Author Archive

Peripartum Cardiomyopathy Review

Jackson et al publish a useful paper on peripartum cardiomyopathy in Education section of  Heart (Jackson AM, Dalzell JR, Walker NL, et al. Heart 2018;104:779–786.)




Use of Ionizing Radiation in Cardiovascular Imaging

Hirshfeld et al provide the comprehensive: CONSENSUS DOCUMENT 2018 ACC/HRS/NASCI/SCAI/SCCT Expert Consensus Document on Optimal Use of Ionizing Radiation in Cardiovascular Imaging: Best Practices for Safety and Effectiveness (

It covers differing cardiovascular imaging modalities, patient, prenatal, operator issues and provides checklists for procedures to minimize radiation dose.



Electrical Cardiac Injuries

Waldmann et al provide a clinical review of electrical injuries (European Heart Journal (2018) 39, 1459–1465).  It is a very useful review.


Alcohol and Cardiac Disease

Whitman et al explore the relationship between alcohol abuse and cardiac disease (atrial fibrillation, myocardial infarction and heart failure)[(J Am Coll Cardiol 2017;69:13–24]. The relationship with traditional risk factors and population attributable fraction was assessed.



Understanding the relationship between alcohol abuse, a common and theoretically modifiable condition, and the most common cause of death in the world, cardiovascular disease, may inform potential prevention strategies.


The study sought to investigate the associations among alcohol abuse and atrial fibrillation (AF), myocardial infarction (MI), and congestive heart failure (CHF).


Using the Healthcare Cost and Utilization Project database, we performed a longitudinal analysis of California residents $21 years of age who received ambulatory surgery, emergency, or inpatient medical care in California between 2005 and 2009. We determined the risk of an alcohol abuse diagnosis on incident AF, MI, and CHF. Patient characteristics modifying the associations and population-attributable risks were determined.


Among 14,727,591 patients, 268,084 (1.8%) had alcohol abuse. After multivariable adjustment, alcohol abuse was associated with an increased risk of incident AF (hazard ratio [HR]: 2.14; 95% confidence interval [CI]: 2.08 to 2.19; p < 0.0001), MI (HR: 1.45; 95% CI: 1.40 to 1.51; p < 0.0001), and CHF (HR: 2.34; 95% CI: 2.29 to 2.39; p < 0.0001). In interaction analyses, individuals without conventional risk factors for cardiovascular disease exhibited a disproportionately enhanced risk of each outcome. The population-attributable risk of alcohol abuse on each outcome was of similar magnitude to other well-recognized modifiable risk factors.


Alcohol abuse increased the risk of AF, MI, and CHF to a similar degree as other well-established risk factors. Those without traditional cardiovascular risk factors are disproportionately prone to these cardiac diseases in the setting of alcohol abuse. Thus, efforts to mitigate alcohol abuse might result in meaningful reductions of cardiovascular disease.


Evaluation and Management of Right Heart Failure

Konstam et provide a comprehensive AHA Statement on the “Evaluation and Management of Right Heart Failure”: Circulation. 2018;137:00–00. DOI: 10.1161/CIR.0000000000000560

It covers the pathophysiology. It deals with acute and chronic heart failure and specific pathologies.



Morphological Patterns of Bicuspid Aortic Valve Disease

Evangelista et al report on “Anatomical and clinical predictors of valve
dysfunction and aortic dilation in bicuspid aortic valve disease” ( heartjnl-2017-311560)



Bicuspid aortic valve (BAV) is associated with early valvular dysfunction and proximal aorta dilation with high heterogeneity. This study aimed to assess the
determinants of these complications.


Eight hundred and fifty-two consecutive adults diagnosed of BAV referred from cardiac outpatient clinics to eight echocardiographic laboratories of tertiary
hospitals were prospectively recruited. Exclusion criteria were aortic coarctation, other congenital disorders or intervention. BAV morphotype, significant valve dysfunction and aorta dilation (≥2 Z-score) at sinuses
and ascending aorta were established.


Three BAV morphotypes were identified: right–left coronary cusp fusion (RL) in 72.9%, right–noncoronary (RN) in 24.1% and left–non-coronary (LN)
in 3.0%. BAV without raphe was observed in 18.3%. Multivariate analysis showed aortic regurgitation (23%) to be related to male sex (OR: 2.80, p<0.0001) and
valve prolapse (OR: 5.16, p<0.0001), and aortic stenosis(22%) to BAV-RN (OR: 2.09, p<0.001), the presence of raphe (OR: 2.75, p<0.001), age (OR: 1.03; p<0.001), dyslipidaemia (OR: 1.77, p<0.01) and smoking (OR:
1.63, p<0.05). Ascending aorta was dilated in 76% without differences among morphotypes and associated with significant valvular dysfunction. By contrast, aortic root was dilated in 34% and related to male sex and
aortic regurgitation but was less frequent in aortic stenosis and BAV-RN.


Normofunctional valves are more prevalent in BAV without raphe. Aortic stenosis is more frequent in BAV-RN and associated with some cardiovascular risk factors, whereas aortic regurgitation (AR) is associated with male sex and sigmoid prolapse. Although ascending aorta is the most commonly dilated
segment, aortic root dilation is present in one-third of patients and associated with AR. Remarkably, BAV-RL increases the risk for dilation of the proximal aorta, whereas BAV-RN spares this area.


ESC Syncope Guidelines

The ESC Syncope guidelines 2018 have been released (European Heart Journal (2018) 00, 1–69 doi:10.1093/eurheartj/ehy037). They are comprhensive. Excerpts follow.