Publications
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Cowie MR, 2001, The prognosis of heart failure: the view from the real world, EUROPEAN HEART JOURNAL, Vol: 22, Pages: 1247-1248, ISSN: 0195-668X
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- Citations: 6
Fox KF, Cowie MR, Wood DA, et al., 2001, Coronary artery disease as the cause of incident heart failure in the population, EUROPEAN HEART JOURNAL, Vol: 22, Pages: 228-236, ISSN: 0195-668X
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- Citations: 254
Hardman S, Cowie MR, 2001, Answers to questions 63,64,66,67,68,69,70, 71,72, Pages: 133-152, ISBN: 9780727914897
Hogg D, Croal B, Culligan D, et al., 2000, Brain natriuretic peptide and cardiac troponin i as markers of doxorubicin cardiotoxicity, Blood, Vol: 96, ISSN: 0006-4971
Introduction. Cardiac troponin (cTnl) is sensitive and specific marker of myocardial damage. Brain natriuretic peptide (BNP) is a sensitive marker of early left ventricular (LV) systolic dysfunction. Doxorubicin cardiotoxicity can result in asymptomatic myocardial damage, but can progress to LV systolic dysfunction of sufficient severity to produce congestive cardiac failure. Objective. To evaluate the change in serum concentration of cTnl and plasma concentrations of BNP in patients receiving doxorubicin. Methods. 27 patients with newly diagnosed non-Hodgkins lymphoma who were to receive standard CHOP chemotherapy, with a total of 300mg/m2 of doxorubicin, were recruited. Samples were taken before and 24 hours after (20 patients) and before only (7 patients) each doxorubin dose. Eighteen patients completed chemotherapy. Echocardiographic assessment of LV systolic contraction by LV fractional shortening (LVFS) was performed prior to after completion of chemotherapy. Results. In 76 paired samples plasma concentrations of BNP showed a significant elevation after each doxorubicin dose (median pre- & post- 50.0 vs 56.3pg/ml, p<0.001). However, there was no significant change in plasma concentration of BNP before each dose from baseline to study completion. In one patient the baseline cTnl was elevated at 0.2Ing/ ml (normal <0. Ing/ml) and there was no significant change after the first doxorubicin dose. All other patients had undetectable cTnl. There was no clinically significant change in LVFS in those who completed chemotherapy (median pre- & post- LVFS 40% vs 39%, p=0.06). Conclusions. CHOP chemotherapy increases the plasma concentration of BNP within 24 hours of administration. Serum concentrations of cTnl did not change. It is unclear whether the rise in BNP is due to fluid loading during dosing or the effects of doxorubicin myocardial toxicity and further study is required.
Fox KF, Cowie MR, Wood DA, et al., 2000, A Rapid Access Heart Failure Clinic provides a prompt diagnosis and appropriate management of new heart failure presenting in the community, EUROPEAN JOURNAL OF HEART FAILURE, Vol: 2, Pages: 423-429, ISSN: 1388-9842
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- Citations: 39
Hogg D, Croal B, Culligan D, et al., 2000, Brain natriuretic peptide and cardiac troponin I as markers of doxorubicin cardiotoxicity., Publisher: AMER SOC HEMATOLOGY, Pages: 239B-239B, ISSN: 0006-4971
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- Citations: 1
Cowie MR, 2000, Statins: where are we now?, HOSPITAL MEDICINE, Vol: 61, Pages: 789-792, ISSN: 1462-3935
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- Citations: 1
Cowie MR, Fox KF, Wood DA, et al., 2000, N-terminal pro-BNP predicts prognosis in patients presenting with heart failure for the first time better than does N-terminal pro-ANP or BNP, CIRCULATION, Vol: 102, Pages: 781-781, ISSN: 0009-7322
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- Citations: 2
Dean JC, Watson J, Jennings K, et al., 2000, Progressive heart block linked to SCN5A, and long QT syndrome with bradycardia linked to HERG: ion channel disorders with bradycardia in two Scottish families., Publisher: UNIV CHICAGO PRESS, Pages: 114-114, ISSN: 0002-9297
Cowie MR, 2000, BNP: soon to become a routine measure in the care of patients with heart failure?, HEART, Vol: 83, Pages: 617-618, ISSN: 1355-6037
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- Citations: 26
Buckley A, Hogg D, Al-Mohammad A, et al., 2000, N-terminal pro-BNP in patients undergoing DC cardioversion: Biochemical evidence of a ventricular cardiomyopathy associated with atrial fibrillation?, Heart, Vol: 83, ISSN: 1355-6037
Background: The plasma concentration of B-type natriuretic peptide is raised in patients with left ventricular dysfunction. It has been suggested that patients with atrial fibrillation (AF) may develop a ventricular cardiomyopathy which may be reversible with the return of sinus rhythm (SR). Objectives of study: To determine the effect of the return of SR on plasma NT-pro-BNP concentrations in patients undergoing DC cardioversion for chronic AF. Patients and methods: Blood samples were drawn immediately prior to and 4 hours, 10 days and 6 weeks after successful DC cardioversion in 50 consecutive patients. An ECG was recorded at each of these time points. Results: the plasma NT-pro-BNP level dropped from a median of 132pmol/l [IQR 74-232] prior to cardioversion to 117 pmol/1 [IQR 69-230] 4 hours later (p<0.001). For those patients remaining in SR at 10 days (N=26) the concentration dropped further to 88 pmol/l [IQR 332-186]. At 6 weeks the level dropped further to 66pmol/l [IQR 24-203] in the 23 patients remaining in SR. For those that relapsed to AF the plasma concentration rapidly returned to that found prior to cardioversion: for the 21 relapsing to AF at 10 days (for whom full data was available) the average concentration rose again to 196pmol/l [IQR 108-312] (p=0.002 compared with levels in these patients 4 hours post cardioversion). Conclusions: return to SR leads to a rapid and sustained reduction in the plasma concentration of NT-pro-BNP in patients with chronic AF. With relapse of AF the plasma concentration rapidly reurns to, or exceeds the pre-cardioversion levels. This provides biochemical evidence that AF may have a deleterious effect on ventricular functioning which may be rapidly reversible on return to SR.
Fox KF, Cowie MR, Wood DA, et al., 2000, Heart failure with normal systolic function: A population based study, Heart, Vol: 83, ISSN: 1355-6037
Most cases of heart failure (HF) are due to abnormal left ventricular (LV) systolic function. If systolic function is normal (NSF), the cause of HF may be due to diastolic dysfunction. We reviewed cases in a population based study of HF to identify those with NSF. All incident cases of HF in a large district of SE London (population 292,000) were identified by surveillance of hospital admissions and through a Rapid Access Heart Failure Clinic to which GPs referred all suspected new cases of HF. The definition of HF, based on the European Society of Cardiology guidelines, was that a case should have symptoms consistent with HF, signs of fluid retention (pulmonary or peripheral oedema), a cardiac abnormality, and wherever possible or in cases of doubt, a response to therapy for HF. Cases were assessed with history, examination, ECG, CXR and echocardiogram (TTE) before presentation to a panel of 3 cardiologists (DAW, AJC, GCS) to determine if a case fulfilled the definition of HF. Over 15 months 332 incident cases of HF were identified with 196 cases (59%) 75 years (population incidence 0.9 cases/1000 population/year). We used the criteria of a non-dilated LV (LVEDD < 5.6cm), a fractional shortening (FS) ≥ 25% or normal LV systolic function on visual assessment, and no valve abnormality to identify cases of HF with NSF. TTE data was missing on 21 non-valvular cases. Of the 311 remaining cases 53 / 311 (17%) were HF with NSF. 18 /131 (14%) were aged < 75 years and 35 /180 (19%) aged ≥ 75 years. 20 / 53 (38%) of these cases were in AF (compared with 34% of all HF cases) where interpretation of diastolic function is more difficult. 22 / 53 (42%) had a septal thickness >1.1cm (found in 34% of all cases). 26 / 53 (49%) were NYHA 4 (75% of all HF cases were in NYHA 4). These proportions are dependent on the definition of NSF. Using a cut off of a LVEDD < 6.0 and a FS ≥ 20% would increase the number of cases of HF with NSF to 84 / 311 (27%). The proportio
Cowie MR, Wood DA, Coats AJS, et al., 2000, Survival of patients with a new diagnosis of heart failure: a population based study, HEART, Vol: 83, Pages: 505-510, ISSN: 1355-6037
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- Citations: 392
Cowie MR, Fox KF, Wood DA, et al., 1999, Hospitalisations and deaths in a population-based cohort of incident (new) cases of heart failure, Heart, Vol: 81, ISSN: 1355-6037
Background: The number of hospital admissions due to heart failure has been rising steadily in many developed countries, including the UK. The factors predictive of hospitalisation on a population basis are not known. Methods: All incident (new) cases of heart failure arising in a population of 292 000 in Bromley HA, South London were identified by in-patient monitoring and from a rapid-access heart failure clinic over a period of 15 months. Cases were followed up for death and hospitalisation. Results: 332 cases of heart failure were identified (178M: 154F; median age 77 years). 211 (64%) were identified from acute admission to the hospitals serving the population and 121 (36%) from the rapid-access clinic. During the follow-up period (median 14 months) there were 78 deaths (86% due to cardiovascular disease). Survival was 87% at 1month, 81% at 6 months and 80% at 12 months. During the follow-up period there were 209 hospitalisations in 127 (38%) of the 332 patients. 78 patients had 1 subsequent hospitalisation and 49 had 2 or more hospitalisations (maximum of 5). 93 of the 209 admissions (44%) were related to the worsening of heart failure. The average duration of a hospital admission was 5 days (range 1 to 84 days). In those that survived the first 4 weeks after diagnosis, the factors independently predictive of subsequent hospitalisation for worsening of heart failure or cardiovascular death were: previous history of vascular disease (angina/hypertension/stroke/previous CABG) [p=0.001]; serum sodium [p=0.02]; first presentation as inpatient rather than outpatient [p=0.04]; and age [p=0.07]. Conclusions: Patients with a new diagnosis of heart failure have a high rate of subsequent hospitalisation with almost half of the admissions being related to the worsening of heart failure. A subgroup of patients can be identified at especially high risk of death or hospitalisation. Interventions designed to reduce hospitalisation should be targeted at this group.
Cowie MR, 1999, Annotated references in epidemiology, EUROPEAN JOURNAL OF HEART FAILURE, Vol: 1, Pages: 101-107, ISSN: 1388-9842
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- Citations: 24
Cowie MR, Wood DA, Coats AJS, et al., 1999, Incidence and aetiology of heart failure - A population-based study, EUROPEAN HEART JOURNAL, Vol: 20, Pages: 421-428, ISSN: 0195-668X
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- Citations: 517
Fox KF, Cowie MR, Wood DA, et al., 1999, New perspectives on heart failure due to myocardial ischaemia, EUROPEAN HEART JOURNAL, Vol: 20, Pages: 256-262, ISSN: 0195-668X
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- Citations: 9
Hardman SM, Cowie MR, 1999, Fortnightly review: anticoagulation in heart disease., BMJ, Vol: 318, Pages: 238-244, ISSN: 0959-8138
Hardman SMC, Cowie MR, 1999, Anticoagulation in heart disease, BMJ-BRITISH MEDICAL JOURNAL, Vol: 318, Pages: 238-244, ISSN: 1756-1833
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- Citations: 16
Cowie MR, 1999, Coronary artery disease: new epidemiological insights, JOURNAL OF THE ROYAL COLLEGE OF PHYSICIANS OF LONDON, Vol: 33, Pages: 8-12, ISSN: 0035-8819
George DSA, McDonald R, Cowie M, 1998, Reactivity of the heterobinuclear phenylacetylide-bridged A-frame [RhIr(CO)<sub>2</sub>(μ-CCPh)(Ph<sub>2</sub>PCH<sub>2</sub>PPh<sub>2</sub>)<sub>2</sub>][O<sub>3</sub>SCF<sub>3</sub>] with small molecules, ORGANOMETALLICS, Vol: 17, Pages: 2553-2566, ISSN: 0276-7333
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- Citations: 33
Cowie MR, 1998, Untitled, HOSPITAL MEDICINE, Vol: 59, Pages: 334-334, ISSN: 1462-3935
Cowie MR, 1998, Assessment of heart failure with plasma natriuretic peptides - Reply, LANCET, Vol: 351, Pages: 445-445, ISSN: 0140-6736
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- Citations: 1
Toft J, 1998, Assessment of heart failure with plasma natriuretic peptides., Lancet, Vol: 351, ISSN: 0140-6736
Griffiths H, Cowie MR, Roberts R, et al., 1998, Incidence and outcome of patients presenting with coronary artery disease for the first time - A population-based study, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol: 31, Pages: 309A-309A, ISSN: 0735-1097
Cowie MR, Suresh V, Wood DA, et al., 1998, Prognosis of heart failure - A population-based study of the outcome in incident cases, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol: 31, Pages: 218A-218A, ISSN: 0735-1097
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- Citations: 7
Cowie MR, Struthers AD, Wood DA, et al., 1997, Value of natriuretic peptides in assessment of patients with possible new heart failure in primary care, LANCET, Vol: 350, Pages: 1349-1353, ISSN: 0140-6736
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- Citations: 634
Cowie MR, 1997, Alcohol and the heart, BRITISH JOURNAL OF HOSPITAL MEDICINE, Vol: 57, Pages: 457-460, ISSN: 0007-1064
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- Citations: 4
Cowie MR, Wood DA, Coats A, et al., 1997, Incidence and aetiology of heart failure in the general population, Heart, Vol: 77, ISSN: 1355-6037
The contemporary incidence of heart failure in the UK is not known. A prospective survey of incident cases of heart failure presenting to 81 general practitioners and a district general hospital serving a population of 151 000 was conducted over 15 months. Cases were identified from hospital admissions and through a daily rapid access heart failure clinic to which GP's referred all new cases of suspected heart failure. Following a standardised interview, physical examination, ECG, CXR and echocardiogram all cases were reviewed by a panel of 3 cardiologists who determined whether the clinical case definition of heart failure was met and the aetiology. 171 incident cases of heart failure were identified (94M:77F) with no case aged under 35 years. Thirty five cases (20%) were identified from 122 referrals to the clinic, the remainder being acute hospital admissions. The incidence increased dramatically with age from 0.2 per 1000 population per annum in those aged 35-44 years to 11.6 in those aged 85 years or over and was higher in males than females (comparative incidence ratio 1.9 [95% CI 1.5-2.4] p<0.0001). The median age at presentation was 76 years. Aetiologies were ischaemic heart disease (36%), hypertension (15%), valve disease (6%), other (7%) but in 36% of cases the aetiology was unknown. Randomised controlled trials of heart failure are conducted in highly selected hospital cases with a strong bias towards younger patients and those with coronary artery disease as the aetiology. However, in the general population new cases of heart failure largely arise in the elderly and in over a third of cases the aetiology cannot be determined from non-invasive investigation. These findings have important implications for the investigation and management of new cases of heart failure in the general population.
Cowie MR, Struthers AD, Wood DA, et al., 1997, The predictive value of natriuretic peptide estimation for detecting new heart failure in general practice, Heart, Vol: 77, ISSN: 1355-6037
The validity of a clinical diagnosis of heart failure in general practice is known to be poor, leading to inappropriate treatment in as many as two thirds of such patients. However, confirming the diagnosis is time consuming requiring further clinical assessment by a specialist and investigation including echocardiography. Since elevation of plasma atrial (ANP and NT-ANP) and brain natriuretic peptides (BNP) occur in patients with heart failure we assessed the utility of measuring these peptides in 122 consecutive patients referred to a rapid access heart failure clinic with a new primary care diagnosis of heart failure. On the basis of clinical examination, chest x-ray and echocardiography a panel of 3 cardiologists confirmed that 35 of the 122 (29%) referred patients had new heart failure. The median level of ANP, BNP & NT-ANP (pmol/l) were much higher in those in heart failure compared with those not in heart failure (30.6 vs 13.0, 60.8 vs 11.9, 1271.3 vs 417.0 respectively, all p<0.00005). The Table displays the sensitivity, specificity and positive predictive value of the three peptides for cut-off levels where the negative predictive value was 98%: BNP ANP NT-ANP ≥22.22 pmol/l ≥18.06 pmol/l ≥537.56 pmol/l sensitivity (%) 97 97 97 specificity (%) 84 72 66 positive pred. value (%) 70 55 54 negative pred. value (%) 98 98 98 A multiple logistic regression model was used to determine the independent contribution of natriuretic peptides in detecting the presence of heart failure and there was no significant improvement in fit by adding either ANP (p=0.18) or NT-ANP (p=0.55) to a model containing BNP only. A plasma BNP level in patients with symptoms which are thought to be due to heart failure by a general practitioner may be a very useful (and relatively inexpensive) screening test for selecting patients who require assessment by a cardiologist.
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