Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. Hi, my name is Dr. Warrick Bishop and I'd like to welcome you to my podcast station and of course I'd like to welcome you to the Healthy Heart Network. Today I'd like to share with you a little bit of information about two interesting aspects of heart care. Firstly, about atrial fibrillation and then secondly, about narrowings within the most important artery in the heart. the left main primary artery but first let's start with atrial fibrillation. I came across this study just recently it was done by a Belgium group and it's really interesting so I thought I would share it with you because I think it's going to change what we do in the future. Well we're always interested in technology and this group in Belgium were able to find an app for a smartphone that could use the camera within the smartphone to take pictures of an individual's face from beat to beat and beat to beat and assess how the face was filling with blood or how it was pulsating, how the flow through the face was affecting the colour appreciation within that individual. This is called photoplastismography. Gosh, I can barely say it, but essentially it's using a photo to get an appreciation of flow, plastismography, through a picture. Photoplastismography. Could be a good trivial pursuit question if you want to file that away. Anyway, the long and the short of it is this group in Belgium put an ad in the local newspaper asking for volunteers. They got over 12,000 people, nearly 12,500 people in actual fact. About 60% of those people were male. And they got good signals on over 90%. So they had a pretty good run. Essentially, the device was held up to the individual's face twice a day. And there was an assessment by the app to assess blood flow through the skin, undertaking photoplystismography. Anyway, they picked up about 1.1% of that total population group by doing that, which is absolutely fascinating. Now, the really good thing about this technology is they've looked at it previously and been able to correlate the accuracy. a photoplethismography with our gold standard which is an ECG and they find that they concur about well about 95% of the time so it's a pretty good test. Well will we see it on shelves anywhere here soon? I'm not sure but I think we will see it at some stage in the future, almost without question. And it is quite possible that we might see an early introduction of this sort of technology, photoplethismography. I'm having a lot of trouble with that. We might see an early introduction of this technology at points of service or where patients may potentially be able to be screened rapidly. And effectively, places like, well, for example, a pharmacy or, for example, in a GP surgery. I think we're going to see this sort of technology in the right sort of individual. That would be older patients, perhaps screening opportunistically individuals over 65 years of age, particularly if they've got some risk factors for atrial fibrillation. to see if there is any abnormality and if there is, then action that with a proper follow-up with the doctor, with an ECG and if necessary, moving on to assessment with a cardiologist. But absolutely fantastic to know that's out there. It might be an app that we may all eventually have on our smartphones one day. And to be honest, it might be one of the few situations where I'd be pretty happy for people to be taking selfies. Well, let me go on to the second interesting study that I came across today. And that was in regard to how we deal with left main coronary artery disease. Now, you may or may not recall the anatomy of the heart. There's two main arteries come out of the aorta. The right coronary artery comes out of the aorta and goes pretty well to the inferior surface of the heart. That's the surface nearest the diaphragm. The other artery that comes out of the aorta to supply the heart is called the left main coronary artery. That is a clue as to how important it is because it's the main artery that comes out on the left. Within a centimetre or two, the left main separates into the other two major arteries. One that supplies the back surface of the heart called the circumflex, the one nearest the backbone. and another artery called the left anterior descending, really the artery that runs down the front of the chest, the surface that's nearest the chest wall of the heart. So if the left main is affected, if that blocks suddenly, two of the three major arteries that supply the heart are suddenly shut down. Well, over the years, We've always thought that the best way to deal with left main coronary artery disease has been surgery. Certainly when I was training, that was the case. However, the last decade has seen improvements and refinements in our ability to put stents in and the quality and technical aspects and durability of our stents. So it's become quite reasonable to ask the question. if you've got a left main coronary artery lesion are you better off having bypass grafting that's a split down the front of the chest opening up the chest and manually plugging in some new bypass grafts going beyond the narrowing in the left main literally bypassing that blockage with different blood vessels either veins or arteries from a different part of the body or can you deal with left main narrowings with a stent well in recent time a trial called the excel trial looked at just that the excel trial took well somewhere around 1900 people just over and out of that group found within them about 20 percent who could go into either stenting or 20% into coronary artery bypass grafting. These were people who were well matched and able to be randomized into the trial. The coronary artery bypass grafting was undertaken as usual with maximal revascularization as appropriate and the stenting was undertaken with the most modern drug eluting stents that we have available. So drug eluting means that the stents are impregnated or have a coating on them and that coating is a coating to try and stop the artery growing back in and blocking off where the stent is so drug eluting stents which is really state-of-the-art technology were used well as you can imagine putting a stent in if everything goes well can be a pretty quick and not that traumatic experience compared to literally having your chest cracked open and a bypass put in place so when they looked at the results of the excel trial the early data suggested that stents favored coronary artery bypass grafting in terms of symptoms and in terms of the side effects that were inherent with the surgery of note was that there was an increased morbidity from stroke related to coronary artery bypass grafting what was interesting though is that at the five-year period and that's really where the data has been released the early benefit of stenting was now lost and the benefit of coronary artery bypass grafting seemed more apparent so that after five years it seemed that either option had similar outcomes with reasonable results in both groups, no significant signals that were detrimental in either group and really a demonstration that although coronary artery bypass grafting perhaps was a bigger undertaking initially, it lasted longer and seemed to have better longevity and vice versa, stenting seemed like the easier option for the short term. but didn't provide quite as much longevity in terms of its ability to continue to reduce risk of heart attack, revascularisation and morbidity. So if you're looking for a five-year end point and you're confronted with either stenting or bypass grafting, you can take your pick. You can have a chat with your doctor, you can think about your own personal desires and know that you'll probably end up at about the same place either road you take in about five years. The question though, which is unresolved, is what about longer than five years? What will happen if we were to watch those people for 10 years' time? I suspect that they're going to follow up that same group and in five years' time, I'll be able to give you the update on that. Well, I'm going to wrap it up for there. I hope you've enjoyed that. A quick spiel on atrial fibrillation screening with photoplethismography. I think I said it properly that time. And a quick up-to-date on where we are with left main coronary artery disease and the results of the Excel trial. Well, I hope I've given you something that you found interesting and informative. As always, if you have any questions, please drop us a note. at, I think it's at members at drWarrickbishop.online and if you've got any suggestions for future podcasts, please let me know. As always, I'd like to wish you the very best and until next time, please don't die from a heart attack. Goodbye. You have been listening to another podcast from Dr. Warrick. Visit his website at drWarrickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.
