Imperial College London

Dr Ranil De Silva

Faculty of MedicineNational Heart & Lung Institute

Clinical Senior Lecturer
 
 
 
//

Contact

 

+44 (0)20 7351 8626r.desilva Website

 
 
//

Assistant

 

Ms Deborah Curcher +44 (0)20 7351 8626

 
//

Location

 

Chelsea WingSydney StreetRoyal Brompton Campus

//

Summary

 

Publications

Publication Type
Year
to

143 results found

Scott A, Jackson T, Khalique Z, Gorodezky M, Pardoe B, Begum L, Bruno VD, Chowdhury R, Ferreira P, Nielles-Vallespin S, Roehl M, McCarthy K, Sarathchandra P, Rose J, Doorly D, Pennell D, Ascione R, De Silva PER, Firmin Det al., 2022, Development of a CMR compatible large animal isolated heart model for direct comparison of beating and arrested hearts, NMR in Biomedicine, ISSN: 0952-3480

BackgroundCardiac motion results in image artefacts and quantification errors in many cardiovascular magnetic resonance (CMR) techniques, including microstructural assessment using diffusion tensor cardiovascular magnetic resonance (DT-CMR). Here we develop a CMR compatible isolated perfused porcine heart model that allows comparison of data obtained in beating and arrested states.Methods10 porcine hearts (8/10 for protocol optimisation) were harvested using a donor heart retrieval protocol and transported to the remote CMR facility. Langendorff perfusion in a 3D printed chamber and perfusion circuit re-established contraction. Hearts were imaged using cine, parametric mapping and STEAM DT-CMR at cardiac phases with the minimum and maximum wall thickness. High potassium and lithium perfusates were then used to arrest the heart in a slack and contracted state respectively. Imaging was repeated in both arrested states. After imaging, tissue was removed for subsequent histology in a location matched to the DT-CMR data using fiducial markers.ResultsRegular sustained contraction was successfully established in 6/10 hearts, including the final 5 hearts. Imaging was performed in 4 hearts and one underwent the full protocol including co-localised histology. Image quality was good and there was good agreement between DT-CMR data in equivalent beating and arrested states. Despite the use of autologous blood and dextran within the perfusate, T2, DT-CMR measures and an increase in mass was consistent with development of myocardial edema resulting in failure to achieve a true diastolic-like state. A contiguous stack of 313 5μm histological sections at and a 100μm thick section showing cell morphology on 3D fluorescent confocal microscopy co-localised to DT-CMR data were obtained.ConclusionsA CMR compatible isolated perfused beating heart setup for large animal hearts allows direct comparisons of beating and arrested heart data with subsequent co-localised histology without

Journal article

Ono M, Tomaniak M, Koenig W, Khamis R, de Silva R, Chichareon P, Kawashima H, Hara H, Gao C, Wang R, Huber K, Vrolix M, Jasionowicz P, Wykrzykowska JJ, Piek JJ, Juni P, Hamm C, Steg PG, Windecker S, Onuma Y, Storey RF, Serruys PWet al., 2022, Impact of white blood cell count on clinical outcomes in patients treated with aspirin-free ticagrelor monotherapy after percutaneous coronary intervention: insights from the GLOBAL LEADERS trial, EUROPEAN HEART JOURNAL-CARDIOVASCULAR PHARMACOTHERAPY, Vol: 8, Pages: 39-47, ISSN: 2055-6837

Journal article

Naser J, Fogell N, Patel M, Yang P, Krams R, Wentzel JJ, Aben JP, De Silva Ret al., 2021, Moving shear stress towards the clinic: preclinical comparison of optical coherence tomography-based versus angiography-based time-averaged wall shear stress estimations, Publisher: OXFORD UNIV PRESS, Pages: 1195-1195, ISSN: 0195-668X

Conference paper

de Silva R, Cheng K, 2021, Microvascular angina: quo tendimus?, EUROPEAN HEART JOURNAL, Vol: 42, Pages: 4601-4604, ISSN: 0195-668X

Journal article

Patel M, Savvopoulos F, Berggren CC, Aslanidou L, Timmins LH, de Silva R, Pedrigi RM, Krams Ret al., 2021, Considerations for analysis of endothelial shear stress and strain in FSI models of atherosclerosis, JOURNAL OF BIOMECHANICS, Vol: 128, ISSN: 0021-9290

Journal article

Ponticelli F, Khokhar AA, Leenders G, Konigstein M, Zivelonghi C, Agostoni P, van Kuijk J-P, Ajmi I, Lindsay S, Bunc M, Tebaldi M, Cafaro A, Cheng K, Ielasi A, Patterson T, Wolter JS, Sgura F, De Marco F, Ioanes D, D'Amico G, Ciardetti M, Berti S, Guarracini S, Di Mauro M, Gallone G, Dekker M, Silvis MJM, Tarantini G, Redwood S, Colombo A, Liebetrau C, de Silva R, Rapezzi C, Ferrari R, Campo G, Schnupp S, Timmers L, Verheye S, Stella P, Banai S, Giannini Fet al., 2021, Safety and efficacy of coronary sinus narrowing in chronic refractory angina: Insights from the RESOURCE study, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 337, Pages: 29-37, ISSN: 0167-5273

Journal article

Naser J, Mein CA, Wozniak E, Carassiti D, Mahomed AS, Krams R, de Silva Ret al., 2021, PROFILING ENDOTHELIAL GENE EXPRESSION IN CORONARY ATHEROSCLEROTIC PLAQUES IN A HUMAN-LIKE D374Y-PCSK9 HYPERLIPIDAEMIC PORCINE MODEL, Publisher: BMJ PUBLISHING GROUP, Pages: A166-A167, ISSN: 1355-6037

Conference paper

de Silva R, Cheng K, 2021, Reducing refractory angina., EuroIntervention, Vol: 16, Pages: e1466-e1467, ISSN: 1774-024X

Journal article

Cheng K, Alhumood K, El Shaer F, De Silva Ret al., 2021, The role of nicorandil in the management of chronic coronary syndromes in the Gulf Region, Advances in Therapy, Vol: 38, Pages: 925-948, ISSN: 0741-238X

Chronic coronary syndromes (CCS) and stable angina are a growing clinical burden worldwide. This is of particular concern in the Gulf region given its high prevalence of cardiovascular risk factors, especially diabetes mellitus and smoking. Despite recommendations on the use of first- and second-line anti-anginal medication, management challenges remain. Current guidelines for pharmacologic treatment are not determined by the range of pathophysiological mechanisms of ischaemia and consequent angina, which may occur either in isolation or co-exist. In this article, we highlight the need to improve knowledge of the epidemiology of chronic coronary syndromes in the Middle East and Gulf region, and the need for studies of stratified pharmacologic approaches to improve symptomatic angina and quality of life in the large and growing number of patients with coronary artery disease from this region. We discuss the role of nicorandil, currently recommended as a second-line anti-anginal drug in CCS patients, and suggest that this may be a particularly useful add-on therapy for patients in the Gulf region.

Journal article

Cheng K, de Silva R, 2021, TCT Connect 2020 Trial Update: FORECAST, COMBINE OCT-FFR and DEFINE-PCI, EUROPEAN CARDIOLOGY REVIEW, Vol: 16, ISSN: 1758-3756

Journal article

Fair MJ, Gatehouse PD, Reyes E, Adluru G, Mendes J, Khan T, de Silva R, Wage R, DiBella EVR, Firmin DNet al., 2020, Initial investigation of free-breathing 3D whole-heart stress myocardial perfusion MRI., Glob Cardiol Sci Pract, Vol: 2020, ISSN: 2305-7823

Objective: Myocardial first-pass perfusion imaging with MRI is well-established clinically. However, it is potentially weakened by limited myocardial coverage compared to nuclear medicine. Clinical evaluations of whole-heart MRI perfusion by 3D methods, while promising, have to date had the limit of breathhold requirements at stress. This work aims to develop a new free-breathing 3D myocardial perfusion method, and to test its performance in a small patient population. Methods: This work required tolerance to respiratory motion for stress investigations, and therefore employed a "stack-of-stars" hybrid Cartesian-radial MRI acquisition method. The MRI sequence was highly optimised for rapid acquisition and combined with a compressed sensing reconstruction. Stress and rest datasets were acquired in four healthy volunteers, and in six patients with coronary artery disease (CAD), which were compared against clinical reference information. Results: This free-breathing method produced datasets that appeared consistent with clinical reference data in detecting moderate-to-strong induced perfusion abnormalities. However, the majority of the mild defects identified clinically were not detected by the method, potentially due to the presence of transient myocardial artefacts present in the images. Discussion: The feasibility of detecting CAD using this 3D first-pass perfusion sequence during free-breathing is demonstrated. Good agreement on typical moderate-to-strong CAD cases is promising, however, questions still remain on the sensitivity of the technique to milder cases.

Journal article

Rajakulasingam R, Nielles-Vallespin S, Ferreira PF, Scott AD, Khalique Z, Rogers P, Barnes G, Tindale A, Prendergast C, Cantor E, Wage R, Dalby M, Firmin DN, Pennell DJ, De Silva Ret al., 2020, Diffusion tensor cardiovascular magnetic resonance detects altered myocardial microstructure in patients with acute st-elevation myocardial infarction, European-Society-of-Cardiology (ESC) Congress, Publisher: OXFORD UNIV PRESS, Pages: 208-208, ISSN: 0195-668X

Conference paper

Nielles-Vallespin S, Ferreira PF, Scott A, Rajakulasingam R, Sehmi J, Gorodezky M, Kellman P, Xue H, Pennell DJ, Firmin DN, Arai AE, De Silva Ret al., 2020, Diffusion tensor cardiovascular magnetic resonance predicts adverse remodelling after myocardial infarction, European-Society-of-Cardiology (ESC) Congress, Publisher: OXFORD UNIV PRESS, Pages: 216-216, ISSN: 0195-668X

Conference paper

Tomaniak M, Katagiri Y, Modolo R, Silva RD, Khamis RY, Bourantas CV, Torii R, Wentzel JJ, Gijsen FJH, van Soest G, Stone PH, West NEJ, Maehara A, Lerman A, van der Steen AFW, Lüscher TF, Virmani R, Koenig W, Stone GW, Muller JE, Wijns W, Serruys PW, Onuma Yet al., 2020, Vulnerable plaques and patients: state-of-the-art, European Heart Journal, Vol: 41, Pages: 2997-3004, ISSN: 0195-668X

Despite advanced understanding of the biology of atherosclerosis, coronary heart disease remains the leading cause of death worldwide. Progress has been challenging as half of the individuals who suffer sudden cardiac death do not experience premonitory symptoms. Furthermore, it is well-recognized that also a plaque that does not cause a haemodynamically significant stenosis can trigger a sudden cardiac event, yet the majority of ruptured or eroded plaques remain clinically silent. In the past 30 years since the term 'vulnerable plaque' was introduced, there have been major advances in the understanding of plaque pathogenesis and pathophysiology, shifting from pursuing features of 'vulnerability' of a specific lesion to the more comprehensive goal of identifying patient 'cardiovascular vulnerability'. It has been also recognized that aside a thin-capped, lipid-rich plaque associated with plaque rupture, acute coronary syndromes (ACS) are also caused by plaque erosion underlying between 25% and 60% of ACS nowadays, by calcified nodule or by functional coronary alterations. While there have been advances in preventive strategies and in pharmacotherapy, with improved agents to reduce cholesterol, thrombosis, and inflammation, events continue to occur in patients receiving optimal medical treatment. Although at present the positive predictive value of imaging precursors of the culprit plaques remains too low for clinical relevance, improving coronary plaque imaging may be instrumental in guiding pharmacotherapy intensity and could facilitate optimal allocation of novel, more aggressive, and costly treatment strategies. Recent technical and diagnostic advances justify continuation of interdisciplinary research efforts to improve cardiovascular prognosis by both systemic and 'local' diagnostics and therapies. The present state-of-the-art document aims to present and critically appraise the latest evidence, developments, and future perspectives in detection, prevent

Journal article

Rathod KS, Beirne A-M, Bogle R, Firoozi S, Lim P, Hill J, Dalby MC, Jain AK, Malik IS, Mathur A, Kalra SS, DeSilva R, Redwood S, MacCarthy PA, Wragg A, Smith EJ, Jones DAet al., 2020, Prior Coronary Artery Bypass Graft Surgery and Outcome After Percutaneous Coronary Intervention: An Observational Study From the Pan-London Percutaneous Coronary Intervention Registry, JOURNAL OF THE AMERICAN HEART ASSOCIATION, Vol: 9

Journal article

Jones DA, Rathod KS, Koganti S, Lim P, Firoozi S, Bogle R, Jain AK, MacCarthy PA, Dalby MC, Malik IS, Mathur A, DeSilva R, Rakhit R, Kalra SS, Redwood S, Ludman P, Wragg Aet al., 2019, The association between the public reporting of individual operator outcomes with patient profiles, procedural management, and mortality after percutaneous coronary intervention: an observational study from the Pan-London PCI (BCIS) Registry using an interrupted time series analysis, EUROPEAN HEART JOURNAL, Vol: 40, Pages: 2620-2629, ISSN: 0195-668X

Journal article

Khan TZ, de Silva R, 2018, Is there a role for invasive assessment of the coronary microcirculation in patients with unobstructed epicardial coronary arteries in clinical practice?, International Journal of Cardiology, Vol: 267, Pages: 46-47, ISSN: 0167-5273

Journal article

Jones DA, Rathod KS, Koganti S, Hamshere S, Astroulakis Z, Lim P, Sirker A, O'Mahony C, Jain AK, Knight CJ, Dalby MC, Malik IS, Mathur A, Rakhit R, Lockie T, Redwood S, MacCarthy PA, Desilva R, Weerackody R, Wragg A, Smith EJ, Bourantas CVet al., 2018, Angiography alone versus angiography plus optical coherence tomography to guide percutaneous coronary intervention: outcomes from the pan-London PCI cohort, JACC: Cardiovascular Interventions, Vol: 11, Pages: 1313-1321, ISSN: 1936-8798

OBJECTIVES: This study aimed to determine the effect on long-term survival of using optical coherence tomography (OCT) during percutaneous coronary intervention (PCI). BACKGROUND: Angiographic guidance for PCI has substantial limitations. The superior spatial resolution of OCT could translate into meaningful clinical benefits, although limited data exist to date about their effect on clinical endpoints. METHODS: This was a cohort study based on the Pan-London (United Kingdom) PCI registry, which includes 123,764 patients who underwent PCI in National Health Service hospitals in London between 2005 and 2015. Patients undergoing primary PCI or pressure wire use were excluded leaving 87,166 patients in the study. The primary endpoint was all-cause mortality at a median of 4.8 years. RESULTS: OCT was used in 1,149 (1.3%) patients, intravascular ultrasound (IVUS) was used in 10,971 (12.6%) patients, and angiography alone in the remaining 75,046 patients. Overall OCT rates increased over time (p < 0.0001), with variation in rates between centers (p = 0.002). The mean stent length was shortest in the angiography-guided group, longer in the IVUS-guided group, and longest in the OCT-guided group. OCT-guided procedures were associated with greater procedural success rates and reduced in-hospital MACE rates. A significant difference in mortality was observed between patients who underwent OCT-guided PCI (7.7%) compared with patients who underwent either IVUS-guided (12.2%) or angiography-guided (15.7%; p < 0.0001) PCI, with differences seen for both elective (p < 0.0001) and acute coronary syndrome subgroups (p = 0.0024). Overall this difference persisted after multivariate Cox analysis (hazard ratio [HR]: 0.48; 95% confidence interval [CI]: 0.26 to 0.81; p = 0.001) and propensity matching (hazard ratio: 0.39; 95% CI: 0.21 to 0.77; p = 0.0008; OCT vs. angiography-alone cohort), with no difference in matched OCT and IVUS cohorts

Journal article

Jones DA, Rathod KS, Pavlidis AN, Gallagher SM, Astroulakis Z, Lim P, Sirker A, Knight CJ, Dalby MC, Malik IS, Mathur A, Rakhit R, Redwood S, MacCarthy PA, Baker C, Desilva R, Di Mario C, Weerackody R, Hill J, Wragg A, Smith EJet al., 2018, Outcomes after chronic total occlusion percutaneous coronary interventions: an observational study of 5496 patients from the Pan-London CTO Cohort., Coron Artery Dis

BACKGROUND: Chronic total occlusions (CTO) are commonly encountered in patients undergoing coronary angiography; however, percutaneous coronary intervention (PCI) is infrequently performed owing to technical difficulty, the perceived risk of complications and a lack of randomized data. The aim of this study was to analyse the frequency and outcomes of CTO-PCI procedures in a large contemporary cohort of successive patients. PATIENTS AND METHODS: We undertook an observational cohort study of 48 234 patients with stable angina of which 5496 (11.4%) procedures were performed for CTOs between 2005 and 2015 at nine tertiary cardiac centres across London, UK. Outcome was assessed by in-hospital major adverse cardiac events and all-cause mortality at a median follow-up of 4.8 years (interquartile range: 2.2-6.4 years). RESULTS: Over time, there was an increase in the proportion of elective PCI procedures performed for CTOs, but no increase in the absolute number. Overall success rates increased over time (74.3% in 2005 to 81.5% in 2015; P=0.0003) despite an increase in case complexity (previous myocardial infarction, diabetes, renal failure, previous coronary artery bypass grafting, peripheral vascular disease and left ventricular impairment) that correlated with procedural advancements. Successful CTO PCI was associated with lower mortality [9.5%, 95% confidence interval (CI): 8.1-11.6 vs. 15.3%, 95% CI: 13.7-20.6, P<0.0001] that persisted after multivariate cox analysis (hazard ratio: 0.37, 95% CI: 0.25-0.62) and propensity matching (hazard ratio=0.36, 95% CI: 0.18-0.73, P=0.0005). CONCLUSION: Successful procedures were associated with lower mortality suggesting that the greater uptake of CTO PCI may improve clinical outcomes in a wider population than are currently being offered therapy.

Journal article

Cheng K, de Silva R, 2018, New Advances in the Management of Refractory Angina Pectoris, EUROPEAN CARDIOLOGY REVIEW, Vol: 13, Pages: 70-79, ISSN: 1758-3756

Journal article

Poulsen CB, Pedrigi RM, Pareek N, Kilic ID, Holm NR, Bentzon JF, Bøtker HE, Falk E, Krams R, de Silva Ret al., 2018, Plaque burden influences accurate classification of fibrous cap atheroma by in-vivo optical coherence tomography in a porcine model of advanced coronary atherosclerosis, EuroIntervention, ISSN: 1774-024X

AIMS: In-vivo validation of coronary optical coherence tomography (OCT) against histology and the effects of plaque burden (PB) on plaque classification remain unreported. We investigated this in a porcine model with human-like coronary atherosclerosis. METHODS AND RESULTS: Five female Yucatan D374Y-PCSK9 transgenic hypercholesterolemic mini-pigs were implanted with a coronary shear-modifying stent to induce advanced atherosclerosis. OCT frames (n=201) were obtained 34 weeks after implantation. Coronary arteries were perfusion-fixed, serially sectioned and co-registered with OCT using a validated algorithm. Lesions were adjudicated using the Virmani classification and PB assessed from histology. OCT had a high sensitivity, but modest specificity (92.9% and 74.6%), for identifying fibrous cap atheroma (FCA). The reduced specificity for OCT was due to misclassification of plaques with histologically defined pathological intimal thickening (PIT) as FCA (46.1% of the frames with histological PIT were misclassified). PIT lesions misclassified as FCA by OCT had a statistically higher PB than in other OCT frames (median 32.0% versus 13.4%; p<0.0001). Misclassification of PIT lesions by OCT occurred when PB exceeded approximately 20%. CONCLUSIONS: Compared with histology, in-vivo OCT classification of FCA had high sensitivity but reduced specificity due to misclassification of PITs with high PB.

Journal article

Pareek N, Kosovitsas A, Rubens M, de Silva Ret al., 2018, Double Trouble: Two Types of Stent Fracture in a Drug-Eluting Stent Secondary to Traction From a Saphenous Vein Graft, JACC-CARDIOVASCULAR INTERVENTIONS, Vol: 11, Pages: 316-318, ISSN: 1936-8798

Journal article

Sainsbury PA, Fisher M, de Silva R, 2017, Alternative interventions for refractory angina, HEART, Vol: 103, Pages: 1911-+, ISSN: 1355-6037

Journal article

de Silva R, Steg PG, 2017, Identifying patients with acute total coronary occlusion in NSTEACS: finding the high-risk needle in the haystack, EUROPEAN HEART JOURNAL, Vol: 38, Pages: 3090-3093, ISSN: 0195-668X

Journal article

Cheng K, Wright C, De Silva R, 2017, The effect of a multi-disciplinary care pathway for refractory angina on psychological outcomes, quality of life and medication use, Publisher: OXFORD UNIV PRESS, Pages: 450-450, ISSN: 0195-668X

Conference paper

Ferreira PF, Nielles-Vallespin S, Scott AD, Silva RD, Kilner PJ, Ennis DB, Auger DA, Suever JD, Zhong X, Spottiswoode BS, Pennell DJ, Arai AE, Firmin DNet al., 2017, Evaluation of the impact of strain correction on the orientation of cardiac diffusion tensors with in vivo and ex vivo porcine hearts, Magnetic Resonance in Medicine, Vol: 79, Pages: 2205-2215, ISSN: 0740-3194

PurposeTo evaluate the importance of strain-correcting stimulated echo acquisition mode echo-planar imaging cardiac diffusion tensor imaging.MethodsHealthy pigs (n = 11) were successfully scanned with a 3D cine displacement-encoded imaging with stimulated echoes and a monopolar-stimulated echo-planar imaging diffusion tensor imaging sequence at 3 T during diastasis, peak systole, and strain sweet spots in a midventricular short-axis slice. The same diffusion tensor imaging sequence was repeated ex vivo after arresting the hearts in either a relaxed (KCl-induced) or contracted (BaCl2-induced) state. The displacement-encoded imaging with stimulated echoes data were used to strain-correct the in vivo cardiac diffusion tensor imaging in diastole and systole. The orientation of the primary (helix angles) and secondary (E2A) diffusion eigenvectors was compared with and without strain correction and to the strain-free ex vivo data.ResultsStrain correction reduces systolic E2A significantly when compared without strain correction and ex vivo (median absolute E2A = 34.3° versus E2A = 57.1° (P = 0.01), E2A = 60.5° (P = 0.006), respectively). The systolic distribution of E2A without strain correction is closer to the contracted ex vivo distribution than with strain correction, root mean square deviation of 0.027 versus 0.038.ConclusionsThe current strain-correction model amplifies the contribution of microscopic strain to diffusion resulting in an overcorrection of E2A. Results show that a new model that considers cellular rearrangement is required.

Journal article

Cheng K, Wright C, de Silva R, 2017, THE IMPACT OF A MULTI-DISCIPLINARY CARE PATHWAY FOR PATIENTS WITH REFRACTORY ANGINA ON PSYCHOSOCIAL OUTCOMES, QUALITY OF LIFE AND MEDICATION, Annual Conference of the British-Cardiovascular-Society (BCS), Publisher: BMJ PUBLISHING GROUP, Pages: A70-A71, ISSN: 1355-6037

Conference paper

Poulsen CB, Pedrigi R, Holm N, Pareek N, Kilic I, Post AL, Di Mario C, Bentzon J, Botker H, Falk E, Krams R, de Silva Ret al., 2017, COMPARISON OF IN VIVO OPTICAL COHERENCE TOMOGRAPHY DERIVED PLAQUE PHENOTYPE AND BURDEN WITH HISTOLOGY IN A PORCINE MODEL OF ADVANCED CORONARY ATHEROSCLEROSIS, 66th Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC), Publisher: ELSEVIER SCIENCE INC, Pages: 1072-1072, ISSN: 0735-1097

Conference paper

This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.

Request URL: http://wlsprd.imperial.ac.uk:80/respub/WEB-INF/jsp/search-html.jsp Request URI: /respub/WEB-INF/jsp/search-html.jsp Query String: respub-action=search.html&id=00535261&limit=30&person=true