Publications
184 results found
Panoulas VF, Ruparelia N, Franks R, et al., 2016, The Impact of Gender on Outcomes Following Transcatheter Aortic Valve Implantation: True Effect or Bias?, J Heart Valve Dis, Vol: 25, Pages: 552-556, ISSN: 0966-8519
Transcatheter aortic valve implantation (TAVI) is currently the treatment of choice for patients with severe aortic stenosis (AS) who are unsuitable for surgical aortic valve replacement (SAVR), and is an acceptable alternative for those at high and intermediate surgical risk. In published TAVI registries and meta-analyses, whilst women are significantly older they present with fewer comorbidities compared to men (including coronary artery disease, peripheral vascular disease, diabetes and chronic obstructive pulmonary disease). In response to chronic pressure overload from AS, women have been shown to develop greater levels of left ventricular hypertrophy than men, as well as having a greater preservation of LV ejection fraction (LVEF) and less fibrosis. Following aortic valve replacement, women have been shown to have a faster regression of myocardial hypertrophy, with a significant improvement in LVEF. Following TAVI, female gender seems to be associated with a significantly lower one-year mortality. In the current viewpoint, it is discussed whether these findings reflect a true differential treatment response to TAVI among women, or simply the higher comorbidity burden among males undergoing TAVI.
Cook CM, Petraco R, Ahmad Y, et al., 2016, Systematic review of non- invasive computed tomography-derived FFR (FFR-CT) studies to guide integration of FFR-CT into mainstream clinical practice, Congress of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 609-610, ISSN: 0195-668X
Panoulas V, Thyregod HG, Nihoyannopoulos P, et al., 2016, Increased survival of females with severe aortic stenosis after transcatheter aortic valve implantation compared to surgical aortic valve replacement; a meta-analysis of randomised controlled studies, Congress of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 72-72, ISSN: 0195-668X
Cook CM, Kousera C, Ahmad Y, et al., 2016, Can computational fluid dynamics (CFD) predictions of FFR really agree with invasive FFR in intermediate stenoses? Lessons from a study using optical coherence tomography (OCT) and invasive measures, Congress of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 609-609, ISSN: 0195-668X
Ruparelia N, Panoulas VF, Frame A, et al., 2016, Impact of clinical and procedural factors upon C reactive protein dynamics following transcatheter aortic valve implantation, World Journal of Cardiology, Vol: 8, Pages: 425-431, ISSN: 1949-8462
AIM: To determine the effect of procedural and clinical factors upon C reactive protein (CRP) dynamics following transcatheter aortic valve implantation (TAVI). METHODS: Two hundred and eight consecutive patients that underwent transfemoral TAVI at two hospitals (Imperial, College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom and San Raffaele Scientific Institute, Milan, Italy) were included. Daily venous plasma CRP levels were measured for up to 7 d following the procedure (or up to discharge). Procedural factors and 30-d safety outcomes according to the Valve Academic Research Consortium 2 definition were collected. RESULTS: Following TAVI, CRP significantly increased reaching a peak on day 3 of 87.6 ± 5.5 mg/dL, P < 0.001. Patients who developed clinical signs and symptoms of sepsis had significantly increased levels of CRP (P < 0.001). The presence of diabetes mellitus was associated with a significantly higher peak CRP level at day 3 (78.4 ± 3.2 vs 92.2 ± 4.4, P < 0.001). There was no difference in peak CRP release following balloon-expandable or self-expandable TAVI implantation (94.8 ± 9.1 vs 81.9 ± 6.9, P = 0.34) or if post-dilatation was required (86.9 ± 6.3 vs 96.6 ± 5.3, P = 0.42), however, when pre-TAVI balloon aortic valvuloplasty was performed this resulted in a significant increase in the peak CRP (110.1 ± 8.9 vs 51.6 ± 3.7, P < 0.001). The development of a major vascular complication did result in a significantly increased maximal CRP release (153.7 ± 11.9 vs 83.3 ± 7.4, P = 0.02) and there was a trend toward a higher peak CRP following major/life-threatening bleeding (113.2 ± 9.3 vs 82.7 ± 7.5, P = 0.12) although this did not reach statistical significance. CRP was not found to be a predictor of 30-d mortality on univariate analysis. CONCLUSION: Careful attention should be paid to baseline clinical characteristics and procedura
Ahmad Y, Cook C, Shun-Shin M, et al., 2016, Resolving the paradox of randomised controlled trials and observational studies comparing multi-vessel angioplasty and culprit only angioplasty at the time of STEMI, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 222, Pages: 1-8, ISSN: 0167-5273
Ng J, Foin N, Ang HY, et al., 2016, Over-expansion capacity and stent design model: an update with contemporary DES platforms, International Journal of Cardiology, Vol: 221, Pages: 171-179, ISSN: 1874-1754
BACKGROUND: Previously, we examined the difference in stent designs across different sizes for six widely used Drug Eluting Stents (DESs). Although stent post-dilatation to larger diameter is commonly done, typically in the setting of long tapering segment or left-main PCI, there is an increasing recognition that information with regard to the different stent model designs has a critical impact on overexpansion results. This study aims to provide an update on stent model designs for contemporary DES platforms as well as test overexpansion results under with oversized post-dilatation. METHODS AND RESULTS: We studied 6 different contemporary commercially available DES platforms: Synergy, Xience Xpedition, Ultimaster, Orsiro, Resolute Onyx and Biomatrix Alpha. We investigated for each platform the difference in stent designs across different sizes and results obtained after post-expansion with larger balloon sizes. The stents were deployed at nominal diameter and subsequently over expanded using increasingly large post dilatation balloon sizes (4.0, 5.0 and 6.0mm at 14ATM). Light microscopy was used to measure the changes in stent geometry and lumen diameter after over-expansion. For each respective DES platform, the MLD observed after overexpansion of the largest stent size available with a 6.0mm balloon was 5.7mm for Synergy, 5.6mm for Xience, 5.2mm for Orsiro, 5.8mm for Ultimaster, 5.5mm for 4mm Onyx (5.9mm for the 5mm XL size) and 5.8mm for BioMatrix Chroma. CONCLUSION: This update presents valuable novel insights that may be helpful for careful selection of stent size for contemporary DES based on model designs. Such information is especially critical in left main bifurcation stenosis treatment where overexpansion to larger oversized diameter may be required to ensure full stent apposition.
van de Hoef TP, Petraco R, van Lavieren MA, et al., 2016, Basal stenosis resistance index derived from simultaneous pressure and flow velocity measurements, EUROINTERVENTION, Vol: 12, Pages: E199-E207, ISSN: 1774-024X
Ahmad Y, Cook C, Petraco R, et al., 2016, Multi-vessel Angioplasty at the Time of STEMI has Equivalent Mortality to a Culprit Only Strategy: Resolving The Paradox of Randomised Controlled Trials and Observational Studies in Multivessel Disease and STEMI, Annual Conference of the British Cardiovascular Society (BCS) on Prediction and Prevention, Publisher: BMJ Publishing Group, Pages: A68-A69, ISSN: 1355-6037
Ahmad Y, Sen S, Nijjer S, et al., 2016, Thrombus Aspiration does not Reduce Mortality in STEMI Patients: A Meta-Analysis of 20,192 Patients, with Implications for Future Trial Design, Annual Conference of the British Cardiovascular Society (BCS) on Prediction and Prevention, Publisher: BMJ Publishing Group, Pages: A24-A25, ISSN: 1355-6037
Cook CM, Ahmad Y, Shun-Shin MJ, et al., 2016, Quantification of the Effect of Pressure Wire Drift on the Diagnostic Performance of Fractional Flow Reserve, Instantaneous Wave-Free Ratio, and Whole-Cycle Pd/Pa, Circulation: Cardiovascular Interventions, Vol: 9, ISSN: 1941-7640
Background—Small drifts in intracoronary pressure measurements (±2 mmHg) can affect stenosis categorization usingpressure indices. This has not previously been assessed for fractional flow reserve (FFR), instantaneous wave-free ratio(iFR), and whole-cycle distal pressure/proximal pressure (Pd/Pa) indices.Methods and Results—Four hundred forty seven stenoses were assessed with FFR, iFR, and whole-cycle Pd/Pa. Cut pointvalues for significance were predefined as ≤0.8, <0.90, and <0.93, respectively. Pressure wire drift was simulated byoffsetting the distal coronary pressure trace by ±2 mmHg. FFR, iFR, and whole-cycle Pd/Pa indices were recalculatedand stenosis misclassification quantified. Median (±median absolute deviation) values for FFR, iFR, and whole-cycle Pd/Pa were 0.81 (±0.11), 0.90 (±0.07), and 0.93 (±0.06), respectively. 34.6% (155), 50.1% (224), and 62.2% (278) of valueslay within ±0.05 U of the cut point for FFR, iFR, and whole-cycle Pd/Pa, respectively. With ±2 mmHg pressure wire drift,21% (94), 25% (110), and 33% (148) of the study population were misclassified with FFR, iFR, and whole-cycle Pd/Pa,respectively. Both FFR and iFR had significantly lower misclassification than whole-cycle Pd/Pa (P<0.001). There wasno statistically significant difference between the diagnostic performance of FFR and iFR (P=0.125).Conclusions—In a substantial proportion of cases, small amounts of pressure wire drift are enough to causestenoses to change classification. Whole-cycle Pd/Pa is more vulnerable to such reclassification than FFR and iFR.
Broyd CJ, Nijjer S, Sen S, et al., 2016, Estimation of coronary wave intensity analysis using noninvasive techniques and its application to exercise physiology, AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY, Vol: 310, Pages: H619-H627, ISSN: 0363-6135
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- Citations: 11
Danson E, Hansen P, Sen S, et al., 2016, Assessment, treatment, and prognostic implications of CAD in patients undergoing TAVI, Nature Reviews Cardiology, Vol: 13, Pages: 276-285, ISSN: 1759-5010
Echavarria-Pinto M, Petraco R, van de Hoef TP, et al., 2016, Fractional flow reserve and minimum P-d/P-a ratio during intravenous adenosine infusion: very similar but not always the same, Eurointervention, Vol: 11, Pages: 1013-1019, ISSN: 1969-6213
Panoulas VF, Sutaria N, Sen S, et al., 2016, Transcatheter aortic valve implantation in the young, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 203, Pages: 626-628, ISSN: 0167-5273
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- Citations: 1
Petraco R, Sen S, Nijjer S, et al., 2015, ECG-Independent Calculation of Instantaneous Wave-Free Ratio, JACC-CARDIOVASCULAR INTERVENTIONS, Vol: 8, Pages: 2043-2046, ISSN: 1936-8798
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- Citations: 13
Panoulas VF, Sen S, Frame A, et al., 2015, Tackling the bends in transcatheter aortic valve implantation, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 201, Pages: 55-57, ISSN: 0167-5273
van de Hoef TP, Meuwissen M, Escaned J, et al., 2015, Head-to-head comparison of basal stenosis resistance index, instantaneous wave-free ratio, and fractional flow reserve: diagnostic accuracy for stenosis-specific myocardial ischaemia, EUROINTERVENTION, Vol: 11, Pages: 914-925, ISSN: 1774-024X
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- Citations: 44
Nijjer SS, de Waard GA, Sen S, et al., 2015, Coronary pressure and flow relationships in humans: phasic analysis of normal and pathological vessels and the implications for stenosis assessment: a report from the Iberian-Dutch-English (IDEAL) collaborators, European Heart Journal, Vol: 37, Pages: 2069-2080, ISSN: 1522-9645
BACKGROUND: Our understanding of human coronary physiological behaviour is derived from animal models. We sought to describe physiological behaviour across a large collection of invasive pressure and flow velocity measurements, to provide a better understanding of the relationships between these physiological parameters and to evaluate the rationale for resting stenosis assessment. METHODS AND RESULTS: Five hundred and sixty-seven simultaneous intracoronary pressure and flow velocity assessments from 301 patients were analysed for coronary flow velocity, trans-stenotic pressure gradient (TG), and microvascular resistance (MVR). Measurements were made during baseline and hyperaemic conditions. The whole cardiac cycle and the diastolic wave-free period were assessed. Stenoses were assessed according to fractional flow reserve (FFR) and quantitative coronary angiography DS%. With progressive worsening of stenoses, from unobstructed angiographic normal vessels to those with FFR ≤ 0.50, hyperaemic flow falls significantly from 45 to 19 cm/s, Ptrend < 0.001 in a curvilinear pattern. Resting flow was unaffected by stenosis severity and was consistent across all strata of stenosis (Ptrend > 0.05 for all). Trans-stenotic pressure gradient rose with stenosis severity for both rest and hyperaemic measures (Ptrend < 0.001 for both). Microvascular resistance declines with stenosis severity under resting conditions (Ptrend < 0.001), but was unchanged at hyperaemia (2.3 ± 1.1 mmHg/cm/s; Ptrend = 0.19). CONCLUSIONS: With progressive stenosis severity, TG rises. However, while hyperaemic flow falls significantly, resting coronary flow is maintained by compensatory reduction of MVR, demonstrating coronary auto-regulation. These data support the translation of coronary physiological concepts derived from animals to patients with coronary artery disease and furthermore, suggest that resting pressure indices can be used to detect the haemodynamic significance of co
Cook C, Ahmad Y, Petraco R, et al., 2015, Accounting for right atrial pressure in the calculation of Fractional Flow Reserve (FFR) significantly increases the number of physiologically significant stenoses suitable for PCI, 27th Annual Symposium on Transcatheter Cardiovascular Therapeutics (TCT), Publisher: ELSEVIER SCIENCE INC, Pages: B18-B19, ISSN: 0735-1097
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- Citations: 2
Cook C, Ahmad Y, Nijjer SS, et al., 2015, Quantification of the effect of measurement drift on the diagnostic performance of FFR, iFR and whole cycle Pd/Pa, 27th Annual Symposium on Transcatheter Cardiovascular Therapeutics (TCT), Publisher: ELSEVIER SCIENCE INC, Pages: B15-B16, ISSN: 0735-1097
Ahmad Y, Sen S, Keene D, et al., 2015, Thrombus aspiration does not reduce mortality in STEMI patients: a meta-analysis of 20,192 patients, with implications for future trial design, 27th Annual Symposium on Transcatheter Cardiovascular Therapeutics (TCT), Publisher: ELSEVIER SCIENCE INC, Pages: B103-B104, ISSN: 0735-1097
Ahmad Y, Nijjer SS, Cook C, et al., 2015, Patients consider PCI and CABG equal: Derivation of a novel patient-centered, quantitative analysis of Major Adverse Cardiac Events (MACE) and its application to trials comparing PCI to CABG, 27th Annual Symposium on Transcatheter Cardiovascular Therapeutics (TCT), Publisher: ELSEVIER SCIENCE INC, Pages: B195-B196, ISSN: 0735-1097
Ahmad Y, Sen S, Shun-Shin M, et al., 2015, Intra-aortic balloon pump therapy does not reduce mortality in acute myocardial infarction, with or without cardiogenic shock: application of a baseline inequality index to account for differential outcomes in randomized and observational studies, 27th Annual Symposium on Transcatheter Cardiovascular Therapeutics (TCT), Publisher: ELSEVIER SCIENCE INC, Pages: B103-B103, ISSN: 0735-1097
Foin N, Lee RD, Bourantas C, et al., 2015, Bioabsorbable Vascular Scaffold Radial Expansion and Conformation Compared to a Metallic platform: Insights from In-vitro Expansion in a Coronary Artery Lesion Model, 27th Annual Symposium on Transcatheter Cardiovascular Therapeutics (TCT), Publisher: ELSEVIER SCIENCE INC, Pages: B209-B209, ISSN: 0735-1097
Sen S, Petraco R, Nijjer S, et al., 2015, Can Resting Indices Obviate the Need for Hyperemia and Promote the Routine Use of Physiologically Guided Revascularization?, Interv Cardiol Clin, Vol: 4, Pages: 459-469
This article assesses the data from contemporary human studies to address some of the common assumptions regarding hyperemic and baseline physiology in the context of the baseline pressure-derived index of instant wave-free ratio and the hyperemic index of fractional flow reserve. The article aims to determine if the available evidence supports the continued investigation, development, and use of baseline indices.
Maznyczka A, Sen S, Cook C, et al., 2015, The ischaemic constellation: an alternative to the ischaemic cascade - implications for the validation of new ischaemic tests, OPEN HEART, Vol: 2, ISSN: 2053-3624
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- Citations: 6
Ahmad Y, Nijjer S, Cook CM, et al., 2015, A new method of applying randomised control study data to the individual patient: A novel quantitative patient-centred approach to interpreting composite end points, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 195, Pages: 216-224, ISSN: 0167-5273
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- Citations: 18
Cook CM, Petraco R, Nijjer S, et al., 2015, Accounting for right atrial pressure in the calculation of fractional flow reserve (FFR) significantly increases the number of physiologically significant stenoses suitable for PCI, Congress of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 858-858, ISSN: 0195-668X
Nijjer SS, De Waard G, Sen S, et al., 2015, Hyperemic flow velocity falls with worsening stenosis severity: the challenge for non-invasive predictors of coronary physiology, Congress of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 299-299, ISSN: 0195-668X
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