Advances in cardiac resynchronisation therapy: review of indications and delivery options
Learning objectives Understand who is likely to benefit from cardiac resynchronisation therapy (CRT). Provide an overview of CRT trial data. Appreciate approaches to maximise patient selection and maximise patient benefit from CRT. Consider the potential for conduction system pacing to deliver CRT and to possibly expand the indications to additional patient groups. Introduction The aim of cardiac resynchronisation therapy (CRT) is to improve cardiac function by delivering more physiological cardiac activation to patients with conduction system disease. The most widely investigated method for delivering CRT is biventricular...
Source: Heart - May 12, 2022 Category: Cardiology Authors: Keene, D., Whinnett, Z. I. Tags: Education in Heart Source Type: research

Severity of anaemia and association with all-cause mortality in patients with medically managed left-sided endocarditis
Conclusion Moderate to severe anaemia was present in 29% of patients with medically treated IE after stabilisation of infection and was independently associated with higher mortality within the following 3 years. Further investigations are warranted to determine whether intensified treatment of anaemia in patients with IE might improve outcome. (Source: Heart)
Source: Heart - May 12, 2022 Category: Cardiology Authors: Pries-Heje, M. M., Hasselbalch, R. B., Wiingaard, C., Fosbol, E. L., Glenthoj, A. B., Ihlemann, N., Gill, S. U. A., Christiansen, U., Elming, H., Bruun, N. E., Povlsen, J. A., Helweg-Larsen, J., Schultz, M., Ostergaard, L., Fursted, K., Christensen, J. J. Tags: Valvular heart disease Source Type: research

Incident aortic stenosis in 49 449 men and 42 229 women investigated with routine echocardiography
Conclusions New onset AS is a common finding among older patients followed up with echocardiography. Any grade of AS is associated with higher mortality, reinforcing the need for proactive vigilance. (Source: Heart)
Source: Heart - May 12, 2022 Category: Cardiology Authors: Stewart, S., Chan, Y.-K., Playford, D., Strange, G. A., NEDA Investigators Tags: Valvular heart disease Source Type: research

Incidence, risk factors, natural history and outcomes of heart failure in patients with Graves disease
Conclusion De novo HF occurs in 5.4% of patients with GD and is associated with increased risk of cardiovascular hospitalisations and mortality. Risk factors include AF, higher TRAb, higher BMI and overt hyperthyroidism. (Source: Heart)
Source: Heart - May 12, 2022 Category: Cardiology Authors: Naser, J. A., Pislaru, S., Stan, M. N., Lin, G. Tags: Heart failure and cardiomyopathies Source Type: research

Physician judgement in predicting obstructive coronary artery disease and adverse events in chest pain patients
Conclusions Compared with D-F and ESC estimates, physician judgement more accurately identified obstructive CAD and worse patient outcomes. Integrating physician judgement may improve risk prediction for patients with stable chest pain. Trial registration number NCT01174550. (Source: Heart)
Source: Heart - May 12, 2022 Category: Cardiology Authors: Fordyce, C. B., Hill, C. L., Mark, D. B., Alhanti, B., Pellikka, P. A., Hoffmann, U., Patel, M. R., Douglas, P. S., on behalf of the PROMISE Investigators Tags: Coronary artery disease Source Type: research

Late complication rates after aortic coarctation repair in patients with or without a bicuspid aortic valve
Conclusion In adults with repaired CoA, patients with CoA-BAV are more than twice as likely to require cardiovascular reintervention by early-to-mid-adult life compared with those with CoA alone. Despite this, no difference in survival outcomes was observed. (Source: Heart)
Source: Heart - May 12, 2022 Category: Cardiology Authors: Lim, M. S., Cordina, R., Kotchetkova, I., Celermajer, D. S. Tags: Congenital heart disease Source Type: research

Fluid challenge and balloon occlusion testing in patients with atrial septal defects
Conclusions In adults with ASD without overt LV disease, even small rises in PVR may have significant implications on cardiovascular haemodynamics. Fluid challenge may provide additional information to balloon occlusion in this setting. (Source: Heart)
Source: Heart - May 12, 2022 Category: Cardiology Authors: DAlto, M., Constantine, A., Chessa, M., Santoro, G., Gaio, G., Giordano, M., Romeo, E., Argiento, P., Wacker, J., DAiello, A. F., Sarubbi, B., Russo, M. G., Naeije, R., Golino, P., Dimopoulos, K. Tags: Congenital heart disease Source Type: research

Man with recent myocardial infarction and heart failure
Clinical introduction A man in his 50s was referred to our hospital after being treated for acute anterior wall myocardial infarction (MI) with intravenous thrombolysis. The patient had worsening dyspnoea. Examination revealed elevated jugular venous pressure, bilateral crackles and a prominent pansystolic murmur. Coronary angiogram revealed significant stenosis of the distal left main and ostioproximal left anterior descending artery. A left ventriculogram was performed during cardiac catheterisation (figure 1, video 1). Figure 1Left ventriculogram in left anterior oblique projection. Video 1Disclaimer: this video summa...
Source: Heart - May 12, 2022 Category: Cardiology Authors: Bhasin, D., Kumar, R., Bansal, S. Tags: Image challenges Source Type: research

Impact of cascade screening for catecholaminergic polymorphic ventricular tachycardia type 1
Conclusions CPVT1 probands harbouring de novo RYR2 variants showed an earlier onset of symptoms than those with assured familial inheritance. Cascade screening may enable early diagnosis, risk stratification and prophylactic therapeutic intervention to prevent sudden cardiac death of probands and potential genotype-positive family members. (Source: Heart)
Source: Heart - May 12, 2022 Category: Cardiology Authors: Shimamoto, K., Ohno, S., Kato, K., Takayama, K., Sonoda, K., Fukuyama, M., Makiyama, T., Okamura, S., Asakura, K., Imanishi, N., Kato, Y., Sakaguchi, H., Kamakura, T., Wada, M., Yamagata, K., Ishibashi, K., Inoue, Y., Miyamoto, K., Nagase, S., Kusano, K., Tags: Open access, Editor's choice Arrhythmias and sudden death Source Type: research

Role of digital health in detection and management of atrial fibrillation
Atrial fibrillation is a common arrhythmia associated with significant morbidity, mortality and decreased quality of life. Mobile health devices marketed directly to consumers capable of detecting atrial fibrillation through methods including photoplethysmography, single-lead ECG as well as contactless methods are becoming ubiquitous. Large-scale screening for atrial fibrillation is feasible and has been shown to detect more cases than usual care—however, controversy still exists surrounding screening even in older higher risk populations. Given widespread use of mobile health devices, consumer-driven screening is ha...
Source: Heart - May 12, 2022 Category: Cardiology Authors: Tooley, J. E., Perez, M. V. Tags: Review articles Reviews Source Type: research

Cardiac myxomas: clinical presentation, diagnosis and management
Cardiac myxomas (CM) are the most common type of primary cardiac tumours in adults, which have an approximate incidence of up to 0.2% in some autopsy series. The purpose of this review is to summarise the literature on CM, including clinical presentation, differential diagnosis, work-up including imaging modalities and histopathology, management, and prognosis. CM are benign neoplasms developed from multipotent mesenchyme and usually present as an undifferentiated atrial mass. They are typically pedunculated and attached at the fossa ovalis, on the left side of the atrial septum. Potentially life-threatening, the presence ...
Source: Heart - May 12, 2022 Category: Cardiology Authors: Griborio-Guzman, A. G., Aseyev, O. I., Shah, H., Sadreddini, M. Tags: Review articles Reviews Source Type: research

British Societies' recommendations for Heart Team multidisciplinary meetings: broadly relevant principles with anticipated regional differences in process
The concept of a Heart Team approach to evaluating patients with cardiovascular disease was fuelled by the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial for severe coronary artery disease and the Placement of Aortic Transcatheter Valves (PARTNER) trial for aortic stenosis (AS).1 2 It was subsequently included as a recommended practice in guidelines for the management of patients with coronary artery disease and AS.3–5 Unpacking the rationale, purpose, composition, process and work of the Heart Team has been an evolving process that is being increasingly applied to additional cardiovascular disease...
Source: Heart - May 12, 2022 Category: Cardiology Authors: Lindman, B. R., Goel, K. Tags: Editorials Source Type: research

Trust us! Time to move on from pretest probability scores for stable chest pain
Over the past four decades the medical community has been searching for methods to accurately assess pretest probability (PTP) of angiographically significant coronary artery disease (CAD) in patients with chest pain to optimally guide testing according to Bayesian principles. In 1979, Diamond and Forrester (D-F)1 famously described an approach using only patient age, sex and angina typicality to estimate the PTP of a stenosis of at least 50% on invasive coronary angiography. Beautiful in its simplicity, the D-F approach was broadly endorsed in international guidelines and clinical practice for decades until it was proven ...
Source: Heart - May 12, 2022 Category: Cardiology Authors: Villines, T. C., Weber, L. A. Tags: Editorials Source Type: research

Catecholaminergic polymorphic ventricular tachycardia: differences in inheritance and implications for patients, families and future studies
Sudden cardiac arrest (SCA) in young and otherwise healthy individuals remains an intriguing occurrence that warrants in-depth evaluation. In the past decades, the origin of these cardiac arrests has finally been elucidated in many SCA victims. For example, long-QT syndrome (LQTS), Brugada syndrome and catecholaminergic polymorphic ventricular tachycardia (CPVT) were found to coincide with these cases.1 2 CPVT is the subject of the paper by Shimamoto and colleagues from multiple centres in Japan.3 CPVT is one of the rare arrhythmia syndromes, its prevalence is estimated to be approximately 1 in 10 000 individuals, and it a...
Source: Heart - May 12, 2022 Category: Cardiology Authors: Postema, P. G., van der Werf, C. Tags: Editorials Source Type: research

Heartbeat: can cardiogenetics reduce adverse events due to catecholaminergic polymorphic ventricular tachycardia?
A genetic diagnosis is of increasing importance in prevention of adverse events in patients with cardiovascular disease.1 For example, catecholaminergic polymorphic ventricular tachycardia type 1 (CPVT1) is usually due to a pathogenic variant in cardiac ryanodine receptor 2 (RYR2) and is inherited in a familial autosomal dominant pattern, but sporadic cases also have been reported. In this issue of Heart, Shimamoto and colleagues2 compared 24 probands with familial inheritance of CPVT1 to 58 patients with de novo variants. In both groups, almost 1/2 the probands presented with syncope or cardiac arrest before a genetic dia...
Source: Heart - May 12, 2022 Category: Cardiology Authors: Otto, C. M. Tags: Heartbeat Source Type: research