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Kimpton TL, Webster M, Ward K. A Mixed Methods Study Exploring Patient Perspectives and Outcome Measures From Not Fasting Before Cardiac Catheterisation. Heart Lung Circ 2024; 33:479-485. [PMID: 38402038 DOI: 10.1016/j.hlc.2023.12.017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/13/2023] [Accepted: 12/20/2023] [Indexed: 02/26/2024]
Abstract
BACKGROUND & AIM This study aimed to describe the patient experience and incidence of adverse events in unfasted patients undergoing coronary angiography and angioplasty. In addition, to identify any association between duration of fasting and adverse events. Historically, patients were fasted before elective cardiac catheterisation. Routine fasting was not evidence-based, and many centres, including our unit, have discontinued the practice. METHODS Patients undergoing cardiac catheterisation at a large urban teaching hospital were invited to participate in a prospective observational cohort study documenting the duration of fasting and incidence of adverse events (n=508). Of these participants, 257 also completed a survey that captured perspectives and opinions regarding not fasting. RESULTS The mean time since last fluid was 1.9±2.2 hours and for food was 3.9±3.7 hours. The most common adverse event was hypotension (10.0%). Rates of nausea (3.9%) and vomiting (0.6%) were low, and there were no episodes of aspiration. No associations were identified between the time since the last food or fluid and any adverse events. Thematic analysis of survey data yielded three themes: (1) in most, not fasting is preferable to fasting; (2) being able to eat and drink before the procedure positively affected well-being, and (3) one-fifth of the cohort expressed no preference between fasting and non-fasting. CONCLUSIONS Not fasting before cardiac catheterisation is viewed favourably by patients. While this study provides additional evidence that not fasting is safe, event rates are low, and larger multicentre studies are needed for confirmation.
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Affiliation(s)
| | - Mark Webster
- Te Whatu Ora, Auckland City Hospital, Auckland, New Zealand
| | - Kim Ward
- Te Kura Neehi, School of Nursing, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
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Kereiakes DJ, Saito S, Nef HM, Webster M, Verheye S, Colombo A. Technology viewpoint: Evolution in PCI: The next major advance in implant technology to restore vessel function. Cardiovasc Revasc Med 2024; 61:95-98. [PMID: 37980263 DOI: 10.1016/j.carrev.2023.11.009] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 11/20/2023]
Affiliation(s)
- Dean J Kereiakes
- The Christ Hospital and Lindner Research Center, Cincinnati, OH, United States.
| | - Shigeru Saito
- Heart Center, Iryohojin Tokushukai Shonan Kamakura General Hospital, Kamakura City, Japan
| | - Holger M Nef
- Department of Cardiology and Angiology, University of Giessen, Giessen, Germany
| | - Mark Webster
- Cardiac Investigation Unit, Auckland City Hospital, Auckland, New Zealand
| | - Stefan Verheye
- Department of Cardiovascular Medicine, UZ Leuven, Leuven, Belgium
| | - Antonio Colombo
- Invasive Cardiology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Looi JL, Easton A, Webster M, To A, Lee M, Kerr AJ. Recurrent Takotsubo Syndrome: How Frequent, and How Does It Present? Heart Lung Circ 2024:S1443-9506(24)00124-0. [PMID: 38555187 DOI: 10.1016/j.hlc.2024.02.008] [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: 10/06/2023] [Revised: 01/22/2024] [Accepted: 02/13/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Recurrent Takotsubo syndrome (TS) is not uncommon but experience with TS recurrence is inherently limited by the infrequency of the condition itself and incomplete long-term follow-up. There is limited published data on the clinical features and outcomes of patients with recurrent TS. We aimed to describe the clinical characteristics and outcomes of patients with recurrent TS in a large Auckland cohort. METHOD The clinical profile, in-hospital, and long-term outcomes were prospectively assessed in consecutive patients with recurrent TS presenting to Auckland's three major hospitals between January 2006 and January 2023. RESULTS During the study period, 472 TS patients were identified. Of the 467 patients discharged alive after the index event, 45 (9.6%) patients (mean age 62.3±11.0 years), all women, experienced recurrent TS. Median time interval from index event to the first recurrence was 3.14 years (range 27 days to 13.8 years). In 27 (60%) of the 45 patients, the subsequent events involved a stressor (physical triggers, n=8; emotional triggers, n=19). The stressor type differed between the index and recurrent event in 18 (40%) of the 45 patients. Thirteen (28.9%) had a different echocardiographic variant of TS at first recurrence. All patients with recurrent TS were discharged alive. Four patients died late after discharge from the first recurrence, all but one from a non-cardiac cause. CONCLUSIONS One in 10 patients with TS experience recurrent events. These may occur many years later, and both the stressor type and the echocardiographic variant may be different at the recurrent event.
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Affiliation(s)
- Jen-Li Looi
- Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland, New Zealand.
| | - Aleisha Easton
- Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland, New Zealand
| | - Mark Webster
- Green Lane Cardiovascular Service, Auckland City Hospital, Grafton, Auckland, New Zealand
| | - Andrew To
- Cardiovascular Division, North Shore Hospital, Takapuna, Auckland, New Zealand
| | - Mildred Lee
- Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland, New Zealand
| | - Andrew J Kerr
- Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland, New Zealand
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Hernandez G, Hernandez Pena A, Hernandez-Cassis C, Herrington WG, Herzog C, Hewins S, Hewitt D, Hichkad L, Higashi S, Higuchi C, Hill C, Hill L, Hill M, Himeno T, Hing A, Hirakawa Y, Hirata K, Hirota Y, Hisatake T, Hitchcock S, Hodakowski A, Hodge W, Hogan R, Hohenstatt U, Hohenstein B, Hooi L, Hope S, Hopley M, Horikawa S, Hosein D, Hosooka T, Hou L, Hou W, Howie L, Howson A, Hozak M, Htet Z, Hu X, Hu Y, Huang J, Huda N, Hudig L, Hudson A, Hugo C, Hull R, Hume L, Hundei W, Hunt N, Hunter A, Hurley S, Hurst A, Hutchinson C, Hyo T, Ibrahim FH, Ibrahim S, Ihana N, Ikeda T, Imai A, Imamine R, Inamori A, Inazawa H, Ingell J, Inomata K, Inukai Y, Ioka M, Irtiza-Ali A, Isakova T, Isari W, Iselt M, Ishiguro A, Ishihara K, Ishikawa T, Ishimoto T, Ishizuka K, Ismail R, Itano S, Ito H, Ito K, Ito M, Ito Y, Iwagaitsu S, Iwaita Y, Iwakura T, Iwamoto M, Iwasa M, Iwasaki H, Iwasaki S, Izumi K, Izumi K, Izumi T, Jaafar SM, Jackson C, Jackson Y, Jafari G, Jahangiriesmaili M, Jain N, Jansson K, Jasim H, Jeffers L, Jenkins A, Jesky M, Jesus-Silva J, Jeyarajah D, Jiang Y, Jiao X, Jimenez G, Jin B, Jin Q, Jochims J, Johns B, Johnson C, Johnson T, Jolly S, Jones L, Jones L, Jones S, Jones T, Jones V, Joseph M, Joshi S, Judge P, Junejo N, Junus S, Kachele M, Kadowaki T, Kadoya H, Kaga H, Kai H, Kajio H, Kaluza-Schilling W, Kamaruzaman L, Kamarzarian A, Kamimura Y, Kamiya H, Kamundi C, Kan T, Kanaguchi Y, Kanazawa A, Kanda E, Kanegae S, Kaneko K, Kaneko K, Kang HY, Kano T, Karim M, Karounos D, Karsan W, Kasagi R, Kashihara N, Katagiri H, Katanosaka A, Katayama A, Katayama M, Katiman E, Kato K, Kato M, Kato N, Kato S, Kato T, Kato Y, Katsuda Y, Katsuno T, Kaufeld J, Kavak Y, Kawai I, Kawai M, Kawai M, Kawase A, Kawashima S, Kazory A, Kearney J, Keith B, Kellett J, Kelley S, Kershaw M, Ketteler M, Khai Q, Khairullah Q, Khandwala H, Khoo KKL, Khwaja A, Kidokoro K, Kielstein J, Kihara M, Kimber C, Kimura S, Kinashi H, Kingston H, Kinomura M, Kinsella-Perks E, Kitagawa M, Kitajima M, Kitamura 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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Grubman D, Ahmad Y, Leipsic JA, Blanke P, Pasupati S, Webster M, Nazif TM, Parise H, Lansky AJ. Predictors of Cerebral Embolic Debris During Transcatheter Aortic Valve Replacement: The SafePass 2 First-in-Human Study. Am J Cardiol 2023; 207:28-34. [PMID: 37722198 DOI: 10.1016/j.amjcard.2023.08.137] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/21/2023] [Indexed: 09/20/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) generates significant debris, and strategies to mitigate cerebral embolization are needed. The novel Emboliner embolic protection catheter (Emboline, Inc., Santa Cruz, California) is designed to capture all particles generated during TAVR. This first-in-human study sought to assess the safety and feasibility of the device and to characterize the distribution and histopathology of the debris generated during TAVR. The SafePass 2 study was a prospective, nonrandomized, multicenter, single-arm investigation of the Emboliner device. Primary end points included 30-day major adverse cardiac and cerebrovascular events (MACCE) and technical performance. Computed tomography angiography was analyzed by an independent core laboratory, and filters were sent for histopathology of captured debris. Predictors of particle number were identified using >150 µm and >500 µm size thresholds. Of 31 subjects enrolled, technical success was 100%, and 30-day MACCE was 6.5% (2 cerebrovascular accidents, with 1 attributed to subtherapeutic dosing of rivaroxaban along with atrial fibrillation and the other to possible previous small ischemic strokes on magnetic resonance imaging; neither MACCE event had a causal relation to the Emboliner). All filters contained debris, with a median of 191.0 particles >150 µm and 14.0 particles >500 µm. Histopathology revealed mostly acute thrombus and valve or arterial tissue with lesser amounts of calcified tissue. A history of atrial fibrillation predicted a greater number of particles >500 µm (p = 0.0259) and its presence on admission was associated with 4.1 times more particles >150 µm (p = 0.0130) and 8.1 times more particles >500 µm (p = 0.0086). Self-expanding valves were associated with twice the number of particles >150 µm (p = 0.0281). TASK score was positively correlated with number of particles >500 µm (p = 0.0337). The Emboliner device was safe and feasible. Emboli after TAVR appear more numerous than previously documented. Atrial fibrillation, higher TASK score, and self-expanding valve use conferred higher embolic burden. Notably, none of the tested computed tomography angiography features were able to identify with higher embolic risk. Larger-scale studies are needed to identify high-risk patients for selective embolic protection device use.
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Affiliation(s)
- Daniel Grubman
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Yale Cardiovascular Research Group, Yale School of Medicine, New Haven, Connecticut
| | - Yousif Ahmad
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jonathon A Leipsic
- Department of Radiology, Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada
| | - Philipp Blanke
- Department of Radiology, Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada
| | | | - Mark Webster
- Department of Cardiology, Auckland City Hospital, Auckland, New Zealand
| | - Tamin M Nazif
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Helen Parise
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Yale Cardiovascular Research Group, Yale School of Medicine, New Haven, Connecticut
| | - Alexandra J Lansky
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Yale Cardiovascular Research Group, Yale School of Medicine, New Haven, Connecticut.
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Dougherty A, Morrow A, Anderson D, Grieve D, Bayes H, Fallon K, Mangion K, Gilmour L, Basu N, Sykes R, Berry C, McInnes IB, Donaldson A, Sage EK, Barrett F, Welsh B, Bell M, Quigley J, Leitch K, Macliver L, Patel M, Hamil R, Deans A, Furniss J, Clohisey S, Elliott A, Solstice AR, Deas C, Tee C, Connell D, Sutherland D, George J, Mohammed S, Bunker J, Holmes K, Dipper A, Morley A, Arnold D, Adamali H, Welch H, Morrison L, Stadon L, Maskell N, Barratt S, Dunn S, Waterson S, Jayaraman B, Light T, Selby N, Hosseini A, Shaw K, Almeida P, Needham R, Thomas AK, Matthews L, Gupta A, Nikolaidis A, Dupont C, Bonnington J, Chrystal M, Greenhaff PL, Linford S, Prosper S, Jang W, Alamoudi A, Bloss A, Megson C, Nicoll D, Fraser E, Pacpaco E, Conneh F, Ogg G, McShane H, Koychev I, Chen J, Pimm J, Ainsworth M, Pavlides M, Sharpe M, Havinden-Williams M, Petousi N, Talbot N, Carter P, Kurupati P, Dong T, Peng Y, Burns A, Kanellakis N, Korszun A, Connolly B, Busby J, Peto T, Patel B, Nolan CM, Cristiano D, Walsh JA, Liyanage K, Gummadi M, Dormand N, Polgar O, George P, Barker RE, Patel S, Price L, Gibbons M, Matila D, Jarvis H, Lim L, Olaosebikan O, Ahmad S, Brill S, Mandal S, Laing C, Michael A, Reddy A, Johnson C, Baxendale H, Parfrey H, Mackie J, Newman J, Pack J, Parmar J, Paques K, Garner L, Harvey A, Summersgill C, Holgate D, Hardy E, Oxton J, Pendlebury J, McMorrow L, Mairs N, Majeed N, Dark P, Ugwuoke R, Knight S, Whittaker S, Strong-Sheldrake S, Matimba-Mupaya W, Chowienczyk P, Pattenadk D, Hurditch E, Chan F, Carborn H, Foot H, Bagshaw J, Hockridge J, Sidebottom J, Lee JH, Birchall K, Turner K, Haslam L, Holt L, Milner L, Begum M, Marshall M, Steele N, Tinker N, Ravencroft P, Butcher R, Misra S, Walker S, Coburn Z, Fairman A, Ford A, Holbourn A, Howell A, Lawrie A, Lye A, Mbuyisa A, Zawia A, Holroyd-Hind B, Thamu B, Clark C, Jarman C, Norman C, Roddis C, Foote D, Lee E, Ilyas F, Stephens G, Newell H, Turton H, Macharia I, Wilson I, Cole J, McNeill J, Meiring J, Rodger J, Watson J, Chapman K, Harrington K, Chetham L, Hesselden L, Nwafor L, Dixon M, Plowright M, Wade P, Gregory R, Lenagh R, Stimpson R, Megson S, Newman T, Cheng Y, Goodwin C, Heeley C, Sissons D, Sowter D, Gregory H, Wynter I, Hutchinson J, Kirk J, Bennett K, Slack K, Allsop L, Holloway L, Flynn M, Gill M, Greatorex M, Holmes M, Buckley P, Shelton S, Turner S, Sewell TA, Whitworth V, Lovegrove W, Tomlinson J, Warburton L, Painter S, Vickers C, Redwood D, Tilley J, Palmer S, Wainwright T, Breen G, Hotopf M, Dunleavy A, Teixeira J, Ali M, Mencias M, Msimanga N, Siddique S, Samakomva T, Tavoukjian V, Forton D, Ahmed R, Cook A, Thaivalappil F, Connor L, Rees T, McNarry M, Williams N, McCormick J, McIntosh J, Vere J, Coulding M, Kilroy S, Turner V, Butt AT, Savill H, Fraile E, Ugoji J, Landers G, Lota H, Portukhay S, Nasseri M, Daniels A, Hormis A, Ingham J, Zeidan L, Osborne L, Chablani M, Banerjee A, David A, Pakzad A, Rangelov B, Williams B, Denneny E, Willoughby J, Xu M, Mehta P, Batterham R, Bell R, Aslani S, Lilaonitkul W, Checkley A, Bang D, Basire D, Lomas D, Wall E, Plant H, Roy K, Heightman M, Lipman M, Merida Morillas M, Ahwireng N, Chambers RC, Jastrub R, Logan S, Hillman T, Botkai A, Casey A, Neal A, Newton-Cox A, Cooper B, Atkin C, McGee C, Welch C, Wilson D, Sapey E, Qureshi H, Hazeldine J, Lord JM, Nyaboko J, Short J, Stockley J, Dasgin J, Draxlbauer K, Isaacs K, Mcgee K, Yip KP, Ratcliffe L, Bates M, Ventura M, Ahmad Haider N, Gautam N, Baggott R, Holden S, Madathil S, Walder S, Yasmin S, Hiwot T, Jackson T, Soulsby T, Kamwa V, Peterkin Z, Suleiman Z, Chaudhuri N, Wheeler H, Djukanovic R, Samuel R, Sass T, Wallis T, Marshall B, Childs C, Marouzet E, Harvey M, Fletcher S, Dickens C, Beckett P, Nanda U, Daynes E, Charalambou A, Yousuf AJ, Lea A, Prickett A, Gooptu B, Hargadon B, Bourne C, Christie C, Edwardson C, Lee D, Baldry E, Stringer E, Woodhead F, Mills G, Arnold H, Aung H, Qureshi IN, Finch J, Skeemer J, Hadley K, Khunti K, Carr L, Ingram L, Aljaroof M, Bakali M, Bakau M, Baldwin M, Bourne M, Pareek M, Soares M, Tobin M, Armstrong N, Brunskill N, Goodman N, Cairns P, Haldar P, McCourt P, Dowling R, Russell R, Diver S, Edwards S, Glover S, Parker S, Siddiqui S, Ward TJC, Mcnally T, Thornton T, Yates T, Ibrahim W, Monteiro W, Thickett D, Wilkinson D, Broome M, McArdle P, Upthegrove R, Wraith D, Langenberg C, Summers C, Bullmore E, Heeney JL, Schwaeble W, Sudlow CL, Adeloye D, Newby DE, Rudan I, Shankar-Hari M, Thorpe M, Pius R, Walmsley S, McGovern A, Ballard C, Allan L, Dennis J, Cavanagh J, Petrie J, O'Donnell K, Spears M, Sattar N, MacDonald S, Guthrie E, Henderson M, Guillen Guio B, Zhao B, Lawson C, Overton C, Taylor C, Tong C, Mukaetova-Ladinska E, Turner E, Pearl JE, Sargant J, Wormleighton J, Bingham M, Sharma M, Steiner M, Samani N, Novotny P, Free R, Allen RJ, Finney S, Terry S, Brugha T, Plekhanova T, McArdle A, Vinson B, Spencer LG, Reynolds W, Ashworth M, Deakin B, Chinoy H, Abel K, Harvie M, Stanel S, Rostron A, Coleman C, Baguley D, Hufton E, Khan F, Hall I, Stewart I, Fabbri L, Wright L, Kitterick P, Morriss R, Johnson S, Bates A, Antoniades C, Clark D, Bhui K, Channon KM, Motohashi K, Sigfrid L, Husain M, Webster M, Fu X, Li X, Kingham L, Klenerman P, Miiler K, Carson G, Simons G, Huneke N, Calder PC, Baldwin D, Bain S, Lasserson D, Daines L, Bright E, Stern M, Crisp P, Dharmagunawardena R, Reddington A, Wight A, Bailey L, Ashish A, Robinson E, Cooper J, Broadley A, Turnbull A, Brookes C, Sarginson C, Ionita D, Redfearn H, Elliott K, Barman L, Griffiths L, Guy Z, Gill R, Nathu R, Harris E, Moss P, Finnigan J, Saunders K, Saunders P, Kon S, Kon SS, O'Brien L, Shah K, Shah P, Richardson E, Brown V, Brown M, Brown J, Brown J, Brown A, Brown A, Brown M, Choudhury N, Jones S, Jones H, Jones L, Jones I, Jones G, Jones H, Jones D, Davies F, Davies E, Davies K, Davies G, Davies GA, Howard K, Porter J, Rowland J, Rowland A, Scott K, Singh S, Singh C, Thomas S, Thomas C, Lewis V, Lewis J, Lewis D, Harrison P, Francis C, Francis R, Hughes RA, Hughes J, Hughes AD, Thompson T, Kelly S, Smith D, Smith N, Smith A, Smith J, Smith L, Smith S, Evans T, Evans RI, Evans D, Evans R, Evans H, Evans J. Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study. Lancet Respir Med 2023; 11:1003-1019. [PMID: 37748493 PMCID: PMC7615263 DOI: 10.1016/s2213-2600(23)00262-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. METHODS In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. FINDINGS Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. INTERPRETATION After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification. FUNDING UK Research and Innovation and National Institute for Health Research.
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Saito S, Bennett J, Nef HM, Webster M, Namiki A, Takahashi A, Kakuta T, Yamazaki S, Shibata Y, Scott D, Vrolix M, Menon M, Möllmann H, Werner N, Neylon A, Mehmedbegovic Z, Smits PC, Morice MC, Verheye S. First randomised controlled trial comparing the sirolimus-eluting bioadaptor with the zotarolimus-eluting drug-eluting stent in patients with de novo coronary artery lesions: 12-month clinical and imaging data from the multi-centre, international, BIODAPTOR-RCT. EClinicalMedicine 2023; 65:102304. [PMID: 38106564 PMCID: PMC10725075 DOI: 10.1016/j.eclinm.2023.102304] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 12/19/2023] Open
Abstract
Background The DynamX™ bioadaptor is the first coronary implant technology with a unique mechanism of unlocking the bioadaptor frame after polymer resorption over 6 months, uncaging the vessel while maintaining a dynamic support to the vessel. It aims to achieve the acute performance of drug-eluting stents (DES) with the advantages of restoration of vessel function. Methods This international, single blinded, randomised controlled (1:1) trial compared a sirolimus-eluting bioadaptor with a contemporary zotarolimus-eluting stent (DES) in 34 hospitals in Europe, Japan and New Zealand. Patients with de novo coronary lesions and absence of acute myocardial infarction were enrolled from January 2021 to Feburary 2022. The implantation of the bioadaptor followed the standards of DES. An imaging subset of 100 patients had angiographic and intravascular ultrasound assessments, and 20 patients additionally optical coherence tomography. Data collection will continue through 5 years, we herein report 12-month data based on an intention-to-treat population. This trial is registered at ClinicalTrials.gov (NCT04192747). Findings 445 patients were randomised between January 2021 and February 2022. Device, lesion and procedural success rates, and acute gain were similar amongst the groups. The primary endpoint, 12-month target lesion failure, was 1.8% [95% CI: 0.5; 4.6] (n = 4) versus 2.8% [95% CI: 1.0; 6.0] (n = 6), pnon-inferiority < 0.001 for the bioadaptor and the DES, respectively (Δ-1.0% [95% CI: -3.3; 1.4]). One definite or probable device thrombosis occurred in each group. The 12-month imaging endpoints showed superior effectiveness of the bioadaptor such as in-device late lumen loss (0.09 mm [SD 0.34] versus 0.25 mm [SD 0.39], p = 0.04), and restored compliance and cyclic pulsatility (%mid in-device lumen area change of 7.5% versus 2.7%, p < 0.001). Interpretation This is the first randomised controlled trial comparing the novel bioadaptor technology against a contemporary DES. The bioadaptor demonstrated similar acute performance and 12-month clinical outcomes, and superior imaging endpoints including restoration of vessel function. Funding The study was funded by Elixir Medical.
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Affiliation(s)
- Shigeru Saito
- Heart Center, Iryohojin Tokushukai Shonan Kamakura General Hospital, Kamakura City, Japan
| | - Johan Bennett
- Department of Cardiovascular Medicine, UZ Leuven, Leuven, Belgium
| | - Holger M. Nef
- Department of Cardiology and Angiology, University of Giessen, Giessen, Germany
| | - Mark Webster
- Cardiac Investigation Unit, Auckland City Hospital, Auckland, New Zealand
| | - Atsuo Namiki
- Department of Cardiology, Kanto Rosai Hospital, Nakahara-ku, Kawasaki-shi, Japan
| | | | - Tsunekazu Kakuta
- Cardiovascular Medicine, Tsuchiura Kyodo Hospital, Tsuchiura City, Japan
| | - Seiji Yamazaki
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki City, Japan
| | - Douglas Scott
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand
| | - Mathias Vrolix
- Department of Cardiology, Ziekenhuis Oost-Limburg, Campus Sint Jan, Genk, Belgium
| | - Madhav Menon
- Department of Cardiology, Waikato Hospital, Hamilton, New Zealand
| | - Helge Möllmann
- Department of Cardiology, St. Johannes Hospital Dortmund, Dortmund, Germany
| | - Nikos Werner
- Department of Cardiology, Krankenhaus der Barmherzigen Brüder Trier, Trier, Germany
| | - Antoinette Neylon
- CERC (Cardiovascular European Research Center) ICPS Ramsay, Massy, France
| | | | - Pieter C. Smits
- CERC (Cardiovascular European Research Center) ICPS Ramsay, Massy, France
| | | | - Stefan Verheye
- Interventional Cardiology, ZNA Cardiovascular Center Middelheim, Antwerp, Belgium
| | - BIOADAPTOR-RCT Collaborators
- Heart Center, Iryohojin Tokushukai Shonan Kamakura General Hospital, Kamakura City, Japan
- Department of Cardiovascular Medicine, UZ Leuven, Leuven, Belgium
- Department of Cardiology and Angiology, University of Giessen, Giessen, Germany
- Cardiac Investigation Unit, Auckland City Hospital, Auckland, New Zealand
- Department of Cardiology, Kanto Rosai Hospital, Nakahara-ku, Kawasaki-shi, Japan
- Department of Cardiology, Takahashi Hospital, Kobe City, Japan
- Cardiovascular Medicine, Tsuchiura Kyodo Hospital, Tsuchiura City, Japan
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki City, Japan
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand
- Department of Cardiology, Ziekenhuis Oost-Limburg, Campus Sint Jan, Genk, Belgium
- Department of Cardiology, Waikato Hospital, Hamilton, New Zealand
- Department of Cardiology, St. Johannes Hospital Dortmund, Dortmund, Germany
- Department of Cardiology, Krankenhaus der Barmherzigen Brüder Trier, Trier, Germany
- CERC (Cardiovascular European Research Center) ICPS Ramsay, Massy, France
- Interventional Cardiology, ZNA Cardiovascular Center Middelheim, Antwerp, Belgium
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Saito S, Nef HM, Webster M, Verheye S. DynamX sirolimus-eluting Bioadaptor versus the zotarolimus-eluting Resolute Onyx stent in patients with de novo coronary artery lesions: Design and rationale of the multi-center, international, randomized BIODAPTOR-RCT. Cardiovasc Revasc Med 2023; 55:76-82. [PMID: 37479544 DOI: 10.1016/j.carrev.2023.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/01/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Conventional drug-eluting stents achieve good safety and performance outcomes, but the stents permanently cage the vessel, leading to a non-plateauing rate of clinical events. The DynamX Bioadaptor is designed to reduce these long-term events through unique design features that permit restoring vessel function and physiology through the disengagement of uncaging elements after the resorption of a biodegradable polymer over six months. Promising initial results have been obtained in the DynamX mechanistic study, with excellent safety and effectiveness, positive arterial remodeling, improved vasomotion, compliance, and cyclic pulsatility. We now aim to confirm these findings randomizing the DynamX Bioadaptor against the Resolute Onyx stent. METHODS This multi-center, international, randomized single-blinded study is conducted in 34 sites across Europe, Japan, and New Zealand and is divided into the European/New Zealand cohort and the Japanese cohort (which includes an imaging subset). It is designed to randomly assign 444 patients (222 per region) in a 1:1 ratio to either the DynamX Bioadaptor or the Resolute Onyx stent. Furthermore, a pharmacokinetic substudy is conducted in 9 patients enrolled in Japan to assess the pharmacokinetics of sirolimus after implantation of the DynamX Bioadaptor. Study follow-up is scheduled at one, six, and 12 months, and annually thereafter for five years; imaging follow-up includes angiographic, intravascular ultrasound, and optical coherence tomography assessments at 12 months in a subset of patients. The primary endpoint is 12-month target lesion failure. CONCLUSIONS This trial will provide valuable insights into the safety and efficacy of this novel bioadaptor when compared to a contemporary drug-eluting stent. CONDENSED ABSTRACT The DynamX Sirolimus-Eluting Bioadaptor has unique design features aiming to reduce long-term events after percutaneous coronary intervention by permitting the restoration of vessel function through the freeing of uncaging elements. Promising initial results have been obtained in the DynamX mechanistic study. This trial aims to confirm these findings in a randomized setting. The European/ New Zealand and Japanese cohorts were designed to randomly assign 444 subjects in a 1:1 ratio to either the DynamX Bioadaptor or the Resolute Onyx stent. Furthermore, a pharmacokinetic substudy is conducted in 9 patients enrolled in Japan to assess the pharmacokinetics of sirolimus.
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Affiliation(s)
- Shigeru Saito
- Iryohojin Tokushukai Shonan Kamakura General Hospital, Japan.
| | - Holger M Nef
- Department of Cardiology, University of Giessen, Germany.
| | - Mark Webster
- Department of Cardiology, Auckland City Hospital, Auckland, New Zealand.
| | - Stefan Verheye
- Interventional Cardiology, ZNA Cardiovascular Center Middelheim, Antwerp, Belgium
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Looi JL, Chan C, Pemberton J, Nankivell A, McLeod P, Webster M, To A, Lee M, Kerr AJ. External Validation of a Clinical Score to Differentiate Takotsubo Syndrome From Non-ST-Elevation Myocardial Infarction in Women. Heart Lung Circ 2023:S1443-9506(23)00164-6. [PMID: 37121882 DOI: 10.1016/j.hlc.2023.04.002] [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: 11/27/2022] [Revised: 03/26/2023] [Accepted: 04/02/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND AND AIMS Clinical presentation of Takotsubo Syndrome (TS) mimics acute coronary syndrome (ACS). A score to differentiate TS from ACS would be helpful to facilitate appropriate investigation and management. We have previously developed a clinical score (NSTE-Takotsubo Score) to distinguish women with non-ST-segment elevation myocardial infarction (NSTEMI) from TS with non-ST-segment elevation (NSTE-TS). This study sought to assess the diagnostic validity of this score in an external validation cohort. METHODS The external cohort consisted of women with NSTE-TS (n=110) and NSTEMI (n=113) from two major tertiary hospitals in New Zealand. The five variables in the arithmetic score (range -6 to +5) and their relative weights are: T-wave inversion (TWI) in ≥6 leads (3 points), recent stress (2 points), diabetes mellitus (DM) (-1 point), prior cardiovascular disease (CVD) (-2 points) and presence of ST depression (-3 points). Two clinicians blinded to the diagnoses calculated the score using clinical and electrocardiogram (ECG) data on day 1 post-admission. RESULTS The NSTE-Takotsubo Score discriminated well between NSTE-TS and NSTEMI. The sensitivity and specificity of a score ≥1 to distinguish NSTE-TS from NSTEMI were 78% and 85%, respectively. The area under the receiver operator curve was 0.78 (95% CI 0.72 to 0.84). CONCLUSION In an external validation cohort, the NSTE-Takotsubo Score was easy to apply and useful to identify women likely to have NSTE-TS on day 1 post-admission.
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Affiliation(s)
- Jen-Li Looi
- Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland, New Zealand.
| | - Christina Chan
- Department of Cardiology, Christchurch Hospital, Riccarton Avenue, Christchurch, New Zealand
| | - James Pemberton
- Department of Cardiology, Dunedin Hospital, Dunedin, New Zealand
| | - Alison Nankivell
- Department of Cardiology, Christchurch Hospital, Riccarton Avenue, Christchurch, New Zealand
| | - Peter McLeod
- Department of Cardiology, Dunedin Hospital, Dunedin, New Zealand
| | - Mark Webster
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Andrew To
- Cardiovascular Division, North Shore Hospital, Takapuna, Auckland, New Zealand
| | - Mildred Lee
- Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland, New Zealand
| | - Andrew J Kerr
- Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland, New Zealand; Department of Medicine and School of Population Health, University of Auckland, Auckland, New Zealand
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Gharleghi R, Adikari D, Ellenberger K, Webster M, Ellis C, Sowmya A, Ooi S, Beier S. Annotated computed tomography coronary angiogram images and associated data of normal and diseased arteries. Sci Data 2023; 10:128. [PMID: 36899014 PMCID: PMC10006074 DOI: 10.1038/s41597-023-02016-2] [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] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 02/14/2023] [Indexed: 03/12/2023] Open
Abstract
Computed Tomography Coronary Angiography (CTCA) is a non-invasive method to evaluate coronary artery anatomy and disease. CTCA is ideal for geometry reconstruction to create virtual models of coronary arteries. To our knowledge there is no public dataset that includes centrelines and segmentation of the full coronary tree. We provide anonymized CTCA images, voxel-wise annotations and associated data in the form of centrelines, calcification scores and meshes of the coronary lumen in 20 normal and 20 diseased cases. Images were obtained along with patient information with informed, written consent as part of the Coronary Atlas. Cases were classified as normal (zero calcium score with no signs of stenosis) or diseased (confirmed coronary artery disease). Manual voxel-wise segmentations by three experts were combined using majority voting to generate the final annotations. Provided data can be used for a variety of research purposes, such as 3D printing patient-specific models, development and validation of segmentation algorithms, education and training of medical personnel and in-silico analyses such as testing of medical devices.
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Affiliation(s)
- R Gharleghi
- Faculty of Engineering, University of New South Wales, Kensington, NSW, 2052, Australia.
| | - D Adikari
- Prince of Wales Clinical School of Medicine, UNSW Sydney, Sydney, NSW, Australia
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
| | - K Ellenberger
- Prince of Wales Clinical School of Medicine, UNSW Sydney, Sydney, NSW, Australia
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
| | - M Webster
- Auckland City Hospital, 2 Park Road, Auckland, 1023, New Zealand
| | - C Ellis
- Auckland City Hospital, 2 Park Road, Auckland, 1023, New Zealand
| | - A Sowmya
- Faculty of Engineering, University of New South Wales, Kensington, NSW, 2052, Australia
| | - S Ooi
- Prince of Wales Clinical School of Medicine, UNSW Sydney, Sydney, NSW, Australia
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
| | - S Beier
- Faculty of Engineering, University of New South Wales, Kensington, NSW, 2052, Australia
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Saito S, Nef HM, Verheye S, Webster M. CRT-100.50 Comparison of an Innovative Sirolimus-Eluting Bioadaptor With a Conventional Zotarolimus-Eluting Stent in De Novo Coronary Arteries: The BIOADAPTOR RCT Study Design and Update. JACC Cardiovasc Interv 2023. [DOI: 10.1016/j.jcin.2023.01.051] [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: 02/22/2023]
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Manzuk RA, Maloof AC, Kaandorp JA, Webster M. Branching archaeocyaths as ecosystem engineers during the Cambrian radiation. Geobiology 2023; 21:66-85. [PMID: 36017532 DOI: 10.1111/gbi.12521] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 06/15/2023]
Abstract
The rapid origination and diversification of major animal body plans during the early Cambrian coincide with the rise of Earth's first animal-built framework reefs. Given the importance of scleractinian coral reefs as ecological facilitators in modern oceans, we investigate the impact of archaeocyathan (Class Archaeocyatha) reefs as engineered ecosystems during the Cambrian radiation. In this study, we present the first high-resolution, three-dimensional (3D) reconstructions of branching archaeocyathide (Order Archaeocyathida) individuals from three localities on the Laurentian paleocontinent. Because branched forms in sponges and corals display phenotypic plasticity that preserve the characteristics of the surrounding growth environment, we compare morphological measurements from our fossil specimens to those of modern corals to infer the surface conditions of Earth's first reefs. These data demonstrate that archaeocyaths could withstand and influence the flow of water, accommodate photosymbionts, and build topographically complex and stable structures much like corals today. We also recognize a stepwise increase in the roughness of reef environments in the lower Cambrian, which would have laid a foundation for more abundant and diverse coevolving fauna.
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Affiliation(s)
- Ryan A Manzuk
- Department of Geosciences, Princeton University, Princeton, New Jersey, USA
| | - Adam C Maloof
- Department of Geosciences, Princeton University, Princeton, New Jersey, USA
| | - Jaap A Kaandorp
- Computational Science Lab, University of Amsterdam, Amsterdam, The Netherlands
| | - Mark Webster
- Department of the Geophysical Sciences, University of Chicago, Chicago, Illinois, USA
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14
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Peterson CK, Randhawa K, Shaw L, Shobbrook M, Moss J, Edmunds LV, Potter D, Pallister S, Webster M. The Councils on Chiropractic Education International Mapping Project: Comparison of Member Organizations' Educational Standards to the Councils on Chiropractic Education International Framework Document. J Chiropr Humanit 2022; 29:1-6. [PMID: 35874302 PMCID: PMC9294650 DOI: 10.1016/j.echu.2022.05.001] [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] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The purpose of this project was to investigate how well each member agency's standards complied with the Councils on Chiropractic Education International (CCEI) framework standards. METHODS Each of the CCEI member agencies were provided with a mapping template that was approved by all representatives. A representative from each agency independently mapped their agency's standards to the CCEI framework standards using the template document. Discrepancies were explored and discussed among members. Member agencies discussed with their constituents the omissions and areas that did not comply or adequately match the CCEI document. Changes or additions to member agency standards were made, and updated versions of the mapping were agreed by all CCEI representatives. RESULTS There were 12 sections containing 30 standards within the CCEI framework standards. The Council of Chiropractic Education Australasia and Council on Chiropractic Education Canada reported relevant standards for all 30 CCEI standards. The European Council on Chiropractic Education had 29 of 30 relevant standards, with no direct standard for service. The products that were created were an executive summary of our findings and a detailed map showing similarities for each of the member agencies. CONCLUSION This mapping project demonstrated the similarities of the CCEI member agency standards and that these standards focused on outcomes-based chiropractic education. This quality improvement project resulted in useful dialogue among the member agencies during this project, which clarified areas of difference.
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Affiliation(s)
- Cynthia K. Peterson
- Councils on Chiropractic Education International, Toronto, Ontario, Canada
- European Council on Chiropractic Education, Düsseldorf, Germany
| | - Kristi Randhawa
- Councils on Chiropractic Education International, Toronto, Ontario, Canada
| | - Lynn Shaw
- Councils on Chiropractic Education International, Toronto, Ontario, Canada
- Council on Chiropractic Education Canada, Toronto, Ontario, Canada
| | - Michael Shobbrook
- Councils on Chiropractic Education International, Toronto, Ontario, Canada
- Council on Chiropractic Education Australasia, Canberra, Australia
| | - Jean Moss
- Councils on Chiropractic Education International, Toronto, Ontario, Canada
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Lenore V. Edmunds
- Academic Standards and Policy Committee of the Canadian Council of Chiropractic Education, Toronto, Ontario, Canada
| | - Drew Potter
- Council on Chiropractic Education Canada, Toronto, Ontario, Canada
| | - Stefen Pallister
- Councils on Chiropractic Education International, Toronto, Ontario, Canada
- Council on Chiropractic Education Australasia, Canberra, Australia
| | - Mark Webster
- Councils on Chiropractic Education International, Toronto, Ontario, Canada
- European Council on Chiropractic Education, Düsseldorf, Germany
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15
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Balaguera-Reina SA, Angulo-Bedoya M, Moncada-Jimenez JF, Webster M, Roberto IJ, Mazzotti FJ. Update: Assessing the evolutionary trajectory of the Apaporis caiman ( Caiman crocodilus apaporiensis, Medem 1955) via mitochondrial molecular markers. Biol J Linn Soc Lond 2022. [DOI: 10.1093/biolinnean/blac115] [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]
Abstract
Abstract
The spectacled caiman (Caiman crocodilus) is currently considered to be a species complex due to the relatively high morphological and molecular diversity expressed across its range. One of the populations of interest, inhabiting the Apaporis River (Colombia), was described based on skull features as an incipient species (C. c. apaporiensis) and has been treated by some authors as a full species. Recent molecular work challenged this hypothesis, because relatively low mitochondrial molecular differentiation was found between the morphologically described Apaporis caiman and C. crocodilus (s.s.) Amazonian populations. Here, we present an update on the topic based on a larger molecular sample size and on analysis of expanded geometric morphometric data that include six newly collected skulls. Morphometric data support the existence of previously recognized morphotypes within the complex in Colombia and demonstrate that the newly collected material can be assigned to the classic Apaporis caiman morphotype. However, our expanded genetic analysis fails to find appreciable mitochondrial molecular divergence of the Apaporis caiman population from the C. c. crocodilus population (COI-CytB: Amazon Peru 0.17 ± 0.06%, CytB-only: Caquetá River Colombia 0.08 ± 0.07%). The Apaporis caiman is interpreted to be a phenotypically distinct member of the cis-Andean C. crocodilus metapopulation that has not yet achieved (or may not be undergoing at all) appreciable genetic differentiation. Thus, it should not be considered a fully independent evolutionary lineage, nor given full species rank.
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Affiliation(s)
- Sergio A Balaguera-Reina
- Department of Wildlife Ecology and Conservation, Fort Lauderdale Research and Education Center, University of Florida , Fort Lauderdale, FL , USA
- Programa de Biología Ambiental, Facultad de Ciencias Naturales y Matemáticas, Universidad de Ibagué , Ibagué , Colombia
| | | | - Juan F Moncada-Jimenez
- Programa de Biología, Facultad de Ciencias, Universidad de Tolima, Calle 42 #1B-1 Barrio Santa Helena, Ibagué, 730001 , Colombia
| | - Mark Webster
- Department of the Geophysical Sciences, University of Chicago , IL , USA
| | - Igor J Roberto
- Laboratorio de Biologia e Ecologia de Animais Silvestres (LABEAS), Universidade Federal do Cariri (UFCA) , Brejo Santo, Ceará, 69077-000 , Brazil
| | - Frank J Mazzotti
- Department of Wildlife Ecology and Conservation, Fort Lauderdale Research and Education Center, University of Florida , Fort Lauderdale, FL , USA
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16
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Ding PYJ, George S, Ormiston JA, Webber B, Dimalapang E, Webster M. Proximal to Distal Y-Stent Deployment for Coronary Bifurcation Lesions: Procedure and Three-Year Clinical Outcomes. J Invasive Cardiol 2022; 34:E397-E407. [PMID: 35451997] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
AIMS Percutaneous coronary intervention with Y-stenting of coronary bifurcation disease is not commonly undertaken. The procedural and medium-term clinical outcomes of coronary bifurcation lesions treated with the proximal to distal Y stent technique by a single experienced operator were reviewed. METHODS A total of 167 consecutive procedures using either provisional Y strategies or full-coverage options performed at Auckland City Hospital, New Zealand, between January 2013 and July 2018 were included in this retrospective observational study. All medical records and coronary angiograms were reviewed. RESULTS Three-year clinical follow-up data were available in 162 of 167 patients. The primary endpoint, defined as the composite of cardiovascular death, spontaneous myocardial infarction (MI), target-lesion revascularization (TLR), target-vessel nontarget-lesion revascularization (nontarget-lesion TVR), and stent thrombosis (ST) occurred in 25 patients (15%) at 3 years. Secondary endpoints were all-cause mortality (12%), including cardiovascular mortality (6%), noncardiovascular mortality (4%), undetermined death (2%), spontaneous MI (7%), TLR (1%), nontarget-lesion TVR (0%), and ST (0.6%). CONCLUSIONS The proximal to distal Y-stent technique is a widely applicable approach to bifurcation lesions, with good medium-term clinical outcomes when used in a heterogeneous group of clinical and anatomical scenarios. Complications related to the stented site were infrequent. Randomized, controlled trials are needed to assess its efficacy compared with other bifurcation interventional techniques.
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Affiliation(s)
- Patricia Ying Jia Ding
- Cardiology Department, Level 3, Building 32, 2 Park Road, Grafton, Auckland 1010, New Zealand.
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17
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Tutt A, Nowecki Z, Szoszkiewicz R, Im SA, Arkenau HT, Armstrong A, Jacot W, Kim J, Webster M, Balmana J, Delaloge S, Lukashchuk N, Odegbami R, Casson E, Loembe A, Drachsler M, Dean E, Punie K. 161O VIOLETTE: Randomised phase II study of olaparib (ola) + ceralasertib (cer) or adavosertib (ada) vs ola alone in patients (pts) with metastatic triple-negative breast cancer (mTNBC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.180] [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] Open
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18
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Saito S, Nef H, Webster M, Verheye S. TCTAP A-001 An Evaluation of a Sirolimus-Eluting Bioadaptor as Compared to a Zotarolimus-Eluting Stent in de Novo Coronary Arteries - “The Bioadaptor RCT Study”. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.03.008] [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: 11/28/2022]
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19
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Hoyte A, Webster M, Ameiss K, Conlee DA, Hainer N, Hutchinson K, Burakova Y, Dominowski PJ, Baima ET, King VL, Rosey EL, Hardham JM, Millership J, Kumar M. Experimental Veterinary SARS-CoV-2 Vaccine cross neutralization of the Delta (B.1.617.2) variant virus in cats. Vet Microbiol 2022; 268:109395. [PMID: 35339817 PMCID: PMC8915440 DOI: 10.1016/j.vetmic.2022.109395] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/04/2022] [Accepted: 03/06/2022] [Indexed: 10/25/2022]
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20
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Clément K, Argente J, Dollfus H, Han J, Haqq A, Martos-Moreno G, Mittleman R, Stewart M, Webster M, Yanovski J, Yuan G, Haws R. Étude de phase 3 sur l’efficacité de setmélanotide chez des patients ayant un syndrome de Bardet-Biedl : résultats contrôlés par placebo. NUTR CLIN METAB 2022. [DOI: 10.1016/j.nupar.2021.12.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Argente J, Clément K, Dollfus H, Han J, Haqq A, Martos-Moreno G, Mittleman R, Stewart M, Webster M, Yanovski J, Yuan G, Haws R. Étude de phase 3 sur le setmélanotide chez des patients ayant un syndrome de Bardet-Biedl : résultats contrôlés par placebo. NUTR CLIN METAB 2022. [DOI: 10.1016/j.nupar.2021.12.029] [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: 11/28/2022]
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22
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Kashyap V, Gharleghi R, Li DD, McGrath-Cadell L, Graham RM, Ellis C, Webster M, Beier S. Accuracy of vascular tortuosity measures using computational modelling. Sci Rep 2022; 12:865. [PMID: 35039557 PMCID: PMC8764056 DOI: 10.1038/s41598-022-04796-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/26/2021] [Accepted: 12/17/2021] [Indexed: 11/26/2022] Open
Abstract
Severe coronary tortuosity has previously been linked to low shear stresses at the luminal surface, yet this relationship is not fully understood. Several previous studies considered different tortuosity metrics when exploring its impact of on the wall shear stress (WSS), which has likely contributed to the ambiguous findings in the literature. Here, we aim to analyze different tortuosity metrics to determine a benchmark for the highest correlating metric with low time-averaged WSS (TAWSS). Using Computed Tomography Coronary Angiogram (CTCA) data from 127 patients without coronary artery disease, we applied all previously used tortuosity metrics to the left main coronary artery bifurcation, and to its left anterior descending and left circumflex branches, before modelling their TAWSS using computational fluid dynamics (CFD). The tortuosity measures included tortuosity index, average absolute-curvature, root-mean-squared (RMS) curvature, and average squared-derivative-curvature. Each tortuosity measure was then correlated with the percentage of vessel area that showed a < 0.4 Pa TAWSS, a threshold associated with altered endothelial cell cytoarchitecture and potentially higher disease risk. Our results showed a stronger correlation between curvature-based versus non-curvature-based tortuosity measures and low TAWSS, with the average-absolute-curvature showing the highest coefficient of determination across all left main branches (p < 0.001), followed by the average-squared-derivative-curvature (p = 0.001), and RMS-curvature (p = 0.002). The tortuosity index, the most widely used measure in literature, showed no significant correlation to low TAWSS (p = 0.86). We thus recommend the use of average-absolute-curvature as a tortuosity measure for future studies.
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Affiliation(s)
- Vishesh Kashyap
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering and Applied Science, University of California, Los Angeles, USA
| | - Ramtin Gharleghi
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, NSW, Australia.
| | - Darson D Li
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, NSW, Australia
| | - Lucy McGrath-Cadell
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Robert M Graham
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | | | | | - Susann Beier
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, NSW, Australia
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23
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Looi JL, Verryt T, McLeod P, Chan C, Pemberton J, Webster M, To A, Lee M, Kerr AJ. Type of Stressor and Medium-Term Outcomes After Takotsubo Syndrome: What Becomes of the Broken Hearted? (ANZACS-QI 59). Heart Lung Circ 2021; 31:499-507. [PMID: 34742642 DOI: 10.1016/j.hlc.2021.09.021] [Citation(s) in RCA: 6] [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: 01/15/2021] [Revised: 06/07/2021] [Accepted: 09/11/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Takotsubo syndrome (TS) is often triggered by an acute physical or emotional stressor. We hypothesised that medium-term prognosis may be better for TS patients with an associated emotional stressor than for those with an acute physical illness. METHODS We identified consecutive TS patients presenting in New Zealand (2006-2018). The clinical presentation and outcomes of TS patients according to types of stressor (physical, emotional or no stressor) were assessed. Post-discharge survival after TS was compared with age- and gender-matched patients after myocardial infarction (MI) and people in the community without known cardiovascular disease (CVD). RESULTS Of 632 TS patients (95.9% women, mean age 65.0±11.1 years), 27.4% had an associated acute physical stressor, 46.4% an emotional stressor and 26.2% no evident stressor. In-hospital mortality was similar for each group (1.7%, 1.2%, 0.3% respectively, p=0.29). In a median 4.4 years post-discharge there were 54 deaths (53 non-cardiac). Compared with patients without known CVD, TS patients with physical stress and those with MI were less likely to survive (HR 4.46, 95%CI 3.10-6.42; HR 4.23, 95%CI 3.81-4.70 respectively) but survival for TS patients associated with emotional stress or no stressor was similar (HR 1.11, 95%CI 0.66-1.85; HR 1.08, 95%CI 0.54-2.18, respectively). Recurrence was similar among the three groups (p=0.14). CONCLUSION Takotsubo syndrome associated with physical stressor has a post-discharge mortality risk as high as after MI. In contrast, prognosis for TS triggered by an emotional stressor is excellent, and similar to that of those without known CVD.
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Affiliation(s)
- Jen-Li Looi
- Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland, New Zealand.
| | - Toby Verryt
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Peter McLeod
- Department of Cardiology, Dunedin Hospital, Dunedin, New Zealand
| | - Christina Chan
- Department of Cardiology, Dunedin Hospital, Dunedin, New Zealand
| | - James Pemberton
- Department of Cardiology, Dunedin Hospital, Dunedin, New Zealand
| | - Mark Webster
- Green Lane Cardiovascular Service, Auckland City Hospital, Grafton, Auckland, New Zealand
| | - Andrew To
- Cardiovascular Division, North Shore Hospital, Takapuna, Auckland, New Zealand
| | - Mildred Lee
- Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland, New Zealand
| | - Andrew J Kerr
- Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland, New Zealand
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24
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Mbizvo RM, Alfadhel M, Williams MJA, Coffey S, Kerr A, Webster M, Lee M. A contemporary presentation of the incidence and management of spontaneous coronary artery dissection (SCAD) in New Zealand: an ANZACS-QI study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Purpose
Spontaneous coronary artery dissection (SCAD) is an underdiagnosed and poorly understood condition that frequently affects younger women without cardiovascular risk factors. In this project we aimed to describe the present landscape of SCAD in New Zealand (NZ).
Methods
All patients in NZ who were admitted to hospital with a diagnosis of Acute Coronary Syndrome (ACS) from July 2019 to December 2020 and underwent coronary angiography were identified from the All NZ Coronary Syndrome Quality Imporvment (ANZACS-QI) registry.
Results
Of 12,053 patients admitted to hospital with an ACS, 122 had SCAD (1.0%). 80% of those with SCAD were female, with mean age of 57 years, and fewer traditional cardiovascular risk factors. Non-ST elevation myocardial infarction was the most common presentation (82.0%), while 16.4% presented with ST elevation myocardial infarction. The majority of patients were managed conservatively (91.8%) while 8.2% underwent PCI. 56.6% of SCAD patients had normal LV function. Nearly 80% of patients were discharged on Acetylsalicylic acid (ASA) therapy, while 60.7% had a P2Y12 inhibitor. Beta blockers, Statins and ACEI/ARB were part of the management strategy in 62.5%, 59.8% and 42.6% of patients respectively while 47.5% had a combination of all 3. Amongst 122 patients, only 1 in-hospital death and 1 inpatient recurrent MI occurred, with 3 patients having bleeding of any kind.
Conclusion
In NZ, incidence of SCAD is approximately 1%. Most patients affected in NZ are female with fewer traditional cardiovascular risk factors. Management is predominantly conservative, and there is a low rate of early adverse outcomes.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R M Mbizvo
- University of Otago, Cardiology Department, Dunedin Hospital, Dunedin, New Zealand
| | - M Alfadhel
- University of British Columbia, Vancouver General Hospital, Vancouver, Canada
| | - M J A Williams
- University of Otago, Cardiology Department, Dunedin Hospital, Dunedin, New Zealand
| | - S Coffey
- University of Otago, Cardiology Department, Dunedin Hospital, Dunedin, New Zealand
| | - A Kerr
- The University of Auckland, Cardiology Department, Middlemore Hospital, Auckland, New Zealand
| | - M Webster
- The University of Auckland, Cardiology Department, Auckland City Hospital, Auckland, New Zealand
| | - M Lee
- The University of Auckland, Cardiology Department, Middlemore Hospital, Auckland, New Zealand
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25
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Ormiston J, Webster M. An Inappropriate Primary Endpoint. JACC Cardiovasc Interv 2021; 14:709-710. [PMID: 33736778 DOI: 10.1016/j.jcin.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 11/15/2022]
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26
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Ding PYJ, Webber B, Ormiston J, Webster M. Proximal to distal Y-stenting for coronary bifurcation lesions using radial access: A modern bifurcation technique. Catheter Cardiovasc Interv 2021; 97:E951-E955. [PMID: 32678477 DOI: 10.1002/ccd.29138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 05/21/2020] [Accepted: 06/27/2020] [Indexed: 11/08/2022]
Abstract
Proximal to distal Y stenting technique is a modified bifurcation technique based on the original Y stenting technique described over 20 years ago. We use a bench top model to illustrate the steps of the technique, which can provide both provisional and full coverage options, using radial artery access. This technique may be applied in clinical settings on a wide range of bifurcation anatomies with a number of unique advantages.
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Affiliation(s)
- Patricia Ying Jia Ding
- Green Lane Cardiovascular Service, Auckland City Hospital, 2 Park Road, Grafton, Auckland, 1010, New Zealand
| | - Bruce Webber
- Interventional Cardiology, Intra Healthcare, 98 Mountain Road, Epsom, Auckland, 1023, New Zealand
| | - John Ormiston
- Interventional Cardiology, Intra Healthcare, 98 Mountain Road, Epsom, Auckland, 1023, New Zealand
| | - Mark Webster
- Green Lane Cardiovascular Service, Auckland City Hospital, 2 Park Road, Grafton, Auckland, 1010, New Zealand
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27
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Karmpaliotis D, Stoler R, Walsh S, El-Jack S, Potluri S, Moses J, Oldroyd K, Banning A, Webster M, Zaman A, Wu W, Ahmed M, Underwood P, Allocco D. Safety and efficacy of Everolimus-Eluting bioabsorbable Polymer-Coated stent in patients with long coronary lesions: The EVOLVE 48 study. Catheter Cardiovasc Interv 2021; 99:373-380. [PMID: 34051049 PMCID: PMC9545912 DOI: 10.1002/ccd.29798] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/09/2021] [Indexed: 11/18/2022]
Abstract
Objectives The EVOLVE 48 study evaluated the safety and effectiveness of the SYNERGY 48 mm stent for the treatment of long lesions. Background Clinical evidence supporting the use of very long stents during percutaneous coronary intervention (PCI) is limited. The bioabsorbable polymer SYNERGY stent has shown good long‐term data in a broad population of patients undergoing PCI. Methods Patients with lesion length >34‐ ≤44 mm and reference vessel diameter (RVD) ≥2.5‐ ≤ 4.0 mm were enrolled in this prospective, multicenter, single‐arm study. The primary endpoint was 12‐month target lesion failure (TLF; composite of target lesion revascularization [TLR], target‐vessel myocardial infarction [TV‐MI], or cardiac death) compared to a prespecified performance goal (PG). Results A total of 100 patients with mean lesion length of 35.34 ± 7.15 mm (26 patients with lesion length > 40 mm) and mean RVD 2.72 ± 0.44 mm were enrolled. Moderate to severe calcification was present in 30% of the patients and 89% had pre‐TIMI flow grade 3. The rates of technical and clinical procedural success were 100%. One‐year TLF was observed in 4.1% patients compared to a prespecified PG of 19.5% (95% upper confidence bound = 9.1%; p < 0.0001). Cardiac death and TLR were each observed in one patient, and TV‐MI in two patients treated with SYNERGY 48 mm stent. Between the 1‐2‐year timeframe, TV‐MI occurred in one additional patient. None of the patients experienced a definite or probable stent thrombosis through 2 years. Conclusions PCI of long coronary lesions with the 48 mm SYNERGY stent demonstrated good procedural and clinical outcomes through 2 years, supporting its clinical safety and efficacy.
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Affiliation(s)
- Dimitrios Karmpaliotis
- Interventional Cardiology, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA
| | - Robert Stoler
- Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas, USA
| | | | | | | | - Jeffrey Moses
- Interventional Cardiology, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA
| | | | | | | | - Azfar Zaman
- Freeman Hospital and Newcastle University, Newcastle, UK
| | - Willis Wu
- Rex Hospital, Raleigh, North Carolina, USA
| | - Mudassar Ahmed
- M Health Fairview St Joseph's Hospital, St. Paul, Minnesota, USA
| | - Paul Underwood
- Boston Scientific Corporation, Marlborough, Massachusetts, USA
| | - Dominic Allocco
- Boston Scientific Corporation, Marlborough, Massachusetts, USA
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28
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Stewart RAH, Jones P, Dicker B, Jiang Y, Smith T, Swain A, Kerr A, Scott T, Smyth D, Ranchord A, Edmond J, Than M, Webster M, White HD, Devlin G. High flow oxygen and risk of mortality in patients with a suspected acute coronary syndrome: pragmatic, cluster randomised, crossover trial. BMJ 2021; 372:n355. [PMID: 33653685 PMCID: PMC7923953 DOI: 10.1136/bmj.n355] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine the association between high flow supplementary oxygen and 30 day mortality in patients presenting with a suspected acute coronary syndrome (ACS). DESIGN Pragmatic, cluster randomised, crossover trial. SETTING Four geographical regions in New Zealand. PARTICIPANTS 40 872 patients with suspected or confirmed ACS included in the All New Zealand Acute Coronary Syndrome Quality Improvement registry or ambulance ACS pathway during the study periods. 20 304 patients were managed using the high oxygen protocol and 20 568 were managed using the low oxygen protocol. Final diagnosis of ST elevation myocardial infarction (STEMI) and non-STEMI were determined from the registry and ICD-10 discharge codes. INTERVENTIONS The four geographical regions were randomly allocated to each of two oxygen protocols in six month blocks over two years. The high oxygen protocol recommended oxygen at 6-8 L/min by face mask for ischaemic symptoms or electrocardiographic changes, irrespective of the transcapillary oxygen saturation (SpO2). The low oxygen protocol recommended oxygen only if SpO2 was less than 90%, with a target SpO2 of less than 95%. MAIN OUTCOME MEASURE 30 day all cause mortality determined from linkage to administrative data. RESULTS Personal and clinical characteristics of patients managed under both oxygen protocols were well matched. For patients with suspected ACS, 30 day mortality for the high and low oxygen groups was 613 (3.0%) and 642 (3.1%), respectively (odds ratio 0.97, 95% confidence interval 0.86 to 1.08). For 4159 (10%) patients with STEMI, 30 day mortality for the high and low oxygen groups was 8.8% (n=178) and 10.6% (n=225), respectively (0.81, 0.66 to 1.00) and for 10 218 (25%) patients with non-STEMI was 3.6% (n=187) and 3.5% (n=176), respectively (1.05, 0.85 to 1.29). CONCLUSION In a large patient cohort presenting with suspected ACS, high flow oxygen was not associated with an increase or decrease in 30 day mortality. TRIAL REGISTRATION ANZ Clinical Trials ACTRN12616000461493.
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Affiliation(s)
- Ralph A H Stewart
- Green Lane Cardiovascular Service, Auckland City Hospital, Private Bag 92024, Auckland 1030, New Zealand
- Department of Medicine, University of Auckland, New Zealand
| | - Peter Jones
- Emergency Medicine Research, Auckland City Hospital, New Zealand
- Department of Surgery, University of Auckland, New Zealand
| | - Bridget Dicker
- St John Auckland and Paramedicine Department, Auckland University of Technology, New Zealand
| | - Yannan Jiang
- National Institute for Health Innovation, University of Auckland, New Zealand
| | - Tony Smith
- St John Ambulance, Auckland, New Zealand
| | - Andrew Swain
- Wellington Free Ambulance, Wellington, New Zealand
| | - Andrew Kerr
- Department of Cardiology, Middlemore Hospital, Otahuhu, Aukland, New Zealand
- Section of Epidemiology and Biostatistics, University of Auckland, New Zealand
| | - Tony Scott
- Cardiology Department, Northshore Hospital, Takapuna, Auckland, New Zealand
| | - David Smyth
- Canterbury District Health Board, Christchurch, New Zealand
| | - Anil Ranchord
- Cardiology Department, Capital and Coast District Health Board, Wellington Hospital, New Zealand
| | - John Edmond
- Southern District Health Board, Dunedin and Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Martin Than
- Department of Emergency Medicine, Christchurch Hospital, New Zealand
| | - Mark Webster
- Green Lane Cardiovascular Service, Auckland City Hospital, Private Bag 92024, Auckland 1030, New Zealand
- Department of Medicine, University of Auckland, New Zealand
| | - Harvey D White
- Green Lane Cardiovascular Service, Auckland City Hospital, Private Bag 92024, Auckland 1030, New Zealand
- Department of Medicine, University of Auckland, New Zealand
| | - Gerard Devlin
- Hauroa Tairāwhiti, Gisborne and Heart Foundation of New Zealand, Gisborn, New Zealand
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Chan D, Stewart R, Kerr A, Dicker B, Kyle C, Adamson P, Devlin G, Edmond J, El-Jack S, Elliott J, Fisher N, Flynn C, Lee M, Liao Y, Rhodes M, Scott T, Smith T, Stiles M, Swain A, Todd V, Webster M, Williams M, White H, Somaratne J. The Impact of a National COVID-19 Lockdown on Acute Coronary Syndrome Hospitalisations in New Zealand: an ANZACS-QI study. Heart Lung Circ 2021. [PMCID: PMC8203216 DOI: 10.1016/j.hlc.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Webster M, Stewart R. Computers, confounding, clusters, consent, cost, COVID and consultation: how the Health and Disability Code impedes the learning health system. N Z Med J 2020; 133:138-143. [PMID: 32994624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The Health and Disability Code precludes any research involving a competent patient without the informed consent of the participant. A learning health system requires rigorous evaluation of both new and established clinical practice, including low-risk components of usual care pathways. When comparing two accepted practices, the only way to control for unknown confounders is by randomisation. In some limited circumstances, particularly when comparing groups or clusters of patients, this comparison can only practicably be undertaken without consent. The current Code impedes a learning health system and is detrimental to the health of New Zealanders. It urgently needs updating.
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Affiliation(s)
- Mark Webster
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland
| | - Ralph Stewart
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland
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Webster M, Stewart R, Aagaard N, McArthur C. The learning health system: trial design and participant consent in comparative effectiveness research. Eur Heart J 2020; 40:1236-1240. [PMID: 29688309 DOI: 10.1093/eurheartj/ehy235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 11/27/2017] [Revised: 02/01/2018] [Accepted: 04/08/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mark Webster
- Green Lane Cardiovascular Service, Auckland City Hospital, Private Bag 92024, Victoria St West, Auckland, New Zealand
| | - Ralph Stewart
- Green Lane Cardiovascular Service, Auckland City Hospital, Private Bag 92024, Victoria St West, Auckland, New Zealand
| | - Nic Aagaard
- Health and Disability Ethics Committees, Ministry of Health, 133 Molesworth Street, Thorndon, Wellington, New Zealand
| | - Colin McArthur
- Department of Critical Care Medicine, Auckland City Hospital, Private Bag 92024, Victoria Street West, Auckland, New Zealand
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Looi JL, Verryt T, McLeod P, Chan C, Pemberton J, Webster M, To A, Lee M, Kerr AJ. A comparison of the clinical features and outcomes of Takotsubo syndrome across five metropolitan hospitals in New Zealand. N Z Med J 2020; 133:73-82. [PMID: 32994595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
AIM Takotsubo syndrome (TS) mimics acute coronary syndrome but has a distinct pathophysiology. This study aimed to compare and contrast the clinical presentation, management and outcomes of patients with TS in five large New Zealand hospitals. METHODS We identified 632 consecutive patients presenting to the five major tertiary hospitals in New Zealand (Middlemore Hospital, Auckland City Hospital, North Shore Hospital, Christchurch Hospital and Dunedin Hospital) between January 2006 and June 2018 and obtained clinical, laboratory, electrocardiography, echocardiography, coronary angiography and long-term follow-up data. RESULTS Six hundred and thirty-two consecutive patients with TS (606 women, mean age 65.0+11.1 years) were included. An associated stressor was identified in two-thirds of patients, and emotional triggers were more frequent than physical triggers (62.9% and 37.1%, respectively). Overall, 12.7% of patient had depression and 11.7% anxiety but this was more common in patients from Christchurch Hospital (20.4% and 23.4%, respectively). The in-hospital mortality among the five hospitals ranges between 0 to 2.0%. The mean follow-up was 4.9+3.4 years (median 4.4 years). Fifty-four people died post-discharge, all but one from a non-cardiac cause. Forty patients had recurrent TS. Mortality post-discharge (p=0.63) and TS recurrence (p=0.38) did not differ significantly among the five hospitals. CONCLUSION In this large New Zealand TS cohort, the clinical characteristics and presentation were similar among the five hospitals. A subset of patients had a complicated in-hospital course, but late deaths were almost all from non-cardiac causes and recurrence was infrequent. Mortality post-discharge and recurrence was similar between the hospitals.
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Affiliation(s)
- Jen-Li Looi
- Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland
| | - Toby Verryt
- Department of Cardiology, Christchurch Hospital, Christchurch
| | - Peter McLeod
- Department of Cardiology, Dunedin Hospital, Dunedin
| | | | | | - Mark Webster
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland
| | - Andrew To
- Cardiovascular Division, North Shore Hospital, Takapuna, Auckland
| | - Mildred Lee
- Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland
| | - Andrew J Kerr
- Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland
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Looi JL, Verryt T, McLeod P, Chan C, Pemberton J, Webster M, To A, Lee M, Kerr AJ. Incidence of Takotsubo syndrome vs acute myocardial infarction in New Zealand (ANZACS-QI 45). N Z Med J 2020; 133:90-94. [PMID: 32161425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Jen-Li Looi
- Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland
| | - Toby Verryt
- Department of Cardiology, Christchurch Hospital, Christchurch
| | - Peter McLeod
- Department of Cardiology, Dunedin Hospital, Dunedin
| | | | | | - Mark Webster
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland
| | - Andrew To
- Cardiovascular Division, North Shore Hospital, Takapuna, Auckland
| | - Mildred Lee
- Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland
| | - Andrew J Kerr
- Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland
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Looi JL, Poppe K, Lee M, Gilmore J, Webster M, To A, Kerr AJ. A Score to differentiate Takotsubo syndrome from non-ST-elevation myocardial nfarction in women at the bedside. Open Heart 2020; 7:e001197. [PMID: 32201588 PMCID: PMC7066633 DOI: 10.1136/openhrt-2019-001197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 10/25/2019] [Revised: 01/02/2020] [Accepted: 02/03/2020] [Indexed: 12/22/2022] Open
Abstract
Objective A score to distinguish Takotsubo syndrome (TS) from acute coronary syndrome would be useful to facilitate appropriate patient investigation and management. This study sought to derive and validate a simple score using demographic, clinical and ECG data to distinguish women with non-ST elevation myocardial infarction (NSTEMI) from NSTE-TS. Methods The derivation cohort consisted of women with NSTE-TS (n=100) and NSTEMI (n=100). Logistic regression was used to derive the score using ECG values available on the postacute ward round on day 1 post-hospital admission. The score was then temporally validated in subsequent consecutive patients with NSTE-TS (n=40) and NSTEMI (n=70). Results The five variables in the score and their relative weights were: T-wave inversion in ≥6 leads (+3), recent stress (+2), diabetes (−1), prior cardiovascular disease (−2) and ST-depression in any lead (−3). When calculated using ECG values obtained at admission, discrimination between conditions was very good (area under the curve (AUC) 0.87 95% CI 0.83 to 0.92). The optimal score cut-point of ≥1 to predict NSTE-TS had 73% sensitivity and 90% specificity. When applied to the validation cohort at admission, AUC was 0.82 (95% CI 0.75 to 0.90) and positive and negative predictive values were 78% and 81%, respectively. On day 1 post-admission, AUC was 0.92 (95% CI 0.87 to 0.97), with positive and negative predictive values of 77% and 91%, respectively. Conclusion This NSTE-TS score is easy to use and may prove useful in clinical practice to distinguish women with NSTE-TS from NSTEMI. Further validation in external cohorts is needed.
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Affiliation(s)
- Jen-Li Looi
- Cardiology, Middlemore Hospital, Auckland, New Zealand
| | - Katrina Poppe
- Epidemiology & Biostatistics, University of Auckland, Auckland, New Zealand
| | - Mildred Lee
- Cardiology, Middlemore Hospital, Auckland, New Zealand
| | - Jill Gilmore
- Cardiology, Middlemore Hospital, Auckland, New Zealand
| | - Mark Webster
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Andrew To
- Lakeview Cardiology Centre, North Shore Hospital, Auckland, New Zealand
| | - Andrew J Kerr
- Cardiology, Middlemore Hospital, Auckland, New Zealand
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Panattoni L, Brown PM, Ao BT, Webster M, Gladding P. Correction to: The Cost Effectiveness of Genetic Testing for CYP2C19 Variants to Guide Thienopyridine Treatment in Patients with Acute Coronary Syndromes. Pharmacoeconomics 2020; 38:315. [PMID: 31960352 DOI: 10.1007/s40273-020-00885-8] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Unfortunately, the article's Supplementary File Link is not working and the ESM material.
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Affiliation(s)
- Laura Panattoni
- School of Population Health, University of Auckland, Auckland, New Zealand.
- Department of Health Policy Research, Palo Alto Medical Foundation Research Institute, 2350 W. El Camino Real, Mountain View, California, CA, 94040, USA.
| | - Paul M Brown
- School of Population Health, University of Auckland, Auckland, New Zealand
- School of Social Sciences, Humanities and Arts, University of California, Merced, CA, USA
| | - Braden Te Ao
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Mark Webster
- School of Medicine, University of Auckland, Auckland, New Zealand
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Patrick Gladding
- School of Medicine, University of Auckland, Auckland, New Zealand
- Cleveland Clinic Foundation, Cleveland, OH, USA
- Theranostics Laboratory, Cleveland, OH, USA
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Bacus SB, Parsons J, Benatar J, Somaratne J, Webster M, Parke R. Fasting prior to cardiac catheterisation: a single-centre observational study. N Z Med J 2020; 133:16-22. [PMID: 32078597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIM Previous generation contrast agents were associated with high rates of nausea, vomiting and risk of aspiration leading to recommendations to fast prior to the procedure. However, modern contrast agents are well tolerated with a low risk of aspiration. Our current guidelines recommend fasting four to six hours before elective and semi-urgent cardiac catheterisation despite a lack of evidence to support this. We sought to determine the duration and effects of fasting at our centre. METHODS A single-centre prospective observational study in patients undergoing elective cardiac catheterisation over a six-month period between 7 August 2017 to 7 February 2018 at Auckland City Hospital, New Zealand. RESULTS One thousand and thirty patients with a mean age of 66±12 years underwent catheterisation. Sixty-seven percent were male, 26% had diabetes, 72% had hypertension and 23% had stage 3 or worse chronic kidney disease. The mean duration of fasting was 11.6±4.9 hours with 80% fasting longer than recommended. One hundred and eight (48%) patients with documented chronic kidney disease did not receive recommended pre-hydration. The most common symptoms related to fasting were hunger (47 %), nausea (3.9%) and vomiting (0.8%). Hypertension (4.1%) and hyperglycaemia (0.8%) occurred due to missed medication. There were no reports of aspiration. CONCLUSION Most patients were fasted for significantly longer than recommended and pre-hydration was underutilised in patients at high risk of contrast-induced nephropathy. There were no episodes of aspiration with modern contrast agents. Further studies are required to evaluate the need for fasting prior to non-emergency cardiac catheterisation.
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Affiliation(s)
| | - John Parsons
- School of Nursing, University of Auckland, Auckland
| | | | | | - Mark Webster
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland
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Masoud-Ansari S, Ormiston J, Webster M, Pontre B, Cowan B, Beier S. Towards validating stent induced micro flow patterns in left main coronary artery bifurcations. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:5749-5752. [PMID: 31947158 DOI: 10.1109/embc.2019.8856419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We investigated if blood flow changes induced through the presence of a stent could be detected using in vitro dynamically scaled 4D Phase-Contrast Magnetic Resonance Imaging (PC-MRI). Using idealized and patient-specific left main coronary artery bifurcations, we 3D-printed the dynamically large scaled geometries and incorporated them into a flow circuit for non-invasive acquisition with a higher effective spatial resolution. We tested the effects of using non-Newtonian and Newtonian fluids for the experiment. We also numerically simulated the same geometries in true scale for comparison using computational fluid dynamics (CFD). We found that the experimental setup increased the effective spatial resolution enough to reveal stent induced blood flow changes close to the vessel wall. Non-Newtonian fluid replicated all of the flow field well with a strong agreement with the computed flow field (R2 > 0.9). Fine flow structures were not as prominent for the Newtonian compared to non-Newtonian fluid consideration. In the patient-specific geometry, arterial non-planarity increased the difficulty to capture the near wall slow velocity changes. Findings demonstrate the potential to dynamically scale in vitro 4D MRI flow acquisition for micro blood flow considerations.
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Cicovic S, Wang T, Kasargod C, Chan D, Somaratne J, Webster M, Devlin G, Kerr A. A025 Diagnostic Coronary Angiography and Percutaneous Coronary Intervention Practices in New Zealand: The All New Zealand Acute Coronary SyndromeQuality Improvement CathPCI registry 3-year study (ANZACS-QI 37). Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.05.030] [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: 10/23/2022]
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Alawami M, Sadler M, Kasargod C, Watson T, Webster M, Ruygrok P. Outcomes of patients with ST elevation myocardial infarction in the era of second-generation drug eluting stents; five-year follow-up. N Z Med J 2019; 132:34-41. [PMID: 31778370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIM The second-generation everolimus and zotarolimus drug eluting stents (DES) have shown superiority for repeat revascularisation and safety to the first-generation devices for stable patients. However, the benefit of those devices in the setting of ST elevation myocardial infarction (STEMI) has remained questionable due to concern regarding stent thrombosis (ST) seen with the first-generation devices. We review the outcomes of patients with STEMI treated in our centre at a time when the second-generation DES became the standard of care. METHODS All patients who presented to our institution with STEMI and underwent emergency percutaneous intervention (PCI) in 2012 with second-generation DES were identified. Case notes and electronic records were reviewed. Patients undergoing staged PCI to non-culprit lesions were excluded. Patients who died during the primary cardiac event with cardiogenic shock were also excluded. RESULTS A total of 399 patients (mean age 65+/-12, 274 (76%) male) were identified. Thirty-five patients (8.7%) died during hospitalisation with cardiogenic shock and were excluded from the subsequent analysis. A further 35 patients died during follow-up. Patients received a mean of 1.15 DES. Median follow-up time was 4.7 years. Median door to reperfusion time was 90 minutes. The all-cause mortality rate for STEMI survivors was 9.6%. Cardiac mortality rate was 3.6%. Thirty-one patients (8.5%) re-presented with symptoms leading to repeat coronary angiography. In-stent restenosis (ISR) was observed only in eight patients (2.2%). The significant factors associated with re-presentation were smoking and medication non-compliance. CONCLUSION Early mortality rates following emergency PCI for STEMI remain high despite low reperfusion times. The five-year follow-up data would suggest that STEMI survivors have good outcomes with the second-generation DES.
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Affiliation(s)
- Mohammed Alawami
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland
| | | | | | - Timothy Watson
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland
| | - Mark Webster
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland
| | - Peter Ruygrok
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland
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Saunders P, Campbell P, Webster M, Thawe M. Analysis of Small Area Environmental, Socioeconomic and Health Data in Collaboration with Local Communities to Target and Evaluate 'Triple Win' Interventions in a Deprived Community in Birmingham UK. Int J Environ Res Public Health 2019; 16:ijerph16224331. [PMID: 31698884 PMCID: PMC6888373 DOI: 10.3390/ijerph16224331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 11/01/2019] [Accepted: 11/05/2019] [Indexed: 11/16/2022]
Abstract
The contemporary environment is a complex of interactions between physical, biological and socioeconomic systems with major impacts on public health. It is well understood that deprived communities are more exposed to negative environmental and social factors, more susceptible to the effects of those exposures, more excluded from access to positive factors, less able to change their circumstances and consequently experience worse health, economic and social outcomes compared to the more affluent. Welsh House Farm estate in Birmingham is one of the most deprived areas in Europe. An alliance between a local charity, City Council Public Health and a University in collaboration with the local community has accessed, analysed and mapped a range of health, social and economic factors at small area level, identifying areas where the community experience is unacceptably worse than other parts of Birmingham and therefore requiring targeted interventions. We make specific recommendations for coordinated action addressing the living, moving and consuming domains of residents' lives and have also identified positive aspects of life on the estate to celebrate. This pilot demonstrates the utility and cost-effectiveness of local collaboration to identify and target health, environmental and social inequalities informed by local concerns.
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Affiliation(s)
- Patrick Saunders
- Faculty of Health Sciences, University of Staffordshire, Stafford ST18 0AD, UK
- Correspondence:
| | - Paul Campbell
- Birmingham City Council, 10 Woodcock St, Birmingham B7 4BL, UK;
| | - Mark Webster
- Welsh House Farm Big Local, 54 Rilstone Rd, Birmingham B32 2NR, UK; (M.W.); (M.T.)
| | - Michael Thawe
- Welsh House Farm Big Local, 54 Rilstone Rd, Birmingham B32 2NR, UK; (M.W.); (M.T.)
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Wang TKM, Kerr A, Kasargod C, Chan D, Cicovic S, Dimalapang E, Webster M, Somaratne J. Percutaneous Coronary Intervention for Left Main Coronary Disease in New Zealand: National Linkage Study of Characteristics and In-Hospital Outcomes (ANZACS-QI 38). Cardiovasc Revasc Med 2019; 21:573-579. [PMID: 31481307 DOI: 10.1016/j.carrev.2019.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/16/2019] [Accepted: 08/19/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Approximately 5% of coronary angiographies detect LMS disease >50%. Recent randomized trials showed PCI has comparable outcomes to coronary artery bypass grafting (CABG) in low or intermediate risk candidates. In clinical practice, PCI is frequently utilized in those with prohibitive surgical risk. We reviewed contemporary national results of percutaneous coronary intervention (PCI) for left main coronary disease (LMS) disease in New Zealand. METHODS All patients undergoing PCI for LMS disease from 01/09/2014-24/09/2017 were extracted from the All New Zealand Acute Coronary Syndrome-Quality Improvement registry with national dataset linkage, analyzing characteristics and in-hospital outcomes. RESULTS The cohort included 469 patients, mean age 70.8 ± 10.7 years, male 331 (71%), and the majority 339 (72%) were unprotected LMS. Indications include ST-elevation myocardial infarction (STEMI) 83 (18%) and NSTEMI or unstable angina 229 (49%). Compared with protected LMS, unprotected LMS were more likely to present with an acute coronary syndrome (73% versus 48%, P < 0.001), and to die in-hospital (9.4% versus 3.9%, P = 0.045). In those with unprotected LMS, in-hospital mortality after acute STEMI PCI was higher than for other indications (21.1% versus 6.1%, P < 0.001). Independent predictors of in-hospital death and major adverse cardiovascular events included STEMI, femoral access and worse renal function. CONCLUSION Our LMS PCI cohort had high mortality rates, especially those presenting with STEMI and an unprotected LMS. This reflects the contemporary real-world practice of LMS PCI being predominantly performed in high risk patients which differs from randomized trial populations, and this should be considered before comparing with CABG outcomes.
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Affiliation(s)
- Tom Kai Ming Wang
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand; Department of Cardiology, Middlemore Hospital, Auckland, New Zealand.
| | - Andrew Kerr
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand; Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Chethan Kasargod
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Daniel Chan
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Sergej Cicovic
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Eliazar Dimalapang
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Mark Webster
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Jithendra Somaratne
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
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Beier S, Ormiston J, Webster M, Medrano P, Masoud-Ansari S, Cowan B. Coronary Artery Shape as a New Biomarker - Anatomical Features Linked to Adverse Haemodynamics. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.261] [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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Abstract
Morphological homeostasis limits the extent to which genetic and/or environmental variation is translated into phenotypic variation, providing generation-to-generation fitness advantage under a stabilizing selection regime. Depending on its lability, morphological homeostasis might also have a longer-term impact on evolution by restricting the variation-and thus the response to directional selection-of a trait. The fossil record offers an inviting opportunity to investigate whether and how morphological homeostasis constrained trait evolution in lineages or clades on long timescales (thousands to millions of years) that are not accessible to neontological studies. Fossils can also reveal insight into the nature of primitive developmental systems that might not be predictable from the study of modern organisms. The ability to study morphological homeostasis in fossils is strongly limited by taphonomic processes that can destroy, blur, or distort the original biological signal: genetic data are unavailable; phenotypic data can be modified by tectonic or compaction-related deformation; time-averaging limits temporal resolution; and environmental variation is hard to study and impossible to control. As a result of these processes, neither allelic sensitivity (and thus genetic canalization) nor macroenvironmental sensitivity (and thus environmental canalization) can be unambiguously assessed in the fossil record. However, homeorhesis-robustness against microenvironmental variation (developmental noise)-can be assessed in ancient developmental systems by measuring the level of fluctuating asymmetry (FA) in a nominally symmetric trait. This requires the analysis of multiple, minimally time-averaged samples of exquisite preservational quality. Studies of FA in fossils stand to make valuable contributions to our understanding of the deep-time significance of homeorhesis. Few empirical studies have been conducted to date, and future paleontological research focusing on how homeorhesis relates to evolutionary rate (including stasis), species survivorship, and purported macroevolutionary trends in evolvability would reap high reward.
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Affiliation(s)
- Mark Webster
- Department of the Geophysical Sciences, University of Chicago, 5734 South Ellis Avenue, Chicago, IL, 60637, USA.
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Webster M, Pasupati S, Lever N, Stiles M. Safety and Feasibility of a Novel Active Fixation Temporary Pacing Lead. J Invasive Cardiol 2018; 30:163-167. [PMID: 29440625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE This first-in-human study evaluated the safety and technical feasibility of the Tempo temporary cardiac pacing lead (BioTrace Medical), which includes a novel fixation mechanism and soft tip. BACKGROUND Complications of temporary pacing leads include dislodgment, arrhythmias, and ventricular perforation. Temporary pacing applications have increased with transcatheter aortic valve replacement (TAVR) growth, for rapid pacing during balloon valvuloplasty (BAV) and valve deployment, and for periprocedural bradyarrhythmia support. METHODS Eligible patients required temporary pacing for TAVR, BAV, or electrophysiology (EP) procedures. Transthoracic echocardiograms were obtained at baseline and 24 hours after lead removal. Safety was defined as freedom from pericardial effusion requiring intervention or evidence of tamponade. Technical feasibility involved successful intracardiac delivery and pace capture. Additional evaluations included pacing threshold (PCT), rapid pacing, dislodgment, or sustained ventricular arrhythmias. Follow-up was to 30 days. RESULTS Twenty-five patients (60% female; mean age, 64 ± 19 years) underwent 13 TAVRs (7 Sapien 3 valves [Edwards Lifesciences], 4 CoreValves [Medtronic], and 2 Lotus valves [Boston Scientific]), 11 EP procedures, and 1 BAV at two New Zealand centers from January 2016 to June 2016. Safety was met in all patients, with no device-related adverse events. Technical feasibility was achieved in 23 cases (92%); 2 patients had unsuitable anatomy. No patient had lead dislodgment or sustained ventricular arrhythmias, and the final procedural PCT was 0.7 ± 0.5 mA. Rapid pacing was successful in all cases. Five patients had successful postprocedural use up to 5 days. CONCLUSION This first-in-human study demonstrates the safety and technical feasibility of the Tempo lead, providing stable periprocedural temporary pacing support.
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Affiliation(s)
| | | | | | - Martin Stiles
- Green Lane Cardiovascular Service, Auckland City Hospital, Private Bag 92024, Victoria St. West, Auckland 1142, New Zealand.
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Barr P, Ormiston J, Stewart J, Nand P, Ramanathan T, Webster M. Transcatheter Aortic Valve Implantation In Patients With a Large Aortic Annulus. Heart Lung Circ 2018; 27:e11-e14. [DOI: 10.1016/j.hlc.2017.08.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/28/2017] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
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Lesiawan E, Stewart R, Webster M. Impact of Outcome Measure and Duration of Follow-Up on the Reliability of Clinical Trials Assessing the Efficacy and Safety of Coronary Artery Stents. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.931] [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: 10/28/2022]
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Lesiawan E, Stewart R, Webster M. Impact of Outcome Measure and Duration of Follow-up on the Reliability of Clinical Trials Assessing the Efficacy and Safety of Coronary Artery Stents. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.05.123] [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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Pilmore H, Webster M, Sidhu K, Srikumar G. Management of coronary artery disease in patients on dialysis. N Z Med J 2017; 130:11-22. [PMID: 29240736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIMS Coronary artery disease is common in patients with end-stage renal failure (ESRF). However, there is little evidence that revascularisation improves outcomes, compared with medical management. This study assessed survival and cardiovascular outcomes in patients with ESRF undergoing coronary angiography and then having coronary artery bypass graft (CABG) surgery, percutaneous coronary intervention (PCI) or medical management. METHODS Survival and major adverse cardiac events (MACE) were examined in all patients with ESRF who underwent coronary angiography at Auckland City Hospital between 2003 and 2012. Outcomes of patients who underwent revascularisation (CABG or PCI) were compared with those managed medically. RESULTS Two hundred and eighty-eight patients with ESRF had a total of 382 diagnostic coronary angiograms. Ninety-one (32%) patients underwent revascularisation (61 PCI, 30 CABG), with the other 197 (68%) treated medically or requiring no specific cardiac treatment. The median survival was 3.3 (IQR 2.1-5.3) years in patients undergoing CABG, 2.9 (IQR 1.5-5.4) years in patients treated with PCI and 2.9 (IQR 1.3-5.5) years in patients managed medically. There was no significant difference in survival between treatment modalities in the entire cohort, nor in the 108 patients with triple vessel disease. Similarly, there was no difference in the incidence of major adverse cardiac events, comparing medical management with revascularisation. CONCLUSION There was no apparent survival advantage with revascularisation by either CABG or PCI, compared with medical management, in patients with ESRF undergoing coronary angiography. This study confirms the poor prognosis of patients with ESRF and coronary disease. Observational studies cannot control for all potential confounders; randomised trial data are needed to guide optimal management of this high-risk patient cohort.
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Affiliation(s)
- Helen Pilmore
- Department of Renal Medicine, University of Auckland, Auckland
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Girdwood M, Webster M. High rates of shoulder and hip pain in water polo players across elite, sub-elite and recreational levels. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2017.09.222] [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: 10/18/2022]
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Alawami M, Webster M. 1176Percutaneous closure of a large right coronary artery to coronary sinus fistula. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx495.1176] [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: 11/14/2022] Open
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