Subjects -> MEDICAL SCIENCES (Total: 8442 journals)
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RESPIRATORY DISEASES (102 journals)                     

Showing 1 - 102 of 102 Journals sorted alphabetically
Advances in Respiratory Medicine     Open Access   (Followers: 7)
American Journal of Respiratory and Critical Care Medicine     Full-text available via subscription   (Followers: 257)
American Journal of Respiratory Cell and Molecular Biology     Full-text available via subscription   (Followers: 20)
American Review of Respiratory Disease     Full-text available via subscription   (Followers: 4)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1)
Annals of the American Thoracic Society     Full-text available via subscription   (Followers: 17)
Annals of Thoracic Medicine     Open Access   (Followers: 6)
Archivos de Bronconeumología     Full-text available via subscription  
Archivos de Bronconeumología (English Edition)     Full-text available via subscription   (Followers: 1)
Asthma Research and Practice     Open Access   (Followers: 1)
BMC Pulmonary Medicine     Open Access   (Followers: 5)
BMJ Open Respiratory Research     Open Access   (Followers: 6)
Breathe     Open Access   (Followers: 4)
Canadian Journal of Respiratory, Critical Care, and Sleep Medicine     Hybrid Journal   (Followers: 1)
Canadian Respiratory Journal     Open Access   (Followers: 3)
Case Reports in Pulmonology     Open Access   (Followers: 3)
Chest     Full-text available via subscription   (Followers: 101)
Chest Disease Reports     Open Access   (Followers: 2)
Chronic Respiratory Disease     Hybrid Journal   (Followers: 9)
Clinical Lung Cancer     Hybrid Journal   (Followers: 6)
Clinical Medicine Insights : Circulatory, Respiratory and Pulmonary Medicine     Open Access   (Followers: 3)
Clinical Pulmonary Medicine     Hybrid Journal   (Followers: 2)
COPD Research and Practice     Open Access   (Followers: 1)
COPD: Journal of Chronic Obstructive Pulmonary Disease     Hybrid Journal   (Followers: 15)
Current Opinion in Pulmonary Medicine     Hybrid Journal   (Followers: 10)
Current Pulmonology Reports     Hybrid Journal  
Current Research in Tuberculosis     Open Access   (Followers: 3)
Current Respiratory Care Reports     Hybrid Journal   (Followers: 1)
Current Respiratory Medicine Reviews     Hybrid Journal   (Followers: 5)
Der Pneumologe     Hybrid Journal   (Followers: 1)
Egyptian Journal of Chest Diseases and Tuberculosis     Open Access   (Followers: 3)
ERJ Open Research     Open Access   (Followers: 3)
Eurasian Journal of Pulmonology     Open Access  
European Clinical Respiratory Journal     Open Access   (Followers: 3)
European Respiratory Journal     Full-text available via subscription   (Followers: 39)
European Respiratory Review     Open Access   (Followers: 7)
Experimental Lung Research     Hybrid Journal  
Expert Review of Respiratory Medicine     Hybrid Journal   (Followers: 5)
Heart & Lung: The Journal of Acute and Critical Care     Hybrid Journal   (Followers: 13)
Heart, Lung and Circulation     Full-text available via subscription   (Followers: 9)
Indian Journal of Respiratory Care     Open Access   (Followers: 3)
Indian Journal of Tuberculosis     Full-text available via subscription  
Influenza and Other Respiratory Viruses     Open Access   (Followers: 3)
International Journal of Chronic Obstructive Pulmonary Disease     Open Access   (Followers: 3)
Journal of Association of Chest Physicians     Open Access   (Followers: 2)
Journal of Asthma     Hybrid Journal   (Followers: 4)
Journal of Asthma Allergy Educators     Hybrid Journal   (Followers: 4)
Journal of Bronchology & Interventional Pulmonology     Hybrid Journal   (Followers: 4)
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases     Open Access  
Journal of Heart and Lung Transplantation     Hybrid Journal   (Followers: 12)
Journal of Respiratory Medicine     Open Access   (Followers: 4)
Journal of Respiratory Research     Open Access   (Followers: 1)
Journal of Tuberculosis Research     Open Access   (Followers: 1)
Jurnal Respirasi     Open Access  
Karger Kompass Pneumologie     Full-text available via subscription   (Followers: 1)
Kindheit und Entwicklung     Hybrid Journal  
Lung     Hybrid Journal   (Followers: 2)
Lung Cancer     Hybrid Journal   (Followers: 16)
Lung Cancer International     Open Access   (Followers: 2)
Lung Cancer: Targets and Therapy     Open Access   (Followers: 3)
Lung India     Open Access   (Followers: 1)
Multidisciplinary Respiratory Medicine     Open Access   (Followers: 4)
npj Primary Care Respiratory Medicine     Open Access   (Followers: 2)
Open Journal of Respiratory Diseases     Open Access   (Followers: 1)
Open Respiratory Medicine Journal     Open Access   (Followers: 1)
Paediatric Respiratory Reviews     Hybrid Journal   (Followers: 11)
Pediatric Quality & Safety     Open Access  
Pediatric Respirology and Critical Care Medicine     Open Access   (Followers: 1)
Pulmonary Circulation     Open Access   (Followers: 4)
Pulmonary Medicine     Open Access   (Followers: 2)
Pulmonary Pharmacology & Therapeutics     Hybrid Journal   (Followers: 2)
Pulmonary Therapy     Open Access   (Followers: 1)
Pulmonology and Respiratory Research     Open Access   (Followers: 1)
Respiratory Care     Full-text available via subscription   (Followers: 10)
Respiratory Investigation     Full-text available via subscription  
Respiratory Medicine     Hybrid Journal   (Followers: 18)
Respiratory Medicine : X     Open Access  
Respiratory Medicine Case Reports     Open Access  
Respiratory Medicine CME     Hybrid Journal  
Respiratory Medicine Extra     Full-text available via subscription   (Followers: 1)
Respiratory Physiology & Neurobiology     Hybrid Journal   (Followers: 4)
Respiratory Research     Open Access   (Followers: 1)
Respirology     Hybrid Journal   (Followers: 5)
Respirology Case Reports     Open Access  
Revista Americana de Medicina Respiratoria     Open Access  
Revista Chilena de Enfermedades Respiratorias     Open Access  
Revista Inspirar     Open Access  
Revista ORL     Open Access  
Revista Portuguesa de Pneumologia     Open Access  
Sarcoidosis Vasculitis and Diffuse Lung Disese     Full-text available via subscription   (Followers: 3)
Seminars in Respiratory and Critical Care Medicine     Hybrid Journal   (Followers: 14)
Sleep Medicine Reviews     Hybrid Journal   (Followers: 18)
The Clinical Respiratory Journal     Hybrid Journal   (Followers: 3)
The International Journal of Tuberculosis and Lung Disease     Full-text available via subscription   (Followers: 8)
The Lancet Respiratory Medicine     Full-text available via subscription   (Followers: 33)
Therapeutic Advances in Chronic Disease     Open Access   (Followers: 7)
Therapeutic Advances in Respiratory Disease     Open Access   (Followers: 1)
Thorax     Hybrid Journal   (Followers: 38)
Translational Respiratory Medicine     Open Access   (Followers: 1)
Tuberculosis     Hybrid Journal   (Followers: 12)
Tuberculosis Research and Treatment     Open Access   (Followers: 3)
Пульмонология     Full-text available via subscription  


Similar Journals
Journal Cover
Heart, Lung and Circulation
Journal Prestige (SJR): 0.599
Citation Impact (citeScore): 1
Number of Followers: 9  
  Full-text available via subscription Subscription journal
ISSN (Print) 1443-9506 - ISSN (Online) 1444-2892
Published by Elsevier Homepage  [3206 journals]
  • Resting Full-Cycle Ratio (RFR) in the Assessment of Left Main Coronary
           Disease: Caution Required
    • Abstract: Publication date: Available online 14 February 2020Source: Heart, Lung and CirculationAuthor(s): Kevin Liou, Sze-Yuan OoiHyperaemia-free indices have been gaining traction in recent times due to the practical advantages they offer over the fractional flow reserve (FFR) in the evaluation of angiographically intermediate coronary lesions. More recently, a new hyperaemia-free index, the resting full-cycle ratio (RFR), was described and found to correlate closely with the instantaneous wave-free ratio (iFR). The comparison between FFR and these hyperaemia-free indices, however, is nuanced and remains an ongoing area of debate and investigation. Herein, we highlight one of the important differences between the RFR and FFR, specifically in relation to the assessment of left main coronary lesion. We contend that the interchangeability of these indices cannot always be assumed and clinicians need to be aware of these limitations in their clinical practice.
  • The Low-Risk TAVI Trials for Severe Aortic Stenosis: Future Implications
           for Australian and New Zealand Heart Teams
    • Abstract: Publication date: Available online 14 February 2020Source: Heart, Lung and CirculationAuthor(s): Heath Adams, Ross Roberts-Thomson, Tiffany Patterson, Bernard Prendergast, Simon Redwood
  • Rib Cage Stabilisation With 3D-Printed Polyethylene Sternal Prosthesis
           Post-Sternotomy Mediastinitis
    • Abstract: Publication date: Available online 13 February 2020Source: Heart, Lung and CirculationAuthor(s): Minesh Prakash, QiHao Ong, Casey Lo, Jeffrey B. Macemon, Adam El GamelBackgroundPost-sternotomy mediastinitis (PSM) is a serious complication of median sternotomy. It is associated with a high mortality rate. Evidence based management recommends debridement followed by closure with vascularised flaps. When large areas of resections are performed, the use of sternal prosthesis could be considered to ensure chest wall stability and cosmesis.MethodWe report an individualised three-dimensional (3D)-printed high-density polyethylene (HDPE) sternum implantation in a patient with a 10 cm chest wall defect.ResultsChest wall reconstruction was uncomplicated and the patient tolerated the procedure well without cardiorespiratory compromise. Postoperatively, the wound healed well and the chest wall remained stable at outpatient clinic follow-up.ConclusionThree-dimensional-printed HDPE prosthesis offers an alternative implant option for closing large chest wall defects for eroded sternum after cure of mediastinitis.
  • The Relationship Between the Effectiveness of Blood Pressure Control and
           Telomerase Reverse Transcriptase Concentration, Adipose Tissue Hormone
           Concentration and Endothelium Function in Hypertensives
    • Abstract: Publication date: Available online 10 February 2020Source: Heart, Lung and CirculationAuthor(s): Helena Martynowicz, Paweł Gać, Olga Kornafel-Flak, Samantha Filipów, Łukasz Łaczmański, Małgorzata Sobieszczańska, Grzegorz Mazur, Rafał PorȩbaBackgroundThis study aimed to evaluate the relationship between the effectiveness of blood pressure (BP) control and telomerase reverse transcriptase concentration (TERT), the concentration of adipose tissue hormones and endothelium function in hypertensive patients.MethodsThe study group included 94 people with arterial hypertension. Two subgroups were distinguished according to effective BP control during 24-hour ambulatory blood pressure monitoring (ABPM): Group A – effective BP control (n=49) and Group B – ineffective BP control (n=45). Telomerase reverse transcriptase concentration, blood visfatin concentration and blood adipsine concentration were determined. The function of the endothelium was measured with the flow-mediated dilatation (FMD) method.ResultsTelomerase reverse transcriptase concentration, blood visfatin concentration and FMD were higher in Group A compared with Group B. Ineffective BP control was an independent risk factor for lower TERT, lower blood visfatin concentration and lower FMD. Diuretics, β-blockers and angiotensin receptor blockers were independent protective factors for lower TERT. Angiotensin-converting enzyme inhibitors (ACEI) were independent protective factors for lower blood visfatin concentration. Calcium channel blockers were independent protective factors for lower FMD.ConclusionsIneffective BP control, assessed by ABPM, was associated with decreased TERT, worse metabolic profile of adipose tissue and impaired endothelial function in hypertensives.
  • The Electrocardiographic Footprints of Ventricular Ectopy
    • Abstract: Publication date: Available online 30 January 2020Source: Heart, Lung and CirculationAuthor(s): Harry G. Mond, Haris M. HaqqaniVentricular ectopics, also known as ventricular extrasystoles, premature ventricular contractions or complexes (PVC) and ventricular premature depolarisations (VPD) are beats arising from within the ventricles. When they occur in groupings such as bigeminy, trigeminy, couplets and triplets they are referred to as ventricular ectopy. The electrocardiogram (ECG) footprints of a ventricular ectopic include a broad (>110 ms), premature, ventricular complex (QRS deflection); no evidence of pure atrioventricular (AV) conduction; a full, more than, or less than compensatory pause; and discordant QRS and T wave axis. Ventricular ectopy is a very common finding on Holter monitoring at all ages, but particularly in the elderly. In the otherwise normal heart, ventricular ectopy is generally infrequent and a benign finding, but in patients with heart disease, they may be a harbinger to more serious ventricular tachyarrhythmias. In this review, the range and manifestations of ventricular ectopy will be explored in detail with ECG examples.
  • Sandwich Technique to Manage Right Ventricular Perforation During Beating
           Heart Coronary Artery Bypass Grafting
    • Abstract: Publication date: Available online 30 January 2020Source: Heart, Lung and CirculationAuthor(s): Suresh Babu Kale, Punithakumar RamasamyIdentification of an intramyocardial left anterior descending artery remains challenging and many techniques have been proposed for its identification. The exposure technique depends on the surgeon’s familiarity and experience with it, and inadvertent right ventricular perforation during exposure on off-pump surgery results in bleeding, which requires urgent cardiopulmonary support and repair. Inadequate repair may result in continued bleeding, closure of the left anterior descending artery, and myocardial infarction. We describe a sandwich technique using the native left anterior descending artery and the bypass graft to repair right ventricular perforation, avoiding closure of this main artery and preserving graft patency.
  • Living With, and Caring for, Congenital Heart Disease in Australia:
           Insights From the Congenital Heart Alliance of Australia and New Zealand
           Online Survey
    • Abstract: Publication date: February 2020Source: Heart, Lung and Circulation, Volume 29, Issue 2Author(s): Geoff Strange, Simon Stewart, Melissa Farthing, Nadine A. Kasparian, Lisa Selbie, Clare O’Donnell, Julian Ayer, Rachael Cordina, David CelermajerBackgroundThere is a paucity of data describing the day-to-day experiences of adult Australians personally living with or caring for a child born with congenital heart disease (CHD). Such data would be of great practical importance to inform health care initiatives to improve outcomes.Methods588 men (38.3 ± 11.9 years) and women (39.6 ± 12.6 years, 78% of respondent patients) living with CHD and 1,091 adult carers (93% mothers) of children with CHD (median age 7.3 [IQR 3.5–13.3 years], 54% male), representing all Australian states and territories, responded to a comprehensive online survey designed and hosted by the Congenital Heart Alliance of Australia and New Zealand. Data on demographic factors, the nature of underlying CHD, interactions with health care services, psychological wellbeing and wider impacts of CHD were collected.ResultsMost respondents were able to identify the type of CHD they (29% with a simple lesion such atrial septal defect, 17% tetralogy of Fallot) or their child had (21% with a simple lesion, 15% tetralogy of Fallot), whilst 90% cases of CHD had undergone cardiac surgery. Patients with CHD were mostly employed (70%) or studying (8.8%), whilst 9.1% were receiving disability benefits. In terms of transition care, 52% of adult patients had been referred by a paediatric to adult cardiologist with 84% still actively managed by a specialist. Overall, 31% of patients with CHD sought emergency care and required>10 days sick leave in the past 12 months. Moreover, 71% and 55% of patients, respectively, reported recent feelings of anxiety/worry or depressive thoughts related to their CHD (61% sought professional assistance). Consistent with high levels of disruption to daily living, 59% of carer respondents (24%>10 days) had taken carer’s leave in the past 12 months.ConclusionsThese contemporary, self-reported, Australian data reveal the burden of living and caring for CHD from an adult’s perspective. Survey respondents highlighted the potential disconnect between paediatric and adult CHD services and suggest an important, unmet need for dedicated health services/community care to cost-effectively manage high levels of health care utilisation coupled with associated psychological distress.
  • Cardiac Society of Australia and New Zealand
    • Abstract: Publication date: February 2020Source: Heart, Lung and Circulation, Volume 29, Issue 2Author(s):
  • Early Gastrointestinal Complications From Ventricular Assist Devices is
           Increased by Non-Pulsatile Flow
    • Abstract: Publication date: February 2020Source: Heart, Lung and Circulation, Volume 29, Issue 2Author(s): Juliana van der Merwe, Eldho Paul, Franklin L. RosenfeldtBackgroundMeasurements of organ flow and perfusion during cardiopulmonary bypass suggest that perfusion of the splanchnic bed can be impaired by non-pulsatile flow. We postulated that non-pulsatile flow from centrifugal ventricular assist devices might also compromise splanchnic blood flow and cause bowel ischaemia especially in the period of circulatory instability early post-implant. The aim of the present studies was to compare the incidence of gastrointestinal (GI) complications in patients having a non-pulsatile device with the incidence in those having a pulsatile device.MethodsIn a pilot study, the initial 12 patients who received the Ventrassist (Ventracor, Sydney, NSW, Australia) centrifugal, non-pulsatile device during the period from June 2003 to September 2005 at the Alfred Hospital, Melbourne were compared with 11 patients who received a Thoratec (Thoratec, Pleasanton, CA, USA), pulsatile, positive displacement device and the incidence was recorded of GI complications requiring an intervention either surgical, endoscopic or by interventional radiology. This was followed by a larger (full) study of a second cohort of similar ventricular assist device (VAD) patients from January 1992 until December 2012 comparing 53 patients having non-pulsatile devices and 110 having pulsatile devices.ResultsIn the pilot study, the overall incidence of complications in the non-pulsatile group (67%) was almost double that in the pulsatile group (36%) but the difference was not statistically significant (p = 0.15) because of the small number (n = 23) of participants. In the full study, all GI complications with either device occurred within the first 3 weeks post-implant. In the non-pulsatile patients, there was a higher incidence of GI bleeding, 23% vs 4% (p = 0.002), endoscopies, 24% vs 12% (p = 0.049). More patients with a non-pulsatile flow device had delayed absorption of nasogastric feeds than their pulsatile counterparts, 35% vs 7% (p 
  • Outcomes of Evolut R Versus CoreValve After Transcatheter Aortic Valve
           Implantation: A Meta-Analysis
    • Abstract: Publication date: February 2020Source: Heart, Lung and Circulation, Volume 29, Issue 2Author(s): Yinghao Sun, Jie Li, Ruixin Fan, Guang Li, Ming Fu, Songyuan Luo, Huanyu Ding, Jianfang LuoBackgroundSuperiority of the new-generation, self-expanding Evolut R compared with the first-generation CoreValve on outcomes after transcatheter aortic valve implantation (TAVI) is unclear. This meta-analysis sought to investigate the outcomes of Evolut R vs CoreValve after TAVI.MethodsA systematic review of studies comparing outcomes of Evolut R and CoreValve after TAVI was performed through PubMed, EMBASE and Cochrane Library. Crude risk ratios (RRs) were calculated with 95% confidence intervals using a random effects model. Outcomes of interest were mortality, myocardial infarction (MI), stroke or transient ischaemic attack (TIA), severe bleeding, acute kidney injury (AKI), major vascular complications (MVC), permanent pacemaker implantation (PPI), moderate or severe paravalvular regurgitation (PVR), and device failure.ResultsSix studies involving 11,530 patients (4,597 receiving Evolut R and 6,933 receiving CoreValve) were included. There was no significant difference in 30-day all-cause mortality between Evolut R and CoreValve (3.4% vs 5.0%, p = 0.10). The incidence of MI (0.2% vs 0.5%, p = 0.02), AKI (6.0% vs 9.2%, p = 0.001), moderate or severe PVR (6.4% vs 8.0%, p = 0.04), and device failure (3.5% vs 5.2%, p = 0.04) were significantly lower in Evolut R than CoreValve. There were trends toward less severe bleeding (7.2% vs 8.8%, p = 0.05) and PPI (18.6% vs 20.8%, p = 0.05) in Evolut R. The rates of stroke or TIA and MVC were similar between the two prostheses.ConclusionsCompared with CoreValve, Evolut R did not reduce 30-day all-cause mortality, but significantly improved periprocedural complications after TAVI.
  • Incidence and Impact of Hypoalbuminaemia on Outcomes Following Acute
           Pulmonary Embolism
    • Abstract: Publication date: February 2020Source: Heart, Lung and Circulation, Volume 29, Issue 2Author(s): Scott Hoskin, Vincent Chow, Leonard Kritharides, Austin Chin Chwan NgBackgroundClinical features and outcomes of patients with hypoalbuminaemia in acute pulmonary embolism (PE) have never been studied. The present study investigated the incidence and determined the prognostic significance of hypoalbuminaemia in patients with confirmed acute PE.MethodsFrom a dedicated tertiary-referral centre database involving 1,426 consecutive patients admitted with confirmed PE (2000–2012), 1,032 patients had serum albumin assessed on admission (day-1). Patients were stratified into hypoalbuminaemia (
  • Procedural and Clinical Outcomes in Management of Bifurcational Lesions in
           ST Elevation Myocardial Infarction
    • Abstract: Publication date: February 2020Source: Heart, Lung and Circulation, Volume 29, Issue 2Author(s): Vimalraj Bogana Shanmugam, Peter J. Psaltis, Leslie Tay, Yuvaraj Malaiapan, Wally AhmarBackgroundBifurcation percutaneous coronary intervention (PCI) remains a challenging frontier in interventional cardiology, especially in the setting of ST-elevation myocardial infarction (STEMI). We examined the procedural and clinical outcomes of this patient subset.MethodsWe conducted a retrospective case–control study. Between February 2006 and March 2011, 129 patients with STEMI underwent bifurcation PCI at our institution. One hundred and twenty-nine (129) control STEMI patients with non-bifurcation PCI were selected from the institutional database, matched for age, gender, culprit vessel, and lesion location. Patients with cardiac arrest, cardiogenic shock, or who required mechanical ventilation were excluded. Twelve (12)-month follow-up data were collected by telephone calls and examination of the medical records.ResultsThe average age of patients presenting with STEMI was 61.6 ± 13.1 in the bifurcation group and 61.5 + 31.1 in the non-bifurcation group. There was no difference in lesion type, use of thrombus aspiration catheters, or glycoprotein inhibitors (GPI) among them. Also, the use of drug eluting stent (DES), total cumulative length of stent used, and diameter of the post-dilation balloon were similar. Final kissing balloon post-dilation was performed in 40.3% of bifurcation PCI cases. The incidence of procedural failure (TIMI 0 flow) was 1.5% vs. 0%; p = 0.478. At 12-months follow-up, the bifurcation PCI group had higher incidence of target lesion revascularisation (TLR) (10.9% vs. 3.9%, p = 0.050), mortality (10.1% vs. 2.3%, p = 0.020), and stent thrombosis (9.3% vs. 1.6%; p = 0.013); comprising one acute, nine subacute, and two late vs. two subacute stent thromboses.ConclusionsDuring acute STEMI, bifurcation PCI has excellent acute procedural outcomes, but significantly increased incidence of TLR, stent thrombosis and mortality at 12 months.
  • Influence of Body Mass Index on Recurrence of Ventricular Arrhythmia,
           Mortality in Defibrillator Recipients With Ischaemic Cardiomyopathy
    • Abstract: Publication date: February 2020Source: Heart, Lung and Circulation, Volume 29, Issue 2Author(s): Rahul Samanta, Arun Narayan, Jim Pouliopoulos, Pramesh Kovoor, Aravinda ThiagalingamBackgroundObesity is associated with increased risk of cardiovascular disease. There is little known, however, about the influence of body mass index (BMI) on spontaneously occurring ventricular arrhythmias in patients with ischaemic heart disease. We sought to examine the effect of BMI on the ventricular arrhythmia (VA) recurrence and mortality in defibrillator recipients with ischaemic cardiomyopathy.MethodsConsecutive patients (n = 123) with ischaemic cardiomyopathy (left ventricular ejection fraction (LVEF) ≤ 40%) and a primary or secondary prevention defibrillator were included. Patients were classified according to their BMI as being normal (18.5–24.99, n = 54/ 43.9%), overweight (2 –29.99, n = 43/ 35%) or obese (>30, n = 26/20.3%).ResultsThe primary combined endpoint of VA recurrence and mortality occurred in 36%, 5.4% and 11.5% of patients with normal, overweight and obese BMI (p = 0.001). When adjusting for risk factors such as ejection fraction, age and triple vessel disease, on multivariable analysis, normal BMI remained a significant predictor for the primary outcome (Hazard Ratio, Normal vs Overweight = 7.1, 95% CI 1.8–25, p = 0.002: Hazard Ratio, Normal vs Obese = 5.5, 95% CI 1.11–25, p = 0.033). There was a non-significant trend towards reduced survival in patients with normal weight in comparison to overweight and obese patients (p = 0.08).ConclusionIn defibrillator recipients with ischaemic cardiomyopathy, BMI appears to be a significant predictor for the combined primary outcome of spontaneously occurring ventricular arrhythmias and mortality. Normal BMI, compared to overweight and obese patients had worse outcomes, suggesting the presence of the obesity paradox in ventricular arrhythmogenesis late post infarction.
  • Does Echocardiography Have a Role in the Cardiologist’s Diagnosis of
           Innocent Murmurs in Childhood'
    • Abstract: Publication date: February 2020Source: Heart, Lung and Circulation, Volume 29, Issue 2Author(s): Hiu L. Ip, Samuel MenahemBackgroundInnocent murmurs are common in childhood. Echocardiography may diagnose almost all congenital cardiac abnormalities. Earlier studies have suggested that it may be unnecessary when a clinical diagnosis of an innocent murmur is made by an experienced cardiologist. Yet, echocardiography is commonly performed despite such a diagnosis. Is that justifiable'MethodsPatients referred to a paediatric cardiologist for evaluation of a murmur were assessed. If an innocent murmur was clinically diagnosed, an echocardiogram and an electrocardiogram were ordered when requested. The cardiologist completed a questionnaire documenting the reasons for the investigations and his degree of confidence in the clinical diagnosis. The parents and patients were informed of the diagnosis and the results of the investigations.ResultsIn almost all 62 cases whose murmurs were clinically considered to be innocent, the referring doctor expected an echocardiogram to be performed. Following echocardiography, one patient was found to have a small muscular ventricular septal defect. On review, the murmur was consistent with that diagnosis. Three (3) others had abnormal echocardiograms namely congenitally corrected transposition of great arteries, partial anomalous right upper lobe pulmonary vein, and left ventricular non-compaction. All on review were still considered clinically to have innocent murmurs.ConclusionsDespite the competency of the cardiologist, echocardiography diagnosed important but relatively uncommon cardiac abnormalities with prognostic implications that would have been missed if only the clinical examination was performed. Over and above the referring doctor’s expectations for an echocardiogram to be performed is the need for the cardiologist to provide a complete and definitive diagnosis.
  • Higher Diuretic Requirements in Acute Heart Failure With Admission
           Hyponatraemia Versus Normonatraemia
    • Abstract: Publication date: February 2020Source: Heart, Lung and Circulation, Volume 29, Issue 2Author(s): Hesham R. Omar, Maya GuglinAbstractBackgroundDiuretic requirements in patients with acute decompensated heart failure (ADHF) and hyponatraemia versus normonatraemia on admission has not been previously explored.MethodsThe Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial dataset was utilised to examine the characteristics and diuretic requirements of patients with ADHF with hyponatraemia or normonatraemia on admission.ResultsPatients with ADHF and admission hyponatraemia (n = 103, average Na 130.2 meq/L) had a higher degree of congestion evident in higher frequency of jugular venous distension (JVD)>12 cmH2O (p = 0.007), 2+ lower extremity oedema (p = 0.001), and higher right atrial pressure (p = 0.007), compared with normonatraemic patients (n = 327, average Na 138.6 meq/L). Despite a similar baseline furosemide dose in both groups (median 200 mg), the hyponatraemia group received higher in-hospital furosemide (280 vs. 200 mg, in both groups, respectively, p 
  • Histopathological and Biochemical Effects of Thyme Essential Oil on H2O2
           Stress in Heart Tissues
    • Abstract: Publication date: February 2020Source: Heart, Lung and Circulation, Volume 29, Issue 2Author(s): Fatma Guesmi, Linda Khantouche, Amel Mehrez, Houda Bellamine, Ahmed LandoulsiBackgroundThymus algeriensis (T. algeriensis) is traditionally used in Tunisia to treat many human diseases. The aim of the present study was to investigate whether terpenes extracted from the aerial parts of T. algeriensis are potent cardioprotective agents for hydrogen peroxide (H2O2)-induced cardiotoxicity in rats.MethodThirty (30) rats were divided into six groups as per the experimental design: control (n = 6); 0.1 mmol/L H2O2 (LD H2O2) (n = 6); 1 mmol/L H2O2 (HD H2O2) (n = 6); oily fraction of T. algeriensis (OFTS) (180 mg/kg b.wt) (n = 6); OFTS + 0.1 mmol/L H2O2 (n = 6); and OFTS + 1 mmol/L H2O2 (n = 6).ResultsThe H2O2 demonstrated concentration-dependent cardiotoxic effects in vitro. While, exposure of rats to OFTS significantly depleted H2O2-induced protein oxidation and lipid peroxidation, it raised antioxidant defence enzymes, and protected against H2O2-induced histopathological alterations. The antioxidant potential of the thyme essence was assessed by both enzymatic and non-enzymatic antioxidants.ConclusionIn conclusion, OFTS may be a potential compound for the therapy of oxidative stress-induced heart disease.
  • Determining the Influence of Psychiatric Comorbidity on Hospital
           Admissions in Cardiac Patients Through Multilevel Modelling of a Large
           Hospital Activity Data Set
    • Abstract: Publication date: February 2020Source: Heart, Lung and Circulation, Volume 29, Issue 2Author(s): Niranjan Bidargaddi, Geoffrey Schrader, Graeme Tucker, Rohan Dhillon, Anand GanesanBackgroundIncreasingly, big data derived from administrative hospital records can be subject to analytics to provide clinical insights. The aim of this study was to determine the impact of psychiatric comorbidity on length of hospital stay and number of hospital admissions in cardiac patients utilising routinely collected hospitalisation records.MethodsWe routinely collected clinical and socio-demographic variables extracted from 37,580 cardiac patients, between 18 and 65 years old, admitted to South Australian hospitals between 2001/02 to 2010/11 financial years with cardiac diagnoses used to derive patient level and separation level variables used in the modelling. Multi-level models were constructed to analyse the impact of psychiatric comorbidity on both length of stay and the total number of hospitalisations, allowing for interactions between socioeconomic status and the burden of disease. Possible confounders for these models were, sex, age, indigenous status, country of birth, and rural status.ResultsFor cardiac patients a mental health diagnosis was associated with an increase of 12.5% in the length of stay, and an increase in the number of stays by 20.0%.ConclusionsThis study demonstrates the potential utility of routinely collected hospitalisation records to demonstrate the impact of psychiatric comorbidity on health service utilisation.
  • Cardiopulmonary Exercise Test Parameters at Three Months After Alcohol
           Septal Ablation in Hypertrophic Obstructive Cardiomyopathy Are Associated
           With Late Clinical Outcome
    • Abstract: Publication date: February 2020Source: Heart, Lung and Circulation, Volume 29, Issue 2Author(s): Angelos G. Rigopoulos, Fotios Panou, Eleftherios Sakadakis, Alexandra Frogoudaki, Konstadia Papadopoulou, Helen Triantafyllidi, Muhammad Ali, Efstathios Iliodromitis, Ioannis Rizos, Michel NoutsiasBackgroundAlcohol septal ablation (ASA) is an established interventional treatment for hypertrophic obstructive cardiomyopathy (HOCM) patients with drug refractory symptoms. This study investigated the prognostic value of cardiopulmonary exercise test (CPET) in relation to the late clinical outcome.MethodsTwenty-one (21) HOCM patients underwent CPET before and 3 months after ASA and were followed yearly thereafter. Clinical success was considered to be a decrease of ≥1 (New York Heart Association or Canadian Cardiovascular Society) functional class. Cardiopulmonary exercise test parameters [maximal oxygen uptake (PeakVO2), % predicted VO2 (PeakVO2%), oxygen uptake at anaerobic threshold (AT), maximal workload (W), % predicted W (W%), ventilation (VE), % predicted VE (VE%), ventilation to maximal carbon dioxide production slope (VE/VCO2), % predicted maximal heart rate (HR%), and maximal systolic blood pressure (SBP)] were compared before and 3 months after ASA.ResultsAfter follow-up of 29 ± 13 months, 16 patients had a good clinical results (clinical responders), while five did not improve (clinical non-responders). The CPET parameters did not change in non-responders, while clinical responders showed significant improvement in VO2, VO2%, W, VE/VCO2, VE, VE%, as well as an increase in HR% and SBP at 3 months.ConclusionsThe data confirmed a good association between the improvement in CPET parameters and the clinical results 3 months after ASA. This may therefore serve as an early marker of HOCM-ASA treatment success.
  • Rugby Player’s Aorta: Alarming Prevalence of Ascending Aortic Dilatation
           and Effacement in Elite Rugby Players
    • Abstract: Publication date: February 2020Source: Heart, Lung and Circulation, Volume 29, Issue 2Author(s): Sharon Kay, Benjamin M. Moore, Laura Moore, Michael Seco, Christopher Barnes, David Marshman, Stuart M. Grieve, David S. CelermajerAbstractBackgroundPrompted by a cluster of observations concerning ascending aortic pathology in elite rugby players, we assessed over 150 asymptomatic predominantly retired players with echocardiography, aiming to document the prevalence and severity of ascending aortic dilatation and/or anterior aortic effacement, both ‘risk factors’ for potentially catastrophic aortic complications.MethodsRugby players (at least 5 years of high level competitive rugby) were classified as elite (national, state or first grade representatives) or non-elite. A total of 152 asymptomatic players with a mean age of 45 ± 13 years (range 21–65) underwent transthoracic echocardiography. Z-scores (number of standard deviations from a population mean) were calculated for aortic root and ascending aortic size.ResultsRegarding the aortic root, a Z-score of>2 was seen in 24% (expected prevalence 2.3%, p 3 was seen in 4% (expected prevalence 0..1%, p 2 in 53% of players and>3 in 22% (p 
  • Combining Ubiquinol With a Statin May Benefit Hypercholesterolaemic
           Patients With Chronic Heart Failure
    • Abstract: Publication date: February 2020Source: Heart, Lung and Circulation, Volume 29, Issue 2Author(s): Hans-Ulrich Kloer, Romualdo Belardinelli, Ou Ruchong, Franklin RosenfeldtHeart failure (HF) is one of the most common causes of death in Western society. Recent results underscore the utility of coenzyme Q10 (CoQ10) addition to standard medications in order to reduce mortality and to improve quality of life and functional capacity in chronic heart failure (CHF). The rationale for CoQ10 supplementation in CHF is two-fold. One is the well-known role of CoQ10 in myocardial bioenergetics, and the second is its antioxidant property. Redox balance is also improved by oral supplementation of CoQ10, and this effect contributes to enhanced endothelium-dependent relaxation. Previous reports have shown that CoQ10 concentration is decreased in myocardial tissue in CHF and by statin therapy, and the greater the CoQ10 deficiency the more severe is the cardiocirculatory impairment. In patients with CHF and hypercholesterolaemia being treated with statins, the combination of CoQ10 with a statin may be useful for two reasons: decreasing skeletal muscle injury and improving myocardial function. Ubiquinol, the active reduced form of CoQ10, presents higher bioavailability than the oxidised form ubiquinone, and should be the preferred form to be added to a statin. The combination ezetimibe/simvastatin may have advantages over single statins. Since ezetimibe reduces absorption of cholesterol and does not affect CoQ10 synthesis in the liver, the impact of this combination on CoQ10 tissue levels will be much less than that of high dose statin monotherapy at any target low density lipoprotein-cholesterol (LDL-C) level to be reached. This consideration makes the ezetimibe/statin combination the ideal LDL-lowering agent to be combined with ubiquinol in CHF patients. However, particular caution is advisable with the use of strategies of extreme lowering of cholesterol that may negatively impact on myocardial function. All in all there is a strong case for considering co-administration of ubiquinol with statin therapy in patients with depressed or borderline myocardial function.
  • Tear Size and Location Influence the Pressure of False Lumen Following
           Type A Aortic Dissection: Perspective of Current Evidence
    • Abstract: Publication date: February 2020Source: Heart, Lung and Circulation, Volume 29, Issue 2Author(s): Monira Sharif, Zhi Jiun Yap, Alaa Ghazal, Mohamad Bashir, Amer HarkyAortic dissection is a surgical emergency which poses a challenge to numerous clinicians across different specialties due to its high rate of associated morbidity and mortalities. Acute type A aortic dissection, which involves the ascending aorta and beyond, is a lethal condition. It is therefore vital to understand the pathophysiology that underlies this condition and the tools that aid its early detection. Haemodynamics factors including lumen wall shear stress and pressure, geometrical factors as entry tear location and size, and the composition of the aortic wall are well known to affect the disease progression. The studies on these factors are well established in Type B aortic dissection but not clearly emphasised in the setting of acute type A aortic dissection. The aim of this paper is to provide a comprehensive review of available literature on the relationship between tear size, location and the pressure of false lumen in acute type A aortic dissection.
  • Sedation and Analgesia for Cardiac Catheterisation and Coronary
    • Abstract: Publication date: February 2020Source: Heart, Lung and Circulation, Volume 29, Issue 2Author(s): Nicholas J. Whitehead, Alison L. Clark, Trent D. Williams, Nicholas J. Collins, Andrew J. BoyleBackgroundWhile cardiac catheterisation is typically well tolerated, discomfort and anxiety are commonplace. Sedation using anxiolytic and analgesic medications has the potential to ameliorate such symptoms, however, is variably employed, with lack of standardised regimens and limited evidence.MethodsWe performed a review of the role of sedation for cardiac catheterisation, including current practices and summarising available evidence relevant to diagnostic and interventional coronary procedures in the cardiac catheterisation laboratory.ResultsUse of sedation and the medication regimens employed are highly variable. Available relevant studies are limited in number and mostly small. Sedation appears to modestly reduce anxiety and pain in most studies. The incidence of radial spasm and the consequent need to alter access site is reduced with procedural sedation. The majority of existing evidence applies to benzodiazepines and opioid use, which appear acceptably efficacious and safe when used with appropriate training and staffing; noting opioid medications reduce the absorption of loading doses of oral anti-platelet drugs.ConclusionsIn conclusion, benzodiazepines and opioids result a modest reduction in pain, improved patient tolerability and reduced risk of radial artery spasm. The decision on whether to use sedation, and which agent(s) and dose, should be individualised based on patient factors, including need for oral antiplatelet therapy administration. Appropriate staffing and monitoring is essential.
  • Heart Foundation
    • Abstract: Publication date: February 2020Source: Heart, Lung and Circulation, Volume 29, Issue 2Author(s):
  • Pre-Test Probability and Genes and Variants of Uncertain Significance in
           Familial Long QT Syndrome
    • Abstract: Publication date: Available online 3 January 2020Source: Heart, Lung and CirculationAuthor(s): Kathryn E. Waddell-Smith, Jonathan R. Skinner, J. Martijn BosThe genetics underlying familial long QT syndrome (LQTS) are among the best characterised of all of the inherited heart conditions. Cohort and registry studies have demonstrated important genotype-phenotype correlations that are now essential in guiding clinical practice of patients with the most common three genotypes; KCNQ1 (LQT type 1), KCNH2 (LQT type 2) and SCN5A (LQT type 3). However, the growing number of genes—now more than 16—is confusing, and there is much doubt as to whether many actually cause LQTS at all. Furthermore, changes in sequencing techniques, evolving variant classification criteria and new scientific discoveries make all genes and variants subject to a continuous process of re-classification. This review discusses the nature of variant adjudication, the important concept of pre-test probability in interpreting a genetic result and how the nomenclature of LQTS is shifting in response to this new knowledge. It further discusses the role of deep phenotyping, the inclusion of evaluation of family members in interpreting a genetic test result, or even deciding if genetic testing should occur at all, and the role of specialist multidisciplinary teams to translate this continuously evolving knowledge into the best clinical advice, in partnership with referring cardiologists.
  • Catheter and Device Management of Inherited Cardiac Conditions
    • Abstract: Publication date: Available online 3 January 2020Source: Heart, Lung and CirculationAuthor(s): Richard Bennett, Timothy Campbell, Saurabh KumarThis state-of-the art review discusses sudden cardiac death (SCD) risk stratification and prevention using implantable cardioverter defibrillator (ICD) therapy and the place of catheter ablation in the major inherited cardiomyopathies and primary arrhythmic syndromes. ICD therapy protects against SCD in many inherited cardiac conditions, particularly the cardiomyopathies in advanced stages, such as hypertrophic cardiomyopathy (HCM) and arrhythmogenic right ventricular cardiomyopathy (ARVC). However, they are not usually indicated in most patients with cardiac ion channelopathies, particularly long QT syndrome, since medical management is safe and preferable for most cases. The general exception is the secondary prevention setting following a cardiac arrest, where guidelines mostly support ICD therapy. However, in the case of catecholaminergic polymorphic ventricular tachycardia (CPVT), ICD therapy is less clear, with some studies indicating increased mortality when an ICD is used following a cardiac arrest, compared to optimal medical therapy alone.When ICDs are placed, they are commonly associated with morbidity, and do not reduce the burden of ventricular arrhythmias (VA), such that multiple ICD shocks can ensue. Catheter ablation has been shown to reduce VA burden, VA related symptoms and ICD therapy in correctly identified patients in each condition. Its role is particularly important in cases where monomorphic ventricular tachycardia (VT) is prevalent, such as Lamin-related dilated cardiomyopathy (DCM) and ARVC. Evidence is growing to support the use of catheter ablation to treat premature ventricular contraction (PVC) induced VF in the setting of long and short QT syndromes, CPVT, idiopathic VF and early repolarisation syndromes. In Brugada syndrome, epicardial substrate ablation can even apparently eliminate the electrocardiographic (ECG) phenotype and reduce VA burden during follow-up.
  • Rare and Anomalous Retro-Oesophageal Course of the Left Brachiocephalic
           Vein in Tetralogy of Fallot: Evaluation on CT Angiography With Relevant
    • Abstract: Publication date: January 2020Source: Heart, Lung and Circulation, Volume 29, Issue 1Author(s): Niraj Nirmal Pandey, Kanika Bhambri, Sanjeev Kumar
  • Considerations for Developing Quality Indicators for Cardiac
           Rehabilitation in Australia
    • Abstract: Publication date: January 2020Source: Heart, Lung and Circulation, Volume 29, Issue 1Author(s): Emma Thomas, Adrienne O’Neil
  • Partial Aortic Root Remodelling for Selected Patients: Less Might be
    • Abstract: Publication date: January 2020Source: Heart, Lung and Circulation, Volume 29, Issue 1Author(s): Kanhua Yin, Zhiqi Zhang
  • Response to “Paradise Lost' New National Heart Foundation of
           Australia Guidelines on Heart Failure Fail to Recognise the Intensity of
           Exercise Evidence”
    • Abstract: Publication date: January 2020Source: Heart, Lung and Circulation, Volume 29, Issue 1Author(s): Tom Briffa, John J. Atherton, Cia Connell
  • The Importance of Considering Sex and Gender in Cardiovascular Research
    • Abstract: Publication date: January 2020Source: Heart, Lung and Circulation, Volume 29, Issue 1Author(s): Anna J. Scovelle, Allison Milner, Alison Beauchamp, Joshua Byrnes, Robyn Norton, Mark Woodward, Adrienne O’Neil
  • The Utility of Whole Body 18F-FDG PET-CT in Diagnosing Isolated Cardiac
           Sarcoidosis: The Western Australian Cardiac Sarcoid Study
    • Abstract: Publication date: January 2020Source: Heart, Lung and Circulation, Volume 29, Issue 1Author(s): Lauren Giudicatti, James Marangou, David Nolan, Lawrence Dembo, Jay Baumwol, Girish DwivediBackgroundIt is reported that up to 29–52% of patients with cardiac sarcoidosis (CS) may have isolated cardiac sarcoidosis (ICS). The wide variation in prevalence may be related to the diagnostic methods for assessing extracardiac involvement. Whole-body 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) imaging is a useful and increasingly used technique for screening for extracardiac involvement in cases of suspected ICS. This study aims to determine the rate of isolated cardiac involvement with clinically manifest CS using cardiac 18F-FDG PET-CT.MethodsWe performed a retrospective analysis of data in the West Australian Cardiac Sarcoid (WACaS) Database. After cardiologist review and workup, all cases of proven or probable CS, based on either current Heart Rhythm Society criteria for the diagnosis of CS or local expert consensus were included. Only patients who underwent whole body 18F-FDG PET-CT were included in the final analysis.ResultsFifty-two (52) cases of CS were identified. Data on symptoms, imaging findings, treatment and outcomes were collected. Of the 42 patients who underwent diagnostic 18F-FDG PET-CT, 32 demonstrated changes consistent with CS. Of the 32, 69% were male, mean age 50 years at diagnosis. Only 3/32 (9.4%) patients had ICS. Pulmonary involvement occurred in 91% with varied involvement in other organs. The mean number of extracardiac sites at diagnosis was 2.2.ConclusionsThis study demonstrates the utility of 18F-FDG PET-CT in diagnosing extracardiac organ involvement in cases of CS. With the use of this modality, ICS may be rarer than previously reported.
  • Vein Graft Patency Rates With Aspirin Plus Clopidogrel Following Coronary
           Artery Bypass Grafting
    • Abstract: Publication date: January 2020Source: Heart, Lung and Circulation, Volume 29, Issue 1Author(s): Joshua A. De Bono, Sean M. Conte, Daniel S. Florisson, Reece A. Davies, Andrew E. NewcombA best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, “In patients who have undergone Coronary Artery Bypass Grafting, does aspirin plus clopidogrel postoperatively improve vein graft patency when compared to aspirin alone'” Altogether, 165 papers were found using the reported search, of which five represented the best evidence to answer the clinical question. Overall analysis of these papers demonstrated similar rates of vein graft patency between the two groups. There was no difference between the groups with regard to mortality, adverse bleeding-related outcomes, or composite vascular events.
  • Outcomes of Double-patch and Warden Techniques in Patients With
           Supracardiac Partial Anomalous Pulmonary Venous Connection
    • Abstract: Publication date: January 2020Source: Heart, Lung and Circulation, Volume 29, Issue 1Author(s): Alexey Zubritskiy, Yuriy Naberukhin, Alexey Arkhipov, Yuriy Gorbatykh, Timur Khapaev, Nataliya Nichay, Yuriy Kulyabin, Alexander Bogachev-Prokophiev, Alexander KaraskovAimThis study compared outcomes following the double-patch and Warden procedures for correcting partial anomalous connection of the right pulmonary veins to the superior vena cava.MethodsEighty (80) patients, aged
  • Quality of Life is Related to Haemodynamics in Precapillary Pulmonary
    • Abstract: Publication date: January 2020Source: Heart, Lung and Circulation, Volume 29, Issue 1Author(s): Alexandra Arvanitaki, Sophia Anastasia Mouratoglou, Alexandros Evangeliou, Vasilios Grosomanidis, Stavros Hadjimiltiades, Lemonia Skoura, Christos Feloukidis, Dimitrios Farmakis, Haralambos Karvounis, George GiannakoulasBackgroundPrecapillary pulmonary hypertension (PH) is characterised by compromised functional capacity and impaired quality of life. Assessment of haemodynamics is routinely used for initial diagnosis, follow-up, and risk stratification in these patients. The purpose of this study was to investigate the relation of health-related quality of life (HRQoL) as assessed by emPHasis-10 score, a self-assessment questionnaire assessing breathlessness, fatigue, control, and confidence, to haemodynamic and neurohormonal indices in patients with precapillary PH.MethodThis was a prospective cross-sectional study which included stable patients with precapillary PH. All patients underwent right heart catheterisation, 6-minute walk test, N-terminal pro–brain natriuretic peptide (NT-proBNP) measurement, and assessment of HRQoL with the emPHasis-10 scale.ResultsOverall, 54 patients were included (32 women; mean age, 58.4 ± 14.6 yr). Mean emPHasis-10 score was 19.2 ± 12.0. EmPHasis-10 score correlated with World Health Organization functional class (r = 0.52, p 
  • Assessing Coronary Microvascular Dysfunction in Ischaemic Heart Disease:
           Little Things Can Make a Big Difference
    • Abstract: Publication date: January 2020Source: Heart, Lung and Circulation, Volume 29, Issue 1Author(s): James Xu, Sidney Lo, Craig P. Juergens, Dominic Y. LeungThe role of coronary microvascular dysfunction (CMD) in the pathogenesis of ischaemic heart disease and in determining long-term prognosis is increasingly recognised. In selected patients, a comprehensive coronary assessment including an assessment of microvascular function may help refine risk stratification and improve patient outcomes. Various non-invasive and invasive techniques have been developed to assess the coronary microcirculation. Many of these tests utilise the indicator-dilution principle to determine coronary or myocardial blood flow. However, these techniques are often limited by their variability and lack of specificity for the coronary microvasculature. Consequently, there is still paucity of data on targeted therapies for CMD and their implications on long-term clinical outcomes, particularly in the setting of non-ST elevation acute coronary syndromes. Recent technical advancements, such as the index of microcirculatory resistance, have largely overcome these limitations and are able to provide novel insights into the assessment and treatment of CMD. This review summarises the currently available techniques for the assessment of CMD and provides an overview of its clinical implications.
  • Mechanisms of Matrix Vesicles Mediating Calcification Transition in
           Diabetic Plaque
    • Abstract: Publication date: January 2020Source: Heart, Lung and Circulation, Volume 29, Issue 1Author(s): Zhongqun Wang, Lili Zhang, Zhen Sun, Chen Shao, Yukun Li, Zhengyang Bao, Lele Jing, Yue Geng, Wen Gu, Qiwen Pang, Lihua Li, Jinchuan YanVascular calcification is a key character of advanced plaque in diabetic atherosclerosis. Microcalcification induces plaque rupture, whereas macrocalcification contributes to plaque stability. However, there is still no clear explanation for the formation and transition of these two types of calcification. Based on existing work and the latest international progress, this article provides a brief review of four aspects: calcification transition in plaque; matrix vesicle-mediated calcification transition in plaque; regulation mechanism of matrix vesicle-mediated calcification transition in diabetic plaque; and proposal of a new hypothesis, which may offer a new perspective on the study of the mechanism of calcification transition in plaque.
  • Renal Artery Denervation in Resistant Hypertension: The Good, The Bad and
           The Future
    • Abstract: Publication date: January 2020Source: Heart, Lung and Circulation, Volume 29, Issue 1Author(s): Sara I. Al Raisi, Jim Pouliopoulos, John Swinnen, Aravinda Thiagalingam, Pramesh KovoorEarly studies of renal artery denervation (RAD) demonstrated efficacy in treating resistant hypertension patients with significant reduction in office blood pressure (BP). This resulted in a growing enthusiasm in the field and a rapid evolution of technology with expanding procedural indications. However, the first randomised sham-controlled trial, Symplicity HTN-3, failed to demonstrate a significant difference in BP reduction between the RAD and the sham control arm, which subsequently led to a major reduction in the clinical application of this procedure. Additionally, the results generated further interest into understanding the mechanism and factors affecting procedural success and identifying the limitations within the field. Many lessons were learned from Symplicity HTN-3 trial, and with recent evidence emerging for RAD in hypertension treatment, the field continues to be refined.
  • Is Atrial Fibrillation a Stroke Risk Factor or Risk Marker' An
           Appraisal Using the Bradford Hill Framework for Causality
    • Abstract: Publication date: January 2020Source: Heart, Lung and Circulation, Volume 29, Issue 1Author(s): Varun Malik, Anand N. Ganesan, Joseph B. Selvanayagam, Derek P. Chew, Andrew D. McGaviganAtrial fibrillation (AF) is strongly associated with stroke risk but association on its own does not necessarily imply causality. Is AF a cause (risk factor) of stroke' Would treatment that reduces AF burden also reduce the burden of stroke' Or, perhaps, AF is a risk marker associated with a vascular syndrome in which there is co-existing atrial structural and electrical remodelling that results in the clinical manifestation of AF and the risk of stroke in parallel. A number of recent studies appear to detach AF as a direct cause of stroke. Studies in which cardiac implantable devices have been used to collect AF data preceding stroke appear to show no immediate temporal relationship. The Global Anticoagulant Registry in the Field - Atrial Fibrillation (GARFIELD-AF) a large worldwide registry of non-valvular AF, has shown that the risk of death exceeds the risk of stroke and that mortality, together with stroke and bleeding risk, is predicted by other vascular risk factors, defined by the CHA2DS2VASc score.Sir Bradford Hill proposed criteria to assess whether two associated factors are causal, more than 50 years ago. This method of analysing cause and effect in a complex scenario could be applied to AF and stroke.This paper aims to clinically appraise the evidence for each criterion outlined by Bradford Hill to single out whether the collective data supports one or the other.
  • Biomarkers in Heart Failure With Preserved Ejection Fraction: An Update on
           Progress and Future Challenges
    • Abstract: Publication date: January 2020Source: Heart, Lung and Circulation, Volume 29, Issue 1Author(s): Jonathan Carnes, Gary GordonHeart failure with preserved ejection fraction (HFpEF) is a major health care problem, with no treatment available that significantly reduces mortality. HFpEF is a phenotypically diverse syndrome, which creates difficulties in establishing an accurate diagnosis, determining prognosis, and developing effective management strategies. The number of serum biomarkers being investigated to further our understanding of HFpEF is rapidly expanding. In this review, we critically appraise the current clinical utility of biomarkers in HFpEF, particularly for pathophysiological pathways involving cardiomyocyte stretch, injury, fibrosis, remodelling, systemic inflammation, and renal dysfunction. Guideline-based clinical indications for biomarker testing in HFpEF and their limitations are discussed. Investigative strategies including the use of multi-biomarker panels and standardisation of research methodologies may prove useful in developing biomarkers for HFpEF in the future.
  • The Future of Open Heart Surgery in the Era of Robotic and Minimal
           Surgical Interventions
    • Abstract: Publication date: January 2020Source: Heart, Lung and Circulation, Volume 29, Issue 1Author(s): Amer Harky, Grace Chaplin, Jeffrey Shi Kai Chan, Peter Eriksen, Beverly MacCarthy-Ofosu, Thomas Theologou, Andrew D. MuirIt has been over two decades since the very first robotic cardiac surgery was performed. Over the years, there has been an increase in the demand for less invasive cardiac surgical techniques. Developments in technology and engineering have provided an opportunity for robotic surgery to be applied to a variety of cardiac procedures, including coronary revascularisation, mitral valve surgery, atrial fibrillation ablation, and others. In coronary revascularisation, it is becoming more widely used in single vessel, as well as hybrid coronary artery approaches. Currently, several international centres are specialising in a totally endoscopic coronary artery bypass surgery involving multiple vessels. Mitral valve and other intracardiac pathologies such as atrial septal defect and intracardiac tumour are also increasingly being addressed robotically. Even though some studies have shown good results with robot-assisted cardiac surgery, there are still concerns about safety, cost and clinical efficacy. There are also limitations and additional challenges with the management of cardiopulmonary bypass and myocardial protection during robotic surgery. Implementing novel strategies to manage these challenges, together with careful patient selection can go a long way to producing satisfactory results. This review examines the current evidence behind robotic surgery in various aspects of cardiac surgery.
  • The Cardiac Society of Australia and New Zealand Position Statement on the
           Diagnosis and Management of Arrhythmogenic Right Ventricular
           Cardiomyopathy (2019 Update)
    • Abstract: Publication date: January 2020Source: Heart, Lung and Circulation, Volume 29, Issue 1Author(s): Christian Hamilton-Craig, Andrew McGavigan, Chris Semsarian, Andrew Martin, John Atherton, Tony Stanton, Andre La Gerche, Andrew J. Taylor, Haris Haqqani
  • Improving the Monitoring of Cardiac Rehabilitation Delivery and Quality: A
           Call to Action for Australia
    • Abstract: Publication date: January 2020Source: Heart, Lung and Circulation, Volume 29, Issue 1Author(s): Emma Thomas, Carolyn Astley, Robyn Gallagher, Rachelle Foreman, Julie Anne Mitchell, Sherry L. Grace, Dominique A. Cadilhac, Stephen Bunker, Alexander Clark, Adrienne O’Neil
  • Cardiac Society of Australia and New Zealand
    • Abstract: Publication date: January 2020Source: Heart, Lung and Circulation, Volume 29, Issue 1Author(s):
  • Twiddler’s Syndrome
    • Abstract: Publication date: January 2020Source: Heart, Lung and Circulation, Volume 29, Issue 1Author(s): Yassar Alamri, Vicky Mann
  • Permanent Pacing in a Patient With Fontan Circulation: Use All You Have at
           Your Discretion
    • Abstract: Publication date: January 2020Source: Heart, Lung and Circulation, Volume 29, Issue 1Author(s): Ashish H. Shah, Aliasghar Khadem, James Tam, Robin DucasPatients with Fontan circulation post significant technical challenges at the time of permanent pacemaker implantation, as majority of them are treated with surgically implanted epicardial pacemakers. However, transvenous pacemaker implantation is technically feasible, and the treating physician should be aware of each individual's anatomy and available treatment options.
  • Heart Foundation
    • Abstract: Publication date: January 2020Source: Heart, Lung and Circulation, Volume 29, Issue 1Author(s):
  • Genetic Heart Diseases: Familial Aortopathies – State of the Art
    • Abstract: Publication date: Available online 30 December 2019Source: Heart, Lung and CirculationAuthor(s): Dominica Zentner, Paul James, Paul Bannon, Richard JeremyAortopathies are conditions that result in aortic dilatation, aneurysm formation and dissection. Familial aortopathies (perhaps better known as heritable thoracic aortic aneurysm and dissection, h-TAAD, as not all have a positive family history) are recognised to have an underlying genetic cause and affect the aorta, predisposing it to the above pathologies. These conditions can also affect the extra aortic vasculature, particularly large elastic arteries and other body systems.Mutations in a number of genes have been associated with h-TAAD. However, not all affected families have a pathogenic gene variant identified—highlighting the importance of a three-generational family history and the likely role of both environmental factors and future gene discoveries in furthering knowledge.Survival has improved over the last few decades, essentially due to surgical intervention. The benefit of identifying affected individuals depends upon a regular surveillance program and timely referral for surgery before complications such as dissection.Further research is required to appreciate fully the effects of individual gene variants and improve evidence for prophylactic medical therapy, as well as to understand the effect of h-TAAD on quality of life and life choices, particularly around exercise and pregnancy, for affected individuals. This will be complemented by laboratory-based research that seeks to understand the tissue pathways that underlie development of arterial pathology, ideally providing targets for novel medical therapies and a means of non-invasively identifying individuals at increased vascular risk to reduce dissection, which remains a devastating life-threatening event.
  • Polygenic Risk Scores in Coronary Artery Disease and Atrial Fibrillation
    • Abstract: Publication date: Available online 27 December 2019Source: Heart, Lung and CirculationAuthor(s): Patrick A. Gladding, Malcolm Legget, Diane Fatkin, Peter Larsen, Robert DoughtyCoronary artery disease (CAD) and atrial fibrillation (AF) are two highly prevalent cardiovascular disorders that are associated with substantial morbidity and mortality. Conventional clinical risk factors for these disorders may not be identified prior to mid-adult life when pathophysiological processes are already established. A better understanding of the genetic underpinnings of disease should facilitate early detection of individuals at risk and preventative intervention. Single rare variants of large effect size that are causative for CAD, AF, or predisposing factors such as hypertension or hyperlipidaemia, may give rise to familial forms of disease. However, in most individuals, CAD and AF are complex traits in which combinations of genetic and acquired factors play a role. Common genetic variants that affect disease susceptibility have been identified by genome-wide association studies, but the predictive value of any single variant is limited. To address this issue, polygenic risk scores (PRS), comprised of suites of disease-associated common variants have been devised. In CAD and AF, incorporation of PRS into risk stratification algorithms has provided incremental prognostic information to clinical factors alone. The long-term health and economic benefits of PRS-guided clinical management remain to be determined however, and further evidence-based data are required.
  • Hypertrophic Cardiomyopathy: Challenging the Status Quo'
    • Abstract: Publication date: Available online 27 December 2019Source: Heart, Lung and CirculationAuthor(s): John Younger, Ada Lo, Louise McCormack, Julie McGaughran, Sandhir Prasad, John J. AthertonHypertrophic cardiomyopathy (HCM) is the most common cardiovascular genetic disorder. While our mechanistic understanding has been informed by elegant gene discovery studies that led to the term “disease of the sarcomere”, more recent investigations have challenged the single-gene hypothesis. Multimodality imaging has allowed better phenotyping to facilitate early diagnosis, identify treatable phenocopies, and guide management. While HCM remains an important cause of sudden death, recent studies have reported a substantial cumulative burden of heart failure and atrial fibrillation in middle-aged and older individuals. Nonetheless, improvements in risk stratification have allowed early intervention to transition HCM from being a common cause of sudden death in the young to a treatable chronic disease.
  • Exercise and Arrhythmogenic Right Ventricular Cardiomyopathy
    • Abstract: Publication date: Available online 26 December 2019Source: Heart, Lung and CirculationAuthor(s): David Prior, Andre La GercheArrhythmogenic right ventricular cardiomyopathy (ARVC) is a group of cardiomyopathies associated with ventricular arrhythmias predominantly arising from the right ventricle, sudden cardiac death and right ventricular failure, caused largely due to inherited mutations in proteins of the desmosomal complex. Whilst long recognised as a cause of sudden cardiac death (SCD) during exercise, it has recently been recognised that intense and prolonged exercise can worsen the disease resulting in earlier and more severe phenotypic expression. Changes in cardiac structure and function as a result of exercise training also pose challenges with diagnosis as enlargement of the right ventricle is commonly seen in endurance athletes. Advice regarding restriction of exercise is an important part of patient management, not only of those with established disease, but also in individuals known to carry gene mutations associated with development of ARVC.
  • Cardiovascular Magnetic Resonance Imaging of Inherited Heart Conditions
    • Abstract: Publication date: Available online 24 December 2019Source: Heart, Lung and CirculationAuthor(s): Mark Dennis, Martin Ugander, Rebecca Kozor, Rajesh PuranikImaging modalities are central to diagnosis and prognostication of confirmed or suspected inherited cardiomyopathies. The availability and use of cardiovascular magnetic resonance imaging (CMR) to supplement traditional modalities has increased substantially and has several advantages over traditional imaging techniques. CMR is unique in its ability to easily acquire images in any plane. Moreover, advances in CMR sequences have begun to enable characterisation of the myocardium without the need for invasive biopsy and has a provided a major step forward in the understanding of inherited heart disease pathology and genotype-phenotype interactions. This review summarises the current role of CMR in inherited cardiomyopathies depending on their genotype and phenotype status, using arrhythmogenic right ventricular dysplasia/cardiomyopathy and hypertrophic cardiomyopathy as prototypical examples.
  • Normative Heart-Rate Corrected Values for Repolarisation Length From
           Holter Recordings in Children and Adults
    • Abstract: Publication date: Available online 24 December 2019Source: Heart, Lung and CirculationAuthor(s): Kathryn E. Waddell-Smith, Alexandra A. Chaptynova, Jian Li, Jackie R. Crawford, Halina Hinds, Jonathan R. SkinnerBackgroundNormative values for heart-rate corrected repolarisation length are not available in children and are scarce in adults. We wished to define repeatability and normative values of Holter recording measurements of repolarisation length in healthy individuals using a commercially available system, and compare measurements with those from 12-lead electrocardiograms (ECGs).MethodsTwenty-four-hour (24)-hour Holter recordings were made on 99 Healthy volunteers: 52 children (7 months to 14 years) and 47 adults (≥15 yrs). Mean and peak values of QTc, and RTPc (R-wave to peak T-wave,) were assessed. Bazett heart rate correction was employed for each measurement and only heart rates between 40 and 120 bpm were analysed. The end of the T-wave was defined from the zero-crossing point. QTc was also determined from 12-lead ECGs from the same population by manual measurement recording the longest QTc of leads 2 and V5. The tangent technique was used to define the end of the T-wave.ResultsInterobserver repeatability: mean QTc ±15 ms (CI 3.5%), peak QTc ±25 ms (CI 4.5%), mean RTPc ±3 ms (CI 1%), peak RTPc ±44 ms (CI 11%). Mean values were very similar for
  • Familial Hypercholesterolaemia in 2020: A Leading Tier 1 Genomic
    • Abstract: Publication date: Available online 24 December 2019Source: Heart, Lung and CirculationAuthor(s): Jing Pang, David R. Sullivan, Tom Brett, Karam M. Kostner, David L. Hare, Gerald F. WattsFamilial hypercholesterolaemia (FH) is caused by a major genetic defect in the low-density lipoprotein (LDL) clearance pathway. Characterised by LDL-cholesterol elevation from birth, FH confers a significant risk for premature coronary artery disease (CAD) if overlooked and untreated. With risk exposure beginning at birth, early detection and intervention is crucial for the prevention of CAD. Lowering LDL-cholesterol with lifestyle and statin therapy can reduce the risk of CAD. However, most individuals with FH will not reach guideline recommended LDL-cholesterol targets. FH has an estimated prevalence of approximately 1:250 in the community. Multiple strategies are required for screening, diagnosing and treating FH. Recent publications on FH provide new data for developing models of care, including new therapies. This review provides an overview of FH and outlines some recent advances in the care of FH for the prevention of CAD in affected families. The future care of FH in Australia should be developed within the context of the National Health Genomics Policy Framework.
  • Worsening Renal Function in Cardiac Mechanical Support
    • Abstract: Publication date: Available online 24 December 2019Source: Heart, Lung and CirculationAuthor(s): Julie Tsay, Daniel Pinkhas, Bryan C. Lee, Aaron Guo, Joel Ferrall, Mohamed H. Derbala, Brent C. Lampert, Sitaramesh Emani, Bryan A. Whitson, Sakima A. SmithBackgroundVenous congestion in heart failure (HF) may lead to worsening renal failure (WRF). We hypothesised that WRF in patients hospitalised for left ventricular assist device (LVAD) implantation is associated with increased 1-year mortality. There is limited data regarding WRF in HF patients with mechanical support. The objective of this paper is to determine whether WRF in HF patients hospitalised for LVAD implantation is associated with increased 1-year mortality and to identify risk factors for WRF.MethodsWe performed a single centre retrospective chart analysis of 162 patients who received an LVAD between August 2006 and December 2014 with pre-LVAD right heart catheterisation data. We stratified patients to those who demonstrated WRF and the use of haemodialysis (HD) or ultrafiltration (UF).ResultsPatients with a higher central venous pressure (CVP)>16 mmHg (17–24 mmHg range) developed WRF (29.7% vs. 14.1%, p=0.019). A CVP ≥ 16 and glomerular filtration rate (GFR)
  • Transitions in Atrial Fibrillation Care: A Systematic Review
    • Abstract: Publication date: Available online 24 December 2019Source: Heart, Lung and CirculationAuthor(s): Kathy L. Rush, Lindsay Burton, Rachel Ollivier, Ryan Wilson, Peter Loewen, Robert Janke, Kira Schaab, Alexandra Lukey, Camille GallowayBackgroundPatients with atrial fibrillation (AF) commonly transition between care settings and providers. These transitions are often points in the health care system where errors and clinical deterioration can occur. Anticoagulation interruption or discontinuation and sub-optimal follow-up post-emergency department (ED) discharge are considered major transitional issues.ObjectiveThe purpose of this study was to synthesise the evidence examining the impact of transitional care interventions on patient, provider, and health care utilisation outcomes.MethodsThis systematic mixed studies review examined citations from three databases Medline, CINAHL, EMBASE, and Cochrane Controlled Register of Trials using relevant search terms. Fourteen (14) moderate to high quality articles were selected.ResultsThe available evidence reporting impacts of transitional interventions on health care utilisation, provider, and patient outcomes in AF patients is mixed and of variable quality. The stronger evidence revealed improvements in patient outcomes including knowledge, quality of life, and medication adherence and increased provider anticoagulant prescriptions resulting from transitional interventions. Hospital admissions and ED visits were not significantly affected by any interventions.ConclusionsApps and educational toolkits improved patient knowledge. Pathways increased patient quality of life and provider prescription rates. There is a need for more research to determine the AF transition interventions which maximise patient, provider and health care outcomes.
  • Clinical and Prognostic Values of ALBI Score in Patients With Acute Heart
    • Abstract: Publication date: Available online 23 December 2019Source: Heart, Lung and CirculationAuthor(s): Yuya Matsue, Nobuyuki Kagiyama, Tetsuo Yamaguchi, Shunsuke Kuroda, Takahiro Okumura, Keisuke Kida, Atsushi Mizuno, Shogo Oishi, Yasutaka Inuzuka, Eiichi Akiyama, Ryuichi Matsukawa, Kota Kato, Kenji Yoshioka, Tatsuya Miyoshi, Satoshi Suzuki, Yuichi Baba, Masayoshi Yamamoto, Kazuo Mizutani, Kazuki Yoshida, Takeshi KitaiBackgroundAlthough liver dysfunction is one of the common complications in patients with acute heart failure (AHF), no integrated marker has been defined. The albumin-bilirubin (ALBI) score has recently been proposed as a novel, clinically-applicable scoring system for liver dysfunction. We investigated the utility of the ALBI score in patients with AHF compared to that for a preexisting liver dysfunction score, the Model of End-Stage Liver Disease Excluding prothrombin time (MELD XI) score.MethodsWe evaluated ALBI and MELD XI scores in 1,190 AHF patients enrolled in the prospective, multicentre REALITY-AHF study. The associations between the two scores and the clinical profile and prognostic predictive ability for 1-year mortality were evaluated.ResultsThe mean MELD XI and ALBI scores were 13.4±4.8 and -2.25±0.48, respectively. A higher ALBI score, but not higher MELD XI score, was associated with findings of fluid overload. After adjusting for pre-existing prognostic factors, the ALBI score (HR 2.11, 95% CI: 1.60–2.79, p
  • The Prognostic Value of Elevated Perioperative Neutrophil-Lymphocyte Ratio
           in Predicting Postoperative Atrial Fibrillation After Cardiac Surgery: A
           Systematic Review and Meta-Analysis
    • Abstract: Publication date: Available online 19 December 2019Source: Heart, Lung and CirculationAuthor(s): Zhengyang Liu, Jacqueline Nguyen Khuong, Carla Borg Caruana, Sarah M. Jackson, Ryan Campbell, Dhruvesh M. Ramson, Jahan C. Penny-Dimri, Michael Kluger, Reny Segal, Luke A. PerryBackgroundThe neutrophil-lymphocyte ratio (NLR) is an emerging inflammatory perioperative biomarker which has been studied to predict the incidence of postoperative atrial fibrillation (POAF) after cardiac surgery. This systematic review and meta-analysis aimed to evaluate the prognostic accuracy of elevated perioperative NLR in predicting POAF after cardiac surgery.MethodsMultiple databases were searched from inception to May 2019 for prognostic studies on perioperative NLR and POAF following cardiac surgery. Maximally adjusted odds ratios (OR) with associated confidence intervals were obtained from each included study and pooled using random effects inverse variance modelling for preoperative NLR measurements, while standardised mean differences were pooled for postoperative NLR values. The significance of inter- and intra-study heterogeneity was explored using meta-regression.Results1,799 unique studies satisfied selection criteria, from which 12 studies incorporating 9,262 participants were included. Elevated preoperative NLR significantly predicted POAF, with a pooled OR of 1.42 (95% CI 1.16–1.72). Multiple predefined covariates contributed to inter-study heterogeneity; however, only prevalence of hypertension (p=0.0055), history of congestive cardiac failure (p=0.0282) and average ejection fraction (p=0.0359) were significant effect modifiers. Elevated postoperative NLR was not a significant predictor of POAF (standardised mean difference 1.60 [95% CI -0.56–3.77] between POAF+ and POAF- groups).ConclusionsElevated preoperative NLR is a promising prognostic biomarker for POAF, but residual sources of heterogeneity remain. Larger scale validation studies are required to justify the integration of preoperative NLR testing into routine clinical practice.
  • How Patient Perceptions Shape Responses and Outcomes in Inherited Cardiac
    • Abstract: Publication date: Available online 18 December 2019Source: Heart, Lung and CirculationAuthor(s): Claire O’Donovan, Jodie Ingles, Elizabeth Broadbent, Jonathan R. Skinner, Nadine A. KasparianAt least one-third of adults living with an inherited cardiac condition report clinically-significant levels of psychological distress. Poorer health-related quality of life compared with population norms is also consistently reported. These outcomes are associated with younger patient age, having an implantable cardioverter defibrillator, and receipt of uncertain clinical test results, and can influence self-management behaviours, such as adherence to potentially critical life-preserving medications. According to the Common Sense Model of Illness, people use information from multiple sources to ‘make sense’ of their health condition, and how they conceptualise the condition can strongly influence adaptation and coping responses. Previous studies with people with inherited cardiac conditions show that illness perceptions, such as greater perceived consequences and a poorer understanding of the condition, are associated with greater psychological distress and poorer adherence to medication. The Common Sense Model provides one potential framework for identifying patients who may be more vulnerable to adverse health outcomes, and for developing early interventions to reduce the physical and psychosocial burden of these conditions. Interventions based on the Common Sense Model have successfully improved physical and psychosocial outcomes associated with other cardiac conditions, and could be tailored for use with patients with an inherited cardiac condition (ICC).
  • Amyloid Cardiomyopathy
    • Abstract: Publication date: Available online 17 December 2019Source: Heart, Lung and CirculationAuthor(s): Nicole K. Bart, Liza Thomas, Dariusz Korczyk, John J. Atherton, Graeme J. Stewart, Diane FatkinAmyloid cardiomyopathy is emerging as an important and under-recognised cause of heart failure and cardiac arrhythmias, especially in older adults. This disorder is characterised by extracellular deposition of amyloid fibrils that form due to misfolding of secreted light chains (AL) or transthyretin protein (ATTR). In ATTR, amyloid aggregates typically result from excessive accumulation of wild-type transthyretin (ATTRwt) or from protein structural defects caused by TTR gene variants (ATTRv). Amyloid fibril deposition may predominantly affect the heart or show multi-system involvement. Previously considered to be rare and inexorably progressive with no specific therapy, there has been enormous recent interest in ATTR cardiomyopathy due to upwardly-revised estimates of disease prevalence together with development of disease-modifying interventions. Because of this, there is a clinical imperative to have a high index of suspicion to identify potential cases and to be aware of contemporary diagnostic methods and treatment options. Genetic testing should be offered to all patients with proven ATTR to access the benefits of new therapies specific to ATTRv and allow predictive testing of family members. With heightened awareness of amyloid cardiomyopathy and expanded use of genetic testing, a substantial rise in the numbers of asymptomatic individuals who are carriers of pathogenic variants is expected, and optimal strategies for monitoring and treatment of these individuals at risk need to be determined. Pre-emptive administration of fibril-modifying therapies provides an unprecedented opportunity for disease prevention and promises to change amyloid cardiomyopathy from being a fatal to a treatable disorder.
  • Familial Dilated Cardiomyopathy
    • Abstract: Publication date: Available online 17 December 2019Source: Heart, Lung and CirculationAuthor(s): Stacey Peters, Renee Johnson, Samuel Birch, Dominica Zentner, Ray E. Hershberger, Diane FatkinAdvances in human genome sequencing have re-invigorated genetics studies of dilated cardiomyopathy (DCM), facilitating genetic testing and clinical applications. With a range of genetic testing options now available, new challenges arise for data interpretation and identifying single pathogenic variants from the many thousands of rare variants present in every individual. There is accumulating evidence that genetic factors have an important role in the pathogenesis of DCM. However, although more than 100 genes have been implicated to date, the sensitivity of genetic testing, even in familial disease, is only ∼25–40%. As more patients are genotyped, nuanced information about disease phenotypes is emerging including variability in age of onset and penetrance of DCM, as well as additional cardiac and extra-cardiac features. Genotype-phenotype correlations have also identified a subset of genes that can be highly arrhythmogenic or show frequent progression to heart failure. Recognition of variants in these genes is important as this may impact on the timing of implantable cardioverter-defibrillators or heart transplantation. Finding a causative variant in a patient with DCM allows predictive testing of family members and provides an opportunity for preventative intervention. Diagnostic imaging modalities such as speckle-tracking echocardiography and cardiac magnetic resonance imaging are increasingly being used to detect and monitor pre-clinical ventricular dysfunction in asymptomatic variant carriers. Although there are several examples of successful genotype-based therapy, optimal strategies for implementation of precision medicine in familial DCM remain to be determined. Identification of modifiable co-morbidities and lifestyle factors that exacerbate or protect against DCM development in genetically-predisposed individuals remains a key component of family management.
  • Brugada Syndrome: Clinical Care Amidst Pathophysiological Uncertainty
    • Abstract: Publication date: Available online 17 December 2019Source: Heart, Lung and CirculationAuthor(s): Julia Isbister, Andrew D. Krahn, Christopher Semsarian, Raymond W. SyBrugada syndrome (BrS) is a complex clinical entity with ongoing conjecture regarding its genetic basis, underlying pathophysiology, and clinical management. Within this paradigm of uncertainty, clinicians are faced with the challenge of caring for patients with this uncommon but potentially fatal condition. This article reviews the current understanding of BrS and highlights the “known unknowns” to reinforce the need for flexible clinical practice in parallel with ongoing scientific discovery.
  • Adherence to Cardiac Medications in Patients With Atrial Fibrillation: A
           Pilot Study
    • Abstract: Publication date: Available online 17 December 2019Source: Heart, Lung and CirculationAuthor(s): Adrienne Pacleb, Nicole Lowres, Sue Randall, Lis Neubeck, Robyn GallagherBackgroundNon-adherence to medications is common in patients with atrial fibrillation (AF), increasing the risk of stroke, co-morbidities, and AF symptoms. Understanding factors influencing medication adherence is important in providing holistic care to patients with AF. This study aimed to explore medication adherence in patients with AF, and explore associations with health literacy, cognition, or AF knowledge.MethodsA single-centre pilot study, using survey questionnaires and open questions. Patients with a primary cardiac diagnosis, with AF as primary or secondary diagnosis, were eligible for recruitment. During hospitalisation, adherence to cardiac medications was assessed using the Basel Assessment of Adherence to Immunosuppressive Medication Scale (BAASIS). Health literacy, cognition, and AF knowledge were assessed through validated questionnaires. Facilitators and barriers for medication adherence were obtained through open-ended question and coded using a content analysis approach.ResultsFifty-four (54) patients were recruited (61% male, mean age 71±11). Twenty-two (22) participants (41%) were classified as non-adherent using the BAASIS; with a corresponding self-reported adherence of 87.7% in non-adherent participants compared to 97.8% in adherent participants. No associations were identified between medication adherence and cognition, health literacy, or AF knowledge. Facilitators for adherence included external assistance, routines, and medication knowledge, and these were reported by both adherent and non-adherent participants. Non-adherent participants reported more barriers including medication concerns, forgetfulness, and lifestyle factors.ConclusionsLarge numbers of AF patients are likely to be non-adherent to medications. Medication adherence is influenced by multiple factors, individual to each patient. Diverse strategies are required to ensure adherence to cardiac medications.
  • Quality of Warfarin Anticoagulation in Indigenous and Non-Indigenous
           Australians With Atrial Fibrillation
    • Abstract: Publication date: Available online 17 December 2019Source: Heart, Lung and CirculationAuthor(s): Mau T. Nguyen, Celine Gallagher, Bradley M. Pitman, Mehrdad Emami, Kadhim Kadhim, Jeroen M. Hendriks, Melissa E. Middeldorp, Kurt C. Roberts-Thomson, Rajiv Mahajan, Dennis H. Lau, Prashanthan Sanders, Christopher X. WongBackgroundStudies have shown that suboptimal anticoagulation quality, as measured by time in therapeutic range (TTR), affects a significant percentage of patients with atrial fibrillation (AF). However, TTR has not been previously characterised in Indigenous Australians who experience a greater burden of AF and stroke.MethodIndigenous and non-Indigenous Australians with AF on warfarin anticoagulation therapy were identified from a large tertiary referral centre between 1999 and 2012. Time in therapeutic range was calculated as a proportion of daily international normalised ratio (INR) values between 2 and 3 for non-valvular AF and 2.5 to 3.5 for valvular AF. INR values between tests were imputed using the Rosendaal technique. Linear regression models were employed to characterise predictors of TTR.ResultsFive hundred twelve (512) patients with AF on warfarin were included (88 Indigenous and 424 non-Indigenous). Despite younger age (51±13 vs 71±12 years, p
  • The Brain-Heart Connection in Sympathetically Triggered Inherited
           Arrhythmia Syndromes
    • Abstract: Publication date: Available online 16 December 2019Source: Heart, Lung and CirculationAuthor(s): Annika Winbo, David J. PatersonSympathetically triggered inherited arrhythmia syndromes, including the long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT), can cause sudden cardiac death in young individuals with structurally normal hearts. With cardiac events typically triggered by physical or emotional stress, not surprisingly, two of the most common treatments are neuromodulators, including mainstay beta blocker pharmacotherapy, and surgical sympathetic cardiac denervation. This review updates the clinician on the relevant anatomy and physiology of the cardiac autonomic nervous system, outlines neurocardiac arrhythmia mechanisms, and discusses the latest rationale for a neurocardiac therapeutic approach to manage sympathetic-induced arrhythmia in patients with inherited cardiac disease.
  • Fears of a Big Bang for Rugby Players, Urgent Validation Required
    • Abstract: Publication date: Available online 11 December 2019Source: Heart, Lung and CirculationAuthor(s): André La Gerche, Aaron L. Baggish, Ben D. Levine, Paul D. Thompson
  • Management of People With a Fontan Circulation: a Cardiac Society of
           Australia and New Zealand Position statement
    • Abstract: Publication date: Available online 15 November 2019Source: Heart, Lung and CirculationAuthor(s): Dominica Zentner, David S. Celermajer, Thomas Gentles, Yves d’Udekem, Julian Ayer, Gillian M. Blue, Cameron Bridgman, Luke Burchill, Michael Cheung, Rachael Cordina, Evelyn Culnane, Andrew Davis, Karin du Plessis, Karen Eagleson, Kirsten Finucane, Belinda Frank, Sebastian Greenway, Leeanne Grigg, Winita Hardikar, Tim HornungAbstractThe Fontan circulation describes the circulatory state resulting from an operation in congenital heart disease where systemic venous return is directed to the lungs without an intervening active pumping chamber. As survival increases, so too does recognition of the potential health challenges. This document aims to allow clinicians, people with a Fontan circulation, and their families to benefit from consensus agreement about management of the person with a Fontan circulation. The document was crafted with input from a multidisciplinary group of health care providers as well as individuals with a Fontan circulation and families. It is hoped that the shared common vision of long-term wellbeing will continue to drive improvements in care and quality of life in this patient population and eventually translate into improved survival.Keypoints•Lifelong quality medical care with access to multidisciplinary services, is of prime importance. Care includes regular tests for surveillance of health status.•Transition from paediatric to adult care is an active process that should commence during early adolescence and continue until successful engagement with adult congenital cardiology care.•Children and adults with a Fontan circulation often have reduced peak exercise capacity (on average, 60–65% of predicted values). Increasingly, evidence suggests exercise training may improve exercise capacity and cardiovascular function.•People with a Fontan circulation have higher rates of anxiety and behavioural disorders, and there needs to be a low threshold for the provision of mental health care.•Pregnancy has increased maternal and fetal risks, and pre-conception multidisciplinary assessment and counselling is essential.•Atrial arrhythmias are common, often late after Fontan surgical repair and due to intra-atrial re-entry or “flutter” mediated by atrial stretch and scarring. Some anti-arrhythmic agents, most classically the type IC drugs, may allow haemodynamically unstable, life-threatening 1:1 AV conduction.•Anticoagulation with warfarin is routine care in patients with atrial arrhythmias.•In patients with recurrent atrial arrhythmias, catheter ablation or surgical conversion may be considered.•The Fontan circulation is an ideal substrate for thrombus formation and may result in intracardiac or intravascular thrombosis, ischaemic stroke, or other embolic phenomena. Antiplatelet and anticoagulant agents are commonly prescribed for thromboprophylaxis in patients with a Fontan circulation. Evidence suggests that treatment with one of these agents is advantageous, but there is no consensus on which is optimal. Despite treatment, symptomatic thromboembolic events are associated with significant mortality.•Heart failure is the leading cause of morbidity and mortality. Diuretics provide symptomatic relief, however standard heart failure medical therapy is not of proven benefit.•Though not well understood, there is increasing concern regarding progressive liver disease with a long-term risk of hepatocellular carcinoma.•Despite early higher mortality post heart transplant, these individuals have better long-term survival outcomes compared with many other heart transplant recipients.
  • Aberrant Origin of Left Vertebral Artery from Left Common Carotid Artery
           in Association with Tetralogy of Fallot and Anomalous Aortic Origin of
           Left Pulmonary Artery
    • Abstract: Publication date: Available online 19 September 2019Source: Heart, Lung and CirculationAuthor(s): Niraj Nirmal Pandey, Mumun Sinha, Arun Sharma, Kanika Bhambri, Sanjeev Kumar
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