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SHARPening up research in Scotland

April 2013 Br J Cardiol 2013;20:57-8. Online First

SHARPening up research in Scotland

March 2012 Br J Cardiol 2012;19:10 News and views

MI deaths continue to fall sharply in England

Beyond cardiovascular disease: SHARP Scientific Meeting 2010

February 2011 Br J Cardiol 2011;18:17-8 Meeting reportNews and views

Beyond cardiovascular disease: SHARP Scientific Meeting 2010

January 2009 Br J Cardiol 2009;16:17-19 News and views

Combating vascular disease in Scotland: 20 years of SHARP

June 2021 Br J Cardiol 2021;28:47–8 doi:10.5837/bjc.2021.025 Editorial

A National Heart Disease Strategy for Scotland: the BHF proposal to Government

David McColgan, Dennis Sandeman, Adrian J B Brady

Abstract

Heart disease remains a major cause of death and disability in Scotland, accounting for around 10,000 deaths each year.1 Ischaemic heart disease is still Scotland’s single biggest killer, responsible for 11.3% of all deaths in 2018, and accounts for 25,000 hospital admissions each year. While it is true that there have been improvements in survival from heart attacks and other acute events in Scotland over the last half century, it is also the case that significant challenges remain.

The reduction in deaths from heart attacks means that more people are living with heart disease as a long-term condition. On top of this, the population is getting older,2 and increasingly people are living with associated comorbidities, many requiring long-term support. The number of people living with cardiovascular risk factors in Scotland continues to increase, health inequalities persist and in some cases, have worsened.3

Beyond ischaemic heart disease, the incidence of conditions like heart failure,4 heart valve disease,5 and atrial fibrillation are increasing. There is also a need to consider the impact of less common, but no less important conditions, such as congenital heart disease and inherited heart conditions. Around 28,000 people in Scotland have an inherited heart condition, the most common of which is hypertrophic cardiomyopathy. Congenital heart disease is one of the most common birth defects in Scotland, affecting around one in every 150 births. Improved survival rates mean that a growing number of people are living into adulthood with congenital heart disease.

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July 2020 Br J Cardiol 2020;27:83–6 doi:10.5837/bjc.2020.021 Clinical article

Coronary lithotripsy: a novel approach to intra-coronary calcification with ‘cracking’ results?

Paula Finnegan, John Jefferies, Ronan Margey, Barry Hennigan

Abstract

This article is available as a BJC Learning CPD activity

Coronary lithotripsy is a novel approach to percutaneous coronary intervention (PCI). It is based on well-established technology dating back to 1980 when lithotripsy was first used to treat renal calculi. Its application in cardiovascular medicine is a more recent development that involves using a low-pressure lithotripsy balloon to deliver unfocused acoustic pulse waves in a circumferential mechanical energy distribution. This causes fracturing of calcification within the surrounding vasculature, facilitating optimal stent deployment.

This article aims to review recent clinical experience and the published data regarding intravascular lithotripsy (IVL). All relevant articles were identified via PubMed using keywords including “intravascular lithotripsy”, “shockwave” and “coronary”. All studies that contained published datasets regarding IVL with patient numbers >50 were included for review. There were 116 results found. After reviewing all the publications, articles were then tabulated and 17 were found to be relevant, including only four clinical studies.

In this review we found that intracoronary lithotripsy for heavily calcified arteries appears to be a safe, effective, easy-to-use method of dealing with an otherwise technically-challenging and high-risk scenario. It appears to carry low risk, uses low pressures, and exerts its effects on both superficial and deep intravascular calcium. Further prospective data with long-term follow-up will be required to explore both the off-label uses of IVL (such as post-stent dilatation), and the long-term patency of these vessels.

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September 2019 Br J Cardiol 2019;26:119 doi:10.5837/bjc.2019.031 Clinical article

Primary meningococcal Y pericarditis with pericardial effusion resulting in cardiac tamponade

Nicolas Buttinger, Mark Forde, Timothy Williams, Sally Curtis, James Cockburn

Abstract

We describe a case of primary meningococcal Y effusive pericarditis in a previously fit and well 35-year-old man who presented with a rapidly developing pericardial effusion resulting in cardiac tamponade. This is a rare, but important, cause of primary pericardial disease, and only the fourth documented case of primary meningococcal pericarditis due to Neisseria meningitidis serotype Y. Our patient was successfully treated with a pericardial drain and intravenous ceftriaxone. Our case highlights the importance of adverse clinical features such as temperature >38°C, subacute course, large effusion or tamponade, and non-steroidal anti-inflammatory drug (NSAID)/aspirin failure, which can identify patients who require close observation as they are at higher risk of complications.

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September 2019 Br J Cardiol 2019;26:90 Meeting reportNews and views

News from the BSH 21st Annual Autumn Meeting

May 2019 Br J Cardiol 2019;26:72–5 doi:10.5837/bjc.2019.022 Clinical article

Practical basics of coronary physiology

Max B Sayers, Cristopher M Cook, Takayuki Warisawa, Justin E Davies

Abstract

Coronary physiology is the collective term for a group of indexes aimed at directly measuring the intracoronary haemodynamic changes that occur across a stenosis in order to guide revascularisation decision-making. Fractional flow reserve (FFR) uses pharmacological dilatation and miniaturised pressure-wires to measure coronary pressure proximal and distal to a stenosis, thereby estimating flow reduction across a stenosis. Several clinical trials have shown that FFR-guided revascularisation improves clinical outcomes, and that deferring revascularisation in patients shown by FFR to have non-haemodynamically significant lesions is safe. Instantaneous wave-free ratio (iFR) is a novel technique that measures the ratio of distal coronary to aortic pressure during a specific period in diastole that obviates the need for pharmacological vasodilatation. Recent randomised-controlled trials have shown iFR to be non-inferior to FFR with respect to major adverse cardiac events, while reducing adverse procedural symptoms and procedure duration.

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Thrombus aspiration in primary percutaneous coronary intervention: to use or not to use?

December 2018 Br J Cardiol 2018;25:152–6 doi:10.5837/bjc.2018.032 Clinical article

Thrombus aspiration in primary percutaneous coronary intervention: to use or not to use?

Telal Mudawi, Mohamed Wasfi, Darar Al-Khdair, Muath Al-Anbaei, Assem Fathi, Nikolay Lilyanov, Mohammed Elsayed, Ahmed Amin, Dalia Besada, Waleed Alenezi, Waleed Shabanh

Abstract

Thrombus aspiration during primary percutaneous coronary intervention (PCI) has been extensively studied. Conflicting results have consistently emerged, hence, no clear guidance has been produced. The authors have examined several key clinical trials and meta-analyses, and discovered, arguably, major flaws within the designs of most trials, thus, accounting for the persistently discordant results. The authors conclude that there is some evidence to support the selective use of thrombectomy in primary PCI but a large-scale trial with the appropriate patient selection criteria is needed in order to substantiate or refute the argument.

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