BMJ - Heart
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Heart is an international peer-reviewed journal focussing on advances in the diagnosis and treatment of cardiovascular disease.
BMJ - Heart
5d ago
Objectives
This study aimed to evaluate the prognostic value of coronary microvascular dysfunction (CMD) at long term after transcatheter aortic valve implantation (TAVI) and to explore its relationship with extravalvular cardiac damage (EVCD). Moreover, we sought to test the correlation between angiography-derived index of microcirculatory resistance (IMRangio) and invasive IMR in patients with aortic stenosis (AS).
Methods
This was a retrospective analysis of the Verona Valvular Heart Disease Registry (Italy) including 250 patients (83 (80–86) years, 53% female) with severe AS who underwent ..read more
BMJ - Heart
5d ago
Objective
CT aortic valve calcium score (AVCscore) and density (AVCdensity) thresholds have been recommended for aortic stenosis (AS) severity assessment in tricuspid aortic valve (TAV). We aimed to compare AVCscore and AVCdensity in bicuspid aortic valve (BAV) versus TAV.
Methods
Retrospective single-centre study of patients with echocardiographic AS-severity and CT-AVC assessments within 6 months, and left ventricular ejection fraction ≥50%, all referred for clinical AS evaluation.
Severe AS was defined as aortic valve area (AVA) ≤1 cm2 or indexed AVA ≤0.6cm2/m2 plus mean gradient ≥40 mm Hg ..read more
BMJ - Heart
5d ago
Objectives
To determine the association between symptoms and signs reported in primary care consultations following a new diagnosis of heart failure (HF), and 3-month hospitalisation and mortality.
Design
Nested case–control study with density-based sampling.
Setting
Clinical Practice Research Datalink, linked to hospitalisation and mortality (1998–2020).
Participants
Database cohort of 86 882 patients with a new HF diagnosis. In two separate analyses for (1) first hospitalisation and (2) death, we compared the 3-month history of symptoms and signs in cases (patients with HF with the event), w ..read more
BMJ - Heart
5d ago
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 catheterisation (RHC). Patients were classified into three groups: non-PH, precapillary PH and postcapillary PH, based on values obtained from RHC. Using 24 parameters, we created predictive mod ..read more
BMJ - Heart
5d ago
Objective
Machine learning (ML) can facilitate prediction of major adverse cardiovascular events (MACEs) in repaired tetralogy of Fallot (rTOF). We sought to determine the incremental value of ML above expert clinical judgement for risk prediction in rTOF.
Methods
Adult congenital heart disease (ACHD) clinicians (≥10 years of experience) participated (one cardiac surgeon and four cardiologists (two paediatric and two adult cardiology trained) with expertise in heart failure (HF), electrophysiology, imaging and intervention). Clinicians identified 10 high-yield variables for 5-year MACE predict ..read more
BMJ - Heart
5d ago
Objective
To investigate the incidence and mortality risk associated with postdischarge major bleeding after coronary artery bypass grafting (CABG), and relate this to the incidence of, and mortality risk from, postdischarge myocardial infarction.
Methods
All patients undergoing first-time isolated CABG in Sweden in 2006–2017 and surviving 14 days after hospital discharge were included in a cohort study. Individual patient data from the SWEDEHEART Registry and five other mandatory nationwide registries were merged. Piecewise Cox proportional hazards models were used to investigate associations ..read more
BMJ - Heart
5d ago
Clinical introduction
A middle-aged patient with no prior comorbidities presented to the emergency department with a sudden onset of palpitations, dizziness and progressive dyspnoea. History was negative for any cardiac disorders in the past. On examination, the pulse rate was around 190 beats/min with a systolic blood pressure of 80 mm Hg. ECG at presentation was suggestive of ventricular tachycardia (VT) (figure 1A). Resuscitation with urgent cardioversion in view of haemodynamic instability with wide complex tachycardia was done. Following cardioversion to sinus rhythm, examination revealed ..read more
BMJ - Heart
5d ago
Objective
In Fontan circulation, pulmonary arterial hypertension (PAH)-targeted therapies could improve the patients’ exercise capacity. This study aimed to investigate the effects of PAH agents on different exercise parameters in stable Fontan patients by synthesising evidence of randomised controlled trials (RCTs).
Methods
A systematic search of PubMed, Cochrane Central Register of Controlled Trials and Web of Science databases, as well as of ClinicalTrials.gov, was performed. Primary outcomes were specific cardiopulmonary exercise test parameters: peak oxygen uptake (peak VO2), peak heart r ..read more
BMJ - Heart
5d ago
Immune-mediated inflammatory diseases (IMIDs) are recognised risk factors for accelerated atherosclerotic cardiovascular disease (CVD), particularly in younger individuals and women who lack traditional CVD risk factors. Reflective of the critical role that inflammation plays in the formation, progression and rupture of atherosclerotic plaques, research into immune mechanisms of CVD has led to the identification of a range of therapeutic targets that are the subject of ongoing clinical trials. Several key inflammatory pathways implicated in the pathogenesis of atherosclerosis are targeted in p ..read more
BMJ - Heart
5d ago
<p>Over the last two decades, the differentiation of severe from non-severe aortic valve stenosis with echocardiography has become more complex. The consideration of flow is now frequently essential to evaluate haemodynamic stenosis severity. Low flow can result in low gradient and, thereby, mask severe aortic stenosis. On the other hand, low flow may impede complete opening of the valve and result in overestimation of the severity by aortic valve area (AVA). Since echocardiographic assessment of flow incorporates parameters which are also used to quantify gradient and AVA, measurement e ..read more