2018, Volume 25, Issue 4, pages 121–160

2018, Volume 25, Issue 4, pages 121–160

Editorials Clinical articles News and views
Topics include:-
  • Cardiovascular outcomes and diabetes drugs
  • Quality of life in PoTS sufferers
  • ECG shared by multiple pathologies
  • Thrombus aspiration and PPCI

Editorials

Back to top

December 2018 Br J Cardiol 2018;25:127–9 doi:10.5837/bjc.2018.030

Prescribing for patients with type 2 diabetes and CV disease: should we be following the Scottish example?

Sean L Zheng

Abstract

The paradigm for glucose control in type 2 diabetes has been based on historic and landmark studies demonstrating the unquestionable microvascular benefits of good glycaemic control.1-3 However, whether better control improves survival and prevents cardiovascular events has been less consistently shown, with one notable study, ACCORD (Action to Control Cardiovascular Risk in Type 2 Diabetes), showing an increased risk of cardiovascular death with tight control.2 Over the past few years, a number of randomised, placebo-controlled, cardiovascular outcome trials (CVOTs) testing novel glucose-lowering agents have demonstrated beneficial effects on mortality and cardiovascular events. This has prompted a change in emphasis away from solely targeting glycaemic control in diabetes, and focusing on reducing cardiovascular events and improving survival.

| Full text

Clinical articles

Back to top

December 2018 Br J Cardiol 2018;25:140–2 doi:10.5837/bjc.2018.031

Quality of life in postural orthostatic tachycardia syndrome (PoTS): before and after treatment

Toby Flack, Jamie Fulton

Abstract

Postural orthostatic tachycardia syndrome (PoTS) can be defined as tachycardia with or without hypotension in the upright posture, and more comprehensively as a manifestation of a wider dysautonomia. The scope of this article is to characterise patients with PoTS and look at patient-rated responses to treatment.

This research comprised a postal survey, sent to patients with diagnosed PoTS at a tertiary hospital in Southwest England. We collected data on the demographics of patients, time to diagnosis, methods of diagnosis, treatments and response to treatment.

PoTS has an impact on quality of life, with patients communicating a drop in quality of life from 7.5 to 3.75 on a 10-point scale. From 40 respondents, 29 patients describe their symptoms improving since diagnosis, with self-rated day-to-day function improving from 3.21 to 6.14 (on a 10-point scale) after initiating treatment.

Many patients experience a delay in receiving a diagnosis with PoTS, and present multiple times to a variety of healthcare professionals. With a simple bedside diagnostic test (sitting and standing heart rate), there is scope to improve the time taken from developing initial symptoms to diagnosis, treatment and an improvement in quality of life.

| Full text

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

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.

| Full text

December 2018 Br J Cardiol 2018;25:159–60 doi:10.5837/bjc.2018.033

Percutaneous endovascular repair of congenital interruption of the thoracic aorta

Richard Armstrong, Kevin Walsh, David Mulcahy

Abstract

Presentation of an interrupted aortic arch in adulthood is rare, and, up until, recently the only treatment strategy was through surgical repair. Advances in percutaneous interventions for congenital heart disease have included the percutaneous repair of coarctation of the aorta – from straightforward luminal narrowing through to full aortic interruption.1-3 We present a case of a 28-year-old man who was diagnosed with a complete aortic interruption and successfully percutaneously treated.

| Full text

October 2018 Br J Cardiol 2018;25:147–9 doi:10.5837/bjc.2018.026

Transitions of an open-heart surgery support lab in a resource-limited setting: effect on turnaround time

Ijeoma Angela Meka, Williams Uchenna Agu, Martha Chidinma Ndubuisi, Chinenye Frances Onyemeh

Abstract

Open-heart surgery is a major surgical procedure that requires intensive patient monitoring. Clinicians require prompt laboratory test results to assist them in this monitoring. Timeliness of result delivery is of great importance in taking prompt clinical decisions. We set out to evaluate the performance of the support laboratory before and after domiciliation at the cardiac centre using turnaround time (TAT) of electrolytes and liver function tests as benchmarks.

This hospital-based descriptive study was carried out at the University of Nigeria Teaching Hospital (UNTH), Enugu. The authors conducted a desk review of laboratory records for electrolytes and liver function tests from March 2013 to July 2017. Relevant laboratory personnel were also interviewed to ascertain types of equipment used and possible causes of delay at different stages of transition during the period under review. The TAT was calculated as the time from sample reception to time of dispatch of results.

Between 2013 and 2014, TAT for electrolytes and liver function tests were ~2 and ~6 hours, respectively. In 2015, TAT reduced to ~1 hour for electrolytes and ~1½ hours for liver function tests. Between 2016 and July 2017, TAT further reduced to ~10 minutes for electrolytes and ~30 minutes for liver function tests.

In conclusion, we were able to demonstrate improvement in performance of the support laboratory as shown by a reduction in TAT following the transition from the main laboratory to being domiciled in the cardiac centre.

| Full text

October 2018 Br J Cardiol 2018;25:150–1 doi:10.5837/bjc.2018.027

Utility of MPS in AAA repair and prognostication of cardiovascular events and mortality

Mark G MacGregor, Neil Donald, Ayesha Rahim, Zara Kwan, Simon Wong, Hannah Sharp, Hannah Burkey, Mark Fellows, David Fluck, Pankaj Sharma, Vineet Prakash, Thang S Han

Abstract

Myocardial perfusion scintigraphy (MPS) is a non-invasive method that can be used to assess reversible left ventricular myocardial perfusion defect (<20% indicates limited and ≥20% indicates extensive ischaemia), and left ventricular ejection fraction (LVEF) at rest and at stress. Data on the utility of MPS used to stratify cardiac risk prior to abdominal aortic aneurysm (AAA) repairs are limited. We evaluated MPS as a stratification tool for patients scheduled for endovascular aneurysm repair (EVAR) or open repair, between 2013 and 2016 at Ashford and St Peter’s NHS Foundation Trust, and 4.9 years (median 2.8 years, interquartile range [IQR] 2.1–3.8) cardiovascular events (n=15, 17.9%) all-cause mortality (n=17, 22.6%). Of the 84 patients recruited (median age 75.7 years, IQR 69.4–79.6), 57 (67.9%) had limited and 27 (32.1%) extensive ischaemia, 62 (73.8%) underwent EVAR and 22 (26.2%) open repair. Compared with open repair patients, EVAR patients were older (median age 70.6 years vs. 76.4 years, p=0.015), had higher rates of extensive ischaemia (13.6% vs. 38.7%, p=0.025), and abnormal LVEF reserve (LVEF at stress minus LVEF at rest ≤0: 40.0% vs. 76.6%, p=0.011), while having lower rates of 30-day postoperative major adverse cardiac events (13.6% vs. 3.3%, p=0.040) but no difference for cardiovascular events (p=0.179) or 4.9 year all-cause mortality (22.7% vs. 22.6%, adjusted hazard ratio 0.80, 95% confidence interval [CI] 0.22 to 3.20, p=0.799). Our findings indicate that MPS provides valuable information for AAA repair procedure.

| Full text

October 2018 Br J Cardiol 2018;25:143–6 doi:10.5837/bjc.2018.028

New-onset giant T-wave inversion with prolonged QT interval: shared by multiple pathologies

Debjit Chatterjee, Priya Philip, Kay Teck Ling

Abstract

This is a case series of 10 patients who presented with the same electrocardiogram (ECG) manifestation of new-onset giant T-wave inversion and QT prolongation over a period of 24 months in a district general hospital. This unique ECG manifestation has been described with several cardiac and non-cardiac conditions.

| Full text

October 2018 Br J Cardiol 2018;25:157–8 doi:10.5837/bjc.2018.029

A case report of transient acute left ventricular dysfunction

Allam Harfoush

Abstract

Stunned myocardium is a rare, but serious, medical condition, and requires emergency intervention. Short periods of hypoperfusion may lead to a prolonged cardiac hypokinesia (hours to days), even though the perfusion is retained eventually. In other words, although the coronary circulation is retained, the hypokinesia remains. It might be considered as a case of prolonged post-ischaemic dysfunction.

In this case, a 60-year-old woman, visiting her siblings, presented with severe dyspnoea and cyanosis to the emergency department. Pulmonary oedema was diagnosed, and transthoracic echocardiography (TTE) showed general hypokinesia and reduced ejection fraction (15%), nevertheless, sequential TTE monitoring after the required medical intervention revealed a continuous improvement, with a 45% ejection fraction three days later and a specific anterior wall hypokinesia, solely.

In conclusion, rapid diagnosis and treatment are essential for stunned myocardium, as these could change the progress of the clinical condition.

| Full text

News and views

Back to top

November 2018 Br J Cardiol 2018;25:131–132

New NICE guidance and first nurse audit in heart failure

The National Institute of Health and Care Excellence (NICE) has published a new guideline on the diagnosis and management of chronic heart failure in...

November 2018 Br J Cardiol 2018;25:131–132

European patient survey shows cancer-associated thrombosis

Blood clots are the second most common cause of preventable mortality in cancer patients. Approximately 4% to 20% of cancer patients experience venous thrombosis,...

November 2018 Br J Cardiol 2018;25:131–132

Preventing potentially fatal anaesthetic accidents

A new study, from the Global Capnography Project (GCAP) and published in the journal Anaesthesia (doi: 10.1111/anae.14426), has identified a need for...

November 2018 Br J Cardiol 2018;25:131–132

Future advances in bifurcation stenting?

Less than 5% of interventional cardiologists attempt left main bifurcation percutaneous coronary intervention stenting procedures because it is so complicated, according to estimates from...

November 2018 Br J Cardiol 2018;25:131–132

Peripheral arterial disease assessment training tool

Clinicians who use handheld devices to ‘listen’ to the blood flow in patients’ lower limbs now have an online teaching aid that will improve...

November 2018 Br J Cardiol 2018;25:133

In brief

Topics covered in brief in this issue include: self-monitoring of type 2 diabetes cuts costs; rivaroxaban licensed in patients with CAD or PAD; new...

October 2018 Br J Cardiol 2018;25:135–7

News from ESC 2018: Not all HDL cholesterol is cardioprotective

Very high levels of high-density lipoprotein (HDL), the lipid that has been considered ‘good’ cholesterol, may be associated with an increased risk of...

October 2018 Br J Cardiol 2018;25:135–7

News from ESC 2018: COMMANDER HF – rivaroxaban in heart failure…

Rivaroxaban, the direct oral, factor Xa inhibitor, does not reduce the risk of a composite end point of survival, myocardial infarction (MI) and...

October 2018 Br J Cardiol 2018;25:135–7

News from ESC 2018: …and in VTE in the MARINER trial

The use of the oral anticoagulant rivaroxaban in medically ill patients for 45 days following hospital discharge showed there was no significant difference...

October 2018 Br J Cardiol 2018;25:135–7

News from ESC 2018: Is it safe for women with heart disease to become pregnant?

“Usually”, appears to be the answer according to 10-year results from the Registry Of Pregnancy And Cardiac disease (ROPAC) a worldwide, prospective registry...

October 2018 Br J Cardiol 2018;25(4)

News from the 10th British Society for Heart Failure Day for revalidation and training

‘All you need to know about heart failure – in one day’ was the promise of the 10th British Society for Heart Failure...

October 2018 Br J Cardiol 2018;25:135–7

European Society of Cardiology 2018 Congress in briefs

This year’s meeting of the European Society of Cardiology (ESC) was held in Munich, Germany, from 25th–29th August...