Defining the Process of a Cardiovascular Risk Assessment Program: Lessons Learned From Cardiac Assessment of Elite Soccer Players in the United Kingdom.

Objective: Retrospectively analyze the cardiac assessment process for elite soccer players, and provide team physicians with a systematic guide to managing longitudinal cardiac risk.

Design: Descriptive Epidemiology Study.

Setting: Cardiac assessments incorporating clinical examination, 12-lead ECG, echocardiography, and health questionnaire.

Exercise and the right ventricle: a potential Achilles' heel.

Exercise is associated with unequivocal health benefits and results in many structural and functional changes of the myocardium that enhance performance and prevent heart failure. However, intense exercise also presents a significant hemodynamic challenge in which the right-sided heart chambers are exposed to a disproportionate increase in afterload and wall stress that can manifest as myocardial fatigue or even damage if intense exercise is sustained for prolonged periods. This review focuses on the physiological factors that result in a disproportionate load on the right ventricle during exercise and the long-term consequences.

Use of the CHADSVASc score to reduce utilisation of transoesophageal echocardiography prior to ablation for atrial fibrillation.

Transoesophageal echocardiography (TOE) is frequently performed prior to atrial fibrillation (AF) ablation to exclude left atrial appendage (LAA) thrombus. However, patients undergoing AF ablation are usually anticoagulated, thus making the presence of thrombus unlikely in most cases. This study aimed to determine whether the CHADSVASc scoring system can be used to identify patients that do not require TOE prior to AF ablation.

Simultaneous myocardial infarction and ischaemic stroke secondary to paradoxical emboli through a patent foramen ovale.

Myocardial infarction (MI) and stroke are common acute conditions that regularly present as an emergency to hospital. Paradoxical embolism is a recognised complication of patent foramen ovale (PFO), and the literature shows that it can cause ischaemic stroke or, less frequently, acute MI. Ischaemic stroke and MI occurring simultaneously has a wide differential diagnosis, which should include a PFO, especially when occurring in young patients.

Aorto-atrial fistula in the absence of infective endocarditis: diagnosis by 2- and 3-dimensional transesophageal echocardiography.

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The clinical applications of myocardial contrast echocardiography.

Recent updates in the field of echocardiography have resulted in improvements in both image quality and techniques allowing echocardiography to maintain it's position as the primary non-invasive imaging modality. In particular, the development of new ultrasound contrast agents and imaging techniques have now made possible the assessment of myocardial perfusion. Myocardial contrast echocardiography utilises acoustically active gas filled microspheres (microbubbles), which have rheology similar to that of red blood cells.

Prognostic role of subclinical left ventricular abnormalities and impact of transplantation in chronic kidney disease.

Objective: The outcome of patients with chronic kidney disease (CKD) is influenced by overt left ventricular (LV) abnormalities. We sought the predictive value and treatment response of subclinical LV dysfunction in CKD.

Method: Resting and dobutamine stress echocardiography were used to identify LV enlargement, dysfunction, or ischemia in 176 patients with CKD.

Risk stratification of patients with chronic kidney disease: results of screening strategies incorporating clinical risk scoring and dobutamine stress echocardiography.

Background: Cardiac disease is the principal cause of death in patients with chronic kidney disease (CKD). Ischemia at dobutamine stress echocardiography (DSE) is associated with adverse events in these patients. We sought the efficacy of combining clinical risk evaluation with DSE.

Screening for coronary artery disease in patients with diabetes: a Bayesian strategy of clinical risk evaluation and exercise echocardiography.

Objective: Screening for coronary artery disease is constrained by its low prevalence in unselected patients. We compared the ability of clinical scores to identify a high-risk group with diabetes mellitus and investigated a Bayesian strategy by combination with exercise echocardiography (ExE).

Methods: The Framingham risk score (FRS), a score based on the American Diabetes Association (ADA) screening guidelines, the United Kingdom Prospective Diabetes Study (UKPDS) risk engine, and a disease-specific diabetic cardiac risk score (DCRS) were calculated in 199 asymptomatic patients with type 2 diabetes mellitus undergoing ExE.

Derivation and validation of a disease-specific risk score for cardiac risk stratification in chronic kidney disease.

Objective: Cardiac events (CE; cardiac death, non-fatal myocardial infarction and acute coronary syndrome) are the principal causes of death in patients with chronic kidney disease (CKD). We sought to devise and validate a cardiac risk score to risk-stratify patients with CKD.

Methods: Clinical history and biochemical data were obtained in 167 CKD patients.