Wycombe General Hospital

BackgroundConcomitant epicardial ablation of ventricular tachycardia (VT) remains a clinical challenge in cardiac surgery due to the need for intra-operative mapping. A preoperative patient-tailored epicardial guide could provide an intraoperative ‘blueprint’ of arrhythmogenic target substrate, thereby facilitating the workflow. Thus far, no 3D printing material or technique has fully met the requirements for this application. This study explores the feasibility of high-consistency rubber (HCR) silicone molding to produce low-cost, customized guides for VT scar ablation.MethodsAn inverted mold was created in Meshmixer using merged LGE–CMR and cardiac CT images of a 61-year-old VT patient, and printed using fused deposition modeling. HCR silicone was milled, sculpted, and trimmed to fit the negative mold. The guide was cured, subjected to autoclaving, and bench-tested on an ex vivo porcine heart model using radiofrequency and cryo-ablation. Various durometers and thicknesses were tested to determine the optimal fit for our application.ResultsFive surgical guides were made using NuSil™ MED-4072 and MED-4080 silicone (thickness range: 2.0–3.4 mm). Models with 2.1–3.0 mm thickness and 70 Shore A hardness achieved the best balance between flexibility and rigidity for application on a beating heart. The thinnest model (2.0 mm) was too pliable for stable placement. The guides withstood autoclaving and ablation procedures (radiofrequency; cryo-energy) without deformation or compromising structural integrity.ConclusionsThe HCR silicone molding technique allows for the production of flexible, cost-effective epicardial guides for VT ablation, minimizing the need for a full electrophysiology team throughout the entire procedure.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12938-025-01435-z.

Abstract Background Atherosclerotic cardiovascular disease (CVD) remains the leading cause of global mortality, necessitating robust biomarkers for improved risk stratification and early intervention. Plasma lysozyme has demonstrated excellent diagnostic accuracy for CAD. However, its prognostic significance in long-term mortality remains unexplored. This study investigates the association between baseline arterial lysozyme concentration and all-cause mortality in a well-characterised cohort, evaluating its potential as a predictive biomarker for adverse outcomes in CAD. Methods We performed a long-term follow-up of a previously established cohort of 399 patients who underwent coronary angiography. Arterial lysozyme concentrations were measured via enzyme-linked immunosorbent assay (ELISA), with clinical and demographic data recorded at baseline. The primary endpoint was all-cause mortality, determined through linkage with national death registries and hospital records. Survival analysis was conducted using Kaplan-Meier curves. Cox proportional hazards regression models were employed to assess the independent association of lysozyme with mortality, adjusting for key confounders including age, sex, comorbidities, and traditional cardiovascular risk factors. A data-driven threshold of 1.5 was identified as the optimal cut-off for defining high-risk individuals. Results Over a median follow-up of 16 years (IQR: 15–20), elevated arterial lysozyme concentration was significantly associated with increased mortality risk in both univariate (HR = 1.06, 95% CI: 1.03–1.08, p < 0.001) and multivariate analysis (HR = 1.10, 95% CI: 1.04–1.15, p < 0.001). Stratification using the 1.5 threshold demonstrated high sensitivity (86.9%) and specificity (87.3%) for CAD risk. Patients in the high lysozyme group had a significantly increased mortality hazard (univariate HR = 2.42, 95% CI: 1.63–3.60, p < 0.001; multivariate HR = 2.07, 95% CI: 1.23–3.50, p = 0.006). Kaplan-Meier survival analysis (Figure 1) further confirmed a markedly reduced survival probability in the high lysozyme group (p < 0.0001), reinforcing its prognostic significance. Conclusion Elevated arterial lysozyme concentration is a powerful and independent predictor of long-term mortality in patients undergoing coronary angiography. The identified threshold of 1.5 effectively stratifies high-risk individuals, demonstrating strong predictive value beyond traditional cardiovascular risk factors. These findings position arterial lysozyme as a promising biomarker for risk assessment in atherosclerosis, warranting further investigation into its mechanistic role and potential integration into clinical decision-making to enhance early intervention and patient outcomes.

BackgroundStress echocardiography is a key imaging modality for assessing coronary artery disease in the UK. Traditionally, stress echo services were led by consultant cardiologists, but evolving workforce models have increased the involvement of cardiac physiologists and scientists. This study, as part of the National Review of Stress Echocardiography Practice (BSE N-STEP), aimed to evaluate current stress echo workforce structures and test outcomes across a group of UK hospitals to inform future workforce planning.ResultsData were analysed from 8506 stress echocardiograms, conducted between September 2020 and June 2023 across 34 UK hospitals. Based on the supervising workforce, stress echocardiograms were allocated into either a doctor-led (DL) or cardiac physiologist/scientist and nurse-led (CNL) model. 56.9% of stress echocardiograms were DL, while 42.7% were conducted under a CNL model. Physiologists/scientists were the most frequently involved staff (81.9%). The primary indication for stress echocardiography was ischaemia evaluation (89.4%). Dobutamine stress echocardiography was more common in DL services (63.0 vs. 56.3%, p < 0.001), while CNL services performed more exercise stress echocardiography (42.8 vs. 36.4%, p < 0.001). Test positivity rates were similar between DL and CNL models (17.1 vs. 17.7%, p = ns), though the CNL group had a lower complication rate (2.2 vs. 5.3%, p < 0.001). Reporting of stress echocardiograms remained consultant-led in 82% of cases, but physiologist/scientist-led reporting showed an increase over time. Training was primarily provided to registrars/fellows (60.2%), with physiologist/scientist trainees accounting for 32.4%. ConclusionsThis study provides a contemporary overview of stress echocardiography workforce models in the UK, highlighting the increasing role of cardiac physiologists and scientists in supervising and reporting stress echocardiography. Despite these shifts, consultant cardiologists remain central to stress echo reporting. The findings support the integration of multidisciplinary workforce models to enhance service efficiency. These insights will aid in future workforce planning and training strategies to optimise stress echocardiography service provision across the NHS. Supplementary InformationThe online version contains supplementary material available at 10.1186/s44156-025-00088-x.

The survival of dogs with pheochromocytoma (PCC) treated with adrenoreceptor antagonists has not been described or compared to surgically managed cases. The objective of this study is to evaluate the survival of medically and surgically managed dogs with PCC and investigate factors associated with survival. Two hundred fifty-five dogs with PCC, treated with alpha-adrenoreceptor antagonists (AA) without adrenalectomy (Group 1, n = 75), adrenalectomy +/- AA (Group 2, n = 128), or neither treatment (Group 3, n = 52). Retrospective, multicenter review of medical records. Median overall survival time (OST) for Groups 1 and 2 combined was calculated using Kaplan-Meier estimates, and then compared between Group 1 and Group 2 using Log-Rank testing. Cox proportional hazard analysis identified factors associated with survival in Groups 1 and 2 individually and combined. Median OST for all cases was 854 (95% CI: 572-1136) days. Median OST was lower in Group 1 (247 days, 95% CI: 76-418 days) than in Group 2 (927 days, 95% CI: 587-1267 days; p < 0.001). In Group 2, 88/92 dogs (97.8%) that received presurgical AA treatment survived to discharge compared to 23/27 (85.2%) that did not receive AA pretreatment (p = 0.03). Lack of clinical signs at presentation was associated with increased survival in both groups combined (HR 0.5; 95% CI 0.3-0.9; p = 0.02) and in Group 2 alone (HR 0.3; 95% CI 0.1-0.7; p = 0.01). Dogs with PCC treated with adrenalectomy have longer survival compared to those managed with AA without adrenalectomy.

This review paper provides a comprehensive analysis of electric vehicles (EVs) and the various factors influencing fast charging technology. The surge in EV adoption has necessitated advancements in charging infrastructure, particularly in fast charging solutions. We delve into the technical aspects of fast charging, including its impact on battery life, charging station architecture, power grid integration, and charging protocols. Moreover, we discuss the influence of battery chemistry, temperature management, and charging infrastructure on the efficacy of fast charging. By synthesizing current research findings and industry trends, this paper offers insights into the challenges and opportunities for enhancing fast charging efficiency and accessibility, thereby accelerating the widespread adoption of electric vehicles.

AimsExcessive prolongation of PR interval impairs coupling of atrio‐ventricular (AV) contraction, which reduces left ventricular pre‐load and stroke volume, and worsens symptoms. His bundle pacing allows AV delay shortening while maintaining normal ventricular activation. HOPE‐HF evaluated whether AV optimized His pacing is preferable to no‐pacing, in a double‐blind cross‐over fashion, in patients with heart failure, left ventricular ejection fraction (LVEF) ≤40%, PR interval ≥200 ms and either QRS ≤140 ms or right bundle branch block.Methods and resultsPatients had atrial and His bundle leads implanted (and an implantable cardioverter‐defibrillator lead if clinically indicated) and were randomized to 6 months of pacing and 6 months of no‐pacing utilizing a cross‐over design. The primary outcome was peak oxygen uptake during symptom‐limited exercise. Quality of life, LVEF and patients' holistic symptomatic preference between arms were secondary outcomes. Overall, 167 patients were randomized: 90% men, 69 ± 10 years, QRS duration 124 ± 26 ms, PR interval 249 ± 59 ms, LVEF 33 ± 9%. Neither peak oxygen uptake (+0.25 ml/kg/min, 95% confidence interval [CI] −0.23 to +0.73, p = 0.3) nor LVEF (+0.5%, 95% CI −0.7 to 1.6, p = 0.4) changed with pacing but Minnesota Living with Heart Failure quality of life improved significantly (−3.7, 95% CI −7.1 to −0.3, p = 0.03). Seventy‐six percent of patients preferred His bundle pacing‐on and 24% pacing‐off (p < 0.0001).ConclusionHis bundle pacing did not increase peak oxygen uptake but, under double‐blind conditions, significantly improved quality of life and was symptomatically preferred by the clear majority of patients. Ventricular pacing delivered via the His bundle did not adversely impact ventricular function during the 6 months.

Virtual clinics have played a huge role in the continuation of service provision during the COVID-19 pandemic. This article provides an overview of how one heart failure clinic transferred its services to virtual clinics and what is needed to sustain these changes going forward.

With an ongoing move towards more management of patients within the community setting, demand for magnetic resonance imaging (MRI) is increasing and commonly used in lower back conditions. There is well recorded overuse of MRI in this scenario which goes against evidence-based practice and adds to rising healthcare costs. The study was a retrospective review of lumbar spine MRI scans performed within a community-based setting over an 18-month period. The review took a randomised purposive sample of patients (n = 450); looking at adherence to, and relevance of, guidelines in managing lower back conditions. Data extracted provided information on demographics and prevalence of clinical presentation and report observations. There is variation in practice and utlisation of MRI with this patient group which warrants further exploration. Results support inappropriate use, lacking adherence to guidelines and pathways, leading to unnecessary imaging. 46% of referrals were considered clinically justified with 38% of report findings considered abnormal and of clinical relevance. Chi-square and binomial logistic regression were used to assess the significance and relationship of any factors on referral justification and report outcome. No difference was found between type of referrer, with patient age and leg symptoms being significant factors. The study highlights the opportunity to integrate better referral criteria to improve referral quality, its suitability and the relevance of final reports. In the current climate this would help manage appropriate use of imaging resources during the post COVID-19 pandemic recovery phase, as well as support recommendations regarding diagnostic reform and a move towards more community-based diagnostics.