British Heart Journal最新文献

{"title":"A retrospective review of empiric acyclovir prescribing practices for suspected viral central nervous system infections: A single-centre study.","authors":"JeongMin Marie Kim, Cesilia Nishi, Jennifer Mina Grant","doi":"10.3138/jammi-2022-0031","DOIUrl":"10.3138/jammi-2022-0031","url":null,"abstract":"<p><strong>Background: </strong>Acyclovir has an important role in the treatment of viral central nervous system (CNS) infection, especially herpes simplex virus (HSV)-1 encephalitis. It is therefore used broadly as empiric therapy for many patients who present to the hospital with symptoms of a possible neurologic infection. We sought to review our practices in acyclovir prescribing, deprescribing, and associated investigations for the clinical syndromes it treats.</p><p><strong>Methods: </strong>Through a retrospective chart review, we identified patients prescribed acyclovir for a possible CNS infection upon admission to Vancouver General Hospital between January 1, 2019, and December 31, 2019. Patient demographics, signs, symptoms, and comorbidities were taken from admission consultation notes or discharge summaries; their investigations, including laboratory tests and imaging, were also recorded. The primary purpose was to describe the appropriateness of empiric acyclovir use in suspected meningoencephalitis cases.</p><p><strong>Results: </strong>Among the 108 patients treated with acyclovir, 94 patients had an indication for starting empiric treatment for encephalitis or meningitis. There was suspicion and workup for encephalitis alone in 76 patients. Among discharge diagnoses, the most common was delirium of a different identified source (18 cases), followed by unknown/other (15 cases). There were seven patients whose CSF viral PCR test was positive for HSV or varicella-zoster virus (VZV); three of them had HSV-1 encephalitis. There were two total adverse events recorded attributed to acyclovir; both cases were of mild acute kidney injury.</p><p><strong>Conclusion: </strong>We found that in many patients, acyclovir was not necessary or could have been stopped earlier, avoiding toxicity and drug costs.</p>","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"87 1","pages":"125-133"},"PeriodicalIF":0.0,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10795701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86327760","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":"Cortical Morphology in Cannabis Use Disorder: Implications for Transcranial Direct Current Stimulation Treatment.","authors":"Ghazaleh Soleimani, Farzad Towhidkhah, Mehrdad Saviz, Hamed Ekhtiari","doi":"10.32598/bcn.2021.3400.1","DOIUrl":"10.32598/bcn.2021.3400.1","url":null,"abstract":"<p><strong>Introduction: </strong>Transcranial direct current stimulation (tDCS) has been studied as an adjunctive treatment option for substance use disorders (SUDs). Alterations in brain structure following SUD may change tDCS-induced electric field (EF) and subsequent responses; however, group-level differences between healthy controls (HC) and participants with SUDs in terms of EF and its association with cortical architecture have not yet been modeled quantitatively. This study provides a methodology for group-level analysis of computational head models to investigate the influence of cortical morphology metrics on EFs.</p><p><strong>Methods: </strong>Whole-brain surface-based morphology was conducted, and cortical thickness, volume, and surface area were compared between participants with cannabis use disorders (CUD) (n=20) and age-matched HC (n=22). Meanwhile, EFs were simulated for bilateral tDCS over the dorsolateral prefrontal cortex. The effects of structural alterations on EF distribution were investigated based on individualized computational head models.</p><p><strong>Results: </strong>Regarding EF, no significant difference was found within the prefrontal cortex; however, EFs were significantly different in left-postcentral and right-superior temporal gyrus (P<0.05) with higher levels of variance in CUD compared to HC [F_{(39, 43)}=5.31, P<0.0001, C=0.95]. Significant differences were observed in cortical area (caudal anterior cingulate and rostral middle frontal), thickness (lateral orbitofrontal), and volume (paracentral and fusiform) between the two groups.</p><p><strong>Conclusion: </strong>Brain morphology and tDCS-induced EFs may be changed following CUD; however, differences between CUD and HCs in EFs do not always overlap with brain areas that show structural alterations. To sufficiently modulate stimulation targets, whether individuals with CUD need different stimulation doses based on tDCS target location should be checked.</p>","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"102 1","pages":"647-662"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11016884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85981103","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":"Socioeconomic status and entrepreneurial networking responses to the COVID-19 crisis.","authors":"Leif Brändle, Helen Signer, Andreas Kuckertz","doi":"10.1007/s11573-022-01120-w","DOIUrl":"10.1007/s11573-022-01120-w","url":null,"abstract":"<p><p>Networks play a vital role for entrepreneurs in overcoming crises. The most vulnerable to crises are those from lower socioeconomic backgrounds. However, we know less about the role of socioeconomic status in entrepreneurial networking. This study investigates whom entrepreneurs call in case of emergency. We develop hypotheses on how entrepreneurs' socioeconomic status influences models of networking agency in situations of economic threat. The results of a pre-registered randomized experiment in the COVID-19 context conducted with 122 entrepreneurs from the US indicate that entrepreneurs in higher socioeconomic status positions activate contacts to serve their own goals (i.e., independent networking agency) when facing an economic threat. In contrast, and counter-intuitively, entrepreneurs of lower socioeconomic status are more likely to support others when facing an economic threat (i.e., interdependent networking agency). Exploring the evolving network structure, our explorative post-hoc analyses suggest that entrepreneurs activate closer networks (i.e., higher density and stronger ties) under threat. The study discusses the implications of these findings for the theory of entrepreneurial networking in general and network responses to crises in particular.</p>","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"97 1","pages":"111-147"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9684885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86358999","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":"Cardiac microstructural alterations measured by echocardiography identify sex-specific risk for heart failure.","authors":"Alan Kwan, Emmanuella Demosthenes, Gerran Salto, David Ouyang, Trevor Nguyen, Chike C Nwabuo, Eric Luong, Amy Hoang, Ewa Osypiuk, Plamen Stantchev, Elizabeth H Kim, Pranoti Hiremath, Debiao Li, Ramachandran Vasan, Vanessa Xanthakis, Susan Cheng","doi":"10.1136/heartjnl-2022-320876","DOIUrl":"10.1136/heartjnl-2022-320876","url":null,"abstract":"<p><strong>Objective: </strong>Established preclinical imaging assessments of heart failure (HF) risk are based on macrostructural cardiac remodelling. Given that microstructural alterations may also influence HF risk, particularly in women, we examined associations between microstructural alterations and incident HF.</p><p><strong>Methods: </strong>We studied N=2511 adult participants (mean age 65.7±8.8 years, 56% women) of the Framingham Offspring Study who were free of cardiovascular disease at baseline. We employed texture analysis of echocardiography to quantify microstructural alteration, based on the high spectrum signal intensity coefficient (HS-SIC). We examined its relations to incident HF in sex-pooled and sex-specific Cox models accounting for traditional HF risk factors and macrostructural alterations.</p><p><strong>Results: </strong>We observed 94 new HF events over 7.4±1.7 years. Individuals with higher HS-SIC had increased risk for incident HF (HR 1.67 per 1-SD in HS-SIC, 95% CI 1.31 to 2.13; p<0.0001). Adjusting for age and antihypertensive medication use, this association was significant in women (p=0.02) but not men (p=0.78). Adjusting for traditional risk factors (including body mass index, total/high-density lipoprotein cholesterol, blood pressure traits, diabetes and smoking) attenuated the association in women (HR 1.30, p=0.07), with mediation of HF risk by the HS-SIC seen for a majority of these risk factors. However, the HS-SIC association with HF in women remained significant after adjusting for relative wall thickness (representing macrostructure alteration) in addition to these risk factors (HR 1.47, p=0.02).</p><p><strong>Conclusions: </strong>Cardiac microstructural alterations are associated with elevated risk for HF, particularly in women. Microstructural alteration may identify sex-specific pathways by which individuals progress from risk factors to clinical HF.</p>","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1800-1806"},"PeriodicalIF":0.0,"publicationDate":"2022-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9626911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42812280","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":"Aspirin","authors":"","doi":"10.1007/s40278-022-25726-4","DOIUrl":"https://doi.org/10.1007/s40278-022-25726-4","url":null,"abstract":"","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"1929 1","pages":"102 - 102"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"52671931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smartphone detection of atrial fibrillation using photoplethysmography: a systematic review and meta-analysis.","authors":"Simrat Gill, Karina V Bunting, Claudio Sartini, Victor Roth Cardoso, Narges Ghoreishi, Hae-Won Uh, John A Williams, Kiliana Suzart-Woischnik, Amitava Banerjee, Folkert W Asselbergs, Mjc Eijkemans, Georgios V Gkoutos, Dipak Kotecha","doi":"10.1136/heartjnl-2021-320417","DOIUrl":"10.1136/heartjnl-2021-320417","url":null,"abstract":"<p><strong>Objectives: </strong>Timely diagnosis of atrial fibrillation (AF) is essential to reduce complications from this increasingly common condition. We sought to assess the diagnostic accuracy of smartphone camera photoplethysmography (PPG) compared with conventional electrocardiogram (ECG) for AF detection.</p><p><strong>Methods: </strong>This is a systematic review of MEDLINE, EMBASE and Cochrane (1980-December 2020), including any study or abstract, where smartphone PPG was compared with a reference ECG (1, 3 or 12-lead). Random effects meta-analysis was performed to pool sensitivity/specificity and identify publication bias, with study quality assessed using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) risk of bias tool.</p><p><strong>Results: </strong>28 studies were included (10 full-text publications and 18 abstracts), providing 31 comparisons of smartphone PPG versus ECG for AF detection. 11 404 participants were included (2950 in AF), with most studies being small and based in secondary care. Sensitivity and specificity for AF detection were high, ranging from 81% to 100%, and from 85% to 100%, respectively. 20 comparisons from 17 studies were meta-analysed, including 6891 participants (2299 with AF); the pooled sensitivity was 94% (95% CI 92% to 95%) and specificity 97% (96%-98%), with substantial heterogeneity (p<0.01). Studies were of poor quality overall and none met all the QUADAS-2 criteria, with particular issues regarding selection bias and the potential for publication bias.</p><p><strong>Conclusion: </strong>PPG provides a non-invasive, patient-led screening tool for AF. However, current evidence is limited to small, biased, low-quality studies with unrealistically high sensitivity and specificity. Further studies are needed, preferably independent from manufacturers, in order to advise clinicians on the true value of PPG technology for AF detection.</p>","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1600-1607"},"PeriodicalIF":0.0,"publicationDate":"2022-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9554073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47546441","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":"Evaluation of the causes of sex disparity in heart failure trials.","authors":"Holly Morgan, Aish Sinha, Margaret Mcentegart, Suzanna Marie Hardman, Divaka Perera","doi":"10.1136/heartjnl-2021-320696","DOIUrl":"10.1136/heartjnl-2021-320696","url":null,"abstract":"<p><strong>Objectives: </strong>Cardiovascular disease is one of the leading causes of mortality and morbidity in women. Despite this, even in contemporary research, female patients are poorly represented in trials. This study aimed to explore reasons behind the sex disparity in heart failure (HF) trials.</p><p><strong>Methods: </strong>HF trials published in seven high-impact clinical journals (impact factor >20), between 2000 and 2020, were identified. Trials with over 300 participants of both sexes were included. Large HF registries, as well as population statistics, were also identified using the same criteria.</p><p><strong>Results: </strong>We identified 146 HF trials, which included 248 620 patients in total. The median proportion of female patients was 25.8%, with the lowest proportions seen in trials enrolling patients with ischaemic cardiomyopathy (17.9%), severe systolic dysfunction (left ventricular ejection fraction (LVEF) <35%) (21.4%) and those involving an invasive procedure (21.1%). The highest proportion of women was seen in trials assessing HF with preserved LVEF (51.6%), as well as trials including older participants (40.5%). Significant differences were seen between prevalence of female trial participants and population prevalence in all LVEF categories (25.8% vs 49.0%, p<0.01).</p><p><strong>Conclusions: </strong>A significant sex disparity was identified in HF trials, most visible in trials assessing patients with severely reduced LVEF and ischaemic aetiology. This is likely due to a complex interplay between enrolment bias and biological variation. Furthermore, the degree of both these aspects may vary according to trial type. Going forward, we should encourage all HF trials to appraise their recruitment log and suggest reasons for any reported sex disparity.</p>","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1547-1552"},"PeriodicalIF":0.0,"publicationDate":"2022-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9484380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42605602","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":"Transcatheter aortic valve implantation in patients with rheumatic aortic stenosis.","authors":"Taishi Okuno, Daijiro Tomii, Eric Buffle, Jonas Lanz, Christoph Ryffel, Caglayan Demirel, Suliman Hashemi, Daniel Hagemeyer, Athanasios Papadis, Dik Heg, Fabien Praz, Stefan Stortecky, Stephan Windecker, Thomas Pilgrim","doi":"10.1136/heartjnl-2021-320531","DOIUrl":"10.1136/heartjnl-2021-320531","url":null,"abstract":"<p><strong>Background: </strong>Rheumatic heart disease (RHD) accounts for the highest number of deaths from valvular heart disease globally. Yet, rheumatic aortic stenosis (AS) was excluded from landmark studies investigating the safety and efficacy of transcatheter aortic valve implantation (TAVI). We aimed to describe the clinical and anatomical characteristics of patients with rheumatic AS undergoing TAVI, and to compare procedural and clinical outcomes with patients undergoing TAVI for degenerative AS.</p><p><strong>Methods: </strong>In a prospective TAVI registry, patients with rheumatic AS were identified based on International Classification of Diseases version 10 codes and/or a documented history of acute rheumatic fever and/or the World Heart Federation criteria for echocardiographic diagnosis of RHD, and were propensity score-matched in a 1:4 ratio to patients with degenerative AS.</p><p><strong>Results: </strong>Among 2329 patients undergoing TAVI, 105 (4.5%) had rheumatic AS. Compared with patients with degenerative AS, patients with rheumatic AS were more commonly female, older, had higher surgical risk and more commonly suffered from multivalvular heart disease. In the unmatched cohort, both technical success (85.7% vs 85.9%, p=0.887) and 1-year cardiovascular mortality (10.0% vs 8.6%; HR 1.16, 95% CI 0.61 to 2.18, p=0.656) were comparable between patients with rheumatic and degenerative AS. In contrast, patients with rheumatic AS had lower rates of 30-day and 1-year cardiovascular mortality compared with matched patients with degenerative AS (1.9% vs 8.9%, adjusted HR (HR_adj) 0.18, 95% CI 0.04 to 0.80, p=0.024; and 10.0% vs 20.3%, HR_adj 0.44, 95% CI 0.24 to 0.84, p=0.012, respectively).</p><p><strong>Conclusion: </strong>TAVI may be a safe and effective treatment strategy for selected elderly patients with rheumatic AS.</p><p><strong>Trial registration number: </strong>NCT01368250.</p>","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1225-1233"},"PeriodicalIF":0.0,"publicationDate":"2022-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49462269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should we always call 911/999 to get it right first time in suspected myocardial infarction?","authors":"Shirley Sze, Sarah L Ayton, Alastair James Moss","doi":"10.1136/heartjnl-2022-320918","DOIUrl":"10.1136/heartjnl-2022-320918","url":null,"abstract":"","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1082-1083"},"PeriodicalIF":0.0,"publicationDate":"2022-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43204691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correspondence on 'Hypertensive response to exercise in adult patients with repaired aortic coarctation' by Meijs <i>et al</i>.","authors":"Nejc Pavšič, Polona Kačar, Jure Dolenc, Katja Prokšelj","doi":"10.1136/heartjnl-2022-321349","DOIUrl":"10.1136/heartjnl-2022-321349","url":null,"abstract":"","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43382885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}