Dear colleagues, welcome to the summer issue of Heart International. We hope this reaches you well and that your personal and professional lives have not been affected adversely by the coronavirus pandemic.
As is fitting for the current circumstances, we include an editorial by Prof. Perera’s group on the effects of COVID-19 on cardiovascular health. The authors discuss the impact of coronavirus on routine management and therapeutic decisions in patients with established cardiovascular disease/cardiovascular risk factors. They summarise some of the published literature on this important and rapidly evolving topic. In another editorial, Prof. Curzen’s group offer a critical appraisal of the recently published ISCHEMIA trial, which is likely to change clinical practice. They emphasize the main message of the study, i.e. the futility of revascularisation over and above optimal medical therapy in patients with little or no angina, but also highlight some study limitations.
Zivelonghi and Verheye provide a review on the coronary sinus reducer, a relatively new, but potentially promising, device for the management of patients with refractory angina, a small, yet challenging group of patients to manage. An overview of contemporary drug-eluting coronary stents is presented by Parker and Iqbal who attempt to summarise the large, and at times overwhelming, body of research on the subject; they do so in a balanced and insightful manner. A review by Katta et al. on the management of coronary artery disease in patients undergoing transcatheter aortic valve replacement is timely, given the expanding role of the latter in treating patients with severe aortic stenosis. They highlight the many unanswered questions in this field and the need for randomised controlled trials to guide management decisions. Noordergraaf et al. present a review on andexanet alfa, an antidote for factor Xa inhibitors, which is a very welcome addition to the pharmacopoeia, given the increasing use of these agents in day-to-day clinical practice. Finally, Soltani et al. present a thought-provoking paper on a possible association between the aspartate transaminase (AST)/alanine transaminase (ALT) ratio and the presence and severity of isolated coronary artery ectasia, a rare but clinically relevant finding in patients undergoing coronary angiography.
In the first of two expert interviews, Dr Paul succinctly summarises the case for and against percutaneous coronary intervention and coronary artery bypass graft surgery, in the management of patients with significant left main stem disease, a topic that continues to attract controversy. In the second interview, Dr Marrouche discusses the expanding role of digital health and in particular wearable electronic devices in the fight against chronic diseases and in allowing patients to partake in the management of their own conditions.
Last, but not least, we include three case reports which, despite their rarity, convey important clinical messages and add to our knowledge pool of the ‘weird and wonderful’ in clinical practice.
We very much hope you enjoy this edition and find education, insight and constructive challenge in the content. On behalf of the Heart International team, we thank our contributors, reviewers and, above all, our readers.
Dr Magdi El-Omar and Dr Rajesh Davé