Heart, Lung and Circulation最新文献

{"title":"ROBITAL Technique: Combination of Sequential ROtational and orBITAL Atherectomy in Management of Complex Coronary Calcium","authors":"Soleiman Aria MBBS, MA(CANTAB), MSc,&nbsp;Su Hnin Hlaing MBBS, MMed, FRACP,&nbsp;Darren L. Walters MBBS, MPhil, FRACP,&nbsp;Rustem Dautov MD, PhD, FRACP","doi":"10.1016/j.hlc.2026.02.005","DOIUrl":"10.1016/j.hlc.2026.02.005","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Heavily calcified coronary artery disease remains one of the most formidable challenges in contemporary percutaneous coronary interventions, often leading to suboptimal stent expansion, procedural complications, and poor long-term outcomes. Over the years, a wide range of calcium modification techniques have been developed, including cutting and scoring balloons, rotational atherectomy, orbital atherectomy, high-pressure balloons, intravascular lithotripsy, and laser atherectomy, each with unique mechanisms, strengths, and limitations. This article aims to provide a comprehensive overview of these established and emerging calcium modification strategies, highlighting their roles in complex lesion preparation. It also introduces the ROtational orBITAL atherectomy (ROBITAL) technique, a novel sequential approach that combines rotational atherectomy followed by orbital atherectomy.</div></div><div><h3>Method &amp; Result</h3><div>Using rotational atherectomy to create an initial lumen, the technique then facilitates orbital crown delivery for more uniform and extensive plaque modification. We illustrate the rationale, technical considerations, and clinical application of the ROBITAL approach, including its use in complex left main bifurcation lesions.</div></div><div><h3>Conclusion</h3><div>This evolving strategy expands the armamentarium of calcium modification techniques, offering a safe, efficient, and potentially cost-effective solution for high-risk and heavily calcified coronary lesions.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 9","pages":"Pages 1271-1279"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630272","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":"Coagulopathy in Cardiac Surgery: A Scoping Review of Prothrombin Complex Concentrate","authors":"Stanislaw Vander Zwaag MD, DESAIC,&nbsp;Imre Kukel MD,&nbsp;Jens Fassl MD, PhD, FASE","doi":"10.1016/j.hlc.2026.01.018","DOIUrl":"10.1016/j.hlc.2026.01.018","url":null,"abstract":"<div><h3>Background</h3><div>Coagulopathy after cardiopulmonary bypass substantially contributes to postoperative bleeding, transfusion requirements, morbidity, and mortality. The traditional treatment option is fresh frozen plasma (FFP), but prothrombin complex concentrate (PCC) has become an alternative in the past years.</div></div><div><h3>Aim</h3><div>This study aimed to systematically map the current evidence and identify critical knowledge gaps regarding the efficacy, optimal timing, dosing regimens, point-of-care testing guidance, administration order, cost-effectiveness, and safety of 4-factor PCC in adult patients undergoing on-pump cardiac surgery, thereby informing future research priorities.</div></div><div><h3>Method</h3><div>A scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A search of several databases was conducted on 8 April 2025 without restrictions on the language or date of the publications. Study selection, data extraction, and charting were performed independently by two mutually blinded reviewers.</div></div><div><h3>Results</h3><div>A total of 57 primary studies (seven randomised controlled trials, 36 retrospective cohorts, five prospective cohorts, and nine experimental investigations) and 15 reviews with or without meta-analyses were identified. Evidence consistently indicates that PCC reduces postoperative chest tube output and transfusion requirements compared with FFP, although the effect sizes vary. Reported dosing ranged from fixed 500–4000 IU to weight-based 15–30 IU kg^-1. Viscoelastic testing guides PCC administration; however, standardised thresholds are lacking. Limited data suggest that PCC may be more cost-effective than FFP, and serious adverse events appear to be rare. No study has directly compared different PCC dosing regimens or prophylactic use in high-risk patients.</div></div><div><h3>Conclusions</h3><div>Substantial evidence gaps remain concerning the optimal dose, timing, viscoelastic targets, sequencing with fibrinogen concentrate, and health economic analyses of PCC use in cardiac surgery. High-quality randomised trials addressing these unanswered questions are warranted to refine the clinical guidelines.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 9","pages":"Pages 1214-1223"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283661","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":"Implementation of Evidence-Based, Person-Centered Alternative Delivery Models for Cardiac Rehabilitation in a Rural and Remote Population: The Country Heart Attack Prevention (CHAP) Project","authors":"Alline Beleigoli MD, PhD,&nbsp;Maria Alejandra Pinero de Plaza PhD,&nbsp;Lemlem G. Gebremichael PhD,&nbsp;Norma Bulamu PhD,&nbsp;Aarti Guyliani MSc,&nbsp;Derek P. Chew MBBS, PhD,&nbsp;Stephen J. Nicholls MBBS, PhD,&nbsp;Joyce S. Ramos PhD,&nbsp;Carol Maher PhD,&nbsp;John Beltrame MBBS, PhD,&nbsp;Billingsley Kaambwa PhD,&nbsp;Vincent L. Versace PhD,&nbsp;Jeroen M. Hendriks PhD,&nbsp;Rosanna Tavella PhD,&nbsp;Jonathon Foote BN,&nbsp;Katie Nesbitt PhD,&nbsp;Sarah Powell BSc,&nbsp;Wendy Keech MPH,&nbsp;Marie Ludlow PhD,&nbsp;Anthony Maeder PhD,&nbsp;Robyn A. Clark PhD","doi":"10.1016/j.hlc.2026.02.008","DOIUrl":"10.1016/j.hlc.2026.02.008","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Access and adherence to cardiac rehabilitation (CR) remain suboptimal, particularly in rural and remote settings. This study evaluated the implementation of person-centred, evidence-based CR delivery model tailored to improve access and completion.</div></div><div><h3>Methods</h3><div>The implementation framework utilised was the Model for Large-Scale Knowledge Translation. The Country Heart Attack Prevention (CHAP) project introduced evidence-based flexible CR including, face-to-face, telehealth, telephone, web-based and primary care options. A matched prospective cohort compared CR attendance, completion (primary outcomes), cardiovascular (CV) readmissions, mortality, and emergency department (ED) visits between CHAP rural services and standard metropolitan face-to-face CR.</div></div><div><h3>Results</h3><div>CR attendance was comparable between groups (24.2% vs 23.8%; odds ratio [OR] 1.15; 95% confidence interval [CI] 0.89–1.47; p=0.16), but completion rates were significantly higher in the CHAP Project (77.1% vs 57.5%; OR 1.69; 95% CI 1.30–2.18; p&lt;0.001). Patient satisfaction was also greater (85.9% vs 77.1%; p&lt;0.001). Median waiting times were similar (38 vs 36 days; p=0.008). Alternative delivery models were equivalent to traditional face-to-face modes for CV readmissions (hazard ratio [HR] 1.19; 95% CI 0.96–1.49; p=0.17), CV mortality (HR 1.70; 95% CI 0.92–3.16; p=0.09), and ED visits (HR 1.06; 95% CI 0.94–1.21; p=0.33). CR completion through CHAP was cheaper and more effective (costs: $6,542 vs $8,689; completions: 77.1% vs 57.5%). The CHAP model had over 50% probability of being cost-effective in improving CR completion. Uptake of the CHAP model would result in a cost reduction ranging from $2 million (m) at 20% uptake to $10m if all patients referred attended and completed CR.</div></div><div><h3>Conclusions</h3><div>The CHAP Project significantly improved program completion and achieved satisfaction without compromising clinical outcomes and showed important levels of economic benefit. Broader implementation of person-centred models of CR, across all geographic areas to enhance uptake and impact of CR in underserved populations is recommended.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 9","pages":"Pages 1337-1347"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204670","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":"Meta-Analysis of Randomised Controlled Trials on the Efficacy of Direct Oral Anticoagulants in Left Ventricular Thrombosis: An Updated Perspective","authors":"Bernardo Resende MD,&nbsp;Mariana Simões MD,&nbsp;Gonçalo Ferraz-Costa MD, MSc,&nbsp;João Gameiro MD,&nbsp;Lino Gonçalves MD, PhD","doi":"10.1016/j.hlc.2026.03.070","DOIUrl":"10.1016/j.hlc.2026.03.070","url":null,"abstract":"<div><h3>Background</h3><div>Left ventricular thrombus (LVT) is associated with significant morbidity and mortality. Current guidelines recommend direct oral anticoagulants (DOACs) and vitamin K antagonists for LVT treatment, although these recommendations are based on limited randomised data. However, a substantial body of new evidence has emerged, prompting the re-assessment of the optimal anticoagulation strategy.</div></div><div><h3>Aim</h3><div>This study aimed to conduct a systematic review and meta-analysis to assess the efficacy and safety profile of DOACs compared with warfarin in the management of LVT.</div></div><div><h3>Method</h3><div>We systematically searched three databases, restricting inclusion to randomised controlled trials comparing DOACs with warfarin. The primary outcomes were overall thrombus resolution and major bleeding events. Secondary outcomes were 1-month and 3-month thrombus resolution, all-cause mortality, and stroke. Dichotomous data were pooled as risk ratios (RRs) using an inverse variance random-effects model.</div></div><div><h3>Results</h3><div>Seven randomised controlled trials were included, providing data on 553 patients. No significant differences were observed in overall thrombus resolution (RR=1.00 [0.96–1.04]; I²=0%) or major bleeding events (RR=0.54 [0.20–1.48]; I²=0%). There was no statistically significant difference in 1-month thrombus resolution (RR=1.35 [0.73–2.51]; I²=72%), 3-month thrombus resolution (RR=1.00 [0.96–1.05]; I²=0%), all-cause mortality (RR=0.83 [0.31–2.17]; I²=0%), or stroke (RR=0.87 [0.17–4.53]; I²=31%).</div></div><div><h3>Conclusions</h3><div>DOACs appear to be effective and safe alternatives to warfarin for LVT management, offering the advantages of a simpler dosing regimen and easier management.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 9","pages":"Pages 1259-1270"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148375312","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":"Initial 4-Year Experience With Microaxial Flow Pumps Within a Tertiary Centre in Regional Australia","authors":"Thomas Quirk BMed,&nbsp;Shanathan Sritharan BMed, MPH/MHLM,&nbsp;Kaylea Short BNurs,&nbsp;Lewis McLean BMed,&nbsp;Arshad Khan MBBS,&nbsp;Nicholas Collins BMed,&nbsp;Andrew Boyle MBBS, PhD,&nbsp;Mohammad Al-Omary MBBS, PhD","doi":"10.1016/j.hlc.2026.02.017","DOIUrl":"10.1016/j.hlc.2026.02.017","url":null,"abstract":"<div><h3>Background &amp; Aim</h3><div>The Microaxial Flow Pump (MFP) is a miniaturised rotary pump that aspirates blood from the left ventricle and expels it into the ascending aorta. It unloads the left ventricle and increases mean arterial pressure and cardiac output. MFP is most commonly utilised in cardiogenic shock, for protected percutaneous coronary intervention (PCI), and for ventricular offloading in veno-arterial extracorporeal membrane oxygenation (VA-ECMO).</div></div><div><h3>Method</h3><div>We conducted a retrospective review of all patients who underwent MFP insertion at John Hunter Hospital, Australia. Categorical data are represented as counts and percentages, with continuous variables described as means with standard deviations.</div></div><div><h3>Results</h3><div>Twenty-three MFP devices were inserted between September 2020 and May 2024. Five (22%) were for protected PCI, three (13%) for venting with VA-ECMO (ECPELLA), and 15 (65%) for acute coronary syndrome (ACS) and cardiogenic shock. The median age for the overall cohort was 62 years, with a 74% male predominance. Eighty percent of the protected PCI cohort were elective outpatient procedures, and there were no deaths in this cohort. The mortality in the ECPELLA group was 67%. Thirteen (87%) of the patients with cardiogenic shock presented with an anterior infarct, and 53% had cardiac arrest on admission. The overall morality in the cardiogenic shock cohort was 40%. Complications in this cohort included limb ischaemia in four patients (17%) and site bleeding in seven patients (30%). Four patients (17%) required vascular surgery intervention.</div></div><div><h3>Conclusion</h3><div>Our initial experience showed the use of MFP in a tertiary centre was safe and feasible, allowing progression from protected percutaneous intervention to acute cardiogenic shock.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 9","pages":"Pages 1306-1312"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381943","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 and Risk of Radial Artery Occlusion After Distal Radial Access: Insights From the KODRA Registry","authors":"Byung Gyu Kim MD,&nbsp;Hyun Cho MD,&nbsp;Sung Eun Kim MD,&nbsp;Joon-Hyung Doh MD, PhD,&nbsp;Yongcheol Kim MD, PhD,&nbsp;Bong-Ki Lee MD, PhD,&nbsp;Sang-Yong Yoo MD, PhD,&nbsp;Sang Yeub Lee MD, PhD,&nbsp;Chan Joon Kim MD, PhD,&nbsp;Han-Young Jin MD, PhD,&nbsp;Jin Sup Park MD, PhD,&nbsp;Jung Ho Heo MD, PhD,&nbsp;Do Hoi Kim MD,&nbsp;Jin Bae Lee MD, PhD,&nbsp;Dong-Kie Kim MD,&nbsp;Jun Ho Bae MD,&nbsp;Sung-Yun Lee MD, PhD,&nbsp;Seung-Hwan Lee MD, PhD,&nbsp;Jun-Won Lee MD, PhD,&nbsp;Sung Woo Cho MD, PhD","doi":"10.1016/j.hlc.2026.02.013","DOIUrl":"10.1016/j.hlc.2026.02.013","url":null,"abstract":"<div><h3>Background</h3><div>Distal radial access (DRA) is increasingly used for coronary angiography (CAG) and percutaneous coronary intervention, but evidence in patients with diabetes is limited. We investigated whether diabetes is associated with forearm radial artery occlusion (RAO) after DRA.</div></div><div><h3>Method</h3><div>From the multicentre KODRA registry (Korean Prospective Registry for Evaluating the Safety and Efficacy of Distal Radial Approach), 4,941 patients undergoing attempted DRA between September 2019 and September 2021 were analysed: diabetes (n=1,813) and non-diabetes (n=3,128). The primary efficacy end point was forearm RAO at 1 month. Secondary safety end points were DRA-related bleeding, other secondary end points included puncture success, access-site crossover, and successful CAG without crossover.</div></div><div><h3>Results</h3><div>Despite a greater burden of comorbidities, patients with diabetes had similar rates of RAO compared with those without diabetes (0.5% vs 0.8%; p<em>=</em>0.139). DRA-related bleeding occurred in 3.0% vs 3.4% (p<em>=</em>0.535), with no major bleeding reported. Puncture success (94.1% vs 94.5%), overall access-site crossover (6.9% vs 6.6%), and successful CAG without crossover (98.9% vs 98.8%) were likewise comparable. In multivariable analysis, diabetes was not independently associated with RAO (odds ratio 0.585; 95% confidence interval 0.261–1.311; p<em>=</em>0.193) or other secondary end points.</div></div><div><h3>Conclusions</h3><div>In this large registry, DRA showed comparable RAO, bleeding, and procedural success between patients with and without diabetes. These results support DRA as a safe, feasible access strategy in this higher-risk population and highlight the need for standardised technique to preserve radial artery patency.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 9","pages":"Pages 1288-1297"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368235","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":"Cost-Effectiveness of Impella Versus Veno-Arterial Extracorporeal Membrane Oxygenation in Patients With Acute Myocardial Infarction Cardiogenic Shock","authors":"Riley Batchelor FRACP,&nbsp;Jocasta Ball PhD,&nbsp;Steven Theng PhD,&nbsp;William Sierakowski MPH,&nbsp;Mia Mudge MMedSci,&nbsp;Tahlia Seage MPH,&nbsp;Stelios I. Tsintzos MD,&nbsp;Dion Stub PhD","doi":"10.1016/j.hlc.2026.01.019","DOIUrl":"10.1016/j.hlc.2026.01.019","url":null,"abstract":"<div><h3>Background</h3><div>Recent trial data support the use of the Impella heart pump for the management of patients with cardiogenic shock (CS). However, questions regarding the cost-effectiveness of Impella compared with alternative mechanical circulatory support (MCS), such as venoarterial extracorporeal membrane oxygenation (VA-ECMO), affect adoption. In this study, we evaluated the cost-effectiveness of Impella versus VA-ECMO among patients requiring MCS for CS, from the perspective of the Australian healthcare system.</div></div><div><h3>Method</h3><div>A survival analysis was constructed to estimate cost-effectiveness. Survivors were assigned costs and outcomes over a lifetime time horizon. Clinical inputs were derived from a meta-analysis of propensity score–matched studies comparing Impella with VA-ECMO. Health care resource use and unit costs were included consistent with the Australian health care system perspective. Utility weights were applied to surviving patients to calculate quality-adjusted life-years (QALY), and both costs and outcomes were discounted at an annual rate of 5%.</div></div><div><h3>Results</h3><div>In the base<strong>–</strong>case, Impella was associated with cost savings of Australian dollars (AUD) $30,157 per person, 2.798 additional life years, and 1.206 additional QALYs compared with VA-ECMO. At a willingness-to-pay threshold of AUD $50,000 per QALY, the estimated net monetary benefit was AUD $90,450. Sensitivity analyses demonstrated that results were most influenced by short-term mortality, daily hospital costs, and length of stay.</div></div><div><h3>Conclusions</h3><div>This cost-effectiveness analysis and economic modelling suggests that targeted use of Impella represents a cost-saving technology compared to VA-ECMO for the management of CS, which may offer both clinical and economic benefits from the perspective of the Australian healthcare system.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 9","pages":"Pages 1313-1320"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148175854","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":"Letter to the Editor regarding: “Attainment of Low-Density Lipoprotein Cholesterol Goals and Statin Use in Patients With Atherosclerotic Cardiovascular Disease in Australian General Practice: Are We Doing Enough?”","authors":"Simon B. Dimmitt BMedSc, MBBS, FRACP, FCSANZ,&nbsp;Hans G. Stampfer MBBS, FRANZCP,&nbsp;Michael C. Kennedy MBBS, MD, FRACP,&nbsp;Jennifer H. Martin MA, MBChB, PhD, FRACP","doi":"10.1016/j.hlc.2026.01.012","DOIUrl":"10.1016/j.hlc.2026.01.012","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 9","pages":"Page e128"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148861828","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":"Low Albumin and Elevated FIB-4 Are Associated With Adverse Outcomes After the Fontan Procedure","authors":"Chaowapong Jarasvaraparn MD,&nbsp;Anthony J. Perkins,&nbsp;Andrew Rodenbarger MD,&nbsp;Jessica Thoe MD,&nbsp;Raj Vuppalanchi MD,&nbsp;Larry W. Markham MD,&nbsp;R. Mark Payne MD,&nbsp;Jean P. Molleston MD","doi":"10.1016/j.hlc.2026.02.010","DOIUrl":"10.1016/j.hlc.2026.02.010","url":null,"abstract":"<div><h3>Background</h3><div>Fontan-associated liver disease contributes to long-term morbidity and mortality. This study evaluated whether non-invasive liver fibrosis scores—aspartate transaminase to platelet ratio index (APRI) and fibrosis-4 (FIB-4) and routine clinical hepatic synthetic function, specifically albumin—predict adverse outcomes when obtained 10 and 20 years after the Fontan procedure.</div></div><div><h3>Method</h3><div>We conducted a retrospective analysis of Fontan patients with laboratory data available at ≥10 years post-procedure. The primary adverse outcomes included death, heart transplantation, or Fontan failure. Failing Fontan physiology was defined as heart failure, poorly controlled ascites, plastic bronchitis, or treatment-resistant protein-losing enteropathy. Cox regression was used to evaluate associations between APRI, FIB-4, and albumin level with adverse outcomes.</div></div><div><h3>Results</h3><div>Outcomes of 98 patients surviving at 10 years (but &lt;20 years), and 109 different patients surviving at 20 years were included. At least one adverse outcome occurred in 8% (8/98) of patients at 10 years and 12% (13/109) of patients at 20 years. Albumin &lt;3.5 g/dL was associated with adverse outcomes at both 10 years (hazard ratio [HR] 8.54; p=0.02) and 20 years (HR 4.31; p=0.03). FIB-4 &gt;1.45 but not APRI was significantly associated with adverse outcomes (HR 21.3; p=0.03) at 20 years.</div></div><div><h3>Conclusions</h3><div>Low albumin and elevated FIB-4 scores, usually leveraged in evaluation of liver disease, are associated with more frequent adverse outcomes of death, heart transplantation, or Fontan failure. These markers may serve as simple, non-invasive prognostic tools in long-term follow-up.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 9","pages":"Pages 1348-1356"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283623","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 Selected by Pressure Wire in Coronary Artery Revascularisation: The OSCAR Study","authors":"Justin Chia BMed, MMed(ClinEpi),&nbsp;Elisabeth Balarezo Rea BMus,&nbsp;Faraz Pathan MBBS,&nbsp;Hisham Hallani MBBS,&nbsp;Robert Gerber MBBS, PhD","doi":"10.1016/j.hlc.2026.03.057","DOIUrl":"10.1016/j.hlc.2026.03.057","url":null,"abstract":"<div><h3>Background</h3><div>Pressure wire-derived indices are widely used to guide revascularisation of angiographically intermediate coronary lesions. While fractional flow reserve (FFR) remains the reference standard, the resting full-cycle ratio (RFR) and other non-hyperaemic indices are increasingly adopted due to their ease of use. Data on real-world outcomes with these indices in Australia remain limited.</div></div><div><h3>Method</h3><div>Consecutive adults undergoing coronary angiography with pressure wire assessment between July 2021 and June 2024 at a tertiary centre in Sydney were included. Patient demographics, procedural data and outcomes were retrieved from hospital records. The primary end point was major adverse cardiac and cerebrovascular events (MACCE: all-cause mortality, non-fatal myocardial infarction, stroke or target vessel failure) during follow-up to June 2025.</div></div><div><h3>Results</h3><div>The study included 381 patients (mean age 64.6 years, 67% male) in whom 476 vessels were interrogated. Over a median follow-up of 460 days (IQR 232–766 days), MACCE occurred in 24 patients (6.3%), including 14 events within the first 12 months. Among those who had revascularisation deferred after negative pressure wire assessment, 6.3% developed MACCE. Outcomes were similar between those where revascularisation decisions were based on RFR or FFR alone and those who had both modalities (log-rank p=0.98). Discordance between RFR and FFR measurements were present in 21.7%.</div></div><div><h3>Conclusions</h3><div>In a contemporary Australian cohort, revascularisation guided by pressure wire assessment was associated with low adverse event rates. Non-hyperaemic indices like RFR are a pragmatic tool in clinical practice. Discordance between pressure wire indices remains clinically relevant and warrants further prospective research.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"35 9","pages":"Pages 1280-1287"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283653","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}