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Joy G, Lopes LR, Webber M, Ardissino AM, Wilson J, Chan F, Pierce I, Hughes RK, Moschonas K, Shiwani H, Jamieson R, Velazquez PP, Vijayakumar R, Dall'Armellina E, Macfarlane PW, Manisty C, Kellman P, Davies RH, Tome M, Koncar V, Tao X, Guger C, Rudy Y, Hughes AD, Lambiase PD, Moon JC, Orini M, Captur G. Electrophysiological Characterization of Subclinical and Overt Hypertrophic Cardiomyopathy by Magnetic Resonance Imaging-Guided Electrocardiography. J Am Coll Cardiol 2024; 83:1042-1055. [PMID: 38385929 PMCID: PMC10945386 DOI: 10.1016/j.jacc.2024.01.006] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Ventricular arrhythmia in hypertrophic cardiomyopathy (HCM) relates to adverse structural change and genetic status. Cardiovascular magnetic resonance (CMR)-guided electrocardiographic imaging (ECGI) noninvasively maps cardiac structural and electrophysiological (EP) properties. OBJECTIVES The purpose of this study was to establish whether in subclinical HCM (genotype [G]+ left ventricular hypertrophy [LVH]-), ECGI detects early EP abnormality, and in overt HCM, whether the EP substrate relates to genetic status (G+/G-LVH+) and structural phenotype. METHODS This was a prospective 211-participant CMR-ECGI multicenter study of 70 G+LVH-, 104 LVH+ (51 G+/53 G-), and 37 healthy volunteers (HVs). Local activation time (AT), corrected repolarization time, corrected activation-recovery interval, spatial gradients (GAT/GRTc), and signal fractionation were derived from 1,000 epicardial sites per participant. Maximal wall thickness and scar burden were derived from CMR. A support vector machine was built to discriminate G+LVH- from HV and low-risk HCM from those with intermediate/high-risk score or nonsustained ventricular tachycardia. RESULTS Compared with HV, subclinical HCM showed mean AT prolongation (P = 0.008) even with normal 12-lead electrocardiograms (ECGs) (P = 0.009), and repolarization was more spatially heterogenous (GRTc: P = 0.005) (23% had normal ECGs). Corrected activation-recovery interval was prolonged in overt vs subclinical HCM (P < 0.001). Mean AT was associated with maximal wall thickness; spatial conduction heterogeneity (GAT) and fractionation were associated with scar (all P < 0.05), and G+LVH+ had more fractionation than G-LVH+ (P = 0.002). The support vector machine discriminated subclinical HCM from HV (10-fold cross-validation accuracy 80% [95% CI: 73%-85%]) and identified patients at higher risk of sudden cardiac death (accuracy 82% [95% CI: 78%-86%]). CONCLUSIONS In the absence of LVH or 12-lead ECG abnormalities, HCM sarcomere gene mutation carriers express an aberrant EP phenotype detected by ECGI. In overt HCM, abnormalities occur more severely with adverse structural change and positive genetic status.
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Affiliation(s)
- George Joy
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom.
| | - Luis R Lopes
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Matthew Webber
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, United Kingdom; Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | | | - James Wilson
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Fiona Chan
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, United Kingdom; Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Iain Pierce
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom; Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
| | - Rebecca K Hughes
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Konstantinos Moschonas
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Hunain Shiwani
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Robert Jamieson
- Electrocardiology Section, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Paula P Velazquez
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Cardiology Clinical and Academic Group, St George's University of London and St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Ramya Vijayakumar
- Cardiac Bioelectricity and Arrhythmia Center, Washington University, St Louis, Missouri, USA
| | - Erica Dall'Armellina
- Biomedical Imaging Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Peter W Macfarlane
- Electrocardiology Section, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Charlotte Manisty
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, Maryland, USA
| | - Rhodri H Davies
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom; Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
| | - Maite Tome
- Cardiology Clinical and Academic Group, St George's University of London and St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Vladan Koncar
- École Nationale Supérieure des Arts et Industries Textiles, University of Lille, Lille, France
| | - Xuyuan Tao
- École Nationale Supérieure des Arts et Industries Textiles, University of Lille, Lille, France
| | | | - Yoram Rudy
- Cardiac Bioelectricity and Arrhythmia Center, Washington University, St Louis, Missouri, USA
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
| | - Pier D Lambiase
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - James C Moon
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Michele Orini
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
| | - Gabriella Captur
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, United Kingdom; Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
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Patterson T, McConkey HZR, Ahmed-Jushuf F, Moschonas K, Nguyen H, Karamasis GV, Perera D, Clapp BR, Roxburgh J, Blauth C, Young CP, Redwood SR, Pavlidis AN. Long-Term Outcomes Following Heart Team Revascularization Recommendations in Complex Coronary Artery Disease. J Am Heart Assoc 2020; 8:e011279. [PMID: 30943827 PMCID: PMC6507188 DOI: 10.1161/jaha.118.011279] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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: 12/02/2022]
Abstract
Background The Heart Team (HT) comprises integrated interdisciplinary decision making. Current guidelines assign a Class Ic recommendation for an HT approach to complex coronary artery disease (CAD). However, there remains a paucity of data in regard to hard clinical end points. The aim was to determine characteristics and outcomes in patients with complex CAD following HT discussion. Methods and Results This observational study was conducted at St Thomas’ Hospital (London, UK). Case mixture included unprotected left main, 2‐vessel (including proximal left anterior descending artery) CAD, 3‐vessel CAD, or anatomical and/or clinical equipoise. HT strategy was defined as optimal medical therapy (OMT) alone, OMT+percutaneous coronary intervention (PCI), or OMT+coronary artery bypass grafting. From April 2012 to 2013, 51 HT meetings were held and 398 cases were discussed. Patients tended to have multivessel CAD (74.1%), high SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) scores (median, 30; interquartile range, 23–39), and average age 69±11 years. Multinomial logistic regression analysis performed to determine variables associated with HT strategy demonstrated decreased likelihood of undergoing PCI compared with OMT in older patients with chronic kidney disease and peripheral vascular disease. The odds of undergoing coronary artery bypass grafting compared with OMT decreased in the presence of cardiogenic shock and left ventricular dysfunction and increased in younger patients with 3‐vessel CAD. Three‐year survival was 60.8% (84 of 137) in the OMT cohort, 84.3% (107 of 127) in the OMT+PCI cohort, and 90.2% in the OMT+coronary artery bypass grafting cohort (92 of 102). Conclusions In our experience, the HT approach involved a careful selection process resulting in appropriate patient‐specific decision making and good long‐term outcomes in patients with complex CAD.
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Affiliation(s)
- Tiffany Patterson
- 1 Division of Cardiovascular The Rayne Institute BHF Centre of Research Excellence King's College London St. Thomas' Hospital London United Kingdom
| | - Hannah Z R McConkey
- 1 Division of Cardiovascular The Rayne Institute BHF Centre of Research Excellence King's College London St. Thomas' Hospital London United Kingdom
| | - Fiyyaz Ahmed-Jushuf
- 2 Department of Cardiothoracic Guy's and St Thomas' NHS Foundation Trust London United Kingdom
| | - Konstantinos Moschonas
- 3 Department of Cardiology King's College Hospital NHS Foundation Trust London United Kingdom
| | - Hanna Nguyen
- 1 Division of Cardiovascular The Rayne Institute BHF Centre of Research Excellence King's College London St. Thomas' Hospital London United Kingdom
| | | | - Divaka Perera
- 1 Division of Cardiovascular The Rayne Institute BHF Centre of Research Excellence King's College London St. Thomas' Hospital London United Kingdom
| | - Brian R Clapp
- 2 Department of Cardiothoracic Guy's and St Thomas' NHS Foundation Trust London United Kingdom
| | - James Roxburgh
- 2 Department of Cardiothoracic Guy's and St Thomas' NHS Foundation Trust London United Kingdom
| | - Christopher Blauth
- 2 Department of Cardiothoracic Guy's and St Thomas' NHS Foundation Trust London United Kingdom
| | - Christopher P Young
- 2 Department of Cardiothoracic Guy's and St Thomas' NHS Foundation Trust London United Kingdom
| | - Simon R Redwood
- 1 Division of Cardiovascular The Rayne Institute BHF Centre of Research Excellence King's College London St. Thomas' Hospital London United Kingdom
| | - Antonis N Pavlidis
- 2 Department of Cardiothoracic Guy's and St Thomas' NHS Foundation Trust London United Kingdom
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Dhanjal TS, Lellouche N, von Ruhland CJ, Abehsira G, Edwards DH, Dubois-Randé JL, Moschonas K, Teiger E, Williams AJ, George CH. Massive Accumulation of Myofibroblasts in the Critical Isthmus Is Associated With Ventricular Tachycardia Inducibility in Post-Infarct Swine Heart. JACC Clin Electrophysiol 2019; 3:703-714. [PMID: 28770255 PMCID: PMC5527067 DOI: 10.1016/j.jacep.2016.11.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objectives In this study the authors determined the extent of cellular infiltration and dispersion, and regional vascularization in electrophysiologically (EP) defined zones in post–myocardial infarction (MI) swine ventricle. Background The critical isthmus (CI) in post-MI re-entrant ventricular tachycardia (VT) is a target for catheter ablation. In vitro evidence suggests that myofibroblasts (MFB) within the scar border zone (BZ) may increase the susceptibility to slow conduction and VT, but whether this occurs in vivo remains unproven. Methods Six weeks after mid–left anterior descending coronary artery occlusion, EP catheter-based mapping was used to assess susceptibility to VT induction. EP data were correlated with detailed cellular profiling of ventricular zones using immunohistochemistry and spatial distribution analysis of cardiomyocytes, fibroblasts, MFB, and vascularization. Results In pigs with induced sustained monomorphic VT (mean cycle length: 353 ± 89 ms; n = 6) the area of scar that consisted of the BZ (i.e., between the normal and the low-voltage area identified by substrate mapping) was greater in VT-inducible hearts (iVT) than in noninducible hearts (non-VT) (p < 0.05). Scar in iVT hearts was characterized by MFB accumulation in the CI (>100 times that in normal myocardium and >5 times higher than that in the BZ in non-VT hearts) and by a 1.7-fold increase in blood vessel density within the dense scar region extending towards the CI. Sites of local abnormal ventricular activity potentials exhibited cellularity and vascularization that were intermediate to the CI in iVT and BZ in non-VT hearts. Conclusions The authors reported the first cellular analysis of the VT CI following an EP-based zonal analysis of iVT and non-VT hearts in pigs post-MI. The data suggested that VT susceptibility was defined by a remarkable number of MFB in the VT CI, which appeared to bridge the few remaining dispersed clusters of cardiomyocytes. These findings define the cellular substrate for the proarrhythmic slow conduction pathway.
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Key Words
- BZ, border zone
- CI, critical isthmus
- CM, cardiomyocytes
- ECM, extracellular matrix
- EP, electrophysiology
- FB, fibroblasts
- IHC, immunohistochemistry
- LAD, left anterior descending
- LAVA, local abnormal ventricular activity
- MFB, myofibroblasts
- MI, myocardial infarction
- MRI, magnetic resonance imaging
- VT
- VT, ventricular tachycardia
- Vim, vimentin
- border zone
- cTnT, cardiac troponin T
- critical isthmus
- iVT, inducible ventricular tachycardia
- myocardial infarction
- myofibroblasts
- pig
- vWF, von Willebrand factor
- α-SMA, α-smooth muscle actin
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Affiliation(s)
- Tarvinder S. Dhanjal
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
- Hôpital Henri Mondor Albert Chenevier, DHU-ATVB, Inserm U955, IMRB, University Paris Est Creteil Paris XII, Paris, France
| | - Nicolas Lellouche
- Hôpital Henri Mondor Albert Chenevier, DHU-ATVB, Inserm U955, IMRB, University Paris Est Creteil Paris XII, Paris, France
| | | | - Guillaume Abehsira
- Hôpital Henri Mondor Albert Chenevier, DHU-ATVB, Inserm U955, IMRB, University Paris Est Creteil Paris XII, Paris, France
| | - David H. Edwards
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
- Institute of Life Sciences, Swansea University Medical School, Swansea, Wales, United Kingdom
| | - Jean-Luc Dubois-Randé
- Hôpital Henri Mondor Albert Chenevier, DHU-ATVB, Inserm U955, IMRB, University Paris Est Creteil Paris XII, Paris, France
| | | | - Emmanuel Teiger
- Hôpital Henri Mondor Albert Chenevier, DHU-ATVB, Inserm U955, IMRB, University Paris Est Creteil Paris XII, Paris, France
| | - Alan J. Williams
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
- Institute of Life Sciences, Swansea University Medical School, Swansea, Wales, United Kingdom
| | - Christopher H. George
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
- Institute of Life Sciences, Swansea University Medical School, Swansea, Wales, United Kingdom
- Address for correspondence: Dr. Christopher H. George, Swansea University Medical School, Institute of Life Sciences, Singleton Park, Swansea, Wales SA2 8PP, United Kingdom.Swansea University Medical SchoolInstitute of Life Sciences, Singleton ParkSwanseaWales SA2 8PPUnited Kingdom
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Moschonas K, Nabeebaccus A, Okonko DO, McDonagh TA, Murgatroyd FD, Dhillon P, Scott PA. The impact of catheter ablation for atrial fibrillation in heart failure. J Arrhythm 2019; 35:33-42. [PMID: 30805042 PMCID: PMC6373662 DOI: 10.1002/joa3.12115] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 07/30/2018] [Accepted: 08/01/2018] [Indexed: 01/20/2023] Open
Abstract
Atrial fibrillation (AF) commonly co‐exists with systolic heart failure (SHF) and its presence is associated with a worse prognosis. Despite this, a rhythm control approach using antiarrhythmic drugs (AADs) to reduce AF burden has demonstrated no prognostic benefit. Catheter ablation (AFA) is more effective than AADs at reducing AF burden. We performed a meta‐analysis to evaluate the impact of AFA on outcomes in SHF. Electronic databases were systematically searched. We included only randomized controlled trials that examined the impact of AFA on clinical outcomes in patients with SHF (LVEF <50%). We included studies with any ablation strategy that incorporated pulmonary vein isolation and any control group. Seven studies (n = 858) were included with a mean follow‐up of 6‐38 months. In comparison to controls, AFA was associated with significant reductions in all‐cause mortality (relative risk [RR] 0.52, P = 0.0009) and unplanned or heart failure hospitalization (RR 0.58, P < 0.00001). Compared to controls, AFA was also associated with significant improvements in LVEF (mean difference 6.30%, P < 0.00001), Minnesota Living with Heart Failure Questionnaire score (mean difference 9.58, P = 0.0003), 6‐minute walk distance (mean difference 31.78 m, P = 0.003) and VO2 max (mean difference 3.17, P = 0.003). However, major procedure‐related complications occurred in 2.4%‐15% of ablation patients. In patients with AF and SHF, catheter ablation has significant benefits. Further work is needed to establish the role of ablation in the routine treatment of SHF patients with AF. We performed a meta‐analysis evaluating the impact of catheter ablation in patients with atrial fibrillation and systolic heart failure. A total of 858 patients were included across seven studies. Compared to controls, ablation was associated with lower all‐cause mortality and hospitalizations, higher LVEF, and improved symptoms and physiologic parameters.
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Affiliation(s)
| | - Adam Nabeebaccus
- Department of Cardiology King's College Hospital NHS Foundation Trust London UK.,King's College London London UK
| | - Darlington O Okonko
- Department of Cardiology King's College Hospital NHS Foundation Trust London UK.,King's College London London UK
| | - Theresa A McDonagh
- Department of Cardiology King's College Hospital NHS Foundation Trust London UK.,King's College London London UK
| | - Francis D Murgatroyd
- Department of Cardiology King's College Hospital NHS Foundation Trust London UK.,King's College London London UK
| | - Para Dhillon
- Department of Cardiology King's College Hospital NHS Foundation Trust London UK.,King's College London London UK
| | - Paul A Scott
- Department of Cardiology King's College Hospital NHS Foundation Trust London UK.,King's College London London UK
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Bleakley C, Eskandari M, Aldalati O, Moschonas K, Huang M, Whittaker A, Monaghan MJ. Impact of 3D echocardiography on grading of mitral stenosis and prediction of clinical events. Echo Res Pract 2018; 5:105-111. [PMID: 30303687 PMCID: PMC6144931 DOI: 10.1530/erp-18-0031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The mitral valve orifice area (MVOA) is difficult to assess accurately by 2D echocardiography because of geometric assumptions; therefore, 3D planimetry may offer advantages. We studied the differences in MVOA measurements between the most frequently used methods, to determine if 3D planimetry would result in the re-grading of severity in any cases, and whether it was a more accurate predictor of clinical outcomes. Methods This was a head-to-head comparison of the three most commonly used techniques to grade mitral stenosis (MS) by orifice area and to assess their impact on clinical outcomes. 2D measurements (pressure half-time (PHT), planimetry) and 3D planimetry were performed retrospectively on patients with at least mild MS. The clinical primary endpoint was defined as a composite of MV balloon valvotomy, mitral valve repair or replacement (MVR) and/or acute heart failure (HF) admissions. Results Forty-one consecutive patients were included; the majority were female (35; 85.4%), average age 55 (17) years. Mean and peak MV gradients were 9.4 (4) mmHg and 19 (6) mmHg, respectively. 2D and 3D measures of MVOA differed significantly; mean 2D planimetry MVOA was 1.28 (0.40) cm2, mean 3D planimetry MVOA 1.15 (0.29) cm2 (P = 0.003). Mean PHT MVOA was 1.43 (0.44) cm2 (P = 0.046 and P < 0.001 in comparison to 2D and 3D planimetry methods, respectively). 3D planimetry reclassified 7 (17%) patients from mild-to-moderate MS, and 1 (2.4%) from moderate to severe. Overall, differences between the two methods were significant (X2, P < 0.001). Only cases graded as severe by 3D predicted the primary outcome measure compared with mild or moderate cases (odds ratio 5.7). Conclusion 3D planimetry in MS returns significantly smaller measurements, which in some cases results in the reclassification of severity. Routine use of 3D may significantly influence the management of MS, with a degree of prediction of clinical outcomes.
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Affiliation(s)
- C Bleakley
- Cardiology Department, Kings College Hospital, London, UK
| | - M Eskandari
- Cardiology Department, Kings College Hospital, London, UK
| | - O Aldalati
- Cardiology Department, Kings College Hospital, London, UK
| | - K Moschonas
- Cardiology Department, Kings College Hospital, London, UK
| | - M Huang
- Cardiology Department, Kings College Hospital, London, UK
| | - A Whittaker
- Cardiology Department, Kings College Hospital, London, UK
| | - M J Monaghan
- Cardiology Department, Kings College Hospital, London, UK
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Patterson T, Perkins GD, Hassan Y, Moschonas K, Gray H, Curzen N, de Belder M, Nolan JP, Ludman P, Redwood SR. Temporal Trends in Identification, Management, and Clinical Outcomes After Out-of-Hospital Cardiac Arrest. Circ Cardiovasc Interv 2018; 11:e005346. [DOI: 10.1161/circinterventions.117.005346] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 04/10/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Tiffany Patterson
- From the Cardiovascular Division, The Rayne Institute BHF Centre of Research Excellence, King’s College London, St. Thomas’ Hospital, United Kingdom (T.P., Y.H., S.R.R.)
| | - Gavin D. Perkins
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, Warwick Medical School, University of Warwick, Coventry, United Kingdom (G.D.P.)
| | - Yahma Hassan
- From the Cardiovascular Division, The Rayne Institute BHF Centre of Research Excellence, King’s College London, St. Thomas’ Hospital, United Kingdom (T.P., Y.H., S.R.R.)
| | | | - Huon Gray
- Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust & Faculty of Medicine, University of Southampton, United Kingdom (H.G., N.C.)
| | - Nick Curzen
- Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust & Faculty of Medicine, University of Southampton, United Kingdom (H.G., N.C.)
| | - Mark de Belder
- Cardiology Department, The James Cook University Hospital, Middlesbrough, United Kingdom (M.d.B.)
| | - Jerry P. Nolan
- School of Clinical Sciences, University of Bristol and Department of Anaesthesia, Royal United Hospital, Bath, United Kingdom (J.P.N.)
| | - Peter Ludman
- Cardiology Department, University Hospitals Birmingham NHS Foundation Trust, United Kingdom (P.L.)
| | - Simon R. Redwood
- From the Cardiovascular Division, The Rayne Institute BHF Centre of Research Excellence, King’s College London, St. Thomas’ Hospital, United Kingdom (T.P., Y.H., S.R.R.)
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Arri SS, Patterson T, Williams RP, Moschonas K, Young CP, Redwood SR. Myocardial revascularisation in high-risk subjects. Heart 2017; 104:166-179. [PMID: 29180542 DOI: 10.1136/heartjnl-2016-310487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Satpal S Arri
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tiffany Patterson
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rupert P Williams
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Christopher P Young
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Simon R Redwood
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Williams R, Asrress K, Lumley M, Arri S, Patterson T, Ellis H, Manou-Stathopoulou V, Khawaja M, Briceno N, Moschonas K, Clapp B, Perera D, Plein S, Marber M, Redwood S. USE OF NOVEL INTRACORONARY TECHNOLOGY TO INVESTIGATE THE EFFECT OF COLD AIR INHALATION DURING EXERCISE ON CORONARY MICROVASCULAR RESISTANCE AND BLOOD FLOW: CROSS-SECTIONAL STUDY IN 39 CORONARY ARTERY DISEASE PATIENTS. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30383-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Moschonas K, Patterson T, Rajani R, Young C. A rare case of a giant saphenous vein graft aneurysm with right atrial fistula formation. BMJ Case Rep 2016; 2016:bcr-2015-213955. [PMID: 26903470 DOI: 10.1136/bcr-2015-213955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 57-year-old hypertensive and dyslipidaemic man with a history of coronary artery bypass graft 19 years previously, presented with severe exertional angina and dyspnoea despite optimal anti-ischaemic pharmacological therapy and previous percutaneous coronary intervention to the left circumflex artery. CT revealed an aneurysm of the saphenous vein graft to the posterior left ventricular branch of the right coronary artery. The aneurysm had formed a fistulous connection with the right atrium. Initially, luminal reconstruction with serial stents was deemed the most appropriate treatment strategy. However, the procedure was abandoned due to the inability to visualise the graft distal to the aneurysm and the significant shunt to the right atrium. Surgical correction of the right atrial wall defect and replacement of the diseased grafts led to complete resolution of the patient's symptoms.
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Affiliation(s)
| | - Tiffany Patterson
- Cardiovascular Division, King's College London BHF Centre of Research Excellence, The Rayne Institute, St Thomas' Hospital, London, UK
| | - Ronak Rajani
- Department of Cardiothoracic Surgery and Cardiology, St Thomas' Hospital, London, UK
| | - Christopher Young
- Department of Cardiothoracic Surgery and Cardiology, St Thomas' Hospital, London, UK
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Moschonas K, Godfrey E, Johns I, Ossei-Gerning N, Kassianos G, Halcox JP. Management of lipids and blood pressure for primary prevention of cardiovascular disease in the UK: results from the EURIKA study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dimitrakakis G, Challoumas D, Moschonas K, Dimitrakaki IA. eComment. Surgical management of coronary-to-pulmonary artery fistulas. Interact Cardiovasc Thorac Surg 2012; 14:104. [PMID: 22232380 DOI: 10.1093/icvts/ivr003a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Georgios Dimitrakakis
- Cardiothoracic Surgery, University Hospital of Wales, Heath Park, Cardiff CF144XW, UK
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