Heart, Lung and Circulation最新文献

{"title":"iCARDIO Alliance Global Implementation Guidelines on Heart Failure 2025.","authors":"Vijay Chopra, Muhammad Shahzeb Khan, Magdy Abdelhamid, William T Abraham, Offer Amir, Stefan D Anker, John J Atherton, Fernando Bacal, Ralph Stephen von Bardeleben, Dulce Brito, Lucrecia Maria Burgos, Javed Butler, Maria Rosa Costanzo, Albertino Damasceno, Justin A Ezekowitz, Ishaque Hameed, Sivadasanpillai Harikrishnan, Tiny Jaarsma, Anuradha Lala, Ileana L Piña, Clara Saldarriaga, David Sim, John R Teerlink, Nqoba Tsabedze, Hiroyuki Tsutsui, Jing Yu, Yuhui Zhang, Mohammad Zubaid, Nikhil Balankhe, Juan Esteban Gomez-Mesa, James L Januzzi, Marvin Konstam, Rhonda Monroe, Elijah Ogola, Vinayagam Palaniappan, Mark C Petrie, Fausto J Pinto, Girish C Rajadhyaksha, Amina Rakisheva, Carlos E Ramos, Victor Rossel, Naoki Sato, P Christian Schulze, Andrew Sindone, Hadi N Skouri, Harriette G C Van Spall, Aistė Štaraitė, Lynne Warner Stevenson, Kadhim Sulaiman, Tzung-Dau Wang, Michael Böhm, Andrew J S Coats, Shelley Zieroth","doi":"10.1016/j.hlc.2025.05.094","DOIUrl":"https://doi.org/10.1016/j.hlc.2025.05.094","url":null,"abstract":"<p><p>Inconsistencies in healthcare access, varying infrastructure, resource constraints and diverse local practices as well as practical and political issues restrict the global applicability of currently available guidelines. There is a need for universal recommendations that address the unique challenges faced by patients and healthcare providers worldwide. Our iCARDIO Alliance Global Implementation Guidelines emphasize the incorporation of novel therapies, while integrating standard of care with the most up-to-date evidence to enable clinicians to optimize patient care. This document is about heart failure (HF), including acute and chronic heart failure, heart failure with reduced ejection fraction and heart failure with preserved ejection fraction as well as cardiomyopathies. Context-specific recommendations tailored to individual patient needs are highlighted providing a thorough evaluation of the risks, benefits, and overall value of each therapy, aiming to establish a standard of care that improves patient outcomes and reduces the burden of hospitalization in this susceptible population. These guidelines provide evidence-based recommendations that represent a group consensus considering the many other published guidelines that have reviewed many of the issues discussed here, but they also make new recommendations where new evidence has recently emerged. Most importantly these guidelines also provide recommendations on a number of issues where resource limitations may put constraints on the care provided to HF patients. Such \"economic adjustment\" recommendations aim to provide guidance for situations when \"Resources are somewhat limited\" or when \"Resources are severely limited\". Hence, this document presents not only a comprehensive but also concise update to HF management guidelines thereby aiming to provide a unified strategy for the pharmacological, non-pharmacological, invasive and interventional management of this significant global health challenge that is applicable to the needs of healthcare around the globe.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325517","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":"A Systematic Review of Minimally Invasive Approaches to Surgical Atrial Septal Defect Repair.","authors":"Ryaan El-Andari, Abeline R Watkins, Nicholas M Fialka, Abdulaziz Mohammed AlAklabi, Jimmy J H Kang, Sabin J Bozso, Devilliers Jonker, Darren H Freed, Mohammed AlAklabi, Denis Bouchard, Michael W A Chu, Michael C Moon, Jeevan Nagendran","doi":"10.1016/j.hlc.2025.01.010","DOIUrl":"https://doi.org/10.1016/j.hlc.2025.01.010","url":null,"abstract":"<p><strong>Aim: </strong>Atrial septal defects (ASD) are the most common congenital cardiac malformations. Over the preceding decades, a host of minimally invasive and interventional techniques for ASD closure have emerged. Minimally invasive ASD (MIASD) repair utilises thoracotomies, endoscopic, robotic, and even beating heart approaches to facilitate MIASD repair. We performed a systematic review to summarise the literature describing the outcomes of patients following MIASD repair.</p><p><strong>Method: </strong>PubMed, Medline, and Scopus were searched by two authors for manuscripts describing outcomes following MIASD repair. Overall, 1,972 titles were screened, 1,945 were excluded, and 27 were included in the review. The primary outcome was mortality and secondary outcomes included postoperative morbidity.</p><p><strong>Results: </strong>Measures of mortality were largely limited to 30 days postoperatively, with 0% mortality reported for MIASD up to 30 days. Rates of postoperative morbidity were low in both sternotomy and MIASD groups, with no consistent differences identified. Rates of intensive care unit and hospital stay were consistently reported to be lower with MIASD than with the conventional approach.</p><p><strong>Conclusions: </strong>MIASD repairs have continued to evolve and improve. Among the various approaches to MIASD repair, all have been associated with low rates of morbidity and mortality. Surgical ASD repair continues to be versatile, allowing for repair of all manner of ASDs, and allowing for the concomitant management of other cardiac conditions. Regular advancements in this field, including the optimisation and development of surgical techniques with regular evaluation of patient outcomes, will ensure appropriate patient selection and optimisation of outcomes for patients with ASD.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293666","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":"Requirements for the Delivery of an Australian Rapid Access Chest Pain Clinic.","authors":"Annika Wilson, Laura Sutton, Rose Nash, Senali Jayasinghe, James E Sharman, J Andrew Black, Niamh Chapman","doi":"10.1016/j.hlc.2025.02.108","DOIUrl":"https://doi.org/10.1016/j.hlc.2025.02.108","url":null,"abstract":"<p><strong>Background: </strong>Rapid access chest pain clinics (RACPCs) are outpatient cardiac services designed to promptly assess and manage patients experiencing chest pain. Despite the establishment of 25 RACPCs across Australia, a standardised implementation framework has yet to be developed. This study aimed to identify the core components of successful delivery of an existing RACPC.</p><p><strong>Method: </strong>A qualitative process assessment study was conducted at an RACPC in a metropolitan, tertiary hospital in Tasmania, Australia from November 2022 to July 2023. Clinical observations and semi-structured interviews were conducted with seven RACPC clinicians. Deductive data analysis was undertaken according to a Context-Mechanism-Outcome framework.</p><p><strong>Results: </strong>Core components of successful RACPC delivery included (1) a multidisciplinary team-based approach to care with discreet clinical roles, (2) timely patient review by RACPC clinicians within 30 days of referral, (3) embedded patient education, (4) ongoing clinical team training and education, and (5) a shared understanding of the RACPC service's identity and purpose. Challenges to RACPC delivery were also identified and included resource constraints and administrative burdens.</p><p><strong>Conclusions: </strong>Successful delivery of an RACPC model of care relies on a range of interrelated factors. These findings align with the broader theme of ongoing health service assessment as a driver for continuous quality improvement and care standards within RACPCs. Further research aimed at developing and implementing effective strategies to enhance service delivery is needed to determine a national model of care.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293668","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":"Computed Tomography Coronary Angiography Versus Stress Echocardiography in a Rapid Access Chest Pain Clinic.","authors":"Jacob P George, Kate A Grunseit, Manoj Rajamohan, Kevin Yang, Clara K Chow, Gemma A Figtree, Rebecca Kozor","doi":"10.1016/j.hlc.2025.01.006","DOIUrl":"https://doi.org/10.1016/j.hlc.2025.01.006","url":null,"abstract":"<p><strong>Background: </strong>Outpatient rapid-access chest pain clinics (RACPCs) investigate and manage low-to intermediate-risk chest pain. Several non-invasive investigations have been employed for RACPCs, including stress echocardiography (SE) and computed tomography coronary angiography (CTCA). However, research on the influence of these tests on diagnosis and management in this setting is limited. This study aimed to determine whether patients who underwent CTCA differed in their risk profile, diagnosis, and management compared to those who underwent SE in RACPC.</p><p><strong>Method: </strong>This retrospective single-centre observational study included 903 patients who presented to the RACPC with low-to-intermediate-risk chest pain. Patients were investigated using SE and/or CTCA at the discretion of the treating cardiologist.</p><p><strong>Results: </strong>Overall, 68.4% of the patients were initially investigated using SE vs CTCA. Individuals with cardiac risk factors, including male patients and those using lipid-lowering agents before the RACPC review, were more likely to be initially investigated with CTCA. Patients who underwent CTCA at any point during their clinic visit had higher rates of invasive angiography, coronary intervention, and cardiac specialist referral than those who underwent SE alone. Patients who received CTCA at any time had higher prescription rates of antiplatelet, antihypertensive, and lipid-lowering medications, irrespective of whether they underwent invasive angiography, compared to the SE-only group.</p><p><strong>Conclusions: </strong>SE remains a popular initial screening method for patients with RACPC with low-to-intermediate-risk profiles. More men had CTCA, and more women had SE in their initial investigation. Patients investigated using a CTCA strategy were more likely to undergo invasive coronary angiography, procedural intervention, and the initiation of antiplatelet, antihypertensive, and lipid-lowering medications.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293667","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 Piezo1/Extracellular Signal-Regulated Kinase Signal Pathway Regulates Proliferation and Migration of Aortic Vascular Smooth Muscle Cells and Participates in Thoracic Aortic Aneurysm.","authors":"Weihong Nie, Wenxuan Cao, Yingzhu Zhuang, Sumin Yang, Hui Zhang, Haoyu Hu, Chunying Shi, Hong Zhang","doi":"10.1016/j.hlc.2025.03.012","DOIUrl":"https://doi.org/10.1016/j.hlc.2025.03.012","url":null,"abstract":"<p><strong>Background: </strong>Vascular smooth muscle cell (VSMC) proliferation and migration contribute to vascular remodelling in thoracic aortic aneurysms (TAA). An increase in cytosolic Ca²⁺ concentration triggers VSMC proliferation and migration. Piezo1, a mechanosensitive cation channel, may be involved in the proliferation and migration of VSMCs, and potentially in the development of TAA.</p><p><strong>Method: </strong>This study analysed Piezo1 and its potential downstream protein extracellular signal-regulated kinases (ERK) in aortic surgical specimens from six patients with TAA and six controls. In in vitro experiments, Yoda1, a Piezo1 agonist, SCH772984, an ERK inhibitor, si-Piezo1, used for silencing the piezo1 gene, and LM22B-10, an ERK activator, were used to regulate the expression of Piezo1 and ERK in rat thoracic aortic VSMCs. The effects of these treatments on cell proliferation, migration, apoptosis, and phenotypic switch were measured.</p><p><strong>Results: </strong>Through the comparison of human samples, it was discovered that the expressions of Piezo1 and ERK in the aortic media of TAA were higher than in normal samples. Additionally, the levels of VSMC proliferation and apoptosis were higher in TAA samples. This confirmed that upregulation of Piezo1 can induce cell proliferation and migration by activating the ERK pathway. It was also found that Piezo1/ERK signalling does not affect cell apoptosis. Additionally, it was discovered that inhibiting Piezo1/ERK signalling can induce a phenotypical switch in cells.</p><p><strong>Conclusions: </strong>These data indicate that Piezo1 is significantly activated in aortic VSMCs from patients with TAA, which may be involved in TAA by promoting VSMC proliferation and migration through the ERK signalling pathway. This study provides a new insight into the biological action of the Piezo1/ERK signalling pathway in the pathogenesis of TAA.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274655","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":"Time to Rethink our Approach to Guidelines? International Cascade Guidelines for Heart Failure.","authors":"John J Atherton, Andrew P Sindone, Andrew J S Coats","doi":"10.1016/j.hlc.2025.05.093","DOIUrl":"https://doi.org/10.1016/j.hlc.2025.05.093","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247655","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":"Emergency Medical Service Use for Acute Coronary Syndrome in Culturally and Linguistically Diverse Immigrant Populations.","authors":"Ararso Baru Olani, Kathryn Eastwood, Stuart Howell, Janet E Bray","doi":"10.1016/j.hlc.2025.01.007","DOIUrl":"https://doi.org/10.1016/j.hlc.2025.01.007","url":null,"abstract":"<p><strong>Background: </strong>In acute coronary syndrome (ACS), emergency medical service (EMS) use reduces pre-hospital delay and increases the chances of survival. However, evidence regarding EMS use in culturally and linguistically diverse (CALD) patients is conflicting. This study aimed to i) examine whether EMS use in patients with ACS varies between CALD and non-CALD populations and ii) identify characteristics associated with EMS and non-EMS use in CALD patients.</p><p><strong>Method: </strong>This is a retrospective analysis of ACS cases presented to emergency departments of public hospitals in Victoria, Australia between January 2016 and June 2021, as recorded in the Victorian Emergency Minimum Dataset maintained by the Victorian Department of Health. Country of birth, preferred language, and the need for an interpreter defined CALD status. Logistic regression was used to describe the characteristics associated with EMS and non-EMS use.</p><p><strong>Results: </strong>Of the 51,101 eligible ACS cases, 15,580 (30.5%) were from the CALD group. EMS use was lower in CALD than in non-CALD groups (61.9% vs 65.3%; p<0.001; adjusted odds ratio [aOR] 0.78; 95% confidence Interval [CI] 0.75-0.81). In CALD patients, the odds of EMS use increased with advancing age, living alone (aOR 1.45; 95% CI 1.24-1.70), self-referral (aOR 4.53; 95% CI 3.97-5.17), hospital presentation in the year 2020 (aOR 1.16; 95% CI 1.03-1.31) or 2021 (aOR 1.20; 95% CI 1.30-1.39), and being diagnosed with acute myocardial infarction (aOR 1.36; 95% CI 1.26-1.39). Reduced odds of EMS use were associated with being born in Southeast Asia (aOR 0.71; 95% CI 0.57-0.89), Northeast Asia (aOR 0.57; 95% CI 0.42-0.77), and the Americas (aOR 0.59; 95% CI 0.43-0.80); speaking a South Asian language (aOR 0.65; 95% CI 0.51-0.83); and hospital presentation in summer (aOR 0.90; 95% CI 0.82-0.99).</p><p><strong>Conclusions: </strong>EMS use was lower in patients with ACS with CALD backgrounds. Our findings have identified CALD population subgroups to target with education.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247652","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":"Efficacy and Safety of Desmopressin in Terms of Bleeding and Transfusion in Cardiac Surgery With Cardiopulmonary Bypass: A Systematic Review and Meta-Analysis.","authors":"Marion Picchio, Carlo Marcucci, Cécile Jaques, Sylvain Mauron, Mael Zuercher","doi":"10.1016/j.hlc.2025.01.003","DOIUrl":"https://doi.org/10.1016/j.hlc.2025.01.003","url":null,"abstract":"<p><p>Bleeding and transfusion during cardiac surgery are major sources of complications. Surgery and cardiopulmonary bypass can induce coagulopathy, including platelet dysfunction. Desmopressin has been shown to reduce bleeding and transfusion requirements, although with conflicting results. This study aimed to systematically evaluate the available evidence regarding the efficacy and safety of desmopressin in cardiac surgery with cardiopulmonary bypass. The Embase, MEDLINE, Cochrane Central, Web of Science, and ClinicalTrials.gov databases were searched for prospective studies comparing desmopressin with placebo in cardiac surgery with cardiopulmonary bypass. A meta-analysis with bleeding at 24 hours as the primary outcome and the amount and incidence of blood product transfusions as secondary outcomes was performed. Safety outcomes included re-exploration rate, thromboembolic events, and mortality. Thirty-four (34) studies comprising 2,523 patients were included. Bleeding at 24 hours was reduced in the desmopressin group (weighted mean difference, 96.20 mL; 95% confidence interval [CI] -148.44 to -43.96; p=0.0003 with heterogeneity [I²]=76%). The amount of blood products transfused (red blood cells) was reduced in the desmopressin group (standardised mean difference [SMD], -0.32; 95% CI -0.58 to -0.05). No significant difference was found for transfusion of platelets (SMD, -0.16; 95% CI -0.58 to 0.26) or fresh frozen plasma (SMD, -0.30; 95% CI -0.67 to -0.06). No significant differences were observed between the two groups with respect to safety outcomes. Results of the present meta-analysis demonstrated that desmopressin reduced blood loss and the amount of red blood cell transfusions after cardiac surgery. However, this result should be interpreted with caution, given the considerable heterogeneity among the studies.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233972","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":"Paid MBP advert: ANZSCTS ASM advert","authors":"","doi":"10.1016/S1443-9506(25)00432-9","DOIUrl":"10.1016/S1443-9506(25)00432-9","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 6","pages":"Page 648"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144241735","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":"Costs and Healthcare Utilisation for Aboriginal and Torres Strait Islander People With Suspected Acute Coronary Syndrome","authors":"L. Stephensen ∗ ,&nbsp;R. Mahoney ,&nbsp;L. Cullen ,&nbsp;W. Parsonage","doi":"10.1016/j.hlc.2025.05.069","DOIUrl":"10.1016/j.hlc.2025.05.069","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 ","pages":"Page S87"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144229553","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}