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Publication Aortic regurgitation management: a systematic review of clinical practice guidelines and recommendations(Oxford University Press, 2022-03-02) Galusko, Victor; Thornton, George; Jozsa, Csilla; Sekar, Baskar; Aktuerk, Dincer; Treibel, Thomas; Petersen, Steffen; Ionescu, Adrian; Ricci, Fabrizio; Khanji, Mohammed; Sekar, Baskar; Medical and DentalGuidelines for the diagnosis and management of aortic regurgitation (AR) contain recommendations that do not always match. We systematically reviewed clinical practice guidelines and summarized similarities and differences in the recommendations as well as gaps in evidence on the management of AR. We searched MEDLINE and Embase (1 January 2011 to 1 September 2021), Google Scholar, and websites of relevant organizations for contemporary guidelines that were rigorously developed as assessed by the Appraisal of Guidelines for Research and Evaluation II tool. Three guidelines met our inclusion criteria. There was consensus on the definition of severe AR and use of echocardiography and of multimodality imaging for diagnosis, with emphasis on comprehensive assessment by the heart valve team to assess suitability and choice of intervention. Surgery is indicated in all symptomatic patients and aortic valve replacement is the cornerstone of treatment. There is consistency in the frequency of follow-up of patients, and safety of non-cardiac surgery in patients without indications for surgery. Discrepancies exist in recommendations for 3D imaging and the use of global longitudinal strain and biomarkers. Cut-offs for left ventricular ejection fraction and size for recommending surgery in severe asymptomatic AR also vary. There are no specific AR cut-offs for high-risk surgery and the role of percutaneous intervention is yet undefined. Recommendations on the treatment of mixed valvular disease are sparse and lack robust prospective data.Publication Mitral regurgitation management: a systematic review of clinical practice guidelines and recommendations(Oxford University Press, 2021-12-08) Galusko, Victor; Sekar, Baskar; Ricci, Fabrizio; Wong, Kit; Bhattacharyya, Sanjeev; Mullen, Michael; Gallina, Sabina; Ionescu, Adrian; Khanji, Mohammed; Sekar, Baskar; Medical and DentalMultiple guidelines exist for the diagnosis and management of mitral regurgitation (MR), the second most common valvular heart disease in high-income countries, with recommendations that do not always match. We systematically reviewed guidelines on diagnosis and management of MR, highlighting similarities and differences to guide clinical decision-making. We searched national and international guidelines in MEDLINE and EMBASE (1 June 2010 to 1 September 2021), the Guidelines International Network, National Guideline Clearinghouse, National Library for Health Guidelines Finder, Canadian Medical Association Clinical Practice Guidelines Infobase, and websites of relevant organizations. Two reviewers independently screened the abstracts and identified articles of interest. Guidelines that were rigorously developed (as assessed with the Appraisal of Guidelines for Research and Evaluation II instrument) were retained for analysis. Five guidelines were retained. There was consensus on a multidisciplinary approach from the heart team and for the definition and grading of severe primary MR. There was general agreement on the thresholds for intervention in symptomatic and asymptomatic primary MR; however, discrepancies were present. There was agreement on optimization of medical therapy in severe secondary MR and intervention in patients symptomatic despite optimal medical therapy, but no consensus on the choice of intervention (surgical repair/replacement vs. transcatheter approach). Cut-offs for high-risk intervention in MR, risk stratification of progressive MR, and guidance on mixed valvular disease were sparse.Publication Automatic adjustment of ventricular antitachycardia pacing and individualized device therapy(Elsevier, 2021-12-06) Tripathi, Rajiv; Gubran, Christopher; Jeavons, Craig; Tripathi, Rajiv; Gubran, Christopher; Medical and DentalNo abstract availablePublication Sudden Cardiac Death in Athletes: Consensuses and Controversies(Springer Nature, 2023-06-02) Ghani, Usman; Farooq, Omer; Alam, Sundus; Khan, Muhammad Junaid; Rahim, Omar; Rahim, Sarah; Alam, Sundus; Khan, Muhammad Junaid; Medical and DentalExercise is widely considered beneficial for cardiovascular health. However, on rare occasions, athletes experience sudden cardiac death without any preceding symptoms. The devastating nature of these events necessitates us to understand the underlying causes. In younger athletes (age <35), the underlying causes are usually hereditary/genetic, whereas in older athletes (age >35), coronary artery disease is prevalent. Sudden cardiac death in athletes can occur regardless of the presence of any structural abnormality in the heart. Despite divergence between guidelines, the majority of cardiology societies recommend at least taking a comprehensive history and performing physical examinations for initial screening for all athletes. This article reviews the consensuses and controversies regarding the incidence, causes, and prevention of sudden cardiac death in athletes.Publication The Spectrum of Heart Failure Management(Springer Nature, 2023-06-18) Ghani, Usman; Farooq, Omer; Aziz, Sundal; Alam, Sundus; Khan, Muhammad Junaid; Rahim, Omar; Khan, Muhammad Junaid; Medical and DentalHeart failure, a complex cardiovascular condition, is a huge burden on patients, caregivers, and healthcare systems and it is prevalent worldwide. Heart failure is caused by a wide variety of underlying conditions that include both cardiac and non-cardiac pathologies. Identifying the underlying cause enables us to apply etiology-based interventions. The spectrum of heart failure management ranges from classification to transplantation. In addition to its classification and monitoring, this article reviews various management strategies, including both conventional methods and the latest innovations. These include lifestyle interventions, pharmacotherapy, device therapy, transplantation, and regenerative medicine.Publication Exploring Sex Inequalities in the Return of Spontaneous Circulation: Quantitative analysis of Adult Out-of-Hospital Cardiac Arrests in England(Elsevier, 2023-10-31) Tang, Sammer; Brown, Terry; Mapstone, James; Tang, Sammer; Medical and DentalNo abstract availablePublication Primary Angioplasty for STEMI Patients With Anomalous Left Coronary Artery Arising From Right Coronary Sinus(Elsevier, 2025-08-06) Anos, Amr; Wassef, Nancy; Anos, Amr; Wassef, Nancy; Medical and DentalWe report a rare case of primary coronary angioplasty in a patient with acute myocardial infarction due to thrombotic occlusion of an anomalous right coronary artery arising from the left sinus of Valsalva. The non-invasive method of ischaemia localisation, such as ST-segment elevation on the electrocardiogram, was useful in identifying the infarct-related artery. A major factor was the selection of the guiding catheter to access the anomalous right coronary artery and also to obtain good angiographic visualisation and adequate support for percutaneous coronary intervention.Publication Cardiovascular Events in Lupus Nephritis: A Systematic Review and Meta-Analysis(Karger Publishers, 2025-04-30) Vakshoori, Mehrbod; Heidari-Bateni, Giv; Mathew, Roy; Abdipour, Amir; Daher, Noha; Hiremath, Swapnil; Hassanein, Mohamed; Golsorkhi, Mohadese; Ebrahimi, Niloufar; Kumar Singh, Arvind; Norouzi, Sayna; Kumar Singh, Arvind; Medical and DentalIntroduction: Systemic lupus erythematous (SLE) is known to be associated with cardiovascular events (CVEs). However, the incidence of CVE has not been thoroughly investigated in lupus nephritis (LN) patients. In this meta-analysis, we aimed to assess the incidence of CVE in patients with LN. Methods: We performed a literature search in PubMed, Scopus, and Web of Science database for studies reporting CVE (myocardial infarction [MI], heart failure, cerebrovascular accident [CVA] [i.e., ischemic or hemorrhagic stroke or transient ischemic attack], any cardiovascular- or cerebrovascular-related disease or death) in patients with LN. In addition, subgroup analyses were conducted according to geographical locations and kidney disease status. We also separately reported the incidence rate of MI, CVA, and cardiovascular- or cerebrovascular-related deaths, with CVE and MI risk in patients with LN. Results: Twenty-one records, encompassing 29,489 subjects, were included. The overall CVE incidence was 9% (95% confidence interval [CI]: 6–12%). Specifically, the incidence of MI (8 studies, n = 5,735), CVA (9 studies, n = 6,053), and mortality attributed to any cardiovascular or cerebrovascular disease (10 studies, n = 26,511) were 4% (95% CI: 2–7%), 4% (95% CI: 2–7%), and 5% (95% CI: 3–7%), respectively. Geographically, patients residing in Asia exhibited a lower incidence of CVE (2.3%, 95% CI: 1.6–3.3%) compared to those residing in North America (10.1%, 95% CI: 5.7–17.2%) and Europe (13.3%, 95% CI: 7.6–22.4%). Patients with LN had higher risk of CVE compared to SLE subjects (odds ratio: 1.18, 95% CI: 1.03–1.34, p = 0.014). Conclusion: CVE occurrence among individuals with LN is significant, and this disease entity increases CVE risk, highlighting the importance of implementing early therapeutic interventions to prevent poor outcomes.Publication Cardiovascular risk assessment for osteoporosis patients considering Romosozumab(Elsevier, 2024-10-23) Macrae, Fiona; Clark, Emma; Walsh, Katherine; Bailey, Sarah-Jane; Roy, Matthew; Hardcastle, Sarah; Cockill, Clare; Tobias, Jon; Faber, Ben; Macrae, Fiona; Medical and DentalCardiovascular risk scoaring tools are suitable for but not interchangable within the osteoporosis clinic.Publication Transcatheter Repair of Acute Torrential Tricuspid Regurgitation Presenting as Platypnea-Orthodeoxia Syndrome(Elsevier, 2025-03-05) Zorman, Mark; Cassar, Mark; Green, Mary; Jenkins, William; Barnes, Cara; Ferreira-Martins, Joao; Newton, James; Cahill, Thomas; Dawkins, Sam; Green, Mary; Jenkins, William; Medical and DentalAn 82-year-old man developed acute breathlessness and cyanosis, exacerbated while upright and improved on lying flat (platypnea-orthodeoxia syndrome). Echocardiography revealed acute torrential tricuspid regurgitation due to a flail posterior leaflet leading to right-to-left shunting through a patent foramen ovale (PFO). The patient’s symptoms resolved after transcatheter PFO closure and tricuspid valve edge-to-edge repair.Publication Regression of late gadolinium enhancement in a case of eosinophilic granulomatous polyangiitis with cardiac involvement(Oxford University Press, 2025-05-26) Tang, Pok-Tin; Raby, Jonathan; Gunn, Jessica; Lewis, Andrew; Gunn, Jessica; Medical and DentalNo abstract availablePublication Sex differences in the radiographic and symptomatic prevalence of knee and hip osteoarthritis(Frontiers Media, 2024-10-04) Faber, Benjamin; Macrae, Fiona; Jung, Mijin; Zucker, Benjamin; Beynon, Rhona; Tobias, Jonathan; Macrae, Fiona; Medical and DentalRecognising sex differences in disease prevalence can lead to clues as to its pathogenesis, for example the role of hormonal factors and related influences such as body composition, as well as forming the basis for new treatments. However, if different methods are used to define the disorder it can be difficult to explore differences in prevalence, making it necessary to draw on multiple sources of evidence. This narrative review addresses sex differences in the prevalence of knee and hip osteoarthritis, which are the most common forms of large joint osteoarthritis. Females appear to have a higher prevalence of knee osteoarthritis across a wide range of disease definitions, while findings for the hip vary depending on how the disease is defined. Clinically or symptomatically defined hip osteoarthritis is more common in females, whereas radiographically defined hip osteoarthritis is more common in males. Therefore, understanding sex differences in large joint arthritis requires consideration that osteoarthritis, as defined structurally, more commonly affects females at the knee, whereas the opposite is true at the hip. Furthermore, despite structural changes in hip osteoarthritis being more common in males, symptomatic hip osteoarthritis is more common in females. The basis for these disparities is currently unclear, but may reflect a combination of hormonal, biomechanical and behavioural factors.Publication Prevalence of Aortic Root Pathologies in Platypnea-Orthodeoxia Syndrome Secondary to Intra-Cardiac Shunts(Elmer Press, 2024-04-15) Farooq, Omer; Ghani, Usman; Friedman, Harvey; Akbar, Muhammad Sikander; Saudye, Hammad; Alam, Sundus; Khan, Muhammad Junaid; Mutti, Sumeet; Alam, Sundus; Khan, Muhammad Junaid; Medical and DentalBackground: Atrial septal defects can allow right to left shunting of venous blood which presents clinically as platypnea-orthodeoxia syndrome. It is believed that concomitant presence of aortic root pathologies increases the likelihood of shunting. Methods: The study included a review of 510 articles listed in PubMed of patients with platypnea-orthodeoxia syndrome. Case reports of patients with extra-cardiac etiologies of platypnea-orthodeoxia were excluded. Results: We reviewed 191 case reports, and 98 cases (51.3%) had evidence of concomitant aortic root pathology. Furthermore, of the remaining 93 case reports, 69 ones excluded any mention of the nature of the aortic root altogether, further suggesting that this is an underreported number. Conclusions: There is a high prevalence of aortic root pathologies in patients with platypnea-orthodeoxia syndrome secondary to intra-cardiac shunts. In patients with unexplained hypoxemia and incidental finding of aortic root pathology, it may be worthwhile to obtain postural oxygen saturation measurements to exclude intra-cardiac shunts as the potential cause.Publication Dual Chamber Pacemaker Implant in Coronary Sinus Leading to Several Complications(MDPI, 2024-11-05) Wassef, Nancy; Ibrahim, Mina; Botrous, Christine; Anos, Amr; Hogrefe, Kai; Pathiraja, Janaka; Wassef, Nancy; Botrous, Christine; Anos, Amr; Pathiraja, Janaka; Medical and DentalPermanent pacemaker implantation is a low-risk procedure. However, complications may occur at a rate of around 4-8%. We present a case where initial implantation resulted in complications that could have been avoided by meticulous assessment of lead position in different projections and early post-procedure X-ray that would have delineated other serious complications. We present a case where the right ventricular lead was placed in the coronary sinus, which resulted in the loss of pacing capture with further syncope after the pacemaker implant. This was apparent in the post-procedure electrocardiogram (ECG) with right bundle branch pacing and the lead was repositioned in the right ventricular apex the following day. Furthermore, the patient was discharged home without a chest X-ray (CXR), and she represented a week later with a haemo-pneumothorax and pericardial effusion. A chest drain was placed and was discharged after a slow recovery following several complications that could have been avoidable.