European heart journal
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Approximately 5% of patients with sarcoidosis will have clinically manifest cardiac involvement presenting with one or more of ventricular arrhythmias, conduction abnormalities, and heart failure. Cardiac presentations can be the first (and/or an unrecognized) manifestation of sarcoidosis in a variety of circumstances. Cardiac symptoms are usually dominant over extra-cardiac as most patients with clinically manifest disease have minimal extra-cardiac disease and up to two-thirds have isolated cardiac sarcoidosis (CS). ⋯ Immunosuppression therapy (usually with corticosteroids) has been suggested for the treatment of clinically manifest CS despite minimal data supporting it. Fluorodeoxyglucose Positron Emission Tomography imaging is often used to detect active disease and guide immunosuppression. Patients with clinically manifest disease often need device therapy, typically with implantable cardioverter defibrillators.
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European heart journal · Sep 2017
Multicenter StudyLong working hours as a risk factor for atrial fibrillation: a multi-cohort study.
Studies suggest that people who work long hours are at increased risk of stroke, but the association of long working hours with atrial fibrillation, the most common cardiac arrhythmia and a risk factor for stroke, is unknown. We examined the risk of atrial fibrillation in individuals working long hours (≥55 per week) and those working standard 35-40 h/week. ⋯ Individuals who worked long hours were more likely to develop atrial fibrillation than those working standard hours.
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European heart journal · Jul 2017
Clinical TrialNatural history of subclinical leaflet thrombosis affecting motion in bioprosthetic aortic valves.
Four-dimensional volume-rendered computed tomography (4DCT) has demonstrated instances of hypo-attenuating leaflet thickening (HALT) with or without hypo-attenuation affecting motion (HAM) after transcatheter and surgical aortic valve implantation (TAVI, SAVR). The temporal pattern of evolution of these phenomena is uncertain. ⋯ NCT02426307.
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Mechanical valves used for aortic valve replacement (AVR) continue to be associated with bleeding risks because of anticoagulation therapy, while bioprosthetic valves are at risk of structural valve deterioration requiring reoperation. This risk/benefit ratio of mechanical and bioprosthetic valves has led American and European guidelines on valvular heart disease to be consistent in recommending the use of mechanical prostheses in patients younger than 60 years of age. Despite these recommendations, the use of bioprosthetic valves has significantly increased over the last decades in all age groups. ⋯ The risk/benefit ratio and choice of valves will be impacted by developments in valve designs, anticoagulation therapy, reducing the required international normalized ratio, and transcatheter and minimally invasive procedures. However, there is currently no evidence to support lowering the age threshold for implanting a bioprosthesis. Physicians in the Heart Team and patients should be cautious in pursuing more bioprosthetic valve use until its benefit is clearly proven in middle-aged patients.
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European heart journal · Jul 2017
Multicenter Study Observational StudyOverall and abdominal obesity and incident aortic valve stenosis: two prospective cohort studies.
The aim of this study was to examine the association of overall and abdominal obesity with aortic valve stenosis (AVS) incidence in two prospective cohorts. ⋯ These findings indicate that obesity is associated with an increased risk of AVS and that a large proportion of the cases may be prevented if the population maintained a healthy BMI.