Heart, Lung and Circulation最新文献

{"title":"Cardiovascular Risk, Comorbidity and Frailty in Patients Undergoing Sleeve Gastrectomy: A Population-Based Study.","authors":"Thomas Goubar, Christopher Goubar, Douglas Fenton-Lee, Aneta Stefanidis, Peter Macdonald, R Louise Rushworth","doi":"10.1016/j.hlc.2026.05.018","DOIUrl":"https://doi.org/10.1016/j.hlc.2026.05.018","url":null,"abstract":"<p><strong>Background: </strong>Cardiometabolic conditions and frailty influence perioperative risk in bariatric surgery; however, contemporary population-level studies describing these factors are limited. This study characterised the cardiometabolic burden, comorbidity, and frailty of adults undergoing laparoscopic sleeve gastrectomy (LSG), with comparisons according to sex and hospital setting.</p><p><strong>Method: </strong>A population-based cohort study was conducted using statewide administrative hospital data from all public and private hospitals in New South Wales, Australia, between 1 July 2017 and 30 June 2022. Adults (≥18 years) undergoing primary LSG were included. The prevalence of cardiometabolic comorbidities and trends in age-adjusted disease rates were assessed. Subgroup analyses according to sex and hospital setting were performed for cardiovascular risk factors, comorbidity, and frailty.</p><p><strong>Results: </strong>Among 34,738 patients (78.3% female; 96.6% treated in private hospitals; mean age 41.3±11.5 years), nearly three-quarters (72.3%, n=25,130) had one or more cardiovascular risk factors. The prevalence of type 2 diabetes mellitus (T2DM) declined by 24.4% (148.8-112.5 per 1,000; p<0.001). Males had a higher cardiovascular risk burden (44.3% vs 28.0% with ≥2 risk factors; p<0.001), greater comorbidity burden (Elixhauser index: 1.35 vs 1.07; p<0.001), and higher frailty scores (Claims Frailty Index: 0.12 vs 0.11; p<0.001). Public hospital patients, particularly males, had the highest burden across all measures.</p><p><strong>Conclusions: </strong>There was substantial variation in cardiometabolic burden among LSG recipients according to sex and hospital sector. The observed decline in T2DM suggests a change in the clinical profile of patients undergoing surgery. These findings warrant further investigation into the factors influencing access to surgery and patient selection.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001636","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":"Reply to Letter to the Editor \"Discordant Stress Testing Results: Looking Beyond Obstructive Coronary Disease\".","authors":"Andrew Dind, Daniel McGhie, Daniel McIntyre, Jennifer Yu, Gregory Cranney, Gita Mathur","doi":"10.1016/j.hlc.2026.06.007","DOIUrl":"https://doi.org/10.1016/j.hlc.2026.06.007","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001615","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":"Short-Term Clinical Outcomes After Percutaneous Coronary Intervention Among Culturally and Linguistically Diverse (CALD) Patients in Australia.","authors":"Cecilia Y T Kwok, Sara Vogrin, Youlin Koh, Omar Al-Mukhtar, Jason E Bloom, Wayne C Zheng, Yanti Octavia, Jiwon Kim, Frank Du, Brendan Backhouse, Samer Noaman, Kawa Haji, Nicholas Cox, William Chan","doi":"10.1016/j.hlc.2026.03.075","DOIUrl":"https://doi.org/10.1016/j.hlc.2026.03.075","url":null,"abstract":"<p><strong>Aims: </strong>We aimed to evaluate the effect of culturally and linguistically diverse (CALD) status on clinical outcome as measured by 30-day major adverse cardiac and cerebrovascular events (MACCE) after percutaneous coronary intervention (PCI).</p><p><strong>Methods: </strong>This observational cohort study involved analysis of data from a high-volume tertiary centre in Melbourne, Australia. Adults who underwent PCI at a tertiary health service in Melbourne, Australia (January 2014-December 2021), were stratified into CALD (those born in non-English-speaking countries and/or whose primary language at home is not English) and non-CALD status. The main outcome measures were in-hospital and 30-day MACCE (composite of new heart failure, myocardial infarction, stent thrombosis, major bleeding, stroke, rehospitalisation, and mortality).</p><p><strong>Results: </strong>Compared to non-CALD (n=3,301, 51%), CALD patients (n=3,112, 49%) were older (mean age 65.2 vs. 61.5 years), more likely to be on medication for type 2 diabetes mellitus (33.5% vs 21.7%), had prior coronary artery bypass grafting (5.5% vs 3.7%) and were on dialysis (2.2% vs 1.0%; all p<0.001). CALD patients presented less frequently with acute coronary syndromes (58.7% vs 65.8%; p<0.001) but had increased rates of multivessel disease (8.9% vs 6.9%; p=0.004). In the ST-elevation myocardial infarction subgroup, CALD patients had lower pre-hospital notification rates (13.1% vs 20.7%) and longer symptom to PCI time (599 vs 420 minutes; both p<0.001). At 30 days, CALD patients had higher rates of rehospitalisation (13.9% vs 11.9%) and major bleeding (0.5% vs 0.1%; both p=0.05) but not overall MACCE (5.0 vs. 5.9%; p=0.12) or mortality (2.8% vs. 3.3%; p=0.28).</p><p><strong>Conclusions: </strong>Despite higher rates of co-morbidities, re-hospitalisation and major bleeding, CALD patients had comparable 30-day mortality compared to non-CALD patients in contemporary systems of care. These data suggest that evolving changes within care network tailored to CALD patient needs might be beneficial and require further prospective studies.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001693","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 Obstructive Stenosis: Interpreting Discordant Exercise ECG and Stress Echocardiography in Clinical Practice.","authors":"Zhaonan Li, Wenxiu Liu, Kang Yi, Tao You","doi":"10.1016/j.hlc.2026.05.021","DOIUrl":"https://doi.org/10.1016/j.hlc.2026.05.021","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001678","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":"Transcatheter Aortic-Valve Implantation for Native-Valve Infective Endocarditis.","authors":"Hisato Takagi","doi":"10.1016/j.hlc.2026.06.006","DOIUrl":"https://doi.org/10.1016/j.hlc.2026.06.006","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001610","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":"Recent Trends in Genetic Testing for Familial Hypercholesterolaemia in Australia.","authors":"Jing Pang, Mitchell N Sarkies, Michael M Page, Kristen J Nowak, Gerald F Watts","doi":"10.1016/j.hlc.2026.04.122","DOIUrl":"https://doi.org/10.1016/j.hlc.2026.04.122","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148968211","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":"Team-Based Hypertension Management in Primary Care: A Synthesis of Systematic Reviews.","authors":"Elizabeth Halcomb, Karla Kuzmins, Emily de Tourettes, Catherine Stephen","doi":"10.1016/j.hlc.2026.05.020","DOIUrl":"https://doi.org/10.1016/j.hlc.2026.05.020","url":null,"abstract":"<p><strong>Background: </strong>People with hypertension often require personalised education and support from health professionals to optimise outcomes. Multidisciplinary team-based care in primary care has been proposed as a strategy to empower patients to manage their blood pressure. Although substantial literature reports team-based interventions for hypertension management in primary care, the optimal models and their components remain unclear.</p><p><strong>Aim: </strong>This scoping review critically synthesised existing systematic reviews that have explored elements of team-based care and collaboration among primary care clinicians for hypertension management, and identified knowledge gaps and areas for future investigation.</p><p><strong>Method: </strong>Following PRISMA-ScR guidelines, CINAHL and MEDLINE were searched for relevant systematic reviews published in English since 2015 that reported trials of team-based primary care in which blood pressure was an outcome or evaluated interventions for hypertension delivered by a team.</p><p><strong>Results: </strong>Of the 12 reviews that met the inclusion criteria, four (33.3%) included multidisciplinary teams, three (25.0%) included nurse-led teams, and two (16.7%) included pharmacist-led teams. The remaining three (25.0%) reviews evaluated which components of teamwork optimised hypertension management. Regardless of the team composition, most, but not all, reviews demonstrated improvements in blood pressure and other outcomes. Most teamwork components improved outcomes; however, a greater number of team components was associated with better outcomes.</p><p><strong>Conclusions: </strong>Although the included reviews confirmed the value of team-based care, the specific intervention components that contribute to successful outcomes, the dose of teamwork required, the nature of task-sharing and the cost-effectiveness of team-based models require further investigation. Additionally, clearer reporting of the nature of teamwork, task-sharing and intervention delivery would facilitate comparisons between studies.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929726","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":"False-Positive Troponins: Clinical Misclassification, Delayed Recognition, and Health Care Costs in a Real-World Cohort.","authors":"Lung En Teng, Preetha Thomas, Edward Quine, Jacqueline Liaw, Amelia Place, Joel Smith, Andrew J Taylor, Timothy Fazio, Cherie Chiang, Anoop N Koshy","doi":"10.1016/j.hlc.2026.05.007","DOIUrl":"https://doi.org/10.1016/j.hlc.2026.05.007","url":null,"abstract":"<p><strong>Background: </strong>Cardiac troponin immunoassays are critical for diagnosing myocardial infarction. Up to 10% of elevated results may be falsely positive because of heterophile antibodies or macrotroponin complexes, leading to misdiagnoses.</p><p><strong>Method: </strong>We conducted a retrospective cohort study at the Royal Melbourne Hospital, Australia (January 2021-December 2024). The Abbott high-sensitivity troponin-I assay was the primary assay used in standard practice. Interference was confirmed according to institutional protocol when alternative assays (Ortho Vitros or Roche high-sensitivity assays) performed on the same plasma sample were negative. Clinical characteristics, investigations, treatment, documentation, and health care costs were reviewed.</p><p><strong>Results: </strong>Among 148,987 high-sensitivity troponin-I requests, 38 patients underwent alternate testing. In the 26 patients with confirmed interference, the median age was 48 years (interquartile range 36-60), with equal sex distribution; 39% had no cardiovascular risk factors. The median troponin levels were 150 ng/L. All underwent transthoracic echocardiography, and 73% received coronary imaging (computed tomography or invasive angiography). More than half had normal cardiac findings. Misdiagnoses included myocarditis (35%) and non-ST-elevation myocardial infarction (23%); 81% received treatment changes, including colchicine, aspirin, or anticoagulation. The median delay to recognition was 7.5 months. Documentation was inconsistent: only 54% had interference recorded in the medical record and 19% in discharge summaries. Estimated costs averaged AUD $16,331 per patient, largely because of avoidable admissions and procedures.</p><p><strong>Conclusions: </strong>Troponin assay interference is an under-recognised source of false-positive troponin elevations, leading to diagnostic error, unnecessary testing, and substantial health care costs. Prompt recognition, consistent documentation, and routine confirmatory testing using alternate assays are essential to mitigate clinical and economic consequences.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929720","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":"Coagulation Defects Promote False Lumen Patency in Type A Aortic Dissection.","authors":"Yattheesh Thanalingam, Daniel Fudulu, Kelly Byrne, Francesco Pirone, Nishith N Patel","doi":"10.1016/j.hlc.2026.04.119","DOIUrl":"https://doi.org/10.1016/j.hlc.2026.04.119","url":null,"abstract":"<p><strong>Background & aim: </strong>Acute type A aortic dissection (TAAD) is associated with high mortality and morbidity. False lumen (FL) patency is associated with malperfusion, aortic expansion, reoperation and reduced survival. Our aim was to determine if coagulation defects predict the fate of the FL.</p><p><strong>Methods: </strong>We conducted a single-centre, retrospective, case-controlled study of patients with TAAD. Patient demographics, preoperative characteristics, operative details, postoperative complications, and follow-up computed tomography scans at 1 year were compared between patients who presented with patent FL and thrombosed FL. Coagulopathy was evaluated using standard laboratory tests and thromboelastography on admission, postoperatively, and at discharge. The primary outcome was long-term survival.</p><p><strong>Results: </strong>Of 123 eligible patients with TAAD, 67% (n=79) had patent FL and 33% (n=38) had thrombosed FL. Patent FL was associated with higher in-hospital (38.0 % vs 5.3% p<0.05) and mid-term mortality (93.0% vs 7.0%, p<0.05), postoperative dialysis (5.1% vs 0, p=0.04) and gastrointestinal ischaemia (17.7% vs 5.3%, p<0.05) compared to the thrombosed FL group. Survival analysis included a maximum follow-up of 8.61 years and demonstrated reduced survival in patients with a patent FL (hazard ratio [HR] 10.2, 95% confidence interval [CI] 3.00-34.6, p<0.001). Multivariable logistic regression analysis identified preoperative activated partial thromboplastin time (APTT), postoperative day 1 APTT, R value and alpha angle as independent predictors of patent FL.</p><p><strong>Conclusions: </strong>Patients with a patent FL have a higher risk of mid- and long-term mortality and postoperative morbidity. Abnormalities in coagulation tests, particularly of the intrinsic pathway, are associated with FL patency. The coagulation cascade represents a novel therapeutic target to promote FL thrombosis.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929717","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":"Pulsed Field Ablation for Atrial Fibrillation in Australia: A Large Tertiary Centre Analysis.","authors":"Francis J Ha, Duron Prinsloo, Edwin Xu, Hui Chen Han, David Adam, Stewart Healy, Mohammad Alasti, Colin Machado, Logan Bittinger, Sing Huey Cheng, Jagat Adhikari, Nitesh Nerlekar, Adam J Brown, Jeffrey Alison, Emily Kotschet","doi":"10.1016/j.hlc.2026.04.125","DOIUrl":"https://doi.org/10.1016/j.hlc.2026.04.125","url":null,"abstract":"<p><strong>Background: </strong>Pulsed field ablation (PFA) is increasingly used for catheter ablation of atrial fibrillation (AF). Limited real-world data exists regarding safety and efficacy of PFA in Australia.</p><p><strong>Method: </strong>We conducted a retrospective analysis of consecutive patients undergoing de novo PFA for paroxysmal or persistent AF at a large tertiary centre using a pentaspline catheter (FARAPULSE, Boston Scientific) from 2022 to 2025. Baseline demographics, procedural characteristics, procedural complications, clinical outcomes and repeat procedures were collected. Arrhythmia recurrence was defined as >30 seconds of AF, atrial flutter or atrial tachycardia at follow-up with no blanking period.</p><p><strong>Results: </strong>Overall, 564 consecutive patients (median age 64 years, 35% female) underwent de novo PFA for AF during the study period. Most patients had paroxysmal AF (63%). Pulmonary vein (PV) isolation was performed in 563 of 564 patients; posterior wall (PW) isolation was performed in 41% and superior vena cava ablation in 3%. Median total applications were 58 (interquartile range [IQR] 50-70). Median total procedural time was 63 minutes (IQR 51-76). Major procedural complications occurred in 1.8% (10/564) patients and minor procedural complications occurred in 12.6% (71/564), mostly because of minor vascular access complications (8.2%). Six (6)-month freedom from arrhythmia was 72%; cardioversions were performed in 5.3% and 2.7% had arrhythmia-related hospitalisation. In 35 patients (6.2%) who underwent repeat procedure, PV and PW durability was 45% and 32%, respectively.</p><p><strong>Conclusions: </strong>PFA for AF is reasonably safe with acceptable clinical outcomes. These real-world data provide clinicians with potential expected clinical outcomes for patients referred for PFA in Australia.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929767","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}