Contribution of NOTCH1 genetic variants to bicuspid aortic valve and other congenital lesions.

Introduction: Bicuspid aortic valve (BAV) affects 1% of the general population. was the first gene associated with BAV. The proportion of familial and sporadic BAV disease attributed to mutations has not been estimated.

Short-term adverse remodeling progression in asymptomatic aortic stenosis.

Objectives: Aortic stenosis (AS) is characterised by a long and variable asymptomatic course. Our objective was to use cardiovascular magnetic resonance imaging (MRI) to assess progression of adverse remodeling in asymptomatic AS.

Methods: Participants from the PRIMID-AS study, a prospective, multi-centre observational study of asymptomatic patients with moderate to severe AS, who remained asymptomatic at 12 months, were invited to undergo a repeat cardiac MRI.

Symptom Onset in Aortic Stenosis: Relation to Sex Differences in Left Ventricular Remodeling.

Objectives: The aim of this study was to establish sex differences in remodeling and outcome in aortic stenosis (AS) and their associations with biomarkers of myocardial fibrosis.

Background: The remodeling response and timing of symptoms is highly variable in AS, and sex plays an important role.

Methods: A total of 174 patients (133 men, mean age 66.

Comparison of exercise testing and CMR measured myocardial perfusion reserve for predicting outcome in asymptomatic aortic stenosis: the PRognostic Importance of MIcrovascular Dysfunction in Aortic Stenosis (PRIMID AS) Study.

Aims: To assess cardiovascular magnetic resonance (CMR) measured myocardial perfusion reserve (MPR) and exercise testing in asymptomatic patients with moderate-severe AS.

Methods And Results: Multi-centre, prospective, observational study, with blinded analysis of CMR data. Patients underwent adenosine stress CMR, symptom-limited exercise testing (ETT) and echocardiography and were followed up for 12-30 months.

Point-of-care cardiac ultrasound in acute medicine--the quick scan.

The optimum management of acute medical patients requires prompt and accurate diagnosis, monitoring and treatment. The clinical history and physical examination remain central to diagnosis, but often need supplementation by laboratory testing or imaging. Echocardiographic assessment of cardiac structure and function provides valuable information that can aid diagnosis and assess clinical progress.

Successful low-dose thrombolysis of submassive pulmonary embolus in a pregnant patient.

Low-dose thrombolysis was effective and safe in a pregnant woman with acute pulmonary embolism causing severe right ventricular dysfunction. This is the first reported case of successful thrombolysis for pulmonary embolus in pregnancy in the absence of shock.

A study of role expansion: a new GP role in cardiology care.

Background: The National Health Service is reconfiguring health care services in order to meet the increasing challenge of providing care for people with long-term conditions and to reduce the demand on specialised outpatient hospital services by enhancing primary care. A review of cardiology referrals to specialised care and the literature on referral management inspired the development of a new GP role in Cardiology. This new extended role was developed to enable GPs to diagnose and manage patients with mild to moderate heart failure or atrial fibrillation and to use a range of diagnostics effectively in primary care.

Developing a rapid access chest pain clinic: qualitative studies of patients' needs and experiences.

Objective: The aims of this study are to understand the needs and experiences of rapid access chest pain clinic attenders and to determine the acceptability and effectiveness of simple procedural changes.

Methods: Two qualitative studies of clinic attenders before and after procedural changes which were guided by the first study.

Results: Study 1: Patients wanted to be reassured, by knowing what was causing their pain, understanding the cause, and feeling able to help themselves.

Revascularization for acute coronary syndromes in older people.

Background: randomised controlled trials have demonstrated that early revascularisation improves outcome in patients with acute coronary syndromes. However, since older people were excluded from these trials, it is not known whether the findings are applicable to them.

Objectives: to evaluate the outcome of revascularisation by percutaneous coronary intervention or coronary artery bypass surgery in older people with acute coronary syndromes.

Characteristics of patients presenting to a cardiac clinic with palpitation.

Background: Palpitation is a very common presenting symptom in primary care and in cardiac clinics, associated with marked disability. Although serious arrhythmias are uncommon causes, treatment of persistent palpitation is difficult.

Aim: To describe the cardiological, behavioural and psychological characteristics of consecutive patients presenting to a cardiac clinic with the main complaint of palpitation.

A randomized controlled trial of a brief educational and psychological intervention for patients presenting to a cardiac clinic with palpitation.

Background: We sought to determine whether a brief psycho-educational intervention reduced disability in patients with benign palpitation.

Method: In a pragmatic randomized controlled trial within a cardiology clinic at a district general hospital, 80 consecutive patients diagnosed as having benign palpitation--either palpitation due to awareness of extrasystoles or sinus rhythm--with associated distress or disability were randomized to an intervention group (usual care plus nurse-delivered intervention based on cognitive-behavioural principles) or to a control group (usual care). Principal outcome was difference in proportion of participants with good or excellent researcher-rated activity levels at 3 months.

Psychological and perceptual factors associated with arrhythmias and benign palpitations.

Objective: Little is known about how patients who seek medical help for benign palpitations can be distinguished from those with clinically significant arrhythmias. This study tested whether patients with arrhythmia can be distinguished from those who are aware of sinus rhythm or extrasystoles on the basis of sex, prevalence of anxiety disorders, and heartbeat perception.

Methods: A consecutive sample of patients referred to a cardiology clinic participated in the study.

Patients with palpitations referred for 24-hour ECG recording.

Palpitations are one of the most common reasons for referral to cardiologists; most are assessed as being medically benign. Eighty consecutive subjects referred for 24-hour ECG recording completed a questionnaire at the time of assessment and a follow-up self-report questionnaire at 18 months. Many of those with and without abnormal hearts reported distress, concern about their symptoms, and limitation of everyday activities.

"Not clinically indicated": patients' interests or resource allocation?

The decision that a particular intervention is not clinically indicated may conceal two quite different ethical assumptions. The first assumption is that the intervention is not of overall benefit to this patient. The second is that limited resources should not be used for this patient.

Continuity equation and Gorlin formula compared with directly observed orifice area in native and prosthetic aortic valves.

Orifice areas calculated by the continuity and Gorlin equations have been shown to correlate well in vivo. The continuity equation, however, gives underestimates compared with the Gorlin formula and it is not clear which is the more accurate. Both equations have therefore been tested against maximal orifice area measured by planimetry in eight prepared native aortic valves and four bioprostheses.