British Heart Journal最新文献

{"title":"Pregnancy-related cardiovascular conditions and outcomes in a United States Medicaid population","authors":"S. Marschner, A. von Huben, S. Zaman, H. Reynolds, V. W. Lee, P. Choudhary, L. Mehta, C. Chow","doi":"10.1136/heartjnl-2021-320684","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-320684","url":null,"abstract":"Objective This study aims to examine the incidence of pregnancy-related cardiometabolic conditions and severe cardiovascular outcomes, and their relationship in US Medicaid-funded women. Methods Medicaid is a government-sponsored health insurance programme for low-income families in the USA. We report the incidence of pregnancy-related cardiometabolic conditions (hypertensive disorders and diabetes in, or complicated by, pregnancy) and severe cardiovascular outcomes (myocardial infarction, stroke, acute heart failure, cardiomyopathy, cardiac arrest, ventricular fibrillation, ventricular tachycardia, aortic dissection/aneurysm and peripheral vascular disease) among Medicaid-funded women with a birth (International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis code O80 or O82) over the period January 2015–June 2019, from the states of Georgia, Ohio and Indiana. In this cross-sectional cohort, we examined the relationship between pregnancy-related cardiometabolic conditions and severe cardiovascular outcomes from pregnancy through to 60 days after birth using multivariable models. Results Among 74 510 women, mean age 26.4 years (SD 5.5), the incidence per 1000 births of pregnancy-related cardiometabolic conditions was 224.3 (95% CI 221.3 to 227.3). The incidence per 1000 births of severe cardiovascular conditions was 10.8 (95% CI 10.1 to 11.6). Women with pregnancy-related cardiometabolic conditions were at greater risk of having a severe cardiovascular condition with an age-adjusted OR of 3.1 (95% CI 2.7 to 3.5). Conclusion This US cohort of Medicaid-funded women have a high incidence of severe cardiovascular conditions during pregnancy. Cardiometabolic conditions of pregnancy conferred threefold higher odds of severe cardiovascular outcomes.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1524 - 1529"},"PeriodicalIF":0.0,"publicationDate":"2022-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47124949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary vasospasm and future percutaneous coronary intervention: relax","authors":"M. McDermott, R. Bing","doi":"10.1136/heartjnl-2022-320974","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-320974","url":null,"abstract":"A clinical diagnosis of suspected angina that is accompanied by non- obstructive epicardial coronary artery disease is not uncommon, as evidenced by results from contemporary registries and trials of anatomical testing in chest pain. The basket labelled as angina with non-obstructive coronary artery disease (ANOCA—the clinical syndrome that may or may not accompany ischaemia with non- obstructive coronary artery disease (INOCA)) contains heterogeneous patho-physiological entities which vary in clinical presentation and adjunctive investigation findings. 1 One distinct entry in this field is vasospastic angina, a dynamic phenomenon with characteristic symptoms that differ from those induced by fixed epicardial coronary artery stenoses. Although the seminal case series which provided the eponymous nomen-clature for this clinical syndrome was published well before many (probably most) readers of Heart were born, attempts to codify and standardise defini-tions for vasospastic angina have only recently been promulgated. 2 The syndrome is seen in only a small propor-tion of patients with chest pain, with correspondingly limited sections in current guidelines. 3 4 The diagnostic process can be difficult and the clinical course uncertain. The latter is salient, events. 5","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1253 - 1254"},"PeriodicalIF":0.0,"publicationDate":"2022-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44595615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac resynchronisation therapy with or without a defibrillator: individualising device prescription","authors":"S. Straw, W. Mullens, K. Witte","doi":"10.1136/heartjnl-2022-320909","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-320909","url":null,"abstract":"Cardiac resynchronisation therapydefibrillators (CRTD) would seem the obvious choice for patients with heart failure with reduced ejection fraction, given implantable cardioverter defibrillators (ICD) reduce the risk of sudden cardiac death in this population. However, despite decades of discussion, COMPANION (Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure) remains the only trial to include both CRTD and CRTpacemakers (CRTP) in which outcomes between the two approaches were similar.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1164 - 1166"},"PeriodicalIF":0.0,"publicationDate":"2022-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44912625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes in spontaneous coronary artery dissection","authors":"M. García-Guimarães, M. Masotti, R. Sanz-Ruiz, F. Macaya, G. Roura, J. Nogales, H. Tizón-Marcos, Maite Velázquez-Martín, G. Veiga, X. Flores-Ríos, Omar Abdul-Jawad Altisent, M. Jiménez-Kockar, S. Camacho-Freire, J. Moreu, S. Ojeda, S. Santos-Martínez, A. Sanz-García, D. del Val, T. Bastante, F. Alfonso","doi":"10.1136/heartjnl-2022-320830","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-320830","url":null,"abstract":"Objective Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndrome. Our aim was to assess adverse events at follow-up from a nationwide prospective cohort. Methods The Spanish Registry on SCAD (SR-SCAD) included patients from 34 hospitals. All coronary angiograms were analysed by two experts. Those cases with doubts regarding the diagnosis of SCAD were excluded. The angiographic SCAD classification by Saw et al was followed. Major adverse cardiovascular and cerebrovascular event (MACCE) was predefined as composite of death, myocardial infarction, unplanned revascularisation, SCAD recurrence or stroke. All events were assigned by a Clinical Events Committee. Results After corelab evaluation, 389 patients were included. Most patients were women (88%); median age 53 years (IQR 47–60). Most patients presented as non-ST-segment-elevation myocardial infarction (54%). A type 2 intramural haematoma (IMH) was the most frequent angiographic pattern (61%). A conservative initial management was selected in 78% of patients. At a median time of follow-up of 29 months (IQR 17–38), 46 patients (13%) presented MACCE, mainly driven by reinfarctions (7.6%) and unplanned revascularisations (6.2%). Previous history of hypothyroidism (HR 3.79; p<0.001), proximal vessel involvement (HR 2.69; p=0.009), type 2 IMH (HR 2.12; p=0.037) and dual antiplatelet therapy (DAPT) at discharge (HR 2.18; p=0.042) were independent predictors of MACCE. Conclusions In this large prospective cohort of patients with SCAD, prognosis was overall favourable, with events mainly driven by reinfarctions or unplanned revascularisations. History of hypothyroidism, proximal vessel involvement, type 2 IMH and DAPT at discharge were associated with MACCE. Trial registration number NCT03607981.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1530 - 1538"},"PeriodicalIF":0.0,"publicationDate":"2022-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44744108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting outcome after cardiac resynchronisation therapy defibrillator implantation: the cardiac resynchronisation therapy defibrillator Futility score","authors":"B. Maille, A. Bodin, A. Bisson, J. Herbert, B. Pierre, N. Clementy, Victor Klein, F. Franceschi, J. Deharo, L. Fauchier","doi":"10.1136/heartjnl-2021-320532","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-320532","url":null,"abstract":"Background Risk-benefit for cardiac resynchronisation therapy (CRT) defibrillator (CRT-D) over CRT pacemaker remains a matter of debate. We aimed to identify patients with a poor outcome within 1 year of CRT-D implantation, and to develop a CRT-D Futility score. Methods Based on an administrative hospital-discharge database, all consecutive patients treated with prophylactic CRT-D implantation in France (2010–2019) were included. A prediction model was derived and validated for 1-year all-cause death after CRT-D implantation (considered as futility) by using split-sample validation. Results Among 23 029 patients (mean age 68±10 years; 4873 (21.2%) women), 7016 deaths were recorded (yearly incidence rate 7.2%), of which 1604 (22.8%) occurred within 1 year of CRT-D implantation. In the derivation cohort (n=11 514), the final logistic regression model included—as main predictors of futility—older age, diabetes, mitral regurgitation, aortic stenosis, history of hospitalisation with heart failure, history of pulmonary oedema, atrial fibrillation, renal disease, liver disease, undernutrition and anaemia. Area under the curve for the CRT-D Futility score was 0.716 (95% CI: 0.698 to 0.734) in the derivation cohort and 0.692 (0.673 to 0.710) in the validation cohort. The Hosmer-Lemeshow test had a p-value of 0.57 suggesting accurate calibration. The CRT-D Futility score outperformed the Goldenberg and EAARN scores for identifying futility. Based on the CRT-D Futility score, 15.9% of these patients were categorised at high risk (predicted futility of 16.6%). Conclusions The CRT-D Futility score, established from a large nationwide cohort of patients treated with CRT-D, may be a relevant tool for optimising healthcare decision-making.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1186 - 1193"},"PeriodicalIF":0.0,"publicationDate":"2022-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49483931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Getting the best from the Heart Team: guidance for cardiac multidisciplinary meetings","authors":"A. Archbold, E. Akowuah, A. Banning, A. Baumbach, P. Braidley, G. Cooper, S. Kendall, P. MacCarthy, P. O'Kane, N. O'Keeffe, B. Shah, Victoria Watt, S. Ray","doi":"10.1136/heartjnl-2021-320510","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-320510","url":null,"abstract":"The purpose of this document is to update the existing joint British Societies recommendations on multidisciplinary meetings (MDMs) published in 2015 to reflect changes in practice. We aim to provide guidance on the structure and function of MDMs which should be taking place in every cardiac surgical centre. Out of scope are MDMs that do not require the routine presence of a cardiac surgeon such as electrophysiology MDMs and those which are not provided in every centre, such as complex aortic surgery.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"e2 - e2"},"PeriodicalIF":0.0,"publicationDate":"2022-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42031890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"British Societies' recommendations for Heart Team multidisciplinary meetings: broadly relevant principles with anticipated regional differences in process","authors":"B. Lindman, K. Goel","doi":"10.1136/heartjnl-2021-320775","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-320775","url":null,"abstract":"The concept of a Heart Team approach to evaluating patients with cardiovascular disease was fuelled by the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial for severe coronary artery disease and the Placement of Aortic Transcatheter Valves (PARTNER) trial for aortic stenosis (AS). 2 It was subsequently included as a recommended practice in guidelines for the management of patients with coronary artery disease and AS. Unpacking the rationale, purpose, composition, process and work of the Heart Team has been an evolving process that is being increasingly applied to additional cardiovascular diseases. Professor Ray and working group colleagues provide a consensus statement which outlines guidance from the British Societies regarding the multidisciplinary meetings of the Heart Team to address myocardial revascularisation; aortic, mitral and tricuspid valve disease; and endocarditis (figure 1).","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"824 - 826"},"PeriodicalIF":0.0,"publicationDate":"2022-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42803663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heartbeat: hypertension risk is higher when obesity onset occurs earlier in adult life","authors":"C. Otto","doi":"10.1136/heartjnl-2022-321152","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321152","url":null,"abstract":"The risk of hypertension is higher in adults with an increased body mass index but there is little data on whether weight gain at a younger age is more detrimental than weight gain later in life. In order to address the impact of age of onset of overweight on the subsequent risk of hypertension, Li and colleagues compared 4742 subjects with newonset overweight to 4742 age and sexmatched normal weight controls in an ongoing communitybased prospective cohort in China with a mean followup interval of 5 years. After multivariable adjustment, they observed a stepwise increase in risk of hypertension in younger adults (particularly those less than age 40 years) with no significantly increased risk for those with onset of overweight at age 60 years or older (figure 1). In an editorial, Wong comments on the strengths of this study—large sample size, serial measurements, robustness of the data—but also points out the limitations—mostly men (68%), a single occupational class (a mining company), hypertension diagnosis based on a single measurement and lack of outcome data. Wong concludes that ‘These data suggest that prevention efforts aimed at the reduction or delay of overweight and obesity in younger individuals, may significantly impact the onset of hypertension in later life. Whether such an intervention significantly impacts the onset of cardiovascular disease and its related adverse outcomes requires future study.’ In studies based on costs and healthcare delivery in the USA, mitral transcatheter edgetoedge repair (TEER) appears to be costeffective for patients with heart failure with reduced ejection fraction (HFrEF) and severe secondary mitral regurgitation. In this issue of Heart, Cohen and colleagues examined whether mitral TEER in HFrEF patients with severe secondary MR would be costeffective in the NHS healthcare system. Overall, TEER reduced the rate of heart failure hospitalisations and improved survival (figure 2), but costs of TEER were higher than guidelinerecommended medical therapy (GRMT). Even so, the incremental costeffectiveness ratio was","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"661 - 663"},"PeriodicalIF":0.0,"publicationDate":"2022-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42697270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A strange heart","authors":"Marinha Silva, Vitor Hugo Pereira, Alexandra Sousa","doi":"10.1136/heartjnl-2021-320677","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-320677","url":null,"abstract":"24 Coronel R, Casini S, Koopmann TT, et al. Right ventricular fibrosis and conduction delay in a patient with clinical signs of Brugada syndrome: a combined electrophysiological, genetic, histopathologic, and computational study. Circulation 2005;112:2769–77. 25 Blok M, Boukens BJ. Mechanisms of arrhythmias in the Brugada syndrome. Int J Mol Sci 2020;21:7051–20. 26 Hoogendijk MGet al. The Brugada ECG pattern a marker of channelopathy, structural heart disease, or neither? Toward a unifying mechanism of the Brugada syndrome. Circ. Arrhythmia Electrophysiol 2010;3:283–90. 27 Catalano O, Antonaci S, Moro G, et al. Magnetic resonance investigations in Brugada syndrome reveal unexpectedly high rate of structural abnormalities. Eur Heart J 2009;30:2241–8. 28 Nademanee K, Raju H, de Noronha SV, et al. Fibrosis, connexin43, and conduction abnormalities in the Brugada syndrome. J Am Coll Cardiol 2015;66:1976–86. 29 Andorin A, Behr ER, Denjoy I, et al. Impact of clinical and genetic findings on the management of young patients with Brugada syndrome. Heart Rhythm 2016;13:1274–82. 30 Michowitz Y, Milman A, SarquellaBrugada G, et al. Feverrelated arrhythmic events in the multicenter survey on arrhythmic events in Brugada syndrome. Heart Rhythm 2018;15:1394–401. 31 Chung FP, Raharjo SB, Lin YJ, et al. A novel method to enhance phenotype, epicardial functional substrates, and ventricular tachyarrhythmias in Brugada syndrome. Heart Rhythm 2017;14:508–17. 32 Ikeda T, Abe A, Yusu S, et al. The full stomach test as a novel diagnostic technique for identifying patients at risk of Brugada syndrome. J Cardiovasc Electrophysiol 2006;17:602–7. 33 Miyazaki T, Mitamura H, Miyoshi S, et al. Autonomic and antiarrhythmic drug modulation of ST segment elevation in patients with Brugada syndrome. J Am Coll Cardiol 1996;27:1061–70. 34 Jons C, Gollob MH. Brugada syndrome: Let’s talk about sex. Heart Rhythm 2018;15:1466–7. 35 Sacher F, Probst V, Maury P, et al. Outcome after implantation of a cardioverterdefibrillator in patients with Brugada syndrome: a multicenter studypart 2. Circulation 2013;128:1739–47. 36 Raju H, Papadakis M, Govindan M, et al. Low prevalence of risk markers in cases of sudden death due to Brugada syndrome relevance to risk stratification in Brugada syndrome. J Am Coll Cardiol 2011;57:2340–5. 37 Sroubek J, Probst V, Mazzanti A, et al. Programmed ventricular stimulation for risk stratification in the Brugada syndrome: a pooled analysis. Circulation 2016;133:622–30. 38 Honarbakhsh S, Providencia R, Lambiase PD. Risk stratification in Brugada syndrome: current status and emerging approaches. Arrhythm Electrophysiol Rev 2018;7:79. 39 Meregalli PG, Tan HL, Probst V, et al. Type of SCN5A mutation determines clinical severity and degree of conduction slowing in lossoffunction sodium channelopathies. Heart Rhythm 2009;6:341–8. 40 AlKhatib SMet al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"675 - 746"},"PeriodicalIF":0.0,"publicationDate":"2022-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46921269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inherited and modifiable factors need to be identified in young patients with atrioventricular block","authors":"E. Roseboom, A. Maass","doi":"10.1136/heartjnl-2022-320841","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-320841","url":null,"abstract":"Atrioventricular block (AVB) is among the leading diagnoses requiring pacemaker implantation. The incidence of this cardiac conduction disorder increases with age: from the UK Biobank, a community-dwelling cohort of approximately half a million participants, conduction disorders were far more present in those ≥65 years of age versus under the age of 55 (55/10.000 vs 11/10.000, respectively). 1 AVB is defined as delayed or interrupted impulse conduction and can be caused by anatomical or func-tional disorders of the conduction system. An extrinsic or physiological AVB can be secondary to increased parasympathetic tone, and is often self- limiting and does not require therapy. Intrinsic or pathological AVB is subdivided into suprahisian and infrahisian, the being predominantly benign and the requiring is referred The main is the conduction elder","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1167 - 1168"},"PeriodicalIF":0.0,"publicationDate":"2022-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41482631","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}