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Sun, Byung Joo; Song, Jae-Kwan
doi: 10.1136/heartjnl-2021-320008pmid: 35264416
Bicuspid aortic valve (BAV), a common congenital anomaly with various morphological phenotypes, is also characterised by marked heterogeneity in clinical presentations including clinically silent condition with mild valvulo-aortopathy, progressive valvulopathy and complex valvulo-aortopathy with shorter life expectancy. The clinical importance of using a general and unified nosology for BAV is well-accepted by opinion leaders and an international consensus statement has been recently published, which will serve as an important scientific platform for BAV. This review describes the current knowledge of BAV based on clinical studies, addresses several unresolved issues requiring investigators’ attention and highlights the necessity of prospective studies with a very long follow-up duration for better appreciation of BAV-associated valvulo-aortopathy. In addition, the progression of valvular calcification in patients with BAV and its potential contribution to development of valvulopathy will be discussed.
Di Fusco, Stefania Angela; Arca, Marcello; Scicchitano, Pietro; Alonzo, Alessandro; Perone, Francesco; Gulizia, Michele Massimo; Gabrielli, Domenico; Oliva, Fabrizio; Imperoli, Giuseppe; Colivicchi, Furio
doi: 10.1136/heartjnl-2021-320708pmid:
van der Velden, Rachel M J; Pluymaekers, Nikki A H A; Dudink, Elton A M P; Luermans, Justin G L M; Meeder, Joan G; Heesen, Wilfred F; Lenderink, Timo; Widdershoven, Jos W M G; Bucx, Jeroen J J; Rienstra, Michiel; Kamp, Otto; van Opstal, Jurren M; Kirchhof, Charles J H J; van Dijk, Vincent F;
Mitropoulou, Panagiota; Grüner-Hegge, Nicolai; Reinhold, Johannes; Papadopoulou, Charikleia
doi: 10.1136/heartjnl-2022-321050pmid: 36007938
ObjectivesTo evaluate the effectiveness of interventions to improve shared decision making (SDM) in cardiology with particular focus on patient-centred outcomes such as decisional conflict.MethodsWe searched Embase (OVID), the Cochrane library, PubMed and Web of Science electronic databases from inception to January 2021 for randomised controlled trials that investigated the effects of interventions to increase SDM in cardiology. The primary outcomes were decisional conflict, decisional anxiety, decisional satisfaction or decisional regret; a secondary outcome was knowledge gained by the patients.ResultsEighteen studies which reported on at least one outcome measure were identified, including a total of 4419 patients. Interventions to increase SDM had a significant effect on reducing decisional conflict (standardised mean difference (SMD) −0.211, 95% CI −0.316 to −0.107) and increasing patient knowledge (SMD 0.476, 95% CI 0.351 to 0.600) compared with standard care.ConclusionsInterventions to increase SDM are effective in reducing decisional conflict and increasing patient knowledge in the field of cardiology. Such interventions are helpful in supporting patient-centred healthcare and should be implemented in wider cardiology practice.
Kanaoka, Koshiro; Iwanaga, Yoshitaka; Nakai, Michikazu; Nishioka, Yuichi; Myojin, Tomoya; Kubo, Shinichiro; Okada, Katsuki; Soeda, Tsunenari; Noda, Tatsuya; Sakata, Yasushi; Miyamoto, Yoshihiro; Saito, Yoshihiko; Imamura, Tomoaki
Showing 1 to 10 of 14 Articles
Lipoprotein(a) (Lp(a)) is a complex circulating lipoprotein, and increasing evidence has demonstrated its role as a risk factor for atherosclerotic cardiovascular disease (ASCVD) and as a possible therapeutic target. Lp(a) atherogenic effects are attributed to several potential mechanisms in addition to cholesterol accumulation in the arterial wall, including proinflammatory effects mainly mediated by oxidised phospholipids. Several studies have found a causal and independent relationship between Lp(a) levels and cardiovascular risk. Furthermore, several studies also suggest a causal association between Lp(a) levels and calcific aortic valve stenosis. Available lipid-lowering agents have at best moderate impact on Lp(a) levels. Among available therapies, antibody proprotein convertase subtilisin/kexin type 9 inhibitors are the most effective in reducing Lp(a). Potent Lp(a)-lowering treatments that target LPA expression are under development. Lp(a) level measurement poses some challenges due to the absence of a definitive reference method and the reporting of Lp(a) values as molar (nanomoles per litre (nmol/L)) or mass concentrations (milligrams per decilitre (mg/dL)) by different assays. Currently, Lp(a) measurement is recommended to refine cardiovascular risk in specific clinical settings, that is, in individuals with a family history of premature ASCVD, in patients with ASCVD not explained by standard risk factors or in those with recurrent events despite optimal management of traditional risk factors. Patients with high Lp(a) levels should be managed with more intensive approaches to treat other modifiable cardiovascular risk factors. Overall, this review focuses on Lp(a) as an ASCVD risk factor and therapeutic target. Furthermore, it reports practical recommendations for Lp(a) measurement and interpretation and updated evidence on Lp(a)-lowering approaches.
doi: 10.1136/heartjnl-2022-321346pmid: 36322782
ObjectiveThe Rate Control versus Electrical Cardioversion Trial 7–Acute Cardioversion versus Wait and See trial compared early to delayed cardioversion for patients with recent-onset symptomatic atrial fibrillation (AF). This study aims to evaluate the adherence to a 4-week mobile health (mHealth) prescription to detect AF recurrences after an emergency department visit.MethodsAfter the emergency department visit, the 437 included patients, irrespective of randomisation arm (early or delayed cardioversion), were asked to record heart rate and rhythm for 1 min three times daily and in case of symptoms by an electrocardiography-based handheld device for 4 weeks (if available). Adherence was appraised as number of performed measurements per number of recordings asked from the patient and was evaluated for longitudinal adherence consistency. All patients who used the handheld device were included in this subanalysis.Results335 patients (58% males; median age 67 (IQR 11) years) were included. The median overall adherence of all patients was 83.3% (IQR 29.9%). The median number of monitoring days was 27 out of 27 (IQR 5), whereas the median number of full monitoring days was 16 out of 27 (IQR 14). Higher age and a previous paroxysm of AF were identified as multivariable adjusted factors associated with adherence.ConclusionsIn this randomised trial, a 4-week mHealth prescription to monitor for AF recurrences after an emergency department visit for recent-onset AF was feasible with 85.7% of patients consistently using the device with at least one measurement per day. Older patients were more adherent.Trial registration number NCT02248753.
doi: 10.1136/heartjnl-2021-320434pmid: 35241624
ObjectiveCardiac rehabilitation (CR) is effective in patients with acute coronary syndrome (ACS); however, CR programmes have not been fully implemented. This study aimed to reveal the current practice of outpatient CR and the dose–effect relationship of CR in real-world settings.MethodsWe performed a nationwide retrospective cohort study using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Patients with ACS who underwent percutaneous coronary intervention between April 2014 and March 2018 were included. We analysed the implementation rate and dose of outpatient CR and the association between dose and outcomes.ResultsOut of 202 320 patients who underwent percutaneous coronary intervention for ACS, a total of 20 444 (10%) underwent outpatient CR. The median (IQR) number of total CR sessions was 9 (3–17), and the median (IQR) duration for each session was 60 (42–60) min. Patients were divided into four groups according to the total number of sessions (≤9 times or ≥10 times) and the duration per session (<50 min or ≥50 min). Compared with the low-number/short-duration group, the adjusted HR for all-cause mortality was 1.00 (95% CI 0.80 to 1.24, p=0.97) in the low-number/long-duration group, 0.63 (95% CI 0.46 to 0.87, p=0.005) in the high-number/short-duration group and 0.74 (95% CI 0.60 to 0.92, p=0.008) in the high-number/long-duration group, respectively.ConclusionWe found that the participation rate for outpatient CR after ACS was low and the doses of sessions vary in real-world settings. A higher number of total sessions of outpatient CR is associated with a better prognosis irrespective of the session’s duration.