cardiac mortality after TTS (maybe through the facilitated recovery from cardiac dysfunction or the prevention of fatal ventricular arrhythmia or other cardiac events), but not noncardiac mortality. However, contrary to this expectation, Silverio et al demonstrated that BB prescription at discharge was significantly associated with lower noncardiac mortality, but not cardiac mortality. The statistically insignificant association between BB prescription and cardiac mortality may be at least partly due to the low cardiac mortality rate (2.3%), as Silverio et al discussed. Notably, however, their data revealed that the estimated risk reduction in allcause mortality by BB use was driven largely by the reduction in noncardiac mortality. How could BB use be strongly associated with lower (nearly half) noncardiac mortality after TTS? As Silverio et al speculated, there might be several possible mechanisms for it. Meanwhile, it might also be due to resid","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1334 - 1337"},"PeriodicalIF":0.0,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45459307","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 : 2022-04-28DOI: 10.1136/heartjnl-2021-320574
Carlijn G E Thijssen, Ferit O Mutluer, Janine E van der Toorn, Lidia R Bons, Arjen L Gökalp, Johanna Jm Takkenberg, Mostafa M Mokhles, Roland R J van Kimmenade, Meike W Vernooij, Aad van der Lugt, Ricardo P J Budde, Jolien W Roos-Hesselink, Maryam Kavousi, Daniel Bos
Objective: Longitudinal data on age-related changes in the diameters of the thoracic aorta are scarce. To better understand normal variation and to identify factors influencing this process, we aimed to report male-female-specific and age-specific aortic growth rate in the ageing general population and identify factors associated with growth rate.
Methods: From the prospective population-based Rotterdam Study, 943 participants (52.0% females, median age at baseline 65 years (62-68)) underwent serial non-enhanced cardiac CT. We measured the diameters of the ascending (AA) and descending aorta (DA) at two time points and expressed absolute and relative differences. Linear mixed effects analysis was performed to identify determinants associated with change in aortic diameters.
Results: Mean AA diameter at baseline was 37.3±3.6 mm in male population and 34.7±3.2 mm in female population, mean DA diameter was 29.6±2.3 in male population and 26.9±2.2 mm in female population. The median absolute change in diameters during follow-up (mean scan interval 14.1±0.3 years) was 1 mm (0-2) for both the AA and DA. Absolute change per decade in AA diameter was significantly larger in males than in females (0.72 mm/decade (0.00-1.43) vs 0.70 mm/decade (0.00-1.41), p=0.006), as well as absolute change in AD diameter (0.71 mm/decade (0.00-1.42) vs 0.69 mm/decade (0.00-1.36), p=0.008). There was no significant difference between male and female population in relative change of their aortic diameters during follow-up. Age, male sex, higher body mass index (BMI) and higher diastolic blood pressure (DBP) showed a statistically significant independent association with increase in AA and DA diameters over time.
Conclusions: Some degree of increase in thoracic aortic diameters is typical in both men and women of an aging population. Factors associated with this change in thoracic aortic diameters were sex, age, BMI and DBP.
{"title":"Longitudinal changes of thoracic aortic diameters in the general population aged 55 years or older.","authors":"Carlijn G E Thijssen, Ferit O Mutluer, Janine E van der Toorn, Lidia R Bons, Arjen L Gökalp, Johanna Jm Takkenberg, Mostafa M Mokhles, Roland R J van Kimmenade, Meike W Vernooij, Aad van der Lugt, Ricardo P J Budde, Jolien W Roos-Hesselink, Maryam Kavousi, Daniel Bos","doi":"10.1136/heartjnl-2021-320574","DOIUrl":"10.1136/heartjnl-2021-320574","url":null,"abstract":"<p><strong>Objective: </strong>Longitudinal data on age-related changes in the diameters of the thoracic aorta are scarce. To better understand normal variation and to identify factors influencing this process, we aimed to report male-female-specific and age-specific aortic growth rate in the ageing general population and identify factors associated with growth rate.</p><p><strong>Methods: </strong>From the prospective population-based Rotterdam Study, 943 participants (52.0% females, median age at baseline 65 years (62-68)) underwent serial non-enhanced cardiac CT. We measured the diameters of the ascending (AA) and descending aorta (DA) at two time points and expressed absolute and relative differences. Linear mixed effects analysis was performed to identify determinants associated with change in aortic diameters.</p><p><strong>Results: </strong>Mean AA diameter at baseline was 37.3±3.6 mm in male population and 34.7±3.2 mm in female population, mean DA diameter was 29.6±2.3 in male population and 26.9±2.2 mm in female population. The median absolute change in diameters during follow-up (mean scan interval 14.1±0.3 years) was 1 mm (0-2) for both the AA and DA. Absolute change per decade in AA diameter was significantly larger in males than in females (0.72 mm/decade (0.00-1.43) vs 0.70 mm/decade (0.00-1.41), p=0.006), as well as absolute change in AD diameter (0.71 mm/decade (0.00-1.42) vs 0.69 mm/decade (0.00-1.36), p=0.008). There was no significant difference between male and female population in relative change of their aortic diameters during follow-up. Age, male sex, higher body mass index (BMI) and higher diastolic blood pressure (DBP) showed a statistically significant independent association with increase in AA and DA diameters over time.</p><p><strong>Conclusions: </strong>Some degree of increase in thoracic aortic diameters is typical in both men and women of an aging population. Factors associated with this change in thoracic aortic diameters were sex, age, BMI and DBP.</p>","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49419113","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 : 2022-04-25DOI: 10.1136/heartjnl-2021-320588
J. Dunning, A. Archbold, J. de Bono, Liz Butterfield, N. Curzen, C. Deakin, Ellie Gudde, Thomas R. Keeble, Alan Keys, Mike Lewis, N. O'Keeffe, J. Sarma, M. Stout, P. Swindell, S. Ray
More than 300 000 procedures are performed in cardiac catheter laboratories in the UK each year. The variety and complexity of percutaneous cardiovascular procedures have both increased substantially since the early days of invasive cardiology, when it was largely focused on elective coronary angiography and single chamber (right ventricular) permanent pacemaker implantation. Modern-day invasive cardiology encompasses primary percutaneous coronary intervention, cardiac resynchronisation therapy, complex arrhythmia ablation and structural heart interventions. These procedures all carry the risk of cardiac arrest. We have developed evidence-based guidelines for the management of cardiac arrest in adult patients in the catheter laboratory. The guidelines include recommendations which were developed by collaboration between nine professional and patient societies that are involved in promoting high-quality care for patients with cardiovascular conditions. We present a set of protocols which use the skills of the whole catheter laboratory team and which are aimed at achieving the best possible outcomes for patients who suffer a cardiac arrest in this setting. We identified six roles and developed a treatment algorithm which should be adopted during cardiac arrest in the catheter laboratory. We recommend that all catheter laboratory staff undergo regular training for these emergency situations which they will inevitably face.
{"title":"Joint British Societies’ guideline on management of cardiac arrest in the cardiac catheter laboratory","authors":"J. Dunning, A. Archbold, J. de Bono, Liz Butterfield, N. Curzen, C. Deakin, Ellie Gudde, Thomas R. Keeble, Alan Keys, Mike Lewis, N. O'Keeffe, J. Sarma, M. Stout, P. Swindell, S. Ray","doi":"10.1136/heartjnl-2021-320588","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-320588","url":null,"abstract":"More than 300 000 procedures are performed in cardiac catheter laboratories in the UK each year. The variety and complexity of percutaneous cardiovascular procedures have both increased substantially since the early days of invasive cardiology, when it was largely focused on elective coronary angiography and single chamber (right ventricular) permanent pacemaker implantation. Modern-day invasive cardiology encompasses primary percutaneous coronary intervention, cardiac resynchronisation therapy, complex arrhythmia ablation and structural heart interventions. These procedures all carry the risk of cardiac arrest. We have developed evidence-based guidelines for the management of cardiac arrest in adult patients in the catheter laboratory. The guidelines include recommendations which were developed by collaboration between nine professional and patient societies that are involved in promoting high-quality care for patients with cardiovascular conditions. We present a set of protocols which use the skills of the whole catheter laboratory team and which are aimed at achieving the best possible outcomes for patients who suffer a cardiac arrest in this setting. We identified six roles and developed a treatment algorithm which should be adopted during cardiac arrest in the catheter laboratory. We recommend that all catheter laboratory staff undergo regular training for these emergency situations which they will inevitably face.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"e3 - e3"},"PeriodicalIF":0.0,"publicationDate":"2022-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45424883","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 : 2022-04-25DOI: 10.1136/heartjnl-2021-320672
J. Bergler-Klein
CALCIUM AND VITAMIN D SUPPLEMENT: RIGHT OR WRONG? Intuitively, one might think that supplementing vitamins and minerals would be the right thing to do especially in older and comorbid people. Every year, billions of dollars are spent in this belief. However, we may all be wrong. A present study in this journal demonstrates a significantly increased cardiovascular (CV) mortality in elderly patients supplementing calcium, be it with or without vitamin D, who initially presented with mild to moderate aortic stenosis (AS) in a longitudinal analysis of a large contemporary echocardiography database cohort of 2657 patients. Patients were followed for aortic valve replacement (AVR) and/or death, as well as AS progression. About half of the study population was on supplementation, with about 40% taking calcium including vitamin D or not during more than 5.5 years. The absolute risk of CV mortality was strikingly higher with 13.7 for calcium±vitamin D supplementation and 9.6 for vitamin D only, compared with 5.8 per 1000 personyears in no supplementation. Surprisingly, also allcause mortality was significantly higher with calcium addition. In almost half of the patients with calcium administration, AVR was performed during the followup, whereas AVR was needed in only 11% of nonsupplementers. Interestingly, when stratifying by osteoporosis status, the differences in survival and AVR persisted unaltered between the groups.
{"title":"Calcium, vitamin D and aortic valve calcification: to the bone or to the heart?","authors":"J. Bergler-Klein","doi":"10.1136/heartjnl-2021-320672","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-320672","url":null,"abstract":"CALCIUM AND VITAMIN D SUPPLEMENT: RIGHT OR WRONG? Intuitively, one might think that supplementing vitamins and minerals would be the right thing to do especially in older and comorbid people. Every year, billions of dollars are spent in this belief. However, we may all be wrong. A present study in this journal demonstrates a significantly increased cardiovascular (CV) mortality in elderly patients supplementing calcium, be it with or without vitamin D, who initially presented with mild to moderate aortic stenosis (AS) in a longitudinal analysis of a large contemporary echocardiography database cohort of 2657 patients. Patients were followed for aortic valve replacement (AVR) and/or death, as well as AS progression. About half of the study population was on supplementation, with about 40% taking calcium including vitamin D or not during more than 5.5 years. The absolute risk of CV mortality was strikingly higher with 13.7 for calcium±vitamin D supplementation and 9.6 for vitamin D only, compared with 5.8 per 1000 personyears in no supplementation. Surprisingly, also allcause mortality was significantly higher with calcium addition. In almost half of the patients with calcium administration, AVR was performed during the followup, whereas AVR was needed in only 11% of nonsupplementers. Interestingly, when stratifying by osteoporosis status, the differences in survival and AVR persisted unaltered between the groups.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"905 - 906"},"PeriodicalIF":0.0,"publicationDate":"2022-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44600313","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 : 2022-04-25DOI: 10.1136/heartjnl-2021-320215
Nicholas Kassis, E. Hariri, A. Karrthik, K. Ahuja, H. Layoun, Anas M. Saad, M. Gad, Manpreet Kaur, Najdat Bazarbashi, B. Griffin, Z. Popović, S. Harb, M. Desai, S. Kapadia
Objective Calcium metabolism has long been implicated in aortic stenosis (AS). Studies assessing the long-term safety of oral calcium and/or vitamin D in AS are scarce yet imperative given the rising use among an elderly population prone to deficiency. We sought to identify the associations between supplemental calcium and vitamin D with mortality and progression of AS. Methods In this retrospective longitudinal study, patients aged ≥60 years with mild-moderate native AS were selected from the Cleveland Clinic Echocardiography Database from 2008 to 2016 and followed until 2018. Groups were stratified into no supplementation, supplementation with vitamin D alone and supplementation with calcium±vitamin D. The primary outcomes were mortality (all-cause, cardiovascular (CV) and non-CV) and aortic valve replacement (AVR), and the secondary outcome was AS progression by aortic valve area and peak/mean gradients. Results Of 2657 patients (mean age 74 years, 42% women) followed over a median duration of 69 months, 1292 (49%) did not supplement, 332 (12%) took vitamin D alone and 1033 (39%) supplemented with calcium±vitamin D. Calcium±vitamin D supplementation was associated with a significantly higher risk of all-cause mortality (absolute rate (AR)=43.0/1000 person-years; HR=1.31, 95% CI (1.07 to 1.62); p=0.009), CV mortality (AR=13.7/1000 person-years; HR=2.0, 95% CI (1.31 to 3.07); p=0.001) and AVR (AR=88.2/1000 person-years; HR=1.48, 95% CI (1.24 to 1.78); p<0.001). Any supplementation was not associated with longitudinal change in AS parameters in a linear mixed-effects model. Conclusions Supplemental calcium with or without vitamin D is associated with lower survival and greater AVR in elderly patients with mild-moderate AS.
{"title":"Supplemental calcium and vitamin D and long-term mortality in aortic stenosis","authors":"Nicholas Kassis, E. Hariri, A. Karrthik, K. Ahuja, H. Layoun, Anas M. Saad, M. Gad, Manpreet Kaur, Najdat Bazarbashi, B. Griffin, Z. Popović, S. Harb, M. Desai, S. Kapadia","doi":"10.1136/heartjnl-2021-320215","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-320215","url":null,"abstract":"Objective Calcium metabolism has long been implicated in aortic stenosis (AS). Studies assessing the long-term safety of oral calcium and/or vitamin D in AS are scarce yet imperative given the rising use among an elderly population prone to deficiency. We sought to identify the associations between supplemental calcium and vitamin D with mortality and progression of AS. Methods In this retrospective longitudinal study, patients aged ≥60 years with mild-moderate native AS were selected from the Cleveland Clinic Echocardiography Database from 2008 to 2016 and followed until 2018. Groups were stratified into no supplementation, supplementation with vitamin D alone and supplementation with calcium±vitamin D. The primary outcomes were mortality (all-cause, cardiovascular (CV) and non-CV) and aortic valve replacement (AVR), and the secondary outcome was AS progression by aortic valve area and peak/mean gradients. Results Of 2657 patients (mean age 74 years, 42% women) followed over a median duration of 69 months, 1292 (49%) did not supplement, 332 (12%) took vitamin D alone and 1033 (39%) supplemented with calcium±vitamin D. Calcium±vitamin D supplementation was associated with a significantly higher risk of all-cause mortality (absolute rate (AR)=43.0/1000 person-years; HR=1.31, 95% CI (1.07 to 1.62); p=0.009), CV mortality (AR=13.7/1000 person-years; HR=2.0, 95% CI (1.31 to 3.07); p=0.001) and AVR (AR=88.2/1000 person-years; HR=1.48, 95% CI (1.24 to 1.78); p<0.001). Any supplementation was not associated with longitudinal change in AS parameters in a linear mixed-effects model. Conclusions Supplemental calcium with or without vitamin D is associated with lower survival and greater AVR in elderly patients with mild-moderate AS.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"964 - 972"},"PeriodicalIF":0.0,"publicationDate":"2022-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42318366","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 : 2022-04-25DOI: 10.1136/heartjnl-2021-320756
P. Kudenchuk
Since first compiled in 45 BCE as the Hippocratic Corpus, medical practice guidelines have served to summarise scientific knowledge and inform clinical management. In 1992, the International Liaison Committee on Resuscitation (ILCOR—the acronym being a deliberate play on words by adding ‘ill’ to the Latin ‘cor’ for heart) was formed by the major world resuscitation councils to carry forward this challenge in emergency cardiovascular care. Comprised of recognised international experts in resuscitation, ILCOR has since been charged with conducting evidence reviews of resuscitation science. The quality of this evidence is rigorously evaluated in terms of its certainty, consistency, indirectness, risk of bias and confounding influences using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology when formulating recommendations, and represents the current standard for timely and now continuously updated resuscitationrelated treatment guidance. The published guidance from ILCOR is then taken by the individual resuscitation councils (such as the American Heart Association, the European Resuscitation Council and others) and adapted to their localities, creating formal regional guidelines. ‘The Joint British Societies’ guideline on management of cardiac arrest in the cardiac catheter laboratory’ presents an additional adaptation of existing resuscitation guidelines. In this instance, the guidelines are applied to a specific place for such events—the cardiac catheterisation laboratory, and are tailored to a specific occasion—a witnessed cardiac arrest in a closely monitored patient. The need to adapt guidelines to this setting is understandable. Both the acuity of patients needing cardiac procedures and the complexity of the interventions themselves can provoke spontaneous or iatrogenic events resulting in haemodynamic destabilisation and cardiac arrest in the laboratory. The circumstances surrounding a cardiac arrest in a catheterisation laboratory also create a unique occasion for intervention. That is, unlike outofhospital cardiac arrest or arrest in other hospital locations, a patient in the laboratory is typically already being monitored and procedurally prepped. In addition, the event is usually witnessed by skilled providers from its outset; reasons for the arrest’s occurrence are likely already apparent or suspected, and invasive tools readily available for its management. Taken together, adapting resuscitation to this environment is sensible and the participating British Societies, which spanned a wide spectrum of specialties, are to be commended for this endeavour. In recognising this exemplary effort, it is also important to appreciate both the value and limitation of these guidelines. What the British Societies’ guidelines do well is provide a paradigm for resuscitation that takes advantage of the immediate
{"title":"Management of cardiac arrest in the cardiac catheterisation laboratory: guidelines tailored to place and occasion","authors":"P. Kudenchuk","doi":"10.1136/heartjnl-2021-320756","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-320756","url":null,"abstract":"Since first compiled in 45 BCE as the Hippocratic Corpus, medical practice guidelines have served to summarise scientific knowledge and inform clinical management. In 1992, the International Liaison Committee on Resuscitation (ILCOR—the acronym being a deliberate play on words by adding ‘ill’ to the Latin ‘cor’ for heart) was formed by the major world resuscitation councils to carry forward this challenge in emergency cardiovascular care. Comprised of recognised international experts in resuscitation, ILCOR has since been charged with conducting evidence reviews of resuscitation science. The quality of this evidence is rigorously evaluated in terms of its certainty, consistency, indirectness, risk of bias and confounding influences using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology when formulating recommendations, and represents the current standard for timely and now continuously updated resuscitationrelated treatment guidance. The published guidance from ILCOR is then taken by the individual resuscitation councils (such as the American Heart Association, the European Resuscitation Council and others) and adapted to their localities, creating formal regional guidelines. ‘The Joint British Societies’ guideline on management of cardiac arrest in the cardiac catheter laboratory’ presents an additional adaptation of existing resuscitation guidelines. In this instance, the guidelines are applied to a specific place for such events—the cardiac catheterisation laboratory, and are tailored to a specific occasion—a witnessed cardiac arrest in a closely monitored patient. The need to adapt guidelines to this setting is understandable. Both the acuity of patients needing cardiac procedures and the complexity of the interventions themselves can provoke spontaneous or iatrogenic events resulting in haemodynamic destabilisation and cardiac arrest in the laboratory. The circumstances surrounding a cardiac arrest in a catheterisation laboratory also create a unique occasion for intervention. That is, unlike outofhospital cardiac arrest or arrest in other hospital locations, a patient in the laboratory is typically already being monitored and procedurally prepped. In addition, the event is usually witnessed by skilled providers from its outset; reasons for the arrest’s occurrence are likely already apparent or suspected, and invasive tools readily available for its management. Taken together, adapting resuscitation to this environment is sensible and the participating British Societies, which spanned a wide spectrum of specialties, are to be commended for this endeavour. In recognising this exemplary effort, it is also important to appreciate both the value and limitation of these guidelines. What the British Societies’ guidelines do well is provide a paradigm for resuscitation that takes advantage of the immediate","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"907 - 908"},"PeriodicalIF":0.0,"publicationDate":"2022-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42590452","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 : 2022-04-21DOI: 10.1136/heartjnl-2021-320148
J. Lim, Martin J. Elliott, J. Wallwork, B. Keogh
The success of cardiac surgery has transformed the prospects of children with congenital heart disease with over 90% now surviving to adulthood. The early pioneering surgeons took on significant risk, whilst current surgical practice emphasises safety and consistency. In this article we review important British contributions to the field and consider challenges for the future, specifically how to better manage and reduce the adverse sequelae of congenital cardiac surgery by continuing to innovate safely.
{"title":"Cardiac surgery and congenital heart disease: reflections on a modern revolution","authors":"J. Lim, Martin J. Elliott, J. Wallwork, B. Keogh","doi":"10.1136/heartjnl-2021-320148","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-320148","url":null,"abstract":"The success of cardiac surgery has transformed the prospects of children with congenital heart disease with over 90% now surviving to adulthood. The early pioneering surgeons took on significant risk, whilst current surgical practice emphasises safety and consistency. In this article we review important British contributions to the field and consider challenges for the future, specifically how to better manage and reduce the adverse sequelae of congenital cardiac surgery by continuing to innovate safely.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"787 - 793"},"PeriodicalIF":0.0,"publicationDate":"2022-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46606147","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 : 2022-04-21DOI: 10.1136/heartjnl-2021-320274
S. Ray, I. Simpson
{"title":"Introduction to the British Cardiovascular Society centenary special issue","authors":"S. Ray, I. Simpson","doi":"10.1136/heartjnl-2021-320274","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-320274","url":null,"abstract":"","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"748 - 748"},"PeriodicalIF":0.0,"publicationDate":"2022-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45195934","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 : 2022-04-21DOI: 10.1136/heartjnl-2021-320147
A. Reid, M. Dweck
Imaging plays a central role in modern cardiovascular practice. It is a field characterised by exciting technological advances that have shaped our understanding of pathology and led to major improvements in patient diagnosis and care. The UK has played a key international role in the development of this subspecialty and is the current home to many of the leading global centres in multimodality cardiovascular imaging. In this short review, we will outline some of the key contributions of the British Cardiovascular Society and its members to this rapidly evolving field and look at how this relationship may continue to shape future cardiovascular practice.
{"title":"Let there be light! The meteoric rise of cardiac imaging","authors":"A. Reid, M. Dweck","doi":"10.1136/heartjnl-2021-320147","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-320147","url":null,"abstract":"Imaging plays a central role in modern cardiovascular practice. It is a field characterised by exciting technological advances that have shaped our understanding of pathology and led to major improvements in patient diagnosis and care. The UK has played a key international role in the development of this subspecialty and is the current home to many of the leading global centres in multimodality cardiovascular imaging. In this short review, we will outline some of the key contributions of the British Cardiovascular Society and its members to this rapidly evolving field and look at how this relationship may continue to shape future cardiovascular practice.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"780 - 786"},"PeriodicalIF":0.0,"publicationDate":"2022-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48958326","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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