Dual potential embolic source detected in left atrium during hyperacute stroke
Clinical introduction A woman in her late 60s with a medical history of hypertension presented to the emergency department with symptoms of a stroke which began 40 min prior. Brain MRI was performed (figure 1A). Hyperacute CT angiography of the head and neck did not find any atherosclerosis. ECG is shown (figure 1B), and subsequent transthoracic echocardiography showed left atrium enlargement and left-to-right flow at the region of the fossa ovalis (figure 1C). Figure 1Brain MRI of diffusion-weighted image sequence (A), ECG (B), and transthoracic echocardiogram (C). Question Which of the following is the most likely mecha...
Source: Heart - September 13, 2023 Category: Cardiology Authors: Fu, Z., Xu, C., Gao, L. Tags: Image challenges Source Type: research
Pericoronary adipose tissue density is increased in patients with recent spontaneous coronary dissection
Conclusions
Patients with recent SCAD have higher PCAT compared with patients without SCAD, suggesting an increased perivascular inflammatory activity. This association is not restricted to the dissected vessel. (Source: Heart)
Source: Heart - September 13, 2023 Category: Cardiology Authors: Wolny, R. R., Kwiecinski, J., Zalewska, J., Michałowska, I., Kruk, M., Kepka, C., Prejbisz, A., Pregowski, J., Chwała, A., Skowronski, J., Kobierska, A., Ciesielski, R., Januszewicz, A., Witkowski, A., Adlam, D., Dey, D., Kadziela, J. Tags: Aortic and vascular disease Source Type: research
Prognostic models for heart failure in patients with type 2 diabetes: a systematic review and meta-analysis
Conclusions
Among the prognostic models identified, four models showed promising performance and, thus, could be implemented in current clinical practice. (Source: Heart)
Source: Heart - September 13, 2023 Category: Cardiology Authors: Kostopoulos, G., Doundoulakis, I., Toulis, K. A., Karagiannis, T., Tsapas, A., Haidich, A.-B. Tags: Heart failure and cardiomyopathies Source Type: research
Role of percutaneous coronary intervention in the modern-day management of chronic coronary syndrome
Contemporary randomised trials of percutaneous coronary intervention (PCI) in chronic coronary syndrome (CCS) demonstrate no difference between patients treated with a conservative or invasive strategy with respect to all-cause mortality or myocardial infarction, although trials lack power to test for individual endpoints and long-term follow-up data are needed. Open-label trials consistently show greater improvement in symptoms and quality of life among patients with stable angina treated with PCI. Further studies are awaited to clarify this finding. In patients with severe left ventricular (LV) systolic dysfunction and o...
Source: Heart - September 13, 2023 Category: Cardiology Authors: Cartlidge, T., Kovacevic, M., Navarese, E. P., Werner, G., Kunadian, V. Tags: Review articles Reviews Source Type: research
Aortic valve calcification and outcomes in severe aortic stenosis
Calcification of the valve leaflets is generally regarded to be a core feature of degenerative aortic stenosis (AS). Indeed, such is the importance of calcium deposition, the condition is commonly referred to as calcific AS. Historically, the process by which stenosis progressed was considered to be passive. It is, however, now well established that the evolution of AS is an active, inflammatory, process.1 Initial valvular endothelial injury, through mechanical shear stress and other risk factors, results in lipid infiltration and oxidisation. This leads to an inflammatory cascade and pathological activation of valvular in...
Source: Heart - September 13, 2023 Category: Cardiology Authors: Courtney, W. A., Schultz, C. J., Hillis, G. S. Tags: Editorials Source Type: research
Aortic stenosis may not be fatal anymore in wealthy societies: but what about the rest of the world?
In this interesting manuscript, Hibino et al set out to describe mortality in the setting of aortic stenosis (AS) in high-income countries over the last 20 years.1 The last 20 years have seen an epic change in management of aortic valve stenosis with the advent, early adoption and proliferation of interventional percutaneous aortic valve replacement (TAVR) which was initially intended to treat patients with prohibitively high risk for surgical valve replacement.2 With adoption and proliferation of non-surgical TAVR, evidence was generated to show non-inferiority as an alternative strategy to open surgical valve replacement...
Source: Heart - September 13, 2023 Category: Cardiology Authors: Nienaber, C. A., Yuan, X., Nienaber, S. A. Tags: Editorials Source Type: research
Typical angina and coronary artery disease: is the common ground smaller than we think?
In 1772, William Heberden described ‘a disorder of the breast marked with strong and peculiar symptoms... [with a] sense of strangling and anxiety’. Individuals affected are ‘seized while they are walking (more especially if it be uphill, and soon after eating) with a painful and most disagreeable sensation in the breast, which seems as if it would extinguish life if it were to increase or to continue; but the moment they stand still, all this uneasiness vanishes’.1 Two hundred and fifty years have passed since Heberden’s original description of angina pectoris: 250 years in which the foundati...
Source: Heart - September 13, 2023 Category: Cardiology Authors: Rajkumar, C., Simader, F., Al-Lamee, R. K. Tags: Editorials Source Type: research
Heartbeat: a trend over the past 20 years towards decreased aortic stenosis mortality in patients aged 80 years or older
Transcatheter aortic valve replacement (TAVR) has transformed the management of older adults with severe symptomatic aortic stenosis (AS) over the past 20 years, allowing relief of valve obstruction in patients of all ages at high and prohibitive surgical risk, as well as in older patients regardless of surgical risk. However, it is unclear if dissemination of this new technology had led to an overall decrease in age-specific mortality due to AS. Hibino and colleagues1 report the trends in mortality from AS over the past 20 years in eight high-income countries based on the WHO database. Although crude mortality rates incre...
Source: Heart - September 13, 2023 Category: Cardiology Authors: Otto, C. M. Tags: Highlights from this issue Source Type: research
Correction: Coronary low-attenuation plaque and high-sensitivity cardiac troponin
This article has been corrected since it first published. The article has been made open access under licence CC BY-NC, 15th August 2023, and the following affiliation was added for MNM: ‘University of Edinburgh - Centre for Cardiovascular Sciences, Edinburgh, UK’. (Source: Heart)
Source: Heart - September 13, 2023 Category: Cardiology Tags: Open access Corrections Source Type: research
Career paths for cardiologists in industry: exploring opportunities in hospital management, medical device industry and biotech
Introduction Following the first two articles of this series on transitioning employment from direct healthcare provision, this article considers potential roles for cardiologists in hospital management, medical device or biotech industries, highlighting specific considerations and strategies for success in each. Hospital management Global economic challenges and heathcare policy changes call for a strong interaction between healthcare managers and clinicians. In-depth knowledge of the healthcare system and clinical processes is crucial for improving medical care and hospital performance. Studies indicate that improving ho...
Source: Heart - August 24, 2023 Category: Cardiology Authors: Daniels, M. J., Sheikhzadeh, S., Franke, J. Tags: Cardiology in Focus Source Type: research
Pacing induced cardiomyopathy: recognition and management
Right ventricle (RV) apex continues to remain as the standard pacing site in the ventricle due to ease of implantation, procedural safety and lack of convincing evidence of better clinical outcomes from non-apical pacing sites. Electrical dyssynchrony resulting in abnormal ventricular activation and mechanical dyssynchrony resulting in abnormal ventricular contraction during RV pacing can result in adverse LV remodelling predisposing some patients for recurrent heart failure (HF) hospitalisation, atrial arrhythmias and increased mortality. While there are significant variations in the definition of pacing induced cardiomyo...
Source: Heart - August 24, 2023 Category: Cardiology Authors: Ponnusamy, S. S., Syed, T., Vijayaraman, P. Tags: Education in Heart Source Type: research
Validation of the TRI-SCORE in patients undergoing surgery for isolated tricuspid regurgitation
Conclusion
This external validation of the TRI-SCORE demonstrated good performance to predict in-hospital mortality in patients undergoing ITVS, which was significantly better than the Log-ES and ES-II, which underestimated the observed mortality. These results support the widespread use of this score as a clinical tool. (Source: Heart)
Source: Heart - August 24, 2023 Category: Cardiology Authors: Anguita-Gamez, M., Giraldo, M. A., Nombela-Franco, L., Eixeres Esteve, A., Cuerpo, G., Lopez-Menendez, J., Gomez-Polo, J. C., Tirado-Conte, G., Torres, B., Pedraz Prieto, A., Jimenez-Quevedo, P., Lopez-Gude, M. J., Mahia, P., Cobiella, J., Zamorano, J. L. Tags: Valvular heart disease Source Type: research
Subannular repair in secondary mitral regurgitation with restricted leaflet motion during systole
Conclusions
Our study demonstrates the safety and feasibility of standardised subannular repair to treat ventricular SMR (Carpentier type IIIb) in a multicentre setting. By addressing mitral leaflet tethering, papillary muscle relocation results in very satisfactory 1-year outcomes and has the potential to durably restore MV geometry; nevertheless, long-term FU is mandatory.
Trial registration number
NCT03470155. (Source: Heart)
Source: Heart - August 24, 2023 Category: Cardiology Authors: Pausch, J., Harmel, E., Reichenspurner, H., Kempfert, J., Kuntze, T., Owais, T., Holubec, T., Walther, T., Krane, M., Vitanova, K., Borger, M. A., Eden, M., Hachaturyan, V., Bramlage, P., Falk, V., Girdauskas, E. Tags: Valvular heart disease Source Type: research
Sex differences in clinical characteristics and prognosis of patients with cardiac sarcoidosis
Conclusion
Approximately two-thirds of patients with CS were females, with a peak age of approximately 60 years at clinical diagnosis in both sexes; male patients were younger than female patients. Male patients had a significantly higher risk of pFVAEs than female patients.
Trial registration number
UMIN000034974. (Source: Heart)
Source: Heart - August 24, 2023 Category: Cardiology Authors: Iso, T., Maeda, D., Matsue, Y., Dotare, T., Sunayama, T., Yoshioka, K., Nabeta, T., Naruse, Y., Kitai, T., Taniguchi, T., Tanaka, H., Okumura, T., Baba, Y., Minamino, T. Tags: Heart failure and cardiomyopathies Source Type: research
Impact on stable chest pain pathways of CT fractional flow reserve
Conclusions
FFRCT adoption was associated with greater compliance with NICE guidelines, reduced invasive diagnostic angiography, planned admissions and needing more than one test to reach a pathway endpoint. (Source: Heart)
Source: Heart - August 24, 2023 Category: Cardiology Authors: O'Leary, R. A., Burn, J., Urwin, S. G., Sims, A. J., Beattie, A., Bagnall, A. Tags: Open access Coronary artery disease Source Type: research
