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Leyva F, Zegard A, Patel P, Stegemann B, Marshall H, Ludman P, de Bono J, Boriani G, Qiu T. Improved prognosis after cardiac resynchronization therapy over a decade. Europace 2023; 25:euad141. [PMID: 37265253 PMCID: PMC10236714 DOI: 10.1093/europace/euad141] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/16/2023] [Indexed: 06/03/2023] Open
Abstract
AIMS The past decade has seen an increased delivery of cardiac resynchronization therapy (CRT) for patients with heart failure (HF). We explored whether clinical outcomes after CRT have changed from the perspective of an entire public healthcare system. METHODS AND RESULTS A national database covering the population of England (56.3 million in 2019) was used to explore clinical outcomes after CRT from 2010 to 2019. A total of 64 698 consecutive patients (age 71.4 ± 11.7 years; 74.8% male) underwent CRT-defibrillation [n = 32 313 (49.7%)] or CRT-pacing [n = 32 655 (50.3%)] implantation. From 2010-2011 to 2018-2019, there was a 76% increase in CRT implantations. During the same period, the proportion of patients with hypertension (59.6-73.4%), diabetes (26.5-30.8%), and chronic kidney disease (8.62-22.5%) increased, as did the Charlson comorbidity index (CCI ≥ 3 from 20.0% to 25.1%) (all P < 0.001). Total mortality decreased at 30 days (1.43-1.09%) and 1 year (9.51-8.13%) after implantation (both P < 0.001). At 2 years, total mortality [hazard ratio (HR): 0.72; 95% confidence interval (CI) 0.69-0.76] and total mortality or HF hospitalization (HR: 0.59; 95% CI 0.57-0.62) decreased from 2010-2011 to 2018-2019, after correction for age, race, sex, device type (CRT-defibrillation or pacing), comorbidities (hypertension, diabetes, chronic kidney disease, and myocardial infarction), or the CCI (HR: 0.81; 95% CI 0.77-0.85). CONCLUSIONS From the perspective of an entire public health system, survival has improved and HF hospitalizations have decreased after CRT implantation over the past decade. This prognostic improvement has occurred despite an increasing comorbidity burden.
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Affiliation(s)
- Francisco Leyva
- Aston Medical Reseach Insitute, Aston Medical School, Aston University, Aston Triangle, Birmingham B4 7ET, UK
| | - Abbasin Zegard
- Aston Medical Reseach Insitute, Aston Medical School, Aston University, Aston Triangle, Birmingham B4 7ET, UK
- Univeristy Hospitals Birmingham Queen Elizabeth, Mindelsohn Way, Birmingham B15 2WB, UK
| | - Peysh Patel
- Univeristy Hospitals Birmingham Queen Elizabeth, Mindelsohn Way, Birmingham B15 2WB, UK
| | - Berthold Stegemann
- Aston Medical Reseach Insitute, Aston Medical School, Aston University, Aston Triangle, Birmingham B4 7ET, UK
- Univeristy Hospitals Birmingham Queen Elizabeth, Mindelsohn Way, Birmingham B15 2WB, UK
| | - Howard Marshall
- Univeristy Hospitals Birmingham Queen Elizabeth, Mindelsohn Way, Birmingham B15 2WB, UK
| | - Peter Ludman
- Univeristy Hospitals Birmingham Queen Elizabeth, Mindelsohn Way, Birmingham B15 2WB, UK
| | - Joseph de Bono
- Univeristy Hospitals Birmingham Queen Elizabeth, Mindelsohn Way, Birmingham B15 2WB, UK
| | - Giuseppe Boriani
- Cardiology Division, Department of Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via Universita 4, Modena 41100, Italy
| | - Tian Qiu
- Univeristy Hospitals Birmingham Queen Elizabeth, Mindelsohn Way, Birmingham B15 2WB, UK
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Thompson SE, Hudsmith LE, Bowater SE, Clift P, Marshall H, Leyva F, Arif S. Cardiac resynchronization therapy in adults with structural congenital heart disease and chronic heart failure. Pacing Clin Electrophysiol 2023. [PMID: 37221925 DOI: 10.1111/pace.14721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/25/2023]
Abstract
AIMS Evidence for CRT in adults with congenital heart disease (ACHD) and chronic heart failure is limited, with recommendations for its use extrapolated from the population with structurally normal hearts. This retrospective observational study investigates the efficacy of CRT in this heterogenous group, discussing factors predicting response to CRT. METHODS Twenty-seven patients with structural ACHD who underwent CRT insertion or upgrade at a tertiary center in the United Kingdom were retrospectively studied. The primary outcome measure was clinical response to CRT, defined as improvement of NYHA class and/or improvement in systemic ventricular ejection fraction by one category. Secondary outcomes included change in QRS duration and adverse events. RESULTS Thirty-seven percent of patients had a systemic right ventricle (sRV). RBBB was the commonest baseline QRS morphology (40.7%) despite this being an unfavorable characteristic for CRT. Overall, positive response to CRT was demonstrated in 18 patients (66.7%). NYHA class improved in 55.5% following CRT (p = .001) and 40.7% showed improvement in systemic ventricular ejection fraction (p = .118). There were no baseline characteristics that predicted response to CRT, and electrocardiographic measures such as QRS shortening post-CRT was not associated with positive response. Good response rates (60.0%) were demonstrated in those with sRV. CONCLUSION CRT is efficacious in structural ACHD including in those who do not meet conventional criteria. Extrapolation of recommendations from adults with structurally normal hearts may be inappropriate. Future research should focus on improving patient selection for CRT, for example using techniques to better quantify mechanical dysynchrony and intra-procedural electrical activation mapping in these complex patients.
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Affiliation(s)
- Sophie E Thompson
- Department of Adult Congenital Heart Disease, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Lucy E Hudsmith
- Department of Adult Congenital Heart Disease, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sarah E Bowater
- Department of Adult Congenital Heart Disease, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paul Clift
- Department of Adult Congenital Heart Disease, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Howard Marshall
- Department of Cardiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Sayqa Arif
- Department of Adult Congenital Heart Disease, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Leyva F, Zegard A, Patel P, Stegemann B, Marshall H, Ludman P, Walton J, de Bono J, Boriani G, Qiu T. Timing of cardiac resynchronization therapy implantation. Europace 2023; 25:euad059. [PMID: 36944529 PMCID: PMC10227865 DOI: 10.1093/europace/euad059] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/14/2023] [Indexed: 03/23/2023] Open
Abstract
AIMS The optimum timing of cardiac resynchronization therapy (CRT) implantation is unknown. We explored long-term outcomes after CRT in relation to the time interval from a first heart failure hospitalization (HFH) to device implantation. METHODS AND RESULTS A database covering the population of England (56.3 million in 2019) was used to quantify clinical outcomes after CRT implantation in relation to first HFHs. From 2010 to 2019, 64 968 patients [age: 71.4 ± 11.7 years; 48 606 (74.8%) male] underwent CRT implantation, 57% in the absence of a previous HFH, 12.9% during the first HFH, and 30.1% after ≥1 HFH. Over 4.54 (2.80-6.71) years [median (interquartile range); 272 989 person-years], the time in years from the first HFH to CRT implantation was associated with a higher risk of total mortality [hazard ratio (HR); 95% confidence intervals (95% CI)] (1.15; 95% CI 1.14-1.16, HFH (HR: 1.26; 95% CI 1.24-1.28), and the combined endpoint of total mortality or HFH (HR: 1.19; 95% CI 1.27-1.20) than CRT in patients with no previous HFHs, after co-variate adjustment. Total mortality (HR: 1.67), HFH (HR: 2.63), and total mortality or HFH (HR: 1.92) (all P < 0.001) were highest in patients undergoing CRT ≥2 years after the first HFH. CONCLUSION In this study of a healthcare system covering an entire nation, delays from a first HFH to CRT implantation were associated with progressively worse long-term clinical outcomes. The best clinical outcomes were observed in patients with no previous HFH and in those undergoing CRT implantation during the first HFH. CONDENSED ABSTRACT The optimum timing of CRT implantation is unknown. In this study of 64 968 consecutive patients, delays from a first heart failure hospitalization (HFH) to CRT implantation were associated with progressively worse long-term clinical outcomes. Each year from a first HFH to CRT implantation was associated with a 21% higher risk of total mortality and a 34% higher risk of HFH. The best outcomes after CRT were observed in patients with no previous HFHs and in those undergoing implantation during their first HFH.
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Affiliation(s)
- Francisco Leyva
- Aston Medical Research Institute, Aston University, Aston Triangle, Birmingham B4 7ET, UK
| | - Abbasin Zegard
- Aston Medical Research Institute, Aston University, Aston Triangle, Birmingham B4 7ET, UK
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Mindelsohn Way, Birmingham B15 2GW, UK
| | - Peysh Patel
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Mindelsohn Way, Birmingham B15 2GW, UK
| | - Berthold Stegemann
- Aston Medical Research Institute, Aston University, Aston Triangle, Birmingham B4 7ET, UK
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Mindelsohn Way, Birmingham B15 2GW, UK
| | - Howard Marshall
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Mindelsohn Way, Birmingham B15 2GW, UK
| | - Peter Ludman
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Mindelsohn Way, Birmingham B15 2GW, UK
| | - Jamie Walton
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Mindelsohn Way, Birmingham B15 2GW, UK
| | - Joseph de Bono
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Mindelsohn Way, Birmingham B15 2GW, UK
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via Università, 4, 41121, Modena, Italy
| | - Tian Qiu
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Mindelsohn Way, Birmingham B15 2GW, UK
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McLeod C, Ramsay J, Flanagan KL, Plebanski M, Marshall H, Dymock M, Marsh J, Estcourt MJ, Wadia U, Williams PCM, Tjiam MC, Blyth C, Subbarao K, Nicholson S, Faust S, Thornton RB, Mckenzie A, Snelling TL, Richmond P. Core protocol for the adaptive Platform Trial In COVID-19 Vaccine priming and BOOsting (PICOBOO). Trials 2023; 24:202. [PMID: 36934272 PMCID: PMC10024280 DOI: 10.1186/s13063-023-07225-z] [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] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/06/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND The need for coronavirus 2019 (COVID-19) vaccination in different age groups and populations is a subject of great uncertainty and an ongoing global debate. Critical knowledge gaps regarding COVID-19 vaccination include the duration of protection offered by different priming and booster vaccination regimens in different populations, including homologous or heterologous schedules; how vaccination impacts key elements of the immune system; how this is modified by prior or subsequent exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and future variants; and how immune responses correlate with protection against infection and disease, including antibodies and effector and T cell central memory. METHODS The Platform Trial In COVID-19 priming and BOOsting (PICOBOO) is a multi-site, multi-arm, Bayesian, adaptive, randomised controlled platform trial. PICOBOO will expeditiously generate and translate high-quality evidence of the immunogenicity, reactogenicity and cross-protection of different COVID-19 priming and booster vaccination strategies against SARS-CoV-2 and its variants/subvariants, specific to the Australian context. While the platform is designed to be vaccine agnostic, participants will be randomised to one of three vaccines at trial commencement, including Pfizer's Comirnaty, Moderna's Spikevax or Novavax's Nuvaxovid COVID-19 vaccine. The protocol structure specifying PICOBOO is modular and hierarchical. Here, we describe the Core Protocol, which outlines the trial processes applicable to all study participants included in the platform trial. DISCUSSION PICOBOO is the first adaptive platform trial evaluating different COVID-19 priming and booster vaccination strategies in Australia, and one of the few established internationally, that is designed to generate high-quality evidence to inform immunisation practice and policy. The modular, hierarchical protocol structure is intended to standardise outcomes, endpoints, data collection and other study processes for nested substudies included in the trial platform and to minimise duplication. It is anticipated that this flexible trial structure will enable investigators to respond with agility to new research questions as they arise, such as the utility of new vaccines (such as bivalent, or SARS-CoV-2 variant-specific vaccines) as they become available for use. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12622000238774. Registered on 10 February 2022.
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Affiliation(s)
- C McLeod
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia.
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia.
- Infectious Diseases Department, Perth Children's Hospital, Nedlands, Australia.
| | - J Ramsay
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
| | - K L Flanagan
- Tasmanian Vaccine Trial Centre, Clifford Craig Foundation, Launceston General Hospital, Launceston, TAS, Australia
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology University (RMIT), Melbourne, VIC, Australia
| | - M Plebanski
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology University (RMIT), Melbourne, VIC, Australia
| | - H Marshall
- Women's and Children's Health Network, North Adelaide, Australia
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - M Dymock
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
| | - J Marsh
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
| | - M J Estcourt
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - U Wadia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia
- Infectious Diseases Department, Perth Children's Hospital, Nedlands, Australia
| | - P C M Williams
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital Network, Westmead, Australia
- School of Women and Children's Health, UNSW, Kensington, Australia
| | - M C Tjiam
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia
| | - C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia
- Infectious Diseases Department, Perth Children's Hospital, Nedlands, Australia
- Division of Paediatrics, School of Medicine, University of Western Australia, Crawley, Australia
| | - K Subbarao
- WHO Collaborating Centre for Reference and Research On Influenza, University of Melbourne, Parkville, VIC, Australia
| | - S Nicholson
- Serology Laboratory, Victorian Infectious Diseases Research Laboratory, Melbourne, Australia
| | - S Faust
- Southampton Clinical Research Facility and Biomedical Research Centre, National Institute of Health Research, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - R B Thornton
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia
| | - A Mckenzie
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
| | - T L Snelling
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - P Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia
- Division of Paediatrics, School of Medicine, University of Western Australia, Crawley, Australia
- General Paediatrics and Immunology Departments, Perth Children's Hospital, Nedlands, Australia
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Dodd R, Sharman A, McGregor D, Stone E, Kielly-Carroll C, De Abreu Lourenco R, Marshall H, Rankin N. EP01.02-004 Education Messages and Strategies About Lung Cancer Screening: A Systematic Review. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.278] [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: 10/14/2022]
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Lau J, Fischer B, Marshall H. EP15.01-001 Ask, Advise, Help (AAH) Smoking Cessation Brief Advice Delivery in Patients with Diagnosed Lung Cancer: A Retrospective Audit. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.999] [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: 11/16/2022]
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Behar Harpaz S, Weber M, Wade S, Ngo P, Vaneckova P, Sarich P, Cressman S, Tammemagi M, Fong K, Marshall H, McWilliams A, Zalcberg J, Caruana M, Canfell K. MA11.03 Updated Cost-Effectiveness Analysis of Lung Cancer Screening for Australia, Capturing Differences in the Impact of NELSON and NLST Outcomes. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.137] [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: 10/14/2022]
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Stirling R, Smith S, Brand M, Harden S, Briggs L, Leigh L, Brims F, Brooke M, Brunelli V, Chia C, Dawkins P, Lawrenson R, Duffy M, Evans S, Leong T, Marshall H, Patel D, Pavlakis N, Philip J, Rankin N, Singhal N, Stone E, Tay R, Vinod S, Windsor M, Wright G, Leong D, Zalcberg J. EP04.01-023 Development of an Australia and New Zealand Lung Cancer Clinical Quality Registry (ANZLCR). J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.435] [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: 10/14/2022]
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Poveda Velasco A, Lheureux S, Colombo N, Cibula D, Elstrand M, Weberpals J, Bjurberg M, Oaknin A, Sikorska M, Gonzalez Martin A, Madry R, Rubio Perez M, Ledermann J, Ozgoren O, Barnicle A, Marshall H, Bashir Z, Skof E. 531P Maintenance olaparib monotherapy in patients (pts) with platinum-sensitive relapsed ovarian cancer (PSR OC) without a germline BRCA1/BRCA2 mutation (non-gBRCAm): Final overall survival (OS) results from the OPINION trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.659] [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: 11/01/2022] Open
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Dodd R, Sharman A, Rhee J, Marshall H, Stone E, Yap M, McCullough S, McWilliams A, Rankin N. EP01.03-012 Acceptability and Feasibility of Lung Cancer Screening in Australia: The View of Key Stakeholders. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.294] [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: 10/14/2022]
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Zegard A, Okafor O, Moody W, Marshall H, Qiu T, Stegemann B, Beadle R, Leyva F. Right ventricular function and long-term clinical outcomes after cardiac resynchronization therapy: A cardiovascular magnetic resonance study. Pacing Clin Electrophysiol 2022; 45:1075-1084. [PMID: 35899803 DOI: 10.1111/pace.14572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 06/09/2022] [Accepted: 07/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Right ventricular (RV) dysfunction has been linked to a poor response to cardiac resynchronization therapy (CRT). We sought to determine whether cardiovascular magnetic resonance (CMR)-derived measures of RV function influence clinical outcomes after CRT. METHODS In this retrospective study, we used cardiovascular magnetic resonance (CMR) to assess pre-implant RV volumes and RV ejection fraction (RVEF) in relation to clinical outcomes after CRT implantation. RESULTS Among 243 patients (age: 70.3 ± 10.8 years [mean ±. SD]; 68.7% male; 121 [49.8%]) with ischemic cardiomyopathy and 122 (50.2%) with non-ischemic cardiomyopathy, 141 (58%) after CRT-defibrillation and 102 (42%) after CRT-pacing, 101 (41.6.0%) patients died, 61 (25.1%) from cardiac causes and 24 (9.88%) from non-cardiac causes, over 5.87 years (median; interquartile range: 4.35-7.73). Two (0.82%) patients underwent cardiac transplantation and 4 (1.64%) had a left ventricular assist device. A total of 41 (16.9%) met the composite endpoint of sudden cardiac death, ventricular tachycardia or ventricular fibrillation. In univariate analyses, no measure of RV function was associated with total mortality or the arrhythmic endpoint. RVEF was associated with cardiac mortality on univariate analyses (HR per 10%: 0.82, 95% CI 0.70-0.96), but not on multivariate analyses that included left ventricular ejection fraction. CONCLUSIONS There is no relationship between measures of RV function, such as RV volumes and RVEF, and the long-term clinical outcome of CRT. These findings indicate that such measures should not be considered in patient selection. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Osita Okafor
- Aston Medical School, Aston University, Birmingham, UK
| | | | | | - Tian Qiu
- University Hospitals Birmingham, Birmingham, UK
| | | | - Roger Beadle
- South Warwickshire NHS Foundation Trust, Warwick, UK
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Zegard A, Okafor O, Foley P, Umar F, Taylor R, Marshall H, Stegemann B, Moody W, Steeds R, Halliday B, Hammersley D, Jones R, Prasad S, Qiu T, Leyva F. Myocardial fibrosis predicts ventricular arrhythmias and sudden death after cardiac electronic device implantation. Europace 2022. [DOI: 10.1093/europace/euac053.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Unrestricted educational grants
Background
Increasing evidence supports a link between myocardial fibrosis (MF) and ventricular arrhythmias. We sought to determine whether presence of MF on visual assessment (MFVA) and gray zone fibrosis (GZF) mass predicts SCD and ventricular fibrillation / sustained ventricular tachycardia after cardiac implantable electronic device (CIED) implantation.
Methods
In this prospective study, total fibrosis and GZF mass, quantified using cardiovascular magnetic resonance, was assessed in relation to the primary endpoint of sudden cardiac death (SCD) and the secondary, arrhythmic endpoint of SCD or ventricular arrhythmias after CIED implantation.
Results
Among 700 patients (age 68.0 ± 12.0yrs [mean ± SD]), 27 (3.85%) experienced a SCD and 121 (17.3%) met the arrhythmic endpoint over 6.93 yrs (median; interquartile range 5.82-9.32). MFVA predicted SCD (hazard ratio [HR]: HR:26.3 [95% confidence interval [CI] 3.70-3337]; negative predictive value: 100%). In competing risks analyses, MFVA also predicted the arrhythmic endpoint (subdistribution [sHR]: 19.9 [95% CI 6.40-61.9]; negative predictive value:98.6%). Compared with no MFVA, a GZF mass measured with the 5SD method (GZF5SD) > 17 g was associated with highest risk of SCD (HR: 44.6;95% CI 6.12-5685) and the arrhythmic endpoint (sHR: 30.3 [95% CI 9.60-95.8]). Adding GZF5SD mass to MFVA led to reclassification of 39% for SCD and 50.2% for the arrhythmic endpoint. In contrast, LVEF did not predict either endpoint.
Conclusions
In CIED recipients, MFVA excluded patients at risk of SCD and virtually excluded ventricular arrhythmias. Quantified GZF5SD mass added predictive value in relation to SCD and the arrhythmic endpoint.
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Affiliation(s)
- A Zegard
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - O Okafor
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - P Foley
- The Great Western Hospital, Swindon, United Kingdom of Great Britain & Northern Ireland
| | - F Umar
- Ottawa Cardiovascular Centre, The Ottawa Hospital, Ottawa, Canada
| | - R Taylor
- Worcestershire Acute Hospitals NHS trust, Alexandra Hospital, Worcestershire, United Kingdom of Great Britain & Northern Ireland
| | - H Marshall
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - B Stegemann
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - W Moody
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - R Steeds
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - B Halliday
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - D Hammersley
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - R Jones
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - S Prasad
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - T Qiu
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - F Leyva
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
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Kahn B, Marshall H. Treatment of pelvic nerve dysfunction with a short course of pudendal nerve blocks and nsaids: a 4-year quality assurance review. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.12.049] [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: 11/16/2022]
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Leyva F, Zegard A, Okafor O, Foley P, Umar F, Taylor RJ, Marshall H, Stegemann B, Moody W, Steeds RP, Halliday BP, Hammersley DJ, Jones RE, Prasad SK, Qiu T. Myocardial Fibrosis Predicts Ventricular Arrhythmias and Sudden Death After Cardiac Electronic Device Implantation. J Am Coll Cardiol 2022; 79:665-678. [PMID: 35177196 DOI: 10.1016/j.jacc.2021.11.050] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [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: 08/26/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Increasing evidence supports a link between myocardial fibrosis (MF) and ventricular arrhythmias. OBJECTIVES The purpose of this study was to determine whether presence of myocardial fibrosis on visual assessment (MFVA) and gray zone fibrosis (GZF) mass predicts sudden cardiac death (SCD) and ventricular fibrillation/sustained ventricular tachycardia after cardiac implantable electronic device (CIED) implantation. METHODS In this prospective study, total fibrosis and GZF mass, quantified using cardiovascular magnetic resonance, was assessed in relation to the primary endpoint of SCD and the secondary, arrhythmic endpoint of SCD or ventricular arrhythmias after CIED implantation. RESULTS Among 700 patients (age 68.0 ± 12.0 years), 27 (3.85%) experienced a SCD and 121 (17.3%) met the arrhythmic endpoint over median 6.93 years (IQR: 5.82-9.32 years). MFVA predicted SCD (HR: 26.3; 95% CI: 3.7-3,337; negative predictive value: 100%). In competing risk analyses, MFVA also predicted the arrhythmic endpoint (subdistribution HR: 19.9; 95% CI: 6.4-61.9; negative predictive value: 98.6%). Compared with no MFVA, a GZF mass measured with the 5SD method (GZF5SD) >17 g was associated with highest risk of SCD (HR: 44.6; 95% CI: 6.12-5,685) and the arrhythmic endpoint (subdistribution HR: 30.3; 95% CI: 9.6-95.8). Adding GZF5SD mass to MFVA led to reclassification of 39% for SCD and 50.2% for the arrhythmic endpoint. In contrast, LVEF did not predict either endpoint. CONCLUSIONS In CIED recipients, MFVA excluded patients at risk of SCD and virtually excluded ventricular arrhythmias. Quantified GZF5SD mass added predictive value in relation to SCD and the arrhythmic endpoint.
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MESH Headings
- Aged
- Aged, 80 and over
- Cardiac Resynchronization Therapy/mortality
- Cardiac Resynchronization Therapy/trends
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/pathology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable/trends
- Female
- Fibrosis
- Follow-Up Studies
- Humans
- Magnetic Resonance Imaging, Cine/mortality
- Magnetic Resonance Imaging, Cine/trends
- Male
- Middle Aged
- Myocardium/pathology
- Predictive Value of Tests
- Prospective Studies
- Ventricular Fibrillation/diagnostic imaging
- Ventricular Fibrillation/mortality
- Ventricular Fibrillation/therapy
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Affiliation(s)
- Francisco Leyva
- Aston Medical School, Aston University, Birmingham, United Kingdom.
| | - Abbasin Zegard
- Aston Medical School, Aston University, Birmingham, United Kingdom; University Hospitals Birmingham, Queen Elizabeth, Birmingham, United Kingdom
| | - Osita Okafor
- Aston Medical School, Aston University, Birmingham, United Kingdom; University Hospitals Birmingham, Queen Elizabeth, Birmingham, United Kingdom
| | - Paul Foley
- The Great Western Hospital, Swindon, United Kingdom
| | - Fraz Umar
- The Ottawa Hospital, Ottawa Cardiovascular Centre, Ottawa, Ontario, Canada
| | - Robin J Taylor
- Worcestershire Acute Hospitals NHS Trust, Alexandra Hospital, Worcestershire, United Kingdom
| | - Howard Marshall
- University Hospitals Birmingham, Queen Elizabeth, Birmingham, United Kingdom
| | | | - William Moody
- University Hospitals Birmingham, Queen Elizabeth, Birmingham, United Kingdom
| | - Richard P Steeds
- University Hospitals Birmingham, Queen Elizabeth, Birmingham, United Kingdom
| | - Brian P Halliday
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Daniel J Hammersley
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Richard E Jones
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Sanjay K Prasad
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Tian Qiu
- University Hospitals Birmingham, Queen Elizabeth, Birmingham, United Kingdom
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Tammemagi M, Myers R, Ruparel M, Tremblay A, Atkar-Khattra S, Marshall H, Brims F, Mcwilliams A, Fogarty P, Stone E, Manser R, Canfell K, Lim K, Rosell A, Weber M, Yee J, Mayo J, Berg C, Lam D, Janes S, Fong K, Lam S. OA19.01 Prospective Study of Lung Cancer Screening Criteria: USPSTF2013 vs PLCOm2012 – International Lung Screening Trial (ILST) Results. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Zegard A, Okafor O, de Bono J, Kalla M, Lencioni M, Marshall H, Hudsmith L, Qiu T, Steeds R, Stegemann B, Leyva F. Greyzone myocardial fibrosis and ventricular arrhythmias in patients with a left ventricular ejection fraction >35. Europace 2021; 24:31-39. [PMID: 34379762 PMCID: PMC8742629 DOI: 10.1093/europace/euab167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Indexed: 11/15/2022] Open
Abstract
AIMS To determine whether myocardial fibrosis and greyzone fibrosis (GZF) on cardiovascular magnetic resonance (CMR) is associated with ventricular arrhythmias in patients with coronary artery disease (CAD) and a left ventricular ejection fraction (LVEF) >35%. METHODS AND RESULTS In this retrospective study of CAD patients, GZF mass using the 3SD method (GZF3SD) and total fibrosis mass using the 2SD method (TF2SD) on CMR were assessed in relation to the primary, combined endpoint of sudden cardiac death, ventricular tachycardia, ventricular fibrillation, or resuscitated cardiac arrest. Among 701 patients [age: 65.8 ± 12.3 years (mean ± SD)], 28 (3.99%) patients met the primary endpoint over 5.91 years (median; interquartile range 4.42-7.64). In competing risks analysis, a GZF3SD mass ≥5.0 g was strongly associated with the primary endpoint [subdistribution hazard ratio (sHR): 17.4 (95% confidence interval, CI 6.64-45.5); area under receiver operator characteristic curve (AUC): 0.85, P < 0.001]. A weaker association was observed for TF2SD mass ≥23 g [sHR 10.4 (95% CI 4.22-25.8); AUC: 0.80, P < 0.001]. The range of sHRs for GZF3SD mass (1-527) was wider than for TF2SD mass (1-37.6). CONCLUSIONS In CAD patients with an LVEF >35%, GZF3SD mass was strongly associated with the arrhythmic endpoint. These findings hold promise for its use in identifying patients with CAD and an LVEF >35% at risk of arrhythmic events.
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Affiliation(s)
- Abbasin Zegard
- Aston Medical School, Aston University, Birmingham, UK.,Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Birmingham, UK
| | - Osita Okafor
- Aston Medical School, Aston University, Birmingham, UK.,Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Birmingham, UK
| | - Joseph de Bono
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Birmingham, UK
| | - Manish Kalla
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Birmingham, UK
| | - Mauro Lencioni
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Birmingham, UK
| | - Howard Marshall
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Birmingham, UK
| | - Lucy Hudsmith
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Birmingham, UK
| | - Tian Qiu
- Aston Medical School, Aston University, Birmingham, UK
| | - Richard Steeds
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Birmingham, UK
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17
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Okafor O, Zegard A, Stegemann B, Arif S, De Bono J, Marshall H, Leyva F. Endocardial pacing is not haemodynamically superior to trans-coronary sinus epicardial pacing in cardiac resynchronization therapy: the Endo-Epi CRT study. Europace 2021. [DOI: 10.1093/europace/euab116.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Medtronic
Background
Cardiac resynchronization therapy (CRT) conventionally involves trans-coronary sinus, epicardial left ventricular (LV) pacing. Some studies have suggested that endocardial LV pacing may be superior to epicardial LV pacing.
Objectives
To compare the acute haemodynamic effects of CRT when delivered from endocardial (Endo-CRT) and epicardial LV stimulation sites (Epi-CRT).
Methods and results
Sixteen CRT recipients (aged 70.4 ± 10.1 years [mean ± SD], 62.5% male, QRS: 156.5 ± 16.1 ms, LBBB in 13 [81.3%]) in sinus rhythm underwent intra-procedural measurements of the rate of rise of LV pressure (dP/dtmax) during Endo- and Epi-CRT (RADI pressure wire). Epi-CRT was delivered in basal, mid and apical positions. The Endo-CRT pacing site was chosen using iterative, biplane fluoroscopic views, to target the same position as the Epi-CRT site on the endocardium (see Figure A). Compared to AAI pacing (10 beats per minute above intrinsic rate), both Endo-CRT and Epi-CRT led to an increase in LV dP/dtmax (6.52 ± 8.90% and 6.15 ± 7.97% respectively, both p < 0.001). There were no significant differences in the change in LV dP/dtmax (ΔLV dP/dtmax) between Endo-CRT and Epi-CRT at basal (p = 0.54), mid (p = 0.78) or apical LV stimulation sites (p = 0.12) [Figure B].
Conclusions
Endo-CRT is not haemodynamically superior to Epi-CRT. Abstract Figure.
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Affiliation(s)
- O Okafor
- Aston University, Aston Medical Research Institute, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - A Zegard
- Aston University, Aston Medical Research Institute, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - B Stegemann
- Aston University, Aston Medical Research Institute, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - S Arif
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - J De Bono
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - H Marshall
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - F Leyva
- Aston University, Aston Medical Research Institute, Birmingham, United Kingdom of Great Britain & Northern Ireland
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18
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Zegard A, Okafor O, Debono J, Kalla M, Lencioni M, Marshall H, Hudsmith L, Qiu T, Steeds R, Stegemann B, Leyva F. Grayzone myocardial fibrosis and ventricular arrhythmias in patients with a left ventricular ejection fraction greater than 35%. Europace 2021. [DOI: 10.1093/europace/euab116.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND Clinical guidelines adopt LVEF cut-offs <30 or <35% as an indication for implantable cardioverter defibrillator (ICD) therapy. Most patients succumbing to sudden cardiac death (SCD), however, have a LVEF≥35%.
OBJECTIVES To determine whether myocardial fibrosis (MF) and grayzone fibrosis (GZF) on cardiovascular magnetic resonance (CMR) is associated with ventricular arrhythmias in patients with coronary artery disease (CAD) and a LVEF≥35%.
METHODS In this retrospective study of CAD patients, GZF mass using the 3SD method (GZF3SD) and total fibrosis mass using the 2SD method (TF2SD) on CMR were assessed in relation to the primary, combined endpoint of SCD, ventricular tachycardia, ventricular fibrillation or resuscitated cardiac arrest.
RESULTS Among 701 patients (age: 65.8 ± 12.3 yrs [mean ± SD]), 28 (3.99%) patients met the primary endpoint over 5.91 years (median; interquartile range 4.42-7.64). In competing risks analysis, a GZF3SD mass ≥ 5.0 g was strongly associated with the primary endpoint (subdistribution hazard ratio [sHR]: 17.4 [95% CI 6.64-45.5]); area under receiver operator characteristic curve [AUC]: 0.85, p < 0.001). A weaker association was observed for TF2SD mass ≥ 23 g (HR: 10.4 [95% CI 4.22-25.8]; AUC: 0.80, p < 0.001). The range of sHRs for GZF3SD mass (1 to 526.6) was wider than for TF2SD mass (1 to 37.6).
CONCLUSIONS In CAD patients with a LVEF≥35%, GZF3SD mass was strongly associated with the arrhythmic endpoint. These findings hold promise for its use in identifying patients with CAD and a LVEF≥35% at risk of arrhythmic events. Abstract Figure.
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Affiliation(s)
- A Zegard
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - O Okafor
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - J Debono
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - M Kalla
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - M Lencioni
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - H Marshall
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - L Hudsmith
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - T Qiu
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - R Steeds
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - B Stegemann
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - F Leyva
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
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19
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Zegard A, Okafor O, Debono J, Kalla M, Lencioni M, Marshall H, Hudsmith L, Qiu T, Steeds R, Stegemann B, Leyva F. Myocardial fibrosis as a predictor of sudden death in patients with coronary artery disease. Europace 2021. [DOI: 10.1093/europace/euab116.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND The ‘grayzone’ of myocardial fibrosis (GZF) on cardiovascular magnetic resonance may be a substrate for ventricular arrhythmias (VAs).
OBJECTIVES To determine whether GZF predicts SCD and VAs (ventricular fibrillation or sustained ventricular tachycardia) in patients with coronary artery disease (CAD) and a wide range of LVEFs.
METHODS In this retrospective study of CAD patients, myocardial fibrosis presence on visual assessment (MFVA) and GZF mass in patients with MFVA was assessed in relation to SCD and the composite, arrhythmic endpoint of SCD or VAs.
RESULTS Among 979 patients (age: 65.8 ± 12.3 yrs [mean ± SD]), 29(2.96%) suffered a SCD and 80(8.17%) met the arrhythmic endpoint over 5.82 years (median; interquartile range: 4.1-7.3). In the whole cohort, MFVA was strongly associated with SCD (hazard ratio [HR]:10.1, 95% CI 1.42-1278.9) and the arrhythmic endpoint (HR:28.0, 95% CI 4.07-3525.4). In competing risks analyses, associations between LVEF < 35% and SCD (subdistribution HR [sHR]:2.99, 95% CI 1.42-6.31) and the arrhythmic endpoint (sHR:4.71, 95% CI 2.97-7.47) were weaker. In competing risks analyses of the MFVA subcohort (n = 832), GZF using the 3SD method (GZF3SD) > 5.0 g was strongly associated with SCD (sHR:10.8, 95% CI 3.74-30.9) and the arrhythmic endpoint (sHR:7.40, 95% CI 4.29-12.8). Associations between LVEF < 35% and SCD (sHR:2.62, 95% CI 1.24-5.52) and the arrhythmic endpoint (sHR:4.14, 95% CI 2.61-6.57) were weaker.
CONCLUSIONS In CAD patients, MFVA plus quantified GZF3SD mass was more strongly associated with SCD and VAs than LVEF. In selecting patients for implantable cardioverter defibrillators, assessment of MFVA followed by quantification of GZF3SD mass may be preferable to LVEF. Abstract Figure.
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Affiliation(s)
- A Zegard
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - O Okafor
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - J Debono
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - M Kalla
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - M Lencioni
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - H Marshall
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - L Hudsmith
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - T Qiu
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - R Steeds
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - B Stegemann
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - F Leyva
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
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20
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Blois SL, Marshall H, Abrams-Ogg ACG, Bersenas AM, Ruotsalo K, Monteith G. Accuracy of a point-of-care major crossmatch test and risk factors for major crossmatch incompatibility in cats. Vet J 2021; 272:105663. [PMID: 33941337 DOI: 10.1016/j.tvjl.2021.105663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
Major crossmatch testing can help identify immunologic incompatibilities between blood donors and recipients; however, there are limited studies describing the accuracy of point-of-care crossmatch tests. The first aim of this study was to determine if a gel-based, point-of-care major crossmatch method (GEL-CM), without antiglobulin-enhancement, could accurately detect compatible and incompatible donor-recipient pairings, using an antiglobulin-enhanced laboratory-based major crossmatch method (LAB-CM) as the reference standard. The second aim was to describe the incidence of, and risk factors for, major crossmatch incompatibility in cats. Nineteen previously-transfused cats and 32 transfusion-naïve cats, representing 132 unique donor-recipient pairings, were included in this study. Both LAB-CM and GEL-CM tests were performed for most parings. There was poor agreement between the LAB-CM and GEL-CM results (kappa = 0.111; 95% confidence interval [CI], -0.093 to 0.314). Transfusion-naïve cats had incompatibility rates of 3% and 6% using LAB-CM and GEL-CM, respectively; previously-transfused cats had incompatibility rates of 32% and 26% using LAB-CM and GEL-CM, respectively. History of previous transfusion was the only identified cat risk factor for an incompatible LAB-CM (odds ratio [OR], 31.0; 95% CI, 3.77-254.98; P = 0.0019) and GEL-CM (OR, 5.7; 95% CI, 1.72-19.20; P = 0.0054). Further studies are needed to determine if GEL-CM can detect clinically-relevant immunologic incompatibilities that would result in transfusion reactions. Major crossmatch testing is of greater importance in cats that have previously received a transfusion.
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Affiliation(s)
- S L Blois
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1, Canada.
| | - H Marshall
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - A C G Abrams-Ogg
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - A M Bersenas
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - K Ruotsalo
- Animal Health Laboratory, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - G Monteith
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1, Canada
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21
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Chacko S, Haseeb SB, Haseeb S, DeBono J, Marshall H. Diathermy-induced Ventricular Fibrillation. J Innov Card Rhythm Manag 2021; 12:4410-4412. [PMID: 33654572 PMCID: PMC7906566 DOI: 10.19102/icrm.2021.120203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/12/2020] [Indexed: 11/25/2022] Open
Abstract
Diathermy is extensively used in patients for intracardiac device implant and extraction. While diathermy helps with adequate hemostasis, it may rarely be associated with fatal dysrhythmias. We report a case of diathermy-induced ventricular fibrillation during device extraction. The case highlights the importance and supports the involvement of a defibrillation facility during pacemaker revisions requiring diathermy.
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Affiliation(s)
- Sanoj Chacko
- Heart Rhythm Service, Queen's University, Kingston, Ontario, Canada
| | - Saud B Haseeb
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sohaib Haseeb
- Heart Rhythm Service, Queen's University, Kingston, Ontario, Canada
| | - Joseph DeBono
- Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Howard Marshall
- Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2TH, UK
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22
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Patel N, Hopcraft K, O'Rourke R, Williamson A, Georgiou P, Yang I, Fong K, Marshall H. P44.05 Bone Density Measures Out-Perform Clinical Risk Scores in Detection of Vertebral Fractures in a Lung Cancer Screening Cohort. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.844] [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: 11/16/2022]
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23
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Roach KM, Castells E, Dixon K, Mason S, Elliott G, Marshall H, Poblocka MA, Macip S, Richardson M, Khalfaoui L, Bradding P. Evaluation of Pirfenidone and Nintedanib in a Human Lung Model of Fibrogenesis. Front Pharmacol 2021; 12:679388. [PMID: 34712131 PMCID: PMC8546112 DOI: 10.3389/fphar.2021.679388] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 09/27/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction: Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal lung disease with a poor prognosis and increasing incidence. Pirfenidone and nintedanib are the only approved treatments for IPF but have limited efficacy and their mechanisms of action are poorly understood. Here we have examined the effects of pirfenidone and nintedanib in a human model of lung fibrogenesis, and compared these with the putative anti-fibrotic compounds Lipoxin A4 (LXA4), and senicapoc, a KCa3.1 ion channel blocker. Methods: Early fibrosis was induced in cultured human lung parenchyma using TGFβ1 for 7 days, ± pirfenidone, nintedanib, or LXA4. Pro-fibrotic responses were examined by RT-PCR, immunohistochemistry and soluble collagen secretion. Results: Thirty six out of eighty four IPF and fibrosis-associated genes tested were significantly upregulated by TGFβ1 in human lung parenchyma with a ≥0.5 log2FC (n = 32). Nintedanib (n = 13) reduced the mRNA expression of 14 fibrosis-associated genes including MMPs (MMP1,-4,-13,-14), integrin α2, CXCR4 and PDGFB, but upregulated α-smooth muscle actin (αSMA). Pirfenidone only reduced mRNA expression for MMP3 and -13. Senicapoc (n = 11) previously attenuated the expression of 28 fibrosis-associated genes, including αSMA, several growth factors, collagen type III, and αV/β6 integrins. Pirfenidone and nintedanib significantly inhibited TGFβ1-induced fibroblast proliferation within the tissue, but unlike senicapoc, neither pirfenidone nor nintedanib prevented increases in tissue αSMA expression. LXA4 was ineffective. Conclusions: Pirfenidone and nintedanib demonstrate modest anti-fibrotic effects and provide a benchmark for anti-fibrotic activity of new drugs in human lung tissue. Based on these data, we predict that the KCa3.1 blocker senicapoc will show greater benefit than either of these licensed drugs in IPF.
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Affiliation(s)
- K M Roach
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, United Kingdom
| | - E Castells
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, United Kingdom
| | - K Dixon
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, United Kingdom
| | - S Mason
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, United Kingdom
| | - G Elliott
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, United Kingdom
| | - H Marshall
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, United Kingdom
| | - M A Poblocka
- Mechanisms of Cancer and Ageing Lab, Department of Molecular and Cell Biology, University of Leicester, Leicester, United Kingdom
| | - S Macip
- Mechanisms of Cancer and Ageing Lab, Department of Molecular and Cell Biology, University of Leicester, Leicester, United Kingdom.,FoodLab, Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - M Richardson
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, United Kingdom
| | - L Khalfaoui
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, United Kingdom
| | - P Bradding
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, United Kingdom
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24
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Leyva F, Zegard A, Okafor O, de Bono J, McNulty D, Ahmed A, Marshall H, Ray D, Qiu T. Survival after cardiac resynchronization therapy: results from 50 084 implantations. Europace 2020; 21:754-762. [PMID: 30590500 PMCID: PMC6479423 DOI: 10.1093/europace/euy267] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 10/20/2018] [Indexed: 11/21/2022] Open
Abstract
Aims Randomized controlled trials have shown that cardiac resynchronization therapy (CRT) prolongs survival in patients with heart failure. No studies have explored survival after CRT in relation to individuals in the general population (relative survival, RS). We sought to determine observed and RS after CRT in a nationwide cohort undergoing CRT. Methods and results A national administrative database was used to quantify observed mortality for patients undergoing CRT. Relative survival (RS) was quantified using life tables. In 50 084 patients [age 72.1 ± 11.6 years (mean ± standard deviation)] undergoing CRT with (CRT-D) (n = 25 273) or without (CRT-P) defibrillation (n = 24 811) over 8.8 years (median follow-up 2.7 years, interquartile range 1.3–4.8), expected survival decreased with age. Device type, male sex, ischaemic heart disease, diabetes, and chronic kidney disease predicted excess mortality. In multivariate analyses, excess mortality (analogue of RS) was lower after CRT-D than after CRT-P in all patients [adjusted hazard ratio (aHR) 0.80, 95% confidence interval (CI) 0.76–0.84] as well as in subgroups with (aHR 0.79, 95% CI 0.74–0.84) or without (aHR 0.82, 95% CI 0.74–0.91) ischaemic heart disease. A Charlson Comorbidity Index (CCI) ≥3 portended a higher excess mortality (aHR 3.04, 95% CI 2.76–3.34). Relative survival was higher in 2015–2017 than in 2009–2011 (aHR 0.64, 95% CI 0.59–0.69). Conclusion Reference RS data after CRT is presented. Sex, ischaemic heart disease, diabetes, chronic kidney disease, and CCI were major determinants of RS after CRT. CRT-D was associated with a higher RS than CRT-P in patients with or without ischaemic heart disease. Relative survival after CRT improved from 2009 to 2017.
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Affiliation(s)
- Francisco Leyva
- Aston Medical Research Institute, Aston University Medical School, Aston University, Birmingham, UK
| | - Abbasin Zegard
- Aston Medical Research Institute, Aston University Medical School, Aston University, Birmingham, UK
| | - Osita Okafor
- Aston Medical Research Institute, Aston University Medical School, Aston University, Birmingham, UK
| | | | | | - Asif Ahmed
- Aston Medical Research Institute, Aston University Medical School, Aston University, Birmingham, UK
| | | | - Daniel Ray
- NHS Digital and Farr Institute, London, UK
| | - Tian Qiu
- Queen Elizabeth Hospital, Birmingham, UK
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Seligmann JF, Wright-Hughes A, Pottinger A, Velikova G, Oughton JB, Murden G, Rizwanullah M, Price C, Passant H, Heudtlass P, Marshall H, Johnston S, Dodwell D. Lapatinib plus Capecitabine versus Trastuzumab plus Capecitabine in the Treatment of Human Epidermal Growth Factor Receptor 2-positive Metastatic Breast Cancer with Central Nervous System Metastases for Patients Currently or Previously Treated with Trastuzumab (LANTERN): a Phase II Randomised Trial. Clin Oncol (R Coll Radiol) 2020; 32:656-664. [PMID: 32600919 DOI: 10.1016/j.clon.2020.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/14/2020] [Accepted: 06/03/2020] [Indexed: 11/12/2022]
Abstract
AIMS Brain (central nervous system; CNS) metastases occur in 30-50% of patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC). A substantive evidence base for treatment is lacking, but activity with lapatinib plus capecitabine (lap-cap) has been reported. We compared lap-cap with trastuzumab plus capecitabine (tras-cap) in patients with HER2-positive MBC with CNS metastases previously treated with trastuzumab. MATERIALS AND METHODS This open-label randomised phase II screening trial aimed to randomise 130 participants over 2 years to receive lap-cap or tras-cap. Eligible patients had HER2-positive MBC with newly diagnosed or recently progressed CNS metastases; previous, or current, treatment included: trastuzumab, a taxane or anthracycline and recent completion of local cranial therapy. The primary end point was time to progression of CNS metastases within the 24-week trial period. Secondary objectives included CNS response rate, progression-free survival, steroid use for CNS symptoms and feasibility of recruitment to a large phase III trial. RESULTS Between September 2011 and October 2013, 30 participants were randomised, 16 to lap-cap and 14 to tras-cap. Recruitment to a large phase III trial was determined not to be feasible. At 24 weeks, CNS disease progression was 41.8% (95% confidence interval 16.1-67.5%) in lap-cap and 41.2% (95% confidence interval 12.8-69.6%) in tras-cap arms; progression-free survival was 44.4% (95% confidence interval 18.1-70.8%) in lap-cap and 50.0% (95% confidence interval 20.9-79.1%) in tras-cap arms. CONCLUSION Poor recruitment confirmed that a larger phase III trial would not be feasible and prohibited a preliminary evaluation of the superiority of lap-cap over tras-cap. Descriptive statistics are presented to inform the limited evidence base and future study design.
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Affiliation(s)
- J F Seligmann
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - A Wright-Hughes
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - A Pottinger
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - G Velikova
- St James's Institute of Oncology, St James University Hospital, Leeds, UK
| | - J B Oughton
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - G Murden
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - M Rizwanullah
- Department of Clinical Oncology, The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - C Price
- Department of Medical Oncology, University Hospitals, Bristol, UK
| | - H Passant
- Department of Medical Oncology, Velindre Hospital, Cardiff, UK
| | - P Heudtlass
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - H Marshall
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - S Johnston
- Department of Medical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - D Dodwell
- St James's Institute of Oncology, St James University Hospital, Leeds, UK; Nuffield Department of Population Health, Oxford University, Oxford, UK.
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Okafor O, Umar F, Zegard A, van Dam P, Walton J, Stegemann B, Marshall H, Leyva F. Effect of QRS area reduction and myocardial scar on the hemodynamic response to cardiac resynchronization therapy. Heart Rhythm 2020; 17:2046-2055. [PMID: 32717314 DOI: 10.1016/j.hrthm.2020.07.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/08/2020] [Accepted: 07/22/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Vectorcardiographic QRS area (QRSarea) predicts clinical outcomes after cardiac resynchronization therapy (CRT). Myocardial scar adversely affects clinical outcomes after CRT. OBJECTIVE The purpose of this study in patients with an ideally deployed quadripolar left ventricular (LV) lead (QUAD) was to determine whether reducing QRSarea leads to an acute hemodynamic response (AHR) and whether scar affects this interaction. METHODS Patients (n = 26; age 69.2 ± 9.12 years [mean ± SD]) underwent assessment of the maximum rate of change of LV pressure (ΔLV dP/dtmax) during CRT using various left ventricular pacing locations (LVPLs). Cardiac magnetic resonance (CMR) scan was used to localize LV myocardial scar. RESULTS Interindividually, ΔQRSarea (area under the receiver operating characteristic curve [AUC] 0.81; P <.001) and change in QRS duration (ΔQRSd) (AUC 0.76; P <.001) predicted ΔLV dP/dtmax after CRT. Scar burden correlated with ΔQRSarea (r = 0.35; P = .003), ΔQRSarea (r = 0.35; P = .003), and ΔQRSd (r = 0.46; P <.001). A reduction in QRSarea was observed with LVPLs remote from scar (-3.28 ± 38.1 μVs) or in LVPLs in patients with no scar at all (-43.8 ± 36.8 μVs), whereas LVPLs over scar increased QRSarea (22.2 ± 58.4 μVs) (P <.001 for all comparisons). LVPLs within 1 scarred LV segment were associated with lower ΔLV dP/dtmax (-2.21% ± 11.5%) than LVPLs remote from scar (5.23% ± 10.3%; P <.001) or LVPLs in patients with no scar at all (10.2% ± 7.75%) (both P <.001). CONCLUSION Reducing QRSarea improves the AHR to CRT. Myocardial scar adversely affects ΔQRSarea and the AHR. These findings may support the use of ΔQRSarea and CMR in optimizing CRT using QUAD.
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Affiliation(s)
- Osita Okafor
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, United Kingdom
| | - Fraz Umar
- Centre for Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Abbasin Zegard
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, United Kingdom
| | | | - Jamie Walton
- Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Berthold Stegemann
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, United Kingdom
| | | | - Francisco Leyva
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, United Kingdom.
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27
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Harji DP, Marshall H, Gordon K, Twiddy M, Pullan A, Meads D, Croft J, Burke D, Griffiths B, Verjee A, Sagar P, Stocken D, Brown J. Laparoscopic versus open colorectal surgery in the acute setting (LaCeS trial): a multicentre randomized feasibility trial. Br J Surg 2020; 107:1595-1604. [PMID: 32573782 DOI: 10.1002/bjs.11703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/11/2020] [Accepted: 04/22/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Approximately 30 000 people undergo major emergency abdominal gastrointestinal surgery annually, and 36 per cent of these procedures (around 10 800) are carried out for emergency colorectal pathology. Some 14 per cent of all patients requiring emergency surgery have a laparoscopic procedure. The aims of the LaCeS (laparoscopic versus open colorectal surgery in the acute setting) feasibility trial were to assess the feasibility, safety and acceptability of performing a large-scale definitive phase III RCT, with a comparison of emergency laparoscopic versus open surgery for acute colorectal pathology. METHODS LaCeS was designed as a prospective, multicentre, single-blind, parallel-group, pragmatic feasibility RCT with an integrated qualitative study. Randomization was undertaken centrally, with patients randomized on a 1 : 1 basis between laparoscopic or open surgery. RESULTS A total of 64 patients were recruited across five centres. The overall mean steady-state recruitment rate was 1·2 patients per month per site. Baseline compliance for clinical and health-related quality-of-life data was 99·8 and 93·8 per cent respectively. The conversion rate from laparoscopic to open surgery was 39 (95 per cent c.i. 23 to 58) per cent. The 30-day postoperative complication rate was 27 (13 to 46) per cent in the laparoscopic arm and 42 (25 to 61) per cent in the open arm. CONCLUSION Laparoscopic emergency colorectal surgery may have an acceptable safety profile. Registration number: ISRCTN15681041 ( http://www.controlled-trials.com).
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Affiliation(s)
- D P Harji
- Department of Colorectal Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - H Marshall
- Clinical Trials Research Unit, Leeds, UK
| | - K Gordon
- Clinical Trials Research Unit, Leeds, UK
| | - M Twiddy
- Institute of Clinical and Applied Health Research, University of Hull, Hull, UK
| | - A Pullan
- Clinical Trials Research Unit, Leeds, UK
| | - D Meads
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - J Croft
- Clinical Trials Research Unit, Leeds, UK
| | - D Burke
- Department of Colorectal Surgery, St James's University Hospital, Leeds, UK
| | - B Griffiths
- Department of Colorectal Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - A Verjee
- Patient and Public Involvement Representative for LaCeS Trial, UK
| | - P Sagar
- Department of Colorectal Surgery, St James's University Hospital, Leeds, UK
| | - D Stocken
- Clinical Trials Research Unit, Leeds, UK
| | - J Brown
- Clinical Trials Research Unit, Leeds, UK
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28
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Zegard A, Qiu T, Mcnulty D, Evison F, Okafor O, Marshall H, Gasparini M, Leyva F. 305Pacemaker therapy after cardiac valve replacement surgery: impact on heart failure hospitalizations. Europace 2020. [DOI: 10.1093/europace/euaa162.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Left ventricular (LV) function is a major determinant of long-term outcomes after valve replacement surgery. Although conventional (right ventricular) pacemaker therapy is life-saving, it may cause heart failure (HF).
Aims
To determine whether permanent pacemaker implantation (PPI) confers a risk of HF in surgical valve recipients.
Methods
The primary endpoint of HF hospitalization and the secondary endpoints of total mortality and total mortality / HF hospitalizations were compared in valve recipients with and without PPI. Traditional as well as multi-state, multivariable modelling was used to assess the influence of PPI on clinical outcomes.
Results
Amongst patients (n = 135,242) undergoing a first aortic (AVR; n = 111,674), mitral (MVR; n = 18,402) valve replacement, or AVR + MVR (n = 5,166) over 14 years in 176 centre, 12,952 (10.6%) had a PPI at any time during follow-up and 5,805 (4.3%) underwent PPI postoperatively. After 3.9 yrs (median, interquartile range: 6.1), heart failure (HF) hospitalizations (HR: 1.47, 95% C.I. 1.36-1.59), total mortality (HR: 1.10, 95% C.I. 1.05-1.16) and total mortality or HF hospitalizations (HR: 1.17, 95% C.I. 1.12-1.22; see figure) were higher in patients with post-operative PPI than in patients without. Multi-state modelling revealed that the transition hazard from PPI at any time to HF hospitalizations was markedly higher (transition hazard rate: 0.29, 95% C.I. 0.24-0.36) than from valve replacement surgery to HF hospitalization.
Conclusions
After valve replacement surgery, PPI is associated with increased HF hospitalization and total mortality, particularly after dual valve replacements.
Abstract Figure.
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Affiliation(s)
- A Zegard
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - T Qiu
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - D Mcnulty
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - F Evison
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - O Okafor
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - H Marshall
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - M Gasparini
- Humanitas Research Hospital, IRCCS, Electrophysiology and Pacing Unit, Rozzano, Italy
| | - F Leyva
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
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29
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Rattanakosit T, Franke K, Marshall H, Agbaedeng T, Sanders P, Lau D, Mahajan R. P1428The outcome of atrial fibrillation ablation in patients undergoing radiofrequency ablation, guided by novel indices incorporating force, time and power. Europace 2020. [DOI: 10.1093/europace/euaa162.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Ablation index (AI) and Lesion Size Index (LSI) are novel parameters that incorporates contact force, time, and power in a weighted formula. Recent studies have shown that such indices predict lesion size and durability of pulmonary vein isolation (PVI). However, the outcomes of ablation guided by indices of force-time-power, such as PV reconnections and atrial fibrillation recurrence, have not been well characterised.
Objectives
To determine the association between indices of force-time-power and acute PV reconnections, procedure and fluoroscopy time and AF recurrence in patients undergoing radiofrequency PVI.
Methods
PUBMED and EMBASE were searched using the terms "catheter ablation" AND "Ablation index" OR "Contact force" OR "Force time integral" OR "lesion size" from inception through 22 May 2019. Studies reporting the procedure time, ablation time, fluoroscopy time, and incidence of AI acute and late reconnection and AF recurrence were included.
Result
Six studies were included in this study with 530 patients, which n = 416 were paroxysmal AF and 114 non-paroxysmal AF. All procedural characteristics (procedure, radiofrequency, and fluoroscopy times) were similar between AI guided and non-AI guided ablation (p > 0.05). Two studies comparing mean PV reconnections in AI guided vs. AI Blinded. Two studies compared minimum AI in reconnected vs. non-reconnected PV segments. Acute PV segment reconnection was associated with a lower minimum AI vs. non-reconnection. In 3 studies reporting AI guided vs. AI blinded ablations, AI was associated with an increased freedom from AF after average follow-up of 12 months.
Conclusions
Radiofrequency ablation guided by AI/LSI was associated with lower acute PV reconnection rates and improved AF freedom after PVI. There was no difference in fluoroscopy, ablation or procedure time with the use of these novel parameters.
Abstract Figure.
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Affiliation(s)
- T Rattanakosit
- South Australian Health and Medical Research Institute, Centre of Heart Rhythm Disorder , Adelaide, Australia
| | - K Franke
- South Australian Health and Medical Research Institute, Centre of Heart Rhythm Disorder , Adelaide, Australia
| | - H Marshall
- South Australian Health and Medical Research Institute, Centre of Heart Rhythm Disorder , Adelaide, Australia
| | - T Agbaedeng
- South Australian Health and Medical Research Institute, Centre of Heart Rhythm Disorder , Adelaide, Australia
| | - P Sanders
- South Australian Health and Medical Research Institute, Centre of Heart Rhythm Disorder , Adelaide, Australia
| | - D Lau
- South Australian Health and Medical Research Institute, Centre of Heart Rhythm Disorder , Adelaide, Australia
| | - R Mahajan
- South Australian Health and Medical Research Institute, Centre of Heart Rhythm Disorder , Adelaide, Australia
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Zegard A, Okafor O, de Bono J, Steeds R, Hudsmith L, Stegemann B, Jani A, Marshall H, Holloway B, Leyva F. Prognosis of incidental left bundle branch block. Europace 2020; 22:956-963. [PMID: 32285097 DOI: 10.1093/europace/euaa008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/09/2020] [Indexed: 01/01/2023] Open
Abstract
AIMS Incidental left bundle branch block (iLBBB) is a frequent cause for cardiology referrals. In such instances, there is uncertainty as to its prognosis. We sought to determine the utility of cardiovascular magnetic resonance (CMR) in the risk stratification of patients with iLBBB. METHODS AND RESULTS Clinical events were collected in patients with iLBBB who had CMR. Controls had no cardiac symptoms or cardiac disease, a normal CMR scan and electrocardiogram. Amongst patients with iLBBB [n = 193, aged 62.7 ± 12.6 years (mean ± SD)], 110/193 (56.9%) had an abnormal phenotype (iLBBBCMR+) and 83/110 (43.0%) had a normal phenotype (iLBBBCMR-). Over 3.75 years (median; inter-quartile range: 2.7-5.5), iLBBBCMR+ had a higher total mortality [adjusted hazard ratio (aHR) 6.49, 95% confidence interval (CI) 1.91-22.0] and total mortality or major adverse cardiac events (MACEs; aHR 9.15, 95% CI 2.56-32.6) than controls (n = 107). In contrast, iLBBBCMR- had a similar risk of total mortality compared with controls, but total mortality or MACEs was higher (aHR 4.24, 95% CI 1.17-15.4; P = 0.028). Amongst iLBBB patients, both myocardial fibrosis (aHR 5.15, 95% CI 1.53-17.4) and left ventricular ejection fraction (LVEF) ≤ 50% (aHR 3.88, 95% CI 1.67-9.06) predicted total mortality. Myocardial fibrosis plus LVEF ≤50% was associated with the highest risk of total mortality (aHR: 9.87, 95% CI 2.99-32.6) and total mortality or MACEs (aHR 3.98, 95% CI 1.73-9.11). CONCLUSIONS Outcomes in iLBBBCMR+ were poor whereas survival in iLBBBCMR- was comparable with controls. Myocardial fibrosis and LVEF <50% had an additive effect on the risk of clinical outcomes. A CMR scan is pivotal in risk-stratifying patients with iLBBB.
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Affiliation(s)
- Abbasin Zegard
- Department of Cardiology, Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham B15 2TH, UK
| | - Osita Okafor
- Department of Cardiology, Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham B15 2TH, UK
| | - Joseph de Bono
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Richard Steeds
- Department of Cardiology, Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham B15 2TH, UK
| | - Lucy Hudsmith
- Department of Cardiology, Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham B15 2TH, UK
| | - Berthold Stegemann
- Department of Cardiology, Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham B15 2TH, UK
| | - Ayman Jani
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Howard Marshall
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Ben Holloway
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Francisco Leyva
- Department of Cardiology, Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham B15 2TH, UK
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Menzies R, Heron L, Lampard J, McMillan M, Joseph T, Chan J, Storken A, Marshall H. A randomised controlled trial of SMS messaging and calendar reminders to improve vaccination timeliness in infants. Vaccine 2020; 38:3137-3142. [PMID: 32147296 DOI: 10.1016/j.vaccine.2020.02.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/11/2020] [Accepted: 02/16/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The effectiveness of SMS reminders in improving vaccination coverage has been assessed previously, with effectiveness varying between settings. However, there are very few studies on their effect on the timeliness of vaccination. DESIGN Unblinded, randomised controlled trial with blocked sampling. METHODS 1594 Australian infants and young children were recruited to assess the impact of (1) SMS reminders only, (2) a personalised calendar, (3) SMS reminder and personalised calendar and (4) no intervention, on receipt of vaccine within 30 days of the due date. Outcomes were measured for receipt of vaccines due at 2, 4, 6, 12 and 18 months of age. A post-hoc assessment was also conducted of the impact of a new national "No jab No Pay" policy introduced during the trial, which removed philosophical objections as an exemption for financial penalties for non-vaccination. RESULTS There was a statistically significant improvement in on-time vaccination only at the 12 month schedule point amongst infants who received SMS reminders alone (RR 1.09, 95% CI 1.01-1.18) or in combination with a personalised calendar (1.11, CI 1.03-1.20) compared to controls. This impact was limited to participants who had received one or more previous doses late. No statistically significant impacts of calendar interventions alone were seen. There was a high rate of on-time compliance amongst control participants - 95%, 86%, 80%, 74% at the 4, 6, 12 and 18 month schedule points respectively, which increased more than 10 percentage points after implementation of the "No Jab, No Pay" policy. CONCLUSIONS SMS reminders are more effective in improving timeliness where pre-existing compliance is lower, but the 18 month schedule point appeared to be less amenable to intervention. Australia and New Zealand Clinical Trial Registration No. ACTRN12614000970640.
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Affiliation(s)
- R Menzies
- Kirby Institute, University of New South Wales, Kensington, NSW, Australia.
| | - L Heron
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, NSW, Australia; Kids Research Institute, The Children's Hospital Westmead, Westmead, NSW, Australia
| | - J Lampard
- Kids Research Institute, The Children's Hospital Westmead, Westmead, NSW, Australia
| | - M McMillan
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - T Joseph
- Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - J Chan
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, NSW, Australia; National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - A Storken
- Department of Health, South Australia, Adelaide, SA, Australia
| | - H Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
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32
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Ahmed I, Loudon BL, Abozguia K, Cameron D, Shivu GN, Phan TT, Maher A, Stegemann B, Chow A, Marshall H, Nightingale P, Leyva F, Vassiliou VS, McKenna WJ, Elliott P, Frenneaux MP. Biventricular pacemaker therapy improves exercise capacity in patients with non-obstructive hypertrophic cardiomyopathy via augmented diastolic filling on exercise. Eur J Heart Fail 2020; 22:1263-1272. [PMID: 31975494 PMCID: PMC7540697 DOI: 10.1002/ejhf.1722] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/19/2019] [Accepted: 11/26/2019] [Indexed: 11/11/2022] Open
Abstract
AIMS Treatment options for patients with non-obstructive hypertrophic cardiomyopathy (HCM) are limited. We sought to determine whether biventricular (BiV) pacing improves exercise capacity in HCM patients, and whether this is via augmented diastolic filling. METHODS AND RESULTS Thirty-one patients with symptomatic non-obstructive HCM were enrolled. Following device implantation, patients underwent detailed assessment of exercise diastolic filling using radionuclide ventriculography in BiV and sham pacing modes. Patients then entered an 8-month crossover study of BiV and sham pacing in random order, to assess the effect on exercise capacity [peak oxygen consumption (VO2 )]. Patients were grouped on pre-specified analysis according to whether left ventricular end-diastolic volume increased (+LVEDV) or was unchanged/decreased (-LVEDV) with exercise at baseline. Twenty-nine patients (20 male, mean age 55 years) completed the study. There were 14 +LVEDV patients and 15 -LVEDV patients. Baseline peak VO2 was lower in -LVEDV patients vs. +LVEDV patients (16.2 ± 0.9 vs. 19.9 ± 1.1 mL/kg/min, P = 0.04). BiV pacing significantly increased exercise ΔLVEDV (P = 0.004) and Δstroke volume (P = 0.008) in -LVEDV patients, but not in +LVEDV patients. Left ventricular ejection fraction and end-systolic elastance did not increase with BiV pacing in either group. This translated into significantly greater improvements in exercise capacity (peak VO2 + 1.4 mL/kg/min, P = 0.03) and quality of life scores (P = 0.02) in -LVEDV patients during the crossover study. There was no effect on left ventricular mechanical dyssynchrony in either group. CONCLUSION Symptomatic patients with non-obstructive HCM may benefit from BiV pacing via augmentation of diastolic filling on exercise rather than contractile improvement. This may be due to relief of diastolic ventricular interaction. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT00504647.
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Affiliation(s)
- Ibrar Ahmed
- Department of Cardiovascular Medicine, University of Birmingham, Birmingham, UK
| | - Brodie L Loudon
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Khalid Abozguia
- Department of Cardiovascular Medicine, University of Birmingham, Birmingham, UK.,Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK
| | - Donnie Cameron
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Ganesh N Shivu
- Department of Cardiovascular Medicine, University of Birmingham, Birmingham, UK
| | - Thanh T Phan
- Department of Cardiovascular Medicine, University of Birmingham, Birmingham, UK.,Cardiology Department, Royal Stoke University Hospital UHNM NHS Trust, Newcastle, UK
| | - Abdul Maher
- Department of Cardiovascular Medicine, University of Birmingham, Birmingham, UK
| | | | - Anthony Chow
- Department of Cardiovascular Medicine, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Howard Marshall
- Queen Elizabeth Hospital Birmingham, Welcome Trust Clinical Research Facility, Birmingham, UK
| | - Peter Nightingale
- Queen Elizabeth Hospital Birmingham, Welcome Trust Clinical Research Facility, Birmingham, UK
| | - Francisco Leyva
- Department of Cardiovascular Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | | | - William J McKenna
- Institute of Cardiovascular Science, University College of London, London, UK
| | - Perry Elliott
- Institute of Cardiovascular Science, University College of London, London, UK
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Swinson D, Hall P, Lord S, Marshall H, Ruddock S, Allmark C, Cairns D, Waters J, Wadsley J, Falk S, Roy R, Joseph M, Nicoll J, Kamposioras K, Tillett T, Cummins S, Grumett S, Stokes Z, Waddell T, Chatterjee A, Garcia A, Khan M, Petty R, Seymour M. OPTIMIZING CHEMOTHERAPY FOR FRAIL AND/OR ELDERLY PATIENTS WITH ADVANCED GASTROESOPHAGEAL CANCER (AGOAC): THE GO2 PHASE III TRIAL. J Geriatr Oncol 2019. [DOI: 10.1016/s1879-4068(19)31133-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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34
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Okafor O, Zegard A, van Dam P, Stegemann B, Qiu T, Marshall H, Leyva F. Changes in QRS Area and QRS Duration After Cardiac Resynchronization Therapy Predict Cardiac Mortality, Heart Failure Hospitalizations, and Ventricular Arrhythmias. J Am Heart Assoc 2019; 8:e013539. [PMID: 31657269 PMCID: PMC6898809 DOI: 10.1161/jaha.119.013539] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Predicting clinical outcomes after cardiac resynchronization therapy (CRT) and its optimization remain a challenge. We sought to determine whether pre‐ and postimplantation QRS area (QRSarea) predict clinical outcomes after CRT. Methods and Results In this retrospective study, QRSarea, derived from pre‐ and postimplantation vectorcardiography, were assessed in relation to the primary end point of cardiac mortality after CRT with or without defibrillation. Other end points included total mortality, total mortality or heart failure (HF) hospitalization, total mortality or major adverse cardiac events, and the arrhythmic end point of sudden cardiac death or ventricular arrhythmias with or without a shock. In patients (n=380, age 72.0±12.4 years, 68.7% male) undergoing CRT over 7.7 years (median follow‐up: 3.8 years [interquartile range 2.3–5.3]), preimplantation QRSarea ≥102 μVs predicted cardiac mortality (HR: 0.36; P<0.001), independent of QRS duration (QRSd) and morphology (P<0.001). A QRSarea reduction ≥45 μVs after CRT predicted cardiac mortality (HR: 0.19), total mortality (HR: 0.50), total mortality or heart failure hospitalization (HR: 0.44), total mortality or major adverse cardiac events (HR: 0.43) (all P<0.001) and the arrhythmic end point (HR: 0.26; P<0.001). A concomitant reduction in QRSarea and QRSd was associated with the lowest risk of cardiac mortality and the arrhythmic end point (both HR: 0.12, P<0.001). Conclusions Pre‐implantation QRSarea, derived from vectorcardiography, was superior to QRSd and QRS morphology in predicting cardiac mortality after CRT. A postimplant reduction in both QRSarea and QRSd was associated with the best outcomes, including the arrhythmic end point.
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Affiliation(s)
- Osita Okafor
- Aston Medical Research Institute Aston Medical School Aston University Birmingham United Kingdom
| | - Abbasin Zegard
- Aston Medical Research Institute Aston Medical School Aston University Birmingham United Kingdom
| | | | - Berthold Stegemann
- Aston Medical Research Institute Aston Medical School Aston University Birmingham United Kingdom
| | - Tian Qiu
- Aston Medical Research Institute Aston Medical School Aston University Birmingham United Kingdom.,Queen Elizabeth Hospital Birmingham United Kingdom
| | | | - Francisco Leyva
- Aston Medical Research Institute Aston Medical School Aston University Birmingham United Kingdom
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35
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Franke K, Marshall H, Worthley M, Psaltis PJ. P3646A systematic review and meta-analysis on spontaneous coronary artery dissection: epidemiology, risk factors and outcomes. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Spontaneous Coronary Artery Dissection (SCAD) is an elusive but increasingly recognised cause of Acute Coronary Syndrome (ACS). Most knowledge about SCAD has arisen from small to medium sized cohort studies that have been published since 2012.
Purpose
This systematic review and meta-analysis aimed to provide an update on SCAD's association with cardiovascular risk factors, angiographic variants and outcomes.
Methods
The term “Spontaneous Coronary Artery Dissection” was searched in PubMed, EMBASE and SCOPUS on the 2nd of February 2019, yielding a total of 1517 articles. Following exclusion (e.g. of isolated case reports and duplicate cohorts), 31 original studies that reported at least one desired parameter in patients with SCAD were included. Statistical analysis was performed independently for each parameter using random effects models.
Results
Of the k=31 studies (n=77,025 patients), only 3 were published before 2012 (n=68). Mean age was 62.4 years and 85.1% [78.9%-89.8%, I2=91.7, k=28] were female. Prevalence of associated conditions and traditional cardiovascular risk factors are outlined in the table. Importantly, only 37.4% [30.0%-45.4%, I2=77.0, k=10] were associated with a traditional Type 1 angiographic appearance. Yearly incidence was 3.4% [2.4%-4.4%, I2=73.4, k=16] for SCAD recurrence and 5.8% [4.1%-7.5%, I2=85.7, k=16] for MACE. Incidence of MACE at follow-up was 4.1% [1.7%-9.9%, I2=74.0, k=3] for conservative treatment and 7.2% [5.1%-10.3%, I2=43.7, k=4] for PCI (p=0.14).
Estimated prevalence of traditional cardiovascular risk factors, associated conditions and angiographic variants in cohorts of patients with SCAD Associated Patient Factor Number of Studies Prevalence (%, [95% CI]) Heterogeneity (I2) Hypertension 29 36.0 [29.9–42.6] 97.9% Dyslipidemia 27 28.7 [17.4–43.5] 99.7% Smoking 29 23.3 [14.5–35.3] 99.6% Depression/Anxiety 6 28.1 [19.3–38.9] 94.3% Fibromuscular Dysplasia 9 50.7 [40.0–61.3] 91.9% Type 1 Angiographic Appearance 11 37.4 [30.0–45.4] 77.0% Type 2 Angiographic Appearance 11 62.4 [50.0–73.3] 93.3% Type 3 Angiographic Appearance 6 10.2 [6.2–16.4] 78.3%
Incidence of Recurrence in SCAD Cohorts
Conclusions
This meta-analysis confirms associations of SCAD with fibromuscular dysplasia, anxiety and depression, and reveals a small but important risk of recurrence and MACE. Furthermore, a majority of SCAD cases present with non-traditional angiographic appearances highlighting the need for increased familiarity with this condition among treating physicians.
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Affiliation(s)
- K Franke
- University of Adelaide, and South Australian Health and Medical Research Institute, Adelaide, Australia
| | - H Marshall
- University of Adelaide, Adelaide, Australia
| | - M Worthley
- University of Adelaide, Adelaide, Australia
| | - P J Psaltis
- University of Adelaide, and South Australian Health and Medical Research Institute, Adelaide, Australia
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36
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Franke K, Marshall H, Kennewell P, Pham HD, Rattanakosit T, Aboustate N, Tully P, Mahajan R. P989Incidence of appropriate implantable cardioverter defibrillator therapy and sudden cardiac death in cardiac sarcoidosis - a systematic review and meta-analysis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Implantation of implantable cardioverter defibrillator (ICD) is a Class IIb indication in patients with Cardiac Sarcoid and with LVEF 36%-49% despite immunosuppression and optimal heart failure therapy.
Purpose
This systematic review and meta-analysis aimed to provide an estimate on the incidence of ventricular arrhythmias and risk of sudden cardiac death (SCD) in patients with CS.
Methods
The terms “Cardiac Sarcoidosis*” AND “Implantable Cardioverter Defibrillator” AND “Sudden Cardiac Death” were searched on PubMed, EMBASE, and Scopus on 21st of September 2018 yielding 759 articles. After exclusions, 12 studies met inclusion criteria.
Results
The 12 studies consisted of 612 patients with CS of which 534 had ICD implanted for primary or secondary prevention. Assuming appropriate device therapy as a surrogate for SCD, the annual incidence of appropriate ICD therapies and SCD combined was 6.3% (95% CI; 3.5%-9.1%) in primary prevention cohorts, 11.6% (95% CI; 7.8%-15.3%) in secondary prevention cohorts, and 8.7% (95% CI; 6.0%-11.5%) in both cohorts. The mean left ventricular ejection fraction (LVEF) was pooled as 59±7 (n=155) in primary prevention cohorts and 48±15 (n=48) in secondary prevention cohorts. However, the LVEF was 35±13 (n=28) in those with appropriate ICD therapy, and 49±16 (n=47) in those with ICDs without therapy.
Incidence of SCD in Combined Cohorts
Conclusion
The incidence of ventricular arrhythmias and SCD is high not only secondary but also in primary prevention cohorts of CS. This data supports the role of implanting ICDs for primary prevention in patients with CS with mild to moderate reduction in LVEF.
Acknowledgement/Funding
None
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Affiliation(s)
- K Franke
- University of Adelaide, and South Australian Health and Medical Research Institute, Adelaide, Australia
| | - H Marshall
- University of Adelaide, Adelaide, Australia
| | | | - H D Pham
- University of Adelaide, Adelaide, Australia
| | - T Rattanakosit
- University of Adelaide, and South Australian Health and Medical Research Institute, Adelaide, Australia
| | - N Aboustate
- University of Adelaide, and South Australian Health and Medical Research Institute, Adelaide, Australia
| | - P Tully
- University of Adelaide, and South Australian Health and Medical Research Institute, Adelaide, Australia
| | - R Mahajan
- University of Adelaide, South Australian Health and Medical Research Institute, and Lyell McEwin Hospital, Adelaide, Australia
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37
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Hall P, Swinson D, Lord S, Handforth C, Cairns D, Marshall H, Petty R, Bennett M, Velikova G, Seymour M. Chemotherapy for frail and elderly patients (pts) with advanced gastroesophageal cancer (aGOAC): Quality of Life (QoL) results from the GO2 phase III trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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38
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Bebane PSA, Hunt BJ, Pegoraro M, Jones ARC, Marshall H, Rosato E, Mallon EB. The effects of the neonicotinoid imidacloprid on gene expression and DNA methylation in the buff-tailed bumblebee Bombus terrestris. Proc Biol Sci 2019; 286:20190718. [PMID: 31213186 PMCID: PMC6599982 DOI: 10.1098/rspb.2019.0718] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/27/2019] [Indexed: 02/07/2023] Open
Abstract
Neonicotinoids are effective insecticides used on many important arable and horticultural crops. They are nicotinic acetylcholine receptor agonists which disrupt the function of insect neurons and cause paralysis and death. In addition to direct mortality, there are numerous sublethal effects of low doses of neonicotinoids on bees. We hypothesize that some of these large array of effects could be a consequence of epigenetic changes in bees induced by neonicotinoids. We compared whole methylome (BS-seq) and RNA-seq libraries of the brains of buff-tailed bumblebee Bombus terrestris workers exposed to field-realistic doses of the neonicotinoid imidacloprid to libraries from control workers. We found numerous genes which show differential expression between neonicotinoid-treated bees and control bees, but no differentially methylated cytosines in any context. We found CpG methylation to be focused mainly in exons and associated with highly expressed genes. We discuss the implications of our results for future legislation.
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Affiliation(s)
- P S A Bebane
- 1 Department of Genetics and Genome Biology, University of Leicester, University Road , Leicester LE1 7RH , UK
| | - B J Hunt
- 2 School of Natural Sciences and Psychology, John Moores University Liverpool , Liverpool L3 3AF , UK
| | - M Pegoraro
- 1 Department of Genetics and Genome Biology, University of Leicester, University Road , Leicester LE1 7RH , UK
| | - A R C Jones
- 1 Department of Genetics and Genome Biology, University of Leicester, University Road , Leicester LE1 7RH , UK
| | - H Marshall
- 1 Department of Genetics and Genome Biology, University of Leicester, University Road , Leicester LE1 7RH , UK
| | - E Rosato
- 1 Department of Genetics and Genome Biology, University of Leicester, University Road , Leicester LE1 7RH , UK
| | - E B Mallon
- 1 Department of Genetics and Genome Biology, University of Leicester, University Road , Leicester LE1 7RH , UK
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39
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Leyva F, Zegard A, Umar F, Taylor RJ, Acquaye E, Gubran C, Chalil S, Patel K, Panting J, Marshall H, Qiu T. Long-term clinical outcomes of cardiac resynchronization therapy with or without defibrillation: impact of the aetiology of cardiomyopathy. Europace 2019; 20:1804-1812. [PMID: 29697764 PMCID: PMC6212789 DOI: 10.1093/europace/eux357] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 09/05/2017] [Accepted: 12/11/2017] [Indexed: 12/20/2022] Open
Abstract
Aims There is a continuing debate as to whether cardiac resynchronization therapy-defibrillation (CRT-D) is superior to CRT-pacing (CRT-P), particularly in patients with non-ischaemic cardiomyopathy (NICM). We sought to quantify the clinical outcomes after primary prevention of CRT-D and CRT-P and identify whether these differed according to the aetiology of cardiomyopathy. Methods and results Analyses were undertaken in the total study population of patients treated with CRT-D (n = 551) or CRT-P (n = 999) and in propensity-matched samples. Device choice was governed by the clinical guidelines in the United Kingdom. In univariable analyses of the total study population, for a maximum follow-up of 16 years (median 4.7 years, interquartile range 2.4–7.1), CRT-D was associated with a lower total mortality [hazard ratio (HR) 0.72] and the composite endpoints of total mortality or heart failure (HF) hospitalization (HR 0.72) and total mortality or hospitalization for major adverse cardiac events (MACE; HR 0.71) (all P < 0.001). After propensity matching (n = 796), CRT-D was associated with a lower total mortality (HR 0.72) and the composite endpoints (all P < 0.01). When further stratified according to aetiology, CRT-D was associated with a lower total mortality (HR 0.62), total mortality or HF hospitalization (HR 0.63), and total mortality or hospitalization for MACE (HR 0.59) (all P < 0.001) in patients with ischaemic cardiomyopathy (ICM). There were no differences in outcomes between CRT-D and CRT-P in patients with NICM. Conclusion In this study of real-world clinical practice, CRT-D was superior to CRT-P with respect to total mortality and composite endpoints, independent of known confounders. The benefit of CRT-D was evident in ICM but not in NICM.
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Affiliation(s)
- Francisco Leyva
- Aston Medical Research Institute, Aston Medical School, Aston University, Aston Triangle, Birmingham, UK
| | - Abbasin Zegard
- Aston Medical Research Institute, Aston Medical School, Aston University, Aston Triangle, Birmingham, UK
| | - Fraz Umar
- Centre for Cardiovascular Sciences, University of Birmingham, United Kingdom Queen Elizabeth Hospital, Metchley Drive, Birmingham, UK
| | - Robin James Taylor
- Centre for Cardiovascular Sciences, University of Birmingham, United Kingdom Queen Elizabeth Hospital, Metchley Drive, Birmingham, UK
| | - Edmund Acquaye
- Queen Elizabeth Hospital, Metchley Drive, Birmingham, UK
| | | | - Shajil Chalil
- Centre for Cardiovascular Sciences, University of Birmingham, United Kingdom Queen Elizabeth Hospital, Metchley Drive, Birmingham, UK
| | - Kiran Patel
- Heart of England NHS Trust, Bordesley Green E, Birmingham, UK.,University of Warwick, Coventry, UK
| | | | | | - Tian Qiu
- Queen Elizabeth Hospital, Metchley Drive, Birmingham, UK
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40
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Smith L, Hughes D, Chan HF, Johnson K, Bray J, Rodgers O, Collier G, Norquay G, Biancardi A, Hughes P, Kotecha S, Wildman M, West N, Horsley A, Marshall H, Wild J. WS17-2 The sensitivity of MRI to detect both functional and structural lung abnormalities in sub-clinical cystic fibrosis. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30218-8] [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: 10/26/2022]
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41
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Smith L, Marshall H, Norquay G, Collier G, Rodgers O, Hughes P, Biancardi A, West N, Wildman M, Horsley A, Wild J. P211 129Xe ventilation MRI and LCI to assess acute maximal exercise as a method of airway clearance. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30504-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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42
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Smith L, Collier G, Marshall H, Hughes P, Biancardi A, Norquay G, Bray J, Rodgers O, Wildman M, West N, Horsley A, Wild J. P212 Ventilation MRI tracks longitudinal lung function changes in patients with cystic fibrosis and clinically stable FEV1 and Lung Clearance Index. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30505-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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43
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Leyva F, Zegard A, Qiu T, de Bono J, Thorne S, Clift P, Marshall H, Hudsmith L. Long-term outcomes of cardiac resynchronization therapy in adult congenital heart disease. Pacing Clin Electrophysiol 2019; 42:573-580. [PMID: 30908673 PMCID: PMC6850101 DOI: 10.1111/pace.13670] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 11/23/2018] [Accepted: 12/21/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Randomized, controlled trials of cardiac resynchronization therapy (CRT) excluded patients with adult congenital heart disease (ACHD). We sought to explore long-term clinical outcomes. METHODS AND RESULTS In this single-center, observational study, events were collected from hospital records on patients with structural ACHD (sACHD) and adults with ischemic (ICM) or nonischemic (NICM) cardiomyopathy undergoing CRT. Patients with sACHD (n = 23, age: 41.6 ± 13.5 years [mean ± standard deviation]) and adults with ICM (n = 533) or NICM (n = 458) were followed-up for 4.1 years (median; interquartile range: 2.2-6.1). Total mortality was 5/23 (21.7%; 4.4 per 100 person-years) in sACHD, 221/533 (41.5%; 11.8 per 100 person-years) in ICM, and 154/458 (33.6%; 9.7 per 100 person-years) in NICM. In univariate analyses, total mortality in sACHD was lower than in ICM (hazard ratio [HR]: 0.38; 95% confidence interval [CI] 0.15-0.91), but similar to NICM (HR: 0.48, 95% CI 0.20-1.16). Cardiac mortality in sACHD was similar to ICM (HR: 0.78, 95% CI 0.32-1.92) and NICM (HR: 1.12, 95% CI 0.45-2.78). Heart failure (HF) hospitalization rates were similar to ICM (HR: 0.44, 95% CI 0.11-1.77) and NICM (HR: 0.75, 95% CI 0.18-3.08). In multivariate analyses, no differences emerged in total mortality, cardiac mortality, or HF hospitalization between sACHD and NICM or ICM, after adjustment for age, sex, New York Heart Association class, diabetes, atrial rhythm, QRS duration, QRS morphology, systemic ventricular ejection fraction, and medical therapy. CONCLUSION Total mortality, cardiac mortality, and HF hospitalization after CRT in patients with sACHD was similar to adults with ICM or NICM.
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Affiliation(s)
- Francisco Leyva
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, UK
| | - Abbasin Zegard
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, UK
| | - Tian Qiu
- Quality and Outcomes Research Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Joseph de Bono
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Sara Thorne
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Paul Clift
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Howard Marshall
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Lucy Hudsmith
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
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44
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Leyva F, Zegard A, Taylor R, Foley PWX, Umar F, Patel K, Panting J, Ferro CJ, Chalil S, Marshall H, Qiu T. Renal function and the long-term clinical outcomes of cardiac resynchronization therapy with or without defibrillation. Pacing Clin Electrophysiol 2019; 42:595-602. [PMID: 30873640 PMCID: PMC6850577 DOI: 10.1111/pace.13659] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 11/30/2022]
Abstract
Background and Aims Patients with moderate‐to‐severe chronic kidney disease (CKD) are underrepresented in clinical trials of cardiac resynchronization therapy (CRT)‐defibrillation (CRT‐D) or CRT‐pacing (CRT‐P). We sought to determine whether outcomes after CRT‐D are better than after CRT‐P over a wide spectrum of CKD. Methods and Results Clinical events were quantified in relation to preimplant estimated glomerular filtration rate (eGFR) after CRT‐D (n = 410 [39.2%]) or CRT‐P (n = 636 [60.8%]) implantation. Over a follow‐up period of 3.7 years (median, interquartile range: 2.1–5.7), the eGFR < 60 group (n = 598) had a higher risk of total mortality (adjusted hazard ratio [aHR]: 1.28; P = 0.017), total mortality or heart failure (HF) hospitalization (aHR: 1.32; P = 0.004), total mortality or hospitalization for major adverse cardiac events (MACEs, aHR: 1.34; P = 0.002), and cardiac mortality (aHR: 1.33; P = 0.036), compared to the eGFR ≥ 60 group (n = 448), after covariate adjustment. In analyses of CRT‐D versus CRT‐P, CRT‐D was associated with a lower risk of total mortality (eGFR ≥ 60 HR: 0.65; P = 0.028; eGFR < 60 HR: 0.64, P = 0.002), total mortality or HF hospitalization (eGFR ≥ 60 aHR: 0.66; P = 0.021; eGFR < 60 aHR: 0.69, P = 0.007), total mortality or hospitalization for MACEs (eGFR ≥ 60 aHR: 0.70; P = 0.039; eGFR < 60 aHR: 0.69, P = 0.005), and cardiac mortality (eGFR ≥ 60 aHR: 0.60; P = 0.026; eGFR < 60 aHR: 0.55; P = 0.003). Conclusion In CRT recipients, moderate CKD is associated with a higher mortality and morbidity compared to normal renal function or mild CKD. Despite less favorable absolute outcomes, patients with moderate CKD had better outcomes after CRT‐D than after CRT‐P.
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Affiliation(s)
- Francisco Leyva
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, United Kingdom
| | - Abbasin Zegard
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, United Kingdom
| | - Robin Taylor
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom
| | - Paul W X Foley
- Great Western Hospitals NHS Foundation Trust, Swindon, United Kingdom
| | - Fraz Umar
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom
| | - Kiran Patel
- Good Hope Hospital, Sutton Coldfield, Birmingham, United Kingdom.,Warwick Medical School, University of Warwick, United Kingdom
| | - Jonathan Panting
- Good Hope Hospital, Sutton Coldfield, Birmingham, United Kingdom
| | - Charles J Ferro
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom
| | - Shajil Chalil
- Blackpool Royal Infirmary, Blackpool, United Kingdom
| | | | - Tian Qiu
- Queen Elizabeth Hospital, Birmingham, United Kingdom
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Hart K, Marshall H, Swinscoe J, Robinson S, Matthew T, Tozer-Loft S, Hatton M, Wild J, Ireland R, Tahir B. OC-0523 3He MRI for functional lung avoidance VMAT treatment planning in lung cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30943-0] [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: 10/26/2022]
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46
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Franke K, Marshall H, Kennewell P, Pham H, Rattanakosit T, Aboustate N, Tully P, Mahajan R. A Systematic Review and Meta-Analysis on the Incidence of Appropriate Implantable Cardioverter Defibrillator Therapy and Sudden Cardiac Death in Cardiac Sarcoidosis. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.153] [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: 11/26/2022]
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47
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Franke K, Marshall H, Worthley M, Psaltis P. A Systematic Review and Meta-analysis on Epidemiology, Angiographic Variants and Outcomes in Spontaneous Coronary Artery Dissection. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.571] [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: 10/26/2022]
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Garside H, Leyva F, Hudsmith L, Marshall H, de Bono J. Eligibility for subcutaneous implantable cardioverter defibrillators in the adult congenital heart disease population. Pacing Clin Electrophysiol 2018; 42:65-70. [DOI: 10.1111/pace.13537] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/03/2018] [Accepted: 10/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Hannah Garside
- Department of Cardiology; Queen Elizabeth Hospital; Birmingham United Kingdom
| | - Francisco Leyva
- Department of Cardiology; Queen Elizabeth Hospital; Birmingham United Kingdom
- Aston Medical Research Institute, Aston Medical School; Aston University; Birmingham United Kingdom
| | - Lucy Hudsmith
- Department of Cardiology; Queen Elizabeth Hospital; Birmingham United Kingdom
| | - Howard Marshall
- Department of Cardiology; Queen Elizabeth Hospital; Birmingham United Kingdom
| | - Joseph de Bono
- Department of Cardiology; Queen Elizabeth Hospital; Birmingham United Kingdom
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Burgess T, Braunack-Mayer A, Tooher R, Collins J, O'Keefe M, Skinner R, Watson M, Ashmeade H, Proeve C, Marshall H. Optimizing intersectoral collaboration between health and education: the Health Bridges study. J Public Health (Oxf) 2018; 38:e430-e437. [PMID: 28158696 DOI: 10.1093/pubmed/fdv190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Burgess
- School of Public Health, University of Adelaide, Adelaide, SA 5005, Australia
| | | | - R Tooher
- School of Public Health, University of Adelaide, Adelaide, SA 5005, Australia
| | - J Collins
- School of Medicine, University of Adelaide, Adelaide, SA 5005, Australia
| | - M O'Keefe
- School of Medicine, University of Adelaide, Adelaide, SA 5005, Australia
| | | | - M Watson
- Immunisation Section, Department for Health and Ageing, Adelaide, SA 5000, Australia
| | - H Ashmeade
- Department for Education and Child Development, South Australia, Australia
| | - C Proeve
- School of Public Health, University of Adelaide, Adelaide, SA 5005, Australia
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Lam S, Myers R, Atkar-Khattra S, Yuan R, Yee J, English J, Grant K, Lee A, Mcguire A, McWilliams A, Brims F, Stone E, Chin V, Chantrill L, Connellan M, Plitt M, Marshall H, Yang I, Bowman R, Fong K, Mayo J. MA03.02 Prospective Evaluation of the Clinical Utility of the International Lung Screen Trial Lung Nodule Management Protocol. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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