Heart, Lung and Circulation最新文献

{"title":"Cardiovascular Risk Factors and Disparities in Management of Embolic Stroke: A Western Sydney Perspective.","authors":"Vlad Danaila, Prakesh Vaheisvaran, Aaisha Ferkh, Sai Nagaratnam, Amy Clark, Peter Emerson, Luke Stefani, Andrew Duggins, Paula Brown, Aravinda Thiagalingam, A Robert Denniss, Eddy Kizana, Liza Thomas","doi":"10.1016/j.hlc.2024.04.300","DOIUrl":"10.1016/j.hlc.2024.04.300","url":null,"abstract":"<p><strong>Background: </strong>Ischaemic stroke remains one of the leading causes of death and disability worldwide. The population of Western Sydney has a unique demographic with lower socioeconomic status and a culturally and linguistically diverse population. This study aims to investigate the demographics and cardiovascular risk factors of patients in Western Sydney, focusing on the prevalence and profile of cardioembolic (CE) strokes and embolic strokes of undetermined source (ESUS).</p><p><strong>Method: </strong>Prospective data were collected in 463 patients with ischaemic stroke presenting to a tertiary centre in Western Sydney, who underwent predischarge transthoracic echocardiography. Patients with haemorrhagic strokes or unclear stroke diagnosis were excluded. Analysis of stroke subtype (CE, ESUS, or non-embolic) and clinical characteristics was performed based on age, gender, and prior atrial fibrillation (AF) prevalence.</p><p><strong>Results: </strong>Of the 463 patients, 147 (32%) had CE strokes, and 147 (32%) had ESUS. Cardioembolic (CE) strokes were associated with older age (≥65 years) and a history of congestive cardiac failure. Older patients had higher rates of hypertension, ischaemic heart disease, AF, and congestive heart failure. History of AF was present in 67 patients (14.5%); however, only 51% received anticoagulation before admission despite a low bleeding risk. The transthoracic echocardiography characteristics of ESUS/non-embolic strokes differed from those of CE strokes; 20% of patients with ESUS had an enlarged left atrium, suggesting a subset of patients with ESUS with a left atrial myopathy.</p><p><strong>Conclusions: </strong>Patients with ischaemic stroke in Western Sydney have a high prevalence of cardiovascular risk factors which were often undertreated. Half of the patients with prior AF did not receive anticoagulation despite low bleeding risk, indicating a gap in optimal stroke prevention. There were distinct echocardiographic characteristics among stroke subtypes. Further analysis of left atrium parameters may provide greater insights into the pathogenesis and prevention of embolic strokes.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141497905","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":"Multimodality Imaging Evaluation of Tumour Peeking Its Head Into the Right Atrium.","authors":"Kouta Nakamura, Akinobu Miyazaki, Masahiro Suzuki, Ken-Ichi Imasaka, Kisho Ohtani","doi":"10.1016/j.hlc.2024.06.1039","DOIUrl":"https://doi.org/10.1016/j.hlc.2024.06.1039","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499357","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":"Perforation of the Septal Perforators: A Case Series and Proposed Management Paradigm.","authors":"Daniel G Brieger, Aditya Bhat, Ravinay Bhindi, Michael R Ward","doi":"10.1016/j.hlc.2024.09.006","DOIUrl":"https://doi.org/10.1016/j.hlc.2024.09.006","url":null,"abstract":"<p><p>Septal artery perforations are an uncommon complication of percutaneous coronary intervention. Unlike epicardial vessels, septal perforations do not result in pericardial effusions but rather produce septal haematomas. While most can be managed expectantly, a small proportion requires active management to prevent rapid haematoma expansion resulting in compromise of right ventricular filling and 'dry tamponade'. We present two cases of septal artery perforation during percutaneous coronary intervention and propose a management approach that takes into account the unique haemodynamic consequences of this complication.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499358","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":"Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitor Eligibility and Prescription Rates in Patients Presenting With Recurrent Acute Coronary Syndromes.","authors":"William B He, Dylan Jape, Shane Nanayakkara, James A Shaw","doi":"10.1016/j.hlc.2024.07.012","DOIUrl":"https://doi.org/10.1016/j.hlc.2024.07.012","url":null,"abstract":"<p><strong>Background: </strong>Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are novel medications for reducing low-density lipoprotein cholesterol (LDL-C) levels. In 2020, the Australian Pharmaceutical Benefits Scheme (PBS) began subsidising PCSK9 inhibitors for secondary prevention of cardiovascular disease in patients with LDL-C >2.6 mmol/L despite statin and ezetimibe therapy. This criterion was expanded to LDL-C >1.8 mmol/L in 2022.</p><p><strong>Method: </strong>A retrospective analysis was conducted on patients admitted to a quaternary hospital with acute coronary syndrome (ACS) between 2020-2022. PCSK9 inhibitor eligibility and prescribing patterns were compared between recurrent ACS patients (≥2 events within 5 years) and first-presentation ACS patients. Australian PBS 2020 and 2022 criteria were applied to assess eligibility.</p><p><strong>Results: </strong>Of 817 ACS patients with LDL-C >1.8 mmol/L, 118 (14.4%) were categorised as recurrent ACS (33.9% female, mean age 67 years, LDL-C 2.9 mmol/L). When compared with first-presentation ACS patients (n=699), recurrent ACS patients had significantly higher proportions already on statin therapy (49.2% vs 6.0%, p<0.001) and ezetimibe (20.3% vs 2.4%, p<0.001). Recurrent ACS patients had significantly higher proportions of 2020 PBS-eligible patients (11.0% vs 1.3%, p<0.001) and 2022 PBS-eligible patients (20.3% vs 2.2%, p<0.001). There were no significant differences in PCSK9 inhibitor prescription rates among eligible patients (four of 13, 30.8% vs four of nine, 44.4%, p=0.51). Univariate binary logistic regression demonstrated that statin intolerance was significantly associated with PCSK9 inhibitor prescription (odds ratio 10; 95% confidence interval 1.3-79.3; p=0.029).</p><p><strong>Conclusions: </strong>Despite significantly higher eligibility rates, PCSK9 inhibitor uptake remains low in recurrent ACS patients, demonstrating the need to raise further awareness about eligibility criteria and encourage proactive prescription to prevent recurrent cardiovascular events.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464095","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":"Phenotypic Characterisation of Obstructive Sleep Apnoea in Acute Coronary Syndrome.","authors":"Benjamin K Tong, Seren Ucak, Hasthi Dissanayake, Sanjay Patel, Glenn M Stewart, Kate Sutherland, Brendon J Yee, Usaid Allahwala, Ravinay Bhindi, Philip de Chazal, Peter A Cistulli","doi":"10.1016/j.hlc.2024.07.014","DOIUrl":"https://doi.org/10.1016/j.hlc.2024.07.014","url":null,"abstract":"<p><strong>Background: </strong>Recent neutral randomised clinical trials have created clinical equipoise for treating obstructive sleep apnoea (OSA) for managing cardiovascular risk. The importance of defining the links between OSA and cardiovascular disease is needed with the aim of advancing the robustness of future clinical trials. We aimed to define the clinical correlates and characterise surrogate cardiovascular markers in patients with acute coronary syndrome (ACS) and OSA.</p><p><strong>Method: </strong>Overall, 66 patients diagnosed with ACS were studied. Patients underwent an unattended polysomnogram after hospital discharge (median [interquartile range] 62 [37-132] days). The Epworth Sleepiness Scale, Berlin, and STOP-BANG questionnaires were administered. Surrogate measures of vascular structure and function, and cardiovascular autonomic function were conducted. Pulse wave amplitude drop was derived from the pulse oximetry signals of the overnight polysomnogram.</p><p><strong>Results: </strong>OSA (apnoea-hypopnea index [AHI] ≥5) was diagnosed in 94% of patients. Moderate-to-severe OSA (AHI≥15) was observed in 68% of patients. Daytime sleepiness (Epworth Sleepiness Scale ≥10) was reported in 17% of patients. OSA screening questionnaires were inadequate to identify moderate-to-severe OSA, with an area under the receiver operating characteristic curve of approximately 0.64. Arterial stiffness (carotid-femoral pulse wave velocity, 6.1 [5.2-6.8] vs 7.4 [6.6-8.6] m/s, p=0.002) and carotid intima-media thickness (0.8 [0.7-1.0] vs 0.9 [0.8-1.0] mm, p=0.027) was elevated in patients with moderate-to-severe OSA. After adjusting for age, sex and body mass index, these relationships were not statistically significant. No relationships were observed in other surrogate cardiovascular markers.</p><p><strong>Conclusions: </strong>A high prevalence of OSA in a mostly non-sleepy population with ACS was identified, highlighting a gross underdiagnosis of OSA among cardiovascular patients. The limitations of OSA screening questionnaires highlight the need for new models of OSA screening as part of cardiovascular risk management. A range of inconsistent abnormalities were observed in measures of vascular structure and function, and these appear to be largely explained by confounding factors. Further research is required to elucidate biomarkers for the presence and impact of OSA in ACS patients.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464094","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 Rare and Fatal Intersection: Pulmonary Atresia Complicated by Major Aortopulmonary Collateral Artery Dissection.","authors":"Ping Hu, Jie Wang, Xiao-Jing Ma","doi":"10.1016/j.hlc.2024.06.1036","DOIUrl":"https://doi.org/10.1016/j.hlc.2024.06.1036","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400176","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":"Outcomes of the Modified Warden Procedure for Partial Anomalous Pulmonary Venous Connection Drainage to a High Location in the Superior Vena Cava.","authors":"Chunjie Mu, Yi Song, Jianming Xia, Ning Cao, Yao Deng, Minzhang Zhao, Runwei Ma","doi":"10.1016/j.hlc.2024.06.1038","DOIUrl":"https://doi.org/10.1016/j.hlc.2024.06.1038","url":null,"abstract":"<p><strong>Aim: </strong>To report the safety and effectiveness of a modified Warden procedure.</p><p><strong>Method: </strong>Twenty-six (26) patients underwent modified Warden surgery at our centre from September 2017 to September 2021. In all patients, the superior vena cava (SVC) was reconstructed by turning the atrial wall in the main body of the right atrium upwards and applying fresh autologous pericardial patches. There were 13 male patients and 13 female patients, and the median age of the patients was 7.0 (range, 0.3-47.0) years. The median follow-up time after surgery was 47.0 (range, 32.0-80.0) months.</p><p><strong>Results: </strong>The aortic cross-clamp time was 108.50±34.72 minutes, the cardiopulmonary bypass time was 154.81±41.65 minutes, the median postoperative mechanical ventilation time was 8.5 (range, 0.0-91.0) hours, the median intensive care unit stay was 43.5 (range, 15.0-352.0) hours, and the median length of postoperative hospital stay was 7.0 (range, 6.0-19.0) days. All patients were safely and successfully discharged from the hospital. No deaths or sinus node dysfunction occurred during the follow-up period. The mean gradient of the reconstructed SVC and/or the right pulmonary vein (PV) increased in eight patients and decreased to less than 1 mmHg in six patients. One (1) adult patient had already undergone two vascular interventions, and one child had persistent stenosis but did not undergo reoperation at the time of the study. In addition, two patients were subjected to pericardial windowing.</p><p><strong>Conclusions: </strong>A modified Warden technique using a right atrial flap and autologous pericardium effectively corrected the high-plane connection between the PVs and SVC. This technique effectively avoids sinus node dysfunction; however, a short-term increase in the differential pressure of the re-established SVC or PV after the procedure is acceptable, and reintervention is required only in rare cases.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406342","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":"Multiple Pulmonary Arteriovenous Malformations in a Cyanotic Child.","authors":"Ertugrul Cakir, Serdar Aslan, Gokhan Tonkaz","doi":"10.1016/j.hlc.2024.04.312","DOIUrl":"https://doi.org/10.1016/j.hlc.2024.04.312","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406341","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":"Massive Right Atrial Enlargement in an Adult.","authors":"Alexander Marschall, Inés Gómez Sánchez, Carmen Dejuán Bitriá, Blanca Coto Morales, Freddy Delgado Calva, David Martí Sánchez","doi":"10.1016/j.hlc.2024.06.1037","DOIUrl":"https://doi.org/10.1016/j.hlc.2024.06.1037","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406340","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":"Knowledge of Acute Coronary Syndrome Symptoms and the Intention to Call Emergency Medical Services in Culturally and Linguistically Diverse Australians.","authors":"Ararso Baru Olani, Kathryn Eastwood, Stuart Howell, Amanda Buttery, Janet E Bray","doi":"10.1016/j.hlc.2024.07.008","DOIUrl":"https://doi.org/10.1016/j.hlc.2024.07.008","url":null,"abstract":"<p><strong>Background: </strong>Prompt recognition of symptoms and response to acute coronary syndrome (ACS) are crucial for reducing pre-hospital delay. This study compares culturally and linguistically diverse (CALD) and non-CALD Australian populations in terms of their (i) ACS symptom knowledge and (ii) intention to call emergency medical services (EMS) for ACS.</p><p><strong>Method: </strong>This cross-sectional study used data from HeartWatch, an online survey collected by the National Heart Foundation of Australia between 2018 and 2020 for Australian adults aged ≥18 years. CALD respondents were defined as non-Indigenous individuals who reported speaking a language other than English at home. Characteristics associated with ACS symptom knowledge and EMS calling intentions were analysed using multivariable logistic regression.</p><p><strong>Results: </strong>Of 31,919 respondents, 16.3% were from CALD backgrounds (n=5,212). Compared with non-CALD, CALD respondents were less likely to name any ACS symptom (63.0% vs 76.0%; adjusted odds ratio [AOR] 0.66; 95% confidence interval [CI] 0.61-0.70) and were less likely to state that they would call an ambulance for ACS (50.2% vs 72.1%; AOR 0.53; 95% CI 0.50-0.57). Almost one-quarter (23.0%) of CALD respondents reported not knowing what they would do. In both groups, males, individuals aged ≤60 years, and those with diabetes were less likely to name an ACS symptom and had lower intention to call an ambulance. Those unable to list a single ACS symptom also had a lower intention to call an ambulance.</p><p><strong>Conclusions: </strong>Knowledge of ACS symptoms and intention to call an ambulance were lower among CALD respondents. The demographics of those with low ACS symptom knowledge and EMS calling intention were similar in the two groups. Future education efforts in Australia should focus on promoting ACS symptom knowledge and EMS use and should target these groups.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400177","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}