The British journal of cardiology最新文献

{"title":"Cardiac ejection fraction as a problematic metric for heart failure phenotyping.","authors":"Rienzi A Diaz-Navarro, Peter L M Kerkhof","doi":"10.5837/bjc.2024.019","DOIUrl":"10.5837/bjc.2024.019","url":null,"abstract":"","PeriodicalId":74959,"journal":{"name":"The British journal of cardiology","volume":"31 2","pages":"019"},"PeriodicalIF":0.0,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11580666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A retrospective observational study of certain interactions with simvastatin 40 mg in an acute hospital in England.","authors":"Danita Boamah, Liam Bastian, Michael Wilcock","doi":"10.5837/bjc.2024.020","DOIUrl":"10.5837/bjc.2024.020","url":null,"abstract":"<p><p>The use of simvastatin 40 mg with various interacting medicines may lead to an increased risk of myopathy. We examined the extent to which hospital inpatients were prescribed simvastatin 40 mg with amiodarone, amlodipine, diltiazem, or verapamil, and assessed if any action was taken by prescribers or the pharmacy team to avoid this interaction. We found 56 patients on a combination of interest during their stay. Of the 20 (36%) patients not discharged on the combination, in six instances this was due to pharmacy intervention, while the remaining instances when simvastatin 40 mg or the interacting drug was amended or ceased were due to other clinical reasons. There is a need among clinicians and pharmacy teams within the hospital for recognition and management of these particular interactions.</p>","PeriodicalId":74959,"journal":{"name":"The British journal of cardiology","volume":"31 2","pages":"020"},"PeriodicalIF":0.0,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardioversion versus ablation versus 'pace and ablate' for persistent atrial fibrillation in older patients.","authors":"William Eysenck, Neil Sulke, Nikhil Patel, Stephen Furniss, Rick Veasey, Nick Freemantle, Neil Bodagh","doi":"10.5837/bjc.2024.014","DOIUrl":"10.5837/bjc.2024.014","url":null,"abstract":"<p><p>Our objective was to compare the efficacy of atrial fibrillation (AF) ablation versus permanent pacemaker (PPM) with atrioventricular node ablation (AVNA) versus direct current cardioversion (DCCV) for persistent AF in patients ≥65 years old. Seventy-seven patients (aged 66-86, mean 75.4 years) with persistent AF were randomised (1:1:1) to AF ablation + amiodarone (± DCCV), PPM with AVNA (+DCCV) or DCCV + amiodarone. The primary end point was persistent AF recurrence, measured with an implanted cardiac monitor or PPM. Cardiopulmonary exercise testing (CPET) was performed at baseline and six months. Symptom questionnaires were completed monthly. Follow-up was 12 months. The primary end point occurred in fewer patients following AF ablation + amiodarone than DCCV + amiodarone (seven patients, 28% <i>vs.</i> 15 patients, 60%; hazard ratio [HR] 0.559, 95% confidence interval [CI] 0.293 to 1.065, p=0.073) with no differences between DCCV + amiodarone and PPM with AVNA (HR 0.990, 95%CI 0.539 to 1.818, p=0.973). AF ablation + amiodarone resulted in a lower AF burden at 12 months compared with DCCV + amiodarone (17.0 ± 37.9% vs. 61.7 ± 48.6%, p<0.0001). Modified European Heart Rhythm Association (EHRA) symptom class improved in all patients (baseline 2.4 ± 0.495 <i>vs.</i> 12-month follow-up 1.84 ± 0.081, p=0.00001). Six-month CPET demonstrated a higher VO₂ peak in sinus rhythm (SR) compared with baseline in AF (12.1 ± 4.2 ml/kg/min at baseline to 15.3 ± 4.2 ml/kg/min at six months, p=0.013). In conclusion, in older patients with persistent AF, ablation + amiodarone resulted in a lower AF burden at 12 months than DCCV + amiodarone. There was a non-significant trend toward reduced recurrence of devicedetected persistent AF episodes. All therapies improved symptoms despite DCCV restoring SR in <50% of patients at 12 months. CPET demonstrated improved VO₂ peak with SR restoration.</p>","PeriodicalId":74959,"journal":{"name":"The British journal of cardiology","volume":"31 2","pages":"014"},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of PCI of all comers: the experience of a Kuwaiti independent healthcare institution.","authors":"Telal Mudawi, Waleed Alenezi, Ahmed Amin, Dalia Besada, Asmaa Aly, Assem Fathi, Darar Al-Khdair, Muath Al-Anbaei","doi":"10.5837/bjc.2024.016","DOIUrl":"10.5837/bjc.2024.016","url":null,"abstract":"<p><p>We present the cumulative percutaneous coronary intervention (PCI) data of all comers (stable angina and acute coronary syndromes [ACS]) who presented to Hadi Clinic between January 2018 and December 2020. As a low-volume PCI centre in the Middle East, we wanted to find out if the outcomes of our PCI procedures are different from those of high-volume PCI centres in the UK and the Western world. Prospectively collected data of all comers for PCI (urgent and elective) were retrospectively analysed. Preprocedural data included patients' baseline characteristics (age, gender, clinical presentation and comorbidities). Intra-procedural data included access route, coronary anatomy, lesion complexity, number of stents deployed, door-to-balloon time for primary PCI, and any intraprocedural complications. Postprocedural data included average length of in-hospital stay, intra-hospital morbidity and mortality, and mortality or admission with ACS 12-36 months after the index procedure. A total of 567 patients underwent coronary catheterisation for the three-year period between January 2018 and December 2020. Mean age was 60.9 ± 9.4 years, and 459/567 (81.0%) were male. Comorbidities included dyslipidaemia 515/567 (90.9%), hypertension 460/567 (81.2%), diabetes 346/567 (61%), known prior coronary disease 250/567 (44.2%), and smoking 188/567 (33.1%). Clinical presentation was stable angina 130/567 (22.9%), non-ST-elevation acute coronary syndrome (NSTEACS) 312/567 (55%), ST-elevation myocardial infarction (STEMI) 125/567 (22.0%), and STEMI with cardiogenic shock 13/125 (10.4%). The radial approach was used in 544/567 (95.94%), the average SYNTAX score was 34.8 ± 9.6, and the average number of stents 2.6. The total number of PCI was 367 (122.3 annually) with PCI procedural complete success in 349/367 (95.1%), partial success 5/367 (1.36%), PCI procedural complications 3/367 (0.82%), PCI in-hospital mortality 1/367 (0.27%), door-to-balloon time for primary PCI 31.8 ± 12.2 minutes, subsequent admission with ACS after 12-36 months 2/367 (0.54%), and post-discharge mortality after 12-36 months 1/367 (0.27%). In conclusion, our patient population have more comorbidities and more complex coronary disease in comparison to their western counterparts. Our annual PCI numbers have been significantly lower than the recommended 400 minimum cut-off figure, yet we have achieved comparable outcomes to those of larger institutions of the western world.</p>","PeriodicalId":74959,"journal":{"name":"The British journal of cardiology","volume":"31 2","pages":"016"},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heartificial intelligence: in what ways will artificial intelligence lead to changes in cardiology over the next 10 years.","authors":"Sam Brown","doi":"10.5837/bjc.2024.015","DOIUrl":"10.5837/bjc.2024.015","url":null,"abstract":"<p><p>Artificial intelligence (AI) will revolutionise cardiology practices over the next decade, from optimising diagnostics to individualising treatment strategies. Moreover, it can play an important role in combating gender inequalities in cardiovascular disease outcomes. There is growing evidence that AI algorithms can match humans at echocardiography analysis, while also being able to extract subtle differences that the human eye cannot detect. Similar promise is evident in the analysis of electrocardiograms, creating a new layer of interpretation. From big data, AI can produce algorithms that individualise cardiac risk factors and prevent perpetuating gender biases in diagnosis. Nonetheless, AI implementation requires caution. To avoid worsening health inequalities, it must be trained across diverse populations, and when errors arise, a robust regulatory framework must be in place to ensure safety and accountability. AI is perfectly positioned to capitalise on the growth of big data, but to proceed we require a generation of physicians who understand its fundamentals.</p>","PeriodicalId":74959,"journal":{"name":"The British journal of cardiology","volume":"31 2","pages":"015"},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of air pollution on atherosclerotic cardiovascular disease development.","authors":"Clayton Tewma, Justin Lee Mifsud","doi":"10.5837/bjc.2024.013","DOIUrl":"10.5837/bjc.2024.013","url":null,"abstract":"","PeriodicalId":74959,"journal":{"name":"The British journal of cardiology","volume":"31 2","pages":"013"},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety outcomes of suspected cardiac pathology assessed in an ambulatory rapid-access cardiology clinic.","authors":"Pok-Tin Tang, Benjamin Bussmann, Asad Shabbir, Andrew Elkington, William Orr","doi":"10.5837/bjc.2024.017","DOIUrl":"10.5837/bjc.2024.017","url":null,"abstract":"<p><p>Cardiac pathology contributes to a significant proportion of emergency department (ED) attendances. Many could be managed as urgent outpatients and avoid hospital admission. We evaluated a novel rapidaccess general cardiology clinic to achieve this, implemented during the COVID-19 pandemic. We performed a retrospective review of baseline characteristics, investigations, final diagnoses, and 90-day safety (readmission, major adverse cardiovascular events [MACE], mortality) from electronic records and conducted a patient experience survey. There were 216 ED referrals made between 1 June and 30 October 2020. The median time to review was two days (interquartile range 1-5). At 90 days, there were three (1.4%) representations requiring admission, two (0.9%) MACE, and no deaths. There were 205 (95%) successfully managed without hospital admission. Among surveyed patients, 96% felt they had concerns adequately addressed in a timely manner. In conclusion, our rapid-access cardiology clinic is a safe model for outpatient management of a range of cardiovascular presentations to the ED.</p>","PeriodicalId":74959,"journal":{"name":"The British journal of cardiology","volume":"31 2","pages":"017"},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correspondence: Other strategies for validating the diagnosis of heart failure.","authors":"Oscar M P Jolobe","doi":"10.5837/bjc.2024.021","DOIUrl":"10.5837/bjc.2024.021","url":null,"abstract":"","PeriodicalId":74959,"journal":{"name":"The British journal of cardiology","volume":"31 2","pages":"021"},"PeriodicalIF":0.0,"publicationDate":"2024-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11580743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison between early and late dapagliflozin administration for decompensated heart failure.","authors":"Takahiro Tokuda, Yoriyasu Suzuki, Ai Kagase, Hiroaki Matsuda, Akira Murata, Tatsuya Ito","doi":"10.5837/bjc.2024.010","DOIUrl":"https://doi.org/10.5837/bjc.2024.010","url":null,"abstract":"<p><p>Sodium-glucose cotransporter 2 inhibitors have demonstrated positive effects in heart failure (HF) patients. However, the effects of dapagliflozin in patients with decompensated HF remain unclear. This study aimed to compare the efficacy and safety of early and late dapagliflozin administration for decompensated HF. Data regarding dapagliflozin administration from 70 patients diagnosed with HF between December 2020 and November 2021 at a Japanese heart centre were analysed retrospectively. Propensity score matching was performed to compare the clinical outcomes of early and late dapagliflozin administration for decompensated HF. The primary end point was HF admission one year after dapagliflozin administration. The secondary end points were evaluated based on 24-hour urine volume, cardiac death, changes in ejection fraction (EF), blood pressure, glomerular filtration rate (GFR), haemoglobin and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, and side effects within one year of treatment. Fifteen matched pairs of patients were analysed. Admission rate within one year was significantly lower in the early administration group than in the late administration group (0 <i>vs.</i> 20%, p=0.03). Secondary end points were not significantly different between the two groups. In conclusion, early dapagliflozin administration significantly reduced HF admission within one year of treatment, although no differences were observed in 24-hour urine volume, cardiac death, EF, GFR, haemoglobin and NT-proBNP levels, and side effects.</p>","PeriodicalId":74959,"journal":{"name":"The British journal of cardiology","volume":"31 1","pages":"010"},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11421070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142334053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The prevalence of coronary artery disease in patients presenting with 'non-anginal chest pain'.","authors":"William Chick, Anita Macnab","doi":"10.5837/bjc.2024.009","DOIUrl":"https://doi.org/10.5837/bjc.2024.009","url":null,"abstract":"<p><p>The National Institute for Health and Care Excellence (NICE) advise against routine testing for coronary artery disease (CAD) in patients with non-anginal chest pain (NACP). This clinical audit sought to establish the prevalence of significant CAD in this cohort using computed tomography angiography (CTCA) and evaluate differences in the prevalence of cardiovascular risk factors between those with and without obstructive coronary disease. Over 23 months, 866 patients with NACP underwent CTCA. Patients were separated into three groups for analysis depending on the degree of CAD on CTCA using the CAD-RADS (Coronary Artery Disease Reporting and Data System) scoring system; no evidence of CAD (group 1), a degree of CAD requiring medical therapy only (group 2), significant CAD defined as a CAD-RADS score 4A/B or 5 (group 3). Cardiovascular risk factors were compared between the groups. We found 11.5% had significant CAD (group 3), 58.3% required medical therapy (group 2) and 30.1% had no CAD (group 1). There were 32 patients who required coronary revascularisation. Patients in group 2 and 3 were more likely to be male (p<0.001) and older (p<0.001) when compared to patients in group 1. Patients in group 3 were more likely to be hypertensive (p=0.008) and have higher Qrisk2 scores (p<0.001) when compared with those in group 1. In conclusion, NICE guidelines for NACP may result in a significant proportion of patients with CAD being underdiagnosed, including some with severe disease requiring revascularisation. This analysis suggests age, male gender, Qrisk2 score and hypertension are predictors of CAD in this cohort.</p>","PeriodicalId":74959,"journal":{"name":"The British journal of cardiology","volume":"31 1","pages":"009"},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11421066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142334061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}