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Aljehani A, Kew T, Baig S, Cox H, Sommerfeld LC, Ensam B, Kalla M, Steeds RP, Fabritz L. Characterisation of patients referred to a tertiary-level inherited cardiac condition clinic with suspected arrhythmogenic right ventricular cardiomyopathy (ARVC). BMC Cardiovasc Disord 2023; 23:14. [PMID: 36635648 PMCID: PMC9837886 DOI: 10.1186/s12872-022-03021-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC) or arrhythmogenic cardiomyopathy is a rare inherited disease with incomplete penetrance and an environmental component. Although a rare disease, ARVC is a common cause of sudden cardiac death in young adults. Data on the different stages of ARVC remains scarce. The purpose of this study is to describe the initial presentation and cardiac phenotype of definite and non-definite ARVC for patients seen at a tertiary service. METHODS This is a single centre, observational cohort study of patients with definite and non-definite ARVC seen at the Inherited Cardiac Conditions services at University Hospital Birmingham (UHB) in the period 2010-2021. Patients were identified by interrogation of digital health records, medical history, imaging and by examining 12-lead electrocardiograms (ECG). RESULT The records of 1451 patients were reviewed; of those, 165 patients were at risk of ARVC (mean age 41 ± 17 years, 56% male). 60 patients fulfilled task force criteria for definite ARVC diagnosis (n = 40, 67% males), and 38 (72%) of them carried a known pathogenic variant. The remaining 105 patients (50% males) were non-definite, and of these 45 (62%) carried a known pathogenic variant. Patients in the definite group were more symptomatic, with palpitations (57% vs. 17%), syncope (35% vs. 6%) and shortness of breath (28% vs. 5%, p < 0.001). T-wave inversion in V1-V3 and epsilon waves were observed only in the definite group. Both PR interval and QRS duration were longer in the definite (170 ± 34 ms and 100 ± 19 ms, p < 0.001) compared to (149 ± 25 and 91 ± 14 ms, p = 0.005). Patients with definite ARVC had significantly larger RV end diastolic areas and significantly reduced biventricular function (RVEDA = 27 ± 10 cm2, RVFAC = 37 ± 11% and EF = 56 ± 12%) compared to the non-definite group (RVEDA = 18 ± 4 cm2, RVFAC 49 ± 6% and LVEF 64 ± 7%, p < 0.001). Sustained ventricular tachycardia (VT) occurred more frequently in the definite group compared to the non-definite group (27% vs. 2%, p < 0.001). Ventricular fibrillation was observed in the definite group only (8 of 60 patients, 13%). CONCLUSION Our study showed differences between definite and non-definite ARVC patients in terms of clinical, electrophysiological and imaging features. Major adverse cardiac events occurred more commonly in the definite group, but also were observed in non-definite ARVC. This single centre observational cohort study forms a basis for further prospective multicentre interventional studies.
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Affiliation(s)
- A. Aljehani
- grid.6572.60000 0004 1936 7486Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK ,grid.412563.70000 0004 0376 6589Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK ,grid.412149.b0000 0004 0608 0662King Saud Bin Abdulaziz University For Health Sciences, Echocardiography Cardiovascular Technology (ECVT) Program, Riyadh, Saudi Arabia
| | - T. Kew
- grid.6572.60000 0004 1936 7486Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK ,grid.412563.70000 0004 0376 6589Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S. Baig
- grid.6572.60000 0004 1936 7486Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK ,grid.412563.70000 0004 0376 6589Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - H. Cox
- grid.498025.20000 0004 0376 6175West Midlands Regional Genetics Unit, Clinical Genetics, Birmingham Women’s and Children’s NHS Foundation Trust (BWC) Birmingham, Birmingham, UK
| | - L. C. Sommerfeld
- grid.6572.60000 0004 1936 7486Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK ,grid.13648.380000 0001 2180 3484University Centre of Cardiovascular Science, UKE Hamburg, Hamburg, Germany
| | - B. Ensam
- grid.412563.70000 0004 0376 6589Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M. Kalla
- grid.6572.60000 0004 1936 7486Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK ,grid.412563.70000 0004 0376 6589Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R. P. Steeds
- grid.6572.60000 0004 1936 7486Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK ,grid.412563.70000 0004 0376 6589Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - L. Fabritz
- grid.6572.60000 0004 1936 7486Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK ,grid.412563.70000 0004 0376 6589Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK ,Department of Cardiology, University Heart and Vascular Centre Hamburg, UKE Hamburg and DZHK, Hamburg/Kiel/Luebeck, Germany ,grid.13648.380000 0001 2180 3484University Centre of Cardiovascular Science, UKE Hamburg, Hamburg, Germany
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2
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Bunting KV, Mehta S, Gill SK, Steeds RP, Kotecha D. Digoxin improves systolic cardiac function in patients with AF and HFpEF: the RATE-AF randomised trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The RAte control Therapy Evaluation in permanent AF trial (RATE-AF; NCT02391337) was the first head-to-head controlled trial of beta-blockers versus digoxin in patients with permanent atrial fibrillation (AF) and symptoms of heart failure. Patients randomised to digoxin had similar physical-related quality of life and heart rate, with significantly improved functional class, reduced N-terminal pro-brain natriuretic peptide (NT-proBNP) and substantially less adverse events. The impact of rate control therapy on measures of cardiac function is not currently understood.
Purpose
To compare the effect of digoxin versus beta-blockers on systolic and diastolic cardiac function according to heart failure sub-type.
Methods
Blinded echocardiograms assessing systolic and diastolic function were performed at baseline and 12 month follow-up, using a robust method to account for rhythm irregularity (average of three index-beats acquired in appropriate cardiac cycles). Outcomes were the change in left-ventricular ejection fraction (LVEF), systolic tissue Doppler velocity (s'), stroke volume, global longitudinal strain (GLS), diastolic tissue Doppler (e'), mitral E wave deceleration time, E/e', pulmonary vein diastolic deceleration time, isovolumic relaxation time and left atrial ejection fraction. Analyses were stratified by baseline LVEF (≥50%, 40–50% and <40%).
Results
160 patients were randomised, of which 145 patients survived to 12-month follow-up with median age 75 years (IQR 69–82) and 44% women. Median baseline heart rate was 96 beats/min (IQR 86–112), blood pressure 135/85 mmHg (IQR 124/77–146/91), NTproBNP 1049 pg/mL (744–1463) and mean NYHA class 2.4 (SD 0.6). In 119 patients with LVEF ≥50% at baseline, diastolic and systolic parameters improved over time with digoxin therapy. There was a significantly greater improvement in systolic function in 63 patients on digoxin compared to 67 with beta-blockers; Figure 1. Patients randomised to digoxin had a higher LVEF at follow-up (adjusted mean difference [AMD] 2.3%, 95% CI 0.3–4.2; p=0.021), higher s' (1.1cm/s, 1.0–1.2; p=0.003) and higher stroke volume (6.5mL, 0.4–12.6; p=0.037) compared to beta-blockers, without any difference in diastolic parameters (Figure 2). In 16 patients with LVEF 40–50% at baseline, s' significantly increased with digoxin compared to beta-blockers (AMD 1.5 cm/s, 1.2–1.7; p=0.001), with no difference for other systolic or diastolic parameters. 10 patients with LVEF <40% at baseline showed no difference between digoxin and beta-blockers for any echocardiographic measures.
Conclusion
Patients randomised to digoxin with permanent AF, heart failure symptoms and preserved LVEF have significantly greater improvement in multiple parameters of systolic function compared to conventional treatment with beta-blockers.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): National Institute of Health Research
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Affiliation(s)
- K V Bunting
- University of Birmingham, Institute of Cardiovascular Sciences , Birmingham , United Kingdom
| | - S Mehta
- University of Birmingham, Birmingham Clinical Trials Unit , Birmingham , United Kingdom
| | - S K Gill
- University of Birmingham, Institute of Cardiovascular Sciences , Birmingham , United Kingdom
| | - R P Steeds
- University of Birmingham, Institute of Cardiovascular Sciences , Birmingham , United Kingdom
| | - D Kotecha
- University of Birmingham, Institute of Cardiovascular Sciences , Birmingham , United Kingdom
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Pallikadavath S, Greenwood JP, Berry C, Dawson DK, Hogrefe K, Kelly DJ, Lang CC, Khoo JP, Springings D, Steeds RP, McCann GP, Singh A. Transaortic flow rate to predict short and long term outcomes in individuals with asymptomatic aortic stenosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Echocardiographic derived transaortic flow rate (TFR), defined as stroke volume over left ventricular ejection time, has been shown to be associated with increased mortality in asymptomatic mild to severe aortic stenosis (AS) and superior to stroke volume index (SVi) in individuals with symptomatic discordant AS undergoing aortic valve replacement. However, TFR has not been explored alongside SVi in asymptomatic moderate to severe AS, who are a group of interest in risk stratifying for early intervention. Moreover, there is no data where TFR is indexed to body surface area (TFRi).
Purpose
We explored the prognostic value of TFR, TFRi and SVi in a homogenous cohort of asymptomatic patients with moderate to severe AS.
Methods
Subjects with asymptomatic moderate to severe AS were prospectively recruited to the Prognostic Importance of Microvascular Dysfunction in asymptomatic patients with AS (PRIMID) study, a multi-centre observational study in the UK conducted between April 2012 and November 2014. All subjects underwent extensive phenotyping with transthoracic echocardiography, bicycle exercise testing and cardiovascular magnetic resonance (CMR) imaging, with blinded core-lab analysis. Patients were followed up in person for a minimum of 12 months, and through health records thereafter. The composite outcome of interest was: cardiovascular mortality, AVR for symptoms and major adverse cardiovascular events (hospitalisation with heart failure, myocardial infarction, syncope and arrhythmia) at one-year and at five years. A cox proportional hazards model was used to calculate a hazard ratio (HR) and 95% confidence intervals (95% CI). Known co-variables associated with the composite outcome were added into the multivariable model.
Results
Overall, 173 individuals were included with a mean age of 66.3—-±13.3 years and 76.4% were male. Most individuals had severe AS (71.1%, n=123). There were 47 (64.4%) primary outcome events at one-year and 110 (63.6%) events at five-years. Age, sex, N-terminal pro brain natriuretic peptide (NT-pro-BNP), peak aortic velocity (AV Vmax), a positive exercise tolerance test (ETT), myocardial perfusion reserve and right ventricular ejection fraction measured on cardiac magnetic resonance were included in the multivariable model in addition to TFR or TFRi or SVi. Decreasing TFR and TFRi remained independently associated with one-year and five-year composite outcome (Figure 1). However, SVi was only associated with the composite outcome at five-years. AV Vmax (HR: 4.36, 95% CI: 2.59, 7.34, p<0.01) and a positive ETT (HR: 1.87, 95% CI: 1.03, 3.37, p=0.04) were independently associated with the primary outcome at one-year.
Conclusion
Both TFR and TFRi have a potential role in risk stratifying asymptomatic patients with AS and identifying those for earlier intervention, and may be superior to SVi. However, further prospectively designed studies are needed before this becomes part of the routine clinical practice.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Independent research from a Post-Doctoral Fellowship supported by the National Institute for Health Research (NIHR-PDF 2011-04-51 Geral P McCann).
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Affiliation(s)
- S Pallikadavath
- NIHR Biomedical Research Unit in Cardiovascular Disease , Leicester , United Kingdom
| | - J P Greenwood
- Leeds Teaching Hospitals NHS Trust, Leeds Institute for Cardiovascular and Diabetes Research , Leeds , United Kingdom
| | - C Berry
- University of Glasgow, BHF Glasgow Cardiovascular Research Centre , Glasgow , United Kingdom
| | - D K Dawson
- University of Aberdeen, Cardiovascular Medicine Research Unit , Aberdeen , United Kingdom
| | - K Hogrefe
- Kettering General Hospital, Cardiology Department , Kettering , United Kingdom
| | - D J Kelly
- Royal Derby Hospital, Cardiology Department , Derby , United Kingdom
| | - C C Lang
- Ninewells Hospital, Division of Cardiovascular and Diabetes Medicine , Dundee , United Kingdom
| | - J P Khoo
- Glenfield Hospital, NIHR Biomedical Research Unit in Cardiovascular Disease , Leicester , United Kingdom
| | - D Springings
- Northampton General Hospital , Northampton , United Kingdom
| | - R P Steeds
- Queen Elizabeth Hospital Birmingham, Cardiovascular Medicine , Birmingham , United Kingdom
| | - G P McCann
- NIHR Biomedical Research Unit in Cardiovascular Disease , Leicester , United Kingdom
| | - A Singh
- NIHR Biomedical Research Unit in Cardiovascular Disease , Leicester , United Kingdom
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Vijapurapu R, Maanja M, Schlegel T, Augusto J, Kurdi H, Moon JC, Hughes DA, Geberhiwot T, Ugander M, Steeds RP, Kozor R. Advanced electrocardiography predicts early cardiac involvement and incident arrhythmias in Fabry disease. Europace 2022. [DOI: 10.1093/europace/euac053.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Fabry disease is an X-linked disorder, with cardiovascular involvement characterised by progressive myocardial sphingolipid deposition. Cardiac disease is a major contributor to morbidity and mortality. Cardiac magnetic resonance (CMR) with T1 mapping and advanced electrocardiography (A-ECG) offer both diagnostic and prognostic potential.
Purpose
To evaluate the predictive power of A-ECG markers in identifying: 1) early cardiac involvement defined as low myocardial T1 on CMR, and 2) adverse cardiovascular outcomes defined as any arrhythmia requiring therapy, atrial fibrillation, hospitalisation for heart failure or mortality.
Methods
Patients included in this longitudinal, multi-centre study underwent same-day standard resting 12-lead ECG and CMR. CMR included standard cine imaging, T1 mapping with modified Look Locker inversion recovery (MOLLI, 5s(3s)3s), and late gadolinium enhancement (LGE). ECG digital files were analysed using in-house A-ECG software. A-ECG analysis included conventional ECG measures, derived vectorcardiographic measures, and singular value decomposition measures of waveform complexity. Significant A-ECG variables were identified using stepwise forward regression and incorporated in a multivariable logistic regression A-ECG score. A Youden index was applied to identify best threshold score and bootstrapping performed to calculate the area under the receiver operating characteristics curve (AUC), sensitivity, specificity, and 95% confidence intervals (CI).
Results
Among included patients (n=155, 40% male, age 46±14 years, 39% on enzyme replacement therapy), left ventricular mass index was higher in males compared to females (106 vs. 59 g/m2, p<0.001), 80% of patients had myocardial native T1 below the local reference range (933 vs. 968 ms, p=0.06), and 51% (70/136) had focal LGE. Multivariable A-ECG scores for detecting low T1, any arrhythmia, or atrial fibrillation had an AUC [95%CI], sensitivity, and specificity of 0.82 [0.75-0.89], 72 [55-95]%, 85 [66-71]%; 0.89 [0.82-0.95], 82 [68-94]%, 88 [70-96]%; and 0.89 [0.80-0.96], 92 [77-100]%, 83 [76-92]%, respectively, Figure 1. No predictors of heart failure hospitalisation or mortality were found.
Conclusion
A-ECG analysis of the resting 12-lead ECG has good diagnostic performance for predicting early myocardial involvement and the occurrence of arrhythmias in Fabry disease. This supports the use of A-ECG both as a screening tool to diagnose early cardiac disease, and for identifying those at risk of adverse arrhythmic outcomes.
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Affiliation(s)
- R Vijapurapu
- Queen Elizabeth Hospital Birmingham, Cardiology, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - M Maanja
- Karolinska University Hospital, Department of Clinical Physiology, Stockholm, Sweden
| | - T Schlegel
- Karolinska University Hospital, Department of Clinical Physiology, Stockholm, Sweden
| | - J Augusto
- Barts Heart Centre, Department of Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - H Kurdi
- Barts Heart Centre, Department of Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - JC Moon
- Barts Heart Centre, Department of Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - DA Hughes
- Royal Free Hospital, Lysosomal Storage Disorder Unit, London, United Kingdom of Great Britain & Northern Ireland
| | - T Geberhiwot
- Queen Elizabeth Hospital Birmingham, Endocrinology, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - M Ugander
- Karolinska University Hospital, Department of Clinical Physiology, Stockholm, Sweden
| | - RP Steeds
- Queen Elizabeth Hospital Birmingham, Cardiology, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - R Kozor
- Royal North Shore Hospital, Kolling Institute, Sydney, Australia
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Sharma H, Yuan M, Shakeel I, Radhakrishnan A, Brown S, May J, Zia N, O'Connor K, Hothi SS, Myerson SG, Nadir MA, Steeds RP. Changes in mitral regurgitation following acute myocardial infarction: early and long-term follow-up. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Mitral regurgitation (MR) is commonly observed following acute myocardial infarction (MI). Localised left ventricular (LV) remodelling in the region of papillary muscles together with impaired myocardial contractility promote MR. There is a paucity of long-term follow-up studies to determine whether the severity of MR observed post-MI, changes with time.
Purpose
This study retrospectively followed up patients with MR detected following acute MI (AMI) to investigate changes in MR severity with time and assess for pre-discharge predictors of MR regression or progression.
Methods
Clinical records of 1000 patients admitted with AMI between 2016 and 2017 to a single centre were retrospectively interrogated. One hundred and nine patients met the inclusion criteria of MR on pre-discharge transthoracic echocardiography (TTE) and follow-up TTE scans. Echocardiographic parameters were investigated to determine predictors of progression or regression at follow-up. Patients were divided according to those who had early follow-up TTE (within 1-year) and late follow-up TTE (beyond 1-year).
Results
Early follow-up TTE was performed in 73 patients at a median of 6 (IQR 3–9) months. Patients had a mean age of 69±13 years and were predominantly male 50/73 (68%). At baseline, relative MR severities were: 49/73 (67%) mild MR, 23/73 (32%) moderate MR and 1 (1%) severe MR. At follow-up, MR had completely resolved in 18/73 (23%) patients, while 39/73 (53%) had mild MR, 15/73 (21%) moderate MR and 1 (1%) severe MR. Compared to patients with no resolution of MR, those with completel resolution were younger (mean age 62±16 vs 72±11 years; p=0.015) but there were no other significant differences between the groups. Resolution at early follow-up did not significantly influence long-term mortality rates. Late follow-up TTE was performed in 69 patients at a median 2.4 (IQR 2–3.2) years. Pre-discharge, 49/69 (71%) patients had mild MR and 20/69 (29%) moderate MR. At follow-up, MR had completely resolved in 18/69 (26%), and amongst patients with persistent MR, proportion of severities were: 37/69 (54%) mild MR, 11/69 (16%) moderate MR and 3/69 (4%) severe MR. Patients with progression of mild MR were more likely to have lower left ventricular ejection fraction (LVEF: 47±15 vs 57±12%; p=0.010) and greater indexed left ventricular end-systolic volume (LVESVi: 37±23 vs 25±14 ml/m2; p<0.001) on pre-discharge TTE. Resolution of MR at late follow-up was associated with a reduction in long-term mortality [deaths: 2/55 (3%) vs 3/14 (21%); p=0.022] at a mean follow-up of 4.2 years from MI.
Conclusion
MR observed following AMI completely resolved in approximately one-quarter of patients at 6-month and 2-year follow-up. Progression of mild MR at long-term follow-up appears to be associated with increased mortality and is predicted by lower LVEF and greater LVESVi pre-discharge.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- H Sharma
- University of Birmingham, Birmingham, United Kingdom
| | - M Yuan
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - I Shakeel
- University of Birmingham, Birmingham, United Kingdom
| | | | - S Brown
- University of Birmingham, Birmingham, United Kingdom
| | - J May
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - N Zia
- University of Birmingham, Birmingham, United Kingdom
| | - K O'Connor
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - S S Hothi
- New Cross Hospital, Wolverhampton, United Kingdom
| | - S G Myerson
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom
| | - M A Nadir
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - R P Steeds
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
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Sharma H, Yuan M, Shakeel I, Morley-Smith A, Nadir MA, Chue C, Myerson SG, Steeds RP, Lim S. Left ventricular assist device therapy improves severe secondary mitral regurgitation without mitral valve repair. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Severe secondary mitral regurgitation (MR) worsens prognosis in patients with medically managed heart failure (HF). In patients treated by left ventricular assist device (LVAD), it is unclear whether severe MR should be corrected at time of LVAD implantation.
Purpose
To evaluate impact of LVAD therapy on severe and non-severe secondary MR over 1 year.
Methods
Retrospective single centre study of consecutive patients who underwent HeartMate (HM)2 or HM3 LVAD implantation between January 2011 and March 2020.
Results
Of 155 patients, 20 were excluded due to LVAD exchange (n=10), mitral valve repair (n=1), or inaccessible pre-LVAD echocardiography (n=9). Based on multiparametric grading, 29/135 patients had severe secondary MR and 106/135 had non-severe secondary MR (including none). Severe MR patients were more often female [10/29 (34%) vs 11/106 (10%); p=0.002] but were of similar age (54±12 vs 55±9 years; p=0.624), size (27±5 vs 27±4 kg/m2; p=1.0), with equivalent renal function (53±22 vs 55±20 ml/min/1.73m2; p=0.641) and median pre-operative NT-proBNP [4076 (IQR 206–5438) vs 4914 (IQR 2706–7518) ng/L; p=0.488]. There were similar proportions of patients with ischaemic aetiology [16/29 (55%) vs 66/106 (62%); p=0.488) and those receiving HM2 [11/29 (38%) vs 32/106 (30%)] and HM3 [18/29 (62%) vs 74/106 (70%); p=0.575] LVAD. Echocardiography before LVAD implantation demonstrated similar left ventricular (LV) size (LV end-diastolic volume: 133±44 vs 118±50ml/m2; p=0.145, end-systolic volume: 107±41 vs 96±59ml/m2; p=0.348) and LV ejection fraction (17±9 vs 17±7%; p=1.0). Severe MR patients had significantly greater (p<0.001) MR by proximal isovolumetric surface area (0.93±0.27 vs 0.60±0.16cm), vena contracta (0.79±0.32 vs 0.57±0.18cm), regurgitant volume (47±25 vs 24±12ml), and fraction (54±15 vs 37±13%). Follow-up (f/u) echocardiography was performed at a median 222 days (range 356 days). Patients who received cardiac transplantation before f/u echocardiography were excluded. Relative severities of MR at f/u were: none = 12 (46%), mild = 8 (31%), moderate = 5 (19%), severe = 1 (4%) amongst patients with severe MR pre-LVAD, and none = 55 (58%), mild = 26 (27%), moderate = 13 (14%), severe = 1 (1%) amongst patients with non-severe MR pre-LVAD. At 1-year, after excluding all patients who underwent cardiac transplantation (severe MR n=4; non-severe MR n=2), rates of HF hospitalisation [5/25 (20%) vs 16/104 (15%); p=0.575] and all-cause mortality [2/25 (18%) vs 22/104 (21%); p=0.129)] were similar, irrespective of pre-LVAD MR severity. No patient who died during follow-up had severe MR prior to death.
Conclusion
LVAD improves severe secondary MR in 96% of cases, resulting in 1-year rates of HF hospitalisation and mortality similar to patients without severe MR pre-LVAD. These data suggest mitral valve surgery at time of LVAD implantation is not warranted.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- H Sharma
- University of Birmingham, Birmingham, United Kingdom
| | - M Yuan
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - I Shakeel
- University of Birmingham, Birmingham, United Kingdom
| | - A Morley-Smith
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - M A Nadir
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - C Chue
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - S G Myerson
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom
| | - R P Steeds
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - S Lim
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
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Radhakrishnan A, Pickup LC, Price AM, Law JP, Mcgee KC, Fabritz L, Senior R, Steeds RP, Ferro CJ, Townend JN. Anaemia and coronary microvascular dysfunction in end-stage renal disease. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): (1) University Hospitals Birmingham Charity (2) Metchley Park Medical Society
Introduction
Coronary microvascular dysfunction (CMD) is common among patients with end-stage renal disease (ESRD) and confers poor prognosis. Coronary flow velocity reserve (CFVR) is a marker of coronary microvascular function and can be reliably measured using Doppler echocardiography. Reduced CFVR in ESRD has been attributed to factors such as hypertension and left ventricular hypertrophy (LVH). Anaemia is prevalent in ESRD but the association between haemoglobin and CFVR in ESRD has not been studied.
Purpose
To assess if CFVR is related to haemoglobin among patients with ESRD.
Methods
22 subjects with ESRD and awaiting kidney transplant (8 pre-dialysis and 14 on peritoneal dialysis) were studied with adenosine myocardial contrast echocardiography, Doppler CFVR assessment and serum multiplex immunoassay analysis. Individuals with diabetes, uncontrolled hypertension or ischaemic heart disease were excluded.
Results
7/22 (32%) of subjects had CMD (defined as CFVR <2). Age (47 years ± 15 vs 55 ± 10, p = 0.177), estimated glomerular filtration rate [7ml/min/1.73m² (5-11) vs 9 (7-10), p = 0.837], systolic blood pressure (129mmHg ± 25 vs 137 ± 20, p = 0.398) and left ventricular mass index (98g/m² ± 31 vs 98 ± 28, p = 0.936) did not significantly differ between subjects with or without CMD. There were no significant differences in other demographic, haemodynamic, laboratory or echocardiographic variables between the two groups. A panel of biomarkers of inflammation, myocardial stretch, cardiac fibrosis and LVH studied by multiplex immunoassay also did not show any significant differences between the two groups. No subjects had wall motion abnormalities or perfusion defects on myocardial contrast echocardiography.
CFVR was significantly lower in subjects with CMD (1.6 ± 0.2 vs 3.2 ± 0.9, p < 0.001). Subjects with CMD had significantly lower haemoglobin than subjects without CMD (102g/L ± 12 vs 117g/L ± 11, p = 0.008). There was a moderate positive correlation between haemoglobin and CFVR (r = 0.65, p = 0.001) – figure 1. In a stepwise multiple regression model with CFVR as the dependent variable and age, haemoglobin, systolic blood pressure, left ventricular mass index and estimated glomerular filtration rate as independent variables, only haemoglobin was an independent predictor of CFVR (β=0.051 95%CI 0.023-0.079, p = 0.001).
Conclusions
Among our cohort of ESRD patients awaiting kidney transplant, there was a high prevalence of CMD despite well controlled blood pressure and no significant LVH. Subjects with CMD had significantly lower haemoglobin than subjects without CMD. Reduced haemoglobin causes impaired oxygen carrying capacity to the myocardium, which may lead to microvascular ischaemia and adverse microvascular remodelling, causing CMD. Thus, anaemia may be a potentially correctible driver of CMD in ESRD. This association needs to be confirmed in larger studies.
Abstract Figure 1
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Affiliation(s)
- A Radhakrishnan
- University of Birmingham, Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - LC Pickup
- University of Birmingham, Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - AM Price
- University of Birmingham, Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - JP Law
- University of Birmingham, Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - KC Mcgee
- University of Birmingham, Institute of Inflammation and Ageing, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - L Fabritz
- University of Birmingham, Institute of Cardiovascular Sciences, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - R Senior
- Royal Brompton Hospital, Department of Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - RP Steeds
- University of Birmingham, Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - CJ Ferro
- University of Birmingham, Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - JN Townend
- University of Birmingham, Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, Birmingham, United Kingdom of Great Britain & Northern Ireland
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8
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Parolin M, Dassie F, Vettor R, Steeds RP, Maffei P. Electrophysiological features in acromegaly: re-thinking the arrhythmic risk? J Endocrinol Invest 2021; 44:209-221. [PMID: 32632903 DOI: 10.1007/s40618-020-01343-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acromegaly is disease associated with a specific cardiomyopathy. Hitherto, it has been widely understood that acromegaly carries an increased risk of arrhythmia. PURPOSE In this review we show that evidences are limited to a small number of case-control studies that reported increased rates of premature ventricular beats (PVB) but no more significant arrhythmia. In contrast, there are several studies that have reported impaired preclinical markers of arrhythmia, including reduced heart rate variability, increased late potentials, QT interval dispersion, impaired heart rate recovery after physical exercise and left ventricular dysynchrony. Whilst these markers are associated with an adverse cardiovascular prognosis in the general population, they do not have a high independent positive predictive accuracy for arrhythmia. In acromegaly, case reports have described sudden cardiac death, ventricular tachyarrhythmia and advanced atrio-ventricular block that required implantation of a cardio-defibrillator or permanent pacemaker. Treatment with somatostatin analogues can reduce cardiac dysrhythmia in some cases by reducing heart rate, PVBs and QT interval. Pegvisomant reduces mean heart rate. Pasireotide is associated with QT prolongation. In the absence of good quality data on risk of arrhythmia in acromegaly, the majority of position statements and guidelines suggest routine 12-lead electrocardiography (ECG) and transthoracic echocardiography (TTE) in every patient at diagnosis and then follow up dependent on initial findings.
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Affiliation(s)
- M Parolin
- Department of Medicine (DIMED), University of Padua, Clinica Medica 3, via Giustiniani 2, 35128, Padova, Italy.
| | - F Dassie
- Department of Medicine (DIMED), University of Padua, Clinica Medica 3, via Giustiniani 2, 35128, Padova, Italy
| | - R Vettor
- Department of Medicine (DIMED), University of Padua, Clinica Medica 3, via Giustiniani 2, 35128, Padova, Italy
| | - R P Steeds
- University Hospital Birmingham and University of Birmingham, Cardiology, Birmingham, West Midlands, UK
| | - P Maffei
- Department of Medicine (DIMED), University of Padua, Clinica Medica 3, via Giustiniani 2, 35128, Padova, Italy
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9
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Abstract
The surveillance strategy for patients taking low dose cabergoline for hyperprolactinaemia is controversial. As more evidence has emerged that the risks of cardiac valvulopathy in this population of patients are low, fewer and fewer endocrinologists adhere strictly to the original medicines and healthcare products agency MHRA guidance of "at least" annual echocardiography. Strict adherence to this guidance would be costly in monetary terms (£5.76 million/year in the UK) and also in resource use (90,000 extra echocardiograms/year). This article reviews the proposed pathophysiological mechanism underlying the phenomenon of dopamine agonist valvulopathy, the characteristic echocardiographic changes seen, summarises the published literature on the incidence of valvulopathy with low dose cabergoline and examines the previous and current evidence-based screening guidelines.
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Affiliation(s)
- C E Stiles
- Department of Endocrinology, Queen Mary University of London, E1 4NS London, United Kingdom; Department of Endocrinology, Saint-Bartholomew's Hospital, EC1A 7BE London, United Kingdom.
| | - R P Steeds
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, B15 2GW Birmingham, United Kingdom; Institute of Cardiovascular Sciences, University of Birmingham, B15 2TT Birmingham, United Kingdom
| | - W M Drake
- Department of Endocrinology, Queen Mary University of London, E1 4NS London, United Kingdom; Department of Endocrinology, Saint-Bartholomew's Hospital, EC1A 7BE London, United Kingdom
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10
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Landells M, Mcaloon CJ, Steeds RP. P1719 A rare complication of homozygous sickle cell disease and high output cardiac failure. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction/Background
Sickle cell disease (SCD) is an autosomal recessive blood disorder characterised by chronic anaemia and abnormally shaped red blood cells. SCD impacts multiple organ systems causing effects on morbidity and mortality, including cardiovascular (CV). Long term SCD can have a significant impact on the heart through multiple pathways, including chronic anaemia, microvascular dysfunction and the development of hypertension and chronic kidney disease, leading to the development of a high-output state and adverse cardiac remodelling. We report a rare case of homozygous SCD with the development of high output cardiac failure complicated by the development of associated pulmonary hypertension.
Case summary
A 58 yr old female patient (Height 158cm, weight 51.25kg, cardiac index 4.01 L/min/m²) with known homozygous SCD (HbSS) undergoing regular transfusions for chronic anaemia was admitted following a routine transthoracic echocardiogram (Figure 1a & 1b) due to the presence of a moderate sized global pericardial effusion, severe tricuspid regurgitation, dilated right heart with impaired longitudinal function, and good left ventricular (LV) systolic function (LVEF Simpson’s biplane = 62 +/- 5%). In the months preceding this, the patient described progressive dyspnoea associated with decreasing workload and orthopnoea. On clinical examination there was evidence of right sided heart failure. Blood results demonstrated a longstanding anaemia (Hb 57 g/L) with MCV 109.6. NT-proBNP was 10233 ng/L. Cardiac magnetic resonance imaging demonstrated LV dilatation with hyperdynamic function, severe LV hypertrophy, and impaired longitudinal function (global longitudinal strain -9.7%). Cardiac output was elevated at 6.5 L/min. There was no late gadolinium enhancement and T2* mapping did not demonstrate cardiac iron loading (29.6ms). Right heart catheterisation confirmed pulmonary hypertension (pulmonary artery pressure 55/33, mean 46mmHg) due to left heart disease (PC wedge pressure (24/30, mean 24mmHg). The pericardial effusion was drained and the aspirate demonstrated a cellular infiltrate reflecting pericardial inflammation (moderate pus cells, no growth after 48hrs, total protein = 56 g/L, no histological evidence of malignancy). Additionally, the patient underwent intravenous diuresis and blood transfusion with improvement in clinical status.
Discussion
We report a rare cause of pulmonary hypertension due to elevated left ventricular end-diastolic pressure as a result of long-term high cardiac output in a patient who has established homozygous SCD. Long-term adverse cardiac remodelling in SCD is well described. Pulmonary hypertension is a rare multifactorial complication of this process and the precise mechanisms remain unclear. It confers a poor prognosis and the only current treatment is the management of the underlying condition. Pulmonary hypertension should always be considered in SCD patients with clinical and cardiac imaging evidence.
Abstract P1719 Figure 1
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Affiliation(s)
- M Landells
- University Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - C J Mcaloon
- University Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - R P Steeds
- University Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
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11
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Bicho Augusto JA, Nordin S, Kozor R, Vijapurapu R, Knott K, Ramaswami U, Geberhiwot TD, Steeds RP, Baig S, Hughes D, Moon JC. P340Inflammatory cardiomyopathy in Fabry disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Fabry disease (FD) is an X-linked lysosomal storage disorder caused by mutations in α-galactosidase A. Cardiovascular magnetic resonance (CMR) has helped unveil the pathogenesis of Fabry cardiomyopathy: sphingolipid storage (low T1 mapping values), left ventricular hypertrophy (LVH) and myocardial fibrosis with late gadolinium enhancement (LGE) characteristically present in the basal inferolateral (BIFL) wall. Recent evidence has suggested that the LGE may be inflammation and oedema as part of this pathogenic process.
Purpose
To assess the presence of inflammation in patients with FD using T2 mapping (for oedema/inflammation) supported by blood troponin levels (showing myocyte death and by inference inflammation).
Methods
A multi-centre international study in gene positive FD patients using CMR and blood biomarkers. All participants underwent CMR at 1.5 T. Native T1 and T2 mapping were performed. The T1 mapping sequence was MOLLI with sampling scheme in seconds. LGE used a phase sensitive inversion recovery sequence. Global longitudinal 2D strain (GLS) values were obtained using feature tracking analysis. Blood high-sensitivity troponin T (hsTnT) was measured on the same day.
Results
100 FD patients (age 43.8±1.3 years, 42% male) were included. 45% had LVH, 35% LGE. Low T1 mapping (normal <943ms) was found in 49% and 33% had high hsTnT values (normal <15ng/L). Mean T2 mapping values were 52.6±0.6ms in the BIFL wall and 49.5±0.3ms in the remote myocardium/septum (p<0.001, normal <53ms). T2 values in the BIFL wall were significantly higher among patients with LGE (58.2±6.1ms vs 49.2±3.1ms, p<0.001, Figure 1). In a per-segment analysis of 1600 segments, higher T2 values correlated positively with percentage of LGE per segment (r=0,262, p<0.001), T1 values (r=0,205, p<0.001), maximum wall thickness (r=0,253, p<0.001) and GLS values (r=0,212, p<0.001). HsTnT values were higher among patients with LGE (median of 31 vs 3ng/L in patients without LGE, p<0.001). There was a strong positive correlation between T2 values in the BIFL wall and ln(hsTnT) (r=0.776, p<0.001, Figure 2). The strongest predictor of increased hsTnT in multivariate analysis (age, sex, LVH, septum T1, T2 in the BIFL, GLS, LGE) was T2 in the BIFL wall (β=0.4, p=0.001).
Conclusions
Cardiac involvement in FD goes beyond storage (low T1 values). When LGE is present, this is almost always associated with a high T2 and troponin elevation supporting FD as a chronic inflammatory cardiomyopathy. Initial reports of LGE being fibrosis are too simplistic – LGE in FD appears to have a significant chronic inflammation/oedema component.
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Affiliation(s)
| | - S Nordin
- Barts Health NHS Trust, London, United Kingdom
| | - R Kozor
- University of Sydney, Sydney Medical School, Sydney, Australia
| | - R Vijapurapu
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom
| | - K Knott
- University College London, London, United Kingdom
| | - U Ramaswami
- Royal Free Hospital, Lysosomal Storage Disorder Unit, London, United Kingdom
| | - T D Geberhiwot
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom
| | - R P Steeds
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom
| | - S Baig
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom
| | - D Hughes
- Royal Free Hospital, Lysosomal Storage Disorder Unit, London, United Kingdom
| | - J C Moon
- Barts Health NHS Trust, London, United Kingdom
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12
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Bicho Augusto JA, Nordon S, Kozor R, Vijapurapu R, Knott K, Hughes R, Rosmini S, Ramaswami U, Geberhiwot T, Steeds RP, Baig S, Hughes D, Moon JC. 323Inflammatory cardiomyopathy in Fabry disease. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez102.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J A Bicho Augusto
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - S Nordon
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - R Kozor
- University of Sydney, Sydney Medical School, Sydney, Australia
| | - R Vijapurapu
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - K Knott
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - R Hughes
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - S Rosmini
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - U Ramaswami
- Royal Free Hospital, Lysosomal Storage Disorder Unit, London, United Kingdom of Great Britain & Northern Ireland
| | - T Geberhiwot
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - R P Steeds
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - S Baig
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - D Hughes
- Royal Free Hospital, Lysosomal Storage Disorder Unit, London, United Kingdom of Great Britain & Northern Ireland
| | - J C Moon
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
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13
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Nickander J, Cole BR, Nordin S, Vijapurapu R, Steeds RP, Moon JC, Kellman P, Ugander M, Kozor R. P171Blood correction of native T1 increases detection of cardiac involvement in patients with fabry disease. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez117.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Nickander
- Karolinska Institute, Clinical Physiology, Stockholm, Sweden
| | - B R Cole
- University of Sydney, Sydney Medical School, Sydney, Australia
| | - S Nordin
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - R Vijapurapu
- University of Birmingham, Institute of Cardiovascular Sciences, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - R P Steeds
- University of Birmingham, Institute of Cardiovascular Sciences, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - J C Moon
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - P Kellman
- National Institute of Health (Home), National Heart, Lung, and Blood Institute, Washington, United States of America
| | - M Ugander
- Karolinska Institute, Clinical Physiology, Stockholm, Sweden
| | - R Kozor
- University of Sydney, Sydney Medical School, Sydney, Australia
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14
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Moody WE, Holloway B, Gill S, Boivin C, Wahid Y, Ferguson J, Steeds RP. 248Prognostic value of single photon emission computed tomography among liver transplantation candidates. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez150.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- W E Moody
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - B Holloway
- University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - S Gill
- University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - C Boivin
- University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - Y Wahid
- University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - J Ferguson
- University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - R P Steeds
- University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom of Great Britain & Northern Ireland
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15
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Baig S, Vijapurapu R, Alharbi F, Nordin S, Kozor R, Moon J, Bembi B, Geberhiwot T, Steeds RP. Diagnosis and treatment of the cardiovascular consequences of Fabry disease. QJM 2019; 112:3-9. [PMID: 29878206 DOI: 10.1093/qjmed/hcy120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Fabry disease (FD) has been a diagnostic challenge since it was first recognized in 1898, with patients traditionally suffering from considerable delay before a diagnosis is made. Cardiac involvement is the current leading cause of death in FD. A combination of improved enzyme assays, availability of genetic profiling, together with more organized clinical services for rare diseases, has led to a rapid growth in the prevalence of FD. The earlier and more frequent diagnosis of asymptomatic individuals before development of the phenotype has focussed attention on early detection of organ involvement and closer monitoring of disease progression. The high cost of enzyme replacement therapy at a time of constraint within many health economies, moreover, has challenged clinicians to target treatment effectively. This article provides an outline of FD for the general physician and summarizes the aetiology and pathology of FD, the cardiovascular consequences thereof, modalities used in diagnosis and then discusses current indications for treatment, including pharmacotherapy and device implantation.
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Affiliation(s)
- S Baig
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Institute of Cardiovascular Science, University of Birmingham, Birmingham, UK
| | - R Vijapurapu
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Institute of Cardiovascular Science, University of Birmingham, Birmingham, UK
| | - F Alharbi
- Central Military Laboratory and Blood Bank, Riyadh, Saudi Arabia
| | - S Nordin
- Institute of Cardiovascular Science, University College London, London, UK
| | - R Kozor
- Sydney Medical School, University of Sydney, Camperdown, Australia
| | - J Moon
- Institute of Cardiovascular Science, University College London, London, UK
| | - B Bembi
- Centre for Rare Diseases, AMC Hospital of Udine, Udine, Italy
| | - T Geberhiwot
- Centre for Rare Diseases, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - R P Steeds
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Institute of Cardiovascular Science, University of Birmingham, Birmingham, UK
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16
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Abstract
A 30 year old asymptomatic male with stage 3 chronic kidney disease (CKD) secondary to Focal Segmental Glomerulosclerosis was found to have features of CKD associated cardiomyopathy including left ventricular hypertrophy (LVH) and focal sub-endocardial scarring on cardiac magnetic resonance imaging. There was also a significantly raised CT coronary calcium score and evidence of non-flow limiting coronary artery disease (CAD) on a CT coronary angiogram. Early stage CKD is a major risk factor for cardiovascular risk causing myocardial hypertrophy and fibrosis and coronary artery atheroma. Cardiovascular risk begins to increase from an eGFR of around 75ml/min/1.73m2. The pathophysiology of cardiovascular disease in CKD is under investigation but to date, treatment options are limited. Blood pressure control and statins have the strongest supportive evidence.
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Affiliation(s)
- A M Price
- Department of Nephrology, Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, UK
- Address correspondence to Dr Anna M. Price, Department of Nephrology, Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, UK.
| | - C J Ferro
- Department of Nephrology, Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, UK
| | - M K Hayer
- Department of Nephrology, Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, UK
| | - R P Steeds
- Department of Cardiology, Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, UK
| | - N C Edwards
- Department of Cardiology, Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, UK
| | - J N Townend
- Department of Cardiology, Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, UK
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17
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Stiles CE, Tetteh-Wayoe ET, Bestwick J, Steeds RP, Drake WM. A meta-analysis of the prevalence of cardiac valvulopathy in hyperprolactinemic patients treated with Cabergoline. J Clin Endocrinol Metab 2018; 104:5094016. [PMID: 30215804 DOI: 10.1210/jc.2018-01071] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/04/2018] [Indexed: 01/08/2023]
Abstract
CONTEXT Cabergoline is first line treatment for most patients with lactotrope pituitary tumors and hyperprolactinemia. Its use at high-dose in Parkinson's disease has largely been abandoned, because of its association with the development of a characteristic restrictive cardiac valvulopathy. Whether similar valvular changes occur in patients receiving lower doses for treatment of hyperprolactinemia is unclear, although stringent regulatory recommendations for echocardiographic screening exist. OBJECTIVE To conduct a meta-analysis exploring any link between the use of cabergoline for the treatment of hyperprolactinemia and clinically-significant cardiac valvulopathy. DATA SOURCES Full-text papers published up to and including January 2017 were found via PubMed and selected according to strict inclusion criteria. STUDY SELECTION All case-control studies were included where patients had received ≥6 months cabergoline treatment for hyperprolactinemia. Single case reports, previous meta-analyses, review papers and papers pertaining solely to Parkinson's disease were excluded. 13/76 originally selected studies met inclusion criteria. DATA EXTRACTION A list of desired data were compiled and extracted from papers by independent observers. Each also independently graded for paper quality (bias) and met to reach consensus. DATA SYNTHESIS More tricuspid regurgitation was observed (OR 3.74; 95% CI 1.79-7.8 p<0.001) in the cabergoline treated patients compared to controls. In no patient was tricuspid valve dysfunction diagnosed as a result of clinical symptoms. There was no significant increase in any other valvulopathy. CONCLUSIONS Treatment with low dose cabergoline in hyperprolactinemia appears to be associated with an increased prevalence of tricuspid regurgitation. The clinical significance of this is unclear and requires further investigation. 51.
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Affiliation(s)
- C E Stiles
- Queen Mary University of London, Department of Endocrinology, London
- Department of Endocrinology, St Bartholomew's Hospital, London
| | - E T Tetteh-Wayoe
- Queen Mary University of London, Department of Endocrinology, London
| | - J Bestwick
- Queen Mary University of London, Centre for Environmental and Preventive Medicine, London
| | - R P Steeds
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham
| | - W M Drake
- Department of Endocrinology, St Bartholomew's Hospital, London
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18
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Daly ME, Steeds RP, Channer KS, Samani NJ, Hampton KK, Croft SA. The Prothrombin 20210A Allele and Its Association with Myocardial Infarction. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1614588] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryThe relationship between the prothrombin (PT) 20210A allele and arterial disease is controversial. We conducted a case-control study to assess its contribution to risk of myocardial infarction (MI). Five hundred and thirty-nine acute MI patients and 498 control subjects aged <75 years were studied. Two percent of cases carried the PT20210A allele compared to 2.8% of controls. The odds ratio for MI was 0.72 (95% CI 0.32-1.60) indicating that the PT20210A allele confers no increased risk for MI. Subgroup analysis showed no association between the PT20210A allele and either premature MI or MI in females. We conclude the PT20210A allele is not a risk factor for MI and suggest that discrepancies in studies relating the PT20210A allele to MI may be due to difficulties in estimating its low allelic frequency in the general population and thus random differences in the observed frequencies in the control populations studied.
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19
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Hayer MK, Ferro CJ, Townend JN, Steeds RP, Edwards NC. Re: assessment of myocardial fibrosis with T1 mapping MRI. Clin Radiol 2016; 71:1309-1310. [PMID: 27733276 DOI: 10.1016/j.crad.2016.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 09/16/2016] [Accepted: 08/18/2016] [Indexed: 12/01/2022]
Affiliation(s)
- M K Hayer
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.
| | - C J Ferro
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - J N Townend
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - R P Steeds
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - N C Edwards
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
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20
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Edwards NC, Yuan M, Nolan O, Pawade TA, Oelofse T, Singh H, Mehrzad H, Zia Z, Geh JI, Palmer DH, May CJH, Ayuk J, Shah T, Rooney SJ, Steeds RP. Effect of Valvular Surgery in Carcinoid Heart Disease: An Observational Cohort Study. J Clin Endocrinol Metab 2016; 101:183-90. [PMID: 26580239 DOI: 10.1210/jc.2015-3295] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
CONTEXT Carcinoid heart disease (NET-CHD) is associated with the development of symptom-limited exercise capacity and high rates of morbidity and mortality. OBJECTIVE This study sought to determine the survival, cardiac function, and functional class following surgery. DESIGN AND SETTING, AND PATIENTS This was a retrospective observational cohort study between 2005 and 2015 at a European Centre of Excellence for Neuroendocrine Tumours, Queen Elizabeth Hospital Birmingham. England consisting of 62 consecutive patients referred to the NET-Cardiology Service. INTERVENTIONS Subjects were assessed at referral using transthoracic echocardiography (with saline contrast) and transesophageal echocardiography, and 77% with confirmed NET-CHD underwent cardiovascular magnetic resonance imaging. Symptomatic patients with concomitant severe valvular dysfunction were referred for surgery with stable NET disease. MAIN OUTCOME MEASURE Survival of patients with proven NET-CHD following medical and surgical treatments was measure. RESULTS In total, 47/62 patients were diagnosed with NET-CHD. Thirty-two patients (68%) underwent surgery with bioprosthetic valve replacements in all subjects; tricuspid, n = 31; pulmonary, n = 30; mitral, n = 3; and aortic, n = 3. Four patients underwent concomitant coronary artery bypass grafting. There were 4 (13%) early post-operative deaths. One- and 2-y survival rates after surgery were 75 and 69% compared with 45 and 15% in un-operated patients. Post-operatively, functional class was improved (pre-New York Heart Association Classification [NYHA], 2.6 [0.5] vs post-NYHA, 1.7 [1.1]), P < .05, right-ventricular (RV) size was reduced (136 ml/m(2) [25] vs 71 ml/m(2) [7]; P < .01) with preserved RV ejection fraction (61% ± 9 vs 55% ± 10; P = .26). CONCLUSION Valve surgery improved functional class and resulted in RV reverse remodelling with improved survival rates at 2 y compared with those not proceeding to operation. These data highlight the importance of close collaboration between NET clinicians, cardiology, and cardiothoracic surgery teams. Early referral can improve functional capacity but more research is needed to define the selection of appropriate candidates and randomized data are needed to define the effect of surgery on prognosis.
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Affiliation(s)
- N C Edwards
- Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom
| | - M Yuan
- Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom
| | - O Nolan
- Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom
| | - T A Pawade
- Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom
| | - T Oelofse
- Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom
| | - H Singh
- Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom
| | - H Mehrzad
- Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom
| | - Z Zia
- Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom
| | - J I Geh
- Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom
| | - D H Palmer
- Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom
| | - C J H May
- Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom
| | - J Ayuk
- Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom
| | - T Shah
- Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom
| | - S J Rooney
- Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom
| | - R P Steeds
- Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom
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Moody WE, Edwards NC, Chue CD, Taylor RJ, Ferro CJ, Townend JN, Steeds RP. Variability in cardiac MR measurement of left ventricular ejection fraction, volumes and mass in healthy adults: defining a significant change at 1 year. Br J Radiol 2015; 88:20140831. [PMID: 25710361 DOI: 10.1259/bjr.20140831] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Variability in the measurement of left ventricular (LV) parameters in cardiovascular imaging has typically been assessed over a short time interval, but clinicians most commonly compare results from studies performed a year apart. To account for variation in technical, procedural and biological factors over this time frame, we quantified the within-subject changes in LV volumes, LV mass (LVM) and LV ejection fraction (EF) in a well-defined cohort of healthy adults at 12 months. METHODS Cardiac MR (CMR) was performed in 42 healthy control subjects at baseline and at 1 year (1.5 T Magnetom® Avanto; Siemens Healthcare, Erlangen, Germany). Analysis of steady-state free precession images was performed manually offline (Argus software; Siemens Healthcare) for assessment of LV volumes, LVM and EF by a single blinded observer. A random subset of 10 participants also underwent repeat imaging within 7 days to determine short-term interstudy reproducibility. RESULTS There were no significant changes in any LV parameter on repeat CMR at 12 months. The short-term interstudy biases were not significantly different from the long-term changes observed at 1 year. The smallest detectable change (SDC) for LVEF, end-diastolic volume, end-systolic volume and LVM that could be recognized with 95% confidence were 6%, 13 ml, 7 ml and 6 g, respectively. CONCLUSION The variability in CMR-derived LV measures arising from technical, procedural and biological factors remains minimal at 12 months. Thus, for patients undergoing repeat annual assessment by CMR, even small differences in LV function, size and LVM (which are greater than the SDC) may be attributed to disease-related factors. ADVANCES IN KNOWLEDGE The reproducibility and reliability of CMR data at 12 months is excellent allowing clinicians to be confident that even small changes in LV structure and function over this time frame are real.
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Affiliation(s)
- W E Moody
- 1 Birmingham CardioRenal Group, Centre for Clinical Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, UK
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Teoh JK, Steeds RP, Warfield AT. Not all myocardium that sparkles is amyloid. QJM 2014; 107:933-4. [PMID: 24694548 DOI: 10.1093/qjmed/hcu071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J K Teoh
- Department of Cardiology, University Hospital Birmingham, UK
| | - R P Steeds
- Department of Cardiology, University Hospital Birmingham, UK
| | - A T Warfield
- Department of Pathology, University Hospital Birmingham, UK
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Leithead JA, Kandiah K, Steed H, Gunson BK, Steeds RP, Ferguson JW. Tricuspid regurgitation on echocardiography may not be a predictor of patient survival after liver transplantation. Am J Transplant 2014; 14:2192-3. [PMID: 24985366 DOI: 10.1111/ajt.12821] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- J A Leithead
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK; NIHR Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, UK
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Edwards NC, Teoh JK, Steeds RP. Hypertrophic cardiomyopathy and Anderson-Fabry disease: unravelling septal hypertrophy with T1-mapping CMR. Eur Heart J 2014; 35:1896. [DOI: 10.1093/eurheartj/ehu138] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Drake WM, Stiles CE, Howlett TA, Toogood AA, Bevan JS, Steeds RP. A cross-sectional study of the prevalence of cardiac valvular abnormalities in hyperprolactinemic patients treated with ergot-derived dopamine agonists. J Clin Endocrinol Metab 2014; 99:90-6. [PMID: 24187407 PMCID: PMC5137780 DOI: 10.1210/jc.2013-2254] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Concern exists in the literature that the long-term use of ergot-derived dopamine agonist drugs for the treatment of hyperprolactinemia may be associated with clinically significant valvular heart disease. OBJECTIVE The aim of the study was to determine the prevalence of valvular heart abnormalities in patients taking dopamine agonists as treatment for lactotrope pituitary tumors and to explore any associations with the cumulative dose of drug used. DESIGN A cross-sectional echocardiographic study was performed in a large group of patients who were receiving dopamine agonist therapy for hyperprolactinemia. Studies were performed in accordance with the British Society of Echocardiography minimum dataset for a standard adult transthoracic echocardiogram. Poisson regression was used to calculate relative risks according to quartiles of dopamine agonist cumulative dose using the lowest cumulative dose quartile as the reference group. SETTING Twenty-eight centers of secondary/tertiary endocrine care across the United Kingdom participated in the study. RESULTS Data from 747 patients (251 males; median age, 42 y; interquartile range [IQR], 34-52 y) were collected. A total of 601 patients had taken cabergoline alone; 36 had been treated with bromocriptine alone; and 110 had received both drugs at some stage. The median cumulative dose for cabergoline was 152 mg (IQR, 50-348 mg), and for bromocriptine it was 7815 mg (IQR, 1764-20 477 mg). A total of 28 cases of moderate valvular stenosis or regurgitation were observed in 24 (3.2%) patients. No associations were observed between cumulative doses of dopamine agonist used and the age-corrected prevalence of any valvular abnormality. CONCLUSION This large UK cross-sectional study does not support a clinically concerning association between the use of dopamine agonists for the treatment of hyperprolactinemia and cardiac valvulopathy.
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Affiliation(s)
- WM Drake
- St Bartholomew’s Hospital, W Smithfield, London, UK, EC1A 7BE
| | - CE Stiles
- St Bartholomew’s Hospital, W Smithfield, London, UK, EC1A 7BE
| | - TA Howlett
- Leicester Royal Infirmary, Infirmary Square, Leicester, Leicestershire, UK, LE1 5WW
| | - AA Toogood
- Queen Elizabeth Hospital, Birmingham, Mindelsohn Way Edgbaston Birmingham, UK, B15 2WB
| | - JS Bevan
- Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK AB25 2ZN
| | - RP Steeds
- Queen Elizabeth Hospital, Birmingham, Mindelsohn Way Edgbaston Birmingham, UK, B15 2WB
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Taylor RJ, Umar F, Meyyappan C, Moody WE, Stegemann B, Steeds RP, Townend JN, Leyva F. Feature-tracking cardiovascular magnetic resonance as a novel technique for the assessment of mechanical dyssynchrony. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1869] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Edwards NC, Moody WE, Springthorpe E, Weale PJ, Paisey RB, Martin U, Geberhiwot T, Steeds RP. Diffuse myocardial fibrosis in Alstrom syndrome: an early marker of disease progression. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p2977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Meijer A, Conradi HJ, Bos EH, Anselmino M, Carney RM, Denollet J, Doyle F, Freedland KE, Grace SL, Hosseini SH, Lane DA, Pilote L, Parakh K, Rafanelli C, Sato H, Steeds RP, Welin C, de Jonge P. Adjusted prognostic association of depression following myocardial infarction with mortality and cardiovascular events: individual patient data meta-analysis. Br J Psychiatry 2013; 203:90-102. [PMID: 23908341 DOI: 10.1192/bjp.bp.112.111195] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The association between depression after myocardial infarction and increased risk of mortality and cardiac morbidity may be due to cardiac disease severity. AIMS To combine original data from studies on the association between post-infarction depression and prognosis into one database, and to investigate to what extent such depression predicts prognosis independently of disease severity. METHOD An individual patient data meta-analysis of studies was conducted using multilevel, multivariable Cox regression analyses. RESULTS Sixteen studies participated, creating a database of 10 175 post-infarction cases. Hazard ratios for post-infarction depression were 1.32 (95% CI 1.26-1.38, P<0.001) for all-cause mortality and 1.19 (95% CI 1.14-1.24, P<0.001) for cardiovascular events. Hazard ratios adjusted for disease severity were attenuated by 28% and 25% respectively. CONCLUSIONS The association between depression following myocardial infarction and prognosis is attenuated after adjustment for cardiac disease severity. Still, depression remains independently associated with prognosis, with a 22% increased risk of all-cause mortality and a 13% increased risk of cardiovascular events per standard deviation in depression z-score.
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Affiliation(s)
- A Meijer
- Interdisciplinary Centre for Psychiatric Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands
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Edwards NC, Griffiths M, Steeds RP. Intra-cardiac echocardiography in mitral valve repair: a novel use of a complimentary imaging modality in a difficult scenario. Heart 2013; 99:1791-2. [PMID: 23813848 DOI: 10.1136/heartjnl-2013-304165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- N C Edwards
- Department of Cardiovascular Medicine, University of Birmingham, , Birmingham, UK
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Taylor RJ, Umar F, Moody WE, Townend J, Steeds RP, Leyva F. 102 THE REPRODUCIBILITY AND ANALYSIS TIME OF CARDIAC MAGNETIC RESONANCE FEATURE TRACKING: POTENTIAL FOR CLINICAL APPLICATION. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Edwards NC, Moody WE, Springthorpe E, Weale PJ, Paisey RB, Martin U, Geberhiwot T, Steeds RP. 160 DIFFUSE FIBROSIS IN ALSTRöM SYNDROME: A MARKER OF DISEASE PROGRESSION. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Moody WE, Taylor RJ, Edwards NC, Chue CD, Umar F, Ferro CJ, Townend JN, Leyva F, Steeds RP. 101 VALIDATION OF MAGNETIC RESONANCE FEATURE TRACKING FOR LONGITUDINAL SYSTOLIC AND DIASTOLIC STRAIN CALCULATION WITH SPATIAL MODULATION OF MAGNETISATION IMAGING ANALYSIS. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Edwards NC, Nundlall N, Moody WE, Davies N, Ferro CJ, Townend JN, Steeds RP. 085 MYOCARDIAL SEGMENTAL ANALYSIS FOR T1-MAPPING IMAGING: A NOVEL SEMI-AUTOMATED METHOD. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Chue CD, Moody WE, Steeds RP, Townend JN, Ferro CJ. Unexpected benefits of participation in a clinical trial: abdominal aortic aneurysms in patients with chronic kidney disease. QJM 2012; 105:1213-6. [PMID: 21930664 DOI: 10.1093/qjmed/hcr172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C D Chue
- Department of Cardiovascular Medicine, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.
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Abstract
The aim of this article is to provide a perspective on the relative importance and contribution of different imaging modalities in patients with valvular heart disease. Valvular heart disease is increasing in prevalence across Europe, at a time when the clinical ability of physicians to diagnose and assess severity is declining. Increasing reliance is placed on echocardiography, which is the mainstay of cardiac imaging in valvular heart disease. This article outlines the techniques used in this context and their limitations, identifying areas in which dynamic imaging with cardiovascular magnetic resonance and multislice CT are expanding.
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Affiliation(s)
- W S Choo
- Penang Medical College, Georgetown, Malaysia
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Abstract
This article reviews the recent developments in echocardiography that have maintained this technology at the forefront of day-to-day imaging in clinical cardiology. The primary reason for most requests for imaging in cardiovascular medicine is to assess left ventricular structure and function. As our understanding of left ventricular mechanics has become more intricate, tissue Doppler and speckle tracking modalities have been developed that deliver greater insights into diagnosis of cardiomyopathy and earlier warning of ventricular dysfunction. Increased accuracy has been achieved with the dissemination of real-time three-dimensional echocardiography, which has also acquired a central role in the pre-operative assessment of patients prior to reparative valvular surgery. The use of contrast has broadened the indications for transthoracic echocardiography and has increased the accuracy of stress echocardiography, while reducing the number of patients who cannot be scanned because of a limited acoustic window. Finally, echocardiography will be seen in the future not only as a diagnostic tool in those affected by cardiovascular disease but also as a method for prediction of risk and perhaps activation of targeted treatment.
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Affiliation(s)
- R P Steeds
- Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
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Kanagala P, Bradley C, Hoffman P, Steeds RP. Guidelines for transoesophageal echocardiographic probe cleaning and disinfection from the British Society of Echocardiography. Eur J Echocardiogr 2012; 12:i17-23. [PMID: 21998464 DOI: 10.1093/ejechocard/jer095] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The clinical utility of transoesophageal echocardiography (TOE) is well established. Being a semi-invasive procedure, however, the potential for transmission of infection between sequential patients exists. This has implications for the protection of both patients and medical staff. Guidelines for disinfection during gastrointestinal endoscopy (GIE) have been in place for many years.(1,2) Unfortunately, similar guidance is lacking with respect to TOE. Although traversing the same body cavities and sharing many similarities with upper GIE, there are fundamental structural and procedural differences with TOE which merit special consideration in establishing a decontamination protocol. This document provides recommendations for TOE probe decontamination based on the available evidence, expert opinion, and modification of the current British Society of Gastroenterology guidelines.
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Affiliation(s)
- C J Ferro
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK.
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Chue CD, de Giovanni J, Steeds RP. The role of echocardiography in percutaneous left atrial appendage occlusion. European Journal of Echocardiography 2011; 12:i3-10. [DOI: 10.1093/ejechocard/jer090] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Moody WE, Chue CD, Inston NG, Edwards NC, Steeds RP, Ferro CJ, Townend JN. Understanding the effects of chronic kidney disease on cardiovascular risk: are there lessons to be learnt from healthy kidney donors? J Hum Hypertens 2011; 26:141-8. [PMID: 21593781 DOI: 10.1038/jhh.2011.46] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Chronic kidney disease (CKD) is now a recognized global public health problem. It is highly prevalent and strongly associated with hypertension and cardiovascular disease (CVD); far more patients with a glomerular filtration rate below 60 ml min(-1) per 1.73 m(2) will die from cardiovascular causes than progress to end-stage renal disease. A better understanding of the complex mechanisms underlying the development of CVD among CKD patients is required if we are to begin devising therapy to prevent or reverse this process. Observational studies of CVD in CKD are difficult to interpret because renal impairment is almost always accompanied by confounding factors. These include the underlying disease process itself (for example, diabetes mellitus and systemic vasculitis) and the complications of CKD, such as hypertension, anaemia and inflammation. Kidney donors provide an ideal opportunity to study healthy subjects without manifest vascular disease who experience an acute change from having normal to modestly impaired renal function at the time of uninephrectomy. Prospectively examining the cardiovascular consequences of uninephrectomy using donors as a model of CKD may provide useful insight into the pathophysiology of CVD in CKD and, therefore, into how the CVD risk associated with renal impairment might eventually be reduced.
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Affiliation(s)
- W E Moody
- Department of Cardiovascular Medicine, Queen Elizabeth Hospital, University of Birmingham, Birmingham, UK.
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Davison P, Clift PF, Steeds RP. The role of echocardiography in diagnosis, monitoring closure and post-procedural assessment of patent foramen ovale. European Journal of Echocardiography 2010; 11:i27-34. [DOI: 10.1093/ejechocard/jeq120] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Chue CD, Townend JN, Steeds RP, Ferro CJ. Republished paper: Arterial stiffness in chronic kidney disease: causes and consequences. Postgrad Med J 2010; 86:560-6. [DOI: 10.1136/pgmj.2009.184879rep] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chue CD, Edwards NC, Ferro CJ, Steeds RP, Townend JN. Reduction of blood pressure already in the normal range further regresses left ventricular mass. Heart 2010; 96:1080; author reply 1080. [PMID: 20483900 DOI: 10.1136/hrt.2009.191619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Edwards NC, Routledge HC, Steeds RP. The authors' reply. Heart 2010. [DOI: 10.1136/hrt.2009.183681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Williams LK, Frenneaux MP, Steeds RP. Echocardiography in hypertrophic cardiomyopathy diagnosis, prognosis, and role in management. Eur J Echocardiogr 2010; 10:iii9-14. [PMID: 19889657 DOI: 10.1093/ejechocard/jep157] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is diagnosed on the basis of left ventricular (LV) hypertrophy for which there is insufficient explanation (e.g. mild hypertension or mild aortic stenosis with marked hypertrophy). Echocardiography is an invaluable tool in the diagnosis and follow-up of patients with HCM. Echocardiographic assessment requires a comprehensive assessment in several imaging planes with careful attention to correct beam alignment in order to minimize errors in the measurement of LV wall thickness and appropriate identification of hypertrophy with an unusual distribution.
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Affiliation(s)
- L K Williams
- Department of Cardiology, University Hospital Birmingham, NHS Trust, Edgbaston, Birmingham B15 2TT, UK.
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Abstract
Cardiovascular magnetic resonance imaging (CMR) is an established clinical tool for the identification of irreversible myocardial injury. More recently, experience with stress-perfusion CMR has increased sufficiently so that this now provides an accurate and reliable aid to clinical decision-making in patients with ischaemic heart disease. T2-weighted or "black blood" imaging is a technique used less frequently to examine the myocardium but one that is growing in stature. This article explains the rationale behind the technique and reviews recent data illustrating clinical and research scenarios in which the addition of T2-weighted sequences to standard cardiac scanning protocols might be warranted.
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Affiliation(s)
- N C Edwards
- University Hospital Birmingham NHS Trust, Edgbaston, Birmingham, UK
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Venkateswaran RV, Steeds RP, Quinn DW, Nightingale P, Wilson IC, Mascaro JG, Thompson RD, Townend JN, Bonser RS. The haemodynamic effects of adjunctive hormone therapy in potential heart donors: a prospective randomized double-blind factorially designed controlled trial. Eur Heart J 2009; 30:1771-80. [DOI: 10.1093/eurheartj/ehp086] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Abstract
Cardiovascular disease remains the leading cause of death world wide. Although atheroma is clearly important, the role of arteriosclerotic vascular disease is often overlooked. Arteriosclerosis causes increased arterial stiffness, with consequent systolic hypertension and left ventricular hypertrophy. Serum phosphate is increasingly being recognised as a cardiovascular risk factor and has been implicated in the development of arteriosclerosis and arterial calcification. Its determinants are unclear, but both diet and minor reductions in renal function may be important. Diets in affluent populations are high in phosphate because of increased consumption of animal protein and the use of phosphate-containing preservatives. This viewpoint suggests that the consumption of a phosphate-rich diet, exacerbated by the high prevalence of chronic kidney disease found in ageing populations, accelerates the development of arteriosclerosis. It is hypothesised that reducing phosphate intake will attenuate the progression of arterial stiffness with major beneficial effects upon cardiovascular mortality and morbidity.
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Affiliation(s)
- C J Ferro
- Department of Nephrology, Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, West Midlands B15 2TH, UK.
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Edwards NC, Ferro CJ, Townend JN, Steeds RP. Aortic distensibility and arterial-ventricular coupling in early chronic kidney disease: a pattern resembling heart failure with preserved ejection fraction. Heart 2008; 94:1038-43. [DOI: 10.1136/hrt.2007.137539] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Edwards NC, Ferro CJ, Townend JN, Steeds RP. Myocardial disease in systemic vasculitis and autoimmune disease detected by cardiovascular magnetic resonance. Rheumatology (Oxford) 2007; 46:1208-9. [PMID: 17478468 DOI: 10.1093/rheumatology/kem077] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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