Recovery Rates of Diagnostic Cardiac Procedural Volume in Oceania 1 Year Into COVID-19: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID 2).

AIM: The aim of this study was to assess the recovery rates of diagnostic cardiac procedure volumes in the Oceania Region, midway through the coronavirus disease 2019 (COVID-19) pandemic. METHODS: A survey was performed comparing procedure volumes between March 2019 (pre-pandemic), April 2020 (during first wave of COVID-19 pandemic), and April 2021 (1 year into the COVID-19 pandemic). A total of 31 health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, as well as teaching and non-teaching hospitals. A comparison was made with 549 centres in 96 countries in the rest of the world (RoW) outside of Oceania. The total number and median percentage change in procedure volume were measured between the three timepoints, compared by test type and by facility. RESULTS: A total of 11,902 cardiac diagnostic procedures were performed in Oceania in April 2021 as compared with 11,835 pre-pandemic in March 2019 and 5,986 in April 2020; whereas, in the RoW, 499,079 procedures were performed in April 2021 compared with 497,615 pre-pandemic in March 2019 and 179,014 in April 2020. There was no significant difference in the median recovery rates for total procedure volumes between Oceania (-6%) and the RoW (-3%) (p=0.81). While there was no statistically significant difference in percentage recovery been functional ischaemia testing and anatomical coronary testing in Oceania as compared with the RoW, there was, however, a suggestion of poorer recovery in anatomical coronary testing in Oceania as compared with the RoW (CT coronary angiography -16% in Oceania vs -1% in RoW, and invasive coronary angiography -20% in Oceania vs -9% in RoW). There was no statistically significant difference in recovery rates in procedure volume between metropolitan vs regional (p=0.44), public vs private (p=0.92), hospital vs outpatient (p=0.79), or teaching vs non-teaching centres (p=0.73). CONCLUSIONS: Total cardiology procedure volumes in Oceania normalised 1 year post-pandemic compared to pre-pandemic levels, with no significant difference compared with the RoW and between the different types of health care facilities.

Risk Factors of Haematoma Formation Following Cardiac Implantable Electronic Device Procedures.

PURPOSE: A single-centre cohort of 2,100 adults who consecutively underwent cardiac implantable electronic device procedures were retrospectively analysed to identify and quantify risk factors of perioperative pocket haematoma formation. RESULTS: Dual antiplatelet therapy was significantly associated with increased odds of haematoma formation (OR 11.7 for aspirin and clopidogrel, OR 11.8 for aspirin and ticagrelor and OR 104 for aspirin and prasugrel, p<0.05) on multivariate binomial logistic regression analysis. Aspirin monotherapy was also associated with increased bleeding risk (OR 3.02, p<0.01). Direct oral anticoagulants and warfarin were also each associated with increased odds of haematoma formation although to a lesser extent than dual anti platelet therapy (DAPT). Amongst oral anticoagulants, apixaban was associated with the lowest bleeding risk (OR 2.59, p=0.03) whilst dabigatran was associated with the highest (OR 3.81, p=0.04). There was a significant incremental reduction in bleeding risk by 8% per 10x103/µL increase in platelet count. CONCLUSION: DAPT was associated with increased odds of pocket haematoma formation following cardiovascular implantable electronic device (CIED) procedure. This likelihood was higher than with oral anticoagulation therapy. Timely medication reconciliation of P2Y12 inhibitors according to guidelines is important to avoid post-procedural bleeding complications. Perioperative policies which account for the half-life of withheld anticoagulant agents may help reduce the haematoma risk.

Combating Inflammation in Cardiovascular Disease.

The role of inflammation in promoting atherosclerosis and subsequent cardiovascular disease is increasingly recognised, particularly after the publication of Anti-inflammatory Therapy with Canakinumab for Atherosclerotic Disease (CANTOS) and Colchicine Cardiovascular Outcomes (COLCOT) trials. It appears that specifically targeting the Nod-like receptor protein 3 (NLRP3) inflammasome-interleukin 1/interleukin 18-interleukin 6 pathway appears to be most beneficial in cardiovascular risk reduction. High sensitivity C-reactive protein (CRP) is a downstream biomarker of inflammation that can be used to monitor treatment. This article will discuss the role of inflammation in cardiovascular disease, the utility of high sensitivity C-reactive protein and treatments that target this inflammation. While further research is needed into the cost effectiveness and safety of newer agents, it remains an evolving approach to manage cardiovascular risk.

Predictive value of symptoms, signs and biomarkers on computed tomography pulmonary angiogram results.

BACKGROUND: Pulmonary embolism (PE) is associated with significant morbidity and mortality. PE is a heterogeneous entity that causes a wide variety of clinical presentations, making it imperative to establish which clinical symptoms, signs and biomarkers can influence the pretest probability of PE to aid clinicians and reduce over testing. AIM: To analyse the clinical parameters used by clinicians to order a computed tomography pulmonary angiogram (CTPA) and establish which were associated with the presence of PE. METHODS: Medical records of patients who underwent CTPA from December 2015 to March 2016 were extracted. Patient demographics, clinical symptoms, diagnostic and radiological results were analysed. RESULTS: The study included 150 CTPA studies. Of the studies, 25 were positive for PE and 125 were negative. There was no significant relationship between the presence or character of chest pain and a positive CTPA result (P = 0.216). Previous history of venous thromboembolism (VTE) (P < 0.0001), one or more risk factors for VTE and positive troponin (P < 0.002) were all predictive of PE. None of the patients with a negative D-dimer had a positive CTPA. CONCLUSION: This study supports the negative predictive value of the D-dimer for excluding PE and demonstrates that the strongest pretest predictors of PE in our population are a prior history of VTE, risk factors for VTE and elevated troponin. None of the parameters that often generate requests for CTPA, including vital signs or the presence of chest pain, was associated with the presence of PE in our study population.

When the first seizure can be the last: ventricular fibrillation following a new-onset seizure.

Sudden unexpected death in epilepsy (SUDEP) is the leading cause of epilepsy-related mortality. Its mechanisms remain incompletely understood. Post-ictal arrhythmias rather than ictal arrhythmias appear to be associated with an increased risk of SUDEP. Only a handful of individuals with epilepsy who have survived ventricular arrhythmias post seizure (near-SUDEP) are reported in the literature. We report a case of ventricular fibrillation following a first-ever unprovoked seizure in a patient without epilepsy, in whom a sinus rhythm was restored following cardioversion. A defibrillator was subsequently implanted. Our case suggests that even first seizures might account for some of the many cases of unexplained ventricular fibrillation or sudden cardiac death.