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Objectives. To identify the proportion of adult emergency department (ED) patients who screen positive for depression. Secondary aims were to identify factors associated with a positive depression screen and determine predictors of a positive depression screen. Methods. This cross-sectional, prevalence survey of ED patients was conducted at two inner-city hospitals. 350 ED patients were screened for depression using the Patient Health Questionnaire-9 (PHQ-9). Clinical and demographic risk factors were examined through medical records and additional questionnaires. Results. Of 350 participants screened, 50 (14.3%; 95% CI = 11.0–18.4%) screened positive. Independent predictors of depression risk included self-reported depression and/or a previous diagnosis of depression (OR = 8.345; 95% CI = 3.524–19.762), seeing a mental health service provider in the past 6 months (OR = 4.518; 95% CI = 2.107–9.690), and previous discussion about mental health with a local doctor (OR = 2.369; 95% CI = 1.025–5.475). Conclusion. ED patients were found to be at a higher risk of depression than the general population. ED-based depression screening, particularly of high-risk populations, has the potential to increase case detection rates and allow earlier management of these patients. Further research and validation of an ED-based depression screening tool are required.

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Fractional flow reserve (FFR) is routinely used to determine lesion severity prior to percutaneous coronary intervention (PCI). However, there is an increasing recognition that FFR may also be useful following PCI to identify mechanisms leading to restenosis and the need for repeat revascularization. Post-PCI FFR is associated with the presence and severity of stent under-expansion and may help identify peri-stent-related complications. FFR pullback may also unmask other functionally significant lesions within the target vessel that were not appreciable on angiography. Recent studies have confirmed the prognostic utility of performing routine post-PCI FFR and suggest possible interventional targets that would improve stent durability. In this review, we detail the theoretical basis underlying post-PCI FFR, provide practical tips to facilitate measurement, and discuss the growing evidence supporting its use.

significant reduction in left atrial (LA) (p=0.001) and LV enddiastolic M-mode dimensions (p=0.001) and volumes (p=0.006), with no change in LV end-systolic volumes, yielding a significant reduction in LV functional measures (fractional shortening (34.5 vs 31.5%, p=0.006), fourchamber ejection fraction (62.6 vs 51.7%, p=0.002) and LV longitudinal strain (-24.3 vs-18.2%, p,0.001). Compared to controls, LA and LV dimensions remained increased with a reduction in all functional parameters after repair. There was a moderate negative correlation between preoperative enddiastolic volumes and postoperative longitudinal strain (r 2 =0.35). Discussion: Persistent LV and LA remodelling with decreased LV function is observed after repair of RHD-MR. While these results reflect changes to volume loading, the unmasking of decreased LV function and persistent remodelling; and linear relation to preoperative LV size, may suggest that early intervention to alleviate MR could benefit selected patients and warrants further study.

Background: Chronic severe AR (CSAR) results in compensatory LV dilatation to maintain forward stroke volume. "Severe" dilatation (LV end-diastolic dimension (LVEDD)) 80mm is associated with sudden cardiac death and poorer postoperative outcomes. European Society of Cardiology guidelines recommend valve surgery (Class IIa) in asymptomatic patients with LVEDD.70mm and LV ejection fraction (LVEF).50%. LVEDD underestimates LV dilatation due to geometrical limitations in comparison to volumetric measurements (Indexed LV end-diastolic volume (iLVEDV)), however thresholds for intervention remain unchanged. Aims: To determine the prevalence of undiagnosed LV dilatation by LVEDD in CSAR when referenced to iLVEDV. Methods: A retrospective review of all transthoracic echocardiograms performed in a tertiary laboratory with CSAR was undertaken. Studies with an aortic prosthesis, moderate mitral regurgitation/aortic stenosis, LVEF,50%, or inadequate images for Simpson's biplane volume assessment were excluded. Results: 54 patients with primary CSAR were included. 18 cases (33%; Males (M)=11, Females (F)=7) had normal LVEDD (M=5364mm; F=4962mm) but were dilated by iLVEDV criteria. Of these patients with discrepant measurements, 22% were reclassified as mildly dilated (M=2, 8364ml/m 2 ; F=2, 6663ml/m 2), 11% moderate (M=1, 92ml/ m 2 ; F=1, 72ml/m 2), and 75% severe (M=8, 117613ml/m 2 ; F=4, 9565ml/m 2). Conversely, severe dilatation by LVEDD demonstrated agreement with iLVEDV in all cases. Conclusions: LVEDD appears sensitive for severe LV dilatation in CSAR. However, a considerable proportion of patients will have normal LVEDD values with evidence of significant dilatation by volumetric assessment. Given the prognostic implications of LV dilatation, chamber sizing by iLVEDV may be more appropriate to guide timing of intervention in volume-loading valvular lesions.