European Heart Journal (Eur Heart J )

Publisher: European Society of Cardiology, Oxford University Press


European Heart Journal is an international, English language, peer-reviewed journal of cardiology. European Heart Journal is an official professional journal of the European Society of Cardiology and is published twice monthly by W.B. Saunders, a Harcourt Health Sciences Company. European Heart Journal aims to publish the highest quality material, both clinical and scientific, on all aspects of cardiology. European Heart Journal includes research findings, technical evaluations, review articles, and in addition provides a forum for the exchange of information and views on all professional cardiology issues including education. European Heart Journal promotes excellence in the profession of cardiology by its commitment to the publication of research, by its support for education, and by its encouragement and dissemination of best practice. The European Heart Journal is cited in : Science Citiation Index, SCISearch, Research Alert, Medical Documentation Sevice, Current Contents/Clinical Medicine, Chemical Abstracts, EMBASE and Index Medicus. Harcourt Home

Impact factor 14.72

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    European Heart Journal website
  • Other titles
    European heart journal (Online), European heart journal
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    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

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Oxford University Press

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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Aims To prospectively validate the SYNTAX Score II and forecast the outcomes of the randomized Evaluation of the Xience Everolimus-Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) Trial. Methods and results Evaluation of the Xience Everolimus Eluting Stent vs. Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization is a prospective, randomized multicenter trial designed to establish the efficacy and safety of percutaneous coronary intervention (PCI) with the everolimus-eluting stent compared with coronary artery bypass graft (CABG) surgery in subjects with unprotected left-main coronary artery (ULMCA) disease and low-intermediate anatomical SYNTAX scores (<33). After completion of patient recruitment in EXCEL, the SYNTAX Score II was prospectively applied to predict 4-year mortality in the CABG and PCI arms. The 95% prediction intervals (PIs) for mortality were computed using simulation with bootstrap resampling (10 000 times). For the entire study cohort, the 4-year predicted mortalities were 8.5 and 10.5% in the PCI and CABG arms, respectively [odds ratios (OR) 0.79; 95% PI 0.43–1.50). In subjects with low (≤22) anatomical SYNTAX scores, the predicted OR was 0.69 (95% PI 0.34–1.45); in intermediate anatomical SYNTAX scores (23–32), the predicted OR was 0.93 (95% PI 0.53–1.62). Based on 4-year mortality predictions in EXCEL, clinical characteristics shifted long-term mortality predictions either in favour of PCI (older age, male gender and COPD) or CABG (younger age, lower creatinine clearance, female gender, reduced left ventricular ejection fraction). Conclusion The SYNTAX Score II indicates at least an equipoise for long-term mortality between CABG and PCI in subjects with ULMCA disease up to an intermediate anatomical complexity. Both anatomical and clinical characteristics had a clear impact on long-term mortality predictions and decision making between CABG and PCI.
    European Heart Journal 01/2015;
  • European Heart Journal 12/2014;
  • European Heart Journal 12/2014;
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    ABSTRACT: Cardiovascular diseases are the leading cause of death globally. Depression is associated with an increased morbidity and mortality rate among cardiovascular (CV) patients. Early detection of, and intervention for, depression among CV patients can reduce morbidity and mortality, and save health care costs. However, information on the presence of depression and mental health care needs among patients hospitalized with acute cardiovascular conditions in the Middle East is lacking. Purpose: This study’s goals are to evaluate the prevalence of depression or mood disturbances and to find ways to effectively manage depression. Methods: A cross-sectional survey was conducted with 1000 Arab patients hospitalized with acute cardiac conditions between January, 2013 and March, 2014 at a hospital in Qatar. Inclusion criteria were; ≥20 years of age, agreeing to participate in the study (98% response rate) and final confirmation of acute cardiac conditions (mainly acute coronary syndrome or heart failure). Face-to-face interviews were conducted using structured survey questionnaires which included an Arabic demographic questionnaire and the self report Arabic version of the Beck Depression Inventory 2nd Edition (BDI-II). Results: 84% of the patients rated their health as excellent or good, 16% rated as poor, 17% considered themselves depressed and 7% said that they had a confirmed history of depression. Of the patients with a history of depression, 31% were receiving medical therapy. Evaluation by the BDI-II indicated that 80% of the patients had no depressive symptoms, 15% suffered low levels of depression and 5% with significant levels of depression. Twice as many females than males were assessed having depression. While 68% and 36% of the patients agreed to share their mental health information with family and friends respectively, only 0.8% agreed to share it with a mental health clinician on a weekly basis. Conclusion: Depression and mood disturbance is common among Middle Eastern patients hospitalize with acute cardiac conditions, more so among women when compared to men. Understanding ways to evaluate depression among different ethnicities is important. To improve quality of life and survival of cardiovascular patients, increase awareness, early recognition of and culturally appropriate treatment for depression are necessary in Qatar.
    European Heart Journal 10/2014; European Heart Journal: Acute Cardiovascular Care 2014(3):74.
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    ABSTRACT: Purpose: Currently, an echocardiogram presents the left ventricle (LV) based on images obtained from ultrasound methods. Utilizing mathematical equations, specific echocardiographic data may provide more detailed, valuable and practical information for physicians. In our project using appropriate mathematically based softwares, we have attempted to create a novel software capable of demonstrate LV model in normal hearts. Methods: Echocardiography was performed on 50 healthy volunteers. Data evaluated included: velocity (radial, longitudinal, rotational and vector point), displacement (longitudinal and rotational), strain rate (longitudinal and circumferential) and strain (radial, longitudinal and circumferential) of all 16 LV myocardial segments. Using these data, force vectors of myocardial samples were estimated by MATLAB and LSDYNA softwares, interfaced in the echocardiograph system. Dynamic orientation contraction (through the cardiac cycle) of every individual myocardial fiber could be created by adding together the sequential steps of the multiple fragmented sectors of that fiber. This way we attempted to mechanically illustrate the global LV model. Results: LV Myocardial modeling: Our study shows that in normal cases myocardial fibers initiate from the posterior-basal region of the heart, continues through the LV free wall, reaches the septum, loops around the apex, ascends, and ends at the superior-anterior edge of LV. Conclusion: We were able to define the whole LV myocardial model mathematically, for the first time, by MATLAB software and LSDYNA software in normal subjects. This will enable physicians to diagnose and follow-up many cardiac diseases when this software is interfaced within echocardiographic machines.
    European Heart Journal 10/2014;
  • European Heart Journal 10/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: AIMS: The aim of the present study was to clarify the significance of myocardial ultrastructural changes in patients with dilated cardiomyopathy (DCM). METHODS AND RESULTS: Endomyocardial biopsy of the left ventricle was performed in 250 consecutive DCM patients (54.9 ± 13.9 years, 79% men), presenting initially as decompensated heart failure (HF). Myofilament changes of cardiomyocytes were evaluated by electron microscopy and compared with clinical and morphometric data. Mortality and HF recurrence were evaluated during the follow-up period. During the follow-up period (4.9 ± 3.9 years), 24 patients (10%) died and 67 (27%) were readmitted because of HF recurrence, including those who had died because of HF. Myofilament changes, classified as either focal derangement of myofilaments (sarcomere damage) or diffuse myofilament lysis (disappearance of most sarcomeres in cardiomyocytes), were identified in 164 patients (66%). Multivariate analysis identified a family history of DCM [hazard ratio (HR) 4.763; 95% confidence interval (CI) 1.012-12.518], atrial fibrillation (HR 6.132; 95% CI 2.188-17.180), haemoglobin level (HR 0.685; 95% CI 0.528-0.889), and diffuse myofilament lysis (HR 4.048; 95% CI 1.427-11.481) as independent predictors of mortality. A family history of DCM (HR 2.268; 95% CI 1.276-4.030), haemoglobin level (HR 0.876; 95% CI 0.785-0.979), focal derangement of myofilaments (HR 7.431; 95% CI 2.916-18.934), and diffuse myofilament lysis (HR 6.480; 95% CI 2.403-17.473) were predictors of readmission due to HF recurrence. CONCLUSIONS: In DCM patients with first-decompensated HF, myofilament changes are strongly associated with mortality and HF recurrence.
    European Heart Journal 10/2014;
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    ABSTRACT: Purpose: The aim of this study is to determine the factors that are associated with the use of ionotropic support during hospitalization in heart failure patients and the outcomes. Methods: We studied the medical records of 7,069 patients with decompensating heart failure who were hospitalized from 1990 to 2010. We performed multivariate analysis on the demographics and clinical characteristics of these patients. Results: 686 patients (9.7%) received intravenous ionotropic support after admission. Patients receiving ionotropes were more likely to be female (38.9% Vs 33.1%, p=0.002), marginally older (62 Vs 61.5 years, p=0.09), with chronic renal impairment (18.2% Vs 7.5%, p<0.001), dyslipidemic (22.7% Vs 18.2%, p=0.004), hypertensive (66.3% Vs 55.6%,p<0.001), obese (8.9% Vs 5.6%, p<0.001), hyperglycemic(10 Vs 9.2 mmol/l, p=0.02), hypercreatinemic (156 Vs 116µmol/L, p<0.001), on dialysis (1.6% Vs 0.2%, p<0.001),troponin positive (23.5% Vs 15.1%, p<0.001), had STEMI (32.1% Vs 25.0%, p<0.001), with aortic regurgitation (16.9% Vs 3.5%, p<0.001), cardiomyopathy (14.3% Vs 11.8%,p=0.06) and had PCI (2.5% Vs 1.3%, p=0.02). Interestingly, patients receiving ionotropes were less likely to have intraaortic balloon pump support (2.3% Vs 6.4%, p<0.001) and have better LV ejection fraction (LVEF>50%, 22.9% Vs 16.1%, p<0.001). There was no difference in the mean plasma BNP and CK-MB levels (p=0.21 and 0.73 respectively). Heart failure patients on ionotropes also suffered from significantcomplications including ventricular tachycardia (2.3% Vs 1.0%, p=0.002), prolonged hospital stay (7.0 Vs 5.6 days,p<0.001), cardiac arrest (22.0% Vs 5.1%, p<0.001) and in hospital mortality (25.8% Vs 6.1%, p<0.001). Conclusion: Conventional cardiac risk factors predict the use of ionotropic support in heart failure patients, even though female is more at risk. Plasma BNP and CK-MB do not seem to influence the likelihood of using ionotropes. Better LVEF observed in ionotropic group may be explained by the susceptibility of these patients to a sudden drop in ejection fraction, even though small, compared to patients pre-conditioned to chronic low ejection fraction. However,further study is required to investigate this observation.
    European Heart Journal 10/2014; 3(1):1–213.
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    ABSTRACT: Purpose: to study the demographics and outcome among cardiac patients hospitalized with RBBB Method: Retrospective analysis of the 23-year registry data (Jan 1991 to Jan 2014) of cardiac patients hospitalized in our general hospital and heart hospital. Results: Among 50606 patients admitted under cardiology department, 386 patients had RBBB (0.8%). Compare to Non-RBBB, Patients with RBBB typically presented with breathlessness rather than chest pain (32.6% vs. 23.1%, P=0.001). They were older (57±12 vs. 54±12 years, P=0.001), have higher incidence of Diabetes (50.5%, vs. 40.3%, P=0.001). Patients with RBBB had significantly higher cardiac markers, CPK (2047±10853 vs 753±2259,P=0.001),CK-MB((292±1253 vs 117±535,P=0.05) despite no difference in the type of ACS (STEMI 13.2% vs. 14.5%,P=0.48) and (7.3% vs 8.9%, P=0.27 for NSTEMI). Compare to patients without RBBB, RBBB patients were more likely to have CHF (21.8% vs 15.8%,P=0.001), cardiogenic Shock (10.6% vs 1.7%,P=0.001) and requiring IABP (3.4% vs.0.4%,P=0.001) despite no statistically difference in EF ( 39±14 %vs 47±15%, P=0.001) Mortality in RBBB patients was five times higher than in non-RBBB patients (29.7% vs. 6%,P=0.001) Conclusion: RBBB is associated with higher episodes of decompensated heart failure with higher mortality despite relatively preserved ejection fraction.
    European Heart Journal 10/2014; 3(1).
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives To look at the prevalence, clinical profile and outcome among cardiac patients with RBBB. Methods Retrospective analysis of the 23-year registry data (Jan 1991 to Jan 2014) of cardiac patients hospitalized our general hospital and heart hospital. Results Among, 50992 patients admitted under cardiology department, 386 patients had RBBB (0.8%) with male represented by 74.4%. Compared to patients without RBBB, RBBB patients were older (57±14 vs. 54±13 years, P=0.002), more likely to have elevated fasting blood glucose (50.5 vs.40.3%, P=0.001). There was no statically significant difference in other risk factors including hypertension (43% vs. 43%,P=0.99),smoking (24.4% vs.23.2%,P=0.60) and dyslipidemia (6.7% vs.7.6%,P=0.50).Congestive heart failure was the most common cause of admission in RBBB (32.6% vs.23.1%, P=0.001) despite relatively preserved left ventricular function (EF 39±14 %vs 47±15%, P=0.001), followed by Acute coronary syndrome (28% vs. 34%,P=0.001) and arrhythmias (16.8% vs. 11.2%, P=0.001) RBBB patients tend to experience more dizzy spells and palpitation (7.8% vs.4%,P=0.001) and have more complete heart block (3.4% vs. 0.4%, P=0.001),atrial fibrillation (3.6% vs.2%, P=0.02) and ventricular tachycardia (4.9% vs. 1.4%,P=0.001) in-hospital Mortality in RBBB patients was significantly higher than in non-RBBB patients (29.7% vs 6%,P=0.001). Conclusion Among cardiovascular risk factors, Diabetes and old age tend to be more associated with RBBB. CHF was the most common presentation despite relatively preserved LV function, Furthermore, CHB and VT is seen more often in combination with RBBB.
    European Heart Journal 10/2014; 3(1).
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    ABSTRACT: The 1946 Medical Research Council National Survey of Health and Development (MRC-NSHD) is the longest running birth cohort in the UK. Making use of this unique resource, Ghosh and colleagues have now demonstrated that left ventricular mass index (LVMI) and relative wall thickness at age 60–64 were associated with blood pressure (BP) or use of antihypertensive drugs from 36 years of age onwards, independent of current BP or treatment status.1 Moreover, the rate of BP increase over time rather than the absolute BP level at a given age determined the LVMI at 60–64 years.1 Ghosh and colleagues have to be congratulated for their meticulous analysis of longitudinal data spanning 28 years. Nevertheless, several issues cannot be disregarded in the interpretation of the results. First, as in all longitudinal studies, the attrition rate was high. Of 5362 initially enrolled participants, only 2856 were invited for echocardiography from 2006 until 2011. Invitations were not sent to those who had died (n = 778), were living abroad (n = 570), had previously withdrawn from the study (n = 594), or had been lost to follow-up (n = 564). Of those invited, 539 (18.9%) accepted to be visited at home, but only 1653 (57.8%) underwent echocardiography and 1480 (51.8%) had analysable images. The authors argued that participants who opted for a home visit had higher BP and were less healthy, …
    European Heart Journal 09/2014;
  • European Heart Journal 09/2014; 35(suppl 1):863.
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    ABSTRACT: Background and objective: Dobutamine stress echocardiography (DSE) is being consistently used as an exercise-independent stress modality aimed at the detection of coronary artery disease (CAD) and the evaluation of myocardial ischemia. It may though occasionally induce coronary vasospasm. In this study, we aimed to evaluate the prevalence and predictors of dobutamine-related coronary spasm in patients without known CAD and false positive DSE (positive DSE but no significant coronary lesions on angiogram) Methods: 3952 patients referred to our echocardiography laboratory for DSE between January 2010 and May 2012 were prospectively investigated. Those with positive DSE underwent coronary angiograms with systematic methylergometrine intracoronary injection in case of absence of significant coronary stenosis or spontaneous occlusive coronary spasm. Patients with spontaneous occlusive coronary spasm or positive methylergometrine test but no significant stenoses were enrolled and compared with those with positive DSE but no coronary lesions nor spontaneous or induced spasm (“true” false positive DSE) Results: 29 patients with DSE-related vasospasm (19.4% of positive DSE without known CAD) were compared with 56 patients with no lesions and no spam (“true” false positive DSE). They were more frequently smokers (72.4% vs 37.5%; p=0.003); they had more frequently dyslipidemia (79.3% vs 43%; p=0.001); they also had a larger ischemic area at peak DSE (3.4 vs 2.7 segments; p=0.05). On multivariate analysis, dyslipidemia (HR=10.7; 95% CI= [2.7-42.1]; p=0.001) and active smoking (HR=6.1; 95% CI= [1.7-21.1]; p=0.004) were found to be independant predictors of spam-related DSE rather than “true” false positive DSE. Conclusion: DSE- related coronary spasm is present in a significant proportion of patients with erroneously labelled “false” positive DSE and should systematically be ruled out. Dyslipidemia and active smoking were independant predictors of spasm rather than “true” false positive DSE
    European Heart Journal 09/2014; 35(supp1):115.