Volume 14, Number 1, January-February 2007

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TOPICEDITORIALAdult congenital heart disease: follow-up and the role of the district general hospital
David J Gwilt, Michael A Gatzoulis

Br J Cardiol 2007;14:5-7.

PRIMARY CAREA pilot study on computer-based opportunistic screening for coronary heart disease: universal assessment and education in primary care
Peter F Tyerman, Gill V Tyerman, Ruth Bacigalupo

Cardiovascular disease prevention is one of the major challenges of medicine in the UK and the developed world. Progress in the primary prevention of these diseases has been slow and patchy due to the difficulties and costs with the methods currently used.
We set out to see in an observational study, if computer-based opportunistic screening could be a practical and cost-effective method of cardiovascular disease prevention in a high-risk primary care practice population in Barnsley, South Yorkshire. We found that over five years, 86% of the practice population was screened and educated for their personal risk of cardiovascular disease. This was carried out at a low cost in terms of both professional and administrative time.
Using this computer-based opportunistic screening enables a profile of risk factors for both individuals and the practice to be de-veloped making the targetting of resources for prevention easy and effective. It is also possible that this programme could prove to be a cheap and targetted method of screening for coronary heart disease, diabetes and familial hyperlipidaemia.
We conclude that computer-based opportunistic screening in general practice is an effective method of reaching a whole population and can enable large-scale interventions at low cost.

Br J Cardiol 2007;14:51-55.

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TOPICPRIMARY CARE‘Tidal wave’ of obesity and type 2 diabetes predicted to dominate CVD practice
The management of the ‘tidal wave’ of obesity and type 2 diabetes that is expected to hit the UK over the next 10 years was one of the major themes to emerge from the Primary Care Cardiovascular Society Annual Meeting and AGM, held in Gateshead, October 5th – 7th 2006. Medical journalist Jo Waters reports.

Br J Cardiol 2007;14:57-60.

REVIEWThe oblique view
Michael Norell

Br J Cardiol 2007;14:15-16.

REVIEWOutcome of atrial repair procedures in patients with transposition of the great arteries followed up in a district general hospital
Sushma Rekhraj, Leisa J Freeman

Patients with transposition of the great arteries (TGA) are now living longer due to improved medical and surgical care. Most of the current patients with TGA followed up at our district general hospital (DGH) grown-up congenital heart (GUCH) clinic have undergone a Mustard or a Senning atrial repair procedure between the early 1960s to mid 1980s. Complications found to be associated with the atrial repair procedure include arrhythmias, right ventricular impairment, tricuspid valve dysfunction, baffle-related problems and sudden death. This article reviews the outcome of patients with TGA in this DGH population and also addresses the issue of pregnancy and insurance.

Br J Cardiol 2007;14:19-22.

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TOPICREVIEWManagement of atrial fibrillation: an overview of the NICE guidance on AF management
Timothy Watson, Eduard Shanstila, Gregory Yh Lip

This article aims to provide an overview of the management of atrial fibrillation (AF), with reference to the recently published National Institute for Health and Clinical Excellence (NICE) guidelines on AF management (http://www.nice. org.uk/CG36/guidance/pdf/english). This article is not meant to cover the whole guideline nor be a systematic review, as the full guideline contains all the search strategies and appraised evidence tables, and represents a comprehensive assessment of the evidence behind the recommendations in the NICE guideline (also available at http://rcplondon.ac.uk/pubs/books/af/index.asp).

Br J Cardiol 2007;14:23-28.

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TOPICREVIEWThe NICE guidelines on atrial fibrillation: a personal view
David Fitzmaurice

Br J Cardiol 2007;14:29-30.

HOT
TOPICREVIEWThe emerging role of intracardiac echocardiography – into the ICE age
Andrew RJ Mitchell, Prasanna Puwanarajah, Jonathan Timperley, Harald Becher, Neil Wilson, Oliver J Ormerod

Intracardiac echocardiography (ICE) is an imaging technique that is becoming increasingly available as an alternative to transoesophageal echocardiography to guide percutaneous interventional procedures. The probe can be inserted under local anaesthesia and is principally used during closure of atrial septal abnormalities. The main advantages of ICE over transoesophageal echocardiography include the elimination of the need for general anaesthesia, clearer imaging, shorter procedure times and reduced radiation doses to the patient. Within this article we review some of the current applications of ICE and how to image from within the heart.

Br J Cardiol 2007;14:31-36.

REVIEWUses of the multi-functional probing catheter in the recannalisation of chronic total occlusions
Lucy JH Blows, S Divaka Perera, Simon R Redwood

This paper discusses the uses of the Multi-functional probing catheter™ (Boston Scientific, Scimed) in the arena of percutaneous coronary intervention with specific reference to treating chronic total occlusions. This catheter is essentially a speedy monorail balloon without the balloon mounted on the end. Thus, it has a short monorail/rapid exchange port which exits at the distal tip of the catheter, and an over-the-wire port which exits proximally at the side of the catheter.
Tackling chronic total occlusions often results in the creation of a false passage intramurally rendering it difficult to redirect the guide-wire into the true lumen. The Multi-functional probing catheter™ allows introduction of a second wire in a different direction from this lumen via the over-the-wire port. The benefits of this equipment for guide-wire support and wire exchange are examined. In addition, this support catheter allows distal vessel visualisation, confirming intraluminal wire position. A further use of this catheter is for intracoronary drug delivery especially in the context of vascular spasm, no reflow or thrombotic occlusion.
The use of the Multi-functional probing catheter™ in two chronic total occlusion interventions cases is discussed in detail.

Br J Cardiol 2007;14:41-44.

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TOPICREVIEWA comparison of once- versus twice-weekly supervised phase III cardiac rehabilitation
Helen J Arnold, Louise Sewell, Sally J Singh

Optimum delivery of cardiac rehabilitation is not well defined. A retrospective analysis was conducted to determine the short-term effectiveness of once-weekly compared to twice-weekly supervised cardiac rehabilitation. The analysis included 206 post-myocardial infarction patients who participated in either once- or twice-weekly supervised exercise sessions for six weeks. The primary outcome measure was the incremental shuttle walking test (ISWT). Secondary measures of health-related quality of life were also completed. Once-weekly supervised rehabilitation was completed by 85 patients (65 men), mean (SD) age 61.89 (10.27) years, and twice-weekly supervised rehabilitation was completed by 121 (94 men) mean (SD) age of 59.24 (10.03) years. Both groups demonstrated a statistically significant increase in ISWT distance post-rehabilitation, with mean increases of 100.71 metres (p<0.001) and 88.44 metres (p<0.001) for the once- and twice-weekly groups respectively. A reduction in hospital anxiety and depression scores and improvements in the MacNew quality of life questionnaire was also found. On comparing the magnitude of these changes, there was no significant difference between the two groups.
There is no evidence of additional short-term benefit, in terms of cardiovascular fitness and improvement in health-related quality of life measures, for patients attending twice-weekly supervised cardiac rehabilitation compared to once-weekly.

Br J Cardiol 2007;14:45-48.

CASE REPORTA case of lipomatous hypertrophy of the interatrial septum and coronary artery disease
Momin Salahuddin, E Jane Flint

Br J Cardiol 2007;14:49-50.

REPORTCoronary artery calcification is associated with alcohol intake but not oxidative stress or inflammation
Natalie C Ward, Kevin D Croft, Henrietta Headlam, Trevor A Mori, Keith Woollard, Ian B Puddey

Coronary artery calcification (CAC) is a component of the development of atherosclerosis. Coronary computed tomography scanning (CCT) can detect calcification and may be useful in individuals considered asymptomatic. Oxidative stress and inflammation are linked through common pathways and both are thought to be involved in the pathogenesis of atherosclerosis. To investigate if CAC was associated with increased oxidative stress (plasma F2-isoprostanes) and inflammation (high sensitivity C-reactive protein [hs-CRP]), we invited 102 self-selected individuals (mean age 52+7 years) who were undergoing CCT to take part in a study. Height, weight and clinic blood pressure was measured, a blood sample taken and a health and lifestyle questionnaire completed.
CAC was found to be positively correlated with age (p<0.01) and alcohol intake (p<0.001). There was a trend for higher CAC in men compared to women (p=0.08). CAC was higher in ex- and current smokers versus non-smokers (115+45 vs. 28+12 Agatston score, p=0.05), and lower in non-drinkers versus drinkers (18+17 vs. 90+29 Agatston score, p=0.03). There were no univariate correlations between CAC and plasma F2-isoprostanes (p=0.25) or HS-CRP (p=0.36). In multivariate analysis, age, male gender and alcohol intake remained independent predictors of CAC. We concluded that CAC was not associated with inflammation or oxidative stress, but was related to lifestyle factors including; age, gender and alcohol consumption.

Br J Cardiol 2007;14:37-40.