Gerry P Mccann

National Health Service | NHS · Department of Cardiology

Introduction Late gadolinium enhancement (LGE) imaging with cardiovascular magnetic resonance (CMR) is considered the non-invasive gold standard for identifying and quantifying myocardial scar. The diagnostic and prognostic importance of myocardial scar quantification by CMR has been demonstrated in a variety of cardiac pathologies. With CMR imagin...

Introduction Current guidelines recommend surgical or transcatheter aortic valve replacement (AVR) for severe aortic stenosis (AS) once symptoms or left ventricular dysfunction develop, whilst those with asymptomatic severe AS remain under active surveillance.The EASY-AS randomised control trial is testing the hypothesis that early surgery in this...

Introduction & Aim Aortic stenosis (AS) is characterised by the progressive accumulation of fibrotic extracellular matrix and calcific mineral within the aortic valve (AV). These structural changes result in reduced leaflet mobility and left ventricular outflow obstruction, which if left untreated is associated with high mortality. The only treatme...

Background Coronary microvascular disease is well recognised in aortic stenosis (AS) and has been shown to be associated with adverse prognosis in a range of cardiovascular diseases. However, the prognostic role of myocardial perfusion reserve (MPR) or coronary flow reserve (CFR) in patients with AS has not been conclusively established. Purpose T...

Introduction People with Type 2 Diabetes (T2D) are at increased risk of heart failure, and as such are classified as having Stage A Heart Failure (SAHF). Stage B Heart Failure (SBHF) encompasses patients without symptoms of heart failure that have evidence of raised filling pressures, biochemical or structural cardiac changes. Identifying patients...

Introduction Skeletal muscle (SkM) abnormalities are well recognised in heart failure (HF). Sarcopenia is characterised by the progressive loss of SkM mass/quality and function. SkM energetics can be assessed non-invasively by 31 Phosphorus Magnetic Resonance Spectroscopy (31P MRS). Phosphocreatine (PCr) regenerates Adenosine Triphosphate (ATP) via...

Background Pre-existing cardiovascular disease (CVD) or cardiovascular risk factors have been associated with an increased risk of complications following hospitalisation with COVID-19, but their impact on the rate of recovery following discharge is not known. Objectives To determine whether the rate of patient-perceived recovery following hospita...

Background: This study assesses the temporal responses of cardiovascular function, fibro-inflammation, and glucometabolic profiles in asymptomatic adults with type 2 diabetes, following a low-energy meal replacement plan (MRP) or exercise training. Methods: Secondary analysis of DIASTOLIC: a randomised, open-label, blinded-endpoint trial of 12 week...

Introduction Dysregulated epicardial adipose tissue (EAT) may play an important role in the development of heart failure in Type 2 Diabetes (T2D). EAT can be measured using computed tomography (CT) but there are limited data directly comparing this with CMR-measured EAT, which offers unique advantages. This study aimed to assess CT- and CMR-measure...

Introduction Type 2 Diabetes (T2D) leads to cardiovascular remodelling, and heart failure has emerged as a major complication of T2D. There is a limited understanding of the impact of T2D on the right heart. This study aimed to assess subclinical right heart alterations and their contribution to aerobic exercise capacity (peak VO2) in adults with T...

Introduction We aimed to assess temporal responses of 1) cardiovascular function 2) inflammation, 3) glucometabolic profiles in asymptomatic adults with T2D, following a low-calorie meal replacement plan (MRP) or exercise training. Materials and Methods A secondary analysis of the DIASTOLIC study, a randomized, open-label, blinded endpoint trial o...

Introduction Limited data exist on the optimum dose of contrast needed for tissue characterisation using CMR at 3T. We assessed whether reduced contrast dose could provide similar quality of late gadolinium enhanced (LGE) images in standard clinical CMR. Materials and Methods This analysis included patients undergoing clinical CMR scans at Glenfie...

Introduction Recent developments in the field of myocardial perfusion assessment with cardiovascular magnetic resonance (CMR) enable the automated inline quantification of myocardial blood flow (MBF).¹ This offers potential advantages over qualitative assessment of images, providing an objective, quantitative and serially evaluable endpoint. Previo...

Background Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) frequently co-exist. There is a limited understanding on whether this coexistence is associated with distinct alterations in myocardial remodelling and mechanics. We aimed to determine if patients with atrial fibrillation (AF) and heart failure with prese...

A 72-year-old female presents with breathlessness. ECG demonstrated deep T-wave inversion in the praecordial leads. Echocardiogram was limited but demonstrated no obvious impairment in left ventricular systolic function or significant valve dysfunction. CMR was conclusive for a diagnosis of apical hypertrophic cardiomyopathy with additional microva...

Background Heart failure with preserved ejection fraction (HFpEF) is a heterogenous multi-system syndrome with limited efficacious treatment options. The prevalence of Type 2 diabetes (T2D) continues to rise and predisposes patients to HFpEF, and HFpEF remains one of the biggest challenges in cardiovascular medicine today. Novel therapeutic targets...

Type 2 diabetes (T2D) is a multisystem disease with rapidly increasing global prevalence. Heart failure has emerged as a major complication of T2D. Dysregulated myocardial calcium handling is evident in the failing heart and this may be a key driver of cardiomyopathy in T2D, but until recently this has only been demonstrated in animal models. In th...

Abstract Aim: To test the feasibility and accuracy of a new attention-based deep learning (DL) method for right ventricular (RV) quantification using 2D echocardiography (2DE) with cardiac magnetic resonance imaging (CMR) as reference. Methods and Results: We retrospectively analyzed images from 50 adult patients (median age 51, interquartile range...

Objective To investigate whether a very early invasive strategy (IS)±revascularisation improves clinical outcomes compared with standard care IS in higher risk patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). Methods Multicentre, randomised, controlled, pragmatic strategy trial of higher risk patients with NSTE-ACS, defined by Gl...

Rationale: There is conflicting evidence whether aerobic exercise training (AET) reduces pulse wave velocity (PWV) in adults with and without long-term conditions (LTCs). Objective: To explore whether PWV improves with AET in adults with and without LTC, to quantify the magnitude of any effect and understand the influence of the exercise prescri...

Aortic distensibility (AD) is important for the prognosis of multiple cardiovascular diseases. We propose a novel resource-efficient deep learning (DL) model, inspired by the bi-directional ConvLSTM U-Net with densely connected convolutions, to perform end-to-end hierarchical learning of the aorta from cine cardiovascular MRI towards streamlining A...

Objectives To determine the association between symptoms and signs reported in primary care consultations following a new diagnosis of heart failure (HF), and 3-month hospitalisation and mortality. Design Nested case–control study with density-based sampling. Setting Clinical Practice Research Datalink, linked to hospitalisation and mortality (19...

The right ventricular (RV) function deterioration strongly predicts clinical outcomes in numerous circumstances. To boost the clinical deployment of ensemble regression methods that quantify RV volumes using tabular data from the widely available two-dimensional echocardiography (2DE), we propose to complement the volume predictions with uncertaint...

Background In patients with COVID-19 requiring supplemental oxygen, dexamethasone reduces acute severity and improves survival, but longer-term effects are unknown. We hypothesised that systemic corticosteroid administration during acute COVID-19 would be associated with improved health-related quality of life (HRQoL) one year after discharge. Meth...

Arrhythmia, characterised by irregular heartbeats, poses significant health risks. Residual networks, a subset of deep learning architectures, have emerged as a potent tool in detecting electrocardiogram (ECG) signal anomalies. However, the enhanced accuracy and capabilities afforded by increasing network depth in these models come at the cost of h...

Introduction: The diagnostic performance of EKG in ruling out myocardial abnormalities following COVID-19 is unclear. Aim: To assess the ability of EKG to exclude cardiac abnormalities on cardiac magnetic resonance imaging (CMR) in post-hospitalised COVID-19 patients. Methods: Post-hospitalized patients (n=212) & comorbidities matched controls (n=3...

Introduction: Patients with moderate or asymptomatic severe aortic stenosis (AS) are at increased risk of cardiovascular events, but markers to guide intervention are lacking. We investigated the use of cardiovascular magnetic resonance (CMR) to identify drivers of outcome. Methods: Moderate (aortic valve area [AVA] 1.0-1.5 cm2) or asymptomatic sev...

Introduction: Abnormal myocardial perfusion and MI are each associated with cardiovascular events in individuals with diabetes mellitus (DM). Hypothesis: We hypothesised that, in patients with T2DM, CMR determined quantitative myocardial perfusion and MI are independent predictors of major adverse cardiovascular and cerebrovascular events (MACCE) a...

Importance In the Revascularization for Ischemic Ventricular Dysfunction (REVIVED-BCIS2) trial, percutaneous coronary intervention (PCI) did not improve outcomes for patients with ischemic left ventricular dysfunction. Whether myocardial viability testing had prognostic utility for these patients or identified a subpopulation who may benefit from P...

Background South Asians (SA) constitute a quarter of the global population and are disproportionally affected by both type 2 diabetes (T2D) and heart failure. There remains limited data of the acceptability and efficacy of low-energy meal replacement plans to induce remission of T2D in SA. Objectives The objective of this exploratory secondary ana...

Introduction Epicardial adipose tissue (EAT) exerts paracrine effects on the myocardium. More lipid-laden adipocytes, with lower attenuation on computed tomography (CT), are associated with greater pro-inflammatory activity. We aim to compare EAT in patients with aortic stenosis (AS) and healthy controls and explore correlations with cardiac remode...

Objective: To characterise cardiac remodelling, exercise capacity and fibroinflammatory biomarkers in patients with aortic stenosis (AS) with and without diabetes, and assess the impact of diabetes on outcomes. Methods: Patients with moderate or severe AS with and without diabetes underwent echocardiography, stress cardiovascular magnetic resona...

In this EACVI clinical scientific update, we will explore the current use of multi-modality imaging in the diagnosis, risk-stratification and follow-up of patients with aortic stenosis, with a particular focus on recent developments and future directions. Echocardiography is and will likely remain the key method of diagnosis and surveillance of aor...

Background and Aims Kidney transplant recipients (KTRs) have an increased burden of cardiovascular disease (CVD) due to clustering of traditional and non-traditional risk factors. Poor cardiorespiratory fitness (CRF) is linked to higher levels of morbidity and mortality. Cardiorespiratory fitness is a significant predictor of 7-year risk of mortali...

Background Cardiac power (CP) describes the cardiac work done to maintain arterial pressure in the vasculature and peak CP is the ceiling of pumping performance the heart can achieve. CP been shown to have prognostic value in heart failure. Patients with aortic stenosis (AS) demonstrate cardiac remodelling in response to pressure overload and a red...

Background People with Type 2 Diabetes (T2D) and obesity have ectopic fat deposition and are at increased risk of heart failure with preserved Ejection Fraction (HFpEF). HFpEF is typified by impaired diastolic function. There is limited evidence on the relationship between visceral adipose tissue (VAT) and diastolic or systolic function in adults w...

Introduction Aortic Stenosis (AS) is the most common valve lesion requiring intervention in developed countries, and its incidence is rising with an ageing population. Current guidelines recommend valve replacement once symptoms develop. However, replacement fibrosis, which occurs as part of the remodelling response to the lesion, starts during the...

Introduction Disparities in aortic valve intervention rates in ethnic minorities have been described, predominantly in the US, with under-utilisation of surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) in Black and Latino patients. However, little is known about intervention rates in the UK. The aim of the...

● PHOSP-COVID is a national UK multi-centre cohort study of patients who were hospitalised for COVID-19 and subsequently discharged. ● PHOSP-COVID was established to investigate the medium- and long-term sequelae of severe COVID-19 requiring hospitalisation, understand the underlying mechanisms of these sequelae, evaluate the medium- and long-term...

In order for mass spectrometry to continue to grow as a platform for high-throughput clinical and translational research, careful consideration must be given to quality control by ensuring that the assay performs reproducibly and accurately and precisely. In particular, the throughput required for large cohort clinical validation in biomarker disco...

Objectives To explore the ethnic differences in patients undergoing aortic valve (AV) intervention for severe aortic stenosis (AS) in Leicestershire, UK. Methods Retrospective cohort study of all surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) at a single tertiary centre between April 2017 and March 2022...

Aims Guidelines for suspected cardiac chest pain have used historical risk stratification tools, advocating invasive coronary angiography (ICA) first-line in those at highest risk. We aimed to determine whether different strategies to manage suspected stable angina affected medium-term cardiovascular event rates and patient-reported quality of life...

Type 2 diabetes (T2D) confers a high risk of heart failure frequently with evidence of cardiovascular structural and functional abnormalities before symptom onset. The effects of remission of T2D on cardiovascular structure and function are unknown. The impact of the remission of T2D, beyond weight loss and glycaemia, on cardiovascular structure an...

Background Metformin is an antihyperglycemic agent frequently used in the treatment of Type 2 Diabetes Mellitus (T2DM). Patients with T2DM are at increased risk of cardiovascular diseases, including coronary artery disease (CAD), silent myocardial infarction (MI) and coronary microvascular dysfunction (CMD), all of which can be detected and quantif...

Objectives: Endurance athletes are at an increased risk of atrial fibrillation (AF) when compared with the general population. However, the risk of stroke in athletes with AF is unknown. Design and setting: We aimed to assess this risk using an international online survey. Patients: Individuals that had competed in ≥1 competitive events and we...

Myocardial infarction (MI) occurs when an artery supplying blood to the heart is abruptly occluded. The “gold standard” method for imaging MI is cardiovascular magnetic resonance imaging (MRI) with intravenously administered gadolinium-based contrast (with damaged areas apparent as late gadolinium enhancement [LGE]). However, no “gold standard” ful...

Background: Recently, deep learning via convolutional neural networks (CNNs) has largely superseded conventional methods for proton (1 H)-MRI lung segmentation. However, previous deep learning studies have utilized single-center data and limited acquisition parameters. Purpose: Develop a generalizable CNN for lung segmentation in 1 H-MRI, robust...

Introduction Altered haemodynamic flow patterns in the aorta are linked with increased risk of bicuspid aortic valve (BAV)-associated aortopathy.1–3 Using 4D-flow cardiovascular magnetic resonance (4DF-CMR), we assessed whether our novel 3D volumetric quantification of vorticity in the ascending aorta can demonstrate flow alterations of BAV patient...

Introduction Aortic valve replacement (AVR) in patients with severe aortic stenosis (AS) leads to reverse remodelling, with reduction in left ventricle (LV) mass and volumes. However, the effect of AVR on LV and left atrial (LA) myocardial deformation using feature tracking cardiovascular magnetic resonance (FT-CMR) has not been extensively studied...

Introduction Cardiac power-to-mass (CPM) describes the hydraulic work done by the heart to maintain pressure in the arterial vasculature. It has been shown to have prognostic value in cardiac disease. Materials and Methods In this prospective observational study, 112 asymptomatic patients with moderate to severe aortic stenosis (AS) (age 66 ± 12 y...

Introduction Bicuspid aortic valve (BAV) is associated with earlier onset valvulo-aortopathy including aortic stenosis (AS) and aortic root dilatation than tri-leaflet aortic valves (TAV). Altered aortic haemodynamic flow patterns are linked with increased risk of BAV-associated aortopathy.1–3 Incremental effects of AS on these are unclear. Materi...

Introduction Untreated severe aortic stenosis (AS) has a poor prognosis. Coexisting type 2 diabetes (T2D) has a detrimental impact on progression and prognosis, but there is limited data on whether there are distinct alterations in myocardial remodelling and exercise capacity in AS patients with T2D. Materials and Methods In this pooled analysis o...

Introduction Type 2 diabetes (T2D) confers 10% higher relative risk of heart failure in women than men,¹ which may be linked to higher prevalence of coronary microvascular dysfunction. We aimed to determine the prevalence and sex-specific determinants of coronary microvascular dysfunction in asymptomatic people with T2D. Materials and Methods We p...

Introduction Asymptomatic people with Type-2 Diabetes (T2D) have reduced exercise capacity and are at high risk of developing heart failure (HF) with evidence of adverse cardiac remodelling (Stage-B HF). We sought to determine whether novel cardiopulmonary exercise testing (CPET) indices were independently associated with Stage B HF in T2D. Materi...

Background: Acute myocardial injury in hospitalized patients with coronavirus disease 2019 (COVID-19) has a poor prognosis. Its associations and pathogenesis are unclear. Our aim was to assess the presence, nature, and extent of myocardial damage in hospitalized patients with troponin elevation. Methods: Across 25 hospitals in the United Kingdom...

A "heart attack" or myocardial infarction (MI), occurs when an artery supplying blood to the heart is abruptly occluded. The "gold standard" method for imaging MI is Cardiovascular Magnetic Resonance Imaging (MRI), with intravenously administered gadolinium-based contrast (late gadolinium enhancement). However, no "gold standard" fully automated me...

Aims Recently developed in-line automated cardiovascular magnetic resonance (CMR) myocardial perfusion mapping has been shown to be reproducible and comparable with positron emission tomography (PET), and can be easily integrated into clinical workflows. Bringing quantitative myocardial perfusion CMR into routine clinical care requires knowledge of...

Introduction: Dysregulated myocardial calcium handling may be a precursor for heart failure in type 1 (T1D) and type 2 diabetes (T2D). Manganese-enhanced magnetic resonance imaging (MEMRI) is a novel non-invasive method of assessing in vivo myocardial calcium handling. Hypothesis Myocardial calcium handling is impaired in patients with either T1D o...

Introduction: Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) frequently occur in parallel. Whether this coexistence is associated with distinct alterations in myocardial remodelling and mechanics is not known. Methods: Adults with heart failure with an LV EF greater than 50% on echocardiography were prospectivel...

Objective To assess whether epicardial adipose tissue (EAT) is associated with early cardiac dysfunction in type 2 diabetes (T2D). Methods Prospective case-control study. Participants with T2D and no known cardiovascular disease underwent comprehensive multimodality phenotyping. CT derived EAT volume was measured using a deep learning method and i...

Introduction Type 2 diabetes mellitus (T2DM) onset before 40 years of age has a magnified lifetime risk of cardiovascular disease. Diastolic dysfunction is its earliest cardiac manifestation. Low energy diets incorporating meal replacement products can induce diabetes remission, but do not lead to improved diastolic function, unlike supervised exer...

Background FFRCT assesses the functional significance of lesions seen on CTCA, and may be a more efficient approach to chest pain evaluation. The FORECAST randomized trial found no significant difference in costs within the UK National Health Service, but implications for US costs are unknown. The purpose of this study was to compare costs in the F...

OBJECTIVE Sodium–glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RA) reduce body weight and improve cardiometabolic health, but their effect on physical activity is unknown. RESEARCH DESIGN AND METHODS We pooled data (n = 148) from three randomized trials to investigate the effect of empagliflozin (S...

Bicuspid aortic valve is the most common congenital cardiac malformation and the leading cause of aortopathy and aortic stenosis in younger patients. Aortic wall remodelling secondary to altered haemodynamic flow patterns, changes in peak velocity, and wall shear stress may be implicated in the development of aortopathy in the presence of bicuspid...

Heart failure with preserved ejection fraction (HFpEF) currently accounts for approximately half of all new heart failure cases in the community. HFpEF is closely associated with chronic lifestyle-related diseases, such as obesity and type 2 diabetes, and clinical outcomes are worse in those with than without comorbidities. HFpEF is pathophysiologi...

Introduction The non-coding locus at 6p24 located in intron 3 of PHACTR1 has consistently been implicated as a risk allele in myocardial infarction and multiple other vascular diseases. Recent murine studies have identified a role for Phactr1 in the development of atherosclerosis. However, the role of PHACTR1 in vascular tone and in vivo vascular r...

Background Type 2 diabetes (T2D) is associated with several perturbations of cardiac structure and function, which are precursors to the development of heart failure. Excess accumulation of epicardial adipose tissue (EAT) may contribute to cardiac dysfunction in individuals with T2D. Lipid-laden adipocytes have a lower computed tomography (CT) atte...

Introduction People with Type 2 Diabetes (T2D) are predisposed to heart failure (HF). South Asian (SA) people are disproportionally affected by T2D. Weight management orientated lifestyle treatments have proven successful in the reversal of T2D in the overweight population. There are no studies comparing the effect of a low-energy meal-replacement...

Introduction Patients with Type 2 Diabetes Mellitus (T2DM) are at increased risk of cardiovascular disease, including epicardial coronary heart disease, silent myocardial infarction (MI), and coronary microvascular dysfunction (CMD). [1] All of these can be assessed and quantified using cardiac magnetic resonance (CMR), including most recently quan...

Introduction The pathophysiology of diabetic cardiomyopathy has yet to be established although pre-clinical studies suggest a role for altered myocardial calcium handling. Manganese-enhanced magnetic resonance imaging (MEMRI) is a novel non-invasive method of assessing in vivo myocardial calcium handling. The purpose of this study was to investigat...

Background: Left ventricular (LV) strain measurements can be derived using cardiac MRI from routinely acquired balanced steady-state free precession (bSSFP) cine images. Purpose: To compare the interfield strength agreement of global systolic strain, peak strain rates and artificial intelligence (AI) landmark-based global longitudinal shortening...

Abstract Background Type 2 diabetes (T2D) and hypertension commonly coexist and are associated with subclinical myocardial structural and functional changes. We sought to determine the association between blood pressure (BP) and left ventricular (LV) remodeling, systolic/diastolic function, and coronary microvascular function, among individuals wit...

Aortic stenosis(AS) is the commonest valve lesion requiring surgery in the western world. The presence of myocardial fibrosis is associated with mortality even after valve replacement. MicroRNAs could serve as biomarkers of fibrosis and risk stratify patients for earlier intervention. This study aimed to systematically review reports of miR associa...

Aims The optimal timing of an invasive strategy (IS) in non-ST-elevation acute coronary syndrome (NSTE-ACS) is controversial. Recent randomized controlled trials (RCTs) and long-term follow-up data have yet to be included in a contemporary meta-analysis. Methods and results A systematic review of RCTs that compared an early IS vs. delayed IS for N...

Background There are a paucity of randomised data on the optimal timing of invasive coronary angiography (ICA) in higher-risk patients with non-ST elevation myocardial infarction (N-STEMI). International guideline recommendations for early ICA are primarily based on retrospective subgroup analyses of neutral trials. Aims The RAPID N-STEMI trial ai...

Objectives: The management of severe aortic stenosis mandates consideration of aortic valve intervention for symptomatic patients. However, for asymptomatic patients with severe aortic stenosis, recent randomised trials supported earlier intervention. We conducted a systematic review and meta-analysis to evaluate all the available data comparing t...

Aims: To investigate the relationship between fibro-inflammatory biomarkers and cardiovascular structure/function in people with Type 2 Diabetes (T2D) compared to healthy controls and the effect of two lifestyle interventions in T2D. Methods: Data were derived from the DIASTOLIC randomised controlled trial (RCT) and includes a comparison between...

Background: Type 2 diabetes (T2D) and hypertension commonly coexist and are associated with subclinical myocardial structural and functional changes. We sought to determine the association between blood pressure (BP) and left ventricular (LV) remodeling, systolic/diastolic function, and coronary microvascular function, among individuals with T2D wi...

Importance: Low-flow severe aortic stenosis (AS) has higher mortality than severe AS with normal flow. The conventional definition of low-flow AS is an indexed stroke volume (SVi) by echocardiography less than 35 mL/m2. Cardiovascular magnetic resonance (CMR) is the reference standard for quantifying left ventricular volumes and function from whic...

OBJECTIVE To investigate the association between admission blood glucose levels and risk of in-hospital cardiovascular and renal complications. RESEARCH DESIGN AND METHODS In this multicenter prospective study of 36,269 adults hospitalized with COVID-19 between 6 February 2020 and 16 March 2021 (N = 143,266), logistic regression models were used t...

Aerobic exercise training and low energy diets have been shown to improve left ventricular remodelling and diastolic function in adults with type 2 diabetes (T2D), albeit with differential effects. The impact of these lifestyle interventions on left atrial (LA) function, however, has not previously been reported. The DIASTOLIC study was a prospecti...

Background Shear wave elastography (SWE) is emerging as a valuable clinical tool for a variety of conditions. The aim of this pilot study was to assess the potential of SWE imaging of the common carotid arteries (CCA) in patients with spontaneous coronary artery dissection (SCAD), a rare but potentially life-threatening condition, hypothesized to b...

Objectives The aim of this study was to use cardiovascular magnetic resonance to 1) quantify coronary microvascular function; 2) examine the relationship between perfusion and fibrosis; and 3) evaluate the impact of microvascular dysfunction (MVD) and fibrosis on long-term clinical outcomes. Background The pathophysiological and clinical significa...

Individuals who participate in regular exercise over time have a markedly reduced risk of cardiovascular disease. Paradoxically, in susceptible individuals with underlying, often undiagnosed, disease states, exercise may acutely increase an individual's risk of cardiovascular events during and immediately following physical exertion. Exercise is th...

Background Although coronavirus disease 2019 (COVID-19) is primarily a respiratory illness, myocardial injury is increasingly reported and associated with adverse outcomes. However, the pathophysiology, extent of myocardial injury and clinical significance remains unclear. Methods COVID-HEART is a UK, multicentre, prospective, observational, longi...

Importance Spontaneous coronary artery dissection (SCAD) has been associated with fibromuscular dysplasia (FMD) and other extracoronary arterial abnormalities. However, the prevalence, severity, and clinical relevance of these abnormalities remain unclear. Objective To assess the prevalence and spectrum of FMD and other extracoronary arterial abno...