Publications
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Vrints CJM, Senior R, Crea F, et al., 2017, Assessing suspected angina: requiem for coronary computed tomography angiography or exercise electrocardiogram?, EUROPEAN HEART JOURNAL, Vol: 38, Pages: 1792-1800, ISSN: 0195-668X
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- Citations: 14
Karogiannis N, Pabla J, Gurunathan S, et al., 2017, THE LONG TERM PROGNOSTIC VALUE OF DIPYRIDAMOLE STRESS MYOCARDIAL CONTRAST ECHOCARDIOGRAPHY IN COMPARISON WITH SINGLE PHOTON EMISSION TOMOGRAPHY IN PATIENTS WITH KNOWN OR SUSPECTED CORONARY ARTERY DISEASE, Annual Conference of the British-Cardiovascular-Society (BCS), Publisher: BMJ PUBLISHING GROUP, Pages: A79-A80, ISSN: 1355-6037
Vamvakidou A, Chahal N, Hampson R, et al., 2017, STROKE VOLUME DETERMINED FLOW RESERVE DOES NOT PREDICT THE TRUE SEVERITY OF LOW-FLOW LOW-GRADIENT AORTIC STENOSIS AND IS NOT A ROBUST MARKER OF CONTRACTILE RESERVE IN PATIENTS UNDERGOING LOW-DOSE DOBUTAMINE ECHOCARDIOGRAPHY, Annual Conference of the British-Cardiovascular-Society (BCS), Publisher: BMJ PUBLISHING GROUP, Pages: A94-A95, ISSN: 1355-6037
Gurunathan S, Elghamaz A, Ahmed A, et al., 2017, DIAGNOSTIC CONCORDANCE AND CLINICAL OUTCOMES IN PATIENTS UNDERGOING FRACTIONAL FLOW RESERVE AND STRESS ECHOCARDIOGRAPHY FOR THE ASSESSMENT OF CORONARY STENOSIS OF INTERMEDIATE SEVERITY, Annual Conference of the British-Cardiovascular-Society (BCS), Publisher: BMJ PUBLISHING GROUP, Pages: A87-A88, ISSN: 1355-6037
Ahmadvazir S, Shah BN, Zacharias K, et al., 2017, Incremental prognostic value of stress echocardiography with carotid ultrasound for suspected CAD., JACC Cardiovasc Imaging, Vol: 11, Pages: 173-180, ISSN: 1936-878X
OBJECTIVES: This study hypothesized that ischemia and atherosclerosis assessment by ultrasound (US) may provide incremental prognostic information in patients with new-onset chest pain who do not have coronary artery disease (CAD). BACKGROUND: The clinical significance of atherosclerosis assessment by carotid US in patients undergoing stress echocardiography (SE) in such patients is unknown. METHODS: Consecutive patients with suspected angina but no history of CAD underwent simultaneous SE and US prospectively to assess myocardial ischemia and carotid plaque burden (CPB), respectively. Patients were followed up for major adverse events (MAEs)-all-cause mortality, nonfatal myocardial infarction, and unplanned coronary revascularization. RESULTS: Of 591 recruited patients, 580 (men, 46%; mean age 59 ± 11 years) patients were available for follow-up. SE demonstrated myocardial ischemia in 12%, but prevalence of carotid plaques was 59%. During a mean follow-up of 1,117 ± 361 days, 40 first MAEs occurred. In the multivariable regression model, pre-test probability (PTP) of CAD (p = 0.001), abnormal SE (p < 0.0001), and CPB (p < 0.0001) predicted MAEs. MAE rates per year increased from 0.9% versus 1.97% versus 4.3% versus 9.7% in patients with no carotid plaque and normal SE versus patients who had plaque and normal SE versus those with no plaque and abnormal SE versus patients with plaque and abnormal SE, respectively (p < 0.0001). In hierarchical analysis, plaque burden provided incremental prognostic value over PTP of CAD and SE; likewise, SE was incremental to PTP-CAD and CPB (p < 0.0001 for both). CONCLUSIONS: In patients with suspected stable angina without known CAD, simultaneous SE (for ischemia) and US (for atherosclerosis) provided incremental prognostic value.
Senior R, Khattar RS, 2017, Cardiac investigation for prognosis in coronary artery disease: where negative is positive, EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING, Vol: 18, Pages: 988-989, ISSN: 2047-2404
Vamvakidou A, Chahal N, Hampson R, et al., 2017, STROKE VOLUME DETERMINED FLOW RESERVE DOES NOT PREDICT THE TRUE SEVERITY OF LOW-FLOW LOW-GRADIENT AORTIC STENOSIS AND IS NOT A ROBUST MARKER OF CONTRACTILE RESERVE IN PATIENTS UNDERGOING LOW-DOSE DOBUTAMINE ECHOCARDIOGRAPHY, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol: 69, Pages: 1419-1419, ISSN: 0735-1097
Shah BN, Chahal NS, Kooner JS, et al., 2017, Contrast-enhanced ultrasonography vs B-mode ultrasound for visualization of intima-media thickness and detection of plaques in human carotid arteries, ECHOCARDIOGRAPHY-A JOURNAL OF CARDIOVASCULAR ULTRASOUND AND ALLIED TECHNIQUES, Vol: 34, Pages: 723-730, ISSN: 0742-2822
Gurunathan S, Ahmed A, Pabla J, et al., 2017, The clinical efficacy and long-term prognostic value of stress echocardiography in octogenarians, HEART, Vol: 103, Pages: 530-536, ISSN: 1355-6037
Karogiannis N, Senior R, 2017, Contrast echocardiography for detection of myocardial perfusion abnormalities A clinical perspective, HERZ, Vol: 42, Pages: 287-294, ISSN: 0340-9937
Cheung WK, Shah BN, Stanziola A, et al., 2017, DIFFERENTIAL INTENSITY PROJECTION FOR VISUALISATION AND QUANTIFICATION OF PLAQUE NEOVASCULARISATION IN CONTRAST-ENHANCED ULTRASOUND IMAGES OF CAROTID ARTERIES, ULTRASOUND IN MEDICINE AND BIOLOGY, Vol: 43, Pages: 831-837, ISSN: 0301-5629
Vamvakidou A, Karogiannis N, Tzalamouras V, et al., 2016, Prognostic usefulness of contemporary stress echocardiography in patients with left bundle branch block and impact of contrast use in improving prediction of outcome, EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING, Vol: 18, Pages: 415-421, ISSN: 2047-2404
Moceri P, Bouvier P, Baudouy D, et al., 2016, Cardiac remodelling amongst adults with various aetiologies of pulmonary arterial hypertension including Eisenmenger syndrome-implications on survival and the role of right ventricular transverse strain., Eur Heart J Cardiovasc Imaging
AIMS: Survival in pulmonary arterial hypertension (PAH) and Eisenmenger syndrome (ES) relates to right ventricular (RV) function. Little is known about differences of ventricular function between ES patients and those suffering from other PAH aetiologies. In this study, we compared global ventricular function assessed by speckle-tracking in adult patients with ES, other PAH aetiologies, or healthy controls; and assessed the relationship between ventricular function and survival. METHODS AND RESULTS: We performed a prospective cohort study recruiting 83 adult PAH patients (43 ES and 40 other PAH aetiologies patients) and 37 controls between March 2011 and June 2015. Patients with complex congenital heart disease were excluded. Fifty-three patients (63.9%) were in NYHA functional class ≥III at baseline and 60 (72.3%) were on advanced therapies. Mean RV peak longitudinal strain was -16.3 ± 7% in ES, lower compared with healthy controls (P < 0.001) but similar to other PAH aetiologies (P = 0.6). Mean RV peak transverse strain was +26.1 ± 17% in ES, lower than in controls (P < 0.001) but higher than in other PAH aetiologies (P < 0.001). No difference was observed between ES and other PAH in LV circumferential and longitudinal strain. Over a median follow-up of 22.6 months (3.3-32.2), 22 (26.5%) patients died all from cardio-pulmonary causes. ES and RV peak transverse strain were independent predictors of survival. RV peak transverse strain ≤22% identified patients with a 14-fold increased risk of death. CONCLUSION: Right ventricular remodelling differs between adults with ES and other PAH aetiologies. ES and increased RV free wall transverse strain are associated with better survival.
Gurunathan S, Young G, Karogiannis N, et al., 2016, TCT-540 Diagnostic Accuracy of Stress Echocardiography Compared With Invasive Coronary Angiography With Fractional Flow Reserve for the Diagnosis of Haemodynamically Significant Stenosis(Es) in Patients With Known or Suspected Coronary Artery Disease., J Am Coll Cardiol, Vol: 68, Pages: B218-B218
Goette A, Merino JL, Ezekowitz MD, et al., 2016, Edoxaban versus enoxaparin-warfarin in patients undergoing cardioversion of atrial fibrillation (ENSURE-AF): a randomised, open-label, phase 3b trial, LANCET, Vol: 388, Pages: 1995-2003, ISSN: 0140-6736
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- Citations: 184
Yeh JSM, Chen J, Minz MM, et al., 2016, Can left ventricular strain analysis detect significant residual mitral regurgitation post mitral clip implantation?, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol: 68, Pages: C156-C156, ISSN: 0735-1097
Qasem M, Utomi V, George K, et al., 2016, A meta-analysis for echocardiographic assessment of right ventricular structure and function in ARVC., Echo Research and Practice, Vol: 3, Pages: 95-104, ISSN: 2055-0464
INTRODUCTION: Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is an inherited pathology that can increase the risk of sudden death. Current Task Force Criteria for echocardiographic diagnosis do not include new, regional assessment tools which may be relevant in a phenotypically diverse disease. We adopted a systematic review and meta-analysis approach to highlight echocardiographic indices that differentiated ARVC patients and healthy controls. METHODS: Data was extracted and analysed from prospective trials that employed a case-control design meeting strict inclusion and exclusion as well as a-priori quality criteria. Structural indices included proximal RV outflow tract(RVOT1) and RV diastolic area(RVDarea). Functional indices included RV fractional area change (RVFAC), Tricuspid Annular Systolic Excursion(TAPSE), peak systolic and early diastolic myocardial velocities (S' and E' respectively) and myocardial strain. RESULTS: Patients with ARVC had larger RVOT1 (mean SD; 34 vs. 28 mm P<0.001) and RVDarea (23 vs. 18 cm2 P<0.001) compared to healthy controls. ARVC patients also had lower RVFAC (38 vs. 46 % P<0.001), TAPSE(17 vs. 23 mm P<0.001), S' (9 vs. 12 cm.s-1 P<0.001), E' (9 vs. 13 cm.s-1 P<0.001) and myocardial strain (-17 vs. -30% P<0.001). CONCLUSION: The data from this meta-analysis support current Task Force criteria for the diagnosis of ARVC. In addition, other RV measures that reflect the complex geometry and function in ARVC clearly differentiated between ARVC and healthy controls and may provide additional diagnostic and management value. We recommend that future working groups consider this data when proposing new / revised criteria for the echocardiographic diagnosis of ARVC.
Morrone D, Senior R, 2016, HIT initiative: discussion with the seniors, EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING, Vol: 18, Pages: 111-111, ISSN: 2047-2404
Vamvakidou A, Shah BN, Senior R, 2016, Can severity of aortic stenosis be determined despite absent contractile reserve in low-flow low-gradient aortic stenosis?, Echocardiography, ISSN: 0742-2822
A 79-year-old man presented with increasing breathlessness and his echocardiogram revealed severe left ventricular systolic dysfunction and low-flow low-gradient aortic stenosis. Low-dose dobutamine stress echocardiography revealed the absence of contractile reserve (increase of stroke volume by ≥20% did not occur). The test would have therefore been inconclusive. However, the attainment of normal flow (FR≥200 mL/s) during dobutamine stress enabled the diagnosis of true severe aortic stenosis.
Saeed S, Senior R, Chahal NS, et al., 2016, Lower trans-aortic flow rate is associated with increased cardiovascular and all-cause mortality in aortic valve stenosis, Congress of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 1138-1138, ISSN: 0195-668X
Gurunathan S, Young G, Parsons G, et al., 2016, Diagnostic accuracy of stress echocardiography compared with invasive coronary angiography with fractional flow reserve measurement for the diagnosis of haemodynamically significant CAD, Congress of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 652-652, ISSN: 0195-668X
Rost NS, Giugliano RP, Ruff CT, et al., 2016, Outcomes With Edoxaban Versus Warfarin in Patients With Previous Cerebrovascular Events Findings From ENGAGE AF-TIMI 48 (Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48), STROKE, Vol: 47, Pages: 2075-2082, ISSN: 0039-2499
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- Citations: 67
Gujral DM, Cheung WK, Shah BN, et al., 2016, Contrast enhancement of carotid adventitial vasa vasorum as a biomarker of radiation-induced atherosclerosis., Radiotherapy and Oncology, ISSN: 0167-8140
PURPOSE: Abnormal proliferation of adventitial vasa vasorum (vv) occurs early at sites of atherosclerosis and is thought to be an early biomarker of vascular damage. Contrast-enhanced ultrasound (CEUS) can detect this process. Its usefulness in irradiated arteries as a measure of accelerated atherosclerosis is unknown. This study investigates contrast intensity in carotid adventitia as an early marker of radiation-induced damage in head and neck cancer (HNC) patients. MATERIALS/METHODS: Patients with HNC treated with a wedged-pair and matched neck technique or hemi-neck radiotherapy (RT) (unirradiated side as control) at least 2years previously were included. Patients had been prescribed a dose of at least 50Gy to the neck. CEUS was performed on both carotid arteries and a region of interest was selected in the adventitia of the far wall of both left and right distal common carotid arteries. Novel quantification software was used to compare the average intensity per pixel between irradiated and unirradiated arteries. RESULTS: 48 patients (34 males) with median age of 59.2years (interquartile range (IQR) 49.2-64.2) were included. The mean maximum point dose to the irradiated artery was 61.2Gy (IQR 52.6-61.8) and 1.1Gy (IQR 1.0-1.8Gy) to the unirradiated side. The median interval from RT was 59.4months (IQR 41-88.7). There was a significant difference in the mean (SD) contrast intensity per pixel on the irradiated side (1.1 (0.4)) versus 0.96 (0.34) on the unirradiated side (p=0.01). After attenuation correction, the difference in mean contrast intensity per pixel was still significant (1.4 (0.58) versus 1.2 (0.47) (p=0.02). Previous surgery or chemotherapy had no effect on the difference in contrast intensity between the 2 sides of the neck. Mean intensity per pixel did not correlate to traditional risk prediction models (carotid intima-medial thickness, QSTROKE score). CONCLUSIONS: Proliferation of vv is demonstrated by increased contrast intensity in irradiated car
Zoppellaro G, Venneri L, Khattar RS, et al., 2016, Simultaneous Assessment of Myocardial Perfusion, Wall Motion, and Deformation during Myocardial Contrast Echocardiography: A Feasibility Study., Echocardiography, Vol: 33, Pages: 889-895, ISSN: 0742-2822
AIMS: Ultrasound contrast agents may be used for the assessment of regional wall motion and myocardial perfusion, but are generally considered not suitable for deformation analysis. The aim of our study was to assess the feasibility of deformation imaging on contrast-enhanced images using a novel methodology. METHODS AND RESULTS: We prospectively enrolled 40 patients who underwent stress echocardiography with continuous intravenous infusion of SonoVue for the assessment of myocardial perfusion imaging with flash replenishment technique. We compared longitudinal strain (Lε) values, assessed with a vendor-independent software (2D CPA), on 68 resting contrast-enhanced and 68 resting noncontrast recordings. Strain analysis on contrast recordings was evaluated in the first cardiac cycles after the flash. Tracking of contrast images was deemed feasible in all subjects and in all views. Contrast administration improved image quality and increased the number of segments used for deformation analysis. Lε of noncontrast and contrast-enhanced images were statistically different (-18.8 ± 4.5% and -22.8 ± 5.4%, respectively; P < 0.001), but their correlation was good (ICC 0.65, 95%CI 0.42-0.78). Patients with resting wall-motion abnormalities showed lower Lε values on contrast recordings (-18.6 ± 6.0% vs. -24.2 ± 5.5%, respectively; P < 0.01). Intra-operator and inter-operator reproducibility was good for both noncontrast and contrast images with no statistical differences. CONCLUSIONS: Our study shows that deformation analysis on postflash contrast-enhanced images is feasible and reproducible. Therefore, it would be possible to perform a simultaneous evaluation of wall-motion abnormalities, volumes, ejection fraction, perfusion defects, and cardiac deformation on the same contrast recording.
Senior R, 2016, Lack of Stroke Volume Determined Flow Reserve Does Not Always Preclude Assessment of Severity of Aortic Stenosis in Low-Flow Low-Gradient State During Dobutamine Echocardiography. Vamvakidou A, Chahal N, Senior R. JACC Cardiovasc Imaging. 2016 Jun 10. pii: S1936-878X(16)30242-X. doi: 10.1016/j.jcmg.2016.04.001. [Epub ahead of print] No abstract available., JACC Cardiovasc Imaging
Ahmadvazir S, Zacharias K, Shah B, et al., 2016, Synergistic Value of Simultaneous Stress Echocardiography and Carotid Ultrasound Performed in Patients with Suspected Angina without Known Coronary Artery Disease for The Prediction of Outcome, Annual Conference of the British Cardiovascular Society (BCS) on Prediction and Prevention, Publisher: BMJ Publishing Group, Pages: A93-A94, ISSN: 1355-6037
Gurunathan S, Young G, Parsons G, et al., 2016, Diagnostic Accuracy of Stress Echocardiography Compared with Invasive Coronary Angiography with Fractional Flow Reserve for The Diagnosis of Haemodynamically Significant Cad in Patients with Known or Suspected CAD, Annual Conference of the British Cardiovascular Society (BCS) on Prediction and Prevention, Publisher: BMJ Publishing Group, Pages: A94-A95, ISSN: 1355-6037
Gurunathan S, Karogiannis N, Senior R, 2016, Imaging the heart failure patient-need for accurate measurements of left ventricular volumes and ejection fraction: the role of three-dimensional and contrast echocardiography, Current Opinion in Cardiology, Vol: 31, Pages: 459-468, ISSN: 1531-7080
PURPOSE OF REVIEW: Left ventricular ejection fraction (LVEF) is a powerful prognostic marker in heart failure and plays a pivotal role in the allocation of many treatments that reduce morbidity and mortality. Although unenhanced two-dimensional echocardiography (2DE) is the most ubiquitous tool for the assessment of left ventricular (LV) size and systolic function, it does not provide reliable, reproducible and accurate measures. The purpose of this review is to critically appraise contrast echocardiography and three-dimensional echocardiography (3DE) for the assessment of LVEF and LV volumes. RECENT FINDINGS: Contrast echocardiography results in more accurate assessment of LVEF and LV volumes than unenhanced 2DE, significantly improving correlation with cardiac magnetic resonance, with comparable reproducibility. Contrast echocardiography reduces downstream testing, frequently alters patient management, and results in substantial cost savings. 3DE shows higher levels of agreement with cardiac magnetic resonance over unenhanced 2DE for LVEF and LV volumes, but requires adequate image quality, and consistently underestimates LV volumes due to limited spatial resolution. SUMMARY: The advent of contrast 2DE and 3DE has marked the dawn of significant improvements in the precision and reproducibility of echocardiography. Contrast 3DE improves LV assessment in patients with suboptimal images, but further work is needed to demonstrate incremental benefit over contrast echocardiography.
Shah BN, Senior R, 2016, Stress echocardiography in patients with morbid obesity, Echo Research and Practice, Vol: 3, Pages: R13-R18, ISSN: 2055-0464
The incidence of significant obesity is rising across the globe. These patients often have a clustering of cardiovascular risk factors and are frequently referred for noninvasive cardiac imaging tests. Stress echocardiography (SE) is widely used for assessment of patients with known or suspected coronary artery disease (CAD), but its clinical utility in morbidly obese patients (in whom image quality may suffer due to body habitus) has been largely unknown. The recently published Stress Ultrasonography in Morbid Obesity (SUMO) study has shown that SE, when performed appropriately with ultrasound contrast agents (whether performed with physiological or pharmacological stress), has excellent feasibility and appropriately risk stratifies morbidly obese patients, including identification of patients who require revascularization. This article reviews the evidence supporting the use of echocardiographic techniques in morbidly obese patients for assessment of known or suspected CAD and briefly discusses other noninvasive modalities, including magnetic resonance and nuclear techniques, comparing and contrasting these techniques against SE.
Cordina R, von Klemperer K, Kempny A, et al., 2016, Echocardiographic predictors of mortality in adults with a fontan circulation, Journal of the American College of Cardiology: Cardiovascular Imaging, Vol: 10, Pages: 212-213, ISSN: 1936-878X
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