2020, Volume 27, (online first)

2020, Volume 27, Issue 1, pages 1–40

Editorials Clinical articles News and views
Topics include:-
  • Cardiac surgery in the very elderly
  • Cancer immunotherapy and cardiac complications
  • Will heart failure become the first cyber-specialty?
  • CVD prevention with aspirin in the older patient


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January 2020 Br J Cardiol 2020;27:8–10 doi:10.5837/bjc.2020.001

Cardiovascular complications of anti-cancer immune checkpoint inhibitor therapy and their combinations: are we ready for challenges ahead?

Alexandros Georgiou, Nadia Yousaf


The use of immune checkpoint inhibitors (ICIs) has transformed the treatment landscape for a number of tumour types over the past decade. Targeting cytotoxic T-lymphocyte-associated protein 4 (CTLA-4; ipilimumab), programmed cell death protein 1 (PD1; nivolumab, pembrolizumab), and programmed death-ligand 1 (PD-L1; atezolizumab, avelumab, or durvalumab), as monotherapy or in combination, activates the immune system to recognise and target cancer cells via a T-cell-mediated immune response and can lead to improved survival in the metastatic setting in a number of malignancies, as well as improved recurrence-free survival when utilised in multi-modality radical treatment paradigms in melanoma and non-small cell lung cancer (NSCLC).1,2 The systemic activation of T-cells can also lead to auto-immune toxicity, affecting any body system; most commonly skin, gastrointestinal, liver and endocrine toxicities.3

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Clinical articles

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January 2020 Br J Cardiol 2020;27:19–23 doi:10.5837/bjc.2020.002

Cancer immunotherapy and its potential cardiac complications

Simon G Findlay, Ruth Plummer, Chris Plummer


Recent advances in immune therapy for cancer have significantly improved the clinical outcomes of patients with advanced cancers, where prognosis has historically been very poor. With these new treatments have come new toxicities and, as the use of immunotherapy increases, we will see an increasing incidence of immune-related adverse events, with patients presenting as an emergency. It is important that all cardiologists, and other physicians who see these patients, are aware of life-threatening immune-related toxicities, in addition to their recommended investigation and treatment.

We describe a patient with acute cardiotoxicity secondary to immune therapy to illustrate the complexity of these adverse cardiovascular events, providing recommendations for screening, diagnosis and management.

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January 2020 Br J Cardiol 2020;27:24–5 doi:10.5837/bjc.2020.003

Cardiac tumours – a brief review

Amaliya A Arakelyanz, Tatiana E Morozova, Anna V Vlasova, Roman Lischke


This short review of cardiac tumours presents a case that clearly demonstrates the manifestation of embolic and cardiac symptoms of an intracardiac mass. Acute onset and rapid progression of a neoplastic process in the heart leading to arrhythmia, cardiac conduction disorders and heart failure combined with highly mobile fragments of tumour, which can cause emboli in cerebral vessels, are characteristic signs of an intracardiac mass. Early diagnosis and immediate treatment may improve the long-term prognosis, but overall the prognosis is poor. Cardiac tumours present to the cardiologist when the patient presents with cardiac symptoms, and the neurologist when there are cerebral symptoms. Most cardiac masses are not amenable to percutaneous biopsy; therefore, definitive diagnosis often awaits surgical excision.

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January 2020 Br J Cardiol 2020;27:34–6 doi:10.5837/bjc.2020.004

Successful treatment of ischaemic ventricular septal defect and acute right ventricular failure: a challenging case in the modern NHS

Renata Greco, Andrew Johnson, Xy Jin, Rajesh K Kharabanda, Adrian P Banning, Mario Petrou


A 52-year-old man, previously fit and well, presented with myocardial infarction complicated by ischaemic ventricular septal defect (VSD) and acute right ventricular failure, was successfully treated with early percutaneous coronary reperfusion, surgical VSD repair and temporary right ventricular assist device (VAD) support.

This case is an example of how a modern healthcare system can successfully manage complex emergency cases, combining high levels of clinical care and medical technology. Access to temporary mechanical support played a vital role in this case. We believe that wider access to VADs may contribute to improvement in the, widely recognised, poor outcome of ischaemic VSD.

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News and views

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January 2020 Br J Cardiol 2020;27:11–4

Cardiorenal Forum 2019: integrating care in cardiorenal medicine

The highly anticipated 14th Annual Scientific Meeting of the Cardiorenal Forum was held at The King’s Fund, London, on 4th October 2019. The focus...