British Heart Journal最新文献

{"title":"Contemporary demographics, diagnostics and outcomes in non-bacterial thrombotic endocarditis.","authors":"Juan A Quintero-Martinez, Joya-Rita Hindy, Said El Zein, Hector I Michelena, Vuyisile T Nkomo, Daniel C DeSimone, Larry M Baddour","doi":"10.1136/heartjnl-2022-320970","DOIUrl":"10.1136/heartjnl-2022-320970","url":null,"abstract":"<p><strong>Objective: </strong>Non-bacterial thrombotic endocarditis (NBTE) is a syndrome characterised by cardiac valve vegetations and/or thickening due to non-infective mechanisms. Nowadays, a premortem diagnosis of NBTE is possible based on echocardiographic findings. Therefore, to better characterise this disease, we performed a contemporary review of the epidemiology, demographics, diagnosis and clinical outcomes of these patients.</p><p><strong>Methods: </strong>Adults with a diagnosis of NBTE seen within the Mayo Clinic Enterprise from December 2014 to December 2021 were included. NBTE diagnosis was identified by clinicians representing at least two specialties including cardiology, infectious diseases, rheumatology and oncology. Patients with positive blood cultures, infective endocarditis, culture-negative endocarditis and denial of research authorisation were excluded. All patients had a 1-year follow-up.</p><p><strong>Results: </strong>Forty-eight cases were identified; mean age was 60.0±13.8 years, 75% were female. The most prevalent comorbidities were malignancy (52.1%) and connective tissue disease (37.5%). Valvular abnormalities included 41 (85.4%) patients with vegetations, 43 (89.6%) patients with thickening and 26 (54.2%) with moderate to severe regurgitation. Thirty-eight (79.2%) patients had an embolic event (stroke in 26 (54.2%) patients) within 1 month of NBTE diagnosis and 16 (33.3%) patients died within 1 year of NBTE diagnosis. Metastatic tumours and lung cancer were associated with 1-year all-cause mortality (p=0.0017 and p=0.0004, respectively).</p><p><strong>Conclusions: </strong>NBTE was more prevalent in females and embolic complications were the most frequent clinical finding. Overall, patients with NBTE had a poor prognosis, particularly in those with lung cancer or metastatic tumours. Further studies in patients with NBTE are needed given its morbidity and mortality.</p>","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48960331","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":"Response to: Correspondence on 'Cost-effectiveness of transcatheter edge-to-edge repair in secondary mitral regurgitation does need confirmation' by Armoiry and Connock","authors":"D. Cohen, E. Magnuson, G. Stone, J. Cleland","doi":"10.1136/heartjnl-2022-321180","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321180","url":null,"abstract":"","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1072 - 1072"},"PeriodicalIF":0.0,"publicationDate":"2022-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48364165","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":"Diagnostic and prognostic role of the electrocardiogram in patients with pericarditis","authors":"M. Imazio, Gabriele Barberi Squarotti, A. Andreis, A. Agosti, M. Millesimo, S. Frea, C. Giustetto, G. Deferrari","doi":"10.1136/heartjnl-2021-320443","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-320443","url":null,"abstract":"Objective The ECG has been traditionally used to support the diagnosis of pericarditis. However, the pericardium is electrically silent and ECG changes may imply concurrent myocardial involvement rather than simple pericarditis. The aim of the present paper is to analyse the frequency, type and clinical implication of ECG changes in patients with pericarditis compared with those with myocarditis. Methods Consecutive patients with pericarditis and/or myocarditis were included in a prospective cohort study from January 2017 to December 2020. A clinical and echocardiographic follow-up was performed at 1, 3, 6 months and then every 6 months. Cardiac magnetic resonance was used to diagnose concurrent myocarditis. Results 166 patients (median age 47 years, 95% CI 44 to 51) with 66 men (39.8%) were included: 110 cases with pericarditis (mean age 47.7 years, 29.1% male) and 56 cases with myocarditis (mean age 44.8, 60.7% male). ECG changes were reported in 61 of 166 (36.7%) patients: 27 of 110 (24.5%) among those with pericarditis and 34 of 56 (60.7%) among those with myocarditis (p<0.0001). In multivariate logistic regression analysis, ECG changes were associated with troponin elevation (risk ratio 1.97; 95% CI 1.13 to 3.43), suggesting myocardial involvement. ECG changes were not associated with increased risk of adverse events. Conclusions ECG changes, mainly widespread ST-segment elevation, can be recorded in about one-quarter of patients with pericarditis, and were not associated with a worse prognosis. These changes may reflect concurrent myocarditis that should be ruled out.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1474 - 1478"},"PeriodicalIF":0.0,"publicationDate":"2022-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44411703","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":"Utilizing social media for cardiovascular education","authors":"Christine Mansour, Nooshin Beygui, M. Mamas, P. Parwani","doi":"10.1136/heartjnl-2021-320483","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-320483","url":null,"abstract":"","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1240 - 1241"},"PeriodicalIF":0.0,"publicationDate":"2022-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43181076","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":"Correction: Heart failure medication dosage and survival in women and men seen at outpatient clinics","authors":"","doi":"10.1136/heartjnl-2021-319229corr1","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-319229corr1","url":null,"abstract":"","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"e4 - e4"},"PeriodicalIF":0.0,"publicationDate":"2022-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46807324","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":"Safety of proprotein convertase subtilisin/kexin 9 inhibitors: a systematic review and meta-analysis","authors":"Jing Li, Heyue Du, Yang Wang, B. Aertgeerts, G. Guyatt, Q. Hao, Yanjiao Shen, Ling Li, N. Su, N. Delvaux, G. Bekkering, Safi U. Khan, I. Riaz, P. Vandvik, Baihai Su, H. Tian, Sheyu Li","doi":"10.1136/heartjnl-2021-320556","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-320556","url":null,"abstract":"Objective To determine the harms of proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitors in people who need lipid-lowering therapy. Methods This systematic review included randomised controlled trials that compared PCSK9 inhibitors with placebo, standard care or active lipid-lowering comparators in people who need lipid-lowering therapy with the follow-up duration of at least 24 weeks. We summarised the relative effects for potential harms from PCSK9 inhibitors using random-effect pairwise meta-analyses and assessed the certainty of evidence using GRADE (Grading of Recommendation Assessment, Development and Evaluation) for each outcome. Results We included 32 trials with 65 861 participants (with the median follow-up duration of 40 weeks, ranging from 24 to 146 weeks). The meta-analysis showed an incidence of injection-site reaction leading to discontinuation (absolute incidence of 15 events (95% CI 11 to 20) per 1000 persons in a 5-year time frame, high certainty evidence). PCSK9 inhibitors do not increase the risk of new-onset diabetes mellitus, neurocognitive events, cataracts or gastrointestinal haemorrhage with high certainty evidence. PCSK9 inhibitors probably do not increase the risks of myalgia or muscular pain leading to discontinuation or any adverse events leading to discontinuation with moderate evidence certainty. Given very limited evidence, PCSK9 inhibitors might not increase influenza-like symptoms leading to discontinuation (risk ratio 1.5; 95% CI 0.06 to 36.58). We did not identify credible subgroup analyses results, including shorter versus longer follow-up duration of trials. Conclusions PCSK9 inhibitors slightly increase the risk of severe injection-site reaction but not cataracts, gastrointestinal haemorrhage, neurocognitive events, new-onset diabetes or severe myalgia or muscular pain.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1296 - 1302"},"PeriodicalIF":0.0,"publicationDate":"2022-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48391593","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":"BMJ Rapid Recommendations on use of proprotein convertase subtilisin/kexin 9 inhibitors and ezetimibe to reduce cardiovascular risk","authors":"H. White","doi":"10.1136/heartjnl-2022-321063","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321063","url":null,"abstract":"The new BMJ Rapid Recommendations addressed the following question: should we add another lipidlowering drug in adults with lowdensity lipoproteincholesterol (LDLC) over 1.8 mmol/L using a maximal dose of statins or intolerant to statins? Why is this question important? Both proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and ezetimibe have been shown to reduce LDLC by approximately 60% and approximately 20%, respectively, and correspondingly may reduce major adverse cardiovascular events (MACE), including allcause death, cardiovascular death, myocardial infarction (MI) and stroke. However, the benefit of ezetimibe is small and PCSK9 inhibitors are very costly. Both drugs have adverse effects which must be considered when balancing recommendations to achieve maximal benefit and minimal harm. Current guidelines recommend differing LDLC treatment targets. Examples of thresholds include the European Society of Cardiology (ESC) guidelines, which recommend an LDLC target of 1.4 mmol/L for patients at very high cardiovascular risk, and the American College of Cardiology/American Heart Association (AHA/ACC) guidelines, which set a less aggressive LDLC target of 1.8 mmol/L. The new guideline is a collaborative initiative from the MAGIC Evidence Ecosystem Foundation (www.magicproject. org) and the BMJ. The authors performed a systematic review and network metaanalysis of 14 trials, with 83 660 participants, to define the absolute incremental beneficial effects of ezetimibe and PCSK9 inhibitors to statins, and this is published simultaneously in the BMJ. The guideline represents a shift from the traditional focus on lipid level goals to a focus on reducing an individual’s absolute cardiovascular risk. Few other guidelines specifically do this. To apply these recommendations, clinicians need to calculate patients’ individual absolute cardiovascular risks using risk calculators applicable to specific geographical regions.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1250 - 1252"},"PeriodicalIF":0.0,"publicationDate":"2022-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48649189","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":"Women in cardiology: narrowing the gender gap.","authors":"Rebecca Dobson, Sarah C Clarke","doi":"10.1136/heartjnl-2021-320144","DOIUrl":"10.1136/heartjnl-2021-320144","url":null,"abstract":"","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"757-759"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9046733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43485917","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":"β-blockers and outcomes of Takotsubo syndrome: need more clinical data","authors":"T. Isogai, Ken-ichi Kato","doi":"10.1136/heartjnl-2022-320950","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-320950","url":null,"abstract":"Takotsubo syndrome (TTS) has gained more awareness and attention in clinical practice in the last decade. Prior studies revealed important insights into the patient characteristics and outcomes of TTS. 2 One of the most notable facts is that the prognosis of TTS is not as benign as initially expected and is comparable to acute coronary syndrome. 2 Therefore, it is no surprise that physicians and researchers investigate a potential treatment option to improve the prognosis of TTS. Although the pathophysiology of TTS remains to be fully elucidated, catecholamines appear to play a critical role, as evidenced by the fact that TTS is frequently triggered by acute emotional or physical stress along with excess plasma catecholamine levels. 3 As a result, β-blockers (BBs) have been empirically considered a reasonable therapy for TTS in the absence of randomised clinical trials. In the current issue of Heart, Silverio et al examined the association between BBs and longterm survival using 825 patients in the Takotsubo Italian Network registry. The authors demonstrated that BB prescription at discharge was significantly associated with lower allcause mortality after TTS (6.8% vs 13.6%; adjusted hazard ratio (aHR)=0.563, 95% confidence interval (CI)=0.356 to 0.889, p=0.014) during a median followup of 24 months, particularly with lower noncardiac mortality (4.9% vs 10.7%; aHR=0.525, 95% CI=0.309 to 0.893, p=0.018) rather than cardiac mortality (1.8% vs 3.0%; aHR=0.699, 95% CI=0.284 to 1.722, p=0.436). Also, the effect modification was observed in patients with hypertension and those who developed cardiogenic shock during the acute phase (p for interaction <0.05). Meanwhile, there was no significant association between BB prescription and TTS recurrence. The authors are to be congratulated on their contribution to current literature on the topic. Nonetheless, several discussions need to be raised about the results and potential limitations of the study. One may expect that BBs theoretically have potential in reducing cardiac mortality after TTS (maybe through the facilitated recovery from cardiac dysfunction or the prevention of fatal ventricular arrhythmia or other cardiac events), but not noncardiac mortality. However, contrary to this expectation, Silverio et al demonstrated that BB prescription at discharge was significantly associated with lower noncardiac mortality, but not cardiac mortality. The statistically insignificant association between BB prescription and cardiac mortality may be at least partly due to the low cardiac mortality rate (2.3%), as Silverio et al discussed. Notably, however, their data revealed that the estimated risk reduction in allcause mortality by BB use was driven largely by the reduction in noncardiac mortality. How could BB use be strongly associated with lower (nearly half) noncardiac mortality after TTS? As Silverio et al speculated, there might be several possible mechanisms for it. Meanwhile, it might also be due to resid","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1334 - 1337"},"PeriodicalIF":0.0,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45459307","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":"Longitudinal changes of thoracic aortic diameters in the general population aged 55 years or older.","authors":"Carlijn G E Thijssen, Ferit O Mutluer, Janine E van der Toorn, Lidia R Bons, Arjen L Gökalp, Johanna Jm Takkenberg, Mostafa M Mokhles, Roland R J van Kimmenade, Meike W Vernooij, Aad van der Lugt, Ricardo P J Budde, Jolien W Roos-Hesselink, Maryam Kavousi, Daniel Bos","doi":"10.1136/heartjnl-2021-320574","DOIUrl":"10.1136/heartjnl-2021-320574","url":null,"abstract":"<p><strong>Objective: </strong>Longitudinal data on age-related changes in the diameters of the thoracic aorta are scarce. To better understand normal variation and to identify factors influencing this process, we aimed to report male-female-specific and age-specific aortic growth rate in the ageing general population and identify factors associated with growth rate.</p><p><strong>Methods: </strong>From the prospective population-based Rotterdam Study, 943 participants (52.0% females, median age at baseline 65 years (62-68)) underwent serial non-enhanced cardiac CT. We measured the diameters of the ascending (AA) and descending aorta (DA) at two time points and expressed absolute and relative differences. Linear mixed effects analysis was performed to identify determinants associated with change in aortic diameters.</p><p><strong>Results: </strong>Mean AA diameter at baseline was 37.3±3.6 mm in male population and 34.7±3.2 mm in female population, mean DA diameter was 29.6±2.3 in male population and 26.9±2.2 mm in female population. The median absolute change in diameters during follow-up (mean scan interval 14.1±0.3 years) was 1 mm (0-2) for both the AA and DA. Absolute change per decade in AA diameter was significantly larger in males than in females (0.72 mm/decade (0.00-1.43) vs 0.70 mm/decade (0.00-1.41), p=0.006), as well as absolute change in AD diameter (0.71 mm/decade (0.00-1.42) vs 0.69 mm/decade (0.00-1.36), p=0.008). There was no significant difference between male and female population in relative change of their aortic diameters during follow-up. Age, male sex, higher body mass index (BMI) and higher diastolic blood pressure (DBP) showed a statistically significant independent association with increase in AA and DA diameters over time.</p><p><strong>Conclusions: </strong>Some degree of increase in thoracic aortic diameters is typical in both men and women of an aging population. Factors associated with this change in thoracic aortic diameters were sex, age, BMI and DBP.</p>","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49419113","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}