Incremental value of machine learning for risk prediction in tetralogy of Fallot
Conclusions
Robust prediction of 5-year MACE in rTOF was achieved using either ML or a multidisciplinary team of ACHD experts. Risk prediction of some clinicians was enhanced by incorporation of ML suggesting that there may be incremental value for ML in select circumstances. (Source: Heart)
Source: Heart - March 22, 2024 Category: Cardiology Authors: Ishikita, A., McIntosh, C., Roche, S. L., Barron, D. J., Oechslin, E., Benson, L., Nair, K., Lee, M. M., Gritti, M. N., Hanneman, K., Karur, G. R., Wald, R. M. Tags: Congenital heart disease Source Type: research
Dyspnoea, dizziness and dysrhythmia in a middle-aged patient
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 a soft first heart sound with...
Source: Heart - March 22, 2024 Category: Cardiology Authors: Soorampally, V., Veeraraghavan, S., Kidambi, B. R. Tags: Image challenges Source Type: research
Pulmonary vasodilators and exercise in Fontan circulation: a systematic review and meta-analysis
Conclusions
Although PAH-targeted therapies did not affect exercise parameters at maximal effort, they induced slight improvements in indices of submaximal effort, measured at the anaerobic threshold. Pharmacological improvement of submaximal exercise seems to be a more suitable indicator of Fontan individuals’ exercise capacity. Larger RCTs, recruiting specific subpopulations and focusing also on the anaerobic threshold, are warranted to draw more robust conclusions.
PROSPERO registration number
CRD42022306674. (Source: Heart)
Source: Heart - March 22, 2024 Category: Cardiology Authors: Kosmidis, D., Arvanitaki, A., Farmakis, I. T., Liakos, A., Giannopoulos, A., Ziakas, A., Giannakoulas, G. Tags: Systematic review Source Type: research
Use of coronarycomputed tomography for cardiovascular risk assessment in immune-mediated inflammatory diseases
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 people with IMIDs. However, car...
Source: Heart - March 22, 2024 Category: Cardiology Authors: Peverelli, M., Maughan, R. T., Gopalan, D., Dweck, M. R., Dey, D., Buch, M. H., Rudd, J. H. F., Tarkin, J. M. Tags: Editor's choice, Review articles Reviews Source Type: research
Towards a gender-specific and morphology-specific assessment of aortic valve stenosis severity
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 errors may lead to major misclassificati...
Source: Heart - March 22, 2024 Category: Cardiology Authors: Jander, N., Minners, J. Tags: Editorials Source Type: research
Artificial intelligence to improve the diagnosis of pulmonary hypertension: promises and pitfalls
Challenges in the diagnosis of pulmonary hypertension Pulmonary hypertension (PH) is a clinical–physiological syndrome thought to affect 1% of the global population.1 PH is defined haemodynamically by mean pulmonary artery pressure >20 mm Hg, resulting in right ventricular (RV) overload and often RV failure. Patients with PH experience symptoms including dyspnoea, fatigue and oedema, often associated with physical and psychosocial disability. In some forms of untreated PH, mean survival is less than 3 years, related in part to delays in diagnosis of 1–2 years after clinical onset of disease. Diagnostic delay...
Source: Heart - March 22, 2024 Category: Cardiology Authors: Singh, N., Mehta, S. Tags: Editorials Source Type: research
Surgical and transcatheter treatments of mechanical complications of acute myocardial infarction
Learning objectives To review the epidemiology, clinical presentation and diagnosis of mechanical complications of acute myocardial infarction including ventricular septal defect, free wall rupture and papillary muscle rupture. To discuss the existing data on outcomes of medical therapy, surgery and percutaneous intervention. To examine the limitations of currently available treatment modalities and need, as well as opportunity, for ongoing evolution and improvement of surgical and percutaneous therapies. To highlight the importance of the heart team in facilitating complex, shared decision making in treating these conditi...
Source: Heart - March 12, 2024 Category: Cardiology Authors: McCabe, J. M., Chung, C. J. Tags: Education in Heart Source Type: research
Reduction of moderate to severe tricuspid regurgitation after catheter ablation for atrial fibrillation
Conclusion
In patients with AF with moderate to severe TR, more than two-thirds of patients experienced reduced TR severity, with notable improvements in echocardiographic parameters. Sinus rhythm maintenance was associated with significant TR reduction. (Source: Heart)
Source: Heart - March 12, 2024 Category: Cardiology Authors: Cha, M.-J., Lee, S.-A., Cho, M. S., Nam, G.-B., Choi, K.-J., Kim, J. Tags: Valvular heart disease Source Type: research
Morphology of the mural and commissural atrioventricular junction of the mitral valve
Conclusions
In the cohort of the patients with healthy hearts, MAD is present in about 20% of all studied hearts. The MADs identified tend to be localised, confined to a single scallop. Moreover, MADs in the commissures are notably smaller than those in the mural leaflet. (Source: Heart)
Source: Heart - March 12, 2024 Category: Cardiology Authors: Krawczyk-Ozog, A., Batko, J., Zdzierak, B., Dziewierz, A., Tyrak, K., Bolechała, F., Kopacz, P., Strona, M., Gil, K., Hołda, J., Hołda, M. K. Tags: Valvular heart disease Source Type: research
Prognostic value of growth differentiation factor-15 3 months after an acute chest pain admission
Conclusions
High GDF-15 concentrations 3 months after admission for suspected NSTE-ACS are associated with long-term mortality and cardiovascular events, independent of traditional risk factors and troponin T. A change in GDF-15 concentration can provide prognostic information. (Source: Heart)
Source: Heart - March 12, 2024 Category: Cardiology Authors: Myrmel, G. M. S., Steiro, O.-T., Tjora, H. L., Langorgen, J., Bjorneklett, R. O., Skadberg, O., Bonarjee, V. V. S., Mjelva, O. R., Pedersen, E. R., Vikenes, K., Omland, T., Aakre, K. M. Tags: Coronary artery disease Source Type: research
Mitral valve dysfunction in a woman with newly diagnosed acute promyelocytic leukemia
Clinical introduction A woman in her mid-40s with a recent diagnosis of pulmonary embolism (on rivaroxaban) presented to the emergency room with dyspnea and fatigue. Vital signs were stable on arrival but a new holosystolic murmur was noted on exam and labs revealed pancytopenia. Infectious workup was unrevealing. CT revealed stable pulmonary emboli compared with prior imaging, along with a new splenic infarct. Transthoracic echocardiography (TTE) (figures 1 and 2, ) demonstrated new findings since the patient’s last normal TTE 3 months prior. Following hospital admission, the patient underwent a bone marrow biopsy w...
Source: Heart - March 12, 2024 Category: Cardiology Authors: Bierowski, M. J., Warner, E. D., Edirisuriya, C. D. Tags: Image challenges Source Type: research
Very early invasive strategy in higher risk non-ST-elevation acute coronary syndrome: the RAPID NSTEMI trial
Conclusions
A strategy of very early IS did not improve clinical outcomes compared with a standard care IS in higher risk patients with NSTE-ACS. However, the primary outcome rate was low and the trial was underpowered to detect such a difference.
Trial registration number
NCT03707314. (Source: Heart)
Source: Heart - March 12, 2024 Category: Cardiology Authors: Kite, T. A., Ladwiniec, A., Greenwood, J. P., Gale, C. P., Anantharam, B., More, R., Hetherington, S. L., Khan, S. Q., O'Kane, P., Rakhit, R., Chase, A., Barber, S., Waheed, G., Berry, C., Flather, M., McCann, G. P., Curzen, N., Banning, A. P., Gershlick, Tags: Open access, Editor's choice, COVID-19 Coronary artery disease Source Type: research
Novel uses for implanted haemodynamic monitoring in adults with subaortic right ventricles
Conclusions
Uses of IHM in patients with sRV are described which may minimise the need for serial catheterisations in a population where PH is prevalent. HFHs were low overall but not impacted by IHM. One device-related complication occurred without long-term consequence. (Source: Heart)
Source: Heart - March 12, 2024 Category: Cardiology Authors: Marshall V, W. H., Mah, M. L., DeSalvo, J., Rajpal, S., Lastinger, L. T., Salavitabar, A., Armstrong, A. K., Berman, D., Lampert, B., Wright, L. K., Hickey, J., Metzger, R., Nandi, D., Gajarski, R., Daniels, C. J. Tags: Congenital heart disease Source Type: research
Generalisability of trials on antithrombotic treatment intensification in patients with cardiovascular disease
Conclusion
A large proportion of contemporary CVD patients would be eligible for intensified antithrombotic treatment trials, with mostly similar adjusted event risks to ineligible patients. Trial-based guideline recommendations are largely applicable to real-world patients. (Source: Heart)
Source: Heart - March 12, 2024 Category: Cardiology Authors: Castelijns, M. C., Hageman, S. H. J., Teraa, M., van der Meer, M. G., Westerink, J., ten Berg, J., Visseren, F. L. J. Tags: Aortic and vascular disease Source Type: research
Beta-blockers and renin-angiotensin system inhibitors for Takotsubo syndrome recurrence: a network meta-analysis
Conclusions
Our study did not find sufficient statistical evidence regarding combination therapy with BB and ACEi/ARBs in reduction of TTS recurrence. (Source: Heart)
Source: Heart - March 12, 2024 Category: Cardiology Authors: Santoro, F., Sharkey, S., Citro, R., Miura, T., Arcari, L., Urbano-Moral, J. A., Stiermaier, T., Nunez-Gil, I. J., Silverio, A., Di Nunno, N., Ragnatela, I., Cetera, R., Nishida, J., Eitel, I., Brunetti, N. D. Tags: Open access Systematic review Source Type: research
