Heart, Lung and Circulation最新文献

{"title":"Unmet Needs and Opportunities for Australian Innovation and Clinical Research to Improve Quality of Life and Outcomes in Patients With Peripheral Artery Disease","authors":"Belinda J. Parmenter PhD ,&nbsp;Mary M. Kavurma PhD ,&nbsp;Toby Richards MD, FRCS ,&nbsp;Clare Arnott MBBS, PhD ,&nbsp;Sarah J. Aitken MD, PhD ,&nbsp;Steven G. Wise PhD ,&nbsp;Michael P. Gray MD ,&nbsp;Jonathan Golledge MB, BChir, MChir ,&nbsp;Christopher D. Askew PhD ,&nbsp;Shreeya Smith ,&nbsp;Alexis Hure PhD ,&nbsp;Gemma A. Figtree MBBS, PhD ,&nbsp;Australian Cardiovascular Alliance National Peripheral Artery Disease Working Group","doi":"10.1016/j.hlc.2024.12.007","DOIUrl":"10.1016/j.hlc.2024.12.007","url":null,"abstract":"<div><div>Peripheral arterial disease (PAD) is characterised by atherosclerotic stenosis or occlusion of arteries that leads to reduced blood flow to the limbs. PAD is associated with a very high rate of cardiovascular morbidity and mortality making the health and economic burden of PAD substantial. Despite high-quality evidence and international guidelines recommending conservative medical management of risk factors, and exercise and lifestyle interventions, surgical revascularisation (open or endovascular) remains the main treatment for PAD. Alarmingly, up to one-third of patients do not receive best medical therapy after revascularisation surgery despite evidence supporting this treatment reduces cardiovascular events.</div><div>Due to the considerable health burden that PAD presents, this manuscript aims to identify gaps in care and clinical research in PAD across Australia and proposes potential collaborative solutions. In Australia, there is significant disparity in care between rural/regional and metropolitan communities. These gaps are exacerbated by inequitable access to services across Australia, particularly for First Nation Australians, culturally and linguistically diverse groups and those living in regional and remote areas. This review identifies unmet needs for patients with PAD that are multifaceted, spanning from improved understanding of disease mechanisms, diagnostic tools for risk stratification and personalised therapy, to a paucity of medical and rehabilitation therapies for symptoms or prevention of cardiovascular complications. Furthermore, there are opportunities for national and international registries to optimise clinical trial quality and outcomes. Strategies should be applied to improve implementation of optimal medical therapy in PAD which will improve quality of life, reduce health care costs, and prevent secondary complications, limb loss, and mortality across Australia’s diverse population.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 3","pages":"Pages 225-234"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370795","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":"Pulsed-Field-Ablation for Atrial Fibrillation in a Patient With Left Atrial Appendage Occlusion Device","authors":"Yehuan Zhou MD, MMed(ClinEpi) ,&nbsp;Stuart P. Thomas MBBS, PhD ,&nbsp;Pierre C. Qian BSc(Med), MBBS, PhD","doi":"10.1016/j.hlc.2024.11.033","DOIUrl":"10.1016/j.hlc.2024.11.033","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 3","pages":"Pages e35-e37"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189187","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":"Palliative Approach to Care for Frailty in Heart Failure","authors":"Gursharan K. Singh PhD ,&nbsp;Julee McDonagh MN, PhD","doi":"10.1016/j.hlc.2025.02.100","DOIUrl":"10.1016/j.hlc.2025.02.100","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 3","pages":"Pages 206-207"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548923","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":"Isochronal Apparent Dispersion at Early Activation Sites Accurately Identifies Outflow Tract Ventricular Ectopy Sites","authors":"Robert D. Anderson MBBS, PhD ,&nbsp;Stephane Masse MASc ,&nbsp;Joshua Hawson MBBS ,&nbsp;Geoffrey Lee MBCHB, PhD ,&nbsp;Mukund Prabhu MD, DM ,&nbsp;Abhishek Bhaskaran MBBS, MD, PhD ,&nbsp;Andrew C.T. Ha MD, MSc ,&nbsp;Krishnakumar Nair MD ,&nbsp;Vijay Chauhan MD ,&nbsp;Kumaraswamy Nanthakumar MD","doi":"10.1016/j.hlc.2024.10.018","DOIUrl":"10.1016/j.hlc.2024.10.018","url":null,"abstract":"<div><h3>Background</h3><div>Localisation of outflow tract (OT) premature ventricular complex (PVC) sites is guided by unipolar and bipolar local activation time (LAT). However, LAT-based localisation can be inaccurate if the site is intramural or distant. Deep foci produce rapid conduction velocity (CV) if the wavefront is tangential to the surface.</div></div><div><h3>Aim</h3><div>We evaluated whether supraphysiological CV, referred to as surface isochronal apparent dispersion (IAD) mapping, can be used to accurately differentiate right and left ventricular OT PVC origin, guiding the successful site for OT PVC ablation.</div></div><div><h3>Method</h3><div>Left ventricular OT mapping was performed if right ventricular OT mapping demonstrated a bipolar electrogram (EGM) &lt;20 ms. The earliest EGMs underwent analysis of the following: first deflection bipolar EGM (bipolar_earliest) to QRS, bipolar_earliest to first deflection unipolar EGM (unipolar_earliest), bipolar_earliest to unipolar −dV/dT_max, unipolar −dV/dT_max to QRS, number of early LAT breakouts, and the surface area of the earliest isochronal breakout. Polynomial CV was calculated using a custom algorithm in MATLAB using cut-offs between 1 and 100,000 cm/s and used to create IAD, referred to as apparent dispersion index. The accuracy of IAD to distinguish between successful and unsuccessful OT sites was assessed and compared with conventional EGM indices.</div></div><div><h3>Results</h3><div>Bipolar_earliest to QRS (28.5±7.3 ms vs 17.8±5.7 ms; p&lt;0.05) is superior to unipolar −dV/dt_max to QRS (0.4±26.4 ms vs −6.4±13.4 ms; p=0.25) in differentiating successful and unsuccessful OT PVC sites. An early isochronal breakout area of less than 1 cm² and less than two breakouts indicates a successful side (both p&lt;0.05). Bipolar_earliest to unipolar −dV/dT_max and to unipolar_earliest were not predictive (28.1±27.7 vs 24.2±13.3 ms; p=0.97 and 6.4±7.3 vs 6.4±5.8 ms; p=0.8, respectively). IAD appears to differentiate between successful and unsuccessful sites using an apparent dispersion index cut-off of 20,000 cm/s, with an accuracy of 93.8% and area under the receiver operator characteristic of 0.95.</div></div><div><h3>Conclusions</h3><div>IAD is a realistic two-dimensional interpretation of the three-dimensional activation mapping surface that may be associated with OT origins to guide a successful side of catheter ablation.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 3","pages":"Pages 253-265"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073199","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":"Location of Left Ventricular Outflow Tract Measurements for Stroke Volume Estimation With Echocardiography","authors":"Brian Cowie FANZCA, FASE ,&nbsp;Leah Wright PhD ,&nbsp;Ben Costello FRACP, PhD ,&nbsp;Kristel Janssens BN ,&nbsp;Erin Howden PhD ,&nbsp;Darragh Flannery FRACP ,&nbsp;Steve Foulkes PhD ,&nbsp;Abarna Devapalasundaram FANZCA ,&nbsp;Roman Kluger FANZCA ,&nbsp;Andre La Gerche FRACP, PhD","doi":"10.1016/j.hlc.2024.11.015","DOIUrl":"10.1016/j.hlc.2024.11.015","url":null,"abstract":"<div><h3>Background</h3><div>The location of the left ventricular outflow tract (LVOT) for measurement of Doppler LVOT stroke volume (SV) remains contentious. Current guidelines recommend LVOT measures at or within 5 mm to 10 mm of the aortic annulus. We aimed to determine the Doppler LVOT SV location that most closely agreed with gold standard cardiac magnetic resonance imaging (CMR).</div></div><div><h3>Method</h3><div>This was a retrospective, single-centre, observational study of volunteer participants free of known cardiac disease, using both athlete and nonathlete controls. Participants had their Doppler LVOT SV measured using the area at the annulus, 3 mm, 6 mm, and 9 mm away from the annulus. This was compared to the gold standard CMR SV.</div></div><div><h3>Results</h3><div>Overall, 181 participants had their Doppler LVOT SV measured by echocardiography and CMR, under baseline resting condition. In this population free of cardiac disease, the LVOT area increased progressively from 0 mm to 9 mm from the annulus (4.4, 4.9, 5.7, and 6.95 cm²). The SV obtained at 3 mm from the annulus most closely agreed with CMR. The mean bias and upper and lower limits of agreement of CMR SV vs Doppler LVOT SV were: at 0 mm (11%, −17.78 to 39.76); 3 mm (0.40% −36.78 to 37.58); 6 mm (−16.48%, −72.16 to 39.19); and 9 mm (−43.16%, −114.93 to 28.61).</div></div><div><h3>Conclusions</h3><div>In patients free of known cardiac disease, measures of LVOT SV within 10 mm of the annulus are not equivalent. LVOT area and SV at 3 mm most closely approximates gold standard CMR SV. LVOT area at the annulus and 6 mm away are within 17% of the CMR SV. The LVOT is larger at 9 mm in this cohort, resulting in a significant overestimation of LV SV.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 3","pages":"Pages 266-272"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189103","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":"Association of Preoperative Oxygen Saturation and McGoon Ratio With Early Prognosis of Tetralogy of Fallot: A Propensity Score-Matched Analysis","authors":"Rong Liufu MD ,&nbsp;Yun Teng MD ,&nbsp;Jinlin Wu MD ,&nbsp;Tao Liu PhD ,&nbsp;Xiaobing Liu MD ,&nbsp;Shusheng Wen MD ,&nbsp;Jimei Chen MD ,&nbsp;Jian Zhuang MD","doi":"10.1016/j.hlc.2024.10.008","DOIUrl":"10.1016/j.hlc.2024.10.008","url":null,"abstract":"<div><h3>Aim</h3><div>Tetralogy of Fallot (TOF) is the most common cyanotic heart disease. This study aimed to demonstrate the effects of preoperative oxygen saturation on the early prognosis of TOF and identify risk factors associated with early complications.</div></div><div><h3>Method</h3><div>A cohort of 1,138 patients who were diagnosed and underwent one-stage surgical repair in this hospital were retrospectively included in this study. The cohort was divided into three groups according to preoperative oxygen saturation: group 1 (≤75%, n=275), group 2 (75%–85%, n=339), and group 3 (≥85, n=524).</div></div><div><h3>Results</h3><div>There were 16 early deaths (16 of 1,138) and no late deaths in this study. The total mortality rate was 1.41%, which was not significantly different among the three groups. Major adverse events (MAE)—including death, extracorporeal membrane oxygenation assistance, delayed sternal closure, and re-operation during hospitalisation—were reported in 11.81% of patients in group 1, 7.93% in group 2, and 5.61% in group 3 (p=0.008). Multivariable risk analysis showed that atrial septal defect fenestration (p=0.002), aortic cross-clamp time (p=0.027), and McGoon ratio (p=0.046) were associated with MAE. By propensity score matching, the lower McGoon ratio was significantly related to MAE.</div></div><div><h3>Conclusions</h3><div>The surgical outcomes were acceptable, with low mortality and MAE rates. The McGoon ratio, not oxygen saturation, presented as a determining factor of MAE.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 3","pages":"Pages 289-296"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871867","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":"Ezetimibe Eligibility and Prescribing in Patients With Acute Coronary Syndrome","authors":"Dylan Jape MD ,&nbsp;William B. He MD ,&nbsp;Dion Stub MBBS, PhD ,&nbsp;Shane Nanayakkara MBBS, PhD ,&nbsp;James A. Shaw MBBS, PhD","doi":"10.1016/j.hlc.2024.12.009","DOIUrl":"10.1016/j.hlc.2024.12.009","url":null,"abstract":"<div><h3>Background</h3><div>Ezetimibe is a safe and effective medication for achieving secondary prevention low-density lipoprotein-cholesterol (LDL-C) targets after acute coronary syndrome (ACS). We sought to examine ezetimibe prescribing after ACS and the effects of expanding the Australian Pharmaceutical Benefits Scheme eligibility criteria.</div></div><div><h3>Method</h3><div>A retrospective analysis was performed for the rates and factors of ezetimibe eligibility and prescribing in ezetimibe-naive patients with ACS admitted to a single quaternary centre between May 2020 and September 2022. Eligibility rates were also assessed with tighter LDL-C targets and with modelling to identify patients unlikely to achieve targets with first-line care.</div></div><div><h3>Results</h3><div>Of 757 patients with ACS with LDL-C &gt;1.8 mmol/L, 94 were eligible for ezetimibe. This subgroup was highly comorbid but only 16 patients were prescribed ezetimibe. The univariate logistic regression identified statin contraindication (odds ratio 19.4; 95% confidence interval 4.58–103.9; p&lt;0.001) and higher LDL-C (odds ratio 2.43 per 1 mmol/L; 95% confidence interval 1.44–4.67; p=0.03) as key predictors of prescribing. Of 956 patients with ACS with an LDL-C &gt;1.4 mmol/L, tightening LDL-C targets from 1.8 to 1.4 mmol/L increased eligibility from 94 (9.8%) to 152 (16.0%) patients, whereas predictive modelling substantially expanded eligibility to 309 (32.3%) and 620 (64.9%) with the 1.8 mmol/L and 1.4 mmol/L targets, respectively.</div></div><div><h3>Conclusions</h3><div>In the acute setting after ACS, Australian Pharmaceutical Benefits Scheme restrictions limit ezetimibe to highly comorbid patients with a high risk of recurrent disease. Despite this, the prescribing rates were poor. Furthermore, a larger group of patients are discharged on treatments that are unlikely to achieve guideline-directed LDL-C targets. Rationalising eligibility criteria for ezetimibe would likely improve access to early and effective secondary prevention.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 3","pages":"Pages 235-243"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189099","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":"Cardiovascular Risk and Knowledge, Attitudes and Beliefs of Football Referees Towards Acute Coronary Syndrome Events","authors":"Toby M. Plasto MD ,&nbsp;Thomas Buckley PhD ,&nbsp;Geoffrey H. Tofler MD","doi":"10.1016/j.hlc.2024.09.010","DOIUrl":"10.1016/j.hlc.2024.09.010","url":null,"abstract":"<div><h3>Background</h3><div>Although exercise is protective against cardiovascular disease, a transient increase in acute coronary syndrome (ACS) exists during heavy exertion. Psychological stressors are also known to precipitate ACS events. Football (soccer) referees are exposed to both physical and emotional stress when officiating a match, as well as being potential first responders for cardiovascular events among players. However, there has been limited research into cardiovascular risk and knowledge among football referees.</div></div><div><h3>Aim</h3><div>To evaluate cardiovascular risk factors in Australian football referees and assess their knowledge, attitudes and beliefs towards symptoms of ACS.</div></div><div><h3>Method</h3><div>An anonymous, online survey administered using REDCap was completed by Australian football referees at all levels of football, from grassroots to professional level. Participants were asked to select which risk factors they had from a pre-existing list. A modified version of the ACS Response Index assessed referees’ knowledge of ACS symptoms and their attitudes and beliefs regarding response to ACS symptoms</div></div><div><h3>Results</h3><div>Overall, 134 participants completed the survey, with a majority male (87.3%) and a median age of 47.0 years. Participants had refereed for an average of 12.5 (±8.9) years, with most officiating at the grassroots/amateur level (62.7%). Risk factors included hypercholesterolaemia (17.2%), hypertension (9.7%), diabetes mellitus (3.7%), peripheral vascular disease (2.2%) and tobacco smoking (0.8%). Overall 30.5% had a positive family history of cardiac disease and 9.7% had been previously diagnosed with a heart condition (including a heart attack or angina). Participants had only a moderate knowledge of ACS symptoms (12.9 [±3.0] with a maximum scale score of 21), scoring well for typical symptoms but less well for atypical symptoms or distinguishing from cerebrovascular events. Almost all would stop play immediately if a player complained of chest pain (95.9%), however, two-thirds (65.0%) would continue for at least 5 minutes if they had unusual chest pain in themselves. A majority were not sure they could recognise a heart attack in themselves or someone else (70.8%). They were supportive of further education to improve knowledge regarding ACS symptoms and interventions (90.9%).</div></div><div><h3>Conclusions</h3><div>Football referees are both at risk of ACS events and potentially first responders to events in players. This population of sampled referees had moderate knowledge of ACS symptoms, with a strong willingness to receive further education.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 3","pages":"Pages 244-252"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189153","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":"The Long-Term Management of Juvenile Mitral Stenosis","authors":"Mohammad Sarraf MD,&nbsp;Vinayak Nagaraja MBBS, MBiostat, FRACP","doi":"10.1016/j.hlc.2025.02.097","DOIUrl":"10.1016/j.hlc.2025.02.097","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 3","pages":"Pages 208-210"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548924","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(25)00159-3","DOIUrl":"10.1016/S1443-9506(25)00159-3","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 3","pages":"Pages 302-303"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548747","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}