Journal Sciences News
Zoology
May 2018
Editorial Board
Publication date: May 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 5

May 2018
The Complementary Role of Real World Evidence: Focus on Oral Anticoagulants
Publication date: May 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 5 Author(s): Andrew Sindone
May 2018
Defining Hypertension — A Storm Across the Pacific
Publication date: May 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 5 Author(s): Garry L.R. Jennings
May 2018
Should We Push the Frontier? Easier Said Than Done
Publication date: May 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 5 Author(s): Johann Brink, Yves d ’Udekem
May 2018
Consensus Statement of Standards for Interventional Cardiovascular Nursing Practice
Publication date: May 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 5 Author(s): Kevin White, Heather Macfarlane, Bernadette Hoffmann, Helene Sirvas-Brown, Kathryn Hines, John Xavier Rolley, Sandi Graham Interventional cardiovascular nursing is a critical care nursing specialty providing complex nursing interventions to patients prone to clinical deterioration, through the combined risks of the pathophysiology of their illness and undergoing technically complex interventional cardiovascular procedures. No guidelines were identified worldwide to assist health care providers and educational institutions in workforce development and education guidelines to minimise patients’ risk of adverse events. The Interventional Nurses Council (INC) developed a definition and scope of practice for interventional cardiac nursing (ICN’s) in 2013. The INC executive committee established a working party of seven representatives from Australia and New Zealand. Selection was based on expertise in interventional cardiovascular nursing and experience providing education and mentoring in the clinical and postgraduate environment. A literature search of the electronic databases Science Direct, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and Health Source was performed, using the search terms: clinical deterioration, ST elevation myocardial infarction, vital signs, primary percutaneous coronary intervention, PCI, AMI, STEMI, acute coronary syndrome, peri-procedural care, unstable angina, PCI complications, structural heart disease, TAVI, TAVR, cardiac rhythm management, pacing, electrophysiology studies, vascular access, procedural sedation. Articles were limited to the cardiac catheterisation laboratory and relevance to nursing based outcomes. Reference lists were examined to identify relevant articles missed in the initial search. The literature was compared with national competency standards, quality and safety documents and the INC definition and scope of practice. Consensus of common themes, a taxonomy of education and seven competency domains were achieved via frequent teleconferences and two face-to-face meetings. The working party finalised the standards on 14 July 2017, following endorsement from the CSANZ, INC, Heart Rhythm Council, CSANZ Quality Standards Committee and the Australian College of Critical Care Nurses (ACCCN). The resulting document provides clinical practice and education standards for interventional cardiac nursing practice.
May 2018
Life After Surviving Fontan Surgery: A Meta-Analysis of the Incidence and Predictors of Late Death
Publication date: May 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 5 Author(s): C.L. Poh, Y. d’Udekem Aim We now know that 20–40% of patients with a single ventricle will develop heart failure after the second decade post-Fontan surgery. However, we remain unable to risk-stratify the cohort to identify patients at highest risk of late failure and death. We conducted a systematic review of all reported late outcomes for patients with a Fontan circulation to identify predictors of late death. Methods We searched MEDLINE, Embase and PubMed with subject terms (“single ventricle”, “Hypoplastic left heart syndrome”, “congenital heart defects” or “Fontan procedure”) AND (“heart failure”, “post-operative complications”, “death”, “cause of death”, “transplantation” or “follow-up studies”) for relevant studies between January 1990 and December 2015. Variables identified as significant predictors of late death on multivariate analysis were collated for meta-analysis. Survival data was extrapolated from Kaplan-Meier survival curves to generate a distribution-free summary survival curve. Results Thirty-four relevant publications were identified, with a total of 7536 patients included in the analysis. Mean follow-up duration was 114 months (range 24–269 months). There were 688 (11%) late deaths. Predominant causes of death were late Fontan failure (34%), sudden death (19%) and perioperative death (16%). Estimated mean survival at 5, 10 and 20 years post Fontan surgery were 95% (95%CI 93–96), 91% (95%CI 89–93) and 82% (95%CI 77–85). Significant predictors of late death include prolonged pleural effusions post Fontan surgery (HR1.18, 95%CI 1.09–1.29, p<0.001), protein losing enteropathy (HR2.19, 95%CI 1.69–2.84, p<0.001), increased ventricular end diastolic volume (HR1.03 per 10ml/BSA increase, 95%CI 1.02–1.05, p<0.001) and having a permanent pacemaker (HR12.63, 95%CI 6.17–25.86, p<0.001). Conclusions Over 80% of patients who survive Fontan surgery will be alive at 20 years. Developing late sequelae including protein losing enteropathy, ventricular dysfunction or requiring a pacemaker predict a higher risk of late death.
May 2018
CaMKII in Vascular Signalling: “Friend or Foe”?
Publication date: May 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 5 Author(s): Obialunanma V. Ebenebe, Alison Heather, Jeffrey R. Erickson Signalling mechanisms within and between cells of the vasculature enable function and maintain homeostasis. However, a number of these mechanisms also contribute to the pathophysiology of vascular disease states. The multifunctional signalling molecule calcium/calmodulin-dependent kinase II (CaMKII) has been shown to have critical functional effects in many tissue types. For example, CaMKII is known to have a dual role in cardiac physiology and pathology. The function of CaMKII within the vasculature is incompletely understood, but emerging evidence points to potential physiological and pathological roles. This review discusses the evidence for CaMKII signalling within the vasculature, with the aim to better understand both positive and potentially deleterious effects of CaMKII activation in vascular tissue.
May 2018
Clinical Characteristics and Burden of Risk Factors Among Patients With Early Onset Acute Coronary Syndromes: The ANZACS-QI New Zealand National Cohort (ANZACS-QI 17)
Publication date: May 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 5 Author(s): Nikki J. Earle, Katrina K. Poppe, Robert N. Doughty, Anna Rolleston, Andrew J. Kerr, Malcolm E. Legget Background Cardiovascular (CV) risk factor profiles of people experiencing acute coronary syndromes (ACS) vary with age, and in New Zealand (NZ), M
May 2018
Normative Values of Short-Term Heart Rate Variability Parameters in Koreans and Their Clinical Value for the Prediction of Mortality
Publication date: May 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 5 Author(s): Chan-Hee Lee, Jung-Hee Lee, Jang-Won Son, Ung Kim, Jong-Seon Park, Jeon Lee, Dong-Gu Shin Background Heart rate variability (HRV) analysis is an important clinical tool for characterising cardiac autonomic status. We sought to determine the normative values and characteristics of the HRV parameters derived from a short-term study in Koreans and to determine their clinical role in predicting mortality. Methods A total of 1828 consecutive patients (range 20–84 years, men 64.8%) with no serious comorbid conditions were recruited. The RR intervals from 10-minute electrocardiograms were used for computation of the following HRV parameters: conventional time- and frequency-domain measures and nonlinear measures. Results A greater age-dependence of most conventional parameters, including the low frequency (LF) and high frequency (HF) powers, was observed than that of the Shannon entropy (ShanEn), approximate entropy (ApEn), and sample entropy. Fifty-four patients (14 cardiac deaths) died during a 10-year follow-up period. The LF/HF ratio (odds ratio [OR], 0.876; p =0.025), ShanEn (OR, 0.372; p =0.028), and ApEn (OR, 0.093; p =0.030) were found to be predictors of all-cause mortality in the multivariate regression analysis. Age was also a powerful risk factor for all-cause mortality (OR, 1.141; p <0.001). Conclusions We presented the normative values and characterised the short-term HRV parameters in Koreans. Among the short-term nonlinear parameters, the ShanEn and ApEn were adjunctive parameters for predicting the all-cause mortality in the general population.
May 2018
Predictors of Long-Term Outcomes After Drug-Eluting Balloon Angioplasty for Bare-Metal Stent Restenosis
Publication date: May 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 5 Author(s): Ming-Jer Hsieh, Yu-Chang Huang, Jih-Kai Yeh, Chun-Chi Chen, Dong-Yi Chen, Chia-Hung Yang, Ming-Lung Tsai, Ming-Yun Ho, Shang-Hung Chang, Chao-Yung Wang, Cheng-Hung Lee, I-Chang Hsieh Background Clinical trials have investigated efficacy of drug-eluting balloon (DEB) angioplasty for bare-metal stent (BMS) in-stent restenosis (ISR). Few studies have investigated predictors of long-term outcomes following BMS-ISR treatment with DEB. Methods From June 2011 to April 2015, 105 patients with 125 BMS-ISR lesions were enrolled from the Cardiovascular Atherosclerosis and Percutaneous TrAnsluminal INterventions (CAPTAIN) registry. All these lesions were treated with DEB angioplasty as final therapy. The major adverse cardiac events (MACEs) were recurrent clinically driven target lesion revascularisation (TLR), myocardial infarction, and cardiac death after DEB angioplasty. Results After DEB angioplasty, the angiographic stenosis decreased from 84.8%±12.4% to 22.6%±10.4%. Over a mean follow-up duration of 21.7±13.4months, the rates of TLR at 1–12 months and 12–48 months were 4.8% and 4.2%, respectively. The rates of MACEs at 1–12 months and 12–48 months were 6.7% and 6.1%, respectively. Chronic haemodialysis, calcified lesion, chronic total occlusion lesion before stenting, stent with metal-to-artery ratio >16.5%, and residual stenosis >25% after DEB angioplasty were potential risk factors for MACEs in univariate analysis. After adjustment in multivariate analysis, independent predictors of long-term MACEs were identified as chronic haemodialysis, chronic total occlusion lesion before stenting, and residual stenosis >25% after DEB angioplasty. Conclusions The long-term results of DEB angioplasty for BMS-ISR are acceptable in this real-world registry. Patient (chronic haemodialysis), lesion (chronic total occlusion) and angioplasty (residual stenosis percentage) related factors predicted long-term outcomes following BMS-ISR treatment with DEB angioplasty.
May 2018
Balloon Aortic Valvuloplasty in the Transcatheter Valve Era: Single Centre Indications and Early Safety Data in a High Risk Population
Publication date: May 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 5 Author(s): Thomas J. Ford, Katherine Nguyen, Joseph Brassil, Virag Kushwaha, Daniel Friedman, Roger Allan, Mark Pitney, Nigel Jepson Background The introduction of transcatheter aortic valve implantation (TAVI) has generated a renewed interest in the techniques available to treat high-risk patients with severe aortic stenosis (AS). We report our single centre experience with balloon aortic valvuloplasty (BAV) focussing on indications, procedural success and 30-day outcomes. Methods We retrospectively reviewed all patients that underwent BAV procedures at our institution between August 2012 and August 2014. Procedural success and complications were adjudicated according to VARC-2 criteria. Results Fifty-one consecutive adult patients with severe symptomatic AS underwent a total of 55 BAV procedures. The patients had a mean age of 88±5.7 years and all had extensive comorbidities with a high surgical risk (mean logistic EuroSCORE of 25.22%±14.5%). Indications for BAV included palliation of symptoms n=42 (76%); bridge to definitive valve replacement (n=6, 11%); and evaluation of response (n=6, 11%). The procedure was completed in all patients with no intraprocedural deaths (within 24hours) and low 30-day mortality at 3.9% (n=2). Minor vascular complications occurred in 11.8% (n=6), whilst permanent pacemaker implantation was required in 5.8% (n=3). There were no cases of myocardial infarction, stroke, tamponade, severe aortic regurgitation or major vascular complications during 30-day follow-up. Conclusions Balloon aortic valvuloplasty may be performed safely and effectively with high procedural success and low 30-day complications, even in a very high-risk and elderly cohort of patients in whom the role of TAVI is uncertain or inappropriate.
May 2018
Adenosine Testing After Atrial Fibrillation Ablation: Systematic Review and Meta-Analysis
Publication date: May 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 5 Author(s): Nelson Wang, Steven Phan, Aran Kanagaratnam, Narendra Kumar, Kevin Phan Background Adenosine can be used to reveal dormant pulmonary vein (PV) conduction after pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF). We performed a systematic review and meta-analysis to assess the impact of adenosine administration in patients undergoing PVI for AF. Methods Meta-analysis of 22 studies was performed to assess the rates of freedom from AF in 1) patients with dormant PV conduction versus patients without dormant PV conduction, and 2) patients given routine adenosine post PVI versus patients not given adenosine. Relative-risks (RR) were calculated using random effects modelling. Results In 18 studies, 3038 patients received adenosine and freedom from AF in those patients with dormant PV reconnection was significantly lower (62.9%) compared to patients without PV reconnection (67.2%) (RR 0.87; 95% CI: 0.78–0.98). In seven studies with 3049 patients, the freedom from AF was significantly higher in patients who received adenosine (67%) versus those patients who did not receive adenosine (63%) (RR: 1.11; 95% CI: 1.01–1.22). Conclusions The present study showed clear benefits of adenosine testing for freedom from AF recurrence. Adenosine-guided dormant conduction is associated with higher AF recurrence despite further ablation. Future studies should investigate the optimal methodology, including dosage and waiting time between PVI and adenosine administration.
May 2018
Early Invasive Versus Initially Conservative Strategy in Elderly Patients Older Than 75 Years with Non-ST-Elevation Acute Coronary Syndrome: A Meta-Analysis
Publication date: May 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 5 Author(s): Wenfang Ma, Yan Liang, Jun Zhu Background Fear of complications related to the procedure and unclear benefits in elderly patients are common reasons for invasive angiography being withheld. Methods We searched PubMed and Embase from inception until February 2016 for studies that enrolled individuals older than 75 years with non-ST-elevation acute coronary syndrome (NSTE-ACS) and allocated patients to either an invasive or conservative strategy. Results Thirteen studies (four randomised controlled trials (RCTs) and nine observational studies) enrolling 832,007 elderly NSTE-ACS patients were analysed. Compared with the conservative treatment, the early invasive approach does significantly reduce the risk of death at follow-up from 6 months to 5 years (risk ratio [RR] 0.65, 95% confidence interval [CI] 0.59–0.73, p<0.001); the definite benefit was mainly observed in observational studies (RR 0.63, 95% CI 0.57–0.70, p<0.001), and the risk of death also showed a strong trend toward reduction with invasive approach (RR 0.82, 95% CI 0.64–1.05, p=0.119) in RCTs. For the outcome of bleeding complications, there was a higher risk of any bleeding occurring in-hospital (RR 2.51, 95% CI 1.53–4.11, p<0.001) in patients treated with invasive strategy than those treated with conservative strategy. However, no difference of in-hospital major bleeding (RR 1.78, 95% CI 0.31–10.13, p=0.514) was observed between the two strategies. Conclusion Elderly patients with NSTE-ACS might benefit from an early invasive strategy but with increasing risk of any bleeding complications. More RCTs are needed to assess early invasive strategies in the elderly.
May 2018
Long-Term Results of Surgical Atrial Fibrillation Radiofrequency Ablation: Comparison of Two Methods
Publication date: May 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 5 Author(s): Song Yang, Bo Mei, Kangni Feng, Weibin Lin, Guangxian Chen, Mengya Liang, Xi Zhang, Zhongkai Wu Background This retrospective study aimed to evaluate the long-term results of two kinds of surgical atrial fibrillation radiofrequency ablations in concomitant cardiac operations. Methods We enrolled 129 patients from January 2006 to December 2015 and performed cardiac operations concomitantly with surgical atrial fibrillation. The patients were divided into a biatrial MAZE group (94 patients) and a left atrial MAZE group (35 patients). A preoperative baseline was compared with intraoperative and postoperative data. Similarly, complications and follow-up results were compared. A matching process based on propensity-score was performed to equalise the potential prognostic factors in both groups and to formulate a balanced 2:1 matched cohort study. Results There were four deaths (4.3%) in the biatrial MAZE group and one death in left atrial MAZE group due to multiple organ failures followed by low cardiac output. No permanent pacemaker implantations were used in either group. The sinus rhythm maintenance rates at the 6-month, 1-year, 6-year and 8-year follow-ups between the biatrial MAZE group and the left atrial MAZE group were not significantly different (84.7%, 83.3%, 67.3%, and 58.8% vs. 84.9%, 77.4%, 61.1%, and 50%, p>0.05). Similarly, between the propensity-score matched groups, there were no significant differences. Conclusion The left atrial MAZE ablation for the patients with mitral valve diseases who needed open cardiac operation was safe and effective when compared with the biatrial MAZE ablation group.
May 2018
Retrograde Type A Dissection after Thoracic Endovascular Aortic Repair: Surgical Strategy and Literature Review
Publication date: May 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 5 Author(s): Zhao An, Zhigang Song, Hao Tang, Lin Han, Zhiyun Xu Background In this study, we investigated the surgical strategy for managing retrograde type A dissection (RTAD) after thoracic endovascular aortic repair (TEVAR) by reporting our experience and literature review. Methods From June 2011 to January 2014, nine patients with RTAD received surgical repair in our institution. The mean age of these patients was 49.3±10.7 years. Data on these RTAD patients was retrospectively collected for further analysis. Literature related to RTAD after TEVAR from 2006 to 2014 was reviewed using the following terms: thoracic endovascular aortic repair, retrograde type A dissection, stent induced new entry, and surgical repair. Results We adopted a total arch replacement combined with a stented elephant trunk implantation and partly preserved the previous TEVAR stent during operation. In-hospital death rate was 11.1% (one of nine). One patient (11.1%) developed paraparesis after operation. No late deaths or complications occurred during follow-up. Literature review identified four articles on the surgical management of RTAD after TEVAR. Our literature review also showed total arch replacement with the stented elephant trunk implantation might be associated with a better prognosis. Conclusions Retrograde type A dissection is a serious complication after TEVAR. The induced factors of RTAD were various and complicated. Our experience and literature review indicates a combination of total arch replacement, stented elephant trunk implantation and partly preserving the previous TEVAR stent is feasible for the surgical repair of RTAD after TEVAR.
May 2018
Surgical Relief of Left Ventricular Outflow Tract Obstruction in Adults With Congenital Aortic Stenosis and Associated Aortic Annulus Hypoplasia and/or Subaortic Obstruction
Publication date: May 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 5 Author(s): Tanveer Ahmad, Amalan Thuraisingam, Marco Larobina, Peter Skillington Background In children and adolescents, a Ross/Konno operation is commonly done to both enlarge the aortic root and provide a competent aortic valve with relief of left ventricular outflow tract obstruction (LVOTO). Optimum management is not so straightforward in adults. Methods Between 1995 and 2014, 16 patients of mean age 39.4 years (18–57 years) with hypoplastic aortic annulus (AA) measuring 20mm and less, and mean aortic valve/LVOT gradient of 61mmHg (30–70mmHg) presented for surgery. Results Eight patients with mean LVOT/AA diameter 19.6mm (18–20mm) underwent an “inclusion-cylinder” type Ross procedure (RP). Eight patients with more severe LVOT/AA obstruction, with mean diameter of 17.4mm (16–19mm) underwent mechanical aortic valve replacement (AVR) with standard Konno-type aortoventriculoplasty. There was zero early and late mortality; with mean follow-up of 11.6 years (3–21 years) in the Ross group and 6 years (2–10 years) in the Konno-AVR group. One patient in the Konno-AVR group had reoperation after 2 years for RVOT obstruction. The postoperative echocardiograms of these patients at last follow-up show residual mean gradient across LVOT/AA of 4.4mmHg (2–6mmHg) after RP, and 11.9mmHg (8–17mmHg) after Konno-AVR. Conclusions In adults, the “inclusion-cylinder” Ross-procedure is a good alternative for mild to moderate aortic root hypoplasia. However, for cases with severe LVOT obstruction, a Ross-Konno is not possible with the same method of autologous support used in a non-Konno RP, and this could be expected to have an impact on late durability and the need for further intervention, in a group that has already undergone multiple procedures in childhood. Both methods of RP and Konno-AVR lead to excellent early and late results.
May 2018
Long Noncoding RNA AK123483 is Involved in the Regulation of Myocardial Ischaemia-Reperfusion Injury by Targeting PARP and Caspase-3
Publication date: May 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 5 Author(s): Chengfei Zheng, Ziheng Wu, Lu Tian, Donglin Li, Xiaohui Wang, Yunjun He, Yangyan He, Wei Jin, Ming Li, Qianqian Zhu, Tao Shang, Hongkun Zhang Backgroud Recently long non-coding RNAs (lncRNAs) have attracted attention in several biomedical fields. The purpose of this study is to investigate the profile of myocardial lncRNAs and their potential roles in myocardial ischaemia-reperfusion injury (IRI). Methods EdgeR bioconductor package was used to screen differentially expressed lncRNAs in myocardial IRI, and lncRNA AK123483 was selected. The mRNA levels of lncRNA AK123483 in normal and anoxia/reoxygenation (A/R) cardiomyocytes were determined by qRT-PCR. After transfection with siRNA-lncRNA, AK123483, LDH release and cell apoptotic rates in normal and A/R cardiomyocytes were determined. The protein expression values of PARP and Caspase-3 were also determined by western blotting. Results The relative level of lncRNA AK123483, LDH release and cell apoptotic rate in A/R cardiomyocytes was significantly higher than that in normal cardiomyocytes. After transfection with siRNA-lncRNA AK123483, LDH release and cell apoptotic rates in A/R cardiomyocytes were reduced, while the values in normal cardiomyocytes had almost no change. The protein expression values of PARP and Caspase-3 in A/R cardiomyocytes were much higher than the Control. After knockdown of lncRNA AK123483, the values decreased. Conclusion Long non-coding RNAs AK123483 could be potential therapeutic targets for the treatment of myocardial IRI.
May 2018
A Flowmeter Technique to Exclude Internal Mammary Artery Anastomosis Error in an Arrested Heart
Publication date: May 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 5 Author(s): Shahrul A. Hashim, Mohd Afiq Amin, Ashvin Nair, Raja Amin Raja Mokhtar, Sivakumar Krishnasamy, Kenny Cheng The revision of an internal mammary artery graft anastomosis because of a technical error can be time-consuming and complicated and may lead to complications. Here, we describe the technical details and our early experience of using a standard transit-time flowmeter to exclude technical errors and facilitate rapid decision making for anastomosis revision in an arrested heart during aortic cross-clamping in the absence of ultrasound guidance.
May 2018
Non-Infectious, Non-Inflammatory Late Dehiscence of Prosthetic Aortic Valve: A “Rocking” Catastrophe
Publication date: May 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 5 Author(s): Yi-Chen Wang, Wei-Chuan Tsai, Yi-Heng Li, Yi-Shan Tsai, Yu-Ting Yu, Kung-Chao Chang, Chwan-Yau Luo, Ting-Wei Lin
May 2018
Heart Foundation
Publication date: May 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 5

Available online 9 April 2018
Cardiac Society of Australia and New Zealand
Publication date: May 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 5

Available online 5 April 2018
Is There a Role for Genes in Exercise-Induced Atrial Cardiomyopathy?
Publication date: Available online 9 April 2018
Source:Heart, Lung and Circulation Author(s): Diane Fatkin, Charles D. Cox, Inken G. Huttner, Boris Martinac In endurance athletes, prolonged high intensity exercise participation can have deleterious effects on the myocardium with subsequent structural and electrical remodelling. In a subset of athletes, there is a predilection for atrial involvement and the risk of atrial fibrillation (AF) is increased. The mechanisms underpinning exercise-induced atrial cardiomyopathy have yet to be fully elucidated and the contribution of an individual’s genetic makeup is unknown. Some athletes may have rare genetic variants that are sufficient to cause AF irrespective of exercise exposure. In AF-causing variant carriers, the additional haemodynamic stress of exercise on atrial structure and function might accelerate or increase the severity of disease. Variants in genes that lack known links to AF may indirectly promote an arrhythmogenic substrate by affecting threshold levels for exercise-induced myocardial damage and remodelling responses, or by effects on AF-associated co-morbidities, sinus node function, and autonomic nervous system tone. Given the exquisite stress-sensitivity of the atria, mechanosensitive ion channels could plausibly have a key role in mediating exercise effects on atrial structure and function. Knowing an athlete’s profile of genetic variants may be useful for AF risk stratification and have implications for clinical management. Pre-participation genetic testing may influence sports choices and facilitate AF prevention.
Available online 4 April 2018
Sudden Cardiac Death in Athletes
Publication date: Available online 5 April 2018
Source:Heart, Lung and Circulation Author(s): Joanna Sweeting, Christopher Semsarian Sudden cardiac death (SCD) in athletes is a rare but tragic complication of a number of cardiovascular diseases. Inherited causes such as the structural and arrhythmogenic genetic heart conditions are often found or suspected to be the underlying cause of death at post mortem examination. Physical activity and intense exercise may trigger cardiac arrhythmias in individuals with these conditions leading to SCD. Prevention and treatment strategies include individual athlete management strategies, coupled with public health measures such as universal cardiopulmonary resuscitation (CPR) training and availability of automatic external defibrillators (AEDs) in public places, thereby preventing SCD in both athletes and the general population. Where an athlete is known to have a cardiac condition, some restrictions from participation may be prudent, however, new evidence is emerging that perhaps current restrictions are too strict and could be relaxed in some cases. An athlete-centred model of care is essential to ensure the clinical implications and athlete preferences are balanced providing the best outcome for all concerned.
Available online 4 April 2018
Diagnosis of Arrhythmogenic Right Ventricular Cardiomyopathy: Progress and Pitfalls
Publication date: Available online 4 April 2018
Source:Heart, Lung and Circulation Author(s): Ad W.G.J. Oomen, Christopher Semsarian, Rajesh Puranik, Raymond W. Sy Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy that predominantly affects the right ventricle. With a prevalence in the range of 1:5000 to 1:2000 persons, ARVC is one of the leading causes of sudden cardiac death in young people and in athletes. Although early detection and treatment is important, the diagnosis of ARVC remains challenging. There is no single pathognomonic diagnostic finding in ARVC; rather, current international task force criteria specify diagnostic major and minor criteria in six categories: right ventricular imaging (including echocardiography and cardiac magnetic resonance imaging (MRI)), histology, repolarisation abnormalities, depolarisation and conduction abnormalities, arrhythmias and family history (including genetic testing). Combining findings from differing diagnostic modalities can establish a “definite”, “borderline” or “possible” diagnosis of ARVC. However, there are limitations inherent in the current task force criteria, including the lack of specificity for ARVC; future iterations may be improved, for example, by enhanced imaging protocols able to detect subtle changes in the structure and function of the right ventricle, incorporation of electro-anatomical data, response to adrenergic challenge, and validated criteria for interpreting genetic variants.
Available online 4 April 2018
Gender is Not a Predictor of Mortality or Major Adverse Cardiovascular Events in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes
Publication date: Available online 4 April 2018
Source:Heart, Lung and Circulation Author(s): Angeline Josiah, Ahmad Farshid Background Historically, studies of percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) have reported worse outcomes for women. We sought to determine if contemporary PCI techniques eliminate gender differences in PCI outcomes. Methods This was a retrospective study of 4776 consecutive patients who underwent PCI for acute coronary syndromes between January 2008 and July 2015. Primary outcomes studied were major adverse cardiovascular events (MACE) and death at 1year. Results Percutaneous coronary intervention success was similar in men and women (97.8% v 97.7%, p=0.76). There was no significant gender difference in the number of vessels attempted (1.14 vs 1.12, p=0.25), mean number of lesions treated (1.34 vs 1.32, p=0.21) or the mean number of stents used (1.32 vs 1.30, p=0.31). There was equivalent use of drug eluting stents (38.2% vs 38.3%, p=0.94). Women with ST-elevation myocardial infarction STEMI had longer median symptom-to-door time (111 vs 90 mins, p=0.0411) but there was no gender difference in door-to-balloon time or symptom-to-balloon time. There was no significant difference in percentages of women and men <75years treated with prasugrel or ticagrelor (11.1% vs 13.4%, p=0.092). Unadjusted 1-year mortality was 6.4% for women and 4% for men (p=0.0012), but on multivariate analysis, female sex was not a predictor of death. There was no significant gender difference in the overall incidence of unadjusted 1-year MACE (11.6% vs 10.8%, p=0.434). Conclusions When contemporary PCI techniques are applied equally to men and women with ACS there is no gender difference in mortality or MACE at 1year.
Available online 4 April 2018
Bilateral Versus Single Internal Mammary Artery Use in Coronary Artery Bypass Grafting: A Propensity Matched Analysis
Publication date: Available online 4 April 2018
Source:Heart, Lung and Circulation Author(s): Ying Yan Zhu, Michael Seco, Stella R. Harris, Michalis Koullouros, Fabio Ramponi, Michael Wilson, Paul G. Bannon, Michael P. Vallely Background Bilateral internal mammary artery (BIMA) grafts have demonstrated superior long-term outcomes compared with single internal mammary artery (SIMA) grafts. Despite this, BIMA remains widely underutilised due to perceived technical challenges and concerns regarding wound healing. We sought to examine the morbidity and mortality associated with BIMA use in a propensity-matched cohort of patients. Methods From 2009 to 2016, 3594 consecutive patients underwent coronary artery bypass surgery at three affiliated institutions. Thirty-day mortality and morbidity data were collected prospectively. Propensity-score matched analyses were performed for BIMA versus SIMA use controlling for a number of preoperative characteristics. Results Overall, 29% of procedures were performed off pump, with a greater proportion in the BIMA group (43% vs. 21%, p<0.001). In the propensity-score analysis consisting of 820 matched pairs, there were similar rates of 30-day mortality (1.3% BIMA vs. 0.9% SIMA, p=0.48) and deep sternal wound infection (1.1% BIMA vs. 0.9% SIMA, p=0.84). The rate of superficial sternal wound infection trended towards being higher in the BIMA group (2.6% vs. 1.3%, p=0.077). The rates of red blood cell transfusions (27.4% vs. 27%, p=0.217), other blood product transfusions (18% vs. 20%, p=0.217), and reoperation for bleeding (2.9% vs. 2.1%, p=0.349) were similar. Conclusions Bilateral internal mammary artery use was associated with similar rates of deep sternal wound infection compared to SIMA use, with a preponderance of superficial sternal wound infections that did not result in increased mortality or transfusion requirements. The use of BIMA should be more widely considered for coronary artery bypass surgery.
Available online 4 April 2018
Transcatheter Aortic Valve Replacement and Atrial Fibrillation: Impact of Antithrombotic Strategy on Clinical Outcomes
Publication date: Available online 4 April 2018
Source:Heart, Lung and Circulation Author(s): Samuel Hui, Robert Gooley, Hashrul N. Rashid, Sarah Zaman Background Antithrombotic recommendations following transcatheter aortic valve replacement (TAVR) are largely based on previous trial protocols. The efficacy and risk of anticoagulation has not been systematically assessed. The aim of this study was to determine the efficacy and safety of oral anticoagulation in patients with atrial fibrillation (AF) following TAVR with the Lotus Valve System (Boston Scientific, Malborough, MA, USA). Methods Consecutive patients with severe aortic stenosis who underwent Lotus valve implantation were prospectively recruited (n=164). Atrial fibrillation patients prescribed oral anticoagulation (standard AF therapy) were compared to non-AF patients prescribed aspirin and clopidogrel (standard non-AF therapy). Twenty of 164 patients were excluded, as they were not prescribed standard therapy. The primary endpoint was 6-month incidence of death, myocardial infarction, stroke/transient ischaemic attack (TIA) or major/life-threatening bleeding. Secondary endpoints included each component of the primary endpoint, defined according to VARC-2. Results Overall, the primary endpoint occurred in 20.8% and 17.7% of the standard AF and standard non-AF therapy groups respectively (p=0.82). There was no statistically significant difference in bleeding (12.5% versus 9.4%, p=0.77) or stroke/TIA (2.1% versus 8.3%, p=0.27) between the standard AF and standard non-AF therapy groups respectively. Conclusions This study supports the safety of anticoagulation in AF patients, which did not result in excess risk of bleeding or stroke/TIA compared with dual antiplatelet therapy in non-AF patients.
Available online 4 April 2018
Trends in the Utilisation and In-Hospital Mortality Associated With Short-Term Mechanical Circulatory Support for Heart Failure With Reduced Ejection Fraction
Publication date: Available online 4 April 2018
Source:Heart, Lung and Circulation Author(s): Rajkumar Doshi, Krunalkumar Patel, Dean Decter, Rajeev Gupta, Perwaiz Meraj Heart failure with reduced ejection fraction (HFrEF) is a systolic dysfunction with an ejection fraction below 40% and the prevalence of it is substantially increasing in the United States. Mechanical circulatory support (MCS) devices have increasingly been used for the management of HFrEF and are associated with improved outcomes. The National Inpatient Sample database was used to identify hospitalisations with mechanical circulatory support for HFrEF from 2005 to 2014. This study observed a reduction in the utilisation of intra-aortic balloon pump (IABP), which is partially replaced by percutaneous left ventricular assist device (pLVAD) and extracorporeal membrane oxygenation (ECMO) for the management of HFrEF. In-hospital mortality in IABP and ECMO recipients decreased during the study period while mortality with pLVAD did not change. Finally, technology for the short-term MCS in HFrEF hospitalisations continues to improve, however, there is still some space for updated technology in future.
April 2018
Oral Anticoagulation Therapy in Atrial Fibrillation Patients Managed in the Emergency Department Compared to Cardiology Outpatient: Opportunities for Improved Outcomes
Publication date: Available online 4 April 2018
Source:Heart, Lung and Circulation Author(s): Geetanjali Rangnekar, Celine Gallagher, Geoffrey R. Wong, Simon Rocheleau, Anthony G. Brooks, Jeroen M.L. Hendriks, Melissa E. Middeldorp, Adrian D. Elliott, Rajiv Mahajan, Prashanthan Sanders, Dennis H. Lau Introduction Recent registry data suggests oral anticoagulation (OAC) usage remains suboptimal in atrial fibrillation (AF) patients. The aim of our study was to determine if rates of appropriate use of OAC in individuals with AF differs between the emergency department (ED) and cardiac outpatient clinic (CO). Methods This was a retrospective study of consecutive AF patients over a 12-month period. Data from clinical records, discharge summaries and outpatient letters were independently reviewed by two investigators. Appropriateness of OAC was assessed according to the CHA2DS2-VASc score. Results Of 455 unique ED presentations with AF as a primary diagnosis, 115 patients who were treated and discharged from the ED were included. These were compared to 259 consecutively managed AF patients from the CO. Inappropriate OAC was significantly higher in the ED compared to the CO group (65 vs. 18%, p<0.001). Treatment in the ED was a significant multivariate predictor of inappropriate OAC (odds ratio 8.2 [4.8–17.7], p<0.001). Conclusions This patient level data highlights that significant opportunity exists to improve disparities in the use of guideline adherent therapy in the ED compared to CO. There is an urgent need for protocol-driven treatment in the ED or streamlined early follow-up in a specialised AF clinic to address this treatment gap.
April 2018
Editorial Board
Publication date: April 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 4

April 2018
The Mystery and Enigma of Spontaneous Coronary Artery Dissection
Publication date: April 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 4 Author(s): Robert M. Graham, Lucy McGrath-Cadell, David W.M. Muller, Cameron J. Holloway
April 2018
A Practical Guide for Fractional Flow Reserve Guided Revascularisation
Publication date: April 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 4 Author(s): Abdul Rahman Ihdayhid, Andy Yong, Richard Harper, Jamie Rankin, Christopher Wong, Adam J. Brown, Michael Leung, Brian Ko The presence and extent of myocardial ischaemia is a major determinant of prognosis and benefit from revascularisation in patients with stable coronary artery disease. Fractional Flow Reserve (FFR) is accepted as the reference standard for invasive assessment of ischaemia. Its ability to detect lesion specific ischaemia makes it a useful test in a wide range of patient and lesion subsets, with FFR guided intervention improving clinical outcomes and reducing health care costs compared to assessment with coronary angiography alone. This article will review the basic principles in FFR, practical tips in FFR guided revascularisation and the role of emerging non-hyperaemic indices of ischaemia.
April 2018
Heart Valve Surgery Performed by Trainee Surgeons: Meta-Analysis of Clinical Outcomes
Publication date: April 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 4 Author(s): Akshat Saxena, Sohaib A. Virk, Sebastian R.A. Bowman, Richmond Jeremy, Paul G. Bannon Background Cardiac surgical units must balance trainee education with the duty to provide optimal patient care. This is particularly challenging with valvular surgery, given the lower volume and increased complexity of these procedures. The present meta-analysis was conducted to assess the impact of trainee operator status on clinical outcomes following valvular surgery. Methods Medline, Embase and CENTRAL databases were systematically searched for studies reporting clinical outcomes according to the training status of the primary operator (consultant or trainee). Data were extracted and meta-analysed according to pre-defined endpoints. Results Eleven observational studies met the inclusion criteria, reporting on five patient cohorts undergoing mitral valve surgery (n=3975), six undergoing aortic valve replacement (AVR) (n=6236) and three undergoing combined AVR and coronary artery bypass grafting (CABG) (n=3495). Perioperative mortality was not significantly different between trainee and consultant cases for mitral valve surgery (odds ratio [OR] 0.92; 95% confidence interval [CI], 0.62–1.37), AVR (OR 0.67; 95% CI, 0.37–1.24), or combined AVR and CABG (OR 1.07; 95% CI, 0.40–2.85). The incidences of perioperative stroke, myocardial infarction, arrhythmias, acute renal failure, reoperation or wound infection were not significantly different between trainee and consultant cases. There was a paucity of mid-term survival data. Conclusions Valvular surgery cases performed primarily by trainees were not associated with adverse perioperative outcomes. These findings suggest the rigorous design of cardiac surgical trainee programs can sufficiently mitigate trainee deficiencies. However, studies with longer follow-up duration and echocardiographic data are required to assess long-term durability and safety.
April 2018
Peripheral Arterial Disease
Publication date: April 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 4 Author(s): Sean M. Conte, Peter R. Vale Peripheral arterial disease (PAD) affects 15% of the Australian population and is a powerful and serious predictor of cardiovascular mortality yet continues to be under-recognised and undertreated. Diagnosis is simple and management is centred upon symptom relief and risk minimisation. While novel and specialised therapies play a role, the bulk of management is approachable and feasible. In this review, we cover the epidemiology, risk factors, associated conditions, classification, and natural history of PAD. We then discuss current diagnostic and therapeutic options as well as emerging therapies for this common condition.
April 2018
The Efficacy of Danshen Injection as Adjunctive Therapy in Treating Angina Pectoris: A Systematic Review and Meta-Analysis
Publication date: April 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 4 Author(s): Huikai Shao, Mengsi Li, Fuchao Chen, Lianghua Chen, Zhengjin Jiang, Lingguo Zhao Background During the last 40 years, Danshen injection has been widely used as an adjunctive therapy for angina pectoris in China, but its efficacy is not yet well defined. The objective of this study was to verify the efficacy of Danshen injection as adjunctive therapy in treating angina pectoris. Methods The major databases including PubMed, Cochrane Library, Sino-Med, Medline, Embase, Google Scholar, China National Knowledge Infrastructure, Wanfang Databases, Chinese Scientific Journal Database, Chinese Biomedical Literature Database and the Chinese Science Citation Database were systematically searched for the published randomised controlled trials (RCTs) on Danshen injection until April 2016. Meta-analysis was conducted on the primary outcomes (i.e., the improvements in symptoms and electrocardiography (ECG)). The quality of the included RCTs was evaluated with the M scoring system (the refined Jadad scale). Based on the quality, year of publication and sample size of RCTs, sensitivity analysis and subgroup analysis were performed in this study. Results Ten RCTs, including 944 anginal patients, were identified in this meta-analysis. Compared with using antianginal agents (
April 2018
Proton Pump Inhibitors and Cardiovascular Events: A Systematic Review
Publication date: April 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 4 Author(s): Timothy P. Shiraev, Andrew Bullen Background Proton pump inhibitors (PPIs) are a commonly prescribed medication that recent data has linked to an increased risk of cardiovascular morbidity and all cause morbidity. The current study sought to perform a systematic review to investigate the link between PPIs and morbidity and mortality Methods A systematic review was carried out as per the PRISMA guidelines, with information databases including Pubmed, Medline, and the Cochrane Review Database. English-language studies of all types published from January 1990 to October 2016 were considered. Dichotomous analysis generating odds ratios was performed using RevMan Version 5.3. Results Thirty-seven studies were considered, of which five directly compared the effect of PPI use on mortality and/or cardiovascular morbidity (including 22,427 patients in mortality datasets, and 354,446 patients in morbidity datasets). For patients taking PPIs, all cause mortality (OR 1.68 [95% CI 1.53–1.84], p<0.001) and rate of major cardiovascular events (OR 1.54 [95% CI 1.11–2.13], p=0.01) were significantly higher. Conclusions The current systematic review demonstrates that, in patients using PPIs, there was a significant increase in morbidity due to cardiovascular disease. Careful consideration should be given to the prescription of PPIs while clinical equipoise remains. Further research in the area is required.
April 2018
The Establishment of the Victorian Cardiac Outcomes Registry (VCOR): Monitoring and Optimising Outcomes for Cardiac Patients in Victoria
Publication date: April 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 4 Author(s): Dion Stub, Jeffrey Lefkovits, Angela L. Brennan, Diem Dinh, Rita Brien, Stephen J. Duffy, Nicholas Cox, Voltaire Nadurata, David J. Clark, Nick Andrianopoulos, Richard Harper, John McNeil, Christopher M. Reid Background The Victorian Cardiac Outcomes Registry (VCOR) was established in 2012 to ensure the safety and quality of cardiac based therapies across Victoria. As a clinical quality registry, VCOR monitors the performance of health services in both the public and private sectors, by measuring and reporting on trends in the quality of patient care over time, within individual hospitals, comparatively with other hospitals, and aggregated at the state level. The current paper describes the VCOR registry aims, methods, governance structure and progress to date. Methods Primary management of the registry is undertaken at Monash University in association with the Victorian Cardiac Clinical Network, Department of Health and Human Services Victoria. Results The Victorian Cardiac Outcomes Registry has currently collected data on more than 33,000 cardiac patients across three separate areas of interest in 35 hospitals. These include percutaneous coronary intervention (PCI), the early treatment of acute myocardial infarction in rural and regional settings, and data relating to in-hospital management of heart failure. Conclusions The Victorian Cardiac Outcomes Registry is a clinical cardiac registry that commenced data collection in 2013, providing a detailed description of selected aspects of contemporary cardiology clinical practice in a majority of Victorian hospitals. This information enables hospitals and cardiac units to benchmark their practice, clinical outcomes and quality of care to other similar units and hospitals across the state. If replicated by other states in Australia, there will be the potential for important national comparisons, with the goal to foster continuous improvement in patient care and outcomes across the entire Australian health system.
April 2018
Implementing Sustainable Data Collection for a Cardiac Outcomes Registry in an Australian Public Hospital
Publication date: April 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 4 Author(s): Nicholas Cox, Angela Brennan, Diem Dinh, Rita Brien, Kath Cowie, Dion Stub, Christopher M. Reid, Jeffrey Lefkovits Background Clinical outcome registries are an increasingly vital component of ensuring quality and safety of patient care. However, Australian hospitals rarely have additional resources or the capacity to fund the additional staff time to complete the task of data collection and entry. At the same time, registry funding models do not support staff for the collection of data at the site but are directed towards the central registry tasks of data reporting, managing and quality monitoring. The sustainability of a registry is contingent on building efficiencies into data management and collection. Methods We describe the methods used in a large Victorian public hospital to develop a sustainable data collection system for the Victorian Cardiac Outcomes Registry (VCOR), using existing staff and resources common to many public hospitals. We describe the features of the registry and the hospital specific strategies that allowed us to do this as part of our routine business of providing good quality cardiac care. Results All clinical staff involved in patient care were given some data collection task with the entry of these data embedded into the staff’s daily workflow. A senior cardiology registrar was empowered to allocate data entry tasks to colleagues when data were found to be incomplete. The task of 30-day follow-up proved the most onerous part of data collection. Cath-lab nursing staff were allocated this role. Conclusion With hospital accreditation and funding models moving towards performance based quality indicators, collection of accurate and reliable information is crucial. Our experience demonstrates the successful implementation of clinical outcome registry data collection in a financially constrained public hospital environment utilising existing resources.
April 2018
The Applicability of the American College of Cardiology Appropriate Use Criteria for Myocardial Perfusion Scintigraphy in Australia
Publication date: April 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 4 Author(s): Chee Loong Chow, Francis A. Ponnuthurai, Kevin C. Allman, William van Gaal Background The American College of Cardiology (ACC) Appropriate Use Criteria (AUC) for radionuclide myocardial perfusion scans (MPS) was developed to promote its rational use in the assessment of stable ischaemic heart disease (IHD). We sought to validate the applicability of this document in the Australian context. Methods 1009 consecutive patients who underwent MPS were retrospectively audited at a single major metropolitan hospital in Victoria, Australia. Appropriateness was assigned based on the 2013 ACC AUC, and common indications and predictors of positive scan results were examined. Results The AUC was successfully applied (99.1%) retrospectively. A large proportion of scans were deemed appropriate (82.7%), whilst 7.8% were maybe appropriate. Positive detection rates in these groups were 17.0% and 17.9% respectively. Eighteen patients (1.8%) were unclassifiable, but had a detection rate of 44.4%. Positive predictors of an abnormal MPS result included prior history of coronary artery disease, typical angina, and following the conservative management of an acute coronary syndrome. Scans that were rarely appropriate had a detection rate of 0%. Conclusion The retrospective application of the 2013 ACC AUC is feasible. Whilst the majority of the scans were appropriate, a group of unclassifiable patients was observed to have a high detection rate. Scans that were rarely appropriate could potentially be rationalised to reduce radiation risk.
April 2018
Effects of Remote Ischaemic Conditioning on Heart Rate Variability and Cardiac Function in Patients With Mild Ischaemic Heart Failure
Publication date: April 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 4 Author(s): Long Chen, Qianxing Zhou, Hong Jin, Kongbo Zhu, Hong Zhi, Zhongpu Chen, Genshan Ma Background Cardioprotective effects of remote ischaemic conditioning (RIC) in the setting of ischaemic heart disease have been shown recently. But the effects of RIC on heart rate variability (HRV) and cardiac function in patients with stable ischaemic heart failure (IHF) are still unknown. Methods Fifty patients with stable IHF were enrolled and randomly divided into RIC group and control group. Remote ischaemic conditioning treatment was performed twice a day for 6 weeks. A remote is chaemic conditioning protocol consisted of 4
April 2018
The Current Epidemiology of Injecting Drug Use-Associated Infective Endocarditis in Victoria, Australia in the Midst of Increasing Crystal Methamphetamine Use
Publication date: April 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 4 Author(s): Alexandra Wright, Ohide Otome, Craig Harvey, Steve Bowe, Eugene Athan Background Infective endocarditis (IE) is associated with significant mortality and morbidity despite recent advances in management. Injecting drug use (IDU) remains an important risk factor. Our aim was to evaluate the rates and patient demographics of IE and injecting drug use-associated infective endocarditis (IDU-IE) in Victoria from 2009 to 2014. Methods The Victorian Admitted Episode Dataset (VAED) was used to identify a population-based cohort with a diagnosis of IE and IDU-IE between 2009 and 2014 in Victoria. Incidence rates were calculated per 100,000 people/year. Rate ratios were calculated using Poisson distributions, and chi squared (
April 2018
Association of Systemic Inflammation Score With Atrial Fibrillation: A Case-Control Study With Propensity Score Matching
Publication date: April 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 4 Author(s): Huan Zhang, Jun Li, Xinghua Chen, Na Wu, Weijia Xie, He Tang, Chengying Li, Long Wu, Ying Xiang, Li Zhong, Yafei Li Background Inflammation plays a key role in the initiation and progression of atrial fibrillation (AF). We developed a novel systemic inflammation score (SIS) based on integration of biomarkers used routinely in clinical settings. We aim to explore the association between SIS and AF. Methods A matched case-control study with 376 pairs of AF cases and controls was performed using a propensity score matching system. The SIS was developed by integrating albumin (ALB), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocytes to monocytes ratio (LMR). Univariate and multivariate analyses were performed to examine the association of each marker and SIS with AF. Results The conditional multivariate logistic regression analysis showed that elevated levels of ALB and LMR were significantly associated with decreased risk of AF with an OR of 0.74 (95% CI: 0.65, 0.85) and 0.73 (95% CI: 0.64, 0.83), respectively. Patients with elevated SIS had a significantly higher risk of AF. Compared to the patients with SIS equal to 1, the patients with SIS equal to 3 and 4 had an OR of 2.16 (95% CI: 1.40 3.32), and 2.55 (95% CI: 1.66, 3.92), respectively. The SIS was positively correlated with left atrial diameter and right atrial diameter in patients with AF. Conclusions In conclusion, this study provides further clinical epidemiological evidence that systemic inflammatory status was correlated with AF. The SIS, as an index to evaluate the intensity of systemic inflammatory status, could be useful for early prediction of AF development and understanding of AF mechanism.
April 2018
Antegrade Versus Continuous Retrograde del Nido Cardioplegia in the David I Operation
Publication date: April 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 4 Author(s): Xuan Jiang, Tianxiang Gu, Enyi Shi, Chun Wang, Zongyi Xiu, Guangwei Zhang Background The efficacy of continuous retrograde del Nido cardioplegia for myocardial protection is still controversial. We hypothesised that antegrade and retrograde cardioplegia offer equivalent safety for myocardial protection in the David I procedure. Methods We retrospectively reviewed 33 patients undergoing the David I operation with antegrade or retrograde del Nido solution from June 2014 to January 2016. The outcomes were compared. The follow-up was 1 month to 15 months. Results There was no hospital mortality or reoperation in both groups. Cardiopulmonary bypass, and aortic clamp times were similar. Troponin I level (TnI), creatine kinase level (CKMB), left ventricular ejection fraction (LVEF), ventilation times, intensive care unit (ICULOS) and hospital stay times (THLOS) were similar between the two groups. The lactate level was slightly higher (9.26±2.56 vs 7.17±1.58, p =0.01) in the antegrade group compared with the retrograde group. The incidence of heart block was higher (four patients) in the retrograde group (26.7% vs 0%, p =0.019). Only one patient (6.7%) required implantation of a permanent cardiac pacemaker. Conclusion Antegrade and continuous retrograde del Nido cardioplegia can be used safely and effectively in the David I operation. The continuous retrograde del Nido cardioplegia is associated with a higher rate of temporary AV block which does not require permanent pacing, and a lower lactate level.
April 2018
Early Diagnostic Performance of Heart-Type Fatty Acid Binding Protein in Suspected Acute Myocardial Infarction: Evidence From a Meta-Analysis of Contemporary Studies
Publication date: April 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 4 Author(s): Li-Qian Xu, Yun-Mei Yang, Hong Tong, Chang-Fu Xu Background Although cardiac troponin is the cornerstone in diagnosis of acute myocardial infarction (AMI), the accuracy is still suboptimal in the early hours after chest pain onset. Due to its small size, heart-type fatty acid-binding protein (H-FABP) has been reported accurate in diagnosis of AMI, however, this remains undetermined. The aim is to investigate the diagnostic performance of H-FABP alone and in conjunction with high-sensitivity troponin (hs-Tn) within 6 hours of symptom onset. Furthermore, accuracy in 0h/3h algorithm was also assessed. Methods Medline and EMBASE databases were searched; sensitivity, specificity and area under ROC curve (AUC) were used as measures of the diagnostic accuracy. We pooled data on bivariate modelling, threshold effect and publication bias was applied for heterogeneity analysis. Results Twenty-two studies with 6602 populations were included, pooled sensitivity, specificity and AUC of H-FABP were 0.75 (0.68–0.81), 0.81 (0.75–0.86) and 0.85 (0.82–0.88) within 6 hours. Similar sensitivity (0.76, 0.69–0.82), specificity (0.80, 0.71–0.87) and AUC (0.85, 0.82–0.88) of H-FABP were observed in 4185 (63%) patients in 0h/3h algorithm. The additional use of H-FABP improved the sensitivity of hs-Tn alone but worsened its specificity (all p <0.001), and resulted in no improvement of AUC (p >0.99). There was no threshold effect (p =0.18) and publication bias (p =0.31) in this study. Conclusions H-FABP has modest accuracy for early diagnosis of AMI within 3 and 6 hours of symptom onset. The incremental value of H-FABP seemed much smaller and was of uncertain clinical significance in addition to hs-Tn in patients with suspected AMI. Routine use of H-FABP in early presentation does not seem warranted.
April 2018
Surgical Aortic Valve Replacement Following Early Sapien-XT Valve Failure: A First
Publication date: April 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 4 Author(s): Tanveer Ahmad, Prakash Ludhani, Ronen Gurvitch, John Goldblatt, James Tatoulis Background Early degeneration of prosthetic aortic valve in transcatheter aortic valve replacement (TAVR) is a rare complication. Method We report the case of a 75-year-old woman who presented with severe calcific stenosis of Edwards SAPIEN-XT valve implanted only 4 years previously. She is a Jehovah’s Witness and has background of Sjogren’s syndrome with secondary cryoglobulinaemic vasculitis. She was not a suitable candidate for valve-in-valve TAVR in view of early prosthetic valve failure by calcification. Result She underwent surgical explantation of the Sapiens XT valve and mechanical aortic valve replacement. Conclusion To our knowledge, this is the first time that early TAVR valve degeneration and failure of an Edwards SAPIEN-XT valve was reported which required surgical replacement with a mechanical valve.
April 2018
Surgical Management of Severe Ischaemic Mitral Regurgitation
Publication date: April 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 4 Author(s): Yong Zhang, Dongxu Wang, Yu Liu, Dengshun Tao, Yan Jin, Hui Jiang, Zengwei Wang, Huishan Wang Background Coronary artery bypass graft surgery (CABG) with mitral valve surgery is undisputed in severe ischaemic mitral regurgitation (IMR) treatment, but the controversy is whether mitral valve replacement (MVR) or mitral valvuloplasty (MVP) should be used. Methods Data was collected from 130 cases of severe IMR patients who underwent CABG and MVP or MVR from June 2010 to June 2015 to compare the short-term efficacy of CABG with MVP or MVR in the treatment of severe IMR patients. There were 70 cases in the MVP group and 60 in the MVP group. The postoperative major cardiac cerebral vascular events and left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD), and left ventricular end-diastolic diameter (LVEDD) were recorded. Results Eleven patients died in hospital, the remaining patients were followed up for 12 months; 18 patients died. The cumulative survival rate and the major cardiac cerebrovascular events were not significantly different. There was no significant change in LVEF, but LVEDD, LVESD and systolic pulmonary artery pressure (sPAP) improved significantly, and there was no difference between the groups. In the MVR group, the rate of postoperative moderate or severe mitral regurgitation patients was significantly less than that in the MVP group. Conclusion The short-term survival rate, reversal of left ventricular remodelling and major cardiac or cerebrovascular events post-CABG combined with MVP were not significantly different to those with CABG combined with MVR in the treatment of severe IMR, but long-term efficacy remains to be observed.
April 2018
A Comfortable Solution To Tracheal Anastomosis Protection: Tracheal Retention Sutures
Publication date: April 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 4 Author(s): Sami Karapolat, Atila Turkyilmaz, Kubra Nur Seyis, Celal Tekinbas Fixation of the chin to the anterior chest wall is the most commonly used method of reducing anastomotic tension following a segmental resection of the trachea and reconstruction with primary anastomosis. However, the sutures required for this method may lead to various organic and psychological problems. In five patients who underwent tracheal resection and primary anastomosis, retention sutures were placed on the proximal and distal-lateral edges of the anastomotic line rather than placing a Guardian chin stitch. All patients were mobilised in the early postoperative period and were able to perform their routine daily activities without restrictions. During their average 14.4 months of follow-up, no complications were found in their anastomotic lines during their clinical, radiological, and bronchoscopic assessments. The placement of tracheal retention sutures proved an inexpensive and reliable method to reduce anastomotic tension without additional surgical burden, and was effective in terms of patient comfort.
April 2018
Percutaneous Transvenous Mitral Valve-in-Valve Implantation Using Commercially Available Transcatheter Valve. First Australian Experience
Publication date: April 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 4 Author(s): Anthony Putrino, Gregory Scalia, Sarvesh Natani, Swaroop Margale, Ivan Rapchuk, Simon Binny, Catherine Lau, Myo Lwin, Andrew Clarke, Christopher Raffel, Darren L. Walters In patients with a degenerative mitral bioprosthesis and prohibitive surgical risk there is emerging evidence for the feasibility of valve-in-valve procedures via a percutaneous transvenous transseptal approach. This paper describes the first time this procedure has been performed in Australia.
April 2018
Acute Myocardial Infarction as the Initial Manifestation of Delayed Bioprosthesis Thrombosis After Transcatheter Aortic Valve Replacement
Publication date: April 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 4 Author(s): Yi-jian Li, Yan-biao Liao, Xin Wei, Yuan Feng, Mao Chen Bioprosthesis thrombosis after transcatheter aortic valve replacement (TAVR) raised concerns about further clinical events. We report the case of a patient who suffered acute myocardial infarction (AMI) after TAVR for 3 years. Thrombosis was confirmed in the right coronary sinus of Valsalva by transthoracic echocardiography. Coronary angiography demonstrated the ostium of the right coronary artery was occluded. As an attempt to perform percutaneous coronary intervention (PCI) was unsuccessful, long-term therapeutic anticoagulation with warfarin was undertaken. Within 2 weeks, symptoms were relieved, and the right coronary ostium thrombus disappeared on computed tomography (CT) angiography. This case highlights the AMI as initial manifestation of delayed bioprosthesis thrombosis and the importance of anticoagulation against the bioprosthesis thrombosis. Meanwhile, the difficulty of PCI after TAVR is not only the stent frame of bioprosthesis, but also the location of the thrombosis.

Heart Foundation
Publication date: April 2018
Source:Heart, Lung and Circulation, Volume 27, Issue 4


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