Heart, Lung and Circulation最新文献

{"title":"Angry Purkinje Syndrome: A Review of Short-Coupled Polymorphic Ventricular Tachycardia with Quinidine Treatment.","authors":"Qing Yi Fang, Vincenzo Somma, Geoffrey Lee, Robert D Anderson","doi":"10.1016/j.hlc.2026.06.027","DOIUrl":"https://doi.org/10.1016/j.hlc.2026.06.027","url":null,"abstract":"<p><strong>Background: </strong>Polymorphic ventricular tachycardia (VT) mediated by short-coupled premature ventricular complexes in patients with recent myocardial infarction is termed 'Angry Purkinje Syndrome'. These arrhythmias are typically refractory to conventional antiarrhythmic therapy but may respond to quinidine.</p><p><strong>Methods & results: </strong>We present a case series of patients with short-coupled polymorphic VT occurring 2-8 days after acute myocardial infarction and coronary revascularisation. All three patients had recurrent polymorphic VT episodes that were consistently initiated by ventricular ectopy with a short coupling interval of 360 milliseconds. All three patients experienced arrhythmic storms requiring multiple cardioversions and were refractory to amiodarone, procainamide, lignocaine, and isoprenaline. Quinidine led to sustained suppression of ventricular arrhythmias, with marked reduction in premature ventricular contraction burden within 24 hours. Two patients were successfully extubated 4 days after arrest, and the third was decannulated from extracorporeal membrane oxygenation 4 days after quinidine initiation.</p><p><strong>Conclusions: </strong>'Angry Purkinje Syndrome' is an uncommon but important cause of polymorphic VT in patients with coronary disease not related to acute myocardial ischaemia. Quinidine appears to provide effective suppression of Purkinje-mediated polymorphic VT and may represent an important therapeutic option in this setting.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Bedside Questions to Scientific Discovery: Rebuilding the Clinician-Scientist Pathway.","authors":"Ashish H Shah","doi":"10.1016/j.hlc.2026.05.031","DOIUrl":"https://doi.org/10.1016/j.hlc.2026.05.031","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lipoprotein(a) Reporting by Australian Chemical Pathology Laboratories.","authors":"Jeff R Ma, Sean Tan, Gerald F Watts, Nick S R Lan, Robert Hungerford, Peter J Psaltis, Jessica A Marathe, Stephen J Nicholls, Adam J Nelson","doi":"10.1016/j.hlc.2026.05.016","DOIUrl":"https://doi.org/10.1016/j.hlc.2026.05.016","url":null,"abstract":"<p><strong>Background: </strong>Levels of lipoprotein(a) [Lp(a)] are largely genetically determined and represent a causal risk factor for atherosclerotic cardiovascular disease. International recommendations suggest measuring Lp(a) at least once in a lifetime to guide risk stratification and cascade screening; however, real-world uptake remains low (<1%). This study aimed to document accessibility, costs, and methods for reporting Lp(a) levels among Australian pathology providers.</p><p><strong>Method: </strong>A cross-sectional national review was completed in January 2025 across all public and private pathology laboratory networks from every Australian state and territory accredited by the Royal College of Pathologists of Australasia. Laboratories were contacted via structured interviews and invited to submit de-identified Lp(a) reports.</p><p><strong>Results: </strong>Seventeen of the 18 laboratory networks contacted provided data. Six were state-wide centralised public pathology networks, and three were national private pathology networks. Lp(a) testing was available on-site at select laboratories within nine laboratory networks and available as a send-away test in the remaining eight. Out-of-pocket testing costs ranged from $0 to $75, with a median cost of $25. Among networks performing in-laboratory testing, the upper limits of the reference intervals ranged from <32 nmol/L to <72 nmol/L. Interpretive comments varied, with thresholds for increased cardiovascular risk ranging from 75 nmol/L to 125 nmol/L. A clinical recommendation for familial screening was utilised by one reporting network. Seven different guidelines were referenced among the nine networks performing Lp(a) measurements.</p><p><strong>Conclusions: </strong>There is significant variability in the local availability, cost, and interpretive thresholds of Lp(a) testing in Australia. Harmonisation of reporting practices will be critical as interest in Lp(a) grows and targeted therapies progress through clinical development.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Quo Vadis for COVADIS Diagnostic Criteria.","authors":"John F Beltrame, Peter Ong, Colin Berry, Paolo G Camici, Filippo Crea, Javier Escaned, Juan Carlos Kaski, Carl J Pepine, Udo Sechtem, Hiroaki Shimokawa, Tim P van de Hoef, Satoshi Yasuda, Christopher J Zeitz, C Noel Bairey Merz","doi":"10.1016/j.hlc.2026.06.030","DOIUrl":"https://doi.org/10.1016/j.hlc.2026.06.030","url":null,"abstract":"<p><p>The Coronary Vasomotor Disorders International Study group (COVADIS) developed the diagnostic criteria for vasospastic angina and microvascular angina more than 8 years ago. This article critically reappraises these criteria (Latin: quid fecisti - what has been done) and proposes the strategies for their advancement (Latin: Quo Vadis - where are you are going?). Although the criteria have some limitations, they remain relevant considering their multifaceted clinical perspective including the presence of symptoms, myocardial ischaemia and objective evidence of coronary vasomotor dysfunction. To improve the criteria, the following strategic directions (Quo Vadis) are proposed, (1) optimising invasive functional coronary angiography assessment - the benchmark diagnostic investigation for coronary vasomotor disorders, (2) diagnosing mixed macrovascular and microvascular coronary vasomotor disorders, (3) advancing non-invasive coronary vasomotor assessment methods, (4) linking coronary vasomotor disorder criteria to clinical outcomes, (5) evaluating coronary vasomotor disorders in the presence of obstructive coronary artery disease, and (6) global partnering of coronary vasomotor disorder initiatives in national networks and patient forums. These strategies will improve the diagnostic approaches to coronary vasomotor disorders thereby facilitating the evolution of the COVADIS Diagnostic Criteria and thus management of these elusive disorders.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary Revascularisation Strategies for Patients with Obstructive Coronary Artery Disease Requiring Lung Transplantation: A Narrative Review and Single-Centre Experience.","authors":"Aaron Adonopulos, Hannah Kempton, Thomas Meredith, Alexander Mullin, Adrian Havryk, Paul Jansz, Peter Macdonald","doi":"10.1016/j.hlc.2026.05.014","DOIUrl":"https://doi.org/10.1016/j.hlc.2026.05.014","url":null,"abstract":"<p><strong>Background: </strong>Lung transplant (LTx) candidates often have multiple risk factors for coronary artery disease (CAD), which was previously considered a contraindication to transplantation. Improvements in revascularisation techniques have broadened transplant eligibility; however, because available evidence is based on small and heterogeneous cohorts, the optimal revascularisation strategy remains unclear.</p><p><strong>Method: </strong>We conducted a literature review and describe our centre's experience with current approaches to revascularisation in LTx candidates with obstructive CAD.</p><p><strong>Results: </strong>The literature review identified 174 studies in the initial search, of which 29 studies were considered relevant. However, only six retrospective studies directly compared percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG), comprising 376 revascularised patients. In some cohorts, CABG was associated with longer ventilation time and longer intensive care unit (ICU) stay and overall hospital stay, although this finding was not consistent across all studies. At our centre, 20 patients underwent concomitant CABG, and 11 underwent PCI within 12 months before transplant listing, after obstructive CAD was diagnosed during transplant assessment. Procedure time in patients undergoing concomitant CABG was significantly longer (1.2 hours; p<0.05); however, all patients in this group underwent bilateral transplantation. Three patients in the PCI group experienced postoperative coronary events, and overall mortality was higher in this group. There were no differences in other outcomes, including ICU and overall length of stay.</p><p><strong>Conclusions: </strong>These findings highlight the heterogeneity and complexity of this patient cohort. Although no patients who underwent CABG experienced postoperative coronary events, the limited published evidence does not support a single preferred revascularisation strategy for patients being considered for lung transplantation. Case-by-case management guided by a multidisciplinary team is therefore warranted.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Value of Pulmonary Elastance Methods in HFrEF: A Comparative Study.","authors":"Feyza Mollaalioglu, Cahit Coskun, Aycan Esen Zencirci, Baris Gungor, Ozlem Yildirimturk","doi":"10.1016/j.hlc.2026.06.018","DOIUrl":"https://doi.org/10.1016/j.hlc.2026.06.018","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary vascular resistance (PVR) is commonly used to quantify right ventricular (RV) afterload in heart failure with reduced ejection fraction (HFrEF), yet it reflects primarily the steady component of pulmonary vascular load. Simplified pulmonary arterial elastance indices may better characterise the integrated arterial load experienced by the RV. The comparative prognostic value of different elastance formulations in HFrEF remains incompletely defined.</p><p><strong>Method: </strong>This retrospective study included 352 patients with HFrEF who underwent right heart catheterisation between 2018 and 2022. Pulmonary elastance was calculated using three simplified formulations: systolic pressure-based elastance (EasPAP=sPAP/SV), transpulmonary gradient-based elastance (EaTPG=[mPAP PCWP]/SV), and pulse pressure-based elastance (EaPP=PP/SV), together with their indexed forms. Discriminatory performance was evaluated using receiver operating characteristic curve analysis. Associations with all-cause mortality were assessed using univariate and multivariable Cox regression analyses adjusted for age, New York Heart Association functional class, and renal function. Subgroup analyses by PVR (<3 vs ≥3 Wood units [WU]) and combined PVR-EaPP phenotype analyses were performed.</p><p><strong>Results: </strong>During a median follow-up of 23 months, 139 patients (39.5%) died. In multivariable models, EasPAP (adjusted hazard ratio [HR] 1.31; p=0.002), EaPP (adjusted HR 1.63; p=0.005), and their indexed forms remained independently associated with mortality, whereas EaTPG-based formulations did not. In patients with PVR <3 WU, EasPAP and EaPP demonstrated stronger associations with mortality than in the high-PVR subgroup. In the combined phenotype analysis, elevated EaPP identified increased mortality risk irrespective of PVR category.</p><p><strong>Conclusions: </strong>In patients with HFrEF undergoing right heart catheterisation, simplified pulsatile elastance indices, particularly EasPAP and EaPP, were independently associated with all-cause mortality. Notably, elevated EaPP identified higher-risk patients even in the absence of elevated PVR, suggesting that resistance-based metrics alone may not fully capture RV afterload. Prospective validation is warranted.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Predictors and Temporal Trends in Intravascular Imaging Use During Percutaneous Coronary Intervention in a Publicly Funded Health System.","authors":"Todd Shephard, Anitha Lakshmanan, Ian R Smith, Michael Mallouhi, William Vollbon, Marcus Prior, Yash Singbal, Gregory Starmer, Rustem Dautov, Johanne Neill, Yohan Chacko","doi":"10.1016/j.hlc.2026.09.003","DOIUrl":"https://doi.org/10.1016/j.hlc.2026.09.003","url":null,"abstract":"<p><strong>Background: </strong>Intravascular imaging (IVI) improves clinical outcomes in percutaneous coronary intervention (PCI), yet real-world utilisation remains inconsistent. We evaluated temporal trends and determinants of IVI use within a large publicly funded, non-fee-for-service, healthcare system.</p><p><strong>Methods: </strong>All PCI procedures performed across Queensland public hospitals between 2016 and 2023 were analysed using registry data. The primary outcome was IVI use. Independent predictors were assessed using multivariable analysis.</p><p><strong>Results: </strong>Among 39,136 PCI procedures, IVI was used in 9.0% overall and increased from 5.6% in 2016 to 16.5% in 2023 (p_trend=0.002). Procedural complexity was the primary determinant: left main PCI (adjusted odds ratio [aOR] 7.84; 95% confidence interval [CI] 5.26-11.69), intravascular lithotripsy (aOR 8.51; 95% CI 3.78-19.15), and bifurcation lesions (aOR 1.34; 95% CI 1.01-1.78) were independent predictors. Conversely, ST-elevation myocardial infarction predicted lower use (aOR 0.49; 95% CI 0.42-0.59). Higher operator procedural volume was associated with increased IVI use (aOR 1.25; 95% CI 1.00-1.54). While operator training era and institutional factors were significant in unadjusted models, associations were attenuated after accounting for hospital-level clustering, suggesting strong influence of local hospital processes and culture toward IVI.</p><p><strong>Conclusions: </strong>IVI use has increased but remains underutilised. Adoption is driven primarily by procedural complexity and operator-level factors, with persistent inter-hospital variability. These findings highlight an ongoing evidence-practice gap and support system-level strategies to standardise IVI use in contemporary PCI.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular Health on a Changing Planet: Opportunities for Action From the CSANZ Planetary Health and Sustainability Working Group.","authors":"Fiona Foo, Anastasia S Mihailidou, Georgia K Chaseling, Harvey D White, Elizabeth Curtis, Jacqueline Colgan, Judith Katzenellenbogan, Eloise Thompson, Daniel Cehic, Stuart K Gibson, Faraz Pathan, Rebecca Kozor","doi":"10.1016/j.hlc.2026.08.004","DOIUrl":"https://doi.org/10.1016/j.hlc.2026.08.004","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventing Clozapine-Induced Myocarditis: A Role for Cardiologists in Promoting Personalised Titration.","authors":"Jose de Leon","doi":"10.1016/j.hlc.2026.04.130","DOIUrl":"https://doi.org/10.1016/j.hlc.2026.04.130","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Rate of Bystander Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis.","authors":"Lan Shen, Chaoming Chen, Li Long, Xiaomei Su, Hao Xie, Jianneng Dai","doi":"10.1016/j.hlc.2026.04.121","DOIUrl":"https://doi.org/10.1016/j.hlc.2026.04.121","url":null,"abstract":"<p><strong>Background: </strong>Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality worldwide, and bystander cardiopulmonary resuscitation (BCPR) is one of determinants of survival. This systematic review and meta-analysis aimed to determine the prevalence of BCPR and investigate sources of heterogeneity.</p><p><strong>Method: </strong>We conducted a systematic search of PubMed, Scopus, Embase, and Web of Science from inception until 1 August 2025, for observational studies that reported the incidence of BCPR in OHCA. We performed a random-effects meta-analysis to calculate the pooled prevalence of BCPR. Subgroup analyses were conducted to explore heterogeneity based on geography, income level, patient demographics, and study characteristics.</p><p><strong>Results: </strong>Our analysis included 229 studies encompassing 4,421,570 OHCA patients from 45 countries. The pooled prevalence of receiving BCPR was 32.1% (95% confidence interval [CI] 29.7%-34.5%), with substantial heterogeneity (I²=99.9%). BCPR rates were significantly higher in high-income countries compared to low- and middle-income countries (34.9% vs 13.9%; p<0.0001) and in paediatric versus adult populations (49.2% vs 31.4%; p=0.0002). OHCAs occurring in residential settings had a 28% lower likelihood of receiving BCPR than those in public locations (risk ratio [RR] 0.72; 95% CI 0.64-0.80). Furthermore, female patients were mildly less likely to receive BCPR than male patients (RR 0.96; 95% CI 0.93-0.99). Trend analysis revealed a modest but significant increase in BCPR prevalence over time (slope 0.29% per year; p=0.016).</p><p><strong>Conclusions: </strong>Less than one-third of individuals with OHCA receive BCPR. Despite a modest temporal increase, significant and actionable disparities persist across income levels, geographic regions, patient populations, and arrest locations. These findings highlight the need for targeted public health interventions, policy reforms, and tailored educational strategies to address these inequities and improve the global response to OHCA.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}