Informed consent-patients' understanding of risk.

Aims: The central concept of informed consent is communication of the chance of a successful outcome. The risks and benefits are probabilistic concepts derived from populations; they do not map with any certainty to the individual. We tested patients' comprehension of basic probability concepts that are needed for informed consent.

Signal-to-noise of linear and volume measures of left ventricular and left atrial size.

Background: Serial echocardiographic assessments are common in clinical cardiology, e.g., for timing of intervention in mitral and aortic regurgitation.

Hospitalisation during lockdown-patients' beds-eye views.

Aims: The global COVID-19 pandemic and lockdowns have affected the patterns of hospital presentations for non-COVID related illnesses. Apprehension and perceived risk of hospitalisation has been postulated to be a significant deterrent to presentation. This study aims to explore pandemic- and- lockdown-related concerns with regards to hospital admission from a patient's perspective.

A Decade of Transcatheter Aortic Valve Implantation in New Zealand: Growth and Inequalities.

Background: Transcatheter aortic valve implantation (TAVI) is an effective treatment increasingly performed for severe aortic stenosis. Developing nationwide accessibility to TAVI can be met with barriers that result in treatment disparities.

Objectives: This nationwide retrospective study aimed to review the first decade of TAVI in New Zealand and identify potential inequalities.

Calcified Coronary Lesions Treated With Intravascular Lithotripsy: One-Year Outcomes.

Calcified lesions often increase the complexity of percutaneous coronary intervention (PCI) and risk of future adverse events. Shockwave intravascular lithotripsy (S-IVL; Shockwave Medical) has been shown to be an effective calcium-modification tool in preparing calcified coronary lesions prior to stent placement. Its circumferential, pulsatile soundwaves provide a different mechanism to fracture calcium compared with existing devices such as rotational atherectomy and cutting balloons.

Empagliflozin-Mediated Lithium Excretion: A Case Study and Clinical Applications.

BACKGROUND Empagliflozin selectively reduces apical sodium-glucose co-transporter 2 function in the proximal convoluted tubules, increasing sodium and glucose excretion in the urine, ultimately reducing glucose reabsorption in the kidneys for diabetic management. Lithium, the gold-standard treatment for bipolar disorder, also utilizes sodium transporters in the proximal convoluted tubules. CASE REPORT Presenting with a manic relapse of refractory schizoaffective disorder, our patient was found to have subtherapeutic levels of lithium on admission due to poor outpatient medication compliance.

Nonbacterial thrombotic endocarditis of a bioprosthetic valve: Questions to ponder before replacement of the valve.

Nonbacterial thrombotic endocarditis (NBTE) of bioprosthetic valves is extremely rare. We report a 67-year-old lady with early bioprosthetic "failure" that at reoperation was proven to be NBTE. The choice of a prosthesis in this condition may have implications for patients' late clinical course.

Treatment of Heavily Calcified Unprotected Left Main Disease With Lithotripsy: The First Case Series.

We present the first case series using Shockwave Intravascular Lithotripsy (S-IVL; Shockwave Medical), a novel coronary calcium modification device, in patients with heavily calcified unprotected left main (LM) coronary artery disease (CAD). Decisions regarding surgical vs percutaneous revascularization in LM-CAD patients are based on anatomical complexity and perceived surgical risk. In this series, we present the use of S-IVL in a patient with LM-CAD with multivessel disease who declined surgery, a patient with an isolated LM-CAD and severe cardiomyopathy, and a late nonagenarian patient where surgical revascularization was not an option.

Shockwave Intravascular Lithotripsy of Calcified Coronary Lesions in ST-Elevation Myocardial Infarction: First-in-Man Experience.

We present the first cases of Shockwave intravascular lithotripsy (S-IVL; Shockwave Medical), a novel coronary calcium modification device, being used in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI). The 3 presented cases include an upfront use of S-IVL in a right coronary artery, an in-stent restenosis, and a community cardiac arrest/STEMI equivalent where S-IVL was used as a bail-out technique to facilitate stent delivery in a tortuous calcified vessel.

Shockwave Intravascular Lithotripsy for Calcified Coronary Lesions: First Real-World Experience.

Background: Calcified coronary lesions often cause suboptimal stent expansion, which is one of the greatest predictors of adverse outcomes such as stent thrombosis and restenosis. Shockwave intravascular lithotripsy (S-IVL; Shockwave Medical, Inc) is a recently approved technique used in the treatment of heavily calcified coronary lesions. We present our early real-world experience with the S-IVL device.

A review of a regional primary percutaneous coronary intervention service, with a focus on door to reperfusion times: the 2012 Auckland/Northland experience.

Aims: Primary percutaneous coronary intervention (PCI) is the optimal management for ST segment elevation myocardial infarction (STEMI) patients. We reviewed the largest primary PCI regional service in New Zealand: the Auckland/Northland service based at Auckland City Hospital, to assess patient management, in particular the door to reperfusion times (DTRTs), and predictors of death in hospital.

Methods: We obtained patient details from a comprehensive prospective database of all primary PCI patients admitted with STEMI from 1/1/12 to 31/12/12 to the Auckland City Hospital cardiac catheterisation laboratory.

An uncommon cause of myocardial infarction.

A 73 year-old lady with hypertension and chronic atrial fibrillation (AF) developed chest pain followed by ventricular fibrillation (VF) cardiac arrest. Her electrocardiogram post-cardioversion revealed inferior ST-elevation myocardial infarction (MI). Her coronary arteries were angiographically normal.

Characteristics and prognostic importance of myocardial fibrosis in patients with dilated cardiomyopathy assessed by contrast-enhanced cardiac magnetic resonance imaging.

Introduction: Dilated cardiomyopathy (DCM) is associated with significant morbidity and mortality. Contrast-enhanced cardiac MRI (CE-CMR) can detect potentially prognostic myocardial fibrosis in DCM. We investigated the role of CE-CMR in New Zealand patients with DCM, both Maori and non-Maori, including the characteristics and prognostic importance of fibrosis.

Prevalence and prognostic significance of left ventricular dysfunction in patients presenting acutely with atrial fibrillation.

Condensed Abstract: The prevalence and prognostic importance of CM occurring as a consequence of AF is poorly defined. This study investigated the incidence of CM in patients with AF, its clinical features and long-term outcomes. We demonstrated that CM is common in patients presenting acutely with newly diagnosed rapid AF, and carries a worse long-term prognosis.

Noncardiac surgery and bleeding after percutaneous coronary intervention.

Background: The decision on whether to implant a drug-eluting or bare-metal stent during percutaneous coronary intervention (PCI) depends in part on the perceived likelihood of the patient developing late stent thrombosis. Noncardiac surgery and bleeding are associated with discontinuation of dual antiplatelet therapy and with increased stent thrombosis. We assessed the incidence of and predictors for subsequent noncardiac surgery and bleeding episodes in patients who had undergone PCI.

The pharmacogenetics and pharmacodynamics of clopidogrel response: an analysis from the PRINC (Plavix Response in Coronary Intervention) trial.

Objectives: This study assessed the effect of pharmacogenetics on the antiplatelet effect of clopidogrel.

Background: Variability in clopidogrel response might be influenced by polymorphisms in genes coding for drug metabolism enzymes (cytochrome P450 [CYP] family), transport proteins (P-glycoprotein) and/or target proteins for the drug (adenosine diphosphate-receptor P2Y12).

Methods: Sixty patients undergoing elective percutaneous coronary intervention in the randomized PRINC (Plavix Response in Coronary Intervention) trial had platelet function measured using the VerifyNow P2Y12 analyzer after a 600-mg or split 1,200-mg loading dose and after a 75- or 150-mg daily maintenance dosage.

The antiplatelet effect of higher loading and maintenance dose regimens of clopidogrel: the PRINC (Plavix Response in Coronary Intervention) trial.

Objectives: This study evaluated the antiplatelet effect of a higher loading and maintenance dose regimen of clopidogrel and a possible drug interaction with verapamil.

Background: Clopidogrel loading doses above 600 mg have not resulted in more rapid or complete platelet inhibition. Higher maintenance dosages may be more effective than 75 mg/day.

A modeling intervention in heart failure.

Background: Peak oxygen uptake (VO(2)) testing is commonly used to assess chronic heart failure (CHF) patients' exercise tolerance. The test requires maximal effort; however, many participants have low confidence (self-efficacy) to perform optimally.

Purpose: This randomized controlled trial examined the effectiveness of a modeling intervention to increase Peak VO(2) (PVO(2)) and self-efficacy in people diagnosed with CHF.

Is it possible to distribute a scarce resource equitably? Access to invasive procedures for patients with acute myocardial infarction.

Aims: To compare waiting times for inpatient cardiac catheterisation between a hospital with on-site cardiac catheterisation facility (Auckland City Hospital, ACH) and one of its referring hospitals (North Shore Hospital, NSH).

Methods: Patients were included if they were admitted ACH or NSH with a myocardial infarction, and subsequently underwent inpatient coronary angiography.

Results: 853 patients were identified from NSH and 600 from ACH.

Reliability of echocardiographic indices of dyssynchrony.

Background: Echocardiographic indices of dyssynchrony are increasingly used to select candidates for cardiac resynchronization therapy. For widespread screening of heart failure patients, such variables need to be comparable when evaluated by different operators using different equipment.

Objective And Methods: To evaluate the reproducibility and obtainability of echocardiographic indices of mechanical dyssynchrony, we studied 40 subjects stratified according to QRS morphology and systolic function.

First-in-human implantation of a fully bioabsorbable drug-eluting stent: the BVS poly-L-lactic acid everolimus-eluting coronary stent.

The first-in-human fully bioabsorbable drug-eluting stent (BVS poly-L-lactic acid everolimus-eluting coronary stent) implantation was performed at Auckland City Hospital, New Zealand as part of the ABSORB trial. There were no adverse events in-hospital or by 1 month. A stent that supports the vessel when needed, delivers an antiproliferative drug then disappears has theoretical advantages with regard to CT and MRI compatibility, restored vessel vasomotion, and facilitated future percutaneous intervention or surgical grafting to the treated site.

Ultrasound-guided venous access for permanent pacemaker leads.

Background: Existing methods of venous access for permanent pacemaker leads have disadvantages. We documented learning times for ultrasound-guided lead implantation and compared them with cephalic venotomy technique.

Methods: Two implanters learnt ultrasound-guided technique by implanting consecutive pacemaker patients.

Detection of myocardial scar by contrast-enhanced cardiac magnetic resonance imaging in patients with troponin-positive chest pain and minimal angiographic coronary artery disease.

Patients who present with chest pain and elevated serum troponin levels may have minimal angiographic coronary artery disease, leading to diagnostic confusion. We investigated patients with troponin-positive acute coronary syndromes and minimal coronary artery disease (CAD) using contrast-enhanced cardiac magnetic resonance imaging to assess for myocardial scar. Twenty-three patients (54 +/- 8 years of age) who presented with chest pain, high troponin I level, and minimal angiographic CAD were included.