Transseptal puncture for structural heart intervention: an old technique with new indications
Learning objectives To learn how to: Select the candidates for the technique Optimise the use of equipment Carry out the procedure Adapt the procedure to specific subsequent structural interventions Manage the complications Introduction Transseptal catheterisation was introduced in the late 50s1 and gained popularity with the introduction of the electrophysiological and structural heart interventions.2–10 Here, we shall describe the use of transseptal puncture (TSP) technique in the main transcatheter structural, and especially valve, interventions. Indications In current practice, the use of TSP has shifted from a d...
Source: Heart - October 27, 2017 Category: Cardiology Authors: Vahanian, A., Brochet, E. Tags: Education in Heart Source Type: research

Systemic inflammation as a novel QT-prolonging risk factor in patients with torsades de pointes
Conclusion The data are first to show that systemic inflammation via elevated IL-6 levels may represent a novel QT-prolonging risk factor contributing to TdP occurrence in the presence of other classical risk factors. If confirmed, this could open new avenues in antiarrhythmic therapy. (Source: Heart)
Source: Heart - October 27, 2017 Category: Cardiology Authors: Lazzerini, P. E., Laghi-Pasini, F., Bertolozzi, I., Morozzi, G., Lorenzini, S., Simpatico, A., Selvi, E., Bacarelli, M. R., Finizola, F., Vanni, F., Lazaro, D., Aromolaran, A., El Sherif, N., Boutjdir, M., Capecchi, P. L. Tags: Arrhythmias and sudden death Source Type: research

Predictors of procedural complications in adult Fontan patients undergoing non-cardiac procedures
Objective Limited data exist regarding the outcomes of non-cardiac procedures (NCPs) in adult patients after Fontan operations (Fontan patients). Methods To compare procedural outcomes after NCPs in Fontan patients with outcomes for two matched control groups: patients with repaired congenital heart disease and biventricular circulation (CHD-BiV) and patients with no heart disease (NHD). We defined cyanosis as oxygen saturation
Source: Heart - October 27, 2017 Category: Cardiology Authors: Egbe, A. C., Khan, A. R., Ammash, N. M., Barbara, D. W., Oliver, W. C., Said, S. M., Akintoye, E., Warnes, C. A., Connolly, H. M. Tags: Congenital heart disease Source Type: research

Effect of Fontan geometry on exercise haemodynamics and its potential implications
This study investigates relationships between TCPC geometries and exercise haemodynamics and performance. Methods This study included 47 patients who completed metabolic exercise stress test with cardiac magnetic resonance (CMR). Phase-contrast CMR images were acquired immediately following supine lower limb exercise. Both anatomies and exercise vessel flow rates at ventilatory anaerobic threshold (VAT) were extracted. The vascular modelling toolkits were used to analyse TCPC geometries. Computational simulations were performed to quantify TCPC indexed power loss (iPL) at VAT. Results A highly significant inverse correla...
Source: Heart - October 27, 2017 Category: Cardiology Authors: Tang, E., Wei, Z., Whitehead, K. K., Khiabani, R. H., Restrepo, M., Mirabella, L., Bethel, J., Paridon, S. M., Marino, B. S., Fogel, M. A., Yoganathan, A. P. Tags: Congenital heart disease Source Type: research

Genetics and clinical response to warfarin and edoxaban in patients with venous thromboembolism
Objective The aim of this study was to investigate whether genetic variants can identify patients with venous thromboembolism (VTE) at an increased risk of bleeding with warfarin. Methods Hokusai-venous thromboembolism (Hokusai VTE), a randomised, multinational, double-blind, non-inferiority trial, evaluated the safety and efficacy of edoxaban versus warfarin in patients with VTE initially treated with heparin. In this subanalysis of Hokusai VTE, patients genotyped for variants in CYP2C9 and VKORC1 genes were divided into three warfarin sensitivity types (normal, sensitive and highly sensitive) based on their genotypes. A...
Source: Heart - October 27, 2017 Category: Cardiology Authors: Vandell, A. G., Walker, J., Brown, K. S., Zhang, G., Lin, M., Grosso, M. A., Mercuri, M. F. Tags: Open access Aortic and vascular disease Source Type: research

Relationship between fibrillin-1 genotype and severity of cardiovascular involvement in Marfan syndrome
Conclusions Patients with an HI mutation had a more severely affected aortic phenotype, with larger aortic root diameters and a more rapid dilation rate, and tended to have an increased risk of death and dissections compared with patients with a DN mutation. (Source: Heart)
Source: Heart - October 27, 2017 Category: Cardiology Authors: Franken, R., Teixido-Tura, G., Brion, M., Forteza, A., Rodriguez-Palomares, J., Gutierrez, L., Garcia Dorado, D., Pals, G., Mulder, B. J., Evangelista, A. Tags: Editor's choice Aortic and vascular disease Source Type: research

Plasma 7-ketocholesterol levels and the risk of incident cardiovascular events
This study was designed to investigate the association of plasma 7-KC level with the incident cardiovascular disease (CVD) events in general population. Methods We measured plasma 7-KC concentrations at baseline in 1944 participants free from CVD in a community-based cohort study. The primary endpoint was incident of a major adverse cardiovascular event. A Cox proportional hazards model was used to calculate the HRs with 95% CI. Results A total of 101 incident CVD events were recorded during the 5.2 year median follow-up. The baseline plasma 7-KC levels were associated with a higher risk of incident CVD events; compared ...
Source: Heart - October 27, 2017 Category: Cardiology Authors: Wang, M., Long, W., Li, D., Wang, D., Zhong, Y., Mu, D., Song, J., Xia, M. Tags: Cardiac risk factors and prevention Source Type: research

Aerobic fitness, muscular strength and obesity in relation to risk of heart failure
Objective Low physical fitness and obesity have been associated with higher risk of developing heart failure (HF), but their interactive effects are unknown. Elucidation of interactions among these common modifiable factors may help facilitate more effective primary prevention. Methods We conducted a national cohort study to examine the interactive effects of aerobic fitness, muscular strength and body mass index (BMI) among 1 330 610 military conscripts in Sweden during 1969–1997 (97%–98% of all 18-year-old men) on risk of HF identified from inpatient and outpatient diagnoses through 2012 (maximum age 62 year...
Source: Heart - October 27, 2017 Category: Cardiology Authors: Crump, C., Sundquist, J., Winkleby, M. A., Sundquist, K. Tags: Cardiac risk factors and prevention Source Type: research

Exertional dyspnoea in a 28-year-old woman
Clinical introduction A 28-year-old woman with a history of critical pulmonic stenosis, status postsurgical valvotomy and subsequent pulmonary valve replacement, presented to the cardiology clinic with 1 year of progressive exertional dyspnoea. She has a heart rate of 75 bpm and blood pressure of 110/55 mm Hg. Cardiac auscultation reveals a 1/6 systolic ejection murmur along the left sternum and an early 3/6 diastolic decrescendo murmur. A transthoracic echocardiogram is obtained (figure 1). Questions Which of the following would be most likely found during right heart catheterisation?Ratio of pulmonary to systemic blood ...
Source: Heart - October 27, 2017 Category: Cardiology Authors: Carlson, S. D., Steinberg, Z. L., Krieger, E. V. Tags: Congenital heart disease Source Type: research

A current approach to heart failure in Duchenne muscular dystrophy
Duchenne muscular dystrophy (DMD) is a genetic, progressive neuromuscular condition that is marked by the long-term muscle deterioration with significant implications of pulmonary and cardiac dysfunction. As such, end-stage heart failure (HF) in DMD is increasingly becoming the main cause of death in this population. The early detection of cardiomyopathy is often challenging, due to a long subclinical phase of ventricular dysfunction and difficulties in assessment of cardiovascular symptomatology in these patients who usually loose ambulation during the early adolescence. However, an early diagnosis of cardiovascular disea...
Source: Heart - October 27, 2017 Category: Cardiology Authors: DAmario, D., Amodeo, A., Adorisio, R., Tiziano, F. D., Leone, A. M., Perri, G., Bruno, P., Massetti, M., Ferlini, A., Pane, M., Niccoli, G., Porto, I., DAngelo, G. A., Borovac, J. A., Mercuri, E., Crea, F. Tags: Reviews Source Type: research

Management of Kawasaki disease in adults
Kawasaki disease is the most common childhood vasculitis in the USA and the most common cause of acquired cardiac disease in children in developed countries. Since the vast majority of Kawasaki disease initially presents at
Source: Heart - October 27, 2017 Category: Cardiology Authors: Denby, K. J., Clark, D. E., Markham, L. W. Tags: Reviews Source Type: research

Importance of the valve durability-life expectancy ratio in selection of a prosthetic aortic valve
Surgical aortic valve replacement (SAVR) has historically been the treatment of choice for patients with severe symptomatic aortic stenosis (AS). More recently, transcatheter aortic valve implantation (TAVI) has become a well-established alternative option for patients considered at high and intermediate preoperative surgical risk. TAVI provides effective relief of valve obstruction with excellent immediate and short-term outcomes. However, long-term (ie >10 years) durability of TAVI, relative to the known durability of surgical bioprosthetic valves,1 also needs to be considered. Indeed, there is, up to now, very f...
Source: Heart - October 27, 2017 Category: Cardiology Authors: Bagur, R., Pibarot, P., Otto, C. M. Tags: Editorials Source Type: research

Cochrane corner: renal denervation for resistant hypertension--a broken promise?
Background Resistant or refractory hypertension is a condition characterised by blood pressure (BP) levels persistently over target, despite the contemporary use of three different classes of antihypertensive agents at optimal doses, including a diuretic.1 Epidemiology data indicate that this form of hypertension is not as rare as supposed. Analyses from the US National Health and Nutrition Examination Survey data and from a large Spanish database estimate that among treated adults with hypertension, about 12%–13% have resistant hypertension,2 while in trials of individuals aggressively titrated to reach BP targ...
Source: Heart - October 27, 2017 Category: Cardiology Authors: Bolignano, D., Coppolino, G. Tags: Editorials Source Type: research

Genotype-phenotype correlations in Marfan syndrome
Marfan syndrome (MFS) is an autosomal dominant connective-tissue disorder associated with abnormalities of the cardiovascular, ocular and musculoskeletal systems. Aortopathy, manifest as thoracic aortic aneurysm (TAA) and dissection, is the major cause of morbidity and mortality. Most individuals with MFS carry mutations in the gene FBN1. This gene encodes the extracellular matrix (ECM) protein fibrillin-1, which plays essential roles in the formation of microfibrils, organisation of ECM components and sequestration of growth factors such as transforming growth factor beta (TGFβ). Thus, mutations in FBN1 lead to delet...
Source: Heart - October 27, 2017 Category: Cardiology Authors: Landis, B. J., Veldtman, G. R., Ware, S. M. Tags: Editorials Source Type: research

Interaction between body mass index and physical fitness in primary heart failure prevention
Heart failure affects more than 40 million people worldwide and is a leading cause of hospitalisation and mortality.1 The aetiology of heart failure is often multifactorial and is influenced by both cardiovascular and non-cardiovascular risk factors.1 Although the prevalence of these risk factors vary according to sex, age, ethnicity, presence of comorbidities and environmental factors, the majority of cases remain preventable.1 In their Heart paper, Crump and colleagues2 provide insights into the aetiologic pathways for heart failure as they examine the interplay between body mass index (BMI) and different ...
Source: Heart - October 27, 2017 Category: Cardiology Authors: Schmidt, M. Tags: Editorials Source Type: research

Heartbeat: The potential power of genotype-phenotype correlations
We now easily can do genetic testing for specific inherited conditions in our patients; indeed, sequencing of the whole genome is possible. Yet, even with inherited conditions due to changes in a single gene, such as the FBN1 gene in Marfan syndrome, there is considerable variation in the specific mutation in each patient. Presumably, resultant differences in the abnormal fibrillin-1 protein translate into differences in clinical disease manifestations. A better understanding of the genotype–phenotype relationships in Marfan syndrome might be useful in identifying which patients require more frequent diagnostic evalu...
Source: Heart - October 27, 2017 Category: Cardiology Authors: Otto, C. M. Tags: Heartbeat Source Type: research

A 49-year-old with chest pain and collapse
Clinical introduction A 49-year-old man presented to the emergency department following sudden onset chest pain with collapse. He was refurbishing his home when he collapsed on the floor with chest and abdominal pain. He awoke 1 hour later and called the emergency services due to persisting chest discomfort that worsened with inspiration. On arrival in the emergency department, his pulse was thready (88/58 mm Hg) with pulsus paradoxus on inspiration. High-sensitivity troponin I was elevated at 325 ng/L (normal range 1–34 ng/L). Fluid resuscitation was administered and contrast-enhanced CT imaging was perfor...
Source: Heart - May 31, 2017 Category: Cardiology Authors: Moss, A. J., Lim, K. H., Japp, A. G. Tags: Open access Image challenge Source Type: research

Re: A case for palliative percutaneous coronary intervention
The Authors’ reply: We would like to thank Sarah Blake et al1 for their thoughtful and insightful comments. First, we agree that ‘palliative percutaneous coronary intervention (PCI)’ can be a very useful treatment in this elderly patient population. Locally at our institution, via our heart team meeting, we can offer an elderly symptomatic patient with multiple comorbidities PCI, which often fails to achieve complete revascularisation (even with small territories left ischaemic) but offers significant improvement in symptoms and can leave them safer in the presence of left main stem or proximal left ...
Source: Heart - May 31, 2017 Category: Cardiology Authors: Cockburn, J., Hildick-Smith, D. J., Trivedi, U., de Belder, A. J. Tags: PostScript Source Type: research

A case for palliative percutaneous coronary intervention
To the editor On reading the review on coronary revascularisation in the elderly by Cockburn et al,1 I must agree that more trials are needed to focus on the benefit of percutaneous coronary intervention (PCI) in elderly populations. When assessing these patients, clinicians should consider the impact of symptom relief versus procedural risk. If a patient is experiencing recurrent and debilitating chest pain requiring frequent hospital admission, then the risks of PCI, despite multiple comorbidities, could easily be rationalised when the benefit to the patient is clear. In such patients this ‘palliative PCI’ ap...
Source: Heart - May 31, 2017 Category: Cardiology Authors: Blake, S. R. Tags: PostScript Source Type: research

84-year-old woman with dizziness
Discussion There is evidence of atrioventricular dissociation with P waves notching the trace in V1–V3 (see online ), and with the... (Source: Heart)
Source: Heart - May 31, 2017 Category: Cardiology Authors: Watson, W., Ring, L., Salahshouri, P. Tags: Image challenge Source Type: research

Aortopathies in adult congenital heart disease and genetic aortopathy syndromes: management strategies and indications for surgery
Learning objectives Review the epidemiology, histology, pathophysiology and genetics of congenital heart disease-associated aortopathies and genetic aortopathy syndromes. Review and describe appropriate imaging strategies for diagnosis and follow-up appropriate pharmacotherapeutic strategies and indications for aortic surgery considerations relevant to pregnancy considerations relevant to sports participation in patients with congenital heart disease-associated aortopathy or a genetic aortopathy syndrome. Introduction Progressive proximal aortic (ie, aortic root and ascending aortic) dilatation is frequently found in adult...
Source: Heart - May 31, 2017 Category: Cardiology Authors: Kuijpers, J. M., Mulder, B. J. Tags: Education in Heart Source Type: research

The management of the third stage of labour in women with heart disease
Conclusions The use of an additional 2 U of oxytocin for the management of third stage in women with HD had no cardiac consequences and was associated with a significantly lower blood loss. Further larger studies on a larger population of women with HD are needed. (Source: Heart)
Source: Heart - May 31, 2017 Category: Cardiology Authors: Cauldwell, M., Steer, P. J., Swan, L., Uebing, A., Gatzoulis, M. A., Johnson, M. R. Tags: Congenital heart disease in adult patients Source Type: research

Antibiotic prophylaxis for infective endocarditis: a systematic review and meta-analysis
The objective of this systematic review was to appraise the evidence for use of AP for prevention of bacteraemia or IE in patients undergoing dental procedures. Methods We conducted electronic searches in Medline, Embase, Cochrane Library and ISI Web of Science. We assessed the methodological characteristics of included studies using the Strengthening the Reporting of Observational Studies in Epidemiology criteria for observational studies and the Cochrane Risk of Bias Tool for trials. Two reviewers independently determined the eligibility of studies, assessed the methodology of included studies and extracted the data. R...
Source: Heart - May 31, 2017 Category: Cardiology Authors: Cahill, T. J., Harrison, J. L., Jewell, P., Onakpoya, I., Chambers, J. B., Dayer, M., Lockhart, P., Roberts, N., Shanson, D., Thornhill, M., Heneghan, C. J., Prendergast, B. D. Tags: Valvular heart disease Source Type: research

Feasibility and predictors of early discharge after percutaneous edge-to-edge mitral valve repair
Conclusions In selected patients undergoing PMVR, ED may be feasible and safe. (Source: Heart)
Source: Heart - May 31, 2017 Category: Cardiology Authors: Tamburino, C., Buccheri, S., Popolo Rubbio, A., Scandura, S., Di Salvo, M. E., Mangiafico, S., Imme, S., Caruso, G., Scalia, M., Condorelli, A., Barbanti, M., Capranzano, P., Capodanno, D., Grasso, C. Tags: Valvular heart disease Source Type: research

Long-term prognosis associated with early repolarisation pattern in Chinese population with atherosclerotic risk factors
Conclusions ERP is associated with a significantly increased risk for SCD, CHD death and death from any cause in people with atherosclerotic risk factors. The observed association between ERP and all-cause mortality appears to be driven by an association with CHD death, in particular SCD. (Source: Heart)
Source: Heart - May 31, 2017 Category: Cardiology Authors: Cheng, Y.-J., Mei, W.-Y., Chen, X.-M., Liu, L.-J., Zheng, D.-D., Ji, C.-c., Tang, K., Wu, S.-H. Tags: Arrhythmias and sudden death Source Type: research

Nationwide experience of catecholaminergic polymorphic ventricular tachycardia caused by RyR2 mutations
Objective The aim of this study was to characterise disease penetrance, course of disease and use of antiarrhythmic medication and implantable cardioverter-defibrillator (ICD) therapy in a Danish nationwide cohort of patients with catecholaminergic polymorphic ventricular tachycardia (CPVT) due to mutations in the ryanodine receptor-2 (RyR2) gene. Methods The study population was identified through the national hereditary heart disease database (Progeny). The study population was divided into three groups: probands, symptomatic and asymptomatic relatives. Results We identified 23 symptomatic probands, 18 symptomatic and ...
Source: Heart - May 31, 2017 Category: Cardiology Authors: Broendberg, A. K., Nielsen, J. C., Bjerre, J., Pedersen, L. N., Kristensen, J., Henriksen, F. L., Bundgaard, H., Jensen, H. K. Tags: Arrhythmias and sudden death Source Type: research

Cyanotic congenital heart disease and atherosclerosis
Improved treatment options in paediatric cardiology and congenital heart surgery have resulted in an ageing population of patients with cyanotic congenital heart disease (CCHD). The risk of acquired heart disease such as atherosclerosis increases with age. Previous studies have speculated whether patients with CCHD are protected against atherosclerosis. Results have shown that the coronary arteries of patients with CCHD are free from plaques and stenosis. Decreased carotid intima-media thickness and low total plasma cholesterol may indicate a reduced risk of later development of atherosclerosis. However, the evidence is st...
Source: Heart - May 31, 2017 Category: Cardiology Authors: Tarp, J. B., Jensen, A. S., Engstrom, T., Holstein-Rathlou, N.-H., Sondergaard, L. Tags: Correction notice Source Type: research

Cochrane corner: self-monitoring and self-management of oral anticoagulation
Background Use of oral anticoagulants such as warfarin is increasing. Part of the reason for this is the rising prevalence of atrial fibrillation, an ageing population and the widening indications for treatment based on evidence of benefit in reducing risk of stroke. A meta-analysis of 29 randomised trials including 28 044 participants with atrial fibrillation found that warfarin decreased the absolute risk of stroke by 2.7% per year (the number needed to treat (NNT) 37) compared with placebo or no treatment and by 0.7% per year (NNT=143) compared with aspirin.1 Management of warfarin, however, is challenging bec...
Source: Heart - May 31, 2017 Category: Cardiology Authors: Heneghan, C. J., Spencer, E. A., Mahtani, K. R. Tags: Editorials Source Type: research

Text messaging for prevention and treatment of cardiovascular disease: time to move on
In patients with cardiovascular diseases, comprehensive risk factor control and lifestyle modification reduce the risk of recurrent events and the need for revascularisation procedures, and improve survival and quality of life.1 Despite this convincing evidence, in the real world, there are several barriers that hamper the application of such measures and prevent patients from benefiting from measures that reduce cardiovascular risk. Non-adherence to preventive and therapeutic lifestyle recommendations remains a special challenge in the management of these patients.2 This challenge requires innovative management strat...
Source: Heart - May 31, 2017 Category: Cardiology Authors: Marcolino, M. S., Oliveira, J. A. d. Q., Ribeiro, A. L. Tags: Editorials Source Type: research

Cost-effectiveness of a text message programme for the prevention of recurrent cardiovascular events
Conclusions The provision of TEXT ME is predicted to lead to better health outcomes and an overall saving in costs for the health system. Trial registration number anzctr.org.au identifier: ACTRN12611000161921. (Source: Heart)
Source: Heart - May 31, 2017 Category: Cardiology Authors: Burn, E., Nghiem, S., Jan, S., Redfern, J., Rodgers, A., Thiagalingam, A., Graves, N., Chow, C. K. Tags: Editor's choice Healthcare delivery, economics and global health Source Type: research

Predicting the future of cardiovascular risk prediction
The iconic Framingham Heart Study paved the way for many prospective epidemiological cohort studies of cardiovascular disease (CVD) around the world, and the subsequent development of tools which can predict risk of future disease. There have been tools for a broad spectrum of outcomes from absolute CVD risk at varying time points to lifetime risk1 and vascular age.2 Multiple scores for incident CVD have been derived and validated, and adopted in consensus guidelines for use in routine practice. However, the major burden of CVD events occurs in individuals who have already been diagnosed with recurrent disease, yet even in...
Source: Heart - May 31, 2017 Category: Cardiology Authors: Banerjee, A. Tags: Editorials Source Type: research

Developing and validating a cardiovascular risk score for patients in the community with prior cardiovascular disease
Objective Patients with atherosclerotic cardiovascular disease (CVD) vary significantly in their risk of future CVD events; yet few clinical scores are available to aid assessment of risk. We sought to develop a score for use in primary care that estimates short-term CVD risk in these patients. Methods Adults aged
Source: Heart - May 31, 2017 Category: Cardiology Authors: Poppe, K. K., Doughty, R. N., Wells, S., Gentles, D., Hemingway, H., Jackson, R., Kerr, A. J. Tags: Cardiac risk factors and prevention Source Type: research

Catecholaminergic polymorphic tachycardia: underestimated and overtreated?
When the first four cases of catecholaminergic polymorphic tachycardia (CPVT) were reported over 40 years ago,1 we could only speculate about the incidence, cause and treatment of this elusive and lethal disease. Since then, important progress has been made in the understanding of CPVT, from bench to bedside. In 1999, Swan et al2 described a linkage to chromosome 1q42-q43, and 2 years later, the gene was identified as coding for the ryanodine receptor gene (RYR2). RYR2 has a crucial role in regulating the calcium homeostasis in the cardiac myocyte. In recent years, additional genes (CASQ2, CALM2 and TRD) involved in the ca...
Source: Heart - May 31, 2017 Category: Cardiology Authors: Pflaumer, A. Tags: Editorials Source Type: research

Heartbeat: Text messaging to improve health
It has been challenging to develop effective interventions to increase the number of people engaged in heart healthy behaviours. We all look at our phones all the time; text messaging offers a simple way to reach our patients one on one. Burn and colleagues1 used a Markov model, based on a previous randomised trial and meta-analysis, to evaluate the effect of a simple text messaging programme for secondary prevention of adverse cardiovascular disease (CVD) events and improvement in quality adjusted life years (QALYs) in patients with known coronary artery disease (CAD). The programme, called TEXT ME, consists of 4 weekly t...
Source: Heart - May 31, 2017 Category: Cardiology Authors: Otto, C. M. Tags: Heartbeat Source Type: research

47-year-old female with an apical mass
Clinical introduction A 47-year-old female with no medical history presented with a sudden collapse. Physical examination, chest X-ray and high-sensitivity cardiac troponin I were normal, however ECG demonstrated anterior T-wave inversion. CT pulmonary angiography was performed which ruled out pulmonary embolism but revealed a non-calcified, homogenous mass at the left ventricular (LV) apex. It was not clear whether this mass was intramyocardial or pericardial. Transthoracic echocardiography confirmed the apical mass but was unable to establish its aetiology. Subsequent cardiac MR (CMR) demonstrated a highly vascular intra...
Source: Heart - May 10, 2017 Category: Cardiology Authors: Andrews, J., Lang, C. C., Dweck, M. Tags: Open access, Image challenges Source Type: research

Optimal duration of dual antiplatelet therapy after acute coronary syndromes and coronary stenting
Learning objectives To provide an overview on the concept of dual antiplatelet therapy (DAPT). To review the evidence regarding shorter and longer DAPT duration. To describe the benefits and risks associated with shorter or longer duration of DAPT in patients with acute coronary syndrome and in patients with stable coronary artery disease after coronary stenting. To suggest an algorithm for optimal duration of DAPT. Introduction Dual antiplatelet therapy (DAPT) consisting of aspirin and a P2Y12 receptor antagonist (either a thienopyridine (clopidogrel or prasugrel) or a cyclopentyl-triazolopyrimidine (ticagrelor)) is the c...
Source: Heart - May 10, 2017 Category: Cardiology Authors: Eisen, A., Bhatt, D. L. Tags: Education in Heart, Drugs: cardiovascular system, Interventional cardiology, Venous thromboembolism, Clinical diagnostic tests Acute coronary syndromes, chronic ischaemic heart disease Source Type: research

Sex differences in prodromal symptoms in acute coronary syndrome in patients aged 55 years or younger
Background Studies suggest that young women are at highest risk for failing to recognise early symptoms of acute coronary syndrome (ACS). Objectives To examine sex differences in prodromal symptoms occurring days and weeks prior to the acute presentation of ACS. We also examined health-seeking behaviours and prehospital management in young patients. Methods Prospective cross-sectional analysis of 1145 patients (368 women) hospitalised for ACS, aged ≤55 years, from the GENdEr and Sex DetermInantS of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary SYndrome cohort study (January 2009–Apri...
Source: Heart - May 10, 2017 Category: Cardiology Authors: Khan, N. A., Daskalopoulou, S. S., Karp, I., Eisenberg, M. J., Pelletier, R., Tsadok, M. A., Dasgupta, K., Norris, C. M., Pilote, L., for the GENESIS PRAXY Team, Bacon, Cox, Engert, Ghali, Humphries, Lavoie, Rabi, So, Stark, Tagalakis, Thanassoulis, Shimo Tags: Coronary artery disease Source Type: research

Fibroblast growth factor 23 as novel biomarker for early risk stratification after ST-elevation myocardial infarction
Objective Adverse left ventricular (LV) remodelling is the major determinant of heart failure and mortality in survivors of ST-elevation myocardial infarction (STEMI). The role of fibroblast growth factor 23 (FGF-23) for LV remodelling prediction after STEMI is unknown. We therefore aimed to investigate the relation between circulating FGF-23 and LV remodelling following revascularised STEMI. Methods In this prospective observational study, we included 88 consecutive patients with STEMI treated by primary percutaneous coronary intervention. FGF-23 concentrations were measured 2 (IQR: 2–2) days after symptom onset. C...
Source: Heart - May 10, 2017 Category: Cardiology Authors: Reindl, M., Reinstadler, S. J., Feistritzer, H.-J., Mueller, L., Koch, C., Mayr, A., Theurl, M., Kirchmair, R., Klug, G., Metzler, B. Tags: Coronary artery disease Source Type: research

Morphological variability of the arterial valve in common arterial trunk and the concept of normality
Objective Until now, no study established a morphometric evaluation of the truncal valve dysplasia and a description of its different presentation patterns. Thus, authors conducted an anatomopathological study describing the gross features and histological findings of the truncal valve. Methods 50 common arterial trunk (CAT) specimens were examined. The number of valvar leaflets was determined and valvar dysplasia was classified as absent, mild, moderate or severe. Selected leaflets were sectioned and submitted to histological analysis and linear measurements (thickness, length and area), besides quantification of collage...
Source: Heart - May 10, 2017 Category: Cardiology Authors: Liguori, G. R., Jatene, M. B., Ho, S. Y., Aiello, V. D. Tags: Congenital heart disease in adult patients Source Type: research

Outcomes of an integrated community-based nurse-led cardiovascular disease prevention programme
Background National guidance for England recommends that cardiovascular disease (CVD) should be managed as a family of diseases in the community. Here, we describe the results of such an approach. Methods Patients with established CVD or who were at high multifactorial risk (HRI) underwent a 12-week community-based nurse-led prevention programme (MyAction) that included lifestyle and risk factor management, prescription of medication and weekly exercise and education sessions. Results Over a 6-year period, 3232 patients attended an initial assessment; 63% were male, and 48% belonged to black and minority ethnic groups. 5...
Source: Heart - May 10, 2017 Category: Cardiology Authors: Connolly, S. B., Kotseva, K., Jennings, C., Atrey, A., Jones, J., Brown, A., Bassett, P., Wood, D. A. Tags: 1507 Source Type: research

A 38-year-old man with progressive dyspnoea and ventricular tachycardia
Clinical introduction A previously healthy 38-year-old man presented with a 3-month history of progressive dyspnoea and ventricular tachycardia (VT). He suffered a viral illness 4 months earlier. There was no family history of cardiac disease or sudden cardiac death (SCD). ECG showed left bundle branch block (LBBB). Echocardiography revealed a dilated left ventricle with severely impaired systolic function. Coronary angiogram showed angiographically normal coronary arteries. He was diagnosed as having dilated cardiomyopathy and was referred for further assessment with cardiovascular magnetic resonance (CMR) (figure 1)...
Source: Heart - May 10, 2017 Category: Cardiology Authors: Liew, A. C., Raphael, C. E., Mohiaddin, R. Tags: Image challenges Source Type: research

Prospective study of oral anticoagulants and risk of liver injury in patients with atrial fibrillation
Conclusions Among patients with non-valvular AF, DOACs were associated with lower risk of liver injury hospitalisation compared with warfarin, with dabigatran showing the lowest risk. (Source: Heart)
Source: Heart - May 10, 2017 Category: Cardiology Authors: Alonso, A., MacLehose, R. F., Chen, L. Y., Bengtson, L. G., Chamberlain, A. M., Norby, F. L., Lutsey, P. L. Tags: Arrhythmias and sudden death Source Type: research

Impact of urbanisation and altitude on the incidence of, and risk factors for, hypertension
Conclusions Our results suggest heterogeneity in the progression towards hypertension depending on urbanisation and site altitude. (Source: Heart)
Source: Heart - May 10, 2017 Category: Cardiology Authors: Bernabe-Ortiz, A., Carrillo-Larco, R. M., Gilman, R. H., Checkley, W., Smeeth, L., Miranda, J. J., CRONICAS Cohort Study Group, Casas, Smith, Ebrahim, Garcia, Huicho, Malaga, Montori, Diette, Gilman, Huicho, Leon-Velarde, Rivera, Wise, Checkley, Garcia, G Tags: Open access Special populations Source Type: research

Warfarin utilisation and anticoagulation control in patients with atrial fibrillation and chronic kidney disease
Conclusions There is a wide variation in anticoagulation prescription based on CKD severity. Patients with moderate-to-severe CKD, including dialysis, have substantially reduced TTR, despite comparable INR monitoring intensity. These findings have implications for more intensive warfarin management strategies in CKD or alternative therapies such as direct oral anticoagulants. (Source: Heart)
Source: Heart - May 10, 2017 Category: Cardiology Authors: Yang, F., Hellyer, J. A., Than, C., Ullal, A. J., Kaiser, D. W., Heidenreich, P. A., Hoang, D. D., Winkelmayer, W. C., Schmitt, S., Frayne, S. M., Phibbs, C. S., Turakhia, M. P. Tags: Drugs: cardiovascular system, Epidemiology Special populations Source Type: research

Amyloid heart disease: genetics translated into disease-modifying therapy
Given increased awareness and improved non-invasive diagnostic tools, cardiac amyloidosis has become an increasingly recognised aetiology of increased ventricular wall thickness and heart failure with preserved ejection fraction. Once considered a rare disease with no treatment options, translational research has harnessed novel pathways and led the way to promising treatment options. Gene variants that contribute to amyloid heart disease provide unique opportunities to explore potential disease-modifying therapeutic strategies. Amyloidosis has become the model disease through which gene therapy using small interfering RNA...
Source: Heart - May 10, 2017 Category: Cardiology Authors: Sperry, B. W., Tang, W. H. W. Tags: Reviews Source Type: research

Drug-induced liver injury with oral anticoagulants: a threat or not?
Drug-induced liver injury (DILI) can develop with the use of virtually any drug. The growing list of medications or herbal products reported in association with DILI presently includes >1000 compounds, but the annual incidence of DILI has been estimated to only 1–1.5 per 1000–10 000 exposed persons.1 Nonetheless, DILI accounts for ~10% of all acute hepatitis cases and is the most common cause of acute liver failure (ALF).1 2 Drugs (or their metabolites) can affect the liver in a dose-dependent, predictable fashion (eg, acetaminophen) or via unpredictable immune-mediated (eg, phenytoin) or metabolic...
Source: Heart - May 10, 2017 Category: Cardiology Authors: Potpara, T. S., Lip, G. Y. Tags: Editorials Source Type: research

Oral anticoagulation in end-stage renal disease and atrial fibrillation: is it time to just say no to drugs?
Atrial fibrillation (AF) frequently complicates the management of chronic kidney disease, especially in patients with end-stage renal disease (ESRD). AF occurs in approximately one in five of the 650 000 patients with ESRD in the USA.1 ESRD confers increased risk for AF, while AF hastens progression to ESRD. The presence of chronic kidney disease in patients with AF is associated with an increased risk for ischaemic stroke independent of traditional risk factors. In addition, chronic kidney disease and particularly ESRD are associated with an increased risk of bleeding. Little is understood about how to safely reduce ...
Source: Heart - May 10, 2017 Category: Cardiology Authors: Black-Maier, E., Piccini, J. P. Tags: Editorials Source Type: research

Integrated programmes for cardiovascular disease risk reduction: the need for new models of care
Cardiovascular disease (CVD) remains a leading cause of mortality and morbidity worldwide. Although mortality rates for CVD have fallen by up to three-quarters in the UK, it still accounts for 26% of all deaths there. It costs the UK economy over £15 billion each year.1 Declining CVD mortality rates increases the number of individuals surviving into old age with CVD, leaving them at increased risk for a subsequent event. For individuals who have not suffered an event, the presence of certain genetic, behavioural and biological factors increases their risk of CVD. At least 80% of CVDs are potentially preventable by th...
Source: Heart - May 10, 2017 Category: Cardiology Authors: Ofori, S. N. Tags: Editorials Source Type: research

Heartbeat: Managing cardiovascular disease as a family of diseases in the community
Although at least 80% of cardiovascular disease (CVD) is potentially preventable by the elimination of health risk behaviours, implementation of effective, large scale and sustainable CVD prevention programs is still a challenge. In this issue of Heart, Connolly et al1 describe an experience in which patients at high risk of or with established CVD underwent a 12 week community-based nurse-led prevention programme called My Action (figure 1) which included lifestyle and risk factor management, prescription of medication and weekly exercise and education sessions. The programme is in accordance to recent British recommendat...
Source: Heart - May 10, 2017 Category: Cardiology Authors: Ribeiro, A. L., Otto, C. M. Tags: Heartbeat Source Type: research

The British Cardiovascular Society Annual Conference, Manchester, 5-7 June 2017: the Vice-Presidents message
One of the first questions I am asked whenever a forthcoming British Cardiovascular Society (BCS) Annual Conference is being discussed is the proposed ‘theme’ of the meeting. Initially I found this surprising as the main function of the conference, at least as far as the programme committee and I are concerned, is to provide a reasonably comprehensive coverage of the latest developments in all the subspecialist areas of cardiology rather than focus on a particular area. The concept of a theme arose a few years ago as a means of adding interest to the programme and as a stimulus for generation of ideas for novel...
Source: Heart - May 10, 2017 Category: Cardiology Authors: Garratt, C. J. Tags: Editorials Source Type: research