496 results found
Benedetto U, Sinha S, Mulla A, et al., 2022, Implications of elevated troponin on time-to-surgery in non-ST elevation myocardial infarction (NIHR Health Informatics Collaborative: TROP-CABG study)., Int J Cardiol, Vol: 362, Pages: 14-19
Implications of elevated troponin on time-to-surgery in non-ST elevation myocardial infarction(NIHR Health Informatics Collaborative:TROP-CABG study). Benedetto et al. BACKGROUND: The optimal timing of coronary artery bypass grafting (CABG) in patients with non-ST elevation myocardial infarction (NSTEMI) and the utility of pre-operative troponin levels in decision-making remains unclear. We investigated (a) the association between peak pre-operative troponin and survival post-CABG in a large cohort of NSTEMI patients and (b) the interaction between troponin and time-to-surgery. METHODS AND RESULTS: Our cohort consisted of 1746 patients (1684 NSTEMI; 62 unstable angina) (mean age 69 ± 11 years,21% female) with recorded troponins that had CABG at five United Kingdom centers between 2010 and 2017. Time-segmented Cox regression was used to investigate the interaction of peak troponin and time-to-surgery on early (within 30 days) and late (beyond 30 days) survival. Average interval from peak troponin to surgery was 9 ± 15 days, with 1466 (84.0%) patients having CABG during the same admission. Sixty patients died within 30-days and another 211 died after a mean follow-up of 4 ± 2 years (30-day survival 0.97 ± 0.004 and 5-year survival 0.83 ± 0.01). Peak troponin was a strong predictor of early survival (adjusted P = 0.002) with a significant interaction with time-to-surgery (P interaction = 0.007). For peak troponin levels <100 times the upper limit of normal, there was no improvement in early survival with longer time-to-surgery. However, in patients with higher troponins, early survival increased progressively with a longer time-to-surgery, till day 10. Peak troponin did not influence survival beyond 30 days (adjusted P = 0.64). CONCLUSIONS: Peak troponin in NSTEMI patients undergoing CABG was a significant predictor of earl
Esdaile H, Mayet J, Hill N, 2022, Cardiovascular disease risk stratification in type 2 diabetes., Diabet Med
Al Saikhan L, Park C, Tillin T, et al., 2022, Relationship Between Image Quality and Bias in 3D Echocardiographic Measures: Data From the SABRE (Southall and Brent Revisited) Study, JOURNAL OF THE AMERICAN HEART ASSOCIATION, Vol: 11
Kelshiker M, Seligman H, Howard JAMES, et al., 2022, Coronary flow reserve and cardiovascular outcomes: a systematic review and meta-analysis, European Heart Journal, Vol: 43, Pages: 1582-1593, ISSN: 0195-668X
Aims: This meta-analysis aims to quantify the association of reduced coronary flow with all3 cause mortality and major adverse cardiovascular events (MACE) across a broad range of patient groups and pathologies. Methods and Results: We systematically identified all studies between 1st January 2000 and1st August 2020, where coronary flow was measured and clinical outcomes were reported. The endpoints were all-cause mortality and MACE. Estimates of effect were calculated from published hazard ratios using a random-effects model. 79 studies, including 59,740 subjects were included. Abnormal coronary flow reserve (CFR) was associated with a higher incidence of all-cause mortality (HR 3.78, 95% CI 2.39-5.97) and a higher incidence of MACE (HR 3.42, 95% CI 2.92-3.99). Each 0.1-unit reduction in CFR was associated with a proportional increase in mortality (per 0.1 CFR unit HR 1.16, 95% CI 1.04-1.29) and MACE (per 0.1 CFR unit HR 1.08, 95% CI 1.04-1.11)). In patients with isolated coronary microvascular dysfunction, an abnormal CFR was associated with a higher incidence of mortality (HR 5.44, 95% CI 3.78-7.83) and MACE (HR 3.56, 95% CI 2.14-5.90). Abnormal CFR was also associated with a higher incidence of MACE in patients with acute coronary syndromes (HR 3.76, 95% CI 2.35-6.00), heart failure (HR 6.38, 95% CI 1.95-20.90), heart transplant (HR 3.32, 95% CI 2.34-4.71) and diabetes mellitus (HR 7.47, 95% CI 3.37-16.55). Conclusions: Reduced coronary flow is strongly associated with increased risk of all-cause mortality and MACE across a wide range of pathological processes. This finding supports recent recommendations that coronary flow should be measured more routinely in clinical practice to target aggressive vascular risk modification for individuals at higher risk
Kaura A, Trickey A, Shah A, et al., 2022, Comparing the longer-term effectiveness of a single dose of the Pfizer-BioNTech and Oxford-AstraZeneca COVID-19 vaccines across the age spectrum, EClinicalMedicine, Vol: 46, ISSN: 2589-5370
Background:A single dose strategy may be adequate to confer population level immunity and protection against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, especially in low- and middle-income countries where vaccine supply remains limited. We compared the effectiveness of a single dose strategy of the Oxford-AstraZeneca or Pfizer-BioNTech vaccines against SARS-CoV-2 infection across all age groups and over an extended follow-up period.Methods:Individuals vaccinated in North-West London, UK, with either the first dose of the Oxford-AstraZeneca or Pfizer-BioNTech vaccines between January 12, 2021 to March 09, 2021, were matched to each other by demographic and clinical characteristics. Each vaccinated individual was additionally matched to an unvaccinated control. Study outcomes included SARS-CoV-2 infection of any severity, COVID-19 hospitalisation, COVID-19 death, and all-cause mortality. Findings:Amongst matched individuals, 63,608 were in each of the vaccine groups and 127,216 were unvaccinated. Between 14-84 days of follow-up after matching, there were 534 SARS-CoV-2 infections, 65 COVID-19 hospitalisations, and 190 deaths, of which 29 were categorized as due to COVID-19. The incidence rate ratio (IRR) for SARS-CoV-2 infection was 0.85 (95% confidence interval [CI], 0.69 to 1.05) for Oxford-Astra-Zeneca, and 0.69 (0.55 to 0.86) for Pfizer-BioNTech. The IRR for both vaccines was the same at 0.25 (0.09 to 0.55) and 0.14 (0.02 to 0.58) for reducing COVID-19 hospitalization and COVID-19 mortality, respectively. The IRR for all-cause mortality was 0.25 (0.15 to 0.39) and 0.18 (0.10 to 0.30) for the Oxford-Astra-Zeneca and Pfizer-BioNTech vaccines, respectively. Age was an effect modifier of the association between vaccination and SARS-CoV-2 infection of any severity; lower hazard ratios for increasing age. Interpretation: A single dose strategy, for both vaccines, was effective at reducing COVID-19 mortality and hospitalization rates. The mag
Sau A, Kaura A, Ahmed A, et al., 2022, Prognostic significance of ventricular arrhythmias in 13444 patients with acute coronary syndrome: a retrospective cohort study based on routine clinical data (NIHR Health Informatics Collaborative VA-ACS Study), Journal of the American Heart Association, Vol: 11, Pages: 1-19, ISSN: 2047-9980
Background: A minority of acute coronary syndrome (ACS) cases are associated with ventricular arrhythmias (VA) and/or cardiac arrest (CA). We investigated the effect of VA/CA at time of ACS on long-term outcomes.Methods and Results: We analysed routine clinical data from 5 NHS Trusts in the United Kingdom, collected between 2010 and 2017, by the National Institute for Health Research Health Informatics Collaborative (NIHR HIC).13,444 patients with ACS, of which 376 (2.8%) had concurrent VA, survived to hospital discharge and were followed up for a median of 3.42 years. Patients with VA or CA at index presentation had significantly increased risks of subsequent VA during follow-up (VA group: adjusted HR 4.15, 95% CI 2.42-7.09, CA group: adjusted HR 2.60 95% CI 1.23-5.48). Patients who suffered a CA in the context of ACS and survived to discharge also had a 36% increase in long-term mortality (adjusted hazard ratio 1.36 (95% 1.04-1.78)), though the concurrent diagnosis of VA alone during ACS did not affect all-cause mortality (adjusted HR 1.03, 95% CI 0.80-1.33). Conclusions: Patients who develop VA or CA during ACS, who survive to discharge, have increased risks of subsequent VA, while those who have CA during ACS also have an increase in long-term mortality. These individuals may represent a subgroup at greater risk of subsequent arrhythmic events due to intrinsically lower thresholds for developing VA.
Kelshiker M, Seligman H, Howard JP, et al., 2022, CORONARY FLOW RESERVE AND CARDIOVASCULAR OUTCOMES: A SYSTEMATIC REVIEW AND META-ANALYSIS, 71st Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC), Publisher: ELSEVIER SCIENCE INC, Pages: 989-989, ISSN: 0735-1097
Kaura A, Hartley A, Panoulas V, et al., 2022, Mortality risk prediction of high-sensitivity C-reactive protein in suspected acute coronary syndrome: a cohort study, PLoS Medicine, Vol: 19, ISSN: 1549-1277
BACKGROUND: There is limited evidence on the use of high-sensitivity C-reactive protein (hsCRP) as a biomarker for selecting patients for advanced cardiovascular (CV) therapies in the modern era. The prognostic value of mildly elevated hsCRP beyond troponin in a large real-world cohort of unselected patients presenting with suspected acute coronary syndrome (ACS) is unknown. We evaluated whether a mildly elevated hsCRP (up to 15 mg/L) was associated with mortality risk, beyond troponin level, in patients with suspected ACS. METHODS AND FINDINGS: We conducted a retrospective cohort study based on the National Institute for Health Research Health Informatics Collaborative data of 257,948 patients with suspected ACS who had a troponin measured at 5 cardiac centres in the United Kingdom between 2010 and 2017. Patients were divided into 4 hsCRP groups (<2, 2 to 4.9, 5 to 9.9, and 10 to 15 mg/L). The main outcome measure was mortality within 3 years of index presentation. The association between hsCRP levels and all-cause mortality was assessed using multivariable Cox regression analysis adjusted for age, sex, haemoglobin, white cell count (WCC), platelet count, creatinine, and troponin. Following the exclusion criteria, there were 102,337 patients included in the analysis (hsCRP <2 mg/L (n = 38,390), 2 to 4.9 mg/L (n = 27,397), 5 to 9.9 mg/L (n = 26,957), and 10 to 15 mg/L (n = 9,593)). On multivariable Cox regression analysis, there was a positive and graded relationship between hsCRP level and mortality at baseline, which remained at 3 years (hazard ratio (HR) (95% CI) of 1.32 (1.18 to 1.48) for those with hsCRP 2.0 to 4.9 mg/L and 1.40 (1.26 to 1.57) and 2.00 (1.75 to 2.28) for those with hsCRP 5 to 9.9 mg/L and 10 to 15 mg/L, respectively. This relationship was independent of troponin in all suspected ACS patients and was further verified in those who were confirmed to have an ACS diagnosis by clinical coding. The main limitation of our study is that we did not
Seligman H, Nijjer SS, van de Hoef TP, et al., 2022, Phasic flow patterns of right versus left coronary arteries in patients undergoing clinical physiological assessment, EUROINTERVENTION, Vol: 17, Pages: 1260-+, ISSN: 1774-024X
Al Saikhan L, Alobaida M, Bhuva A, et al., 2021, Imaging Protocol, Feasibility, and Reproducibility of Cardiovascular Phenotyping in a Large Tri-Ethnic Population-Based Study of Older People: The Southall and Brent Revisited (SABRE) Study (vol 7,591946,2020), FRONTIERS IN CARDIOVASCULAR MEDICINE, Vol: 8, ISSN: 2297-055X
Kaura A, Mayet J, Manisty C, 2021, Sharpening focus through wider collaboration: evolving heterogeneity in the bi-directional relationship between cardiovascular disease and COVID-19, EUROPEAN HEART JOURNAL, Vol: 43, Pages: 1121-1123, ISSN: 0195-668X
Piggin M, Johnson H, Papadimitriou D, et al., 2021, Insight Report: Digital health online public involvement session on building our digital healthcare programme in North West London, Insight Report: Digital health online public involvement session on building our digital healthcare programme in North West London
Summary report on the views of members of the public on building the digital healthcare programme of research in North West London.
Ratneswaren A, Shah ASV, Thom SA, et al., 2021, Tissue Doppler E prime velocity and E/E prime predict 19-year cardiovascular mortality in hypertension, Publisher: OXFORD UNIV PRESS, Pages: 2336-2336, ISSN: 0195-668X
Ratneswaren A, Hadjiloizou N, Ahmad Y, et al., 2021, Coronary haemodynamics associated with left ventricular hypertrophy in aortic stenosis and hypertension, Publisher: OXFORD UNIV PRESS, Pages: 1728-1728, ISSN: 0195-668X
Al Saikhan L, Park C, Tillin T, et al., 2021, Myocardial strain by 3D-speckle tracking echocardiography predicts long-term risk of cardiovascular morbidity and mortality in the general population: the Southall And Brent Revisited (SABRE) study, Publisher: OXFORD UNIV PRESS, Pages: 67-67, ISSN: 0195-668X
Cook CM, Howard JP, Ahmad Y, et al., 2021, Comparing invasive hemodynamic responses in adenosine hyperemia versus physical exercise stress in chronic coronary syndromes, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 342, Pages: 7-14, ISSN: 0167-5273
Seligman H, Zaman S, Pitcher DS, et al., 2021, Correction: Reusable snorkel masks adapted as particulate respirators, PLoS One, Vol: 16, Pages: 1-1, ISSN: 1932-6203
Ramakrishnan A, Hadjiloizou N, Ahmad Y, et al., 2021, DIFFERENTIAL EFFECTS OF LEFT VENTRICULAR HYPERTROPHY ON CORONARY HAEMODYNAMICS IN AORTIC STENOSIS AND HYPERTENSION, Publisher: BMJ PUBLISHING GROUP, Pages: A1-A2, ISSN: 1355-6037
Ramakrishnan A, Reavette R, Rowland E, et al., 2021, A NOVEL ULTRASOUND BASED METHOD FOR SCREENING FOR HEART FAILURE, Publisher: BMJ PUBLISHING GROUP, Pages: A106-A106, ISSN: 1355-6037
Ramakrishnan A, Shah A, Thom S, et al., 2021, 182 Tissue doppler E’ velocity and E/e’ predict 19-year cardiovascular mortality in hypertension, British Cardiovascular Society Virtual Annual Conference, ‘Cardiology and the Environment’, Publisher: BMJ Publishing Group, Pages: A140-A142, ISSN: 1355-6037
Background We have previously shown that tissue Doppler assessments of left ventricular (LV) diastolic function predict cardiac events in a hypertensive population over a period of 4 years. These out-performed traditional echocardiographic measures in a well-treated hypertensive population.Purpose We aimed to test whether tissue Doppler assessment of LV diastolic function would predict cardiovascular (CV) mortality in the Hypertension Associated Cardiovascular Disease sub-study of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT).Methods ASCOT was a multicentre randomised trial with a 2x2 factorial design. Inclusion criteria for the study included hypertension and three other CV risk factors, including male sex and age over 55. Protocols, including for echocardiography, have been detailed previously.This study comprised the 519 patients recruited to the St Mary’s Hospital site of the ASCOT study, who were followed for a median of 19 years with mortality flagged by the Office for National Statistics. We have used all reported deaths on or before 31st January 2019. CV deaths include deaths due to coronary heart disease (CHD), stroke and other CV causes. Echocardiography was performed one year after blood pressure control. mean tissue Doppler E’ was calculated as the average of septal, lateral and inferior wall measurements over three cycles. The ratio of the transmitral Doppler E wave velocity and the composite mean of E’ was used to calculate E/E’ ratio. Statistical analysis was performed using Python including multivariable Cox proportional hazards regression. A two-sided P-value <0.05 was considered statistically significant.Results After a median of 19 years (±5 years), 317 patients survived (mean age at baseline 60y, 38 female) and 202 did not (mean age 68y, 30 female). Twenty-three deaths were due to CHD, 11 were due to stroke, 27 were due to other CV causes, and 76 were due to cancer. Baseline characteristics were not signi
Levy S, Cole G, Pabari P, et al., 2021, New horizons in cardiogeriatrics: geriatricians and heart failure care-the custard in the tart, not the icing on the cake, AGE AND AGEING, Vol: 50, Pages: 1064-1068, ISSN: 0002-0729
Seligman H, Zaman S, Pitcher DS, et al., 2021, Reusable snorkel masks adapted as particulate respirators, PLoS One, Vol: 16, Pages: 1-11, ISSN: 1932-6203
ntroductionDuring viral pandemics, filtering facepiece (FFP) masks together with eye protection form the essential components of personal protective equipment (PPE) for healthcare workers. There remain concerns regarding insufficient global supply and imperfect protection offered by currently available PPE strategies. A range of full-face snorkel masks were adapted to accept high grade medical respiratory filters using bespoke-designed 3D-printed connectors. We compared the protection offered by the snorkel to that of standard PPE using a placebo-controlled respirator filtering test as well as a fluorescent droplet deposition experiment. Out of the 56 subjects tested, 42 (75%) passed filtering testing with the snorkel mask compared to 31 (55%) with a FFP3 respirator mask (p = 0.003). Amongst the 43 subjects who were not excluded following a placebo control, 85% passed filtering testing with the snorkel versus to 68% with a FFP3 mask (p = 0.008). Following front and lateral spray of fluorescence liquid particles, the snorkel mask also provided superior protection against droplet deposition within the subject’s face, when compared to a standard PPE combination of FFP3 masks and eye protection (3.19x108 versus 6.81x108 fluorescence units, p<0.001). The 3D printable adaptors are available for free download online at https://www.ImperialHackspace.com/COVID-19-Snorkel-Respirator-Project/.ConclusionFull-face snorkel masks adapted as particulate respirators performed better than a standard PPE combination of FFP3 mask and eye protection against aerosol inhalation and droplet deposition. This adaptation is therefore a promising PPE solution for healthcare workers during highly contagious viral outbreaks.
Sweeney M, Cole GD, Pabari P, et al., 2021, Urinary drug metabolite testing in chronic heart failure patients indicates high levels of adherence with life-prolonging therapies, ESC HEART FAILURE, Vol: 8, Pages: 2334-2337, ISSN: 2055-5822
Kotecha T, Knight DS, Razvi Y, et al., 2021, Patterns ofmyocardial injury in recovered troponin-positive COVID-19 patients assessed by cardiovascular magnetic resonance, EUROPEAN HEART JOURNAL, Vol: 42, Pages: 1866-1878, ISSN: 0195-668X
Thompson D, Al-Lamee R, Foley M, et al., 2021, Achieving optimal adherence to medical therapy by telehealth: Findings from the ORBITA medication adherence sub-study, Pharmacology Research and Perspectives, Vol: 9, Pages: e00710-e00710, ISSN: 2052-1707
INTRODUCTION: The ORBITA trial of percutaneous coronary intervention (PCI) versus a placebo procedure for patients with stable angina was conducted across six sites in the United Kingdom via home monitoring and telephone consultations. Patients underwent detailed assessment of medication adherence which allowed us to measure the efficacy of the implementation of the optimization protocol and interpretation of the main trial endpoints. METHODS: Prescribing data were collected throughout the trial. Self-reported adherence was assessed, and urine samples collected at pre-randomization and at follow-up for direct assessment of adherence using high-performance liquid chromatography with tandem mass spectrometry (HPLC MS/MS). RESULTS: Self-reported adherence was >96% for all drugs in both treatment groups at both stages. The percentage of samples in which drug was detected at pre-randomization and at follow-up in the PCI versus placebo groups respectively was: clopidogrel, 96% versus 90% and 98% versus 94%; atorvastatin, 95% versus 92% and 92% versus 91%; perindopril, 95% versus 97% and 85% versus 100%; bisoprolol, 98% versus 99% and 96% versus 97%; amlodipine, 99% versus 99% and 94% versus 96%; nicorandil, 98% versus 96% and 94% versus 92%; ivabradine, 100% versus 100% and 100% versus 100%; and ranolazine, 100% versus 100% and 100% versus 100%. CONCLUSIONS: Adherence levels were high throughout the study when quantified by self-reporting methods and similarly high proportions of drug were detected by urinary assay. The results indicate successful implementation of the optimization protocol delivered by telephone, an approach that could serve as a model for treatment of chronic conditions, particularly as consultations are increasingly conducted online.
Kaura A, Sterne JAC, Trickey A, et al., 2021, Managing NSTEMI in older patients reply, LANCET, Vol: 397, Pages: 371-372, ISSN: 0140-6736
Naderi H, Robinson S, Swaans MJ, et al., 2021, Adapting the role of handheld echocardiography during the COVID-19 pandemic: A practical guide, PERFUSION-UK, Vol: 36, Pages: 547-558, ISSN: 0267-6591
Barakat MF, Chehab O, Kaura A, et al., 2020, Systolic Velocity Is Associated with Lethal Arrhythmias in Cardiac Device Recipients Irrespective of Left Ventricular Ejection Fraction, JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY, Vol: 33, Pages: 1509-1516, ISSN: 0894-7317
Seligman H, Sen S, Nijjer S, et al., 2020, Management of Acute Coronary Syndromes During the Coronavirus Disease 2019 Pandemic: Deviations from Guidelines and Pragmatic Considerations for Patients and Healthcare Workers, Interventional Cardiology Review, Vol: 15, Pages: e16-e16, ISSN: 1756-1477
Coronavirus disease 2019 (COVID-19) is forcing cardiology departments to rapidly adapt existing clinical guidelines to a new reality and this is especially the case for acute coronary syndrome pathways. In this focused review, the authors discuss how COVID-19 is affecting acute cardiology care and propose pragmatic guideline modifications for the diagnosis and management of acute coronary syndrome patients, particularly around the appropriateness of invasive strategies as well as length of hospital stay. The authors also discuss the use of personal protective equipment for healthcare workers in cardiology. Based on shared global experiences and growing peer-reviewed literature, it is possible to put in place modified acute coronary syndrome treatment pathways to offer safe pragmatic decisions to patients and staff.
Al Saikhan L, Alobaida M, Bhuva A, et al., 2020, Imaging Protocol, Feasibility, and Reproducibility of Cardiovascular Phenotyping in a Large Tri-Ethnic Population-Based Study of Older People: The Southall and Brent Revisited (SABRE) Study, FRONTIERS IN CARDIOVASCULAR MEDICINE, Vol: 7, ISSN: 2297-055X
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