Heart, Lung and Circulation最新文献

{"title":"Ventricular Tachycardia Ablation in Heart Failure: Substrate Characteristics, Outcomes of Catheter Ablation and Role of Papillary Muscle","authors":"Tai Chung So MBBS,&nbsp;Kasun De Silva MD,&nbsp;Ashwin Bhaskaran MD,&nbsp;Kaimin Huang BSc, MBBS,&nbsp;Samual Turnbull BSc,&nbsp;Kenji Hashimoto MD,&nbsp;Timothy Campbell BSc, PhD,&nbsp;Saurabh Kumar BSc(Med), MBBS, PhD","doi":"10.1016/j.hlc.2025.12.004","DOIUrl":"10.1016/j.hlc.2025.12.004","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Ventricular tachycardia (VT) is common in heart failure (HF) with up to 20% of patients with HF experiencing VT. However, substrate characteristics and outcomes of VT ablation in a population with reduced left ventricular ejection fraction (LVEF) are not well described. This study aimed to: (i) evaluate the substrate characteristics in patients with HF with VT, in particular the role of papillary muscles (PM); and (ii) evaluate the outcomes of catheter ablation, including VT recurrence and mortality.</div></div><div><h3>Methods</h3><div>This is a retrospective single-centre study, including patients with LVEF &lt;35% and sustained monomorphic VT undergoing VT ablation. Procedural characteristics, VT substrate characteristics and clinical outcomes were evaluated. Intracardiac echocardiography was used to identify abnormalities in PM.</div></div><div><h3>Results</h3><div>A total of 48 patients were included (age 68±11 years; males 93%; LVEF 27±6%; ischaemic cardiomyopathy 56%; non-ischaemic cardiomyopathy 39%; mixed cardiomyopathy 4%). The main findings were: (i) 33% of the VT exit sites were located at LV PM; (ii) 68% patients had LV PM abnormal tissue characteristics on intracardiac echocardiography; however, such characteristics were not indicative of VT exit; (iii) the presence of VT exit in the LV PM was associated with a higher rate of VT recurrence (log-rank p=0.03), and a trend towards higher mortality at 1 year (log-rank p=0.07).</div></div><div><h3>Conclusions</h3><div>In patients with LVEF &lt;35%, VT with endocavitary structures as exit sites is not uncommon. Patients with VT exiting at the LV PM have worse clinical outcomes with higher VT recurrence and mortality.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 5","pages":"Pages 627-635"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147608801","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":"Prevalence of Lipoprotein(a) Testing in Patients With Atherosclerotic Cardiovascular Disease Within a Large Australian Cardiology Network","authors":"David Eccleston MBBS, PhD ,&nbsp;Enayet K. Chowdhury MBBS, MPH, PhD ,&nbsp;Anna Williamson PhD ,&nbsp;Meherin Rahman MPharmSc ,&nbsp;Catherine Sciascia MSc, MPharmSc ,&nbsp;Ravi Santani MBBS, MD ,&nbsp;Renae Deans BSN","doi":"10.1016/j.hlc.2025.11.017","DOIUrl":"10.1016/j.hlc.2025.11.017","url":null,"abstract":"<div><h3>Background</h3><div>Increased lipoprotein(a) [Lp(a)] is a genetically determined causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Historically, Lp(a) testing has been uncommon in Australia. This study aims to assess the prevalence and trends in Lp(a) testing in Australia, and the associated patient characteristics.</div></div><div><h3>Method</h3><div>This retrospective cross-sectional study examined over 1.1 million de-identified electronic medical records from patients seen in the Advara HeartCare network from 2011 to 2022. Adult patients from 2011 to 2021 comprised the historical group, while those from 2022 formed the baseline group. A natural language processing algorithm identified patients with ASCVD and Lp(a) testing, and extracted demographics, characteristics, and cardiovascular comorbidities from clinical letters. Patients with ASCVD in the baseline group were followed up for 18 months to assess trends in Lp(a) testing.</div></div><div><h3>Results</h3><div>Testing Lp(a) was infrequent among patients with ASCVD but increased gradually over time. In the historical cohort, of 164,121 patients identified with ASCVD, 1,501 (0.9%) underwent Lp(a) testing. Of these, 44.8% had Lp(a) levels &lt;30 mg/dL, and 25.0% &gt;90 mg/dL. In the baseline cohort, 1,460 (2.6%) of 55,427 patients with ASCVD underwent Lp(a) testing. Of 730 with recorded Lp(a) values, 30.2% had Lp(a) levels ≥70 mg/dL, and 86.8% were on lipid-lowering therapy. Dyslipidaemia was the most common comorbidity (72.8%), followed by Stage 1 or 2 chronic kidney disease (40.1%). During 18-month follow-up from the baseline period, 329 additional patients underwent Lp(a) testing in 2023.</div></div><div><h3>Conclusions</h3><div>The study revealed that Lp(a) testing is underutilised among patients with ASCVD in Australia despite recent guidelines recommending it. This emphasises the need to expand Lp(a) testing to improve health outcomes for high-risk patients.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 5","pages":"Pages 606-619"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147769926","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":"Optimal Size of Transannular Patches for Tetralogy of Fallot Repair","authors":"Fumiaki Shikata MD, PhD ,&nbsp;Norihiko Oka MD, PhD ,&nbsp;Toru Okamura MD, PhD ,&nbsp;Masahiro Kaneko MD, PhD ,&nbsp;Kenta Matsui MD ,&nbsp;Tsutomu Hataoka MD ,&nbsp;Tadashi Kitamura MD, PhD ,&nbsp;Nobuyuki Inoue MD, PhD ,&nbsp;Masaomi Fukuzumi MD, PhD ,&nbsp;Ryoichi Kondo MD, PhD ,&nbsp;Sakura Horie MD ,&nbsp;Yoichiro Hirata MD, PhD ,&nbsp;Kagami Miyaji MD, PhD","doi":"10.1016/j.hlc.2025.09.017","DOIUrl":"10.1016/j.hlc.2025.09.017","url":null,"abstract":"<div><h3>Background</h3><div>This study investigates factors preventing the emergence of pulmonary regurgitation (PR) after transannular patch (TAP) repair for tetralogy of Fallot (TOF) with a small pulmonary valve annulus (PVA) in the long term.</div></div><div><h3>Methods</h3><div>Seventy-seven patients who underwent intracardiac repairs (ICR) with TAP using a monocusp for right ventricular outflow tract reconstruction for TOF at three institutions (2008–2023) were enrolled. Reconstructed PVA size was calculated using the formula: (width of TAP [mm] + native PVA [mm] ∗ 3.14) / 3.14. PR ≥ moderate on echocardiography was considered significant. Factors influencing PR emergence post-ICR were analysed using Cox proportional hazard analysis.</div></div><div><h3>Results</h3><div>No deaths occurred post-ICR. The median age and weight at ICR were 239 days and 7.3 kg, respectively. The median preoperative native PVA Z score was -3.0 (IQR: -4.5 to -2.0), and the reconstructed PVA Z score was 0.6 (IQR: -0.3 to 1.6). Patients whose reconstructed PVA Z scores increased by ≥4 from preoperative values had a significantly higher cumulative PR ratio (57.6%) compared to those with an increase of &lt;4 from preoperative values (30.1%) (p=0.03). Extensive TAP (reconstructed PVA Z scores ≥+4 from preoperative values) was identified as a risk factor for progressive PR in the multivariable analysis.</div></div><div><h3>Conclusions</h3><div>Extensive TAP was a significant risk factor for progressive PR in the long-term. Patients whose reconstructed PVA Z scores increased by less than 4 from preoperative values demonstrated better cumulative PR ratios after ICR.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 5","pages":"Pages 685-695"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147432512","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":"Fatigue Is a Key Contributor to Quality of Life in Heart Valve Disease and After Valve Replacement/Repair: A Qualitative Study","authors":"Ariel Pons MBChB, PhD ,&nbsp;Gillian Whalley MHSc, DMU, PhD ,&nbsp;Rosemary Wyber MBChB, MPH, FRACGP ,&nbsp;Paul Bridgman MD, FRACP, FCSANZ ,&nbsp;Ralph Stewart MD, FRACP, FESC ,&nbsp;Philip Adamson MBChB, PhD, FESC ,&nbsp;Ross Roberts-Thompson BMedSc, FRACP ,&nbsp;Crispin Jenkinson BA, MSc, DPhil ,&nbsp;David Morley PhD ,&nbsp;Sean Coffey FRACP, PhD","doi":"10.1016/j.hlc.2025.11.008","DOIUrl":"10.1016/j.hlc.2025.11.008","url":null,"abstract":"<div><h3>Background</h3><div>Heart valve disease (HVD) can cause morbidity and impairment of quality of life (QOL) both before and after intervention. However, descriptions of the QOL of people with HVD across the disease course are limited. We aimed to collect the experience of people living with HVD through qualitative interviews, focusing on how HVD impacts their self-perceived QOL.</div></div><div><h3>Method</h3><div>Semi-structured interviews were conducted in people with HVD, their family members, and clinical experts. A simple thematic analysis was used to summarise their perceptions of QOL.</div></div><div><h3>Results</h3><div>We interviewed 34 people with HVD: seven with aortic stenosis, seven with rheumatic heart disease involving the mitral valve, nine with mitral regurgitation, and 11 with valve replacement/repair (mean age 66 years, 56% female). Three family members and five clinical experts were also interviewed. A key contributor to QOL was fatigue: most participants experienced fatigue, even mild fatigue impaired QOL directly, and severe fatigue had devastating effects on QOL. Physical limitations impaired QOL due to the loss of ‘normal’ activity rather than objective physical limitation. Symptoms of HVD impaired QOL directly, but the indirect effects of valve disease inspiring worry that reduced confidence and activity led to greater impairment.</div></div><div><h3>Conclusions</h3><div>Fatigue both before and after valve intervention is a contributor to QOL and requires further assessment. Research is recommended into whether fatigue is a specific enough symptom to warrant valvular intervention in HVD.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 5","pages":"Pages 676-684"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147608734","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":"Challenges to Telehealth in Regional Areas: Cross-Sectional Survey Study of Cardiology Outpatients","authors":"Kristy Fakes PhD ,&nbsp;Hannah Fraser Wetzler BSocSc ,&nbsp;Trent Williams PhD ,&nbsp;Nicholas Collins PhD ,&nbsp;Aaron L. Sverdlov PhD ,&nbsp;Breanne Hobden PhD ,&nbsp;Andrew Boyle PhD","doi":"10.1016/j.hlc.2025.12.021","DOIUrl":"10.1016/j.hlc.2025.12.021","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 5","pages":"Pages e67-e71"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147769916","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":"Improving Health Outcomes and Survival Rates After Heart Surgery","authors":"Yugeesh Lankadeva BBMed(Hons), MBA, PhD,&nbsp;Emily Smith BMediaComm, BNutrDiet,&nbsp;Victoria Leitch BSci(Biomed), MScC, PhD","doi":"10.1016/j.hlc.2026.04.004","DOIUrl":"10.1016/j.hlc.2026.04.004","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 5","pages":"Page 704"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147828039","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":"Missed Dual Left Anterior Descending Artery: Look for Missed Territory","authors":"Sudipta Mondal MD, DM, PDF-EP ,&nbsp;Nadeem Afroz Muslim MD, DM ,&nbsp;Debargha Dhua MD, DM","doi":"10.1016/j.hlc.2025.12.018","DOIUrl":"10.1016/j.hlc.2025.12.018","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 5","pages":"Pages e72-e73"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672803","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 Differences on Long-Term Survival Following TAVI in Patients With Aortic Stenosis: Insights From the TAVI-NOR Study","authors":"Daanyaal Wasim MD, PhD ,&nbsp;Abukar Mohamed Ali MD ,&nbsp;Øyvind Bleie MD, PhD ,&nbsp;Kjetil Halvorsen Løland MD, PhD ,&nbsp;Erik Jerome Stene Packer MD, PhD ,&nbsp;Jon Herstad MD ,&nbsp;Sahrai Saeed MD, PhD","doi":"10.1016/j.hlc.2026.01.009","DOIUrl":"10.1016/j.hlc.2026.01.009","url":null,"abstract":"<div><h3>Background</h3><div>The incidence of aortic stenosis (AS) in the older adult population in Western countries is increasing. When left untreated, AS progresses to clinical heart failure, reduced quality of life and functional capacity, and ultimately death. We aimed to assess sex differences in the long-term survival benefits of transcatheter aortic valve implantation (TAVI) in patients with severe AS.</div></div><div><h3>Method</h3><div>A total of 600 consecutive patients with AS who underwent TAVI were included. Clinical and echocardiographic data were analysed. Propensity score matching was performed to assess the impact of sex on the survival benefit following TAVI, yielding 213 men and women with similar baseline characteristics.</div></div><div><h3>Results</h3><div>The mean age in the total population was 80.8±6.5 years. Women (49.3%) were older (82.2±5.3 vs 79.5±7.3 years; p&lt;0.001), had more severe AS, higher prevalence of hypertension and basal septal hypertrophy, and higher left ventricular ejection fraction (LVEF) than men. By contrast, the prevalence of diabetes mellitus, cardiovascular disease, overall abnormal electrocardiogram, and atrial fibrillation was higher in men. During a mean follow-up of 59±24 months for men and 66±25 months for women, a total of 279 deaths occurred (125 in women and 154 in men; p=0.039). There was no difference in mortality at 1 and 2 years. The most pronounced benefit was observed at 3-year follow-up, with survival estimates of 92% for women and 84% for men (p=0.006). In a multivariable Cox regression analysis of the propensity-matched cohort, long-term event-free survival was significantly higher among women than men (hazard ratio 0.66; 95% confidence interval 0.49–0.88; p=0.004).</div></div><div><h3>Conclusions</h3><div>At presentation, women were older, had a higher burden of hypertensive heart disease, more often exhibited concentric hypertrophy with preserved LVEF, and less frequently had atrial fibrillation compared with men. Women had better long-term survival following TAVI, with the most pronounced survival benefit observed at 3 years.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 5","pages":"Pages 636-649"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147769877","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":"Machine Learning for Cardiovascular Risk Prediction: A Practical Primer for Clinicians","authors":"Hari P. Sritharan MD ,&nbsp;Harrison Nguyen PhD ,&nbsp;Usaid K. Allahwala MBBS, PhD ,&nbsp;Ravinay Bhindi MBBS, PhD","doi":"10.1016/j.hlc.2026.01.006","DOIUrl":"10.1016/j.hlc.2026.01.006","url":null,"abstract":"<div><div>Machine learning (ML) offers powerful tools for clinical risk prediction, enhancing traditional statistical approaches through improved pattern recognition and predictive capability—its role and use in cardiovascular care and research is expanding. This guide provides readers with foundational knowledge of ML methodology for risk prediction, including model development, validation, and implementation considerations. We discuss supervised and unsupervised learning approaches, feature selection, performance metrics, and advanced techniques such as deep learning and interrupted time-series analysis. Challenges regarding interpretability, bias, and clinical integration are addressed alongside practical recommendations for readers evaluating or implementing ML-based risk prediction tools in practice. This primer equips readers with essential knowledge to critically appraise ML-based risk prediction models and collaborate effectively with data scientists.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 5","pages":"Pages 598-605"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716750","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":"Christmas Lights on the Heart: A Rare Case of Multiple Giant Coronary Artery Aneurysms","authors":"Giovanni Taverna MD ,&nbsp;Roberta Antonazzo Panico MD ,&nbsp;Nicola Masiello MD ,&nbsp;Mattia Romanello MD ,&nbsp;Corrado Fiore MD ,&nbsp;Giuseppe Santarpino MD, PhD ,&nbsp;Martina Perazzolo Marra MD, PhD ,&nbsp;Giuseppe Speziale MD, PhD ,&nbsp;Giuseppe Andò MD, PhD","doi":"10.1016/j.hlc.2025.11.018","DOIUrl":"10.1016/j.hlc.2025.11.018","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 5","pages":"Pages e74-e75"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147689877","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}