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Kaddoura R, Al-Tamimi H, Abushanab D, Hayat S, Papasavvas T. Cardiac rehabilitation for participants with implantable cardiac devices: A systematic review and meta-analysis. Int J Cardiol Cardiovasc Risk Prev 2024; 21:200255. [PMID: 38737437 PMCID: PMC11087999 DOI: 10.1016/j.ijcrp.2024.200255] [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: 08/03/2023] [Revised: 02/17/2024] [Accepted: 03/07/2024] [Indexed: 05/14/2024]
Abstract
Aim The aim is to discuss efficacy and safety of exercise-based cardiac rehabilitation (CR) programmes in participants with implantable cardiac devices compared with usual care. Methods MEDLINE, EMBASE and Cochrane databases were searched from inspection till July 15, 2022. Randomized controlled trials were included if they enrolled adult participants with implantable cardiac devices and tested exercise-based CR interventions in comparison with any control. Risk of bias was assessed, and endpoints data were pooled using random-effects model. Results Sixteen randomized trials enrolling 2053 participants were included. Study interventions differed between studies in terms of programme components, setting, exercise intensity, and follow-up. All studies included physical exercise component. In both implantable cardioverter defibrillators (ICD) and cardiac resynchronization therapy (CRT) groups, exercise training in CR programmes improved peak oxygen uptake (VO2) [(mean difference (MD) 2.08 ml/kg/min; 95 % CI: 1.44-2.728, p < 0.0001; I2 = 99 %) and (MD 2.24 ml/kg/min; 95 % CI: 1.43-3.04, p < 0.0001; I2 = 96 %), respectively] and 6-min walk test in ICD group (MD 41.51 m; 95 % CI: 15.19-67.82 m, p = 0.002; I2 = 95 %) compared with usual care. In CRT group, there was no statistically significant improvement in left ventricular ejection fraction change between comparison groups. The results were consistent in subgroup analysis according to high or low-to-moderate exercise intensity for change in peak VO2 and ejection fraction in CRT group. There was no difference in number of ICD shocks between the comparators. Conclusion Exercise-based CR programmes appear to be safe when enrolling participants with implantable cardiac devices and leading to favourable functional outcomes.
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Affiliation(s)
- Rasha Kaddoura
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Al-Tamimi
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Dina Abushanab
- Drug Information Centre, Hamad Medical Corporation, Doha, Qatar
| | - Sajad Hayat
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Theodoros Papasavvas
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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2
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Lobo G, Rivers L, Reeves D, Shah S, Quinet R, Davis W, Zakem J, Keshavamurthy C, Hayat S, Harris T, You Z, Zhang X. High fat diet in lupus: gender differences in skin lesion, nephritis, and autoimmunity in MRL/lpr mice. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00529-3] [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: 01/28/2023]
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3
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Kanagaratnam P, McCready J, Tayebjee M, Shepherd E, Sasikaran T, Todd D, Johnson N, Kyriacou A, Hayat S, Hobson NA, Mann I, Balasubramaniam R, Whinnett Z, Earley M, Petkar S, Veasey R, Kirubakaran S, Coyle C, Kim MY, Lim PB, O'Neill J, Davies DW, Peters NS, Babalis D, Linton N, Falaschetti E, Tanner M, Shah J, Poulter N. Ablation versus anti-arrhythmic therapy for reducing all hospital episodes from recurrent atrial fibrillation: a prospective, randomized, multi-centre, open label trial. Europace 2022; 25:863-872. [PMID: 36576323 PMCID: PMC10062288 DOI: 10.1093/europace/euac253] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 07/28/2022] [Accepted: 12/02/2022] [Indexed: 12/29/2022] Open
Abstract
AIMS There is rising healthcare utilization related to the increasing incidence and prevalence of atrial fibrillation (AF) worldwide. Simplifying therapy and reducing hospital episodes would be a valuable development. The efficacy of a streamlined AF ablation approach was compared to drug therapy and a conventional catheter ablation technique for symptom control in paroxysmal AF. METHODS AND RESULTS We recruited 321 patients with symptomatic paroxysmal AF to a prospective randomized, multi-centre, open label trial at 13 UK hospitals. Patients were randomized 1:1:1 to cryo-balloon ablation without electrical mapping with patients discharged same day [Ablation Versus Anti-arrhythmic Therapy for Reducing All Hospital Episodes from Recurrent (AVATAR) protocol]; optimization of drug therapy; or cryo-balloon ablation with confirmation of pulmonary vein isolation and overnight hospitalization. The primary endpoint was time to any hospital episode related to treatment for atrial arrhythmia. Secondary endpoints included complications of treatment and quality-of-life measures. The hazard ratio (HR) for a primary endpoint event occurring when comparing AVATAR protocol arm to drug therapy was 0.156 (95% CI, 0.097-0.250; P < 0.0001 by Cox regression). Twenty-three patients (21%) recorded an endpoint event in the AVATAR arm compared to 76 patients (74%) within the drug therapy arm. Comparing AVATAR and conventional ablation arms resulted in a non-significant HR of 1.173 (95% CI, 0.639-2.154; P = 0.61 by Cox regression) with 23 patients (21%) and 19 patients (18%), respectively, recording primary endpoint events (P = 0.61 by log-rank test). CONCLUSION The AVATAR protocol was superior to drug therapy for avoiding hospital episodes related to AF treatment, but conventional cryoablation was not superior to the AVATAR protocol. This could have wide-ranging implications on how demand for AF symptom control is met. TRIAL REGISTRATION Clinical Trials Registration: NCT02459574.
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Affiliation(s)
- Prapa Kanagaratnam
- National Heart and Lung Institute, Imperial College London, St Mary's Hospital, Praed Street, Paddington W2 1NY, UK.,Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, 72 Du Cane Rd, London, W12 0HS, UK
| | - James McCready
- Department of Cardiology, Brighton & Sussex University Hospital, Brighton, UK
| | - Muzahir Tayebjee
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ewen Shepherd
- Cardiology Department, Newcastle-upon-Tyne NHS Foundation Trust, Newcastle, UK
| | - Thiagarajah Sasikaran
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
| | - Derick Todd
- Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Nicholas Johnson
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
| | - Andreas Kyriacou
- Department of Cardiology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Sajad Hayat
- Cardiology, University Hospitals Coventry & Warwickshire, Coventry, UK
| | - Neil A Hobson
- Cardiology Department, Hull & East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Ian Mann
- National Heart and Lung Institute, Imperial College London, St Mary's Hospital, Praed Street, Paddington W2 1NY, UK
| | - Richard Balasubramaniam
- Cardiac Intervention Unit, Royal Bournemouth & Christchurch Hospitals NHS Trust, Bournemouth, UK
| | - Zachary Whinnett
- National Heart and Lung Institute, Imperial College London, St Mary's Hospital, Praed Street, Paddington W2 1NY, UK
| | - Mark Earley
- Cardiology, Barts Health NHS Trust, London, UK
| | - Sanjiv Petkar
- Cardiology Department, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Rick Veasey
- Cardiology Department, East Sussex Healthcare NHS Trust, Eastbourne, UK
| | | | - Clare Coyle
- National Heart and Lung Institute, Imperial College London, St Mary's Hospital, Praed Street, Paddington W2 1NY, UK
| | - Min-Young Kim
- National Heart and Lung Institute, Imperial College London, St Mary's Hospital, Praed Street, Paddington W2 1NY, UK
| | - Phang Boon Lim
- Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, 72 Du Cane Rd, London, W12 0HS, UK
| | - James O'Neill
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D Wyn Davies
- Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, 72 Du Cane Rd, London, W12 0HS, UK
| | - Nicholas S Peters
- National Heart and Lung Institute, Imperial College London, St Mary's Hospital, Praed Street, Paddington W2 1NY, UK
| | - Daphne Babalis
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
| | - Nicholas Linton
- National Heart and Lung Institute, Imperial College London, St Mary's Hospital, Praed Street, Paddington W2 1NY, UK
| | - Emanuela Falaschetti
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
| | - Mark Tanner
- Cardiology, Western Sussex NHS Foundation Trust, Chichester, UK
| | - Jaymin Shah
- Cardiology, London North West University Healthcare NHS Trust, London, UK
| | - Neil Poulter
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
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Yu F, Courjaret R, Elmi A, Adap EA, Orie NN, Zghyer F, Hubrack S, Hayat S, Asaad N, Worgall S, Suthanthiran M, Ali VM, Machaca K. Chronic reduction of store operated Ca 2+ entry is viable therapeutically but is associated with cardiovascular complications. J Physiol 2022; 600:4827-4848. [PMID: 36181482 DOI: 10.1113/jp283811] [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: 09/05/2022] [Accepted: 09/23/2022] [Indexed: 12/24/2022] Open
Abstract
Loss of function mutations in store-operated Ca2+ entry (SOCE) are associated with severe paediatric disorders in humans, including combined immunodeficiency, anaemia, thrombocytopenia, anhidrosis and muscle hypotonia. Given its central role in immune cell activation, SOCE has been a therapeutic target for autoimmune and inflammatory diseases. Treatment for such chronic diseases would require prolonged SOCE inhibition. It is, however, unclear whether chronic SOCE inhibition is viable therapeutically. Here we address this issue using a novel genetic mouse model (SOCE hypomorph) with deficient SOCE, nuclear factor of activated T cells activation, and T cell cytokine production. SOCE hypomorph mice develop and reproduce normally and do not display muscle weakness or overt anhidrosis. They do, however, develop cardiovascular complications, including hypertension and tachycardia, which we show are due to increased sympathetic autonomic nervous system activity and not cardiac or vascular smooth muscle autonomous defects. These results assert that chronic SOCE inhibition is viable therapeutically if the cardiovascular complications can be managed effectively clinically. They further establish the SOCE hypomorph line as a genetic model to define the therapeutic window of SOCE inhibition and dissect toxicities associated with chronic SOCE inhibition in a tissue-specific fashion. KEY POINTS: A floxed stromal interaction molecule 1 (STIM1) hypomorph mouse model was generated with significant reduction in Ca2+ influx through store-operated Ca2+ entry (SOCE), resulting in defective nuclear translocation of nuclear factor of activated T cells, cytokine production and inflammatory response. The hypomorph mice are viable and fertile, with no overt defects. Decreased SOCE in the hypomorph mice is due to poor translocation of the mutant STIM1 to endoplasmic reticulum-plasma membrane contact sites resulting in fewer STIM1 puncta. Hypomorph mice have similar susceptibility to controls to develop diabetes but exhibit tachycardia and hypertension. The hypertension is not due to increased vascular smooth muscle contractility or vascular remodelling. The tachycardia is not due to heart-specific defects but rather seems to be due to increased circulating catecholamines in the hypomorph. Therefore, long term SOCE inhibition is viable if the cardiovascular defects can be managed clinically.
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Affiliation(s)
- Fang Yu
- Calcium Signaling Group, Research Department, Weill Cornell Medicine Qatar, Education City, Qatar Foundation, Doha, Qatar.,Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA
| | - Raphael Courjaret
- Calcium Signaling Group, Research Department, Weill Cornell Medicine Qatar, Education City, Qatar Foundation, Doha, Qatar.,Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA
| | - Asha Elmi
- College of Health and Life Science, Hamad bin Khalifa University, Doha, Qatar
| | - Ethel Alcantara Adap
- Calcium Signaling Group, Research Department, Weill Cornell Medicine Qatar, Education City, Qatar Foundation, Doha, Qatar
| | | | - Fawzi Zghyer
- Medical Program, Weill Cornell Medicine Qatar, Doha, Qatar
| | - Satanay Hubrack
- Calcium Signaling Group, Research Department, Weill Cornell Medicine Qatar, Education City, Qatar Foundation, Doha, Qatar.,Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA
| | - Sajad Hayat
- Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Nidal Asaad
- Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Stefan Worgall
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - Manikkam Suthanthiran
- Division of Nephrology and Hypertension, Departments of Medicine and Transplantation Medicine, New York Presbyterian Hospital - Weill Cornell Medical College, New York, NY, USA
| | | | - Khaled Machaca
- Calcium Signaling Group, Research Department, Weill Cornell Medicine Qatar, Education City, Qatar Foundation, Doha, Qatar.,Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA
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Ikram M, Shahzadi A, Hayat S, Nabgan W, Ul-Hamid A, Haider A, Noor M, Goumri-Said S, Kanoun MB, Ali S. Novel Ta/chitosan-doped CuO nanorods for catalytic purification of industrial wastewater and antimicrobial applications. RSC Adv 2022; 12:16991-17004. [PMID: 35755577 PMCID: PMC9172551 DOI: 10.1039/d2ra03006c] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/30/2022] [Indexed: 02/05/2023] Open
Abstract
Novel tantalum (Ta) and chitosan (CS)-doped CuO nanorods (NRs) were synthesized using a single step co-precipitation route. Different concentrations (2 and 4%) of Ta were used in fixed amounts of CS and CuO to examine their catalytic activity and antimicrobial potential. For critical analysis, synthesized NRs were systematically examined using XRD, FTIR HRTEM, EDS, UV-Vis and PL spectroscopy. The XRD technique revealed the monoclinic structure of CuO while an increase in its crystallite size (from 15.5 to 18.5 nm) was observed upon doping. FTIR spectra were examined to study the functional groups of CuO where peaks at 514 cm-1 and 603 cm-1 confirmed the formation of CuO NRs. PL spectra depicted the charge transfer efficiency of the synthesized samples. The presence of dopants (Ta and CS) and constituent elements (Cu, O) was detected using EDS spectra. Additionally, the pH based catalytic performance of fabricated NRs revealed 99.7% dye degradation of toxic methylene blue (MB) dye in neutral media, 99.4% in basic media and 99.5% in acidic media along with promising antibacterial activities for Gram negative/positive bacteria, respectively upon doping of Ta (4%) into CS/CuO. The adsorption energies of CuO co-doped with CS/Ta led to the creation of stable structures that were investigated theoretically using density functional theory.
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Affiliation(s)
- M Ikram
- Solar Cell Application Research Lab, Department of Physics, Government College University Lahore Lahore 54000 Punjab Pakistan
| | - A Shahzadi
- Faculty of Pharmacy, The University of Lahore Lahore 54000 Pakistan
| | - S Hayat
- Department of Physics, Riphah Institute of Computing and Applied Sciences (RICAS), Riphah International University 14 Ali Road Lahore Pakistan
| | - W Nabgan
- Departament d'Enginyeria Química, Universitat Rovira i Virgili Av Països Catalans 26 43007 Tarragona Spain
| | - A Ul-Hamid
- Core Research Facilities, King Fahd University of Petroleum & Minerals Dhahran 31261 Saudi Arabia
| | - A Haider
- Department of Clinical Sciences, Faculty of Veterinary and Animal Sciences, Muhammad Nawaz Shareef University of Agriculture Multan 66000 Pakistan
| | - M Noor
- Department of Physics, Riphah Institute of Computing and Applied Sciences (RICAS), Riphah International University 14 Ali Road Lahore Pakistan
| | - Souraya Goumri-Said
- College of Science, Physics Department, Alfaisal University P. O. Box 50927 Riyadh 11533 Saudi Arabia
| | - Mohammed Benali Kanoun
- Department of Physics, College of Science, King Faisal University P. O. Box 400 Al-Ahsa 31982 Saudi Arabia
| | - S Ali
- Department of Physics, Riphah Institute of Computing and Applied Sciences (RICAS), Riphah International University 14 Ali Road Lahore Pakistan
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McGregor G, Evans B, Sandhu H, Simmonds J, Joshi S, Devi G, Zhupaj A, Holliday N, Pearce G, Patel C, Hee SW, Powell R, Heine P, Patel S, Kavi L, Bruce J, Hayat S, Lim B, Eftekhari H, Panikker S. Protocol update for a randomised controlled feasibility trial of exercise rehabilitation for people with postural tachycardia syndrome: the PULSE study. Pilot Feasibility Stud 2022; 8:101. [PMID: 35525992 PMCID: PMC9077338 DOI: 10.1186/s40814-022-01056-6] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 04/28/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The PULSE (PostUraL tachycardia Syndrome Exercise) study is a randomised controlled trial assessing the feasibility of conducting a multicentre RCT testing supervised exercise rehabilitation with behavioural and motivational support, compared to best-practice usual care, for people with Postural Tachycardia Syndrome (PoTS). The original trial protocol was published in BMC Pilot & Feasibility Studies (accessible at https://doi.org/10.1186/s40814-020-00702-1 ). The PULSE intervention consists of (1) individual assessment; (2) 12-week, twice-weekly, supervised exercise training; (3) behavioural and motivational support; and (4) guided lifestyle physical activity. The control intervention is best-practice usual care with a single 30-min, one-to-one practitioner appointment, and general advice on safe and effective physical activity. Sixty-two people (aged 18-60 years) with a confirmed diagnosis of PoTS will be invited to enrol on a feasibility RCT with an embedded qualitative study. The primary outcome will be feasibility; process-related measures will include eligibility, recruitment, randomisation and withdrawal rates, along with indicators of exercise programme adherence and acceptability. Secondary physiological, clinical and health-related outcomes will be assessed. In response to the COVID-19 pandemic, here we describe amendments to the trial protocol. METHODS Restrictions imposed by the COVID-19 pandemic meant it was necessary to change the delivery of the PULSE and control interventions. These changes reflected the need to limit the risk of COVID-19 transmission in a clinical population, some of whom were at increased risk of contracting the virus and suffering serious illness. The major change was that the originally intended centre-based PULSE and control interventions would now be delivered remotely on-line. Subsequently, there were minor changes to the participant eligibility criteria. These decisions followed an on-line co-creation session with people affected by PoTS, and relevant public and professional stakeholders. CONCLUSIONS We present an update of the original trial protocol in response to the COVID-19 pandemic. No participants were recruited to the original protocol; thus, results will reflect the on-line delivery of the intervention. PULSE will be the first randomised trial to assess the feasibility of conducting a definitive multi-centre RCT testing supervised on-line exercise rehabilitation with behavioural and motivational support, compared to best-practice usual care, for people with PoTS. TRIAL REGISTRATION ISRCTN45323485 registered on 7 April 2020.
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Affiliation(s)
- Gordon McGregor
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, CV1 3LN UK
- Centre for Sport, Exercise and Life Sciences, Research Institute for Health &Wellbeing, Coventry University, Coventry, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Becky Evans
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, CV1 3LN UK
| | - Harbinder Sandhu
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jane Simmonds
- UCL Great Ormond Street Institute of Child Health, Faculty of Population Health, University College, London, UK
| | - Shivam Joshi
- Research & Development, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Gita Devi
- Centre for Sport, Exercise and Life Sciences, Research Institute for Health &Wellbeing, Coventry University, Coventry, UK
| | - Albiona Zhupaj
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Nikki Holliday
- Centre for Sport, Exercise and Life Sciences, Research Institute for Health &Wellbeing, Coventry University, Coventry, UK
| | - Gemma Pearce
- Centre for Sport, Exercise and Life Sciences, Research Institute for Health &Wellbeing, Coventry University, Coventry, UK
| | - Chloe Patel
- Centre for Sport, Exercise and Life Sciences, Research Institute for Health &Wellbeing, Coventry University, Coventry, UK
| | - Siew Wan Hee
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Richard Powell
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, CV1 3LN UK
- Centre for Sport, Exercise and Life Sciences, Research Institute for Health &Wellbeing, Coventry University, Coventry, UK
| | - Peter Heine
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Shilpa Patel
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, CV1 3LN UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Julie Bruce
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sajad Hayat
- Department of Cardiology, Hamad Medical Corporation, Doha, Qatar
| | - Boon Lim
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Helen Eftekhari
- Research & Development, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sandeep Panikker
- Research & Development, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
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Naeem H, Naqvi SZH, Hussain J, Abbas N, Hayat S, Arshad L, Ghayas A, Rehman A. Efficacy of Tulsi (Ocimum Sanctum) Plant Powder on Health, Growth and Carcass Traits of Japanese Quail (Coturnix Japonica). Braz J Poult Sci 2022. [DOI: 10.1590/1806-9061-2021-1453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- H Naeem
- University of Lahore, Pakistan
| | | | - J Hussain
- University of Veterinary and Animal Sciences, Pakistan
| | - N Abbas
- Government Graduate College District Jhang Pakistan, Pakistan
| | - S Hayat
- University of Lahore, Pakistan
| | | | - A Ghayas
- University of Veterinary and Animal Sciences, Pakistan
| | - A Rehman
- University of Veterinary and Animal Sciences, Pakistan
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Eftekhari H, He H, Lee JD, Paul G, Zhupaj A, Lachlan T, Kuehl M, Dhanjal T, Panikker S, Yusuf S, Hayat S, Osman F. Safety and outcome of nurse-led syncope clinics and implantable loop recorder implants. Heart Rhythm 2021; 19:443-447. [PMID: 34767989 DOI: 10.1016/j.hrthm.2021.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/26/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Implantable loop recorders (ILRs) are effective in achieving symptom-rhythm correlation. Data on the diagnostic yield of ILRs, on nurse-led syncope clinics, and on nurse-led ILR implants are limited. OBJECTIVE We evaluated the safety and efficacy of our nurse-led syncope clinic and nurse-led ILR implants. METHODS A retrospective study of all consecutive patients undergoing nurse-led ILR implantations was performed between April 2016 and April 2018. Patients were referred from both nurse-led and physician-led clinics. Data were collected on baseline demographic characteristics, referral source, symptom-rhythm correlation, ILR findings, and subsequent changes to management. All ILRs were enrolled into remote monitoring with automatic arrhythmia detection, and all immediate (≤24 hours) ILR implant complications were recorded. Comparisons were made between nurse-led and physician-led clinics and subsequent outcomes. RESULTS A total of 432 patients with an ILR were identified: 164 (38%) from nurse-led and 268 (62%) from physician-led clinics; 200 (46%) were women (mean age 66.5 ± 18.2 years; mean follow-up duration 28.9 ± 9.5 months). Primary ILR indications were syncope (n = 251 [58%]), presyncope (n = 33 [7%]), palpitation (n = 39 [9%]), cryptogenic stroke (n = 78 [18%]), and other reasons (n = 31 [7%]). No immediate ILR implant complications occurred. Overall, 156 patients (36%) had a change in management as a direct result of ILR findings, with no overall differences between nurse-led and physician-led clinics (35% vs 36%; P = .7). More patients had newly diagnosed atrial fibrillation in physician-led clinics (15% vs 7%; P = .01), and more patients had pacemaker implants for bradycardia in nurse-led clinics (23% vs 13%; P < .01). CONCLUSION Nurse-led ILR implantation was safe and effective. Nurse-led syncope clinics achieved good symptom-rhythm correlation with resultant significant changes to management in comparison to physician-led clinics. Larger prospective studies are needed to evaluate their longer-term impact.
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Affiliation(s)
- Helen Eftekhari
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Hejie He
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - James Doug Lee
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Geeta Paul
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Albiona Zhupaj
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Thomas Lachlan
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Michael Kuehl
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Tarv Dhanjal
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Sandeep Panikker
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Shamil Yusuf
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Sajad Hayat
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Faizel Osman
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom.
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Chaudhary A, Akram AM, Ahmad QUA, Hussain Z, Zahra S, Minahal Q, Azhar S, Ahmad S, Hayat S, Javed MA, Haider MS, Ali Q, Karita S. Optimized biotransformation of acid-treated water melon peel hydrolyzate into ethanol. BRAZ J BIOL 2021; 83:e253009. [PMID: 34495170 DOI: 10.1590/1519-6984.253009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/08/2021] [Indexed: 11/22/2022] Open
Abstract
Today, global focus of research is to explore the solution of energy crisis and environmental pollution. Like other agricultural countries, bulk quantities of watermelon peels (WMP) are disposed-off in environment as waste in Pakistan and appropriate management of this waste is the need of hour to save environment from pollution. The work emphasizes the role of ethanologenic yeasts to utilize significant sugars present in WMP for low-cost bioethanol fermentation. Dilute hydrochloric acid hydrolysis of WMP was carried out on optimized conditions employing RSM (response surface methodology) following central composite design (CCD). This experimental design is based on optimization of ethanologenesis involving some key independent parameters such as WMP hydrolysate and synthetic media ratio (X1), incubation temperature (X2) and incubation temperature (X3) for maximal ethanol yield exploiting standard (Saccharomyces cerevisiae K7) as well as experimental (Metchnikowia cibodasensisY34) yeasts. The results revealed that maximal ethanol yields obtained from S. cerevisiae K7 was 0.36±0.02 g/g of reducing sugars whereas M. cibodasensisY34, yielded 0.40±0.01 g ethanol/g of reducing sugars. The yeast isolate M. cibodasensisY34 appeared as promising ethanologen and embodies prospective potential for fermentative valorization of WMP-to-bioethanol.
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Affiliation(s)
- A Chaudhary
- University of Education, Department of Zoology, Division of Science and Technology, Lahore, Pakistan
| | - A M Akram
- University of Education, Department of Zoology, Division of Science and Technology, Lahore, Pakistan
| | - Qurat-Ul-Ain Ahmad
- University of Education, Department of Zoology, Division of Science and Technology, Lahore, Pakistan
| | - Z Hussain
- University of Education, Department of Zoology, Division of Science and Technology, Lahore, Pakistan
| | - S Zahra
- University of Education, Department of Physics, Division of Science and Technology, Lahore, Pakistan
| | - Q Minahal
- University of Education, Department of Zoology, Division of Science and Technology, Lahore, Pakistan
| | - S Azhar
- University of the Punjab, Institute of Zoology, Lahore, Pakistan
| | - S Ahmad
- University of the Punjab Lahore, Department of Entomology, Lahore, Pakistan
| | - S Hayat
- The University of Lahore, Institute of Molecular Biology and Biotechnology, Lahore, Pakistan
| | - M A Javed
- University of the Punjab Lahore, Department of Plant Breeding and Genetics, Lahore, Pakistan
| | - M S Haider
- University of the Punjab Lahore, Department of Plant Pathology, Lahore, Pakistan
| | - Q Ali
- The University of Lahore, Institute of Molecular Biology and Biotechnology, Lahore, Pakistan
| | - S Karita
- Mie University, Graduate School of Bioresources, Tsu city, Mie, Japan
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10
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Aslam N, Hayat S, Ali T, Waseem M, Siddique MH, Afzal M, Muzammil A, Naz G, Sarwar A, Muzammil S. Antiadhesion and antibiofilm potential of Fagonia indica from Cholistan desert against clinical multidrug resistant bacteria. BRAZ J BIOL 2021; 82:e239991. [PMID: 34190801 DOI: 10.1590/1519-6984.239991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 11/05/2020] [Indexed: 11/22/2022] Open
Abstract
High resistance to antimicrobials is associated with biofilm formation responsible for infectious microbes to withstand severe conditions. Therefore, new alternatives are necessary as biofilm inhibitors to control infections. In this study, the antimicrobial and antibiofilm activities of Fagonia indica extracts were evaluated against MDR clinical isolates. The extract exhibited its antibiofilm effect by altering adherence and disintegration of bacterial cell wall. Fagonia indica has antibacterial effect as minimum inhibitory concentration (MIC) values ranging from 125 to 500 µg mL-1 and minimum bactericidal concentration (MBC) value was 500-3000 µg mL-1 against multidrug resistant (MDR) clinical isolates. The extract exhibited its antibiofilm effect by altering adherence and disintegration of bacterial cell wall. Fagonia indica had antibacterial effect as minimum inhibitory concentration (MIC) values ranging from 125 to 500 µg mL-1 and minimum bactericidal concentration (MBC) value was 500-3000 µg mL-1 against MDR isolates. The maximum inhibitory effects of Fagonia indica chloroform extract on biofilm formation was observed on Staphylococcus aureus (71.84%) followed by Klebsiella pneumoniae (70.83%) after 48 hrs showing that inhibition is also time dependent. Our results about bacterial cell protein leakage indicated that MDR isolates treated with chloroform extract of Fagonia indica showed maximum protein leakage of K. pneumoniae (59.14 µg mL-1) followed by S. aureus (56.7 µg mL-1). Cell attachment assays indicated that chloroform extract resulted in a 43.5-53.5% inhibition of cell adherence to a polystyrene surface. Our results revealed that extracts of Fagonia indica significantly inhibited biofilm formation among MDR clinical isolates, therefore, could be applied as antimicrobial agents and cost effective biofilm inhibitor against these MDR isolates.
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Affiliation(s)
- N Aslam
- Government College University, Department of Biochemistry, Faisalabad, Pakistan
| | - S Hayat
- Government College University, Department of Microbiology, Faisalabad, Pakistan
| | - T Ali
- Government College University, Department of Biochemistry, Faisalabad, Pakistan.,University of Agriculture, Department of Biochemistry, Faisalabad, Pakistan
| | - M Waseem
- Government College University, Department of Microbiology, Faisalabad, Pakistan
| | - M H Siddique
- Government College University, Department of Bioinformatics and Biotechnology, Faisalabad, Pakistan
| | - M Afzal
- Government College University, Department of Bioinformatics and Biotechnology, Faisalabad, Pakistan
| | - A Muzammil
- Government College University, Department of Bioinformatics and Biotechnology, Faisalabad, Pakistan
| | - G Naz
- Government College University, Department of Microbiology, Faisalabad, Pakistan
| | - A Sarwar
- Government College University, Department of Microbiology, Faisalabad, Pakistan
| | - S Muzammil
- Government College University, Department of Microbiology, Faisalabad, Pakistan
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11
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Ikram M, Hayat S, Imran M, Haider A, Naz S, Ul-Hamid A, Shahzadi I, Haider J, Shahzadi A, Nabgan W, Ali S. Novel Ag/cellulose-doped CeO 2 quantum dots for efficient dye degradation and bactericidal activity with molecular docking study. Carbohydr Polym 2021; 269:118346. [PMID: 34294353 DOI: 10.1016/j.carbpol.2021.118346] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 04/01/2021] [Revised: 06/10/2021] [Accepted: 06/12/2021] [Indexed: 02/08/2023]
Abstract
In the present study, the novel Ag/cellulose nanocrystal (CNC)-doped CeO2 quantum dots (QDs) with highly efficient catalytic performance were synthesized using one pot co-precipitation technique, which were then applied in the degradation of methylene blue and ciprofloxacin (MBCF) in wastewater. Catalytic activity against MBCF dye was significantly reduced (99.3%) for (4%) Ag dopant concentration in acidic medium. For Ag/CNC-doped CeO2 vast inhibition domain of G-ve was significantly confirmed as (5.25-11.70 mm) and (7.15-13.60 mm), while medium- to high-concentration of CNC levels were calculated for G + ve (0.95 nm, 1.65 mm), respectively. Overall, (4%) Ag/CNC-doped CeO2 revealed significant antimicrobial activity against G-ve relative to G + ve at both concentrations, respectively. Furthermore, in silico molecular docking studies were performed against selected enzyme targets dihydrofolate reductase (DHFR), dihydropteroate synthase (DHPS), and DNA gyrase belonging to folate and nucleic acid biosynthetic pathway, respectively to rationalize possible mechanism behind bactericidal potential of CNC-CeO2 and Ag/CNC-CeO2.
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Affiliation(s)
- M Ikram
- Solar Cell Application Research Lab, Department of Physics, Government College University Lahore, Lahore 54000, Punjab, Pakistan.
| | - S Hayat
- Department of Physics, Riphah Institute of Computing and Applied Sciences (RICAS), Riphah International University, 14 Ali Road, Lahore, Pakistan
| | - M Imran
- State Key Laboratory of Chemical Resource Engineering, Beijing Advanced Innovation Centre for Soft Matter Science and Engineering, Beijing Engineering Centre for Hierarchical Catalysts, Beijing University of Chemical Technology, Beijing 100029, China
| | - A Haider
- Department of Clinical Medicine and Surgery, University of Veterinary and Animal Sciences, Lahore 54000, Punjab, Pakistan
| | - S Naz
- Tianjin Institute of Industrial Biotechnology, Chinese Academy of Sciences, Tianjin 300308, China
| | - A Ul-Hamid
- Core Research Facilities, King Fahd University of Petroleum & Minerals, Dhahran 31261, Saudi Arabia.
| | - I Shahzadi
- College of Pharmacy, University of the Punjab, 54000 Lahore, Pakistan
| | - J Haider
- Tianjin Institute of Industrial Biotechnology, Chinese Academy of Sciences, Tianjin 300308, China
| | - A Shahzadi
- College of Pharmacy, University of the Punjab, 54000 Lahore, Pakistan
| | - W Nabgan
- School of Chemical and Energy Engineering, Faculty of Engineering, Universiti Teknologi Malaysia, 81310 Skudai, Johor, Malaysia.
| | - S Ali
- Department of Physics, Riphah Institute of Computing and Applied Sciences (RICAS), Riphah International University, 14 Ali Road, Lahore, Pakistan
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12
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Ikram M, Inayat T, Haider A, Ul-Hamid A, Haider J, Nabgan W, Saeed A, Shahbaz A, Hayat S, Ul-Ain K, Butt AR. Graphene Oxide-Doped MgO Nanostructures for Highly Efficient Dye Degradation and Bactericidal Action. Nanoscale Res Lett 2021; 16:56. [PMID: 33825981 PMCID: PMC8026802 DOI: 10.1186/s11671-021-03516-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/24/2021] [Indexed: 05/30/2023]
Abstract
Various concentrations (0.01, 0.03 and 0.05 wt ratios) of graphene oxide (GO) nanosheets were doped into magnesium oxide (MgO) nanostructures using chemical precipitation technique. The objective was to study the effect of GO dopant concentrations on the catalytic and antibacterial behavior of fixed amount of MgO. XRD technique revealed cubic phase of MgO, while its crystalline nature was confirmed through SAED profiles. Functional groups presence and Mg-O (443 cm-1) in fingerprint region was evident with FTIR spectroscopy. Optical properties were recorded via UV-visible spectroscopy with redshift pointing to a decrease in band gap energy from 5.0 to 4.8 eV upon doping. Electron-hole recombination behavior was examined through photoluminescence (PL) spectroscopy. Raman spectra exhibited D band (1338 cm-1) and G band (1598 cm-1) evident to GO doping. Formation of nanostructure with cubic and hexagon morphology was confirmed with TEM, whereas interlayer average d-spacing of 0.23 nm was assessed using HR-TEM. Dopants existence and evaluation of elemental constitution Mg, O were corroborated using EDS technique. Catalytic activity against methyl blue ciprofloxacin (MBCF) was significantly reduced (45%) for higher GO dopant concentration (0.05), whereas bactericidal activity of MgO against E. coli was improved significantly (4.85 mm inhibition zone) upon doping with higher concentration (0.05) of GO, owing to the formation of nanorods.
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Affiliation(s)
- M Ikram
- Solar Cell Application Research Lab, Department of Physics, Government College University Lahore, Lahore, 54000, Punjab, Pakistan.
| | - T Inayat
- Physics Department, Lahore Garrison University, Lahore, 54000, Punjab, Pakistan
| | - A Haider
- Department of Clinical Medicine and Surgery, University of Veterinary and Animal Sciences, Lahore, 54000, Punjab, Pakistan
| | - A Ul-Hamid
- Core Research Facilities, King Fahd University of Petroleum & Minerals, Dhahran, 31261, Saudi Arabia.
| | - J Haider
- Tianjin Institute of Industrial Biotechnology, Chinese Academy of Sciences, Tianjin, 300308, China
| | - W Nabgan
- School of Chemical and Energy Engineering, Faculty of Engineering, Universiti Teknologi Malaysia, 81310, Skudai, Johor, Malaysia
| | - A Saeed
- Department of Chemistry, Quaid-i-Azam University, Islamabad, 45320, Pakistan
| | - A Shahbaz
- Department of Physics, Government College University Lahore, 54000, Lahore, Pakistan
| | - S Hayat
- Department of Physics, Riphah Institute of Computing and Applied Sciences (RICAS), Riphah International University, 14 Ali Road, Lahore, Pakistan
| | - K Ul-Ain
- Department of Physics, Riphah Institute of Computing and Applied Sciences (RICAS), Riphah International University, 14 Ali Road, Lahore, Pakistan
| | - A R Butt
- Physics Department, Lahore Garrison University, Lahore, 54000, Punjab, Pakistan
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13
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Proietti R, Dowd R, Gee LV, Yusuf S, Panikker S, Hayat S, Osman F, Patel K, Salim H, Aldhoon B, Foster W, Merghani A, Kuehl M, Banerjee P, Lellouche N, Dhanjal T. Impact of a high-density grid catheter on long-term outcomes for structural heart disease ventricular tachycardia ablation. J Interv Card Electrophysiol 2021; 62:519-529. [PMID: 33392856 PMCID: PMC8645535 DOI: 10.1007/s10840-020-00918-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/31/2020] [Indexed: 01/04/2023]
Abstract
Background Substrate mapping has highlighted the importance of targeting diastolic conduction channels and late potentials during ventricular tachycardia (VT) ablation. State-of-the-art multipolar mapping catheters have enhanced mapping capabilities. The purpose of this study was to investigate whether long-term outcomes were improved with the use of a HD Grid mapping catheter combining complementary mapping strategies in patients with structural heart disease VT. Methods Consecutive patients underwent VT ablation assigned to either HD Grid, Pentaray, Duodeca, or point-by-point (PbyP) RF mapping catheters. Clinical endpoints included recurrent anti-tachycardia pacing (ATP), appropriate shock, asymptomatic non-sustained VT, or all-cause death. Results Seventy-three procedures were performed (33 HD Grid, 22 Pentaray, 12 Duodeca, and 6 PbyP) with no significant difference in baseline characteristics. Substrate mapping was performed in 97% of cases. Activation maps were generated in 82% of HD Grid cases (Pentaray 64%; Duodeca 92%; PbyP 33% (p = 0.025)) with similar trends in entrainment and pace mapping. Elimination of all VTs occurred in 79% of HD Grid cases (Pentaray 55%; Duodeca 83%; PbyP 33% (p = 0.04)). With a mean follow-up of 372 ± 234 days, freedom from recurrent ATP and shock was 97% and 100% respectively in the HD Grid group (Pentaray 64%, 82%; Duodeca 58%, 83%; PbyP 33%, 33% (log rank p = 0.0042, p = 0.0002)). Conclusions This study highlights a step-wise improvement in survival free from ICD therapies as the density of mapping capability increases. By using a high-density mapping catheter and combining complementary mapping strategies in a strict procedural workflow, long-term clinical outcomes are improved.
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Affiliation(s)
- Riccardo Proietti
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK.,Department of Cardiac, Thoracic, Vascular Sciences, and University of Padua, Padua, Italy
| | - Rory Dowd
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Lim Ven Gee
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Shamil Yusuf
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Sandeep Panikker
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Sajad Hayat
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Faizel Osman
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK.,University of Warwick (Medical School), Gibbet Hill, Coventry, CV4 7AJ, UK
| | - Kiran Patel
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK.,University of Warwick (Medical School), Gibbet Hill, Coventry, CV4 7AJ, UK
| | - Handi Salim
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Bashar Aldhoon
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Will Foster
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Ahmed Merghani
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Michael Kuehl
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Prithwish Banerjee
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Nicolas Lellouche
- Hopital Henri Mondor Albert Chenevier, University Paris Est Creteil Paris XII, Avenue du Marechal de Lattre de Tassigny, 94000, Creteil, Inserm U955, Paris, France
| | - Tarvinder Dhanjal
- Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK. .,University of Warwick (Medical School), Gibbet Hill, Coventry, CV4 7AJ, UK.
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14
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McGregor G, Hee SW, Eftekhari H, Holliday N, Pearce G, Sandhu H, Simmonds J, Joshi S, Kavi L, Bruce J, Panikker S, Lim B, Hayat S. Protocol for a randomised controlled feasibility trial of exercise rehabilitation for people with postural tachycardia syndrome: the PULSE study. Pilot Feasibility Stud 2020; 6:157. [PMID: 33083000 PMCID: PMC7569199 DOI: 10.1186/s40814-020-00702-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/12/2020] [Indexed: 11/10/2022] Open
Abstract
Background Postural orthostatic tachycardia syndrome (POTS) is an autonomic nervous system disorder causing an abnormal cardiovascular response to upright posture. It affects around 0.2% of the population, most commonly women aged 13 to 50 years. POTS can be debilitating; prolonged episodes of pre-syncope and fatigue can severely affect activities of daily living and health-related quality of life (HRQoL). Medical treatment is limited and not supported by randomised controlled trial (RCT) evidence. Lifestyle interventions are first-line treatment, including increased fluid and salt intake, compression tights and isometric counter-pressure manoeuvres to prevent fainting. Observational studies and small RCTs suggest exercise training may improve symptoms and HRQoL in POTS, but evidence quality is low. Methods Sixty-two people (aged 18-40 years) with a confirmed diagnosis of POTS will be invited to enrol on a feasibility RCT with embedded qualitative study. The primary outcome will be feasibility; process-related measures will include the number of people eligible, recruited, randomised and withdrawn, along with indicators of exercise programme adherence and acceptability. Secondary physiological, clinical and health-related outcomes including sub-maximal recumbent bike exercise test, active stand test and HRQoL will be measured at 4 and 7 months post-randomisation by researchers blinded to treatment allocation. The PostUraL tachycardia Syndrome Exercise (PULSE) intervention consists of (1) individual assessment; (2) 12-week, once to twice-weekly, supervised out-patient exercise training; (3) behavioural and motivational support; and (4) guided lifestyle physical activity. The control intervention will be best-practice usual care with a single 30-min, one-to-one practitioner appointment, and general advice on safe and effective physical activity. For the embedded qualitative study, participants (n = 10 intervention, n = 10 control) will be interviewed at baseline and 4 months post-randomisation to assess acceptability and the feasibility of progressing to a definitive trial. Discussion There is very little high-quality research investigating exercise rehabilitation for people with POTS. The PULSE study will be the first randomised trial to assess the feasibility of conducting a definitive multicentre RCT testing supervised exercise rehabilitation with behavioural and motivational support, compared to best-practice usual care, for people with POTS. Trial registration ISRCTN45323485 registered on 7 April 2020.
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Affiliation(s)
- Gordon McGregor
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Watch Close, Coventry, CV1 3LN UK.,Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK.,Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Siew Wan Hee
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Helen Eftekhari
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Nikki Holliday
- Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK
| | - Gemma Pearce
- Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK
| | - Harbinder Sandhu
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jane Simmonds
- UCL Great Ormond Street Institute of Child Health, Faculty of Population Health, University College London, London, UK
| | - Shivam Joshi
- Research & Development, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | | | - Julie Bruce
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sandeep Panikker
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Boon Lim
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Sajad Hayat
- Department of Cardiology, Hamad Medical Corporation, Doha, Qatar
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15
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Barakat MF, Chehab O, Kaura A, Sunderland N, Hayat S, Dhillon PS, Gall N, Monaghan MJ, Amin-Youssef G, Mayet J, Shah AM, Scott PA, Okonko DO. Tissue Doppler-Derived Left Ventricular Systolic Velocity Is Associated with Lethal Arrhythmias in Cardiac Device Recipients Irrespective of Left Ventricular Ejection Fraction. J Am Soc Echocardiogr 2020; 33:1509-1516. [PMID: 33051107 DOI: 10.1016/j.echo.2020.08.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Life-threatening arrhythmias (LTAs) can trigger sudden cardiac death or provoke implantable cardioverter-defibrillator (ICD) discharges that escalate morbidity and mortality. Longitudinal myofibrils predominate in the subendocardium, which is uniquely sensitive to arrhythmogenic triggers. In this study, we test the hypothesis that mitral annular systolic velocity (S'), a simple routinely obtained tissue Doppler index of LV long-axis systolic function, might predict lethal arrhythmias irrespective of left ventricular ejection fraction (LVEF). METHODS This is a retrospective analysis of data from 302 patients (mean age, 68 years; LVEF, 32%; 77% male; 52% ischemic; 35% primary prevention; and 53% cardiac resynchronization therapy defibrillator [CRT-D]) who were followed up (median, 15 months) at two centers after receipt of an ICD or CRT-D for diverse indications. S', averaged from tissue Doppler-derived medial and lateral mitral annular velocities, was correlated with the primary outcome of time to sustained ventricular tachycardia (VT) or fibrillation (VF) needing device therapy. RESULTS The median S' was 5.1 (interquartile range, 4.0-6.2) cm/sec and lower in CRT-D than ICD subjects (4.5 [3.8-5.6] cm/sec vs 5.5 [4.8-6.8] cm/sec, P < .001). Fifty-six (19%) subjects had LTA. Each 1 cm/sec higher S' correlated to a 30% decreased risk of LTA (hazard ratio = 0.70; 95% CI, 0.57-0.87; P = .001) independently of age, sex, β-blocker use, center, ICD use, and LVEF. Adding S' to the baseline Cox model improved net reclassification (P = .02). An S' > 5.6 cm/sec was the best cutoff and linked to a 58% lower LTA risk than an S' ≤ 5.6 cm/sec (95% CI, 0.23-0.85; P = .02). CONCLUSIONS A higher S' is associated with a reduced probability of LTA in cardiac device recipients irrespective of LVEF and may have the potential to be used clinically to titrate medical, device, and ablative therapies to mitigate future arrhythmic risk.
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Affiliation(s)
- Mohamad F Barakat
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, London, United Kingdom; Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Omar Chehab
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, London, United Kingdom
| | - Amit Kaura
- Department of Cardiology, King's College Hospital, London, United Kingdom; National Heart and Lung institute, Imperial College London and Imperial College NHS Foundation Trust, London, United Kingdom
| | | | - Sajad Hayat
- Department of Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Para S Dhillon
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Nick Gall
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Mark J Monaghan
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, London, United Kingdom; Department of Cardiology, King's College Hospital, London, United Kingdom
| | | | - Jamil Mayet
- National Heart and Lung institute, Imperial College London and Imperial College NHS Foundation Trust, London, United Kingdom
| | - Ajay M Shah
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, London, United Kingdom; Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Paul A Scott
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Darlington O Okonko
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, London, United Kingdom; Department of Cardiology, King's College Hospital, London, United Kingdom.
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16
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Adlan AM, Eftekhari H, Paul G, Hayat S, Osman F. The Impact of a Nurse-Led Syncope Clinic: Experience from a single UK tertiary center. J Arrhythm 2020; 36:854-862. [PMID: 33024463 PMCID: PMC7532277 DOI: 10.1002/joa3.12420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/30/2020] [Accepted: 08/06/2020] [Indexed: 12/02/2022] Open
Abstract
Background Syncope is a leading cause of hospital admission and is associated with significant morbidity and mortality. Our Syncope Clinic commenced in 2014 and we sought to evaluate its impact on outcomes (1‐yr mortality and syncope re‐hospitalization) in patients discharged following syncope admission. Methods A single‐center study of all consecutive patients discharged with syncope (ICD‐10 R55) between April 2012 and 2017. Patient demographics, comorbidities, hospital stay, syncope re‐hospitalization, and mortality at one‐year were collected. Those subsequently referred and seen in Syncope Clinic were compared with those who were not and predictors of poor outcome were evaluated. Results In total 2950 patients were discharged from hospital with syncope (median age: 73years, 51% male) with 1220 (41%) discharged same‐day; after commencement of Syncope Clinic 231were subsequently reviewed here. Overall mortality was 11%, which was lower in the Syncope Clinic group (3% vs 12%, P < .001). Temporal analysis revealed reduced re‐hospitalization following commencement of Syncope Clinic (2% vs 6%, P = .027). Independent predictors of mortality were increasing age (HR 1.03, 95% CI 1.03‐1.04), AF (HR 1.6, 95% CI 1.2‐2.1), HF (HR 2.2, 95% CI 1.6‐3.0), COPD (HR 1.9, 95% CI 1.4‐2.7), and CHADS2 score ≥ 1 (HR 1.45, 95% CI 1,12‐1.87). Syncope Clinic attendance was associated with reduced mortality (HR 0.3, 95% CI 0.1‐0.6). Conclusions Syncope patients discharged from hospital had reduced 1yr mortality if seen in subsequent Syncope Clinic. Independent predictors of mortality were COPD, HF, AF, and CHADS2 ≥1. Prospective randomized trials of Syncope Clinics are warranted.
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Affiliation(s)
- Ahmed M Adlan
- Department of Cardiology University Hospitals Coventry & Warwickshire NHS Trust Coventry UK
| | - Helen Eftekhari
- Department of Cardiology University Hospitals Coventry & Warwickshire NHS Trust Coventry UK
| | - Geeta Paul
- Department of Cardiology University Hospitals Coventry & Warwickshire NHS Trust Coventry UK
| | - Sajad Hayat
- Department of Cardiology University Hospitals Coventry & Warwickshire NHS Trust Coventry UK.,Department of Adult Cardiology Heart Hospital Hamad Medical Corporation Doha Qatar
| | - Faizel Osman
- Department of Cardiology University Hospitals Coventry & Warwickshire NHS Trust Coventry UK.,University of Warwick (Medical School) Coventry UK
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He H, Datla S, Weight N, Raza S, Lachlan T, Aldhoon B, Panikker S, Dhanjal T, Yusuf S, Foster W, Hayat S, Osman F. Safety and cost-effectiveness of same-day complex left atrial ablation. Int J Cardiol 2020; 322:170-174. [PMID: 33002522 PMCID: PMC7521347 DOI: 10.1016/j.ijcard.2020.09.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/18/2020] [Accepted: 09/23/2020] [Indexed: 11/28/2022]
Abstract
Background Catheter ablation for complex left-atrial arrhythmia is increasing worldwide with many centres admitting patients overnight. Same-day procedures using conscious sedation carry significant benefits to patients/healthcare providers but data are limited. We evaluated the safety and cost-effectiveness of same-day complex left-atrial arrhythmia ablation. Method Multi-centre retrospective cohort study of all consecutive complex elective left-atrial ablation procedures performed between January 2011 and December 2019. Data were collected on planned same-day discharge versus overnight stay, baseline parameters, procedure details/success, ablation technology, post-operative complications, unplanned overnight admissions/outcomes at 4-months and mortality up to April 2020. A cost analysis of potential savings was also performed. Results A total of 967 consecutive patients underwent complex left-ablation using radiofrequency (point-by-point ablation aided by 3D-mapping or PVAC catheter ablation with fluoroscopic screening) or cryoballoon-ablation (mean age: 60.9 ± 11.6 years, range 23-83 yrs., 572 [59%] females). The majority of patients had isolation of pulmonary veins alone (n = 846, 87%) and most using conscious-sedation alone (n = 921, 95%). Of the total cohort, 414 (43%) had planned same-day procedure with 35 (8%) admitted overnight due to major (n = 5) or minor (n = 30) complications. Overall acute procedural success-rate was 96% (n = 932). Complications in planned overnight-stay/same-day cohorts were low. At 4-month follow-up there were 62 (6.4%) readmissions (femoral haematomas, palpitation, other reasons); there were 3 deaths at mean follow-up of 42.0 ± 27.6 months, none related to the procedure. Overnight stay costs £350; the same-day ablation policy over this period would have saved £310,450. Conclusions Same-day complex left-atrial catheter ablation using conscious sedation is safe and cost-effective with significant benefits for patients and healthcare providers. This is especially important in the current financial climate and Covid-19 pandemic. We have previously reported same-day standard catheter ablation is safe, feasible and cost-effective. Data on same-day complex left-atrial ablation are limited. Our multi-centre cohort study of 967 consecutive elective complex left-atrial ablation procedures between January 2011 and December 2019 revealed same-day ablations using conscious sedation were safe and associated with very few complications and could have significant benefits to patients and cost-savings for healthcare providers worldwide. Same-day complex left-atrial ablation procedures can be performed safely without the need for overnight-stay. This has major implications for both patients and healthcare providers, especially given the current financial challenges and Covid-19 pandemic.
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Affiliation(s)
- Hejie He
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK; Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7HL, UK
| | - Sushma Datla
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Nicholas Weight
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Sidra Raza
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Thomas Lachlan
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK; Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7HL, UK
| | - Bashar Aldhoon
- Department of Cardiology, Worcester Royal Hospital, Charles Hastings Way, Worcester WR5 1DD, UK
| | - Sandeep Panikker
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Tarv Dhanjal
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK; Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7HL, UK
| | - Shamil Yusuf
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - William Foster
- Department of Cardiology, Worcester Royal Hospital, Charles Hastings Way, Worcester WR5 1DD, UK
| | - Sajad Hayat
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK; Department of Adult Cardiology Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Faizel Osman
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK; Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7HL, UK.
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Al-Herz A, Sultan A, Almahmeed A, Saleh K, Al-Awadhi A, Al-Kandari W, Hasan E, Ghanem A, Hussain M, Ali Y, Nahar E, Alenizi A, Hayat S, Abutiban F, Aledei A, Al-Qadhi A, Alhajeri H, Behbehani H, Alhadhood N, Alsaber A. AB0176 RISK OF ANTI-CITRULLINATED PEPTIDE ANTIBODIES AND RHEUMATOID FACTOR IN MALE SMOKERS: DATA FROM KUWAIT REGISTRY FOR RHEUMATIC DISEASES (KRRD). Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Smoking has been proposed to be associated with the development of anti-citrullinated peptide antibodies (ACPA) in rheumatoid arthritis (RA) patients.Objectives:To study the relationship between smoking and ACPA as well as smoking and RF in patients with RA in Kuwait Registry for Rheumatic Diseases (KRRD).Methods:Data on RA patients were extracted from KRRD from four major hospitals from February 2013 through December 2019. As females rarely smoke in Kuwait with a smoking prevalence of 3% in female RA patients in KRRD, females were excluded from the study population to reach the minimum statistical percentage needed to perform chi square test and assess the association between smoking and other variables. Statistical tests were applied where appropriate. Logistic regression was conducted to adjust for possible confounders including age, disease duration, comorbidities, family history of a rheumatic disease, ANA, treatment agents and disease activity and quality of life assessment tools.Results:A total of 863 RA male patients were studied with a mean age of 53.9±12.5 years and a mean disease duration 7.3±5.5 years. 652 (75.6%) had positive RF and 624 (72.3%) had positive ACPA. 431 (50%) had at least one comorbidity. 640 (74.2%) were on conventional disease modifying agents (cDMARD’s) and 223 (25.8%) were on biologic therapy. 183 (21.2%) were smokers. After adjustment of other factors, logistic regression showed that smokers were significantly different than non-smokers in terms of a positive ACPA (β=-1.051,p<0.001, odds=4.019) and a positive RF (β=-0.804,p=0.019, odds=2.517).Conclusion:Smokers have a higher risk of expressing a positive RF and a positive ACPA in a male population. Smoking should be considered as a possible risk factor for RA and efforts should be done to educate the population to cease smoking to possibly lower that risk.References:[1]Benowitz, N.L., 2009. Pharmacology of nicotine: addiction, smoking-induced disease, and therapeutics. Annual review of pharmacology and toxicology, 49, pp.57-71.[2]Firestein, G.S., 2003. Evolving concepts of rheumatoid arthritis. Nature, 423(6937), p.356.[3]Heliövaara, M., Aho, K., Aromaa, A., Knekt, P. and Reunanen, A., 1993. Smoking and risk of rheumatoid arthritis. The Journal of rheumatology, 20(11), pp.1830-1835.[4]Hoy, K. W., 2009. Quantitative Research in Education: A Primer. SAGE. pp. 69-86.[5]Kerlan-Candon, S., Combe, B., Vincent, R., Clot, J., Pinet, V. and Eliaou, J.F., 2001. HLA-DRB1 gene transcripts in rheumatoid arthritis. Clinical & Experimental Immunology, 124(1), pp.142-149.[6]Kuada, J., 2012. Research Methodology: A Project Guide for University Students. Samfundslitteratur. pp. 45-56.[7]Kumar, R., 2010. Research Methodology: A Step-by-Step Guide for Beginners. SAGE. pp. 148-159.[8]Masdottir, B., Jonsson, T., Manfreðsdóttir, V., Víkingsson, A., Brekkan, Á. and Valdimarsson, H., 2000. Smoking, rheumatoid factor isotypes and severity of rheumatoid arthritis. Rheumatology, 39(11), pp.1202-1205.[9]Neuman, W., 2009. Understanding research. Boston: Pearson. pp. 230- 255.Disclosure of Interests:None declared
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Alsaber A, Al-Herz A, Pan J, Saleh K, Al-Awadhi A, Al-Kandari W, Hasan E, Ghanem A, Hussain M, Ali Y, Nahar E, Alenizi A, Hayat S, Abutiban F, Aledei A, Al-Qadhi A, Alhajeri H, Behbehani H, Alhadhood N. THU0556 MISSING DATA AND MULTIPLE IMPUTATION IN RHEUMATOID ARTHRITIS REGISTRIES USING SEQUENTIAL RANDOM FOREST METHOD. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Missing data in clinical epidemiological researches violate the intention to treat principle,reduce statistical power and can induce bias if they are related to patient’s response to treatment. In multiple imputation (MI), covariates are included in the imputation equation to predict the values of missing data.Objectives:To find the best approach to estimate and impute the missing values in Kuwait Registry for Rheumatic Diseases (KRRD) patients data.Methods:A number of methods were implemented for dealing with missing data. These includedMultivariate imputation by chained equations(MICE),K-Nearest Neighbors(KNN),Bayesian Principal Component Analysis(BPCA),EM with Bootstrapping(Amelia II),Sequential Random Forest(MissForest) and mean imputation. Choosing the best imputation method wasjudged by the minimum scores ofRoot Mean Square Error(RMSE),Mean Absolute Error(MAE) andKolmogorov–Smirnov D test statistic(KS) between the imputed datapoints and the original datapoints that were subsequently sat to missing.Results:A total of 1,685 rheumatoid arthritis (RA) patients and 10,613 hospital visits were included in the registry. Among them, we found a number of variables that had missing values exceeding 5% of the total values. These included duration of RA (13.0%), smoking history (26.3%), rheumatoid factor (7.93%), anti-citrullinated peptide antibodies (20.5%), anti-nuclear antibodies (20.4%), sicca symptoms (19.2%), family history of a rheumatic disease (28.5%), steroid therapy (5.94%), ESR (5.16%), CRP (22.9%) and SDAI (38.0%), The results showed that among the methods used, MissForest gave the highest level of accuracy to estimate the missing values. It had the least imputation errors for both continuous and categorical variables at each frequency of missingness and it had the smallest prediction differences when the models used imputed laboratory values. In both data sets, MICE had the second least imputation errors and prediction differences, followed by KNN and mean imputation.Conclusion:MissForest is a highly accurate method of imputation for missing data in KRRD and outperforms other common imputation techniques in terms of imputation error and maintenance of predictive ability with imputed values in clinical predictive models. This approach can be used in registries to improve the accuracy of data, including the ones for rheumatoid arthritis patients.References:[1]Junninen, H.; Niska, H.; Tuppurainen, K.; Ruuskanen, J.; Kolehmainen, M. Methods for imputation ofmissing values in air quality data sets.Atmospheric Environment2004,38, 2895–2907.[2]Norazian, M.N.; Shukri, Y.A.; Azam, R.N.; Al Bakri, A.M.M. Estimation of missing values in air pollutiondata using single imputation techniques.ScienceAsia2008,34, 341–345.[3]Plaia, A.; Bondi, A. Single imputation method of missing values in environmental pollution data sets.Atmospheric Environment2006,40, 7316–7330.[4]Kabir, G.; Tesfamariam, S.; Hemsing, J.; Sadiq, R. Handling incomplete and missing data in water networkdatabase using imputation methods.Sustainable and Resilient Infrastructure2019, pp. 1–13.[5]Di Zio, M.; Guarnera, U.; Luzi, O. Imputation through finite Gaussian mixture models.ComputationalStatistics & Data Analysis2007,51, 5305–5316.Disclosure of Interests:None declared
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20
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Adlan AM, Arujuna A, Dowd R, Hayat S, Panikker S, Foster W, Yusuf S, Umar F, Lellouche N, Osman F, Dhanjal T. Long-term follow-up of normal and structural heart ventricular tachycardia catheter ablation: real-world experience from a UK tertiary centre. Open Heart 2019; 6:e000996. [PMID: 31673380 PMCID: PMC6802998 DOI: 10.1136/openhrt-2018-000996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 07/08/2019] [Accepted: 09/12/2019] [Indexed: 12/14/2022] Open
Abstract
Background Ventricular tachycardia (VT) is associated with increased morbidity and mortality. There is growing evidence for the effectiveness of catheter ablation in improving outcomes in patients with recurrent VT. Consequently the threshold for referral for VT ablation has fallen over recent years, resulting in increased number of procedures. Objective To evaluate the effectiveness and safety of VT ablation in a real-world tertiary centre setting. Methods This is a prospective analysis of all VT ablation cases performed at University Hospital Coventry. Follow-up data were obtained from review of electronic medical records and patient interview. The primary endpoint for normal heart VT was death, cardiovascular hospitalisation and VT recurrence, and for structural heart VT was arrhythmic death, VT storm (>3 episodes within 24 hours) or appropriate shock. Results Forty-seven patients underwent 53 procedures from January 2012 to January 2018. The mean age ±SD was 57±15 years, 68% were male, 81% were Caucasian and 66% were elective cases. The aetiology of VT included normal heart (49%), ischaemic cardiomyopathy (ICM, 36%), dilated cardiomyopathy (9%), hypertrophic cardiomyopathy (4%) and valvular heart disease (2%). Procedural success occurred in 83%, with six major complications. After a median follow-up of 231 days (lower quartile 133, upper quartile 631), the primary outcome occurred in 28% of patients. There were two non-arrhythmic deaths (4%). At a median follow-up of 193 days (129–468), the primary outcome occurred in 19% of patients with ICM, while VT storm/appropriate shocks occurred in three patients (17%). Conclusions Our real-world registry confirms that VT ablation is safe, and is associated with high acute procedural success and long-term outcomes comparable with randomised controlled studies.
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Affiliation(s)
- Ahmed M Adlan
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.,Department of Cardiology, University Hospital Coventry, Coventry, UK
| | - Aruna Arujuna
- Department of Cardiology, University Hospital Coventry, Coventry, UK
| | - Rory Dowd
- Department of Cardiology, University Hospital Coventry, Coventry, UK.,Department of Cardiology, Good Hope Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sajad Hayat
- Department of Cardiology, University Hospital Coventry, Coventry, UK
| | - Sandeep Panikker
- Department of Cardiology, University Hospital Coventry, Coventry, UK
| | - Will Foster
- Department of Cardiology, University Hospital Coventry, Coventry, UK.,Department of Cardiology, Worcestershire Royal Hospital, Worcester, UK
| | - Shamil Yusuf
- Department of Cardiology, University Hospital Coventry, Coventry, UK.,Department of Cardiology, Good Hope Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Fraz Umar
- University Hospital Coventry, Coventry, UK
| | | | - Faizel Osman
- Cardiology, University Hospital Coventry, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Tarvinder Dhanjal
- Department of Cardiology, University Hospital Coventry, Coventry, UK
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21
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Datla S, Weight N, Lange J, Berwick K, He H, Lachlan T, Foster W, Yusuf S, Dhanjal T, Panikker S, Hayat S, Osman F. P2837Day-case complex left atrial ablation is safe and cost-effective: experience from a UK tertiary centre. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1147] [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
Day-case standard catheter ablation is becoming routine. However, patients having complex left atrial ablation for atrial fibrillation (AF) or left atrial tachycardia (LAT) often stay overnight. We have been performing day-case complex left atrial ablation since 2015.
Purpose
To evaluate the safety, efficacy and cost-effectiveness of day-case complex left atrial ablation compared with those who stayed overnight.
Methods
A retrospective analysis of all consecutive complex left atrial ablations performed in a UK tertiary cardiac centre between 2010–2018. Data were collected on baseline parameters, procedure details including mapping technique, ablation strategy, immediate efficacy, and acute complications.
Results
A total of 830 complex left atrial catheter ablations were performed; mean age±SD=60±12 years, 63% male. The majority were AF ablation (n=804, 96.9%), with the rest being LAT/left-atrial flutter. Of the AF cases, 545 were paroxysmal (≤7 days), 212 persistent (>7 days) and 47 long-standing (>1yr); 98% of cases were elective. Pulmonary vein isolation was performed in all; additional LA lines were done in 163, CTI ablation in 129 and CFAEs in 33. 3D-mapping (Carto/Precision)=44.7% (with contact sensing=38.0%), PVAC=18.7%, PVI cryo-balloon=36.6%. Of the cohort 331 (39.9%) were done as day-case. Acute success= 94.9%, acute complications=4.58% (femoral site complications, n=12; pericardial effusion, n=19 (9 needing drain); stroke/cerebral embolus, n=3; phrenic nerve palsy, n=5; first degree heart block, n=1). Comparison of day-case vs non day-case revealed no significant difference in number of complications (Table 1). An overnight stay at out hospital costs £350. During the period of study our institution saved £115.850 (∼140,000 euros).
Day-case vs non day-case ablation Parameters Day-case (n=331) Non day-case (n=499) p-value Mean age ± SD (years) 61.2±11.6 59.1±11.9 0.009 Males (n, %) 205 (61.9%) 321 (64.3%) 0.484 Normal heart (n, %) 243 (73.4%) 383 (76.8%) 0.276 Paroxysmal AF (n, %) 218 (65.9%) 327 (65.5%) 0.928 Fluoroscopy time (mins) 23.8±13.9 27.0±14.5 0.001 Procedure time (mins) 150±89.6 163±68.2 0.025 % with 3D-mapping 30.8% 56.9% <0.001 Acute complications (n, %) 12 (3.63%) 26 (5.21%) 0.285
Conclusions
Day-case complex left atrial cardiac ablation is safe and effective. It is associated with good clinical outcomes and leads to significant cost savings as an overnight stay is not needed.
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Affiliation(s)
- S Datla
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - N Weight
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - J Lange
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - K Berwick
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - H He
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - T Lachlan
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - W Foster
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - S Yusuf
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - T Dhanjal
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - S Panikker
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - S Hayat
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - F Osman
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
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Barakat MF, Sunderland N, Chehab O, Kaura A, Hayat S, Amin-Youssef G, Scott P, Okonko DO. P5975Diminished LV systolic velocity on tissue Doppler imaging is linked to an amplified risk of lethal arrhythmias independently of LV ejection fraction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0696] [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
Life threatening arrhythmias (LTA) can trigger sudden cardiac death, or provoke implantable cardioverter defibrillator (ICD) discharges that escalate morbidity and mortality. Longitudinal myofibrils predominate in the subendocardium which is uniquely sensitive to arrhythmogenic triggers.
Objectives
To test the hypothesis that mitral annular systolic velocity (S'), a tissue Doppler index of LV long-axis systolic function, might predict lethal arrhythmias irrespective of LVEF.
Methods
We analysed data from diverse ICD and cardiac resynchronization therapy defibrillator (CRT-D) patients at 2 London centres. Channelopathies were excluded. S' was averaged from medial and lateral mitral annuli velocities. Primary outcome was time to sustained ventricular tachycardia (VT) or fibrillation (VF) needing device therapy.
Results
In 302 patients (mean age 68 years, LVEF 32%, 77% male, 52% ischemic, 35% primary prevention, and 53% CRT-D), median S' was 5.1 (IQR: 4.0–6.2) cm/s and lower in CRT-D than ICD subjects. After a median follow-up of 15 months, 56 (19%) subjects had LTA and those who did had a lower S' than those who did not (4.6±1.4 cm/s vs. 5.4±1.7 cm/s, P=0.003-Fig A). Each 1cm/s lower S' correlated to a 43% increased risk of LTA (HR: 0.70, 95% CI: 0.57–0.87, P=0.001) independently of age, gender, β-blocker use, centre, ICD use and LVEF. Adding S' to the baseline model improved net reclassification (P=0.02) implying incremental utility (Fig B). An S' ≤5.6cm/s was the best cut-off, conferring a 2.4-fold higher LTA risk than an S'>5.6 cm/s (95% CI: 1.17–4.37, P=0.02–Fig C).
Conclusion
A lower S' forecasts an enhanced probability of LTA in cardiac device recipients irrespective of LVEF, and could be used to titrate medical, device and ablative therapies to mitigate future arrhythmic risk.
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Affiliation(s)
- M F Barakat
- King's College London, London, United Kingdom
| | | | - O Chehab
- King's College London, London, United Kingdom
| | - A Kaura
- Kings College Hospital, London, United Kingdom
| | - S Hayat
- University Hospital, Cardiology, Coventry, United Kingdom
| | | | - P Scott
- Kings College Hospital, London, United Kingdom
| | - D O Okonko
- King's College London, London, United Kingdom
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Lee JD, Eftekari H, Paul G, Zhupaj A, Panikker S, Dhanjal T, Yusuf S, Hayat S, Osman F. P6561Diagnostic yield of implantable loop recorders: a comparison of arrhythmia nurse specialists versus clinicians. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1151] [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
Implantable loop recorders (ILR) are recommended in guidelines to determine symptom-rhythm correlation. Arrhythmia Nurse Specialists (ANS) play a critical role in the assessment of such patients. Their effectiveness at risk stratification for ILR implantation is unknown. The ESC 2018 Syncope guidelines recommend more research in this field.
Aim
To evaluate the diagnostic yield of consecutive ILR implants at a tertiary centre over a 2year period and compare ANS versus Clinicians.
Methods
A retrospective study of all patients undergoing ILR implant between April 2016 and April 2018. Data collected included baseline patient demographics, referral source and management changes made by ILR findings.
Results
305 patients had an ILR; median age was 71yrs (interquartile range 52–81), 55% male. Median follow-up time was 15months. Referrals were from general cardiology (GC) = 98 (32%), electrophysiology (EP) = 105 (34%), and ANS-led syncope clinic = 102 (34%). Indications for ILR implant were syncope = 203 (65.9%), palpitation = 21 (6.9%), pre-syncope = 16 (5.2%), cryptogenic stroke = 35 (11.5%) and others 7 (8.9%) (falls, channelopathies). Of the entire cohort, 102 (34.0%) experienced arrhythmias recorded on the ILR that resulted in a change of management. This included: pacemaker implant = 49 (16.1%), complex-device implant = 7 (2.3%), AF=28 (9.2%), SVT=14 (4.6%), VT=1 (0.3%). Of those with a syncope indication (n=203), findings on ILR altered management in 73patients (36.0%) over a median follow-up of 18months; a pacing indication in this syncope group was present in 44 (21.9%) patients (median time to diagnosis: 2.7 months) with 24 receiving a pacemaker indication within 3 months of ILR insertion. ANS had a higher pacemaker implant rate. Overall, an ILR resulted in a diagnostic yield of 34.1% (n=104). Specialist nurse referral resulted in an overall greater trend towards change of management in 38.2% of patients compared with GC (32.7%) and EP (31.0%) (p=0.593 nurse vs. consultant).
Conclusion
The overall diagnostic yield of ILR insertion was 34% in our study. ANS had a trend towards a greater diagnostic yield compared with clinicians, and significantly more pacemaker indications. Our data suggests that ANS patient selection for ILR insertion are at least comparable to clinicians.
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Affiliation(s)
- J D Lee
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - H Eftekari
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - G Paul
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - A Zhupaj
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - S Panikker
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - T Dhanjal
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - S Yusuf
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - S Hayat
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - F Osman
- University Hospital Coventry and Warwickshire NHS Trust, and Warwick Medical School, Coventry, United Kingdom
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Qureshi NA, Kim SJ, Cantwell CD, Afonso VX, Bai W, Ali RL, Shun-Shin MJ, Malcolme-Lawes LC, Luther V, Leong KMW, Lim E, Wright I, Nagy S, Hayat S, Ng FS, Wing MK, Linton NWF, Lefroy DC, Whinnett ZI, Davies DW, Kanagaratnam P, Peters NS, Lim PB. Voltage during atrial fibrillation is superior to voltage during sinus rhythm in localizing areas of delayed enhancement on magnetic resonance imaging: An assessment of the posterior left atrium in patients with persistent atrial fibrillation. Heart Rhythm 2019; 16:1357-1367. [PMID: 31170484 PMCID: PMC6722483 DOI: 10.1016/j.hrthm.2019.05.032] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Indexed: 11/30/2022]
Abstract
Background Bipolar electrogram voltage during sinus rhythm (VSR) has been used as a surrogate for atrial fibrosis in guiding catheter ablation of persistent atrial fibrillation (AF), but the fixed rate and wavefront characteristics present during sinus rhythm may not accurately reflect underlying functional vulnerabilities responsible for AF maintenance. Objective The purpose of this study was determine whether, given adequate temporal sampling, the spatial distribution of mean AF voltage (VmAF) better correlates with delayed-enhancement magnetic resonance imaging (MRI-DE)–detected atrial fibrosis than VSR. Methods AF was mapped (8 seconds) during index ablation for persistent AF (20 patients) using a 20-pole catheter (660 ± 28 points/map). After cardioversion, VSR was mapped (557 ± 326 points/map). Electroanatomic and MRI-DE maps were co-registered in 14 patients. Results The time course of VmAF was assessed from 1–40 AF cycles (∼8 seconds) at 1113 locations. VmAF stabilized with sampling >4 seconds (mean voltage error 0.05 mV). Paired point analysis of VmAF from segments acquired 30 seconds apart (3667 sites; 15 patients) showed strong correlation (r = 0.95; P <.001). Delayed enhancement (DE) was assessed across the posterior left atrial (LA) wall, occupying 33% ± 13%. VmAF distributions were (median [IQR]) 0.21 [0.14–0.35] mV in DE vs 0.52 [0.34–0.77] mV in non-DE regions. VSR distributions were 1.34 [0.65–2.48] mV in DE vs 2.37 [1.27–3.97] mV in non-DE. VmAF threshold of 0.35 mV yielded sensitivity of 75% and specificity of 79% in detecting MRI-DE compared with 63% and 67%, respectively, for VSR (1.8-mV threshold). Conclusion The correlation between low-voltage and posterior LA MRI-DE is significantly improved when acquired during AF vs sinus rhythm. With adequate sampling, mean AF voltage is a reproducible marker reflecting the functional response to the underlying persistent AF substrate.
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Affiliation(s)
- Norman A Qureshi
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | | | | | | | - Wenjia Bai
- Imperial College London, London, United Kingdom
| | | | - Matt J Shun-Shin
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | | | - Vishal Luther
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Kevin M W Leong
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Elaine Lim
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Ian Wright
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Szabi Nagy
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Sajad Hayat
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Fu Siong Ng
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Michael Koa Wing
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Nick W F Linton
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - David C Lefroy
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Zachary I Whinnett
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - D Wyn Davies
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Prapa Kanagaratnam
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Nicholas S Peters
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Phang Boon Lim
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom.
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Williams-Gray CH, Wijeyekoon RS, Scott KM, Hayat S, Barker RA, Jones JL. Abnormalities of age-related T cell senescence in Parkinson's disease. J Neuroinflammation 2018; 15:166. [PMID: 29807534 PMCID: PMC5972443 DOI: 10.1186/s12974-018-1206-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A wealth of evidence implicates both central and peripheral immune changes as contributing to the pathogenesis of Parkinson's disease (PD). It is critical to better understand this aspect of PD given that it is a tractable target for disease-modifying therapy. Age-related changes are known to occur in the immune system (immunosenescence) and might be of particular relevance in PD given that its prevalence rises with increasing age. We therefore sought to investigate this with respect to T cell replicative senescence, a key immune component of human ageing. METHODS Peripheral blood mononuclear cells were extracted from blood samples from 41 patients with mild PD (Hoehn and Yahr stages 1-2, mean (SD) disease duration 4.3 (1.2) years) and 41 age- and gender-matched controls. Immunophenotyping was performed with flow cytometry using markers of T lymphocyte activation and senescence (CD3, CD4, CD8, HLA-DR, CD38, CD28, CCR7, CD45RA, CD57, CD31). Cytomegalovirus (CMV) serology was measured given its proposed relevance in driving T cell senescence. RESULTS Markers of replicative senescence in the CD8+ population were strikingly reduced in PD cases versus controls (reduced CD57 expression (p = 0.005), reduced percentage of 'late differentiated' CD57loCD28hi cells (p = 0.007) and 'TEMRA' cells (p = 0.042)), whilst expression of activation markers (CD28) was increased (p = 0.005). This was not driven by differences in CMV seropositivity. No significant changes were observed in the CD4 population. CONCLUSIONS This study demonstrates for the first time that the peripheral immune profile in PD is distinctly atypical for an older population, with a lack of the CD8+ T cell replicative senescence which characterises normal ageing. This suggests that 'abnormal' immune ageing may contribute to the development of PD, and markers of T cell senescence warrant further investigation as potential biomarkers in this condition.
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Affiliation(s)
- C H Williams-Gray
- John Van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Forvie Site, Cambridge, CB2 0PY, UK.
| | - R S Wijeyekoon
- John Van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Forvie Site, Cambridge, CB2 0PY, UK
| | - K M Scott
- John Van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Forvie Site, Cambridge, CB2 0PY, UK
| | - S Hayat
- John Van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Forvie Site, Cambridge, CB2 0PY, UK
| | - R A Barker
- John Van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Forvie Site, Cambridge, CB2 0PY, UK
| | - J L Jones
- Neurology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Padwick A, Osman F, Paul G, Jones G, Hayat S, Eftekhari H. 9Implementation of opportunistic screening at Pre-Assessment Clinics for upgrade/downgrade of cardiac devices. Europace 2017. [DOI: 10.1093/europace/eux283.018] [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: 11/13/2022] Open
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Eftekhari H, Osman F, Maddock H, Hayat S. 102Protocol for a systematic search and critical review of studies, in effective strategies to maintain quality of life in adult patients with postural orthostatic tachycardia syndrome utilizing an interpretive approach. Europace 2017. [DOI: 10.1093/europace/eux283.096] [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
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Lim CW, Dirksen A, Taraborrelli P, Sau A, Nagy S, Hayat S, Lim PB. 50Modification in head up tilt test protocol increases diagnostic yield and better-elucidates the mechanism of situational syncope. Europace 2017. [DOI: 10.1093/europace/eux283.007] [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: 11/12/2022] Open
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29
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Sau A, Sritharan V, Taraborrelli P, Dirksen A, Dhutia N, Lim CW, Hayat S, Sutton R, Lim PB. 29Refining the diagnostic criteria of the postural orthostatic tachycardia syndrome (POTS) using power spectral indices. Europace 2017. [DOI: 10.1093/europace/eux283.038] [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: 11/13/2022] Open
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30
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Eftekhari HR, Osman F, Paul G, Padwick A, Hayat S. 103How is our local AF management? The management of atrial fibrillation (af) in coventry and rugby clinical commissioning group (ccg), england compared to national data and nice (national institute for clinical excellence) 2014. Europace 2017. [DOI: 10.1093/europace/eux283.097] [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
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31
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Luther V, Linton NWF, Jamil-Copley S, Koa-Wing M, Lim PB, Qureshi N, Ng FS, Hayat S, Whinnett Z, Davies DW, Peters NS, Kanagaratnam P. A Prospective Study of Ripple Mapping the Post-Infarct Ventricular Scar to Guide Substrate Ablation for Ventricular Tachycardia. Circ Arrhythm Electrophysiol 2017; 9:CIRCEP.116.004072. [PMID: 27307519 DOI: 10.1161/circep.116.004072] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/12/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Post-infarct ventricular tachycardia is associated with channels of surviving myocardium within scar characterized by fractionated and low-amplitude signals usually occurring late during sinus rhythm. Conventional automated algorithms for 3-dimensional electro-anatomic mapping cannot differentiate the delayed local signal of conduction within the scar from the initial far-field signal generated by surrounding healthy tissue. Ripple mapping displays every deflection of an electrogram, thereby providing fully informative activation sequences. We prospectively used CARTO-based ripple maps to identify conducting channels as a target for ablation. METHODS AND RESULTS High-density bipolar left ventricular endocardial electrograms were collected using CARTO3v4 in sinus rhythm or ventricular pacing and reviewed for ripple mapping conducting channel identification. Fifteen consecutive patients (median age 68 years, left ventricular ejection fraction 30%) were studied (6 month preprocedural implantable cardioverter defibrillator therapies: median 19 ATP events [Q1-Q3=4-93] and 1 shock [Q1-Q3=0-3]). Scar (<1.5 mV) occupied a median 29% of the total surface area (median 540 points collected within scar). A median of 2 ripple mapping conducting channels were seen within each scar (length 60 mm; initial component 0.44 mV; delayed component 0.20 mV; conduction 55 cm/s). Ablation was performed along all identified ripple mapping conducting channels (median 18 lesions) and any presumed interconnected late-activating sites (median 6 lesions; Q1-Q3=2-12). The diastolic isthmus in ventricular tachycardia was mapped in 3 patients and colocated within the ripple mapping conducting channels identified. Ventricular tachycardia was noninducible in 85% of patients post ablation, and 71% remain free of ventricular tachycardia recurrence at 6-month median follow-up. CONCLUSIONS Ripple mapping can be used to identify conduction channels within scar to guide functional substrate ablation.
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Affiliation(s)
- Vishal Luther
- From the Imperial College Healthcare NHS Trust, London, United Kingdom.
| | - Nick W F Linton
- From the Imperial College Healthcare NHS Trust, London, United Kingdom.
| | | | - Michael Koa-Wing
- From the Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Phang Boon Lim
- From the Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Norman Qureshi
- From the Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Fu Siong Ng
- From the Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Sajad Hayat
- From the Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Zachary Whinnett
- From the Imperial College Healthcare NHS Trust, London, United Kingdom
| | - D Wyn Davies
- From the Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nicholas S Peters
- From the Imperial College Healthcare NHS Trust, London, United Kingdom
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Abstract
The prevalence of heart failure is increasing and it is associated with significant mortality and morbidity. Optimal medical therapy improves outcome, but heart failure continues to have a substantial impact on both the individual patient and wider society. Over the last two decades, cardiac resynchronization therapy has revolutionized the treatment of selected patients who have heart failure. Cardiac resynchronization therapy significantly reduces mortality and hospitalization through reverse cardiac remodelling. This review informs non-specialists about cardiac resynchronization therapy and for which patients it should be considered.
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Affiliation(s)
- Christopher J McAloon
- Cardiology Research Fellow, Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX and Translational & Experimental Medicine, University of Warwick Medical School, Coventry
| | - Mark D Theodoreson
- Core Medical Trainee Year One, Department of Cardiology, University Hospitals Bristol NHS Trust, Bristol Heart Institute, Bristol
| | - Sajad Hayat
- Consultant Cardiologist and Electrophysiologist, Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry
| | - Faizel Osman
- Consultant Cardiologist and Electrophysiologist, Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry and Translational & Experimental Medicine, University of Warwick Medical School, Coventry
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Abstract
A 26-year-old man presented to our syncope service with debilitating daily palpitations, shortness of breath, presyncope and syncope following a severe viral respiratory illness 4 years previously. Mobitz type II block had previously been identified, leading to a permanent pacemaker and no further episodes of frank syncope. Transthoracic echocardiography, electophysiological study and repeated urine metanepherines were normal. His palpitations and presyncope were reproducible on deep inspiration, coughing, isometric hand exercise and passive leg raises. We demonstrated rapid increases in heart rate with no change in morphology on his 12 lead ECG. His symptoms were resistant to fludrocortisone, flecainide, β blockers and ivabradine. Initiation of clonidine in combination with ivabradine led to rapid resolution of his symptoms. We suggest that an excessive respiratory sinus arrhythmia was responsible for his symptoms and achieved an excellent response with the centrally acting sympatholytic clonidine, where previous peripherally acting treatments had failed.
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Affiliation(s)
| | | | - Sajad Hayat
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Phang Boon Lim
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
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Raine D, Begg G, Moore J, Taylor E, Buck R, Honarbakhsh S, Yew Ding W, Redfearn D, Opel A, Opel A, Thomas D, Prakash K, Thomas D, Khokhar A, Honarbakhsh S, Tairova S, Getman N, McAloon C, Honarbakhsh S, Shah M, Al-Lawati K, Al-Lawati K, Ensam B, Collins G, Akbar S, Merghani A, Furniss G, Yones E, Vijayashankar SS, Vijayashankar SS, Shariat H, Moss A, Yeoh A, Sadiq A, Taylor R, Edwards T, Nizam ud Din K, Langley P, Shepherd E, Murray S, Lord S, Bourke J, Plein S, Lip G, Tayebjee MH, Owen N, White S, O'Neill M, Hughes L, Carroll S, Moss-Morris R, Baker V, Kirkby C, Patel K, Robinson G, Antoniou S, Richmond L, Ullah W, Hunter R, Finlay M, Earley M, Whitbread M, Schilling R, Cooper R, Modi S, Somani R, Ng A, Hobson N, Caldwell J, Hadjivassilev S, Ang R, Finlay M, Dhinoja M, Earley M, Sporton S, Schilling R, Hunter R, Hadjivassilev S, Earley M, Lambiase P, Turley A, Child N, Linker N, Owens W, James S, Milner J, Tayebjee M, Sibley J, Griffiths A, Meredith T, Basher Y, Betts T, Rajappan K, Lambiase P, Lowe M, Hunter R, Schilling R, Finlay M, Rakhimbaeva G, Akramova N, Getman T, Hamborg T, O'Hare J, Randeva H, Osman F, Srinivasan N, Kirkby C, Firman E, Tobin L, Murphy C, Lowe M, Hunter R, Finlay M, Schilling R, Lambiase P, Mohan P, Salahia G, Lim H, Lim HS, Batchvarov V, Brennan P, Cox A, Muir A, Behr E, Hamill S, Laventure C, Newell S, Gordon B, Bashir K, Chuen J, Foster W, Yusuf S, Osman F, Hayat S, Panagopoulos D, Davies E, Tomlinson D, Haywood G, Mullan J, Kelland N, Horwood A, Connell N, Odams S, Maloney J, Shetty A, Kyriacou A, Sahu J, Lee J, Uzun O, Wong A, Ashtekar S, Uzun O, Wong A, Ashtekar S, Hashemi J, Gazor S, Redfearn D, Song A, Jenkins J, Glancy J, Wilson D, Sammut E, Diab I, Cripps T, Gill A, Abbas S, Enye J, Wahab A, Elshafie S, Ling K, Carey P, Chatterjee D, Timbrell S, Tufail W, Why H, Martos R, Thornley A, James S, Turley A, Bates M, Linker N, Hassan E, Quick J, Cowell R, Ho E. POSTERS (1)59MULTIPOLAR CONTACT MAPPING GUIDED ABLATION OF TEMPORALLY STABLE HIGH FREQUENCY AND COMPLEX FRACTIONATED ATRIAL ELECTROGRAM SITES IN PATIENTS WITH PERSISTENT ATRIAL FIBRILLATION60INTRA-CARDIAC AND PERIPHERAL LEVELS OF BIOCHEMICAL MARKERS OF FIBROSES IN PATIENTS UNDERGOING CATHETER ABLATION FOR ATRIAL FIBRILATION61THE DON'T WAIT TO ANTICOAGULATE PROJECT (DWAC) BY THE WEST OF ENGLAND ACADEMIC HEALTH SCIENCE NETWORK (AHSN) OPTIMISES STROKE PREVENTION FOR PATIENTS WITH ATRIAL FIBRILLATION (AF) WITHIN PRIMARY CARE IN LINE WITH NICE CG180 IN THE WEST OF ENGLAND62ILLNESS AND TREATMENT REPRESENTATIONS, COPING AND DISTRESS: VICIOUS CYCLES OF EVERYDAY EXPERIENCES IN PATIENTS WITH PERSISTENT ATRIAL FIBRILLATION63THE NEEDS OF THE ADOLESCENT LIVING WITH AN INHERITED CARDIAC CONDITION: THE PATIENTS' PERSPECTIVE64SAFETY AND EFFICACY OF PARAMEDIC TREATMENT OF REGULAR SUPRAVENTRICULAR TACHYCARDIA (PARA-SVT)65NATURAL PROGRESSION OF QRS DURATION FOLLOWING IMPLATABLE CARDIOVERTER DEFIBRILLATORS (ICD) - IMPLANTATION66COMPARISON OF EFFICACY OF VOLTAGE DIRECTED CAVOTRICUSPID ISTHMUS ABLATION USING MINI VS CONVENTIONAL ELETRODES67CRYOBALLOON ABLATION (CRYO) FOR ATRIAL FIBRILLATION (AF) CANNOT BE GUIDED BY TEMPERATURE END-POINTS ALONE68MODERATOR BAND ECTOPY UNMASKED BY ADENOSINE AS A CAUSE OF ECTOPIC TRIGGERED IDIOPATHIC VF69EARLY CLINICAL EXPERIENCE WITH TARGETED SITE SELECTION FOR THE WiCS-LV ELECTRODE FOR CRT70DOES VECTOR MAPPING PRIOR TO IMPLANTABLE LOOP RECORDER INSERTION IMPROVE THE DETECTION OF ARRHYTHMIA?71THE ROLE OF SPECKLE TRACKING STRAIN IMAGING IN ASSESSING LEFT VENTRICULAR RESPONSE TO CARDIAC RESYNCHRONISATION THERAPY IN RESPONDERS AND NON-RESPONDERS72EVALUATING PATIENTS' EXPERIENCE AND SATISFACTION OF THE ATRIAL FIBRILLATION ABLATION PROCEDURE: A RETROSPECTIVE ANALYSIS73TROUBLESHOOTING LV LEAD IMPLANTATION - NOVEL “UNIRAIL TECHNIQUE”74SUBCLINICAL ATHEROSCELEROSIS AND COGNITIVE IMPAIRMENT75EFFECT OF LOZARTANE ON DEVELOPMENT OF THE ELECTRICAL INSTABILITY OF THE MYOCARDIUM76THE INTERPLAY BETWEEN BODY COMPOSITION AND LEFT VENTRICULAR REMODELLING IN CARDIAC RESYNCHRONISATION THERAPY77FAMILY SCREENING IN IDIOPATHIC VENTRICULAR FIBRILLATION78MANAGEMENT OF ATRIAL FIBRILLATION IN A LARGE TEACHING HOSPITAL79THE EFFECT OF LEFT VENTRICULAR LEAD POSITION ON SURVIVAL IN PATIENTS WITH BINVENTRICULAR PACEMAKRS/DEFIBRILLATORS80ACUTE DEVICE IMPLANT-RELATED COMPLICATIONS DO NOT INCREASE LATE MORTALITY81ABORTED CARIDAC ARREST AS THE SENTINEL PRESENTATION IN A COHORT OF PATIENTS WITH THE CONCEALED BRUGADA PHENOTYPE82POST-CARDIAC DEVICE IMPLANTATION MOBILISATION ADVICE: A NATIONAL SURVEY83DO RISK SCORES DEVELOPED TO PROTECT ONE-YEAR MORTALITY ACTUALLY HELP IN ACCURATELY SELECTING PATIENTS RECEIVING PRIMARY PREVENTION ICD?84ATRIAL TACHYCARDIA ARISING FROM THE NON-CORONARY AORTIC CUSP85THE EFFECT OF DIFFERENT ATRIAL FIBRILLATION ABLATION STRATEGIES ON SURFACE ECG P WAVE DURATION86PRESCRIBING DRONEDARONE: HOW IS IT DONE ACROSS THE UK AND IS IT SAFE?87A CASE OF WIDE COMPLEX TACHYCARDIA88TRANSITION TO DEDICATED DAY CASE DEVICES - SAFETY AND EFFICACY IN A LARGE VOLUME CENTRE89SEQUENTIAL REGIONAL DOMINANT FREQUENCY MAPPING DURING ATRIAL FIBRILLATION: A NOVEL TEQUNIQUE90ELECTIVE CARDIOVERSION ENERGY PROTOCOLS: A RETROSPECTIVE COMPARISON OF ESCALATION STRATEGIES91THE INCIDENCE OF CLINCALLY RELEVANT HAEMATOMAS WITH PERIOPERATIVE USE OF NEWER P2Y12 INHIBITORS AND INTERRUPTED NOAC THERAPY IN CARDIAC IMPLANTABLE ELECTRONIC DEVICE INSERTION92AN AUDIT OF THE OUTCOMES FOR CHEMICAL AND DIRECT CURRENT CARDIOVERSION FOR ATRIAL FIBRILLATION AT OUR DGH OVER A 3 YEAR DURATION93REAL LIFE ACUTE MANAGEMET OF HAEMODYNAMICALLY TOLERATED MONOMORPHIC VENTRICULAR TACHYCARDIA. ARE WE MAKING EVIDENCE BASED ON DECISIONS?94A SERVICE EVALUATION TO ASSESS THE EFFICACY AND SAFETY OF NOVEL ORAL ANTICOAGULANTS VERSUS WARFARIN FOR ELECTIVE CARDIVERSION IN PATIENTS WITH NON VALVULAR AF IN A NURSE LED CARDIOVERSION SERVICE95PICK UP RATE OF IMPLANTED LOOP RECORDER AT A DISTRICT HOSPITAL. Europace 2016. [DOI: 10.1093/europace/euw273] [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: 11/13/2022] Open
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Wani AS, Ahmad A, Hayat S, Tahir I. Is foliar spray of proline sufficient for mitigation of salt stress in Brassica juncea cultivars? Environ Sci Pollut Res Int 2016; 23:13413-13423. [PMID: 27026543 DOI: 10.1007/s11356-016-6533-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 07/01/2015] [Accepted: 03/21/2016] [Indexed: 06/05/2023]
Abstract
The effects of foliar application of proline (20 mM) on growth, physio-biochemical, and yield parameters were assessed in two Brassica juncea (L.) Czern & Coss cultivars, namely, Varuna and RH-30, at different levels (2.8, 4.2, or 5.6 dsm(-1)) of NaCl in soil. At 29 days after sowing (DAS), plants were sprayed with either 20 mM proline or water in the presence or absence of NaCl stress. The NaCl negatively affected parameters related to growth, photosynthesis, and yield in both varieties but more in RH-30 than in Varuna. Exogenous application of proline counteracted the effects of salt stress in Varuna only, by increasing the antioxidative capacity of the plants. Moreover, proline was not effective in alleviating the detrimental effects of higher salt concentrations on the studied parameters. Proline application to unstressed plants increased growth, photosynthesis, and yield parameters in both varieties; however, the effects were more prominent in Varuna than in RH-30.
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Affiliation(s)
- A S Wani
- Plant Physiology and Biochemistry Research Lab, Department of Botany, University of Kashmir, Srinagar, 190006, India
| | - A Ahmad
- Plant Physiology Section, Department of Botany, Aligarh Muslim University, Aligarh, 202002, India
| | - S Hayat
- Plant Physiology Section, Department of Botany, Aligarh Muslim University, Aligarh, 202002, India.
| | - I Tahir
- Plant Physiology and Biochemistry Research Lab, Department of Botany, University of Kashmir, Srinagar, 190006, India
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Kyriacou A, Hayat S, Qureshi N, Peters NS, Kanagaratnam P, Lim PB. Dissociated pulmonary vein potentials: Expression of the cardiac autonomic nervous system following pulmonary vein isolation? HeartRhythm Case Rep 2016; 1:401-405. [PMID: 26949598 PMCID: PMC4750876 DOI: 10.1016/j.hrcr.2015.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Andreas Kyriacou
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Sajad Hayat
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Norman Qureshi
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nicholas S Peters
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Prapa Kanagaratnam
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Phang Boon Lim
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
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Mereu R, Taraborrelli P, Sau A, Di Toro A, Halim S, Hayat S, Bernardi L, Francis DP, Sutton R, Lim PB. Diagnostic role of head-up tilt test in patients with cough syncope. Europace 2016; 18:1273-9. [PMID: 26787669 DOI: 10.1093/europace/euv283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 04/08/2015] [Accepted: 06/11/2015] [Indexed: 11/12/2022] Open
Abstract
AIMS The aim of this study was to describe the head-up tilt (HUT) test and carotid sinus massage (CSM) responses, and the occurrence of syncope with coughing during HUT in a large cohort of patients. METHODS AND RESULTS A total of 5133 HUT were retrospectively analysed to identify patients with cough syncope. Head-up tilt followed by CSM were performed. Patients were made to cough on two separate occasions in an attempt to reproduce typical clinical symptoms on HUT. Patients with cough syncope were compared with 29 age-matched control patients with syncope unrelated to coughing. A total of 29 patients (26 male, age 49 ± 14 years) with cough syncope were identified. Coughing during HUT reproduced typical prodromal symptoms of syncope in 16 (55%) patients and complete loss of consciousness in 2 (7%) patients, with a mean systolic blood pressure reduction of 45 ± 26 mmHg, and a mean increase in heart rate of 13 ± 8 b.p.m. No syncope or symptoms after coughing were observed in the control group. The HUT result was positive in 13 (48%) patients with the majority of positive HUT responses being vasodepressor (70% of positive HUT). Carotid sinus massage was performed in 18 patients being positive with a vasodepressor response causing mild pre-syncopal symptoms in only 1 patient. CONCLUSION Syncope during coughing is a result of hypotension, rather than bradycardia. Coughing during HUT is a useful test in patients suspected to have cough syncope but in whom the history is not conclusive.
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Affiliation(s)
- Roberto Mereu
- Emergency Department, G. Brotzu Hospital, Cagliari, Italy
| | - Patricia Taraborrelli
- Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | | | | | - Sandra Halim
- Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Sajad Hayat
- Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Luciano Bernardi
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Darrel P Francis
- Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Richard Sutton
- Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Phang Boon Lim
- Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
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Welikala RA, Fraz MM, Hayat S, Rudnicka AR, Foster PJ, Whincup PH, Owen CG, Strachan DP, Barman SA. Automated retinal vessel recognition and measurements on large datasets. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2015:5239-42. [PMID: 26737473 DOI: 10.1109/embc.2015.7319573] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The characteristics of the retinal vascular network have been prospectively associated with many systemic and vascular diseases. QUARTZ is a fully automated software that has been developed to localize and quantify the morphological characteristics of blood vessels in retinal images for use in epidemiological studies. This software was used to analyse a dataset containing 16,000 retinal images from the EPIC-Norfolk cohort study. The objective of this paper is to both assess the suitability of this dataset for computational analysis and to further evaluate the QUARTZ software.
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Luther V, Linton NW, Koa-Wing M, Lim PB, Jamil-Copley S, Qureshi N, Ng FS, Hayat S, Whinnett Z, Davies DW, Peters NS, Kanagaratnam P. A Prospective Study of Ripple Mapping in Atrial Tachycardias. Circ Arrhythm Electrophysiol 2016; 9:e003582. [DOI: 10.1161/circep.115.003582] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 11/16/2022]
Abstract
Background—
Post ablation atrial tachycardias are characterized by low-voltage signals that challenge current mapping methods. Ripple mapping (RM) displays every electrogram deflection as a bar moving from the cardiac surface, resulting in the impression of propagating wavefronts when a series of bars move consecutively. RM displays fractionated signals in their entirety thereby helping to identify propagating activation in low-voltage areas from nonconducting tissue. We prospectively used RM to study tachycardia activation in the previously ablated left atrium.
Methods and Results—
Patients referred for atrial tachycardia ablation underwent dense electroanatomic point collection using CARTO3v4. RM was played over a bipolar voltage map and used to determine the voltage “activation threshold” that differentiated functional low voltage from nonconducting areas for each map. Ablation was guided by RM, but operators could perform entrainment or review the isochronal activation map for diagnostic uncertainty. Twenty patients were studied. Median RM determined activation threshold was 0.3 mV (0.19–0.33), with nonconducting tissue covering 33±9% of the mapped surface. All tachycardias crossed an isthmus (median, 0.52 mV, 13 mm) bordered by nonconducting tissue (70%) or had a breakout source (median, 0.35 mV) moving away from nonconducting tissue (30%). In reentrant circuits (14/20) the path length was measured (87–202 mm), with 9 of 14 also supporting a bystander circuit (path lengths, 147–234 mm). In breakout tachycardias, splitting of wavefronts resulted in 2 to 4 incomplete circuits. RM-guided ablation interrupted the tachycardia in 19 of 20 cases with the first ablation set.
Conclusions—
RM helps to define activation through low-voltage regions and aids ablation of atrial tachycardias.
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Affiliation(s)
- Vishal Luther
- From the Department of Cardiac Electrophysiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nick W.F. Linton
- From the Department of Cardiac Electrophysiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Michael Koa-Wing
- From the Department of Cardiac Electrophysiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Phang Boon Lim
- From the Department of Cardiac Electrophysiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Shahnaz Jamil-Copley
- From the Department of Cardiac Electrophysiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Norman Qureshi
- From the Department of Cardiac Electrophysiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Fu Siong Ng
- From the Department of Cardiac Electrophysiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Sajad Hayat
- From the Department of Cardiac Electrophysiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Zachary Whinnett
- From the Department of Cardiac Electrophysiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - D. Wyn Davies
- From the Department of Cardiac Electrophysiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nicholas S. Peters
- From the Department of Cardiac Electrophysiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Prapa Kanagaratnam
- From the Department of Cardiac Electrophysiology, Imperial College Healthcare NHS Trust, London, United Kingdom
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Heck P, Luther V, Luther V, Williams S, Schricker A, Zaman J, Ang R, Li X, Aziz S, Sugihara C, Grace A, Reddy V, Neuzil P, Linton N, Koa-Wing M, Lim P, Jamil-Copley S, Whinnett Z, Qureshi N, Ng F, Hayat S, Davies D, Peters N, Kanagaratnam P, Jamil-Copley S, Linton N, Koa-Wing M, Lim P, Hayat S, Ng F, Davies D, Peters N, Kanagaratnam P, Chubb H, Harrison J, Whitaker J, Cooklin M, Rinaldi C, Gill J, Wright M, Plank G, Niederer S, O'Neill M, Zaman J, Baykaner T, Lalani G, Hopper K, Moyeda A, Krummen D, Narayan S, Lalani G, Baykaner T, Swerdlow M, Park S, Krummen D, Wang P, Narayan S, Opel A, Ullah W, Baker V, Finlay M, Dhinoja M, Earley M, Sporton S, Schilling R, Hunter R, Chu G, Almeida T, Vanheusden F, Dastagir N, Salinet J, Stafford P, Schlindwein F, Ng G, Chubb H, Harrison J, Williams S, Whitaker J, Wright M, Schaeffter T, Razavi R, O'Neill M, Barlow N, Owens E, Sallomi D, Furniss S, Sulke N. Mapping & Ablation19Novel global ultrasound imaging and continuous dipole density mapping: initial findings in AF patients20Low voltage functional myocardium is critical in determining the substrate of post-ablation atrial tachycardia: results from a prospective study using ripple mapping distinguishing low-voltage scar from conducting tissue21Ripple mapping of post infarct ventricular scar to identify conduction channels and guide substrate based ablation22Effect of chamber geometry and activation pattern on optimal local activation time sampling density for tachycardia diagnosis25Clinical measures of good basket placement predict successful outcome from atrial fibrillation rotor ablation26Unipolar electrogram amplitude is reduced at rotor sites critical to focal termination of human persistent AF27Cryoballoon versus point by point radiofrequency ablation or a novel combined approach: long term follow up and comparison of patterns of pulmonary vein reconnection between different ablation strategies in a randomised controlled trial28Recurrent high dominant frequency patterns in persistent atrial fibrillation29Optimisation of late gadolinium enhanced (LGE) cmr imaging of atrial ablation scar30Hyperacute and chronic changes in cerebral magnetic resonance images after PVAC, NMARQ and epicardial thoracoscopic surgical ablation for paroxysmal atrial fibrillation. Europace 2015. [DOI: 10.1093/europace/euv326] [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: 11/15/2022] Open
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Shiota T, Imai K, Qiu J, Hewitt VL, Tan K, Shen HH, Sakiyama N, Fukasawa Y, Hayat S, Kamiya M, Elofsson A, Tomii K, Horton P, Wiedemann N, Pfanner N, Lithgow T, Endo T. Molecular architecture of the active mitochondrial protein gate. Science 2015; 349:1544-8. [DOI: 10.1126/science.aac6428] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Keevil VL, Luben R, Dalzell N, Hayat S, Sayer AA, Wareham NJ, Khaw KT. Cross-sectional associations between different measures of obesity and muscle strength in men and women in a British cohort study. J Nutr Health Aging 2015; 19:3-11. [PMID: 25560810 PMCID: PMC6284799 DOI: 10.1007/s12603-014-0492-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The relationship between obesity and grip strength, a key indicator of sarcopenia, has been inconsistently reported. We aimed to examine associations between grip strength and both body mass index (BMI), a clinical indicator of total adiposity, and waist circumference (WC), an indicator of central adiposity. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Data collected from 8,441 men and women, aged 48-92 years old, who attended the third health examination of the European Prospective Investigation into Cancer-Norfolk study was used. MEASUREMENTS Maximum grip strength (Smedley dynamometer), BMI (weight/height2) and WC (measured at the natural waist) were ascertained at a research clinic. The associations between grip strength and adiposity measures were explored using linear regression with adjustment for age, height, social class, physical activity, prevalent disease, smoking status and alcohol intake. RESULTS Men and women were examined separately and those in the upper quartile of BMI were 2.70kg (95%CI 2.07, 3.33) and 1.46kg (95%CI 1.05, 1.86) stronger respectively than those in the bottom quartile (P trends <0.001). Grip strength also increased weakly with increasing WC. However, including both BMI and WC in the same regression model revealed an inverse association between grip strength and WC, whilst the previously observed association with BMI strengthened. For every 10cm increase in WC, grip strength was 3.56kg (95%CI 3.04, 4.08) lower in men and 1.00kg (95%CI 0.74, 1.24) lower in women. CONCLUSIONS Larger overall body mass, indicated by higher BMI, is associated with stronger grip strength but high WC, a clinical indicator of central obesity, is associated with lower grip strength. Abdominal fat is the most metabolically active adipose tissue and this provides a clue to potential mechanisms underlying relationships between fat and skeletal muscle. Additionally, it reinforces the recommendation to measure WC in clinical practice, especially when BMI is below obese ranges.
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Affiliation(s)
- V L Keevil
- Victoria L Keevil, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Wort's Causeway, Cambridge. CB1 8RN, United Kingdom,
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Luther V, Jamil-Copley S, Shun-Shin M, Koa-Wing M, Wright I, Hayat S, Linton N, Lim P, Lefroy D, Whinnett Z, Davies D, Peters N, Kanagaratnam P. 24Acute and long-term outcomes for patients undergoing radiofrequency catheter ablation of scar-related ventricular tachycardia by robotic catheter navigation. Europace 2014. [DOI: 10.1093/europace/euu238.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hayat S, Courtney P, Lanyon P. FRI0499 Retrospective CASE Series of Refractory Antisynthetase Syndrome Successfully Treated with Rituximab (3 CASES). Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1878] [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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Rahman MR, Saiedullah M, Shermin S, Begum S, Hayat S. Diagnostic Efficacy of HbA1c in Diagnosis of Diabetes Mellitus in a Bangladesh Population. ACTA ACUST UNITED AC 2014. [DOI: 10.3329/bmj.v41i1.18785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
American Diabetic Association (ADA) affirms HbA1c with cut off value of 6.5% as a diagnostic criteria of diabetes mellitus. World Health Organization (WHO) also supports but recommended that a value <6.5% does not exclude diabetes which is diagnosed by glucose test. The aim of this study was to evaluate the diagnostic efficacy of HbA1c in terms of sensitivity, specificity, positive and negative predictive value and accuracy in a selected group of Bangladeshi subjects. This cross-sectional study included 761 adult Bangladeshi subjects of both sex attending the outdoor in a tertiary healthcare center during the period of September 2009 to September 2010. Fasting, postprandial (2 hours after glucose load) plasma glucose and HbA1c were measured. Diabetes is defined according to HbA1c and plasma glucose. Sensitivity, specificity, positive and negative predictive value of HbA1c were 90.00% (CI 86.48-92.86%), 76.21% (CI 71.68-80.35%), 78.17% (CI 73.94-82.00%) and 88.96% (CI 85.10-92.10%) respectively. Accuracy was 82.92% with odds ratio (OR) 28.84 (CI 19.10-43.54%); p < 0.001. Though HbA1c revealed remarkable diagnostic efficacy and ease of performance, still it can not over rule the role of plasma glucose in diagnosis of diabetes mellitus. DOI: http://dx.doi.org/10.3329/bmj.v41i1.18785 Bangladesh Medical Journal 2012 Vol. 41 No. 1; 53-54
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Lee G, Hunter R, Lovell M, Finlay M, Sawhney V, Ullah W, Diab I, Dhinoja M, Earley M, Sporton S, Schilling RJ, Williams SE, Linton NWF, Harrison J, Wright M, O'Neill M, Jamil-Copley S, Linton N, Koa-Wing M, Lim PB, Hayat S, Qureshi N, Whinnett Z, Davies W, Peters N, Francis D, Kanagaratnam P, Jamil-Copley S, Ryan B, Kojodjojo P, Qureshi N, Koa-Wing M, Hayat S, Kyriacou A, Sandler B, Sohaib A, Wright I, Davies W, Peters N, Whinnett Z, Kanagaratnam P, Lim PB, Qureshi NA, Bai W, Ariff B, Williams A, Monro C, Kim S, Jamil-Copley S, Hayat S, Kao-Wing M, Kyriacou A, Sandler B, Fu NS, Kanagaratnam P, Whinnett Z, Davies DW, Lefroy D, Peters NS, Lim PB, Ryan MJ, Ezzat VA, O'Leary J, Bull C, Chow A, Lambiase P, Lowe MD, Anwar AS, Collitt S, Iddon P, Rice N, Dodd M, Dunsdale A, Petkar S, Mudd J, Linker N, Fitzpatrick AP, Fraser S, Choo WK, Padfield G, Rushworth G, Bloe C, Forsyth P, Cross SJ, Leslie SJ, Phan TT, Dewhurst M, Lee D, Williams D, James S, Thornley A, de Belder M, Linker N, Turley A, Campbell NG, Cantor E, Sawhney V, Duncan ER, Demartini C, Baker V, Diab IG, Dhinoja M, Earley MJ, Sporton S, Davies LC, Schilling RJ, Pettit SJ, Randles DA, Shaw M, Hawkins NM, Wright DJ, Lambiase PD, Barr C, Knops R, Neuzil P, Theuns D, Johansen JB, Hood M, Pederson S, Reeve HL, Boersma L. ABSTRACTS FOR ORAL PRESENTATION, SESSION 3, HRC 2013. Europace 2013. [DOI: 10.1093/europace/eut316] [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
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Fabritz L, Fortmuller L, Vloumidi E, Yue TY, Syeda F, Kirchhof P, Leube R, Krusche C, Chin SH, Winter J, Brack KE, Ng GA, Ng FS, Holzem KM, Koppel AC, Janks D, Wit AL, Peters NS, Efimov IR, Chowdhury RA, El-Harasis MA, Dupont E, Terracciano CMN, Peters NS, Mellor GJ, Raju H, de Noronha SV, Papadakis M, Sharma S, Behr ER, Sheppard MN, Jamil-Copley S, Bai W, Ariff B, Lim PB, Koa-Wing M, Kyriacou A, Hayat S, Sohaib A, Qureshi N, Sandler B, O'Regan D, Whinnett Z, Davies W, Rueckert D, Kanagaratnam P, Peters N, Lambiase PD, Chow AW, Lowe MD, Segal OR, Ahsan S, de Bono J, Dhaliwal M, Mfuko C, Ng A, Sandilands A, Paisey J, Roberts P, Morgan JM, McCready J, Yue A, Ullah W, Hunter R, Lovell M, Dhinoja M, Sporton S, Earley M, Schilling R, Ghosh J, Martin A, Keech A, Chan KH, Gomes S, Singarayar S, McGuire M, Lee G, Hunter R, Berriman T, Diab I, Kamdar R, Richmond L, Baker V, Goromonzi F, Sawhney V, Duncan E, Unsworth B, Mayet J, Abrams D, Dhinoja M, Sporton S, Earley M, Schilling RJ, Bowers RW, Mulholland V, Balasubramaniam RN, Paisey JR, Sopher SM, Chu GS, Chin SH, Winter J, Armstrong S, Masca N, Almeida TP, Brown PD, Sandilands AJ, Schlindwein FS, Ng GA. ABSTRACTS FOR ORAL PRESENTATION, SESSION 2, HRC 2013. Europace 2013. [DOI: 10.1093/europace/eut315] [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: 11/13/2022] Open
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Panchal S, Moorthy A, Hayat S, Pande I, Adebajo A, Chakravarty K, Samanta A. FRI0446 A national audit of patients with rheumatoid arthritis of black and minority ethnic origin. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2903] [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]
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Anantharam B, Janardhanan R, Hayat S, Senior R. Ischaemic burden determined by myocardial contrast echocardiography predicts mortality in patients with new-onset shortness of breath, suspected heart failure and no previous coronary artery disease. Int J Cardiol 2013; 168:1670-1. [PMID: 23618431 DOI: 10.1016/j.ijcard.2013.03.094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 03/23/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Brijesh Anantharam
- Department of Cardiology and Institute of Postgraduate Medical Education and Research, Northwick Park Hospital, Harrow, HA1 3UJ, United Kingdom
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Leng Y, Wainwright NWJ, Hayat S, Stephan BCM, Matthews FE, Luben R, Surtees PG, Khaw KT, Brayne C. The association between social stress and global cognitive function in a population-based study: the European Prospective Investigation into Cancer (EPIC)-Norfolk study. Psychol Med 2013; 43:655-66. [PMID: 22687394 DOI: 10.1017/s0033291712001316] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Stress is thought to exert both positive and negative effects on cognition, but the precise cognitive effects of social stress and individuals' response to stress remain unclear. We aimed to investigate the association between different measures of social stress and cognitive function in a middle- to older-aged population using data from the European Prospective Investigation into Cancer (EPIC)-Norfolk study. METHOD Participants completed a comprehensive assessment of lifetime social adversity between 1993 and 1997 and the short form of the Mini Mental State Examination (SF-MMSE), an assessment of global cognitive function, during the third health check between 2004 and 2011 (a median of 10.5 years later). A low MMSE score was defined as a score in the bottom quartile (20-26). RESULTS Completed MMSE scores and stress measures were available for 5129 participants aged 48-90 years. Participants who reported that their lives had been more stressful over the previous 10 years were significantly more likely to have low MMSE scores [odds ratio (OR) 1.14, 95% confidence interval (CI) 1.04-1.24 per unit increase in perceived stress], independently of sociodemographic factors, physical and emotional health. The effects were restricted to the highest level of stress and the association was stronger among participants with a lower educational level. Adaptation following life event experiences also seemed to be associated with MMSE scores after adjusting for sociodemographic factors, but the association was attenuated with further adjustment. CONCLUSIONS In this generally high-functioning population, individuals' interpretations and responses to stressful events, rather than the events themselves, were associated with cognitive function.
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Affiliation(s)
- Y Leng
- Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, UK.
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