Heart, Lung and Circulation最新文献

{"title":"Established and Emerging Therapies for Cardiovascular-Kidney-Metabolic Syndrome: Harnessing the Benefits of SGLT-2 Inhibitors, GLP-1 Receptor Agonists, and Beyond","authors":"Momina A. Allahwala MBBS ,&nbsp;Chinmay S. Marathe PhD, FRACP ,&nbsp;Adam J. Nelson PhD, FRACP ,&nbsp;Peter J. Psaltis PhD, FRACP ,&nbsp;Jessica A. Marathe PhD, FRACP","doi":"10.1016/j.hlc.2025.07.005","DOIUrl":"10.1016/j.hlc.2025.07.005","url":null,"abstract":"<div><div>Cardiovascular-kidney-metabolic (CKM) syndrome is a term that is increasingly used to describe interconnected conditions that lead to poor health outcomes, including cardiovascular disease, chronic kidney disease, type 2 diabetes, and obesity. Historically, there have been very few targeted pharmacotherapies available that have changed cardiovascular outcomes for people with CKM syndromes; however, over the past decade, new pharmacologic options have rapidly expanded, with strong evidence for cardiovascular and kidney protective benefits in CKM conditions. Of note, sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists have emerged as key therapeutic options and are now widely guideline-endorsed. However, amid a growing pipeline of therapeutic classes on the horizon, real-world use of these agents has become increasingly complex. This review will compare the efficacy of these therapies, exploring their distinct and complementary mechanisms, with consideration to their role in contemporary clinical care. Emerging classes of therapy that may confer additional benefits for people with CKM syndrome will also be highlighted.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 10","pages":"Pages 995-1005"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008266","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":"Diabetes is an Increasingly Common Issue After Heart Transplantation: A Case for Integrated Diabetes Care.","authors":"Lisa M Raven, Andrew Jabbour, Peter S Macdonald, Jerry R Greenfield, Christopher A Muir","doi":"10.1016/j.hlc.2025.04.081","DOIUrl":"https://doi.org/10.1016/j.hlc.2025.04.081","url":null,"abstract":"<p><strong>Background: </strong>Orthotopic heart transplantation (OHT) survival rates have improved with advances in immunosuppression over the last 20 years. With these improvements, there has been a greater focus on post-transplant care. Diabetes is common after transplantation and may be pre-existing (type 2 diabetes mellitus [T2DM]) or develop after transplant (post-transplant diabetes mellitus [PTDM]). The aim of this study was to compare the incidence and prevalence of diabetes in OHT recipients in two cohorts separated by 20 years.</p><p><strong>Methods: </strong>Retrospective audit comparing the prevalence of T2DM and cumulative 2-year incidence of PTDM in 88 consecutive OHT recipients in 1996-1998 and 141 consecutive OHT recipients in 2015-2018 at the same tertiary referral teaching hospital.</p><p><strong>Results: </strong>The prevalence of pre-transplant T2DM at the time of OHT increased three-fold between 1998 and 2018, from 6% (n=5) to 18% (n=25) respectively (p=0.009). Similarly, the incidence of PTDM increased from 16% (n=13) in 1998 to 36% (n=42) in 2018 (p=0.001). OHT recipients who developed PTDM were older in 2018 vs 1998 (mean age 52 [±11] vs 44 [±9] years; p=0.03). The mean age was not different between individuals with T2DM between the 1998 and 2018 eras. Body mass index was not different between the 1998 and 2018 eras in any of the diabetes status subgroups.</p><p><strong>Conclusions: </strong>The incidence and prevalence of diabetes after OHT at our Australian institution has increased over 20 years. With improved OHT survival and rates of diabetes, endocrinologists should be incorporated into the care teams of heart transplant recipients. Further studies of glucose-lowering therapies in patients with diabetes after transplantation are warranted.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182029","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 Clinical Spectrum of Bradyarrhythmias \"To Pace or Not to Pace\".","authors":"Vrijraj S Rathod, Harry G Mond","doi":"10.1016/j.hlc.2025.04.001","DOIUrl":"https://doi.org/10.1016/j.hlc.2025.04.001","url":null,"abstract":"<p><p>Asystolic bradyarrhythmias, documented on ambulatory electrocardiographic monitoring, present a perplexing problem regarding clinical management. These asystolic episodes can be instigated by intrinsic and extrinsic influences. Intrinsic events are precipitated by disease in the conduction system, while extrinsic incidents are modulated by vagal tone. Vagal-mediated bradyarrhythmias represent a diverse group of arrhythmias that are poorly understood. There is a deficiency in the literature for defining vagal-mediated bradycardia and hence without a full appreciation of the multitude of characteristics that define atrioventricular block, it can be challenging to make a firm diagnosis. This review discusses the elemental characteristics of bradyarrhythmias in combination with the current guidelines to enable risk stratification for permanent cardiac pacing. Cardiac pacing has been established to alleviate symptoms and improve longevity in patients with conduction system disease, whereas vagal-mediated bradycardias are a benign phenomenon and thus it is imperative that such rhythms are correctly identified.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174532","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":"Medium-Term Outcomes of Perceval Sutureless Aortic Valve Replacement in Aotearoa New Zealand.","authors":"Navneet Singh, Hannah Kim, Parma Nand","doi":"10.1016/j.hlc.2025.06.005","DOIUrl":"https://doi.org/10.1016/j.hlc.2025.06.005","url":null,"abstract":"<p><strong>Background: </strong>The Perceval bioprosthesis is a contemporary sutureless technology utilised for surgical aortic valve replacement (AVR). Perceval valves allow for AVR with reduced cross-clamp and cardiopulmonary bypass times, which correlates with improved postoperative patient morbidity and mortality. However, there is a paucity of literature reporting the medium-term outcomes from Perceval AVR in New Zealand. We aimed to investigate the mid-term outcomes from Perceval AVR at our single centre.</p><p><strong>Method: </strong>All consecutive patients undergoing Perceval AVR (during isolated or combined procedures) at our unit from March 2011 to August 2021 were retrospectively analysed from a prospectively-collected database.</p><p><strong>Results: </strong>Across the 10-year study period, 145 patients (mean age: 73.2 years; males: 71.7%; mean EuroSCORE II: 3.78%) underwent Perceval AVR. The most common indication for surgery was aortic stenosis (82.5%). The operative caseload was complex, with only 27.6% of patients undergoing first-time isolated AVR. The mean crossclamp and cardiopulmonary bypass times were 74.7±40.6 and 111.3±63.6 minutes respectively. Latest follow-up transthoracic echocardiography (performed at a mean of 2.2±1.7 years postoperatively) revealed that 96% of patients had either none or only trivial paravalvular/transvalvular leaks. The 30-day mortality and stroke rates were 6.2% and 2.1% respectively. Medium-term survival rates across 5-year and 9.5-year follow-up were 70% and 55% respectively. There was only one reoperation on the aortic valve.</p><p><strong>Conclusions: </strong>Across an older patient population undergoing complex cardiac surgery, Perceval AVR facilitates acceptable short-term and medium-term outcomes in terms of both prosthetic valvular function and survival.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174562","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":"An Integrative Analysis of Echocardiographic and Haemodynamic Parameters in Heart Transplant Candidates: Specific Focus on Pulmonary Regurgitation Jet-Derived Mean Pulmonary Artery Pressure and Pulmonary Vascular Resistance.","authors":"Ayşe İrem Demirtola, Anar Mammadli, Ozan Oğuz, Alican Özkan, Burcu Demirkan, Kumral Çağlı","doi":"10.1016/j.hlc.2025.08.021","DOIUrl":"https://doi.org/10.1016/j.hlc.2025.08.021","url":null,"abstract":"<p><strong>Background and aim: </strong>Precise haemodynamic assessment is critical in heart transplant candidates with advanced left heart failure. While right heart catheterisation (RHC) is the gold standard for evaluating pulmonary haemodynamics, its invasive nature necessitates non-invasive alternatives. Transthoracic echocardiography provides a non-invasive approach to estimate haemodynamic parameters. This study focused on pulmonary regurgitation (PR) jet-derived mean pulmonary artery pressure (mPAP) and Doppler-based pulmonary vascular resistance (PVR), evaluating their correlation and agreement with RHC-derived measurements in this high-risk population.</p><p><strong>Method: </strong>This prospective, single-centre study included 51 heart transplant candidates with a median ejection fraction of 15% (interquartile range, 13-20). PR jet-derived mPAP was calculated using the formula mPAP=4(PR peak velocity)²+right atrial pressure, and Doppler-based PVR as tricuspid regurgitation peak velocity/time-velocity integral (right ventricular outflow tract)×10+0.16. Correlation and agreement were assessed using Pearson correlation coefficients and Bland-Altman analysis. Subgroup and covariance analyses were performed, and receiver operating characteristic curves determined diagnostic performance.</p><p><strong>Results: </strong>PR jet-derived mPAP correlated strongly with RHC (r=0.701; p<0.001), with a mean bias of -1 mmHg and limits of agreement from -14.6 to 12.6 mmHg. Echocardiographic PVR showed moderate correlation (r=0.681; p<0.001) and a mean bias of +0.88 Wood units. Subgroup analysis showed better agreement in patients with dilated cardiomyopathy and New York Heart Association class II, while tricuspid coaptation defects were associated with the lowest PVR correlation (r=0.368). Covariance analysis identified time-velocity integral (right ventricular outflow tract) as the strongest predictor of PVR. Receiver operating characteristic analysis identified optimal cut-offs of ≥26 mmHg for mPAP (area under the curve [AUC]=0.939) and ≥3.99 Wood units for PVR (AUC=0.910).</p><p><strong>Conclusions: </strong>PR jet-derived mPAP showed good agreement with RHC, while Doppler-based PVR estimations demonstrated moderate correlation. These findings support transthoracic echocardiography as a complementary tool for pulmonary haemodynamic assessment, while emphasising the need for RHC for precise measurements.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148976","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 10-Year Review of Intravascular Imaging Use in Australia: Findings From a Statewide Registry.","authors":"Arun Sharma, Riley J Batchelor, Diem Dinh, Angela Brennan, Sinjini Biswas, Simon Thackray, Jacob Park, Samuel Norman, William Wilson, Ronen Gurvitch, Dion Stub, Jeffrey Lefkovits, Anoop N Koshy","doi":"10.1016/j.hlc.2025.08.017","DOIUrl":"https://doi.org/10.1016/j.hlc.2025.08.017","url":null,"abstract":"<p><strong>Background: </strong>In several recent randomised trials, intravascular imaging (IVI)-guided percutaneous intervention (PCI) has demonstrated superiority to angiography-guided PCI, particularly, in certain lesion subsets. Given the recent Medicare Benefits Schedule (MBS) criteria changes to incorporate intravascular ultrasound (IVUS) for PCI, we sought to report the real-world use of IVI.</p><p><strong>Methods: </strong>Consecutive patients undergoing PCI entered into the Victorian Cardiac Outcomes Registry from 2013 to 2022 were included. Patients presenting with cardiogenic shock or out-of-hospital cardiac arrest requiring intubation were excluded given their distinct clinical urgency and unstable physiology. The overall use of either IVUS and optical coherence tomography (OCT) was assessed. Additionally, we assessed the use of IVI in PCI in scenarios as per MBS criteria: lesion length ≥28 mm (using stent length as a surrogate marker) and left main PCI, as well as in cases of in-stent restenosis.</p><p><strong>Results: </strong>A total of 104,722 PCI procedures were included. IVUS/OCT was used in 3,137 (3.0%) cases. There was a significant increase in rates of IVI-PCI over the study period, increasing from 2.2% (n=105 of 4,809) in 2013 to 6.3% (n=730 of 11,651) in 2022 (p=0.005). Comparing 2013-2017 with 2018-2022, there was a significant increase in IVUS/OCT use for left main disease (p=0.01) and PCIs with stent length ≥28 mm (p=0.001). Of the 39,492 PCI cases with stent length ≥28 mm, IVUS/OCT was used in 3.3% of cases (1,313), with these patients being younger (p=0.001) and more likely to have diabetes (p=0.001) and previous PCI (p=0.001). Of the 1,831 left main PCI cases, IVI was used in 460 (25.1%).</p><p><strong>Conclusions: </strong>Although IVI use has grown significantly, 75% of left main coronary artery PCIs have still been done without imaging. With recent MBS changes, we anticipate further growth for IVI-guided PCI.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137310","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":"Long-Term Outcomes of Dor Versus Cooley Procedure in Patients With Post-Infarction Left Ventricular Aneurysm Repair: A Propensity Score-Matched Study.","authors":"Andrey V Protopopov, Alexander V Bogachev-Prokophiev, Alexander V Afanasyev, Dmitry A Sirota, Sergey Ye Khrushchev, Pavel S Ruzankin, Maxim O Zhulkov, Aleksandr M Chernyavskiy","doi":"10.1016/j.hlc.2025.04.089","DOIUrl":"https://doi.org/10.1016/j.hlc.2025.04.089","url":null,"abstract":"<p><strong>Aim: </strong>The optimal surgical strategy for patients with post-infarction left ventricular aneurysms remains unclear. The superiority of the Dor technique over the Cooley repair has not been demonstrated in terms of long-term outcomes. This study aimed to compare the clinical outcomes between the Dor and Cooley repair techniques.</p><p><strong>Methods: </strong>Patients who underwent left ventricular repair between 2003 and 2021 were retrospectively recruited. All the patients underwent left ventricular aneurysm repair and coronary artery bypass grafting. For comparative assessment of outcomes between the Cooley and Dor groups, 1:2 propensity score matching was applied. The primary study endpoint was long-term mortality, whereas the secondary endpoints included major adverse cardiac and cerebrovascular events (MACCEs), defined as a combination of cardiac death, myocardial infarction, stroke, readmission due to nonfatal myocardial infarction, and repeat revascularisation.</p><p><strong>Results: </strong>The median follow-up period was 106 months (interquartile range: 41-148). Eight hospital deaths (2.1%) occurred in the Cooley group and 11 (5.1%) in the Dor group within 30 days postoperatively. For the entire follow-up period, the Dor group had lower mortality (hazard ratio [HR] 0.67; 95% confidence interval [CI] 0.45-0.99; p=0.043) and greater freedom from myocardial infarction (HR 0.41; 95% CI 0.18-0.93; p=0.033). The overall incidence of MACCEs was significantly lower in the Dor group (HR 0.65; 95% Cl 0.48-0.88; p=0.005). The Dor group showed a notably lower readmission rate (HR 0.63; 95% Cl 0.42-0.94; p=0.022).</p><p><strong>Conclusions: </strong>For long-term survival and MACCEs, the Dor procedure demonstrated better outcomes than the Cooley reconstruction.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137367","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":"Bentall Versus David Procedure for Aortic Root Replacement in Patients With Bicuspid Aortic Valve: Systematic Review and Meta-Analysis Using Reconstructed Time-to-Event Data.","authors":"Ioannis Zoupas, Andreas Sarantopoulos, Nikolaos Schizas, Evangelos Boultadakis, Ioannis Koukis, Ibrahim Manna, Dimitrios C Iliopoulos","doi":"10.1016/j.hlc.2025.03.020","DOIUrl":"https://doi.org/10.1016/j.hlc.2025.03.020","url":null,"abstract":"<p><strong>Background: </strong>There is little evidence comparing the effectiveness of valve-sparing aortic root replacement with the David procedure and replacement with a composite graft (Bentall procedure) for patients with bicuspid aortic valves (BAV). This systematic review and meta-analysis compared the overall survival and the freedom from re-intervention in BAV patients who underwent root replacement with either the David or Bentall procedure.</p><p><strong>Methods: </strong>Two databases were searched for studies including BAV patients who underwent either the David or Bentall operation. This review was performed in accordance with the recommendations of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement. One-stage and two-stage meta-analyses were conducted with Kaplan-Meier-derived individual patient data and a random-effects model.</p><p><strong>Results: </strong>Thirteen studies were included, providing data about 1,264 BAV patients who underwent a Bentall procedure and 602 patients who underwent a David procedure. During a follow-up period of 8 years, overall survival rates were significantly improved in the David group compared with the Bentall group (hazard ratio [HR] 0.19, 95% confidence interval [CI] 0.08-0.42; p<0.001). This was confirmed by the two-stage meta-analysis (HR 0.22, 95% CI 0.09-0.55; p=0.00, I²=0.00%). Regarding freedom from re-intervention, splitting timepoint analysis revealed that no arm offered a statistically significant advantage (HR 1.24, 95% CI 0.58-2.63; p=0.575). Finally, the David operation was associated with fewer postoperative complications.</p><p><strong>Conclusions: </strong>The David operation is associated with improved survival and lower complication rates than the Bentall procedure for patients with BAV. However, freedom from re-operation rates were comparable between the two procedures.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080450","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":"Risk of Readmission After Acute Myocardial Infarction: Insights From the CADOSA Registry.","authors":"Clementine Labrosciano, John A Spertus, Jing Wu, Christopher J Zeitz, Rosanna Tavella, Matthew I Worthley, Margaret Arstall, Ajay Sinhal, John F Beltrame","doi":"10.1016/j.hlc.2025.06.1024","DOIUrl":"https://doi.org/10.1016/j.hlc.2025.06.1024","url":null,"abstract":"<p><strong>Background: </strong>Early identification of the one in five patients readmitted within 30 days of an acute myocardial infarction (AMI) hospitalisation provides an opportunity for targeted proactive intervention thereby reducing the risk of readmission. To target such an intervention to those most likely to benefit, this study sought to develop and validate a model predicting 30-day, all-cause, unplanned readmission after hospitalisation for AMI.</p><p><strong>Methods: </strong>The index AMI encounter for patients undergoing acute coronary angiography between 2012 and 2022 enrolled into the CADOSA (Coronary Angiogram Database of South Australia) Registry and discharged home across four tertiary hospitals were included. A random split sample of 70% and 30% was used for the derivation and validation cohorts, respectively. Logistic regression with combination elimination was performed to develop the parsimonious clinical model within the derivation cohort and model discrimination was assessed in the validation cohort.</p><p><strong>Results: </strong>Among 13,289 unique patients (mean age 64±13 years, 71% male, 41% ST-elevation AMIs), 14.2% were readmitted within 30 days. Readmitted patients were older (67±14 vs 63±13; p<0.001) and less likely to present with a ST-elevation AMI (38% vs 42%; p=0.003). Predictors showing a higher likelihood of readmission were patients with abnormal estimated glomerular filtration rate, cardiogenic shock and increased heart rate upon arrival, new diagnosis of heart failure, being older and female, and a history of depression. The model had consistent moderate discrimination (C statistic=0.63 in the derivation and validation cohorts).</p><p><strong>Conclusions: </strong>An Australian model for 30-day all-cause unplanned readmission has a similar performance to United States models. Further emphasis should be placed on providing additional support to high-risk patients upon arrival to the hospital to assist in reducing readmissions.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075250","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":"Geographical and Temporal Variation in Coronary Intravascular Imaging Utilisation and Barriers to Wider Adoption: A Systematic Review and Pooled Analysis.","authors":"Samuel Norman, Anoop N Koshy, Anna Wan, Sinjini Biswas, William Wilson, David Eccleston, Jeffrey Lefkovits","doi":"10.1016/j.hlc.2025.04.086","DOIUrl":"https://doi.org/10.1016/j.hlc.2025.04.086","url":null,"abstract":"<p><strong>Background: </strong>Despite the accumulation of randomised data demonstrating improved outcomes with intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI), utilisation is uncommon in most countries. This systematic review maps geographical and temporal trends in IVI use using PCI registry and government data.</p><p><strong>Method: </strong>A systematic review adhering to the PRISMA framework was conducted to identify provincial, national, and international data sets reporting real-world IVI rates published between 2014 and 2024.</p><p><strong>Results: </strong>A total of 36 publications from 24 countries were included, totalling 9,459,897 patients. Intravascular ultrasound was the preferred imaging modality, with optical coherence tomography accounting for <10% of IVI. Most countries reported low rates of IVI uptake, however, significant increases over time were observed. Rates varied significantly between and within regions and countries. Asia had the highest mean utilisation rate (35.4%; standard deviation, 35.9), followed by the Americas (9.3%; 5.7), Europe (5.7%; 4.9), and Oceania (4.5%; 2.6).</p><p><strong>Conclusions: </strong>Significant variability in IVI utilisation was observed across regions and countries. Most countries reported low IVI rates; however, adoption increased over time in most areas. Local variables such as health care system characteristics, physician preferences, and financial considerations appear to inform IVI rates more than clinical factors.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069439","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}