Glucagon-like Peptide 1 (GLP-1)-based medications have been extensively studied for the management of type 2 diabetes, obesity, chronic kidney disease, and atherosclerotic cardiovascular disease. More recently, their potential role in preventing and treating heart failure has gained increasing attention. Given the strong pathophysiological links among diabetes, obesity, and heart failure, GLP-1-based medications represent a promising therapeutic option to improve morbidity and mortality across these interconnected conditions. In this review, we summarise and discuss recent studies involving GLP-1-based medications that have reported on HF-related outcomes. There is increasing evidence that these medications have beneficial effects on HF outcomes in patients with heart failure with preserved ejection fraction and possibly in those with mildly reduced ejection fraction. The usefulness of GLP-1-based medications in reduced ejection fraction HF remains to be defined.

Background Purulent pericarditis is rare and associated with significant mortality. We outline a case of Group A streptococcus (GAS, Streptococcus pyogenes) native aortic valve infective endocarditis with associated purulent pericarditis and review the literature. Of the reported cases, most occur in children and have high degrees of mortality. There are no cases that describe GAS purulent pericarditis as a complication of infective endocarditis. Case Summary A 43-year-old female presented with an altered conscious state and refractory hypotension. An urgent transthoracic echocardiogram revealed a vegetation on the aortic valve, moderate-severe aortic regurgitation and a moderate-large circumferential pericardial effusion with evidence of early cardiac tamponade. An urgent pericardiocentesis was performed and drained 500 mL of purulent pericardial fluid. Peripheral blood and pericardial fluid cultures grew GAS. Unfortunately the pericardiocentesis did not improve the patient’s haemodynamics, she developed recurrent malignant arrhythmias culminating in cardiac arrest and was unable to be resuscitated. Discussion To our knowledge this is the first described case of GAS purulent pericarditis arising from infective endocarditis. This case contributes to the limited evidence regarding GAS-related purulent pericarditis. Management includes multidisciplinary care with timely administration of broad-spectrum antibiotics, prompt drainage, and contemplation of early surgical intervention. Our review of the 20 reported cases of GAS purulent pericarditis reveals that only 6 out of 20 patients were over 18 years old and the mortality ranged from 40% to 85%. A high degree of clinical suspicion is required as more than half of the cases are diagnosed at post-mortem.

BACKGROUND:Glucagon-like peptide-1 receptor agonist (GLP-1RA) therapies are increasingly used for the treatment of type 2 diabetes mellitus and obesity. Despite growing awareness of potentially increased risk of pulmonary aspiration due to delayed gastric emptying, the risks and benefits of their perioperative use in patients undergoing cardiac procedures remains unexplored. A scoping review was performed to investigate the perioperative GLP-1RA use in patients undergoing cardiac procedures and recommendations. METHOD:PubMed and Ovid MEDLINE were searched up to April 2024 to identify English-language studies on the perioperative use of weekly and daily dosed GLP-1RAs in adult patients undergoing cardiac procedures (including cardiac surgery, trans-oesophageal echocardiograms, and cardiac catheterisation procedures). RESULTS:Three studies were identified, which investigated daily dosed GLP-1RAs in patients undergoing cardiac surgery. No studies were found investigating GLP-1RA use in cardiac catheterisation or trans-oesophageal echocardiograms procedures, and none which specifically examined risk of pulmonary aspiration in patients using GLP-1RAs undergoing cardiac procedures. CONCLUSIONS:GLP-1RAs are beneficial for perioperative weight loss, glycaemic control, and cardiovascular health. Existing guidelines and consensus recommendations are highly contradictory on perioperative GLP-1RA management. Although no known published case reports exist to date of pulmonary aspiration in patients using GLP-1RAs undergoing cardiac procedures, non-cardiac surgical literature strongly suggests that patients are at theoretical risk and a cautious approach is advised in the absence of robust evidence informing recommendations for optimal withholding periods.

Abstract Background Air emboli are a life-threatening diagnosis, which may form through a range of mechanisms. In this case, we describe the case of extensive multi-territory air emboli in a patient with a history of intravenous drug abuse. Case summary This case describes a 41-year-old male who presented with confusion following fall with long lie. He was diagnosed with hyperkalaemia, renal failure, rhabdomyolysis, and compartment syndrome, and he developed extensive multi-territory air emboli. Air embolism was identified in arterial, venous, subcutaneous, and mediastinal territories. Echocardiography demonstrated right ventricular dilation and dysfunction, consistent with air visualized in the right coronary artery on computed tomography. The patient was transferred to the intensive care unit for close cardiac and neurological monitoring and supportive organ care, and ultimately made an uneventful recovery by 6 weeks without apparent complications from the air emboli. Discussion The presence of multi-territory air emboli has previously been described in the setting of surgery, manipulation of intravascular catheters, pulmonary barotrauma, and in sepsis with gas-forming organisms. It has not previously been reported in intravenous drug use or sterile rhabdomyolysis. Computed tomography imaging and echocardiography are useful to diagnose air emboli and their haemodynamic impact. Our patient’s case provides a novel example of multi-territory air emboli in a unique scenario.

Background Pericardial decompression syndrome (PDS) is an uncommon complication of pericardial drainage of large pericardial effusions and cardiac tamponade characterized by paradoxical haemodynamic instability following drainage. Pericardial decompression syndrome may occur immediately, or in the days following pericardial decompression, and presents with signs and symptoms suggestive of uni-/biventricular failure or acute pulmonary oedema. Case summary This series describes two cases of this syndrome which demonstrates acute right ventricular failure as a mechanism of PDS and provides insights into the echocardiographic findings and clinical course of this poorly understood syndrome. Case 1 describes a patient who underwent pericardiocentesis, whilst Case 2 describes a patient who underwent surgical pericardiostomy. In both patients, acute right ventricular failure was observed following the release of tamponade and is favoured to be the cause of haemodynamic instability. Discussion Pericardial decompression syndrome is a poorly understood, likely underreported complication of pericardial drainage for cardiac tamponade associated with high morbidity and mortality. Whilst a number of hypotheses exist as to the aetiology of PDS, this case series supports haemodynamic compromise being secondary to left ventricular compression following acute right ventricular dilatation.

Cardiopulmonary complications of connective tissue diseases (CTDs), particularly pulmonary arterial hypertension (PAH) and interstitial lung disease (ILD), are major determinants of morbidity and mortality. Multidisciplinary meetings may improve diagnostic accuracy and optimise treatment. We review the literature regarding multidisciplinary meetings in CTD-ILD and PAH and describe our tertiary centre experience of the role of the multidisciplinary meeting in managing CTD-PAH.

Methamphetamines are illicit drugs of the amphetamine-type stimulant class that have been increasing in popularity, availability, and purity in recent decades. As a result, rates of methamphetamine-associated cardiomyopathy (MAC) are rising globally. MAC is associated with high rates of sudden cardiac arrest, late presentation, and poor outcomes. This review discusses the medical management of MAC, including anticipated challenges specific to methamphetamine users. Not only are patients with MAC more likely to present at a younger age and with multisystem disease than patients with cardiomyopathy of other etiologies, but there may also be significant behavioral, psychosocial, financial, and system-based challenges to providing the best medical care. An individualized treatment plan that emphasizes methamphetamine abstinence as the foundation of therapy, as well as introducing optimal heart failure therapy and providing multidisciplinary support is likely to result in optimal outcomes. Given the potential reversibility of MAC, institution of guideline-directed heart failure therapy and patient support for adherence to therapy and abstinence from methamphetamines should be energetically pursued.

Long diffuse coronary artery stenosis is often encountered in elderly patients. Many of these patients have multivessel disease, previous myocardial infarction, diabetes and impaired left ventricular function. Due to a combination of diffuse disease, small caliber vessels and often heavy calcification, bypass graft surgery for such vessels is associated with poor short and long-term outcomes. Current approaches include the use of long balloons, rotational atherectomy, laser angioplasty, and a combination of primary or bail-out spot stenting.

OBJECTIVE:To assess whether hypertension is an independent risk factor for mortality among patients hospitalised with COVID-19, and to evaluate the impact of ACE inhibitor and angiotensin receptor blocker (ARB) use on mortality in patients with a background of hypertension.METHOD:This observational cohort study included all index hospitalisations with laboratory-proven COVID-19 aged ≥18 years across 21 Australian hospitals. Patients with suspected, but not laboratory-proven COVID-19, were excluded. Registry data were analysed for in-hospital mortality in patients with comorbidities including hypertension, and baseline treatment with ACE inhibitors or ARBs.RESULTS:546 consecutive patients (62.9±19.8 years old, 51.8% male) hospitalised with COVID-19 were enrolled. In the multivariable model, significant predictors of mortality were age (adjusted OR (aOR) 1.09, 95% CI 1.07 to 1.12, p<0.001), heart failure or cardiomyopathy (aOR 2.71, 95% CI 1.13 to 6.53, p=0.026), chronic kidney disease (aOR 2.33, 95% CI 1.02 to 5.32, p=0.044) and chronic obstructive pulmonary disease (aOR 2.27, 95% CI 1.06 to 4.85, p=0.035). Hypertension was the most prevalent comorbidity (49.5%) but was not independently associated with increased mortality (aOR 0.92, 95% CI 0.48 to 1.77, p=0.81). Among patients with hypertension, ACE inhibitor (aOR 1.37, 95% CI 0.61 to 3.08, p=0.61) and ARB (aOR 0.64, 95% CI 0.27 to 1.49, p=0.30) use was not associated with mortality.CONCLUSIONS:In patients hospitalised with COVID-19, pre-existing hypertension was the most prevalent comorbidity but was not independently associated with mortality. Similarly, the baseline use of ACE inhibitors or ARBs had no independent association with in-hospital mortality.

Type 1 diabetes (T1DM) is a risk factor for cardiovascular disease (CVD) and is associated with increased cardiovascular mortality, heart failure and ischaemic heart disease (IHD). CVD is the leading cause of death in those with T1DM over 40 years of age. At our institution, patients undergoing islet cell transplantation (ICT) for T1DM are subject to routine serial myocardial perfusion scanning (MIBI) pre- and post-transplant to evaluate for IHD.

This document establishes the minimum standard for accreditation of institutions and operators as endorsed by the Cardiac Society of Australia and New Zealand (CSANZ) and the Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS). The original Joint Society Position Statement was ratified in August 2014. This 2021 update replaces the original and serves as a consensus within which the Conjoint Committee for Trancatheter Aortic Valve Implantation (TAVI) Accreditation will function, as recommended by Medical Services Advisory Committee (MSAC) Determination for TAVI. This is not a Guideline Statement but takes into consideration regional, legislative, and health system factors important to establishing requirements for TAVI accreditation in Australia.

Intensive metabolic control reduces the incidence and progression of diabetes-related micro- and macrovascular complications.1, 2 Nevertheless, the risk of developing cardiovascular disease is higher for people with diabetes,3 although cardiovascular disease incidence rates are generally declining more rapidly for people with diabetes than for other people.4, 5 We analysed hospital discharge data from the Victorian Admitted Episode Dataset6 for 1 January 1999 – 31 December 2016. We identified incident cases of three cardiovascular disease complications (acute myocardial infarction [AMI], stroke, and heart failure) by International Statistical Classification of Diseases, tenth revision, Australian modification (ICD-10-AM) codes. Data for 1999‒2003 were examined to ensure that admissions during the observation period (2004‒2016) were index admissions for the specific complication, but were not included in our main analysis. Admission rates were separately calculated for people with type 1 or type 2 diabetes (numbers of people with diagnosed diabetes, by year, were obtained from the National Diabetes Services Scheme, which captures 80–90% of diabetes diagnoses7) and for people without diabetes (derived from Australian Bureau of Statistics census data8). We analysed changes in admission rates by Joinpoint regression (https://surveillance.cancer.gov/joinpoint); points at which changes in the direction or magnitude of linear trends were statistically significant (P < 0.05) were determined with permutation tests. Each trend segment was described by an annual percentage change (APC), and the change for the entire study period as the mean APC (further details: online Supporting Information). The study was approved by the St Vincent’s Hospital Melbourne Human Research Ethics Committee (HREC/18/SVHM/146). A total of 382 107 patients were admitted to Victorian hospitals during 2004–2016 with cardiovascular complications: 278 991 without diabetes (73%), 3645 with type 1 diabetes (1%), and 99 471 with type 2 diabetes (26%). AMI admission rates declined during this period for people with type 1 (mean APC, –7.7%; 95% confidence interval [CI], –13.4% to –1.5%) or type 2 diabetes (mean APC, –11.4%; 95% CI, –13.0% to –9.9%), as well as for people without diabetes (mean APC, –5.0%; 95% CI, –6.7% to –3.4%) (Box 1, Box 2). Change in event rate, 2004–2016* Change in event rate, by period* Cardiovascular complication and diabetes status Admissions Overall change (95% CI) Mean APC (95% CI%) Mean APC (95% CI) Acute myocardial infarction No diabetes 114 965 –32.7% (–32.9% to –23.5%) –5.0% (–6.7% to –3.4%) — Type 1 diabetes 1272 –8.3% (–9.9% to –7.2%) –7.7% (–13.4% to –1.5%) 1. 2005–2009: +7.0% (–9.7% to +22.8%) 2. 2009–2016: –15.1% (–21.3% to –8.7%) Type 2 diabetes 15 278 –222% (–223% to –221%) –11.4% (–13.0% to –9.9%) — Stroke No diabetes 52 320 –11.7% (–11.8% to –11.7%) –1.7% (–4.9% to +1.5%) 1. 2005–2014: –4.1% (–5.8% to –2.3%) 2. 2014–2016: +9.6% (–10.2% to +33.8%) Type 1 diabetes 504 –80.0% (–99.5% to –70.2%) –7.2% (–12.2% to –1.9%) — Type 2 diabetes 17 440 –212% (–212% to –212%) –11.9% (–17.0% to –6.5%) 1. 2005–2011: –14.7% (–17.6% to –11.7%) 2. 2011–2014: +5.8% (–19.0% to +38.2%) 3. 2014–2016: –26.1% (–39.8% to –9.2%) Heart failure No diabetes 135 524 –28.7% (–28.9% to –28.6%) –2.8% (–4.1% to –1.5%) — Type 1 diabetes 1393 –122% (–141% to –110%) –10.3% (–14.1% to –6.4%) — Type 2 diabetes 52 831 –207% (–207% to –206%) –9.2% (–11.0% to –7.3%) — Stroke admission rates declined significantly during 2004–2016 for people with type 1 diabetes (mean APC, –7.2%; 95% CI, –12.2% to –1.9%); for people with type 2 diabetes, rates declined during 2005–2011 and 2014–2016, but not during 2011–2014 (overall change: –11.9%; 95% CI, –17.0% to –6.5%). For patients without diabetes, the decline during 2005–2014 was significant (mean APC, –4.1%; 95% CI, –5.8% to –2.3%), but not during 2015–2016 (Box 1, Box 2). Admissions for heart failure declined during 2004–2016 for people with type 1 diabetes (mean APC, –10.3%; 95% CI, –14.1% to –6.4%) or type 2 diabetes (mean APC, –9.2%; 95% CI, –11.0% to –7.3%), and also for people without diabetes (mean APC, –2.8%; 95% CI, –4.1% to –1.5%) (Box 1, Box 2). As hospital discharge coding data do not provide information on metabolic control or medication use, we could not assess whether cardiovascular risk factor modification and use of specific medications were associated with changes in admission rates. We also lacked information on disease duration for patients with hospital-coded diabetes. Further, we have counted admissions of any patients who had presented with complications before 1998 (ie, outside our 5-year clearance period) as incident admissions; these patients would be at very high risk of further admissions, and their inclusion may have inflated the admission rates we report for the observation period of our study. Few recent studies have assessed outcomes for all three cardiovascular complications in a single investigation. Cardiovascular complication-related admissions to Victorian hospitals declined during 2004–2016 more rapidly for people with diabetes than for those without diabetes. The relatively greater absolute decline in the numbers of admissions of people with diabetes may be related to the fact that they are considered to be at high risk for cardiovascular disease and are therefore treated more aggressively; the scope for reducing risk with multifactorial target-driven interventions is greater in these patients. Nevertheless, admission rates for cardiovascular complications of people with diabetes remain relatively high. Some analysed data were provided by the National Diabetes Services Scheme, an Australian government initiative administered by Diabetes Australia. Katerina Kiburg is supported by an Australian Government Research Training Program Scholarship, St Vincent’s Institute of Medical Research, and by the Research Endowment Fund, St Vincent’s Hospital Melbourne. No relevant disclosures. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Desmoplakin (DSP) gene mutations can cause a unique variant of cardiomyopathy with features similar to arrhythmogenic right ventricular cardiomyopathy. Clinical presentation is variable.

Introduction: To assess whether hypertension is an independent risk factor for mortality amongst patients hospitalised with COVID-19 and to evaluate the impact of angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) on mortality in patients with a background of hypertension. Methods: This observational cohort study included all consecutive index hospitalisations with laboratory proven COVID-19 aged 18 years or older across 21 Australian hospitals entered in the AUS-COVID Registry by 22nd January 2021. Patients were excluded if their past medical or medication history was not available or if they were transferred to another hospital in which case mortality outcomes were not available. Registry data were analysed for in-hospital mortality in patients with comorbidities including hypertension, and baseline treatment with ACE inhibitors or ARBs. Results: 546 consecutive patients (62.9±19.8 years old, 51.8% male) hospitalised with COVID-19 were enrolled. In the multivariable model, significant predictors of mortality were age (aOR 1.09, 95% CI 1.07-1.12, p<.001), heart failure or cardiomyopathy (aOR 2.71, 95% CI 1.13-6.53, p=.026), chronic kidney disease (aOR 2.33, 95% CI 1.02-5.32, p=.044) and chronic obstructive pulmonary disease (aOR 2.27, 95% CI 1.06-4.85, p=.035) (Figure 1). Hypertension was the most prevalent comorbidity (49.5%) but was not independently associated with increased mortality (aOR 0.92, 95% CI 0.48-1.77, p=.81). Amongst patients with hypertension, ACE inhibitors (aOR 1.37, 95% CI 0.61-3.08, p=.61) and ARBs (aOR 0.64, 95% CI 0.27-1.49, p=.30) did not affect mortality. Conclusions: In patients hospitalised with COVID-19, pre-existing hypertension was the most prevalent comorbidity but was not independently associated with mortality. Similarly, the baseline use of ACE inhibitors or ARBs had no independent association with in-hospital mortality.

Frailty measures are shown to be predictive of morbidity in TAVI patients. Low muscle mass, also known as sarcopenia, is a surrogate marker of frailty. CT assessed total psoas muscle area standardised to body surface area at the L3 vertebral level (PMAi), is a validated measure of sarcopenia.

In type 1 diabetes (T1DM), a higher resting heart rate (RHR) correlates with poor glycaemic control, retinopathy, and nephropathy. Intensive medical treatment of T1DM has resulted in a sustained reduction in RHR, coinciding with a reduction in HbA1c. Cardiovascular autonomic neuropathy (CAN) describes impaired autonomic control of the cardiovascular system and portends increased cardiovascular morbidity and mortality in T1DM. Elevated RHR is associated with the presence of CAN, and therefore RHR is likely a marker of CAN in T1DM.

The use of telehealth has increased dramatically in Australia in 2020 as a pragmatic response to the COVID‐19 pandemic; however, differences between telehealth modalities have not been established.

Objectives Describe the incidence of cardiac complications in patients admitted to hospital with COVID-19 in Australia. Design Observational cohort study. Setting Twenty-one (21) Australian hospitals. Participants Consecutive patients aged >= 18 years admitted to hospital with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Main outcome measures Incidence of cardiac complications. Results Six-hundred-and-forty-four (644) hospitalised patients (62.5 +/- 20.1 yo, 51.1% male) with COVID-19 were enrolled in the study. Overall in-hospital mortality was 14.3%. Twenty (20) (3.6%) patients developed new atrial fibrillation or flutter during admission and 9 (1.6%) patients were diagnosed with new heart failure or cardiomyopathy. Three (3) (0.5%) patients developed high grade atrioventricular (AV) block. Two (2) (0.3%) patients were clinically diagnosed with pericarditis or myopericarditis. Among the 295 (45.8%) patients with at least one troponin measurement, 99 (33.6%) had a peak troponin above the upper limit of normal (ULN). In-hospital mortality was higher in patients with raised troponin (32.3% vs 6.1%, p<0.001). New onset atrial fibrillation or flutter (6.4% vs 1.0%, p=0.001) and troponin elevation above the ULN (50.3% vs 16.4%, p<0.001) were more common in patients 65 years and older. There was no significant difference in the rate of cardiac complications between males and females. Conclusions Among patients with COVID-19 requiring hospitalisation in Australia, troponin elevation was common but clinical cardiac sequelae were uncommon. The incidence of atrial arrhythmias and troponin elevation was greatest in patients 65 years and older.

An anomalous single coronary artery (SCA) is extremely rare with registry studies suggesting a prevalence of 0.014%-0.066%. SCA may be associated with symptomatic transient myocardial ischaemia, arrhythmias, and sudden cardiac death regardless of the presence of coronary atherosclerosis.

Introduction: Cardiac computed tomographic angiography (CCTA) and stress echocardiogram are used in patients with stable chest pain to determine who may benefit from medical therapy. CCTA is the considered most sensitive test for detecting atherosclerosis but does not provide a functional assessment. Data on the concordance between CCTA and stress echocardiogram is limited.