Thu.Dec 28, 2023

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What’s wrong with the NHS? – part five

Dr. Malcolm Kendrick

29th December 2023 The underlying forces In the last few blogs, I have been writing about the proliferation of guidelines, targets, and regulatory work in the NHS. Hopefully I have managed to give you a sense of how much time and effort these pile on to everyday work. Time and effort which eats away at clinical time, erodes morale and drives down productivity.

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New Secure Image Sharing Technology: Save Time and Reduce Costs

NOVARAD

Healthcare organizations are always looking for ways to save time and money while providing quality patient care. As innovative technology emerges, new secure image-sharing technology that maximizes time and reduces costs has taken the forefront of data mobility.

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Oral Factor XIa Inhibitor Disappoints for Secondary Stroke Prevention

Med Page Today

(MedPage Today) -- Factor XIa inhibitor milvexian did not provide meaningful secondary prevention over dual antiplatelet therapy for stroke survivors, the phase II trial AXIOMATIC-SSP found. In patients with recent ischemic stroke or transient.

Stroke 95
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Impact of Transjugular Intracardiac Echocardiography-Guided Self-Expandable Transcatheter Aortic Valve Implantation on Reduction of Conduction Disturbances

Circulation: Cardiovascular Interventions

Circulation: Cardiovascular Interventions, Ahead of Print. BACKGROUND:A high permanent pacemaker implantation (PPI) risk remains a concern of self-expandable transcatheter aortic valve implantation, despite the continued improvements in implantation methodology. We aimed to assess the impact of real-time direct visualization of the membranous septum using transjugular intracardiac echocardiography (ICE) during transcatheter aortic valve implantation on reducing the rates of conduction disturbanc

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Premier Health, Christ Hospital tap exec to lead cardiovascular partnership

Becker's Hospital Review - Cardiology

Deb Kiser, RN, BSN, was named executive lead of the new cardiovascular partnership between Dayton, Ohio-based Premier Health and The Christ Hospital Health Network.

RN 64
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Impact of Intensity of Vascular Care Preceding Major Amputation Among Patients With Chronic Limb-Threatening Ischemia

Circulation: Cardiovascular Interventions

Circulation: Cardiovascular Interventions, Ahead of Print. BACKGROUND:Lower-limb amputation rates in patients with chronic limb-threatening ischemia vary across the United States, with marked disparities in amputation rates by gender, race, and income status. We evaluated the association of patient, hospital, and geographic characteristics with the intensity of vascular care received the year before a major lower-limb amputation and how intensity of care associates with outcomes after amputation

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Contractile effects of amphetamine, pseudoephedrine, nor-pseudoephedrine (cathine) and cathinone on atrial preparations of mice and humans

Journal of Cardiovascular Pharmacology

Amphetamine derivatives are used worldwide legally or illegally and intoxications may be accompanied by cardiac arrhythmias. Here, we tested contractile effects of cumulative applied (±)-amphetamine, pseudoephedrine, nor-pseudoephedrine (cathine) and cathinone in electrically stimulated (1 Hz) human right atrial preparations (HAP) and mouse left atrial preparations (LA) as well as in spontaneously beating mouse right atrial preparations (RA).

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KCNQ5 Controls Perivascular Adipose Tissue–Mediated Vasodilation

Hypertension Journal

Hypertension, Ahead of Print. BACKGROUND:Small arteries exhibit resting tone, a partially contracted state that maintains arterial blood pressure. In arterial smooth muscle cells, potassium channels control contraction and relaxation. Perivascular adipose tissue (PVAT) has been shown to exert anticontractile effects on the blood vessels. However, the mechanisms by which PVAT signals small arteries, and their relevance remain largely unknown.

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New Study Highlights Most Frequent Elicitors of Work-Related Anaphylaxis Cases

HCPLive

These results provided valuable insights into occupational anaphylaxis through the use of anaphylaxis registry data.

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Proteogenomic Data Integration Reveals CXCL10 as a Potentially Downstream Causal Mediator for IL-6 Signaling on Atherosclerosis

Circulation

Circulation, Ahead of Print. BACKGROUND:Genetic and experimental studies support a causal involvement of IL-6 (interleukin-6) signaling in atheroprogression. Although trials targeting IL-6 signaling are underway, any benefits must be balanced against an impaired host immune response. Dissecting the mechanisms that mediate the effects of IL-6 signaling on atherosclerosis could offer insights about novel drug targets with more specific effects.METHODS:Leveraging data from 522 681 individuals, we c

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Allergy Questionnaire: Spotlighting Results of Delabeling Penicillin Allergy with Direct Oral Challenge

HCPLive

This study looked at results of DOC, allergy risk level risk distinctions, and rationale for families and physicians to move forward with DOC.

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Neuroimmune Modulation Mediated by Il-6: A Potential Target for the Treatment of Ischemia-Induced Ventricular Arrhythmias

HeartRhythm

Neural remodeling in the left stellate ganglion (LSG), as mediated by neuroimmune reactions, promotes cardiac sympathetic nerve activity (SNA) and thus increases incidence of VAs. Interleukin-6 is an important factor of the neuroimmune interaction.

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Metabolic Communication by SGLT2 Inhibition

Circulation

Circulation, Ahead of Print. BACKGROUND:SGLT2 (sodium-glucose cotransporter 2) inhibitors (SGLT2i) can protect the kidneys and heart, but the underlying mechanism remains poorly understood.METHODS:To gain insights on primary effects of SGLT2i that are not confounded by pathophysiologic processes or are secondary to improvement by SGLT2i, we performed an in-depth proteomics, phosphoproteomics, and metabolomics analysis by integrating signatures from multiple metabolic organs and body fluids after

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Social Determinants of Health and Disparities in Hypertension and Cardiovascular Diseases

Hypertension Journal

Hypertension, Ahead of Print. High blood pressure causes over 10 million preventable deaths annually globally. Populations in low- and middle-income countries suffer the most, experiencing increased uncontrolled blood pressure and cardiovascular disease (CVD) deaths. Despite improvements in high-income countries, disparities persist, notably in the United States, where Black individuals face up to 4× higher CVD mortality than White individuals.Social determinants of health encompass complex, mul

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NEJM Journal Watch Cardiology Top Stories of 2023

NEJM Journal Watch - Cardiology

NEJM Journal Watch reviews over 250 scientific and medical journals to present important clinical research findings and insightful commentary

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Artificial Intelligence methods for Improved Detection of undiagnosed Heart Failure with Preserved Ejection Fraction (HFpEF)

European Journal of Heart Failure

Abstract Background and aim Heart Failure with preserved Ejection Fraction (HFpEF) remains under-diagnosed in clinical practice despite accounting for nearly half of all Heart Hailure (HF) cases. Accurate and timely diagnosis of HFpEF is crucial for proper patient management and treatment. In this study, we explored the potential of natural language processing (NLP) to improve the detection and diagnosis of HFpEF according to the European Society of Cardiology (ESC) diagnostic criteria.

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Safety and Efficacy of Reteplase Versus Alteplase for Acute Ischemic Stroke: A Phase 2 Randomized Controlled Trial

Stroke Journal

Stroke, Ahead of Print. BACKGROUND:Reteplase is a more affordable new-generation thrombolytic with a prolonged half-life. We aimed to determine the safety dose range of reteplase for patients with acute ischemic stroke within 4.5 hours of onset.METHODS:This is a multicenter, prospective, randomized controlled, open-label, blinded-end point phase 2 clinical trial.

Stroke 40
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Exercise catheterization in adults post?Fontan with normal and abnormal hemodynamic criteria: insights into normal Fontan physiology

European Journal of Heart Failure

Abstract Background The normal (i.e., expected) hemodynamics in adults post-Fontan remain poorly delineated. Moreover, the definitions of elevated exercise pulmonary artery (PA) and PA wedge pressure (PAWP) for this population have not been described. Methods and Results Seventy-two adults post-Fontan undergoing exercise catheterization were categorized into abnormal (Group I, n = 59; defined as resting mean PA ≥14 mmHg and/or PAWP ≥12 mmHg, ΔPAWP/Δsystemic flow >2 mmHg/L/min, and/or ΔPA/Δpul

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Calculating Relative Lung Perfusion Using Fluoroscopic Sequences and Image Analysis: The Fluoroscopic Flow Calculator

Circulation: Cardiovascular Interventions

Circulation: Cardiovascular Interventions, Ahead of Print. BACKGROUND:Maldistribution of pulmonary blood flow in patients with congenital heart disease impacts exertional performance and pulmonary artery growth. Currently, measurement of relative pulmonary perfusion can only be performed outside the catheterization laboratory. We sought to develop a tool for measuring relative lung perfusion using readily available fluoroscopy sequences.METHODS:A retrospective cohort study was conducted on patie

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Effects of Contact Force on Lesion Size During Pulsed Field Catheter Ablation: Histochemical Characterization of Ventricular Lesion Boundaries

Circulation: Arrhythmia and Electrophysiology

Circulation: Arrhythmia and Electrophysiology, Ahead of Print. Background:Effects of contact force (CF) on lesion formation during pulsed field ablation (PFA) have not been well validated. The purpose of this study was to determine the relationship between average CF and lesion size during PFA using a swine-beating heart model.Methods:A 7F catheter with a 3.5-mm ablation electrode and CF sensor (TactiCath SE, Abbott) was connected to a PFA system (CENTAURI, Galvanize Therapeutics).

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Cardiorespiratory Fitness and Risk of Heart Failure with Preserved Ejection Fraction

European Journal of Heart Failure

Abstract Aims Preventive strategies for heart failure (HF) with preserved ejection fraction (HFpEF) include pharmacotherapies and lifestyle modifications. However, the association between cardiorespiratory fitness (CRF) assessed objectively by a standardized exercise treadmill test (ETT) and the risk of HFpEF has not been evaluated. Thus, we evaluated the association between CRF and HFpEF incidence.

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Confronting Treatment Disparities in Chronic Limb-Threatening Ischemia

Circulation: Cardiovascular Interventions

Circulation: Cardiovascular Interventions, Ahead of Print.

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Coronary cameral fistula secondary to pacemaker implantation

Coronary Artery Disease Journal

No abstract available

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Intravenous Tenecteplase and Carotid Artery Stenting in a Young Adult With Fibromuscular Dysplasia and Carotid Dissection

Stroke Journal

Stroke, Ahead of Print.

Stents 40
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Anomalous origin of the right coronary artery originating from the pulmonary trunk: pre- and postoperative computed tomography images and virtual reality reconstructions

Coronary Artery Disease Journal

No abstract available

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Reduction in Racial Differences in Stroke Thrombolytics in Flint, Michigan

Stroke Journal

Stroke, Ahead of Print.

Stroke 40
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Dr. Rasha Al-Lamee and Dr. C. Michael Gibson Present: An Interventional Cardiology 2023 Year in Review

Clinical Trial Results

Disclosures: TBD

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Past, Present, and Future of Intracranial Atherosclerosis Treatment

Stroke Journal

Stroke, Ahead of Print.

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Cardiovascular Complications in Pheochromocytoma and Paraganglioma: Does Phenotype Matter?

Hypertension Journal

Hypertension, Ahead of Print. BACKGROUND:Adrenaline-producing tumors are mostly characterized by a sudden release of catecholamines with episodic symptoms. Noradrenergic ones are usually less symptomatic and characterized by a continuous overproduction of catecholamines that are released into the bloodstream. Their effects on the cardiovascular system can thus be different.

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Stroke in Women: Research Accomplishments and Remaining Gaps

Stroke Journal

Stroke, Ahead of Print.

Stroke 40
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Arterial Thromboembolism in Patients With Atrial Fibrillation and CHA2DS2-VASc 1: A Nationwide Study

Circulation

Circulation, Ahead of Print. BACKGROUND:Oral anticoagulation is suggested in patients with atrial fibrillation and a CHA2DS2-VASc score ≥1 (congestive heart failure, hypertension, age ≥75 years, diabetes, stroke, vascular disease, age 65–74 years, and sex score). To assess granular differences within CHA2DS2-VASc 1, the incidence of arterial thromboembolism according to CHA2DS2-VASc 1 subgroups was examined.METHODS:The Danish National Patient Registry and the Danish Prescription Registry linked

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Sex-Specific Risk Factors of Nonstenotic Carotid Plaque in Embolic Stroke of Unknown Source: A Case-Control Study

Stroke Journal

Stroke, Ahead of Print. BACKGROUND:Many ischemic strokes are diagnosed as embolic strokes of undetermined source (ESUS). Recent evidence suggests that nonstenotic carotid plaque (nsCP) may be a substantial contributor to the risk for ESUS. We aimed to investigate the risk factor profile associated with nsCP in ESUS and defined stroke etiologies.METHODS:In this retrospective case-control study, we investigated consecutive patients with acute ischemic stroke due to ESUS, small-vessel disease, or c

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Fetal Sexual Dimorphism and Preeclampsia Among Twin Pregnancies

Hypertension Journal

Hypertension, Ahead of Print. BACKGROUND:In singleton pregnancies, fetal sexual dimorphism has been observed in hypertensive disorders of pregnancy, particularly preeclampsia, a morbid syndrome that increases the risk of adult-onset cardiovascular disease for mothers and their offspring. However, few studies have explored the effect of fetal sex on hypertensive disorders of pregnancy among twin pregnancies.METHODS:We conducted a retrospective cohort study of 1032 twin pregnancies between 2011 an

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Association between bone mineral density and coronary plaque burden in patients with coronary artery disease: a cross-sectional study using quantitative computed tomography

Coronary Artery Disease Journal

Purpose To evaluate the association between osteoporosis and coronary calcification and coronary plaque burden in patients with atherosclerosis and coronary artery disease (CAD). Methods This study included 290 men and 177 postmenopausal women with angiography-confirmed atherosclerosis or CAD who underwent chest multidetector row computed tomography covering L1-L2 between September 2020 and October 2021.