Highlights From the Circulation Family of Journals
2019; Lippincott Williams & Wilkins; Volume: 139; Issue: 14 Linguagem: Inglês
10.1161/circulationaha.119.040626
ISSN1524-4539
Tópico(s)ECG Monitoring and Analysis
ResumoHomeCirculationVol. 139, No. 14Highlights From the Circulation Family of Journals Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBHighlights From the Circulation Family of Journals Originally published1 Apr 2019https://doi.org/10.1161/CIRCULATIONAHA.119.040626Circulation. 2019;139:1744–1749Circulation: Arrhythmia and ElectrophysiologyPermanent nonselective His bundle pacing is an emerging option for pacing. This study developed and assessed a maneuver for differentiating His bundle capture from right ventricle (RV) myocardial capture by using a programmed extrastimulus technique. They found shorter effective refractory periods for RV pacing than for His bundle and used this to accurately distinguish His bundle pacing from RV pacing.Programmed His Bundle PacingA Novel Maneuver for the Diagnosis of His Bundle CaptureMarek Jastrzębski, MD, PhDPaweł Moskal, MDAgnieszka Bednarek, MD, PhDGrzegorz Kiełbasa, MDPugazhendhi Vijayaraman, MDDanuta Czarnecka, MD, PhDCorrespondence to: Marek Jastrzębski, MD, PhD, First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, ul. Kopernika 17, 31-501 Kraków, Poland. Email [email protected]edu.pBACKGROUND: During permanent nonselective His bundle (ns-HB) pacing, it is crucial to confirm HB capture/exclude that only right ventricle (RV) myocardial septal pacing is present. Because the effective refractory period (ERP) of the working myocardium is different than the ERP of the HB, we hypothesized that it should be possible to differentiate ns-HB capture from RV myocardial capture using programmed extrastimulus technique.METHODS: In consecutive patients during HB pacemaker implantation, programmed HB pacing was delivered from the screwed-in HB pacing lead. Premature beats were introduced at 10-ms steps during intrinsic rhythm and also after a drive train of 600 ms. The longest coupling interval that resulted in an abrupt change of QRS morphology was considered equal to ERP of HB or RV myocardium.RESULTS: Programmed HB pacing was performed from 50 different sites in 32 patients. In 34 of 36 cases of ns-HB pacing, the RV myocardial ERP was shorter than HB ERP (271.8±38 versus 353.0±30 ms; P<0.0001). Programmed HB pacing using a drive train resulted in a typical abrupt change of paced QRS morphology: from ns-HB to RV myocardial QRS (34 of 36 cases) or to selective HB QRS (2 of 36 cases). Programmed HB pacing delivered during native conduction resulted in obtaining selective HB QRS in 20 of 34 and RV myocardial QRS in 14 of 34 of the ns-HB cases. In RV myocardial–only pacing cases (false ns-HB pacing, n=14), such responses were not observed—the QRS morphology remained stable. Therefore, the programmed HB pacing correctly diagnosed all ns-HB cases and all RV myocardial pacing cases.CONCLUSIONS: A novel maneuver for the diagnosis of HB capture, based on the differences in ERP between HB and myocardium, was formulated, assessed, and found as diagnostically valuable. This method is unique in enabling to visualize selective HB QRS in patients with otherwise obligatory ns-HB pacing (RV myocardial capture threshold <HB capture threshold).Circ Arrhythm Electrophysiol. 2019;12:e007052. doi: 10.1161/CIRCEP.118.007052.Circulation: Genomic and Precision MedicineUsing a systematic approach to evaluate gene-disease associations, this study analyzes the validity of previously reported hypertrophic cardiomyopathy (HCM) genes. The authors found that the majority of genes reported as causative for HCM in diagnostic panels had limited or no association with HCM. Despite increasing gene panel sizes on diagnostic genetic testing, improvements are needed to accurately identify causative mutations for HCM.Evaluating the Clinical Validity of Hypertrophic Cardiomyopathy GenesJodie Ingles, GradDipGenCouns, PhD, MPHJennifer Goldstein, PhD, CGCCourtney Thaxton, PhDColleen Caleshu, MScEdward W. Corty, BAStephanie B. Crowley, PhDKristen Dougherty, MSSteven M. Harrison, PhDJennifer McGlaughon, PhDLaura V. Milko, PhDAna Morales, MS, CGCBryce A. Seifert, PhDNatasha Strande, PhDKate Thomson, BSc, FRCPathJ. Peter van Tintelen, MD, PhDKathleen Wallace, BARoddy Walsh, PhDQuinn Wells, MD, PharmD, MScNicola Whiffin, PhDLeora Witkowski, PhDChristopher Semsarian, MBBS, PhD, MPHJames S. Ware, MRCP, PhDRay E. Hershberger, MDBirgit Funke, PhD, FACMGCorrespondence to: Jodie Ingles, GradDipGenCouns, PhD, MPH, Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Locked Bag 6, Newtown, NSW, Sydney 2042, Australia. Email j.[email protected]org.auBACKGROUND: Genetic testing for families with hypertrophic cardiomyopathy (HCM) provides a significant opportunity to improve care. Recent trends to increase gene panel sizes often mean variants in genes with questionable association are reported to patients. Classification of HCM genes and variants is critical, as misclassification can lead to genetic misdiagnosis. We show the validity of previously reported HCM genes using an established method for evaluating gene-disease associations.METHODS: A systematic approach was used to assess the validity of reported gene-disease associations, including associations with isolated HCM and syndromes including left ventricular hypertrophy. Genes were categorized as having definitive, strong, moderate, limited, or no evidence of disease causation. We also reviewed current variant classifications for HCM in ClinVar, a publicly available variant resource.RESULTS: Fifty-seven genes were selected for curation based on their frequent inclusion in HCM testing and prior association reports. Of 33 HCM genes, only 8 (24%) were categorized as definitive (MYBPC3, MYH7, TNNT2, TNNI3, TPM1, ACTC1, MYL2, and MYL3); 3 had moderate evidence (CSRP3, TNNC1, and JPH2; 33%); and 22 (66%) had limited (n=16) or no evidence (n=6). There were 12 of 24 syndromic genes definitively associated with isolated left ventricular hypertrophy. Of 4191 HCM variants in ClinVar, 31% were in genes with limited or no evidence of disease association.CONCLUSIONS: The majority of genes previously reported as causative of HCM and commonly included in diagnostic tests have limited or no evidence of disease association. Systematically curated HCM genes are essential to guide appropriate reporting of variants and ensure the best possible outcomes for HCM families.Circ Genom Precis Med. 2019;12:e002460. doi: 10.1161/CIRCGEN.119.002460.Circulation: Cardiovascular ImagingThis study aimed to develop an echocardiographic score for rheumatic heart disease (RHD) screening using components of the World Heart Federation criteria. The score accurately identified risk levels for progression to RHD. This tool is the first for risk stratification at the time of diagnosis of latent RHD.Simplified Echocardiography Screening Criteria for Diagnosing and Predicting Progression of Latent Rheumatic Heart DiseaseMaria Carmo P. Nunes, MD, PhDCraig Sable, MDBruno R. Nascimento, MD, MSc, PhDEmilly Malveira de Lima, MScJose Luiz Padilha da Silva, PhDAdriana C. Diamantino, MDKaciane K.B. Oliveira, MScEmmy Okello, MD, PhDTwalib Aliku, MDPeter Lwabi, MDEnrico Antonio Colosimo, PhDAntonio Luiz P. Ribeiro, MD, PhDAndrea Z. Beaton, MDCorrespondence to: Maria Carmo P. Nunes, MD, PhD, Department of Internal Medicine, School of Medicine of the Federal University of Minas Gerais, Av Prof Alfredo Balena, 190 Santa Efigênia, Belo Horizonte-MG 30130 100, Brazil. Email [email protected] waymail.com.brBACKGROUND: The 2012 World Heart Federation Criteria are the current gold standard for the diagnosis of latent rheumatic heart disease (RHD). Because data and experience using these criteria have grown, there is opportunity to simplify and develop outcome prediction tools. We aimed to develop a simple echocardiographic score applicable for RHD screening with potential to predict disease progression.METHODS: This study included 3 cohorts used for score derivation (n=9501), score validation (n=7312), and assessment of outcomes prediction (n=227). In the derivation cohort, variables independently associated with definite RHD were assigned point values proportional to their regression coefficients. The sum of these values was stratified into low (0–6), intermediate (7–9), and high (≥10) risk.RESULTS: Five components were selected for score development, including mitral valve anterior leaflet thickening, excessive leaflet tip motion, and regurgitation jet length ≥2 cm, and aortic valve focal thickening and any regurgitation. The score showed optimal discrimination and calibration for RHD diagnosis in the derivation and validation cohorts (C statistic, 0.998 and 0.994, respectively), with good discrimination for predicting disease progression (C statistic, 0.811). Progression-free survival rate in the low-risk children at 1-, 2-, and 3-year follow-up was 100%, 100%, and 93%, respectively, compared with 90%, 60%, and 47% in high-risk group. The point-based score was strongly associated with disease progression (hazard ratio, 1.270; 95% CI, 1.188–1.358; P<0.001).CONCLUSIONS: This simplified score, based on components of the World Heart Federation criteria, is highly accurate to recognize definite RHD and provides the first tool for risk stratification, assigning children with latent RHD to low, intermediate, or high risk based on echocardiographic features at diagnosis.Circ Cardiovasc Imaging. 2019;12:e007928. doi: 10.1161/CIRCIMAGING.118.007928.Circulation: Cardiovascular InterventionsA high dose of radiation is still received by interventional cardiologists at the pelvic level during percutaneous coronary procedures, despite the use of protective devices designed to reduce exposure. The EXTRA-RAD study (Extended Protective Shield Under Table to Reduce Operator Radiation Dose in Percutaneous Coronary Procedures) evaluates the use of under-the-table adjunctive shields and their ability to reduce exposure. The use of an adjunctive protective shield under the angiographic table is linked with a significant reduction of radiation exposure at the pelvic level, without limiting the operator’s movement.Extended Protective Shield Under Table to Reduce Operator Radiation Dose in Percutaneous Coronary ProceduresThe EXTRA-RAD StudyAlessandro Sciahbasi, MD, PhDAlessandro Sarandrea, EngStefano Rigattieri, MD, PhDRoberto Patrizi, MDMaria Cera, MDCristian Di Russo, MD, PhDLuigi Zezza, MDSilvio Fedele, MDGiuseppe Ferraiuolo, MDCorrespondence to: Alessandro Sciahbasi, MD, PhD, Interventional Cardiology, Sandro Pertini Hospital, ASL Roma2, Rome, Italy. Email [email protected]comBACKGROUND: Different tools and devices are effective to reduce operator radiation exposure at thorax level during percutaneous coronary procedures, but the operator radiation dose received at pelvic region still remains high. Our aim was to evaluate the efficacy of underthe-table adjunctive shields to reduce operator radiation exposure during percutaneous coronary proceduresMETHODS AND RESULTS: The EXTRA-RAD study (Extended Protective Shield Under Table to Reduce Operator Radiation Dose in Percutaneous Coronary Procedures) is a prospective, single-center, randomized study. Patients who underwent transradial coronary procedures were randomized into 2 groups: group 1 (standard arrangement) and group 2 (adjunctive antirx shield under the angiographic table). In group 2, a further randomization was performed to compare 2 different underthe-table shields (a small curtain and a drape). A total of 205 procedures (122 diagnostic coronary angiographies and 83 percutaneous coronary interventions) performed in 157 patients by 4 different operators were included without significant differences in clinical and procedural characteristics between groups. The use of adjunctive shields was associated with lower radiation dose compared with no shield at pelvic region (42 µSv [14–98] in group 1, 13 µSv [5–27] in group 2; P<0.0001) and also at thorax level (4 µSv [1–13] in group 1, 2 µSv [1–4] in group 2; P=0.001). The reduction in dose was observed in all the operators. No significant differences were observed in pelvic dose using the 2 different shields (P=0.183).CONCLUSIONS: The use of adjunctive antirx shields under the angiographic table during transradial coronary procedures is associated with a significant lower radiation dose to operators at pelvic and thorax level.CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03259126.Circ Cardiovasc Interv. 2019;12:e007586. doi: 10.1161/CIRCINTERVENTIONS.118.007586.Circulation: Cardiovascular Quality and OutcomesThis perspective highlights the rise of maternal mortality and the value of a team-based approach to address problems facing high-risk obstetric populations. Developing a cardio-obstetrics team can potentially help improve maternal outcomes.Cardio-ObstetricsTeam-Based Care to Improve Maternal OutcomesMelinda B. Davis, MDMary Norine Walsh, MDCorrespondence to: Melinda B. Davis, MD, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109. Email [email protected]umich.eduMaternal MortalityDespite global improvements in maternal mortality, the rate of pregnancy-related deaths in the United States has been rising.1 Pregnant women in the United States have a higher risk of death than in any other industrialized country. The reasons for this are complex. Black women have a 3 to 4× higher risk of maternal mortality than white women,2 underscoring alarming trends in the racial-ethnic disparities in this country. Insufficient access to care, socioeconomic inequalities, and variable quality of care all require attention. Additionally, maternal demographics and risk factors have changed over time. At the time of pregnancy, women are older and have more chronic medical conditions, such as obesity, hypertension, and diabetes mellitus.1 Cardiovascular disease is now a leading cause of maternal death and severe morbidity.2Centers for Disease Control and Prevention. Pregnancy Mortality Surveillance System. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-mortality-surveillance-system.htm. Accessed November 25, 2018.Creanga AA, Syverson C, Seed K, Callaghan WM. Pregnancy-related mortality in the United States, 2011 to 2013. Obstet Gynecol. 2017;130:366–373. doi: 10.1097/AOG.0000000000002114Circ Cardiovasc Qual Outcomes. 2019;12:e005417. doi: 10.1161/CIRCOUTCOMES.118.005417.Circulation: Heart FailureA combined treatment strategy of long-term ventricular assist device (VAD) support and cell therapy in patients with advanced heart failure has not been explored. This review outlines the effects of VAD support and cell therapy to promote myocardial recovery in patients who have chronic heart failure and provides reason to study a combination approach.Stem Cell and Left Ventricular Assist Device Combination TherapyA Novel Approach Aiming to Achieve Myocardial Recovery in Patients With Advanced Chronic Heart FailureGregor Poglajen, MD, PhDIgor D. Gregoric, MDRajko Radovancevic, MDBojan Vrtovec, MD, PhDCorrespondence to: Gregor Poglajen, MD, PhD, Advanced Heart Failure and Transplantation Center, University Medical Center Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia. Email [email protected]ABSTRACT: Ventricular assist device (VAD) technology has evolved significantly over the past decades and currently represents one of the most important treatment strategies for patients with advanced chronic heart failure. There is increasing evidence that in selected patients undergoing long-term VAD support, improvement of myocardial structure and function may occur. However, there seems to be a significant discrepancy between structural and functional recovery of the failing myocardium, as only a small fraction of VAD-supported patients demonstrate reverse structural remodeling and eventually reach clinically significant and stable, functional improvement. More recently, cell therapy has gained a growing interest in the heart failure community because of its potential to augment reverse remodeling of the failing myocardium. Although theoretically the combination of long-term VAD support and cell therapy may offer significant advantages over using these therapeutic modalities separately, it remains largely unexplored. This review aims to summarize the current state of the art of the effects of VAD support and cell therapy on the reverse remodeling of the failing myocardium and to discuss the rationale for using a combined treatment strategy to further promote myocardial recovery in patients with advanced chronic heart failure.Circ Heart Fail. 2019;12:e005454. doi: 10.1161/CIRCHEARTFAILURE.118.005454.Footnoteshttps://www.ahajournals.org/journal/circ Previous Back to top Next FiguresReferencesRelatedDetails April 2, 2019Vol 139, Issue 14 Advertisement Article InformationMetrics © 2019 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.119.040626PMID: 30933624 Originally publishedApril 1, 2019 PDF download Advertisement
Referência(s)