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Publication COVID-19 Management and Arrhythmia: Risks and Challenges for Clinicians Treating Patients Affected by SARS-CoV-2(Frontiers Media, 2020-05-05) Carpenter, Alexander; Chambers, Owen; El Harchi, Aziza; Bond, Richard; Hanington, Oliver; Harmer, Stephen; Hancox, Jules; James, Andrew; Bond, Richard; Medical and DentalThe COVID-19 pandemic is an unprecedented challenge and will require novel therapeutic strategies. Affected patients are likely to be at risk of arrhythmia due to underlying comorbidities, polypharmacy and the disease process. Importantly, a number of the medications likely to receive significant use can themselves, particularly in combination, be pro-arrhythmic. Drug-induced prolongation of the QT interval is primarily caused by inhibition of the hERG potassium channel either directly and/or by impaired channel trafficking. Concurrent use of multiple hERG-blocking drugs may have a synergistic rather than additive effect which, in addition to any pre-existing polypharmacy, critical illness or electrolyte imbalance, may significantly increase the risk of arrhythmia and Torsades de Pointes. Knowledge of these risks will allow informed decisions regarding appropriate therapeutics and monitoring to keep our patients safe.Publication 29 The use of residual syntax score for prognostication in elderly patients undergoing percutaneous coronary intervention(BMJ Publishing Group, 2020-01-18) Abramik, Joanna; Kontogiannis, Nestoras; Scarsini, Roberto; De Maria, Giovanni Luigi; Raina, Tushar; KASSIMIS, GEORGE; Abramik, Joanna; Kontogiannis, Nestoras; Raina, Tushar; Medical and DentalNo abstract availablePublication HBA1C TESTING IN PATIENTS ADMITTED WITH ACUTE CORONARY SYNDROMES IDENTIFIES POOR GLYCAEMIC CONTROL AND FACILITATES NEW DIAGNOSES OF DIABETES(BMJ Publishing Group, 2020-07-17) Williams, Howell; Kelshiker, Mihir; Mouy, Florence; Rendall, Alice; Sabin, Jodie; Thrower, Sally; Hui, Elaine; Raina, Tushar; Shah, Jaymin; William, Howell; Mouy, Florence; Sabin, Jodie; Thrower, Sally; Raina, Tushar; Medical and DentalAbstract Background Diabetes is a powerful but modifiable vascular risk factor, and it is well-established that effective glycaemic control improves cardiovascular outcomes. Current international guidelines do not recommend routine measurement of HbA1c in patients with acute coronary syndrome (ACS). We hypothesise that measuring HbA1c levels in all patients during admission to hospital with ACS would allow: Identification of patients with known diabetes and poor glycaemic control Increased diagnoses in patients with previously undiagnosed diabetes Aims To identify how often HbA1c was measured in patients admitted with ACS, and when measured whether HbA1c identified poor glycaemic control in patients with known diabetes and/or led to new diagnoses of diabetes. Methods Measurement of HbA1c was audited among patients admitted with ACS to two large acute NHS Trusts. Electronic records of patients admitted with ACS during a two-month period at Trust 1 and a three-month period at Trust 2 were analysed. Results 218 patients were admitted with ACS (122/218 Trust 1, 96/218 Trust 2). Mean age was 71 (range 34-97), 70% male. 77/218 (35%) had known diabetes. HbA1c was measured during admission (or <3 months prior) in 51/218 (23%) of patients in total (37/122 [30%] in Trust 1 and 14/96 [15%] in Trust 2). 36/51 had known diabetes; in this population mean HbA1c was 68mmol/mol (range 39-121). Poor glycaemic control (HbA1c >64mmol/mol) was identified in 16/36 (44%) patients with known diabetes. 15/51 patients did not have known diabetes; in this population mean HbA1c was 40mmol/mol (range 31-50). HbA1c testing led to 1 new diagnosis of diabetes being confirmed. Among patients with known diabetes, 33/36 who had an HbA1c test underwent invasive angiography; 15/33 had an HbA1c >64mmol/mol and 18/33 HbA1c <64mmol/mol. The HbA1c >64mmol/mol population were more likely to undergo CABG than be managed with PCI or medical therapy alone than the HbA1c <64mmol/mol population (3/15 [20%] and 0/18 required CABG respectively, p=0.05). Comparing all patients with HbA1c >64mmol/mol (n=16) and HbA1c <64mmol/mol (n=35), there was no difference in length of stay. There were no in-hospital deaths and ACS re-admission rates were not significantly different (3/16 [19%] and 4/35 [11%] respectively, p=0.54) over mean 2.5 year follow-up Conclusion In this study of patients admitted with ACS, HbA1c testing identified poor glycaemic control in a large number of patients with known diabetes. Only 1 new diagnosis of diabetes was made, likely due to established screening programs in primary care being effective in prior identification. Among patients with known diabetes, revascularisation with CABG was more common in those with poor glycaemic control in keeping with current revascularisation guidelines. HbA1c testing therefore identified a higher risk group within the ACS population, as well as identifying poor glycaemic control. These results, taken together with the recent development of novel therapies for diabetes, suggest that HbA1c testing should be considered routinely in all patients admitted with ACS.Publication 33 Percutaneous coronary intervention in elderly patients – ten years’ experience from a large non-surgical centre(BMJ Publishing Group, 2020-07-17) Abramik, Joanna; Dastidar, Amardeep; Kontogiannis, Nestoras; Patri, Gopendu; North, Victoria; Weight, Nicholas; Raina, Tushar; Kassimis, George; Abramik, Joanna; Kontogiannis, Nestoras; North, Victoria; Weight, Nicholas; Raina, Tushar; Medical and DentalBackground With an ageing population, the need for treating coronary artery disease in the elderly using percutaneous coronary intervention (PCI) is on the rise. Technical advances, better peri-procedural pharmacology and greater operator experience have led to improved outcomes after PCI. Octogenarians as a group, however, have been underrepresented in randomised clinical trials for coronary revascularisation. Observational studies therefore provide useful insights into the safety and efficacy of PCI in this patient population in a real-world setting. Aim The aim of this study was to examine the trends in patient characteristics and clinical outcomes after PCI in octogenarians over a 10-year period in a large non-surgical PCI centre and to determine the predictors of mortality in this high risk patient cohort. Methods A total of 782 consecutive octogenarians were identified from a prospectively collected database of all patients undergoing PCI at our centre over a 10-year period between 1st January 2007 and 31st December 2016. The analysis evaluated the characteristics of the cohort with respect to all-cause in- hospital and 1-year mortality, in-hospital Major Adverse Cardiovascular Events (MACE) rates, duration of hospital stay, complexity of coronary artery disease and major comorbidities. The cohort was stratified into three chronological tertiles to assess differences over time. A multivariate analysis was performed to determine predictors for mortality in this patient cohort. Results The number of octogenarians undergoing PCI was found to have increased nearly ten-fold, from 19 in 2007 to 178 in 2016 (Figure 1). Despite this, there were no statistically significant differences in adverse clinical outcomes or peri-procedural patient characteristics (Table 1). A greater use of radial access for performing PCI was noted (p<0.0001), as well as increasing proportion of patients with multivessel disease (p=0.011). Increasing age, the presence of cardiogenic shock, severe left ventricular impairment, peripheral vascular disease, diabetes mellitus and low creatinine clearance were identified as independent predictors of mortality after PCI (Table 2). Conclusion This study has shown that PCI in octogenarians is a safe and effective revascularisation option, which is increasingly being used in the real-world clinical practice. Further randomised clinical trial data is needed to enhance the evidence base for this challenging patient population.Publication Shockwave Intravascular Lithotripsy for the Treatment of Severe Vascular Calcification(SAGE Publications, 2020-06-22) Kassimis, George; Didagelos, Matthaios; De Maria, Giovanni; Kontogiannis, Nestoras; Karamasis, Grigoris; Katsikis, Athanasios; Sularz, Agata; Karvounis, Haralambos; Kanonidis, Ioannis; Krokidis, Miltiadis; Ziakas, Antonios; Banning, Adrian; Kontogiannis, Nestoras; Medical and DentalVascular calcification is a highly prevalent pathophenotype that is associated with aging, atherosclerotic cardiovascular disease, diabetes mellitus, and chronic kidney disease. When present, it portends a worse clinical outcome and predicts major adverse cardiovascular events. Heavily calcified coronary and peripheral artery lesions are difficult to dilate appropriately with conventional balloons during percutaneous intervention, and the use of several adjunctive strategies of plaque modification has been suggested. Intravascular lithotripsy (IVL) offers a novel option for lesion preparation of severely calcified plaques in coronary and peripheral vessels. It is unique among all technologies in its ability to modify calcium circumferentially and transmurally, thus modifying transmural conduit compliance. In this article, we summarize the currently available evidence on this technology, and we highlight its best clinical application through appropriate patient and lesion selection, with the main objective of optimizing stent delivery and implantation, and subsequent improved short- and long-term outcomes. We believe that the IVL balloon will transform the market, as it is easy to use, with predictable results. However, cost-effectiveness of such advanced technology will need to be considered.Publication Successful bailout T‑stenting for iatrogenic coronary dissection involving left main stem bifurcation: “first, do no harm”(Via Medica, 2020-08-13) KASSIMIS, GEORGE; Konstantinos, Theodoropoulos; Kontogiannis, Nestoras; Raina, Tushar; Kassimis, George; Kontogiannis, Nestoras; Tushar, Raina; Medical and DentalNo abstract availablePublication Identification of familial hypercholesterolaemia in patients presenting with premature acute coronary syndrome(BMJ Publishing Group, 2021-06-04) Duff, James; Wang, Robin; Graby, John; O'Doherty, Moya; Wang, Robin; Medical and DentalIntroduction Familial hypercholesterolaemia (FH) is an underdiagnosed inherited disorder which confers substantial risk of premature cardiovascular disease. Over 90% of those with FH in the UK remain undiagnosed. Its importance was acknowledged in the 2019 NHS long term plan with an aim to identify 25% of FH patients by 2025. Patients with FH may present with an early acute coronary syndrome (ACS) which may represent the first opportunity for diagnosis. Identification of possible FH in this cohort enables specialist follow up, mitigation of risk and investigation of family members via cascade testing. We evaluated local disease burden, assessment of dyslipidaemia and identification of possible FH in a retrospective single centre review. Methods A retrospective review was conducted of patients presenting with premature ACS to Royal United Hospitals Bath over a 1-year period. Results We identified 96/573 (17%) patients who presented with ACS under age 60. Although 77/96 (80%) patients had cholesterol measured within 24 hours, only 13/96 (14%) patients had a full lipid profile checked. 14/77 (18%) had a total cholesterol >6.0, of whom 4/14 (29%), 4/14 (29%) and 7/14 (50%) had investigation for hypothyroidism, diabetes or alcohol excess respectively, as secondary causes for hypercholesterolaemia. 5/14 (36%) patients with total cholesterol >6.0 had a family history taken with ages of relatives at onset of CVD; 4/5 (80%) of those asked had a family history of premature CVD. Upon review of high risk cases, 8 were deemed appropriate for referral to lipid clinic, while a further 5 patients may have warranted referral in the presence of a significant family history, but this information was absent in the medical notes. A decision to refer to lipid clinic was documented in 4 patients’ notes, although only 2 referrals were received. Conclusion We identified missed opportunities in the identification of genetic dyslipidaemia (including FH) within a high-risk population. Further investigation through referral to lipid clinic was limited by a number of factors. Limited details of family history, particularly in patients with significant dyslipidaemia, is likely to contribute to under-identification of FH. We identified variable risk stratification and reduced clarity on the accepted threshold for referral to lipid clinic as key barriers to appropriate diagnosis. We propose the introduction of a degree of protocolisation through an ‘ACS proforma’ and ‘lipid clinic referral decision aid’ to facilitate appropriate identification, assessment and management of patients with possible FH.Publication Persisting Adverse Ventricular Remodeling in COVID-19 Survivors: A Longitudinal Echocardiographic Study(Elsevier, 2021-02-01) Moody, William; Liu, Boyang; Mahmoud-Elsayed, Hani; Senior, Jonathan; Lalla, Sasha; Khan-Kheil, Ayisha; Brown, Stewart; Saif, Abdullah; Moss, Alastair; Bradlow, William; Khoo, Jeffrey; Ahamed, Mubarak; McAloon, Christopher; Hothi, Sandeep; Steeds, Richard; Brown, Stewart; McAloon, Christopher; Medical and DentalNo abstract availablePublication Should Percutaneous Coronary Intervention be the Standard Treatment Strategy for Significant Coronary Artery Disease in all Octogenarians?(Bentham Science Publishers, 2021-05-01) Kassimis, George; Karamasis, Grigoris; Katsikis, Athanasios; Abramik, Joanna; Kontogiannis, Nestoras; Didagelos, Matthaios; Petroglou, Dimitrios; Papadopoulos, Christodoulos; Poulimenos, Leonidas; Vassilikos, Vassilios; Kanonidis, Ioannis; Raina, Tushar; Ziakas, Antonios; Abramik, Joanna; Kontogiannis, Nestoras; Medical and DentalCoronary artery disease (CAD) remains the leading cause of cardiovascular death in octogenarians. This group of patients represents nearly a fifth of all patients treated with percutaneous coronary intervention (PCI) in real-world practice. Octogenarians have multiple risk factors for CAD and often greater myocardial ischemia than younger counterparts, with a potential of an increased benefit from myocardial revascularization. Despite this, octogenarians are routinely under- -treated and belittled in clinical trials. Age does make a difference to PCI outcomes in older people, but it is never the sole arbiter of any clinical decision, whether in relation to the heart or any other aspect of health. The decision when to perform revascularization in elderly patients and especially in octogenarians is complex and should consider the patient on an individual basis, with clarification of the goals of the therapy and the relative risks and benefits of performing the procedure. In ST-segment elevation myocardial infarction (MI), there is no upper age limit regarding urgent reperfusion and primary PCI must be the standard of care. In non-ST-segment elevation acute coronary syndromes, a strict conservative strategy must be avoided; whereas the use of a routine invasive strategy may reduce the occurrence of MI and the need for revascularization at follow-up, with no established benefit in terms of mortality. In stable CAD patients, invasive therapy on top of optimal medical therapy seems better in symptom relief and quality of life. This review summarizes the available data on percutaneous revascularization in the elderly patients and particularly in octogenarians, including practical considerations on PCI risk secondary to ageing physiology. We also analyse technical difficulties met when considering PCI in this cohort and the ongoing need for further studies to ameliorate risk stratification and eventually outcomes in these challenging patients.Publication Contouring techniques in cardiac magnetic resonance assessment of right ventricular volumes in repaired tetralogy of fallot(Elsevier, 2022-08-06) Lodge, Freya; Moody, William; McAloon, Christopher; Stoll, Victoria; Mahmoud-Elsayed, Hani; Steeds, Richard; Holloway, Benjamin; Hudsmith, Lucy; McAloon, Christopher; Medical and DentalIntroduction: Right ventricular size and function on cardiac MRI provides thresholds for referral for pulmonary valve intervention in repaired Tetralogy of Fallot (RTOF). However, different contouring techniques are available to calculate right ventricular volumes and ejection fraction. It is not known whether these contouring techniques impact on threshold triggers for intervention. Methods: Right ventricular volumes on cardiac MRI for 24 consecutive subjects with RTOF were measured by two independent, experienced observers using three contouring techniques: smooth, detailed manual and detailed with semi-automated thresholding. Results: End-diastolic and end-systolic volumes were significantly different between contouring techniques: largest for smooth contours, intermediate for thresholding and smallest for manual (EDV: smooth 233 ml, SD 105 ml; thresholding 215 ml, SD 95 ml; manual 206 ml, SD 94 ml; ESV: smooth 122 ml, SD 71 ml; thresholding 113 ml, SD 67 ml; manual 103 ml, SD 64 ml; p < 0.001 for all comparisons). Stroke volume from contours by thresholding correlated most strongly with velocity mapping (r = 0.87, p < 0.001). Interobserver agreement was strongest for smooth (end-diastolic volume ICC = 1.0 (confidence interval (CI):0.999-1.0, p < 0.001); end-systolic volume ICC = 0.999 (CI:0.994-1.0, p < 0.001) and weakest for manual contours ((end-diastolic volume ICC = 0.89 (CI:0.33-0.99, p = 0.01); end-diastolic volume ICC = 0.88 (CI:0.30-0.99, p = 0.01). Intra-observer agreement was uniformly high (ICC≥0.996, p < 0.001 for all). In 4/24 cases, contouring technique altered threshold triggers for pulmonary valve intervention. Conclusions: Differences in contouring technique for measuring right ventricular volumes in patients with RTOF can affect thresholds triggering referral for pulmonary valve intervention. Standardisation of right ventricular measurement is needed in congenital cardiac MRI practice.Publication Prospective multicentre cohort study of transthoracic echocardiography provision in the South West of the UK during the first wave of SARS-CoV-2 pandemic(BMJ Publishing Group, 2021-01-27) Crook, Rebecca; Williams, Howell; Green, Mary; Brown, Stewart; Morris, Richard; Fletcher, Hannah; Walters, Sarah; Walsh, Catherine; Price, Anna; King, Samantha; McAloon, Christopher; Crook, Rebecca; Williams, Howell; Green, Mary; Brown, Stewart; Morris, Richard; Fletcher, Hannah; Walters, Sarah; Walsh, Catherine; Price, Anna; King, Samantha; McAloon, Christopher; Medical and Dental; Additional Professional Scientific and Technical; Nursing and Midwifery RegisteredAims: It was predicted internationally that transthoracic echocardiography (TTE) would be vital during the SARS-CoV-2 outbreak. We therefore, designed a study to report the demand for TTE in two large District General Hospitals during the rise in the first wave of the SARS-CoV-2 pandemic in the UK. A primary clinical outcome of 30-day mortality was also assessed. Methods: The TTE service across two hospitals was reconfigured to maximise access to inpatient scanning. All TTEs of suspected or confirmed SARS-CoV-2 patients over a 3-week period were included in the study. All patients were followed up until at least day 30 after their scan at which point the primary clinical outcome of mortality was recorded. Comparative analysis based on mortality was conducted for all TTE results, biochemical markers and demographics. Results: 27 patients with confirmed SARS-CoV-2 had a TTE within the inclusion window. Mortality comparative analysis showed the deceased group were significantly older (mean 68.4, SD 11.9 vs 60.5, SD 13.0, p=0.03) and more commonly reported fatigue in their presenting symptoms (29.6% vs 71.4%, p=0.01). No other differences were identified in the demographic or biochemical data. Left ventricular systolic dysfunction was noted in 7.4% of patients and right ventricular impairment or dilation was seen in 18.5% patients. TTE results were not significantly different in mortality comparative analysis. Conclusion: This study demonstrates an achievable approach to TTE services when under increased pressure. Data analysis supports the limited available data suggesting right ventricular abnormalities are the most commonly identified echocardiographic change in SARS-CoV-2 patients. No association can be demonstrated between mortality and TTE results.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.