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Heer RS, Selby FL, Mandal AKJ, Baktash V, Szawarski P, Mattoo S, Mohiaddin H, Makuloluwa KK, Chreif H, Amin FR, Missouris CG. Fragmentation of the QRS Complex Is Associated with Right Ventricular Dilatation and Mortality in Critically Unwell Coronavirus Disease 2019 Patients. Anatol J Cardiol 2024. [PMID: 38530215 DOI: 10.14744/anatoljcardiol.2024.3494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND QRS fragmentation (fQRS) is a depolarization disorder that can be detected on routine electrocardiography (ECG). Current evidence suggests that fQRS is a prognosticator of adverse cardiovascular events. This study aimed to assess the relationship between fQRS and all-cause mortality in critically unwell coronavirus disease 2019 (COVID-19) patients and to investigate the significance of associated abnormalities on echocardiography. METHODS A retrospective cohort study of COVID-19 patients in a critical care setting was performed. Electrocardiography was performed on presentation to hospital, admission to the critical care unit, and at subsequent points according to clinical need. Transthoracic echocardiography was performed at clinical discretion to assess for structural and functional cardiac abnormalities. Primary outcome was in-hospital mortality and secondary outcome was the need for mechanical invasive ventilation. RESULTS Totally, 212 consecutive patients were included of which 120 (57%) exhibited fQRS and inferior leads were involved in 88% of the patients. Overall, fQRS was a significant predictor of mortality [65% vs. 44% P =.003; multivariate odds ratio = 2.96, 95% confidence interval (CI): 1.42-6.40, P =.005] and inferior fQRS itself was a significant predictor of mortality (P =.03). There was no significant association between fQRS and the need for invasive mechanical ventilation. A total of 112 patients underwent echocardiography. There was a greater incidence of right ventricular (RV) dilatation in the fQRS group (16% vs. 2% respectively, P =.02) and pulmonary hypertension (33% vs. 14% respectively, P =.03) based on echocardiographic criteria. CONCLUSION Our study demonstrates that fQRS is significantly associated with RV dilation, pulmonary hypertension, and mortality in critically unwell COVID-19 patients.
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Affiliation(s)
- Randeep S Heer
- Wexham Park Hospital, Frimley Health NHS Trust, Slough, UK
| | - Faye L Selby
- Wexham Park Hospital, Frimley Health NHS Trust, Slough, UK
| | | | - Vadir Baktash
- Wexham Park Hospital, Frimley Health NHS Trust, Slough, UK
| | | | - Sirtaaj Mattoo
- Wexham Park Hospital, Frimley Health NHS Trust, Slough, UK
| | | | | | - Hussein Chreif
- Wexham Park Hospital, Frimley Health NHS Trust, Slough, UK
| | - Fouad R Amin
- Wexham Park Hospital, Frimley Health NHS Trust, Slough, UK
| | - Constantinos G Missouris
- Wexham Park Hospital, Frimley Health NHS Trust, Slough, UK;University of Nicosia Medical School, Nicosia, Cyprus
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Chai J, Mohiaddin H, Mandal AKJ, Gan J, Hirani T, Sholapurkar R, Missouris CG. Role of open access echocardiography in detection of cardiac structural and functional abnormalities. Postgrad Med J 2022:7131002. [PMID: 37076770 DOI: 10.1136/postmj/postgradmedj-2021-141195] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 01/06/2022] [Indexed: 04/21/2023]
Abstract
PURPOSE To evaluate the prevalence and incidence of significant structural heart disease in targeted patients with cardiac symptoms referred by general practitioners (GPs) using open access echocardiography, without prior clinical evaluation by a cardiologist. DESIGN Data were derived from 488 subjects who underwent transthoracic echocardiography between January and April 2018. Patients were referred directly by GPs in East Berkshire, South England, through an online platform. Echocardiography was performed within 4-6 weeks of referral and all reports were assessed by a consultant cardiologist with expedited follow-up facilitated pro re nata. Results were analysed to determine the frequency of detection of structural abnormalities, particularly of the left ventricle and cardiac valves. RESULTS Echocardiography was prospectively performed in consecutive subjects (50% male, mean (±SD) age 68.5±22 years; 50% female; mean (±SD) 64.6 (±19.1)). At least one abnormality likely to change management was found in 133 (27.3%) of all open access echocardiograms. Clinical heart failure with left ventricular systolic dysfunction (LVSD) and diastolic dysfunction was confirmed in 46 (9%) and 69 (14%), respectively. Of the 46 patients with LVSD, 33 were new diagnoses. Significant cardiac valve disease was found in 42 (8.6%) patients. 12 of these had known valvular disease or previous valvular surgery, and 30 were new diagnoses. CONCLUSION Major structural and functional cardiac abnormalities are common in late middle-aged patients who present to GPs with cardiac symptoms and signs. Reported, unrestricted open access echocardiography enables early detection of significant cardiac pathology and timely intervention may improve cardiovascular outcomes.
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Affiliation(s)
- Jason Chai
- Department of Medicine and Cardiology, Wexham Park Hospital, Slough, UK
| | - Hasan Mohiaddin
- Department of Medicine and Cardiology, Wexham Park Hospital, Slough, UK
| | - Amit K J Mandal
- Department of Medicine and Cardiology, Wexham Park Hospital, Slough, UK
| | - Jasmine Gan
- Department of Medicine and Cardiology, Wexham Park Hospital, Slough, UK
| | - Trisha Hirani
- Department of Medicine and Cardiology, Wexham Park Hospital, Slough, UK
| | | | - Constantinos G Missouris
- Department of Medicine and Cardiology, Wexham Park Hospital, Slough, UK
- Department of Cardiology, University of Nicosia Medical School, Nicosia, Cyprus
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Chai J, Mohiaddin H, Mandal AKJ, Gan J, Hirani T, Sholapurkar R, Missouris CG. Role of open access echocardiography in detection of cardiac structural and functional abnormalities. Postgrad Med J 2022; 99:postgradmedj-2021-141195. [PMID: 35027469 DOI: 10.1136/postgradmedj-2021-141195] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 01/06/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To evaluate the prevalence and incidence of significant structural heart disease in targeted patients with cardiac symptoms referred by general practitioners (GPs) using open access echocardiography, without prior clinical evaluation by a cardiologist. DESIGN Data were derived from 488 subjects who underwent transthoracic echocardiography between January and April 2018. Patients were referred directly by GPs in East Berkshire, South England, through an online platform. Echocardiography was performed within 4-6 weeks of referral and all reports were assessed by a consultant cardiologist with expedited follow-up facilitated pro re nata. Results were analysed to determine the frequency of detection of structural abnormalities, particularly of the left ventricle and cardiac valves. RESULTS Echocardiography was prospectively performed in consecutive subjects (50% male, mean (±SD) age 68.5±22 years; 50% female; mean (±SD) 64.6 (±19.1)). At least one abnormality likely to change management was found in 133 (27.3%) of all open access echocardiograms. Clinical heart failure with left ventricular systolic dysfunction (LVSD) and diastolic dysfunction was confirmed in 46 (9%) and 69 (14%), respectively. Of the 46 patients with LVSD, 33 were new diagnoses. Significant cardiac valve disease was found in 42 (8.6%) patients. 12 of these had known valvular disease or previous valvular surgery, and 30 were new diagnoses. CONCLUSION Major structural and functional cardiac abnormalities are common in late middle-aged patients who present to GPs with cardiac symptoms and signs. Reported, unrestricted open access echocardiography enables early detection of significant cardiac pathology and timely intervention may improve cardiovascular outcomes.
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Affiliation(s)
- Jason Chai
- Department of Medicine and Cardiology, Wexham Park Hospital, Slough, UK
| | - Hasan Mohiaddin
- Department of Medicine and Cardiology, Wexham Park Hospital, Slough, UK
| | - Amit K J Mandal
- Department of Medicine and Cardiology, Wexham Park Hospital, Slough, UK
| | - Jasmine Gan
- Department of Medicine and Cardiology, Wexham Park Hospital, Slough, UK
| | - Trisha Hirani
- Department of Medicine and Cardiology, Wexham Park Hospital, Slough, UK
| | | | - Constantinos G Missouris
- Department of Medicine and Cardiology, Wexham Park Hospital, Slough, UK .,Department of Cardiology, University of Nicosia Medical School, Nicosia, Cyprus
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Mohiaddin H, Malik A, Murtagh GM. Maximizing the acquisition of core communication skills at the start of medical training. Adv Med Educ Pract 2019; 10:727-735. [PMID: 31695549 PMCID: PMC6717721 DOI: 10.2147/amep.s212727] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/29/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Clinical communication teaching for medical undergraduates may involve real patient contact alongside simulated patient (SP) contact. However, there is still comparatively little known about the experience of learning with real patients and how that may impact on the SP encounter. AIM To explore the impact of real patient contact on the experience of communication skills training and SP contact for first-year medical undergraduate students. METHODS As part of the 6-year MBBS undergraduate medical degree at Imperial College London, students are obliged to undertake communication skills training, which involves teaching with simulated and real patients. In 2017 (toward the end of formal teaching), a small sample of Year 1 medical students, who had taken part in extra-curricular teaching with real patients were recruited for the study to compare their performance with a control group in a SP encounter. The performance of both groups was analyzed alongside follow-up focus group data from a sample of the study group. RESULTS Quantitative analysis revealed there was no significant difference in communication skills during a scored SP interview between students with real patient contact and those without. Focus group data, however, revealed valuable insights into the experience of learning with real patients. Students reported a marked increase in their confidence and ability to naturalize their communication skills as a result of real patient contact. Students also reported that skills gained through real patient contact may not always transfer easily to the SP setting. CONCLUSION Real patient contact is an invaluable component of communication training for undergraduate medical students. For successful implementation, there needs to be a clear curricular purpose at pedagogical, practical and organizational levels. Students' experience of real patient contact can provide an informed foundation upon which to implement other modes of teaching.
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Affiliation(s)
- Hasan Mohiaddin
- Faculty of Medicine, Sir Alexander Fleming Building, South Kensington Campus, Imperial College London, LondonSW7 2AZ, UK
| | - Anam Malik
- Faculty of Medicine, Sir Alexander Fleming Building, South Kensington Campus, Imperial College London, LondonSW7 2AZ, UK
| | - Ged M Murtagh
- Division of Surgery, Department of Surgery and Cancer, St Mary’s Campus, Imperial College London, LondonW2 1BL, UK
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Mohiaddin H, Wong TDFK, Burke-Gaffney A, Bogle RG. Drug-Coated Balloon-Only Percutaneous Coronary Intervention for the Treatment of De Novo Coronary Artery Disease: A Systematic Review. Cardiol Ther 2018; 7:127-149. [PMID: 30368735 PMCID: PMC6251821 DOI: 10.1007/s40119-018-0121-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 09/04/2018] [Indexed: 02/06/2023] Open
Abstract
Percutaneous coronary intervention (PCI) with a drug coated balloon (DCB) is a novel treatment which seeks to acutely dilate a coronary stenosis and deliver an anti-proliferative drug to the vessel wall (reducing the risk of re-stenosis), without implanting a drug eluting stent (DES). In this study, we performed a systematic review of stentless DCB-only angioplasty in de novo coronary artery disease. We identified 41 studies examining the effects of DCB-only PCI in a variety of clinical scenarios including small vessels, bifurcations, calcified lesions, and primary PCI. DCB-only PCI appears to be associated with comparable clinical outcomes to DESs and superior angiographic outcomes to plain-old balloon angioplasty. Although current data are promising, there is still a need for further long-term randomized control trial data comparing a DCB-only approach specifically against a second- or third-generation DES. A 4-week period of dual antiplatelet therapy provides a real advantage for the DCB-only PCI approach, which is not possible with most DESs. Since rates of adverse clinical outcomes are very low for all PCI procedures attention should be turned to the development of robust endpoints with which to compare DCB-only PCI approaches to the standard treatment with a DES.
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Affiliation(s)
| | | | - Anne Burke-Gaffney
- Vascular Biology, National Heart & Lung Institute (NHLI), Faculty of Medicine, Imperial College London, London, UK
| | - Richard G Bogle
- Clinical Academic Group, St George's University Foundation Hospitals NHS Trust, London, UK
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Abstract
Cystic fibrosis (CF) is the most common autosomal recessive disorder in Caucasian populations. Individuals with CF have seen significant increases in life expectancy in the last 60 years. As a result, previously rare complications are now coming to light. The most common of these is cystic fibrosis-related diabetes (CFRD), which affects 40-50% of CF adults. CFRD significantly impacts the pulmonary function and longevity of CF patients, yet a lack of consensus on the best methods to diagnose and treat CFRD remains. We begin by reviewing our understanding of the pathogenesis of CFRD, as emerging evidence shows the cystic fibrosis transmembrane conductance regulator (CFTR) also has important roles in the release of insulin and glucagon and in the protection of β cells from oxidative stress. We then discuss how current recommended methods of CFRD diagnosis are not appropriate, as continuous glucose monitoring becomes more effective, practical, and cost-effective. Finally, we evaluate emerging treatments which have narrowed the mortality gap within the CF patient group. In the future, pharmacological potentiators and correctors directly targeting CFTR show huge promise for both CFRD and the wider CF patient groups.
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Affiliation(s)
- Kayani Kayani
- Faculty of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Raihan Mohammed
- Faculty of Medicine, University of Cambridge, Cambridge, United Kingdom
- *Correspondence: Raihan Mohammed,
| | - Hasan Mohiaddin
- Faculty of Medicine, Imperial College London, London, United Kingdom
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Al-Allaf AW, Mohiaddin H, Al-Allaf O. AB0799 Gout Management: Audit for Best Practice in Gout. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1082] [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]
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