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Chambault AL, Drury NE, Poole E, Jones T, Khan N, Hudsmith L, Bowater S, Arif S, Botha P, Clift P. Adult outcomes of complex pulmonary atresia, ventricular septal defect and major aortopulmonary collaterals following repair during childhood, a single centre experience. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1847] [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
Complex pulmonary atresia with a ventricular septal defect and major aortopulmonary collateral arteries (PA VSD MAPCA) is a rare and complex form of congenital heart disease. Staged surgical palliation is carried out in childhood, and in expert centres, is associated with good medium term survival. Adult outcomes following transition to adult care are not known.
Purpose
To establish adult outcomes of PA VSD MAPCA following repair during childhood in our institution
Methods
Review of clinical records for outcome data including life status, NYHA class, employment status, re-intervention in adult life, arrhythmia, pregnancy, exercise capacity and mode of death, where known. We predefined our population into two groups based on their status at transition to adult care, A) complete repair with RV-PA conduit and VSD closed and B) repaired but VSD left open.
Results
188 patients from our series have transitioned to adult services. As many were tertiary referrals (nationally and internationally) the local follow up population was 53 adults (54.7% male), mean age of those alive under follow up is 27.2±6.5 years, with a mean follow up of 25.3±6.1 years. There were 43 in group A and 10 in group B. Mortality in the total population was 18.9% (10/53), group A (16.3%), group B (30.0%), mean age at death 37.5±10.3 years and 29.9±8.4 years, 6/10 deaths were sudden. 22.6% of the whole group had DiGeorge/22q11 microdeletion, with a learning deficit in 32.7% of the cohort, where this could be assessed. Reinterventions included RV-PA conduit change, coil occlusion, pacemaker implantation, ICD implantation and ablation procedures, overall 39.6% underwent reintervention in adult life. Pregnancy occurred in 33.3% of 24 female patients. 50% of individuals were found to have undertaken some form of paid work and of these 11.5% had DiGeorge.
Conclusions
Complex PA VSD MAPCA is associated with good late survival with late attrition including sudden death and heart failure. 22q11 is associated with learning deficit and consequent lack of employment. Non 22q11 have good educational outcomes and there is less observed deficit regarding employment. Successful pregnancy is possible within this population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A L Chambault
- University of Birmingham, Medical School, College of Medical and Dental Sciences , Birmingham , United Kingdom
| | - N E Drury
- University of Birmingham, Medical School, College of Medical and Dental Sciences , Birmingham , United Kingdom
| | - E Poole
- Birmingham Children's Hospital, Department of Cardiology , Birmingham , United Kingdom
| | - T Jones
- Birmingham Children's Hospital, Department of Cardiology , Birmingham , United Kingdom
| | - N Khan
- Birmingham Children's Hospital, Department of Cardiology , Birmingham , United Kingdom
| | - L Hudsmith
- Queen Elizabeth Hospital , Birmingham , United Kingdom
| | - S Bowater
- Queen Elizabeth Hospital , Birmingham , United Kingdom
| | - S Arif
- Queen Elizabeth Hospital , Birmingham , United Kingdom
| | - P Botha
- Birmingham Children's Hospital, Department of Cardiology , Birmingham , United Kingdom
| | - P Clift
- Queen Elizabeth Hospital , Birmingham , United Kingdom
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Jones J, Prabakhar CRK, Arif S, Bowater S, Clift P, Hudsmith L. 19. The search for 22q11 deletion syndrome. Are we doing enough? International Journal of Cardiology Congenital Heart Disease 2021. [DOI: 10.1016/j.ijcchd.2020.100047] [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: 11/27/2022] Open
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Prabhakar CRK, Kasmani Z, Turner L, Mullally D, Bowater S, Clift P, Hudsmith L. 20. Vitamin D level measurements–are we forgetting this ‘vital’ element amongst complex cardiac patients? International Journal of Cardiology Congenital Heart Disease 2021. [DOI: 10.1016/j.ijcchd.2020.100048] [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: 10/21/2022] Open
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McGregor G, Bruce J, Ennis S, Mason J, Lall R, Ji C, Sandhu H, Seers K, Banerjee P, Canaway A, Booth K, Taylor SJC, Robertson E, Pincus T, Singh S, Fitzmaurice D, Bowater S, Clift P, Underwood M. Supervised pulmonary hypertension exercise rehabilitation (SPHERe): study protocol for a multi-centre randomised controlled trial. BMC Pulm Med 2020; 20:143. [PMID: 32429969 PMCID: PMC7236437 DOI: 10.1186/s12890-020-01182-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/11/2020] [Indexed: 12/21/2022] Open
Abstract
Background Supervised cardio-pulmonary rehabilitation may be safe and beneficial for people with pulmonary hypertension (PH) in groups 1 (pulmonary arterial hypertension) and 4 (chronic thromboembolic disease), particularly as a hospital in-patient. It has not been tested in the most common PH groups; 2 (left heart disease), 3 (lung disease), or 5 (other disorders). Further it has not been evaluated in the UK National Health Service (NHS) out-patient setting, or with long-term follow-up. The aim of this randomised controlled trial (RCT) is to test the clinical and cost-effectiveness of a supervised exercise rehabilitation intervention with psychosocial support compared to best practice usual care for people with PH in the community/outpatient setting. Methods This multi-centre, pragmatic, two-arm RCT with embedded process evaluation aims to recruit 352 clinically stable adults with PH (groups 1–5) and WHO functional class II-IV. Participants will be randomised to either the Supervised Pulmonary Hypertension Exercise Rehabilitation (SPHERe) intervention or control. The SPHERe intervention consists of 1) individual assessment and familiarisation sessions; 2) 8-week, twice-weekly, supervised out-patient exercise training; 3) psychosocial/motivational support and education; 4) guided home exercise plan. The control intervention consists of best practice usual care with a single one-to-one practitioner appointment, and general advice on physical activity. Outcomes will be measured at baseline, 4 months (post-intervention) and 12 months by researchers blinded to treatment allocation. The primary outcome is the incremental shuttle walk test at 4 months. Secondary outcomes include health-related quality of life (HRQoL), time to clinical worsening and health and social care use. A purposive sample of participants (n = 20 intervention and n = 20 control) and practitioners (n = 20) will be interviewed to explore experiences of the trial, outcomes and interventions. Discussion The SPHERe study is the first multi-centre clinical RCT to assess the clinical and cost effectiveness of a supervised exercise rehabilitation intervention compared to usual care, delivered in the UK NHS, for people in all PH groups. Results will inform clinicians and commissioners as to whether or not supervised exercise rehabilitation is effective and should be routinely provided for people with PH. Trial registration ISRCTN no. 10608766, prospectively registered on 18th March 2019.
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Affiliation(s)
- Gordon McGregor
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK. .,Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK. .,Centre for Sport Exercise & Life Sciences, Coventry University, Coventry, UK.
| | - Julie Bruce
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Stuart Ennis
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK.,Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - James Mason
- Centre for Health Economics at Warwick, Warwick Medical School, University of Warwick, Coventry, UK
| | - Ranjit Lall
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Chen Ji
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Harbinder Sandhu
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Kate Seers
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Prithwish Banerjee
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.,Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Alastair Canaway
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Katie Booth
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Stephanie J C Taylor
- Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Tamar Pincus
- Department of Psychology, Royal Holloway University of London, London, UK
| | - Sally Singh
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - David Fitzmaurice
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sarah Bowater
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paul Clift
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Lewis RA, Billings CG, Bolger A, Bowater S, Charalampopoulos A, Clift P, Elliot CA, English K, Hamilton N, Hill C, Hurdman J, Jenkins PJ, Johns C, MacDonald S, Oliver J, Papaioannou V, Rajaram S, Sabroe I, Swift AJ, Thompson AAR, Kiely DG, Condliffe R. Partial anomalous pulmonary venous drainage in patients presenting with suspected pulmonary hypertension: A series of 90 patients from the ASPIRE registry. Respirology 2020; 25:1066-1072. [PMID: 32249494 PMCID: PMC8653892 DOI: 10.1111/resp.13815] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 11/30/2022]
Abstract
Background and objective There are limited data regarding patients with PAPVD with suspected and diagnosed PH. Methods Patients with PAPVD presenting to a large PH referral centre during 2007–2017 were identified from the ASPIRE registry. Results Ninety patients with PAPVD were identified; this was newly diagnosed at our unit in 71 patients (78%), despite 69% of these having previously undergone CT. Sixty‐seven percent had a single right superior and 23% a single left superior anomalous vein. Patients with an SV‐ASD had a significantly larger RV area, pulmonary artery and L‐R shunt and a higher % predicted DLCO (all P < 0.05). Sixty‐five patients were diagnosed with PH (defined as mPAP ≥ 25 mm Hg), which was post‐capillary in 24 (37%). No additional causes of PH were identified in 28 patients; 17 of these (26% of those patients with PH) had a PVR > 3 WU. Seven of these patients had isolated PAPVD, five of whom (8% of those patients with PH) had anomalous drainage of a single pulmonary vein. Conclusion Undiagnosed PAPVD with or without ASD may be present in patients with suspected PH; cross‐sectional imaging should therefore be specifically assessed whenever this diagnosis is considered. Radiological and physiological markers of L‐R shunt are higher in patients with an associated SV‐ASD. Although many patients with PAPVD and PH may have other potential causes of PH, a proportion of patients diagnosed with PAH have isolated PAPVD in the absence of other causative conditions. PAPVD was frequently missed in patients presenting with suspected PH. L‐R shunt was higher in patients with associated ASD. Although patients may have other potential causes of PH, some patients with PAH have isolated PAPVD without other causative conditions. See relatedEditorial
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Affiliation(s)
- Robert A Lewis
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Catherine G Billings
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Aidan Bolger
- Department of Adult Congenital Cardiology, Glenfield Hospital, Leicester, UK
| | - Sarah Bowater
- Department of Adult Congenital Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | | | - Paul Clift
- Department of Adult Congenital Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Charlie A Elliot
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Kate English
- Department of Adult Congenital Cardiology, Leeds General Infirmary, Leeds, UK
| | - Neil Hamilton
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Catherine Hill
- Department of Academic Radiology, University of Sheffield, Sheffield, UK
| | - Judith Hurdman
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Petra J Jenkins
- Department of Adult Congenital Cardiology, Manchester Royal Infirmary, Manchester, UK
| | - Christopher Johns
- Department of Academic Radiology, University of Sheffield, Sheffield, UK
| | - Simon MacDonald
- Department of Adult Congenital Cardiology, Glenfield Hospital, Leicester, UK
| | - James Oliver
- Department of Adult Congenital Cardiology, Leeds General Infirmary, Leeds, UK
| | - Vasilios Papaioannou
- Department of Adult Congenital Cardiology, Manchester Royal Infirmary, Manchester, UK
| | - Smitha Rajaram
- Department of Academic Radiology, University of Sheffield, Sheffield, UK
| | - Ian Sabroe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Andy J Swift
- Department of Academic Radiology, University of Sheffield, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - A A Roger Thompson
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
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Ooues G, Plummer C, Hall J, Lawson C, Price S, Smith R, Wilson I, Wright R, Bowater S. How to succeed in the EEGC: a guide for trainees and their trainers. Heart 2019; 105:1044-1045. [PMID: 30723100 DOI: 10.1136/heartjnl-2018-314496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Georgina Ooues
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Chris Plummer
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Jim Hall
- Department of Cardiology, James Cook University Hospital, Middlesbrough, UK
| | - Clive Lawson
- Department of Cardiology, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - Susanna Price
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Russell Smith
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Ian Wilson
- Department of Cardiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Rob Wright
- Department of Cardiology, James Cook University Hospital, Middlesbrough, UK
| | - Sarah Bowater
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
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Plummer C, Bowater S, Hall J, Lawson C, Ooues G, Price S, Smith R, Wilson I, Wright R. Behind the scenes of the European Examination in General Cardiology. Heart 2019; 105:889-890. [PMID: 30712001 DOI: 10.1136/heartjnl-2018-314495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Chris Plummer
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Sarah Bowater
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Jim Hall
- Department of Cardiology, James Cook University Hospital, Middlesbrough, UK
| | - Clive Lawson
- Department of Cardiology, Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, UK
| | - Georgina Ooues
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Susanna Price
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Russell Smith
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Ian Wilson
- Department of Cardiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Rob Wright
- Department of Cardiology, James Cook University Hospital, Middlesbrough, UK
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Ooues G, Clift P, Bowater S, Arif S, Epstein A, Prasad N, Adamson D, Cummings M, Spencer C, Woodmansey P, Borley J, Ingram T, Morley-Davies A, Roberts W, Qureshi N, Hawkesford S, Pope N, Anthony J, Gaffey T, Thorne S, Hudsmith L. Patient experience within the adult congenital heart disease outreach network: a questionnaire-based study. J Congenit Heart Dis 2018. [DOI: 10.1186/s40949-018-0020-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Stoll V, Pickup L, Rutter L, Luke L, Bowater S, Thorne S, Hudsmith L, Clift P. P4526Cardiac structure and function do not relate to functional capacity in a Fontan cohort. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4526] [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] Open
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Pickup L, Gaffey T, Clift P, Bowater S, Thorne S, Hudsmith L. Employment characteristics of a complex adult congenital heart disease cohort. Occup Med (Lond) 2017; 67:453-455. [DOI: 10.1093/occmed/kqx085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Demetriades P, Bell A, Christopher G, Clift P, Thorne S, Bowater S, Marshall H, DeBono J, Hudsmith L. 81 Suitability of cardiac resynchronisation therapy in patients with univentricular and systemic right ventricular hearts. Heart 2017. [DOI: 10.1136/heartjnl-2017-311726.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Stoll V, Pickup L, Gaffey T, Rutter L, Luke L, Bowater S, Thorne S, Hudsmith L, Clift P. 82 Relationship between cardiac structure and functional capacity in a fontan cohort. Heart 2017. [DOI: 10.1136/heartjnl-2017-311726.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abiodun A, Pickup L, Moore H, Bowater S, Thorne S, Hudsmith L, Clift P. 74 Non-invasive Assessment of Pulmonary Haemodynamics in Fontan Patients. Heart 2016. [DOI: 10.1136/heartjnl-2016-309890.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Plunkett E, Bull S, Gertig R, Bowater S, Clift P, Hudsmith L, Thorne S, Morris K, Selman T, Thompson P. 73 Maternal and Fetal Outcomes in Women with Aortopathy: Experience in a Tertiary Joint Cardiac Obstetric Centre. Heart 2016. [DOI: 10.1136/heartjnl-2016-309890.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pickup L, Quinton E, Thorne S, Bowater S, Clift P, de Bono JP, Hudsmith L. 20 Do atriopulmonary (AP) fontan dimensions using CMR influence the development of atrial tachyarrhythmia? Heart 2016. [DOI: 10.1136/heartjnl-2016-309668.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ooues G, Arif S, Bowater S, Thorne S, Hudsmith L, Clift P. P30 Early outcomes in adults with palliated hypoplastic left heart syndrome. Heart 2016. [DOI: 10.1136/heartjnl-2016-309377.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Moore H, Abiodun A, Bowater S, Clift P, Thorne S, Bono JD, Hudsmith L. P25 Stroke risk from atrial fibrillation in repaired tetralogy of fallot. Heart 2016. [DOI: 10.1136/heartjnl-2016-309377.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Arif S, Bowater S, Clift P, Thorne S, Hudsmith L. P2 Outcomes in adults following anatomic repair of congenitally corrected transposition of the great arteries. Heart 2016. [DOI: 10.1136/heartjnl-2016-309377.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Luke L, Rutter L, Bowater S, Hudsmith L, Thorne S, Clift P. YI-4 Non invasive assessment of pulmonary capacitance in the fontan patient correlates with functional class and peak oxygen consumption. Heart 2016. [DOI: 10.1136/heartjnl-2016-309377.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abiodun A, Moore H, Bowater S, Thorne S, Clift P, Hudsmith L, Bono JD. P1 Diagnosis and stroke risk of atrial fibrillation in patients with atrial septal defects: A single centre experience. Heart 2016. [DOI: 10.1136/heartjnl-2016-309377.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pickup L, Bowater S, Thorne S, Clift P, Hudsmith L. P31 Travel insurance in achd patients: Do they declare their condition? Heart 2016. [DOI: 10.1136/heartjnl-2016-309377.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Carpenter A, Khan N, Stickley J, Thorne S, Hudsmith L, Bowater S, Clift P. P6 The outcomes of maze surgery in achd patients. Heart 2016. [DOI: 10.1136/heartjnl-2016-309377.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Modhwadia S, Jiang J, Bowater S, Hudsmith L, Thorne S, Clift P. P24 The status of the liver in the adult fontan. Heart 2016. [DOI: 10.1136/heartjnl-2016-309377.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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O’Mahony E, Clift P, Thorne S, Bowater S, Hudsmith L. P29 Management and follow up in patients with a fontan circulation: are we following esc guidelines? Heart 2016. [DOI: 10.1136/heartjnl-2016-309377.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Edwards N, Yuan M, Bowater S, Clift P, Thorne S, Hudsmith L. 139 Reduced Aortic Distensibility and Adverse Cardiovascular Functional Performance in Adult Patients with Single Ventricular Physiology. Heart 2015. [DOI: 10.1136/heartjnl-2015-308066.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Beadle RM, Williams LK, Kuehl M, Bowater S, Abozguia K, Leyva F, Yousef Z, Wagenmakers AJM, Thies F, Horowitz J, Frenneaux MP. Improvement in cardiac energetics by perhexiline in heart failure due to dilated cardiomyopathy. JACC Heart Fail 2015; 3:202-11. [PMID: 25650370 DOI: 10.1016/j.jchf.2014.09.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/05/2014] [Accepted: 09/19/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to determine whether short-term treatment with perhexiline improves cardiac energetics, left ventricular function, and symptoms of heart failure by altering cardiac substrate utilization. BACKGROUND Perhexiline improves exercise capacity and left ventricular ejection fraction (LVEF) in patients with heart failure (HF). (31)P cardiac magnetic resonance spectroscopy can be used to quantify the myocardial phosphocreatine/adenosine triphosphate ratio. Because improvement of HF syndrome can improve cardiac energetics secondarily, we investigated the effects of short-term perhexiline therapy. METHODS Patients with systolic HF of nonischemic etiology (n = 50, 62 ± 1.8 years of age, New York Heart Association functional class II to IV, LVEF: 27.0 ± 1.44%) were randomized to receive perhexiline 200 mg or placebo for 1 month in a double-blind fashion. Clinical assessment, echocardiography, and (31)P cardiac magnetic resonance spectroscopy were performed at baseline and after 1 month. A substudy of 22 patients also underwent cross-heart blood sampling at completion of the study to quantify metabolite utilization. RESULTS Perhexiline therapy was associated with a 30% increase in the phosphocreatine/adenosine triphosphate ratio (from 1.16 ± 0.39 to 1.51 ± 0.51; p < 0.001) versus a 3% decrease with placebo (from 1.36 ± 0.31 to 1.34 ± 0.31; p = 0.37). Perhexiline therapy also led to an improvement in New York Heart Association functional class compared with placebo (p = 0.036). Short-term perhexiline therapy did not change LVEF. Cross-heart measures of cardiac substrate uptake and respiratory exchange ratio (which reflects the ratio of substrates used) did not differ between patients who received perhexiline versus placebo. CONCLUSIONS Perhexiline improves cardiac energetics and symptom status with no evidence of altered cardiac substrate utilization. No change in LVEF is seen at this early stage. (Metabolic Manipulation in Chronic Heart Failure; NCT00841139).
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Affiliation(s)
- Roger M Beadle
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, Scotland
| | - Lynne K Williams
- Department of Cardiology, Toronto General Hospital, Toronto, Ontario, Canada
| | - Michael Kuehl
- Department of Cardiovascular Medicine, University of Birmingham, Birmingham, England
| | - Sarah Bowater
- Department of Cardiovascular Medicine, University of Birmingham, Birmingham, England
| | - Khalid Abozguia
- Department of Cardiovascular Medicine, University of Birmingham, Birmingham, England
| | - Francisco Leyva
- Department of Cardiovascular Medicine, University of Birmingham, Birmingham, England
| | - Zaheer Yousef
- Department of Cardiology, University Hospital of Wales, Cardiff, Wales
| | - Anton J M Wagenmakers
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, England
| | - Frank Thies
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, Scotland
| | - John Horowitz
- Department of Cardiology and Pharmacology, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - Michael P Frenneaux
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, Scotland.
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Beadle RM, Williams LK, Kuehl M, Bowater S, Abozguia K, Leon FL, Frenneaux MP. 95 Impaired cardiac energetics in dilated cardiomyopathy: magnetic resonance spectroscopy at 3T. Heart 2011. [DOI: 10.1136/heartjnl-2011-300198.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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