Heart Podcast

Dr Divaka Perera from King's College, London and Guy's and St Thomas' Hopsital joins Dr James Rudd, associate editor at Heart, to discuss his recent Education in Heart paper titled: "Ischaemic cardiomyopathy: pathophysiology, assessment and the role of revascularisation" They cover the aetiology of ischaemic cardiomyopathy, the definitions of stunning, hibernation and viability and what the trials and guidelines can tell us. Optimal imaging strategies are debated. There is also mention of the REVIVED BCIS-2 study, of which Dr Perera is PI.

In this episode of the Heart Podcast, Heart Digital Media Editor Dr James Rudd is in conversation with Dr Chris Fordyce from the Duke Clinical Research Institute. His team has just published an Education in Heart paper on "Optimal non-invasive imaging test selection for the diagnosis of ischemic heart disease." In this podcast, they discuss the similarities and differences between the international guidelines on the investigation of chest pain. They also highlight the results of the landmark PROMISE and SCOT-HEART studies and discuss how the results of these trials might influence future guidelines. The paper contains many high-resolution multimedia elements, along with MCQs to test your knowledge in this area.

In this podcast Dr James Rudd talks to Dr Sarah Clarke, President of the British Cardiovascular Society and Editor of the Education in Heart section of the journal. They talk about the education stream of the journal, new multimedia developments, and aligning content with the ESC curriculum.

In this podcast Dr James Rudd talks to Professor Stephen Nicholls, consultant cardiologist and Deputy Director of the South Australian Health and Medical Research Institute in Adelaide, at the 2015 European Cardiology meeting in London. They discuss the next generation of lipid therapies and imaging as a surrogate marker of disease.

In this podcast Dr James Rudd speaks to Dr Alexander Lyon, consultant cardiologist at the Royal Brompton Hospital, about the effects of cancer treatments on the heart, the problems of an aging population, and the new field of cardio-oncology. Editorial >> http://heart.bmj.com/content/early/2015/09/09/heartjnl-2015-308208.full Full paper >> http://heart.bmj.com/content/early/2015/09/08/heartjnl-2015-307848.full

Editor-in-Chief Dr Catherine Otto talks to Dr Elizabeth Mostofsky at the Cardiac Society of Australia & New Zealand meeting in Melbourne. They discuss the various environmental, physical and psychological triggers for heart disease.

Editor-in-Chief Dr Catherine Otto talks to Dr Carolyn Lam at the Cardiac Society of Australia & New Zealand meeting in Melbourne. They discuss her session on heart failure with preserved ejection fraction.

Editor-in-Chief Dr Catherine Otto talks to Dr David Calemajer at the Cardiac Society of Australia & New Zealand meeting in Melbourne. They discuss his session on managing the large spectrum of Ebstein's anomaly in adults in the absence of RCT data.

Alistair Lindsey talks to Martin Hülsmann and Noemi Pavo, both from the Medical University of Vienna, about their paper examining cardiovascular biomarkers in cancer patients. Paper: http://heart.bmj.com/content/early/2015/09/08/heartjnl-2015-307848.abstract

Chocolate is an important dietary source of flavonoid antioxidants, which are hypothesised to have a beneficial effect on endothelial function and protect against cardiovascular disease (CVD). In this podcast Dr Alistair Lindsay talks to Dr Phyo K Myint about his team's research into this topic. In order to evaluate any association between habitual chocolate consumption and the risk of cardiovascular events, they analysed data from the European Prospective Investigation into Cancer-Norfolk (EPIC-Norfolk), and incorporated the results from this observational study into the evidence available to date.

Aortic valve stenosis (AS) is a progressive disease, but the impact of baseline AS haemodynamic or anatomic severity on AS progression remains unclear. In this podcast Dr Alistair Lindsay talks to Dr Virginia Nguyen about her study to evaluate the impact of baseline AS severity assessed, either by using echocardiography (haemodynamic assessment) or MSCT (anatomic assessment) on AS progression.

Percutaneous Coronary Intervention (PCI) has a considerable evidence base and it is firmly established as the most common procedure used in the invasive treatment of patients with CHD in the UK. The evidence base relating to PCI has been reviewed and this has been published in Heart. The guidelines focus on issues pertinent to practice within the UK and set out a recommended template to ensure optimal delivery of patient care. Dr Alistair Lindsay speaks to Professor Adrian Banning from the John Radcliffe Hospital at the University of Oxford who was co-author on the guidelines.

Dr Alistair Lindsay speaks to Dr Tomasz Baron about his research which aimed to assess differences in incidence, clinical features, current treatment strategies and outcome in patients with type 2 vs. type 1 acute myocardial infarction (AMI). Full paper found here >> http://heart.bmj.com/content/101/2/101.full?sid=e9538ca9-604b-40af-95a7-c03f016f4c2e

Frailty in older age is known to be associated with cardiovascular disease (CVD) risk. However, the extent to which frailty is associated with the CVD risk profile has been little studied. Dr Alistair Lindsay talked to Dr Sheena Ramsay about her study and the clinical implications of the results. The original paper can be found here: http://heart.bmj.com/content/101/8/616.full?sid=767613b9-71bb-41af-80e8-361647c03828

Dr Alistair Lindsay speaks to Dr Edward Carlton about his published paper investigating whether a novel accelerated diagnostic protocol (ADP) for suspected acute coronary syndrome (ACS) could successfully identify low-risk patients suitable for discharge after a single high-sensitivity troponin T.

Dr Alistair Lindsay spoke to Dr Eliseo Guallar about his study to nvestigate the association between regular coffee consumption and the prevalence of coronary artery calcium (CAC) in a large sample of young and middle-aged asymptomatic men and women. Read the article here http://heart.bmj.com/content/early/2015/02/06/heartjnl-2014-306663.full?sid=3959ea9e-52ba-4e69-97fa-1b55aa2b9738

Alistair Lindsay talks to Scott Montgomery, honorary professor of epidemiology and public health, Institute of Epidemiology & Health, UCL, about his paper investigating physical fitness and stress resilience in adolescence and risk of coronary heart disease in middle age. Read the paper: http://heart.bmj.com/content/early/2015/02/10/heartjnl-2014-306703

Alistair Lindsey talks to Christopher Cannon, Havard Clinical Research Institute, about the results of his IMPROVE-IT trial, which examined clinical outcomes of adding ezetimibe to simvastatin. This podcast was recorded at the American Heart Association scientific sessions in Chicago.

Some studies have suggested endothelial dysfunction in adult patients after repair of aortic coarctation (CoA), and it has been proposed to play a key role in the pathogenesis of arterial hypertension in the absence of re-coarctation. A study recently published in Heart aimed to assess the presence of endothelial dysfunction, the number of endothelial progenitor cells, and the levels of proinflammatory cytokines associated with endothelial injury in contemporary patients after CoA repair. Alistair Lindsay discusses what the work revealed with lead author Robert Radke, Division of Adult Congenital and Valvular Heart Disease, Department of Cardiology and Angiology, University Hospital Muenster. Read the full paper (for free): http://goo.gl/z32cOl

The ESC has published new guidelines for diagnosis and management of thoracic aortic disease. In this podcast, Catherine Otto asks Dr Iung, Professor of Cardiology, Bichat Hopital, Paris Diderot University, France, to summarise the key new points in these guidelines, specifically focusing on aortopathy in patients with bicuspid valve disease, and in those with Marfan syndrome and other inherited connective tissue disorders. This podcast was recorded at the European Society of Cardiology Annual Scientific Sessions, Barcelona, Spain, August 2014.

In this episode of the Heart podcast, Dr James Rudd, associate editor, sits down to talk with Prof Valentin Fuster, director of Mount Sinai Heart and physician-in-chief at The Mount Sinai Medical Center in New York, at the ESC meeting in Barcelona. They discuss his ground-breaking work in the primary prevention of cardiovascular disease in children and young adults across the world and the role of imaging in identifying early heart disease. Prof. Fuster also explains the rationale behind the polypill and how he came to have his own character on Sesame Street.

In this podcast Catherine Otto speaks to Dr P G Pieper, Associate Professor of Cardiology, University Medical Center Groningen, the Netherlands, about the recent paper in Heart on assessing the risk of pregnancy for women with congenital heart disease. This study compared three different scoring systems and found that the WHO score provided the most accurate risk prediction. The importance of this issue is illustrated by the approximately 10% risk of maternal complications in this patient group. This podcast was recorded at the European Society of Cardiology Annual Scientific Sessions, Barcelona Spain, August 31, 2014. Read the original article: Prospective validation and assessment of cardiovascular and offspring risk models for pregnant women with congenital heart disease http://heart.bmj.com/content/100/17/1373

Recorded at the 2014 British Cardiovascular Society meeting in Manchester, Heart associate editor Dr James Rudd talks to Dr Rob Casserley, summiteer of Everest, and his wife and cardiologist Marie-Kristelle Ross. Rob initially worked as surgeon and is now a GP with a specialist interest in altitude and expedition medicine. He has climbed Everest eight times, including double summits in spring 2007 and spring 2010, and is the first-ever Western climber to have achieved this feat. He was been featured in "Everest ER", a BBC1 documentary series about medicine and climbing on Everest. He assisted Sir Ranulph Fiennes as doctor, guide and cameraman in a 2008 climb of Everest. In this episode of the Heart podcast, they discuss high altitude, endurance sports and their effects on the heart and lungs in both health and disease.

Professor Vahanian, Bichat Hospital, Paris, France, is a world leader in management of patients with Valvular Heart Disease and is the lead author of the European Society of Cardiology Guidelines. In this interview, held during the Transcatheter Valve Therapeutics Meeting in Vancouver, Canada in June 2014, Professor Vahanian talks with Catherine Otto about the current approach to patient selection for transcatheter aortic valve implantation (TAVI). The availability of TAVI has transformed our approach to the elderly or high risk patient with severe aortic stenosis and the use of this technology continues to expand as technical issues are resolved and more data on valve durability is published. Clinicians will want to keep up to date on the latest information so appropriate patients are referred for this life saving treatment. To read more about transcatheter aortic valve implantation, see several recent articles in Heart: Predictive factors of early mortality after transcatheter aortic valve implantation: individual risk assessment using a simple score http://goo.gl/lcflnl Predictors of 1-year mortality in patients with aortic regurgitation after transcatheter aortic valve implantation: an analysis from the multicentre German TAVI registry http://goo.gl/WkfmM5 Aortic regurgitation severity after transcatheter aortic valve implantation is underestimated by echocardiography compared with MRI http://goo.gl/KIo6B4 Cardiac magnetic resonance versus transthoracic echocardiography for the assessment and quantification of aortic regurgitation in patients undergoing transcatheter aortic valve implantation http://goo.gl/YTcbaf Original article: Device-dependent association between paravalvar aortic regurgitation and outcome after TAVI http://goo.gl/u5dK82

In this interview held during the Transcatheter Valve Therapeutics Meeting in Vancouver, Canada in June 2014, Heart editor Catherine Otto talks to Ted Feldman, Evanston Hospital. Professor Feldman is one of the leaders in the field of transcatheter mitral valve repair, and discusses patient selection, procedural aspects and intermediate term outcomes with this exciting new therapy. Clinicians will find this brief summary useful as this new technique offers a therapeutic options for many of our patients with mitral regurgitation who are not candidates for conventional open surgery. For more information about intervention for patients with severe mitral regurgitation, readers can consult several recent articles in Heart: A systematic review on the safety and efficacy of percutaneous edge-to-edge mitral valve repair with the MitraClip system for high surgical risk candidates http://goo.gl/0MBpMF 2014 ACC/AHA valve guidelines: earlier intervention for chronic mitral regurgitation http://goo.gl/dXDX0U Valvular heart disease: The evolving role of multimodality imaging in valvular heart disease http://goo.gl/IcJdqW Almanac 2013: Novel non-coronary cardiac interventions http://goo.gl/OpoHGC Predictors for efficacy of percutaneous mitral valve repair using the MitraClip system: the results of the MitraSwiss registry http://goo.gl/DqHBAi

Recorded at the 2014 British Cardiovascular Society meeting in Manchester, Heart associate editor Dr James Rudd talks to Dr Arthur Yue, consultant electrophysiologist at the University Hospital of Southampton. In this podcast, they discuss the expanding roles of electrophysiological specialists in managing arrhythmias, accessory pathways and the new upcoming NICE guidelines on atrial fibrillation.

Extensive research has established that physical activity is inversely associated with the risk of developing cardiovascular disease in healthy adults. In patients with manifest cardiovascular disease, current clinical practice guidelines recommend encouraging patients to undertake daily moderate intensity physical exercise for secondary prevention. While such recommendations are based on numerous clinical trials clearly showing that exercise-based cardiac rehabilitation improves prognosis in heart disease patients, only a few prospective studies have examined the potential benefit of physical activity in clinical practice under real-life conditions. A recent Heart paper investigates the association of leisure time physical activity level with prognosis in a cohort of patients with coronary heart disease. Lead author Ute Mons, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, discusses what they found. Read the full paper: http://goo.gl/gDHlH2

Experimental and epidemiological studies have provided evidence of associations between air pollution and cardiovascular health. More pollution-related deaths occur from heart disease than from any other cause. A recent study in Heart aimed to further current understanding of pathophysiological mechanisms by examining the strength and specificity of acute relationships between ambient air pollution and a range of CVD events. The key mechanistic question addressed is whether events of clear thrombotic origin, namely, acute MI, stroke and related outcomes, have a stronger association with air pollution than non-thrombotic outcomes. Lead author Ai Milojevic, Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, describes what they found.

In this podcast Heart editor in chief Catherine Otto, discusses patient prothesis mismatch with Professor Philippe Pibarot, Directeur, Chaire de Recherche du Canada sur les Maladies Valvulaires Cardiaques, after he presented a commentary on the issue at the Transcatheter Valve Therapies meeting in Vancouver, Canada on June 5, 2014. Aortic valve stenosis is prevalent in the elderly and valve replacement for severe symptomatic obstruction improves symptoms and prolongs life. However, some patients have persistent symptoms after intervention because the functional valve area of the prosthetic valve is too small for the patient’s body size, a situation termed patient-prosthesis mismatch (PPM). The hemodynamics of PPM have been well described but the actual clinical impact of PPM is controversial. In the June issue of Heart, Dr Price and colleagues (heartjnl-2013-305118) report that PPM was associated with decreased survival and persistent symptoms only in patients with a low left ventricular ejection fraction who were under age 70 years at the time of valve surgery. In older adults, although PPM was associated with impaired regression of LV hypertrophy, PPM was not associated with increased mortality or heart failure symptoms. This data has important implications for clinical management suggesting that additional procedures to allow implantation of a larger prosthesis may not be necessary in older adults or in younger patients with normal left ventricular function. See also: The impact of prosthesis–patient mismatch after aortic valve replacement varies according to age at operation http://goo.gl/JNX42v

Heart failure (HF) self-care matters, but what matters most in HF self-care? To inform the design of future interventions and promote effective HF self-care, a systematic review of qualitative studies has recently been published in Heart. This examines patients’ and caregivers’ needs, experiences and preferences regarding the nature and determinants of HF self-care. Alistair Lindsay talks to co-author Alexander Clark, professor in the Faculty of Nursing, University of Alberta, about the findings. Read the full review here: Determinants of effective heart failure self-care: a systematic review of patients’ and caregivers’ perceptions http://goo.gl/Lb3adm

This podcast discusses the 3rd Joint British Societies’ (JBS) consensus recommendations, released on 26th March 2014. These eagerly anticipated guidelines incorporate much of the recent research in primary and secondary prevention of cardiovascular disease, and include a new risk calculator for physicians. Heart’s social media editor, Dr Alistair Lindsay, discusses the most important points of the recommendations with Dr Iain Simpson, President of the British Cardiovascular Society and a member of the JBS 3 editorial group.

In this podcast, Philip Urban, Cardiovascular Department, Hôpital de La Tour, Geneva, discusses the Charlson Comorbidity Index (CCI). Read the related paper: Validity of Charlson Comorbidity Index in patients hospitalised with acute coronary syndrome. Insights from the nationwide AMIS Plus registry 2002–2012 http://goo.gl/Kjpj0l

Coronary heart disease (CHD) is a major public health problem not only in developed but also in developing countries.1 CHD rates in Japan are uniquely low compared to the USA and other developed countries. In a paper in April's Heart, Akira Sekikawa and colleagues from the University of Pittsburgh looked at whether serum concentrations of long chain n-3 polyunsaturated fatty acids (LCn3PUFAs) contribute to the difference in the incidence rate of coronary artery calcification (CAC) between Japanese men in Japan and white men in the USA. Alistair Lindsay asks him what they found. Read the full paper: Long chain n-3 polyunsaturated fatty acids and incidence rate of coronary artery calcification in Japanese men in Japan and white men in the USA: population based prospective cohort study http://goo.gl/rwKUCW

Catherine Otto, Heart editor, talks to Greg Roth from the Division of Cardiology at University of Washington about his editorial which appears on heart.bmj.com and discusses prescription of statins after an acute myocardial infarction.

Dr Alistair Lindsay speaks to Dr Corina Grey, School of Population Health, University of Auckland, about her recent study looking at long-term adherence to statins in ACS patients. Read the full paper: http://goo.gl/KF3NAK

Bicuspid aortic valve (BAV) is related to aortic dilatation, but patterns/rates are conflicting with no comparison among aneurysms of different aetiology. In this podcast Alistair Lindsey talks to Hector Michelena from the Division of Cardiovascular Diseases at the Mayo Clinic about his research published in heart.bmj.com Read the full research: http://heart.bmj.com/content/100/2/126.full

At the 2013 Uruguayan Society of Cardiology meeting in Montevideo, Dr Robert Bonow, Professor of Cardiology at Northwestern University Feinberg School of Medicine, gave a talk on aortic valve stenosis. In this podcast he and Catherine Otto, discuss some of the new concepts in diagnosis and management of the condition.

Read the full research onine: http://heart.bmj.com/content/99/22/1675 Dr Joao Lima, from the Division of Cardiology at Johns Hopkins Hospital in Balitmore, and colleagues set out to evaluate the benefit of niacin in addition to statin therapy on plaque regression among older individuals with established atherosclerosis. They used MRI to more measure the plaque volume, and in this podcast Dr Lima explains to Laura Templer why that's a more accurate measure than the surrogates used in previous studies.

Read the full research online: http://heart.bmj.com/content/99/23/1734 In 2010, the Department of Health in England introduced an incentivised national target for National Health Service (NHS) hospitals aiming to increase the number of patients assessed for the risk of developing venous thromboembolism (VTE) associated with hospital admission. Will Lester, from the Quality and Outcomes Research Unit at the University Hospital Birmingham, and colleagues assessed the impact of this initiative on VTE mortality and subsequent readmission with non-fatal VTE. He joins Alistair Lindsey to talk about the study.

Catherine Otto, Heart's editor in chief, interviews April Stempien-Otero from the University of Washington, at the American Heart Association meeting in Dallas. They discuss Dr Stempien-Otero's late breaking clinical trial, presented at the meeting, which looks at the use of bone marrow derived stem cells, and their use in ischemic cardiomyopathy with LVAD bridge to transfer.

Patrick Calvert interviews Alain Cribier, Director of Cardiology at Charles Nicolle Hospital, University of Rouen in France, and pioneer in the field of aortic and mitral valvuloplasty.

Patrick Calvert interviews Alec Vahanian, Head of the Cardiology Department, Bichat University Hospital, Paris at the annual British Cardiovascular Society meeting in London.

Alistair Lindsay interviews Anthony De Maria, director of the Cardiovascular Center at the UC San Diego medical school, and current Editor in Chief of JACCE.

As we near ten years since the first transcatheter aortic vale implantation, Alistair Lindsey, Heart’s JournalScan editor, talks to Philip MacCarthy, consultant cardiologist, King’s College Hospital, about his work examining how the ventricle responds following the procedure. See also: Successful transcatheter aortic valve implantation (TAVI) is associated with transient left ventricular dysfunction http://bit.ly/12Fwwcf

Mark de Belder (consultant cardiologist in Middlesbrough) talks to James McLenachan (consultant cardiologist in Leeds) and Keith Channon (professor of Cardiovascular Medicine, University of Oxford) about the pathophysiology and management of acute coronary syndromes. See also: Webcasts from all the sessions at the British Cardiovascular Society Conference 2012 bit.ly/ZMGmUE

Guy Lloyd (a consultant cardiologist in Eastbourne) talks to Gerry McCann (a cardiologist in Leicester) and John Chambers (president of the British Heart Valve Society) about aortic valve disease. They discuss stratifying cases by risk, myocardial fibrosis, the various assessments available, whether clinicians should be looking more to prescribe ACE inhibitors, and how best valve service should be configured. See also: Postconditioning and protection from reperfusion injury: where do we stand? http://bit.ly/15EmdIy Webcasts from all the sessions at the British Cardiovascular Society Conference 2012 bit.ly/ZMGmUE

Michael Marber (professor of Cardiology at King’s College London) discusses reperfusion injury with Michel Ovize (professor at the Hôpitaux de Lyon). See also: Postconditioning and protection from reperfusion injury: where do we stand?http://bit.ly/15EmdIy Webcasts from all the sessions at the British Cardiovascular Society Conference 2012 http://bit.ly/ZMGmUE

Jim Hall (BCS vice-president for training, and chairman of the SAC) talks to Thanh Phan (SPL trainee from the Northern Deanery) about current issues in cardiology training. These include Workplace Based Assessments, clinical genetics, and workforce projections. See also: Webcasts from all the sessions at the British Cardiovascular Society Conference 2012 http://bit.ly/ZMGmUE

Iain Simpson (vice president for Education and Research at the British Cardiovascular Society, and a cardiologist in Southampton) talks to Michael Joy (professor at the University of Surrey, and cardiologist to the Civil Aviation Authority) about his experience in interpreting the ECGs of pilots. See also: Webcasts from all the sessions at the British Cardiovascular Society Conference 2012 http://bit.ly/ZMGmUE

Matthias Schmitt (cardiac magnetic resonance specialist, University Hospital of South Manchester) and Guy Lloyd (consultant cardiologist in Eastbourne) talk to William Zoghbi (president of the American College of Cardiology) about where we are going with cardiovascular imaging. See also: Webcasts from all the sessions at the British Cardiovascular Society Conference 2012 http://bit.ly/ZMGmUE