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Aortic stenosis: flow matters
The presence of a low transvalvular pressure gradient (<40 mm Hg) in conjunction with a small aortic valve area (AVA ≤1 cm2) is a challenging situation as it raises uncertainty about the actual severity of aortic stenosis (AS) and therefore about the indication of aortic valve replacement (AVR) if the patient is symptomatic. This low-gradient ‘severe’ (small AVA) AS entity may in fact be related to: (i) measurement errors: underestimation of stroke volume (SV), AVA and/or gradient;S1 (ii) small body size: a small AVA in a small patient may correspond to moderate AS and low gradient; (iii) i...
Source: Heart - December 12, 2014 Category: Cardiology Authors: Pibarot, P. Tags: Drugs: cardiovascular system, Echocardiography, Hypertension, Aortic valve disease, Mitral valve disease, Right sided valvular heart disease, Clinical diagnostic tests, Epidemiology Editorials Source Type: research

Survival by stroke volume index in patients with low-gradient normal EF severe aortic stenosis
Conclusions Lower SVI is incrementally associated with mortality in LG severe AS with preserved EF. These findings have implications for classification of AS severity, identification of high-risk groups and subsequent management.
Source: Heart - December 12, 2014 Category: Cardiology Authors: Eleid, M. F., Sorajja, P., Michelena, H. I., Malouf, J. F., Scott, C. G., Pellikka, P. A. Tags: Editor's choice, Drugs: cardiovascular system, Echocardiography, Aortic valve disease, Clinical diagnostic tests, Epidemiology Valvular heart disease Source Type: research

Low dietary sodium in heart failure: a need for scientific rigour
There is much evidence that higher sodium intake is associated with elevated blood pressure and there is a strong likelihood that the relationship between excess dietary sodium intake and hypertension is causal.1–3 Corresponding evidence from clinical trials shows that significant reductions in blood pressure can be achieved by lowering dietary sodium consumption in groups with hypertension as well as among normotensive individuals.4 With high blood pressure identified as the leading cause of cardiovascular disease in the world, responsible for more than 60% of stroke events and almost 50% of coronary heart disease,5...
Source: Heart - October 11, 2014 Category: Cardiology Authors: Jun, M., Neal, B. Tags: Electronic page Source Type: research

ST2 may not be a useful predictor for incident cardiovascular events, heart failure and mortality
Conclusions In a healthy general population from Finland, sST2 did not improve long-term prediction of cardiovascular events including heart failure or all-cause mortality.
Source: Heart - October 11, 2014 Category: Cardiology Authors: Hughes, M. F., Appelbaum, S., Havulinna, A. S., Jagodzinski, A., Zeller, T., Kee, F., Blankenberg, S., Salomaa, V., on behalf of the FINRISK and BiomarCaRE investigators Tags: Drugs: cardiovascular system, Acute coronary syndromes, Epidemiology Cardiac risk factors and prevention Source Type: research

Prediction of stroke or TIA in patients without atrial fibrillation using CHADS2 and CHA2DS2-VASc scores
Conclusions In patients with ACS but no AF, the CHADS2 and CHA2DS2-VASc scores predict ischaemic stroke/TIA events with similar accuracy to that observed in historical populations with non-valvular AF, but with lower absolute event rates. Further study of the utility of the CHADS2 and CHA2DS2-VASc scores for the assessment of thromboembolic risk and selection of antithrombotic therapy in patients without AF is warranted.
Source: Heart - September 9, 2014 Category: Cardiology Authors: Mitchell, L. B., Southern, D. A., Galbraith, D., Ghali, W. A., Knudtson, M., Wilton, S. B., for the APPROACH investigators Tags: Drugs: cardiovascular system, Epidemiology Coronary artery disease Source Type: research

Diabetes, incretin hormones and cardioprotection
The diabetes pandemic In 2012 an estimated 371 million people had diabetes and of those about a half were undiagnosed. That number is set to expand to 552 million by 2030. Type 2 diabetes mellitus (T2DM) constitutes 85–95% of all diabetes in high income nations and may account for an even greater proportion in their low and middle income counterparts (figure 1). As a global pandemic, diabetes claimed the lives of 4.8 million people in 2012, half of whom were below the age of 60 years.w1 The predominant cause of morbidity and mortality in diabetes is cardiovascular disease, with at least a twofold excess risk of ...
Source: Heart - September 9, 2014 Category: Cardiology Authors: Myat, A., Redwood, S. R., Gersh, B. J., Yellon, D. M., Marber, M. S. Tags: Diabetic heart disease, Education in Heart, Drugs: cardiovascular system, Epidemiology, Diabetes, Metabolic disorders Source Type: research

Increased risk of coronary heart disease in patients with chronic osteomyelitis: a population-based study in a cohort of 23 million
Conclusions This study demonstrates that COM is an independent risk factor for CHD, particularly in the younger population. Further studies are necessary to explore the underlying mechanisms linking COM and CHD.
Source: Heart - August 21, 2014 Category: Cardiology Authors: Hsiao, L.-C., Muo, C.-H., Chen, Y.-C., Chou, C.-Y., Tseng, C.-H., Chang, K.-C. Tags: Health policy, Drugs: cardiovascular system, Hypertension, Epidemiology, Metabolic disorders Coronary artery disease Source Type: research

Asymptomatic adults with mild/moderate isolated native pulmonary valve stenosis are in need of treatment... but not the kind you are thinking of!
As new treatment strategies are developed which outperform previous approaches in terms of safety, efficacy and long-term results, a reappraisal of old therapeutic dogmas is warranted, including lowering the threshold for intervention. Pulmonary valvuloplasty was introduced in 1982 to treat children and adults with significant isolated pulmonary valve stenosis (PS) and provided a very reliable tool to treat the problem avoiding cardiac surgery, with very good long-term results in terms of reinterventions as well as functional outcomes.1 2 Besides the neonate with critical PS, the same technique has been used to treat older...
Source: Heart - August 6, 2014 Category: Cardiology Authors: Giardini, A., Cervi, E. Tags: Congenital heart disease, Drugs: cardiovascular system, Hypertension, Interventional cardiology, Right sided valvular heart disease Editorials Source Type: research

RV stroke work in children with pulmonary arterial hypertension: estimation based on invasive haemodynamic assessment and correlation with outcomes
Conclusions RVSW can be estimated in children with PAH, and is significantly associated with abnormal WHO class, the need for septostomy, as well as mortality. Indices accounting for RV performance as well as ventricular-vascular coupling may be useful in the prognosis and, hence, management of children with PAH.
Source: Heart - August 6, 2014 Category: Cardiology Authors: Di Maria, M. V., Younoszai, A. K., Mertens, L., Landeck, B. F., Ivy, D. D., Hunter, K. S., Friedberg, M. K. Tags: Congenital heart disease, Drugs: cardiovascular system, Echocardiography, Hypertension, Clinical diagnostic tests, Epidemiology Pulmonary vascular disease Source Type: research

Infective endocarditis: old problem, new guidelines and still much to learn
Despite major advances in treating valvular heart disease, the in-hospital mortality (15–20%) and 1-year mortality (~=40%) for infective endocarditis (IE) has not improved even with modern antibiotics and surgical therapy. Further, stroke (17%), embolisation other than stroke (23%), heart failure (HF) (32%) and other complications remain common; therefore, all precautions to help prevent IE should be employed where indicated. In underdeveloped countries, IE is most often associated with rheumatic heart disease. In developed countries, IE is increasingly associated with prosthetic valves and intracardiac devices, with...
Source: Heart - June 9, 2014 Category: Cardiology Authors: Erwin, J. P., Otto, C. M. Tags: Drugs: cardiovascular system, Echocardiography, Clinical diagnostic tests, Epidemiology, Diabetes, Metabolic disorders Editorials Source Type: research

Resistant hypertension: resistance to treatment or resistance to taking treatment?
The treatment of hypertension has been a therapeutic success. A generation or more of effective drugs deserves considerable credit for their contribution to the substantial decline in age-related incidence of stroke, ischaemic heart disease and heart failure. And because almost all the drugs are long-since off patent, the cost of success comes cheaply. Indeed, National Institute of Health and Care Excellence (NICE) has branded treatment of hypertension as not only cost effective but cost saving.1 Yet not all patients achieve their blood pressure target and are labelled as ‘resistant hypertension’. A contentious...
Source: Heart - May 8, 2014 Category: Cardiology Authors: Brown, M. J. Tags: Drugs: cardiovascular system, Hypertension, Interventional cardiology, Epidemiology Editorials Source Type: research

Progress: the ROPAC multinational registry advances our understanding of an important outcome in pregnant women with heart disease
When caring for women with structural heart disease (SHD), clinicians face an apparent paradox: most women with SHD are able to complete a pregnancy without complication; however, compared with the general population, maternal risk is increased and SHD remains a major source of maternal morbidity and mortality and poor fetal outcomes.1–4 Identifying those women with SHD who are at increased risk for meaningful complications during pregnancy is critical. During pregnancy, intravascular volume, stroke volume, heart rate and cardiac output increase, while systemic vascular resistance decreases. During pregnancy, women w...
Source: Heart - January 3, 2014 Category: Cardiology Authors: Krieger, E. V., Stout, K. K. Tags: Congenital heart disease, Drugs: cardiovascular system, Hypertension, Acute coronary syndromes, Epidemiology Editorials Source Type: research

The unnatural history of an atrial septal defect: Longitudinal 35 year follow up after surgical closure at young age
Conclusions Very long-term outcome after surgical ASD closure in childhood shows good survival and low morbidity. Early surgical closure prevents pulmonary hypertension and reduces the occurrence of supraventricular arrhythmias. Early postoperative arrhythmias are predictive for the need for pacemaker implantation during early follow-up, but the rate of late pacemaker implantation remains low. Although RVEF was unexpectedly found to be decreased in one-third of patients, the functional status remains excellent.
Source: Heart - August 15, 2013 Category: Cardiology Authors: Cuypers, J. A. A. E., Opic, P., Menting, M. E., Utens, E. M. W. J., Witsenburg, M., Helbing, W. A., van den Bosch, A. E., Ouhlous, M., van Domburg, R. T., Meijboom, F. J., Bogers, A. J. J. C., Roos-Hesselink, J. W. Tags: Congenital Heart Disease, Congenital heart disease, Drugs: cardiovascular system, Echocardiography, Hypertension, Clinical diagnostic tests, Epidemiology Source Type: research

Secondhand smoke exposure and intermittent claudication: a Scotland-wide study of 4231 non-smokers
Conclusions As with coronary heart disease and stroke, SHS exposure was independently associated with IC. Our findings add to the published evidence in support of protecting the general public from SHS exposure.
Source: Heart - August 15, 2013 Category: Cardiology Authors: Lu, L., Mackay, D. F., Pell, J. P. Tags: Health policy, Drugs: cardiovascular system, Epidemiology, Tobacco use Peripheral vascular disease Source Type: research

Recent advances in the epidemiology, outcome, and prevention of myocardial infarction and stroke in sub-Saharan Africa
The early part of the new millennium witnessed reports of a growing burden of cardiovascular disease in Sub-Saharan Africa (SSA). However the contribution of ischemic heart disease and stroke to this increasing burden relative to that caused by hypertensive heart disease, cardiomyopathy and rheumatic heart disease was not clear. Over the last decade, data from the continent has begun to clarify this issue and suggests three main points. The burden of ischemic heart disease relative to other causes of heart disease remains low particularly in the black Africans majority. Stroke caused predominantly by hypertension is now a ...
Source: Heart - August 2, 2013 Category: Cardiology Authors: Ntsekhe, M., Damasceno, A. Tags: Drugs: cardiovascular system, Hypertension, Acute coronary syndromes, Epidemiology Global burden of cardiovascular disease Source Type: research

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