Cardiology

Rutland, J., Ayoub, K., Etaee, F., Ogunbayo, G., Darrat, Y., Marji, M., Masri, A. and Elayi, C.S. (2020). “CHA(2)DS(2)-VASc and readmission with new-onset atrial fibrillation, atrial flutter, or acute cerebrovascular accident.” Int J Cardiol Aug 13;S0167-5273(20)33554-3. [Epub ahead of print.].

Full text of this article.

BACKGROUND: Although risk factors for atrial fibrillation (AF) and atrial flutter (AFL) are known, identifying patients who will develop AF/AFL within the near future remains challenging. We sought to evaluate if the CHA(2)DS(2)-VASc risk score (CVRS) can identify hospital readmissions with AF, AFL, or acute cerebrovascular accident (CVA) among hospitalized patients without prior history of AF/AFL. METHODS: Using the Nationwide Readmission Database, a study cohort included patients without prior AF/AFL or new diagnosis of AF/AFL at the index hospitalization from 2012 to 2014. Patients were stratified based on the CVRS into three groups: Low (CVRS ≤1), Intermediate (CVRS 2-5), and High (CVRS ≥6).The primary outcome of interest was 180-day readmission rate with a primary or secondary diagnosis of AF/AFL. Secondary outcomes of interest were acute CVA and 6-month mortality rate. RESULTS: A total of 17,820,640 patients were included in our study. Over a 6-month follow up duration from the index hospitalization, the overall re-admission rate for new onset atrial arrhythmias (AF/AFL) was 3.48% (n = 620,986), acute CVA 0.13% (n = 22,522), and all-cause mortality 0.31% (n = 55,632). When compared to other groups, patients with a higher CVRS were readmitted more frequently for AF/AFL [odds ratio (OR) 2.43; 95% confidence interval (CI) 2.41-2.45, P < .0001), acute CVA (OR 3.96; 95%CI 3.85-4.08, P < .0001), and all-cause mortality (OR 2.19; 95%CI 2.14-2.24, P < .0001). CONCLUSION: In this large contemporary cohort, a CHADS2VA2SC score ≥ 6 identified patients without known prior atrial arrhythmias at an elevated risk of developing AF/AFL or acute CVA within 6 months of hospitalization.

Alam, A., Milligan, G.P. and Joseph, S.M. (2020). “Reconsidering the Diagnostic Criteria of Right Ventricular Primary Graft Dysfunction.” J Card Fail Aug 7;S1071-9164(20)30901-5. [Epub ahead of print.].

Full text of this article.

Primary graft dysfunction is defined as left and/or right ventricular (RV) failure occurring in the immediate post-transplant period in the absence of an immunologic or anatomic etiology. It is the leading cause of peri-operative mortality among patients receiving heart transplants1 making early and accurate diagnosis critical to optimizing outcomes. Diagnostic criteria were proposed by the International Society of Heart and Lung Transplantation,2 however the diagnosis of right ventricular primary graft dysfunction (RV-PGD) remains controversial. We review the currently accepted diagnostic criteria for RV-PGD, detail their inherent limitations, and propose a simplified approach to diagnosis and classification of RV-PGD severity. [No abstract available; excerpt from article.].

Roberts, W.C. (2020). “Proceedings from the Editorial Board Meeting of The AJC in 2019.” Am J Cardiol 129: 120-121.

Full text of this article.

Usually the editorial board of The American Journal of Cardiology (AJC) meets at the Annual Scientific Sessions of the American College of Cardiology which takes place usually in March of each year. The 2020 meeting was canceled because of the Covid-19 pandemic. Nevertheless, the following data summarize the journal’s performance in 2019. [No abstract available; excerpt from Editorial.].

Ather, N. and Roberts, W.C. (2020). “Cardiovascular ochronosis.” Cardiovasc Pathol 48: 107219.

Full text of this article.

In this review, we summarize previously reported case reports (n=66) in which the presence of ochronotic pigment was found in one or more cardiovascular structures either at necropsy or after operative excision of a cardiac valve or portions of arteries or both. As illustration, we describe black pigment in operatively excised aortic valves and aorta in 2 patients, both probably examples of secondary ochronosis. Ochronosis appears to have fascinated a number of prominent historical figures in medicine, and this review also summarizes their important contributions to this topic.

Cheng, X.S., Wall, A. and Teuteberg, J. (2020). “Ethical decision-making in simultaneous heart-liver transplantation.” Curr Opin Organ Transplant Aug 31. [Epub ahead of print.].

Full text of this article.

PURPOSE OF REVIEW: Simultaneous heart-liver (SHL) transplants are only a small proportion of overall heart and liver transplantation, they have been increasing in frequency and thus challenge the equitable allocation of organs. RECENT FINDINGS: The incidence of SHL transplants is reviewed along with the outcomes of SHL transplants and their impact on the waitlist, particularly in the context of solitary heart and liver transplantation. The ethical implications, most importantly the principles of utility and equity, of SHL transplant are addressed. In the context of utility, the distinction of a transplant being life-saving versus life-enhancing is investigated. The risk of hepatic decompensation for those awaiting both solitary and combined organ transplantation is an important consideration for the principle of equity. Lastly, the lack of standardization of programmatic approaches to SHL transplant candidates, the national approach to allocation, and the criteria by which programs are evaluated are reviewed. SUMMARY: As with all multiorgan transplantation, SHL transplantation raises ethical issues of utility and equity. Given the unique patient population, good outcomes, lack of alternatives, and overall small numbers, we feel there is continued ethical justification for SHL, but a more standardized nationwide approach to the evaluation, listing, and allocation of organs is warranted.