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Heart
Journal Prestige (SJR): 2.853
Citation Impact (citeScore): 3
Number of Followers: 53  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1355-6037 - ISSN (Online) 1468-201X
Published by BMJ Publishing Group Homepage  [64 journals]
  • Heartbeat: sex-related inequities versus differences in management and
           outcomes of patients with cardiovascular disease

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      Authors: Otto C. M.
      Pages: 1683 - 1685
      Abstract: Sex differences in clinical management and outcomes of patients with cardiovascular disease sometimes are due to healthcare inequities (which should be eliminated) but also might be due to sex-related differences in aetiology and pathophysiology. For example, the optimal medical dose for management of heart failure with reduced ejection fraction (HFrEF) may be lower in women compared with men. In a study of 561 women and 615 men with a new diagnosis of either HRrEF or heart failure with preserved ejection fraction (HFpEF), Bots and colleagues1 found that although 79% of women and 86% of men with HFrEF were prescribed an ACE inhibitor (ACEI) or angiotensin receptor blocker (ARB), the average dose was only about 50% of the recommended target dose for both sexes. A lower ACEI/ARB dose was associated with higher survival outcomes in women, but not men, with HFrEF. In patients of both sexes with HFpEF, there...
      PubDate: 2021-10-11T01:00:49-07:00
      DOI: 10.1136/heartjnl-2021-320350
      Issue No: Vol. 107, No. 21 (2021)
       
  • Coronary artery calcium paradox and physical activity

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      Authors: Gulsin, G. S; Moss, A. J.
      Pages: 1686 - 1687
      Abstract: Reducing the risk of plaque rupture events in individuals without a prior myocardial infarction is an imprecise science. To help clarify whether there is evidence of coronary artery disease and avoid ‘medicalisation’ of otherwise healthy individuals, international guidelines recommend incorporating the measurement of coronary artery calcium alongside risk prediction models.1 Coronary artery calcium serves as a surrogate marker of advanced calcified atherosclerosis and can be calculated from a non-contrast ECG-gated CT scan where a score of 1–99 Agatston units represents subclinical atherosclerosis, and a score of 100 or more Agatston units is considered an appropriate threshold for initiating medical therapy.1 At ≥100 Agatston units, the burden of advanced calcified atherosclerosis justifies statin implementation and this has been validated in a real-world cohort study of 16 996 subjects with a 10-year number needed to treat to prevent one cardiovascular event of 12.2 Many clinicians have...
      Keywords: Press releases
      PubDate: 2021-10-11T01:00:49-07:00
      DOI: 10.1136/heartjnl-2021-319868
      Issue No: Vol. 107, No. 21 (2021)
       
  • Bias: does it account for low surgical rates in women with infective
           endocarditis'

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      Authors: Van Spall, H. G. C; Jaffer, I, Mamas, M. A.
      Pages: 1688 - 1689
      Abstract: In recent years, there has been increasing evidence of sex-related disparities in diagnostic investigations, medical therapies, referrals for invasive care as well as health services, and outcomes across a range of cardiovascular conditions.1–3 While several factors including sex-specific differences in age, physiological differences and comorbidities might contribute to these differences, adjusting for these variables often leaves sex as an independent predictor of treatments as well as outcomes; women are underdiagnosed, under referred and undertreated, and suffer worse outcomes across several cardiovascular conditions. Relatively little is known about sex differences in clinical profile, surgical referrals and outcomes in infective endocarditis (IE). IE appears to occur in men more commonly than women, with sex differences in the microbial profile, aetiology and comorbidities of patients with IE.4–6 Some of these differences may translate to differences in outcomes, but evidence in...
      PubDate: 2021-10-11T01:00:49-07:00
      DOI: 10.1136/heartjnl-2021-319944
      Issue No: Vol. 107, No. 21 (2021)
       
  • Adding to the evidence or to the confusion: dual antithrombotic therapy in
           chronic coronary syndrome and atrial fibrillation

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      Authors: Kany, S; Schnabel, R.
      Pages: 1690 - 1691
      Abstract: Atrial fibrillation (AF) is the most common arrhythmia in the world with the lifetime risk estimated to be 1/3 in men and women over the age of 50 years.1 Cardiovascular disease, like misfortune, does not come singly in most cases. Coronary artery disease (CAD) with the chronic coronary syndrome (CCS) or acute coronary syndrome (ACS) is a common comorbid condition. Management of patients with AF with a comprehensive treatment of risk factors and concomitant diseases is the key to treat these patients. Yet, the devil is in the details as treatment becomes increasingly complex. Patients with AF and CAD require antiplatelet therapy (APT) in addition to oral anticoagulation (OAC) after myocardial infarction or percutaneous coronary intervention (PCI) for a limited time period. Depending on ischaemic risk, bleeding risk and unplanned PCI, different treatment regimens are available with dual antithrombotic therapy with OAC and APT up to 12...
      Keywords: Open access
      PubDate: 2021-10-11T01:00:49-07:00
      DOI: 10.1136/heartjnl-2021-319830
      Issue No: Vol. 107, No. 21 (2021)
       
  • Sex differences in heart failure and precision medicine: right patient,
           right time...wrong dose'

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      Authors: Hassan, R; Ahmed, S. B.
      Pages: 1692 - 1693
      Abstract: Heart failure (HF) affects women and men differently, in part due to sex-related differences in disease aetiology and pathophysiology, which may ultimately impact treatment response and outcomes. Sex differences in HF outcomes may be further exacerbated by differences in medication pharmacokinetics and pharmacodynamics, with female-specific physiological factors including lower body mass, as well as decreased renal excretion and gastrointestinal enzymatic activity, leading to higher medication bioavailability. As a result, the administration of sex-neutral medication doses leads to greater drug exposure in female patients, which may subsequently lead to a higher incidence of adverse drug reactions.1 This raises the possibility of sex-based HF treatments to improve clinical outcomes. However, current guidelines adopt a ‘one size fits all’ approach, with an emphasis on target-dosed therapy. In this era of precision medicine, is it time to redefine optimal HF therapy based on the sex of the patient' Bots and colleagues
      PubDate: 2021-10-11T01:00:49-07:00
      DOI: 10.1136/heartjnl-2021-319831
      Issue No: Vol. 107, No. 21 (2021)
       
  • Cardiotoxicities of novel cancer immunotherapies

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      Authors: Stein-Merlob, A. F; Rothberg, M. V, Ribas, A, Yang, E. H.
      Pages: 1694 - 1703
      Abstract: Immunotherapy revolutionised oncology by harnessing the native immune system to effectively treat a wide variety of malignancies even at advanced stages. Off-target immune activation leads to immune-related adverse events affecting multiple organ systems, including the cardiovascular system. In this review, we discuss the current literature describing the epidemiology, mechanisms and proposed management of cardiotoxicities related to immune checkpoint inhibitors (ICIs), chimeric antigen receptor (CAR) T-cell therapies and bispecific T-cell engagers. ICIs are monoclonal antibody antagonists that block a co-inhibitory pathway used by tumour cells to evade a T cell-mediated immune response. ICI-associated cardiotoxicities include myocarditis, pericarditis, atherosclerosis, arrhythmias and vasculitis. ICI-associated myocarditis is the most recognised and potentially fatal cardiotoxicity with mortality approaching 50%. Recently, ICI-associated dysregulation of the atherosclerotic plaque immune response with prolonged use has been linked to early progression of atherosclerosis and myocardial infarction. Treatment strategies include immunosuppression with corticosteroids and supportive care. In CAR T-cell therapy, autologous T cells are genetically engineered to express receptors targeted to cancer cells. While stimulating an effective tumour response, they also elicit a profound immune reaction called cytokine release syndrome (CRS). High-grade CRS causes significant systemic abnormalities, including cardiovascular effects such as arrhythmias, haemodynamic compromise and cardiomyopathy. Treatment with interleukin-6 inhibitors and corticosteroids is associated with improved outcomes. The evidence shows that, although uncommon, immunotherapy-related cardiovascular toxicities confer significant risk of morbidity and mortality and benefit from rapid immunosuppressive treatment. As new immunotherapies are developed and adopted, it will be imperative to closely monitor for cardiotoxicity.
      Keywords: Review articles
      PubDate: 2021-10-11T01:00:49-07:00
      DOI: 10.1136/heartjnl-2020-318083
      Issue No: Vol. 107, No. 21 (2021)
       
  • ST elevation in a critically ill patient with COVID-19: what is the
           emergency treatment'

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      Authors: Raqabani, M. A; Musa, A. M, Al-assaf, O. Y.
      Pages: 1703 - 1764
      Abstract: Clinical IntroductionECG challenge A previously healthy patient presented to the emergency department with acute dyspnoea preceded by 2 days’ history of cough and chest pain. The patient was diagnosed with moderate COVID-19 pneumonia based on the chest X-ray findings and positive nasal swab for SARS-CoV-2. Three days later, his condition deteriorated with progressive renal failure and development of acute right cerebellar infarction, low GCS and desaturation requiring mechanical ventilation. Clinically, the patient was sedated, on mechanical ventilation and anuric; had a blood pressure of 157/80 mmHg and a heart rate of 116 beats/min; and maintained saturation at FiO2 of 60%. Laboratory investigations showed elevated inflammatory markers, ferritin, dimer and cardiac troponin. His creatinine was 8 mg/dL; urea was 369 mg/dL; and potassium was 6.2 mmol/L. He was referred to the cardiology team for an abnormal ECG (Figure 1) and an episode of ventricular tachycardia. Figure 1Patient...
      Keywords: Image challenges, COVID-19
      PubDate: 2021-10-11T01:00:49-07:00
      DOI: 10.1136/heartjnl-2021-319723
      Issue No: Vol. 107, No. 21 (2021)
       
  • Pregnancy outcome in thoracic aortic disease data from the Registry Of
           Pregnancy And Cardiac disease

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      Authors: Campens, L; Baris, L, Scott, N. S, Broberg, C. S, Bondue, A, Jondeau, G, Grewal, J, Johnson, M. R, Hall, R, De Backer, J, Roos-Hesselink, J. W, On behalf of the ROPAC investigators group, Aquieri, Saad, Ruda Vega, Hojman, Caparros, Vazquez Blanco, Arstall, Chung, Mahadavan, Aldridge, Wittwer, Chow, Parsonage, Lust, Collins, Warner, Hatton, Gordon, Nyman, Stein, Donhauser, Gabriel, Bahshaliyev, Guliyev, Hasanova, Jahangirov, Gasimov, Salim, Ahmed, Begum, Mahmood, Islam, Haque, Banerjee, Parveen, Morissens, De Backer, Demulier, de Hosson, Budts, Beckx, Kozic, Lovric, Kovacevic-Preradovic, Chilingirova, Kratunkov, Wahab, Gordon, Walter, Marelli, Montesclaros, Monsalve, Rodriguez, Balthazar, Quintero, Palacio, Mejia Cadavid, Munoz Ortiz, Fortich Hoyos, Arevalo Guerrero, Gandara Ricardo, Velasquez Penagos, Vavera, Popelova, Vejlstrup, Gronbeck, Johansen, Ersboll, Elrakshy, Eltamawy, Gamal Abd-El Aziz, El Nagar, Ebaid, Abo Elenin, Saed, Farag, Makled, Sorour, Ashour, El-Sayed, Abdel Meguid Mahdy, Taha, Dardeer, Shabaan, Saad, Ali, Moceri, Duthoit, Gouton, Nizard, Baris, Cohen, Ladouceur, Khimoud, Iung, Berger, Olsson, Gembruch, Merz, Reinert, Clade, Kliesch, Sinning, Kozlik-Feldmann, Blankenberg, Zengin-Sahm, Mueller, Hillebrand, Hauck, von Kodolitsch, Zarniko, Baumgartner, Hellige, Tutarel, Kaemmerer, Kuschel, Motz, Maisuradze, Frogoudaki, Iliodromitis, Anastasiou-Nana, Marousi, Triantafyllis, Bekiaris, Karvounis, Giannakoulas, Ntiloudi, Mouratoglou, Temesvari, Kohalmi, Merkely, Liptai, Nemes, Forster, Kalapos, Berek, Havasi, Ambrus, Shelke, Patil, Martanto, Aprami, Purnomowati, Cool, Hasan, Akbar, Hidayat, Dewi, Permadi, Soedarsono, Ansari-Ramandi, Samiei, Tabib, Kashfi, Ansari-Ramandi, Rezaei, Ali Farhan, Al-Hussein, Al-Saedi, Mahmood, Yaseen, Al-Yousuf, AlBayati, Mahmood, Raheem, AlHaidari, Dakhil, Thornton, Donnelly, Bowen, Blatt, Elbaz-Greener, Shotan, Yalonetsky, Goland, Biener, Egidy Assenza, Bonvicini, Donti, Bulgarelli, Prandstraller, Romeo, Crepaz, Sciatti, Metra, Orabona, Ait Ali, Festa, Fesslova, Bonanomi, Calcagnino, Lombardi, Colli, Ossola, Gobbi, Gherbesi, Tondi, Schiavone, Squillace, Carmina, Maina, Macchi, Gollo, Comoglio, Montali, Re, Bordese, Todros, Donvito, Grosso Marra, Sinagra, D'Agata Mottolese, Bobbo, Gesuete, Rakar, Ramani, Niwa, Mekebekova, Mussagaliyeva, Lee, Mirrakhimov, Abilova, Bektasheva, Neronova, Lunegova, Zaliunas, Jonkaitiene, Petrauskaite, Lauce, vicius, Jancauskaite, Lauciuviene, Gumbiene, Lankutiene, Glaveckaite, Solovjova, Rudiene, Chee, C.C-W, Ang, Kuppusamy, Watson, Caruana, Estensen, Mahmood Kayani, Munir, Sobkowicz, Przepiesc, Lesniak-Sobelga, Tomkiewicz-Pajak, Komar, Olszowska, Podolec, Wisniowska-Smialek, Lelonek, Faflik, Cichocka-Radwan, Plaskota, Trojnarska, de Sousa, Cruz, Ribeiro, Jovanova, Petrescu, Jurcut, Ginghina, Mircea Coman, Musteata, Osipova, Golivets, Khamnagadaev, Golovchenko, Nagibina, Ropatko, Gaisin, Valeryevna Shilina, Sharashkina, Shlyakhto, Irtyuga, Moiseeva, Karelkina, Zazerskaya, Kozlenok, Sukhova, Jovovic, Prokselj, Kozelj, Askar, Abdilaahi, Mohamed, Sliwa, Manga, Galian-Gay, Tornos, Subirana, Subirana, Murga, Oliver, Garcia-Aranda Dominguez, Hernandez Gonzalez, Escribano Subias, Elbushi, Suliman, Jazzar, Murtada, Ahamed, Dellborg, Furenas, Jinesjo, Skoglund, Eriksson, Gilljam, Thilen, Tobler, Wustmann, Schwitz, Schwerzmann, Rutz, Bouchardy, Greutmann, Santos Lopes, Meier, Arrigo, de Boer, Konings, Wajon, Wagenaar, Polak, Pieper, Roos-Hesselink, Baris, van Hagen, Duvekot, Cornette, De Groot, van Oppen, Sarac, Batukan Esen, Catirli Enar, Mondo, Ingabire, Nalwanga, Semu, Salih, Almahmeed, Wani, Mohamed Farook, Al Ain, Gerges, Komaranchath, Al bakshi, Al Mulla, Yusufali, Al Hatou, Bazargani, Hussain, Hudsmith, Thompson, Thorne, Bowater, Money-Kyrle, Clifford, Ramrakha, Firoozan, Chaplin, Bowers, Adamson, Schroeder, Wendler, Nihoyannopoulos, Hall, Freeman, Veldtman, Kerr, Tellett, Scott, Bhatt, DeFaria Yeh, Youniss, Wood, Sarma, Tsiaras, Stefanescu, Duran, Stone, Majdalany, Chapa, Chintala, Gupta, Botti, Ting, Davidson, Wells, Sparks, Paruchuri, Marzo, Patel, Wagner, Ahanya, Colicchia, Jentink, Han, Loichinger, Parker, Wagner, Longtin, Yetman, Erickson, Tsai, Fletcher, Warta, Cohen, Lindblade, Puntel, Nagaran, Croft, Gurvitz, Otto, Talluto, Murphy, Perlroth
      Pages: 1704 - 1709
      Abstract: BackgroundCardiovascular disease is the leading cause of death during pregnancy with thoracic aortic dissection being one of the main causes. Thoracic aortic disease is commonly related to hereditary disorders and congenital heart malformations such as bicuspid aortic valve (BAV). Pregnancy is considered a high risk period in women with underlying aortopathy.MethodsThe ESC EORP Registry Of Pregnancy And Cardiac disease (ROPAC) is a prospective global registry that enrolled 5739 women with pre-existing cardiac disease. With this analysis, we aim to study the maternal and fetal outcome of pregnancy in women with thoracic aortic disease.ResultsThoracic aortic disease was reported in 189 women (3.3%). Half of them were patients with Marfan syndrome (MFS), 26% had a BAV, 8% Turner syndrome, 2% vascular Ehlers-Danlos syndrome and 11% had no underlying genetic defect or associated congenital heart defect. Aortic dilatation was reported in 58% of patients and 6% had a history of aortic dissection. Four patients, of whom three were patients with MFS, had an acute aortic dissection (three type A and one type B aortic dissection) without maternal or fetal mortality. No complications occurred in women with a history of aortic dissection. There was no significant difference in median fetal birth weight if treated with a beta-blocker or not (2960 g (2358–3390 g) vs 3270 g (2750–3570 g), p value 0.25).ConclusionThis ancillary analysis provides the largest prospective data review on pregnancy risk for patients with thoracic aortic disease. Overall pregnancy outcomes in women with thoracic aortic disease followed according to current guidelines are good.
      Keywords: Open access
      PubDate: 2021-10-11T01:00:49-07:00
      DOI: 10.1136/heartjnl-2020-318183
      Issue No: Vol. 107, No. 21 (2021)
       
  • Physical activity and the progression of coronary artery calcification

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      Authors: Sung, K.-C; Hong, Y. S, Lee, J.-Y, Lee, S.-J, Chang, Y, Ryu, S, Zhao, D, Cho, J, Guallar, E, Lima, J. A. C.
      Pages: 1710 - 1716
      Abstract: BackgroundThe association of physical activity with the development and progression of coronary artery calcium (CAC) scores has not been studied. This study aimed to evaluate the prospective association between physical activity and CAC scores in apparently healthy adults.MethodsProspective cohort study of men and women free of overt cardiovascular disease who underwent comprehensive health screening examinations between 1 March 2011 and 31 December 2017. Baseline physical activity was measured using the International Physical Activity Questionnaire Short Form (IPAQ-SF) and categorised into three groups (inactive, moderately active and health-enhancing physically active (HEPA)). The primary outcome was the difference in the 5-year change in CAC scores by physical activity category at baseline.ResultsWe analysed 25 485 participants with at least two CAC score measurements. The proportions of participants who were inactive, moderately active and HEPA were 46.8%, 38.0% and 15.2%, respectively. The estimated adjusted average baseline CAC scores (95% confidence intervals) in participants who were inactive, moderately active and HEPA were 9.45 (8.76, 10.14), 10.20 (9.40, 11.00) and 12.04 (10.81, 13.26). Compared with participants who were inactive, the estimated adjusted 5-year average increases in CAC in moderately active and HEPA participants were 3.20 (0.72, 5.69) and 8.16 (4.80, 11.53). Higher physical activity was association with faster progression of CAC scores both in participants with CAC=0 at baseline and in those with prevalent CAC.ConclusionWe found a positive, graded association between physical activity and the prevalence and the progression of CAC, regardless of baseline CAC scores.
      Keywords: Press releases
      PubDate: 2021-10-11T01:00:49-07:00
      DOI: 10.1136/heartjnl-2021-319346
      Issue No: Vol. 107, No. 21 (2021)
       
  • Analysis of sex differences in the clinical presentation, management and
           prognosis of infective endocarditis in Spain

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      Authors: Varela Barca, L; Vidal-Bonnet, L, Farinas, M, Munoz, P, Valerio Minero, M, de Alarcon, A, Gutierrez Carretero, E, Gutierrez Cuadra, M, Moreno Camacho, A, Kortajarena Urkola, X, Goikoetxea Agirre, J, Ojeda Burgos, G, Lopez-Cortes, L. E, Porres Azpiroz, J, Lopez-Menendez, J, GAMES Investigators, Sanchez, Noureddine, Rosas, Lima, Bereciartua, Blanco, Boado, Lazaro, Crespo, Carrion, Lagos, Ugarte, Goikoetxea, Hierro, Iruretagoyena, Zuazabal, Lopez-Soria, Montejo, Nieto, Rodrigo, Rodriguez, Vitoria, Voces, Lopez, Georgieva, Ojeda, Bailon, Morales, Galparsoro, Boronat, Odriozola, Martin, Echeverria, Yarza, Fuentes, Goenaga, Rio, Bauza, Iribarren, Urkola, Lopez, Jimenez, Reviejo, Berbejillo, Haza, Alda, Ruiz, Ugartemendia, Anza, Benito, Arrieta, Carrasco, Climent, Llamas, Merino, Plazas, Reus, Alvarez, Bravo-Ferrer, Castelo, Cuenca, Llinares, Rey, Mayo, Sanchez, Regueiro, Martinez, Ma del Mar Alonso, Melian, Sarabia, Rosado, Gonzalez, Lacalzada, Pena, Ramirez, Arrondo, Moreno, Ciezar, Iglesias, Alvarez, Costas, Hera, Suarez, Fraile, Arguero, Menendez, Bajo, Morales, Torrico, Palomo, Martinez, Esteban, Garcia, Asensio, Almela, Ambrosioni, Azqueta, Brunet, Bodro, Cartana, Falces, Fita, Fuster, Maria, Garcia-Pares, Hernandez-Meneses, Perez, Marco, Miro, Moreno, Nicolas, Ninot, Quintana, Pare, Pereda, Pericas, Pomar, Ramirez, Rovira, Sandoval, Sitges, Soy, Tellez, Tolosana, Vidal, Vila, Adan, Alonso, Alvarez-Uria, Bermejo, Bouza, Caballero, Montero, Mansilla, Leoni, Gargallo, Ramallo, Hernandez, Hualde, Machado, Marin, Martinez-Selles, Munoz, Olmedo, Pinilla, Pinto, Rincon, Rodriguez-Abella, Rodriguez-Creixems, AntonioSegado, Valerio, Vazquez, Moreno, Antorrena, Loeches, Mar Moreno, Baston, Romero, Rosillo, Balbin, Amado, Castillo, Arnaiz, Revillas, Belaustegui, Farinas, Farinas-Alvarez, Sampedro, Garcia, Rico, Gutierrez-Fernandez, Gutierrez-Cuadra, Diez, Pajaron, Parra, Teira, Zarauza, Parra, Cobo, Dominguez, Fortaleza, Pavia, Gonzalez, Cruz, Munez, Ramos, Romero, Centella, Hermida, Moya, Martin-Davila, Navas, Oliva, Rio, Stuart, Ruiz, Tenorio, Delia, Araji, Barquero, Jambrina, Cueto, Acebal, Mendez, Morales, Lopez-Cortes, Alarcon, Garcia, Haro, Lepe, Lopez, Luque, Alonso, Azcarate, Gutierrez, Blanco, Villegas, Garcia-Alvarez, Garcia, Oteo, Benito, Gurgui, Pacho, Pericas, Pons, Alvarez, Fernandez, Martinez, Prieto, Regueiro, Tijeira, Vega, Blasco, Mollar, Arana, Uriarte, Lopez, Zarate, Matos, Antonio, Alejandro, Leal, Vazquez, Torres, Blazquez, Valenzuela, Alonso, Aramburu, Calvo, Rodriguez, Tarabini-Castellani, Galvez, Bellido, Pau, Sepulveda, Sierra, Iqbal-Mirza, Alcolea, Yanez, Martinez, Ballesta, Escobar, Monje, Cabrera, Garcia, Asenjo, Luna, Morcillo, Seco, Gelabert, Guallar, Abad, Mangas, Adell, Ruiz, Porres, Vidal, Trigueros, Espin, Caro, JimenezSanchez, Almazan, Freire, Gonzalez, Ramis, Blanco, Bordes, Bonet, Munera, Garaizabal, Martinez, Luquem, Badia, Palop, Xercavins, Ibars, Nebreda, Herrera, Gallego, Santiago, Martinez, Alamo, Blanco, Gonzalez, Peiretti, Esteve, Perez, Tejido, Roman, Robles, Medrano, Gude, Miguel, Pilkington, Ostalaza, Morales, Solis, Collado, Fernandez, Rallo, Martin, Ardanuy, Requena, Grillo, Majoral, Alvarez, Ubeda, Roblas, Lobato, Pello
      Pages: 1717 - 1724
      Abstract: IntroductionSex-dependent differences of infective endocarditis (IE) have been reported. Women suffer from IE less frequently than men and tend to present more severe manifestations. Our objective was to analyse the sex-based differences of IE in the clinical presentation, treatment, and prognosis.Material and methodsWe analysed the sex differences in the clinical presentation, modality of treatment and prognosis of IE in a national-level multicentric cohort between 2008 and 2018. All data were prospectively recorded by the GAMES cohort (Spanish Collaboration on Endocarditis).ResultsA total of 3451 patients were included, of whom 1105 were women (32.0%). Women were older than men (mean age, 68.4 vs 64.5). The most frequently affected valves were the aortic valve in men (50.6%) and mitral valve in women (48.7%). Staphylococcus aureus aetiology was more frequent in women (30.1% vs 23.1%; p
      PubDate: 2021-10-11T01:00:49-07:00
      DOI: 10.1136/heartjnl-2021-319254
      Issue No: Vol. 107, No. 21 (2021)
       
  • Sacubitril/valsartan in the treatment of systemic right ventricular
           failure

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      Authors: Zandstra, T. E; Nederend, M, Jongbloed, M. R. M, Kies, P, Vliegen, H. W, Bouma, B. J, Tops, L. F, Schalij, M. J, Egorova, A. D.
      Pages: 1725 - 1730
      Abstract: ObjectivePharmacological options for patients with a failing systemic right ventricle (RV) in the context of transposition of the great arteries (TGA) after atrial switch or congenitally corrected TGA (ccTGA) are not well defined. This study aims to investigate the feasibility and effects of sacubitril/valsartan treatment in a single-centre cohort of patients.MethodsData on all consecutive adult patients (n=20, mean age 46 years, 50% women) with a failing systemic RV in a biventricular circulation treated with sacubitril/valsartan in our centre are reported. Patients with a systemic RV ejection fraction of ≤35% who were symptomatic despite treatment with β-blocker and ACE-inhibitor/angiotensin II receptor-blockers were started on sacubitril/valsartan. This cohort underwent structural follow-up including echocardiography, exercise testing, laboratory investigations and quality of life (QOL) assessment.ResultsSix-month follow-up data were available in 18 out of 20 patients, including 12 (67%) patients with TGA after atrial switch and 6 (33%) patients with ccTGA. N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) decreased significantly (950–358 ng/L, p
      Keywords: Open access
      PubDate: 2021-10-11T01:00:49-07:00
      DOI: 10.1136/heartjnl-2020-318074
      Issue No: Vol. 107, No. 21 (2021)
       
  • Aspirin versus P2Y12 inhibitors with anticoagulation therapy for atrial
           fibrillation

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      Authors: Fukaya, H; Ako, J, Yasuda, S, Kaikita, K, Akao, M, Matoba, T, Nakamra, M, Miyauchi, K, Hagiwara, N, Kimura, K, Hirayama, A, Matsui, K, Ogawa, H.
      Pages: 1731 - 1738
      Abstract: ObjectivePatients with coronary artery disease (CAD) and atrial fibrillation (AF) can be treated with multiple antithrombotic therapies including antiplatelet and anticoagulant therapies; however, this has the potential to increase bleeding risk. Here, we aimed to evaluate the efficacy and safety of P2Y12 inhibitors and aspirin in patients also receiving anticoagulant therapy.MethodsWe evaluated patients from the Atrial Fibrillation and Ischaemic Events with Rivaroxaban in Patients with Stable Coronary Artery Disease (AFIRE) trial who received rivaroxaban plus an antiplatelet agent; the choice of antiplatelet agent was left to the physician’s discretion. The primary efficacy and safety end points, consistent with those of the AFIRE trial, were compared between P2Y12 inhibitors and aspirin groups. The primary efficacy end point was a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularisation or death from any cause. The primary safety end point was major bleeding according to the International Society on Thrombosis and Haemostasis criteria.ResultsA total of 1075 patients were included (P2Y12 inhibitor group, n=297; aspirin group, n=778). Approximately 60% of patients were administered proton pump inhibitors (PPIs) and there was no significant difference in PPI use in the groups. There were no significant differences in the primary end points between the groups (efficacy: HR 1.31; 95% CI 0.88 to 1.94; p=0.178; safety: HR 0.79; 95% CI 0.43 to 1.47; p=0.456).ConclusionsThere were no significant differences in cardiovascular and bleeding events in patients with AF and stable CAD taking rivaroxaban with P2Y12 inhibitors or aspirin in the chronic phase.Trial registration numberUMIN000016612; NCT02642419.
      PubDate: 2021-10-11T01:00:49-07:00
      DOI: 10.1136/heartjnl-2021-319321
      Issue No: Vol. 107, No. 21 (2021)
       
  • Antiplatelet therapy in patients with myocardial infarction without
           obstructive coronary artery disease

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      Authors: Bossard, M; Gao, P, Boden, W, Steg, G, Tanguay, J.-F, Joyner, C, Granger, C. B, Kastrati, A, Faxon, D, Budaj, A, Pais, P, Di Pasquale, G, Valentin, V, Flather, M, Moccetti, T, Yusuf, S, Mehta, S. R.
      Pages: 1739 - 1747
      Abstract: ObjectiveApproximately 10% of patients with myocardial infarction (MI) have no obstructive coronary artery disease. The prognosis and role of intensified antiplatelet therapy in those patients were evaluated.MethodsWe analysed data from the Clopidogrel and Aspirin Optimal Dose Usage to Reduce Recurrent Events–Seventh Organisation to Assess Strategies in Ischaemic Symptoms trial randomising patients with ACS referred for early intervention to receive either double-dose (600 mg, day 1; 150 mg, days 2–7; then 75 mg/day) or standard-dose (300 mg, day 1; then 75 mg/day) clopidogrel. Outcomes in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) versus those with obstructive coronary artery disease (CAD) and their relation to standard-dose versus double-dose clopidogrel were evaluated. The primary outcome was cardiovascular (CV) death, MI or stroke at 30 days.ResultsWe included 23 783 patients with MI and 1599 (6.7%) with MINOCA. Patients with MINOCA were younger, presented more frequently with non-ST-segment elevation MI and had fewer comorbidities. All-cause mortality (0.6% vs 2.3%, p=0.005), CV mortality (0.6% vs 2.2%, p=0.006), repeat MI (0.5% vs 2.3%, p=0.001) and major bleeding (0.6% vs 2.4%, p
      PubDate: 2021-10-11T01:00:49-07:00
      DOI: 10.1136/heartjnl-2020-318045
      Issue No: Vol. 107, No. 21 (2021)
       
  • Heart failure medication dosage and survival in women and men seen at
           outpatient clinics

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      Authors: Bots, S. H; Onland-Moret, N. C, Tulevski, I. I, van der Harst, P, Cramer, M. J. M, Asselbergs, F. W, Somsen, G. A, den Ruijter, H. M.
      Pages: 1748 - 1755
      Abstract: ObjectiveWomen with heart failure with reduced ejection fraction (HFrEF) may reach optimal treatment effect at half of the guideline-recommended medication dose. This study investigates prescription practice and its relation with survival of patients with HF in daily care.MethodsElectronic health record data from 13 Dutch outpatient cardiology clinics were extracted for HF receiving at least one guideline-recommended HF medication. Dose changes over consecutive prescriptions were modelled using natural cubic splines. Inverse probability-weighted Cox regression was used to assess the relationship between dose (reference≥50% target dose) and all-cause mortality.ResultsThe study population comprised 561 women (29% HFrEF (ejection fraction (EF)
      Keywords: Open access, Editor's choice
      PubDate: 2021-10-11T01:00:49-07:00
      DOI: 10.1136/heartjnl-2021-319229
      Issue No: Vol. 107, No. 21 (2021)
       
  • Mental disorders and cardiovascular disease: what should we be looking out
           for'

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      Authors: Michal, M; Beutel, M.
      Pages: 1756 - 1761
      Abstract: Learning objectives
      To understand the importance of detecting and managing common non-organic mental disorders for the outcome of patients with cardiovascular disease.
      To be able to identify common mental disorders and to inform the patient about it.
      To be able to manage the mental healthcare needs of patients in cardiological settings (referral, interdisciplinary patient care).
      To be able to explain basic mechanisms of common mental disorders to the patient.
      To be familiar with common treatment options for patients with mental disorders. Introduction Mental disorders are prevalent. They impair patients’ quality of life severely and are associated with an increased risk of developing cardiovascular disease (CVD) and worse prognosis.1–4 Although these facts have been well established, there is still a gap in diagnostic awareness and treatment of mental disorders in patients with CVD.
      Keywords: Education in Heart
      PubDate: 2021-10-11T01:00:49-07:00
      DOI: 10.1136/heartjnl-2019-316379
      Issue No: Vol. 107, No. 21 (2021)
       
  • How to write an image challenge multiple choice question

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      Authors: Krieger E. V.
      Pages: 1762 - 1763
      Abstract: The purpose of the image challenge In each issue of Heart, we publish an image challenge which consists of a brief clinical vignette, an image and an accompanying multiple choice question (MCQ), followed by a short discussion. The goal of the image challenge is to make an educational point, so authors must reflect on what they wish to teach. The clarity of the educational point is often what distinguishes a strong image challenge which is accepted for publication from those that are not. Even though the importance of a clearly defined teaching and testing point is self-evident, it is natural that the the inspiration to write an image challenge occurs when an author encounters a remarkable image in clinical practice and wishes to share it. High-quality and engaging images are critical, but the best image challenge submissions are not show-and-tell, in which the image is primary and the...
      Keywords: Cardiology in Focus
      PubDate: 2021-10-11T01:00:49-07:00
      DOI: 10.1136/heartjnl-2021-319175
      Issue No: Vol. 107, No. 21 (2021)
       
 
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