Bhavik Modi

Glenfield

Key points High‐altitude pregnancy is associated with reduced oxygenation and placental complications, which can affect maternal and fetal outcome. However, most high‐altitude populations are also impoverished and because maternal undernutrition itself is known to promote placental problems, the extent to which complications during high‐altitude p...

Objectives: This study set out to assess the quality of online information available on coronary angioplasty. Background: Patients searching for healthcare information frequently use the Internet. However the lay reader may not be able to discern the robustness of evidence presented. At present, the overall quality and accuracy of online content re...

Perivalvular extension of infection in Prosthetic Valve Endocarditis (PVE) is frequent and associated with high rates of heart failure and death. Patients with PVE due to staphylococcal aureus are ...

Ordered subset expectation maximisation with depth-dependent resolution recovery (OSEM-RR) is a processing algorithm reported to improve images with halved tracer activity in myocardial perfusion scintigraphy (MPS) compared to filtered backprojection (FBP) using conventional activities. OSEM-RR has not yet been compared with maximal likelihood expe...

Cardiac resynchronisation therapy (CRT) is an established treatment for selected patients with symptomatic left ventricular (LV) systolic dysfunction. Heart failure (HF) is primarily a disease of the elderly; however, these patients are underrepresented in CRT trials. Our aim was to evaluate the impact of age on clinical outcomes following CRT. A c...

While cardiovascular magnetic resonance imaging (CMR) is the gold standard diagnostic test for heart failure etiology, it is not universally available. Our aim was to investigate whether quantifying the extent of coronary disease on angiography can predict the presence of an ischemic etiology. We included 176 patients who underwent CMR and coronary...

Nearly half of all patients with angina have non-obstructive coronary artery disease (ANOCA); this is an umbrella term comprising heterogeneous vascular disorders, each with disparate pathophysiology and prognosis. Approximately two-thirds of patients with ANOCA have coronary microvascular disease (CMD). CMD can be secondary to architectural change...

Objectives: Fractional flow reserve (FFR) pullback is frequently used to assess serially diseased arteries, but has been shown to be inaccurate due to physiological interaction between individual lesions. We evaluated the clinical utility of a novel solution that improves estimation of true FFR contribution of each stenosis in the presence of seri...

The coronary angiogram is an indicator of flow limiting coronary artery disease but coronary physiology at the time of angiography is vital in assessing the true functional significance of coronary artery disease. With advances in guidewire technology and the greater use of physiology within the catheter laboratory, there is now a slow evolution of...

Background: Coronary microvascular dysfunction (MVD) is defined by impaired flow augmentation in response to a pharmacological vasodilator in the presence of nonobstructive coronary artery disease. It is unknown whether diminished coronary vasodilator response correlates with abnormal exercise physiology or inducible myocardial ischemia. Methods:...

Aims: Physiological indices such as fractional flow reserve (FFR), instantaneous wave-free ratio (iFR) and resting distal coronary to aortic pressure (Pd/Pa) are increasingly used to guide revascularisation. However, reliably assessing individual stenoses in serial coronary disease remains an unmet need. This study aimed to compare conventional pr...

Background: Fractional flow reserve (FFR) is commonly used to assess the functional significance of coronary artery disease but is theoretically limited in evaluating individual stenoses in serially diseased vessels. We sought to characterize the accuracy of assessing individual stenoses in serial disease using invasive FFR pullback and the noninv...

Background There has been a gradual upward creep of revascularization thresholds for both fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR), before the clinical outcome trials for both indices. The increase in revascularization that has potentially resulted is at odds with increasing evidence questioning the benefits of revascul...

Background Assessing the physiological significance of stenoses with coexistent serial disease is prone to error. We aimed to use 3‐dimensional‐printing to characterize serial stenosis interplay and to derive and validate a mathematical solution to predict true stenosis significance in serial disease. Methods and Results Fifty‐two 3‐dimensional‐pr...

Figure S1. Validation of in vitro model of coronary circulation. Figure S2. Theoretical model derivation. Figure S3. Example clinical case demonstrating utility of mathematical correction model.

Background: Growing evidence supports physiology-guided revascularization, with Fractional Flow Reserve (FFR) the most commonly used invasive measure of coronary blood flow impairment at the time of diagnostic angiography. Recently, there has been growing interest in stenosis severity indices measured at rest, such as Instantaneous Wave Free Ratio...

Introduction Growing evidence supports ischemia-guided management of chest pain, with invasive and non-invasive tests reliant upon achieving adenosine-induced coronary hyperemia (defined as increased blood flow to an organ’s perfusion bed). In the non-invasive setting, surrogate markers of hyperemia, such as increases in heart rate, are often used,...

Background: Biventricular pacing has been shown to increase both cardiac contractility and coronary flow acutely but the causal relationship is unclear. We hypothesised that changes in coronary flow are secondary to changes in cardiac contractility. We sought to examine this relationship by modulating coronary flow and cardiac contractility. Meth...

Importance Ischemia-guided revascularization is the cornerstone of contemporary management of coronary artery disease and has evolved from noninvasive functional evaluation to real-time assessment with invasive physiological indices during diagnostic catheterization. However, serial/diffuse disease is common, and revascularization decisions often n...

Background Physiology-guided coronary revascularisation is associated with better outcomes however it is unclear if pressure-derived indices, such as FFR, can reliably assess individual lesions in serial disease. Methods 3D printed serial disease phantoms were assessed in vitro. FFR of a lesion was predicted from the size of step up on pressure-wi...

The left main coronary artery (LMCA) is responsible for supplying the majority of the left ventricular myocardium. Visual estimation of stenosis severity on angiography has major limitations and methods to assess functional significance, such as Fractional Flow Reserve (FFR), have been shown to yield better outcomes but major trials examining the u...

Introduction Fractional Flow Reserve (FFR) is a pressure-derived estimate of coronary flow impairment during maximal and constant hyperaemia provided by an adenosine infusion, when flow and pressure approximate linearly. The need for adenosine-induced hyperaemia has led to development of a stenosis severity index measured at rest, Instantaneous Wav...

Background and aim: To objectively assess the quality of information available on the World Wide Web on Cardiac Resynchronisation Therapy. Patients frequently search the internet regarding their healthcare issues. It has been shown that patients seeking information can help or hinder their healthcare outcomes depending on the quality of informatio...

A 24-year-old Nepali man presented to hospital with a short history of feeling unwell with a flu-like illness. He subsequently went into acute renal failure requiring several sessions of renal replacement therapy by haemofiltration. The underlying aetiology of his renal failure was unclear. His renal function recovered following haemofiltration and...

Purpose: Limited information exists regarding procedural success and clinical outcomes of ST-segment elevation myocardial infarction (STEMI) in patients with previous Coronary Artery Bypass Graft (CABG) undergoing Primary Percutaneous Coronary Intervention (PCI). We sought to compare outcomes in STEMI patients undergoing Primary PCI with or without...

Introduction: During Primary PCI (PPCI) for STEMI, both manual thrombectomy and GP IIb/IIIa antagonists have been shown to improve clinical outcomes but evidence is limited and inconsistent. We aimed to assess the impact of manual thrombectomy and GP IIb/IIIa use on mortality. Methods and results: This was an observational cohort study of 9,266 con...

Background Limited information exists regarding procedural success and clinical outcomes of ST-segment elevation myocardial infarction (STEMI) in patients with previous CABG undergoing primary PCI. We sought to compare outcomes in STEMI patients undergoing primary percutaneous coronary intervention (PCI) with or without previous coronary artery byp...

Introduction During Primary Percutaneous Coronary Intervention (PPCI) post ST-Segment Myocardial Infarction (STEMI), distal embolisation of thrombus may lead to failure to re-establish normal flow in the infarct-related artery. Manual thrombus aspiration has been shown to improve coronary perfusion as assessed by time to ST-segment resolution and m...

We present the case of a transverse fracture of the scapula resulting from the use of electronic muscle stimulation (EMS): highlighting the dangers of these devices that are commonly used for massage and body-building purposes.

Patients awaiting surgery are often fasted preoperatively well in excess of the recommended fasting times. Educated perioperative practitioners were asked to discuss preoperative starvation with patients. Preoperative starvation period for clear fluids was significantly reduced from a mean of 8 hours 30 minutes in the original audit, to 6 hours 10...

Triple assessment of breast lesions usually involves the use of core biopsy (CB) or fine needle aspiration cytology (FNAC). Punch Biopsy (PB) is a technique widely used by dermatologists and can be used in superficial breast lesions with dermal involvement. We studied the utilization of PB in a rapid diagnosis breast clinic. We reviewed patients wh...

Objective: Study preoperative fasting times of adult elective surgical patients. Methods: Fasting times for food and clear fluids, and the information used by patients to decide when to start fasting were studied. Results: Among 200 patients, median fasting times were 2-4 times the guideline recommendations. Most patients used hospital written...