-
Mashup Score: 4Aetiology, ejection fraction and mortality in chronic heart failure: a mediation analysis - 8 hour(s) ago
Objective Clinical decision making in chronic heart failure (CHF) is based primarily on left ventricular ejection fraction (LVEF), and only secondarily on aetiology of the underlying disease. Our aim was to investigate the mediating role of LVEF in the relationship between aetiology and mortality. Methods Using data of 2056 Austrian patients with CHF (mean age 57.2 years; mean follow-up 8.8 years), effects of aetiology on LVEF and overall mortality were estimated using multivariable-adjusted linear and Cox regression models. In causal mediation analyses, we decomposed the total effect of aetiology on mortality into direct and indirect (mediated through LVEF) effects. Results For the analysed aetiologies (dilated (DCM, n=1009) and hypertrophic (HCM, n=89) cardiomyopathy; ischaemic (IHD, n=529) and hypertensive (HHD, n=320) heart disease; cardiac amyloidosis (CA, n=109)), the effect of LVEF on mortality was similar (HR5%-points lower LVEF=1.07, 95% CI 1.04 to 1.10; pinteraction=0.718). H
Source: heart.bmj.comCategories: General Medicine News, CardiologistsTweet
-
Mashup Score: 16Twenty-four-hour blood pressure trajectories and clinical outcomes in patients who had an acute ischaemic stroke - 1 day(s) ago
Objective The management of blood pressure (BP) in acute ischaemic stroke remains a subject of controversy. This investigation aimed to explore the relationship between 24-hour BP patterns following ischaemic stroke and clinical outcomes. Methods A cohort of 4069 patients who had an acute ischaemic stroke from 26 hospitals was examined. Five systolic BP trajectories were identified by using latent mixture modelling: trajectory category 5 (190–170 mm Hg), trajectory category 4 (180–140 mm Hg), trajectory category 3 (170–160 mm Hg), trajectory category 2 (155–145 mm Hg) and trajectory category 1 (150–130 mm Hg). The primary outcome was a composite outcome of death and major disability at 3 months poststroke. Results Patients with trajectory category 5 exhibited the highest risk, while those with trajectory category 1 had the lowest risk of adverse outcomes at 3-month follow-up. Compared with the patients in the trajectory category 5, adjusted ORs (95% CIs) for the primary outcome were 0.
Source: heart.bmj.comCategories: General Medicine News, Cardiology News and JournTweet
-
Mashup Score: 2Role of coronary computed tomography angiography to optimise percutaneous coronary intervention outcomes - 2 day(s) ago
### Learning objectives: Coronary CT angiography (CTA) is recommended as the first-line diagnostic evaluation for patients presenting with chest pain.1 As a result, a significant proportion of patients referred to the catheterisation laboratory now undergo coronary CTA assessment before the invasive procedure. This approach has been shown to reduce the frequency of major procedure-related complications.2 Nonetheless, coronary CTA is primarily used as a trigger for deciding to perform an invasive angiogram. Despite the undeniable value of coronary CTA in providing anatomical information, its role in guiding revascularisation procedures is often underutilised. The systematic utilisation of coronary CTA in the field of interventional cardiology is hindered by the limited familiarity of interventional cardiologists with CT imaging. However, for readers who are well-versed in invasive angiography and intravascular imaging, grasping the fundamentals of coronary CTA is relatively straightforw
Source: heart.bmj.comCategories: General Medicine News, Cardiology News and JournTweet
-
Mashup Score: 216Biomarkers in heart failure: a focus on natriuretic peptides - 2 day(s) ago
While progress has been made in the management of most aspects of cardiovascular disease, the incidence and prevalence of heart failure (HF) remains high. HF affects around a million people in the UK and has a worse prognosis than most cancers. Patients with HF are often elderly with complex comorbidities, making accurate assessment of HF challenging. A timely diagnosis and initiation of evidence-based treatments are key to prevent hospitalisation and improve outcomes in this population. Biomarkers have dramatically impacted the way patients with HF are evaluated and managed. The most studied biomarkers in HF are natriuretic peptides (NPs). Since their discovery in the 1980s, there has been an explosion of work in the field of NPs and they have become an important clinical tool used in everyday practice to guide diagnosis and prognostic assessment of patients with HF. In this article, we will review the physiology of NPs and study their biological effects. Then, we will discuss the rol
Source: heart.bmj.comCategories: General Medicine News, Cardiology News and JournTweet
-
Mashup Score: 17Augmenting reality in echocardiography - 3 day(s) ago
Echocardiography is a vital first-line imaging tool for the diagnosis and management of many cardiovascular diseases. Its availability and low cost have encouraged widespread use by clinicians for the diagnosis and management of patients with heart failure.1 Visual estimation is widely used to assess ejection fraction (EF), the percentage of blood the left ventricle pumps out during a contraction. Accurately determining the EF in patients with heart failure is crucial for the implementation of timely guideline-directed medical treatment. There is a substantial need for high-fidelity determination of EF in emergency settings. However, there is high interobserver variability with visual estimation methods, which can be compounded by inadequate quality of capture and lack of specialised training in both obtaining and interpreting echocardiograms in these settings.2 The work presented by Choi et al 3 represents an important advance in reducing the burden of time and cost constraints in mea
Source: heart.bmj.comCategories: General Medicine News, Cardiology News and JournTweet
-
Mashup Score: 24
Coronary physiology assessment, including epicardial and microvascular investigations, is a fundamental tool in the contemporary management of patients with coronary artery disease. Coronary revascularisation guided by functional evaluation has demonstrated superiority over angiography-only-guided treatment. In patients with chronic coronary syndrome, revascularisation did not demonstrate prognostic advantage in terms of mortality over optimal medical therapy (OMT). However, revascularisation of coronary stenosis, which induces myocardial ischaemia, has demonstrated better outcome than OMT alone. Pressure wire (PW) or angiography-based longitudinal coronary physiology provides a point-by-point analysis of the vessel to detect the atherosclerotic pattern of coronary disease. A careful evaluation of this disease pattern allows clinicians to choose the appropriate management strategy. Patients with diffuse disease showed a twofold risk of residual angina after percutaneous coronary interv
Source: heart.bmj.comCategories: General Medicine News, CardiologistsTweet
-
Mashup Score: 4Management of arrythmias during pregnancy - 4 day(s) ago
### Learning objectives A sensation of abnormal or irregular heart beating is a very common symptom in pregnancy. This is often secondary to sinus tachycardia, sinus bradycardia and sinus arrhythmia, or isolated premature atrial or ventricular arrhythmias (VAs). The overall incidence of arrhythmia documented in pregnancy is reported to be in the range of 0.03%–0.5% of pregnancies,1 making this one of the most common cardiac complications of pregnancy, in women with and without structural heart disease.2–4 The incidence of arrhythmia in pregnancy is increasing, a rise attributable to the increase in the proportion of women with structural heart disease achieving successful pregnancies in the last decade.5 Clinical evaluation of the symptomatic pregnant patient begins with a careful history, detailing the timing of onset of symptoms, frequency and potential exacerbating factors. A careful family history, probing for a history of unexplained sudden death, heart failure, cardiac transplant
Source: heart.bmj.comCategories: General Medicine News, Cardiologists1Tweet
-
Mashup Score: 4Management of arrythmias during pregnancy - 5 day(s) ago
### Learning objectives A sensation of abnormal or irregular heart beating is a very common symptom in pregnancy. This is often secondary to sinus tachycardia, sinus bradycardia and sinus arrhythmia, or isolated premature atrial or ventricular arrhythmias (VAs). The overall incidence of arrhythmia documented in pregnancy is reported to be in the range of 0.03%–0.5% of pregnancies,1 making this one of the most common cardiac complications of pregnancy, in women with and without structural heart disease.2–4 The incidence of arrhythmia in pregnancy is increasing, a rise attributable to the increase in the proportion of women with structural heart disease achieving successful pregnancies in the last decade.5 Clinical evaluation of the symptomatic pregnant patient begins with a careful history, detailing the timing of onset of symptoms, frequency and potential exacerbating factors. A careful family history, probing for a history of unexplained sudden death, heart failure, cardiac transplant
Source: heart.bmj.comCategories: General Medicine News, Cardiologists1Tweet
-
Mashup Score: 78Right atrial function, a mostly ignored but very valuable parameter in patients with secondary tricuspid regurgitation - 5 day(s) ago
Significant secondary tricuspid regurgitation (STR) has increasing prevalence with age, it is associated with impaired quality of life, and it is an independent predictor of patients’ morbidity and mortality. Although the association of right ventricular (RV) function with outcome has been reported in patients with STR,1 2 the role of the right atrial (RA) geometry and function remains to be elucidated. In the past, RA has been considered as an innocent bystander that passively dilates due to the chronic volume overload imposed by STR. Recently, the role of RA enlargement in determining the dilation of the tricuspid annulus, as the main mechanism in the pathophysiology of atrial-STR, has been postulated.3 4 However, the association of RA function with outcomes in patients with STR received less attention. , Galloo and co-authors5 reported that RA function (measured as RA longitudinal reservoir strain, RAsR) was independently associated with all-cause mortality at 10 years in a retrospe
Source: heart.bmj.comCategories: General Medicine News, Cardiology News and JournTweet
-
Mashup Score: 1
Background Elevated heart rate (HR) predicts cardiovascular disease and mortality, but there are no established normal limits for ambulatory HR. We used data from the Swedish CArdioPulmonary Imaging Study to determine reference ranges for ambulatory HR in a middle-aged population. We also studied clinical correlates of ambulatory HR. Methods A 24-hour ECG was registered in 5809 atrial fibrillation-free individuals, aged 50–65 years. A healthy subset (n=3942) was used to establish reference values (excluding persons with beta-blockers, cardiovascular disease, hypertension, heart failure, anaemia, diabetes, sleep apnoea or chronic obstructive pulmonary disease). Minimum HR was defined as the lowest 1-minute HR. Reference ranges are reported as means±SDs and 2.5th–97.5th percentiles. Clinical correlates of ambulatory HR were analysed with multivariable linear regression. Results The average mean and minimum HRs were 73±9 and 48±7 beats per minute (bpm) in men and 76±8 and 51±7 bpm in wome
Source: heart.bmj.comCategories: General Medicine News, CardiologistsTweet
RT @Heart_BMJ: Aetiology, ejection fraction and mortality in chronic heart failure: a mediation analysis https://t.co/E7EeA6BItE https://t…