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

589 results found

Sohaib SMA, Jones S, Kyriacou A, Manisty C, Mayet J, Kanagaratnam P, Peters N, Hughes A, Whinnett Z, Francis Det al., 2014, EVIDENCE THAT HAEMODYNAMIC RESPONSE TO VV DELAY OPTIMISATION OF CRT DEVICES MAY BE SIMPLY A FUNCTION OF THE METHOD OF PROGRAMMING AV DELAY, HEART, Vol: 100, Pages: A21-A22, ISSN: 1355-6037

Journal article

Sau A, Cole G, Cook C, Shun-Shin M, Francis Det al., 2014, SYSTEMATIC ANALYSIS OF EUROPEAN SOCIETY OF CARDIOLOGY GUIDELINES: WHAT DO WE ACTUALLY BASE OUR PRACTICE ON?, HEART, Vol: 100, Pages: A63-A64, ISSN: 1355-6037

Journal article

Jabbour R, Shun-Shin M, Finegold J, Sohaib A, Cook C, Whinnett Z, Manisty C, Francis Det al., 2014, META-ANALYSIS IDENTIFYING THE SOURCE OF CONFLICT BETWEEN DIFFERENT TRIAL REPORTS ON THE EFFECT OF CRT IN HEART FAILURE WITH NARROW QRS COMPLEXES, HEART, Vol: 100, Pages: A23-A23, ISSN: 1355-6037

Journal article

Cook C, Cole G, Asaris P, Jabbour R, Francis Det al., 2014, THE ANNUAL GLOBAL ECONOMIC BURDEN OF HEART FAILURE, HEART, Vol: 100, Pages: A28-A29, ISSN: 1355-6037

Journal article

Keene D, Shun-Shin M, Price C, Francis Det al., 2014, 108 The Observational HDL Hypothesis: A Useful Therapeutic Target? a Meta Analysis of 117,411 Patients in Randomised Controlled Trials., Heart, Vol: 100 Suppl 3, Pages: A62-A63

Epidemiological studies have shown HDL to be a prognostic marker. We undertook a meta-analysis to assess the benefit on cardiovascular outcomes for those patients on pharmacological interventions aimed at increasing HDL. Niacin, fibrates and cholesteryl ester transfer protein inhibitors (CETP-I) were identified as agents that raise HDL levels.

Journal article

Kidher E, Harling L, Ashrafian H, Naase H, Chukwuemeka A, Anderson J, Francis DP, Athanasiou Tet al., 2014, Pulse wave velocity and neutrophil gelatinase-associated lipocalin as predictors of acute kidney injury following aortic valve replacement, Journal of Cardiothoracic Surgery, Vol: 9, ISSN: 1749-8090

BackgroundAccurate prediction, early detection and treatment of acute kidney injury (AKI) are essential for improving post-operative outcomes. This study aimed to examine the role of aortic stiffness and neutrophil gelatinase-associated lipocalin (NGAL) as predictors of AKI or need for early medical renal intervention following aortic valve replacement (AVR).MethodsAortic pulse wave velocity and plasma NGAL were measured pre-operatively in recruited patients undergoing AVR for aortic stenosis (AS). Plasma NGAL was also measured at 3 and 18–24 hours after cardiopulmonary bypass (CPB). AKI was defined using RIFLE criteria. Early medical renal intervention included diuretics or dopamine infusion exclusively for renal causes.ResultsFifty-three patients aged 71 ± 9 years were included. Sixteen (30%) developed AKI (AKI-Yes) and 24 patients (45%) received early medical intervention (Intervention-Yes). There was no significant difference in the demographic, clinical or operative characteristics between the two groups for either outcome. PWV did not significantly correlate with AKI (r = 0.12, P = 0.13) or early intervention (r = 0.18, P = 0.18). At 3 h post-CPB, plasma NGAL was a much stronger predictor of both AKI and the need for early medical intervention than conventional markers such as creatinine (AKI: AUC 83%, 95% CI 0.70–0.95 vs. AUC 65%, 95% CI 0.47- 0.82; Medical intervention: AUC 84%, 95% CI 0.72–0.96 vs. AUC 56%, 95% CI 0.38–0.73). Post-CPB (3 hr) plasma NGAL was also significantly associated with AKI (r = 0.68, P < 0.001) at levels above 150 ng/ml; and significantly associated with early intervention (r = 0.64, P < 0.001) above 136 ng/ml. Simple linear regression showed no relationship between PWV and NGAL levels.ConclusionAortic PWV does not correlate significantly with pos

Journal article

Wensel R, Francis DP, 2014, Prognosis in patients with chronic heart failure: it's the way they breathe that matters, HEART, Vol: 100, Pages: 754-755, ISSN: 1355-6037

Journal article

Ingle L, Rigby AS, Sloan R, Carroll S, Goode KM, Cleland JG, Clark ALet al., 2014, Development of a composite model derived from cardiopulmonary exercise tests to predict mortality risk in patients with mild-to-moderate heart failure, HEART, Vol: 100, Pages: 781-786, ISSN: 1355-6037

Journal article

Zolgharni M, Dhutia NM, Cole GD, Bahmanyar MR, Jones S, Sohaib SMA, Tai SB, Willson K, Finegold JA, Francis DPet al., 2014, Automated Aortic Doppler Flow Tracing for Reproducible Research and Clinical Measurements, IEEE TRANSACTIONS ON MEDICAL IMAGING, Vol: 33, Pages: 1071-1082, ISSN: 0278-0062

Journal article

Cook CM, Cole G, Asaria P, Jabbour R, Francis Det al., 2014, The annual global economic burden of heart failure, EUROPEAN JOURNAL OF HEART FAILURE, Vol: 16, Pages: 184-184, ISSN: 1388-9842

Journal article

Park CM, Tillin T, March K, Ghosh AK, Jones S, Wright A, Heasman J, Francis D, Sattar N, Mayet J, Chaturvedi N, Hughes ADet al., 2014, Hyperglycemia Has a Greater Impact on Left Ventricle Function in South Asians Than in Europeans, Diabetes Care, Vol: 37, Pages: 1124-1131, ISSN: 1935-5548

OBJECTIVE Diabetes is associated with left ventricular (LV) diastolic and systolic dysfunction. South Asians may be at particular risk of developing LV dysfunction owing to a high prevalence of diabetes. We investigated the role of diabetes and hyperglycemia in LV dysfunction in a community-based cohort of older South Asians and white Europeans.RESEARCH DESIGN AND METHODS Conventional and Doppler echocardiography was performed in 999 participants (542 Europeans and 457 South Asians aged 58–86 years) in a population-based study. Anthropometry, fasting bloods, coronary artery calcification scoring, blood pressure, and renal function were measured.RESULTS Diabetes and hyperglycemia across the spectrum of HbA1c had a greater adverse effect on LV function in South Asians than Europeans (N-terminal-probrain natriuretic peptide β ± SE 0.09 ± 0.04, P = 0.01, vs. −0.04 ± 0.05, P = 0.4, P for HbA1c/ethnicity interaction 0.02), diastolic function (E/e′ 0.69 ± 0.12, P < 0.0001, vs. 0.09 ± 0.2, P = 0.6, P for interaction 0.005), and systolic function (s′ −0.11 ± 0.06, P = 0.04, vs. 0.14 ± 0.09, P = 0.1, P for interaction 0.2). Multivariable adjustment for hypertension, microvascular disease, LV mass, coronary disease, and dyslipidemia only partially accounted for the ethnic differences. Adverse LV function in diabetic South Asians could not be accounted for by poorer glycemic control or longer diabetes duration.CONCLUSIONS Diabetes and hyperglycemia have a greater adverse effect on LV function in South Asians than Europeans, incompletely explained by adverse risk factors. South Asians may require earlier and more aggressive treatment of their cardiometabolic risk factors to reduce risks of LV dysfunction.

Journal article

Nowbar AN, Mielewczik M, Karavassilis M, Dehbi H-M, Shun-Shin MJ, Jones S, Howard JP, Cole GD, Francis DPet al., 2014, Discrepancies in autologous bone marrow stem cell trials and enhancement of ejection fraction (DAMASCENE): weighted regression and meta-analysis, British Medical Journal, Vol: 348, ISSN: 1468-5833

Journal article

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

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