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
Review of the National Institute for Health and Care Excellence guidelines on chronic heart failure
This article reviews the most recent iteration of NICE chronic heart failure guidelines and compares them with major guidelines on an international scale. Variations in recommendations will be explored including implications for NICE guideline updates in the future. (Source: Heart)
Source: Heart - March 12, 2024 Category: Cardiology Authors: Doherty, D. J., Docherty, K. F., Gardner, R. S. Tags: Review articles Reviews Source Type: research
Mitral annular disjunction: a ubiquitous finding with or without mitral valvar prolapse
As is shown in the study of 224 hearts with so-called mitral annular disjunction,1 the wheel has now come full circle. Although now usually credited to having first been seen by Henle as long ago as 1876, it was Hutchins and his colleagues who brought the feature to attention as a potential harbinger of pathological change.2 The investigators working at Johns Hopkins Hospital had noticed the anatomical arrangement in their investigation of over 900 hearts coming to autopsy, and being examined using a standardised technique. They defined the feature as ‘a wide separation between the atrium-valve junction and the atria...
Source: Heart - March 12, 2024 Category: Cardiology Authors: Anderson, R. H., Westaby, J., Sheppard, M. N., Cook, A. C. Tags: Editorials Source Type: research
Very early invasive strategy in patients with non-ST-elevation myocardial infarction: should we go for it?
According to the recent guidelines from the European Society of Cardiology,1 an invasive strategy should be performed within the first 24 hours from diagnosis in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) at high risk; and a very early invasive strategy (<2 hours) deserves only to those patients at very high risk. The question of the optimal timing of the invasive procedure is however still a matter of debate. In this context, the absence of P2Y12 inhibitor (P2Y12i) pretreatment may impact the decision. Indeed, in the absence of P2Y12i pretreatment, recurrent ischaemic events may occur more freque...
Source: Heart - March 12, 2024 Category: Cardiology Authors: Lemesle, G., Schurtz, G., Verdier, B., Bonello, L. Tags: Editorials Source Type: research
Inclusivity in randomised clinical trials: myth or reality?
In this issue of Heart, Castelijns et al aimed to apply the inclusion and exclusion criteria from the Cardiovascular Outcomes for People Using Anticoagulation Strategies, Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management and Avoidance trials, Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarction and Dual Antiplatelet Therapy to patients included in the Utrecht Cardiovascular Cohort-Second Manifestations of Arterial Disease. The study aims to evaluate the applicability in th...
Source: Heart - March 12, 2024 Category: Cardiology Authors: Iannaccone, M., Gamardella, M., Chieffo, A. Tags: Editorials Source Type: research
Association of right atrial strain and long-term outcome in severe secondary tricuspid regurgitation
Conclusions
Patients with severe STR presented with significant RA remodelling, and lower RA function, as measured by RASr, was independently associated with all-cause mortality, potentially improving risk stratification in these patients. (Source: Heart)
Source: Heart - February 23, 2024 Category: Cardiology Authors: Galloo, X., Fortuni, F., Meucci, M. C., Butcher, S. C., Dietz, M. F., Prihadi, E. A., Cosyns, B., Delgado, V., Bax, J. J., Ajmone Marsan, N. Tags: Valvular heart disease Source Type: research
