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Effectiveness of polypill for primary and secondary prevention of cardiovascular disease: a pragmatic cluster-randomised controlled trial (PolyPars) Heart (IF 5.7) Pub Date : 2024-03-14 Fatemeh Malekzadeh, Abdullah Gandomkar, Hossein Poustchi, Arash Etemadi, Gholamreza Roshandel, Armin Attar, Firoozeh Abtahi, Shahrokh Sadeghi Boogar, Vahid Mohammadkarimi, Mohammad Reza Fattahi, Abbas Mohagheghi, Reza Malekzadeh, Sadaf G Sepanlou
Background We aimed to investigate the effectiveness of fixed-dose combination therapy (polypill) for primary and secondary prevention of major cardiovascular diseases in a typical rural setting. Methods The PolyPars Study is a two-arm pragmatic cluster-randomised trial nested within the PARS cohort study, including all residents aged over 50 years in the entire district in southern Iran. The 91 villages
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The role of COVID-19 vaccines in preventing post-COVID-19 thromboembolic and cardiovascular complications Heart (IF 5.7) Pub Date : 2024-03-12 Núria Mercadé-Besora, Xintong Li, Raivo Kolde, Nhung TH Trinh, Maria T Sanchez-Santos, Wai Yi Man, Elena Roel, Carlen Reyes, Antonella Delmestri, Hedvig M E Nordeng, Anneli Uusküla, Talita Duarte-Salles, Clara Prats, Daniel Prieto-Alhambra, Annika M Jödicke, Martí Català
Objective To study the association between COVID-19 vaccination and the risk of post-COVID-19 cardiac and thromboembolic complications. Methods We conducted a staggered cohort study based on national vaccination campaigns using electronic health records from the UK, Spain and Estonia. Vaccine rollout was grouped into four stages with predefined enrolment periods. Each stage included all individuals
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European Society of Cardiology 0/1-hour algorithm (high-sensitivity cardiac troponin T) performance across distinct age groups Heart (IF 5.7) Pub Date : 2024-03-12 Marissa J Millard, Nicklaus P Ashburn, Anna C Snavely, Tara Hashemian, Michael Supples, Brandon Allen, Robert Christenson, Troy Madsen, James McCord, Bryn Mumma, Jason Stopyra, Richard Gentry Wilkerson, Simon A Mahler
Background To determine if the European Society of Cardiology 0/1-hour (ESC 0/1-h) algorithm with high-sensitivity cardiac troponin T (hs-cTnT) meets the ≥99% negative predictive value (NPV) safety threshold for 30-day cardiac death or myocardial infarction (MI) in older, middle-aged and young subgroups. Methods We conducted a subgroup analysis of adult emergency department patients with chest pain
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Birth cohort effect in atrial fibrillation: a matter of detection? Heart (IF 5.7) Pub Date : 2024-03-12 Michelle Samuel, Michiel Rienstra
Atrial fibrillation (AF) is the most common sustained cardiac rhythm disorder, affecting an estimated 43 million people globally.1 In the last 20 years, the incidence of AF increased by 33% and it is expected to increase by threefold in the next three decades.1 Long-term AF management, including outpatient visits, hospitalisations and disabilities from stroke and heart failure (HF), adds substantial
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Birth cohort effects on diagnosed atrial fibrillation incidence: nationwide cohort study from 1980 to 2018 Heart (IF 5.7) Pub Date : 2024-03-12 Nicklas Vinter, Pia Cordsen, Søren Paaske Johnsen, Emelia J Benjamin, Lars Frost, Ludovic Trinquart
Background The incidence of atrial fibrillation (AF) shows substantial temporal trends, but the contribution of birth cohort effects is unknown. These effects refer to the relationship between birth year and the likelihood of developing AF. We aimed to assess trends in cumulative incidence of diagnosed AF across birth cohorts and to disentangle the effects of age, birth cohort and calendar period by
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Inclusivity in randomised clinical trials: myth or reality? Heart (IF 5.7) Pub Date : 2024-04-01 Mario Iannaccone, Marco Gamardella, Alaide Chieffo
In this issue of Heart, Castelijns et al aimed to apply the inclusion and exclusion criteria from the Cardiovascular Outcomes for People Using Anticoagulation Strategies, Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management and Avoidance trials, Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of
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Very early invasive strategy in patients with non-ST-elevation myocardial infarction: should we go for it? Heart (IF 5.7) Pub Date : 2024-04-01 Gilles Lemesle, Guillaume Schurtz, Basile Verdier, Laurent Bonello
According to the recent guidelines from the European Society of Cardiology,1 an invasive strategy should be performed within the first 24 hours from diagnosis in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) at high risk; and a very early invasive strategy (<2 hours) deserves only to those patients at very high risk. The question of the optimal timing of the invasive procedure is
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Mitral annular disjunction: a ubiquitous finding with or without mitral valvar prolapse Heart (IF 5.7) Pub Date : 2024-04-01 Robert H Anderson, Joseph Westaby, Mary N Sheppard, Andrew C Cook
As is shown in the study of 224 hearts with so-called mitral annular disjunction,1 the wheel has now come full circle. Although now usually credited to having first been seen by Henle as long ago as 1876, it was Hutchins and his colleagues who brought the feature to attention as a potential harbinger of pathological change.2 The investigators working at Johns Hopkins Hospital had noticed the anatomical
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Review of the National Institute for Health and Care Excellence guidelines on chronic heart failure Heart (IF 5.7) Pub Date : 2024-04-01 Daniel J Doherty, Kieran F Docherty, Roy S Gardner
Guidelines are more accessible than ever and represent an important tool in clinical practice. The National Institute for Health and Care Excellence (NICE) has developed recommendations for heart failure diagnosis and management based not only on morbidity and mortality trial outcome data but also in-depth economic analysis, with a focus on generalisability to UK National Health Service clinical practice
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Beta-blockers and renin-angiotensin system inhibitors for Takotsubo syndrome recurrence: a network meta-analysis Heart (IF 5.7) Pub Date : 2024-04-01 Francesco Santoro, Scott Sharkey, Rodolfo Citro, Tetsuji Miura, Luca Arcari, Jose Angel Urbano-Moral, Thomas Stiermaier, Ivan Javier Nuñez-Gil, Angelo Silverio, Nicola Di Nunno, Ilaria Ragnatela, Rosa Cetera, Junichi Nishida, Ingo Eitel, Natale Daniele Brunetti
Introduction Takotsubo syndrome (TTS) is an acute heart failure syndrome, featured by transient left ventricular systolic dysfunction. Recurrences of TTS are not infrequent and there is no standard preventive therapy. The aim of this study was to evaluate in a network meta-analysis if beta-blockers (BB) and ACE inhibitors/angiotensin receptor blockers (ACEi/ARBs), in combination or not, can effectively
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Generalisability of trials on antithrombotic treatment intensification in patients with cardiovascular disease Heart (IF 5.7) Pub Date : 2024-04-01 Maria C Castelijns, Steven H J Hageman, Martin Teraa, Manon G van der Meer, Jan Westerink, Jurrien ten Berg, Frank L J Visseren
Objective Assessment of generalisability of guideline-informing trials on antithrombotic treatment intensification to real-world patients with cardiovascular disease (CVD). Methods Inclusion and exclusion criteria of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS), Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management and Avoidance (CHARISMA)
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Novel uses for implanted haemodynamic monitoring in adults with subaortic right ventricles Heart (IF 5.7) Pub Date : 2024-04-01 William H Marshall V, May Ling Mah, Jennifer DeSalvo, Saurabh Rajpal, Lauren T Lastinger, Arash Salavitabar, Aimee K Armstrong, Darren Berman, Brent Lampert, Lydia K Wright, Jenne Hickey, Rachel Metzger, Deipanjan Nandi, Robert Gajarski, Curt J Daniels
Background Pulmonary hypertension (PH) is a common complication in patients with complete dextro-transposition of the great arteries (TGA) after atrial switch (D-TGA/AS) and congenitally corrected TGA (ccTGA). In this population with subaortic right ventricles (sRVs), echocardiography is a poor screening tool for PH; implantable invasive haemodynamic monitoring (IHM) could be used for this purpose
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Very early invasive strategy in higher risk non-ST-elevation acute coronary syndrome: the RAPID NSTEMI trial Heart (IF 5.7) Pub Date : 2024-04-01 Thomas A Kite, Andrew Ladwiniec, John P Greenwood, Chris P Gale, Brijesh Anantharam, Ranjit More, Simon Lee Hetherington, Sohail Q Khan, Peter O'Kane, Roby Rakhit, Alexander Chase, Shaun Barber, Ghazala Waheed, Colin Berry, Marcus Flather, Gerry P McCann, Nick Curzen, Adrian P Banning, Anthony H Gershlick
Objective To investigate whether a very early invasive strategy (IS)±revascularisation improves clinical outcomes compared with standard care IS in higher risk patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). Methods Multicentre, randomised, controlled, pragmatic strategy trial of higher risk patients with NSTE-ACS, defined by Global Registry of Acute Coronary Events 2.0 score of
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Prognostic value of growth differentiation factor-15 3 months after an acute chest pain admission Heart (IF 5.7) Pub Date : 2024-04-01 Gard Mikael Sæle Myrmel, Ole-Thomas Steiro, Hilde Lunde Tjora, Jørund Langørgen, Rune Oskar Bjørneklett, Øyvind Skadberg, Vernon Vijay Singha Bonarjee, Øistein Rønneberg Mjelva, Eva Ringdal Pedersen, Kjell Vikenes, Torbjorn Omland, Kristin Moberg Aakre
Objective Growth differentiation factor-15 (GDF-15) is a predictor of death and cardiovascular events when measured during index hospitalisation in patients with acute chest pain. This study investigated the prognostic utility of measuring GDF-15 3 months after an admission with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS). Methods GDF-15 was measured at baseline and 3 months after
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Morphology of the mural and commissural atrioventricular junction of the mitral valve Heart (IF 5.7) Pub Date : 2024-04-01 Agata Krawczyk-Ożóg, Jakub Batko, Barbara Zdzierak, Artur Dziewierz, Kamil Tyrak, Filip Bolechała, Paweł Kopacz, Marcin Strona, Krzysztof Gil, Jakub Hołda, Mateusz K Hołda
Objective This study investigates mitral annular disjunctions (MAD) in the atrial wall-mitral annulus-ventricular wall junction along the mural mitral leaflet and commissures. Methods We examined 224 adult human hearts (21.9% females, 47.9±17.6 years) devoid of cardiovascular diseases (especially mitral valve disease). These hearts were obtained during forensic medical autopsies conducted between January
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Reduction of moderate to severe tricuspid regurgitation after catheter ablation for atrial fibrillation Heart (IF 5.7) Pub Date : 2024-04-01 Myung-Jin Cha, Seung-Ah Lee, Min Soo Cho, Gi-Byoung Nam, Kee-Joon Choi, Jun Kim
Objective Tricuspid regurgitation (TR) is a progressive disease with high mortality and limited medical treatment options, and its association with atrial fibrillation (AF) has been documented. This study aimed to investigate whether successful rhythm control through catheter ablation for AF could reduce TR severity. Methods A total of 106 patients with drug-refractory AF with moderate to severe secondary
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Surgical and transcatheter treatments of mechanical complications of acute myocardial infarction Heart (IF 5.7) Pub Date : 2024-04-01 James M McCabe, Christine J Chung
### Learning objectives Major advances in reperfusion therapies after acute myocardial infarction (AMI) have resulted in dramatic reductions in the rate of mechanical complications including ventricular septal defect (VSD), free wall rupture (FWR) and papillary muscle rupture (PMR). However, the drastic decline in their incidence has not been accompanied by a similar decrease in their risk of major
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Mitral valve dysfunction in a woman with newly diagnosed acute promyelocytic leukemia Heart (IF 5.7) Pub Date : 2024-04-01 Matthew J Bierowski, Eric D Warner, Chelsea D Edirisuriya
A woman in her mid-40s with a recent diagnosis of pulmonary embolism (on rivaroxaban) presented to the emergency room with dyspnea and fatigue. Vital signs were stable on arrival but a new holosystolic murmur was noted on exam and labs revealed pancytopenia. Infectious workup was unrevealing. CT revealed stable pulmonary emboli compared with prior imaging, along with a new splenic infarct. Transthoracic
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Association of pulmonary hypertension with the outcome in patients undergoing edge-to-edge mitral valve repair Heart (IF 5.7) Pub Date : 2024-02-22 Timm Ubben, Christian Frerker, Buntaro Fujita, Stephan Rosenkranz, Roman Pfister, Stephan Baldus, Hannes Alessandrini, Karl-Heinz Kuck, Stephan Willems, Ingo Eitel, Tobias Schmidt
Objectives The association of pulmonary hypertension (PH) with the outcome after mitral transcatheter edge-to-edge repair (M-TEER) focusing on the new ESC/ERS guidelines definition for PH. Background PH is frequently found in patients with mitral regurgitation and is associated with lower survival rates. Recent studies were based on echocardiographic parameters, but results based on invasive haemodynamics
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Percutaneous intramyocardial septal radiofrequency ablation after 5-year follow-up Heart (IF 5.7) Pub Date : 2024-02-22 Shengjun Ta, Jing Li, David H Hsi, Rui Hu, Changhui Lei, Bo Shan, Wenxia Li, Jing Wang, Bo Wang, Nan Kang, Xiaojuan Li, Jiani Liu, Caixia Qi, Junzhe Huang, Yupeng Han, Fangqi Ruan, Jun Zhang, Liwen Liu
Objective The objective is to evaluate the 5-year follow-up results of percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) for hypertrophic obstructive cardiomyopathy (HOCM), including clinical status, electrocardiographic and echocardiographic characteristics. Methods 27 patients (age: 44.3±15.5 years; 67% men, 33% women) with severely symptomatic HOCM who underwent PIMSRA from October
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Prehospital triage in suspected myocardial infarction: a calculated risk? Heart (IF 5.7) Pub Date : 2024-03-01 Thomas A Kite, Andrew Ladwiniec, Alastair James Moss
In the prehospital setting, accurate decision-making is of paramount importance in the management of cardiac emergencies. For life-threatening events involving complete occlusion of a coronary artery, the activation of ST-elevation myocardial infarction protocols instructs the emergency services to provide immediate treatment and liaise directly with cardiac centres regarding invasive management, in
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Augmenting reality in echocardiography Heart (IF 5.7) Pub Date : 2024-03-01 Veer Sangha
Echocardiography is a vital first-line imaging tool for the diagnosis and management of many cardiovascular diseases. Its availability and low cost have encouraged widespread use by clinicians for the diagnosis and management of patients with heart failure.1 Visual estimation is widely used to assess ejection fraction (EF), the percentage of blood the left ventricle pumps out during a contraction.
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Right atrial function, a mostly ignored but very valuable parameter in patients with secondary tricuspid regurgitation Heart (IF 5.7) Pub Date : 2024-03-01 Michele Tomaselli, Luigi P Badano, Denisa Muraru
Significant secondary tricuspid regurgitation (STR) has increasing prevalence with age, it is associated with impaired quality of life, and it is an independent predictor of patients’ morbidity and mortality. Although the association of right ventricular (RV) function with outcome has been reported in patients with STR,1 2 the role of the right atrial (RA) geometry and function remains to be elucidated
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The role of physiology in the contemporary management of coronary artery disease Heart (IF 5.7) Pub Date : 2024-03-01 Francesca Rubino, Graziella Pompei, Salvatore Brugaletta, Carlos Collet, Vijay Kunadian
Coronary physiology assessment, including epicardial and microvascular investigations, is a fundamental tool in the contemporary management of patients with coronary artery disease. Coronary revascularisation guided by functional evaluation has demonstrated superiority over angiography-only-guided treatment. In patients with chronic coronary syndrome, revascularisation did not demonstrate prognostic
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New National Institute for Health and Care Excellence guidance for hypertension: a review and comparison with the US and European guidelines Heart (IF 5.7) Pub Date : 2024-03-01 Fraser C Goldie, Adrian J B Brady
The UK National Institute for Health and Care Excellence (NICE) guidance for hypertension management has recently been updated. This review article summaries the main recommendations in NICE guidelines, and compares them with the American and European guidelines. NICE and the European Society of Cardiology (ESC) recommend diagnosing hypertension at a higher level than the American College of Cardiology/American
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Heart rate: an accessible risk indicator in adult congenital heart disease Heart (IF 5.7) Pub Date : 2024-03-01 Paul M Hendriks, Annemien E van den Bosch, Jan A Kors, Laurie W Geenen, Vivan J M Baggen, Jannet A Eindhoven, Robert M Kauling, Judith A A E Cuypers, Eric Boersma, Jolien W Roos-Hesselink
Background Higher resting heart rate has been described as a risk factor for adverse outcome in healthy individuals and cardiovascular patients. The aim of this study was to evaluate resting heart rate as risk factor in adult congenital heart disease (ACHD). Methods In this prospective observational cohort study, patients with moderate or complex ACHD were included at routine outpatient visit. Standard
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Prehospital risk assessment and direct transfer to a percutaneous coronary intervention centre in suspected acute coronary syndrome Heart (IF 5.7) Pub Date : 2024-03-01 Jesse Demandt, Arjan Koks, Dennis Sagel, Veerle A E van Hattem, Rutger J Haest, Eric Heijmen, H Thijssen, Luuk C Otterspoor, Dennis van Veghel, Rob Eerdekens, Mohamed el Farissi, Koen Teeuwen, Inge Wijnbergen, Pim van der Harst, Nico H J Pijls, Marcel van 't Veer, Pim A L Tonino, Lukas R C Dekker, Pieter J Vlaar
Objective Prehospital risk stratification and triage are currently not performed in patients suspected of non-ST-segment elevation acute coronary syndrome (NSTE-ACS). This may lead to prolonged time to revascularisation, increased duration of hospital admission and higher healthcare costs. The preHEART score (prehospital history, ECG, age, risk factors and point-of-care troponin score) can be used
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Cognitive impairment and outcomes in older adults with non-ST-elevation acute coronary syndrome Heart (IF 5.7) Pub Date : 2024-03-01 Valerie Josephine Dirjayanto, Mohammad Alkhalil, John Dodson, Gregory Mills, Graziella Pompei, Francesca Rubino, Vijay Kunadian
Objective This study aimed to explore the prognostic impact of cognitive impairment on the long-term risk of major adverse cardiovascular events (MACEs) in older patients with non-ST-elevation acute coronary syndrome (NSTEACS) undergoing invasive treatment. Methods Patients aged ≥75 years with NSTEACS undergoing an invasive strategy were included in the multicentre prospective study ([NCT01933581][1])
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Shortness of breath as a diagnostic factor for acute coronary syndrome in male and female callers to out-of-hours primary care Heart (IF 5.7) Pub Date : 2024-03-01 Michelle Spek, Roderick P Venekamp, Daphne C A Erkelens, Maarten van Smeden, Loes T C M Wouters, Hester M den Ruijter, Frans H Rutten, Dorien L Zwart
Objective Chest discomfort and shortness of breath (SOB) are key symptoms in patients with acute coronary syndrome (ACS). It is, however, unknown whether SOB is valuable for recognising ACS during telephone triage in the out-of-hours primary care (OHS-PC) setting. Methods A cross-sectional study performed in the Netherlands. Telephone triage conversations were analysed of callers with chest discomfort
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Accuracy of visual estimation of ejection fraction in patients with heart failure using augmented reality glasses Heart (IF 5.7) Pub Date : 2024-03-01 Sungwoo Choi, Sangun Nah, Young Soon Cho, Inki Moon, Jae Wook Lee, Choung Ah Lee, Ji Eun Moon, Sangsoo Han
Objective Left ventricular ejection fraction (LVEF) is measured to assess haemodynamic status and cardiac function. It may be difficult to accurately measure in patients with heart failure (HF) as they are often poorly echogenic. The augmented reality (AR) technology is expected to provide real-time guidance that will enable more accurate measurements. Methods A prospective, randomised, case-crossover
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Pathophysiological insights into machine learning-based subphenotypes of acute heart failure with preserved ejection fraction Heart (IF 5.7) Pub Date : 2024-03-01 Yohei Sotomi, Shunsuke Tamaki, Shungo Hikoso, Daisaku Nakatani, Katsuki Okada, Tomoharu Dohi, Akihiro Sunaga, Hirota Kida, Taiki Sato, Yuki Matsuoka, Daisuke Sakamoto, Tetsuhisa Kitamura, Sho Komukai, Masahiro Seo, Masamichi Yano, Takaharu Hayashi, Akito Nakagawa, Yusuke Nakagawa, Tomohito Ohtani, Yoshio Yasumura, Takahisa Yamada, Yasushi Sakata
Objective The heterogeneous pathophysiology of the diverse heart failure with preserved ejection fraction (HFpEF) phenotypes needs to be examined. We aim to assess differences in the biomarkers among the phenotypes of HFpEF and investigate its multifactorial pathophysiology. Methods This study is a retrospective analysis of the PURSUIT-HFpEF Study (N=1231), an ongoing, prospective, multicentre observational
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Association of right atrial strain and long-term outcome in severe secondary tricuspid regurgitation Heart (IF 5.7) Pub Date : 2024-03-01 Xavier Galloo, Federico Fortuni, Maria Chiara Meucci, Steele C Butcher, Marlieke F Dietz, Edgard A Prihadi, Bernard Cosyns, Victoria Delgado, Jeroen J Bax, Nina Ajmone Marsan
Objective Severe secondary tricuspid regurgitation (STR) causes significant right atrial (RA) volume overload, resulting in structural and functional RA-remodelling. This study evaluated whether patients with severe STR and reduced RA function, as assessed by RA-reservoir-strain (RASr), show lower long-term prognosis. Methods Consecutive patients, from a single centre, with first diagnosis of severe
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Right atrial mass Heart (IF 5.7) Pub Date : 2024-03-01 Swasthi S Kumar, Sudipta Mondal, Vishnu Kesavan
A middle-aged patient with well-controlled hypothyroidism presented with exertional dyspnoea for a few years. General and systemic examinations were within normal limits. The ECG and chest X-ray were essentially normal. A transthoracic and transoesophageal echocardiogram are shown in figure 1A–C, online supplemental videos 1–3. Ventricular function was normal, with no significant valvar stenosis or
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Artificial intelligence to improve the diagnosis of pulmonary hypertension: promises and pitfalls Heart (IF 5.7) Pub Date : 2024-02-15 Namisha Singh, Sanjay Mehta
Pulmonary hypertension (PH) is a clinical–physiological syndrome thought to affect 1% of the global population.1 PH is defined haemodynamically by mean pulmonary artery pressure >20 mm Hg, resulting in right ventricular (RV) overload and often RV failure. Patients with PH experience symptoms including dyspnoea, fatigue and oedema, often associated with physical and psychosocial disability. In some
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Cardiovascular sequelae of trastuzumab and anthracycline in long-term survivors of breast cancer Heart (IF 5.7) Pub Date : 2024-02-12 Claire Glen, Andrew Morrow, Giles Roditi, Tracey Hopkins, Iain Macpherson, Philip Stewart, Mark C Petrie, Colin Berry, Fred Epstein, Ninian N Lang, Kenneth Mangion
Objectives Long-term follow-up of patients treated with trastuzumab largely focuses on those with reduced left ventricular ejection fraction (LVEF) on treatment completion. This study sought to evaluate the prevalence of cardiovascular risk factors, overt cardiovascular disease and cardiac imaging abnormalities using cardiac magnetic resonance (CMR), in participants with normal LVEF on completion of
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Comparison of definitive approaches for conotruncal defects following bidirectional Glenn procedure Heart (IF 5.7) Pub Date : 2024-02-12 Yuze Liu, Qiyu He, Zheng Dou, Kai Ma, Xinjie Lin, Shoujun Li
Background Staged repair is common for complex conotruncal defects, often involving bidirectional Glenn (BDG) procedure. Following the cavopulmonary shunt, both Fontan completion and biventricular conversion (BiVC) serve as definitive approaches. The optimal strategy remains controversial. Methods The baseline, perioperative and follow-up data were obtained for all paediatric patients with conotruncal
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Winning the battle but losing the war: increased population-based mortality from aortic dissection Heart (IF 5.7) Pub Date : 2024-03-01 Barbara C S Hamilton, Kim A Eagle
We read with great interest ‘Temporal Trends in Mortality of Aortic Dissection and Rupture in the UK, Japan, the USA, and Canada’. In their study, Hibino and colleagues1 performed a retrospective database analysis examining trends in mortality from aortic dissection and rupture across four countries over a 19-year time-period. The main outcome was age-standardised mortality rates and annual percentage
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Raising the bar: triple therapy for pulmonary arterial hypertension associated with congenital heart disease Heart (IF 5.7) Pub Date : 2024-03-01 Michele D'Alto, Pier Paolo Bassareo
Pulmonary arterial hypertension related to congenital heart disease (PAH-CHD) really represents a paradigm of complexity. As such, some patients develop PAH-CHD during the infancy, usually as a result of a large post-tricuspid shunt, with pulmonary arterial pressures which may never drop after birth. In others, PAH may persist after late repair or develop later in life. Again, in rare cases, PAH-CHD
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Right atrial pressure, not Doppler jet velocity, is the problem in estimating pulmonary pressure when tricuspid regurgitation is severe Heart (IF 5.7) Pub Date : 2024-03-01 Catherine M Otto, Joanna Bartkowiak, Rebecca T Hahn
Echocardiography allows estimation of right ventricular (RV) systolic pressure by adding the estimated right atrial pressure (RAP) to the systolic pressure gradient between the RV and right atrium (RA) calculated from the tricuspid regurgitant (TR) Doppler velocity. RV systolic pressure is equivalent to pulmonary artery systolic pressure (PASP) in the absence of pulmonic valve stenosis. Some degree
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Review of the National Institute for Health and Care Excellence guidelines on the management of atrial and ventricular arrhythmias Heart (IF 5.7) Pub Date : 2024-03-01 Pier D Lambiase, Edd Maclean
The National Institute for Health and Care Excellence (NICE) guidelines present a synopsis of extensive internal evidence and technology reviews, with a particular focus on clinical efficacy and cost-effectiveness within the NHS in England. This approach has delivered a novel perspective on arrhythmia management, with important distinctions from other policymakers’ recommendations. For example, when
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Optimal antiplatelet strategy following coronary artery bypass grafting: a meta-analysis Heart (IF 5.7) Pub Date : 2024-03-01 Ankit Agrawal, Ashwin Kumar, Muhammad Majid, Osamah Badwan, Aro Daniela Arockiam, Joseph El Dahdah, Alveena B Syed, Mary Schleicher, Grant W Reed, Paul C Cremer, Brian P Griffin, Venu Menon, Tom Kai Ming Wang
Objective Coronary artery bypass grafting (CABG) is an established revascularisation strategy for multivessel and left main coronary artery disease. Although aspirin is routinely recommended for patients with CABG, the optimal antiplatelet regimen after CABG remains unclear. We evaluated the efficacies and risks of different antiplatelet regimens (dual (DAPT) versus single (SAPT), and dual with clopidogrel
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Temporal trends in mortality of aortic dissection and rupture in the UK, Japan, the USA and Canada Heart (IF 5.7) Pub Date : 2024-03-01 Makoto Hibino, Subodh Verma, Craig M Jarret, Junichi Shimamura, Raj Verma, Hiromi Hibino, Cristian R Baeza, Dagfinn Aune, Bobby Yanagawa, Akihiko Usui, Christoph A Nienaber, Marc P Pelletier
Objective Aortic dissection and aortic aneurysm rupture are aortic emergencies and their clinical outcomes have improved over the past two decades; however, whether this has translated into lower mortality across countries remains an open question. The purpose of this study was to compare mortality trends from aortic dissection and rupture between the UK, Japan, the USA and Canada. Methods We analysed
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Associations between air pollution and the risk of first admission and multiple readmissions for cardiovascular diseases Heart (IF 5.7) Pub Date : 2024-03-01 Shiyu Zhang, Lan Chen, Zhengmin (Min) Qian, Dan Li, Miao Cai, Chongjian Wang, Zilong Zhang, Michael G. Vaughn, Amy E. Keith, Haitao Li, Hualiang Lin
Objectives We aimed to investigate the associations between air pollutants and the risk of admission and multiple readmission events for cardiovascular disease (CVD). Methods A total of 285 009 participants free of CVD at baseline from the UK Biobank were included in this analysis. Four major cardiovascular admission events were identified during the follow-up: chronic ischaemic heart disease (CIHD)
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Triple vasodilator therapy in pulmonary arterial hypertension associated with congenital heart disease Heart (IF 5.7) Pub Date : 2024-03-01 Raquel Luna-Lopez, Teresa Segura de la Cal, Fernando Sarnago Cebada, Irene Martin de Miguel, Williams Hinojosa, Alejandro Cruz-Utrilla, Maria Teresa Velazquez, Juan F Delgado, Alberto Mendoza, Fernando Arribas Ynsaurriaga, Pilar Escribano-Subías
Objective This study assessed the long-term effects of triple therapy with prostanoids on patients with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD), as there is limited information on the safety and efficacy of this treatment approach. Methods A retrospective cohort study was conducted on patients with PAH-CHD who were actively followed up at our centre. All patients
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Peak oxygen consumption by smartwatches compared with cardiopulmonary exercise test in complex congenital heart disease Heart (IF 5.7) Pub Date : 2024-03-01 Tomio Tran, Jill Marie Steiner, Aparajithan Venkateswaran, Jonathan Buber
Objective To evaluate for correlation between exercise capacity as assessed by peak oxygen consumption (pVO2) measurement during a cardiopulmonary exercise test (CPET) and smartwatches reporting this parameter in patients with adult congenital heart disease (ACHD) complex lesions. Methods A prospective study that included patients with ACHD either a Fontan circulation or a right ventricle supporting
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Rationale and design of the United Kingdom Heart Failure with Preserved Ejection Fraction Registry Heart (IF 5.7) Pub Date : 2024-03-01 UK HFpEF Collaborative Group
Objective Heart failure with preserved ejection fraction (HFpEF) is a common heterogeneous syndrome that remains imprecisely defined and consequently has limited treatment options and poor outcomes. Methods The UK Heart Failure with Preserved Ejection Fraction Registry (UK HFpEF) is a prospective data-enabled cohort and platform study. The study will develop a large, highly characterised cohort of
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Echocardiographic estimation of pulmonary pressure in patients with severe tricuspid regurgitation Heart (IF 5.7) Pub Date : 2024-03-01 Léo Lemarchand, Vincent Auffret, Hervé Le Breton, Marc Bedossa, Dominique Boulmier, Elena Galli, Erwan Donal, Guillaume Leurent
Objectives The estimation of systolic pulmonary artery pressure (sPAP) by transthoracic echocardiography (TTE) is challenging in patients with severe tricuspid regurgitation (TR). The study aimed to determine the reliability of the assessment of sPAP by TTE in this population. Methods This study was a single-centre analysis of consecutive patients at the University Hospital of Rennes with right heart
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Exercise training in heart failure Heart (IF 5.7) Pub Date : 2024-03-01 Grace Olivia Dibben, Jennifer R Hannay, Rod S Taylor
### Learning objectives Management of heart failure (HF) requires multidisciplinary, pharmacological and non-pharmacological strategies, one component of which is exercise training. Consistent evidence from meta-analyses and clinical trials shows that exercise training improves exercise tolerance, rates of hospitalisation and health-related quality of life (HRQoL) in patients with HF,1 although there
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Correspondence on ‘Echocardiographic estimation of pulmonary pressure in patients with severe tricuspid regurgitation’ by Lemarchand et al Heart (IF 5.7) Pub Date : 2024-03-01 Francisco Gual-Capllonch, Pere Pericàs
Lemarchand et al 1 address an everyday question in the echocardiography laboratories about the reliability of systolic pulmonary artery pressure (sPAP) estimation in cases of severe tricuspid regurgitation (TR). It is concluded that sPAP is underestimated in cases of massive or torrential TR (TR-V), high right atrial (RA) pressure and ‘V-wave cut-off’sign on echocardiography. The applicability of the
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Young adult with left ventricular dysfunction Heart (IF 5.7) Pub Date : 2024-03-01 Sudipta Mondal, Richard R Raj, Sravan Kumar Gaddamedi
A patient in their 30s had been diagnosed with peripartum cardiomyopathy, pulmonary oedema, with severe left ventricular dysfunction at the seventh month of gestation in the third pregnancy in their late 20s. The patient had pregnancy-induced hypertension and hypothyroidism and was treated accordingly. The patient was managed medically and was referred to us in view of worsening symptoms with severe
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Colchicine in atherosclerotic cardiovascular disease Heart (IF 5.7) Pub Date : 2024-02-08 Bradley Tucker, Neil Goonetilleke, Sanjay Patel, Anthony Keech
Inflammation has a direct role in the development of atherosclerotic vascular disease, and oral colchicine displays broad anti-inflammatory properties. Several large, randomised controlled trials (RCTs) have evaluated colchicine’s impact on cardiovascular outcomes. Results from a meta-analysis of these trials demonstrate that colchicine reduces the risk of recurrent major adverse cardiovascular events
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Adherence in a fortnight: is this a true reflection of a lifetime? Heart (IF 5.7) Pub Date : 2024-02-08 Suraya H Kamsani, Melissa E Middeldorp
Recently, there has been significant momentum in the widespread adoption of digital health technologies for detecting and managing atrial fibrillation (AF). The diagnostic accuracy of various commercially available devices is well described and influenced by factors such as device type (handheld vs wearables), technology used (photoplethysmography vs ECG) and duration of monitoring (continuous vs intermittent)
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Cardiac rehabilitation: the gateway for secondary prevention Heart (IF 5.7) Pub Date : 2024-02-01 Sherrie Khadanga, Patrick Savage, Steven Keteyian, Blair Yant, Diann Gaalema, Philip Ades
Cardiac rehabilitation (CR) is a multidisciplinary supervised programme which typically consists of tailored exercise and education on lifestyle management and risk factor modification in cardiac patients. Participation in CR reduces morbidity and mortality, while improving quality of life following major cardiovascular events. Despite the benefits of CR, it is underutilised, generally in the 20%–30% range
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Pericardiocentesis versus window formation in malignant pericardial effusion: trends and outcomes Heart (IF 5.7) Pub Date : 2024-02-01 Jaeoh Lee, Kyu Kim, Seo-Yeon Gwak, Hyun-Jung Lee, Iksung Cho, Geu-Ru Hong, Jong-Won Ha, Chi Young Shim
Objectives Malignant pericardial effusion (MPE) in patients with cancer is associated with poor prognosis. This study aimed to compare clinical outcomes in patients with cancer who underwent pericardiocentesis versus pericardial window formation. Methods In the present study, 765 consecutive patients with cancer (mean age 58.4 years, 395 men) who underwent pericardial drainage between 2003 and 2022
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Echocardiographic artificial intelligence for pulmonary hypertension classification Heart (IF 5.7) Pub Date : 2024-01-30 Yukina Hirata, Takumasa Tsuji, Jun'ichi Kotoku, Masataka Sata, Kenya Kusunose
Objective The classification of pulmonary hypertension (PH) is crucial for determining the appropriate therapeutic strategy. We investigated whether machine learning (ML) algorithms may assist in echocardiographic PH prediction, where current guidelines recommend integrating several different parameters. Methods We obtained physical and echocardiographic data from 885 patients who underwent right heart
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Percutaneous coronary intervention versus medical therapy in stable angina: a matched cohort study Heart (IF 5.7) Pub Date : 2024-01-29 Sang-Ho Jo, Hoseob Kim, Hyun-Jin Kim, Min-Ho Lee, Won-Woo Seo, Mina Kim, Hack-Lyoung Kim
Objective It is uncertain whether percutaneous coronary intervention (PCI) in addition to optimal medical therapy (OMT) can reduce adverse clinical events in the long term as compared with OMT alone in patients with pure stable angina. Methods We enrolled patients from 2006 to 2010 using the Korean national insurance data. 58 742 patients with pure stable angina with no history of myocardial infarction
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Utility of exercise ECG testing in clinical practice: back to the future? Heart (IF 5.7) Pub Date : 2024-02-01 Marcus Flather, Suprateeka Talukder
Assessment of patients presenting for the first time with suspected coronary artery disease (CAD) remains cumbersome with multiple diagnostic options. Likelihood of CAD can be estimated based on symptoms and risk factors, and an abnormal ECG may also be helpful. Patients with moderate/high probability of CAD are usually referred for further tests including angiography (CT or invasive) or isotope-based
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Understanding the driving mechanisms of bioprosthetic valve degeneration Heart (IF 5.7) Pub Date : 2024-02-01 Kristian Wachtell
Over the last decade, it has become increasingly clear that different mechanisms drive the development of native aortic stenosis. Most patients who develop native aortic stenosis have hypertension, and some have increased cholesterol. However, male sex, body mass index, smoking, metabolic syndrome, renal failure and genetic factors (eg, bicuspid aortic valve) have been identified in epidemiological
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Synopsis of JBS recommendations for magnetic resonance imaging in patients with cardiac implantable electronic devices Heart (IF 5.7) Pub Date : 2024-02-01 Tarek Zghaib, Saman Nazarian
Over the last several decades, magnetic resonance (MR) imaging has become the diagnostic modality of choice for several conditions, cardiac and non-cardiac. However, MR uses a static magnetic field, gradient magnetic fields and pulsed radiofrequency energy, all of which may interact with metallic and electronic components within the field. As such, patients with cardiac implantable electronic devices
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Comprehensive imaging in patients with suspected pulmonary arterial hypertension Heart (IF 5.7) Pub Date : 2024-02-01 Simina Crisan, Ruxandra-Maria Baghina, Silvia Ana Luca, Alina-Ramona Cozlac, Alina-Gabriela Negru, Cristina Vacarescu, Mihai-Andrei Lazar, Constantin-Tudor Luca, Dan Gaita
Currently, several imaging techniques are being used for a comprehensive evaluation of patients with suspected pulmonary hypertension (PH), in order to provide information that may clarify the presence and identify the aetiology of this complex pathology. The current paper is focused on recent updates regarding the importance of comprehensive imaging techniques for patients with suspected PH. Transthoracic