Imperial College London

Dr Tarun K Mittal MD, FRCR, MSc, FSCCT

Faculty of MedicineNational Heart & Lung Institute

Honorary Clinical Senior Lecturer
 
 
 
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Contact

 

+44 (0)1895 828 609t.mittal

 
 
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Location

 

Dept of Medical ImagingHarefield HospitalHarefield Hospital

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Summary

 

Publications

Publication Type
Year
to

59 results found

Rajani P, ElMorsy ElMaghawry M, Mittal T, Mattar Wet al., 2021, Anomalous Left Coronary Artery Arising From Right Coronary Sinus in the Setting of Anterior STEMI., JACC Case Rep, Vol: 3, Pages: 1182-1186

We present the case of a 55-year-old man who had a diagnosis of an acute anterior ST-segment elevation myocardial infarction. Emergency angiography demonstrated that both coronary systems originated from the right coronary sinus with a culprit proximal left anterior descending artery lesion, which was stented. This is a rare presentation, with only 1 similar case found in published reports. (Level of Difficulty: Intermediate.).

Journal article

Mittal TK, Marcus N, 2021, Imaging diagnosis of aortic stenosis, CLINICAL RADIOLOGY, Vol: 76, Pages: 3-14, ISSN: 0009-9260

Journal article

Nazir MS, Mittal TK, Weir-McCall J, Nieman K, Channon K, Nicol EDet al., 2020, Opportunities and challenges of implementing computed tomography fractional flow reserve into clinical practice, HEART, Vol: 106, Pages: 1387-1393, ISSN: 1355-6037

Journal article

Smail H, Stock UA, De Robertis F, Bhudia SK, Mittal T, Mattison S, Petrou M, Hill J, Gaer Jet al., 2020, Cardiac surgery during the COVID-19 pandemic: from vita minima to recovery, BRITISH JOURNAL OF SURGERY, Vol: 107, Pages: E481-E483, ISSN: 0007-1323

Journal article

Sabry H, Baltabaeva A, Gkikas A, Valencia O, Sarri G, Mirsadraee S, Mittal T, Bahrami Tet al., 2020, Rapid deployment aortic valve replacement through anterior right thoracotomy: Clinical outcomes and haemodynamic performance, JOURNAL OF CARDIAC SURGERY, Vol: 35, Pages: 1420-1424, ISSN: 0886-0440

Journal article

Mittal TK, Reichmuth L, Bhattacharyya S, Jain M, Baltabaeva A, Haley SR, Mirsadraee S, Panoulas V, Kabir T, Nicol ED, Dalby M, Long Qet al., 2019, Inconsistency in aortic stenosis severity between CT and echocardiography: prevalence and insights into mechanistic differences using computational fluid dynamics, Open Heart, Vol: 6, ISSN: 2053-3624

Objectives The aims of this study were to evaluate the inconsistency of aortic stenosis (AS) severity between CT aortic valve area (CT-AVA) and echocardiographic Doppler parameters, and to investigate potential underlying mechanisms using computational fluid dynamics (CFD).Methods A total of 450 consecutive eligible patients undergoing transcatheter AV implantation assessment underwent CT cardiac angiography (CTCA) following echocardiography. CT-AVA derived by direct planimetry and echocardiographic parameters were used to assess severity. CFD simulation was performed in 46 CTCA cases to evaluate velocity profiles.Results A CT-AVA>1 cm2 was present in 23% of patients with echocardiographic peak velocity≥4 m/s (r=−0.33) and in 15% patients with mean Doppler gradient≥40 mm Hg (r=−0.39). Patients with inconsistent severity grading between CT and echocardiography had higher stroke volume index (43 vs 38 mL/m2, p<0.003) and left ventricular outflow tract (LVOT) flow rate (235 vs 192 cm3/s, p<0.001). CFD simulation revealed high flow, either in isolation (p=0.01), or when associated with a skewed velocity profile (p=0.007), as the main cause for inconsistency between CT and echocardiography.Conclusion Severe AS by Doppler criteria may be associated with a CT-AVA>1 cm2 in up to a quarter of patients. CFD demonstrates that haemodynamic severity may be exaggerated on Doppler analysis due to high LVOT flow rates, with or without skewed velocity profiles, across the valve orifice. These factors should be considered before making a firm diagnosis of severe AS and evaluation with CT can be helpful.

Journal article

Kalogeras K, Kabir T, Mittal T, Mirsadraee S, Skondras E, Haley SR, Zuhair M, Vavuranakis M, Tousoulis D, Dalby M, Panoulas Vet al., 2019, Real-world comparison of the new 34 mm self-expandable transcatheter aortic prosthesis Evolut R to its 31 mm core valve predecessor, CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Vol: 93, Pages: 685-691, ISSN: 1522-1946

Journal article

Rogers P, Al-Aidrous S, Banya W, Haley SR, Mittal T, Kabir T, Panoulas V, Raja S, Bhudia S, Probert H, Prendergast C, Spence MS, Davies S, Moat N, Taylor RS, Dalby Met al., 2018, Cardiac rehabilitation to improve health-related quality of life following trans-catheter aortic valve implantation: a randomised controlled feasibility study: RECOVER-TAVI Pilot, ORCA 4, For the Optimal Restoration of Cardiac Activity Group., Pilot Feasibility Stud, Vol: 4, ISSN: 2055-5784

Objectives: Transcatheter aortic valve implantation (TAVI) is often undertaken in the oldest frailest cohort of patients undergoing cardiac interventions. We plan to investigate the potential benefit of cardiac rehabilitation (CR) in this vulnerable population. Design: We undertook a pilot randomised trial of CR following TAVI to inform the feasibility and design of a future randomised clinical trial (RCT). Participants: We screened patients undergoing TAVI at a single institution between June 2016 and February 2017. Interventions: Participants were randomised post-TAVI to standard of care (control group) or standard of care plus exercise-based CR (intervention group). Outcomes: We assessed recruitment and attrition rates, uptake of CR, and explored changes in 6-min walk test, Nottingham Activities of Daily Living, Fried and Edmonton Frailty scores and Hospital Anxiety and Depression Score, from baseline (30 days post TAVI) to 3 and 6 months post randomisation. We also undertook a parallel study to assess the use of the Kansas City Cardiomyopathy Questionnaire (KCCQ) in the post-TAVI population. Results: Of 82 patients screened, 52 met the inclusion criteria and 27 were recruited (3 patients/month). In the intervention group, 10/13 (77%) completed the prescribed course of 6 sessions of CR (mean number of sessions attended 7.5, SD 4.25) over 6 weeks. At 6 months, all participants were retained for follow-up. There was apparent improvement in outcome scores at 3 and 6 months in control and CR groups. There were no recorded adverse events associated with the intervention of CR. The KCCQ was well accepted in 38 post-TAVI patients: mean summary score 72.6 (SD 22.6). Conclusions: We have demonstrated the feasibility of recruiting post-TAVI patients into a randomised trial of CR. We will use the findings of this pilot trial to design a fully powered multicentre RCT to inform the provision of CR and support guideline development to optimise health-r

Journal article

Mittal TK, Cleghorn CL, Cade JE, Barr S, Grove T, Bassett P, Wood DA, Kotseva Ket al., 2017, A cross-sectional survey of cardiovascular health and lifestyle habits of hospital staff in the UK: Do we look after ourselves?, European Journal of Preventive Cardiology, Vol: 25, Pages: 543-550, ISSN: 2047-4873

Background A high prevalence of stress-related disorders is well known among healthcare professionals. We set out to assess the prevalence of cardiovascular risk factors and compliance with national dietary and physical activity recommendations in NHS staff in the UK with comparison between clinical and non-clinical staff, and national surveys. Design A multi-centre cross-sectional study. Methods A web-based questionnaire was developed to include anonymised data on demographics, job role, cardiovascular risk factors and diseases, dietary habits, physical activity and barriers towards healthy lifestyle. This was distributed to staff in four NHS hospitals via emails. Results A total of 1158 staff completed the survey (response rate 13%) with equal distribution between the clinical and non-clinical groups. Most staff were aged 26-60 years and 79% were women. Half of the staff were either overweight or obese (51%) with no difference between the groups ( P = 0.176), but there was a lower prevalence of cardiovascular risk factors compared to the general population. The survey revealed a low compliance (17%) with the recommended intake of five-a-day portions of fruit and vegetables, and that of moderate or vigorous physical activity (56%), with no difference between the clinical and non-clinical staff ( P = 0.6). However, more clinical staff were exceeding the alcohol recommendations ( P = 0.02). Lack of fitness facilities and managerial support, coupled with long working hours, were the main reported barriers to a healthy lifestyle. Conclusions In this survey of UK NHS staff, half were found to be overweight or obese with a lower prevalence of cardiovascular risk factors compared to the general population. There was a low compliance with the five-a-day fruit and vegetables recommendation and physical activity guidelines, with no difference between the clinical and non-clinical staff.

Journal article

Mittal TK, Pottle A, Nicol E, Barbir M, Ariff B, Mirsadraee S, Dubowitz M, Gorog DA, Clifford P, Firoozan S, Smith R, Dubrey S, Chana H, Shah J, Stephens N, Travill C, Kelion A, Pakkal M, Timmis Aet al., 2017, Prevalence of obstructive coronary artery disease and prognosis in patients with stable symptoms and a zero-coronary calcium score, EHJ Cardiovascular Imaging / European Heart Journal - Cardiovascular Imaging, Vol: 18, Pages: 922-929, ISSN: 2047-2412

Aims:CT calcium scoring (CTCS) and CT cardiac angiography (CTCA) are widely used in patients with stable chest pain to exclude significant coronary artery disease (CAD). We aimed to resolve uncertainty about the prevalence of obstructive coronary artery disease and long-term outcomes in patients with a zero-calcium score (ZCS).Methods and results:Consecutive patients with stable cardiac symptoms referred for CTCS or CTCS and CTCA from chest pain clinics to a tertiary cardiothoracic centre were prospectively enrolled. In those with a ZCS, the prevalence of obstructive CAD on CTCA was determined. A follow-up for all-cause mortality was obtained from the NHS tracer service. A total of 3914 patients underwent CTCS of whom 2730 (69.7%) also had a CTCA. Half of the patients were men (50.3%) with a mean age of 56.9 years. Among patients who had both procedures, a ZCS was present in 52.2%, with a negative predictive value of 99.5% for excluding ≥70% stenosis on CTCA. During a mean follow-up of 5.2 years, the annual event rate was 0.3% for those with ZCS compared with 1.2% for CS ≥1. The presence of non-calcified atheroma on CTCA in patients with ZCS did not affect the prognostic value (P = 0.98).Conclusion:In patients with stable symptoms and a ZCS, obstructive CAD is rare, and prognosis over the long-term is excellent, regardless of whether non-calcified atheroma is identified. A ZCS could reliably be used as a ‘gatekeeper’ in this patient cohort, obviating the need for further more expensive tests.

Journal article

Mittal TK, Reichmuth L, Ariff B, Rao PP, Baltabaeva A, Rahman-Haley S, Kabir T, Wong J, Dalby Met al., 2016, Imaging diagnoses and outcome in patients presenting for primary angioplasty but no obstructive coronary artery disease, Heart, Vol: 102, Pages: 1728-1734, ISSN: 1468-201X

OBJECTIVE: A proportion of patients with suspected ST-elevation myocardial infarction (STEMI) presenting for primary percutaneous coronary intervention (PPCI) do not have obstructive coronary disease and other conditions may be responsible for their symptoms and ECG changes. In this study, we set out to determine the prevalence and aetiology of alternative diagnoses in a large PPCI cohort as determined with multimodality imaging and their outcome. METHODS: From 2009 to 2012, 5238 patients with suspected STEMI were referred for consideration of PPCI. Patients who underwent angiography but had no culprit artery for revascularisation and no previous history of coronary artery disease were included in the study. Troponin values, imaging findings and all-cause mortality were obtained from hospital and national databases. RESULTS: A total of 575 (13.0%) patients with a mean age of 58±15 years (69% men) fulfilled the inclusion criteria. A specific diagnosis based on imaging was made in 237 patients (41.2%) including cardiomyopathies (n=104, 18%), myopericarditis (n=48, 8.4%), myocardial infarction/other coronary abnormality (n=27, 4.9%) and severe valve disease (n=23, 4%). Pulmonary embolism and type A aortic dissection were identified in seven (1.2%) and four (0.7%) cases respectively. A total of 40 (7.0%) patients died over a mean follow-up of 42.6 months. CONCLUSIONS: A variety of cardiac and non-cardiac conditions are prevalent in patients presenting with suspected STEMI but culprit-free angiogram, some of which may have adverse outcomes. Further imaging of such patients could thus be useful to help in appropriate management and follow-up.

Journal article

Dubrey S, Sharma R, Underwood R, Mittal T, Wells Aet al., 2016, Sarcoidosis of the cardio-pulmonary systems, Clinical Medicine, Vol: 16, Pages: 34-41, ISSN: 1470-2118

Sarcoidosis is a multi-system disease with a wide range ofphenotypes. Pulmonary involvement is the most frequentlyidentified target for sarcoidosis and is responsible forthe majority of deaths. Cardiac sarcoid is less commonlyidentified, may be occult, is significantly influenced by race,and can portend an unpredictable and sometimes fataloutcome. Sarcoidosis remains an enigmatic disease spectrumof unknown aetiology, frequently difficult to diagnose andwith a variable disease course. This article summarises currentviews on the diagnosis and management of cardiopulmonaryinvolvement.

Journal article

Bhattacharyya S, Mittal T, Abayalingam M, Kabir T, Dalby M, Cleland JG, Baltabaeva A, Rahman Haley Set al., 2015, Classification of Aortic Stenosis by Flow and Gradient Patterns Provides Insights into the Pathophysiology of Disease, Angiology, Vol: 67, Pages: 664-669, ISSN: 1940-1574

Different patterns of flow and valve gradients can lead to diagnostic uncertainty about the severity of aortic stenosis (AS). Consecutive patients with severe AS (valve area <1 cm(2)) underwent echocardiography and computed tomography. Patients were classified into 4 groups (high-gradient/normal flow [HGNF], high-gradient/low flow [HGLF], low-gradient/normal flow [LGNF], and low-gradient/low flow [LGLF]). Low flow was defined as stroke volume index <35 mL/m(2) and low gradient as a mean aortic gradient <40 mm Hg. Aortic valve calcification (AVC) was calculated using the Agatston score. Of 181 patients, 56, 30, 46, and 49 had HGNF, HGLF, LGNF and LGLF with median AVC of 2048, 2015, 1366, and 1178 AU/m(2) (P < .0001) and valvuloarterial impedance of 4.5, 6.4, 4.2, and 5.9, respectively (P < .0001). Among those with LGLF, AVC was lower in patients with preserved compared to reduced left ventricular ejection fraction (1018 vs 2550 AU/m(2); P < .0001), but valvuloarterial impedance was similar (P = .33). The LGLF AS with preserved ejection fraction is associated with lower AVC and may identify patients with less severe AS in association with an adaptive ventricular response to high afterload.

Journal article

Callington A, Long Q, Mohite P, Simon A, Mittal TKet al., 2015, Computational fluid dynamic study of hemodynamic effects on aortic root blood flow of systematically varied left ventricular assist device graft anastomosis design, JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, Vol: 150, Pages: 696-704, ISSN: 0022-5223

Journal article

Dubrey SW, Sharma R, Underwood R, Mittal Tet al., 2015, Cardiac sarcoidosis: diagnosis and management, POSTGRADUATE MEDICAL JOURNAL, Vol: 91, Pages: 384-394, ISSN: 0032-5473

Journal article

Dubrey SW, Grocott-Mason R, Ghonim S, Mittal Tet al., 2015, Takayasu's arteritis in an active man: burnt out or quiescent?, Br J Hosp Med (Lond), Vol: 76, Pages: 364-365, ISSN: 1750-8460

Journal article

Mittal TK, Reichmuth L, Chana H, Baltabaeva A, Rahman-Haley S, Dalby M, Long Qet al., 2015, Discrepancy in the severity of aortic valve stenosis between Echocardiography and CT cardiac angiography and evaluation of potential mechanism using computational flow dynamics., Annual Scientific Meeting of Society of Cardiovascular Computed Tomography

Conference paper

Mittal TK, Chana H, Reichmuth L, 2015, The optimal cardiac phase for measuring annulus size prior to transcatheter aortic valve implantation, Annual Scientific Meeting of Society of Cardiovascular Computed Tomography

Conference paper

Costopoulos C, Wong J, Mittal T, Srinivasan Met al., 2015, Multi-modality imaging aids the diagnosis of bilateral coronary-cameral fistulae with involvement of the left ventricle, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 182, Pages: 166-167, ISSN: 0167-5273

Journal article

Ali OF, Schultz C, Jabbour A, Rubens M, Mittal T, Mohiaddin R, Davies S, Di Mario C, Van der Boon R, Ahmad AS, Amrani M, Moat N, De Jaegere PPT, Dalby Met al., 2015, Predictors of paravalvular aortic regurgitation following self-expanding Medtronic CoreValve implantation: The role of annulus size, degree of calcification, and balloon size during pre-implantation valvuloplasty and implant depth, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 179, Pages: 539-545, ISSN: 0167-5273

Journal article

Kanaganayagam GS, An TN, Alsafi A, Kamanahalli R, Sutaria N, Mittal T, Ariff Bet al., 2014, CT coronary angiography in the investigation of chest pain - Beyond coronary artery atherosclerosis; A pictorial review, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 176, Pages: 618-629, ISSN: 0167-5273

Journal article

Mittal TK, Mitchell AG, Banner NR, 2014, Untitled, RADIOLOGY, Vol: 271, Pages: 308-309, ISSN: 0033-8419

Journal article

Mittal TK, Mitchell AG, Banner NR, 2014, Response., Radiology, Vol: 271, Pages: 309-310

Journal article

Torii R, Ibrahim M, Mittal T, Lee S-L, Yacoub MHet al., 2014, The wide spectrum of aortic root dilatation after the Ross operation., Pages: 49-50, ISSN: 2305-7823

Conference paper

Mittal TK, Panicker MG, Mitchell AG, Banner NRet al., 2013, Cardiac Allograft Vasculopathy after Heart Transplantation: Electrocardiographically Gated Cardiac CT Angiography for Assessment, RADIOLOGY, Vol: 268, Pages: 374-381, ISSN: 0033-8419

Journal article

Navaratnarajah M, Mahesh B, Mensah K, Mittal T, Raja S, Gaer Jet al., 2013, Saphenous vein graft pseudoaneurysm mimicking septic false aneurysm of thoracic aorta, Chirurgia (Turin), Vol: 26, Pages: 177-179, ISSN: 0394-9508

Saphenous vein graft aneurysm or pseudoaneurysm, and thoracic aortic false aneurysm are rare, but potentially lethal complications of cardiac surgery. We report a case of a 63 year old man who presented 5 years after coronary artery bypass grafting with a chronically discharging sternal wound. A thoracic computerized tomogram revealed a large aortic false aneurysm, presumed to be infective from the clinical scenario. Subsequently, this was shown at operation to be a non-infected thrombosed saphenous vein graft pseudoaneurysm. Definitive confirmation of a non-infective pathology prior to surgery could have prompted non-surgical management with radiological intervention.

Journal article

Dubrey SW, Singh VD, Mittal TK, 2013, Hernia of Morgagni: an unusual cause of apparent 'cardiomegaly'., Eur Heart J, Vol: 34

Journal article

Fernandez-Jimenez R, Kempny A, Prapa M, Amrani M, Trimlett R, Uebing A, Diller G-P, Dimopoulos K, Mittal T, Swan L, Gatzoulis MAet al., 2013, Giant Saphenous Vein Graft Aneurysm Compressing Right Ventricular Outflow Tract and Main Pulmonary Artery, CIRCULATION, Vol: 127, Pages: 650-651, ISSN: 0009-7322

Journal article

Mittal TK, Nicol ED, Harden SP, 2013, The national evolution of cardiovascular CT practice: A UK NHS perspective., … journal of cardiology

Journal article

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