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Ha FJ, Dimitriou J, Huang AL. A rare case of left atrial undifferentiated pleomorphic sarcoma. Eur Heart J Case Rep 2023; 7:ytad481. [PMID: 37841043 PMCID: PMC10572086 DOI: 10.1093/ehjcr/ytad481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/12/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Francis J Ha
- Department of Cardiology, St Vincent’s Hospital Melbourne, 41 Victoria Parade, Fitzroy, Melbourne, Victoria 3065, Australia
| | - Jim Dimitriou
- Department of Cardiothoracic Surgery, St Vincent’s Hospital Melbourne, 41 Victoria Parade, Fitzroy, Melbourne, Victoria 3065, Australia
| | - Alex L Huang
- Department of Cardiology, St Vincent’s Hospital Melbourne, 41 Victoria Parade, Fitzroy, Melbourne, Victoria 3065, Australia
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Ha FJ, Mclellan A, Newcomb A, Creati L. Forty years after mediastinal radiotherapy for Hodgkin lymphoma: how late is late cardiotoxicity? A case report. Eur Heart J Case Rep 2023; 7:ytad288. [PMID: 37416512 PMCID: PMC10320229 DOI: 10.1093/ehjcr/ytad288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 05/19/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
Radiation-associated cardiovascular disease is well-described yet under-recognized. Mediastinal radiation is known to affect any component of the heart. We present a case of valvular, coronary, and conduction abnormalities up to decades after initial radiotherapy.
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Affiliation(s)
| | - Alex Mclellan
- Department of Cardiology, St Vincent’s Hospital Melbourne, Australia
| | - Andrew Newcomb
- Department of Cardiothoracic Surgery, St Vincent’s Hospital Melbourne, Australia
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Somma V, Ha FJ, Palmer S, Mohamed U, Agarwal S. Pacing-induced cardiomyopathy: A systematic review and meta-analysis of definition, prevalence, risk factors, and management. Heart Rhythm 2023; 20:282-290. [PMID: 36356656 DOI: 10.1016/j.hrthm.2022.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 11/09/2022]
Abstract
Pacing-induced cardiomyopathy is a potential complication of right ventricular pacing. Definition varies between studies and the optimal management approach is uncertain. We aimed to characterize definition, prevalence, risk factors, and treatment strategies of pacing-induced cardiomyopathy (PiCM). We performed a systematic review and meta-analysis of studies that evaluated PiCM after pacemaker implantation identified through a literature search of PubMed and EMBASE up to March 2022. We collected data on the study definition of PiCM and calculated pooled prevalence across studies. Meta-analysis with random effects modeling was used to assess the association between potential risk factors and PiCM, reported as odds ratio with 95% confidence interval. Twenty-six studies (6 prospective studies) with a total of 57,993 patients (mean/median age range was 51-78 years; female 45%) were included in the final analysis. Fifteen unique definitions of PiCM were reported. The pooled prevalence of PiCM was 12% (95% confidence interval 11%-14%). In meta-analysis, risk factors included male sex, history of myocardial infarction, chronic kidney disease, atrial fibrillation, baseline left ventricular ejection fraction, native QRS duration, right ventricular pacing percentage, and paced QRS duration. Treatment strategies identified included biventricular cardiac resynchronization therapy (6 studies) and His-bundle pacing (3 studies). Definition of PiCM varied significantly between studies. More than 1 in 10 patients with chronic right ventricular pacing developed PiCM. Key risk factors included baseline left ventricular ejection fraction, native QRS duration, RV pacing percentage, and paced QRS duration. The optimal management strategy has yet to be defined. Further research is needed to define and treat this understated complication.
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Affiliation(s)
- Vincenzo Somma
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Francis J Ha
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Australia.
| | - Sonny Palmer
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Uwais Mohamed
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Sharad Agarwal
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
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Ha FJ, Han HC, Sanders P, La Gerche A, Teh AW, Farouque O, Lim HS. Sudden cardiac death related to physical exercise in the young: a nationwide cohort study of Australia. Intern Med J 2021; 53:497-502. [PMID: 34719841 DOI: 10.1111/imj.15606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/24/2021] [Accepted: 10/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sudden cardiac death (SCD) during physical exercise is devastating. We aimed to evaluate causes and circumstances of exercise-related SCD in the young in Australia. METHODS We reviewed the National Coronial Information System database for deaths in Australia relating to cardiovascular disease in cases aged 10-35 years between 2000-2016. Included cases had undertaken physical exercise at time of event. We collected demographics, circumstances of death, type of physical exercise, bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use prior to ambulance arrival. RESULTS Over a 17-year period, 1,925 SCD cases were identified of which 110 cases (6%) (median age 27 years [interquartile range [IQR] 21-32 years], 92% male) were related to sports/physical exercise. Thirteen cases (12%) occurred in active athletes. Most common causes were coronary artery disease (CAD; 37%) and sudden arrhythmic death syndrome (SADS; 20%). Amongst Aboriginal and Torres Strait Islanders (n=10), all deaths were related to CAD. Australian Rules Football (24%), running/jogging (14%) and soccer (14%) were the most frequent physical exercise activities. Prior symptoms were present in 39% (chest pain 37%, presyncope/syncope 26%). Most were witnessed (87%) with bystander CPR in 70%. AED use prior to ambulance arrival was 8%. CONCLUSIONS This study demonstrates the high occurrence of CAD and SADS in SCD in the young related to physical exercise. Aboriginal and Torres Strait Islanders were disproportionately affected by CAD. Although events were commonly witnessed, AED was seldom used prior to ambulance arrival and highlights an important opportunity to improve outcomes in the post-arrest chain of survival. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Francis J Ha
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,St Vincent's Hospital Melbourne, Victoria, Australia
| | - Hui-Chen Han
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australia Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, South Australia, Australia
| | - Andre La Gerche
- St Vincent's Hospital Melbourne, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Andrew W Teh
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Han S Lim
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,Department of Cardiology, Northern Health, Melbourne, Victoria, Australia
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Ha FJ, Stevens W, Darby J, Martyres R, Burns AT. Refractory seronegative arthropathy: think outside the joint. Intern Med J 2021; 51:1003-1004. [PMID: 34155753 DOI: 10.1111/imj.15370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 02/27/2020] [Accepted: 03/11/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Francis J Ha
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Wendy Stevens
- Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan Darby
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Department of Infectious Diseases, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Raymond Martyres
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Andrew T Burns
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Ha FJ, Bissland K, Mandrawa C, Palmer SC. Frailty in patients with aortic stenosis awaiting intervention. Intern Med J 2021; 51:319-326. [PMID: 31908088 DOI: 10.1111/imj.14737] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/07/2019] [Accepted: 12/21/2019] [Indexed: 01/12/2023]
Abstract
Aortic stenosis (AS) is a common valvular disease in older age. Definitive interventions include surgical aortic valve replacement or transcatheter aortic valve implantation (TAVI). In high-risk patients, frailty is observed in up to 50% awaiting TAVI. Frailty is now an established predictor of outcomes in patients with AS who undergo intervention. There is currently no consensus definition for frailty. It is widely described as a syndrome of loss in physiological reserve predisposing to increased vulnerability for death or dependency. Frailty encompasses a holistic view including domains of physical function, cognition, depression, nutrition and medical comorbidities. Individual components of frailty have been shown to significantly predict mortality, functional recovery and quality of life after TAVI. The addition of frailty components to conventional risk prediction models traditionally used in cardiac surgery has been shown to augment overall prediction for post-operative mortality and morbidity. Identifying patients who are frail at baseline provides an opportunity to modify dynamic aspects of frailty prior to, and after definitive intervention for AS. A multidisciplinary approach including comprehensive geriatric pre-operative assessment will likely become standard of care to identify and optimise frail patients awaiting TAVI. In this review, we discuss the definition and measurement of frailty in patients with AS, evaluate recent data on risk prediction associated with frailty, and outline approaches to optimisation of dynamic components of frailty to improve outcomes after AS intervention.
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Affiliation(s)
- Francis J Ha
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Kenneth Bissland
- Department of Geriatric Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Christine Mandrawa
- Department of Geriatric Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Sonny C Palmer
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Ha FJ, Farouque O, Lim HS. Response by Ha et al to Letter Regarding Article, "Sudden Cardiac Death in the Young: Incidence, Trends and Risk Factors in a Nationwide Study". Circ Cardiovasc Qual Outcomes 2021; 14:e007775. [PMID: 33641337 DOI: 10.1161/circoutcomes.121.007775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Francis J Ha
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., O.F., H.S.L.).,St Vincent's Hospital Melbourne, Victoria, Australia (F.J.H.)
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., O.F., H.S.L.).,University of Melbourne, Victoria, Australia (O.F., H.S.L.)
| | - Han S Lim
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., O.F., H.S.L.).,University of Melbourne, Victoria, Australia (O.F., H.S.L.)
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Ha FJ, Han HC, Sanders P, Fendel K, Teh AW, Kalman JM, O'Donnell D, Leong T, Farouque O, Lim HS. Sudden Cardiac Death in the Young: Incidence, Trends, and Risk Factors in a Nationwide Study. Circ Cardiovasc Qual Outcomes 2020; 13:e006470. [PMID: 33079584 DOI: 10.1161/circoutcomes.119.006470] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Sudden cardiac death (SCD) in the young is devastating. Contemporary incidence remains unclear with few recent nationwide studies and limited data addressing risk factors for causes. We aimed to determine incidence, trends, causes, and risk factors for SCD in the young. METHODS AND RESULTS The National Coronial Information System registry was reviewed for SCD in people aged 1 to 35 years from 2000 to 2016 in Australia. Subjects were identified by the International Classification of Diseases, Tenth Revision code relating to circulatory system diseases (I00-I99) from coronial reports. Baseline demographics, circumstances, and cause of SCD were obtained from coronial and police reports, alongside autopsy and toxicology analyses where available. During the study period, 2006 cases were identified (median age, 28±7 years; men, 75%; mean body mass index, 29±8 kg/m2). Annual incidence ranged from 0.91 to 1.48 per 100 000 age-specific person-years, which was the lowest in 2013 to 2015 compared with previous 3-year intervals on Poisson regression model (P=0.001). SCD incidence was higher in nonmetropolitan versus metropolitan areas (0.99 versus 0.53 per 100 000 person-years; P<0.001). The most common cause of SCD was coronary artery disease (40%), followed by sudden arrhythmic death syndrome (14%). Incidence of coronary artery disease-related SCD decreased from 2001-2003 to 2013-2015 (P<0.001). Proportion of SCD related to sudden arrhythmic death syndrome increased during the study period (P=0.02) although overall incidence was stable (P=0.22). Residential remoteness was associated with coronary artery disease-related SCD (odds ratio, 1.44 [95% CI, 1.24-1.67]; P<0.001). For every 1-unit increase, body mass index was associated with increased likelihood of SCD from cardiomegaly (odds ratio, 1.08 [95% CI, 1.05-1.11]; P<0.001) and dilated cardiomyopathy (odds ratio, 1.04 [95% CI, 1.01-1.06]; P=0.005). CONCLUSIONS Incidence of SCD in the young and specifically coronary artery disease-related SCD has declined in recent years. Proportion of SCD related to sudden arrhythmic death syndrome increased over the study period. Geographic remoteness and obesity are risk factors for specific causes of SCD in the young.
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Affiliation(s)
- Francis J Ha
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., H.-C.H., K.F., A.W.T., D.O., O.F., H.S.L.).,St. Vincent's Hospital Melbourne, Victoria, Australia (F.J.H.)
| | - Hui-Chen Han
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., H.-C.H., K.F., A.W.T., D.O., O.F., H.S.L.).,University of Melbourne, Victoria, Australia (H.-C.H., A.W.T., J.M.K., O.F., H.S.L.)
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australia Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital Adelaide, South Australia, Australia (P.S.)
| | - Kim Fendel
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., H.-C.H., K.F., A.W.T., D.O., O.F., H.S.L.)
| | - Andrew W Teh
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., H.-C.H., K.F., A.W.T., D.O., O.F., H.S.L.).,University of Melbourne, Victoria, Australia (H.-C.H., A.W.T., J.M.K., O.F., H.S.L.)
| | - Jonathan M Kalman
- University of Melbourne, Victoria, Australia (H.-C.H., A.W.T., J.M.K., O.F., H.S.L.).,Melbourne Heart Centre, Royal Melbourne Hospital, Victoria, Australia (J.M.K.)
| | - David O'Donnell
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., H.-C.H., K.F., A.W.T., D.O., O.F., H.S.L.)
| | - Trishe Leong
- Department of Anatomical Pathology, St. Vincent's Hospital, Melbourne, Victoria, Australia (T.L.)
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., H.-C.H., K.F., A.W.T., D.O., O.F., H.S.L.).,University of Melbourne, Victoria, Australia (H.-C.H., A.W.T., J.M.K., O.F., H.S.L.)
| | - Han S Lim
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., H.-C.H., K.F., A.W.T., D.O., O.F., H.S.L.).,University of Melbourne, Victoria, Australia (H.-C.H., A.W.T., J.M.K., O.F., H.S.L.).,Department of Cardiology, Northern Health, Melbourne, Victoria, Australia (H.S.L.)
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Ha FJ, Agarwal S, Tweed K, Palmer SC, Adams HS, Thillai M, Williams L. Imaging in Suspected Cardiac Sarcoidosis: A Diagnostic Challenge. Curr Cardiol Rev 2020; 16:90-97. [PMID: 31345153 PMCID: PMC7460708 DOI: 10.2174/1573403x15666190725121246] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/05/2019] [Accepted: 07/11/2019] [Indexed: 12/18/2022] Open
Abstract
Cardiac Sarcoidosis (CS) represents a unique diagnostic dilemma. Guidelines have been recently revised to reflect the established role of sophisticated imaging techniques. Trans-thoracic Echocardiography (TTE) is widely adopted for initial screening of CS. Contemporary TTE techniques could enhance detection of subclinical Left Ventricular (LV) dysfunction, particularly LV global longitudinal strain assessment which predicts event-free survival (meta-analysis of 5 studies, hazard ratio 1.28, 95% confidence interval 1.18-1.37, p < 0.0001). However, despite the wide availability of TTE, it has limited sensitivity and specificity for CS diagnosis. Cardiac Magnetic resonance Imaging (CMR) is a crucial diagnostic modality for suspected CS. Presence of late gadolinium enhancement signifies myocardial scar and enables risk stratification. Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) coupled with myocardial perfusion imaging can identify active CS and guide immunosuppressant therapy. Gallium scintigraphy may be considered although FDG-PET is often preferred. While CMR and FDG-PET provide complementary information in CS evaluation, current guidelines do not recommend which imaging modalities are essential in suspected CS and if so, which modality should be performed first. The utility of hybrid imaging combining both advanced imaging modalities in a single scan is currently being explored, although not yet widely available. In view of recent, significant advances in cardiac imaging techniques, this review aims to discuss changes in guidelines for CS diagnosis, the role of various cardiac imaging modalities and the future direction in CS.
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Affiliation(s)
- Francis J Ha
- St Vincent's Hospital Melbourne, Victoria, Australia
| | - Sharad Agarwal
- Royal Papworth Hospital, NHS Foundation Trust, Cambridge, CB2 0AY, United Kingdom
| | - Katharine Tweed
- Royal Papworth Hospital, NHS Foundation Trust, Cambridge, CB2 0AY, United Kingdom
| | - Sonny C Palmer
- St Vincent's Hospital Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Victoria, Australia
| | - Heath S Adams
- St Vincent's Hospital Melbourne, Victoria, Australia
| | - Muhunthan Thillai
- Royal Papworth Hospital, NHS Foundation Trust, Cambridge, CB2 0AY, United Kingdom.,Department of Medicine University of Cambridge, Cambridge, CB2 0AY, United Kingdom
| | - Lynne Williams
- Royal Papworth Hospital, NHS Foundation Trust, Cambridge, CB2 0AY, United Kingdom
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Al-Kaisey AM, Koshy AN, Ha FJ, Spencer R, Toner L, Sajeev JK, Teh AW, Farouque O, Lim HS. Accuracy of wrist-worn heart rate monitors for rate control assessment in atrial fibrillation. Int J Cardiol 2019; 300:161-164. [PMID: 31787389 DOI: 10.1016/j.ijcard.2019.11.120] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/14/2019] [Accepted: 11/15/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Wrist-worn heart rate (HR) monitors are increasingly popular. A paucity of data exists on their accuracy in atrial fibrillation (AF) in ambulatory patients. We sought to assess the HR accuracy of two commercially available smart watches [SW] (Fitbit Charge HR [FB] and Apple Watch Series 3 [AW]) compared with Holter monitoring in an ambulant patient cohort. METHODS Thirty-two participants ≥18 years referred for 24-hour Holter monitoring were prospectively recruited. Each participant was randomly allocated to wear either a FB or AW along with their Holter monitor. RESULTS Across all devices, 53,288 heart rate values were analysed from 32 participants. Twenty wore the AW (17 had persistent AF and 3 had sinus rhythm [SR]) while 12 participants wore the FB (9 in persistent AF and 3 in SR). Participants in SR demonstrated strong agreement compared to Holter monitoring (bias <1 beat, limits of agreement [LoA] -11 to 11 beats). In AF, both devices underestimated HR measurements (bias -9 beats, LoA -41 to 23). The degree of underestimation was more pronounced when HR > 100 bpm (bias of -28 beats for HR range 100-120 bpm, -48 for 120-140 bpm, and -69 for >140 bpm) compared to a slower HR (bias of -6 for HR range 80-100 bpm, <1 for 60-80 bpm, and -1 for <60 bpm). CONCLUSION In ambulatory patients, smartwatches underestimated HR in AF particularly at HR ranges >100 bpm. Further improvements in device technology are needed before integrating them into the clinical management of rate control in AF.
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Affiliation(s)
- Ahmed M Al-Kaisey
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
| | - Anoop N Koshy
- Department of Cardiology, Eastern Health, Boxhill, Victoria, Australia; University of Melbourne, Melbourne, Australia
| | - Francis J Ha
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
| | - Ryan Spencer
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
| | - Liam Toner
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
| | - Jithin K Sajeev
- Department of Cardiology, Eastern Health, Boxhill, Victoria, Australia
| | - Andrew W Teh
- Department of Cardiology, Eastern Health, Boxhill, Victoria, Australia; Eastern Health Clinical School, Monash University, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia; University of Melbourne, Melbourne, Australia
| | - Han S Lim
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia; University of Melbourne, Melbourne, Australia.
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11
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Han HC, Ha FJ, Teh AW, Calafiore P, Jones EF, Johns J, Koshy AN, O'Donnell D, Hare DL, Farouque O, Lim HS. Mitral Valve Prolapse and Sudden Cardiac Death: A Systematic Review. J Am Heart Assoc 2019; 7:e010584. [PMID: 30486705 PMCID: PMC6405538 DOI: 10.1161/jaha.118.010584] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background The relationship between mitral valve prolapse (MVP) and sudden cardiac death (SCD) remains controversial. In this systematic review, we evaluate the relationship between isolated MVP and SCD to better define a potential high‐risk subtype. In addition, we determine whether premortem parameters could predict SCD in patients with MVP and the incidence of SCD in MVP. Methods and Results Electronic searches were conducted in PubMed and Embase for all English literature articles published between 1960 and 2018 regarding MVP and SCD or cardiac arrest. We also identified articles investigating predictors of ventricular arrhythmias or SCD and cohort studies reporting SCD outcomes in MVP. From 2180 citations, there were 79 articles describing 161 cases of MVP with SCD or cardiac arrest. The median age was 30 years and 69% of cases were female. Cardiac arrest occurred during situations of stress in 47% and was caused by ventricular fibrillation in 81%. Premature ventricular complexes on Holter monitoring (92%) were common. Most cases had bileaflet involvement (70%) with redundancy (99%) and nonsevere mitral regurgitation (83%). From 22 articles describing predictors for ventricular arrhythmias or SCD in MVP, leaflet redundancy was the only independent predictor of SCD. The incidence of SCD with MVP was estimated at 217 events per 100 000 person‐years. Conclusions Isolated MVP and SCD predominantly affects young females with redundant bileaflet prolapse, with cardiac arrest usually occurring as a result of ventricular arrhythmias. To better understand the complex relationship between MVP and SCD, standardized reporting of clinical, electrophysiological, and cardiac imaging parameters with longitudinal follow‐up is required.
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Affiliation(s)
- Hui-Chen Han
- 1 Department of Cardiology Austin Health University of Melbourne Melbourne Australia
| | - Francis J Ha
- 1 Department of Cardiology Austin Health University of Melbourne Melbourne Australia
| | - Andrew W Teh
- 1 Department of Cardiology Austin Health University of Melbourne Melbourne Australia.,3 Department of Cardiology Eastern Health Monash University Melbourne Australia
| | - Paul Calafiore
- 1 Department of Cardiology Austin Health University of Melbourne Melbourne Australia
| | - Elizabeth F Jones
- 1 Department of Cardiology Austin Health University of Melbourne Melbourne Australia
| | - Jennifer Johns
- 1 Department of Cardiology Austin Health University of Melbourne Melbourne Australia
| | - Anoop N Koshy
- 1 Department of Cardiology Austin Health University of Melbourne Melbourne Australia
| | - David O'Donnell
- 1 Department of Cardiology Austin Health University of Melbourne Melbourne Australia
| | - David L Hare
- 1 Department of Cardiology Austin Health University of Melbourne Melbourne Australia
| | - Omar Farouque
- 1 Department of Cardiology Austin Health University of Melbourne Melbourne Australia
| | - Han S Lim
- 1 Department of Cardiology Austin Health University of Melbourne Melbourne Australia.,2 Department of Cardiology Northern Health University of Melbourne Melbourne Australia
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12
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Toukhsati SR, Mathews S, Sheed A, Freijah I, Moncur L, Cropper P, Ha FJ, Hare DL. Confirming a beneficial effect of the six-minute walk test on exercise confidence in patients with heart failure. Eur J Cardiovasc Nurs 2019; 19:165-171. [DOI: 10.1177/1474515119876784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Low confidence to exercise is a barrier to engaging in exercise in heart failure patients. Participating in low to moderate intensity exercise, such as the six-minute walk test, may increase exercise confidence. Aim: To compare the effects of a six-minute walk test with an educational control condition on exercise confidence in heart failure patients. Methods: This was a prospective, quasi-experimental design whereby consecutive adult patients attending an out-patient heart failure clinic completed the Exercise Confidence Scale prior to and following involvement in the six-minute walk test or an educational control condition. Results: Using a matched pairs, mixed model design ( n=60; 87% male; Mage=58.87±13.16), we identified a significantly greater improvement in Total exercise confidence ( F(1,54)=4.63, p=0.036, partial η2=0.079) and Running confidence ( F(1,57)=4.21, p=0. 045, partial η2=0.069) following the six-minute walk test compared to the educational control condition. These benefits were also observed after adjustment for age, gender, functional class and depression. Conclusion: Heart failure patients who completed a six-minute walk test reported greater improvement in exercise confidence than those who read an educational booklet for 10 min. The findings suggest that the six-minute walk test may be used as a clinical tool to improve exercise confidence. Future research should test these results under randomized conditions and examine whether improvements in exercise confidence translate to greater engagement in exercise behavior.
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Affiliation(s)
- SR Toukhsati
- Psychology, School of Health and Life Sciences, Federation University Australia, Australia
- Department of Cardiology, Austin Health, Australia
| | - S Mathews
- Department of Cardiology, Austin Health, Australia
- Faculty of Health, Arts and Design, Swinburne University of Technology, Australia
| | - A Sheed
- Department of Cardiology, Austin Health, Australia
| | - I Freijah
- Department of Cardiology, Austin Health, Australia
- Department of Psychiatry, University of Melbourne, Australia
| | - L Moncur
- Department of Cardiology, Austin Health, Australia
| | - P Cropper
- Department of Cardiology, Austin Health, Australia
| | - FJ Ha
- Department of Cardiology, Austin Health, Australia
- Faculty of Health, Arts and Design, Swinburne University of Technology, Australia
| | - DL Hare
- Psychology, School of Health and Life Sciences, Federation University Australia, Australia
- Department of Cardiology, Austin Health, Australia
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13
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Al-Kaisey A, Koshy A, Ha FJ, Sajeev J, Toner L, Spencer R, Teh A, Farouque O, Lim HS. P574Accuracy of wrist-worn heart rate monitors for chronotropic assessment in atrial fibrillation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Wrist-worn fitness and heart rate (HR) monitors are increasingly popular. Previous studies in healthy participants with sinus rhythm (SR) have yielded variable results depending on HR, activity levels and device tested. A paucity of data exists on their accuracy in atrial fibrillation (AF) in ambulatory patients.
Purpose
We sought to assess the HR accuracy of 2 commercially available smart watches (Fitbit Charge HR [FB] and Apple Watch Series 3 [AW]) compared with Holter monitoring in an ambulant patient cohort.
Methods
Patients aged >18 years referred for 24-hour Holter monitoring were prospectively recruited. The Holter monitor was the criterion measure. Each patient was randomly allocated to either a FB or AW along with their Holter monitor. The study protocol was approved by the institutional review board.
Statistical analysis: Pearson (r) correlation coefficients and Bland-Altman comparison with 95% limits of agreement (LoA) were evaluated to assess criterion validity and agreement between the smart watch and Holter ECG-HR. Bias was the calculated mean difference between the smart watch and ECG-HR. A ± 10-beat different between Holter-HR and SW-HR was used as a clinically relevant range to establish the accuracy of HR estimation by SW.
Results
Across all devices, 53,288 hear rate values were recorded from 32 patients. Twenty six patients were in persistent AF and six were in SR. Twelve patients wore the FB while 20 wore the AW. In the FB arm, nice patient were in persistent AF and three in SR. In the AW arm, persistent AF was the rhythm in seventeen and SR in three. Patients in SR demonstrated overall strong agreement compared to Holter monitoring (Mean Bias <1 beat, LoA −11 to 11 beats) and a correlation coefficient of 0.87 (p<0.001). In AF, both devices underestimated HR measurements (Overall Bias −9 beats, LoA −41 to 23, r=0.60, p<0.001). The AW had lower bias and narrower LoA compared to FB (−5 beats vs −13 beats, LoA −31 to 21 beats vs −50 to 22 beats). Using a ± 10-beat range against ECG-HR for clinical accuracy, both the AW and FB performed satisfactorily in SR with 95.2% of AW and 92.2% of FB HR readings considered valid. In AF, however, the AW-HR readings were within the ± 10-beat threshold in 76.5% of the time compared with only 56.1% of FB readings.
Conclusion
In ambulatory patients, smart watches were accurate in HR estimation when compared to Holter monitor in SR; however tended to underestimate HR in AF. Further improvements in device technology are needed before the widespread consumer adoption of this nascent technology for chronotropic assessment in arrhythmias.
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Affiliation(s)
- A Al-Kaisey
- Austin Health Hospital, Melbourne, Australia
| | - A Koshy
- Austin Health Hospital, Melbourne, Australia
| | - F J Ha
- Austin Health Hospital, Melbourne, Australia
| | - J Sajeev
- Box Hill Hospital, Cardiology, Melbourne, Australia
| | - L Toner
- Austin Health Hospital, Melbourne, Australia
| | - R Spencer
- Austin Health Hospital, Melbourne, Australia
| | - A Teh
- Austin Health Hospital, Melbourne, Australia
| | - O Farouque
- Austin Health Hospital, Melbourne, Australia
| | - H S Lim
- Austin Health Hospital, Melbourne, Australia
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14
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Ha FJ, Adams H, Palmer S. Device closure for patent foramen ovale in patients with cryptogenic stroke: a paradigm in evidence. Med J Aust 2019; 211:343-344.e1. [DOI: 10.5694/mja2.50341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | - Heath Adams
- St Vincent's Hospital Melbourne Melbourne VIC
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15
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Al-Kaisey AM, Chandra N, Ha FJ, Al-Kaisey YM, Vasanthakumar S, Koshy AN, Anderson RD, Ord M, Srivastava PM, O'Donnell D, Lim HS, Matalanis G, Teh AW. Permanent pacing and conduction recovery in patients undergoing cardiac surgery for active infective endocarditis in an Australian Tertiary Center. J Cardiovasc Electrophysiol 2019; 30:1306-1312. [PMID: 31045305 DOI: 10.1111/jce.13963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/24/2019] [Accepted: 04/29/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Postoperative heart block is common among patients undergoing surgery for infective endocarditis (IE). Limited data exists allowing cardiologists to predict who will require permanent pacemaker (PPM) implantation postoperatively. We aimed to determine the rate of postoperative PPM insertion, predictors for postoperative PPM, and describe PPM utilization and rates of device-related infection during follow-up. MATERIALS AND METHODS A retrospective analysis was performed of 191 consecutive patients from a single institution who underwent cardiac surgery for IE between 2001 and 2017. Preoperative and operative predictors for postoperative PPM were evaluated using univariate and multivariate logistic regression. RESULTS The rate of postoperative PPM implantation was 11% (17/154). The PPM group had more preoperative prolonged PR interval alone (33% vs 12%; P = .03), coexistent prolonged PR and QRS durations (13% vs 2%; P = .01), infection beyond the valve leaflets (82% vs 41%; P = .001), aortic root debridement (65% vs 23%; P = <.001), patch repair (47% vs 20%; P = .01), postoperative prolonged PR interval (50% vs 24%; P = .01), and prolonged QRS duration (47% vs 15%; P = .001). On multivariate analysis, infection beyond the valve leaflets emerged as an independent predictor for postoperative PPM (odds ratio, 1.94, 95% confidence interval, 1.14-3.28; P = .014). A reduction in PPM utilization was observed in five patients while eight patients continued to show significant ventricular pacing with no underlying rhythm at 12 months. There were no device-related infections. CONCLUSION Postoperative PPM was required in 11% of patients undergoing surgery for IE over a 16-year period. Infection beyond the valve leaflet was an independent predictor for postoperative PPM insertion.
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Affiliation(s)
- Ahmed M Al-Kaisey
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
| | - Nikhil Chandra
- Department of Cardiac Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Francis J Ha
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
| | - Yasir M Al-Kaisey
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
| | | | - Anoop N Koshy
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
| | - Robert D Anderson
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michelle Ord
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
| | - Piyush M Srivastava
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - David O'Donnell
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
| | - Han S Lim
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
| | - George Matalanis
- Department of Cardiac Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Andrew W Teh
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia.,Department of Cardiology, Box Hill Hospital, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
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16
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Ha FJ, Tham JLM, Paleri S, Wright C, Yap KK, Adams HS, Whitbourn RJ, Palmer SC. Outcomes of incidental findings on multi-detector computed tomography for transcatheter aortic valve implantation assessment: A single-centre study and review of the literature. J Med Imaging Radiat Oncol 2019; 63:446-453. [PMID: 30874377 DOI: 10.1111/1754-9485.12872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/17/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Patients with severe aortic stenosis (AS) require multi-detector computed tomography (MDCT) when considered for transcatheter aortic valve implantation (TAVI). Incidental findings on MDCT are common given the age group and region imaged. Our aim was to evaluate the frequency and outcome of incidental findings (IF) identified on MDCT and the impact on survival. METHODS This single-centre analysis retrospectively reviewed severe AS patients who underwent MDCT during TAVI workup. MDCT reports were reviewed for any IF and defined into three categories: IF of no relevant clinical significance (IF-NoCS), IF of non-immediate clinical significance (IF-NICS) and IF of immediate clinical significance (IF-ICS). Demographics, follow-up of IF and survival were calculated from MDCT date. RESULTS Two hundred and sixty-five patients underwent MDCT for TAVI suitability (mean age 83 ± 6 years, 52% male). The majority proceeded to TAVI (65%). Renal lesions (25%) and lung nodules (18%) were the most common IF. Fifty-nine patients (22%) had IF-NICS; 39% (23/59) were benign, 59% were not further investigated and one patient had suspected lung cancer. Six patients (2.3%) had IF-ICS and all were diagnosed with lung cancer. During a median follow-up of 272 days, there was no survival difference between patients with IF-ICS or IF-NICS versus patients without IF or IF-NoCS in the overall cohort (P = 0.44) or in TAVI patients (P = 0.88). CONCLUSION Incidental findings on MDCT are common with one-quarter having IF-ICS or IF-NCIS. Most patients with IF-NICS did not undergo further investigation. Standardized reporting of MDCT may assist in clarifying the need for further investigation which will in turn influence decision and timing to proceed with TAVI.
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Affiliation(s)
- Francis J Ha
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Jodie Li Mei Tham
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Sarang Paleri
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Christine Wright
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Kelvin K Yap
- Medical Imaging Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Heath Sl Adams
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Faculty of Health Science, University of Tasmania, Hobart, Tasmania, Australia
| | - Robert J Whitbourn
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Sonny C Palmer
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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17
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Ha FJ, Spain L, Dowling A, Kwan EM, Pezaro C, Day D, Chia PL, Tran B, Pook D, Weickhardt AJ. Timing of brain metastases development in metastatic renal cell cancer patients treated with targeted therapies and survival outcomes: An Australian multicenter study. Asia Pac J Clin Oncol 2019; 15:e97-e102. [PMID: 30701671 DOI: 10.1111/ajco.13109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 10/27/2018] [Indexed: 11/30/2022]
Abstract
AIM Targeted therapy (TT) has improved survival for metastatic renal cell carcinoma (mRCC). However, survival is usually limited if brain metastases (BMs) develop. We aimed to evaluate survival outcomes in mRCC patients based on timing of BM diagnosis. METHODS We conducted a multicenter, retrospective study of mRCC patients with BM who received TT at any point between 2005 and 2014. We determined overall survival (OS) from stage IV diagnosis, TT initiation and BM diagnosis, and prognostic factors. Patients were grouped into three categories: synchronous-BM, metachronous-BM diagnosed while conservatively managed (metachronous-BM before TT) and metachronous-BM diagnosed during TT. Survival was calculated by Kaplan-Meier method and predictors were calculated using Cox hazards regression. RESULTS Incidence of BM was 17% in mRCC patients treated with TT (two centers). Fifty-four mRCC-BM patients were identified from five tertiary centers. Twenty-eight percentage (15/54) had synchronous-BM, 28% (15/54) had metachranous-BM before TT and 44% (24/54) had metachronous-BM during TT. Most had central nervous system (CNS) symptoms at BM diagnosis (78%; 42/54). Median OS from stage IV diagnosis, TT commencement and BM diagnosis was 28 months (95% confidence interval [CI] 16-43), 19 months (95% CI 9-26) and 9 months (95% CI 5-16), respectively. Synchronous-BM group trended toward poorer survival from TT commencement (P = 0.06). Metachronous-BM during TT group had lower survival from BM diagnosis than synchronous-BM and metachronous-BM before TT group (P < 0.001). Eight of 50 deaths (16%) were from neurological complications. The presence of CNS symptoms did not predict worse survival from stage IV diagnosis (P = 0.73). CONCLUSION In patients with mRCC, the development of BM while on TT portends shorter prognosis compared with synchronous diagnosis of BM at stage IV disease or metachronous BM developed prior to commencing TT. The presence of CNS symptoms does not predict worse survival.
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Affiliation(s)
- Francis J Ha
- Olivia Newton-John Cancer Wellness & Research Centre, Austin Hospital, Melbourne, Victoria, Australia
| | - Lavinia Spain
- Olivia Newton-John Cancer Wellness & Research Centre, Austin Hospital, Melbourne, Victoria, Australia
| | - Anthony Dowling
- Department of Medical Oncology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Edmond M Kwan
- Department of Medical Oncology, Monash Health, Melbourne, Victoria, Australia
| | - Carmel Pezaro
- Eastern Health and Monash University, Melbourne, Victoria, Australia
| | - Daphne Day
- Department of Medical Oncology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Puey Ling Chia
- Olivia Newton-John Cancer Wellness & Research Centre, Austin Hospital, Melbourne, Victoria, Australia
| | - Ben Tran
- Department of Medical Oncology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - David Pook
- Department of Medical Oncology, Monash Health, Melbourne, Victoria, Australia
| | - Andrew J Weickhardt
- Olivia Newton-John Cancer Wellness & Research Centre, Austin Hospital, Melbourne, Victoria, Australia
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18
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Ha FJ, Nerlekar N, Cameron JD, Bennett MR, Meredith IT, West NEJ, Brown AJ. Midterm Safety and Efficacy of ABSORB Bioresorbable Vascular Scaffold Versus Everolimus-Eluting Metallic Stent: An Updated Meta-Analysis. JACC Cardiovasc Interv 2018; 10:308-310. [PMID: 28183474 DOI: 10.1016/j.jcin.2016.11.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 11/17/2016] [Indexed: 12/22/2022]
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19
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Hamid AA, Ha FJ, Das O, Weickhardt AJ. Communicating prognosis of patients with advanced cancer between health care providers: a tertiary cancer center review of written correspondence. Ann Palliat Med 2018; 7:404-410. [DOI: 10.21037/apm.2018.06.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/09/2018] [Indexed: 11/06/2022]
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20
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Ha FJ, Nogic J, Montone RA, Cameron JD, Nerlekar N, Brown AJ. Drug eluting versus bare metal stents for percutaneous coronary intervention of saphenous vein graft lesions: An updated meta-analysis of randomized controlled trials. Cardiovascular Revascularization Medicine 2018; 19:837-844. [DOI: 10.1016/j.carrev.2018.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/16/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
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21
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Abstract
With the increasing incidence of cancer and related survival, junior doctors are more commonly involved the management of oncology patients. A comprehensive oncology curriculum has been developed and adopted across medi-cal schools in Australia. However, it was not designed to inform how medical students should be taught, and whether curriculum content translates to knowledge and competency can depend on its implementation. We have conducted a literature review of PubMed, Embase and Cochrane databases to identify and summarise the evidence for novel approaches to delivering the undergraduate oncology curriculum. Numerous effective approaches have been developed across areas of prevention, clinical examination through simulation, the multidisciplinary team, psycho-oncology, palliative care and even research. There is growing focus on a holistic and multidisciplinary approach to cancer education although direct clinical exposure and interactions with cancer patients is still crucial. Medical schools may also have an under-recognised role in promoting positive health behaviour if their graduates are to convey these preventative measures to their patients. Application of such methods relies upon clinicians and medical educators to consider the practicability and relevance of specific implementation in their local context.
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Affiliation(s)
- Francis J Ha
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Medical Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, 145 Studley Road Heidelberg, Melbourne, Australia, 3084
| | - Sagun Parakh
- Department of Medical Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, 145 Studley Road Heidelberg, Melbourne, Australia, 3084.
- Tumour Targeting Laboratory, Olivia Newton-John Cancer Research Institute, Melbourne, Australia.
- School of Cancer Medicine, La Trobe University, Melbourne, Australia.
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22
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Nogic J, Baey YW, Nerlekar N, Ha FJ, Cameron JD, Nasis A, West NE, Brown AJ. Polymer-free versus permanent polymer-coated drug eluting stents for the treatment of coronary artery disease: A meta-analysis of randomized trials. J Interv Cardiol 2018; 31:608-616. [DOI: 10.1111/joic.12522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/22/2018] [Accepted: 05/01/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jason Nogic
- Monash Cardiovascular Research Centre; Monash University and Monash Heart, Monash Health; Melbourne Victoria Australia
| | - Yi-Wei Baey
- Monash Cardiovascular Research Centre; Monash University and Monash Heart, Monash Health; Melbourne Victoria Australia
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre; Monash University and Monash Heart, Monash Health; Melbourne Victoria Australia
| | - Francis J. Ha
- Monash Cardiovascular Research Centre; Monash University and Monash Heart, Monash Health; Melbourne Victoria Australia
| | - James D. Cameron
- Monash Cardiovascular Research Centre; Monash University and Monash Heart, Monash Health; Melbourne Victoria Australia
| | - Arthur Nasis
- Monash Cardiovascular Research Centre; Monash University and Monash Heart, Monash Health; Melbourne Victoria Australia
| | - Nick E.J. West
- Department of Interventional Cardiology; Papworth Hospital NHS Trust; Cambridge UK
| | - Adam J. Brown
- Monash Cardiovascular Research Centre; Monash University and Monash Heart, Monash Health; Melbourne Victoria Australia
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23
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Ha FJ, Han HC, Sanders P, Teh AW, O'Donnell D, Farouque O, Lim HS. Challenges and limitations in the diagnosis of atrioesophageal fistula. J Cardiovasc Electrophysiol 2018; 29:861-871. [DOI: 10.1111/jce.13494] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/23/2018] [Accepted: 03/26/2018] [Indexed: 12/01/2022]
Affiliation(s)
| | - Hui-Chen Han
- Austin Health; Melbourne Victoria Australia
- University of Melbourne; Melbourne Victoria Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders (CHRD), South Australia Health and Medical Research Institute (SAHMRI); University of Adelaide and Royal Adelaide Hospital; South Australia Australia
| | - Andrew W. Teh
- Austin Health; Melbourne Victoria Australia
- University of Melbourne; Melbourne Victoria Australia
| | | | - Omar Farouque
- Austin Health; Melbourne Victoria Australia
- University of Melbourne; Melbourne Victoria Australia
| | - Han S. Lim
- Austin Health; Melbourne Victoria Australia
- University of Melbourne; Melbourne Victoria Australia
- Northern Health; Melbourne Victoria Australia
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24
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Thakur U, Muthalaly R, Wong NC, Ha FJ, Cameron J, Brown A, Smith J, Nerlekar N. LONG-TERM SURVIVAL BETWEEN OFF VERSUS ON PUMP CORONARY ARTERY BYPASS GRAFTING: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)30750-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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25
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Nerlekar N, Ha FJ, Cheshire C, Rashid H, Cameron JD, Wong DT, Seneviratne S, Brown AJ. Computed Tomographic Coronary Angiography–Derived Plaque Characteristics Predict Major Adverse Cardiovascular Events. Circ Cardiovasc Imaging 2018; 11:e006973. [DOI: 10.1161/circimaging.117.006973] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/01/2017] [Indexed: 12/26/2022]
Abstract
Background—
Computed tomographic coronary angiography is a noninvasive imaging modality that permits identification and characterization of coronary plaques. Despite consensus statements supporting routine reporting of computed tomographic coronary angiography plaque characteristics, there remains uncertainty whether these data convey prognostic information. We performed a systematic review and meta-analysis assessing the strength of association between computed tomographic coronary angiography–derived plaque characterization and major adverse cardiovascular events (MACE).
Methods and Results—
Electronic databases were searched for studies reporting computed tomographic coronary angiography plaque characterization and MACE. Data were gathered on plaque morphology (noncalcified, partially calcified, and calcified) and high-risk plaque (HRP) features, including low-attenuation plaque, napkin-ring sign, spotty calcification, and positive remodeling. Of 5496 citations, 13 studies met inclusion criteria. Five hundred fifty-two (3.9%) MACE occurred in 13 977 patients with mean follow-up ranging between 1.3 and 8.2 years. In terms of plaque morphology, the strongest association was observed for noncalcified plaque (hazard ratio [HR], 1.45; 95% confidence interval [CI], 1.24–1.70;
P
<0.001), with weaker associations found for partially calcified (HR, 1.37; 95% CI, 1.18–1.60;
P
<0.001) and calcified plaques (HR, 1.23; 95% CI, 1.16–1.30;
P
<0.001). All HRP features were strongly associated with MACE, including napkin-ring sign (HR, 5.06; 95% CI, 3.23–7.94;
P
<0.001), low-attenuation plaque (HR, 2.95; 95% CI, 2.03–4.29;
P
<0.001), positive remodeling (HR, 2.58; 95% CI, 1.84–3.61;
P
<0.001), and spotty calcification (HR, 2.25; 95% CI, 1.26–4.04;
P
=0.006). The presence of ≥2 HRP features had highest risk of MACE (HR, 9.17; 95% CI, 4.10–20.50;
P
<0.001).
Conclusions—
These data demonstrate that HRP is most likely an independent predictor of MACE, which supports the inclusion of HRP reporting in clinical practice. However, at this point, it remains unclear whether HRP reporting has clinical implications.
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Affiliation(s)
- Nitesh Nerlekar
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Francis J. Ha
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Caitlin Cheshire
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Hashrul Rashid
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - James D. Cameron
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Dennis T. Wong
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Sujith Seneviratne
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Adam J. Brown
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
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26
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Ha FJ, Toukhsati SR, Cameron JD, Yates R, Hare DL. Association between the 6-minute walk test and exercise confidence in patients with heart failure: A prospective observational study. Heart Lung 2018; 47:54-60. [DOI: 10.1016/j.hrtlng.2017.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 12/13/2022]
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27
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Han HC, Ha FJ, Sanders P, Spencer R, Teh AW, O'Donnell D, Farouque O, Lim HS. Atrioesophageal Fistula: Clinical Presentation, Procedural Characteristics, Diagnostic Investigations, and Treatment Outcomes. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005579. [PMID: 29109075 DOI: 10.1161/circep.117.005579] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 09/07/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Percutaneous or surgical ablation are increasingly used worldwide in the management of atrial fibrillation. The development of atrioesophageal fistula (AEF) is among the most serious and lethal complications of atrial fibrillation ablation. We sought to characterize the clinical presentation, procedural characteristics, diagnostic investigations, and treatment outcomes of all reported cases of AEF. METHODS AND RESULTS Electronic searches were conducted in PubMed and Embase for English scientific literature articles. Out of 628 references, 120 cases of AEF were identified using various ablation modalities. Clinical presentation occurred between 0 and 60 days postablation (median 21 days). Fever (73%), neurological (72%), gastrointestinal (41%), and cardiac (40%) symptoms were the commonest presentations. Computed tomography of the chest was the commonest mode of diagnosis (68%), although 7 cases required repeat testing. Overall mortality was 55%, with significantly reduced mortality in patients undergoing surgical repair (33%) compared with endoscopic treatment (65%) and conservative management (97%) (adjusted odds ratio, 24.9; P<0.01, compared with surgery). Multivariable predictors of mortality include presentation with neurological symptoms (adjusted odds ratio, 16.0; P<0.001) and gastrointestinal bleed (adjusted odds ratio, 4.2; P=0.047). CONCLUSIONS AEF complicating atrial fibrillation ablation is associated with a high mortality. Clinicians should have a high suspicion for the development of AEF in patients presenting with infective, neurological, gastrointestinal, or cardiac symptoms within 2 months of an atrial fibrillation ablation. Investigation by contrast computed tomography of the chest with consideration of repeat testing can lead to prompt diagnosis. Surgical intervention is associated with improved survival rates.
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Affiliation(s)
- Hui-Chen Han
- From the Austin Health, Melbourne, Victoria, Australia (H.-C.H., F.J.H., R.S., A.W.T., D.O., O.F., H.S.L.); University of Melbourne, Victoria, Australia (H.-C.H., A.W.T., O.F., H.S.L.); Centre for Heart Rhythm Disorders (CHRD), South Australia Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital (P.S.); and Northern Health, Melbourne, Victoria, Australia (H.S.L.)
| | - Francis J Ha
- From the Austin Health, Melbourne, Victoria, Australia (H.-C.H., F.J.H., R.S., A.W.T., D.O., O.F., H.S.L.); University of Melbourne, Victoria, Australia (H.-C.H., A.W.T., O.F., H.S.L.); Centre for Heart Rhythm Disorders (CHRD), South Australia Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital (P.S.); and Northern Health, Melbourne, Victoria, Australia (H.S.L.)
| | - Prashanthan Sanders
- From the Austin Health, Melbourne, Victoria, Australia (H.-C.H., F.J.H., R.S., A.W.T., D.O., O.F., H.S.L.); University of Melbourne, Victoria, Australia (H.-C.H., A.W.T., O.F., H.S.L.); Centre for Heart Rhythm Disorders (CHRD), South Australia Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital (P.S.); and Northern Health, Melbourne, Victoria, Australia (H.S.L.)
| | - Ryan Spencer
- From the Austin Health, Melbourne, Victoria, Australia (H.-C.H., F.J.H., R.S., A.W.T., D.O., O.F., H.S.L.); University of Melbourne, Victoria, Australia (H.-C.H., A.W.T., O.F., H.S.L.); Centre for Heart Rhythm Disorders (CHRD), South Australia Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital (P.S.); and Northern Health, Melbourne, Victoria, Australia (H.S.L.)
| | - Andrew W Teh
- From the Austin Health, Melbourne, Victoria, Australia (H.-C.H., F.J.H., R.S., A.W.T., D.O., O.F., H.S.L.); University of Melbourne, Victoria, Australia (H.-C.H., A.W.T., O.F., H.S.L.); Centre for Heart Rhythm Disorders (CHRD), South Australia Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital (P.S.); and Northern Health, Melbourne, Victoria, Australia (H.S.L.)
| | - David O'Donnell
- From the Austin Health, Melbourne, Victoria, Australia (H.-C.H., F.J.H., R.S., A.W.T., D.O., O.F., H.S.L.); University of Melbourne, Victoria, Australia (H.-C.H., A.W.T., O.F., H.S.L.); Centre for Heart Rhythm Disorders (CHRD), South Australia Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital (P.S.); and Northern Health, Melbourne, Victoria, Australia (H.S.L.)
| | - Omar Farouque
- From the Austin Health, Melbourne, Victoria, Australia (H.-C.H., F.J.H., R.S., A.W.T., D.O., O.F., H.S.L.); University of Melbourne, Victoria, Australia (H.-C.H., A.W.T., O.F., H.S.L.); Centre for Heart Rhythm Disorders (CHRD), South Australia Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital (P.S.); and Northern Health, Melbourne, Victoria, Australia (H.S.L.)
| | - Han S Lim
- From the Austin Health, Melbourne, Victoria, Australia (H.-C.H., F.J.H., R.S., A.W.T., D.O., O.F., H.S.L.); University of Melbourne, Victoria, Australia (H.-C.H., A.W.T., O.F., H.S.L.); Centre for Heart Rhythm Disorders (CHRD), South Australia Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital (P.S.); and Northern Health, Melbourne, Victoria, Australia (H.S.L.).
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Nerlekar N, Ha FJ, Verma KP, Bennett MR, Cameron JD, Meredith IT, Brown AJ. Percutaneous Coronary Intervention Using Drug-Eluting Stents Versus Coronary Artery Bypass Grafting for Unprotected Left Main Coronary Artery Stenosis: A Meta-Analysis of Randomized Trials. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.116.004729. [PMID: 27899408 DOI: 10.1161/circinterventions.116.004729] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 11/17/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Current guidelines suggest that coronary artery bypass grafting (CABG) should be the preferred revascularization method for unprotected left main coronary artery stenosis. In light of evidence from recent randomized trials, we assessed whether percutaneous coronary intervention (PCI) using drug-eluting stents is as safe and effective as CABG for the treatment of unprotected left main coronary artery disease. METHODS AND RESULTS Digital databases and manual searches were performed for randomized trials comparing PCI and CABG for unprotected left main coronary artery stenosis. Among 3887 potentially relevant studies, 5 met inclusion criteria. The primary safety end point was defined as the composite of all-cause death, myocardial infarction, or stroke. Secondary end points included a clinical effectiveness composite, which was defined as all-cause death, myocardial infarction, stroke, or repeat revascularization. Summary estimates were obtained using random-effects modeling. In total, 4594 patients were included in the analysis. There was no significant difference in the primary safety end point between the revascularization strategies (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.79-1.17; P=0.73). However, when compared with CABG, PCI was less effective (OR, 1.36; 95% CI, 1.18-1.58; P<0.001) because of significantly higher rates of repeat revascularization (OR, 1.85; 95% CI, 1.53-2.23; P<0.001). The incidence of all-cause death (OR, 1.03; 95% CI, 0.78-1.35; P=0.61), myocardial infarction (OR, 1.46; 95% CI, 0.88-2.45; P=0.08), and stroke (OR, 0.88; 95% CI, 0.39-1.97; P=0.53) did not differ between PCI and CABG. CONCLUSIONS PCI using drug-eluting stents and CABG are equally safe methods of revascularization for patients at low surgical risk with significant unprotected left main coronary artery stenosis. However, CABG is associated with significantly lower rates of repeat revascularization.
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Affiliation(s)
- Nitesh Nerlekar
- From the Monash Cardiovascular Research Centre, Monash University, Clayton, Victoria, Australia (N.N., F.J.H., K.P.V., J.D.C., I.T.M., A.J.B.); MonashHeart, Clayton, Victoria, Australia (N.N., F.J.H., K.P.V., J.D.C., I.T.M., A.J.B.); Monash Health, Clayton, Victoria, Australia (N.N., F.J.H., K.P.V., J.D.C., I.T.M., A.J.B.); and Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (M.R.B., A.J.B.)
| | - Francis J Ha
- From the Monash Cardiovascular Research Centre, Monash University, Clayton, Victoria, Australia (N.N., F.J.H., K.P.V., J.D.C., I.T.M., A.J.B.); MonashHeart, Clayton, Victoria, Australia (N.N., F.J.H., K.P.V., J.D.C., I.T.M., A.J.B.); Monash Health, Clayton, Victoria, Australia (N.N., F.J.H., K.P.V., J.D.C., I.T.M., A.J.B.); and Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (M.R.B., A.J.B.)
| | - Kunal P Verma
- From the Monash Cardiovascular Research Centre, Monash University, Clayton, Victoria, Australia (N.N., F.J.H., K.P.V., J.D.C., I.T.M., A.J.B.); MonashHeart, Clayton, Victoria, Australia (N.N., F.J.H., K.P.V., J.D.C., I.T.M., A.J.B.); Monash Health, Clayton, Victoria, Australia (N.N., F.J.H., K.P.V., J.D.C., I.T.M., A.J.B.); and Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (M.R.B., A.J.B.)
| | - Martin R Bennett
- From the Monash Cardiovascular Research Centre, Monash University, Clayton, Victoria, Australia (N.N., F.J.H., K.P.V., J.D.C., I.T.M., A.J.B.); MonashHeart, Clayton, Victoria, Australia (N.N., F.J.H., K.P.V., J.D.C., I.T.M., A.J.B.); Monash Health, Clayton, Victoria, Australia (N.N., F.J.H., K.P.V., J.D.C., I.T.M., A.J.B.); and Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (M.R.B., A.J.B.)
| | - James D Cameron
- From the Monash Cardiovascular Research Centre, Monash University, Clayton, Victoria, Australia (N.N., F.J.H., K.P.V., J.D.C., I.T.M., A.J.B.); MonashHeart, Clayton, Victoria, Australia (N.N., F.J.H., K.P.V., J.D.C., I.T.M., A.J.B.); Monash Health, Clayton, Victoria, Australia (N.N., F.J.H., K.P.V., J.D.C., I.T.M., A.J.B.); and Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (M.R.B., A.J.B.)
| | - Ian T Meredith
- From the Monash Cardiovascular Research Centre, Monash University, Clayton, Victoria, Australia (N.N., F.J.H., K.P.V., J.D.C., I.T.M., A.J.B.); MonashHeart, Clayton, Victoria, Australia (N.N., F.J.H., K.P.V., J.D.C., I.T.M., A.J.B.); Monash Health, Clayton, Victoria, Australia (N.N., F.J.H., K.P.V., J.D.C., I.T.M., A.J.B.); and Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (M.R.B., A.J.B.)
| | - Adam J Brown
- From the Monash Cardiovascular Research Centre, Monash University, Clayton, Victoria, Australia (N.N., F.J.H., K.P.V., J.D.C., I.T.M., A.J.B.); MonashHeart, Clayton, Victoria, Australia (N.N., F.J.H., K.P.V., J.D.C., I.T.M., A.J.B.); Monash Health, Clayton, Victoria, Australia (N.N., F.J.H., K.P.V., J.D.C., I.T.M., A.J.B.); and Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (M.R.B., A.J.B.).
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Ha FJ, Hare DL, Cameron JD, Toukhsati SR. Heart Failure and Exercise: A Narrative Review of the Role of Self-Efficacy. Heart Lung Circ 2017; 27:22-27. [PMID: 28969981 DOI: 10.1016/j.hlc.2017.08.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 05/23/2017] [Accepted: 08/13/2017] [Indexed: 12/21/2022]
Abstract
Chronic heart failure (CHF) is a common, debilitating condition associated with significant health and economic burden. CHF management is multidisciplinary, however, achieving better health relies on a collaborative effort and patient engagement in self-care. Despite the importance of self-care in CHF, many patients have poor adherence to their medical and lifestyle regimens, in particular with regards to engaging in physical exercise. The patient's confidence in their ability, otherwise known as self-efficacy, is an important determinant of CHF health outcomes, most likely due to its effect on the uptake of CHF self-care activities especially exercise initiation and maintenance. Self-efficacy is responsive to experience such as exercise training, however the critical components of exercise interventions to improve self-efficacy have yet to be determined. This narrative review provides an overview of the role of self-efficacy in exercise adherence in CHF.
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Affiliation(s)
- Francis J Ha
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Vic, Australia; Department of Cardiology, Austin Hospital, Melbourne, Vic, Australia.
| | - David L Hare
- Department of Cardiology, Austin Hospital, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia
| | - James D Cameron
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Vic, Australia
| | - Samia R Toukhsati
- Department of Cardiology, Austin Hospital, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia
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Ha FJ, Thong L, Khalil H. Quality of Life after Intestinal Resection in Patients with Crohn Disease: A Systematic Review. Dig Surg 2017; 34:355-363. [PMID: 28099962 DOI: 10.1159/000453590] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/17/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS Most patients with Crohn disease (CD) require surgery within 10 years of diagnosis. Intestinal resection is the most commonly performed operation although the effects on health-related quality of life (HRQOL), particularly long-term, are contentious. METHODS We conducted a systematic review evaluating the impact of intestinal resection on the HRQOL of CD patients, predictors of postoperative HRQOL, and patient satisfaction with surgery. RESULTS Nine studies including 1,108 CD patients undergoing intestinal resection were identified as eligible for inclusion. The median age at surgery was 29-41 years with varying follow-up period (range 30 days-5 years). Ileocolic resection was the most commonly performed operation on an elective basis (range 95-100%). HRQOL improved as early as 2 weeks postoperatively and lasted up to 5 years across both generic and gastrointestinal domains. Gender, smoking, and disease recurrence were potential predictors of postoperative HRQOL. Patient satisfaction is high with regard to surgery, with preference for a laparoscopic approach. CONCLUSION Intestinal resection in CD patients improved HRQOL in the short- and long-term and patients describe high satisfaction about their surgery. Further studies are needed to validate potential predictors of postoperative HRQOL in this cohort.
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Affiliation(s)
- Francis J Ha
- Faculty of Medicine, Nursing and Health Sciences, Monash Rural Health, Joanna Briggs Centre, Monash University, Moe, VIC, Australia
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