1
|
Cuthbert JJ, Pellicori P, Rigby AS, Abel AAI, Kalvickbacka-Bennet A, Shah P, Kearsley JW, Kazmi S, Cleland JGF, Clark AL. Are non-invasive estimations of plasma volume an accurate measure of congestion in patients with chronic heart failure? Eur Heart J Qual Care Clin Outcomes 2023; 9:281-292. [PMID: 35723241 DOI: 10.1093/ehjqcco/qcac035] [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: 03/13/2022] [Revised: 06/10/2022] [Accepted: 06/15/2022] [Indexed: 05/17/2023]
Abstract
AIMS We report associations between different formulae for estimating plasma volume status (PVS) and clinical and ultrasound markers of congestion in patients with chronic heart failure (CHF) enrolled in the Hull Lifelab registry. METHODS AND RESULTS Cohort 1 comprised patients with data on signs and symptoms at initial evaluation (n = 3505). Cohort 2 included patients with ultrasound assessment of congestion [lung B-line count, inferior vena cava (IVC) diameter, jugular vein distensibility (JVD) ratio] (N = 341). Two formulae for PVS were used: (a) Hakim (HPVS) and (b) Duarte (DPVS). Results were compared with clinical and ultrasound markers of congestion. Outcomes assessed were mortality and the composite of heart failure (HF) hospitalisation and all-cause mortality. In cohort 1, HPVS was associated with mortality [hazard ratio (HR) per unitary increase = 1.02 (1.01-1.03); P < 0.001]. In cohort 2, HPVS was associated with B-line count (HR) = 1.05 [95% confidence interval (CI) (1.01-1.08); P = 0.02] and DPVS with the composite outcome [HR = 1.26 (1.01-1.58); P = 0.04]. HPVS and DPVS were strongly related to haemoglobin concentration and HPVS to weight. After multivariable analysis, there were no strong or consistent associations between PVS and measures of congestion, severity of symptoms, or outcome. By contrast, log[NTproBNP] was strongly associated with all three. CONCLUSION Amongst patients with CHF, HPVS and DPVS are not strongly or consistently associated with clinical or ultrasound evidence of congestion, nor clinical outcomes after multivariable adjustment. They appear only to be surrogates of the variables from which they are calculated with no intrinsic clinical utility.
Collapse
Affiliation(s)
- J J Cuthbert
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
- Department of Cardiology, Hull University Hospitals Trust, Castle Hill Hospital, Castle Road, Cottingham, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU16 5JQ
| | - P Pellicori
- Robertson Centre for Biostatistics, Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - A S Rigby
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
| | - A A I Abel
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
- Department of Cardiology, Hull University Hospitals Trust, Castle Hill Hospital, Castle Road, Cottingham, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU16 5JQ
| | - A Kalvickbacka-Bennet
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
| | - P Shah
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
| | - J W Kearsley
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
| | - S Kazmi
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
| | - J G F Cleland
- Robertson Centre for Biostatistics, Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - A L Clark
- Department of Cardiology, Hull University Hospitals Trust, Castle Hill Hospital, Castle Road, Cottingham, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU16 5JQ
| |
Collapse
|
2
|
Brown OI, Sklirou M, Cuthbert JJ, Abel AA, Samuel NA, Kazmi S, Clark AL. The relation between change in left ventricular systolic function and subsequent mortality in patients with chronic heart failure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Increasing severity of impairment of left ventricular systolic dysfunction (LVSD) in patients with chronic heart failure (CHF) is associated with higher mortality. However, the relation between temporal changes in LVSD severity and long-term clinical outcome is unknown.
Purpose
We therefore investigated the effects of change of LVSD as measured by serial echocardiography on all-cause mortality in patients with CHF.
Methods
Patients with CHF defined as the presence of compatible symptoms and either at least moderate LVSD or NTproBNP >125 ng/L were enrolled. LVSD was qualitatively assessed as: none, mild, moderate, and severe. Echocardiography was performed at baseline and 12 months. The primary endpoint was all-cause mortality. Cox proportional hazard models were used to assess the relation between changes in LVSD and outcome. Hazard ratios (HR) are reported with 95% confidence intervals (CI).
Results
At baseline, 170 (11%) had no, 231 (16%) mild, 633 (43%) moderate and 453 (30%) severe LVSD. Amongst patients with either moderate or severe LVSD at baseline, 40% had improvement in function at 12 months (figure 1). Amongst patients with no LVSD at baseline, only 14% had deterioration of function. During subsequent median follow up of 2773 days, 868 patients died. Worsening of LVSD was associated with increasing all-cause mortality in patients with moderate LVSD and severe LVSD at baseline, but this was not significant after adjustment for covariables (table 1). Improvement of LVSD was independently associated with better survival in patients with moderate LVSD at baseline (HR 0.72 (95% CI: 0.53–0.98, p=0.04).
Conclusion
Greater severity of LVSD at baseline is associated with increasing likelihood of improvement. Amongst patients with moderate LVSD, improvement in LVSD is independently associated with survival.
Funding Acknowledgement
Type of funding sources: Public Institution(s).
Collapse
Affiliation(s)
- O I Brown
- University of Hull , Hull , United Kingdom
| | - M Sklirou
- University of Hull , Hull , United Kingdom
| | | | - A A Abel
- University of Hull , Hull , United Kingdom
| | - N A Samuel
- University of Hull , Hull , United Kingdom
| | - S Kazmi
- University of Hull , Hull , United Kingdom
| | - A L Clark
- University of Hull , Hull , United Kingdom
| |
Collapse
|
3
|
Iaconelli A, Pellicori P, Maffia P, Clark AL, Cleland JGF. Inferior vena cava diameter adds information to pulmonary artery systolic pressure in outpatients with heart failure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Evaluation of pulmonary arterial pressure (PAP) is recommended by guidelines to diagnose and monitor congestion in patients with heart failure (HF). However, the high compliance of the venous system might buffer the effects of a large increase in intravascular volume and delay an elevation in PAP. Therefore, measuring inferior vena cava (IVC) diameter by ultrasounds might add important information in patients with HF, regardless of PAP.
Aim
To evaluate the relationship between the IVC diameter and systolic PAP (PAsP) assessed by echocardiography with mortality in outpatients with HF.
Methods
We enrolled consenting out-patients attending a community HF clinic for initial diagnosis or follow-up in Kingston upon Hull, UK between 2009–2012. HF was defined as the presence of relevant symptoms and signs and objective evidence of cardiac dysfunction: either a left ventricular systolic function (LVEF) <50% or elevated amino-terminal pro-brain natriuretic peptide (NT-proBNP) ≥125 pg/ml. IVC was considered dilated when >2.0 cm, PAsP elevated when >35 mmHg.
Results
Amongst the 874 patients enrolled, median age was 75 years, 68% were men, median LVEF was 44% and median NT-proBNP was 1125 pg/ml. 468 patients (54%) had normal IVC and PAsP, 117 (13%) had normal IVC but elevated PAsP, 75 (8%) had dilated IVC but normal PAsP and 214 (25%) had both dilated IVC and elevated PAsP. Compared to those with normal IVC and PAsP, those with elevated PAsP but normal IVC were older, more likely to be women, and had higher LVEF and NT-proBNP, whilst those with dilated IVC but normal PAsP had similar age and LVEF, but more signs of congestion and higher NT-proBNP. Compared to those with both normal IVC and PAsP (reference), those with dilated IVC but normal PAsP (HR: 1.83; CI: 1.04–3.25; P=0.037) or elevated PAsP but normal IVC (HR: 1.88; CI: 1.25–2.85; P=0.003) had a similarly increased risk of death but those with a dilated IVC and elevated PAsP had the greatest risk (HR: 4.16; CI: 3.10–5.57; P<0.001).
Conclusion
A dilated IVC is associated with mortality even when PAsP is not elevated. Tailoring treatments to reduce IVC diameter is a strategy worth exploring to improve outcomes in outpatients with heart failure.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- A Iaconelli
- Institute of Cardiovascular and Medical Sciences , Glasgow , United Kingdom
| | - P Pellicori
- Robertson Centre for Biostatistics , Glasgow , United Kingdom
| | - P Maffia
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow , Glasgow , United Kingdom
| | - A L Clark
- Hull University Teaching Hospitals NHS Trust , Hull , United Kingdom
| | - J G F Cleland
- Robertson Centre for Biostatistics , Glasgow , United Kingdom
| |
Collapse
|
4
|
Cuthbert JJ, Ransome N, Clark AL. Re-defining iron deficiency in patients with heart failure. Expert Rev Cardiovasc Ther 2022; 20:667-681. [DOI: 10.1080/14779072.2022.2100349] [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: 10/17/2022]
Affiliation(s)
- JJ Cuthbert
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Kingston-Upon-Hull, East Riding of Yorkshire, UK
- Department of Cardiology, Hull University Teaching Hospital Trust, Castle Hill Hospital, Castle Road, Cottingham, Kingston-Upon-Hull, East Riding of Yorkshire, UK
| | - N Ransome
- Department of Haematology, York and Scarborough Teaching Hospitals NHS Trust, York, UK
| | - AL Clark
- Department of Cardiology, Hull University Teaching Hospital Trust, Castle Hill Hospital, Castle Road, Cottingham, Kingston-Upon-Hull, East Riding of Yorkshire, UK
| |
Collapse
|
5
|
Cuthbert JJ, Brown OI, Urbinati A, Pan D, Pellicori P, Dobbs K, Bulemfu J, Kazmi S, Sokoreli I, Pauws SC, Riistama JM, Cleland JGF, Clark AL. Hypochloraemia following admission to hospital with heart failure is common and associated with an increased risk of readmission or death: a report from OPERA-HF. Eur Heart J Acute Cardiovasc Care 2022; 11:43-52. [PMID: 34897402 DOI: 10.1093/ehjacc/zuab097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/19/2021] [Accepted: 10/11/2021] [Indexed: 06/14/2023]
Abstract
AIMS Hypochloraemia is common in patients hospitalized with heart failure (HF) and associated with a high risk of adverse outcomes during admission and following discharge. We assessed the significance of changes in serum chloride concentrations in relation to serum sodium and bicarbonate concentrations during admission in a cohort of 1002 consecutive patients admitted with HF and enrolled into an observational study based at a single tertiary centre in the UK. METHODS AND RESULTS Hypochloraemia (<96 mmol/L), hyponatraemia (<135 mmol/L), and metabolic alkalosis (bicarbonate >32 mmol/L) were defined by local laboratory reference ranges. Outcomes assessed were all-cause mortality, all-cause mortality or all-cause readmission, and all-cause mortality or HF readmission. Cox regression and Kaplan-Meier curves were used to investigate associations with outcome. During a median follow-up of 856 days (interquartile range 272-1416), discharge hypochloraemia, regardless of serum sodium, or bicarbonate levels was associated with greater all-cause mortality [hazard ratio (HR) 1.44, 95% confidence interval (CI) 1.15-1.79; P = 0.001], all-cause mortality or all-cause readmission (HR 1.26, 95% CI 1.04-1.53; P = 0.02), and all-cause mortality or HF readmission (HR 1.41, 95% CI 1.14-1.74; P = 0.002) after multivariable adjustment. Patients with concurrent hypochloraemia and natraemia had lower haemoglobin and haematocrit, suggesting congestion; those with hypochloraemia and normal sodium levels had more metabolic alkalosis, suggesting decongestion. CONCLUSION Hypochloraemia is common at discharge after a hospitalization for HF and is associated with worse outcome subsequently. It is an easily measured clinical variables that is associated with morbidity or mortality of any cause.
Collapse
Affiliation(s)
- J J Cuthbert
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Kingston-Upon-Hull, East Riding of Yorkshire HU6 7RX, UK
- Department of Cardiology, Castle Hill Hospital, Hull University Teaching Hospitals Trust, Castle Road, Cottingham, Kingston-Upon-Hull, East Riding of Yorkshire HU3 2JZ, UK
| | - O I Brown
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Kingston-Upon-Hull, East Riding of Yorkshire HU6 7RX, UK
- Department of Cardiology, Castle Hill Hospital, Hull University Teaching Hospitals Trust, Castle Road, Cottingham, Kingston-Upon-Hull, East Riding of Yorkshire HU3 2JZ, UK
| | - A Urbinati
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Kingston-Upon-Hull, East Riding of Yorkshire HU6 7RX, UK
| | - D Pan
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Kingston-Upon-Hull, East Riding of Yorkshire HU6 7RX, UK
| | - P Pellicori
- Robertson Centre for Biostatistics, Glasgow Clinical Trials Unit, University of Glasgow, Glasgow G12 8QQ, UK
| | - K Dobbs
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Kingston-Upon-Hull, East Riding of Yorkshire HU6 7RX, UK
| | - J Bulemfu
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Kingston-Upon-Hull, East Riding of Yorkshire HU6 7RX, UK
| | - S Kazmi
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Kingston-Upon-Hull, East Riding of Yorkshire HU6 7RX, UK
| | - I Sokoreli
- Remote Patient Management & Chronic Care, Philips Research, Eindhoven 5656 AE, the Netherlands
| | - S C Pauws
- Remote Patient Management & Chronic Care, Philips Research, Eindhoven 5656 AE, the Netherlands
- Department of Communication and Cognition, Tilburg University, Tilburg 5037 AB, the Netherlands
| | - J M Riistama
- Philips Image Guided Therapy Devices, Best 1096 BC, The Netherlands
| | - J G F Cleland
- Robertson Centre for Biostatistics, Glasgow Clinical Trials Unit, University of Glasgow, Glasgow G12 8QQ, UK
| | - A L Clark
- Department of Cardiology, Castle Hill Hospital, Hull University Teaching Hospitals Trust, Castle Road, Cottingham, Kingston-Upon-Hull, East Riding of Yorkshire HU3 2JZ, UK
| |
Collapse
|
6
|
Sze S, Pellicori P, Zhang J, Weston J, Squire IB, Clark AL. The efficacy of using a holistic 4-domain approach in evaluating frailty in ambulatory patient with heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1002] [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
Recently, the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) proposed a four-domain approach to assess frailty in patients with heart failure (HF), to tailor treatment and potentially improve outcomes. The efficacy of such approach in detecting frailty and predicting outcome in patients with HF is unknown.
Aim
To study the prevalence and prognostic value of four different types of frailty deficits: clinical, physical, cognitive and social frailty in ambulatory patients with HF.
Methods
We assessed prospectively consecutive patients attending a routine follow-up visit. Patients with ≥5 non-HF comorbidities were classified as having a clinical deficit. Those who scored ≥3 using the Fried criteria were classified as having a physical deficit. Those who failed to complete a clock test accurately were classified as having a cognitive deficit. Those who lived alone or in a residential home were classified as having a social deficit. All patients were followed for a minimum of 1 year. The primary end point is all-cause mortality.
Results
We enrolled 467 patients (67% male, median (25th–75th centile) age 76 (69–82) years, median (25th–75th centile) NT-proBNP 1156 (469–2463) ng/L). 65% of patients had clinical deficits, 52% had a physical deficit, 39% had a social deficit and 18% had a cognitive deficit. 28% had 2, 19% had 3, 8% of patients had all 4 deficits; 16% had none. An increasing number of frailty deficits was associated with worse symptoms, higher NT-proBNP and less likelihood of being prescribed guideline-indicated HF treatment.
During a median follow-up of 554 days, 82 patients died. The presence of any frailty deficit was associated with increased risk of mortality. (Figure 1) The more frailty deficit a patient had, the higher the risk of mortality (Figure 2). A base model (including age, body mass index, NYHA class and log [NT-proBNP]) for predicting mortality at 1 year achieved a C-statistic of 0.78. Addition of all four deficits improved the performance of the base model (C-statistic = 0.82).
Conclusion
Clinical, physical, cognitive and social deficits are common in patients with HF and are associated with a poor outcome. Future studies should evaluate how a domain-based approach can be used to optimise care for frail patients with HF.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Collapse
Affiliation(s)
- S Sze
- Cardiovascular Research Unit of Leicester, Leicester, United Kingdom
| | - P Pellicori
- University of Glasgow, Glasgow, United Kingdom
| | - J Zhang
- Anglia Ruskin University, Cambridge, United Kingdom
| | - J Weston
- Castle Hill Hospital, Cottingham, United Kingdom
| | - I B Squire
- Cardiovascular Research Unit of Leicester, Leicester, United Kingdom
| | - A L Clark
- Castle Hill Hospital, Cottingham, United Kingdom
| |
Collapse
|
7
|
Abstract
Therapy to activate bone formation is required to reverse and restore the damaged bone architecture found in women with postmenopausal osteoporosis. The osteoanabolic drugs include teriparatide, which has been available for several years, and abaloparatide and romosozumab, novel osteoanabolic drugs that have become available more recently. By stimulating bone formation, these drugs produce greater increases in bone mass and bone strength, and they do so more quickly compared to the commonly used anti-remodeling (also called antiresorptive) drugs such as bisphosphonates. In head-to-head trials, teriparatide and romosozumab reduce fracture risk more effectively than do oral bisphosphonates in women with osteoporosis and high fracture risk. Osteoanabolic drugs have little role in the prevention of bone loss during early menopause, but they have an important place in the treatment of women at very high risk of fracture or who remain at high fracture risk after a course of bisphosphonate therapy. Primarily because of the high cost of the drugs, these therapies are initiated by specialists rather than primary-care physicians in most countries. This review will present the evidence for efficacy and safety of these drugs so that clinicians may discern their appropriate use when caring for postmenopausal women with osteoporosis.
Collapse
Affiliation(s)
- M R McClung
- Oregon Osteoporosis Center, Portland, OR, USA.,Mary McKillop Center for Health Research, Australia Catholic University, Melbourne, VIC, Australia
| | - A L Clark
- Kaiser Center for Health Research, Portland, OR, USA.,Department of Obstetrics and Gynecology, Kaiser Permanente Northwest, Portland, OR, USA.,Department of Obstetrics and Gynecology, Oregon Health Sciences University, Portland, OR, USA
| |
Collapse
|
8
|
Nichols S, Taylor C, Goodman T, Page R, Kallvikbacka-Bennett A, Nation F, Clark AL, Birkett ST, Carroll S, Ingle L. Corrigendum to Routine exercise-based cardiac rehabilitation does not increase aerobic fitness: A CARE CR study, International Journal of Cardiology, 305 (2020) 25-34. Int J Cardiol 2020; 322:294. [PMID: 32890613 DOI: 10.1016/j.ijcard.2020.08.078] [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: 10/23/2022]
Affiliation(s)
- S Nichols
- Centre for Sports and Exercise Science, Sheffield Hallam University, Collegiate Campus, Sheffield S10 2BP, United Kingdom.
| | - C Taylor
- Department of Sport, Health and Exercise Science, Don Building, University of Hull Cottingham Road Hull, HU6 7RX, United Kingdom
| | - T Goodman
- City Health Care Partnership CIC, East Riding Community Hospital, Swinemoore Lane, Beverley HU17 0FA, United Kingdom
| | - R Page
- Department of Sport, Health and Exercise Science, Don Building, University of Hull Cottingham Road Hull, HU6 7RX, United Kingdom
| | - A Kallvikbacka-Bennett
- Academic Cardiology Castle Hill Hospital, Hull and East Yorkshire Hospitals, Castle Road, Cottingham HU16 5JQ, United Kingdom
| | - F Nation
- Department of Sport, Health and Exercise Science, Don Building, University of Hull Cottingham Road Hull, HU6 7RX, United Kingdom
| | - A L Clark
- Academic Cardiology Castle Hill Hospital, Hull and East Yorkshire Hospitals, Castle Road, Cottingham HU16 5JQ, United Kingdom
| | - S T Birkett
- School of Sport and Health Sciences, University of Central Lancashire, Preston PR1 2HE, United Kingdom
| | - S Carroll
- Department of Sport, Health and Exercise Science, Don Building, University of Hull Cottingham Road Hull, HU6 7RX, United Kingdom
| | - L Ingle
- Department of Sport, Health and Exercise Science, Don Building, University of Hull Cottingham Road Hull, HU6 7RX, United Kingdom
| |
Collapse
|
9
|
Sze S, Pellicori P, Zhang J, Weston J, Clark AL. P4514Agreement and prognostic significance of 6 frailty tools in patients with chronic heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Frailty is common in patients with chronic heart failure (CHF) and is associated with adverse outcome. Many frailty tools are available, however, there is no standard way of evaluating frailty in patients with CHF.
Purpose
To report the prevalence of frailty, agreement and prognostic significance amongst 3 frailty assessment tools and 3 screening tools in CHF patients.
Methods
We comprehensively studied frailty using 6 frailty tools. Frailty screening tools include: Clinical frailty scale (CFS); Derby frailty index & Acute frailty network frailty criteria. Frailty assessment tools include: Fried criteria; Edmonton frailty score & Deficit index. Since there is no gold standard in evaluating frailty in CHF patients, for each of the frailty tools, we used the results of the other 5 tools to produce a combined frailty index which we used as a “standard” frailty tool. Subjects were defined as frail if so identified by at least 3 out of 5 tools.
Results
467 consecutive ambulatory CHF patients (67% male, median age 76 (IQR: 69–82) years, median NTproBNP 1156 (IQR: 469–2463) ng/L) and 87 controls (79% male, median age 73 (IQR: 69–77 years) were studied.
Prevalence of frailty was much higher in CHF patients than in controls (30–52% vs 2–15%, respectively). Amongst the frailty screening tools, DFI scored the greatest proportion of patients as frail (48%) while CFS scored the lowest proportion as frail (44%). Amongst the assessment tools, Fried criteria scored the greatest proportion of patients as frail (52%) while EFS scored the lowest proportion as frail (30%). Frail patients were older, have worse symptoms, higher NTproBNP and more co-morbidities compared to non-frail patients.
Of the screening tools, CFS had the strongest agreement with assessment tools (kappa coefficient: 0.65–0.72, all p<0.001). CFS had the highest sensitivity (87%) and specificity (89%) amongst screening tools and the lowest misclassification rate (12%) amongst all 6 frailty tools in identifying frailty according to the combined frailty index.
During a median follow-up of 559 days (IQR 512–629 days), 82 (18%) patients died. 55% (N=45) of frail patients died of non-cardiovascular causes. Worsening frailty as detected by all 6 frailty tools was associated with worse outcome. A base model for mortality prediction including sex, NYHA class (III/IV vs I/II), BMI, log NTproBNP and haemoglobin had a C-statistics of 0.78. Amongst frailty tools: CFS and Fried criteria increased model performance most compared with base model (c-statistics: 0.80 for both). Patients who were frail according to CFS had a 9 times greater mortality risk than non-frail patients (Figure).
Conclusion
Frailty is common in CHF patients and is associated with worse outcome. CFS is a simple screening tool which identifies a similar group as lengthy assessment tools and has similar prognostic significance. Frailty screening should be incorporated into routine care of patients with CHF.
Acknowledgement/Funding
None
Collapse
Affiliation(s)
- S Sze
- Cardiovascular Research Unit of Leicester, Leicester, United Kingdom
| | - P Pellicori
- University of Glasgow, Glasgow, United Kingdom
| | - J Zhang
- Anglia Ruskin University, Cambridge, United Kingdom
| | - J Weston
- Castle Hill Hospital, Cottingham, United Kingdom
| | - A L Clark
- Castle Hill Hospital, Cottingham, United Kingdom
| |
Collapse
|
10
|
Brown OI, Witte K, Shahi S, Clark AL. P2506Prognostic importance of ventilatory efficiency in healthy subjects. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Low cardiorespiratory fitness, defined by reduced maximal oxygen consumption (VO2), is a predictor of mortality in patients without chronic disease. However, the relation between ventilatory efficiency (as measured by the slope of the relation between ventilation (VE) and carbon dioxide production (VCO2)) and all-cause mortality is unknown.
Purpose
To assess the relation between variables derived from cardiopulmonary exercise testing and long-term survival in normal subjects
Method
We recruited 145 healthy subjects, with no history of chronic disease (57% male, mean age 63±12) from primary care at random. All participants underwent cardiopulmonary exercise testing at baseline. Participants were followed for 15.5±3.5 years. The primary end-point was all-cause mortality. Cox-proportional hazard models were used to assess the relationship between measures of exercise performance and outcome. Hazard ratios (HR) are reported with 95% confidence intervals (CI).
Results
During follow up, 34 participants (23.4%) died. On univariable analysis, VE/VCO2 slope, peak VO2, respiratory exchange ratio at peak exercise, peak heart rate and 6-minute walk test distance were significant predictors of all-cause mortality (table 1). However, only VE/VCO2 slope (HR per unit increase: 1.13, 95% CI: 1.00–1.28, P=0.043) and peak heart rate (HR per 10 unit increase: 0.73, 95% CI: 0.57–0.93, P=0.010) were independent predictors of all-cause mortality on multivariable analysis.
Table 1. Cox regression analysis (univariable and multivariable) for cardiopulmonary exercise testing measures and all-cause mortality HR Presentation Univariable analysis Multivariable analysis HR 95% CI p value HR 95% CI p value Peak VO2 (ml/kg/min) Per unit increase 0.90 0.86–0.95 <0.001 0.94 0.86–1.03 0.214 VE/VCO2 slope Per unit increase 1.08 1.01–1.17 0.049 1.13 1.00–1.28 0.043 Exercise RER Per 0.1 unit increase 0.46 0.31–0.67 <0.001 0.72 0.45–1.17 0.185 Peak heart rate (bpm) Per 10 unit increase 0.73 0.65–0.81 <0.001 0.73 0.57–0.93 0.010 6MWT (metre) Per 25 unit increase 0.92 0.86–0.98 0.009 1.02 0.86–1.17 0.789 Peak systolic BP (mmHg) Per 10 unit increase 1.13 0.98–1.31 0.101 – – – Multivariable analysis is adjusted for age, body mass index, sex, smoking, resting systolic blood pressure and forced vital capacity. Abbreviations: 6MWT, 6-minute walk test; CI, confidence interval; HR, hazard ratio; RER, respiratory exchange ratio.
Conclusions
Raised VE/VCO2 slope is an independent predictor of all-cause mortality in healthy patients with no history of chronic disease.
Collapse
Affiliation(s)
- O I Brown
- University of Hull, Hull, United Kingdom
| | - K Witte
- University of Leeds, Leeds, United Kingdom
| | - S Shahi
- University of Hull, Hull, United Kingdom
| | - A L Clark
- University of Hull, Hull, United Kingdom
| |
Collapse
|
11
|
Shoaib A, Farag M, Nolan J, Rigby A, Patwala A, Rashid M, Kwok CS, Perveen R, Clark AL, Komajda M, Cleland JGF. Mode of presentation and mortality amongst patients hospitalized with heart failure? A report from the First Euro Heart Failure Survey. Clin Res Cardiol 2018; 108:510-519. [PMID: 30361818 PMCID: PMC6484773 DOI: 10.1007/s00392-018-1380-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/25/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Heart failure is heterogeneous in aetiology, pathophysiology, and presentation. Despite this diversity, clinical trials of patients hospitalized for HF deal with this problem as a single entity, which may be one reason for repeated failures. METHODS The first EuroHeart Failure Survey screened consecutive deaths and discharges of patients with suspected heart failure during 2000-2001. Patients were sorted into seven mutually exclusive hierarchical presentations: (1) with cardiac arrest/ventricular arrhythmia; (2) with acute coronary syndrome; (3) with rapid atrial fibrillation; (4) with acute breathlessness; (5) with other symptoms/signs such as peripheral oedema; (6) with stable symptoms; and (7) others in whom the contribution of HF to admission was not clear. RESULTS The 10,701 patients enrolled were classified into the above seven presentations as follows: 260 (2%), 560 (5%), 799 (8%), 2479 (24%), 1040 (10%), 703 (7%), and 4691 (45%) for which index-admission mortality was 26%, 20%, 10%, 8%, 6%, 6%, and 4%, respectively. Compared to those in group 7, the hazard ratios for death during the index admission were 4.9 (p ≤ 0.001), 4.0 (p < 0.001), 2.2 (p < 0.001), 2.1 (p < 0.001), 1.4 (p < 0.04) and 1.4 (p = 0.04), respectively. These differences were no longer statistically significant by 12 weeks. CONCLUSION There is great diversity in the presentation of heart failure that is associated with very different short-term outcomes. Only a minority of hospitalizations associated with suspected heart failure are associated with acute breathlessness. This should be taken into account in the design of future clinical trials.
Collapse
Affiliation(s)
- Ahmad Shoaib
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences and Centre for Prognosis Research, Keele University, Stoke on Trent, UK.
- Department of Academic Cardiology, University of Hull, Kingston upon Hull, UK.
| | - M Farag
- Postgraduate Medical School, University of Hertfordshire, Hertfordshire, UK
| | - J Nolan
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences and Centre for Prognosis Research, Keele University, Stoke on Trent, UK
| | - A Rigby
- Department of Academic Cardiology, University of Hull, Kingston upon Hull, UK
| | - A Patwala
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences and Centre for Prognosis Research, Keele University, Stoke on Trent, UK
| | - M Rashid
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences and Centre for Prognosis Research, Keele University, Stoke on Trent, UK
| | - C S Kwok
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences and Centre for Prognosis Research, Keele University, Stoke on Trent, UK
| | - R Perveen
- Department of Academic Cardiology, University of Hull, Kingston upon Hull, UK
| | - A L Clark
- Department of Academic Cardiology, University of Hull, Kingston upon Hull, UK
| | - M Komajda
- Department of Cardiology, University of Pierre and Marie Curie Paris VI, La Pitié-Salpêtrière Hospital, Paris, France
| | - J G F Cleland
- Robertson Centre for Biostatistics, University of Glasgow and National Heart and Lung Institute, Imperial College London, London, UK
| |
Collapse
|
12
|
Pellicori P, Cuthbert J, Shah P, Zhang J, Urbinati A, Kazmi S, Clark AL, Cleland JGF. P5674HsCRP in patients with heart failure and its associations with outcome. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5674] [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)
- P Pellicori
- University of Glasgow, Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | - J Cuthbert
- University of Hull, Department of Academic Cardiology, Hull, United Kingdom
| | - P Shah
- University of Hull, Department of Academic Cardiology, Hull, United Kingdom
| | - J Zhang
- University of Hull, Department of Academic Cardiology, Hull, United Kingdom
| | - A Urbinati
- University of Hull, Department of Academic Cardiology, Hull, United Kingdom
| | - S Kazmi
- University of Hull, Department of Academic Cardiology, Hull, United Kingdom
| | - A L Clark
- University of Hull, Department of Academic Cardiology, Hull, United Kingdom
| | - J G F Cleland
- University of Glasgow, Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| |
Collapse
|
13
|
Sze S, Pellicori P, Zhang J, Clark AL. P1823Malnutrition and its association with congestion in chronic heart failure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1823] [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)
- S Sze
- Castle Hill Hospital, Hull, United Kingdom
| | - P Pellicori
- University of Glasgow, Glasgow, United Kingdom
| | - J Zhang
- Anglia Ruskin University, Cambridge, United Kingdom
| | - A L Clark
- Castle Hill Hospital, Hull, United Kingdom
| |
Collapse
|
14
|
Zeymer U, Clark AL, Barrios V, Damy T, Drozdz J, Fonseca C, Lund LH, Hupfer S, Maggioni A. P908Characteristics of heart failure patients treated with Sacubitril - Valsartan in Europe. Results from ARIADNE. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p908] [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)
- U Zeymer
- Institut für Herzinfarktforschung, Ludwigshafen Am Rhein, Germany
| | - A L Clark
- Castle Hill Hospital, Kingston upon Hill, United Kingdom
| | - V Barrios
- University Hospital Ramon y Cajal de Madrid, Madrid, Spain
| | - T Damy
- University Hospital Henri Mondor, Creteil, France
| | - J Drozdz
- Medical University of Lodz, Lodz, Poland
| | - C Fonseca
- Hospital de Sao Francisco Xavier, Lisbon, Portugal
| | - L H Lund
- Karolinska University Hospital, Stockholm, Sweden
| | - S Hupfer
- Novartis Pharma, Nuremberg, Germany
| | - A Maggioni
- Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy
| | | |
Collapse
|
15
|
Clark AL, Bruce Wirta S, Zhou M, Kazmi S, Goode KM, Pellicori P, Corda S, Balas B, Calado F, Cleland JGF. P6530What proportion of patients with heart failure are candidates for sacubitril/valsartan? Differences between guideline recommendations and regulatory labels. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6530] [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 L Clark
- Hull York Medical School (at University of Hull), Castle Hill Hospital, Department of Cardiology, Kingston upon Hull, United Kingdom
| | - S Bruce Wirta
- Novartis Sweden AB, Real World Evidence Center of Excellence, Stockholm, Sweden
| | - M Zhou
- IQVIA, Real-World Insights, Basel, Switzerland
| | - S Kazmi
- Hull York Medical School (at University of Hull), Castle Hill Hospital, Department of Cardiology, Kingston upon Hull, United Kingdom
| | - K M Goode
- Hull York Medical School (at University of Hull), Castle Hill Hospital, Department of Cardiology, Kingston upon Hull, United Kingdom
| | - P Pellicori
- Hull York Medical School (at University of Hull), Castle Hill Hospital, Department of Cardiology, Kingston upon Hull, United Kingdom
| | - S Corda
- Novartis, Basel, Switzerland
| | - B Balas
- Novartis, Basel, Switzerland
| | | | - J G F Cleland
- University of Hull, Kingston upon Hull, United Kingdom
| |
Collapse
|
16
|
Brown OI, Costanzo P, Clark AL, Condorelli G, Cleland JGF, Sathyapalan T, Hepburn D, Kilpatrick ES, Atkin SL. P4475Glycated haemoglobin and risk of all-cause, causal mortality and cardiovascular hospitalisation in type 2 diabetes mellitus according to body mass index. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4475] [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)
- O I Brown
- University of Hull, Hull, United Kingdom
| | - P Costanzo
- University of Hull, Hull, United Kingdom
| | - A L Clark
- University of Hull, Hull, United Kingdom
| | - G Condorelli
- Clinical Institute Humanitas IRCCS, Rozzano, Italy
| | | | | | - D Hepburn
- University of Hull, Hull, United Kingdom
| | | | - S L Atkin
- Weill Cornell Medicine - Qata, Doha, Qatar
| |
Collapse
|
17
|
Pan D, Pellicori P, Urbinati A, Sze S, Clark AL. P2281Relationship of the chest x-ray and outcome in patients with hospitalised heart failure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2281] [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)
- D Pan
- Castle Hill Hospital, Academic Cardiology, Hull, United Kingdom
| | - P Pellicori
- Castle Hill Hospital, Academic Cardiology, Hull, United Kingdom
| | - A Urbinati
- Castle Hill Hospital, Academic Cardiology, Hull, United Kingdom
| | - S Sze
- Castle Hill Hospital, Academic Cardiology, Hull, United Kingdom
| | - A L Clark
- Castle Hill Hospital, Academic Cardiology, Hull, United Kingdom
| |
Collapse
|
18
|
Sze S, Pellicori P, Kamzi S, Anton A, Clark AL. P1821The effect of beta-adrenergic blockade on weight change and mortality in patients with chronic heart failure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1821] [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)
- S Sze
- Castle Hill Hospital, Hull, United Kingdom
| | - P Pellicori
- University of Glasgow, Glasgow, United Kingdom
| | - S Kamzi
- Castle Hill Hospital, Hull, United Kingdom
| | - A Anton
- Castle Hill Hospital, Hull, United Kingdom
| | - A L Clark
- Castle Hill Hospital, Hull, United Kingdom
| |
Collapse
|
19
|
Orff HJ, Sorg SF, Holiday KA, Clark AL, Delano-Wood L, Schiehser DM. 0300 Comparison of Sleep Disturbance and Quantitative Volumetric MRI Measures in Veterans With and Without History of Mild Traumatic Brain Injury (mTBI). Sleep 2018. [DOI: 10.1093/sleep/zsy061.299] [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: 11/13/2022] Open
Affiliation(s)
- H J Orff
- VA San Diego, Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA
- UCSD Department of Psychiatry, San Diego, CA
| | - S F Sorg
- UCSD Department of Psychiatry, San Diego, CA
- VA San Diego Healthcare System, San Diego, CA
| | - K A Holiday
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
- VA San Diego Healthcare System, San Diego, CA
| | - A L Clark
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
- VA San Diego Healthcare System, San Diego, CA
| | - L Delano-Wood
- VA San Diego, Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA
- UCSD Department of Psychiatry, San Diego, CA
| | - D M Schiehser
- VA San Diego, Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA
- UCSD Department of Psychiatry, San Diego, CA
| |
Collapse
|
20
|
Koulaouzidis G, Barrett D, Mohee K, Clark AL. Telemonitoring in subjects with newly diagnosed heart failure with reduced ejection fraction: From clinical research to everyday practice. J Telemed Telecare 2018; 25:167-171. [PMID: 29419343 DOI: 10.1177/1357633x17751004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Heart failure is increasingly common, and characterised by frequent admissions to hospital. To try and reduce the risk of hospitalisation, techniques such as telemonitoring (TM) may have a role. We wanted to determine if TM in patients with newly diagnosed heart failure and ejection fraction <40% reduces the risk of readmission or death from any cause in a 'real-world' setting. METHODS This is a retrospective study of 124 patients (78.2% male; 68.6 ± 12.6 years) who underwent TM and 345 patients (68.5% male; 70.2 ± 10.7 years) who underwent the usual care (UC). The TM group were assessed daily by body weight, blood pressure and heart rate using electronic devices with automatic transfer of data to an online database. Follow-up was 12 months. RESULTS Death from any cause occurred in 8.1% of the TM group and 19% of the UC group ( p = 0.002). There was no difference between the two groups in all-cause hospitalisation, either in the number of subjects hospitalised ( p = 0.7) or in the number of admissions per patient ( p = 0.6). There was no difference in the number of heart-failure-related readmissions per person between the two groups ( p = 0.5), but the number of days in hospital per person was higher in the UC group ( p = 0.03). Also, there were a significantly greater number of days alive and out of hospital for the patients in the TM group compared with the UC group ( p = 0.0001). DISCUSSION TM is associated with lower any-cause mortality and also has the potential to reduce the number of days lost to hospitalisation and death.
Collapse
Affiliation(s)
- G Koulaouzidis
- 1 Academic Cardiology Unit, University of Hull, Castle Hill Hospital, UK
| | - D Barrett
- 2 Faculty of Health and Social Care, University of Hull, UK
| | - K Mohee
- 1 Academic Cardiology Unit, University of Hull, Castle Hill Hospital, UK
| | - A L Clark
- 1 Academic Cardiology Unit, University of Hull, Castle Hill Hospital, UK
| |
Collapse
|
21
|
Nikolaidou T, Johnson MJ, Ghosh JM, Marincowitz C, Shah S, Lammiman MJ, Clark AL. 81Post-mortem ICD interrogation in mode of death classification. Europace 2017. [DOI: 10.1093/europace/eux283.076] [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: 11/14/2022] Open
|
22
|
Gonzalez S, Windram JD, Sathyapalan T, Javed Z, Clark AL, Atkin SL. Effects of human recombinant growth hormone on exercise capacity, cardiac structure, and cardiac function in patients with adult-onset growth hormone deficiency. J Int Med Res 2017; 45:1708-1719. [PMID: 28856940 PMCID: PMC5805223 DOI: 10.1177/0300060517723798] [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] [Indexed: 01/23/2023] Open
Abstract
Objective Epidemiological studies suggest that adult-onset growth hormone deficiency
(AGHD) might increase the risk of death from cardiovascular causes. Methods This was a 6-month double-blind, placebo-controlled, randomised, cross-over
trial followed by a 6-month open-label phase. Seventeen patients with AGHD
received either recombinant human growth hormone (rGH) (0.4 mg injection
daily) or placebo for 12 weeks, underwent washout for 2 weeks, and were then
crossed over to the alternative treatment for a further 12 weeks. Cardiac
magnetic resonance imaging, echocardiography, and cardiopulmonary exercise
testing were performed at baseline, 12 weeks, 26 weeks, and the end of the
open phase (12 months). The results were compared with those of 16 age- and
sex-matched control subjects. Results At baseline, patients with AGHD had a significantly higher systolic blood
pressure, ejection fraction, and left ventricular mass than the control
group, even when corrected for body surface area. Treatment with rGH
normalised the insulin-like growth factor 1 concentration without an effect
on exercise capacity, cardiac structure, or cardiac function. Conclusion Administration of rGH therapy for 6 to 9 months failed to normalise the
functional and structural cardiac differences observed in patients with AGHD
when compared with a control group.
Collapse
Affiliation(s)
- S Gonzalez
- 1 Department of Diabetes, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, West Yorkshire, UK
| | - J D Windram
- 2 Department of Academic Cardiology, Hull Royal Infirmary, Kingston upon Hull, UK
| | - T Sathyapalan
- 3 Academic Endocrinology, Diabetes and Metabolism, 12195 Hull York Medical School , University of Hull, UK
| | - Z Javed
- 3 Academic Endocrinology, Diabetes and Metabolism, 12195 Hull York Medical School , University of Hull, UK
| | - A L Clark
- 2 Department of Academic Cardiology, Hull Royal Infirmary, Kingston upon Hull, UK
| | - S L Atkin
- 4 Weill Cornell Medical College Qatar, Doha, Qatar
| |
Collapse
|
23
|
Nichols S, Gleadall-Siddall DO, Antony R, Clark AL, Cleland JGF, Carroll S, Ingle L. Estimated peak functional capacity: an accurate method for assessing change in peak oxygen consumption after cardiac rehabilitation? Clin Physiol Funct Imaging 2017; 38:681-688. [PMID: 28857391 DOI: 10.1111/cpf.12468] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/14/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Cardiopulmonary exercise testing (CPET) is the 'gold standard' method of determining VO2peak . When CPET is unavailable, VO2peak may be estimated from treadmill or cycle ergometer workloads and expressed as estimated metabolic equivalents (METs). Cardiac rehabilitation (CR) programmes use estimated VO2peak (METs) to report changes in cardiorespiratory fitness (CRF). However, the accuracy of determining changes in VO2peak based on estimated functional capacity is not known. METHODS A total of 27 patients with coronary heart disease (88·9% male; age 59·5 ± 10·0 years, body mass index 29·6 ± 3·8 kg m-2 ) performed maximal CPET before and after an exercise-based CR intervention. VO2peak was directly determined using ventilatory gas exchange data and was also estimated using the American College of Sports Medicine (ACSM) leg cycling equation. Agreement between changes in directly determined VO2peak and estimated VO2peak was evaluated using Bland-Altman limits of agreement (LoA) and intraclass correlation coefficients. RESULTS Directly determined VO2peak did not increase following CR (0·5 ml kg-1 min-1 (2·7%); P = 0·332). Estimated VO2peak increased significantly (0·4 METs; 1·4 ml kg-1 min-1 ; 6·7%; P = 0·006). The mean bias for estimated VO2peak versus directly determined VO2peak was 0·7 ml kg-1 min-1 (LoA -4·7 to 5·9 ml kg-1 min-1 ). Aerobic efficiency (ΔVO2 /ΔWR slope) was significantly associated with estimated VO2peak measurement error. CONCLUSION Change in estimated VO2peak derived from the ACSM leg cycling equation is not an accurate surrogate for directly determined changes in VO2peak . Our findings show poor agreement between estimates of VO2peak and directly determined VO2peak . Applying estimates of VO2peak to determine CRF change may over-estimate the efficacy of CR and lead to a different interpretation of study findings.
Collapse
Affiliation(s)
- S Nichols
- Faculty of Medical Sciences, Sport and Exercise Science, School of Biomedical Science, Newcastle University, Newcastle upon Tyne, UK
| | - D O Gleadall-Siddall
- Sport Health and Exercise Science, University of Hull, Cottingham Road, Hull, HU6 7RX, Cottingham, UK
| | - R Antony
- Academic Cardiology, Castle Hill Hospital, Cottingham, UK
| | - A L Clark
- Academic Cardiology, Castle Hill Hospital, Cottingham, UK
| | - J G F Cleland
- Faculty of Medicine, Imperial College London, National Heart and Lung Institute, London, UK
| | - S Carroll
- Sport Health and Exercise Science, University of Hull, Cottingham Road, Hull, HU6 7RX, Cottingham, UK
| | - L Ingle
- Sport Health and Exercise Science, University of Hull, Cottingham Road, Hull, HU6 7RX, Cottingham, UK
| |
Collapse
|
24
|
Shin SY, Pozzi A, Boyd SK, Clark AL. Integrin α1β1 protects against signs of post-traumatic osteoarthritis in the female murine knee partially via regulation of epidermal growth factor receptor signalling. Osteoarthritis Cartilage 2016; 24:1795-1806. [PMID: 27211864 DOI: 10.1016/j.joca.2016.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 10/28/2015] [Revised: 04/06/2016] [Accepted: 05/11/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the role of integrin α1β1 in the progression of post-traumatic osteoarthritis (PTOA), and elucidate the contribution of epidermal growth factor receptor (EGFR) signalling to the mechanism by which integrin α1β1 might control PTOA. We hypothesised that integrin α1β1 plays a protective role in the course of PTOA and that the effect of PTOA (e.g., synovitis, loss of cartilage and growth of osteophytes) would be exacerbated in mice lacking integrin α1β1 at every time point post destabilisation of medial meniscus (DMM). METHODS DMM or sham surgery was performed on integrin α1-null and wild type (WT) mice and the progression of PTOA analysed at 2, 4, 8 and 12 weeks post-surgery (PS) using micro-computed tomography (microCT), histology, and immunohistochemistry. In addition, the effects of EGFR blockade were examined by treating the mice with the EGFR inhibitor erlotinib. RESULTS Integrin α1-null female, but not male, mice showed earlier cartilage degradation post DMM surgery compared to WT controls. Furthermore, erlotinib treatment resulted in significantly less cartilage damage in integrin α1-null but not WT mice. Independent of genotype, erlotinib treatment significantly mitigated the effects of PTOA on many tissues of female mice including meniscal and fabella bone volume, subchondral bone thickness and density and cartilage degradation. In contrast, reduced EGFR signalling had little effect on signs of PTOA in male mice. CONCLUSION Integrin α1β1 protects against PTOA-induced cartilage degradation in female mice partially via the reduction of EGFR signalling. Furthermore, reduction of EGFR signalling protects against the development of PTOA in female, but not male mice.
Collapse
Affiliation(s)
- S Y Shin
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - A Pozzi
- Department of Medicine, Vanderbilt University, Nashville, TN, USA; Department of Medicine, Veterans Affairs Hospital, Nashville, TN, USA
| | - S K Boyd
- Department of Radiology, Faculty of Medicine, University of Calgary, Calgary, AB, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - A L Clark
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada; Department of Surgery, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.
| |
Collapse
|
25
|
van Vliet EOG, Dijkema GH, Schuit E, Heida KY, Roos C, van der Post JAM, Parry EC, McCowan L, Lyell DJ, El-Sayed YY, Carr DB, Clark AL, Mahdy ZA, Uma M, Sayin NC, Varol GF, Mol BW, Oudijk MA. Nifedipine maintenance tocolysis and perinatal outcome: an individual participant data meta-analysis. BJOG 2016; 123:1753-60. [DOI: 10.1111/1471-0528.14249] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2016] [Indexed: 11/28/2022]
Affiliation(s)
- EOG van Vliet
- Obstetrics and Gynaecology; University Medical Centre Utrecht; Utrecht The Netherlands
| | - GH Dijkema
- Obstetrics and Gynaecology; University Medical Centre Utrecht; Utrecht The Netherlands
| | - E Schuit
- Julius Centre for Health Sciences and Primary Care; University Medical Centre Utrecht; Utrecht The Netherlands
- Obstetrics and Gynaecology; Academic Medical Centre; Amsterdam The Netherlands
- Department of Medicine; Stanford Prevention Research Centre; Stanford University; Stanford CA USA
| | - KY Heida
- Obstetrics and Gynaecology; University Medical Centre Utrecht; Utrecht The Netherlands
| | - C Roos
- Obstetrics and Gynaecology; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - JAM van der Post
- Obstetrics and Gynaecology; Academic Medical Centre; Amsterdam The Netherlands
| | - EC Parry
- Consultant Maternal Fetal Medicine Service; Auckland District Health Board; Auckland New Zealand
| | - L McCowan
- Obstetrics and Gynaecology; University Medical Centre Auckland; Auckland New Zealand
| | - DJ Lyell
- Obstetrics and Gynaecology; Stanford University Medical School; Stanford CA USA
| | - YY El-Sayed
- Obstetrics and Gynaecology; Stanford University Medical School; Stanford CA USA
| | - DB Carr
- Obstetrics and Gynaecology; University of Washington; Washington DC USA
| | - AL Clark
- Obstetrics and Gynaecology; University of Washington; Washington DC USA
| | - ZA Mahdy
- Obstetrics and Gynaecology; National University of Malaysia Medical Center; Cheras Malaysia
| | - M Uma
- Obstetrics and Gynaecology; National University of Malaysia Medical Center; Cheras Malaysia
| | - NC Sayin
- Obstetrics and Gynaecology; Trakya University; Edime Turkey
| | - GF Varol
- Obstetrics and Gynaecology; Trakya University; Edime Turkey
| | - BW Mol
- School of Paediatrics and Reproductive Health; University of Adelaide; Adelaide SA Australia
| | - MA Oudijk
- Obstetrics and Gynaecology; University Medical Centre Utrecht; Utrecht The Netherlands
- Obstetrics and Gynaecology; Academic Medical Centre; Amsterdam The Netherlands
| |
Collapse
|
26
|
Pellicori P, Zhang J, Lukaschuk E, Joseph AC, Bourantas CV, Loh H, Bragadeesh T, Clark AL, Cleland JGF. Left atrial function measured by cardiac magnetic resonance imaging in patients with heart failure: clinical associations and prognostic value. Eur Heart J 2015; 36:733-742. [DOI: 10.1093/eurheartj/ehu405] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
|
27
|
|
28
|
Kon SSC, Canavan JL, Nolan CM, Clark AL, Jones SE, Cullinan P, Polkey MI, Man WDC. What the 4-metre gait speed measures and why it cannot replace functional capacity tests. Eur Respir J 2014; 43:1820-2. [DOI: 10.1183/09031936.00222013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
29
|
Zachariah D, Brown R, Kanagala P, Bashir A, Mohan M, Callan P, Rajendra R, Clark AL, Squire I, Gunning M, Lang CC, Kalra PR. The impact of age and chronic kidney disease on secondary prevention post-primary percutaneous coronary intervention. QJM 2014; 107:185-92. [PMID: 24194563 DOI: 10.1093/qjmed/hct222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Historical data suggest elderly patients and those with chronic kidney disease (CKD) receive suboptimal secondary prevention following myocardial infarction (MI). We evaluated the impact of age and CKD on secondary prevention following primary percutaneous coronary intervention (PPCI) in a contemporary unselected cohort. DESIGN We studied 1169 consecutive patients from five UK centres receiving PPCI for ST elevation MI, with use of evidence-based secondary prevention at discharge assessed by age (<60, 60-75 and >75 years) and estimated glomerular filtration rate (eGFR). Follow-up prescribing practice was assessed in 567 patients. RESULTS One-fifth of patients receiving PPCI were >75 years. This group received fewer secondary prevention drugs at discharge compared to younger patients (P < 0.01 for β-blockers, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARB) and statins). By 6 weeks post-PPCI, there was a small drop-off in evidence-based therapy; β-blocker and statin use in those >75 years fell from 90% to 86% and 96% to 93%, respectively. CKD (eGFR<60 ml/min/1.73 m(2)) was seen in 17.6%. Declining renal function was associated with age, female sex and lower use of ACE inhibitor/ARB. At discharge 83.5% of patients with eGFR<60 ml/min/1.73 m(2) were receiving ACE inhibitors/ARB, dropping to 77.5% at 6 weeks (compared with 95% and 92%, respectively, in patients with eGFR >60 ml/min/1.73 m(2)). CONCLUSION The uptake of secondary prevention medication is high following PPCI in the UK, even in the elderly and in those with renal dysfunction. A focus on strategies to improve up-titration and continuation of drugs following discharge is required.
Collapse
Affiliation(s)
- D Zachariah
- Cardiology Department, Queen Alexandra hospital, Southwick Hill Rd, Cosham, Portsmouth, PO6 3LY, UK.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Parekh R, Lorenzo MK, Shin SY, Pozzi A, Clark AL. Integrin α1β1 differentially regulates cytokine-mediated responses in chondrocytes. Osteoarthritis Cartilage 2014; 22:499-508. [PMID: 24418674 PMCID: PMC4028170 DOI: 10.1016/j.joca.2013.12.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 09/10/2013] [Revised: 12/07/2013] [Accepted: 12/25/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To elucidate the role of integrin α1β1 in chondrocyte responses to inflammatory interleukin-1α (IL-1) and anabolic transforming growth factor-β1 (TGF-β1) in the knee. METHODS Intracellular calcium transient responses to IL-1 and TGF-β1 were measured in wild type and integrin α1-null chondrocytes using real time ex vivo confocal microscopy, and immunohistochemistry was performed to analyze TGF-β1-mediated activation of Smad2/3 in tibial and femoral chondrocytes. RESULTS Loss of integrin α1β1 reduces intracellular calcium transient response to IL-1, while it enhances chondrocyte responses to TGF-β1 as measured by intracellular calcium transients and activation of downstream Smad2/3. CONCLUSIONS Integrin α1β1 plays a vital role in mediating chondrocyte responses to two contrasting factors that are critical players in the onset and progression of osteoarthritis - inflammatory IL-1 and anabolic TGF-β. Further investigation into the molecular mechanisms by which integrin α1β1 mediates these responses will be an important next step in understanding the influence of increased expression of integrin α1β1 during the early stages of osteoarthritis on disease progression.
Collapse
Affiliation(s)
- R Parekh
- Faculty of Science, The University of Calgary, Calgary, AB, Canada
| | - MK Lorenzo
- Faculty of Science, The University of Calgary, Calgary, AB, Canada
| | - SY Shin
- Faculty of Kinesiology, The University of Calgary, Calgary, AB, Canada
| | - A Pozzi
- Department of Medicine, Vanderbilt University, Nashville, TN, USA,Department of Medicine, Veterans Affairs Hospital, Nashville, TN, USA
| | - AL Clark
- Faculty of Kinesiology, The University of Calgary, Calgary, AB, Canada,Department of Surgery, Faculty of Medicine, The University of Calgary, Calgary, AB, Canada
| |
Collapse
|
31
|
Fleming SL, Jones SE, Green S, Clark AL, Howe C, Kon SSC, Dickson M, Godden J, Bell D, Haselden BM, Man WDC. P43 Patients’ experiences of early post-hospitalisation pulmonary rehabilitation: A quality improvement initiative. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.193] [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: 11/04/2022]
|
32
|
Jones SE, Kon SSC, Green SA, Bell D, Canavan JL, Nolan CM, Clark AL, Dickson M, Nolan AM, Fleming S, Haselden M, Man WDC. P47 Patient characteristics of those referred and not referred for early post-hospitalisation pulmonary rehabilitation: Abstract P47 Table 1. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
33
|
Kon SSC, Canavan JL, Clark AL, Jones SE, Nolan CM, Polkey MI, Man WDC. P34 The minimal clinically important difference of the COPD assessment test. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
34
|
Pellicori P, Lukaschuk E, Zhang J, Joseph A, Mabote T, Shoaib A, Bourantas C, Loh H, Clark AL, Cleland JGF. Right bundle branch block in patients with heart failure. Is it associated with worse cardiac function on MRI and an adverse prognosis? Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p2920] [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
|
35
|
Torabi A, Clark AL, Pellicori P, Shoaib A, Mabote T, Antony R, Rigby AS, Atkin PB, Dicken B, Cleland JGF. The outcome of patients with troponin T with and without an acute coronary syndrome. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht311.5903] [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: 11/14/2022] Open
|
36
|
Pellicori P, Lukaschuk E, Joseph A, Bourantas C, Sherwi N, Loh H, Rigby A, Zhang J, Clark AL, Cleland JGF. Clinical significance of left atrial ejection fraction measured by MRI in patients with suspected heart failure. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1492] [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: 11/14/2022] Open
|
37
|
Clark AL. Blood biomarker measurement as disease target: the case for generic treatment of high natriuretic peptide levels without a diagnosis of heart failure. J R Coll Physicians Edinb 2013; 43:99-100. [DOI: 10.4997/jrcpe.2013.201] [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: 11/19/2022] Open
|
38
|
Pellicori P, Joseph A, Zhang J, Lukaschuk E, Bourantas C, Loh H, Clark AL, Cleland JGF. 012 MRI CHARACTERISTICS OR DIFFERENT QRS MORPHOLOGIES IN PATIENTS REFERRED WITH SUSPECTED HEART FAILURE. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.12] [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]
|
39
|
Khaleva O, Sherwi N, Lukaschuk E, Borovickova M, Khan ZH, Lee V, Joshi A, Loh H, Bourantas C, Clark AL, Cleland JGF, Wong K. 011 QT PEAK DISPERSION CORRELATED WITH LV SIZE AND MASS IN PATIENTS WITH CHRONIC HEART FAILURE, BUT NOT TO THE AMOUNT OF SCAR PRESENT. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.11] [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]
|
40
|
Ali HMM, Clark AL, Caplin J, Bragadeesh T. Congenital circumflex coronary artery fistulae; presentation and diagnosis. Case Reports 2013; 2013:bcr-2012-006817. [DOI: 10.1136/bcr-2012-006817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
41
|
Caliste XA, Roztocil E, Clark AL, Cullen JP, Gillespie DL. The Thrombotic Reactivity of Endothelial Cells from Deep Vein and Pulmonary Artery Venous Beds in Response to Thrombin. J Vasc Surg Venous Lymphat Disord 2013; 1:114-5. [PMID: 26993947 DOI: 10.1016/j.jvsv.2012.10.049] [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: 11/30/2022]
Affiliation(s)
- X A Caliste
- University of Rochester Medical Center, Rochester, NY
| | - E Roztocil
- University of Rochester Medical Center, Rochester, NY
| | - A L Clark
- University of Rochester Medical Center, Rochester, NY
| | - J P Cullen
- University of Rochester Medical Center, Rochester, NY
| | - D L Gillespie
- University of Rochester Medical Center, Rochester, NY
| |
Collapse
|
42
|
Kon SSC, Clark AL, Dilaver D, Peasey MM, Canavan JL, Jones SE, Ng MGS, Patel MS, Polkey MI, Man WDC. P104 Response of the COPD Assessment Test (CAT) to Pulmonary Rehabilitation in Non-COPD Patients: Abstract P104 Table 1. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.387] [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: 11/04/2022]
|
43
|
Mittal MM, Kon SSC, Clark AL, Dilaver D, Peasey MM, Canavan JL, Jones SE, Ng MGS, Polkey MI, Man WDC. P106 Validity of the Clinical COPD Questionaire (CCQ) in Non-COPD Patients: Abstract P106 Table 1. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.389] [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: 11/04/2022]
|
44
|
Peasey MM, Kon SS, Dilaver D, Canavan JL, Ng MG, Jones SE, Clark AL, Polkey MI, Man WDC. P99 Pulmonary Rehabilitation in Interstitial Lung Disease Patients: Effects on Maximum Exercise Capacity, Anxiety and Depression. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
45
|
Dilaver D, Peasey MM, Clark AL, Ng MGS, Mittal M, Kon SSC, Canavan JL, Jones SE, Polkey MI, Man WDC. P100 The Clinical COPD Questionnaire: Response to Pulmonary Rehabilitation: Abstract P100 Table 1. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.342] [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: 11/03/2022]
|
46
|
Jones SE, Kon SSC, Canavan JL, Clark AL, Patel MS, Dilaver D, Peasey M, Ng MGS, Polkey MI, Man WDC. S109 Five-Repetition Sit-To-Stand Test: Reliability, Validity and Response to Pulmonary Rehabilitation in COPD. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
47
|
Jones SE, Green SA, Clark AL, Dickson MJ, Nolan AM, Moloney C, Kon SSC, Godden J, Howe C, Haselden BM, Fleming S, Man WDC. P102 Post-Hospitalisation Outpatient Pulmonary Rehabilitation: A Translational Gap? Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
48
|
Rich DR, Clark AL. Chondrocyte primary cilia shorten in response to osmotic challenge and are sites for endocytosis. Osteoarthritis Cartilage 2012; 20:923-30. [PMID: 22554793 DOI: 10.1016/j.joca.2012.04.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 03/08/2012] [Accepted: 04/23/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the influence of cartilage site and osmolarity on primary cilia incidence, length and orientation in live chondrocytes in undisturbed cartilage. Additionally, we imaged endocytotic markers to test our hypothesis that the ciliary pocket is a site for endocytosis. MATERIALS AND METHODS We measured primary cilia incidence, length and orientation in the coronal plane using ex vivo live cell confocal imaging of intact murine femoral chondrocytes. Measurements were taken from five regions of the medial and lateral condyles of the left and right femur and also after one minute of osmotic challenge. Transmission electron microscopy and immunocytochemistry were used to characterize the orientation and position of chondrocyte primary cilia in the saggital plane and to determine the colocalization of clathrin coated vesicles, endosomal and lysosomal proteins and CD44 with the ciliary pocket. RESULTS Chondrocyte primary cilia length decreased significantly after a one minute hypo- or hyper-osmotic challenge and varied between condyles and across the surface of each condyle. The majority of the length of the chondrocyte primary cilia was positioned within a membranous invagination rather than projecting out from the cell membrane and clathrin coated vesicles, endosomal proteins and CD44 colocalised with the ciliary pocket. CONCLUSIONS We demonstrate that live ex vivo chondrocyte primary cilia are capable of shortening within minutes in response to osmotic challenge and provide subcellular and cellular evidence that chondrocyte primary cilia are deeply invaginated in a ciliary pocket which contains sites for endocytosis.
Collapse
Affiliation(s)
- D R Rich
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | | |
Collapse
|
49
|
Keshavarzi F, Hoye A, Clark AL, Oliver R, Cleland JG, Alamgir F. 079 “MitraClip, a summit well worth reaching for”. Outcome of transcatheter mitral valve clip for the management of mitral regurgitation in high risk group patients unsuitable for surgical intervention. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.79] [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]
|
50
|
Ingram KA, Fowler RP, Clark AL, Marns PL, Patel MS, Kon SSC, Canavan JL, Man WDC. P145 Effect of pulmonary rehabilitation on waist circumference and waist-hip ratio. Thorax 2011. [DOI: 10.1136/thoraxjnl-2011-201054c.145] [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: 11/04/2022]
|