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Birth cohort effect in atrial fibrillation: a matter of detection? Heart (IF 5.7) Pub Date : 2024-05-01 Michelle Samuel, Michiel Rienstra
Atrial fibrillation (AF) is the most common sustained cardiac rhythm disorder, affecting an estimated 43 million people globally.1 In the last 20 years, the incidence of AF increased by 33% and it is expected to increase by threefold in the next three decades.1 Long-term AF management, including outpatient visits, hospitalisations and disabilities from stroke and heart failure (HF), adds substantial
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Eosinophilic myocarditis: systematic review Heart (IF 5.7) Pub Date : 2024-05-01 Witina Techasatian, Maan Gozun, Kristine Vo, Jennifer Yokoyama, Todd Nagamine, Parthav Shah, Kimberly Vu, James Zhang, Yoshito Nishimura
Objective In clinical practice, patients with eosinophilic myocarditis (EM) may forgo the gold standard diagnostic procedure, endomyocardial biopsy (EMB), although it is highly recommended in guidelines. This systematic review aims to summarise current approaches in diagnosing and treating EM with a particular emphasis on the utilisation and value of alternative diagnostic methods. Methods Following
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Birth cohort effects on diagnosed atrial fibrillation incidence: nationwide cohort study from 1980 to 2018 Heart (IF 5.7) Pub Date : 2024-05-01 Nicklas Vinter, Pia Cordsen, Søren Paaske Johnsen, Emelia J Benjamin, Lars Frost, Ludovic Trinquart
Background The incidence of atrial fibrillation (AF) shows substantial temporal trends, but the contribution of birth cohort effects is unknown. These effects refer to the relationship between birth year and the likelihood of developing AF. We aimed to assess trends in cumulative incidence of diagnosed AF across birth cohorts and to disentangle the effects of age, birth cohort and calendar period by
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Heightened long-term cardiovascular risks after exacerbation of chronic obstructive pulmonary disease Heart (IF 5.7) Pub Date : 2024-05-01 Nathaniel M Hawkins, Clementine Nordon, Kirsty Rhodes, Manisha Talukdar, Suzanne McMullen, Paul Ekwaru, Tram Pham, Arsh K Randhawa, Don D Sin
Objective To examine the risk of adverse cardiovascular (CV) events following an exacerbation of chronic obstructive pulmonary disease (COPD). Methods This retrospective cohort study identified patients with COPD using administrative data from Alberta, Canada from 2014 to 2019. Exposure periods were 12 months following moderate or severe exacerbations; the reference period was time preceding a first
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Hypertensive disorders of pregnancy and cardiovascular disease risk: a Mendelian randomisation study Heart (IF 5.7) Pub Date : 2024-05-01 Lena Tschiderer, Yvonne T van der Schouw, Stephen Burgess, Kitty W M Bloemenkamp, Lisa Seekircher, Peter Willeit, Charlotte Onland-Moret, Sanne A E Peters
Objective Observational studies show that hypertensive disorders of pregnancy (HDPs) are related to unfavourable maternal cardiovascular disease (CVD) risk profiles later in life. We investigated whether genetic liability to pre-eclampsia/eclampsia and gestational hypertension is associated with CVD risk factors and occurrence of CVD events. Methods We obtained genetic associations with HDPs from a
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Percutaneous coronary intervention versus medical therapy in stable angina: a matched cohort study Heart (IF 5.7) Pub Date : 2024-05-01 Sang-Ho Jo, Hoseob Kim, Hyun-Jin Kim, Min-Ho Lee, Won-Woo Seo, Mina Kim, Hack-Lyoung Kim
Objective It is uncertain whether percutaneous coronary intervention (PCI) in addition to optimal medical therapy (OMT) can reduce adverse clinical events in the long term as compared with OMT alone in patients with pure stable angina. Methods We enrolled patients from 2006 to 2010 using the Korean national insurance data. 58 742 patients with pure stable angina with no history of myocardial infarction
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Presence and utility of electrocardiographic abnormalities in long-term childhood cancer survivors Heart (IF 5.7) Pub Date : 2024-05-01 Esmée C de Baat, Remy Merkx, Jan M Leerink, Coen Boerhout, Heleen J H van der Pal, Elvira C van Dalen, Jacqueline Loonen, Dorine Bresters, Eline van Dulmen-den Broeder, Margriet van der Heiden-van der Loo, Marry M van den Heuvel, Judith L Kok, Marloes Louwerens, Sebastian J C M M Neggers, Cecline M Ronckers, Jop C Teepen, Wim J E Tissing, Andrica C de Vries, Livia Kapusta, Leontien C M Kremer, Annelies
Background We assessed the prevalence and diagnostic value of ECG abnormalities for cardiomyopathy surveillance in childhood cancer survivors. Methods In this cross-sectional study, 1381 survivors (≥5 years) from the Dutch Childhood Cancer Survivor Study part 2 and 272 siblings underwent a long-term follow-up ECG and echocardiography. We compared ECG abnormality prevalences using the Minnesota Code
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Efficacy and safety of colchicine for the treatment of myopericarditis Heart (IF 5.7) Pub Date : 2024-05-01 Valentino Collini, Maria De Martino, Alessandro Andreis, Marzia De Biasio, Francesca Gaspard, Elena Paneva, Mariacristina Tomat, Gaetano Maria Deferrari, Miriam Isola, Massimo Imazio
Objective Clinical trials have evaluated the efficacy and safety of colchicine only in simple pericarditis, excluding cases of concomitant myocarditis. The aim of this paper is to evaluate the efficacy and safety of colchicine for the treatment of the first attack of acute pericarditis with concomitant myocardial involvement. Methods Double-centre retrospective cohort study analysing consecutive patients
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Predictors of outcome in patients with moderate mixed aortic valve disease Heart (IF 5.7) Pub Date : 2024-05-01 Kush P Patel, Michael McKenna, George D Thornton, Sebastian Vandermolen, Zaid Ali Abdulelah, Wael Awad, Andreas Baumbach, Anthony Mathur, Thomas A Treibel, Guy Lloyd, Michael J Mullen, Sanjeev Bhattacharyya
Objectives Grading the severity of moderate mixed aortic stenosis and regurgitation (MAVD) is challenging and the disease poorly understood. Identifying markers of haemodynamic severity will improve risk stratification and potentially guide timely treatment. This study aims to identify prognostic haemodynamic markers in patients with moderate MAVD. Methods Moderate MAVD was defined as coexisting moderate
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Exercise intolerance in a man with ischaemic cardiomyopathy and biventricular pacing Heart (IF 5.7) Pub Date : 2024-05-01 Graham H Bevan, Jonathan Buber
A patient in his 60s with a history of ischaemic cardiomyopathy and severely reduced left ventricular ejection fraction of 20% presents with worsening dyspnoea on exertion. He is tolerating therapeutic doses of guideline-directed medical therapy including sacubitril-valsartan, carvedilol, spironolactone and empagliflozin, and has a biventricular implantable cardiac defibrillator. He undergoes cardiopulmonary
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Thoracic versus coronary calcification for atherosclerotic cardiovascular disease events prediction Heart (IF 5.7) Pub Date : 2024-04-23 Keishi Ichikawa, Rui Wang, Robyn L McClelland, Venkat S Manubolu, Shriraj Susarla, Duo Lee, Leili Pourafkari, Hooman Fazlalizadeh, Jairo Aldana Bitar, Rick Robin, April Kinninger, Sion Roy, Wendy S Post, Matthew Budoff
This study compared the prognostic value of quantified thoracic artery calcium (TAC) including aortic arch on chest CT and coronary artery calcium (CAC) score on ECG-gated cardiac CT. Methods A total of 2412 participants who underwent both chest CT and ECG-gated cardiac CT at the same period were included in the Multi-Ethnic Study of Atherosclerosis Exam 5. All participants were monitored for incident
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Sarcopenia and aortic valve disease Heart (IF 5.7) Pub Date : 2024-04-22 Manish Kumar, Anthony Pettinato, Feria Ladha, Jacob E Earp, Varun Jain, Shivaraj Patil, Daniel T Engelman, Peter F Robinson, Mohamad B Moumneh, Parag Goyal, Abdulla A Damluji
Valvular heart disease, including calcific or degenerative aortic stenosis (AS), is increasingly prevalent among the older adult population. Over the last few decades, treatment of severe AS has been revolutionised following the development of transcatheter aortic valve replacement (TAVR). Despite improvements in outcomes, older adults with competing comorbidities and geriatric syndromes have suboptimal
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Outcomes in patients treated with loop diuretics without a diagnosis of heart failure: a retrospective cohort study Heart (IF 5.7) Pub Date : 2024-04-17 Joseph James Cuthbert, Ireneous Soyiri, Stephanie Jayne Lomax, John Turgoose, Ahmet Fuat, Judith Cohen, Andrew L Clark
Background Loop diuretics are commonly prescribed in the community, not always to patients with a recorded diagnosis of heart failure (HF). The rate of HF events in patients prescribed loop diuretics without a diagnosis of HF is unknown. Methods This was a propensity-matched cohort study using data from the Clinical Practice Research Datalink, Hospital Episode Statistics and Office of National Statistics
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Preconception counselling in women of reproductive age attending cardiology clinics in Scotland Heart (IF 5.7) Pub Date : 2024-04-16 Joanna Osmanska, Alice M Jackson, Joanne Simpson, Carly Adamson, Daniel Doherty, Helene Mamet, Lynsey Moir, Niki L Walker, Duncan Hogg, Maggie Simpson
Background Guidelines for the management of cardiovascular disease (CVD) recommend preconception risk stratification and counselling in all women of childbearing age. We assessed the provision of preconception counselling (PCC) among women of reproductive age attending general cardiology outpatient clinics over a 12-month period in two large health boards in Scotland. Methods and results Electronic
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Adherence in a fortnight: is this a true reflection of a lifetime? Heart (IF 5.7) Pub Date : 2024-05-01 Suraya H Kamsani, Melissa E Middeldorp
Recently, there has been significant momentum in the widespread adoption of digital health technologies for detecting and managing atrial fibrillation (AF). The diagnostic accuracy of various commercially available devices is well described and influenced by factors such as device type (handheld vs wearables), technology used (photoplethysmography vs ECG) and duration of monitoring (continuous vs intermittent)
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Colchicine in atherosclerotic cardiovascular disease Heart (IF 5.7) Pub Date : 2024-05-01 Bradley Tucker, Neil Goonetilleke, Sanjay Patel, Anthony Keech
Inflammation has a direct role in the development of atherosclerotic vascular disease, and oral colchicine displays broad anti-inflammatory properties. Several large, randomised controlled trials (RCTs) have evaluated colchicine’s impact on cardiovascular outcomes. Results from a meta-analysis of these trials demonstrate that colchicine reduces the risk of recurrent major adverse cardiovascular events
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Adherence to a handheld device-based atrial fibrillation screening protocol is associated with clinical outcomes Heart (IF 5.7) Pub Date : 2024-05-01 Rachel M J van der Velden, Carl Bonander, Harry J G M Crijns, Katrin Kemp-Gudmundsdottir, Johan Engdahl, Dominik Linz, Emma Svennberg
Objective To evaluate adherence and adherence consistency to the handheld ECG device-based screening protocol and their association with adverse cerebral and cardiovascular outcomes in two systematic atrial fibrillation (AF) screening programmes. Methods In 2012 (Systematic ECG Screening for Atrial Fibrillation Among 75-Year Old Subjects in the Region of Stockholm and Halland, Sweden (STROKESTOP) study)
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The role of COVID-19 vaccines in preventing post-COVID-19 thromboembolic and cardiovascular complications Heart (IF 5.7) Pub Date : 2024-05-01 Núria Mercadé-Besora, Xintong Li, Raivo Kolde, Nhung TH Trinh, Maria T Sanchez-Santos, Wai Yi Man, Elena Roel, Carlen Reyes, Antonella Delmestri, Hedvig M E Nordeng, Anneli Uusküla, Talita Duarte-Salles, Clara Prats, Daniel Prieto-Alhambra, Annika M Jödicke, Martí Català
Objective To study the association between COVID-19 vaccination and the risk of post-COVID-19 cardiac and thromboembolic complications. Methods We conducted a staggered cohort study based on national vaccination campaigns using electronic health records from the UK, Spain and Estonia. Vaccine rollout was grouped into four stages with predefined enrolment periods. Each stage included all individuals
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Interaction of genetic risk and lifestyle on the incidence of atrial fibrillation Heart (IF 5.7) Pub Date : 2024-05-01 Tanja Charlotte Frederiksen, Morten Krogh Christiansen, Emelia J Benjamin, Kim Overvad, Anja Olsen, Mette K Andersen, Torben Hansen, Niels Grarup, Henrik Kjaerulf Jensen, Christina C Dahm
Background The relationship between combined genetic predisposition and lifestyle and the risk of incident atrial fibrillation (AF) is unclear. Therefore, we aimed to assess a possible interaction between lifestyle and genetics on AF risk. Methods We included AF cases and a randomly drawn subcohort of 4040 participants from the Danish Diet, Cancer and Health cohort. Lifestyle risk factors were assessed
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Cardiovascular sequelae of trastuzumab and anthracycline in long-term survivors of breast cancer Heart (IF 5.7) Pub Date : 2024-05-01 Claire Glen, Andrew Morrow, Giles Roditi, Tracey Hopkins, Iain Macpherson, Philip Stewart, Mark C Petrie, Colin Berry, Fred Epstein, Ninian N Lang, Kenneth Mangion
Objectives Long-term follow-up of patients treated with trastuzumab largely focuses on those with reduced left ventricular ejection fraction (LVEF) on treatment completion. This study sought to evaluate the prevalence of cardiovascular risk factors, overt cardiovascular disease and cardiac imaging abnormalities using cardiac magnetic resonance (CMR), in participants with normal LVEF on completion of
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Aortic valve perivascular adipose tissue computed tomography attenuation in patients with aortic stenosis Heart (IF 5.7) Pub Date : 2024-05-01 Simona B Botezatu, Xinming Yu, Mohammed N Meah, Michelle C Williams, Damini Dey, David E Newby, Evangelos Tzolos, Marc R Dweck
Objective Aortic stenosis (AS) shares pathophysiological similarities with atherosclerosis including active inflammation. CT attenuation of perivascular adipose tissue provides a measure of vascular inflammation that is linked to prognosis and has the potential to be applied to the aortic valve. We investigated perivascular adipose tissue attenuation around the aortic valve in patients with AS. Methods
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Filamin A heart valve disease as a genetic cause of inherited bicuspid and tricuspid aortic valve disease Heart (IF 5.7) Pub Date : 2024-05-01 Constance Delwarde, Claire Toquet, Anne Sophie Boureau, Robin Le Ruz, Solena Le Scouarnec, Jean Mérot, Florence Kyndt, Daniel Bernstein, Jonathan A Bernstein, Jan J J Aalberts, Hervé Le Marec, Jean-Jacques Schott, Jean-Christian Roussel, Thierry Le Tourneau, Romain Capoulade
Objective Variants in the FLNA gene have been associated with mitral valve dystrophy (MVD), and even polyvalvular disease has been reported. This study aimed to analyse the aortic valve and root involvement in FLNA -MVD families and its impact on outcomes. Methods 262 subjects (37 (18–53) years, 140 male, 79 carriers: FLNA +) from 4 FLNA -MVD families were included. Echocardiography was performed in
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Assessment and management of asymptomatic atrial fibrillation Heart (IF 5.7) Pub Date : 2024-05-01 Jason G. Andrade, Marc W. Deyell, Richard Bennett, Laurent Macle
Atrial fibrillation (AF) is the most common sustained cardiac dysrhythmia encountered in practice. It is currently estimated that AF affects approximately 2% of the general population; however, the true prevalence of AF is likely to be at least 3%–4% when asymptomatic AF is considered. For clinically apparent AF, the investigations and management are relatively well established. The identification
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Young man with chest pain and an abnormal echocardiogram Heart (IF 5.7) Pub Date : 2024-05-01 Matthew Peters, Dinesh Kalra
A man in his 40s with a history of hyperlipidaemia presented with intermittent, dull left-sided chest pain for 2 weeks that was not consistently exertional. He denied dyspnoea, cough, fevers, recent travel or exposure to sick people. He did not smoke or use alcohol or illicit drugs. There was no pertinent family history. Physical examination, an ECG, basic laboratories and a chest X-ray were unremarkable
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Machine learning-based detection of sleep-disordered breathing in hypertrophic cardiomyopathy Heart (IF 5.7) Pub Date : 2024-04-08 Keitaro Akita, Shigetaka Kageyama, Sayumi Suzuki, Kazuto Ohno, Masamitsu Kamakura, Ryuzo Nawada, Chiei Takanaka, Yasushi Wakabayashi, Takahiro Kanda, Kei Tawarahara, Masahiro Mutoh, Masaki Matsunaga, Satoru Suwa, Yasuyo Takeuchi, Hiroki Sakamoto, Hideki Saito, Kazusa Hayashi, Nobuyuki Wakahara, Kyoko Unno, Takenori Ikoma, Ryota Sato, Keisuke Iguchi, Terumori Satoh, Makoto Sano, Kenichiro Suwa, Yoshihisa
Background Hypertrophic cardiomyopathy (HCM) is often concomitant with sleep-disordered breathing (SDB), which can cause adverse cardiovascular events. Although an appropriate approach to SDB prevents cardiac remodelling, detection of concomitant SDB in patients with HCM remains suboptimal. Thus, we aimed to develop a machine learning-based discriminant model for SDB in HCM. Methods In the present
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Reference ranges for ambulatory heart rate measurements in a middle-aged population Heart (IF 5.7) Pub Date : 2024-04-05 Anders Paul Persson, Alexandra Måneheim, Johan Economou Lundeberg, Artur Fedorowski, Jeff S Healey, Johan Sundström, Gunnar Engström, Linda S B Johnson
Background Elevated heart rate (HR) predicts cardiovascular disease and mortality, but there are no established normal limits for ambulatory HR. We used data from the Swedish CArdioPulmonary Imaging Study to determine reference ranges for ambulatory HR in a middle-aged population. We also studied clinical correlates of ambulatory HR. Methods A 24-hour ECG was registered in 5809 atrial fibrillation-free
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Sex differences in the intensity of statin prescriptions at initiation in a primary care setting Heart (IF 5.7) Pub Date : 2024-04-05 Pauline A J Kiss, Alicia Uijl, Annemarijn R de Boer, Tessa C X Duk, Diederick E Grobbee, Monika Hollander, Elisabeth Smits, Miriam C J M Sturkenboom, Sanne A E Peters
Background Current guidelines for the prevention and management of cardiovascular diseases (CVD) provide similar recommendations for the use of statins in both women and men. In this study, we assessed sex differences in the intensity of statin prescriptions at initiation and in the achievement of treatment targets, among individuals without and with CVD, in a primary care setting. Methods Electronic
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Twenty-four-hour blood pressure trajectories and clinical outcomes in patients who had an acute ischaemic stroke Heart (IF 5.7) Pub Date : 2024-04-03 Ruirui Wang, Yang Liu, Qilu Zhang, Jing Zhang, Hao Peng, Mengyao Shi, Yanbo Peng, Tian Xu, Aili Wang, Tan Xu, Jing Chen, Yonghong Zhang, Jiang He
Objective The management of blood pressure (BP) in acute ischaemic stroke remains a subject of controversy. This investigation aimed to explore the relationship between 24-hour BP patterns following ischaemic stroke and clinical outcomes. Methods A cohort of 4069 patients who had an acute ischaemic stroke from 26 hospitals was examined. Five systolic BP trajectories were identified by using latent
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Microvascular disease and arrhythmias: a renewed focus on the myocardial microvasculature? Heart (IF 5.7) Pub Date : 2024-03-28 Celine Gallagher, Gemma Wilson, Dennis H Lau
Arrhythmias, and in particular atrial fibrillation (AF), are one of the greatest healthcare challenges of our time. Hospitalisation due to this condition is exponentially growing, and now outnumbers those for both heart failure and myocardial infarction.1 While much effort has been directed at pharmacological and interventional techniques to improve outcomes for those living with these conditions,
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Microvascular disease, modifiable risk factor profiles and incident arrhythmias in type 2 diabetes Heart (IF 5.7) Pub Date : 2024-03-21 Guo-Chong Chen, Daniel Nyarko Hukportie, Wei-Dong Fan, Jie-Qiong Lyu, Hai-Peng Wang, Liqiang Qin, Xian-Bo Wu, Fu-Rong Li
Background To assess the roles of diabetic microvascular disease and modifiable risk factors and their combination in the development of arrhythmias. Methods We included participants with type 2 diabetes (T2D) who were free of arrhythmias during recruitment in the UK Biobank study. The associations of microvascular disease states (defined by the presence of retinopathy, peripheral neuropathy or chronic
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Artificial intelligence to improve the diagnosis of pulmonary hypertension: promises and pitfalls Heart (IF 5.7) Pub Date : 2024-04-01 Namisha Singh, Sanjay Mehta
Pulmonary hypertension (PH) is a clinical–physiological syndrome thought to affect 1% of the global population.1 PH is defined haemodynamically by mean pulmonary artery pressure >20 mm Hg, resulting in right ventricular (RV) overload and often RV failure. Patients with PH experience symptoms including dyspnoea, fatigue and oedema, often associated with physical and psychosocial disability. In some
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Towards a gender-specific and morphology-specific assessment of aortic valve stenosis severity Heart (IF 5.7) Pub Date : 2024-04-01 Nikolaus Jander, Jan Minners
Over the last two decades, the differentiation of severe from non-severe aortic valve stenosis with echocardiography has become more complex. The consideration of flow is now frequently essential to evaluate haemodynamic stenosis severity. Low flow can result in low gradient and, thereby, mask severe aortic stenosis. On the other hand, low flow may impede complete opening of the valve and result in
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Use of coronarycomputed tomography for cardiovascular risk assessment in immune-mediated inflammatory diseases Heart (IF 5.7) Pub Date : 2024-04-01 Marta Peverelli, Robert T Maughan, Deepa Gopalan, Marc R Dweck, Damini Dey, Maya H Buch, James H F Rudd, Jason M Tarkin
Immune-mediated inflammatory diseases (IMIDs) are recognised risk factors for accelerated atherosclerotic cardiovascular disease (CVD), particularly in younger individuals and women who lack traditional CVD risk factors. Reflective of the critical role that inflammation plays in the formation, progression and rupture of atherosclerotic plaques, research into immune mechanisms of CVD has led to the
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Pulmonary vasodilators and exercise in Fontan circulation: a systematic review and meta-analysis Heart (IF 5.7) Pub Date : 2024-04-01 Diamantis Kosmidis, Alexandra Arvanitaki, Ioannis T Farmakis, Aris Liakos, Andreas Giannopoulos, Antonios Ziakas, George Giannakoulas
Objective In Fontan circulation, pulmonary arterial hypertension (PAH)-targeted therapies could improve the patients’ exercise capacity. This study aimed to investigate the effects of PAH agents on different exercise parameters in stable Fontan patients by synthesising evidence of randomised controlled trials (RCTs). Methods A systematic search of PubMed, Cochrane Central Register of Controlled Trials
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Incremental value of machine learning for risk prediction in tetralogy of Fallot Heart (IF 5.7) Pub Date : 2024-04-01 Ayako Ishikita, Chris McIntosh, S Lucy Roche, David J Barron, Erwin Oechslin, Lee Benson, Krishnakumar Nair, Myunghyun M Lee, Michael N Gritti, Kate Hanneman, Gauri Rani Karur, Rachel M Wald
Objective Machine learning (ML) can facilitate prediction of major adverse cardiovascular events (MACEs) in repaired tetralogy of Fallot (rTOF). We sought to determine the incremental value of ML above expert clinical judgement for risk prediction in rTOF. Methods Adult congenital heart disease (ACHD) clinicians (≥10 years of experience) participated (one cardiac surgeon and four cardiologists (two
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Postdischarge major bleeding, myocardial infarction, and mortality risk after coronary artery bypass grafting Heart (IF 5.7) Pub Date : 2024-04-01 Erik Björklund, Philip Enström, Susanne J Nielsen, Hans Tygesen, Andreas Martinsson, Emma C Hansson, Martin Lindgren, Carl-Johan Malm, Aldina Pivodic, Anders Jeppsson
Objective To investigate the incidence and mortality risk associated with postdischarge major bleeding after coronary artery bypass grafting (CABG), and relate this to the incidence of, and mortality risk from, postdischarge myocardial infarction. Methods All patients undergoing first-time isolated CABG in Sweden in 2006–2017 and surviving 14 days after hospital discharge were included in a cohort
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Symptoms and signs in patients with heart failure: association with 3-month hospitalisation and mortality Heart (IF 5.7) Pub Date : 2024-04-01 Mohammad Rizwan Ali, Carolyn S P Lam, Anna Strömberg, Simon P P Hand, Sarah Booth, Francesco Zaccardi, Iain Squire, Gerry P McCann, Kamlesh Khunti, Claire Alexandra Lawson
Objectives To determine the association between symptoms and signs reported in primary care consultations following a new diagnosis of heart failure (HF), and 3-month hospitalisation and mortality. Design Nested case–control study with density-based sampling. Setting Clinical Practice Research Datalink, linked to hospitalisation and mortality (1998–2020). Participants Database cohort of 86 882 patients
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Echocardiographic artificial intelligence for pulmonary hypertension classification Heart (IF 5.7) Pub Date : 2024-04-01 Yukina Hirata, Takumasa Tsuji, Jun'ichi Kotoku, Masataka Sata, Kenya Kusunose
Objective The classification of pulmonary hypertension (PH) is crucial for determining the appropriate therapeutic strategy. We investigated whether machine learning (ML) algorithms may assist in echocardiographic PH prediction, where current guidelines recommend integrating several different parameters. Methods We obtained physical and echocardiographic data from 885 patients who underwent right heart
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Computed tomography calcium scoring in aortic stenosis: bicuspid versus tricuspid morphology Heart (IF 5.7) Pub Date : 2024-04-01 Zi Ye, Marie-Annick Clavel, Thomas A Foley, Philippe Pibarot, Maurice Enriquez-Sarano, Hector I Michelena
Objective CT aortic valve calcium score (AVCscore) and density (AVCdensity) thresholds have been recommended for aortic stenosis (AS) severity assessment in tricuspid aortic valve (TAV). We aimed to compare AVCscore and AVCdensity in bicuspid aortic valve (BAV) versus TAV. Methods Retrospective single-centre study of patients with echocardiographic AS-severity and CT-AVC assessments within 6 months
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Coronary microvascular dysfunction in patients undergoing transcatheter aortic valve implantation Heart (IF 5.7) Pub Date : 2024-04-01 Roberto Scarsini, Leonardo Portolan, Francesco Della Mora, Margherita Fabroni, Stefano Andreaggi, Andrea Mainardi, Paolo Springhetti, Alberto Dotto, Paolo Alberto Del Sole, Simone Fezzi, Sara Pazzi, Domenico Tavella, Concetta Mammone, Mattia Lunardi, Gabriele Pesarini, Giovanni Benfari, Flavio Luciano Ribichini
Objectives This study aimed to evaluate the prognostic value of coronary microvascular dysfunction (CMD) at long term after transcatheter aortic valve implantation (TAVI) and to explore its relationship with extravalvular cardiac damage (EVCD). Moreover, we sought to test the correlation between angiography-derived index of microcirculatory resistance (IMRangio) and invasive IMR in patients with aortic
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Dyspnoea, dizziness and dysrhythmia in a middle-aged patient Heart (IF 5.7) Pub Date : 2024-04-01 Vijay Soorampally, Sriram Veeraraghavan, Bharath Raj Kidambi
A middle-aged patient with no prior comorbidities presented to the emergency department with a sudden onset of palpitations, dizziness and progressive dyspnoea. History was negative for any cardiac disorders in the past. On examination, the pulse rate was around 190 beats/min with a systolic blood pressure of 80 mm Hg. ECG at presentation was suggestive of ventricular tachycardia (VT) (figure 1 A)
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Effectiveness of polypill for primary and secondary prevention of cardiovascular disease: a pragmatic cluster-randomised controlled trial (PolyPars) Heart (IF 5.7) Pub Date : 2024-03-14 Fatemeh Malekzadeh, Abdullah Gandomkar, Hossein Poustchi, Arash Etemadi, Gholamreza Roshandel, Armin Attar, Firoozeh Abtahi, Shahrokh Sadeghi Boogar, Vahid Mohammadkarimi, Mohammad Reza Fattahi, Abbas Mohagheghi, Reza Malekzadeh, Sadaf G Sepanlou
Background We aimed to investigate the effectiveness of fixed-dose combination therapy (polypill) for primary and secondary prevention of major cardiovascular diseases in a typical rural setting. Methods The PolyPars Study is a two-arm pragmatic cluster-randomised trial nested within the PARS cohort study, including all residents aged over 50 years in the entire district in southern Iran. The 91 villages
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European Society of Cardiology 0/1-hour algorithm (high-sensitivity cardiac troponin T) performance across distinct age groups Heart (IF 5.7) Pub Date : 2024-03-12 Marissa J Millard, Nicklaus P Ashburn, Anna C Snavely, Tara Hashemian, Michael Supples, Brandon Allen, Robert Christenson, Troy Madsen, James McCord, Bryn Mumma, Jason Stopyra, Richard Gentry Wilkerson, Simon A Mahler
Background To determine if the European Society of Cardiology 0/1-hour (ESC 0/1-h) algorithm with high-sensitivity cardiac troponin T (hs-cTnT) meets the ≥99% negative predictive value (NPV) safety threshold for 30-day cardiac death or myocardial infarction (MI) in older, middle-aged and young subgroups. Methods We conducted a subgroup analysis of adult emergency department patients with chest pain
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Inclusivity in randomised clinical trials: myth or reality? Heart (IF 5.7) Pub Date : 2024-04-01 Mario Iannaccone, Marco Gamardella, Alaide Chieffo
In this issue of Heart, Castelijns et al aimed to apply the inclusion and exclusion criteria from the Cardiovascular Outcomes for People Using Anticoagulation Strategies, Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management and Avoidance trials, Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of
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Very early invasive strategy in patients with non-ST-elevation myocardial infarction: should we go for it? Heart (IF 5.7) Pub Date : 2024-04-01 Gilles Lemesle, Guillaume Schurtz, Basile Verdier, Laurent Bonello
According to the recent guidelines from the European Society of Cardiology,1 an invasive strategy should be performed within the first 24 hours from diagnosis in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) at high risk; and a very early invasive strategy (<2 hours) deserves only to those patients at very high risk. The question of the optimal timing of the invasive procedure is
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Mitral annular disjunction: a ubiquitous finding with or without mitral valvar prolapse Heart (IF 5.7) Pub Date : 2024-04-01 Robert H Anderson, Joseph Westaby, Mary N Sheppard, Andrew C Cook
As is shown in the study of 224 hearts with so-called mitral annular disjunction,1 the wheel has now come full circle. Although now usually credited to having first been seen by Henle as long ago as 1876, it was Hutchins and his colleagues who brought the feature to attention as a potential harbinger of pathological change.2 The investigators working at Johns Hopkins Hospital had noticed the anatomical
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Review of the National Institute for Health and Care Excellence guidelines on chronic heart failure Heart (IF 5.7) Pub Date : 2024-04-01 Daniel J Doherty, Kieran F Docherty, Roy S Gardner
Guidelines are more accessible than ever and represent an important tool in clinical practice. The National Institute for Health and Care Excellence (NICE) has developed recommendations for heart failure diagnosis and management based not only on morbidity and mortality trial outcome data but also in-depth economic analysis, with a focus on generalisability to UK National Health Service clinical practice
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Beta-blockers and renin-angiotensin system inhibitors for Takotsubo syndrome recurrence: a network meta-analysis Heart (IF 5.7) Pub Date : 2024-04-01 Francesco Santoro, Scott Sharkey, Rodolfo Citro, Tetsuji Miura, Luca Arcari, Jose Angel Urbano-Moral, Thomas Stiermaier, Ivan Javier Nuñez-Gil, Angelo Silverio, Nicola Di Nunno, Ilaria Ragnatela, Rosa Cetera, Junichi Nishida, Ingo Eitel, Natale Daniele Brunetti
Introduction Takotsubo syndrome (TTS) is an acute heart failure syndrome, featured by transient left ventricular systolic dysfunction. Recurrences of TTS are not infrequent and there is no standard preventive therapy. The aim of this study was to evaluate in a network meta-analysis if beta-blockers (BB) and ACE inhibitors/angiotensin receptor blockers (ACEi/ARBs), in combination or not, can effectively
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Generalisability of trials on antithrombotic treatment intensification in patients with cardiovascular disease Heart (IF 5.7) Pub Date : 2024-04-01 Maria C Castelijns, Steven H J Hageman, Martin Teraa, Manon G van der Meer, Jan Westerink, Jurrien ten Berg, Frank L J Visseren
Objective Assessment of generalisability of guideline-informing trials on antithrombotic treatment intensification to real-world patients with cardiovascular disease (CVD). Methods Inclusion and exclusion criteria of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS), Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management and Avoidance (CHARISMA)
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Novel uses for implanted haemodynamic monitoring in adults with subaortic right ventricles Heart (IF 5.7) Pub Date : 2024-04-01 William H Marshall V, May Ling Mah, Jennifer DeSalvo, Saurabh Rajpal, Lauren T Lastinger, Arash Salavitabar, Aimee K Armstrong, Darren Berman, Brent Lampert, Lydia K Wright, Jenne Hickey, Rachel Metzger, Deipanjan Nandi, Robert Gajarski, Curt J Daniels
Background Pulmonary hypertension (PH) is a common complication in patients with complete dextro-transposition of the great arteries (TGA) after atrial switch (D-TGA/AS) and congenitally corrected TGA (ccTGA). In this population with subaortic right ventricles (sRVs), echocardiography is a poor screening tool for PH; implantable invasive haemodynamic monitoring (IHM) could be used for this purpose
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Very early invasive strategy in higher risk non-ST-elevation acute coronary syndrome: the RAPID NSTEMI trial Heart (IF 5.7) Pub Date : 2024-04-01 Thomas A Kite, Andrew Ladwiniec, John P Greenwood, Chris P Gale, Brijesh Anantharam, Ranjit More, Simon Lee Hetherington, Sohail Q Khan, Peter O'Kane, Roby Rakhit, Alexander Chase, Shaun Barber, Ghazala Waheed, Colin Berry, Marcus Flather, Gerry P McCann, Nick Curzen, Adrian P Banning, Anthony H Gershlick
Objective To investigate whether a very early invasive strategy (IS)±revascularisation improves clinical outcomes compared with standard care IS in higher risk patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). Methods Multicentre, randomised, controlled, pragmatic strategy trial of higher risk patients with NSTE-ACS, defined by Global Registry of Acute Coronary Events 2.0 score of
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Prognostic value of growth differentiation factor-15 3 months after an acute chest pain admission Heart (IF 5.7) Pub Date : 2024-04-01 Gard Mikael Sæle Myrmel, Ole-Thomas Steiro, Hilde Lunde Tjora, Jørund Langørgen, Rune Oskar Bjørneklett, Øyvind Skadberg, Vernon Vijay Singha Bonarjee, Øistein Rønneberg Mjelva, Eva Ringdal Pedersen, Kjell Vikenes, Torbjorn Omland, Kristin Moberg Aakre
Objective Growth differentiation factor-15 (GDF-15) is a predictor of death and cardiovascular events when measured during index hospitalisation in patients with acute chest pain. This study investigated the prognostic utility of measuring GDF-15 3 months after an admission with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS). Methods GDF-15 was measured at baseline and 3 months after
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Morphology of the mural and commissural atrioventricular junction of the mitral valve Heart (IF 5.7) Pub Date : 2024-04-01 Agata Krawczyk-Ożóg, Jakub Batko, Barbara Zdzierak, Artur Dziewierz, Kamil Tyrak, Filip Bolechała, Paweł Kopacz, Marcin Strona, Krzysztof Gil, Jakub Hołda, Mateusz K Hołda
Objective This study investigates mitral annular disjunctions (MAD) in the atrial wall-mitral annulus-ventricular wall junction along the mural mitral leaflet and commissures. Methods We examined 224 adult human hearts (21.9% females, 47.9±17.6 years) devoid of cardiovascular diseases (especially mitral valve disease). These hearts were obtained during forensic medical autopsies conducted between January
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Reduction of moderate to severe tricuspid regurgitation after catheter ablation for atrial fibrillation Heart (IF 5.7) Pub Date : 2024-04-01 Myung-Jin Cha, Seung-Ah Lee, Min Soo Cho, Gi-Byoung Nam, Kee-Joon Choi, Jun Kim
Objective Tricuspid regurgitation (TR) is a progressive disease with high mortality and limited medical treatment options, and its association with atrial fibrillation (AF) has been documented. This study aimed to investigate whether successful rhythm control through catheter ablation for AF could reduce TR severity. Methods A total of 106 patients with drug-refractory AF with moderate to severe secondary
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Surgical and transcatheter treatments of mechanical complications of acute myocardial infarction Heart (IF 5.7) Pub Date : 2024-04-01 James M McCabe, Christine J Chung
### Learning objectives Major advances in reperfusion therapies after acute myocardial infarction (AMI) have resulted in dramatic reductions in the rate of mechanical complications including ventricular septal defect (VSD), free wall rupture (FWR) and papillary muscle rupture (PMR). However, the drastic decline in their incidence has not been accompanied by a similar decrease in their risk of major
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Mitral valve dysfunction in a woman with newly diagnosed acute promyelocytic leukemia Heart (IF 5.7) Pub Date : 2024-04-01 Matthew J Bierowski, Eric D Warner, Chelsea D Edirisuriya
A woman in her mid-40s with a recent diagnosis of pulmonary embolism (on rivaroxaban) presented to the emergency room with dyspnea and fatigue. Vital signs were stable on arrival but a new holosystolic murmur was noted on exam and labs revealed pancytopenia. Infectious workup was unrevealing. CT revealed stable pulmonary emboli compared with prior imaging, along with a new splenic infarct. Transthoracic
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Association of pulmonary hypertension with the outcome in patients undergoing edge-to-edge mitral valve repair Heart (IF 5.7) Pub Date : 2024-02-22 Timm Ubben, Christian Frerker, Buntaro Fujita, Stephan Rosenkranz, Roman Pfister, Stephan Baldus, Hannes Alessandrini, Karl-Heinz Kuck, Stephan Willems, Ingo Eitel, Tobias Schmidt
Objectives The association of pulmonary hypertension (PH) with the outcome after mitral transcatheter edge-to-edge repair (M-TEER) focusing on the new ESC/ERS guidelines definition for PH. Background PH is frequently found in patients with mitral regurgitation and is associated with lower survival rates. Recent studies were based on echocardiographic parameters, but results based on invasive haemodynamics
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Percutaneous intramyocardial septal radiofrequency ablation after 5-year follow-up Heart (IF 5.7) Pub Date : 2024-02-22 Shengjun Ta, Jing Li, David H Hsi, Rui Hu, Changhui Lei, Bo Shan, Wenxia Li, Jing Wang, Bo Wang, Nan Kang, Xiaojuan Li, Jiani Liu, Caixia Qi, Junzhe Huang, Yupeng Han, Fangqi Ruan, Jun Zhang, Liwen Liu
Objective The objective is to evaluate the 5-year follow-up results of percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) for hypertrophic obstructive cardiomyopathy (HOCM), including clinical status, electrocardiographic and echocardiographic characteristics. Methods 27 patients (age: 44.3±15.5 years; 67% men, 33% women) with severely symptomatic HOCM who underwent PIMSRA from October
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Prehospital triage in suspected myocardial infarction: a calculated risk? Heart (IF 5.7) Pub Date : 2024-03-01 Thomas A Kite, Andrew Ladwiniec, Alastair James Moss
In the prehospital setting, accurate decision-making is of paramount importance in the management of cardiac emergencies. For life-threatening events involving complete occlusion of a coronary artery, the activation of ST-elevation myocardial infarction protocols instructs the emergency services to provide immediate treatment and liaise directly with cardiac centres regarding invasive management, in
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Augmenting reality in echocardiography Heart (IF 5.7) Pub Date : 2024-03-01 Veer Sangha
Echocardiography is a vital first-line imaging tool for the diagnosis and management of many cardiovascular diseases. Its availability and low cost have encouraged widespread use by clinicians for the diagnosis and management of patients with heart failure.1 Visual estimation is widely used to assess ejection fraction (EF), the percentage of blood the left ventricle pumps out during a contraction.