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Murphy D, Firoozi S, Herzog CA, Banerjee D. Cardiac Troponin, Kidney Function, Heart Failure and Mortality After Myocardial Infarction in Patients With and Without Kidney Impairment. Am J Cardiol 2023; 204:383-391. [PMID: 37579521 DOI: 10.1016/j.amjcard.2023.07.106] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 08/16/2023]
Abstract
Cardiac troponins (cTn) are routinely measured for the diagnosis and prognosis of myocardial infarction (MI). The relation between troponin levels, estimated glomerular filtration rate (eGFR), postinfarction heart failure (HF), and mortality is unclear in patients with kidney impairment. This is a retrospective, cross-sectional study of patients presenting to the Emergency Department at a single tertiary center. Participants presenting with confirmed type I MI from January 1, 2019, to December 31, 2021, were analyzed from the Myocardial Ischemia National Audit Project database. Main outcomes were acute HF, measured using Killip class, and inpatient mortality. Peak cardiac troponin T (cTnT) level was a secondary outcome. Data on 2,815 patients (67±14 years, 28% female) were analyzed. Ordinal logistic regression analysis was used to test for predictors of increasing Killip class. Binary logistic regression was used to test for predictors of inpatient mortality. Analysis of a sub-sample matched for age and diabetes mellitus status showed increased mortality in patients with eGFR <60 ml/min/1.73 m2 (12.2% vs 4.4%, p <0.001). Multivariate predictors of acute HF included log-transformed peak cTnT, eGFR, body mass index (BMI), and diabetes mellitus status. Multivariate predictors of inpatient mortality included log-transformed peak cTnT, eGFR, age, BMI, and Killip class 3/4. On multivariate analysis, eGFR, ST-elevation MI diagnosis, BMI, male gender, diabetes mellitus status, and hypertension were all predictive of peak cTnT after MI. In conclusion, peak cTnT level and eGFR at presentation after MI are independent predictors of acute HF severity and death in patients with and without kidney impairment.
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Affiliation(s)
- Daniel Murphy
- Cardiology Clinical Academic Group, Institute of Medical and Biomedical Education, St George's, University of London, Cranmer Terrace, London, United Kingdom; Department of Renal and Transplant Medicine, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, United Kingdom
| | - Sami Firoozi
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, United Kingdom
| | - Charles A Herzog
- Division of Cardiology, Department of Medicine, Hennepin Healthcare and University of Minnesota, Minneapolis, Minnesota
| | - Debasish Banerjee
- Cardiology Clinical Academic Group, Institute of Medical and Biomedical Education, St George's, University of London, Cranmer Terrace, London, United Kingdom; Department of Renal and Transplant Medicine, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, United Kingdom.
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Dargan J, Kenawi A, Khan F, Firoozi S, Brecker S. Patient-Specific Computer Modeling to Guide Redo Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2023; 16:2332-2334. [PMID: 37758388 DOI: 10.1016/j.jcin.2023.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/25/2023] [Indexed: 10/03/2023]
Affiliation(s)
- James Dargan
- Cardiovascular Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom.
| | - Abdelrahman Kenawi
- Cardiovascular Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Faisal Khan
- Cardiovascular Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sami Firoozi
- Cardiovascular Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Stephen Brecker
- Cardiovascular Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
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Dowling C, Gooley R, McCormick L, Sharma RP, Yeung AC, Fearon WF, Dargan J, Khan F, Firoozi S, Brecker SJ. Ongoing experience with patient-specific computer simulation of transcatheter aortic valve replacement in bicuspid aortic valve. Cardiovasc Revasc Med 2023; 51:31-37. [PMID: 36740551 DOI: 10.1016/j.carrev.2023.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/23/2022] [Accepted: 01/18/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is increasingly being used to treat younger, lower-risk patients with bicuspid aortic valve (BAV). Patient-specific computer simulation may identify patients at risk for developing paravalvular regurgitation (PVR) and major conduction disturbance. Only limited prospective experience of this technology exist. We wished to describe our ongoing experience with patient-specific computer simulation. METHODS Patients who were referred for consideration of TAVR with a self-expanding transcatheter heart valve (THV) and had BAV identified on pre-procedural cardiac computed tomography imaging underwent patient-specific computer simulation. The computer simulations were reviewed by the Heart Team and used to guide surgical or transcatheter treatment approaches and to aid in THV sizing and positioning. Clinical outcomes were recorded. RESULTS Between May 2019 and May 2021, 16 patients with BAV were referred for consideration of TAVR with a self-expanding THV. Sievers Type 1 morphology was present in 15 patients and Type 0 in the remaining patient. Two patients were predicted to develop moderate-to-severe PVR with a TAVR procedure and these patients underwent successful surgical aortic valve replacement. In the remaining 14 patients, computer simulation was used to optimize THV sizing and positioning to minimise PVR and conduction disturbance. One patient with a low valve implantation depth developed moderate PVR and this complication was correctly predicted by the computer simulations. No patient required insertion of a new permanent pacemaker. CONCLUSION Patient-specific computer simulation may be used to guide the most appropriate treatment modality for patients with BAV. The usage of computer simulation to guide THV sizing and positioning was associated with favourable clinical outcomes.
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Affiliation(s)
- Cameron Dowling
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia.
| | - Robert Gooley
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Liam McCormick
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Rahul P Sharma
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - James Dargan
- Cardiology Clinical Academic Group, St. George's University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Faisal Khan
- Cardiology Clinical Academic Group, St. George's University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sami Firoozi
- Cardiology Clinical Academic Group, St. George's University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Stephen J Brecker
- Cardiology Clinical Academic Group, St. George's University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
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Dowling C, Gooley R, McCormick L, Rashid HN, Dargan J, Khan F, Firoozi S, Brecker SJ. Patient-Specific Computer Simulation to Predict Conduction Disturbance With Current-Generation Self-Expanding Transcatheter Heart Valves. Struct Heart 2022; 6:100010. [PMID: 37274548 PMCID: PMC10236875 DOI: 10.1016/j.shj.2022.100010] [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] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/19/2022] [Accepted: 02/02/2022] [Indexed: 10/18/2022]
Abstract
Background Patient-specific computer simulation may predict the development of conduction disturbance following transcatheter aortic valve replacement (TAVR). Validation of the computer simulations with current-generation devices has not been undertaken. Methods A retrospective study was performed on patients who had undergone TAVR with a current-generation self-expanding transcatheter heart valve (THV). Preprocedural computed tomography imaging was used to create finite element models of the aortic root. Procedural contrast angiography was reviewed, and finite element analysis performed using a matching THV device size and implantation depth. A region of interest corresponding to the atrioventricular bundle and proximal left bundle branch was identified. The percentage of this area (contact pressure index [CPI]) and maximum contact pressure (CPMax) exerted by THV were recorded. Postprocedural electrocardiograms were reviewed, and major conduction disturbance was defined as the development of persistent left bundle branch block or high-degree atrioventricular block. Results A total of 80 patients were included in the study. THVs were 23- to 29-mm Evolut PRO (n = 53) and 34-mm Evolut R (n = 27). Major conduction disturbance occurred in 27 patients (33.8%). CPI (28.3 ± 15.8 vs. 15.6 ± 11.2%; p < 0.001) and CPMax (0.51 ± 0.20 vs. 0.36 ± 0.24 MPa; p = 0.008) were higher in patients who developed major conduction disturbance. CPI (area under the receiver operating characteristic curve [AUC], 0.74; 95% CI, 0.63-0.86; p < 0.001) and CPMax (AUC, 0.69; 95% CI, 0.57-0.81; p = 0.006) demonstrated a discriminatory power to predict the development of major conduction disturbance. Conclusions Patient-specific computer simulation may identify patients at risk for conduction disturbance after TAVR with current-generation self-expanding THVs.
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Affiliation(s)
- Cameron Dowling
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Robert Gooley
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Liam McCormick
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Hashrul N. Rashid
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - James Dargan
- Cardiovascular Clinical Academic Group, St. George’s, University of London and St. George’s University Hospitals NHS Foundation Trust, London, UK
| | - Faisal Khan
- Cardiovascular Clinical Academic Group, St. George’s, University of London and St. George’s University Hospitals NHS Foundation Trust, London, UK
| | - Sami Firoozi
- Cardiovascular Clinical Academic Group, St. George’s, University of London and St. George’s University Hospitals NHS Foundation Trust, London, UK
| | - Stephen J. Brecker
- Cardiovascular Clinical Academic Group, St. George’s, University of London and St. George’s University Hospitals NHS Foundation Trust, London, UK
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Dowling C, Gooley R, McCormick L, Firoozi S, Brecker SJ. Patient-specific computer simulation to predict long-term outcomes after transcatheter aortic valve replacement. J Cardiovasc Comput Tomogr 2021; 16:254-261. [PMID: 34887238 DOI: 10.1016/j.jcct.2021.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/02/2021] [Accepted: 11/24/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Patient-specific computer simulation may predict the development of paravalvular regurgitation (PVR) after transcatheter aortic valve replacement (TAVR). We hypothesised that patient-specific computer simulation might identify patients at risk for long-term adverse outcomes after TAVR. METHODS A multi-centre retrospective study was performed on patients with symptomatic severe aortic stenosis who had undergone TAVR with a self-expanding transcatheter heart valve (THV). Pre-procedural cardiac computed tomography imaging was used to create finite element models of the aortic root. Finite element analysis (FEA) was performed in order to simulate the interaction between the THV and the native anatomy. The blood domain was extracted from the FEA output and computational fluid dynamics (CFD) simulation undertaken. Predicted PVR was recorded in the left ventricular outflow tract. Patients were classified into those where computer simulation predicted no significant PVR (predicted PVR from CFD <16.0 mL/s) and those where computer simulation predicted significant PVR (predicted PVR from CFD ≥16.0 mL/s). RESULTS A total of 203 patients were included in the study. THVs implanted were CoreValve (n = 20), Evolut R (n = 90) and Evolut PRO (n = 93). At 2 years, the Kaplan-Meier estimate of the rate of death from any cause was higher in the group where CFD simulation predicted significant PVR (35.8% vs. 16.3%; hazard ratio, 2.62; 95% confidence interval, 1.29 to 5.30; P = 0.006 by log-rank test). CONCLUSIONS Computer simulation may identify patients who are at a higher risk for death after TAVR.
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Affiliation(s)
- Cameron Dowling
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia.
| | - Robert Gooley
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia.
| | - Liam McCormick
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia.
| | - Sami Firoozi
- Cardiovascular Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom.
| | - Stephen J Brecker
- Cardiovascular Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom.
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6
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Dowling C, Gooley R, McCormick L, Brecker SJ, Firoozi S, Bapat VN, Kodali SK, Khalique OK, Brouwer J, Swaans MJ. Patient-Specific Computer Simulation to Optimize Transcatheter Heart Valve Sizing and Positioning in Bicuspid Aortic Valve. Structural Heart 2021. [DOI: 10.1080/24748706.2021.1991604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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7
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Dowling C, Gooley R, McCormick L, Firoozi S, Brecker SJ. Patient-specific Computer Simulation: An Emerging Technology for Guiding the Transcatheter Treatment of Patients with Bicuspid Aortic Valve. Interv Cardiol 2021; 16:e26. [PMID: 34721665 PMCID: PMC8419845 DOI: 10.15420/icr.2021.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/19/2021] [Indexed: 12/21/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is increasingly being used to treat younger, lower-risk patients, many of whom have bicuspid aortic valve (BAV). As TAVI begins to enter these younger patient cohorts, it is critical that clinical outcomes from TAVI in BAV are matched to those achieved by surgery. Therefore, the identification of patients who, on an anatomical basis, may not be suitable for TAVI, would be desirable. Furthermore, clinical outcomes of TAVI in BAV might be improved through improved transcatheter heart valve sizing and positioning. One potential solution to these challenges is patient-specific computer simulation. This review presents the methodology and clinical evidence surrounding patient-specific computer simulation of TAVI in BAV.
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Affiliation(s)
- Cameron Dowling
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash UniversityMelbourne, Australia
| | - Robert Gooley
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash UniversityMelbourne, Australia
| | - Liam McCormick
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash UniversityMelbourne, Australia
| | - Sami Firoozi
- Cardiology Clinical Academic Group, St George’s, University of London and St George’s University Hospitals NHS Foundation TrustLondon, UK
| | - Stephen J Brecker
- Cardiology Clinical Academic Group, St George’s, University of London and St George’s University Hospitals NHS Foundation TrustLondon, UK
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8
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Dowling C, Gooley R, McCormick L, Firoozi S, Brecker S. Patient-Specific Computer Simulation to Predict Long-term Outcomes After Transcatheter Aortic Valve Implantation. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.236] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Dowling C, Gooley R, McCormick L, Brecker S, Firoozi S, Bapat V, Kodali S, Khalique O, Brouwer J, Swaans M. Patient-Specific Computer Simulation to Optimise Transcatheter Heart Valve Sizing and Positioning in Bicuspid Aortic Valve. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.496] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Panoulas V, Rathod K, Kain A, Firoozi S, Nevett J, Kalra S, Malik I, Mathur A, Redwood S, MacCarthy P, Wragg A, Jones D, Dalby M. Impact of early (<24h) versus delayed (>24h) intervention in patients with non ST segment elevation myocardial infarction (an observational study of 20882 patients). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2523] [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
In patients presenting with non ST-segment elevation acute coronary syndromes (NSTE-ACS) an invasive approach has been shown to be superior to conservative management.
Purpose
We aimed to investigate the optimal timing of invasive coronary angiography and subsequent intervention.
Methods
We examined the impact ofearly (≤24h) versus delayed (>24h) intervention in a large observational cohort of 20882 consecutive patients with acute NSTE myocardial infarction (NSTEMI) treated with PCI between 2005 and 2015 at 9 tertiary cardiac centers in London (UK) using Cox-regression analysis and propensity matching.
Results
Mean age was 64.5±12.7 years and 26.1% were females. A quarter (27.6%), were treated within 24h.Patients treated within 24h were slightly younger (62.8±12.8 vs. 65.2±12.6, p<0.001), most commonly male (76% vs. 72.9%, p<0.001) and were more frequently ventilated (2.3% vs. 1.4%, p<0.001) and in cardiogenic shock (3.6% vs. 1.4%, p<0.001) with dynamic changes on their ECG (84.5% vs. 76.1% p<0.001). At a median follow up of 4.2 years (interquartile range 1.8 to 7) 17.7% of patients had died. Estimated 5-year survival in patients treated within 24h was 84.6% vs. 81% for those treated >24h following their presentation (p<0.001). This survival benefit remained following adjustment for confounders; HR (delayed vs. early management)1.11 (95% CI 1.003 to 1.23, p=0.046). In the propensity matched cohort of 4356 patients in each group, there remained a trend for higher survival in the early intervention group (p=0.061).
Conclusions
Notwithstanding the limitations of the retrospective design, this real-world cohort of NSTEMI patients suggests that an early intervention (≤24h) may improve mid term survival.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- V Panoulas
- Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - K Rathod
- Barts Health NHS Trust, Cardiology, London, United Kingdom
| | - A Kain
- Barts Health NHS Trust, Cardiology, London, United Kingdom
| | - S Firoozi
- St George's Healthcare NHS Trust, Cardiology, London, United Kingdom
| | - J Nevett
- London Ambulance Service, London, United Kingdom
| | - S Kalra
- Royal Free Hospital, Cardiology, London, United Kingdom
| | - I Malik
- Hammersmith Hospital, London, United Kingdom
| | - A Mathur
- Barts Health NHS Trust, Cardiology, London, United Kingdom
| | - S Redwood
- St Thomas' Hospital, Cardiology, London, United Kingdom
| | - P.A MacCarthy
- King's College Hospital, Cardiology, London, United Kingdom
| | - A Wragg
- Barts Health NHS Trust, Cardiology, London, United Kingdom
| | - D Jones
- Barts Health NHS Trust, Cardiology, London, United Kingdom
| | - M.C Dalby
- Harefield Hospital, Interventional cardiology, London, United Kingdom
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Junarta J, Fernandez M, Chung I, Salha A, Klaud Francheska BD, Lowe-Jones R, Sharma R, Firoozi S, Banerjee D. Role of a cardio-renal multi-disciplinary team meeting in managing cardiovascular risk in patients on kidney transplant waitlists. Clin Transplant 2020; 34:e14061. [PMID: 32780546 DOI: 10.1111/ctr.14061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/26/2020] [Accepted: 08/03/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Waitlisted kidney transplant patients suffer from excess cardiovascular events. The benefits of regular cardiac investigations, potentially harmful and expensive, are unknown. We investigate the effectiveness of a cardio-renal MDT in managing high cardiovascular risk waitlisted transplant patients to prevent events and enable transplantation. METHODS Clinical outcomes in waitlisted transplant candidates managed by our cardio-renal MDT protocol were compared against our standard protocol. Data compared include the transplantation, event, and death rates, cost of cardiac investigations and procedures, and graft, patient survival, and re-hospitalization rates in transplanted patients. RESULTS 207 patients were studied (81 standard, 126 cardio-renal MDT). Over 2.7 years, the cardio-renal MDT protocol transplanted more patients than the standard group (35% vs 21%; P = .02). The managing cost per patient per year was higher in the standard group (£692 vs £610). This was driven by more echocardiograms and more tests per patient in the standard group (P < .01). There was no difference in adverse events or death. There was no difference in re-hospitalization, graft or patient survival rate in transplanted patients. CONCLUSIONS Our cardio-renal MDT was effective in managing high-risk kidney transplant candidates with greater rates of transplantation and low rates of events at a lower cost.
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Affiliation(s)
- Joey Junarta
- Renal and Transplantation Unit, St George's University Hospitals NHS Foundation Trust, London, UK.,Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Maria Fernandez
- Renal and Transplantation Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Isaac Chung
- Renal and Transplantation Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Ahmad Salha
- Renal and Transplantation Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Racquel Lowe-Jones
- Renal and Transplantation Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Rajan Sharma
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Sami Firoozi
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Debasish Banerjee
- Renal and Transplantation Unit, St George's University Hospitals NHS Foundation Trust, London, UK.,Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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12
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Wilson SJ, Connolly MJ, Elghamry Z, Cosgrove C, Firoozi S, Lim P, Sharma R, Spratt JC. Effect of the COVID-19 Pandemic on ST-Segment–Elevation Myocardial Infarction Presentations and In-Hospital Outcomes. Circ Cardiovasc Interv 2020; 13:e009438. [DOI: 10.1161/circinterventions.120.009438] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [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: 01/16/2023]
Affiliation(s)
- Simon J. Wilson
- Department of Cardiology, St. George’s University Foundation Hospitals NHS Trust, London, United Kingdom
| | - Michelle J. Connolly
- Department of Cardiology, St. George’s University Foundation Hospitals NHS Trust, London, United Kingdom
| | - Ziyad Elghamry
- Department of Cardiology, St. George’s University Foundation Hospitals NHS Trust, London, United Kingdom
| | - Claudia Cosgrove
- Department of Cardiology, St. George’s University Foundation Hospitals NHS Trust, London, United Kingdom
| | - Sami Firoozi
- Department of Cardiology, St. George’s University Foundation Hospitals NHS Trust, London, United Kingdom
| | - Pitt Lim
- Department of Cardiology, St. George’s University Foundation Hospitals NHS Trust, London, United Kingdom
| | - Rajan Sharma
- Department of Cardiology, St. George’s University Foundation Hospitals NHS Trust, London, United Kingdom
| | - James C. Spratt
- Department of Cardiology, St. George’s University Foundation Hospitals NHS Trust, London, United Kingdom
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13
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Akhtar Z, Dargan J, Gaze D, Firoozi S, Collinson P, Shanmugam N. False-positive troponin elevation due to an immunoglobulin-G-cardiac troponin T complex: a case report. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 32617489 PMCID: PMC7319834 DOI: 10.1093/ehjcr/ytaa082] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/12/2019] [Accepted: 03/17/2020] [Indexed: 11/22/2022]
Abstract
Background Troponin is a crucial biomarker for the diagnosis of an acute coronary syndrome (ACS). It rises in response to myocardial injury from significant acute myocardial ischaemia caused by obstructive coronary artery disease [‘classical’ myocardial infarction (MI)]. However, raised levels have also been noted in conditions not recognized as classical ACS. This may include MI with non-obstructed coronary arteries such as takotsubo cardiomyopathy and other acute or chronic conditions such as pulmonary embolus or chronic kidney disease. This is commonly labelled as a ‘falsely elevated’ troponin although there is some myocardial strain to explain the rise, such as an increase in cardiac oxygen demand. True ‘falsely elevated’ troponin, characterized by a persistent elevation in the absence of cardiac injury does occur and thought to be secondary to an immunoglobulin-troponin complex (macrotroponin). Case summary A 53-year-old gentleman with a background of diabetes, hypertension, hypercholesterolaemia, and hepatitis B was admitted with chest pain and persistently elevated cardiac troponin T (cTnT) levels. Investigations revealed unobstructed coronary arteries and a structurally normal, well-functioning heart. Subsequent biochemical analysis found the persistently elevated cTnT secondary to macrotroponin T. Discussion Macrotroponin, an immunoglobulin-troponin bound complex should be considered as a differential diagnosis when the biochemistry is not reflective of the clinical picture. Early recognition requires effective collaboration with the biochemistry laboratory for accurate diagnosis.
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Affiliation(s)
- Zaki Akhtar
- Department of Cardiology, St George's University Hospital, Blackshaw Road, London SW17 0QT, UK
| | - James Dargan
- Department of Cardiology, St George's University Hospital, Blackshaw Road, London SW17 0QT, UK
| | - David Gaze
- Department of Cardiology, St George's University Hospital, Blackshaw Road, London SW17 0QT, UK.,School of Life Sciences, University of Westminster, Cavendish Street, London W1W 6UW, UK
| | - Sami Firoozi
- Department of Cardiology, St George's University Hospital, Blackshaw Road, London SW17 0QT, UK
| | - Paul Collinson
- Department of Cardiology, St George's University Hospital, Blackshaw Road, London SW17 0QT, UK
| | - Nesan Shanmugam
- Department of Cardiology, St George's University Hospital, Blackshaw Road, London SW17 0QT, UK
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Dowling C, Firoozi S, Panoulas V, Dalby M, Kashyap MN, Kabir T, Kalogeras K, Buch MH, Levy R, Chowdhary S, Saraf S, Roberts D, More R, Wiper A, Abdelaziz HK, Neylon A, Mylotte D, Pisaniello AD, Fraser DGW, Anderson R, Cunnington MS, Malkin CJ, Blackman DJ, Brennan PF, Owens CG, Manoharan G, Spence MS, Brecker SJ. Initial experience of a self-expanding transcatheter aortic valve with an outer pericardial wrap: The United Kingdom and Ireland Implanters' registry. Catheter Cardiovasc Interv 2019; 95:1340-1346. [PMID: 31713325 DOI: 10.1002/ccd.28512] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/12/2019] [Accepted: 09/16/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The United Kingdom and Ireland Implanters' registry is a multicenter registry which reports on real-world experience with new transcatheter heart valves. BACKGROUND The Evolut PRO (Medtronic, Minneapolis, MN) transcatheter aortic valve is a self-expanding transcatheter aortic valve with an outer pericardial wrap, designed to minimize paravalvular regurgitation. METHODS Between July 2017 and December 2018, clinical, procedural, and 30-day outcome data were prospectively collected from all patients receiving the Evolut PRO valve across nine participating centers in the United Kingdom and Ireland. The primary efficacy outcome was the Valve Academic Research Consortium-2 (VARC-2)-defined endpoint of device success. The primary safety outcome was the VARC-2-defined composite endpoint of early safety at 30 days. RESULTS A total of 317 patients underwent implantation. Mean age was 81.8 ± 6.4 years and Society of Thoracic Surgeons Predicted Risk of Mortality Score 5.5 ± 1.8%. Iliofemoral access was used in 99.1% of patients. Device success was 91.2%. Mean gradient was 7.6 ± 4.7 mmHg and effective orifice area 1.9 ± 0.7 cm2 . The incidence of moderate paravalvular regurgitation was 1.7% and there was no severe paravalvular regurgitation. A new permanent pacemaker was implanted in 17.8% of patients without a pacemaker at baseline. Early safety was demonstrated in 92.7%. At 30 days, all-cause mortality was 0.6%, stroke 3.8%, and major vascular complication 2.8%. CONCLUSIONS Real-world experience of the Evolut PRO transcatheter aortic valve demonstrated favorable procedural success, safety, valve function, and incidence of new permanent pacemaker implantation.
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Affiliation(s)
- Cameron Dowling
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's Hospital, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Sami Firoozi
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's Hospital, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Vasileios Panoulas
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Miles Dalby
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Mavin N Kashyap
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Tito Kabir
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Konstantinos Kalogeras
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Mamta H Buch
- North West Cardiac Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Richard Levy
- North West Cardiac Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Saqib Chowdhary
- North West Cardiac Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Smriti Saraf
- North West Cardiac Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - David Roberts
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Ranjit More
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Andrew Wiper
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Hesham K Abdelaziz
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.,Cardiovascular Department, Ain Shams University, Cairo, Egypt
| | - Antoinette Neylon
- Department of Cardiology, University Hospital Galway, Galway University Hospitals, Galway, Ireland
| | - Darren Mylotte
- Department of Cardiology, University Hospital Galway, Galway University Hospitals, Galway, Ireland
| | - Anthony D Pisaniello
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Douglas G W Fraser
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Richard Anderson
- Department of Cardiology, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
| | - Michael S Cunnington
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Christopher J Malkin
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Daniel J Blackman
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul F Brennan
- Belfast Heart Centre, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Colum G Owens
- Belfast Heart Centre, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Ganesh Manoharan
- Belfast Heart Centre, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Mark S Spence
- Belfast Heart Centre, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Stephen J Brecker
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's Hospital, St. George's University Hospitals NHS Foundation Trust, London, UK
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15
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Beirne A, Rathod K, Jain A, Mathur A, Wragg A, Smith EJ, Jones DA, Kalra S, Malik I, Redwood S, MacCarthy P, Bogle R, Firoozi S, Dalby M. P6516The association between prior coronary artery bypass graft surgery and outcome after percutaneous coronary intervention (PCI): an observational study of 123,780 patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1106] [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
Limited information exists regarding procedural success and clinical outcomes in patients with previous CABG undergoing percutaneous coronary intervention (PCI). We sought to compare outcomes in patients undergoing PCI with or without previous coronary artery bypass grafts (CABG).
Methods
This was an observational cohort study of 123,780 consecutive PCI procedures from the Pan-London (United Kingdom) PCI registry, from January 2005 to December 2015. The primary end-point was all-cause mortality at a median follow-up of 3.0 years (interquartile range 1.2–4.6 years).
Results
12,641 (10.2%) patients had a history of previous CABG, of whom 29.3% (n=3,703) underwent PCI to native vessels and 70.7% (n=8,938) to bypass grafts. There were significant differences in the demographic, clinical, and procedural characteristics of these groups. The risk of mortality during follow-up was significantly higher in patients with prior CABG (23.2%) (p=0.0005) compared to patients with no history of prior CABG (12.1%) and was seen for patients who underwent either native vessel (20.1%) or bypass graft PCI (24.2%, p<0.0001). However, after adjustment for baseline characteristics, there was no significant difference in outcomes seen between the groups when PCI was performed in native vessels in patients with previous CABG (HR 1.02, 95% CI 0.77–1.34; P=0.89) but a significant increase in mortality among patients with PCI to bypass grafts (HR 1.33 95% CI 1.03–1.71, P=0.026). This was seen after multivariate adjustment and propensity matching.
Figure 1. Kaplan-Meier Curves
Conclusion
Patients with prior CABG are older, with a greater comorbid burden and more complex procedural characteristics, but after adjustment for these differences clinical outcomes are similar to patients undergoing PCI without prior CABG. In these patients, native vessel PCI was associated with better outcomes compared to the treatment of vein grafts.
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Affiliation(s)
- A Beirne
- Barts Health NHS Trust, London, United Kingdom
| | - K Rathod
- Barts Health NHS Trust, London, United Kingdom
| | - A Jain
- Barts Health NHS Trust, London, United Kingdom
| | - A Mathur
- Barts Health NHS Trust, London, United Kingdom
| | - A Wragg
- Barts Health NHS Trust, London, United Kingdom
| | - E J Smith
- Barts Health NHS Trust, London, United Kingdom
| | - D A Jones
- Barts Health NHS Trust, London, United Kingdom
| | - S Kalra
- Royal Free Hospital, London, United Kingdom
| | - I Malik
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - S Redwood
- St Thomas' Hospital, London, United Kingdom
| | - P MacCarthy
- Kings College Hospital, London, United Kingdom
| | - R Bogle
- St Georges Hospital, London, United Kingdom
| | - S Firoozi
- St Georges Hospital, London, United Kingdom
| | - M Dalby
- Harefield Hospital, London, United Kingdom
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16
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Dowling C, Kondapally Seshasai SR, Firoozi S, Brecker SJ. Transcatheter aortic valve replacement versus surgery for symptomatic severe aortic stenosis: A reconstructed individual patient data meta-analysis. Catheter Cardiovasc Interv 2019; 96:158-166. [PMID: 31566902 DOI: 10.1002/ccd.28504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/07/2019] [Accepted: 09/05/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES We wished to undertake a reconstructed individual patient data meta-analysis of randomized clinical trials comparing transcatheter aortic valve replacement (TAVR) and surgery for patients with severe symptomatic aortic stenosis. BACKGROUND TAVR and surgery are both well-established methods for treating patients with symptomatic severe aortic stenosis who are at low, intermediate, and high risk for surgery. METHODS Data were identified by searches of Medline, Embase, CENTRAL and ClinicalTrials.gov for all randomized clinical trials, which compared TAVR and surgery that had published at least 1 year of follow-up. Individual patient data were reconstructed from Kaplan-Meier curves. RESULTS A total of 7,770 patients from seven randomized clinical trials were included in this meta-analysis. At 1 year, TAVR was associated with a lower risk of death from any cause (hazard ratio [HR], 0.85, 95% confidence interval [CI], 0.73-0.98; p = .03), disabling stroke (HR, 0.71; 95% CI, 0.54-0.93; p = .01) and the composite end point of death or disabling stroke (HR, 0.79; 95% CI, 0.67-0.92; p = .002). Significant interactions were found for access suitability, with TAVR associated with a lower risk of these end points in patients suitable for transfemoral access. TAVR was associated with a lower risk of periprocedural events, whereas the risk of late events was similar between TAVR and surgery. CONCLUSIONS At 1 year, TAVR was associated with a lower risk of death, disabling stroke and the composite end point, when compared with surgery. These associations were strongest within the subgroup of patients in whom transfemoral access was feasible.
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Affiliation(s)
- Cameron Dowling
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Sreenivasa Rao Kondapally Seshasai
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Sami Firoozi
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Stephen J Brecker
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, UK
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17
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Dowling C, Firoozi S, Doyle N, Blackman DJ, Malkin CJ, Cunnington MS, Saraf S, Buch MH, Levy R, Chowdhary S, Spence MS, Manoharan G, Owens CG, Brennan PF, Roberts D, More R, Wiper A, Abdelaziz HK, Mylotte D, Neylon A, Martin N, Mercanti F, Dorman S, Panoulas V, Dalby M, Kashyap MN, Kabir T, Kovac J, Kontoprias K, Malik IS, Ghada MW, Sen S, Ruparelia N, Demir OM, Frame A, Uren NG, Anderson R, Rajathurai T, Tapp L, Deegan L, Grech E, Hall I, Neville M, Rampat R, Hildick-Smith D, Mullen M, Kennon S, Chandrala P, Doshi S, Brecker SJ. Initial experience of a large, self-expanding, and fully recapturable transcatheter aortic valve: The UK & Ireland Implanters' registry. Catheter Cardiovasc Interv 2018; 93:751-757. [PMID: 30394657 DOI: 10.1002/ccd.27934] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/04/2018] [Accepted: 09/23/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The UK & Ireland Implanters' registry is a multicenter registry which reports on real-world experience with novel transcatheter heart valves. BACKGROUND The 34 mm Evolut R transcatheter aortic valve is a self-expanding and fully recapturable transcatheter aortic valve, designed to treat patients with a large aortic annulus. METHODS Between January 2017 and April 2018, clinical, procedural and 30-day outcome data were prospectively collected from all patients receiving the 34 mm Evolut R valve across 17 participating centers in the United Kingdom and Ireland. The primary efficacy outcome was the Valve Academic Research Consortium-2(VARC-2)-defined endpoint of device success. The primary safety outcome was the VARC-2-defined composite endpoint of early safety at 30 days. RESULTS A total of 217 patients underwent attempted implant. Mean age was 79.5 ± 8.8 years and Society of Thoracic Surgeons Predicted Risk of Mortality Score 5.2% ± 3.4%. Iliofemoral access was used in 91.2% of patients. Device success was 79.7%. Mean gradient was 7.0 ± 4.6 mmHg and effective orifice area 2.0 ± 0.6 cm2 . Paravalvular regurgitation was more than mild in 7.2%. A new permanent pacemaker was implanted in 15.7%. Early safety was demonstrated in 91.2%. At 30 days, all-cause mortality was 3.2%, stroke 3.7%, and major vascular complication 2.3%. CONCLUSIONS Real-world experience of the 34 mm Evolut R transcatheter aortic valve demonstrated acceptable procedural success, safety, valve function, and incidence of new permanent pacemaker implantation.
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Affiliation(s)
- Cameron Dowling
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sami Firoozi
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Niamh Doyle
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Daniel J Blackman
- Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom
| | | | | | - Smriti Saraf
- Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom.,Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Mamta H Buch
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Richard Levy
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Saqib Chowdhary
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Mark S Spence
- Belfast Heart Centre, Royal Victoria Hospital, Belfast, United Kingdom
| | - Ganesh Manoharan
- Belfast Heart Centre, Royal Victoria Hospital, Belfast, United Kingdom
| | - Colum G Owens
- Belfast Heart Centre, Royal Victoria Hospital, Belfast, United Kingdom
| | - Paul F Brennan
- Belfast Heart Centre, Royal Victoria Hospital, Belfast, United Kingdom
| | - David Roberts
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Ranjit More
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Andrew Wiper
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Hesham K Abdelaziz
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom.,Cardiovascular Department, Ain Shams University, Cairo, Egypt
| | - Darren Mylotte
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Antoinette Neylon
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Niamh Martin
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Federico Mercanti
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Stephen Dorman
- Department of Cardiology, Bristol Heart Institute, Bristol, United Kingdom
| | | | - Miles Dalby
- Department of Cardiology, Harefield Hospital, London, United Kingdom
| | - Mavin N Kashyap
- Department of Cardiology, Harefield Hospital, London, United Kingdom
| | - Tito Kabir
- Department of Cardiology, Harefield Hospital, London, United Kingdom
| | - Jan Kovac
- Biomedical Research Unit, University of Leicester, Leicester, United Kingdom
| | - Kosmas Kontoprias
- Biomedical Research Unit, University of Leicester, Leicester, United Kingdom
| | - Iqbal S Malik
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Mikhail W Ghada
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Sayan Sen
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Neil Ruparelia
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ozan M Demir
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Angela Frame
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Neal G Uren
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Richard Anderson
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom
| | | | - Luke Tapp
- Department of Cardiology, University Hospital, Coventry, United Kingdom
| | - Lauren Deegan
- Department of Cardiology, University Hospital, Coventry, United Kingdom
| | - Ever Grech
- Department of Cardiology, Northern General Hospital, Sheffield, United Kingdom
| | - Ian Hall
- Department of Cardiology, Northern General Hospital, Sheffield, United Kingdom
| | - Melanie Neville
- Department of Cardiology, Northern General Hospital, Sheffield, United Kingdom
| | - Rajiv Rampat
- Department of Cardiology, Royal Sussex County Hospital, Brighton, United Kingdom
| | - David Hildick-Smith
- Department of Cardiology, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Michael Mullen
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Simon Kennon
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Pavan Chandrala
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Sagar Doshi
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Stephen J Brecker
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
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18
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Dowling C, Firoozi S, Sharma R, Brecker SJ. A 'fluttering' diastolic murmur. Eur Heart J Cardiovasc Imaging 2018; 19:1252. [PMID: 30113654 DOI: 10.1093/ehjci/jey115] [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)
- Cameron Dowling
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, Blackshaw Rd, London, UK
| | - Sami Firoozi
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, Blackshaw Rd, London, UK
| | - Rajan Sharma
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, Blackshaw Rd, London, UK
| | - Stephen J Brecker
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, Blackshaw Rd, London, UK
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19
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Ekmejian A, Lee A, Chandra Shetty P, Nguyen-Dang T, Yeung A, Sapontis J, Firoozi S, Bhindi R, Hansen P, Hill J, Dworakowski R, Maccarthy P, ajay shah, Byrne J. TCT-238 Comparing 3 year outcomes between medical therapy and percutaneous revascularisation for the surgically ineligible cohort. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1364] [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: 11/30/2022]
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20
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Ekmejian A, Lee A, Firoozi S, Sapontis J, Bhindi R, Hansen P, Ward M, Kaura A, Hill J, Dwokarowski R, MacCarthy P, Melikian N, Webb I, Shah A, Byrne J. P3585Comparison of 3 year outcomes between medical therapy and percutaneous revascularisation for surgically ineligible patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3585] [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: 11/13/2022] Open
Affiliation(s)
- A Ekmejian
- Wollongong Hospital, Cardiology, Wollongong, Australia
| | - A Lee
- Wollongong Hospital, Cardiology, Wollongong, Australia
| | - S Firoozi
- St Georges Hospital, London, United Kingdom
| | | | - R Bhindi
- Royal North Shore Hospital, Sydney, Australia
| | - P Hansen
- Royal North Shore Hospital, Sydney, Australia
| | - M Ward
- Royal North Shore Hospital, Sydney, Australia
| | - A Kaura
- King's College London, London, United Kingdom
| | - J Hill
- King's College London, London, United Kingdom
| | | | - P MacCarthy
- King's College London, London, United Kingdom
| | - N Melikian
- King's College London, London, United Kingdom
| | - I Webb
- King's College London, London, United Kingdom
| | - A Shah
- King's College London, London, United Kingdom
| | - J Byrne
- King's College London, London, United Kingdom
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Williams R, Shouls G, Firoozi S. Mother-and-Child Telescopic Guide-Catheter Extension to Identify Severe Left Main Stem Disease in a Patient With a Severely Dilated Aortic Root. J Invasive Cardiol 2018; 30:E71-E72. [PMID: 30068790] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The importance of selective coronary angiography in patients with severely dilated aortas awaiting surgery is discussed.
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Affiliation(s)
- Rupert Williams
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, London, SW17 0QT.
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22
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Dowling C, Firoozi S, Brecker S. Percutaneous coronary intervention for stable angina in ORBITA. Lancet 2018; 392:28. [PMID: 30047397 DOI: 10.1016/s0140-6736(18)31209-1] [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] [Received: 11/10/2017] [Accepted: 05/17/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Cameron Dowling
- Cardiology Clinical Academic Group, St George's, University of London, London SW17 0QT, UK.
| | - Sami Firoozi
- Cardiology Clinical Academic Group, St George's, University of London, London SW17 0QT, UK
| | - Stephen Brecker
- Cardiology Clinical Academic Group, St George's, University of London, London SW17 0QT, UK
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23
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Kalra SS, Firoozi S, Yeh J, Blackman DJ, Rashid S, Davies S, Moat N, Dalby M, Kabir T, Khogali SS, Anderson RA, Groves PH, Mylotte D, Hildick-Smith D, Rampat R, Kovac J, Gunarathne A, Laborde JC, Brecker SJ. Initial Experience of a Second-Generation Self-Expanding Transcatheter Aortic Valve: The UK & Ireland Evolut R Implanters' Registry. JACC Cardiovasc Interv 2017; 10:276-282. [PMID: 28183467 DOI: 10.1016/j.jcin.2016.11.025] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/24/2016] [Accepted: 11/17/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The authors present the UK and Irish real-world learning curve experience of the Evolut R transcatheter heart valve. BACKGROUND The Evolut R is a self-expanding, repositionable, and fully recapturable second-generation transcatheter heart valve with several novel design features to improve outcomes and reduce complications. METHODS Clinical, procedural, and 30-day outcome data were prospectively collected for the first 264 patients to receive the Evolut R valve in the United Kingdom and Ireland. RESULTS A total of 264 consecutive Evolut R implantations were performed across 9 centers. The mean age was 81.1 ± 7.8 years, and the mean logistic European System for Cardiac Operative Risk Evaluation score was 19.9 ± 13.7%. Procedural indications included aortic stenosis (72.0%), mixed aortic valve disease (17.4%), and failing aortic valve bioprostheses (10.6%). Conscious sedation was used in 39.8% of patients and transfemoral access in 93.6%. The procedural success rate was 91.3%, and paravalvular leak immediately after implantation was mild or less in 92.3%. Major complications were rare: cardiac tamponade in 0.4%, conversion to sternotomy in 0.8%, annular rupture in 0.0%, coronary occlusion in 0.8%, major vascular in 5.3%, acute kidney injury in 6.1%, new permanent pacemaker implantation in 14.7%, and procedure-related death in 0.0%. At 30-day follow-up, survival was 97.7%, paravalvular leak was mild or less in 92.3%, and the stroke rate was 3.8%. CONCLUSIONS This registry represents the largest published real-world experience of the Evolut R valve. The procedural success rate was high and safety was excellent, comparable with previous studies of the Evolut R valve and other second-generation devices. The low rate of complications represents an improvement on first-generation devices.
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Affiliation(s)
- Sundeep S Kalra
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust & St. George's University of London, London, United Kingdom
| | - Sami Firoozi
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust & St. George's University of London, London, United Kingdom
| | - James Yeh
- Cardiology Department, Royal Brompton and Harefield NHS Trust, London, United Kingdom
| | - Daniel J Blackman
- Cardiology Department, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Shabnam Rashid
- Cardiology Department, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Simon Davies
- Cardiology Department, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Neil Moat
- Cardiology Department, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Miles Dalby
- Cardiology Department, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Tito Kabir
- Cardiology Department, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Saib S Khogali
- Cardiology Department, The Royal Wolverhampton Hospitals, Wolverhampton, United Kingdom
| | - Richard A Anderson
- Cardiology Department, University Hospital of Wales, Cardiff, United Kingdom
| | - Peter H Groves
- Cardiology Department, University Hospital of Wales, Cardiff, United Kingdom
| | - Darren Mylotte
- Cardiology Department, University Hospital Galway, Galway, Ireland
| | - David Hildick-Smith
- Cardiology Department, Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - Rajiv Rampat
- Cardiology Department, Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - Jan Kovac
- Cardiology Department, Glenfield Hospital, Leicester, United Kingdom
| | - Ashan Gunarathne
- Cardiology Department, Glenfield Hospital, Leicester, United Kingdom
| | - Jean-Claude Laborde
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust & St. George's University of London, London, United Kingdom
| | - Stephen J Brecker
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust & St. George's University of London, London, United Kingdom.
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Rampat R, Khawaja MZ, Hilling-Smith R, Byrne J, MacCarthy P, Blackman DJ, Krishnamurthy A, Gunarathne A, Kovac J, Banning A, Kharbanda R, Firoozi S, Brecker S, Redwood S, Bapat V, Mullen M, Aggarwal S, Manoharan G, Spence MS, Khogali S, Dooley M, Cockburn J, de Belder A, Trivedi U, Hildick-Smith D. Conduction Abnormalities and Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement Using the Repositionable LOTUS Device. JACC Cardiovasc Interv 2017. [DOI: 10.1016/j.jcin.2017.03.044] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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25
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Dehestani M, Teimortashlu E, Molaei M, Ghomian M, Firoozi S, Aghili S. Experimental data on compressive strength and durability of sulfur concrete modified by styrene and bitumen. Data Brief 2017; 13:137-144. [PMID: 28603759 PMCID: PMC5451180 DOI: 10.1016/j.dib.2017.05.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 05/12/2017] [Accepted: 05/16/2017] [Indexed: 10/24/2022] Open
Abstract
In this data article experimental data on the compressive strength, and the durability of styrene and bitumen modified sulfur concrete against acidic water and ignition are presented. The percent of the sulfur cement and the gradation of the aggregates used are according to the ACI 548.2R-93 and ASTM 3515 respectively. For the styrene modified sulfur concrete different percentages of styrene are used. Also for the bitumen modified sulfur concrete, different percentages of bitumen and the emulsifying agent (triton X-100) are utilized. From each batch three 10×10×10 cm cubic samples were casted. One of the samples was used for the compressive strength on the second day of casting, and one on the twenty-eighth day. Then the two samples were put under the high pressure flame of the burning liquid gas for thirty seconds and their ignition resistances were observed. The third sample was put into the acidic water and after twenty eight days immersion in water was dried in the ambient temperature. After drying its compressive strength has been evaluated.
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Affiliation(s)
- M Dehestani
- Faculty of Civil Engineering, Babol Noshirvani University of Technology, Babol, Iran
| | - E Teimortashlu
- Faculty of Civil Engineering, Babol Noshirvani University of Technology, Babol, Iran
| | - M Molaei
- Faculty of Civil Engineering, Babol Noshirvani University of Technology, Babol, Iran
| | - M Ghomian
- Faculty of Civil Engineering, Babol Noshirvani University of Technology, Babol, Iran
| | - S Firoozi
- Faculty of Civil Engineering, Babol Noshirvani University of Technology, Babol, Iran
| | - S Aghili
- Faculty of Civil Engineering, Babol Noshirvani University of Technology, Babol, Iran
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26
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Collinson PO, Hersey J, Bray R, Gaze D, Lim P, Firoozi S, Ntalianis A, Boa F, Prasad A. Heart Fatty Acid Binding Protein for the Diagnosis of Myocardial Ischemia and Infarction. J Appl Lab Med 2017. [DOI: 10.1373/jalm.2016.022418] [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: 11/06/2022]
Abstract
Abstract
Objective
To establish the analytical performance of a heart fatty acid binding protein (HFABP) method suitable for routine clinical use and examine its role for the diagnosis of myocardial ischemia and myocardial infarction.
Methods
Analyses of HFABP were performed on an Advia 2400 (Siemens Healthcare Diagnostics). Imprecision, limit of detection (LOD), limit of blank (LOB), and linearity were assessed using standard methods. Stability was assessed at 4 °C, −20 °C, and with 3 repeated freeze-thaw cycles. Clinical diagnostic performance was assessed using chest pain in patients, with a final diagnosis according to the universal definition of myocardial infarction with cardiac troponin I (cTnI) measured on the Siemens Advia Centaur (cTnI Ultra method, 99th percentile 50 ng/L, 10% CV 30 ng/L). Ischemia was detected using sampling pre- and postangioplasty.
Results
LOD and analytical imprecision exceeded the manufacturer's specification (LOD 1.128 μg/L, 20% CV 1.3 μg/L, 10% CV 2.75 μg/L). Clinical diagnostic efficiency was less than cTnI. Addition of HFABP to cTnI produced a modest increase in diagnostic sensitivity at a cost of significant loss of specificity.
Conclusions
Although the test had excellent analytical performance, it did not contribute to the clinical diagnosis of patients with chest pain. HFABP appears to be a marker of myocardial infarction not myocardial ischemia.
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Affiliation(s)
- Paul O Collinson
- Clinical Blood Sciences, St George's University Hospitals NHS Foundation Trust, London, UK
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
- St George's University of London, London, UK
| | - Jennifer Hersey
- Clinical Blood Sciences, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Rosalind Bray
- Clinical Blood Sciences, St George's University Hospitals NHS Foundation Trust, London, UK
| | - David Gaze
- Clinical Blood Sciences, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Pitt Lim
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sami Firoozi
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Argyrios Ntalianis
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Frances Boa
- Clinical Blood Sciences, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Abhiram Prasad
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
- St George's University of London, London, UK
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27
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Kalra SS, Firoozi S, Laborde JC, Brecker SJ. Transcatheter Aortic Valve Replacement in a Patient With a Single Coronary Artery: Use of a Recapturable System. J Interv Cardiol 2016; 29:124. [DOI: 10.1111/joic.12252] [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] [Indexed: 11/28/2022] Open
Affiliation(s)
- Sundeep S. Kalra
- Department of Cardiology; St. George's University Hospital, London SW17 0QT; United Kingdom
| | - Sami Firoozi
- Department of Cardiology; St. George's University Hospital, London SW17 0QT; United Kingdom
| | - Jean-Claude Laborde
- Department of Cardiology; St. George's University Hospital, London SW17 0QT; United Kingdom
| | - Stephen J. Brecker
- Department of Cardiology; St. George's University Hospital, London SW17 0QT; United Kingdom
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28
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Rampat R, Khawaja MZ, Byrne J, MacCarthy P, Blackman DJ, Krishnamurthy A, Gunarathne A, Kovac J, Banning A, Kharbanda R, Firoozi S, Brecker S, Redwood S, Bapat V, Mullen M, Aggarwal S, Manoharan G, Spence MS, Khogali S, Dooley M, Cockburn J, de Belder A, Trivedi U, Hildick-Smith D. Transcatheter Aortic Valve Replacement Using the Repositionable LOTUS Valve. JACC Cardiovasc Interv 2016; 9:367-372. [DOI: 10.1016/j.jcin.2015.12.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 11/24/2015] [Accepted: 12/03/2015] [Indexed: 02/07/2023]
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29
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Yates MT, Soppa GK, Valencia O, Jones S, Firoozi S, Jahangiri M. Impact of European Society of Cardiology and European Association for Cardiothoracic Surgery Guidelines on Myocardial Revascularization on the activity of percutaneous coronary intervention and coronary artery bypass graft surgery for stable coronary artery disease. J Thorac Cardiovasc Surg 2014; 147:606-10. [DOI: 10.1016/j.jtcvs.2013.01.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 12/20/2012] [Accepted: 01/14/2013] [Indexed: 11/29/2022]
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30
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Mirzakouchaki B, Firoozi F, Firoozi S. Effect of psychological stress on orthodontic tooth movement in rats. Med Oral Patol Oral Cir Bucal 2011; 16:e285-91. [PMID: 20711127 DOI: 10.4317/medoral.16.e285] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 03/10/2010] [Indexed: 11/05/2022] Open
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31
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Papadakis M, Basavarajaiah S, Rawlins J, Edwards C, Makan J, Firoozi S, Carby L, Sharma S. Prevalence and significance of T-wave inversions in predominantly Caucasian adolescent athletes. Eur Heart J 2009; 30:1728-35. [DOI: 10.1093/eurheartj/ehp164] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Abstract
OBJECTIVES To define physiological upper limits of left ventricular (LV) cavity size in trained adolescent athletes. DESIGN Cross sectional echocardiographic study. SETTING British national sports training grounds and Olympic Medical Institute. SUBJECTS 900 elite adolescent athletes (77% boys) aged 15.7 (1.2) years participating in ball, racket, and endurance sports and 250 healthy controls matched for age, sex, and size. MAIN OUTCOME MEASURES LV end diastolic cavity size. RESULTS Compared with controls, athletes had a larger LV cavity (50.8 (3.7) v 47.9 (3.5) mm), a difference of 6%. The LV cavity was > 54 mm in 18% athletes, whereas none of the controls had an LV cavity > 54 mm. The LV cavity exceeded predicted sizes in 117 (13%) athletes. Among the athletes with LV dilatation, 78% were boys, LV size ranged from 52-60 mm, and left atrial diameter and LV wall thickness were enlarged. Systolic and diastolic function were normal. None of the athletes in the study had an LV cavity size > 60 mm. LV cavity size correlated with age, sex, heart rate, and body surface area. CONCLUSION Highly trained junior athletes usually have only modest increases in LV cavity size. A proportion of trained adolescent athletes have LV cavity size exceeding predicted values but, in absolute terms, LV cavity rarely exceeds 60 mm as in patients with dilated cardiomyopathy. In highly trained adolescent athletes with an LV cavity size > 60 mm and any impairment of systolic or diastolic function, the diagnosis of dilated cardiomyopathy should be considered.
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Affiliation(s)
- J Makan
- Department of Cardiology, University Hospital Lewisham, Lewisham High Street, London SE13 6LH, UK.
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Whyte GP, George K, Sharma S, Firoozi S, Stephens N, Senior R, McKenna WJ. The upper limit of physiological cardiac hypertrophy in elite male and female athletes: the British experience. Eur J Appl Physiol 2004; 92:592-7. [PMID: 15054661 DOI: 10.1007/s00421-004-1052-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2004] [Indexed: 10/26/2022]
Abstract
Establishment of upper normal limits of physiological hypertrophy in response to physical training is important in the differentiation of physiological and pathological left ventricular hypertrophy. The genetic differences that exist in the adaptive response of the heart to physical training and the causes of sudden cardiac death in young athletes indicate the need for population-specific normal values. Between September 1994 and December 2001, 442 (306 male, 136 female) elite British athletes from 13 sports were profiled. Standard two-dimensional guided M-mode and Doppler echocardiography were employed to evaluate left ventricular morphology and function. Eleven (2.5%) athletes, competing in a range of sports including judo, skiing, cycling, triathlon, rugby and tennis, presented with a wall thickness >13 mm, commensurate with a diagnosis of hypertrophic cardiomyopathy. Eighteen (5.8%) male athletes presented with a left ventricular internal diameter during diastole (LVIDd) >60 mm, with an upper limit of 65 mm. Of the 136 female athletes, none where found to have a maximum wall thickness >11 mm. Left ventricular internal diameter was <60 mm in all female athletes. Systolic and diastolic function were within normal limits for all athletes. Upper normal limits for left ventricular wall thickness and LVIDd are 14 mm and 65 mm for elite male British athletes, and 11 mm and 60 mm for elite female British athletes. Values in excess of these should be viewed with caution and should prompt further investigation to identify the underlying mechanism.
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Affiliation(s)
- G P Whyte
- CRY Centre for Sports Cardiology, Olympic Medical Institute, Northwick Park Hospital, Watford Road, Middlesex HA1 3UJ, Harrow, UK.
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Thaman R, Murphy RT, Firoozi S, Hamid SM, Gimeno JR, Sachdev B, Paul V, Rowland E, Frenneaux MP, Elliott PM. Restrictive transmitral filling patterns predict improvements in left ventricular function after biventricular pacing. Heart 2003; 89:1087-8. [PMID: 12923039 PMCID: PMC1767855 DOI: 10.1136/heart.89.9.1087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
The majority of sudden deaths in young athletes occur in the context of underlying inherited or genetic cardiac disorders. The evaluation of every athlete regarding underlying cardiac disease is impractical and therefore needs to be targeted at those who are at a higher risk. A practical approach would be to channel efforts towards athletes with cardiac symptoms, those with a family history of inherited cardiac disease, and those with a family history of premature sudden death. There are potential pitfalls in the evaluation of young athletes using non-invasive tests when making the distinction between physiological adaptations to exercise and cardiac pathology. Physicians evaluating young athletes need to be aware of the spectrum of physiological adaptations and to be familiar with conditions responsible for sudden death in this population.
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Affiliation(s)
- S Firoozi
- Department of Cardiological Sciences, St George's Hospital Medical School, London, UK
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36
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Thaman R, Varnava A, Hamid MS, Firoozi S, Sachdev B, Condon M, Gimeno JR, Murphy R, Elliott PM, McKenna WJ. Pregnancy related complications in women with hypertrophic cardiomyopathy. Heart 2003; 89:752-6. [PMID: 12807849 PMCID: PMC1767741 DOI: 10.1136/heart.89.7.752] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [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] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To determine whether pregnancy is well tolerated in hypertrophic cardiomyopathy. SETTING Referral clinic. DESIGN The study cohort comprised 127 consecutively referred women with hypertrophic cardiomyopathy. Forty (31.5%) underwent clinical evaluation before pregnancy. The remaining 87 (68.5%) were referred after their first pregnancy. All underwent history, examination, electrocardiography, and echocardiography. Pregnancy related symptoms and complications were determined by questionnaire and review of medical and obstetric records where available. RESULTS There were 271 pregnancies in total. Thirty six (28.3%) women reported cardiac symptoms in pregnancy. Over 90% of these women had been symptomatic before pregnancy. Symptoms deteriorated during pregnancy in fewer than 10%. Of the 36 women with symptoms during pregnancy, 30 had further pregnancies. Symptoms reoccurred in 18 (60%); symptomatic deterioration was not reported. Heart failure occurred postnatally in two women (1.6%). No complications were reported in 19 (15%) women who underwent general anaesthesia and in 22 (17.4%) women who received epidural anaesthesia, three of whom had a significant left ventricular outflow tract gradient at diagnosis after pregnancy. Three unexplained intrauterine deaths occurred in women taking cardiac medication throughout pregnancy. No echocardiographic or clinical feature was a useful indicator of pregnancy related complications. CONCLUSIONS Most women with hypertrophic cardiomyopathy tolerate pregnancy well. However, rare complications can occur and therefore planned delivery and fetal monitoring are still required for some patients.
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Affiliation(s)
- R Thaman
- Department of Cardiological Sciences, St George's Hospital Medical School, London, UK
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38
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Hamid MS, Quraishi A, Gimeno JR, Thaman R, Johns A, Firoozi S, Elliott PM, McKenna WJ, Pennell D. The role of cardiovascular magnetic resonance in the evaluation of familial arrhythmogenic right ventricular dysplasia/cardiomyopathy. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)81579-6] [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: 10/26/2022]
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39
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Sachdev B, Richfield L, Thaman R, Firoozi S, Gimeno J, Mehta A, Elliott PM. Cardiovascular manifestations in females with Anderson-Fabry disease. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)81584-x] [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: 10/26/2022]
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40
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Batchvarov VN, Hamid MS, Hnatkova K, Thaman R, Gimeno JR, Smetana P, Firoozi S, Quaraishi A, Elliott PM, McKenna WJ, Malik M. Heterogeneity of ventricular repolarization is increased in first degree relatives of patients with arrhythmogenic right ventricular cardiomyopathy. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)81580-2] [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: 11/15/2022]
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41
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Sharma S, Maron BJ, Whyte G, Firoozi S, Elliott PM, McKenna WJ. Physiologic limits of left ventricular hypertrophy in elite junior athletes: relevance to differential diagnosis of athlete's heart and hypertrophic cardiomyopathy. J Am Coll Cardiol 2002; 40:1431-6. [PMID: 12392833 DOI: 10.1016/s0735-1097(02)02270-2] [Citation(s) in RCA: 196] [Impact Index Per Article: 8.9] [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: 11/23/2022]
Abstract
OBJECTIVES The present study was undertaken to define physiologic limits of left ventricular hypertrophy in elite adolescent athletes. BACKGROUND Systematic sports training may cause increased left ventricular wall thickness (LVWT), creating uncertainty regarding the differential diagnosis of athlete's heart from hypertrophic cardiomyopathy (HCM). This distinction is crucial because HCM is responsible for about one-third of all sudden deaths in young athletes. Echocardiographic data defining athlete's heart are limited largely to adults, with little information specifically in adolescent athletes (14 to 18 years old), for whom the risk of sudden death from HCM is highest. METHODS Seven hundred and twenty elite adolescent athletes (75% male) aged 15.7 +/- 1.4 years participating in ball, racket, and endurance sports and 250 healthy sedentary controls of similar age, gender, and body surface area underwent echocardiography. RESULTS Compared with controls, athletes had greater absolute LVWT (9.5 +/- 1.7 mm vs. 8.4 +/- 1.4 mm; p < 0.0001). Maximal LVWT exceeded predicted upper limits in 38 athletes (5%); however, no female athlete had a LVWT >11 mm and only three trained male athletes had absolute LVWT >12 mm (0.4%). Each of the 38 athletes with a LVWT exceeding predicted limits also showed enlarged left ventricular cavity dimension (54.4 +/- 2.1 mm; range 52 to 60 mm). CONCLUSIONS Trained adolescent athletes demonstrated greater absolute LVWT compared with nonathletes. Only a small proportion of athletes exhibited a LVWT exceeding upper limits, very rarely >12 mm, and then always with chamber enlargement. Hypertrophic cardiomyopathy should be considered strongly in any trained adolescent male athlete with LVWT >12 mm (females >11 mm) and nondilated left ventricle.
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Affiliation(s)
- Sanjay Sharma
- Department of Cardiology, University Hospital Lewisham, London, United Kingdom
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42
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Hamid MS, Norman M, Quraishi A, Firoozi S, Thaman R, Gimeno JR, Sachdev B, Rowland E, Elliott PM, McKenna WJ. Prospective evaluation of relatives for familial arrhythmogenic right ventricular cardiomyopathy/dysplasia reveals a need to broaden diagnostic criteria. J Am Coll Cardiol 2002; 40:1445-50. [PMID: 12392835 DOI: 10.1016/s0735-1097(02)02307-0] [Citation(s) in RCA: 235] [Impact Index Per Article: 10.7] [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: 12/20/2022]
Abstract
OBJECTIVES We sought to ascertain the prevalence and mode of expression of familial disease in a consecutive series of patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D). BACKGROUND Autosomal-dominant inheritance is recognized in ARVC. The prevalence and mode of expression of familial disease in consecutive, unselected families is uncertain. METHODS First- and second-degree relatives of 67 ARVC index patients underwent cardiac evaluation with history and examination, 12-lead and signal-averaged electrocardiogram (ECG), two-dimensional and Doppler echocardiography, metabolic exercise testing and Holter monitoring. Diagnoses were made in accordance with published criteria. RESULTS Of 298 relatives, 29 (10%; mean age 37.4 +/- 16.4 years) had ARVC. These were from 19 of the 67 families, representing familial involvement in 28%. Of these affected relatives, 72% were asymptomatic, 17% had ventricular tachycardia (sustained VT 10%, nonsustained VT 7%) and 21% had left ventricular involvement. A further 32 relatives (11%; 37.7 +/- 12.4 years) exhibited nondiagnostic ECG, echocardiographic or Holter abnormalities. Fifteen of these relatives were from families with only the proband affected, and inclusion of this subset of relatives would have resulted in familial ARVC in 48% of index cases. Four additional relatives (1% to 3%) fulfilled diagnostic criteria for dilated cardiomyopathy without any features of right ventricular disease. CONCLUSIONS By using current diagnostic criteria, familial disease was present in 28% of index patients. A further 11% of their relatives had minor cardiac abnormalities, which, in the context of a disease whose mode of inheritance is autosomal dominant, are likely to represent early or mild disease expression. We advocate that the current ARVC diagnostic criteria are modified to reflect the broader spectrum of disease that is observed in family members.
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Affiliation(s)
- M Shoaib Hamid
- Department of Cardiological Sciences, St. George's Hospital Medical School, London, United Kingdom
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43
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Firoozi S, Elliott PM, Sharma S, Murday A, Brecker SJ, Hamid MS, Sachdev B, Thaman R, McKenna WJ. Septal myotomy-myectomy and transcoronary septal alcohol ablation in hypertrophic obstructive cardiomyopathy. A comparison of clinical, haemodynamic and exercise outcomes. Eur Heart J 2002; 23:1617-24. [PMID: 12323162 DOI: 10.1053/euhj.2002.3285] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.5] [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: 11/11/2022] Open
Abstract
AIMS Surgical myectomy has been successfully used to treat patients with symptomatic obstructive hypertrophic cardiomyopathy (HCM). More recently, alcohol septal ablation has been advocated as a less invasive, but equally effective alternative therapy. The aim of this non-randomized cohort study was to compare subjective and objective outcomes in patients undergoing these therapies. METHODS Forty-four patients (25 male; age 41+/-15 years) with symptomatic drug-refractory obstructive HCM were studied. Twenty-four patients underwent surgical myectomy and 20 alcohol septal ablation. All patients underwent clinical evaluation, echocardiography and upright maximal cardiopulmonary exercise testing using a cycle ergometer before and following their intervention. RESULTS Peak gradient was reduced to a similar extent by both modalities (myectomy: 83+/-23 to 15+/-10 mmHg (P<0.000001); ablation: 91+/-18 to 22+/-14 mmHg (P<0.000002);P =0.48 for myectomy vs ablation) and led to similar improvements in NYHA class (myectomy: 2.4+/-0.6 to 1.5+/-0.7 (P<0.00001); ablation: 2.3+/-0.5 to 1.7+/-0.8 (P<0.0001);P=0.3 for myectomy vs ablation). Myectomy resulted in a greater improvement in peak oxygen consumption (myectomy: 16.4+/-5.8 to 23.1+/-7.1 ml.kg(-1) min(-1) (P<0.00002); ablation: 16.2+/-5.2 to 19.3+/-6.1 ml.kg(-1) min(-1) (P<0.05);P <0.05 for myectomy vs ablation) and work rate achieved (myectomy: 130+/-57 to 161+/-60 watts (P<0.04); ablation: 121+/-53 to 137+/-51 watts (P=0.11);P <0.05 for myectomy vs ablation). CONCLUSION Surgical myectomy and alcohol septal ablation are equally effective at reducing obstruction and subjective exercise limitation in appropriately selected patients. However, the superior effect of surgical myectomy on exercise test parameters suggests that surgery remains the gold standard against which new treatment modalities should be compared.
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Affiliation(s)
- S Firoozi
- Department of Cardiological Sciences, St George's Hospital Medical School, London, UK
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44
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Abstract
Hypertrophic cardiomyopathy is an inherited cardiac disorder. Sudden cardiac death frequently occurs in otherwise healthy individuals, and accounts for nearly 35% of all sudden deaths within this age group. Although symptoms occur commonly, they often go unreported. Despite this, a degree of functional limitation is often seen on objective assessment. Management of hypertrophic cardiomyopathy is aimed at relieving symptoms, identifying and treating those individuals at increased risk of sudden death, and screening family members.
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Affiliation(s)
- Rajesh Thaman
- Department of Cardiological Sciences, St. George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, England
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45
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Virdee MS, Matsumura Y, Firoozi S, Elliott PM, McKenna WJ. Determinants of exercise capacity in hypertrophic cardiomyopathy: the role of left ventricular outflow tract obstruction. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)80577-0] [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: 11/25/2022]
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46
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Affiliation(s)
- William J McKenna
- Department of Cardiological Sciences, St George's Hospital, Medical School, London, UK
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47
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Abstract
Hypertrophic cardiomyopathy (HCM) is a genetic disease of the sarcomeric contractile proteins. A majority of patients with HCM are limited in terms of functional capacity, and a minority of these patients die suddenly. The main aims of management are symptom alleviation and prevention of sudden cardiac death. In patients with HCM, cardiopulmonary exercise testing provides a much more accurate index of functional capacity than New York Heart Association classification status, and it is useful in assessing symptoms after various therapeutic strategies have been implemented. Exercise testing is also valuable in identifying patients with HCM who are at high risk of sudden cardiac death and is an integral part of the algorithm in risk stratification and delivery of prophylactic therapy. Also, cardiopulmonary exercise testing plays an important role in differentiating HCM from other conditions associated with left ventricular hypertrophy, such as physiologic athlete's heart. Therefore, during the last few years, cardiopulmonary exercise testing has provided insights into the diagnosis, determinants, and mechanisms of exercise limitation in HCM. This understanding aids physicians in targeting therapy and developing new treatment modalities.
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Affiliation(s)
- S Sharma
- Department of Cardiological Sciences, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK
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48
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Abstract
Hypertrophic cardiomyopathy (HCM) is a genetic disease of the sarcomeric contractile proteins that is characterized by left ventricular hypertrophy and myocyte disarray. The majority of patients are limited in terms of functional capacity and a minority die suddenly. The main aims of management are symptom alleviation and prevention of sudden cardiac death. In patients with HCM, cardiopulmonary exercise testing provides a more accurate index of functional capacity than New York Heart Association classification status and is useful in assessing symptoms following various therapeutic interventions. Cardiopulmonary exercise testing plays an important role in differentiating HCM from other conditions associated with left ventricular hypertrophy. Cardiopulmonary exercise testing is also valuable in identifying individuals at high risk of sudden cardiac death and is an integral part of the algorithm in risk stratification and delivery of prophylactic therapy. Over the past few years, cardiopulmonary exercise testing has provided insight into the determinants and mechanisms of exercise limitation. This understanding helps in targeting therapy and the development of new treatment modalities.
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Affiliation(s)
- S Firoozi
- Department of Cardiological Sciences, St. George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, England.
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