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

577 results found

Whinnett ZI, Sohaib SMA, Jones S, Kyriacou A, March K, Coady E, Mayet J, Hughes AD, Frenneaux M, Francis DPet al., 2014, British randomised controlled trial of AV and VV optimization ("BRAVO") study: rationale, design, and endpoints, BMC CARDIOVASCULAR DISORDERS, Vol: 14, ISSN: 1471-2261

Journal article

Barron A, Dhutia N, Mayet J, Hughes AD, Francis DP, Wensel Ret al., 2014, Test-retest repeatability of cardiopulmonary exercise test variables in patients with cardiac or respiratory disease, EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, Vol: 21, Pages: 445-453, ISSN: 2047-4873

Journal article

Jones S, Shun-Shin MJ, Cole GD, Sau A, March K, Williams S, Kyriacou A, Hughes AD, Mayet J, Frenneaux M, Manisty CH, Whinnett ZI, Francis DPet al., 2014, Applicability of the iterative technique for cardiac resynchronization therapy optimization: full-disclosure, 50-sequential-patient dataset of transmitral Doppler traces, with implications for future research design and guidelines, EUROPACE, Vol: 16, Pages: 541-550, ISSN: 1099-5129

Journal article

Foin N, Gutierrez-Chico JL, Nakatani S, Torii R, Bourantas CV, Sen S, Nijjer S, Petraco R, Kousera C, Ghione M, Onuma Y, Garcia-Garcia HM, Francis DP, Wong P, Di Mario C, Davies JE, Serruys PWet al., 2014, Incomplete Stent Apposition Causes High Shear Flow Disturbances and Delay in Neointimal Coverage as a Function of Strut to Wall Detachment Distance Implications for the Management of Incomplete Stent Apposition, CIRCULATION-CARDIOVASCULAR INTERVENTIONS, Vol: 7, Pages: 180-189, ISSN: 1941-7640

Journal article

Barron A, Dhutia N, Mayet J, Hughes AD, Francis DP, Wensel Ret al., 2014, Response to editorial 'Reproducibility of cardiopulmonary exercise test variables: getting into an additional strength of the test', EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, Vol: 21, Pages: 454-455, ISSN: 2047-4873

Journal article

Finegold JA, Manisty CH, Goldacre B, Barron AJ, Francis DPet al., 2014, What proportion of symptomatic side effects in patients taking statins are genuinely caused by the drug? Systematic review of randomized placebo-controlled trials to aid individual patient choice, EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, Vol: 21, Pages: 464-474, ISSN: 2047-4873

Journal article

Jarman JWE, Wong T, Kojodjojo P, Spohr H, Davies JER, Roughton M, Francis DP, Kanagaratnam P, O'Neill MD, Markides V, Davies DW, Peters NSet al., 2014, Organizational Index Mapping to Identify Focal Sources During Persistent Atrial Fibrillation, JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Vol: 25, Pages: 355-363, ISSN: 1045-3873

Journal article

Shun-Shin MJ, Howard JP, Francis DP, 2014, Removing the hype from hypertension, BMJ-BRITISH MEDICAL JOURNAL, Vol: 348, ISSN: 1756-1833

Journal article

Nowbar AN, Cole GD, Shun-Shin MJ, Finegold JA, Francis DPet al., 2014, International RCT-based guidelines for use of preoperative stress testing and perioperative beta-blockers and statins in non-cardiac surgery, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 172, Pages: 138-143, ISSN: 0167-5273

Journal article

Howard JP, Cole GD, Sievert H, Bhatt DL, Papademetriou V, Kandzari DE, Davies JE, Francis DPet al., 2014, Unintentional overestimation of an expected antihypertensive effect in drug and device trials: Mechanisms and solutions, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 172, Pages: 29-35, ISSN: 0167-5273

Journal article

Bouri S, Shun-Shin MJ, Cole GD, Mayet J, Francis DPet al., 2014, Meta-analysis of secure randomised controlled trials of beta-blockade to prevent perioperative death in non-cardiac surgery, Heart, Vol: 100, Pages: 456-464, ISSN: 1355-6037

Background Current European and American guidelines recommend the perioperative initiation of a course of β-blockers in those at risk of cardiac events undergoing high- or intermediate-risk surgery or vascular surgery. The Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography (DECREASE) family of trials, the bedrock of evidence for this, are no longer secure. We therefore conducted a meta-analysis of randomised controlled trials of β-blockade on perioperative mortality, non-fatal myocardial infarction, stroke and hypotension in non-cardiac surgery using the secure data.Methods The randomised controlled trials of initiation of β-blockers before non-cardiac surgery were examined. Primary outcome was all-cause mortality at 30 days or at discharge. The DECREASE trials were separately analysed.Results Nine secure trials totalling 10 529 patients, 291 of whom died, met the criteria. Initiation of a course of β-blockers before surgery caused a 27% risk increase in 30-day all-cause mortality (p=0.04). The DECREASE family of studies substantially contradict the meta-analysis of the secure trials on the effect of mortality (p=0.05 for divergence). In the secure trials, β-blockade reduced non-fatal myocardial infarction (RR 0.73, p=0.001) but increased stroke (RR 1.73, p=0.05) and hypotension (RR 1.51, p<0.00001). These results were dominated by one large trial.Conclusions Guideline bodies should retract their recommendations based on fictitious data without further delay. This should not be blocked by dispute over allocation of blame. The well-conducted trials indicate a statistically significant 27% increase in mortality from the initiation of perioperative β-blockade that guidelines currently recommend. Any remaining enthusiasts might best channel their energy into a further randomised trial which should be designed carefully and conducted honestly.

Journal article

Cook C, Cole G, Asaria P, Jabbour R, Francis DPet al., 2014, The annual global economic burden of heart failure, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 171, Pages: 368-376, ISSN: 0167-5273

Journal article

Kyriacou A, Pabari PA, Mayet J, Peters NS, Davies DW, Lim PB, Lefroy D, Hughes AD, Kanagaratnam P, Francis DP, Whinnett ZIet al., 2014, Cardiac resynchronization therapy and AV optimization increase myocardial oxygen consumption, but increase cardiac function more than proportionally, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 171, Pages: 144-152, ISSN: 0167-5273

Journal article

Petraco R, Escaned J, Nijjer S, Sen S, Echavarria-Pinto M, Francis DP, Davies JEet al., 2014, Fractional Flow Reserve: A Good or a Gold Standard? Reply, JACC-CARDIOVASCULAR INTERVENTIONS, Vol: 7, Pages: 228-229, ISSN: 1936-8798

Journal article

Sutton R, Salukhe TV, Franzen-Mcmanus A-C, Collins A, Lim PB, Francis DPet al., 2014, Ivabradine in treatment of sinus tachycardia mediated vasovagal syncope, EUROPACE, Vol: 16, Pages: 284-288, ISSN: 1099-5129

Journal article

Al-Lamee R, Broyd C, Parker J, Davies JE, Mayet J, Sutaria N, Ariff B, Unsworth B, Cousins J, Bicknell C, Anderson J, Malik IS, Chukwuemeka A, Blackman DJ, Moat N, Ludman PF, Francis DP, Mikhail GWet al., 2014, Influence of Gender on Clinical Outcomes Following Transcatheter Aortic Valve Implantation,from the UK Transcatheter Aortic Valve Implantation Registry and the National Institute for Cardiovascular Outcomes Research, AMERICAN JOURNAL OF CARDIOLOGY, Vol: 113, Pages: 522-528, ISSN: 0002-9149

Journal article

Giannoni A, Baruah R, Leong T, Rehman MB, Pastormerlo LE, Harrell FE, Coats AJS, Francis DPet al., 2014, Do Optimal Prognostic Thresholds in Continuous Physiological Variables Really Exist? Analysis of Origin of Apparent Thresholds, with Systematic Review for Peak Oxygen Consumption, Ejection Fraction and BNP, PLOS ONE, Vol: 9, ISSN: 1932-6203

Journal article

Unsworth B, Francis DP, Mayet J, 2014, RE: Impact of transcatheter aortic valve implantation or surgical aortic valve replacement on right ventricular function, HEART, Vol: 100, Pages: 180-180, ISSN: 1355-6037

Journal article

Bouri S, Whinnett ZI, Cole GD, Manisty CH, Cleland JG, Francis DPet al., 2014, Definitions of Outcome, Response and Effect in Imaging Research to Avoid Confusion, JACC-CARDIOVASCULAR IMAGING, Vol: 7, Pages: 104-106, ISSN: 1936-878X

Journal article

Cole GD, Francis DP, 2014, Research failure can result in lost lives (Retracted article. See vol. 14, 2014), EUROPEAN HEART JOURNAL, Vol: 35, Pages: 135-137, ISSN: 0195-668X

Journal article

Tarkin JM, Nijjer S, Sen S, Petraco R, Echavarria-Pinto M, Asress KN, Lockie T, Khawaja MZ, Mayet J, Hughes AD, Malik IS, Mikhail GW, Baker CS, Foale RA, Redwood S, Francis DP, Escaned J, Davies JEet al., 2014, Hemodynamic Response to Intravenous Adenosine and Its Effect on Fractional Flow Reserve Assessment Results of the Adenosine for the Functional Evaluation of Coronary Stenosis Severity (AFFECTS) Study, CELL BIOLOGY INTERNATIONAL, Vol: 38, Pages: 654-661, ISSN: 1065-6995

Journal article

Zolgharni M, Dhutia NM, Cole GD, Willson K, Francis DPet al., 2014, Feasibility of using a reliable automated Doppler flow velocity measurements for research and clinical practices, Pages: 90401D-90401D

Conference paper

Baruah R, Giannoni A, Willson K, Manisty CH, Mebrate Y, Kyriacou A, Yadav H, Unsworth B, Sutton R, Mayet J, Hughes AD, Francis DPet al., 2014, Novel cardiac pacemaker-based human model of periodic breathing to develop real-time, pre-emptive technology for carbon dioxide stabilisation., Open Heart, Vol: 1, ISSN: 2053-3624

BACKGROUND: Constant flow and concentration CO2 has previously been efficacious in attenuating ventilatory oscillations in periodic breathing (PB) where oscillations in CO2 drive ventilatory oscillations. However, it has the undesirable effect of increasing end-tidal CO2, and ventilation. We tested, in a model of PB, a dynamic CO2 therapy that aims to attenuate pacemaker-induced ventilatory oscillations while minimising CO2 dose. METHODS: First, pacemakers were manipulated in 12 pacemaker recipients, 6 with heart failure (ejection fraction (EF)=23.7±7.3%) and 6 without heart failure, to experimentally induce PB. Second, we applied a real-time algorithm of pre-emptive dynamic exogenous CO2 administration, and tested different timings. RESULTS: We found that cardiac output alternation using pacemakers successfully induced PB. Dynamic CO2 therapy, when delivered coincident with hyperventilation, attenuated 57% of the experimentally induced oscillations in end-tidal CO2: SD/mean 0.06±0.01 untreated versus 0.04±0.01 with treatment (p<0.0001) and 0.02±0.01 in baseline non-modified breathing. This translated to a 56% reduction in induced ventilatory oscillations: SD/mean 0.19±0.09 untreated versus 0.14±0.06 with treatment (p=0.001) and 0.10±0.03 at baseline. Of note, end-tidal CO2 did not significantly rise when dynamic CO2 was applied to the model (4.84±0.47 vs 4.91± 0.45 kPa, p=0.08). Furthermore, mean ventilation was also not significantly increased by dynamic CO2 compared with untreated (7.8±1.2 vs 8.4±1.2 L/min, p=0.17). CONCLUSIONS: Cardiac pacemaker manipulation can be used to induce PB experimentally. In this induced PB, delivering CO2 coincident with hyperventilation, ventilatory oscillations can be substantially attenuated without a significant increase in end-tidal CO2 or ventilation. Dynamic CO2 administration might be developed into a clinical treatment for PB. TRIAL REGISTRATION N

Journal article

Dhutia NM, Zolgharni M, Willson K, Cole G, Nowbar AN, Manisty CH, Francis DPet al., 2014, Calibration of echocardiographic tissue doppler velocity, using simple, universally-applicable methods, Pages: 90400G-90400G

Conference paper

Finegold JA, Raphael CE, Levy WC, Whinnett Z, Francis DPet al., 2013, Quantification of survival gain from cardiac resynchronization therapy: nonlinear growth with time, and greater gain in low-risk patients, make raw trial data an underestimate of real-world behavior., J Am Coll Cardiol, Vol: 62, Pages: 2406-2413

OBJECTIVES: The goal of this study was to examine the impact of calculation-window duration on lifespan gain (as observed in trials) and on who gains most. BACKGROUND: The landmark trials of biventricular pacing (cardiac resynchronization therapy [CRT]) typically ran for <1 device battery life, and they may therefore underestimate lifespan benefit over longer durations. METHODS: We conducted a meta-analysis of biventricular pacing trials to calculate lifespan gained: first, within the duration of randomized controlled trial data up to 2 years; second, over a 5-year typical battery life; and third, over >1 battery life. Importantly, we applied the Gompertz method for age-related increase in mortality from non-CRT-preventable causes. RESULTS: Five landmark trials (COMPANION [Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure], CARE-HF (CArdiac REsynchronization-Heart Failure), MADIT-CRT [Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy], REVERSE [Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction], RAFT (Resynchronization-Defibrillation for Ambulatory Heart Failure)) provided data for 2 years (6,561 patients), with an average hazard ratio of 0.71. Lifespan gained across all trials increased nonlinearly with time from 0.1 month at 1 year, to 0.5 month at 2 years, and a projected 6.5 months at 5 years (65 times more than at 1 year). After multiple devices, it reached 14 months, involving on average 1.6 devices (i.e., 8.8 months per device implanted). Moreover, while over a short window (e.g., 2 years), lower-mortality patients may gain less than higher-mortality patients (1.4 vs. 2.3 months), their positions reverse by 15 years (16.0 vs. 13.7 months). CONCLUSIONS: Lifespan gain from biventricular pacing rises nonlinearly with time. Early on, higher-risk patients exhibit more gain, but later, lower-risk patients exhibit more gain. Quantifying ga

Journal article

Sohaib SMA, Whinnett ZI, Ellenbogen KA, Stellbrink C, Quinn TA, Bogaard MD, Bordachar P, van Gelder BM, van Geldorp IE, Linde C, Meine M, Prinzen FW, Turcott RG, Spotnitz HM, Wichterle D, Francis DPet al., 2013, Cardiac resynchronisation therapy optimisation strategies: Systematic classification, detailed analysis, minimum standards and a roadmap for development and testing, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 170, Pages: 118-131, ISSN: 0167-5273

Journal article

Schlaich MP, Schmieder RE, Bakris G, Blankestijn PJ, Boehm M, Campese VM, Francis DP, Grassi G, Hering D, Katholi R, Kjeldsen S, Krum H, Mahfoud F, Mancia G, Messerli FH, Narkiewicz K, Parati G, Rocha-Singh KJ, Ruilope LM, Rump LC, Sica DA, Sobotka PA, Tsioufis C, Vonend O, Weber MA, Williams B, Zeller T, Esler MDet al., 2013, International Expert Consensus Statement Percutaneous Transluminal Renal Denervation for the Treatment of Resistant Hypertension, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol: 62, Pages: 2031-2045, ISSN: 0735-1097

Journal article

Jamil-Copley S, Linton N, Koa-Wing M, Kojodjojo P, Lim PB, Malcolme-Lawes L, Whinnett Z, Wright I, Davies W, Peters N, Francis DP, Kanagaratnam Pet al., 2013, Application of Ripple Mapping with an Electroanatomic Mapping System for Diagnosis of Atrial Tachycardias, JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Vol: 24, Pages: 1361-1369, ISSN: 1045-3873

Journal article

Tarkin JM, Nijjer S, Sen S, Petraco R, Echavarria-Pinto M, Asress KN, Lockie T, Khawaja MZ, Mayet J, Hughes AD, Malik IS, Mikhail GW, Baker CS, Foale RA, Redwood S, Francis DP, Escaned J, Davies JEet al., 2013, Hemodynamic Response to Intravenous Adenosine and Its Effect on Fractional Flow Reserve Assessment Results of the Adenosine for the Functional Evaluation of Coronary Stenosis Severity (AFFECTS) Study, CIRCULATION-CARDIOVASCULAR INTERVENTIONS, Vol: 6, Pages: 654-661, ISSN: 1941-7640

Journal article

Sohaib SMA, Chen Z, Whinnett ZI, Bouri S, Dickstein K, Linde C, Hayes DL, Manisty CH, Francis DPet al., 2013, Meta-analysis of symptomatic response attributable to the pacing component of cardiac resynchronization therapy, EUROPEAN JOURNAL OF HEART FAILURE, Vol: 15, Pages: 1419-1428, ISSN: 1388-9842

Journal article

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