Heart, Lung and Circulation最新文献

{"title":"Assessing the Role of Echocardiography in Pregnancy in First Nations Australian Women: Is it an Underutilised Resource?","authors":"","doi":"10.1016/j.hlc.2024.04.301","DOIUrl":"10.1016/j.hlc.2024.04.301","url":null,"abstract":"<div><h3>Background</h3><p>Rheumatic heart disease (RHD) remains prevalent within First Nations Australian communities. RHD is more common in females and peak prevalence corresponds with childbearing age. Significant valvular disease can complicate pregnancy. Current practice in Northern Australia is to refer pregnant women for echocardiography if there are signs or symptoms of possible cardiac pathology or a history of acute rheumatic fever (ARF) or RHD. It is not currently routine practice to offer echocardiographic screening for all pregnant women at high risk of RHD.</p></div><div><h3>Aim</h3><p>This study aimed to assess the current referral practices for echocardiography and disease patterns in pregnant women in the Northern Territory, Australia—a region with a known high prevalence of RHD in the First Nations population.</p></div><div><h3>Method</h3><p>A retrospective analysis of all echocardiography referrals of pregnant women over a 4-year period was performed. Data included indication for echocardiography, clinical history, echocardiographic findings, and location of delivery. Comparisons were made using Fisher’s exact and Mann–Whitney <em>U</em> tests.</p></div><div><h3>Results</h3><p>A total of 322 women underwent echocardiography during pregnancy: 195 First Nations and 127 non-Indigenous women (median age, 25 vs 30 years, respectively; p<0.01). Indications for echocardiography differed by ethnicity, with history of ARF or RHD being the most common indication in First Nations women, and incidental murmur the most common in non-Indigenous women. First Nations women were more likely to have abnormal echocardiograms (35.9% vs 11.0% in non-Indigenous women; p<0.01) or a history of ARF or RHD (39.5% vs 0.8%; p<0.01), but less likely to have documented cardiac symptoms as an indication for echocardiography (8.2% vs 20.5%; p<0.01). New cardiac diagnoses were made during pregnancy in 11 (5.6%) First Nations and two (1.6%) non-Indigenous women (p=0.02). Moderate or severe valve lesions were detected in 26 (13.3%) First Nations women (all previously diagnosed), and 11 (5.6%) had previous cardiac surgery. No severe valve lesions were identified in the non-Indigenous group. Interstate transfer to a tertiary centre with valve intervention services was required during pregnancy or the puerperium for 12 (6.2%) First Nations women and no non-Indigenous women.</p></div><div><h3>Conclusions</h3><p>Amongst pregnant women in the Northern Territory who had an indication for echocardiography, First Nations women were more likely to have abnormal echocardiograms. This was mainly due to valvular disease secondary to RHD. Cardiac symptoms were infrequently recorded as an indication for echocardiography in First Nations women, suggesting possible underappreciation of symptoms. Having a low threshold for echocardiographic investigation, including consideration of universal screening during pregnancy, is important in a high RHD-burden setting such as","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"33 9","pages":"Pages 1307-1313"},"PeriodicalIF":2.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1443950624005870/pdfft?md5=6476c5f668c984a021310abd2f5356c7&pid=1-s2.0-S1443950624005870-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141450376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Practice Patterns for Transradial Coronary Artery Catheterisation in Australian and New Zealand: Mixed-Methods Survey and Interview Study","authors":"","doi":"10.1016/j.hlc.2024.03.009","DOIUrl":"10.1016/j.hlc.2024.03.009","url":null,"abstract":"<div><h3>Background</h3><p>While there has been an increase in the use of the transradial approach when performing percutaneous coronary angiography and intervention, there is evidence of variations in international practice. Ensuring that operators’ practices are supported by evidence is important to ensure optimal outcomes.</p></div><div><h3>Method</h3><p>Interventional cardiologists and advanced trainees completed a cross-sectional survey followed by semi-structured interviews to map current practices for transradial coronary artery procedures in Australia and New Zealand and explore factors that influence clinical decision-making around procedural practice.</p></div><div><h3>Results</h3><p>The right radial artery was the preferred access site (88%). Over a third (37%) of the participants indicated that they tested the hand circulation pre-procedure. Over a quarter of respondents (28.6%) reported that they would carry out transradial procedures regardless of the patient’s coagulation status. Most participants (77.8%) described radial artery spasm in around 10% of transradial procedures performed. Only 62% of participants assessed for radial artery occlusion post-catheterisation. Interview data revealed four themes that guided clinical decision-making, namely (1) Decision-making based on research, (2) Using clinical experience, (3) Being led by their training, and (4) Individual patient factors.</p></div><div><h3>Conclusions</h3><p>This study has demonstrated that despite clinical guidelines, substantial practice variation exists in transradial coronary artery catheterisation across Australia and New Zealand. The variation in practice and factors impacting clinical decision-making highlight a need for future strategies to optimise evidence translation and implementation across clinical settings.</p></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"33 9","pages":"Pages 1280-1286"},"PeriodicalIF":2.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1443950624001719/pdfft?md5=5b1a9c52c315db6faefc1b8110cb2b4b&pid=1-s2.0-S1443950624001719-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141467606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Coronary Vasomotor Disorders in Patients With Angina and Nonobstructive Coronary Arteries: A Sydney Experience","authors":"","doi":"10.1016/j.hlc.2024.02.020","DOIUrl":"10.1016/j.hlc.2024.02.020","url":null,"abstract":"<div><h3>Background</h3><p>Patients with angina and non-obstructive coronary arteries (ANOCA) frequently have coronary vasomotor disorders (CVaD), characterised by transient pathological vasoconstriction and/or impaired microvascular vasodilatation. Functional coronary angiography is the gold standard for diagnosing CVaD. Despite recommendations, testing is only available at a limited number of Australian and New Zealand centres. This study aimed to determine the prevalence of CVaDs in an Australian ANOCA population and identify predictive factors associated with specific endotypes.</p></div><div><h3>Method</h3><p>Functional coronary angiography was performed in patients with suspected ANOCA. Vasoreactivity testing was performed using intracoronary acetylcholine provocation. A pressure-temperature sensor guidewire was used for coronary physiology assessment. Comprehensive clinical data on patient characteristics, cardiac risk factors, and symptom profiles was collected before testing.</p></div><div><h3>Results</h3><p>This prospective observational study at Royal Prince Alfred and Concord Repatriation General Hospital included 110 patients (58±13 years with 63.6% women), with 81.8% (90/110) having a CVaD. Regarding specific ANOCA endotypes, microvascular angina (MVA) occurred in 31.8% (35/110) of cases, vasospastic angina (VSA) in 25.5% (28/110) and a mixed presentation of MVA and VSA in 24.5% (27/110) of patients. Patients with CVaD were found to be older (59±11 vs 51±15, p=0.024), overweight (61.1% vs 15.0%, p&lt;0.001) and had a worse quality of life (EuroQol 5 Dimensions-5 Levels; 0.61 vs 0.67, p=0.043). MVA was associated with being overweight (odds ratio [OR] 4.2 [95% confidence interval [CI] 1.9–9.3]; p=0.015) and ischaemia on stress testing (OR 2.4 [95% CI 1.1–4.3]; p=0.028), while VSA was associated with smoking (OR 9.1 [95% CI 2.21–39.3]; p=0.007).</p></div><div><h3>Conclusions</h3><p>Coronary vasomotor disorders are highly prevalent among ANOCA patients. This study highlights the importance of increasing national awareness and the use of functional coronary angiography to evaluate and manage this unique cohort.</p></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"33 9","pages":"Pages 1297-1306"},"PeriodicalIF":2.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1443950624001616/pdfft?md5=aaef38a62c101d61e19719c65b0de60c&pid=1-s2.0-S1443950624001616-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141456343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Society of Australia and New Zealand","authors":"","doi":"10.1016/S1443-9506(24)01794-3","DOIUrl":"10.1016/S1443-9506(24)01794-3","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"33 9","pages":"Page 1380"},"PeriodicalIF":2.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1443950624017943/pdfft?md5=9591253d67246b90f84dacb9be2bd845&pid=1-s2.0-S1443950624017943-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142167865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radial First Mantra Strong Whilst Catheterisation Practice Variations are Common: Transradial Access for Invasive Coronary Angiography","authors":"Garry W. Hamilton MBBS ,&nbsp;Omar Farouque MBBS, PhD ,&nbsp;Jaishankar Raman MBBS, MMed, PhD","doi":"10.1016/j.hlc.2024.08.006","DOIUrl":"10.1016/j.hlc.2024.08.006","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"33 9","pages":"Pages 1237-1238"},"PeriodicalIF":2.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142167946","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":"Navigating Coronary Artery Disease in Aviation Cardiology in Australia and New Zealand","authors":"","doi":"10.1016/j.hlc.2024.05.004","DOIUrl":"10.1016/j.hlc.2024.05.004","url":null,"abstract":"<div><h3>Background</h3><p><span>Cardiologists will commonly assess patients who hold an aviation medical certificate and require unique assessments and communications with national civil aviation authorities (in Australia, the Civil Aviation Safety Authority [CASA] and in New Zealand, the Civil Aviation Authority of New Zealand [CAA NZ]). Cardiac conditions are the most common reason for disqualification from holding an aviation licence, and </span>coronary artery disease is considered a high-risk condition for pilot incapacitation.</p></div><div><h3>Aim</h3><p>To provide a contemporary update on the aeromedical approach to the evaluation, detection, and management of coronary artery disease in an Australasian context.</p></div><div><h3>Methods</h3><p>A narrative view of current and historical practice in the area of aeromedical evaluation of coronary disease was undertaken.</p></div><div><h3>Results</h3><p><span>This review highlights the aeromedical approach to risk stratification and specific challenges of the aviation environment for patients with coronary artery disease. Scenarios of coronary artery disease screening, common and rare </span>acute coronary syndromes, and the assessment of established coronary artery disease are examined in detail. Suggestions to facilitate communications between specialists and CASA or CAA NZ to facilitate patient re-certification are also provided.</p></div><div><h3>Conclusion</h3><p>Patients who are pilots have unique requirements in terms of their coronary assessment, management, and follow-up to maintain eligibility to fly. It is important for cardiologists to be aware of relevant occupational requirements to provide optimal care to their patients.</p></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"33 9","pages":"Pages 1242-1249"},"PeriodicalIF":2.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141319506","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":"Impact of Sex on Long-Term Outcomes Following Surgical Aortic Valve Replacement","authors":"","doi":"10.1016/j.hlc.2024.03.006","DOIUrl":"10.1016/j.hlc.2024.03.006","url":null,"abstract":"<div><h3>Background</h3><p>The impact of sex on outcomes following surgical aortic valve replacement (SAVR) remains unclear. It has been proposed that females experience inferior outcomes, but this has yet to be conclusively established, particularly in the long term. The objective of this study is to identify discrepancies in postoperative outcomes between males and females following SAVR to better inform consideration for surgical intervention.</p></div><div><h3>Method</h3><p>We retrospectively reviewed the outcomes of 4,927 patients who underwent SAVR from 2004 to 2018 at our centre. In total, 531 propensity-matched males and females were included in the final analysis. The primary outcome was mortality at any point during the follow-up period. Secondary outcomes included various measures of postoperative morbidity. Follow-up duration was 15 years.</p></div><div><h3>Results</h3><p>In SAVR all-comers, females experienced inferior short-term mortality, but equivalent mid-term and long-term mortality. Rates of mediastinal bleeding, sternal wound infections, sepsis, heart failure, and pacemaker insertion were all equivalent between the sexes; however, males experienced a higher rate of acute kidney injury and readmission for stroke at the longest follow-up while females experienced a longer intensive care unit and hospital length of stay. In a sub-analysis of isolated SAVR, males and females experienced equivalent early, mid, and late mortality. Of note, a trend towards increased aortic valve reoperation was noted in females at the longest follow-up.</p></div><div><h3>Conclusions</h3><p>Males and females experience equivalent long-term mortality following isolated SAVR. Sex is not an independent risk factor of poor outcomes post-SAVR; however, the increased preoperative risk profile of females requires diligent consideration.</p></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"33 9","pages":"Pages 1331-1339"},"PeriodicalIF":2.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1443950624001677/pdfft?md5=44ed349155a8a22ebcf05919d2141d06&pid=1-s2.0-S1443950624001677-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141467607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Diabetes in Patients With Acute Myocardial Infarction Undergoing Coronary Artery Bypass Surgery Within 48 Hours","authors":"","doi":"10.1016/j.hlc.2024.02.014","DOIUrl":"10.1016/j.hlc.2024.02.014","url":null,"abstract":"<div><h3>Background</h3><p>Diabetic patients with coronary artery disease may benefit from elective coronary artery bypass graft (CABG) surgery. It is unknown whether this merit is transferable to patients with acute myocardial infarction (AMI) undergoing surgery.</p></div><div><h3>Method</h3><p>A total of 1,427 patients underwent CABG within 48 hours of being diagnosed with AMI at the current institution between 2001 and 2019. Of these patients, 206 (14.4%) had insulin-dependent diabetes mellitus (IDDM) and 148 (10.4%) had non-insulin dependent diabetes mellitus (NIDDM). Retrospective data analysis was performed.</p></div><div><h3>Results</h3><p>Patients with NIDDM showed the highest perioperative risk profile, with a EuroScore II of 11.6 (±10.3) compared with 7.8 (±8.0) in non-diabetic patients and 8.4 (±7.8) in patients with IDDM (p&lt;0.001). Sub-analysis demonstrated a higher proportion of non-ST-elevation myocardial infarction patients in the NIDDM cohort compared with the IDDM cohort (70.9% vs 56.8%; p=0.005). Postoperatively, NIDDM patients had more sepsis (p&lt;0.01) and longer ventilation times (p&lt;0.001) compared with non-DM and IDDM patients (p&lt;0.01). Wound healing complications were rare, but almost twice as high in NIDDM patients compared with non-DM and IDDM patients (4.7% vs 0.9% vs 2.4%, respectively). The 30-day mortality was highest in the NIDDM cohort (18.3% vs 11.3% vs 7.8%; p=0.012). Analysis of survival for up to 15 years revealed a significantly reduced survival of diabetic patients compared with non-diabetic patients, with lowest survival rates in NIDDM patients (p&lt;0.001).</p></div><div><h3>Conclusions</h3><p>Non-insulin dependent diabetes mellitus patients undergoing CABG within 48 hours of being diagnosed with AMI are at increased risk of short-term and long-term complications. Therefore, this particular group should undergo a careful evaluation concerning the expected risks and benefits of CABG in this setting.</p></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"33 9","pages":"Pages 1272-1279"},"PeriodicalIF":2.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1443950624001525/pdfft?md5=07c9e26336afac874009fb7fc736951b&pid=1-s2.0-S1443950624001525-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141175280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leveraging Smartwatch Technology for Rural Australian Health: Challenges and Opportunities","authors":"Alasdair Leslie MBBS, MBEE ,&nbsp;Joshua Kovoor MBBS ,&nbsp;Stephen Bacchi MBBS, PhD","doi":"10.1016/j.hlc.2024.04.309","DOIUrl":"10.1016/j.hlc.2024.04.309","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"33 9","pages":"Pages e49-e50"},"PeriodicalIF":2.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142167863","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":"Cor Triatriatum Sinister: A Rare Congenital Phenomenon in our Everyday Clinical–Surgical Practice","authors":"","doi":"10.1016/j.hlc.2024.02.024","DOIUrl":"10.1016/j.hlc.2024.02.024","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"33 9","pages":"Pages e45-e46"},"PeriodicalIF":2.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141450377","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}