• European Society of Cardiology Heart Failure Guidelines 2021: What should we be doing in current practice?
    By Joe Cuthbert The recommendations for clinicians from ESC HF Guidelines 2021 most likely to impact management of the heart failure patient: Aim to start all patients with heart failure and a reduced ejection fraction (HeFREF) on “quadruple therapy” – with one of either an angiotensin converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), or sacubitril valsartan) plus mineralocorticoid receptor antagonist (MRA) plus β-blocker plus sodium glucose co-transporter 2 inhibitors (SGLT2I). Treatment with ACEI, ARB, β-blocker, MRA or sacubitril valsartan now has a class IIb…
  • AF screening and thromboembolic risk: How much AF is significant?
    By Andre Briosa e Gala Take Home Messages AF may go undetected in patients until they experience a complication, such as an AF-related stroke. Early diagnosis of AF and initiation of oral anticoagulation may prevent AF-related stroke and death. However, there are knowledge gaps regarding screening strategy and the thromboembolic risk related to duration of AF. STROKESTOP and LOOP studies investigated the benefits of systematic screening in high-risk populations with different screening modalities. Intermittent ECG screening in STROKESTOP yielded a small but significant net clinical…
  • Exercise as a treatment: do we talk about it enough in Hypertension Management?
    By John Graby Take Home Messages CVD remains a leading cause of morbidity and mortality suggesting a need for improving its management Exercise is important in the management of specific conditions, e.g. hypertension, and has been shown to be as effective as first-line anti-hypertensive medication in improving blood pressure control A recent ESC Consensus Document highlighted, for the first time, how clinicians can prescribe exercise relative to an individual’s baseline hypertensive category and ethnicity Cardiologists and Clinical Practitioners need to proactively and directly discuss the…
  • Bullying in UK cardiology: 1-in-10 trainees affected
    By Dr. Timothy Swinn AcronymsEEA- European Economic AreaOR- Odds ratioCI- Confidence interval A study published in Heart earlier this week shed light on the extensive nature of bullying that persists within UK Cardiology. Camm et al used data from the British Junior Cardiologists Association’s (BJCA) annual survey between 2017-2020 to assess what proportion of trainees had experienced or witnessed bullying at work. Additionally, they performed univariable analyses to investigate how gender, age, type of hospital, and location of undergraduate training affected prevalence of reported bullying.…
  • Exercise-related cardiac arrest associated with higher rate of shockable rhythm
    By Dr. Jonathan Shurlock Grubic et al. systematically reviewed the available literature exploring exercise-related sudden cardiac arrest (SCA). Studies eligible for inclusion were observational studies which assessed populations with exercise related SCA (defined by out-of-hospital cardiac arrest occurring during or within 1 hour of exercise). Studies were excluded if they did not include data on survival outcomes, and the use of cardiopulmonary resuscitation (CPR) or automated external defibrillator (AED). The systematic review contained 29 studies with a median sample size of 91. The authors found…
  • Bentracimab: A potential new reversal agent for Ticagrelor
    By Dr Megha Agarwal P2Y12 receptor antagonists such as clopidogrel, ticagrelor, prasugrel are used in acute coronary syndrome for their anti-platelet properties. To date, no reversal agents exist, and clinicians often must plan to withhold these medications for 3-7 days prior to surgery, to prevent major bleeding. Unlike for aspirin reversal, platelet transfusions are of little benefit for reversal of P2Y12 receptor antagonists [1]. Ticagrelor binds reversibly to the P2Y12 receptor on platelets, unlike clopidogrel and prasugrel. In 2019, Bhatt and colleagues [1] reported findings…
  • BJCA Cardiac Crossroads Seminar 1: Hot topics in Arrhythmia management and Heart Failure
    Cardiac Crossroads has been produced by the British Junior Cardiologists’ Association (BJCA) in collaboration with the British Heart Rhythm Society (BHRS) and the British Society for Heart Failure (BSH). The event will cover interesting topics overlapping arrhythmia and heart failure management, providing an excellent platform for discussion for both Cardiology Trainees and Consultants. From the BJCA: ‘Please join us for this first in a series of cross-sub-specialty debate evenings. Hosted by the BJCA with the support of the BHRS and BSH, we welcome eminent experts…
  • Long-standing BCS member rows the Atlantic!
    Professor Alan Graham Stuart has been a BCS member since 1988, and is a Consultant Cardiologist and Associate Professor of Sport and Exercise Cardiology at the University of Bristol. In December 2021 he will be rowing approximately 3,000 nautical miles across the Atlantic, from the Canary islands to Antigua, raising money for the Tearfund – a charity that partners with churches in more than 50 of the world’s poorest countries to tackle poverty through sustainable development, responding to disasters, and challenging injustice. You can donate…
  • Good infection prevention practice when using ultrasound gel: guidance from the UK Health Security Agency (UKHSA)
    By Ahmed El-Medany Ultrasound gel has been associated with healthcare associated infections worldwide, and the risk of contamination of non-sterile ultrasound is well documented. This important guidance from the UKHSA covers the safe use of ultrasound gel to reduce the risk of transmission of infection. Additional guidance includes scenarios when sterile gel is recommended and what types of gel containers should be used. This is an important document for any clinician using ultrasound gel in their day-to-day practice.
  • DOACs in patients over 120kg
    By Barbara S. Wiggins Taken directly from the ACC The use of direct oral anticoagulants (DOACs) in patients with nonvalvular atrial fibrillation (AF) weighing ≥120 kg was not associated with an increased risk of thromboembolic events or bleeding compared to those patients weighing 60-120 kg. The results of this study add to the growing body of literature demonstrating that DOACs are a reasonable alternative for patients with non-valvular AF who are obese, specifically those with a body weight exceeding 120 kg. Read full summary ReferenceWiethorn,…
  • Is there a role of CMR in grading aortic stenosis severity?
    Aliased Flow Signal Planimetry by Cardiovascular Magnetic Resonance Imaging for Grading Aortic Stenosis Severity: A Prospective Pilot Study By Cesare Mantini et al Taken directly from Frontiers in Cardiovascular MedicineTransthoracic echocardiography (TTE) is the standard technique for assessing aortic stenosis (AS), with effective orifice area (EOA) recommended for grading severity. EOA is operator-dependent, influenced by a number of pitfalls and requires multiple measurements introducing independent and random sources of error. Mantini et al tested the diagnostic accuracy and precision of aliased orifice area planimetry (AOAcmr),…
  • The great resignation!!
    By Julian Sheather and Dubhfeasa Slattery Taken directly from the British Medical Journal Doctors constantly went above and beyond their ordinary obligations to respond to a threat to national and global wellbeing. But they aren’t inexhaustible. Economists have called the coming months the time of “the great resignation” and our healthcare service is unlikely to emerge unscathed from it. A recent survey of UK doctors found that half of those who responded plan to work fewer hours, with a further 21% considering leaving the NHS…
  • Are wine, chocolate, coffee: forbidden joys?
    By Thomas F LüscherTaken directly from the European Heart Journal. Well, wine is truly a joy, but at best neutral when consumed in moderation. Chocolate is a joy for our CV system, if consumed in dark, bitter form. And coffee? It wakes us up, less so, if you drink it regularly, and at that dose of up to 4 cups a day, might even be protective. Read the full article: https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehab654/6409460 Reference: Thomas F Lüscher, Wine, chocolate, and coffee: forbidden joys?, European Heart Journal, 2021;,ehab654, https://doi.org/10.1093/eurheartj/ehab654
  • Are patients willing to participate in cardiac telerehabilitation?
    Results from semi-structured interviews By Maarten Falter et alTaken directly from: European Heart Journal Digital Health While many trials have investigated telerehabilitation, few have studied participation rates in conventional cardiac rehabilitation non-participants. The aim of this study was to identify the percentage of patients that would be willing to participate in a TR programme to identify the main perceived barriers and facilitators for participating in TR. Two groups of patients were recruited: cardiac rehabilitation non-participants and cardiac rehabilitation participants. Semi-structured interviews were conducted. Results are demonstrated…
  • Resources on Ischemic Heart Disease
    The British Medical Journal (BMJ) has recently launched an online resource to support health care professionals, patients and researchers with important research, best practice information, and online courses on Ischemic Heart Disease. The content is free to access until the end of the year (2021) and can be accessed at: https://www.bmj.com/company/resources-on-Ischemic-heart-disease/
  • Year in Cardiology Course
    The culmination to the cardiovascular year will review the biggest and most relevant topics of the past 12 months. This course is a must-attend for consultants and cardiology trainees who wish to keep up to date on advances in cardiology. There will also be a live Q&A session posing questions to the expert panel. Date: Friday 10 December, 2021Venue: Royal College of PhysiciansRegistration: Register online now.Fees: BCS Members £ 200 Non-Members £300Online registration closes: Midday Monday 6 December 2021 Find out more and register at https://www.britishcardiovascularsociety.org/education-courses
  • Physical activity associated with progression of coronary artery calcification
    By Ahmed El-Medany This prospective study by Sung et al assessed the relationship between physical activity (PA) and the development of coronary artery calcification (CAC). Interestingly, the researchers identified a correlation between PA and the prevalence and the progression of CAC, regardless of baseline CAC scores.25,485 participants, free of overt cardiovascular disease, were included. Baseline PA was measured using the International Physical Activity Questionnaire Short Form (IPAQ-SF) and categorised into three groups (inactive, moderately active, and health-enhancing physically active (HEPA)). The primary outcome was the…
  • Cardiac MRI key diagnostic tool in suspected cardiac tumour, predictive of prognosis
    By Ahmed El-Medany This research by Shenoy et al included 903 individuals undergoing CMRI for suspected cardiac tumour. The cardiac MRI diagnosis of ‘no mass’ was made for 25% of the cohort, ‘pseudomass’ for 16%, thrombus for 16%, ‘benign tumour’ for 17%, and ‘malignant tumour’ for 23%. The MRI diagnosis was accurate in 98.4% of patients. The estimated 5-year rate of all-cause mortality was 22% for patients with no mass, 26% for pseudomass, 17% for benign tumour, 36% for thrombus, and 73% for malignant tumour.…
  • Iron deficiency linked with development of coronary artery disease
    By Ahmed El-Medany A study by Schrage et al assessed 12,164 individuals from 3 European population-based cohorts. Absolute iron deficiency was defined as a ferritin <100g/L, with severe deficiency defined as ferritin <30g/L. Absolute and severe iron deficiency was prevalent among 60% and 16.4% of individuals, respectively. During a median follow-up of 13.3 years, 18.2% of individuals died, with 4.7% attributable to a cardiovascular (CV) cause. After adjusting for various confounders, absolute iron deficiency was not associated with all-cause (HR = 1.08; 95% CI, 0.98-1.19; P =…
  • Nocturnal increase in blood pressure associated with increased mortality in diabetics
    By Ahmed El-Medany Presented by Dr. Chiriacò at the American Heart Association’s Hypertension Scientific Sessions, a prospective study including 349 diabetic participants assessed the  long-term effects of elevated blood pressure at night. ‘It is important that health care professionals look for abnormal blood pressure dipping patterns in people with type 1 or type 2 diabetes,’ Chiriacò said. ‘There are strategies to reduce blood pressure during the night. ‘During the study period (median follow-up 21 years) those that demonstrated either <10% reduction, or >0.1% increase in average…
  • Clinical Validation and Evaluation of the novel six lead handheld ECG recorder compared to the 12 lead ECG in unselected cardiology patients (EVALECG Cardio)
    By M Azram et al Taken directly from European Heart Journal – Digital Health  There is a lack of studies validating the use of handheld devices against the standard 12 lead ECG. The Kardia 6 L is a novel handheld ECG monitor which can produce a 6 lead ECG. This prospective study compared the 6 L ECG against the 12 lead ECG. Unselected cardiac inpatients and outpatients All participants had a 12 and 6 Lead ECGs All ECG parameters were analysed by using a standard method template for…
  • Application of artificial intelligence to the electrocardiogram
    By ZI Attia et al Taken directly from the European Heart Journal  Artificial intelligence (AI) has given the electrocardiogram (ECG) and clinicians reading them super-human diagnostic abilities. Trained without hard-coded rules by finding often subclinical patterns in huge datasets, AI transforms the ECG, a ubiquitous, non-invasive cardiac test that is integrated into practice workflows, into a screening tool and predictor of cardiac and non-cardiac diseases, often in asymptomatic individuals.  This review describes the mathematical background behind supervised AI algorithms, and discusses selected AI ECG cardiac screening…
  • Early CTCA in patients with suspected ACS: RCT – results
    By AJ Gray et alTaken directly from BMJ  In intermediate risk patients with acute chest pain and suspected acute coronary syndrome, early CT coronary angiography did not alter overall coronary therapeutic interventions or one year clinical outcomes, but reduced rates of invasive angiography while modestly increasing length of hospital stay. These findings do not support the routine use of early CT coronary angiography in intermediate risk patients with acute chest pain and suspected acute coronary syndrome. Adults with suspected or a provisional diagnosis of acute…
  • Coronary Artery Disease in Young Women After Radiation Therapy for Breast Cancer: Results from the WECARE Study
    By LE Carlson et al. Taken directly from JACC Radiation therapy (RT) for breast cancer increases risk of coronary artery disease (CAD). Women treated for left- vs right-sided breast cancer receive greater heart radiation exposure, which may further increase this risk. The purpose of this study was to report CAD risk amongst younger breast cancer survivors that participanted in the Women’s Environmental Cancer and Radiation Epidemiology Study.A total of 1,583 women who were <55 years of age when diagnosed with breast cancer between 1985 and 2008 completed…
  • A coffee a day keeps the doctor away?
    By Ahmed El-Medany Presented at ESC 2021 by Dr. Judit Simon, of the Heart and Vascular Centre, Semmelweis University, Budapest, Hungary; this large study included 468,629 UK Biobank participants with no known cardiac history (mean age, 56 years; 56% women; median follow-up, 11 years). Participants were stratified into 3 groups based on their coffee habits: none (did not consume coffee on a regular basis, 22.1%), light-to-moderate (0.5 to 3 cups/day, 58.4%), and high (more than 3 cups/day, 19.5%). After adjustment for all potential cardiovascular (CV)…
  • Defibrillator drones? A potential method of reducing response time in OHCA
    By Ahmed El-Medany A prospective pilot study by Schierbeck et al (2021), presented at ESC 2021, investigated the practicality of drone-delivered automatic external defibrillators (AEDs) in cases of out-of-hospital cardiac arrest (OHCA). Three AED-equipped drones were placed within controlled airspace in Sweden, covering approximately 80,000 inhabitants (125 km2). Drones were integrated in the emergency medical services for automated deployment. The primary outcome was the proportion of successful AED deliveries when drones were dispatched in cases of suspected OHCA. Secondary outcomes included the proportion of cases…
  • Polypill beats monotherapy for hypertension: results from the QUARTET stud
    By Ahmed El-Medany Treatment with a ‘quadpill’ containing quarter doses of four antihypertensive drugs demonstrated better blood pressure control than initial monotherapy with full-dose irbesartan, according to findings from the phase III QUARTET trail, which was presented at the ESC Congress 2021. QUARTET was a multicentre, double-blind, parallel-group, randomised trial among Australian adults with hypertension, who were untreated or receiving monotherapy. Participants were randomly assigned to either treatment with the quadpill (containing irbesartan at 37.5 mg, amlodipine at 1.25 mg, indapamide at 0.625 mg, and…
  • RCP release statement on COVID-19 vaccination for the severely immunosuppressed
    On the 13th of September the Royal College of Physicians (RCP) released a statement regarding vaccination in the severely immunocompromised, in response to the Joint Committee on Vaccination and Immunisation (JCVI) advice that a third COVID-19 vaccination would be offered to ‘severely immunosuppressed people’. The statement covers JCVI advice regarding which vaccine to administer, as well as guidance on identifying severely immunosuppressed individuals by medical specialty. Of note, those who are severely immunosuppressed will not be able to self-refer for a third primary vaccination, and…
  • Inequalities in Health Alliance calls on Prime Minister to reduce health inequalities.
    92 senior representatives of the Inequalities in Health Alliance (IHA) have written to the Prime Minister calling for a cross-government strategy to reduce health inequalities. The letter makes calls for a cross-government health inequalities strategy with clear measurable goals, that consider the role of every department and every available policy lever. Health inequality was a problem before COVID-19 – with a gap in healthy life expectancy between the richest and poorest areas of around 19 years – but the pandemic has tragically demonstrated how these inequalities can…
  • Danger: High levels of hospital bed occupancy rates in England
    Taken directly from BMJ news Overall, 83.8% of the 123 707 beds available overnight were occupied between April and June this year, show bed occupancy rates data from NHS England. 82 trusts exceeded the 85% rate which is generally considered to be the limit at which hospitals are able to work safely and effectively. 35 of these trusts had reached occupancy levels above 90%, while six trusts reached levels above 95%. “Hospitals will experience capacity pressures at lower overall occupancy rates than would previously have been the…
  • Reducing barriers to MRI in patients with CIEDs
    Taken directly from European Heart Journal  Many cardiac pacemakers and defibrillators are not approved by regulators for magnetic resonance imaging (MRI) which makes patient access to MRI challenging, but there is no evidence of increased clinical risk. It is estimated that patients have a 50–75% probability of requiring an MRI during the lifetime of the device.This study showed there was no increased risk of MRI in patients with non-MR conditional pacemaker or defibrillator leads when following recommended protocols. Patients undergoing clinical 1.5T MRI with pacemakers…
  • Percutaneous Coronary Revascularisation: Historical Breakthroughs
     Taken directly from JACC Over the last 4 decades, percutaneous coronary intervention has evolved dramatically and is now an acceptable treatment option for patients with advanced coronary artery disease. However, trialists have struggled to establish the respective roles for percutaneous coronary intervention and coronary artery bypass graft surgery, especially in patients with multivessel disease and unprotected left-main stem coronary artery disease. Several pivotal trials and meta-analyses comparing these two revascularisation strategies have enabled the relative merits of each technique to be established with regard to…
  • Guidance for Health Care Leaders During the Recovery Stage of the COVID-19 Pandemic
    A Consensus StatementTaken directly from JAMA Network Open  Question  What leadership imperatives are most essential for health leaders following the emergency stages of the COVID-19 pandemic? Findings  In this consensus statement, 32 co-authors from 17 countries with expertise in various aspects of health leadership, health care, public health, and related fields outline 10 imperatives to guide leaders through recovery from the emergency stages of the pandemic. Key leadership capabilities and reflection questions are presented to guide leaders and to structure performance reviews. Meaning  Leaders who…
  • Highlights from Day 2 of the ESC 2021 congress – APAF-CRT
    By Ahmed El-Medany Presented by Professor Michele Brignole, San Luca Hospital, Milan, APAF-CRT was a two-phase trial in individuals with severely symptomatic atrial fibrillation (AF) with narrow QRS. The first phase, focused on morbidity and showed that AV junction ablation and cardiac resynchronisation therapy (CRT) reduced hospitalisation due to heart failure and improved heart failure symptoms compared with pharmacological rate control following two years of follow-up. Results of the second phase, presented at ESC 2021, focused on mortality. In a larger population with a longer…
  • Highlights from Day 2 of the ESC 2021 congress – ENVISAGE-TAVI AF
    The ENVISAGE-TAVI AF trial demonstrated that Edoxaban’s non-inferiority to warfarin with regards to myocardial infarction (MI), ischaemic stroke, systemic thromboembolism, and valve thrombosis, in participants with atrial fibrillation (AF) after transcatheter aortic valve implantation (TAVI). However, the incidence of major bleeding was found to be higher with Edoxaban versus warfarin and its analogues. Presented by Dr. George Dangas at the ESC 2021 virtual congress, this study assessed the efficacy and safety of Edoxaban versus warfarin and other vitamin K antagonists (VKAs) among patients undergoing TAVI…
  • Highlights from Day 2 of the ESC 2021 congress – MASTER DAPT
    Presented by Dr. Marco Valgimigli, the MASTER DAPT trial assessed whether 1 month of dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI), with a drug-eluting coronary stent maintained, the same benefit in relation to cardiovascular events as longer duration DAPT (6-12 months); whilst reducing adverse bleeding events. Currently, guidelines advise reducing the duration of DAPT to 6 months or less in patients with high risk of bleeding, although the current recommendation is level C, based on expert consensus. 4,579 patients were randomised in a…
  • Highlights from Day 1 of the ESC congress – SMART-MI
    By Ahmed El-Medany As usual, there were a multitude of fascinating trials presented at the Hot Line session at the ESC Congress 2021. Professor Axel Bauer, from Innsbruck Medical University in Austria, presented the SMART-MI trial, a prospective, randomised, open-label trial conducted between May 2016 and Feb 2021 at 33 centres in Austria and Germany. The trial examined whether implantable cardiac monitors (ICMs) were effective in early detection of arrhythmias in high-risk patients with autonomic dysfunction and reduced left ventricular function (LVEF 36-50%) following myocardial…
  • New approaches to Lipid management
    New agreement between Novartis and the NHS enables broad and rapid access to cholestrol lowering medicine ‘Inclisiran’. In December 2019, an in-principle agreement was made between UK Government, the NHS in England and Novartis UK. ₁ The agreement proposed to pioneer a population-level approach to reducing the risk posed by elevated LDL-cholesterol (LDL-C) in patients with atherosclerotic cardiovascular disease (ASCVD) through the implementation of a new, first-in-class LDL-C lowering therapy, inclisiran. Contingent on a positive recommendation by NICE, on 1 September 2021 the inclisiran programme will…
  • New 2021 ESC Guidelines for the diagnosis and management of heart failure published
    By Ahmed El-Medany The 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure (HF) were published on the 27th of August. New concepts include a new simplified treatment algorithm for heart failure with reduced ejection fraction (HFrEF), modified classification for acute heart failure, updated treatments for co-morbidities including diabetes, and updates on cardiomyopathies including the role of genetic testing and novel treatments. The new guidelines focus on each phenotype of HF with regards to diagnosis and treatment. Notable new recommendations…
  • Impaired retinal microvascular function predicts long-term adverse events in patients with cardiovascular disease
    By Theuerle JD, Al-Fiadh AH et al Endothelial dysfunction is a precursor to the development of symptomatic atherosclerosis. Retinal microvascular reactivity to flicker light stimulation is a marker of endothelial function and can be quantified in vivo. Theuerle et al sought to determine whether retinal microvascular endothelial dysfunction predicts long-term major adverse cardiovascular events (MACE). In a single-centre prospective observational study, patients with coronary artery disease (CAD) or cardiovascular risk factors underwent dynamic retinal vessel assessment in response to flicker light stimulation and were followed…
  • Plant‐Centered Diet is associated with a lower risk of Cardiovascular Disease
    By Y Choi et alTaken directly from the Journal of the American Heart Association The study expands on previous studies by exploring the time‐varying relationship between plant‐centered diet quality and risk of cardiovascular disease during the transition from young to middle adulthood. An important aspect is to clarify whether a flexible, plant‐centered diet improves cardiovascular outcomes, where nutritionally rich plant foods are the central component of the diet, and subsets of animal products may be integrated. Long‐term consumption of a plant‐centered diet and shifting to…
  • Low-temperature electrocautery reduces adverse effects from secondary cardiac implantable electronic device procedures: Insights from the WRAP-IT trial
    By S Mittal et alTaken directly from Heart Rhythm Cardiac device procedures require tissue dissection to free existing device lead(s). The purpose of this study was to determine whether standard or low-temperature electrocautery impacts the development of an adverse event. Patients enrolled in WRAP-IT (Worldwide Randomized Antibiotic EnveloPe Infection PrevenTion Trial) undergoing cardiac implantable electronic device (CIED) revision, upgrade, or replacement were evaluated. All adverse events were adjudicated by an independent physician committee. In total, 5641 patients underwent device revision/upgrade/replacement. Electrocautery was used in 5205…
  • Left atrial appendage occlusion in the UK: prospective registry and data linkage to Hospital Episode Statistics
    By I Willits et al This single-arm study has reported the results of the real-world safety and efficacy of LAAO from a multicentre, prospective, observational registry, with patient selection and treatment reflecting UK practice within the NHS of England. It is the largest study performed on LAAO in the UK to date. The results of this registry partly informed NHS England’s decision to commission LAAO routinely. In a cohort of 537 procedures, successful implantation of the LAAO device (in the absence of major complications) was…
  • Multimodality imaging of myocardial viability: An expert consensus document from the European Association of Cardiovascular Imaging (EACVI)
    By Saadia Aslam This expert consensus document reviews current insight into the underlying pathophysiology and available methods for assessing viability. In particular the document reviews contemporary viability imaging techniques, including stress echocardiography, single photon emission computed tomography, positron emission tomography, cardiovascular magnetic resonance, and computed tomography and provides clinical recommendations for how to standardise these methods in terms of acquisition and interpretation. Finally, it presents clinical scenarios where viability assessment is clinically useful. Read full article ReferenceAna G Almeida, John-Paul Carpenter, Matteo Cameli, Erwan Donal,…
  • AI Filter Improves Positive Predictive Value of Atrial Fibrillation Detection by an Implantable Loop Recorder
    By Suneet Mittal et al The purpose of this study was to determine whether incorporation of a 2-part artificial intelligence (AI) filter can improve the positive predictive value (PPV) of implantable loop recorder (ILR)–detected atrial fibrillation (AF) episodes. 1500 AF episodes were evaluated from patients with cryptogenic stroke or known AF who underwent ILR implantation. Each episode was annotated as either a true or false AF episode to determine the PPV. A 2-part AI-based filter (Cardiologs, Paris, France) was then employed using a deep neural…
  • In case you missed it: a summary of the BCS ’21 top 10 trials (Part II)
    By Ahmed El-Medany One of the most popular sessions every year, an excellent variety of trials were presented at the 2021 BCS Annual Conference. For those that were unable to attend, or for the sake of refreshing one’s memory, the following is a summary of all the trials presented: STEP-1 Presented by Dr. Hussain Contractor, perspective by Dr. Mimi Chen Purpose: Evaluate the efficacy and safety of once-weekly s.c. semaglutide (GLP-1) 2.4mg in people with overweight or obesity, with or without weight-related complications. Study design…
  • In case you missed it: a summary of the BCS ’21 top 10 trials (Part I)
    One of the most popular sessions every year, an excellent variety of trials were presented at the 2021 BCS Annual Conference. For those that were unable to attend, or for the sake of refreshing one’s memory, the following is a summary of all the trials presented…
  • Novel pacing system improves clinical response in heart failure patients un-responsive to, or unsuitable for, cardiac resynchronisation therapy
    overall, the results looked great. Hopefully, over the course of the next 12 months, we will finish recruitment for the final phase of the study to further confirm the primary safety and efficacy endpoints that we saw with the….
  • Exercise training effective in reducing ambulatory blood pressure in resistant hypertension, results from the EnRicH trial
    ‘These findings provide clinicians with evidence to embrace moderate-intensity aerobic exercise as a standard coadjutant therapy targeting this patient population.’ The authors state.
  • FDA allows drugs without proven clinical benefit to languish for years on accelerated pathway
    By Elisabeth Mahase Taken Directly from the BMJ doi: https://doi.org/10.1136/bmj.n1898 Criticisms of the US Food and Drug Administration’s accelerated approval process have resurfaced after the recent approval of aducanumab (Aduhelm) for dementia. Elisabeth Mahase finds that the process is plagued by missing efficacy data and questionable evidence. Read the full article here: https://www.bmj.com/content/374/bmj.n1898 Related FDA calls for investigation into industry influence during Alzheimer’s drug approval Published: 12 July 2021; BMJ 374 doi:10.1136/bmj.n1778FDA approves controversial Alzheimer’s drug despite uncertainty over effectiveness Published: 08 June 2021; BMJ 373 doi:10.1136/bmj.n1462
  • Impact of adiposity on cardiovascular outcomes: an umbrella review and meta-analysis provides updated insights
    The aim of this study was to investigate the causal relationship and evidence of an association between increased adiposity and the risk of incident cardiovascular disease (CVD) events or mortality.
  • Anticoagulation of Patients with Mechanical Heart Valves.
    The British Cardiovascular Society (BCS) has today released a Joint Statement together with the British Heart Valve Society (BHVS), the Society for Cardiothoracic Surgeons (SCTS), the British Society of Echocardiography (BSE), the Primary Care Cardiovascular Society (PCCS) and the British Congenital Cardiac Association (BCCA) on Anticoagulation of Patients with Mechanical Heart Valves. On 14 July 2021, a National Patient Safety Alert was issued by NHS England relating to choice of anticoagulant drugs prescribed to patients with mechanical heart valves. [1] This was triggered by cases…
  • Clinical outcome of COVID-19 in patients with adult congenital heart disease
    By Saadia Aslam Original research from Professor Markus Schwerzmann and his team collected clinical outcome data to help identify risk factors for a complicated course of COVID-19 (defined as: hospitalisation requiring non-invasive or invasive ventilation and/or inotropic support, or a fatal outcome) in patients with adult congenital heart disease. Twenty-five centres from nine different European countries participated in the study and recruited consecutive ACHD patients diagnosed with COVID-19 between 27 March and 6 June 2020. The results showed that of 105 patients with a mean…
  • Heart failure with preserved ejection fraction
    By Sean Zheng Key messages Heart failure with preserved ejection fraction (HFPEF) is a common cause of hospitalisation, impaired quality of life, restricted functional capacity, and mortality. There are currently no specific treatments for HFPEF with proven efficacy. PARAGON-HF (sacubitril-valsartan) demonstrated statistically non-significant improvements in heart failure outcomes in HFPEF, most notably signs of greater efficacy in those participants with lower left ventricular ejection fractions. Ongoing studies (DELIVER and EMPEROR-Preserved) will evaluate the effects of SGLT-2 inhibitors, a class of agent with striking efficacy in…
  • Utility of CT coronary angiography in non-ST elevation acute coronary syndrome
    By Syed Ghias Take Home Messages Coronary computed tomographic angiography (CCTA) is a well-established non-invasive diagnostic modality which reliably rules out obstructive coronary artery disease in patients with chronic coronary syndrome. CCTA is now also recommended as an alternative diagnostic strategy to invasive angiography to exclude ACS when there is a low-to-intermediate likelihood of coronary artery disease. Although CCTA demonstrates high diagnostic performance in patients with non-ST elevation acute coronary syndrome, a strategy of routine CCTA makes little difference to treatment decisions or 1-year clinical…
  • Sodium-glucose co-transporter 2 inhibitors – new frontier in the treatment of heart failure
    By Syed Ghias Take Home Messages Sodium-glucose co-transporter-2 (SGLT-2) inhibitors are a novel class of oral hypoglycaemic medications which have been shown to be effective in reducing heart failure hospitalisations and cardiovascular death in patients with either established cardiovascular disease or high cardiovascular risk. European and American guidelines recommend using SGLT-2 inhibitors in patients with type 2 diabetes mellitus and cardiovascular disease to reduce cardiovascular events and hospitalisations with heart failure. Dapagliflozin has also received NICE and FDA approval for use in patient with heart…
  • NICE- Atrial Fibrillation Guidelines
    Expert Opinion by: Dr Steve Furniss, Consultant Cardiologist, East Sussex Healthcare Trust
  • Outcomes of mitral surgery after transcatheter edge-to-edge mitral repair – Analysis from Society of Thoracic Surgeons database
    By Chikwe J, O’Gara P, Fremes S et al Transcatheter edge-to-edge (TEER) mitral repair may be complicated by residual or recurrent mitral regurgitation. An increasing need for surgical reintervention has been reported, but operative outcomes are ill defined. This study evaluated national outcomes of mitral surgery after TEER. The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database was used to identify 524 adults who underwent mitral surgery after TEER between July 2014 and June 2020. Emergencies, previous mitral surgery, or open implantation of transcatheter…
  • Diagnostic pathways in myocardial infarction with non-obstructive coronary artery disease (MINOCA)
    By Giovanni Occhipinti, Chiara Bucciarelli-Ducci & Davide Capodanno When acute myocardial injury is found in a clinical setting suggestive of myocardial ischaemia, the event is labelled as acute myocardial infarction, and the absence of coronary stenosis angiographically 50% or greater leads to the working diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA). The initial diagnosis of MINOCA can be confirmed or ruled out based on the results of subsequent investigations. This review appraises strengths and limitations of invasive and non-invasive investigations for this condition.…
  • Real-world performance and accuracy of stress echocardiography: the EVAREST observational multi-centre study
    By Saadia Aslam The EVAREST (prospective, observational) study provides UK-wide data to evaluate real-world performance and accuracy of stress echocardiography in patients with obstructive coronary artery disease. Participants undergoing stress echocardiography for CAD were recruited from 31 hospitals. They were followed up through health records which underwent expert adjudication. Cardiac outcome was defined as anatomically or functionally significant stenosis on angiography, revascularization, medical management of ischaemia, acute coronary syndrome, or cardiac-related death within 6 months. A total of 5131 patients (55% male) participated with a…
  • Digital solutions to identify worsening heart failure: TRIAGEHF PLUS
    By Ahmed El-Medany Presented by: Dr Fozia Ahmed, Consultant Cardiologist, Manchester Heart Centre The Digital Innovation in Cardiology session at BCS 2021 was a fascinating and inspiring insight into the technology available in various areas of Cardiology and covered exciting digital prospects for the future. Dr. Ahmed discussed TRIAGEHF PLUS, a risk-based digital heart failure (HF) care pathway, designed to help optimise the care of HF patients with implanted devices. There are currently around 920,000 individuals with HF in the UK, with approximately 200,000 new…
  • Efpeglenatide, a novel GLP-1 receptor agonist, reduces cardiovascular events and progression of chronic renal failure in type 2 diabetes
    By Ahmed El-Medany Weekly subcutaneous injections of efpeglenatide, a novel exendin-based GLP1-RA, have been shown to reduce the risk of major adverse cardiovascular events (MACE) by and chronic kidney disease progression by, compared with placebo, for high-risk adults with type 2 diabetes. In a randomised, placebo-controlled trial by Gerstein et al (2021), a total of 4,076 participants were enrolled, and randomly assigned in a 1:1:1 ratio to receive weekly injections of efpeglanatide at 4mg, 6mg, or placebo. During a median follow-up of 1.81 years, an…
  • Myocarditis recognised rare adverse association with COVID-19 vaccine
    By Ahmed El-Medany In a case series of 23 male patients, by Montgomery et al (2021), myocarditis was identified within 4 days of administration of a COVID-19 vaccine. 20 out of 23 of these patients received a diagnosis of myocarditis following their second dose of mRNA COVID-19 vaccine. It is important to note that these episodes occurred against a backdrop of 2.8 million delivered doses of mRNA COVID-19 vaccine in the United States. Furthermore, a case series by Rosner et al (2021) in Circulation, as…
  • The ECHOES cardiovascular digital twin: the brain assist device needed to make sense of data overload?
    By Ahmed El-Medany Presented by Prof Tim Chico, Honorary Consultant Cardiologist and Professor of Cardiovascular medicine, University of Sheffield. The Digital Innovation in Cardiology session at BCS 2021 was a fascinating and inspiring insight into the technology available in various areas of Cardiology and covered exciting digital prospects for the future. Prof Chico ended the session by talking about an exciting project looking at streamlining and simplifying the abundance of data presented to us in our day-to-day clinical work. ‘ECHOES is built on the premise…
  • Artificial Intelligence, precision phenotyping and risk prediction in cardiomyopathy
    By Ahmed El-Medany Presented by Prof O’Regan, MRC Investigator and Consultant Radiologist, Imperial College London The Digital Innovation in Cardiology session at BCS 2021 was a fascinating and inspiring insight into the technology available in various areas of Cardiology and covered exciting digital prospects for the future. Prof O’Regan discussed Artificial Intelligence’s (AI) role in cardiovascular imaging; particularly when integrating imaging and non-imaging data, understanding new mechanisms of heart disease, and early diagnosis and risk prediction. The speaker demonstrated some excellent examples of 3D segmentation…
  • Women in Cardiology: Building a Healthy Culture
    Highlights from the BCS 2021 Virtual Conference By Saadia Aslam Speakers: Dr Derek and Emma Harrington: Cardiology through my daughter’s eyesDr Rebecca Dobson: Back to the futureDr Dipti Itchaporia: Leading a team and maintaining clinician well-being  An excellent and insightful session which highlighted the potential causes of lack of recruitment of women to the field of cardiology, the current initiatives that are being undertaken by the BCS Women in Cardiology group and finally, how to lead a team whilst ensuring clinician well-being. The first talk highlighted…
  • Prevalence of coronary artery disease and coronary microvascular dysfunction is high in in patients with HFpEF
    Taken directly from JAMA Network In a prospective, multi-center cohort study, 106 consecutive participants with preserved ejection fraction were evaluated with coronary angiography, invasive coronary physiologic and vasoreactivity testing, and cardiac magnetic resonance imaging. A total of 51% of the study participants had obstructive epicardial coronary artery disease, 66% had endothelium-independent coronary microvascular dysfunction, and 24% had endothelium-dependent coronary microvascular dysfunction. The findings of this study suggest that obstructive epicardial coronary artery disease and coronary microvascular dysfunction are common and often unrecognised in hospitalised patients…
  • Pregnancy during cardiology training: a call to action
    By Saadia Aslam In the UK, 28% of cardiology trainees and 13% of cardiology consultants are women. A recent article published in the “Heart” highlights the issues and concerns faced by the pregnant cardiologist such as: the impact of fertility treatment, pregnancy symptoms, radiation exposure during pregnancy, shift work, securing maternity leave and childcare. The pregnant cardiologist may feel isolated and unsupported due to the limited number of female cardiologists in the field. Furthermore, education of radiation exposure is consistent and resources are lacking. These…
  • Prevalence of LA thrombus despite guideline directed anticoagulation – results from a meta-analysis
    Taken directly from the American College of Cardiology A summary by Sarah Kohnstamm, MD, FACC Quick Takes This meta-analysis set out to answer the prevalence of LA thrombus in patients with atrial fibrillation or flutter on guideline-directed anticoagulation. It further identified higher-risk populations in whom the diagnostic yield of a pre-procedure TEE would be beneficial. The overall prevalence of LA thrombus in patients with atrial fibrillation or flutter, receiving a minimum of 3 weeks of uninterrupted anticoagulation, was approximately 3%. The prevalence of LA thrombus was…
  • Can artificial intelligence guide novice operators to obtain echocardiographic scans with limited diagnostic utility?
    By A. Narang et al In this prospective, multi-centre diagnostic study by Narang et al, a cohort of 8 nurses without prior ultrasonography experience used artificial intelligence guidance to scan 30 patients each with a 10-view echocardiographic protocol (240 total patients). Five expert echocardiographers blindly reviewed these scans and felt they were of diagnostic quality for left ventricular size and function in 98.8% of patients, right ventricular size in 92.5%, and presence of pericardial effusion in 98.8%. Artificial intelligence can extend the reach of echocardiography…
  • Impact of wearable devices on clinical outcomes and health care utilisation in AF patients
    Summary taken directly from the American College of Cardiology  Quick Takes Patients with AF who use wearable devices for detection of AF are more than twice as likely to undergo an ablation procedure as comparable patients who do not use a wearable device. There is no evidence that use of wearable devices improves heart rate control in patients with AF. Younger patients are overall more likely to use wearable devices than older patients. Read more:https://www.acc.org/latest-in-cardiology/journal-scans/2021/06/02/18/10/wearable-devices-and-health-care-useFull article: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2780408 Reference: Wang L, Nielsen K, Goldberg J, Brown JR, Rumsfeld…
  • Reversal agents for DOACs – a recent meta-analysis
    By Saadia Aslam Major bleeding that requires hospitalisation occurs in 2% to 3.5% of patients that take DOACs. Some of these patients may require reversal agents to control bleeding. Recent work from Gómez-Outes et al evaluated clinical outcomes associated with the use of 4-factor prothrombin complex concentrates, idarucizumab, or andexanet in this setting.This evaluation included 60 studies in 4,735 patients with severe DOAC-related bleeding who were treated with 4-factor prothrombin complex concentrates (n = 2,688), idarucizumab (n = 1,111), or andexanet (n = 936). Mortality…
  • British Society of CMR survey reveals high levels of regional variation and poor equity in access to CMR
    By Ahmed El-Medany Cardiovascular magnetic resonance (CMR) is widely available and established in the United Kingdom (UK) with high scan volumes by international standards. The British Society for CMR periodically surveyed all UK CMR units, starting in 2008. An electronic survey was sent to the service leads of all CMR units in the UK in 2019, requesting data from 2017 and 2018. Responses were then analysed and interpreted by region alongside population statistics.The survey response rate was 100% from 82 units across the nation. 11,967…
  • Cardiologist Burnout to Clinical Wellness: A mountain to climb but a roadmap to follow
    By Guy Lloyd In one of the standout session during BCS 2021, the enormous problem of cardiologist burnout, its causes and consequences as well as potential strategies to address the issue were discussed. In the concluding remarks it was noted that none of the panellists (which included the Presidents of the British Cardiovascular Society (BCS) and Irish Cardiac Society (ICS), the current and past presidents of to American College of Cardiology (ACC) and the Director of Health and Wellbeing for the RCPI) could imagine such…
  • In VICTORIA, elevated baseline troponin associated with cardiovascular mortality and heart failure hospitilisation
    By Ahmed El-Medany Elevated baseline high-sensitivity cardiac troponin T was associated with increased risk for CV death and heart failure (HF) hospitalisation in patients from the VICTORIA trial, according to a presentation at the American College of Cardiology Scientific Session. The VICTORIA trial (Armstrong et al, 2020) assessed the effect of vericiguat (a novel oral soluble guanylate cyclase stimulator) in recently hospitalised patients with heart failure and reduced ejection fraction. Among the 4,614 participants from VICTORIA for whom baseline cardiac troponin T levels were available,…
  • Intensive lipid therapy in preventive cardiology: a summary of the latest ESC/EAS recommendations
    By Ahmed El-Medany Guidelines for the management of dyslipidaemia from the ESC and the EAS were updated in late 2019. With the advent of combination therapy using ezetimibe and/or proprotein convertase subtilisin/kexin type 9 inhibitors in addition to statins, the routine attainment of extremely low LDL-C levels in the clinic has become a reality. This helpful and thorough review by Packard et al discusses the evidence that led to the most aggressive goals yet for LDL-C lowering, and explores a case-based interpretation of the practicality…
  • Can the consent process be improved using animation?
    Video update: 8 June 2021. Article originally published 7 May 2021. Patient understanding of angiography and angioplasty is often incomplete at the time of consent. Language barriers and time constraints are significant obstacles, particularly in the urgent setting.  Multi-language animations explaining angiography and angioplasty were introduced at nine district hospitals for patients with acute coronary syndrome before urgent transfer to a cardiac centre for their procedure.  Reported understanding of the reason for transfer, the procedure, its benefits and risks in 100 consecutive patients were recorded…
  • HOLIDAY Monitors: Alcohol Consumption Significantly Increases Risk of AFib Episode
    Taken directly from the American College of Cardiology One glass of wine, beer or other alcoholic beverage may significantly increase the risk of an atrial fibrillation (AFib) episode within the next four hours, according to results of the HOLIDAY Monitors study presented May 17 during ACC.21. The study, led by Gregory M. Marcus, MD, FACC, looked at alcohol consumption and AFib episodes in 100 patients with paroxysmal or intermittent AFib who consumed at least one alcoholic beverage per month. All participants wore an electrocardiogram (ECG)…
  • Are ethnicity-specific BMI cutoffs now needed for type 2 diabetes risk in England?
    By Saadia Aslam A study by Caleyachetty et al has prospectively identified ethnicity-specific BMI cutoffs for obesity based on the risk of type 2 diabetes that are risk-equivalent to the BMI cutoff for obesity among White populations (≥30 kg/m2). Research in context: (directly taken from the paper) Evidence before this study WHO and the National Institute for Health and Care Excellence (NICE) in England both recommend a BMI cutoff of 27·5 kg/m2 to trigger action to reduce the risk of obesity-related conditions, such as type…
  • When detecting heart murmurs, has Artificial Intelligence surpassed the Consultant Cardiologist?
    A study by Chorba et al investigate Deep learning approaches in detect heart murmurs and clinically significant valvular heart disease, using recording from digital stethoscopes. A deep neural network was trained using 34 hours of previously recorded and annotated heart sounds. 962 participants were then enrolled, and recording collected at 4 primary auscultation locations. Digital algorithm sensitivity was analysed by comparing results to patient echocardiograms and annotations by 3 expert Cardiologists. Sensitivity and specificity of the algorithm for detecting murmurs was 76.3% and 91.4%, respectively.…
  • COVID-19 and Cardiology ARCP outcomes: a summary for trainers and trainees
    By Ahmed El-Medany Disruption to training due to the COVID-19 pandemic has led to difficulties for some trainees in acquiring the competencies required to progress, or complete, their training. However, where the acquisition of competencies has been delayed due to COVID-19 and there are no serious concerns about the trainee, one of the two new ARCP outcomes, Outcome 10.1 or Outcome 10.2 have been suggested by the Statutory Education Bodies (SEBs) of the 4 Nations. The aim of introducing these new ARCP outcomes has been…
  • The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030
    By Dr Rebecca Dobson, BCS Women in Cardiology Lead and Consultant Cardiologist at the Liverpool Heart and Chest Hospital A bold and ambitious statement from an international team of experts and leaders makes welcome reading in the Lancet this week. In the first-ever global report on cardiovascular disease in women, the Commission aims to reduce the global burden of cardiovascular disease in women by 2030. Cardiovascular disease is the leading cause of death in women, which despite a global decline in prevalence, is on the…
  • Getting the best from the Heart Team: Guidance for the structure and function of cardiac multidisciplinary meetings
    Today the British Cardiovascular Society, together with the Association for Cardiothoracic Anaesthesia and Critical Care, the British Cardiovascular Intervention Society, the British Heart Valve Society and the Society for Cardiothoracic Surgery published a guidance document on the structure and function of cardiac multidisciplinary meetings (MDMs). The purpose of Getting the best from the Heart Team: Guidance for the structure and function of cardiac multidisciplinary meetings is to update the existing joint British Societies recommendations published in 2015 to reflect changes in practice. The documents aim is…
  • MITRAL Trial Valve-in-Valve Arm 1-Year Outcomes
    Summary taken directly from the American College of CardiologyWritten by: Debabrata Mukherjee, MD, FACC Quick Takes Transseptal MViV in selected patients at high surgical risk was associated with a 100% technical success rate, a low complication rate, and a low mortality rate (3.3%) at 1 year. Based on these preliminary data, transseptal MViV may be considered for selected high-risk patients with degenerated mitral bioprosthesis who have favorable anatomy. Additional prospective randomized controlled studies are needed to validate these results and to assess the durability of…
  • NICE publishes updated clinical guideline on the diagnosis and management of atrial fibrillation
    Key changes: Bleeding risk scoreNew NICE guideline recommends using the ORBIT bleeding risk score but equally recognises that existing bleeding risk scores may still be used as they are embedded in clinical pathways and electronic systems.  AnticoagulationDOACs are preferred in patients with atrial fibrillation and a CHA2DS2‑VASc score of 2 or above. Apixaban, dabigatran, edoxaban and rivaroxaban are all recommended as options. However if these are contra-indicated or not tolerated then vitamin K antagonist (VKA) should be offered. However, if patients are established on treatment with…
  • Air pollution tied to hypertension in children and adolescents
    By Ahmed El-Medany A meta-analysis by Huang et al has suggests exposure to short- and long-term air pollution in childhood and adolescence increases the likelihood of hypertension later in life.14 studies (351,766 participants) were analysed, with a mean age of 5.4-12.7 years. studies were divided into groups by composition of air pollutants (NO2, particulate matter (PM) with diameter ≤10 μm or ≤2.5 μm) and length of exposure. The beta regression coefficients (β) and their 95% confidence intervals (Cis) were calculated to evaluate the strength of…
  • STEMI after TAVR associated with poorer outcomes.
    By Ahmed El-Medany Longer door-to-balloon times and higher percutaneous coronary intervention (PCI) failure rate were observed in a multicentre study by Faroux et al. 118 patients presenting with STEMI following transcutaneous aortic valve replacement (TAVR) were analysed and compared to 439 ‘non-TAVR’ STEMI patients. Results suggested that median door-to-balloon time was 40 minutes in the TAVR group (IQR, 25-57) and 30 minutes in the non-TAVR group (IQR, 25-30; P = .003). A door-to-balloon time of 60 minutes or more occurred in 20.8% of the TAVR…
  • Greater adverse outcomes in patients presenting with COVID-19 and STEMI
    Outcomes from the North American COVID-19 STEMI registry The goal of the NACMI (North American COVID-19 and STEMI) registry is to describe demographic characteristics, management strategies, and outcomes of COVID-19 patients with STEMI. MethodsA prospective, ongoing observational registry was created under the guidance of 3 cardiology societies.  Group 1: STEMI patients with confirmed COVID+Group 2: suspected COVID-19 infectionGroup 3: Control group that was age- and sex-matched STEMI patients (matched to COVID+ patients in a 2:1 ratio) treated in the pre-COVID era (2015 to 2019)  The…
  • Conference update from Society for Cardiovascular Angiography and Interventions (SCAI) 2021 Scientific Sessions
    The National Cardiogenic Shock Initiative is a single-arm, prospective, multi-center study assessing outcomes associated with early mechanical circulatory support (MCS) in patients presenting with acute myocardial infarction and cardiogenic shock (AMICS) treated with percutaneous coronary intervention (PCI).
  • Techniques to Decrease PPM Implantation Rates Post-TAVR
    Kris Kumar, DO; Firas E. Zahr, MD, FACC; Harsh Golwala, MDExpert Analysis (from the ACC) Quick Takes: Decreasing the degree that the transcatheter heart valve (THV) is within the left ventricular outflow tract (LVOT) can help diminish forces on the conduction apparatus and atrioventricular node, leading to lower rates of conduction abnormalities and permanent pacemaker (PPM) implantation. Understanding the anatomical considerations as well as the angiographic projections necessary to achieve a reduction in parallax and valve deployment aligned with the radiolucent line in the right anterior oblique-caudal…
  • Warfarin and DOACs show similar safety and efficacy in left ventricular thrombus
    By Ahmed El-Medany A meta-analysis by Xuan et al, evaluated the safety and efficacy of direct oral anticoagulants (DOACs) versus warfarin in patients with left ventricular thrombus (LVT). A total of 6 studies (837 patients; mean age 60.2 ± 1.6 years; 77.2% male) were included. There was no significant difference found with regards to thromboembolic events (relative risk [RR] 1.69, 95% confidence interval [CI] 0.94–3.06, P 0.08, heterogeneity (I2) 12.7%), rate of resolution of thrombus (RR 1.08, 95% CI 0.96–1.21, P 0.21, I2 4.8%), and…
  • Pharmacist-led hypertension care in Black barbershops – a cost-effective way to improve blood pressure control and reduce health inequities?
    By Ahmed El-Medany In the Los Angeles Barbershop Blood Pressure Study (LABBPS), pharmacist-led hypertension care in Black-owned barbershops significantly improved blood pressure (BP) control in non-Hispanic Black men with poorly controlled hypertension at baseline. In this analysis, Bryant et al conducted a 10-year event simulation that predicted BP, medication-related adverse events, fatal and nonfatal CVD events, and non-CVD death among study participants. The researchers estimated program costs, health care costs, and quality-adjusted life-years (QALYs). Simulation analysis showed that the barbershop intervention was highly cost-effective, with…
  • Depression associated with increased risk of heart failure events and sudden cardiac death in hypertrophic cardiomyopathy
    Hu et al sought to investigate the impact of depression on clinical outcomes in individuals with hypertrophic cardiomyopathy (HCM)
  • Inflammatory biomarkers linked with heart failure hospitalisation in atrial fibrillation
    By Ahmed El-Medany Among atrial fibrillation (AF) patients, inflammatory markers strongly predict heart failure (HF) hospitilisation. Benz et al analysed 3,784 individuals with AF (median follow-up 4 years). High-sensitivity c-reactive protein (hs-CRP) and interleukin-6 (IL-6) were measured at baseline. The authors state, ‘We calculated an inflammation score ranging from 0 to 4 (1 point for each biomarker between the 50th and 75th percentile, 2 points for each biomarker above the 75th percentile)’. After multivariable adjustment, both biomarkers were significantly associated with risk of HF hospitalisation…
  • Atrial fibrillation increases beat-to-beat variability of cerebral microcirculatory perfusion – a potential target for reducing long-term cognitive decline?
    By Ahmed El-Medany This pioneering in vivo study by Saglietto et al investigated beat-to-beat microcirculatory perfusion during atrial fibrillation (AF) by using near-infrared spectroscopy to non-invasively monitor cerebral haemodynamics. A proxy of microcirculatory cerebral perfusion was compared before and after restoration of AF to sinus rhythm following DC cardioversion (DCCV). DCCV was successful in restoring SR in 51 (96%) of 53 enrolled participants. A significant decrease of both hypoperfusive and hyperperfusive/hypertensive microcirculatory events was observed after restoration to sinus rhythm (P < 0.001 and P = 0.041, respectively). As…
  • Clinical Outcomes When a Stroke Thrombectomy Program Is Started in an Experienced Cardiology Cath Lab
    By Saadia Aslam Mechanical thrombectomy has proven to be the best treatment option for ischemic stroke patients, but it is not widely available. When a catheter-based thrombectomy program was initiated in an experienced cardiac cath lab in close cooperation between cardiologists, neurologists, and radiologists, outcomes were comparable to those of neuroradiology centers. The desired clinical results were achieved from the onset of the program, without any signs of a learning curve effect. These findings support the potential role of interventional cardiac cath labs in the…
  • Medical therapy comparable to intervention in spontaneous coronary artery dissection (SCAD)
    By Ahmed El-Medany A meta-analysis by Krittanawong et al found no significant difference to long-term risk of death, recurrent myocardial infarction (MI) and SCAD, and repeat revascularisation. The researchers stated that high-risk patients, including those with hemodynamic instability, persistent and worsening signs of myocardial ischemia, and shock or malignant ventricular arrythmias, may benefit from invasive therapy in cases in which no other options were available.In the study population of 1,369 patients, with a mean age of 49 years, 82% were women, 860 were treated with…
  • Physical activity reduces cardiovascular risk and all-cause mortality if performed during leisure time, not working hours
    By Ahmed El-Medany The contemporary Copenhagen General Population Study recently published their findings in the European Heart Journal. This large study, which was established in 2003-2014, tested the hypothesis that leisure time physical activity correlated with reduced major adverse cardiovascular events (MACE) and all-cause mortality risk, while occupational physical activity related to increased risks. Holtermann et al studied 104,046 individuals over a median 10-year follow-up. Higher self-reported leisure time physical activity was found to be associated with reduced MACE and all-cause mortality risk, while higher…