Heart Podcast

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