Latest articles

Ejection fraction (EF) offers a remarkable approach to assess ventricular and atrial pumping capacity. Its value can easily be calculated, and it seems to reflect performance. However, EF is a non-preferred candidate from a conceptual point of view. To fully understand the weakness of the EF metric, it is necessary to appreciate that its numerical value (by its definition) solely depends on end-systolic volume (ESV) and end-diastolic volume (EDV). This tight mathematical connection can best be graphically represented in the ventricular volume domain while relating ESV to EDV, leading to straight conclusions about EF.

No previous paper has addressed the curious tradition of applying EF in cardiology in terms of the indirect reasons for its popularity, as well as the intrinsic shortcomings, alongside the statistical irregularities involved. This review highlights the misleading attractiveness of EF, while also offering logical alternatives without invoking the need for relying on additional data beyond standard measurements.

Cardiovascular disease incidence is increasing worldwide, rendering it the most common cause of death worldwide. As such, nanomedicine has emerged in the context of overcoming these biological barriers. In this review, novel technologies are illustrated on two levels: molecular imaging and nanotechnology in atherosclerosis and therapeutic options in atherosclerosis. The former includes many diagnostic techniques, such as fluorescence imaging, computed tomography angiography (CTA), magnetic resonance imaging (MRI), photoacoustic imaging, contrast-enhanced ultrasound (CEUS), and multi-modality imaging. The latter is divided into two main subgroups: the first group includes inflammation-targeted therapies involving the endothelial cells and macrophages, and the second group includes nanoparticle transporters, like liposomes, micelles, dendrimers, polymeric nanoparticles (NPs), gel-like NPs, carbon nanotube, magnetic NPs, iron oxide NPs and gold NPs, and nanocoating (stent polymeric coatings to nanotextured ceramic coatings). In conclusion, nanoparticles show promise in enhancing the early diagnosis and targeted treatment of coronary artery disease. While several imaging and therapeutic techniques have demonstrated efficacy in preclinical models, only a few have progressed to human trials or clinical use.

Systemic inflammatory diseases (SIDs) can present with a wide range of cardiac manifestations, which, although uncommon, are frequently associated with significant morbidity and poor prognosis. Behçet’s disease and antiphospholipid syndrome (APS) are two distinct immune-mediated disorders encompassed within this spectrum, both capable of causing intracardiac thrombi and systemic embolisation, which causes diagnostic and therapeutic challenges. While Behçet’s disease is a classic systemic inflammatory vasculitis, APS primarily represents a prothrombotic autoimmune disorder with variable inflammatory features. This case series highlights two patients with cardiac involvement in SIDs, emphasising the importance of early recognition, individualised treatment strategies, and a multi-disciplinary approach to optimise outcomes in these complex clinical scenarios.

A coronary artery fistula (CAF) is an abnormal connection between a coronary artery and another structure. This rare condition has an incidence in the general population of 0.002%. A 57-year-old woman presented with angina, a normal electrocardiogram (ECG) and a peak troponin I of 0.22 µg/L (normal <0.04 µg/L). She was treated with a standard medical regimen for non-ST-elevation myocardial infarction. Coronary angiography revealed non-obstructed coronary arteries, with fistulae arising from the left anterior descending, left circumflex and right coronary arteries, all terminating in the pulmonary artery. Cardiac magnetic resonance (CMR) imaging was performed to investigate coronary steal syndrome. This confirmed there was no significant shunt or evidence of infarction. There was a small concentric pericardial effusion with a focal region of inferolateral epicardial fibrosis, suggesting a diagnosis of myopericarditis. The patient was treated with colchicine for three months.

CAF can cause patients to present with a variety of symptoms or potentially life-threatening complications, including fistula rupture and myocardial infarction. Early recognition, characterisation and shunt analysis are imperative to facilitate management. Although left/right heart catheterisation is considered the gold standard, CMR proved to be a useful diagnostic tool in our case, ruling out significant shunting and helping to identify a differential diagnosis.

This case report highlights the clinical course of a young patient with a history of ischaemic cardiomyopathy and severely impaired left ventricular (LV) systolic function following a delayed anterior myocardial infarction, which was further complicated by the presence of large LV thrombus. The patient subsequently presented with persistent ventricular tachycardia (VT) refractory to multiple anti-arrhythmic medications and antitachycardia pacing (ATP). VT ablation was contraindicated due to the LV thrombus, and the failure of conventional medical therapy. Heart transplantation was considered as the final viable management strategy. This case highlights the complexity of managing patients with advanced heart failure and ventricular arrhythmias, emphasising the importance of timely consideration of advanced therapeutic options in refractory scenarios.

Sudden cardiac death (SCD) in young athletes is a rare but devastating event, most often caused by structural or electrical abnormalities of the heart. Although athletes are generally among the healthiest individuals, the occurrence of SCD in this group attracts significant public attention, particularly as exercise may trigger fatal events in those with underlying disease. This has driven debate around the role of pre-participation screening (PPS) as a strategy to identify at-risk individuals before they compete. Several international sporting and scientific organisations have issued recommendations, but screening protocols vary, and the balance between benefit, feasibility, cost, and potential harm remains controversial. While evidence suggests that screening may detect otherwise silent cardiovascular disease, limitations include false-positives, false-negatives, interpretation challenges, and the ethical implications of disqualification. This review explores the benefits and potential challenges of cardiac screening in athletes, and the implications for protecting athlete health and ensuring safe participation in sport.

Most cardiologists view themselves as strong, hardened clinicians with a broad knowledge-base, alongside (sometimes very) specialist expertise. As clinicians we are seen to embody the quintessential type A stereotype, impervious to most emotional traumas, managing and coping with frequent, both sudden and slow, demises and challenging, complex and often time-pressured, scenarios.

I am no stranger to the demands of a profession that requires precision, composure, and resilience. Yet, behind the façade of clinical and academic competence, lies a reality that many of us, including myself, are reluctant to confront: the personal and professional toll that psychiatric illness can take on physicians.

Cardiovascular disease (CVD) is one of the leading causes of death and disability in the UK. The implications for the NHS are profound, as increasing hospital admissions strain resources and escalate wait times. Currently, people with one or more long-term conditions use 50% of all general practitioner (GP) appointments, 64% of all outpatient appointments, and 70% of hospital beds.¹ With CVD now the cause of one in four premature deaths² in the UK, transforming the way CVD is prevented and care is provided, is becoming increasingly crucial.

With National Health Service England (NHSE) recently publishing their 2025/26 priorities and operational planning guidance,³ there is a need for systems to address inequalities and shift towards prevention. To address this challenge in the West Midlands, a transformative approach to CVD prevention and management was taken that included early diagnosis, effective management and comprehensive education. The work was led by Health Innovation West Midlands (HIWM) and colleagues from primary and secondary care across all six integrated care systems (ICSs).

This article explores using artificial intelligence (AI) to detect atrial fibrillation (AF) early, highlighting its potential to revolutionise cardiology. It reviews numerous studies demonstrating AI’s superior accuracy to traditional methods, particularly in leveraging electrocardiography data from various sources like smart devices and chest radiographs. A key concern addressed is the ‘black box’ nature of some AI algorithms, emphasising the critical need for transparency to build clinician confidence and ensure ethical patient care. It concludes by advocating for policy changes and further research to enhance AI algorithm transparency and integration into clinical practice.