Imperial College London

ProfessorDarrelFrancis

Faculty of MedicineNational Heart & Lung Institute

Professor of Cardiology
 
 
 
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Contact

 

+44 (0)20 7594 3381d.francis Website

 
 
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Assistant

 

Miss Juliet Holmes +44 (0)20 7594 5735

 
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Location

 

Block B Hammersmith HospitalHammersmith Campus

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Summary

 

Publications

Publication Type
Year
to

581 results found

Dhutia NM, Cole GD, Willson K, Rueckert D, Parker KH, Hughes AD, Francis DPet al., 2012, A new automated system to identify a consistent sampling position to make tissue Doppler and transmitral Doppler measurements of E, E ' and E/E ', INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 155, Pages: 394-399, ISSN: 0167-5273

Journal article

Moraldo M, Del Franco A, Pugliese NR, Pabari PA, Francis DPet al., 2012, Avoiding bias in measuring "hemisphere radius" in echocardiographic mitral regurgitation quantification: Mona Lisa PISA, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 155, Pages: 318-320, ISSN: 0167-5273

Journal article

Manisty CH, Al-Hussaini A, Unsworth B, Baruah R, Pabari PA, Mayet J, Hughes AD, Whinnett ZI, Francis DPet al., 2012, The Acute Effects of Changes to AV Delay on BP and Stroke Volume Potential Implications for Design of Pacemaker Optimization Protocols, CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY, Vol: 5, Pages: 122-U209, ISSN: 1941-3149

Journal article

Nijjer SS, Davies JE, Francis DP, 2012, Quantitative comparison of clopidogrel 600 mg, prasugrel and ticagrelor, against clopidogrel 300 mg on major adverse cardiovascular events and bleeding in coronary stenting: synthesis of CURRENT-OASIS-7, TRITON-TIMI-38 and PLATO, International journal of cardiology, Vol: 158, Pages: 181-185, ISSN: 1874-1754

The convention of loading with clopidogrel 300 mg before coronary intervention may be due for change, but to what? Newer antiplatelet agents may offer better outcomes, at some financial cost. Disappointingly for decision-making clinicians, head-to-head comparisons for the newer alternatives are not available. We systematically review and compare the three alternative strategies: clopidogrel 600 mg, prasugrel and ticagrelor. A total of 14 studies have compared these strategies with the long-standing convention of 300 mg. Throughout this analysis, we consistently report incremental costs and consequences using clopidogrel 300 mg as the reference strategy. Risk ratios for major adverse cardiovascular events at 30 days were 0.74 (95% confidence interval 0.66-0.82, p=0.002) for clopidogrel 600 mg, 0.78 (0.69-0.89; p<0.001) for prasugrel and 0.88 (0.77-1.00; p=0.045) for ticagrelor. All-cause mortality risk ratios were 0.87 (0.74-1.03) with clopidogrel 600 mg, 0.95 (0.78-1.16) with prasugrel and 0.78 (0.69-0.89) with ticagrelor. TIMI major bleeding has risk ratio 0.92 (0.74-1.16; p=0.85) with clopidogrel 600 mg, 1.32 (1.03-1.16; p=0.03) with prasugrel and 1.25 (1.03-1.53; p=0.03) with ticagrelor. Incremental cost for the first year was £0.32 (US$0.50, €0.40) with clopidogrel 600 mg, £608 (US$977, €709) with prasugrel and £665 (US$1068, €775) with ticagrelor. All three strategies have shown a similar reduction in MACE at 30 days by comparison to clopidogrel 300 mg. All three strategies offer progressive benefit, most marked with Ticagrelor. Whether this is worth both the risk of non-compliance with twice-a-day dosing in real-life patients lacking the same motivation as their trial-volunteer counterparts, and the 2000-fold difference in incremental cost, is the remaining matter for debate.

Journal article

Ghosh AK, Et al, 2012, Duration of diabetes is a significant independent predictor of elevated left ventricular mass, J Am Coll Cardiol;59:1727

Journal article

Sen S, Escaned J, Francis D, Davies Jet al., 2012, Reply, Journal of the American College of Cardiology, Vol: 59, Pages: 1917-1918, ISSN: 0735-1097

Journal article

Sen S, Escaned J, Malik IS, Mikhail GW, Foale RA, Mila R, Tarkin J, Petraco R, Broyd C, Jabbour R, Sethi A, Baker CS, Bellamy M, Al-Bustami M, Hackett D, Khan M, Lefroy D, Parker KH, Hughes AD, Francis DP, Di Mario C, Mayet J, Davies JEet al., 2012, Development and Validation of a New Adenosine-Independent Index of Stenosis Severity From Coronary Wave–Intensity Analysis, Journal of the American College of Cardiology, Vol: 59, Pages: 1392-1402, ISSN: 0735-1097

Journal article

Petraco R, Escaned J, Sen S, Nijjer S, Asrress KN, Echavarria-Pinto M, Lockie T, Khawaja MZ, Cuevas C, Foin N, Broyd C, Foale RA, Hadjiloizou N, Malik IS, Mikhail GW, Sethi A, Kaprielian R, Baker CS, Lefroy D, Bellamy M, Al-Bustami M, Khan MA, Hughes AD, Francis DP, Mayet J, Di Mario C, Redwood S, Davies JEet al., 2012, Classification performance of instantaneous wave-free ratio (iFR) and fractional flow reserve in a clinical population of intermediate coronary stenoses: results of the ADVISE registry, EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, ISSN: 1969-6213

Aims: To evaluate the classification agreement between instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) in patients with angiographic intermediate coronary stenoses. Methods and results: Three hundred and twelve patients (339 stenoses) with angiographically intermediate stenoses were included in this international clinical registry. The iFR was calculated using fully automated algorithms. The receiver operating characteristic (ROC) curve was used to identify the iFR optimal cut-point corresponding to FFR 0.8. The classification agreement of coronary stenoses as significant or non-significant was established between iFR and FFR and between repeated FFR measurements for each 0.05 quantile of FFR values, from 0.2 to 1. Close agreement was observed between iFR and FFR (area under ROC curve= 86%). The optimal iFR cut-off (for an FFR of 0.80) was 0.89. After adjustment for the intrinsic variability of FFR, the classification agreement (accuracy) between iFR and FFR was 94%. Amongst the stenoses classified as non-significant by iFR (>0.89) and as significant by FFR (≤0.8), 81% had associated FFR values located within the FFR "grey-zone" (0.75-0.8) and 41% within the 0.79-0.80 FFR range. Conclusions: In a population of intermediate coronary stenoses, the classification agreement between iFR and FFR is excellent and similar to that of repeated FFR measurements in the same sample. Vasodilator-independent assessment of intermediate stenosis seems applicable and may foster adoption of coronary physiology in the catheterisation laboratory.

Journal article

Nijjer SS, Pabari PA, Stegemann B, Palmieri V, Leyva F, Linde C, Freemantle N, Davies JE, Hughes AD, Francis DPet al., 2012, The limit of plausibility for predictors of response: application to biventricular pacing, JACC. Cardiovascular imaging, Vol: 5, Pages: 1046-1065, ISSN: 1876-7591

OBJECTIVES: We sought a method for any reader to quantify the limit, imposed by variability, to sustainably observable R(2) between any baseline predictor and response marker. We then apply this to echocardiographic measurements of mechanical dyssynchrony and response. BACKGROUND: Can mechanical dyssynchrony markers strongly predict ventricular remodeling by biventricular pacing (cardiac resynchronization therapy)? METHODS: First, we established the mathematical depression of observable R(2) arising from: 1) spontaneous variability of response markers; and 2) test-retest variability of dyssynchrony measurements. Second, we contrasted published R(2) values between externally monitored randomized controlled trials and highly skilled single-center studies (HSSCSs). RESULTS: Inherent variability of response markers causes a contraction factor in R(2) of 0.48 (change in left ventricular ejection fraction [ΔLVEF]), 0.50 (change in end-systolic volume [ΔESV]), and 0.40 (change in end-diastolic volume [ΔEDV]). Simultaneously, inherent variability of mechanical dyssynchrony markers causes a contraction factor of between 0.16 and 0.92 (average, 0.6). Therefore the combined contraction factor, that is, limit on sustainably observable R(2) between mechanical dyssynchrony markers and response, is ~0.29 (ΔLVEF), ~0.24 (ΔESV), and ~0.30 (ΔEDV). Many R(2) values published in HSSCSs exceeded these mathematical limits; none in externally monitored trials did so. Overall, HSSCSs overestimate R(2) by 5- to 20-fold (p = 0.002). Absence of bias-resistance features in study design (formal enrollment and blinded measurements) was associated with more overstatement of R(2). CONCLUSIONS: Reports of R(2) > 0.2 in response prediction arose exclusively from studies without formally documented enrollment and blinding. The HSSCS approach overestimates R(2) values, frequently breaching the mathematical ceiling on sustainably observable R(2), which is far belo

Journal article

Lota AS, Manisty CH, Sutton R, Francis DPet al., 2011, CHRISTMAS 2011: PROFESSIONAL MATTERS When is a "free" registrar in clinic not free?, BRITISH MEDICAL JOURNAL, Vol: 343, ISSN: 0959-535X

Journal article

Raphael CE, Koa-Wing M, Stain N, Wright I, Francis DP, Kanagaratnam Pet al., 2011, Implantable Cardioverter-Defibrillator Recipient Attitudes towards Device Deactivation: How Much do Patients Want to Know?, PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, Vol: 34, Pages: 1628-1633, ISSN: 0147-8389

Journal article

Francis DP, 2011, Precision of a Parabolic Optimum Calculated from Noisy Biological Data, and Implications for Quantitative Optimization of Biventricular Pacemakers (Cardiac Resynchronization Therapy), Applied Mathematics, Vol: 2, Pages: 1497-1506, ISSN: 2152-7385

In patients with heart failure and disordered intracardiac conduction of activation, doctors implant a biven- tricular pacemaker (“cardiac resynchronization therapy”, CRT) to allow adjustment of the relative timings of activation of parts of the heart. The process of selecting the pacemaker timings that maximize cardiac function is called “optimization”. Although optimization—more than any other clinical assessment—needs to be precise, it is not yet conventional to report the standard error of the optimum alongside its value in clinical practice, nor even in research, because no method is available to calculate precision from one optimization dataset. Moreover, as long as the determinants of precision remain unknown, they will remain unconsidered, preventing candidate haemodynamic variables from being screened for suitability for use in optimization. This manuscript derives algebraically a clinically-applicable method to calculate the precision of the optimum value of x arising from fitting noisy biological measurements of y (such as blood flow or pressure) obtained at a series of known values of x (such as atrioventricular or interventricular delay) to a quadratic curve. A formula for uncertainty in the optimum value of x is obtained, in terms of the amount of scatter (irreproducibility) of y, the intensity of its curvature with respect to x, the width of the range and number of values of x tested, the number of replicate measurements made at each value of x, and the position of the optimum within the tested range. The ratio of scatter to curvature is found to be the overwhelming practical determinant of precision of the optimum. The new formulae have three uses. First, they are a basic science for anyone desiring time-efficient, reliable optimization protocols. Second, asking for the precision of every reported op-timum may expose optimization methods whose precision is unacceptable. Third, evaluating precision quantitatively wi

Journal article

Dimopoulos K, Giannakoulas G, Bendayan I, Liodakis E, Petracco R, Diller GP, Piepoli MF, Swan L, Mullen M, Best N, Poole-Wilson PA, Francis DP, Rubens MB, Gatzoulis MAet al., 2011, Cardiothoracic ratio from postero-anterior chest radiographs: A simple, reproducible and independent marker of disease severity and outcome in adults with congenital heart disease, International Journal of Cardiology

Journal article

Manisty C, Giannoni A, Mebrate Y, Mayet J, Willson K, Francis DPet al., 2011, Inverse Frequency Dependence of the Chemoreflex - is the Gain Measured with Rebreathing Relevant to Periodic Breathing in Heart Failure?, CIRCULATION, Vol: 124, ISSN: 0009-7322

Journal article

Barthel P, Wensel R, Mueller A, Ulm K, Malik M, Francis DP, Schmidt Get al., 2011, Risk Prediction Early After Myocardial Infarction: Resting Respiratory Rate Is Independent of GRACE Score, CIRCULATION, Vol: 124, ISSN: 0009-7322

Journal article

Jabbour R, Husain S, Zaman N, Aung N, Ling HZ, Baruah R, Cole G, Manisty C, Barron A, Mayet J, Francis D, Thomas M, Woldman S, Okonko DOet al., 2011, Attenuations in Serum Albumin Over Time Powerfully Predict an Amplified Risk of Death in Chronic Heart Failure, CIRCULATION, Vol: 124, ISSN: 0009-7322

Journal article

Papalia F, Aung N, Ling HZ, Aggarwal S, Flint J, Connell A, Weissert S, Mayet J, Francis D, Thomas M, Woldman S, Okonko DOet al., 2011, Prognostic Utility of the Hemoglobin/Hematocrit Equation for Estimating Plasma Volume Changes Over Time in Chronic Heart Failure, CIRCULATION, Vol: 124, ISSN: 0009-7322

Journal article

Lim PB, Malcolme-Lawes LC, Stuber T, Kojodjojo P, Wright IJ, Francis DP, Davies DW, Peters NS, Kanagaratnam Pet al., 2011, Stimulation of the Intrinsic Cardiac Autonomic Nervous System Results in a Gradient of Fibrillatory Cycle Length Shortening Across the Atria During Atrial Fibrillation in Humans, JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Vol: 22, Pages: 1224-1231, ISSN: 1045-3873

Journal article

Davies JE, Sen S, Broyd C, Hadjiloizou N, Baksi J, Francis DP, Foale RA, Parker KH, Hughes AD, Chukwuemeka A, Casula R, Malik IS, Mikhail GW, Mayet Jet al., 2011, Arterial Pulse Wave Dynamics After Percutaneous Aortic Valve Replacement Fall in Coronary Diastolic Suction With Increasing Heart Rate as a Basis for Angina Symptoms in Aortic Stenosis, CIRCULATION, Vol: 124, Pages: 1565-1572, ISSN: 0009-7322

Journal article

Cleland JGF, Teerlink JR, Senior R, Nifontov EM, Mc Murray JJV, Lang CC, Tsyrlin VA, Greenberg BH, Mayet J, Francis DP, Shaburishvili T, Monaghan M, Saltzberg M, Neyses L, Wasserman SM, Lee JH, Saikali KG, Clarke CP, Goldman JH, Wolff AA, Malik FIet al., 2011, The effects of the cardiac myosin activator, omecamtiv mecarbil, on cardiac function in systolic heart failure: a double-blind, placebo-controlled, crossover, dose-ranging phase 2 trial, LANCET, Vol: 378, Pages: 676-683, ISSN: 0140-6736

Journal article

Zaman N, Barron A, Thomas M, Woldman S, Mayet J, Francis D, Okonko DOet al., 2011, Red cell distribution width relates to exercise capacity in chronic heart failure but provides prognostic information incremental to peak oxygen consumption, EUROPEAN HEART JOURNAL, Vol: 32, Pages: 134-134, ISSN: 0195-668X

Journal article

Pabari PA, Kyriacou A, Whinnett ZI, Wright I, Willson K, Mayet J, Hughes AD, Francis DPet al., 2011, Invasive evaluation of whether decline in pressure after initial immediate increment on improving AV delay of CRT is due to vasodilatation or decline in cardiac function, EUROPEAN HEART JOURNAL, Vol: 32, Pages: 782-782, ISSN: 0195-668X

Journal article

Kyriacou A, Pabari P, Wright I, Cornellussen R, Sen S, Mayet J, Peters N, Kanagaratnam P, Whinnett Z, Francis DPet al., 2011, The effect of cardiac resynchronization therapy and of atrioventricular delay optimization on mechanoenergetic efficiency: simply, a better value for money, EUROPEAN HEART JOURNAL, Vol: 32, Pages: 151-151, ISSN: 0195-668X

Journal article

Lim PB, Malcolme-Lawes LC, Stuber T, Koa-Wing M, Wright IJ, Tillin T, Sutton R, Davies DW, Peters NS, Francis DP, Kanagaratnam Pet al., 2011, Feasibility of multiple short, 40-s, intra-procedural ECG recordings to detect immediate changes in heart rate variability during catheter ablation for arrhythmias, Journal of Interventional Cardiac Electrophysiology, Vol: 32, Pages: 163-171, ISSN: 1572-8595

Journal article

Aung N, Ling HZ, Aggarwal S, Flint J, Weissert S, Cheng A, Richards T, Francis DP, Mayet J, Thomas M, Okonko DOet al., 2011, EXPANSION OF THE RED CELL DISTRIBUTION WIDTH AND EVOLVING IRON DEFICIENCY AS PREDICTORS OF POOR OUTCOME IN CHRONIC HEART FAILURE, Annual Conference of the British-Cardiovascular-Society (BCS), Publisher: B M J PUBLISHING GROUP, Pages: A61-A62, ISSN: 1355-6037

Conference paper

Ling HZ, Aung N, Flint J, Aggarwal S, Weissert S, Cheng A, Francis DP, Mayet J, Thomas M, Woldman S, Okonko DOet al., 2011, PROGNOSTIC UTILITY OF CALCULATED PLASMA VOLUME STATUS IN CHRONIC HEART FAILURE, Annual Conference of the British-Cardiovascular-Society (BCS), Publisher: B M J PUBLISHING GROUP, Pages: A60-A60, ISSN: 1355-6037

Conference paper

Manisty CH, Unsworth B, Baruah R, Pabari P, Whinnett ZI, Mayet J, Francis DPet al., 2011, PRESSURE VS FLOW AS A GUIDE FOR PACEMAKER OPTIMISATION? THE ACUTE HAEMODYNAMIC EFFECTS OF CHANGES TO ATRIOVENTRICULAR DELAY, Annual Conference of the British-Cardiovascular-Society (BCS), Publisher: B M J PUBLISHING GROUP, Pages: A58-A58, ISSN: 1355-6037

Conference paper

Lim PB, Malcolme-Lawes LC, Stuber T, Wright I, Francis DP, Davies DW, Peters NS, Kanagaratnam Pet al., 2011, Intrinsic Cardiac Autonomic Stimulation Induces Pulmonary Vein Ectopy and Triggers Atrial Fibrillation in Humans, JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Vol: 22, Pages: 638-646, ISSN: 1045-3873

Journal article

Francis DP, 2011, Duration and magnitude of the effect of a single statin tablet in primary prevention of cardiovascular events, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 149, Pages: 102-107, ISSN: 0167-5273

Journal article

Pabari PA, Willson K, Stegemann B, van Geldorp IE, Kyriacou A, Moraldo M, Mayet J, Hughes AD, Francis DPet al., 2011, When is an optimization not an optimization? Evaluation of clinical implications of information content (signal-to-noise ratio) in optimization of cardiac resynchronization therapy, and how to measure and maximize it, HEART FAILURE REVIEWS, Vol: 16, Pages: 277-290, ISSN: 1382-4147

Journal article

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