Heart, Lung and Circulation最新文献

{"title":"Venous But Not Arterial Graft Failure Associated with Ischaemic Sequelae After Coronary Bypass Surgery.","authors":"Christopher Siderakis, Nilesh Srivastav, Justin Ren, Colin Royse, Alistair Royse","doi":"10.1016/j.hlc.2026.05.019","DOIUrl":"https://doi.org/10.1016/j.hlc.2026.05.019","url":null,"abstract":"<p><strong>Background: </strong>Late survival after coronary artery bypass grafting may depend not only on patency of the graft but also on patency of the proximal coronary lesion in the event of graft failure. Reduced proximal coronary patency following graft failure may be associated with ischaemic sequelae, potentially affecting postoperative survival. Arterial and venous conduits follow distinct mechanisms of failure, and the postoperative patency status of the proximal coronary stenosis has not been widely considered in this context.</p><p><strong>Method: </strong>Patients underwent predominantly symptom-indicated coronary angiography between August 1997 and March 2020, following coronary artery bypass grafting. Patients with greater than or equal to one angiographically occluded graft distal to a coronary lesion that was patent at surgery, were primarily analysed. For each occluded graft, the coronary lesion proximal to the anastomosis was assessed for preservation of patency on postoperative angiography. The occurrence of non-fatal non-ST-segment elevation myocardial infarction (NSTEMI) in symptomatic patients undergoing postoperative angiography, with and without graft failure, was evaluated in a secondary analysis. Primary graft-level outcomes were analysed using exchangeable Generalised Estimating Equations binary logistic regression, and secondary patient-level outcomes were analysed using binary logistic regression.</p><p><strong>Results: </strong>Overall, 145 patients were included in the primary analysis, with a mean follow-up of 9.2±5.6 years after surgery. Native coronary patency was 100% at surgery, with a similar degree of stenosis proximal to occluded arterial conduits and saphenous vein grafts (SVGs), 68.2±16.5% vs 72.2±15.7%, respectively, (p=0.216). At postoperative angiography, proximal coronary patency was more frequently preserved with occluded arterial grafts than with occluded SVGs, 83.1% (133/160) vs 38.7% (12/31) (odds ratio [OR] 4.96; 95% confidence interval [CI] 1.91-12.89; p=0.001). Among 179 symptomatic patients in the secondary analysis with greater than or equal to one SVG, NSTEMI occurred more frequently in those with SVG failure than in those without SVG failure, 42.2% vs 17.9% (OR 3.35; 95% CI 1.60-7.01; p=0.001). Among 563 symptomatic patients who underwent total arterial revascularisation, the frequency of NSTEMI was similar in those with and without arterial graft failure, 20.8% vs 24.4% (OR=0.81, 95% CI 0.52-1.27; p=0.360).</p><p><strong>Conclusions: </strong>Venous, but not arterial, graft failure is associated with reduced proximal coronary lesion patency, which may contribute to ischaemic sequelae.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108076","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":"Marked Variability in Lipid Profile Reporting Among Australian Pathology Providers: A National Cross-Sectional Review of Low-Density Lipoprotein Cholesterol.","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.2026.05.025","DOIUrl":"https://doi.org/10.1016/j.hlc.2026.05.025","url":null,"abstract":"<p><strong>Background: </strong>Lipid profiles facilitate cardiovascular risk stratification, therapeutic monitoring, and patient education. Variability in pathology reporting practices may generate confusion among clinicians and patients. While there is a central accreditation body for the provision of pathology in Australia, reporting formats are not regulated. This study aimed to characterise the variation in reporting of low-density lipoprotein cholesterol (LDL-C) levels among Australian pathology providers.</p><p><strong>Method: </strong>A cross-sectional national review was conducted in November 2024. Public and private pathology laboratory networks from every Australian state and territory, accredited by the Royal College of Pathologists of Australasia, were contacted via structured interviews and invited to submit de-identified or template lipid panel reports.</p><p><strong>Results: </strong>Seventeen of the 18 laboratory networks contacted provided data. Six were state-wide centralised public pathology providers, eight were individual public hospital laboratory networks, and three were national private pathology networks. Six different LDL-C upper reference limits were observed (range, 2.0-3.7 mmol/L). Formatting practices for abnormal values varied significantly. Only four pathology networks provided individualised interpretative comments. Among the eight laboratory networks that included recommendations for familial dyslipidaemia investigation, LDL-C cut-offs differed considerably. Seven different guidelines were referenced in the reports, and none reflected contemporary recommendations.</p><p><strong>Conclusions: </strong>The format and content of lipid panel reporting varied widely across Australian pathology providers. Referenced guidelines were outdated, and this likely contributes to misunderstanding of contemporary treatment targets for both patients and clinicians. Harmonised lipid panel reporting may significantly improve dyslipidaemia management.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108839","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":"Canine Rather than Bovine? Revisiting So-Called Bovine Aortic Arch.","authors":"Hisato Takagi","doi":"10.1016/j.hlc.2026.05.024","DOIUrl":"https://doi.org/10.1016/j.hlc.2026.05.024","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108735","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":"Beyond Grantsmanship: Why Patient Impact Must be the Measure of Funded Science.","authors":"Ashish H Shah, Amir Ravandi","doi":"10.1016/j.hlc.2026.06.005","DOIUrl":"https://doi.org/10.1016/j.hlc.2026.06.005","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108730","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":"Review of Attitudes, Perceptions, and Behaviours in Physical Activity, Sports, and Exercise Participation in Individuals With Genetic Heart Disease.","authors":"Kshitij Cyril, Daniel Hackett, Jasmine Follett, Charlotte Burns, Caroline Medi, Derek L Tran, Belinda Gray","doi":"10.1016/j.hlc.2026.05.022","DOIUrl":"https://doi.org/10.1016/j.hlc.2026.05.022","url":null,"abstract":"<p><strong>Aim: </strong>This study explored attitudes, perceptions and physical activity behaviours in individuals with genetic heart disease (GHD), with a focus on how these have evolved as exercise guidelines have changed over time.</p><p><strong>Method: </strong>A series of surveys was conducted among patients with GHD from the Royal Prince Alfred Hospital GHD and Sports Cardiology Clinic. Eligible participants were consecutively approached and invited to participate. Surveys and questionnaires assessed self-efficacy, barriers and perceptions across three timeframes: the past 12 months, previous 5 years and previous 10 years. Current physical activity levels were assessed using the International Physical Activity Questionnaire-Short Form.</p><p><strong>Results: </strong>Ninety-nine participants with GHD completed the survey (mean age, 41±17 years; 52% female). Across all time periods, the influence of \"doctor/cardiologist recommendations\" as an exercise barrier decreased significantly (p=0.02). Seven-day physical activity recall showed that patients with channelopathies engaged in more walking and vigorous activity than patients with cardiomyopathies (p=0.004). Exercise participation rates were similar among patients at high and low risk of sudden cardiac death (p=0.17). Qualitative responses identified fear, fatigue and other non-diagnosis-related issues as potential barriers to exercise.</p><p><strong>Conclusions: </strong>In this contemporary cohort of patients with GHD, the influence of physician-directed restrictions appeared to diminish over time, coinciding with evolving guideline recommendations. Patients with channelopathies reported greater engagement in vigorous intensity activity than those with cardiomyopathies, likely reflecting preserved functional capacity rather than differences in perceived sudden cardiac death risk. Importantly, exercise participation did not differ according to clinical risk stratification. These findings highlight a shift towards more permissive exercise behaviours in GHD and underscore the need for phenotype-specific, evidence-based exercise guidance to optimise participation.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149107753","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":"Transfemoral TAVI in the Contemporary Era: From High-Risk Innovation to Mainstream Cath-Lab Procedure","authors":"Ashish H. Shah MD, MD-Research","doi":"10.1016/j.hlc.2026.03.055","DOIUrl":"10.1016/j.hlc.2026.03.055","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 10","pages":"Pages e144-e145"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149094596","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":"Cardiac Society of Australia and New Zealand","authors":"","doi":"10.1016/S1443-9506(26)01742-7","DOIUrl":"10.1016/S1443-9506(26)01742-7","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 10","pages":"Pages 1499-1502"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149094598","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":"Cost-Effectiveness of Radiofrequency Renal Denervation for Resistant Hypertension in Australia","authors":"Markus P. Schlaich MD,&nbsp;Anne M. Ryschon MA,&nbsp;Sharad Shetty MD,&nbsp;Antony Walton MD,&nbsp;Murray D. Esler MBBS, PhD,&nbsp;Alessandro Ciorra MSc,&nbsp;Michelle Hill PhD,&nbsp;Jan B. Pietzsch PhD","doi":"10.1016/j.hlc.2026.04.006","DOIUrl":"10.1016/j.hlc.2026.04.006","url":null,"abstract":"<div><h3>Aim</h3><div>Radiofrequency renal denervation (RF RDN) is a guideline-recommended, minimally invasive therapy for patients with uncontrolled, including resistant, hypertension. This analysis assesses the cost-effectiveness of RF RDN compared with optimal medical management for treatment of resistant hypertension in the Australian health care setting on the basis of contemporary clinical data.</div></div><div><h3>Method</h3><div>A previously published and validated decision-analytic Markov model was adapted to the Australian health care setting. Primary health states modelled included hypertension, myocardial infarction, stroke, heart failure), angina pectoris/coronary artery disease, end-stage renal disease, and all-cause mortality, with transitions among health states informed by multivariate risk equations. Costs (reported in 2025 Australian Dollar [AUD]$) and utilities were sourced from fee schedules and published literature. The base case modelled a resistant hypertension cohort, informed by registry data, in whom treatment with RF RDN reduced office systolic blood pressure by −5.2 mmHg, based on sham-adjusted results from the SPYRAL HTN-ON MED randomised controlled trial. The primary outcomes included 5-year clinical event rates, in addition to strategy-specific costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio over lifetime. Cost-effectiveness was assessed against an assumed willingness-to-pay threshold of AUD$50,000 per QALY gained. Costs and effects were discounted 5% per annum in accordance with Australian cost-effectiveness guidelines. Extensive scenario and sensitivity analyses were conducted.</div></div><div><h3>Results</h3><div>At 5 years, RF RDN yielded meaningful reductions in clinical events (relative risks of 0.80 for stroke, 0.88 for myocardial infarction, and 0.71 for heart failure). Under the base-case assumptions, RF RDN was associated with incremental costs of AUD$10,396 and QALYs of 0.28, producing a lifetime incremental cost-effectiveness ratio of AUD$36,655 per QALY gained. RF RDN was shown to be cost-effective across the range of scenario and sensitivity analyses explored.</div></div><div><h3>Conclusions</h3><div>Blood pressure reductions observed with RF RDN are projected to lead to meaningful clinical event reductions that render the therapy a cost-effective adjunctive treatment option for patients with resistant hypertension in Australia.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 10","pages":"Pages 1487-1497"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148619566","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":"Early Outcomes and Utilisation of Drug-Coated Balloons for Coronary Artery Revascularisation From the Victorian Cardiac Outcomes Registry","authors":"Davide R. Tomassoni MD, MMed,&nbsp;Timothy Yeung MD,&nbsp;Edmond Wong MBBS,&nbsp;Emily Schembri MSci,&nbsp;Angela L. Brennan BSci,&nbsp;Diem Dinh PhD,&nbsp;Jeffrey Lefkovits MBBS,&nbsp;David Tong MBBS, PhD,&nbsp;Jason Nogic MBBS, MMed, PhD","doi":"10.1016/j.hlc.2026.03.059","DOIUrl":"10.1016/j.hlc.2026.03.059","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Recent trends towards a “leave nothing behind” strategy are reshaping coronary artery disease management. Drug-coated balloons (DCB) deliver an antiproliferative drug via their abluminal surface, reducing neointimal proliferation without risks attributable to drug-eluting stents (DES). While emerging data support DCB safety and efficacy, real-world usage and outcome data remain limited. This study examines DCB use, trends, and clinical outcomes in Victoria, Australia.</div></div><div><h3>Method</h3><div>Registry data from all percutaneous coronary intervention-capable centres within the Victorian Cardiac Outcomes Registry over an 11-year period from January 2013 to December 2023 were collected. Indications for DCB use, short and long-term mortality, and 30-day major adverse cardiovascular events, defined as cardiac death, myocardial infarction, target vessel revascularisation or target lesion thrombosis, were assessed.</div></div><div><h3>Results</h3><div>Among 117,308 patients undergoing percutaneous coronary intervention during the study period, 1,266 received DCB-only intervention, rising from 0.17% in 2013 to 2.8% in 2023. Compared with DES, DCB recipients were older (69.0 vs 66.5 years; p=0.002), with higher lesion complexity (B2/C; 70.1% vs A/B1; 29.9%). The predominant indication for DCB was stable angina (70.2%), followed by myocardial infarction (ST-elevated myocardial infarction [STEMI] 5.3%, non-STEMI 17.1%) and unstable angina pectoris (unstable angina pectoris 7.4%). Thirty-day all-cause mortality and major adverse cardiovascular events rates in the DCB group compared to DES remained low (0.5% vs 1.6%; p=0.012, and 1.6% vs 3.0; p=0.009). A total of 470 patients (0.4%) received a combination DCB and DES strategy over the study period.</div></div><div><h3>Conclusions</h3><div>DCB usage has significantly increased over the past decade, reflecting evolving clinical practice, although absolute numbers remain small. With advancing guidelines, growing experience, and emerging evidence, its utilisation is expected to rise further.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 10","pages":"Pages 1478-1486"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648503","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":"Outcomes of the Rapid Two-Stage Norwood Procedure in Hypoplastic Left Heart Syndrome: A Retrospective Cohort Study Stratified by Birth Weight","authors":"Shinichi Ishida MD,&nbsp;Takahisa Sakurai MD, PhD,&nbsp;Hajime Sakurai MD, PhD,&nbsp;Toshimichi Nonaka MD, PhD,&nbsp;Hideyuki Okawa MD,&nbsp;Takuya Osawa MD,&nbsp;Aoi Kato MD,&nbsp;Genki Maeno MD,&nbsp;Masato Mutsuga MD, PhD","doi":"10.1016/j.hlc.2026.01.020","DOIUrl":"10.1016/j.hlc.2026.01.020","url":null,"abstract":"<div><h3>Background</h3><div>We evaluated the surgical outcomes of the rapid two-stage Norwood procedure for hypoplastic left heart syndrome (HLHS) and its variants, focusing on low birth weight.</div></div><div><h3>Method</h3><div>From October 2010 to September 2023, 67 consecutive children with HLHS or HLHS variants underwent bilateral pulmonary artery banding (bil-PAB). They were categorised into Group S (birth weight &lt;2,500 g) and Group L (birth weight ≥2,500 g). Clinical perioperative data were analysed.</div></div><div><h3>Results</h3><div>There were no inter-stage deaths or patients requiring comfort care in either group. The in-hospital mortality rate for the Norwood procedure was 23.8% in Group S and 4.5% in Group L (p=0.031). At the time of the procedure, patients in Group S were older (p&lt;0.001) and had a longer time from bil-PAB (p&lt;0.001) and lower weight (p=0.013). Overall survival was significantly better in Group L than in Group S (5-year survival: Group L, 72%; Group S, 48%, p=0.037).</div></div><div><h3>Conclusions</h3><div>The rapid two-stage Norwood procedure yielded excellent results for HLHS and its variants, particularly in patients with greater body weight who had a 4.5% in-hospital mortality rate. Despite challenging outcomes for those with birth weights &lt;2,500 g, the strategy of allowing a waiting period and further weight gain before the Norwood procedure may still offer a viable alternative to comfort care.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 10","pages":"Pages 1438-1446"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470314","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}