Imperial College London

DrVasileiosPanoulas

Faculty of MedicineNational Heart & Lung Institute

Honorary Clinical Senior Lecturer
 
 
 
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Guy Scadding BuildingRoyal Brompton Campus

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Summary

 

Publications

Publication Type
Year
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237 results found

Vandenbriele C, M'Pembele R, Dannenberg L, Metzen D, Zako S, Helten C, Mourikis P, Ignatov D, Huhn R, Balthazar T, Adriaenssens T, Vanassche T, Meyns B, Panoulas V, Monteagudo-Vela M, Arachchillage D, Janssens S, Scherer C, Orban M, Petzold T, Horn P, Jung C, Zeus T, Price S, Westenfeld R, Kelm M, Polzin Aet al., 2024, Heparin dosing in patients with Impella-supported cardiogenic shock., Int J Cardiol, Vol: 399

BACKGROUND: Impella™ is increasingly used in cardiogenic shock. However, thromboembolic and bleeding events are frequent during percutaneous mechanical circulatory support (pMCS). OBJECTIVE: Therefore, we aimed to explore the optimal anticoagulation regime for pMCS to prevent thromboembolism and bleedings. METHODS: This hypothesis-generating multi-center cohort study investigated 170 patients with left-Impella™ support. We (A) compared bleeding/thrombotic events in two centers with therapeutic range (TR-aPTT) activated partial thromboplastin time (60-80s) and (B) compared events of these centers with one center with intermediate range aPTT (40-60s). RESULTS: After matching, there were no differences in patients' characteristics. In centers aiming at TR-aPTT, major bleeding was numerically lower with aPTT <60s within 48 h of left-Impella™ support, versus patients that achieved the aimed aPTT of ≥60s [aPTT ≥60s: 22 (37.3%) vs. aPTT<60s 14 (23.7%); Hazard ratio [HR], 0.62 (95%) CI, 0.28-1.38; p = 0.234]. Major cardiovascular and cerebrovascular adverse events (MACCE) did not differ between groups. In comparison of centers, TR-aPTT strategy showed higher major bleeding rates [TR: 8 (47.1%) vs. intermediate range: 1 (5.9%); HR, 0.06 (95%) CI, 0.01-0.45; p = 0.006]. MACCE were lower in the intermediate range aPTT group as well [TR 12 (70.6%) vs. intermediate range 5 (29.4%) HR, 0.32 (95%) CI, 0.11-0.92; p = 0.034]. CONCLUSION: This pilot analysis showed that lowering UFH-targets in left-Impella™ supported CS patients seems to be a safe and promising strategy for reducing major bleedings without increasing MACCE. This needs to be validated in larger, randomized clinical trials.

Journal article

Iannaccone M, Barbero U, Franchin L, Montabone A, De Filippo O, D'ascenzo F, Boccuzzi G, Panoulas V, Hill J, Brilakis ES, Chieffo Aet al., 2024, Comparison of mid-term mortality after surgical, supported or unsupported percutaneous revascularization in patients with severely reduced ejection fraction: A direct and network meta-analysis of adjusted observational studies and randomized-controlled., Int J Cardiol, Vol: 396

INTRODUCTION: The optimal revascularization strategy in patients with heart failure with reduced ejection fraction (HFrEF) remains to be elucidated. The aim of this paper is to compare the mid-term mortality rate among patients with severely reduced ejection fraction (EF) and complex coronary artery disease who underwent coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI) with Impella support, or without. METHODS: Randomized control trials and propensity-adjusted observational studies including patients with ischemic cardiomyopathy (ICM) and severe EF reduction undergoing revascularization were selected. Different revascularization strategies (CABG, supported PCI, and PCI without Impella) were compared in pairwise and network meta-analysis. The primary endpoint was mid-term mortality (within the first year after revascularization). RESULTS: Fifteen studies, mostly observational (17,841 patients; 6779 patients treated with CABG, 8478 treated with PCI without Impella, and 2584 treated with Impella-supported PCI) were included in this analysis. The median age was 67.8 years (IQR 65-70.1), 21.2% (IQR 16.4-26%) of patients were female sex, and a high prevalence of cardiovascular risk factors was noted across the entire population. At pairwise analysis, CABG and PCI without Impella showed similar one-year all-cause mortality (10.6% [IQR 7.5-12.6%] vs 12% [IQR 8.4-11.5%]) RR 0.85 CI 0.67-1.09, while supported PCI reduced one-year all-cause mortality compared to PCI without Impella (9.4% [IQR 5.7-12.5%] vs 10.6% [IQR 8.9-10.7%]) RR 0.77 CI 0.6-0.89. At network meta-analysis, supported PCI showed better results (RR 0.75, 95% CI 0.59-0.94) compared to CABG. CONCLUSION: Our analysis found that supported PCI may have a benefit over standard PCI in patients in direct comparison, and over CABG from indirect comparison, and with HFrEF undergoing revascularization. Further RCTs are needed to confirm this result. (PROSPERO CRD42023425667).

Journal article

Tindale A, Panoulas V, 2024, Validation of the BALLAR score for predicting 30-day mortality in patients requiring left-sided Impella support., Cardiovasc Revasc Med, Vol: 58, Pages: 98-100

Journal article

Bertoldi LF, Montisci A, Westermann D, Iannaccone M, Panoulas V, Werner N, Mangner Net al., 2023, From medical therapy to mechanical support: Strategies for device selection and implantation techniques, European Heart Journal, Supplement, Vol: 25, Pages: I11-I18, ISSN: 1520-765X

Cardiogenic shock (CS) is a complex clinical syndrome with a high risk of mortality. The recent, rapid development of temporary mechanical circulatory support (tMCS) has altered CS treatment. While catecholamines remain the cornerstone of CS therapy, tMCS usage has increased. According to shock severity, different treatment strategies including catecholamines alone, catecholamines and tMCS, or multiple tMCS might be used. State-of-The-Art implantation techniques are necessary to avoid complications linked to the invasive nature of tMCS. In particular, bleeding and access-site complications might counteract the potential haemodynamic benefit of a percutaneous ventricular assist device. In this review, we describe the role of catecholamines in CS treatment and present the different tMCS devices with an explanation on how to use them according to CS aetiology and severity. Finally, an overview of the best practice for device implantation is provided.

Journal article

Montisci A, Panoulas V, Chieffo A, Skurk C, Schäfer A, Werner N, Baldetti L, D'Ettore N, Pappalardo Fet al., 2023, Recognizing patients as candidates for temporary mechanical circulatory support along the spectrum of cardiogenic shock, European Heart Journal, Supplement, Vol: 25, Pages: I3-I10, ISSN: 1520-765X

A growing body of evidence indicates that the benefits of temporary mechanical circulatory support (tMCS) in patients with cardiogenic shock (CS) is dependent on its aetiology and timing of implantation. As such, appropriate diagnosis, screening, selection, and treatment is crucial to achieving good outcomes with tMCS. Here, the latest guidance on CS phenotypes and diagnostics for correctly identifying tMCS candidates is discussed. This includes comprehensive overviews of patient screening with attention given to differences in CS presentation between the sexes, and contraindications for mechanical circulatory support.

Journal article

Tindale A, Cretu I, Meng H, Panoulas Vet al., 2023, Complete revascularization is associated with higher mortality in patients with ST-elevation myocardial infarction, multi-vessel disease and shock defined by hyperlactataemia: results from the Harefield Shock Registry incorporating explainable machine learning, European Heart Journal – Acute CardioVascular Care, Vol: 12, Pages: 615-623, ISSN: 2048-8726

Aims:Revascularization strategy for patients with ST-elevation myocardial infarction (STEMI) and multi-vessel disease varies according to the patient’s cardiogenic shock status, but assessing shock acutely can be difficult. This article examines the link between cardiogenic shock defined solely by a lactate of ≥2 mmol/L and mortality from complete vs. culprit-only revascularization in this cohort.Methods and results:Patients presenting with STEMI, multi-vessel disease without severe left main stem stenosis and a lactate ≥2 mmol/L between 2011 and 2021 were included. The primary endpoint was mortality at 30 days by revascularization strategy for shocked patients. Secondary endpoints were mortality at 1 year and over a median follow-up of 30 months. Four hundred and eight patients presented in shock. Mortality in the shock cohort was 27.5% at 30 days. Complete revascularization (CR) was associated with higher mortality at 30 days [odds ratio (OR) 2.1 (1.02–4.2), P = 0.043], 1 year [OR 2.4 (1.2–4.9), P = 0.01], and over 30 months follow-up [hazard ratio (HR) 2.2 (1.4–3.4), P < 0.001] compared with culprit lesion-only percutaneous coronary intervention (CLOP). Mortality was again higher in the CR group after propensity matching (P = 0.018) and inverse probability treatment weighting [HR 2.0 (1.3–3.0), P = 0.001]. Furthermore, explainable machine learning demonstrated that CR was behind only blood gas parameters and creatinine levels in importance for predicting 30-day mortality.Conclusion:In patients presenting with STEMI and multi-vessel disease in shock defined solely by a lactate of ≥2 mmol/L, CR is associated with higher mortality than CLOP.

Journal article

Hewitson LJ, Cadiz S, Al-Sayed S, Fellows S, Amin A, Asimakopoulos G, Barnes E, Beale A, Browne S, Chandrasekaran B, Dalby M, Foley P, Hawkins M, Haynes D, Heng EL, Hyde T, Kabir T, Khavandi A, Mirsadraee S, Mccrea W, Petrou M, Senior R, Smith D, Smith R, Spartera M, Wamil M, Panoulas V, Rahbi Het al., 2023, Time to TAVI: streamlining the pathway to treatment, OPEN HEART, Vol: 10, ISSN: 2053-3624

Journal article

Poletti E, De Backer O, Scotti A, Costa G, Bruno F, Fiorina C, Buzzatti N, Latini A, Rudolph TK, van den Dorpel MMP, Brinkmann C, Patel KP, Panoulas V, Schofer J, Giordano A, Barbanti M, Regazzoli D, Taramasso M, Saia F, Baumbach A, Maisano F, Van Mieghem NM, Søndergaard L, Latib A, Amat Santos IJ, Bedogni F, Testa Let al., 2023, Transcatheter Aortic Valve Replacement for Pure Native Aortic Valve Regurgitation: The PANTHEON International Project., JACC Cardiovasc Interv, Vol: 16, Pages: 1974-1985

BACKGROUND: Transcatheter aortic valve replacement (TAVR) in patients with pure severe native aortic valve regurgitation (NAVR) has been associated with suboptimal results. The available evidence concerns mostly outdated transcatheter heart valves (THVs). OBJECTIVES: The aim of this study was to investigate the performance of new-generation THVs in patients treated for pure severe NAVR. METHODS: The PANTHEON (Performance of Currently Available Transcatheter Aortic Valve Platforms in Inoperable Patients With Pure Aortic Regurgitation of a Native Valve) study retrospectively included patients who underwent TAVR with currently available devices (both self-expanding [SE] and balloon expandable [BE]) for severe NAVR. Technical and device success rates as well as a composite of all-cause mortality and heart failure rehospitalization at 1 year were evaluated. The rate and clinical consequences of acute transcatheter valve embolization or migration (TVEM) were also considered. RESULTS: A total of 201 patients were included. Overall technical and device success rates were 83.6% and 76.1%, respectively, and did not differ between SE and BE devices. These figures were due mostly to TVEM occurrence (14.6% vs 16.1%; P = 0.47) and residual moderate or greater aortic regurgitation (9.2% vs 10.1%; P = 0.87). Patients who experienced TVEM compared with those without TVEM had a significantly higher incidence of the composite endpoint at 1 year (25.7% vs 15.8%; P = 0.05). CONCLUSIONS: Despite improved THV platforms and techniques, TAVR for pure severe NAVR remains a challenging procedure, with significant risk for TVEM. SE and BE platforms demonstrated comparable performance in this setting. (Performance of Currently Available Transcatheter Aortic Valve Platforms in Inoperable Patients With Pure Aortic Regurgitation of a Native Valve [PANTHEON]; NCT05319171).

Journal article

Tindale A, Panoulas V, 2023, The BE-ALIVE score: assessing 30-day mortality risk in patients presenting with acute coronary syndromes, Open Heart, Vol: 10, Pages: 1-7, ISSN: 2053-3624

AIM: To create and validate a simple scoring system for predicting 30-day mortality in patients presenting with acute coronary syndromes (ACS) at their moment of admission. METHODS AND RESULTS: 2407 consecutive patients presenting to Harefield Hospital with measured arterial blood gases, from January 2011 to December 2020, were studied to build the training set. 30-day mortality in this group was 17.2%. A scoring algorithm that was built using binary logistic regression of variables available on admission was then converted to an additive risk score. The resultant scoring system is the BE-ALIVE score, which incorporates the following factors:Base Excess (1 point for <-2 mmol/L), Age (<65 years: 0 points, 65-74: 1 point, 75-84: 2 points, ≥85: 3 points), Lactate (<2 mmol/L: 0 points, 2-4.9: 1 point, 5-9.9: 3 points, ≥10: 6 points), Intubated (2 points), Left Ventricular function (mildly impaired or better: -1 point, moderately impaired: 1 point, severely impaired: 3 points) and External/out of hospital cardiac arrest 2 points).The scoring system was validated using a testing set of 515 patients presenting to Harefield Hospital in 2021. The validation metrics were excellent with a c-statistic of 0.9, Brier's score 0.06 vs a naïve classifier of 0.15, Spiegelhalter's z-statistic probability of 0.267 and a calibration slope of 1.08. CONCLUSION: The BE-ALIVE score is a simple and accurate scoring system to predict 30-day mortality in patients presenting with ACS. Appreciating this mortality risk can allow prompt involvement of appropriate care such as the shock team.

Journal article

Monteagudo-Vela M, Monguio-Santin E, de Antonio Anton N, Aguirre F, Bernal Gallego B, Reyes-Copa G, Panoulas Vet al., 2023, Mini aortic valve replacement versus transcatheter aortic valve implantation: a propensity-matched study, Journal of Cardiac Surgery, Vol: 2023, ISSN: 0886-0440

Background: Total sternotomy for aortic valve replacement has been superseded by less invasive approaches such as mini sternotomy or transcatheter procedures.There has been an exponential uptake in transcatheter aortic valve implantation (TAVI) in younger and lower risk patients following recent randomized trials.This study aims to compare the outcomes of patients with aortic stenosis treated with minimally invasive approaches: mini sternotomy for aortic valve replacement (mini AVR) and TAVI implantation.Methods: Between January 2015 and December 2021, a total of 1437 TAVI and 176 mini AVR patients from 2 tertiary centers fulfilled the criteria and were included in the propensity matching model.Results: A total of 256 TAVIs and 146 mini AVR were included in the matched cohort. There was no significant difference in 30-day mortality in the two groups (TAVI vs. mini AVR 2.7% vs. 2.8%, p=0.935). TAVI confers slightly lower gradients in the follow-up echo when compared with mini AVR (peak gradient 20±8.7mmHg vs 24.5±10mmHg, p <0.001; mean gradient 10.9±5.6mmHg vs 13.2±5.7mmHg, p<0.001). On the other hand, mini AVR exhibits remarkably lower rates of paravalvular leak (mild leak 8% vs 41.5%, p<0.001; moderate leak 2.8% vs 0%, p<0.001), and of need for permanent pacemaker implantation (2% vs 12.2%, p<0.001). Unsurprisingly, TAVI has lower in hospital stay 3 (2 to 6) days vs. 10 (8 to 13) days, p<0.001).Conclusions: For eligible aortic stenosis patients in the 7th decade of life, mini AVR remains an excellent therapeutic option.

Journal article

Van Edom CJ, Gramegna M, Baldetti L, Beneduce A, Castelein T, Dauwe D, Frederiks P, Giustino G, Jacquemin M, Janssens SP, Panoulas VF, Pöss J, Rosenberg A, Schaubroeck HAI, Schrage B, Tavazzi G, Vanassche T, Vercaemst L, Vlasselaers D, Vranckx P, Belohlavek J, Gorog DA, Huber K, Mebazaa A, Meyns B, Pappalardo F, Scandroglio AM, Stone GW, Westermann D, Chieffo A, Price S, Vandenbriele Cet al., 2023, Management of Bleeding and Hemolysis During Percutaneous Microaxial Flow Pump Support: A Practical Approach., JACC Cardiovasc Interv, Vol: 16, Pages: 1707-1720

Percutaneous ventricular assist devices (pVADs) are increasingly being used because of improved experience and availability. The Impella (Abiomed), a percutaneous microaxial, continuous-flow, short-term ventricular assist device, requires meticulous postimplantation management to avoid the 2 most frequent complications, namely, bleeding and hemolysis. A standardized approach to the prevention, detection, and treatment of these complications is mandatory to improve outcomes. The risk for hemolysis is mostly influenced by pump instability, resulting from patient- or device-related factors. Upfront echocardiographic assessment, frequent monitoring, and prompt intervention are essential. The precarious hemostatic balance during pVAD support results from the combination of a procoagulant state, due to critical illness and contact pathway activation, together with a variety of factors aggravating bleeding risk. Preventive strategies and appropriate management, adapted to the impact of the bleeding, are crucial. This review offers a guide to physicians to tackle these device-related complications in this critically ill pVAD-supported patient population.

Journal article

Kalogeras K, Jabbour RJ, Pracon R, Kabir T, Shannon J, Duncan A, Quarto C, Heng E-L, Rahbi H, Oikonomou E, Katsianos E, Patel N, Chandra N, Vavuranakis M-A, Cadiz S, Bougiakli M, Smith RD, Siasos G, Vavuranakis M, Davies S, Dalby M, Panoulas Vet al., 2023, Midterm Outcomes in Patients With Aortic Stenosis Treated With Contemporary Balloon-Expandable and Self-Expanding Valves: Does Valve Size Have an Impact on Outcome?, JOURNAL OF THE AMERICAN HEART ASSOCIATION, Vol: 12

Journal article

Kallis C, Kaura A, Samuel N, Glampson B, Panoulas V, Elliott P, Asselbergs F, Mayer E, Mayet J, Quint JKet al., 2023, The Relationship Between Cardiac Troponin in Hospitalised Exacerbating Chronic Obstructive Pulmonary Disease (COPD) Patients With Major Adverse Cardiac Events (MACE) and COPD Readmissions, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X

Conference paper

Monteagudo-Vela M, Tindale A, Monguio-Santin E, Reyes-Copa G, Panoulas Vet al., 2023, Right ventricular failure: Current strategies and future development, FRONTIERS IN CARDIOVASCULAR MEDICINE, Vol: 10, ISSN: 2297-055X

Journal article

Van Edom C, Fiorelli F, Balthazar T, Jacquemin M, Janssens S, Meyns B, Vela MM, Price S, Rosenberg A, Tindale A, Van der Linden L, Vanassche T, Panoulas V, Vandenbriele Cet al., 2023, Heparin monitoring in Impella™-supported cardiogenic shock patients: the benefit of a parallel dual test approach, Publisher: TAYLOR & FRANCIS LTD, Pages: 20-21, ISSN: 0001-5385

Conference paper

Monteagudo-Vela M, Bastante T, Monguio-Santin E, del Val D, Panoulas V, Reyes-Copa Get al., 2022, Coronary-subclavian steal syndrome: a case report of a rare entity that can become a deadly threat, EUROPEAN HEART JOURNAL-CASE REPORTS, Vol: 7

Journal article

Panoulas V, Tan S-T, Hill J, Tarantini Get al., 2022, Specific clinical vignettes in high-risk protected percutaneous coronary intervention, EUROPEAN HEART JOURNAL SUPPLEMENTS, Vol: 24, Pages: J43-J48, ISSN: 1520-765X

Journal article

Tindale A, Panoulas V, 2022, Real-world intravascular ultrasound (IVUS) use in percutaneous intervention-naive patients is determined predominantly by operator, patient, and lesion characteristics, FRONTIERS IN CARDIOVASCULAR MEDICINE, Vol: 9, ISSN: 2297-055X

Journal article

Leick J, Werner N, Mangner N, Panoulas V, Aurigemma Cet al., 2022, Optimized patient selection in high-risk protected percutaneous coronary intervention, European Heart Journal, Supplement, Vol: 24, Pages: J4-J10, ISSN: 1520-765X

Percutaneous mechanical circulatory support (pMCS) is increasingly used in patients with poor left-ventricular (LV) function undergoing elective high-risk percutaneous coronary interventions (HR-PCIs). These patients are often in critical condition and not suitable candidates for coronary artery bypass graft surgery. For the definition of HR-PCI, there is a growing consensus that multiple factors must be considered to define the complexity of PCI. These include haemodynamic status, left-ventricular ejection fraction, clinical characteristics, and concomitant diseases, as well as the complexity of the coronary anatomy/lesions. Although haemodynamic support by percutaneous LV assist devices is commonly adopted in HR-PCI (protected PCI), there are no clear guideline recommendations for indication due to limited published data. Therefore, decisions to use a nonsurgical, minimally invasive procedure in HR-PCI patients should be based on a risk–benefit assessment by a multidisciplinary team. Here, the current evidence and indications for protected PCI will be discussed.

Journal article

Briar C, Swedan S, Price S, Trimlett R, Jackson T, Davies S, Panoulas V, Evans E, Lytton R, Caroli S, Till J, Desai A, Dominy ACet al., 2022, INNOVATIVE ADAPTATION OF PAEDIATRIC E-CPR (EXTRACORPOREAL CARDIOPULMONARY RESUSCITATION) WITH ADDITION OF AN IMPELLA VENTRICULAR SUPPORT DEVICE FACILITATED BY MULTISPECIALITY COLLABORATION, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 1529-7535

Conference paper

Kanji R, Panoulas VF, Duncan A, Davies SW, Luscher TF, Mirsadraee SS, Arachchillage DRJ, Gorog DAet al., 2022, Increasing transvalvular gradient related to effectiveness of endogenous fibrinolysis in patients with severe aortic stenosis, Publisher: OXFORD UNIV PRESS, ISSN: 0008-6363

Conference paper

Naganuma T, Panoulas VF, Onishi H, Kawamoto H, Nakamura Set al., 2022, 5-Year Follow-Up Images of a Balloon Expandable Valve Placed in Descending Aorta., JACC Cardiovasc Interv, Vol: 15, Pages: e203-e204

Journal article

Monteagudo Vela M, Rosengerb A, Fiorelli F, Tindale A, Panoulas Vet al., 2022, Using a Protocolized Approach and a Dedicated Shock Team Leads to Significant Reductions in 30-day Mortality in Acute Coronary Syndrome Patients With Cardiogenic Shock, 34th Annual Symposium on Transcatheter Cardiovascular Therapeutics (TCT), Publisher: ELSEVIER SCIENCE INC, Pages: B30-B31, ISSN: 0735-1097

Conference paper

Tindale A, Panoulas V, 2022, Complete Revascularisation in Patients Presenting With STSegment Elevation MI, Cardiogenic Shock, and Multivessel Disease Is Associated With Higher Mortality at 30 Days, 1 Year, and up to 30 Months of Follow-Up, 34th Annual Symposium on Transcatheter Cardiovascular Therapeutics (TCT), Publisher: ELSEVIER SCIENCE INC, Pages: B28-B28, ISSN: 0735-1097

Conference paper

Pracon R, Dimitrov A, McGarvey M, Cadiz S, Kabir T, Dalby M, Duncan A, Davies SW, Panoulas Vet al., 2022, Outcomes of Patients Undergoing TAVI for Purely Regurgitant Native Aortic Valves With the Current Generation Transcatheter Aortic Valve Platforms, 34th Annual Symposium on Transcatheter Cardiovascular Therapeutics (TCT), Publisher: ELSEVIER SCIENCE INC, Pages: B173-B174, ISSN: 0735-1097

Conference paper

Pracon R, McGarvey M, Dimitrov A, Cadiz S, Kabir T, Dalby M, Duncan A, Davies SW, Panoulas Vet al., 2022, Outcomes of Patients Undergoing ViV TAVR With the Current-Generation Transcatheter Aortic Valves for Purely Regurgitant Surgical Bioprostheses, 34th Annual Symposium on Transcatheter Cardiovascular Therapeutics (TCT), Publisher: ELSEVIER SCIENCE INC, Pages: B213-B213, ISSN: 0735-1097

Conference paper

Jabbour R, Pracon R, Kabir T, Shannon J, Duncan A, Heng EL, Oikonomou E, Katsianos E, Patel N, Chandra N, Smith R, Vavouranakis M, Dalby M, Panoulas V, Kalogeras Ket al., 2022, Improved Mid-term Survival in Aortic Stenosis Patients Treated With Small Self-Expanding vs Balloon- Expandable Transcatheter Heart Valves, 34th Annual Symposium on Transcatheter Cardiovascular Therapeutics (TCT), Publisher: ELSEVIER SCIENCE INC, Pages: B186-B186, ISSN: 0735-1097

Conference paper

Benedetto U, Sinha S, Mulla A, Glampson B, Davies J, Panoulas V, Gautama S, Papadimitriou D, Woods K, Elliott P, Hemingway H, Williams B, Asselbergs FW, Melikian N, Krasopoulos G, Sayeed R, Wendler O, Baig K, Chukwuemeka A, Angelini GD, Sterne JAC, Johnson T, Shah AM, Perera D, Patel RS, Kharbanda R, Channon KM, Mayet J, Kaura Aet al., 2022, Implications of elevated troponin on time-to-surgery in non-ST elevation myocardial infarction (NIHR Health Informatics Collaborative: TROP-CABG study)., Int J Cardiol, Vol: 362, Pages: 14-19

Implications of elevated troponin on time-to-surgery in non-ST elevation myocardial infarction(NIHR Health Informatics Collaborative:TROP-CABG study). Benedetto et al. BACKGROUND: The optimal timing of coronary artery bypass grafting (CABG) in patients with non-ST elevation myocardial infarction (NSTEMI) and the utility of pre-operative troponin levels in decision-making remains unclear. We investigated (a) the association between peak pre-operative troponin and survival post-CABG in a large cohort of NSTEMI patients and (b) the interaction between troponin and time-to-surgery. METHODS AND RESULTS: Our cohort consisted of 1746 patients (1684 NSTEMI; 62 unstable angina) (mean age 69 ± 11 years,21% female) with recorded troponins that had CABG at five United Kingdom centers between 2010 and 2017. Time-segmented Cox regression was used to investigate the interaction of peak troponin and time-to-surgery on early (within 30 days) and late (beyond 30 days) survival. Average interval from peak troponin to surgery was 9 ± 15 days, with 1466 (84.0%) patients having CABG during the same admission. Sixty patients died within 30-days and another 211 died after a mean follow-up of 4 ± 2 years (30-day survival 0.97 ± 0.004 and 5-year survival 0.83 ± 0.01). Peak troponin was a strong predictor of early survival (adjusted P = 0.002) with a significant interaction with time-to-surgery (P interaction = 0.007). For peak troponin levels <100 times the upper limit of normal, there was no improvement in early survival with longer time-to-surgery. However, in patients with higher troponins, early survival increased progressively with a longer time-to-surgery, till day 10. Peak troponin did not influence survival beyond 30 days (adjusted P = 0.64). CONCLUSIONS: Peak troponin in NSTEMI patients undergoing CABG was a significant predictor of earl

Journal article

Tindale A, Vela MM, Panoulas V, 2022, Using Base Excess, Albumin, Lactate, and Renal Function to Predict 30-Day Mortality in Patients Requiring Impella Monotherapy for Left-Sided Mechanical Circulatory Support: The BALLAR Score, CARDIOVASCULAR REVASCULARIZATION MEDICINE, Vol: 41, Pages: 129-135, ISSN: 1553-8389

Journal article

Kaura A, Samuel NA, Roddick A, Glampson B, Mulla A, Davies J, Panoulas V, Woods K, Shah AD, Gautama S, Elliott P, Hemingway H, Williams B, Asselbergs FW, Melikian N, Shah AM, Kharbanda R, Perera D, Patel RS, Channon KM, Shah ASV, Mayet Jet al., 2022, PROGNOSTIC SIGNIFICANCE OF TROPONIN IN PATIENTS WITH MALIGNANCY (NIHR HEALTH INFORMATICS COLLABORATIVE TROP-MALIGNANCY STUDY), Annual Conference of the British-Cardiovascular-Society - 100 Years of Cardiology, Publisher: BMJ PUBLISHING GROUP, Pages: A135-A135, ISSN: 1355-6037

Conference paper

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