Clinical and cardiovascular magnetic resonance factors associated with elevated neutrophil-to-lymphocyte ratio in patients with heart failure: an analysis of a single-centre, prospective registry.

Objectives: The neutrophil-to-lymphocyte ratio (NLR) is defined as the ratio of neutrophils to lymphocytes measured in the full blood count. It has been studied across a range of conditions including cancer, sepsis and stroke. It has been proven that in patients with heart failure (HF) with reduced ejection fraction (HF-rEF), an elevated NLR reflects a higher risk of adverse outcomes.

Cost effectiveness of CMR over MPS-SPECT: a systematic review of recent trends for diagnosing CAD.

Aims: The health economic impacts of cardiovascular magnetic resonance (CMR) imaging and myocardial perfusion scintigraphy by single photon emission computed tomography (MPS-SPECT) as diagnostic modalities are not well understood. This review is based on a wider systematic review and aims to compare CMR and MPS-SPECT as first-line, non-invasive modalities for the diagnosis of symptomatic individuals with a low-to-intermediate pre-test probability of coronary artery disease (CAD).

Materials And Methods: We performed a systematic review of MEDLINE and Embase, MEDLINE In-process, the Cochrane Database of Systematic reviews, the Cochrane Central Register of Controlled Trials, and the UK National Health Service Economic Evaluation Database of Abstract of Reviews and Effects.

Cost savings from prioritization of non-invasive modalities within CAD diagnostic protocols: a systematic review.

Aims: While the clinical benefits of non-invasive modalities to diagnose coronary artery disease (CAD) are well recognized, the economic implications of their use over invasive options remain unclear. This review aims to understand the health economic consequences of using non-invasive versus invasive modalities in symptomatic patients with low-to-intermediate pre-test probability (PTP) of CAD, and to explore whether economic and humanistic data can inform future investment decisions around non-invasive and invasive diagnostic modalities.

Materials And Methods: We performed a systematic review of MEDLINE and Embase, MEDLINE In-process, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials.

Artificial intelligence-generated deepfakes in healthcare and biomedical research: major adverse implications for patients, public and professionals.

False advertising is a long-term problem, but, with modern technology, it is now possible to create rapidly and inexpensively and widely distribute fake video, audio and written social media presentations attributed to people without their knowledge or permission. Such 'deepfake' videos and other promotional material, allegedly by healthcare and biomedical research experts, are increasingly being used, often encouraging the purchase of a product that is not scientifically validated, and with which the expert is not associated. We describe some of our recent experiences and suggest potential actions.

Haemodynamic implications of cardiovascular magnetic resonance pulmonary capillary wedge pressure in acute myocardial infarction.

Aims: Cardiovascular magnetic resonance (CMR)-derived pulmonary capillary wedge pressure (PCWP) has demonstrated diagnostic and prognostic utility in heart failure patients. However, its clinical value in acute myocardial infarction (AMI) remains undetermined. This study investigates the relationship between CMR-derived PCWP, myocardial injury, and left ventricular (LV) remodelling in re-perfused acute ST-elevation myocardial infarction (STEMI).

Normal values of high-resolution transmural perfusion distribution metrics for automated quantitative pixel-wise myocardial perfusion cardiovascular magnetic resonance.

Background: The myocardial blood flow (MBF) transmural distribution between the subendocardial (ENDO) and subepicardial (EPI) layers under resting and hyperemic conditions can aid in the diagnosis of several forms of heart disease. Recently proposed automated in-line myocardial perfusion cardiovascular magnetic resonance (CMR) allows pixel-wise quantification of ENDO- and EPI-MBF, but normal values for these parameters are lacking. We therefore aimed to establish normal values for transmural distribution of MBF in a healthy population.

Design and rationale of "a pragmatic approach to the investigation of stable chest pain: A UK, multicenter, randomized trial to assess patient outcomes, quality of life and cost effectiveness (CE-MARC 3)".

Rationale: The optimal noninvasive diagnostic imaging strategy for patients with suspected coronary artery disease (CAD) is widely debated. Computed Tomography Coronary Angiography (CTCA) and functional imaging are both guideline-recommended, although comparative effectiveness in patients with intermediate-high pretest likelihood (PTL) is limited. Primary Hypothesis: We aim to establish if a personalized investigation strategy compared to CTCA first-line for allcomers, leads to improved patient outcomes.

Length of ischemia duration is associated with fibrin film coverage of acute myocardial infarction thrombi.

Background: Coronary artery disease plaque rupture leads to occlusive thrombosis, causing acute myocardial infarction requiring immediate life-saving treatment. The blood clot is supported by a mesh of fibrin fibers that are generated through the polymerization of fibrin. We recently showed that fibrin also produces a film on the surface of blood clots.

Implementation of a national AI technology program on cardiovascular outcomes and the health system.

Coronary artery disease (CAD) is a major cause of ill health and death worldwide. Coronary computed tomographic angiography (CCTA) is the first-line investigation to detect CAD in symptomatic patients. This diagnostic approach risks greater second-line heart tests and treatments at a cost to the patient and health system.

Assessing the impact of COmorbidities and Sociodemographic factors on Multiorgan Injury following COVID-19: rationale and protocol design of COSMIC, a UK multicentre observational study of COVID-negative controls.

Introduction: SARS-CoV-2 disease (COVID-19) has had an enormous health and economic impact globally. Although primarily a respiratory illness, multi-organ involvement is common in COVID-19, with evidence of vascular-mediated damage in the heart, liver, kidneys and brain in a substantial proportion of patients following moderate-to-severe infection. The pathophysiology and long-term clinical implications of multi-organ injury remain to be fully elucidated.

Sex-Specific Association of Myocardial Fibrosis With Mortality in Patients With Aortic Stenosis.

Importance: Myocardial fibrosis in aortic stenosis (AS) may exhibit sex differences. However, its prognostic significance in women with AS remains unclear.

Objective: To investigate sex differences in myocardial fibrosis assessed by cardiovascular magnetic resonance (CMR) and evaluate its prognostic value in women and men with AS.

Myocardial ischaemia following COVID-19: a cardiovascular magnetic resonance study.

The pathophysiology of myocardial injury following COVID-19 remains uncertain. COVID-HEART was a prospective, multicentre study utilising cardiovascular magnetic resonance (CMR) to characterise COVID-related myocardial injury. In this pre-specified analysis, the objectives were to examine (1) the frequency of myocardial ischaemia following COVID-19, and (2) the association between ischaemia and myocardial injury.

Joint British Societies' position statement on cardiology training in the United Kingdom.

Cardiology training in the UK is facing significant challenges due to a range of factors. Recent curriculum changes have further compounded this issue and significantly risk the ability to produce adequately trained consultants capable of managing patients with increasingly complex cardiovascular disease. The introduction of mandatory dual accreditation in general internal medicine (GIM) alongside cardiology, by design, results in significantly reduced training opportunities, including procedural and subspecialty exposure.

Cardiac structural, functional, and energetic assessments during and after pregnancy in women with gestational diabetes mellitus, preeclampsia, and healthy pregnancy.

Background: Gestational diabetes mellitus (GDM) and preeclampsia are common complications of pregnancy, for which overweight/obesity is a common risk factor. Both conditions are associated with a two-to-four-fold increase in future incident heart failure, which may be linked to early maladaptive myocardial changes.

Objective: To determine maternal myocardial structural, functional, and energetic responses to pregnancies complicated by GDM or preeclampsia compared to healthy pregnancies (HP) at third-trimester of pregnancy and 12-months postpartum.

Metformin associates with higher myocardial perfusion reserve and survival in type 2 diabetes mellitus patients.

Metformin is an antihyperglycemic used to treat type 2 diabetes mellitus (T2DM). Patients with T2DM are at increased risk of cardiovascular disease. We explored the association between metformin use and cardiovascular magnetic resonance (CMR) derived stress myocardial blood flow (MBF), myocardial perfusion reserve (MPR) and major adverse cardiovascular events (MACE; all cause death, MI, stroke, heart failure hospitalisation and coronary revascularisation) in patients with T2DM.

Early Intervention in Patients With Asymptomatic Severe Aortic Stenosis and Myocardial Fibrosis: The EVOLVED Randomized Clinical Trial.

Importance: Development of myocardial fibrosis in patients with aortic stenosis precedes left ventricular decompensation and is associated with an adverse long-term prognosis.

Objective: To investigate whether early valve intervention reduced the incidence of all-cause death or unplanned aortic stenosis-related hospitalization in asymptomatic patients with severe aortic stenosis and myocardial fibrosis.

Design, Setting, And Participants: This prospective, randomized, open-label, masked end point trial was conducted between August 2017 and October 2022 at 24 cardiac centers across the UK and Australia.

Cost-effectiveness of a novel AI technology to quantify coronary inflammation and cardiovascular risk in patients undergoing routine coronary computed tomography angiography.

Aims: Coronary computed tomography angiography (CCTA) is a first-line investigation for chest pain in patients with suspected obstructive coronary artery disease (CAD). However, many acute cardiac events occur in the absence of obstructive CAD. We assessed the lifetime cost-effectiveness of integrating a novel artificial intelligence-enhanced image analysis algorithm (AI-Risk) that stratifies the risk of cardiac events by quantifying coronary inflammation, combined with the extent of coronary artery plaque and clinical risk factors, by analysing images from routine CCTA.

Zibotentan in Microvascular Angina: A Randomized, Placebo-Controlled, Crossover Trial.

Background: Microvascular angina is associated with dysregulation of the endothelin system and impairments in myocardial blood flow, exercise capacity, and health-related quality of life. The G allele of the noncoding single nucleotide polymorphism enhances expression of the endothelin-1 gene () in human vascular cells, potentially increasing circulating concentrations of Endothelin-1 (ET-1). Whether zibotentan, an oral receptor selective antagonist, is efficacious and safe for the treatment of microvascular angina is unknown.

Occult coronary microvascular dysfunction and ischemic heart disease in patients with diabetes and heart failure.

Background: Patients with diabetes mellitus (DM) and heart failure (HF) have worse outcomes than normoglycemic HF patients. Cardiovascular magnetic resonance (CMR) can identify ischemic heart disease (IHD) and quantify coronary microvascular dysfunction (CMD) using myocardial perfusion reserve (MPR). We aimed to quantify the extent of silent IHD and CMD in patients with DM presenting with HF.