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Rosmini S, Seraphim A, Knott K, Brown JT, Knight DS, Zaman S, Cole G, Sado D, Captur G, Gomes AC, Zemrak F, Treibel TA, Cash L, Culotta V, O’Mahony C, Kellman P, Moon JC, Manisty C. Non-invasive characterization of pleural and pericardial effusions using T1 mapping by magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 2022; 23:1117-1126. [PMID: 34331054 PMCID: PMC9612798 DOI: 10.1093/ehjci/jeab128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Indexed: 12/20/2022] Open
Abstract
AIMS Differentiating exudative from transudative effusions is clinically important and is currently performed via biochemical analysis of invasively obtained samples using Light's criteria. Diagnostic performance is however limited. Biochemical composition can be measured with T1 mapping using cardiovascular magnetic resonance (CMR) and hence may offer diagnostic utility for assessment of effusions. METHODS AND RESULTS A phantom consisting of serially diluted human albumin solutions (25-200 g/L) was constructed and scanned at 1.5 T to derive the relationship between fluid T1 values and fluid albumin concentration. Native T1 values of pleural and pericardial effusions from 86 patients undergoing clinical CMR studies retrospectively analysed at four tertiary centres. Effusions were classified using Light's criteria where biochemical data was available (n = 55) or clinically in decompensated heart failure patients with presumed transudative effusions (n = 31). Fluid T1 and protein values were inversely correlated both in the phantom (r = -0.992) and clinical samples (r = -0.663, P < 0.0001). T1 values were lower in exudative compared to transudative pleural (3252 ± 207 ms vs. 3596 ± 213 ms, P < 0.0001) and pericardial (2749 ± 373 ms vs. 3337 ± 245 ms, P < 0.0001) effusions. The diagnostic accuracy of T1 mapping for detecting transudates was very good for pleural and excellent for pericardial effusions, respectively [area under the curve 0.88, (95% CI 0.764-0.996), P = 0.001, 79% sensitivity, 89% specificity, and 0.93, (95% CI 0.855-1.000), P < 0.0001, 95% sensitivity; 81% specificity]. CONCLUSION Native T1 values of effusions measured using CMR correlate well with protein concentrations and may be helpful for discriminating between transudates and exudates. This may help focus the requirement for invasive diagnostic sampling, avoiding unnecessary intervention in patients with unequivocal transudative effusions.
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Affiliation(s)
- Stefania Rosmini
- Department of Cardiac Imaging, Barts Heart Centre, St Bartholomew’s Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
- King’s College Hospital NHS Trust Foundation, Denmark Hill, London SE5 9RS, UK
| | - Andreas Seraphim
- Department of Cardiac Imaging, Barts Heart Centre, St Bartholomew’s Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - Kristopher Knott
- Department of Cardiac Imaging, Barts Heart Centre, St Bartholomew’s Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - James T Brown
- Royal Free London NHS Foundation Trust, Pond St, London NW3 2QG, UK
| | - Daniel S Knight
- Royal Free London NHS Foundation Trust, Pond St, London NW3 2QG, UK
| | - Sameer Zaman
- Imperial College London, Imperial College, Healthcare NHS Trust, South Kensington, London SW7 2BX, UK
| | - Graham Cole
- Imperial College London, Imperial College, Healthcare NHS Trust, South Kensington, London SW7 2BX, UK
| | - Daniel Sado
- King’s College Hospital NHS Trust Foundation, Denmark Hill, London SE5 9RS, UK
| | - Gabriella Captur
- Department of Cardiac Imaging, Barts Heart Centre, St Bartholomew’s Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
- Institute for Cardiovascular Sciences, University College London, 62 Huntley St, London WC1E 6DD, UK
| | - Ana Caterina Gomes
- Department of Cardiac Imaging, Barts Heart Centre, St Bartholomew’s Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - Filip Zemrak
- Department of Cardiac Imaging, Barts Heart Centre, St Bartholomew’s Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - Thomas A Treibel
- Department of Cardiac Imaging, Barts Heart Centre, St Bartholomew’s Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - Lizette Cash
- Department of Cardiac Imaging, Barts Heart Centre, St Bartholomew’s Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - Veronica Culotta
- Department of Cardiac Imaging, Barts Heart Centre, St Bartholomew’s Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - Constantinos O’Mahony
- Department of Cardiac Imaging, Barts Heart Centre, St Bartholomew’s Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - Peter Kellman
- National Heart, Lung and Blood Institute, National Institutes of Health, Medical Signal and Imaging Processing Program, 10 Center Dr, Bethesda, MD 20814, USA
| | - James C Moon
- Department of Cardiac Imaging, Barts Heart Centre, St Bartholomew’s Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
- Institute for Cardiovascular Sciences, University College London, 62 Huntley St, London WC1E 6DD, UK
| | - Charlotte Manisty
- Department of Cardiac Imaging, Barts Heart Centre, St Bartholomew’s Hospital, King George V Building, West Smithfield, London EC1A 7BE, UK
- Institute for Cardiovascular Sciences, University College London, 62 Huntley St, London WC1E 6DD, UK
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2
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Jin C, Torii R, Ramasamy A, Tufaro V, Little CD, Konstantinou K, Tan YY, Yap NAL, Cooper J, Crake T, O’Mahony C, Rakhit R, Egred M, Ahmed J, Karamasis G, Räber L, Baumbach A, Mathur A, Bourantas CV. Morphological and Physiological Characteristics of Ruptured Plaques in Native Arteries and Neoatherosclerotic Segments: An OCT-Based and Computational Fluid Dynamics Study. Front Cardiovasc Med 2022; 9:890799. [PMID: 35722127 PMCID: PMC9204481 DOI: 10.3389/fcvm.2022.890799] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Intravascular imaging has been used to assess the morphology of lesions causing an acute coronary syndrome (ACS) in native vessels (NV) and identify differences between plaques that ruptured (PR) and caused an event and those that ruptured without clinical manifestations. However, there is no data about the morphological and physiological characteristics of neoatherosclerotic plaques that ruptured (PR-NA) which constitute a common cause of stent failure. Methods We retrospectively analyzed data from patients admitted with an acute myocardial infarction that had optical coherence tomography (OCT) imaging of the culprit vessel before balloon pre-dilation. OCT pullbacks showing PR were segmented at every 0.4 mm. The extent of the formed cavity, lipid and calcific tissue, thrombus, and macrophages were measured, and the fibrous cap thickness (FCT) and the incidence of micro-channels and cholesterol crystals were reported. These data were used to reconstruct a representative model of the native and neoatherosclerotic lesion geometry that was processed with computational fluid dynamics (CFD) techniques to estimate the distribution of the endothelial shear stress and plaque structural stress. Result Eighty patients were included in the present analysis: 56 had PR in NV (PR-NV group) and 24 in NA segments (PR-NA group). The PR-NV group had a larger minimum lumen area (2.93 ± 2.03 vs. 2.00 ± 1.26 mm2, p = 0.015) but similar lesion length and area stenosis compared to PR-NA group. The mean FCT (186 ± 65 vs. 232 ± 80 μm, p = 0.009) and the lipid index was smaller (16.7 ± 13.8 vs. 25.9 ± 14.1, p = 0.008) while the of calcific index (8.3 ± 9.5 vs. 2.2 ± 1.6%, p = 0.002) and the incidence of micro-channels (41.4 vs. 12.5%, p = 0.013) was higher in the PR-NV group. Conversely, there was no difference in the incidence of cholesterol crystals, thrombus burden or the location of the rupture site between groups. CFD analysis revealed higher maximum endothelial shear stress (19.1 vs. 11.0 Pa) and lower maximum plaque structural stress (38.8 vs. 95.1 kPa) in the PR-NA compared to the PR-NV model. Conclusion We reported significant morphological and physiological differences between culprit ruptured plaques in native and stented segments. Further research is needed to better understand the causes of these differences and the mechanisms regulating neoatherosclerotic lesion destabilization.
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Affiliation(s)
- Chongying Jin
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Anantharaman Ramasamy
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Vincenzo Tufaro
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Callum D. Little
- Royal Free Hospital, University College London, London, United Kingdom
| | - Klio Konstantinou
- Essex Cardiothoracic Centre, Anglia Ruskin School of Medicine, Essex, United Kingdom
| | - Yi Ying Tan
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Nathan A. L. Yap
- Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Jackie Cooper
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Tom Crake
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Constantinos O’Mahony
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Roby Rakhit
- Royal Free Hospital, University College London, London, United Kingdom
| | - Mohaned Egred
- Freeman Hospital, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Javed Ahmed
- Freeman Hospital, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Grigoris Karamasis
- Essex Cardiothoracic Centre, Anglia Ruskin School of Medicine, Essex, United Kingdom
| | - Lorenz Räber
- Department of Cardiology, University of Bern, Bern, Switzerland
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- Yale University School of Medicine, New Haven, CT, United States
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Christos V. Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
- *Correspondence: Christos V. Bourantas,
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3
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Frain K, Rathod KS, Tumi E, Chen Y, Hamshere S, Choudry F, Akhtar MM, Curtis M, Amersey R, Guttmann O, O’Mahony C, Jain A, Wragg A, Baumbach A, Mathur A, Jones DA, Rees P. The impact of the COVID-19 pandemic on the delivery of primary percutaneous coronary intervention in STEMI. Am J Cardiovasc Dis 2021; 11:647-658. [PMID: 34849298 PMCID: PMC8611259] [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] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/10/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The clinical environment has been forced to adapt to meet the unprecedented challenges posed by the COVID-19 pandemic. Intensive care facilities were expanded in anticipation of the pandemic where the consequences include severe delays in elective procedures. Emergent procedures such as Percutaneous Coronary Intervention (PCI) in acute myocardial infarction (AMI) in which delays in timely delivery have well established adverse prognostic effects must also be explored in the context of changes in procedure and public behaviour associated with the COVID-19 pandemic. The aim for this single centre retrospective cohort study is to determine if door-to-balloon (D2B) times in PCI for ST Elevation Myocardial Infarction (STEMI) during the United Kingdom's first wave of the COVID-19 pandemic differed from pre-COVID-19 populations. METHODS Data was extracted from our single centre PCI database for all patients that underwent pPCI for STEMI. The reference (Pre-COVID-19) cohort was collected over the period 01-03-2019 to 31-05-2019 and the exposure group (COVID-19) over the period 01-03-2020 to 31-05-2020. Baseline patient characteristics for both populations were extracted. The primary outcome measurement was D2B times. Secondary outcome measurements included: time of symptom onset to call for help, transfer time to first hospital, transfer time from non-PCI to PCI centre, time from call-to-help to PCI centre, time to table and onset of symptoms to balloon time. Categorical and continuous variables were assessed with Chi squared and Mann-Whitney U analysis respectively. Procedural times were calculated and compared in the context of heterogeneity findings. RESULTS 4 baseline patient characteristics were unbalanced between populations with statistical significance (P<0.05). The pre-covid-19 cohort was more likely to have suffered out of hospital cardiac arrest (OHCA) and had left circumflex disease, whereas the 1st wave cohort were more likely to have been investigated with left ventriculography and be of Afro-Caribbean origin. No statistically significant difference in in-hospital procedural times was found with D2B, C2B, O2B times comparable between groups. Pre-hospital delays were the greatest contributors in missed target times: the 1st wave group had significantly longer delayed time of symptom onset to call for help (Control: 31 mins; IQR [82.5] vs 1st wave: 60 mins; IQR [90.0], P=0.001) and time taken from call for help to arrival at the PCI hospital (control: 72 mins; IQR [23] vs 1st wave: 80 mins; IQR [66.5], P=0.042). CONCLUSION Enhanced infection prevention and control procedures considering the COVID-19 pandemic did not impede the delivery of pPCI in our single centre cohort. The public health impact of the pandemic has been demonstrated with times being significantly impacted by patient related delays. The recovery of public engagement in emergency medical services must become the focus for public health initiatives as we emerge from the height of COVID-19 disease burden in the UK.
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Affiliation(s)
- Kristina Frain
- Faculty of Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of LondonLondon E1 4NS, UK
| | - Krishnaraj S Rathod
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
- Centre for Cardiovascular Medicines and Devices, Queen Mary University LondonLondon E1 4NS, UK
| | - Ebrahiem Tumi
- London School of Hygiene and Tropical MedicineLondon WC1E 7HT, UK
| | - Yang Chen
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Stephen Hamshere
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
- Centre for Cardiovascular Medicines and Devices, Queen Mary University LondonLondon E1 4NS, UK
| | - Fizzah Choudry
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
- Centre for Cardiovascular Medicines and Devices, Queen Mary University LondonLondon E1 4NS, UK
| | - Mohammed M Akhtar
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
- Centre for Cardiovascular Medicines and Devices, Queen Mary University LondonLondon E1 4NS, UK
| | - Miles Curtis
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Rajiv Amersey
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Oliver Guttmann
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
- Centre for Cardiovascular Medicines and Devices, Queen Mary University LondonLondon E1 4NS, UK
| | - Constantinos O’Mahony
- Faculty of Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of LondonLondon E1 4NS, UK
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Ajay Jain
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
- Centre for Cardiovascular Medicines and Devices, Queen Mary University LondonLondon E1 4NS, UK
| | - Andrew Wragg
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
- Centre for Cardiovascular Medicines and Devices, Queen Mary University LondonLondon E1 4NS, UK
| | - Andreas Baumbach
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
- Centre for Cardiovascular Medicines and Devices, Queen Mary University LondonLondon E1 4NS, UK
| | - Anthony Mathur
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
- Centre for Cardiovascular Medicines and Devices, Queen Mary University LondonLondon E1 4NS, UK
| | - Daniel A Jones
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
- Centre for Cardiovascular Medicines and Devices, Queen Mary University LondonLondon E1 4NS, UK
| | - Paul Rees
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
- Centre for Cardiovascular Medicines and Devices, Queen Mary University LondonLondon E1 4NS, UK
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4
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Akhtar MM, Lorenzini M, Pavlou M, Ochoa JP, O’Mahony C, Restrepo-Cordoba MA, Segura-Rodriguez D, Bermúdez-Jiménez F, Molina P, Cuenca S, Ader F, Larrañaga-Moreira JM, Sabater-Molina M, Garcia-Alvarez MI, Arantzamendi LG, Truszkowska G, Ortiz-Genga M, Ruiz IS, Nielsen SK, Rasmussen TB, Robles Mezcua A, Alvarez-Rubio J, Eiskjaer H, Gautel M, Garcia-Pinilla JM, Ripoll-Vera T, Mogensen J, Limeres Freire J, Rodríguez-Palomares JF, Peña-Peña ML, Rangel-Sousa D, Palomino-Doza J, Arana Achaga X, Bilinska Z, Zamarreño Golvano E, Climent V, Peñalver MN, Barriales-Villa R, Charron P, Yotti R, Zorio E, Jiménez-Jáimez J, Garcia-Pavia P, Elliott PM. Association of Left Ventricular Systolic Dysfunction Among Carriers of Truncating Variants in Filamin C With Frequent Ventricular Arrhythmia and End-stage Heart Failure. JAMA Cardiol 2021; 6:891-901. [PMID: 33978673 PMCID: PMC8117057 DOI: 10.1001/jamacardio.2021.1106] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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] [Received: 11/01/2020] [Accepted: 02/22/2021] [Indexed: 12/28/2022]
Abstract
Importance Truncating variants in the gene encoding filamin C (FLNCtv) are associated with arrhythmogenic and dilated cardiomyopathies with a reportedly high risk of ventricular arrhythmia. Objective To determine the frequency of and risk factors associated with adverse events among FLNCtv carriers compared with individuals carrying TTN truncating variants (TTNtv). Design, Setting, and Participants This cohort study recruited 167 consecutive FLNCtv carriers and a control cohort of 244 patients with TTNtv matched for left ventricular ejection fraction (LVEF) from 19 European cardiomyopathy referral units between 1990 and 2018. Data analyses were conducted between June and October, 2020. Main Outcomes and Measures The primary end point was a composite of malignant ventricular arrhythmia (MVA) (sudden cardiac death, aborted sudden cardiac death, appropriate implantable cardioverter-defibrillator shock, and sustained ventricular tachycardia) and end-stage heart failure (heart transplant or mortality associated with end-stage heart failure). The secondary end point comprised MVA events only. Results In total, 167 patients with FLNCtv were studied (55 probands [33%]; 89 men [53%]; mean [SD] age at baseline evaluation, 43 [18] years). For a median follow-up of 20 months (interquartile range, 7-60 months), 29 patients (17.4%) reached the primary end point (19 patients with MVA and 10 patients with end-stage heart failure). Eight (44%) arrhythmic events occurred among individuals with baseline mild to moderate left ventricular systolic dysfunction (LVSD) (LVEF = 36%-49%). Univariable risk factors associated with the primary end point included proband status, LVEF decrement per 10%, ventricular ectopy (≥500 in 24 hours) and myocardial fibrosis detected on cardiac magnetic resonance imaging. The LVEF decrement (hazard ratio [HR] per 10%, 1.83 [95% CI, 1.30-2.57]; P < .001) and proband status (HR, 3.18 [95% CI, 1.12-9.04]; P = .03) remained independent risk factors on multivariable analysis (excluding myocardial fibrosis and ventricular ectopy owing to case censoring). There was no difference in freedom from MVA between FLNCtv carriers with mild to moderate or severe (LVEF ≤35%) LVSD (HR, 1.29 [95% CI, 0.45-3.72]; P = .64). Carriers of FLNCtv with impaired LVEF at baseline evaluation (n = 69) had reduced freedom from MVA compared with 244 TTNtv carriers with similar baseline LVEF (for mild to moderate LVSD: HR, 16.41 [95% CI, 3.45-78.11]; P < .001; for severe LVSD: HR, 2.47 [95% CI, 1.04-5.87]; P = .03). Conclusions and Relevance The high frequency of MVA among patients with FLNCtv with mild to moderate LVSD suggests that higher LVEF values than those currently recommended should be considered for prophylactic implantable cardioverter-defibrillator therapy in FLNCtv carriers.
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MESH Headings
- Adult
- Cardiomyopathy, Dilated/genetics
- Cardiomyopathy, Dilated/mortality
- Cardiomyopathy, Dilated/physiopathology
- Cardiomyopathy, Dilated/therapy
- Codon, Nonsense
- Connectin/genetics
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Female
- Filamins/genetics
- Heart Failure/genetics
- Heart Failure/mortality
- Heart Failure/physiopathology
- Heart Failure/therapy
- Heart Transplantation/statistics & numerical data
- Humans
- Male
- Middle Aged
- Mutation
- Stroke Volume
- Tachycardia, Ventricular/epidemiology
- Tachycardia, Ventricular/genetics
- Tachycardia, Ventricular/physiopathology
- Ventricular Dysfunction, Left/genetics
- Ventricular Dysfunction, Left/physiopathology
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Affiliation(s)
- Mohammed Majid Akhtar
- Department of Inherited Cardiovascular Diseases, Bart’s Heart Centre St Bartholomew’s Hospital, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Massimiliano Lorenzini
- Department of Inherited Cardiovascular Diseases, Bart’s Heart Centre St Bartholomew’s Hospital, London, United Kingdom
| | - Menelaos Pavlou
- Department of Statistical Science, University College London, London, United Kingdom
| | | | - Constantinos O’Mahony
- Department of Inherited Cardiovascular Diseases, Bart’s Heart Centre St Bartholomew’s Hospital, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Maria Alejandra Restrepo-Cordoba
- Department of Cardiology, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART)
| | | | | | - Pilar Molina
- Pathology Department, Institute of Legal Medicine and Forensic Sciences of Valencia and Faculty of Medicine of the Universitat de València, CAFAMUSME Research Group, IIS La Fe, Valencia, Spain
| | - Sofia Cuenca
- Hospital General Universitario Gregorio Marañon, Madrid, Spain
- Instituto de Investigación Sanitarias Gregorio Marañón, Spain
| | - Flavie Ader
- APHP, UF Cardiogénétique et Myogénétique, Service de Biochimie Métabolique, Hôpitaux Universitaires de la Pitié- Salpêtrière- Charles Foix, 47-83 Bd de l’Hôpital, Paris, France
- Sorbonne Universités, UPMC Univ. Paris 06, INSERM, UMR_S 1166 and ICAN Institute for Cardiometabolism and Nutrition, Paris, France
| | - Jose M. Larrañaga-Moreira
- Unidad de Cardiopatías Familiares, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
- Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde (SERGAS), A Coruña, Spain
- Department of Cardiology, Universidade da Coruña, A Coruña, Spain
- Centro de Investigación Biomédica en Red (CIBERCV), Madrid, Spain
| | - Maria Sabater-Molina
- Inherited Cardiac Disease Unit, Hospital Universitario Virgen Arrixaca, Murcia, Spain
- Universidad de Murcia, Murcia, Spain
| | - Maria I. Garcia-Alvarez
- Cardiology Department, University General Hospital of Alicante, Alicante, Spain
- Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | | | - Grazyna Truszkowska
- Molecular Biology Laboratory, Department of Medical Biology, The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland
| | | | - Itziar Solla Ruiz
- Cardiology Specialist in Heart Failure and Inherited Cardiac Diseases, Department of Cardiology, Hospital Universitario Donostia, Spain
| | | | | | - Ainhoa Robles Mezcua
- Heart Failure and Familial Heart Diseases Unit, Cardiology Department, Hospital Universitario Virgen de la Victoria, CIBER-CV, IBIMA, Malaga, Spain
| | - Jorge Alvarez-Rubio
- Inherited Cardiovascular Diseases Unit, Son Llatzer University Hospital & IdISBa, Palma de Mallorca, Spain
| | - Hans Eiskjaer
- Department of Cardiology, Aarhus University Hospital, Hjertesygdomme, Aarhus, Denmark
| | - Mathias Gautel
- Randall Institute, King’s College London, London, United Kingdom
| | - José M. Garcia-Pinilla
- Heart Failure and Familial Heart Diseases Unit, Cardiology Department, Hospital Universitario Virgen de la Victoria, CIBER-CV, IBIMA, Malaga, Spain
| | - Tomas Ripoll-Vera
- Inherited Cardiovascular Diseases Unit, Son Llatzer University Hospital & IdISBa, Palma de Mallorca, Spain
| | - Jens Mogensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Javier Limeres Freire
- Department of Cardiology, Vall d’ Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’ Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jose F. Rodríguez-Palomares
- Department of Cardiology, Vall d’ Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’ Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Luisa Peña-Peña
- Heart Failure and Heart Transplantation Unit, Virgen del Rocio University Hospital, Sevilla, Spain
| | - Diego Rangel-Sousa
- Heart Failure and Heart Transplantation Unit, Virgen del Rocio University Hospital, Sevilla, Spain
| | - Julian Palomino-Doza
- Hereditary Cardiopathies Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Instituto de Investigación 12 de Octubre i+12, Madrid, Spain
| | - Xabier Arana Achaga
- Cardiology Specialist in Heart Failure and Inherited Cardiac Diseases, Department of Cardiology, Hospital Universitario Donostia, Spain
| | - Zofia Bilinska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland
| | | | - Vincent Climent
- Cardiology Department, University General Hospital of Alicante, Alicante, Spain
- Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | | | - Roberto Barriales-Villa
- Unidad de Cardiopatías Familiares, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
- Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde (SERGAS), A Coruña, Spain
- Department of Cardiology, Universidade da Coruña, A Coruña, Spain
- Centro de Investigación Biomédica en Red (CIBERCV), Madrid, Spain
| | - Philippe Charron
- Sorbonne Universités, UPMC Univ. Paris 06, INSERM, UMR_S 1166 and ICAN Institute for Cardiometabolism and Nutrition, Paris, France
- APHP, Centre de Référence pour les Maladies Cardiaques Héréditaires, Département de Génétique, Hôpital Pitié-Salpêtrière, Paris, France
| | - Raquel Yotti
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Hospital General Universitario Gregorio Marañon, Madrid, Spain
- Instituto de Investigación Sanitarias Gregorio Marañón, Spain
| | - Esther Zorio
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department at Hospital Universitario y Politécnico La Fe and Research Group on Inherited Heart Diseases, Sudden Death and Mechanisms of Disease (CaFaMuSMe) from the Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Juan Jiménez-Jáimez
- Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Pablo Garcia-Pavia
- Department of Cardiology, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART)
| | - Perry M. Elliott
- Department of Inherited Cardiovascular Diseases, Bart’s Heart Centre St Bartholomew’s Hospital, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
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5
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Merghani A, Monkhouse C, Kirkby C, Savvatis K, Mohiddin SA, Elliott P, O’Mahony C, Lowe MD, Schilling RJ, Lambiase PD. Diagnostic Impact of Repeated Expert Review & Long-Term Follow-Up in Determining Etiology of Idiopathic Cardiac Arrest. J Am Heart Assoc 2021; 10:e019610. [PMID: 34056909 PMCID: PMC8477849 DOI: 10.1161/jaha.120.019610] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Indexed: 11/30/2022]
Abstract
Background Recognizing the etiology of sudden cardiac arrest (SCA) has an enormous impact on the management of victims and their immediate families. A significant proportion of SCA survivors with a structurally normal heart are not offered a diagnosis and there is no clear consensus on the type and duration of follow‐up. We aimed to assess the utility of a multidisciplinary approach in optimizing diagnosis of cardiac arrest etiology during follow‐up. Methods and Results We retrospectively assessed 327 consecutive SCA survivors (mean age 61.9±16.2 years, 80% men) who underwent secondary prevention implantable cardioverter defibrillators between May 2015 and November 2018. The initial diagnosis was recorded at the time of admission and follow‐up diagnosis was deduced from subsequent clinic records, investigations, and outcomes of multidisciplinary team meetings. Structural heart disease accounted for 282 (86%) of SCAs. Forty‐five (14%) patients had a structurally normal heart and underwent comprehensive testing and follow‐up (mean duration 93±52 weeks). On initial evaluation, 14/45 (31%) of these received a diagnosis, rising to 29/45 (64%) with serial reviews during follow‐up. Discussion in multidisciplinary team meetings and imaging reassessment accounted for 47% of new diagnoses. No additional diagnoses were made beyond 96 weeks. Nineteen (5.8%) fatalities occurred in the entire cohort, exclusively in patients with structural heart disease. Conclusions Systematic comprehensive testing combined with multidisciplinary expert team review of SCA survivors without structural heart disease improves the yield and time to diagnosis compared with previously published studies. This approach has positive implications in the management of SCA survivors and their families.
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Affiliation(s)
- Ahmed Merghani
- Barts Heart CentreSt Bartholomew's HospitalLondonUnited Kingdom
| | | | - Claire Kirkby
- Barts Heart CentreSt Bartholomew's HospitalLondonUnited Kingdom
| | - Konstantinos Savvatis
- Barts Heart CentreSt Bartholomew's HospitalLondonUnited Kingdom
- William Harvey Research InstituteQueen Mary University LondonLondonUnited Kingdom
- Institute for Cardiovascular ScienceUniversity College LondonLondonUnited Kingdom
| | | | - Perry Elliott
- Barts Heart CentreSt Bartholomew's HospitalLondonUnited Kingdom
- Institute for Cardiovascular ScienceUniversity College LondonLondonUnited Kingdom
| | | | - Martin D. Lowe
- Barts Heart CentreSt Bartholomew's HospitalLondonUnited Kingdom
| | | | - Pier D. Lambiase
- Barts Heart CentreSt Bartholomew's HospitalLondonUnited Kingdom
- Institute for Cardiovascular ScienceUniversity College LondonLondonUnited Kingdom
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6
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Perera D, Rathod KS, Guttmann O, Beirne AM, O’Mahony C, Weerackody R, Baumbach A, Mathur A, Wragg A, Jones DA. Routine aspiration thrombectomy is associated with increased stroke rates during primary percutaneous coronary intervention for myocardial infarction. Am J Cardiovasc Dis 2020; 10:548-556. [PMID: 33489457 PMCID: PMC7811915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 11/16/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Recent studies have suggested that the routine use of aspiration thrombectomy catheters during primary percutaneous coronary intervention (PCI) do not result in improved mortality and may be associated with an increased stroke rate. This study sought to investigate this hypothesis. METHODS This was an observational study analysing data from a prospective database of 6366 patients undergoing primary PCI between August 2003 and May 2015 at a UK cardiac centre. Patients' details were collected from the hospital electronic database. Primary outcome was thirty-day stroke rates. RESULTS 3989 (62.7%) patients underwent PCI alone and 2,377 (37.3%) patients underwent PCI with adjuctive thrombus aspiration. PCI alone group had an older demographic (63 (± 14) years vs 60.7 (± 14)), a lower proportion of male participants 75% vs 79% (P=0.001) and cardiovascular risk factors such as hypertension 22.4% vs 25.3% (P=0.007), hypercholesterolemia 18.5% vs 22.6% (P<0.0001) and a history of smoking 33.5% vs 44.3% (P<0.0001). Thrombus aspiration was associated with a higher 30-day stroke rate [16 (0.7%) vs 11 (0.3%) (HR 2.51; 95% CI 1.03-6.08, P 0.03). Multivariate analysis suggested that this increased risk of stroke was maintained following adjustment for confounders (HR: 1.86; 95% CI 1.02-4.38). There was 379 deaths of which 114 (4.8%) were in the thrombus aspiration cohort vs 265 (6.6%) in PCI only cohort over the follow-up period (60 months). This resulted in a significantly lower rate of all-cause-mortality HR 0.70 (95% CI 0.52-0.94; P 0.02). There was no statistically significant difference in observed myocardial infarction rates HR 0.76 (95% CI 0.47-1.23; P 0.27) and the rates of unscheduled revascularisations HR 0.70 (95% CI 0.43-1.13; P 0.14) between the two groups. CONCLUSIONS Our data series of STEMI patients, suggest that routine thrombus aspiration during primary PCI is associated with a significantly higher stroke, rate however, thrombus aspiration reduced mortality rate. This is consistent with current guidelines which don't recommend the routine use of thrombus aspiration for primary PCI. A possible mortality reduction in patients with high thrombus grades was seen which may warrant further study.
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7
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Ramasamy A, Chen Y, Zanchin T, Jones DA, Rathod K, Jin C, Onuma Y, Zhang YJ, Amersey R, Westwood M, Ozkor M, O’Mahony C, Lansky A, Crake T, Serruys PW, Mathur A, Baumbach A, Bourantas CV. Optical coherence tomography enables more accurate detection of functionally significant intermediate non-left main coronary artery stenoses than intravascular ultrasound: A meta-analysis of 6919 patients and 7537 lesions. Int J Cardiol 2020; 301:226-234. [DOI: 10.1016/j.ijcard.2019.09.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/19/2019] [Accepted: 09/25/2019] [Indexed: 01/18/2023]
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8
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Norrish G, Ding T, Field E, Ziółkowska L, Olivotto I, Limongelli G, Anastasakis A, Weintraub R, Biagini E, Ragni L, Prendiville T, Duignan S, McLeod K, Ilina M, Fernández A, Bökenkamp R, Baban A, Kubuš P, Daubeney PEF, Sarquella-Brugada G, Cesar S, Marrone C, Bhole V, Medrano C, Uzun O, Brown E, Gran F, Castro FJ, Stuart G, Vignati G, Barriales-Villa R, Guereta LG, Adwani S, Linter K, Bharucha T, Garcia-Pavia P, Rasmussen TB, Calcagnino MM, Jones CB, De Wilde H, Toru-Kubo J, Felice T, Mogensen J, Mathur S, Reinhardt Z, O’Mahony C, Elliott PM, Omar RZ, Kaski JP. Development of a Novel Risk Prediction Model for Sudden Cardiac Death in Childhood Hypertrophic Cardiomyopathy (HCM Risk-Kids). JAMA Cardiol 2019; 4:918-927. [PMID: 31411652 PMCID: PMC6694401 DOI: 10.1001/jamacardio.2019.2861] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [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] [Received: 04/29/2019] [Accepted: 06/19/2019] [Indexed: 12/16/2022]
Abstract
Importance Sudden cardiac death (SCD) is the most common mode of death in childhood hypertrophic cardiomyopathy (HCM), but there is no validated algorithm to identify those at highest risk. Objective To develop and validate an SCD risk prediction model that provides individualized risk estimates. Design, Setting, and Participants A prognostic model was developed from a retrospective, multicenter, longitudinal cohort study of 1024 consecutively evaluated patients aged 16 years or younger with HCM. The study was conducted from January 1, 1970, to December 31, 2017. Exposures The model was developed using preselected predictor variables (unexplained syncope, maximal left-ventricular wall thickness, left atrial diameter, left-ventricular outflow tract gradient, and nonsustained ventricular tachycardia) identified from the literature and internally validated using bootstrapping. Main Outcomes and Measures A composite outcome of SCD or an equivalent event (aborted cardiac arrest, appropriate implantable cardioverter defibrillator therapy, or sustained ventricular tachycardia associated with hemodynamic compromise). Results Of the 1024 patients included in the study, 699 were boys (68.3%); mean (interquartile range [IQR]) age was 11 (7-14) years. Over a median follow-up of 5.3 years (IQR, 2.6-8.3; total patient years, 5984), 89 patients (8.7%) died suddenly or had an equivalent event (annual event rate, 1.49; 95% CI, 1.15-1.92). The pediatric model was developed using preselected variables to predict the risk of SCD. The model's ability to predict risk at 5 years was validated; the C statistic was 0.69 (95% CI, 0.66-0.72), and the calibration slope was 0.98 (95% CI, 0.59-1.38). For every 10 implantable cardioverter defibrillators implanted in patients with 6% or more of a 5-year SCD risk, 1 patient may potentially be saved from SCD at 5 years. Conclusions and Relevance This new, validated risk stratification model for SCD in childhood HCM may provide individualized estimates of risk at 5 years using readily obtained clinical risk factors. External validation studies are required to demonstrate the accuracy of this model's predictions in diverse patient populations.
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Affiliation(s)
- Gabrielle Norrish
- Centre for Inherited Cardiovascular Diseases, Department of Cardiology, Great Ormond Street Hospital, London, United Kingdom
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
| | - Tao Ding
- Department of Statistical Science, University College London, London, United Kingdom
| | - Ella Field
- Centre for Inherited Cardiovascular Diseases, Department of Cardiology, Great Ormond Street Hospital, London, United Kingdom
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
| | - Lidia Ziółkowska
- Department of Cardiology, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Iacopo Olivotto
- Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Giuseppe Limongelli
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
- Department of Cardiothoracic Sciences, Monaldi Hospital, Naples, Italy
| | | | - Robert Weintraub
- Department of Cardiology, The Royal Children’s Hospital, Melbourne, Australia
- Department of Clinical Sciences, The Murdoch Children’s Research Institute, Parkville, Australia
- Department of Medical and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Elena Biagini
- Department of Cardiology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Luca Ragni
- Department of Cardiology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Terence Prendiville
- The Children’s Heart Centre, Our Lady’s Children’s Hospital, Dublin, Ireland
| | - Sophie Duignan
- The Children’s Heart Centre, Our Lady’s Children’s Hospital, Dublin, Ireland
| | - Karen McLeod
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Maria Ilina
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Adrián Fernández
- Department of Ambulatory Cardiology, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Regina Bökenkamp
- Department of Paediatric Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Anwar Baban
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
- Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesu Hospital, Rome, Italy
| | - Peter Kubuš
- Children’s Heart Centre, University Hospital Motol, Prague, Czech Republic
| | - Piers E. F. Daubeney
- Department of Paediatric Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom
| | - Georgia Sarquella-Brugada
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
- Arrhythmia and Inherited Cardiac Diseases Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Medical Sciences Department, School of Medicine, University of Girona, Girona, Spain
| | - Sergi Cesar
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
- Arrhythmia and Inherited Cardiac Diseases Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Chiara Marrone
- Department of Paediatric Cardiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Vinay Bhole
- The Heart Unit, Birmingham Children’s Hospital, Birmingham, United Kingdom
| | - Constancio Medrano
- Department of Paediatric Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Orhan Uzun
- Children’s Heart Unit, University Hospital of Wales, Cardiff, United Kingdom
| | - Elspeth Brown
- Department of Paediatric Cardiology, Leeds General Infirmary, Leeds, United Kingdom
| | - Ferran Gran
- Paediatric Cardiology Department, Val d’Hebron University Hospital, Barcelona, Spain
| | - Francisco J. Castro
- Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Graham Stuart
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | | | - Roberto Barriales-Villa
- Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, A Coruña, Spain
| | - Luis G. Guereta
- Department of Cardiology, University Hospital La Paz, Madrid, Spain
| | - Satish Adwani
- Department of Paediatric Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Katie Linter
- Department of Paediatric Cardiology, Glenfield Hospital, Leicester, United Kingdom
| | - Tara Bharucha
- Department of Paediatric Cardiology, Southampton General Hospital, Southampton, United Kingdom
| | - Pablo Garcia-Pavia
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Madrid, Spain
- Department of Cardiology, University Francisco de Vitoria, Pozuelo de Alarcon, Spain
| | | | - Margherita M. Calcagnino
- Department of Cardiology, University Hospitals Parma, Parma, Italy
- Cardiology Unit, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Caroline B. Jones
- Department of Cardiology, Alder Hey Children’s Hospital, Liverpool, United Kingdom
| | - Hans De Wilde
- Department of Paediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - J. Toru-Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Tiziana Felice
- Department of Paediatric Cardiology, Mater Dei Hospital, Msida, Malta
| | - Jens Mogensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Sujeev Mathur
- Children’s Heart Service, Evelina Children’s Hospital, London, United Kingdom
| | - Zdenka Reinhardt
- Department of Paediatric Cardiology, The Freeman Hospital, Newcastle, United Kingdom
| | - Constantinos O’Mahony
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
- St Bartholomew’s Centre for Inherited Cardiovascular Diseases, Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London, United Kingdom
| | - Perry M. Elliott
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
- St Bartholomew’s Centre for Inherited Cardiovascular Diseases, Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London, United Kingdom
| | - Rumana Z. Omar
- Department of Statistical Science, University College London, London, United Kingdom
| | - Juan P. Kaski
- Centre for Inherited Cardiovascular Diseases, Department of Cardiology, Great Ormond Street Hospital, London, United Kingdom
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
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9
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Tahmasebi F, Hurrell A, Ford A, Gupta M, Geindreau D, Pimenta D, O’Mahony C. Coronary artery dissection in the puerperium: A case report and literature review. Obstet Med 2018; 11:144-147. [PMID: 30214482 PMCID: PMC6134346 DOI: 10.1177/1753495x17740063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 09/27/2017] [Indexed: 11/16/2022] Open
Abstract
Spontaneous coronary artery dissection is a rare but important cause of acute coronary syndrome. Its relevance for women during the puerperium mandates awareness and understanding amongst obstetric healthcare professionals. The aetiology of the increased risk in pregnancy has not been fully elucidated, but include medial eosinophilic angitis, pregnancy-induced degeneration of collagen in conjunction with the stresses of parturition, and rupture of the vasa vasorum. The risk of mortality necessitates prompt diagnosis, usually by angiography. There is no one-size-fits-all treatment; management must be individualised according to haemodynamic status and affected vessel(s) and includes conservative management, percutaneous coronary intervention, or bypass grafting. Recovery complications include extension of the haematoma or false lumen, valvular pathology secondary to ischaemia, and sudden cardiac death. Close post-operative surveillance is mandatory. We present a 41-year-old lady with post-partum spontaneous coronary artery dissection, complicated by ischaemic papillary rupture and mitral regurgitation requiring valve replacement. Additionally, we present a literature review, including guidance on management and critical analysis of potential complications.
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Affiliation(s)
- Farshad Tahmasebi
- Obstetrics and Gynaecology,
Whipps
Cross University Hospital, London, UK
| | - Alice Hurrell
- Obstetrics and Gynaecology,
Whipps
Cross University Hospital, London, UK
| | - Amie Ford
- Bart's and The London School of Medicine
and Dentistry, London, UK
| | - Manish Gupta
- Obstetrics and Gynaecology,
Whipps
Cross University Hospital, London, UK
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10
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Jones DA, Rathod KS, Koganti S, Hamshere S, Astroulakis Z, Lim P, Sirker A, O’Mahony C, Jain AK, Knight CJ, Dalby MC, Malik IS, Mathur A, Rakhit R, Lockie T, Redwood S, MacCarthy PA, Desilva R, Weerackody R, Wragg A, Smith EJ, Bourantas CV. Angiography Alone Versus Angiography Plus Optical Coherence Tomography to Guide Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2018; 11:1313-1321. [DOI: 10.1016/j.jcin.2018.01.274] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/16/2018] [Accepted: 01/30/2018] [Indexed: 10/28/2022]
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11
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O’Mahony C, Jichi F, Ommen SR, Christiaans I, Arbustini E, Garcia-Pavia P, Cecchi F, Olivotto I, Kitaoka H, Gotsman I, Carr-White G, Mogensen J, Antoniades L, Mohiddin SA, Maurer MS, Tang HC, Geske JB, Siontis KC, Mahmoud KD, Vermeer A, Wilde A, Favalli V, Guttmann OP, Gallego-Delgado M, Dominguez F, Tanini I, Kubo T, Keren A, Bueser T, Waters S, Issa IF, Malcolmson J, Burns T, Sekhri N, Hoeger CW, Omar RZ, Elliott PM. International External Validation Study of the 2014 European Society of Cardiology Guidelines on Sudden Cardiac Death Prevention in Hypertrophic Cardiomyopathy (EVIDENCE-HCM). Circulation 2018; 137:1015-1023. [DOI: 10.1161/circulationaha.117.030437] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 11/06/2017] [Indexed: 11/16/2022]
Abstract
Background:
Identification of people with hypertrophic cardiomyopathy (HCM) who are at risk of sudden cardiac death (SCD) and require a prophylactic implantable cardioverter defibrillator is challenging. In 2014, the European Society of Cardiology proposed a new risk stratification method based on a risk prediction model (HCM Risk-SCD) that estimates the 5-year risk of SCD. The aim was to externally validate the 2014 European Society of Cardiology recommendations in a geographically diverse cohort of patients recruited from the United States, Europe, the Middle East, and Asia.
Methods:
This was an observational, retrospective, longitudinal cohort study.
Results:
The cohort consisted of 3703 patients. Seventy three (2%) patients reached the SCD end point within 5 years of follow-up (5-year incidence, 2.4% [95% confidence interval {CI}, 1.9–3.0]). The validation study revealed a calibration slope of 1.02 (95% CI, 0.93–1.12), C-index of 0.70 (95% CI, 0.68–0.72), and D-statistic of 1.17 (95% CI, 1.05–1.29). In a complete case analysis (n= 2147; 44 SCD end points at 5 years), patients with a predicted 5-year risk of <4% (n=1524; 71%) had an observed 5-year SCD incidence of 1.4% (95% CI, 0.8–2.2); patients with a predicted risk of ≥6% (n=297; 14%) had an observed SCD incidence of 8.9% (95% CI, 5.96–13.1) at 5 years. For every 13 (297/23) implantable cardioverter defibrillator implantations in patients with an estimated 5-year SCD risk ≥6%, 1 patient can potentially be saved from SCD.
Conclusions:
This study confirms that the HCM Risk-SCD model provides accurate prognostic information that can be used to target implantable cardioverter defibrillator therapy in patients at the highest risk of SCD.
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Affiliation(s)
- Constantinos O’Mahony
- St. Bartholomew’s Centre for Inherited Cardiovascular Disease, St Bartholomew’s Hospital, West Smithfield, London, United Kingdom (C.O., S.A.M., O.P.G., J.M., N.S., P.M.E.)
- Centre for Heart Muscle Disease, Institute of Cardiovascular Science (C.O., P.M.E.)
- University College London, United Kingdom. European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART; http://guardheart.ern-net.eu) (C.O., I.C., P.G.-P., S.A.M., A.V., A.W., V.F., O.P.G., J.M., N.S., P.M.E.)
| | - Fatima Jichi
- Biostatistics Group, University College London Hospitals/University College London Joint Research Office (F.J.)
| | - Steve R. Ommen
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (S.R.O., J.B.G., K.C.S., K.D.M.)
| | - Imke Christiaans
- University College London, United Kingdom. European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART; http://guardheart.ern-net.eu) (C.O., I.C., P.G.-P., S.A.M., A.V., A.W., V.F., O.P.G., J.M., N.S., P.M.E.)
- Heart Center, Department of Clinical and Experimental Cardiology (I.C., A.V., A.W.)
- Department of Clinical Genetics (I.C., A.V.)
| | - Eloisa Arbustini
- Academic Medical Center, Amsterdam, Netherlands. Centre for Inherited Cardiovascular Diseases, Transplant Research Area, Istituto di Ricovero e Cura a Carattere Scientifico Foundation, Policlinico San Matteo, Pavia, Italy (E.A., V.F.)
| | - Pablo Garcia-Pavia
- University College London, United Kingdom. European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART; http://guardheart.ern-net.eu) (C.O., I.C., P.G.-P., S.A.M., A.V., A.W., V.F., O.P.G., J.M., N.S., P.M.E.)
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain (P.G.-P., M.G.-D., F.D.)
- Centro de Investigacion Biomedica en Red en Enfermedades Cardiovasculares, Madrid, Spain (P.G.-P.). University Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain (P.G.-P.)
| | - Franco Cecchi
- Department of Cardiology, Careggi University Hospital, Florence, Italy (F.C., I.O., I.T.)
| | - Iacopo Olivotto
- Department of Cardiology, Careggi University Hospital, Florence, Italy (F.C., I.O., I.T.)
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku-shi, Japan (H.K., T.K.)
| | - Israel Gotsman
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel (I.G., A.K.)
| | - Gerald Carr-White
- Guy’s and St. Thomas’ Hospital National Health Service Foundation Trust, London, United Kingdom (G.C.-W., T.B., S.W.)
| | - Jens Mogensen
- London Chest Hospital, United Kingdom (S.A.M., J.M., T.B., N.S.)
| | - Loizos Antoniades
- Inherited Cardiovascular Disease Unit, Department of Cardiology, Nicosia General Hospital, Latsia, Cyprus (L.A.)
| | - Saidi A. Mohiddin
- St. Bartholomew’s Centre for Inherited Cardiovascular Disease, St Bartholomew’s Hospital, West Smithfield, London, United Kingdom (C.O., S.A.M., O.P.G., J.M., N.S., P.M.E.)
- University College London, United Kingdom. European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART; http://guardheart.ern-net.eu) (C.O., I.C., P.G.-P., S.A.M., A.V., A.W., V.F., O.P.G., J.M., N.S., P.M.E.)
- London Chest Hospital, United Kingdom (S.A.M., J.M., T.B., N.S.)
| | - Mathew S. Maurer
- Columbia University Medical Center, New York, NY (M.S.M., C.W.H.)
| | - Hak Chiaw Tang
- Department of Cardiology, National Heart Centre Singapore (H.C.T.)
| | - Jeffrey B. Geske
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (S.R.O., J.B.G., K.C.S., K.D.M.)
| | - Konstantinos C. Siontis
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (S.R.O., J.B.G., K.C.S., K.D.M.)
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (K.C.S.)
| | - Karim D. Mahmoud
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (S.R.O., J.B.G., K.C.S., K.D.M.)
- Thorax Center, Department of Cardiology, Erasmus Medical Center, Rotterdam, Netherlands (K.D.M.)
| | - Alexa Vermeer
- University College London, United Kingdom. European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART; http://guardheart.ern-net.eu) (C.O., I.C., P.G.-P., S.A.M., A.V., A.W., V.F., O.P.G., J.M., N.S., P.M.E.)
- Heart Center, Department of Clinical and Experimental Cardiology (I.C., A.V., A.W.)
- Department of Clinical Genetics (I.C., A.V.)
| | - Arthur Wilde
- University College London, United Kingdom. European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART; http://guardheart.ern-net.eu) (C.O., I.C., P.G.-P., S.A.M., A.V., A.W., V.F., O.P.G., J.M., N.S., P.M.E.)
- Heart Center, Department of Clinical and Experimental Cardiology (I.C., A.V., A.W.)
| | - Valentina Favalli
- University College London, United Kingdom. European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART; http://guardheart.ern-net.eu) (C.O., I.C., P.G.-P., S.A.M., A.V., A.W., V.F., O.P.G., J.M., N.S., P.M.E.)
- Academic Medical Center, Amsterdam, Netherlands. Centre for Inherited Cardiovascular Diseases, Transplant Research Area, Istituto di Ricovero e Cura a Carattere Scientifico Foundation, Policlinico San Matteo, Pavia, Italy (E.A., V.F.)
| | - Oliver P. Guttmann
- St. Bartholomew’s Centre for Inherited Cardiovascular Disease, St Bartholomew’s Hospital, West Smithfield, London, United Kingdom (C.O., S.A.M., O.P.G., J.M., N.S., P.M.E.)
- The Inherited Cardiac Diseases Unit, The Heart Hospital (O.P.G., P.M.E.)
- University College London, United Kingdom. European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART; http://guardheart.ern-net.eu) (C.O., I.C., P.G.-P., S.A.M., A.V., A.W., V.F., O.P.G., J.M., N.S., P.M.E.)
| | - Maria Gallego-Delgado
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain (P.G.-P., M.G.-D., F.D.)
| | - Fernando Dominguez
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain (P.G.-P., M.G.-D., F.D.)
| | - Ilaria Tanini
- Department of Cardiology, Careggi University Hospital, Florence, Italy (F.C., I.O., I.T.)
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku-shi, Japan (H.K., T.K.)
| | - Andre Keren
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel (I.G., A.K.)
- Clalit Health Services Beit Hadfus 20, Jerusalem, Israel (A.K.). Assuta Hospitals, Tel Aviv, Israel (A.K.)
| | - Teofila Bueser
- London Chest Hospital, United Kingdom (S.A.M., J.M., T.B., N.S.)
- King’s College London, United Kingdom (T.B.). St George’s, University of London, United Kingdom (T.B.)
| | - Sarah Waters
- Guy’s and St. Thomas’ Hospital National Health Service Foundation Trust, London, United Kingdom (G.C.-W., T.B., S.W.)
| | - Issa F. Issa
- Department of Cardiology, Odense University Hospital, Denmark (J.M., I.F.I.)
| | - James Malcolmson
- St. Bartholomew’s Centre for Inherited Cardiovascular Disease, St Bartholomew’s Hospital, West Smithfield, London, United Kingdom (C.O., S.A.M., O.P.G., J.M., N.S., P.M.E.)
- University College London, United Kingdom. European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART; http://guardheart.ern-net.eu) (C.O., I.C., P.G.-P., S.A.M., A.V., A.W., V.F., O.P.G., J.M., N.S., P.M.E.)
- Department of Cardiology, Odense University Hospital, Denmark (J.M., I.F.I.)
| | - Tom Burns
- Guy’s and St. Thomas’ Hospital National Health Service Foundation Trust, London, United Kingdom (G.C.-W., T.B., S.W.)
| | - Neha Sekhri
- St. Bartholomew’s Centre for Inherited Cardiovascular Disease, St Bartholomew’s Hospital, West Smithfield, London, United Kingdom (C.O., S.A.M., O.P.G., J.M., N.S., P.M.E.)
- University College London, United Kingdom. European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART; http://guardheart.ern-net.eu) (C.O., I.C., P.G.-P., S.A.M., A.V., A.W., V.F., O.P.G., J.M., N.S., P.M.E.)
- London Chest Hospital, United Kingdom (S.A.M., J.M., T.B., N.S.)
| | | | | | - Perry M. Elliott
- St. Bartholomew’s Centre for Inherited Cardiovascular Disease, St Bartholomew’s Hospital, West Smithfield, London, United Kingdom (C.O., S.A.M., O.P.G., J.M., N.S., P.M.E.)
- Centre for Heart Muscle Disease, Institute of Cardiovascular Science (C.O., P.M.E.)
- The Inherited Cardiac Diseases Unit, The Heart Hospital (O.P.G., P.M.E.)
- University College London, United Kingdom. European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART; http://guardheart.ern-net.eu) (C.O., I.C., P.G.-P., S.A.M., A.V., A.W., V.F., O.P.G., J.M., N.S., P.M.E.)
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Pujades-Rodriguez M, Guttmann OP, Gonzalez-Izquierdo A, Duyx B, O’Mahony C, Elliott P, Hemingway H. Identifying unmet clinical need in hypertrophic cardiomyopathy using national electronic health records. PLoS One 2018; 13:e0191214. [PMID: 29324812 PMCID: PMC5764451 DOI: 10.1371/journal.pone.0191214] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/29/2017] [Indexed: 12/11/2022] Open
Abstract
Introduction To evaluate unmet clinical need in unselected hypertrophic cardiomyopathy (HCM) patients to determine the risk of a wide range of subsequent cardiovascular disease endpoints and safety endpoints relevant for trial design. Methods Population based cohort (CALIBER, linked primary care, hospital and mortality records in England, period 1997–2010), all people diagnosed with HCM were identified and matched by age, sex and general practice with ten randomly selected people without HCM. Random-effects Poisson models were used to assess the associations between HCM and cardiovascular diseases and bleeding. Results Among 3,290,455 eligible people a diagnosis of hypertrophic cardiomyopathy was found in 4 per 10,000. Forty-one percent of the 1,160 individuals with hypertrophic cardiomyopathy were women and the median age was 57 years. The median follow-up was 4.0 years. Compared to general population controls, people with HCM had higher risk of ventricular arrhythmia (incidence rate ratio = 23.53, [95% confidence interval 12.67–43.72]), cardiac arrest or sudden cardiac death (6.33 [3.69–10.85]), heart failure (4.31, [3.30–5.62]), and atrial fibrillation (3.80 [3.04–4.75]). HCM was also associated with a higher incidence of myocardial infarction ([MI] 1.90 [1.27–2.84]) and coronary revascularisation (2.32 [1.46–3.69]).The absolute Kaplan-Meier risks at 3 years were 8.8% for the composite endpoint of cardiovascular death or heart failure, 8.4% for the composite of cardiovascular death, stroke or myocardial infarction, and 1.5% for major bleeding. Conclusions Our study identified major unmet need in HCM and highlighted the importance of implementing improved cardiovascular prevention strategies to increase life-expectancy of the contemporary HCM population. They also show that national electronic health records provide an effective method for identifying outcomes and clinically relevant estimates of composite efficacy and safety endpoints essential for trial design in rare diseases.
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Affiliation(s)
- Mar Pujades-Rodriguez
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom
- Farr Institute of Health Informatics Research, Institute of Health Informatics, University College London, London, United Kingdom
- * E-mail:
| | - Oliver P. Guttmann
- Institute for Cardiovascular Science, University College London Institute for Cardiovascular Science and Barts Heart Centre, St. Bartholomew’s Hospital, St Bartholomew’s Hospital, London, United Kingdom
| | - Arturo Gonzalez-Izquierdo
- Farr Institute of Health Informatics Research, Institute of Health Informatics, University College London, London, United Kingdom
| | - Bram Duyx
- Farr Institute of Health Informatics Research, Institute of Health Informatics, University College London, London, United Kingdom
- CAPHRI School for Public Health and Primary Care, Maastricht University, Universiteitssingel, Maastricht, the Netherlands
| | - Constantinos O’Mahony
- Institute for Cardiovascular Science, University College London Institute for Cardiovascular Science and Barts Heart Centre, St. Bartholomew’s Hospital, St Bartholomew’s Hospital, London, United Kingdom
| | - Perry Elliott
- Institute for Cardiovascular Science, University College London Institute for Cardiovascular Science and Barts Heart Centre, St. Bartholomew’s Hospital, St Bartholomew’s Hospital, London, United Kingdom
| | - Harry Hemingway
- Farr Institute of Health Informatics Research, Institute of Health Informatics, University College London, London, United Kingdom
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Rathod KS, Koganti S, Iqbal MB, Jain AK, Kalra SS, Astroulakis Z, Lim P, Rakhit R, Dalby MC, Lockie T, Malik IS, Knight CJ, Whitbread M, Mathur A, Redwood S, MacCarthy PA, Sirker A, O’Mahony C, Wragg A, Jones DA. Contemporary trends in cardiogenic shock: Incidence, intra-aortic balloon pump utilisation and outcomes from the London Heart Attack Group. European Heart Journal: Acute Cardiovascular Care 2017; 7:16-27. [DOI: 10.1177/2048872617741735] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background: Cardiogenic shock remains a major cause of morbidity and mortality in patients with ST-segment elevation myocardial infarction. We aimed to assess the current trends in cardiogenic shock management, looking specifically at the incidence, use of intra-aortic balloon pump therapy and outcomes in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. Methods and results: We undertook an observational cohort study of 21,210 ST-segment elevation myocardial infarction patients treated between 2005–2015 at the eight Heart Attack Centres in London, UK. Patients’ details were recorded at the time of the procedure into local databases using the British Cardiac Intervention Society percutaneous coronary intervention dataset. There were 1890 patients who presented with cardiogenic shock. The primary outcome was all-cause mortality at a median follow-up of 4.1 years (interquartile range: 2.2–5.8 years). Increasing rates of cardiogenic shock were seen over the course of the study with consistently high mortality rates of 45–70%. A total of 685 patients underwent intra-aortic balloon pump insertion during primary percutaneous coronary intervention for cardiogenic shock with decreasing rates over time. Those patients undergoing intra-aortic balloon pump therapy were younger, more likely to have poor left ventricular function and less likely to have had previous percutaneous coronary intervention compared to the control group. Procedural success rates were similar (86.0% vs 87.1%, p=0.292) although crude, in-hospital major adverse cardiac event rates were higher (43.8% vs 33.7%, p<0.0001) in patients undergoing intra-aortic balloon pump therapy. Kaplan-Meier analysis demonstrated significantly higher mortality rates in patients receiving intra-aortic balloon pump therapy (50.9% intra-aortic balloon pump vs 39.9% control, p<0.0001) during the follow-up period. After multivariate Cox analysis (hazard ratio 1.04, 95% confidence interval 0.62–1.89) and the use of propensity matching (hazard ratio: 1.29, 95% confidence interval: 0.68–1.45) intra-aortic balloon pump therapy was not associated with mortality. Conclusion: Cardiogenic shock treated by percutaneous coronary intervention is increasing in incidence and remains a condition associated with high mortality and limited treatment options. Intra-aortic balloon pump therapy was not associated with a long-term survival benefit in this cohort and may be associated with increased early morbidity.
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Affiliation(s)
| | | | - M Bilal Iqbal
- Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, UK
| | | | - Sundeep S Kalra
- Kings College Hospital, King’s College Hospital NHS Foundation Trust, UK
| | - Zoe Astroulakis
- St George’s Healthcare NHS Foundation Trust, St George’s Hospital, UK
| | - Pitt Lim
- St George’s Healthcare NHS Foundation Trust, St George’s Hospital, UK
| | | | - Miles C Dalby
- Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, UK
| | - Tim Lockie
- Royal Free London NHS Foundation Trust, UK
| | - Iqbal S Malik
- Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, UK
| | | | | | | | - Simon Redwood
- St Thomas’ NHS Foundation Trust, Guys and St Thomas Hospital, UK
| | - Philip A MacCarthy
- Kings College Hospital, King’s College Hospital NHS Foundation Trust, UK
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Rathod K, Koganti S, Jain A, Knight C, Mathur A, Sirker A, O’Mahony C, Wragg A, Jones D. TCT-97 Culprit lesion versus multi-vessel intervention in patients with cardiogenic shock complicating myocardial infarction: Incidence and outcomes from The London Heart Attack Group. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.1121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rathod K, Koganti S, Jain A, Knight C, Mathur A, Sirker A, O’Mahony C, Wragg A, Jones D. TCT-5 Complete versus Culprit only lesion intervention in ACS Patients with multi-vessel disease: Incidence and outcomes from The London Heart Attack Group. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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O’Mahony C, Jichi F, Monserrat L, Ortiz-Genga M, Anastasakis A, Rapezzi C, Biagini E, Gimeno JR, Limongelli G, McKenna WJ, Omar RZ, Elliott PM. Inverted U-Shaped Relation Between the Risk of Sudden Cardiac Death and Maximal Left Ventricular Wall Thickness in Hypertrophic Cardiomyopathy. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.115.003818. [DOI: 10.1161/circep.115.003818] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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] [Received: 12/03/2015] [Accepted: 04/06/2016] [Indexed: 11/16/2022]
Abstract
Background—
Hypertrophic cardiomyopathy is associated with sudden cardiac death (SCD). Some studies have shown an association between risk of sudden death and left ventricular maximal wall thickness (MWT), but there are few data in patients with extreme hypertrophy. The aim of this study was to determine the relation between MWT and the risk of SCD.
Methods and Results—
This is a multicenter, retrospective, longitudinal cohort study of 3673 adult (≥16 years) patients, previously used to develop and validate a risk prediction model for SCD (HCM Risk-SCD [hypertrophic cardiomyopathy risk-SCD]). There was an inverted U-shaped relation between MWT and the estimated 5-year risk of SCD. In patients with MWT≥35 mm (n=47; mean age, 33 years; 81% men), there was a single SCD end point (annual rate, 0.2%; 95% confidence interval, 0.03–1.60) and 3 additional cardiovascular events during a median follow-up of 9.5 years. Compared with patients with MWT≤14 mm, those with MWT≥35 mm did not have a higher risk for SCD (hazard ratio, 0.22; 95% confidence interval, 0.03–1.65), cardiovascular death (hazard ratio, 0.66; 95% confidence interval, 0.26–1.67), or all-cause mortality (hazard ratio, 0.73; 95% confidence interval, 0.32–1.69).
Conclusions—
The risk of SCD has a complex, nonlinear relationship to MWT. The pathophysiological mechanisms behind this observation require further study but implantable cardioverter defibrillator implantation should not be guided solely on the severity of left ventricular hypertrophy.
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Affiliation(s)
- Constantinos O’Mahony
- From the Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (C.O’M., W.J.M., P.M.E.); Biostatistics Group, University College London Hospitals/University College London Research Support Centre, London, United Kingdom (F.J., R.Z.O.); Department of Statistical Science, University College London, London, United Kingdom (R.Z.O.); Research Unit, Department of Cardiology, A Coruña University Hospital, and Galician Health Service, A Coruña, Spain (L.M., M
| | - Fatima Jichi
- From the Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (C.O’M., W.J.M., P.M.E.); Biostatistics Group, University College London Hospitals/University College London Research Support Centre, London, United Kingdom (F.J., R.Z.O.); Department of Statistical Science, University College London, London, United Kingdom (R.Z.O.); Research Unit, Department of Cardiology, A Coruña University Hospital, and Galician Health Service, A Coruña, Spain (L.M., M
| | - Lorenzo Monserrat
- From the Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (C.O’M., W.J.M., P.M.E.); Biostatistics Group, University College London Hospitals/University College London Research Support Centre, London, United Kingdom (F.J., R.Z.O.); Department of Statistical Science, University College London, London, United Kingdom (R.Z.O.); Research Unit, Department of Cardiology, A Coruña University Hospital, and Galician Health Service, A Coruña, Spain (L.M., M
| | - Martin Ortiz-Genga
- From the Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (C.O’M., W.J.M., P.M.E.); Biostatistics Group, University College London Hospitals/University College London Research Support Centre, London, United Kingdom (F.J., R.Z.O.); Department of Statistical Science, University College London, London, United Kingdom (R.Z.O.); Research Unit, Department of Cardiology, A Coruña University Hospital, and Galician Health Service, A Coruña, Spain (L.M., M
| | - Aristides Anastasakis
- From the Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (C.O’M., W.J.M., P.M.E.); Biostatistics Group, University College London Hospitals/University College London Research Support Centre, London, United Kingdom (F.J., R.Z.O.); Department of Statistical Science, University College London, London, United Kingdom (R.Z.O.); Research Unit, Department of Cardiology, A Coruña University Hospital, and Galician Health Service, A Coruña, Spain (L.M., M
| | - Claudio Rapezzi
- From the Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (C.O’M., W.J.M., P.M.E.); Biostatistics Group, University College London Hospitals/University College London Research Support Centre, London, United Kingdom (F.J., R.Z.O.); Department of Statistical Science, University College London, London, United Kingdom (R.Z.O.); Research Unit, Department of Cardiology, A Coruña University Hospital, and Galician Health Service, A Coruña, Spain (L.M., M
| | - Elena Biagini
- From the Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (C.O’M., W.J.M., P.M.E.); Biostatistics Group, University College London Hospitals/University College London Research Support Centre, London, United Kingdom (F.J., R.Z.O.); Department of Statistical Science, University College London, London, United Kingdom (R.Z.O.); Research Unit, Department of Cardiology, A Coruña University Hospital, and Galician Health Service, A Coruña, Spain (L.M., M
| | - Juan Ramon Gimeno
- From the Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (C.O’M., W.J.M., P.M.E.); Biostatistics Group, University College London Hospitals/University College London Research Support Centre, London, United Kingdom (F.J., R.Z.O.); Department of Statistical Science, University College London, London, United Kingdom (R.Z.O.); Research Unit, Department of Cardiology, A Coruña University Hospital, and Galician Health Service, A Coruña, Spain (L.M., M
| | - Giuseppe Limongelli
- From the Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (C.O’M., W.J.M., P.M.E.); Biostatistics Group, University College London Hospitals/University College London Research Support Centre, London, United Kingdom (F.J., R.Z.O.); Department of Statistical Science, University College London, London, United Kingdom (R.Z.O.); Research Unit, Department of Cardiology, A Coruña University Hospital, and Galician Health Service, A Coruña, Spain (L.M., M
| | - William J. McKenna
- From the Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (C.O’M., W.J.M., P.M.E.); Biostatistics Group, University College London Hospitals/University College London Research Support Centre, London, United Kingdom (F.J., R.Z.O.); Department of Statistical Science, University College London, London, United Kingdom (R.Z.O.); Research Unit, Department of Cardiology, A Coruña University Hospital, and Galician Health Service, A Coruña, Spain (L.M., M
| | - Rumana Z. Omar
- From the Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (C.O’M., W.J.M., P.M.E.); Biostatistics Group, University College London Hospitals/University College London Research Support Centre, London, United Kingdom (F.J., R.Z.O.); Department of Statistical Science, University College London, London, United Kingdom (R.Z.O.); Research Unit, Department of Cardiology, A Coruña University Hospital, and Galician Health Service, A Coruña, Spain (L.M., M
| | - Perry M. Elliott
- From the Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (C.O’M., W.J.M., P.M.E.); Biostatistics Group, University College London Hospitals/University College London Research Support Centre, London, United Kingdom (F.J., R.Z.O.); Department of Statistical Science, University College London, London, United Kingdom (R.Z.O.); Research Unit, Department of Cardiology, A Coruña University Hospital, and Galician Health Service, A Coruña, Spain (L.M., M
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Oldring P, O’Mahony C, Dixon J, Vints M, Mehegan J, Dequatre C, Castle L. Development of a new modelling tool (FACET) to assess exposure to chemical migrants from food packaging. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2014; 31:444-65. [DOI: 10.1080/19440049.2013.862348] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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McNamara C, Mehegan J, O’Mahony C, Safford B, Smith B, Tennant D, Buck N, Ehrlich V, Sardi† M, Haldemann† Y, Nordmann H, Jasti P. Uncertainty analysis of the use of a retailer fidelity card scheme in the assessment of food additive intake. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2011; 28:1636-44. [DOI: 10.1080/19440049.2011.606232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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O’Mahony C, Mohiddin SA, Knight C. Alcohol Septal Ablation for the Treatment of Hypertrophic Obstructive Cardiomyopathy. Interv Cardiol 2011. [DOI: 10.15420/articles/alcohol-septal-ablation-treatment-hypertrophic-obstructive-cardiomyopathy] [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] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is an inherited myocardial disorder characterised by left ventricular hypertrophy. A subgroup of patients develops limiting symptoms in association with left ventricular outflow tract obstruction (LVOTO). Current international guidelines recommend that symptomatic patients are initially treated by alleviating exacerbating factors and negatively inotropic medication. Drug-refractory symptoms require a comprehensive evaluation of the mechanism of LVOTO and review by a multidisciplinary team to consider the relative merits of myectomy, alcohol septal ablation (ASA) and pacing. This article provides a brief overview of HCM and the pathophysiology of LVOTO, and reviews the use of ASA in patients with drug-refractory symptoms secondary to LVOTO.
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Walsh PN, Conliffe C, Abdulkadir AS, Kelehan P, Conroy R, Foley M, Lenehan P, Murphy JF, Stronge J, Cantwell B, Wright C, Millward M, Carpenter M, Lennard T, Wilson R, Home C, Corbett AR, O’Sullivan G, Collins JK, Doran M, McDermott EWM, Mercer P, Smyth P, O’Higgins NJ, Duffy MJ, Reilly D, McDermott E, Faul C, Fennelly JJ, O’Higgins N, Lowry S, Russell H, Atkinson R, Hickey I, O’Brien F, O’Mahony A, O’Donoghue M, Pomeroy M, Prosser ES, Barker F, Casey M, Carroll K, Davis M, Duffy G, O’Kennedy R, Smyth PPA, O’Carroll D, Hetherton AM, Coveney E, McAlister V, Murray MJ, Brayden DJ, O’Hora A, Street J, O’Leary J, Pollock AM, Crowley M, Healy I, Murphy J, Landers R, Burke L, O’Brien D, Annis P, Hogan J, Kealy W, Lewis FA, Doyle CT, Callaghan M, Whelan A, Feighery C, Bresnihan B, Kelleher D, Reams G, Murphy A, Hall N, Casey EB, Mulherin D, Doherty E, Yanni G, Wallace E, Jackson J, Bennett M, Tighe O, Mulcahy H, O’Donoghue D, Croke DT, Cahill RJ, Beattie S, Hamilton H, O’Morain C, Corridan B, Collins RA, O’Morain CA, Fitzgerald E, Gilvarry JM, Leader M, Fielding JF, Johnson BT, Lewis SA, Love AHG, Johnston BT, Collins JSA, McFarland RJ, Johnston PW, Collins BJ, Kilgallen CM, Murphy GM, Markey GM, McCormack JA, Curry RC, Morris TCM, Alexander HD, Edgar S, Treacy M, O’Connell MA, Weir DG, Sheehan J, O’Loughlin G, Traynor O, Walsh N, Xia HX, Daw MA, Keane CT, Dupont C, Gibson G, McGinnity E, Walshe J, Carmody M, Donohoe J, McGrath P, O’Moore R, Kieran E, Rogers S, McKenna KE, Walsh M, Bingham EA, Hughes AE, Nevin NC, Todd DJ, Stanford CF, Callender ME, Burrows D, Paige DG, Allen GE, O’Brien DP, Gough DB, Phelan C, Given HF, Kamal SZ, Kehoe S, Coldicott S, Luesley D, Ward K, MacDonnell HF, Mullins S, Gordon I, Norris LA, Devitt M, Bonnar J, Sharma SC, Sheppard BL, Fitzsimons R, Kingston S, Garvey M, Hoey HMCV, Glasgow JFT, Moore R, Robinson PH, Murphy E, Murphy JFA, Wood AE, Sweeney P, Neligan M, MacLeod D, Cunnane G, Kelly P, Corcoran P, Clancy L, Drury RM, Drury MI, Powell D, Firth RGR, Jones T, Ferris BF, O’Flynn W, O’Donnell J, Kingston SM, Cunningham F, Hinds GME, McCluskey DR, Howell F, O’Mahony M, Devlin J, O’Reilly O, Buttanshaw C, Jennings S, Keane ER, Foley-Nolan C, Ryan FM, Taylor M, Lyons RA, O’Kelly F, Mason J, Carroll D, Doherty K, Flynn M, O’Dwyer R, Gilmartin JJ, McCarthy CF, Armstrong C, Mannion D, Feely T, Fitzpatrick G, Cooney CM, Aleong JC, Rooney R, Lyons J, Phelan DM, Joshi GP, McCarroll SM, Blunnie WP, O’Brien TM, Moriarty DC, Brangan J, Kelly CP, Kenny P, Gallagher H, McGovern E, Luke D, Lowe D, Rice T, Phelan D, Lyons JB, Lyons FM, McCoy DM, McGinley J, Hurley J, McDonagh P, Crowley JJ, Donnelly SM, Tobin M, Fitzgerald O, Maurer BJ, Quigley PJ, King G, Duly EB, Trinick TR, Boyle D, Wisdom GB, Geoghegan F, Collins PB, Goss C, Younger K, Mathias P, Graham I, MacGowan SW, Sidhu P, McEneaney DJ, Cochrane DJ, Adgey AAJ, Anderson JM, Moriarty J, Fahy C, Lavender A, Lynch L, McGovern C, Nugent AM, Neely D, Young I, McDowell I, O’Kane M, Nicholls DP, McEneaney D, Nichols DP, Campbell NPS, Campbell GC, Halliday MI, O’Donnell AF, Lonergan M, Ahearne T, O’Neill J, Keaveny TV, Ramsbottom D, Boucher-Hayes D, Sheahan R, Garadaha MT, Kidney D, Freyne P, Gearty G, Crean P, Singh HP, Hargrove M, Subareddy K, Hurley JP, O’Rourke W, O’Connor C, FitzGerald MX, McDonnell TJ, Chan R, Stinson J, Hemeryck L, Feely J, Chopra MP, Sivner A, Sadiq SM, Abernathy E, Plant L, Bredin CP, Hickey P, Slevin G, McCrory K, Long M, Conlon P, Walker F, Fitzgerald P, O’Neill SJ, O’Connor CM, Quigley C, Donnelly S, Southey A, Healy E, Mulcahy F, Lyons DJ, Keating J, O’Mahony C, Roy D, Shattock AG, Hillary IB, Waiz A, Hossain R, Chakraborthy B, Clancy LP, O’Reilly L, Byrne C, Costello E, O’Shaughnessy E, Cryan B, Farrell J, Walshe JJ, Mellotte GJ, Ho CA, Morgan SH, Bending MR, Bonner J. Inaugural national scientific medical meeting. Ir J Med Sci 1993. [PMCID: PMC7101915 DOI: 10.1007/bf02942100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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O’Byrne P, Collins P, Johnson A, Ledwith M, Lane B, Bouchier-Hayes D, MacMathuna P, O’Reilly T, Barry M, Duanes-Laita A, Feely J, Keeling PWN, Cotter P, Burke G, Waldron R, Zinner MJ, Jaffe BM, Givan F, Keye G, Byrne P, O’Brien M, O’Farrelly C, Stevens F, McCarthy C, Feighery C, Weir DG, Hannigan MC, Stevens FM, McCarthy CF, Fottrell PF, O’Connor MP, Kennedy NP, Courtney MG, Kelleher D, Weir DW, Senapati A, Kitler ME, Thompson RPH, O’Shea B, Madigan D, Keeling P, Hennessy TPJ, Meenan JJ, Gaffney EF, Duigan JP, Johnson AH, Collins PB, Healy MV, Skehill R, Grimes H, O’Farrelly C, Kelly J, Rees R, Hoey H, Humphreys H, Dooley C, O’Leary D, Bourke S, McKenna D, Power B, Keane C, Sweeney E, O’Morain CA, Afdhal NH, McCormick A, O’Donoghue DP, Quigley EMM, Turnberg LA, Moorehead RJ, Hoper M, McKelvey STD, Tobbia I, Rafferty R, Gillen P, Stuart R, Dawson K, Collins JSA, McKnigh JA, Pyper PC, Love AHG, Dillon ME, O’Connor E, Keeling PWN, Broe PJ, Harte PI, Keane T, Garstin WIH, Buchanan KD, Walsh JP, Bloomfield FJ, Maxwell WJ, Hogan FP, O’Malley VP, Postier RG, Lombard M, Craven C, Spencer S, Crowe J, Quinn F, Templeton JL, Tobin MV, Hughes S, Gilmore IT, Keane RM, Johnson AB, Duenas-Laita A, Younger K, O’Brien T, Cotter J, Cullinane T, Whelton MJ, Waldron D, Bowes K, Given HF, Gawley WF, Gorey TF, Osborne DH, Lane BE, Collins PG, Boston VE, O’Mahony C. Irish society of gastroenterology. Ir J Med Sci 1986. [DOI: 10.1007/bf02962975] [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: 11/30/2022]
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Whelton MJ, Fitzgerald P, Ritchie E, Jenkins D, Leahy AL, Nee JM, Wait RB, Pollock TW, Collins BJ, Elliott H, Sloan JM, McFarland RJ, Love AHG, Mac Mathúna P, O’Reilly T, Kelleher D, Keeling PWN, Feely J, West B, Byrne P, Sheahan G, Stephens R, Hennessy T, Doyle CT, Bloomfield FJ, Maxwell WJ, Hogan FP, Walsh JP, Duffy MJ, O’Sullivan F, O’Donoghue D, Afdhal N, Collins JSA, Kennedy TL, Buchanan KD, Johnston CF, O’Hare MMT, Walsh TN, Alderson D, Tate P, Lavells MI, Ryan P, Lennon G, Walsh D, Hegarty JH, Keane FBV, Tanner WA, Afdhal NH, Long AA, Tobbia I, Tobin B, O’Rafferty R, O’Donoghue DP, Deasy J, Clinton O, Burke G, Delaney P, O’Mahony C, O’Farrelly C, Weir DG, Finch T, Feighery CF, Traynor OJ, Byrne PJ, Hennessy TPJ, Lombard M, Murray FE, Connolly G, Lennon J, Crowe J, McCann A, Seymour C, Broe PJ, Bouchier-Hayes DJ, Bloomfield FF, O’Farrelly C, Stevens F, McCarthy C, Feighery C, McKee CM, McMillan SA, Dawson AT, O’Toole J, Haire M, Callender ME, Fulton TT, McEntee GP, Duignan JP, O’Malley E, Graeme-Cook F, O’Farrelly G, O’B Hourihane D, Fitzgerald R, Dervan P, Lennon JR, Moran B, Delaney PV, Kelly J, O’Shea B, O’Dorioghue DP, Keeling P, Stuart R, Stewart RJ, Parks TG, Devery R, Tomkin GH, McKay PA, O’Connor M, Miller S, McDonald G, Fryene PJ, Martin L, Ryan F, Collum C, Lavelle J, Ennis J, Doyle JS, O’Connor HJ, Schorah CJ, Axon ATR, Riley SE, Garner RC, Burke O, Long JP, Lennon F. Irish Society of Gastroenterology. Ir J Med Sci 1986. [DOI: 10.1007/bf02940056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lucey J, Gaffney R, Laher MS, Comerford J, Broe P, Ennis J, Bouchier-Hayes D, O’Malley K, Horgan JH, Lee RJE, MacLennan B, Beringer TRO, Ohman EM, Walsh T, Kelly J, O’Malley K, Nolan MT, FitzGerald MX, Delaney E, Carville P, Flanagan M, Turner M, Donovan D, Gillen P, FitzGerald GR, Watson RGP, O’Mahony C, O’Farrelly C, Thompson AJ, Brazil J, Martin EA, Feighery C, Hutchinson M, Mongey AB, Glynn D, Hutchinson M, Bresnihan B, Cox J, Gormley MJJ, Farrell R, Owens D, Tyrrell D, Tomkin GH. Royal academy of medicine in Ireland section of medicine. Ir J Med Sci 1985. [DOI: 10.1007/bf02937202] [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: 12/01/2022]
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Hannigan MC, Kennedy SM, Stevens FM, McCarthy CF, Little MPG, Murphy PD, Gill RC, Bowes KL, Malone DE, McCormick PA, Long A, Jones B, Bresnihan B, Moloney J, O’Donoghue DP, Dinsmore WW, McMaster D, Callerder ME, Love AHG, McGowan PF, O’Mahony C, O’Farrelly C, Mansfield M, Whelan CA, Weir DG, Feighery CF, Spence RAJ, Collins BJ, Parks TG, Crowe J, Minogue S, Lowe H, Jackson PT, Glasgow JFT, Carré IJ, Conway W, Rich AJ, Johnston IDA, Keye GD, Byrne PJ, Sheppard BL, West AB, Hennessy TPJ, Fielding JF, Dolan C, Kelly J, Monagan H, Feighery C, Brennan FN, Majury C, O’Connor FA, Murray F, Lennon JR, Unit GG, Collins JSA, Trouton TG, McFarland RJ, O’Callaghan TW, Morgan MA, Duignan J, Collins P, Johnson A, Dickson B, Ledwith M, Bouchier-Hayes D, Bloomfield FJ, Maxwell WJ, Walsh JP, Hogan FP, Kelleher D, Clayton Love W, Keeling PWN, Attwood SEA, Mealy K, Cafferkey M, Buckley T, Keane FB, Cooper GG, Gordon SA, Murray WR, Quigley EMM, Phillips SF, O’Brien CJ, Vento S, Eddleston ALWF, Williams R, Templeton JL, McKelvey STD, Humphreys WG, Brown JS, Monson JRT, Jones NAG, Vowden P, Brennan TG, Prakash D, Pearson FG, Hegarty J, Lombard M, Fitzgerald R, O’Callagan TW, Kernohan RM, Gilmartin D, McNulty J, Behan J, Osborne DH, Gillan P, Ryan W, Leahy A, Devlin HB, Peel ALG, Buchanan KD, O’Hare MMT, Sloan JM, Kennedy TL, Mahapatra DN, McKenna RM, Kearns M, Morrison P, Kelly KA. Irish Society of Gastroenterology. Ir J Med Sci 1985. [PMID: 4055322 DOI: 10.1007/bf02937184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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McEntee GP, Ruddy R, Heffernan SJ, Kirwan WO, Doyle CT, Stevens FM, O’Riordan M, Collins JSA, Porter KG, Kelleher D, Cryan E, Flanagan M, Weir DG, Kelly J, O’Farrelly C, O’Mahony C, Thompson A, Rees JP, Feighery C, McKeever U, Lawlor E, Brian West A, Sheahan DG, Maguire C, Tighe B, O’Higgins NJ, Harvey CF, Hood JM, Anderson JR, Wilson BG, Parks TG, Lyons T, Brougham R, West B, O’Briain DS, Falkiner F, Keeling PWN, Keane C, Fitzgerald P, Moss N, Whelton MJ, Unit GI, Watt PCH, Patterson CC, Kennedy TL, Anderson MC, Delaney PV, Gilmartin D, Rhatigan M, Duggan J, Osborne DH, Walsh TN, Alderson D, Farndon JR, Johnston IDA, Given F, Flanagan PV, O’Higgins N, McGeeney KF, Naughton PM, Duignan JP, Morrissey B, O’Malley E, Collins BJ, McFarland RJ, Sloan J, Love AHG, Spense RAJ, Johnston GW, Odling-Smee GW, Walters JW, McCarthy CF. Irish Society Of Gastroenterology 21st Anniversary Year Meeting, November 1983. Ir J Med Sci 1985. [DOI: 10.1007/bf02937364] [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: 11/30/2022]
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Gebruers EM, Hall WJ, O’Sullivan MF, O’Leary D, McCarthy PG, Hooper ACB, Graham A, Blake J, Scott JA, O’Connor S, Cottell DC, Jamison JJ, Taylor M, Kernan RP, Westphal W, Garvey E, Morris A, Bannigan J, Cottell D, Finn T, McCann SR, Lawlor E, Murray R, Keenan AK, Treacy M, Gough L, Martin F, Smyth PPA, McMullan NM, Godfrey A, Molloy JG, Arbuthnott ER, Halliday NJ, Harper KW, Loughran PG, Molloy AG, Waddington JL, Perry MJ, Gaffney PJ, Wilson CM, Thompson EM, Moore J, McClean E, Dundee JW, Warnock P, Docherty JR, Hyland L, Allen JM, McHale NG, Iggulden LA, Thornbury KD, O’Connell MJM, Deasy PB, Chestnutt WN, Lowry KG, McMaster EA, Mealy K, O’Farrelly C, Stephens R, Feighery C, Clarke RSJ, Lavery GG, Mirakhur RK, Gibson FM, Reynolds M, McPartlin J, Younger KM, Trayhurn P, Iputo J, Kelly M, Moore RE, Tomkins PT, Carroll C, Houghton JA, Comerford FR, McFartlin J, Whelan CA, Feighery CF, Weir DG, O’Mahony C, Kelly J, Keating S, Scott JM, Brazil JK, Thompson AJ, Hutchinson M, Martin EA, O’Regan MG, Sheehan JD, O’Mahony DP, Wilson AM, O’Keeffe PJM, Rochford S, Fraher JP, O’Sullivan VR. Section of biological sciences. Ir J Med Sci 1984. [DOI: 10.1007/bf02939805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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