Cardiology and Cardiothoracic Services

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Now showing 1 - 5 of 183
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    Inflammatory risk and cardiovascular events in patients without obstructive coronary artery disease: the ORFAN multicentre, longitudinal cohort study.
    (Elsevier, 2024-05-29) McAlindon, Elisa; Munir, Shahzad
    Background: Coronary computed tomography angiography (CCTA) is the first line investigation for chest pain, and it is used to guide revascularisation. However, the widespread adoption of CCTA has revealed a large group of individuals without obstructive coronary artery disease (CAD), with unclear prognosis and management. Measurement of coronary inflammation from CCTA using the perivascular fat attenuation index (FAI) Score could enable cardiovascular risk prediction and guide the management of individuals without obstructive CAD. The Oxford Risk Factors And Non-invasive imaging (ORFAN) study aimed to evaluate the risk profile and event rates among patients undergoing CCTA as part of routine clinical care in the UK National Health Service (NHS); to test the hypothesis that coronary arterial inflammation drives cardiac mortality or major adverse cardiac events (MACE) in patients with or without CAD; and to externally validate the performance of the previously trained artificial intelligence (AI)-Risk prognostic algorithm and the related AI-Risk classification system in a UK population. Methods: This multicentre, longitudinal cohort study included 40 091 consecutive patients undergoing clinically indicated CCTA in eight UK hospitals, who were followed up for MACE (ie, myocardial infarction, new onset heart failure, or cardiac death) for a median of 2·7 years (IQR 1·4-5·3). The prognostic value of FAI Score in the presence and absence of obstructive CAD was evaluated in 3393 consecutive patients from the two hospitals with the longest follow-up (7·7 years [6·4-9·1]). An AI-enhanced cardiac risk prediction algorithm, which integrates FAI Score, coronary plaque metrics, and clinical risk factors, was then evaluated in this population. Findings: In the 2·7 year median follow-up period, patients without obstructive CAD (32 533 [81·1%] of 40 091) accounted for 2857 (66·3%) of the 4307 total MACE and 1118 (63·7%) of the 1754 total cardiac deaths in the whole of Cohort A. Increased FAI Score in all the three coronary arteries had an additive impact on the risk for cardiac mortality (hazard ratio [HR] 29·8 [95% CI 13·9-63·9], p<0·001) or MACE (12·6 [8·5-18·6], p<0·001) comparing three vessels with an FAI Score in the top versus bottom quartile for each artery. FAI Score in any coronary artery predicted cardiac mortality and MACE independently from cardiovascular risk factors and the presence or extent of CAD. The AI-Risk classification was positively associated with cardiac mortality (6·75 [5·17-8·82], p<0·001, for very high risk vs low or medium risk) and MACE (4·68 [3·93-5·57], p<0·001 for very high risk vs low or medium risk). Finally, the AI-Risk model was well calibrated against true events. Interpretation: The FAI Score captures inflammatory risk beyond the current clinical risk stratification and CCTA interpretation, particularly among patients without obstructive CAD. The AI-Risk integrates this information in a prognostic algorithm, which could be used as an alternative to traditional risk factor-based risk calculators.
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    The impact of ferric derisomaltose on cardiovascular and noncardiovascular events in patients with anemia, iron deficiency, and heart failure with reduced ejection fraction.
    (Elsevier., 2024-05-01) Spencer, Charles
    Background: In some countries, intravenous ferric derisomaltose (FDI) is only licensed for treating iron deficiency with anemia. Accordingly, we investigated the effects of intravenous FDI in a subgroup of patients with anemia in the IRONMAN (Effectiveness of Intravenous (IV) Iron Treatment Versus Standard Care in Patients With Heart Failure and Iron Deficiency) trial. Method and results: IRONMAN enrolled patients with heart failure, a left ventricular ejection fraction of ≤45%, and iron deficiency (ferritin <100 µg/L or transferrin saturation of <20%), 771 (68%) of whom had anemia (hemoglobin <12 g/dL for women and <13 g/dL for men). Patients were randomized, open label, to FDI (n = 397) or usual care (n = 374) and followed for a median of 2.6 years. The primary end point, recurrent hospitalization for heart failure and cardiovascular death, occurred less frequently for those assigned to FDI (rate ratio 0.78, 95% confidence interval 0.61-1.01; P = .063). First event analysis for cardiovascular death or hospitalization for heart failure, less affected by the coronavirus disease 2019 pandemic, gave similar results (hazard ratio 0.77, 95% confidence interval 0.62-0.96; P = .022). Patients randomized to FDI reported a better Minnesota Living with Heart Failure quality of life, for overall (P = .013) and physical domain (P = .00093) scores at 4 months. Conclusions: In patients with iron deficiency anemia and heart failure with reduced left ventricular ejection fraction, intravenous FDI improves quality of life and may decrease cardiovascular events.
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    Closed incision negative pressure therapy use as a strategy to reduce sternal wound infection in identified high-risk patients: a multicentre propensity-matched study.
    (Oxford Academic., 2024-04-08) Ahmed, Parvez; Cartwright , Carly; Muppiri, Vijayakumar; Nikolaidis, Nicolas
    Objective: The premise of this retrospective study was to evaluate the intraoperative use of closed incision negative pressure therapy (ciNPT) to help reduce the incidence of postoperative sternal wound infections (SWI) in multimorbid patients with an elevated risk of developing an SWI post cardiac surgery versus a cohort that received standard of care dressings. Methods: Data of all adult patients were collected from each cardiothoracic surgery units across three hospitals in the United Kingdom. High-risk patients had two or more recognised risk factors. Fisher’s exact test (two-tailed) and unpaired t-test helped analyse categorical and continuous data. Propensity matching was performed to compare the two groups. Results: A total of 5,288 patients who had cardiac surgery were included. Propensity matching led to 766 matched cases. There were significantly fewer sternal wound infections in the ciNPT group (43 [5.6%] versus 119 [15.5%] cases; p = 0.0001), as well as fewer deep sternal wound infections (14 [1.8%] versus 31 [4.0%] cases; p = 0.0149) and superficial sternal wound infections (29 [3.8%] versus 88 [11.4%] cases; p = 0.0001). A higher mean length of stay in the ciNPT group was statistically significant (11.23±13 versus 9.66±10 days; p = 0.0083) as well as a significantly higher mean logistic EuroSCORE (11.143±13 versus 8.094±11; p = 0.0001). A statistically significant higher readmission to intensive care due to sternal wound infection was noted for the Control (16 [2.08%] versus 3 [0.39%] readmissions; p = 0.0042). Conclusion: ciNPT appears to be an effective intervention to help reduce the incidence of sternal wound infection in high-risk individuals undergoing cardiac surgery.
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    Manubriectomy made easy.
    (EACTS, 2024-05-03) El-Zeki , Ahmed; Habib, Ahmed; Mughal , Aishah Z ; Oliemy, Ahmed
    Bone metastasis is the most common form of distant metastasis encountered within the breast cancer population. Surgical resection of bone metastases is a curative treatment option in patients who present with an isolated solitary lesion and no other associated disease. This decision is typically made following a multidisciplinary discussion. Patients can also be put forward for surgical excision of bone metastases following inadequate response to chemotherapy or radiotherapy. With tumours located in the manubrium of the sternum, surgery serves not only to resect the bone metastasis but to provide suitable chest wall reconstruction. The goal of this approach is to maintain the structural and bony stability of the chest wall as well as that of associated structures, e.g. rib insertion or articulation of the shoulder girdle. A widely utilized approach involves excising the area of metastasis within the manubrium followed by implanting a bone cement prosthesis. Titanium plates are used to fix the bone prosthesis to the sternal body inferiorly and to the remainder of the manubrium superiorly. We present a step-by-step video tutorial for performing a lower hemi-manubriectomy in a patient with triple-negative breast cancer. Our goal is to describe the fundamental principles and surgical techniques used to perform this procedure followed by the postoperative outcomes.
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    Transcatheter aortic valve replacement with the navitor system: real-world united kingdom experience.
    (Elsevier, 2024-04-29) Khogali, Saib
    Background: The Navitor (THV) is the latest iteration of the Portico self-expanding valve system. Early prospective studies have shown promising outcomes, however there is a lack of complementary ‘real-world’ data. Aims: To assess early safety and efficacy outcomes of the Navitor Transcatheter Heart Valve (THV) using registry data from six high-volume UK TAVR centers. Methods; Demographic, procedural and in-hospital outcome data were retrieved from six UK centers. The primary safety end-point was 30-day mortality. Primary efficacy end-points were procedural success, mean aortic gradient, and ≥moderate paravalvular leak (PVL). Secondary endpoints included rates of new pacemaker implantation (PPM), stroke and vascular injury. Results: 574 patients (Mean age 83.4 years; 54.5% female) underwent Navitor TAVR between January 2020 and May 2023. The 30-day mortality in this patient cohort was 1.6%. Procedural success was 98.1%, mean echo-derived gradient post-TAVR was 7.7±4.8mmHg (95% CI [7.2, 8.3], p<0.001) and 5.1% of patients had ≥moderate PVL (p̂=0.051, 95% CI [0.035, 0.073, p<0.001). New PPM to discharge was required in 11% (p̂ =0.119, 95% CI [0.088, 0.158], p<0.001), stroke occurred in 1.2% of patients (p̂= 0.017, 95% CI [0.006, 0.036], p<0.001) and significant vascular injury in 1.6% (p̂= 0.014, 95% CI [0.005, 0.032], p<0.001). Conclusion: Early procedural outcomes with Navitor TAVR compare favorably to new generation THVs. Procedural success was high with a low incidence of complications.