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

Citation

BibTex format

@article{Cook:2018:10.1016/j.jacc.2018.06.033,
author = {Cook, CM and Ahmad, Y and Howard, JP and Shun-Shin, MJ and Sethi, A and Clesham, GJ and Tang, KH and Nijjer, SS and Kelly, PA and Davies, JR and Malik, IS and Kaprielian, R and Mikhail, G and Petraco, R and Al-Janabi, F and Karamasis, GV and Mohdnazri, S and Gamma, R and Al-Lamee, R and Keeble, TR and Mayet, J and Sen, S and Francis, DP and Davies, JE and Cook, CM and Ahmad, Y and James, H and Shun-Shin, M and Sethi, A and Clesham, G and Tang, K and Nijjer, S and Kelly, P and Davies, J and Malik, I and Kaprielian, R and Mikhail, G and Petraco, R and Al-Janabi, F and Karamasis, G and Mohdnazri, S and Gamma, R and Al-Lamee, R and Keeble, T and Mayet, J and Sen, S and Francis, D and Davies, J},
doi = {10.1016/j.jacc.2018.06.033},
journal = {Journal of the American College of Cardiology},
pages = {970--983},
title = {Impact of percutaneous revascularization on exercise hemodynamics in patients with stable coronary disease},
url = {http://dx.doi.org/10.1016/j.jacc.2018.06.033},
volume = {72},
year = {2018}
}

RIS format (EndNote, RefMan)

TY  - JOUR
AB - BACKGROUND: Recently, the therapeutic benefits of percutaneous coronary intervention (PCI) have been challenged in patients with stable coronary artery disease (SCD). OBJECTIVES: The authors examined the impact of PCI on exercise responses in the coronary circulation, the microcirculation, and systemic hemodynamics in patients with SCD. METHODS: A total of 21 patients (mean age 60.3 ± 8.4 years) with SCD and single-vessel coronary stenosis underwent cardiac catheterization. Pre-PCI, patients exercised on a supine ergometer until rate-limiting angina or exhaustion. Simultaneous trans-stenotic coronary pressure-flow measurements were made throughout exercise. Post-PCI, this process was repeated. Physiological parameters, rate-limiting symptoms, and exercise performance were compared between pre-PCI and post-PCI exercise cycles. RESULTS: PCI reduced ischemia as documented by fractional flow reserve value (pre-PCI 0.59 ± 0.18 to post-PCI 0.91 ± 0.07), instantaneous wave-free ratio value (pre-PCI 0.61 ± 0.27 to post-PCI 0.96 ± 0.05) and coronary flow reserve value (pre-PCI 1.7 ± 0.7 to post-PCI 3.1 ± 1.0; p < 0.001 for all). PCI increased peak-exercise average peak coronary flow velocity (p < 0.0001), coronary perfusion pressure (distal coronary pressure; p < 0.0001), systolic blood pressure (p = 0.01), accelerating wave energy (p < 0.001), and myocardial workload (rate-pressure product; p < 0.01). These changes observed immediately following PCI resulted from the abolition of stenosis resistance (p < 0.0001). PCI was also associated with an immediate improvement in exercise time (+67 s; 95% confidence interval: 31 to 102 s; p < 0.0001) and a reduction in rate-limiting angina symptoms (81% reduction in rate-limiting angina symptoms post-PCI; p < 0.001). CONCLUSIONS: In patients with SCD and severe single-vessel stenosis, objective physiological
AU - Cook,CM
AU - Ahmad,Y
AU - Howard,JP
AU - Shun-Shin,MJ
AU - Sethi,A
AU - Clesham,GJ
AU - Tang,KH
AU - Nijjer,SS
AU - Kelly,PA
AU - Davies,JR
AU - Malik,IS
AU - Kaprielian,R
AU - Mikhail,G
AU - Petraco,R
AU - Al-Janabi,F
AU - Karamasis,GV
AU - Mohdnazri,S
AU - Gamma,R
AU - Al-Lamee,R
AU - Keeble,TR
AU - Mayet,J
AU - Sen,S
AU - Francis,DP
AU - Davies,JE
AU - Cook,CM
AU - Ahmad,Y
AU - James,H
AU - Shun-Shin,M
AU - Sethi,A
AU - Clesham,G
AU - Tang,K
AU - Nijjer,S
AU - Kelly,P
AU - Davies,J
AU - Malik,I
AU - Kaprielian,R
AU - Mikhail,G
AU - Petraco,R
AU - Al-Janabi,F
AU - Karamasis,G
AU - Mohdnazri,S
AU - Gamma,R
AU - Al-Lamee,R
AU - Keeble,T
AU - Mayet,J
AU - Sen,S
AU - Francis,D
AU - Davies,J
DO - 10.1016/j.jacc.2018.06.033
EP - 983
PY - 2018///
SN - 0735-1097
SP - 970
TI - Impact of percutaneous revascularization on exercise hemodynamics in patients with stable coronary disease
T2 - Journal of the American College of Cardiology
UR - http://dx.doi.org/10.1016/j.jacc.2018.06.033
UR - https://www.ncbi.nlm.nih.gov/pubmed/30139442
UR - http://hdl.handle.net/10044/1/61322
VL - 72
ER -