2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines | Circulation

Amazing Video Takes Trip Inside The 'Google Earth' Of The Human Heart

Experts in Britain and France were able to show individual cells of the organ thanks to a technique labelled the "Google Earth for the human heart"

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Whole adult human hearts imaged in 'unprecedented detail'

This amazing video takes a trip inside the human heart in greater detail than ever before - with experts hailing it as a "Google Earth"-like discovery.

Experts in Britain and France were able to show individual cells of the organ using a new X-ray technique to detail the heart structure down to a remarkable 20 micrometres. The clip compared the hearts of two deceased patients; the healthy one was from a 63-year-old white male donor without any known heart problems. And the second was a diseased heart from an 87-year-old white female donor.

The female donor had a history of ischaemic heart disease, which is when the heart is weakened due to receiving reduced blood flow. In comparing the two, the healthy heart is a clearly defined shape, while the unhealthy heart is rounder and has withered vessels and muscle fibers.

The clear difference between a healthy heart and a diseased one (

Image:

European Synchrotron Radiation Facility)

"The atlas that we've created in this study is like having Google Earth for the human heart,' said Professor Peter Lee at UCL's Department of Mechanical Engineering. "It allows us to view the whole organ at global scale, then zoom in to street level to look at cardiovascular features in unprecedented detail." Experts have archived the amazing images at University College London (UCL) and the European Synchrotron Radiation Facility (ESRF) in Grenoble, France.

The man's healthy heart (

Image:

European Synchrotron Radiation Facility)

According to experts, Ischaemic heart disease was responsible for 8.9 million or 16 percent of deaths globally in 2019, a figure that had risen by more than two million since 2001. The 87-year-old also had hypertension, high blood pressure, and atrial fibrillation, an irregular and often very rapid heart rhythm.

The team used an X-ray technique called hierarchical phase-contrast tomography (HiP-CT) to show the hearts down to a scale of 20 micrometres. "One of the major advantages of this technique is that it achieves a full 3D view of the organ that's around 25 times better than a clinical CT scanner," said Professor Lee.

The diseased heart is rounder, with withered vessels and muscle fibres (

Image:

European Synchrotron Radiation Facility)

"In addition, it can zoom in to cellular level in selected areas, which is 250 times better, to achieve the same detail as we would through a microscope but without cutting the sample. Being able to image whole organs like this reveals details and connections that were previously unknown.'

The experts admitted it would not be possible to image a living person's heart using this technique due to the radiation dose being too high. Using this technique, imaging for each heart generated 10 terabytes of data – which is a staggering 1 million times more than a standard CT scan.

This heart was taken from an 87-year-old with a history of ischaemic heart disease (

Image:

European Synchrotron Radiation Facility)

"The main limiting factor is the processing of the very large data produced by HiP-CT,' said Paul Tafforeau at ESRF, who came up with the technique. However, the experts believe the images will provide an resource for better understanding cardiovascular disease.

"We now have a way to determine differences in the thickness of tissue and fat layers located between the outer surface of the heart and the protective sac surrounding the heart, which could be relevant when treating arrhythmia," said Professor Andrew Cook, heart anatomist from the UCL's cardiovascular science institute.

Indian Doctors Highlight Growing Concerns Over Lung Disorders

Concerns have been raised by Indian doctors that the prevalence of lung-related disorders may exceed the estimates of a recent Lancet study. The study, published in May, suggests that ischaemic heart disease will remain the leading global cause of death, with stroke, diabetes, and chronic obstructive pulmonary disease (COPD) following closely behind.

According to Dr. Atul Mathur of Fortis Escorts Heart Institute, ischaemic heart disease will continue to be the top killer due to poor lifestyles and increasing stress levels. Dr. Mathur highlighted a lack of understanding of the disease's mechanisms as a significant barrier to finding solutions.

Dr. Arvind Kumar from Medanta Hospital pointed out that India's burden of chest diseases is compounded by high levels of pollution, tobacco consumption, and persistent infectious diseases like tuberculosis. Dr. Lancelot Pinto of P. D. Hinduja Hospital warned that smoking and air pollution are key contributors to COPD, stressing the urgency of preventive health measures.

(With inputs from agencies.)

Higher Mortality, MI And ESRD Risks For Tophaceous Gout Than Nontophaceous

Photo Credit: Mykola Churpita

A study finds that risks for mortality, acute myocardial infarction, and end-stage renal disease are higher in tophaceous gout than nontophaceous gout.

A longitudinal cohort analysis suggests that risks for mortality, acute myocardial infarction (MI), and end-stage renal disease (ESRD) in patients with gout are higher in tophaceous than nontophaceous gout. In tophaceous gout, the mortality hazard was increased by 24% at 5 years.

A longitudinal cohort analysis, presented by Gregory Challener, MD, sought to investigate whether the overall increased mortality risk in patients with gout varies between the subgroups with or without tophi. Data for the multicentre study was collected from the US TriNetX Diamond network of claims records. Outcomes of mortality, acute MI, and ESRD were measured at years 1 and 5.

The tophaceous gout cohort included 73,569 patients, and the non-tophaceous gout cohort was 284,241. The mean age was about 67 years, more than 50% were men, around 70% had hypertension, just more than 25% had ischaemic heart disease, and between 27.3% and 28.5% had chronic kidney disease. Before matching, significant differences existed between the cohorts for diabetes, obesity, and medication. After matching, all standardized mean differences between the two now equally sized groups were less than 0.1.

At 1 year, the mortality risk for tophaceous gout versus nontophaceous gout within the 2 matched groups was 5.0% versus 4.3%, leading to an HR of 1.20 (95% CI, 1.15–1.26). After 5 years, the likelihood of mortality was 24% greater for patients with tophaceous gout (HR, 1.24; 95% CI, 1.20–1.27). Also, the chances for acute MI at 1 and 5 years were increased in the tophaceous gout group: HR,1.20 (95% CI, 1.10–1.31) and HR, 1.21 (95% CI, 1.15–1.28), respectively. Kidney impairment in terms of ESRD followed a similar pattern: HR, 1.12 with 95% CI, 1.02–1.24 (1 year), and HR, 1.16 with 95% CI, 1.09–1.25 (5 years).

Although this was a retrospective study, Dr. Challener pointed out that it had strengths in its large population, multicentricity, and propensity score matching. "This result suggests that it is important to identify patients with tophaceous gout and treat them aggressively, including with uricase treatment and those with an inadequate response on xanthine oxidase inhibitors," Dr. Challener concluded.

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