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Hoernschemeyer DG, Elliott P, Lonner BS, Eaker L, Boeyer ME. Bilateral vertebral body tethering: identifying key factors associated with successful outcomes. Eur Spine J 2024; 33:723-731. [PMID: 38180517 DOI: 10.1007/s00586-023-08074-9] [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: 07/25/2023] [Revised: 10/25/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE The treatment of operative double major pediatric spinal deformities (e.g., Lenke 3 or 6) with bilateral vertebral body tethering (VBT) can be significantly more challenging when compared to other deformity patterns (e.g., Lenke 1) or treatment with a posterior spinal fusion. We aimed to identify preoperative and perioperative characteristics that were associated with successful postoperative outcomes in patients treated with both a thoracic and thoracolumbar (e.g., bilateral) tether. METHODS We retrospectively assessed radiographic and clinical data from patients enrolled in a large multi-center study who had a minimum postoperative follow-up of two years. Standard radiographic parameters were extracted from standing spine and left hand-wrist radiographs at various timepoints. We classified patients based on their preoperative deformity pattern (Primary Thoracic [TP] vs. Primary Thoracolumbar [TLP]) and assessed: (1) deformity balance, (2) tilt of the transitional vertebra, and (3) postoperative success. RESULTS We analyzed data from thirty-six patients (TP: 19 and TLP: 17). We observed no relationship between deformity balance at first erect and postoperative success (p = 0.354). Patients with a horizontal transitional vertebra at first erect were significantly (p = 0.001) more likely to exhibit a successful outcome when compared to those who exhibited a tilted transitional vertebra (83% vs. 62%). Patients who had TLP were also more likely to exhibit a successful outcome when compared to patients who exhibited TP (76% vs. 50%). CONCLUSION These data indicate that double major deformities can be successfully treated with VBT, particularly for those who exhibit TLP.
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Affiliation(s)
| | - Patrick Elliott
- School of Medicine, University of Missouri, Columbia, MO, USA
| | - Baron S Lonner
- Department of Orthopaedic Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Lily Eaker
- Department of Orthopaedic Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Melanie E Boeyer
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA.
- Missouri Orthopaedic Institute, 1100 Virginia Ave, Columbia, MO, 65212, USA.
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2
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Thomas EO, Manara A, Dineen RA, Mortimer A, Aziz O, Dean P, Elliott P, Summers DM, Whitfield PC, Hutchinson PJ, Gardiner D. The use of cerebral computed tomographic angiography as an ancillary investigation to support a clinical diagnosis of death using neurological criteria: a consensus guideline. Anaesthesia 2023; 78:330-336. [PMID: 36709511 DOI: 10.1111/anae.15950] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 01/30/2023]
Abstract
This multidisciplinary consensus statement was produced following a recommendation by the Faculty of Intensive Care Medicine to develop a UK guideline for ancillary investigation, when one is required, to support the diagnosis of death using neurological criteria. A multidisciplinary panel reviewed the literature and UK practice in the diagnosis of death using neurological criteria and recommended cerebral CT angiography as the ancillary investigation of choice when death cannot be confirmed by clinical criteria alone. Cerebral CT angiography has been shown to have 100% specificity in supporting a diagnosis of death using neurological criteria and is an investigation available in all acute hospitals in the UK. A standardised technique for performing the investigation is described alongside a reporting template. The panel were unable to make recommendations for ancillary testing in children or patients receiving extracorporeal membrane oxygenation.
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Affiliation(s)
- E O Thomas
- Department of Intensive Care Medicine, University Hospitals NHS Trust Plymouth, UK
| | - A Manara
- Department of Intensive Care Medicine, North Bristol NHS Trust, Bristol, UK
| | - R A Dineen
- Faculty of Medicine and Health Sciences, University of Nottingham, UK.,Department of Radiology, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - A Mortimer
- Department of Radiology, North Bristol NHS Trust, Bristol, UK
| | - O Aziz
- Bristol Royal Hospital for Children and University Hospital Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - P Dean
- Department of Intensive Care Medicine and Anaesthesia, East Lancashire Hospitals NHS Trust, Lancashire, UK
| | - P Elliott
- Royal College of Anaesthetists, London, UK
| | - D M Summers
- Department of Neuroradiology, NHS Lothian, Edinburgh, UK.,University of Edinburgh, UK
| | - P C Whitfield
- South West Neurosurgery Centre, University Hospitals NHS Trust Plymouth, UK
| | - P J Hutchinson
- Department of Neurosurgery, University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - D Gardiner
- Department of Intensive Care Medicine, Nottingham University Hospital NHS Trust, Nottingham, UK
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3
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Savvatis K, Vissing C, Klouvi L, Florian A, Béhin A, Masingue M, Stojkovic T, Mochel F, Stalens C, Procaccio V, Spinazzi M, Echaniz-Laguna A, Quinlivan R, Hanna M, Tard C, Yilmaz A, Vissing J, Laforêt P, Elliott P, Wahbi K. Prediction of cardiac outcomes in 600 adult patients with mitochondrial diseases. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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4
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Mizia-Stec K, Gimeno Blanes JRG, Charron P, Elliott P, Kaski JP, Maggioni AL, Tavazzi L, Tendera M, Wybraniec MT, Caforio A. Hypertrophic cardiomyopathy and atrial fibrillation: the Cardiomyopathy/Myocarditis registry of the EURObservational Research Programme of the European Society of Cardiology. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1728] [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
Current guidelines for AF management underline a complex approach to detecting and treating atrial fibrillation (AF). Hypertrophic cardiomyopathy (HCM) is commonly associated with AF.
Purpose
To assess the clinical characteristic and prognosis in patients with HCM and AF.
Methods and results
Overall, 1739 adult patients with HCM (711/40.9% female; median age at diagnosis: 55.5 years) were enrolled in the EURObservational Research Programme – Cardiomyopathy/Myocarditis Long-Term Registry. Baseline clinical characteristics and adverse cardiovascular endpoints at 1-year follow-up were analysed.
Results
At baseline, AF was found in 478 (27.5%) subjects (paroxysmal: 54.7%, persistent: 17.6%, permanent: 27.7%). Newly diagnosed AF was identified during 1-year follow-up in 48 (2.8%) subjects with HCM.
The presence of AF was associated with higher age (59.6±13.8 vs 50.8±16.1, p<0.001); BMI (27.7±5.1 vs 26.6±4.6 kg/m2, p<0.001); more advanced NYHA class (NYHA I/II and III/IV: 75.1 and 24.9 vs 86.2 and 13.8%, p<0.001); more frequent history of diabetes (14.6 vs 8.4%, p<0.001); arterial hypertension 43.4 vs 34.6%, p<0.001); renal impairment (15.4 vs 6.35%, p<0.001); and history of sustained VT (10.8 vs 6.35%, p<0.001). AF patients were characterized by lower left ventricular ejection fraction (LV EF) (59±12 vs 63±11%, P<0.001), left atrium (LA) dilatation (48.9±9.1 vs 42.4±7.7%, p<0.001), increased pulmonary artery systolic pressure (37.8±13.7 vs 29.6±12.6 mmHg, p<0.001), distribution of LV hypertrophy (p=0.032) and more advanced LV diastolic dysfunction (p<0.001).
On multivariate logistic regression analysis, independent predictors of AF in the HCM population were: age at enrolment (OR 1.068, P<0.001); LVEF (OR 0.978, p<0.001); and LA diameter (OR 1.094, p<0.001).
Oral anticoagulation (OAC) was administered in 69.5% of patients with AF (vitamin K antagonist: 48.5%; direct OAC: 21%). ICD was implanted in 26.8% in AF and 16.9% in non-AF subjects (p<0.001). PVI was performed in 9.9% of AF patients only.
The annual incidence of stroke/TIA was higher in AF than in the non-AF population (2.64 vs 0.85%, p=0.009). There was a trend towards increased death from any cause in the AF population (3.39 vs 1.74%, p=0.05). There were no differences in SCD-risk score between AF and non-AF subjects.
Conclusion
The study reveals a high prevalence of AF in patients with HCM that corresponds with more advanced symptoms, increased prevalence of comorbidities, structural and functional heart remodelling along with inadequate anticoagulation and a significant increase in the risk of stroke. The clinical characteristics of HCM-AF patients indicate that the ESC recommended complex AF approach “CC To ABC” is appropriate in this population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Mizia-Stec
- Medical University of Silesia, First Department of Cardiology, European Reference Network on Heart diseases (ERN GUARD-HEART) , Katowice , Poland
| | - J R G Gimeno Blanes
- Virgen of the Arrixaca University Hospital, Cardiac Department , Murcia , Spain
| | - P Charron
- Centre de Reference des maladies cardiaques hereditaires , Paris , France
| | - P Elliott
- University College of London , London , United Kingdom
| | - J P Kaski
- University College of London , London , United Kingdom
| | - A L Maggioni
- ANMCO Foundation For Your Heart , Florence , Italy
| | - L Tavazzi
- Maria Cecilia Hospital , Cotignola , Italy
| | - M Tendera
- Medical University of Silesia, Department of Cardiology and Structural Heart Disease , Katowice , Poland
| | - M T Wybraniec
- Medical University of Silesia, First Department of Cardiology, European Reference Network on Heart diseases (ERN GUARD-HEART) , Katowice , Poland
| | - A Caforio
- University of Padua, Department of Cardiological Thoracic and Vascular Sciences , Padova , Italy
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5
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Cannie D, Protonotarios A, Syrris P, Sengupta A, Bilinska Z, Arana Achaga X, Barriales-Villa R, Garcia-Pavia P, Gimeno J, Merlo M, Wahbi K, Fatkin D, Mogensen J, Rasmussen TB, Elliott P. Influence of sex on cardiovascular outcomes in RBM20 variant carriers. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1744] [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
Variants in the RBM20 gene cause dilated cardiomyopathy and may be associated with a poor prognosis.
Objectives
To determine disease penetrance, the risk of adverse events and the influence of sex on outcomes in RBM20 variant carriers.
Methods
Consecutive probands and relatives carrying pathogenic or likely pathogenic RBM20 variants were retrospectively recruited from 12 cardiomyopathy units. The primary endpoint was a composite of malignant ventricular arrhythmia (MVA) and end-stage heart failure (ESHF). MVA and ESHF endpoints were also analysed separately and males and females compared.
Results
Longitudinal follow-up data were available for 163 RBM20 variant carriers (82 male, median age 36.5 years, median follow-up 77.6 months). 10/163 had an MVA event at baseline. 30/153 without baseline MVA (19.6%) reached the primary endpoint with a trend towards worse outcomes in males (p=0.08). 16/153 (10.5%) had new MVA with no difference between males and females (p=0.92). 20/163 (12.2%) developed ESHF (17 males and 3 females; p<0.001).
By the end of follow-up, 114 patients (70%) had either left ventricular systolic dysfunction (LVSD) or had experienced MVA. 22 patients received a first diagnosis of LVSD during follow-up. Disease penetrance in individuals over 40 years of age was 78.5% by last evaluation.
Eleven patients that reached the MVA endpoint had a left ventricular ejection fraction (LVEF) available within 6 months of the event. Median [IQR] contemporary LVEF was 30% [23.75, 40%]. 5/11 patients had a contemporary LVEF >35%. 1/11 had a contemporary LVEF >45% (a female, 1st degree relative presenting with sustained ventricular tachycardia and an LVEF of 65%).
Conclusions
RBM20 variants are highly penetrant. The risk of MVA in male and female RBM20 variant carriers is similar but male sex is strongly associated with ESHF. MVA events occur in patients with LVEF >35%.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Clinical Research Training Fellowship
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Affiliation(s)
- D Cannie
- University College London & Barts Heart Centre , London , United Kingdom
| | - A Protonotarios
- University College London & Barts Heart Centre , London , United Kingdom
| | - P Syrris
- University College London , London , United Kingdom
| | - A Sengupta
- Yorkshire Heart Centre , Leeds , United Kingdom
| | - Z Bilinska
- Institute of Cardiology, Unit for Screening Studies in Inherited Cardiovascular Disease , Warsaw , Poland
| | - X Arana Achaga
- University Hospital Donostia, Heart Failure and Inherited Cardiac Diseases , Donostia , Spain
| | - R Barriales-Villa
- Universidade da Coruna, Instituto de Investigaciόn Biomédica de A Coruña (INIBIC/ CIBERCV) , A Coruna , Spain
| | - P Garcia-Pavia
- Hospital Universitario Puerta de Hierro, IDIPHISA, CIBERCV, Heart Failure and Inherited Cardiac Diseases Unit , Madrid , Spain
| | - J Gimeno
- Virgin of the Arrixaca University Clinical Hospital, Inherited Cardiac Disease Unit , Murcia , Spain
| | - M Merlo
- University of Trieste, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina , Trieste , Italy
| | - K Wahbi
- Université de Paris, Institut Imagine, AP-HP, Cochin Hospital, Cardiology Department , Paris , France
| | - D Fatkin
- Victor Chang Cardiac Research Institute , Sydney , Australia
| | - J Mogensen
- Aalborg University Hospital , Aalborg , Denmark
| | | | - P Elliott
- University College London & Barts Heart Centre , London , United Kingdom
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6
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Lopes LR, Losi MA, Sheikh N, Laroche C, Charron P, Gimeno J, Kaski JP, Maggioni AP, Tavazzi L, Arbustini E, Brito D, Celutkiene J, Hagege A, Linhart A, Mogensen J, Garcia-Pinilla JM, Ripoll-Vera T, Seggewiss H, Villacorta E, Caforio A, Elliott PM, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Erlinge D, Emberson J, Glikson M, Gray A, Kayikcioglu M, Maggioni A, Nagy KV, Nedoshivin A, Petronio AS, Hesselink JR, Wallentin L, Zeymer U, Caforio A, Blanes JRG, Charron P, Elliott P, Kaski JP, Maggioni AP, Tavazzi L, Tendera M, Komissarova S, Chakova N, Niyazova S, Linhart A, Kuchynka P, Palecek T, Podzimkova J, Fikrle M, Nemecek E, Bundgaard H, Tfelt-Hansen J, Theilade J, Thune JJ, Axelsson A, Mogensen J, Henriksen F, Hey T, Nielsen SK, Videbaek L, Andreasen S, Arnsted H, Saad A, Ali M, Lommi J, Helio T, Nieminen MS, Dubourg O, Mansencal N, Arslan M, Tsieu VS, Damy T, Guellich A, Guendouz S, Tissot CM, Lamine A, Rappeneau S, Hagege A, Desnos M, Bachet A, Hamzaoui M, Charron P, Isnard R, Legrand L, Maupain C, Gandjbakhch E, Kerneis M, Pruny JF, Bauer A, Pfeiffer B, Felix SB, Dorr M, Kaczmarek S, Lehnert K, Pedersen AL, Beug D, Bruder M, Böhm M, Kindermann I, Linicus Y, Werner C, Neurath B, Schild-Ungerbuehler M, Seggewiss H, Pfeiffer B, Neugebauer A, McKeown P, Muir A, McOsker J, Jardine T, Divine G, Elliott P, Lorenzini M, Watkinson O, Wicks E, Iqbal H, Mohiddin S, O'Mahony C, Sekri N, Carr-White G, Bueser T, Rajani R, Clack L, Damm J, Jones S, Sanchez-Vidal R, Smith M, Walters T, Wilson K, Rosmini S, Anastasakis A, Ritsatos K, Vlagkouli V, Forster T, Sepp R, Borbas J, Nagy V, Tringer A, Kakonyi K, Szabo LA, Maleki M, Bezanjani FN, Amin A, Naderi N, Parsaee M, Taghavi S, Ghadrdoost B, Jafari S, Khoshavi M, Rapezzi C, Biagini E, Corsini A, Gagliardi C, Graziosi M, Longhi S, Milandri A, Ragni L, Palmieri S, Olivotto I, Arretini A, Castelli G, Cecchi F, Fornaro A, Tomberli B, Spirito P, Devoto E, Bella PD, Maccabelli G, Sala S, Guarracini F, Peretto G, Russo MG, Calabro R, Pacileo G, Limongelli G, Masarone D, Pazzanese V, Rea A, Rubino M, Tramonte S, Valente F, Caiazza M, Cirillo A, Del Giorno G, Esposito A, Gravino R, Marrazzo T, Trimarco B, Losi MA, Di Nardo C, Giamundo A, Musella F, Pacelli F, Scatteia A, Canciello G, Caforio A, Iliceto S, Calore C, Leoni L, Marra MP, Rigato I, Tarantini G, Schiavo A, Testolina M, Arbustini E, Di Toro A, Giuliani LP, Serio A, Fedele F, Frustaci A, Alfarano M, Chimenti C, Drago F, Baban A, Calò L, Lanzillo C, Martino A, Uguccioni M, Zachara E, Halasz G, Re F, Sinagra G, Carriere C, Merlo M, Ramani F, Kavoliuniene A, Krivickiene A, Tamuleviciute-Prasciene E, Viezelis M, Celutkiene J, Balkeviciene L, Laukyte M, Paleviciute E, Pinto Y, Wilde A, Asselbergs FW, Sammani A, Van Der Heijden J, Van Laake L, De Jonge N, Hassink R, Kirkels JH, Ajuluchukwu J, Olusegun-Joseph A, Ekure E, Mizia-Stec K, Tendera M, Czekaj A, Sikora-Puz A, Skoczynska A, Wybraniec M, Rubis P, Dziewiecka E, Wisniowska-Smialek S, Bilinska Z, Chmielewski P, Foss-Nieradko B, Michalak E, Stepien-Wojno M, Mazek B, Lopes LR, Almeida AR, Cruz I, Gomes AC, Pereira AR, Brito D, Madeira H, Francisco AR, Menezes M, Moldovan O, Guimaraes TO, Silva D, Ginghina C, Jurcut R, Mursa A, Popescu BA, Apetrei E, Militaru S, Coman IM, Frigy A, Fogarasi Z, Kocsis I, Szabo IA, Fehervari L, Nikitin I, Resnik E, Komissarova M, Lazarev V, Shebzukhova M, Ustyuzhanin D, Blagova O, Alieva I, Kulikova V, Lutokhina Y, Pavlenko E, Varionchik N, Ristic AD, Seferovic PM, Veljic I, Zivkovic I, Milinkovic I, Pavlovic A, Radovanovic G, Simeunovic D, Zdravkovic M, Aleksic M, Djokic J, Hinic S, Klasnja S, Mircetic K, Monserrat L, Fernandez X, Garcia-Giustiniani D, Larrañaga JM, Ortiz-Genga M, Barriales-Villa R, Martinez-Veira C, Veira E, Cequier A, Salazar-Mendiguchia J, Manito N, Gonzalez J, Fernández-Avilés F, Medrano C, Yotti R, Cuenca S, Espinosa MA, Mendez I, Zatarain E, Alvarez R, Pavia PG, Briceno A, Cobo-Marcos M, Dominguez F, Galvan EDT, Pinilla JMG, Abdeselam-Mohamed N, Lopez-Garrido MA, Hidalgo LM, Ortega-Jimenez MV, Mezcua AR, Guijarro-Contreras A, Gomez-Garcia D, Robles-Mezcua M, Blanes JRG, Castro FJ, Esparza CM, Molina MS, García MS, Cuenca DL, de Mallorca P, Ripoll-Vera T, Alvarez J, Nunez J, Gomez Y, Fernandez PLS, Villacorta E, Avila C, Bravo L, Diaz-Pelaez E, Gallego-Delgado M, Garcia-Cuenllas L, Plata B, Lopez-Haldon JE, Pena Pena ML, Perez EMC, Zorio E, Arnau MA, Sanz J, Marques-Sule E. Association between common cardiovascular risk factors and clinical phenotype in patients with hypertrophic cardiomyopathy from the European Society of Cardiology (ESC) EurObservational Research Programme (EORP) Cardiomyopathy/Myocarditis registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:42-53. [PMID: 35138368 PMCID: PMC9745665 DOI: 10.1093/ehjqcco/qcac006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 12/15/2022]
Abstract
AIMS The interaction between common cardiovascular risk factors (CVRF) and hypertrophic cardiomyopathy (HCM) is poorly studied. We sought to explore the relation between CVRF and the clinical characteristics of patients with HCM enrolled in the EURObservational Research Programme (EORP) Cardiomyopathy registry. METHODS AND RESULTS 1739 patients with HCM were studied. The relation between hypertension (HT), diabetes (DM), body mass index (BMI), and clinical traits was analysed. Analyses were stratified according to the presence or absence of a pathogenic variant in a sarcomere gene. The prevalence of HT, DM, and obesity (Ob) was 37, 10, and 21%, respectively. HT, DM, and Ob were associated with older age (P<0.001), less family history of HCM (HT and DM P<0.001), higher New York Heart Association (NYHA) class (P<0.001), atrial fibrillation (HT and DM P<0.001; Ob p = 0.03) and LV (left ventricular) diastolic dysfunction (HT and Ob P<0.001; DM P = 0.003). Stroke was more frequent in HT (P<0.001) and mutation-positive patients with DM (P = 0.02). HT and Ob were associated with higher provocable LV outflow tract gradients (HT P<0.001, Ob P = 0.036). LV hypertrophy was more severe in Ob (P = 0.018). HT and Ob were independently associated with NYHA class (OR 1.419, P = 0.017 and OR 1.584, P = 0.004, respectively). Other associations, including a higher proportion of females in HT and of systolic dysfunction in HT and Ob, were observed only in mutation-positive patients. CONCLUSION Common CVRF are associated with a more severe HCM phenotype, suggesting a proactive management of CVRF should be promoted. An interaction between genotype and CVRF was observed for some traits.
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Affiliation(s)
- Luis R Lopes
- Corresponding author. Tel: +447765109343, , Twitter handle: @LuisRLopesDr
| | - Maria-Angela Losi
- Department of Advanced Biomedical Sciences, University Federico II, Corso Umberto I, 40, Naples 80138, Italy
| | - Nabeel Sheikh
- Department of Cardiology and Division of Cardiovascular Sciences, Guy's and St. Thomas’ Hospitals and King's College London, Strand, London WC2R 2LS, UK
| | - Cécile Laroche
- EORP, European Society of Cardiology, Sophia-Antipolis, France
| | | | | | - Juan P Kaski
- Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK,Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
| | - Aldo P Maggioni
- EORP, European Society of Cardiology, Sophia-Antipolis, France,Maria Cecilia Hospital, GVM Care&Research, Via Corriera, 1, Cotignola 48033 RA, Italy
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care&Research, Via Corriera, 1, Cotignola 48033 RA, Italy
| | | | - Dulce Brito
- Serviço de Cardiologia, Centro Hospitalar Universitário Lisboa Norte, Lisbon 1169-050, Portugal,CCUL, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz MB, Lisbon 1649-028, Portugal
| | - Jelena Celutkiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Universiteto g. 3, Vilnius 01513, Lithuania,State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | | | - Ales Linhart
- 2nd Department of Internal Cardiovascular Medicine, General University Hospital and First Medical Faculty, Charles University, Opletalova 38, Prague 110 00, Czech Republic
| | - Jens Mogensen
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, Odense 5000, Denmark
| | - José Manuel Garcia-Pinilla
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares. Servicio de Cardiología. Hospital Universitario Virgen de la Victoria. IBIMA. Málaga and Ciber-Cardiovascular. Instituto de Salud Carlos III. Madrid, Spain
| | - Tomas Ripoll-Vera
- Inherited Cardiovascular Disease Unit Son Llatzer University Hospital & IdISBa, Palma de Mallorca, Spain
| | - Hubert Seggewiss
- Universitätsklinikum Würzburg, Deutsches Zentrum für Herzinsuffizienz (DZHI), Comprehensive Heart Failure Center (CHFC), Am Schwarzenberg 15, Haus 15A, 97078 Wurzburg, Germany
| | - Eduardo Villacorta
- Member of National Centers of expertise for familial cardiopathies (CSUR), Cardiology Department, University Hospital of Salamanca. Institute of Biomedical Research of Salamanca (IBSAL), CIBERCV, Salamanca, Spain
| | | | - Perry M Elliott
- Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK,St. Bartholomew's Hospital, Barts Heart Centre, Barts Health NHS Trust, Whitechapel Rd, London E1 1BB, UK
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Rocha Lopes L, Hernandez SG, Lorenzini M, Futema M, Chumakova O, Villacorta E, Garcia-Pavia P, Bilbao R, Sandin-Fuentes M, Pinilla JG, Rasmussen TB, Revilla-Marti P, Elliott D, Monserrat L, Elliott P. Alpha-protein kinase 3 (ALPK3) truncating variants cause an autosomal dominant form of hypertrophic cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
More than half of hypertrophic cardiomyopathy (HCM) remains genetically unsolved. ALPK3 truncating variants (ALPK3tv) have been described as a cause of autosomal recessive cardiomyopathy in a small number of paediatric cases, but the pathogenicity in heterozygosity as a possible cause of autosomal dominant HCM is unknown.
Aims
To determine the frequency of heterozygous ALPK3tv in patients with HCM and to confirm their pathogenicity by means of burden testing in independent cohorts, family co-segregation studies, and functional analysis of an allelic series of ALPK3tv using human embryonic stem cell-cardiomyocytes (hESC-CM). Phenotype was compared with a cohort of 1679 genotyped HCM patients.
Methods and results
In a discovery cohort of 770 index patients with HCM, 12 (1.56%) were heterozygous for ALPK3tv, odds ratio (OR) 16.01 (95% confidence interval (95% CI): 7.89 to 29.74, p<8.36e-11), compared to the Genome Aggregation Database (gnomAD) population. In a validation cohort of 2047 HCM probands, 32 (1.56%) carried heterozygous ALPK3tv, OR 16.17 (95% CI: 10.31 to 24.87; p<2.2e-16, compared to gnomAD). Combined logarithm of odds score in 7 families with ALPK3tv was 2.99. In comparison with a large cohort of genotyped HCM patients, the phenotype of 51 HCM patients with ALPK3tv (probands and relatives) was characterised by a higher prevalence of apical/concentric patterns of hypertrophy (60%) compared to both sarcomere-positives or negatives (p<0.001 overall), with the age at diagnosis (56±16ys) and maximum wall thickness (18±4mm) similar to sarcomere-negatives and LV systolic impairment at baseline (6%) and non-sustained ventricular tachycardia (31%) similar to sarcomere-positives. Short PR (10%, p=0.009 overall) and extensive fibrosis>15% of LV segments (49%) were distinctive features. During follow-up (5.3±5.7 years), 4 (9%) patients died of heart failure or had cardiac transplantation (p=0.012 vs sarcomere-negatives and p=0.425 vs sarcomere-positives). Analysis of hESC-CM showed that ALPK3 heterozygotes had phenotypic characteristics of HCM, including increased contractile force and delayed membrane repolarization.
Conclusions
Heterozygous ALPK3tv are pathogenic and segregate with a characteristic HCM phenotype.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): MRC UK, UCLH BRC
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Affiliation(s)
| | - S G Hernandez
- Institute of Biomedical Research of La Coruna (INIBIC), Health In Code, A Coruna, Spain
| | - M Lorenzini
- St Bartholomew's Hospital, London, United Kingdom
| | - M Futema
- University College London, London, United Kingdom
| | - O Chumakova
- City Clinical Hospital No. 17, Moscow, Russian Federation
| | | | - P Garcia-Pavia
- University Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - R Bilbao
- Alvaro Cunqueiro Hospital, Vigo, Spain
| | | | - J G Pinilla
- University Hospital Virgen de la Victoria, Malaga, Spain
| | | | | | - D Elliott
- University of Melbourne, Melbourne, Australia
| | - L Monserrat
- Institute of Biomedical Research of La Coruna (INIBIC), Health In Code, A Coruna, Spain
| | - P Elliott
- St Bartholomew's Hospital, London, United Kingdom
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8
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Norrish G, Qu C, Field E, Cervi E, Elliott P, Ho C, Omar R, Kaski JP. External validation of the HCM Risk-Kids model for predicting sudden cardiac death in childhood hypertrophic cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Sudden cardiac death (SCD) is the most common mode of death in childhood hypertrophic cardiomyopathy (HCM). The newly developed HCM Risk-Kids model provides clinicians with individualised estimates of risk. The aim of this study was to externally validate the model in a large independent, multi-centre patient cohort.
Methods
A retrospective, longitudinal cohort of patients diagnosed with HCM aged 1–16 years independent of the HCM-Risk-Kids development and internal validation cohort was studied. Data on HCM Risk-Kids predictor variables (unexplained syncope, non-sustained ventricular tachycardia, maximal left ventricular wall-thickness, left atrial diameter and left ventricular outflow tract gradient) were collected from the time of baseline clinical evaluation. The performance of the HCM Risk-Kids model in predicting risk at 5 years was assessed.
Results
The cohort consisted of 421 patients with a median age at baseline evaluation of 12.3 years (IQR 7.3, 14.4). Over a median total follow up 3.48 years (IQR 1.83, 6.62, range 1 month – 20.7 years). Fourteen patients (3.3%) died and 10 (2.4%) underwent cardiac transplantation. Twenty-three patients (5.4%) met the SCD end-point within 5-years, with an overall incidence rate of 2.03 per 100 patient years (95% CI 1.48–2.78). Model validation showed a Harrell's C-index of 0.745 (95% CI 0.52–0.97) and Uno's C-index 0.714 (95% 0.58–0.85) with a calibration slope of 1.15 (95% 0.51–1.80). Figure 1a describes the agreement between predicted and observed 5-year cumulative proportion of SCD or equivalent events for each tertile of predicted risk in one imputed data set. One hundred and twenty-five (29.7%) patients had a predicted 5-year risk of ≥6%. SCD events occurred in 6 patients (2.0%) with a predicted risk <6% and 17 (13.6%) with a predicted risk ≥6. A 5-year predicted risk threshold of ≥6% identified 17 (73.9%) SCD-events with a corresponding C-statistic of 0.702 (95% CI 0.60–0.81) (Figure 1b).
Conclusions
This study reports the first external validation of the HCM Risk-Kids model in a large and geographically diverse patient population. A 5-year predicted risk of ≥6% identified over 70% of events, confirming that HCM Risk-Kids provides a method for individualised risk predictions and shared decision making in children with HCM. Incorporation of the model into routine clinical care will enable independent prospective model validation and assessment of the effect of its use in clinical practice.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): British Heart FoundationMedical Research Council Observed vs predicted risk by tertilesObserved vs predicted by threshold
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Affiliation(s)
- G Norrish
- Great Ormond Street Hospital for Children, Inherited Cardiovascular Disease, London, United Kingdom
| | - C Qu
- University College London, Department of statistical science, London, United Kingdom
| | - E Field
- Great Ormond Street Hospital for Children, Inherited Cardiovascular Disease, London, United Kingdom
| | - E Cervi
- Great Ormond Street Hospital for Children, Inherited Cardiovascular Disease, London, United Kingdom
| | - P Elliott
- Barts Health NHS Trust, St Bartholomew's Centre for Inherited Cardiovascular Diseases, London, United Kingdom
| | - C Ho
- Brigham and Women's Hospital, Cardiovascular division, Boston, United States of America
| | - R Omar
- University College London, Department of statistical science, London, United Kingdom
| | - J P Kaski
- Great Ormond Street Hospital for Children, Inherited Cardiovascular Disease, London, United Kingdom
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Van Vliet N, Bos M, Thesing C, Chaker L, Pietzner M, Houtman E, Neville M, Li-Gao R, Trompet S, Mustafa R, Ahmadizar F, Beekman M, Bot M, Budde K, Christodoulides C, Dehghan A, Delles C, Elliott P, Evangelou M, Gao H, Ghanbari M, Van Herwaarden A, Ikram M, Jaeger M, Jukema J, Karaman I, Karpe F, Kloppenburg M, Meessen J, Meulenbelt I, Milaneschi Y, Mooijaart S, Mook-Kanamori D, Netea M, Netea-Maier R, Peeters R, Penninx B, Sattar N, Slagboom P, Suchiman H, Völzke H, Van Dijk KW, Noordam R. Higher thyroid stimulating hormone leads to cardiovascular disease and an unfavorable lipid profile: EVidence from multi-cohort Mendelian randomization and metabolomic profiling. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Moreno-Martinez D, Aguiar P, Auray-Blais C, Beck M, Bichet DG, Burlina A, Cole D, Elliott P, Feldt-Rasmussen U, Feriozzi S, Fletcher J, Giugliani R, Jovanovic A, Kampmann C, Langeveld M, Lidove O, Linhart A, Mauer M, Moon JC, Muir A, Nowak A, Oliveira JP, Ortiz A, Pintos-Morell G, Politei J, Rozenfeld P, Schiffmann R, Svarstad E, Talbot AS, Thomas M, Tøndel C, Warnock D, West ML, Hughes DA. Standardising clinical outcomes measures for adult clinical trials in Fabry disease: A global Delphi consensus. Mol Genet Metab 2021; 132:234-243. [PMID: 33642210 DOI: 10.1016/j.ymgme.2021.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Recent years have witnessed a considerable increase in clinical trials of new investigational agents for Fabry disease (FD). Several trials investigating different agents are currently in progress; however, lack of standardisation results in challenges to interpretation and comparison. To facilitate the standardisation of investigational programs, we have developed a common framework for future clinical trials in FD. METHODS AND FINDINGS A broad consensus regarding clinical outcomes and ways to measure them was obtained via the Delphi methodology. 35 FD clinical experts from 4 continents, representing 3389 FD patients, participated in 3 rounds of Delphi procedure. The aim was to reach a consensus regarding clinical trial design, best treatment comparator, clinical outcomes, measurement of those clinical outcomes and inclusion and exclusion criteria. Consensus results of this initiative included: the selection of the adaptative clinical trial as the ideal study design and agalsidase beta as ideal comparator treatment due to its longstanding use in FD. Renal and cardiac outcomes, such as glomerular filtration rate, proteinuria and left ventricular mass index, were prioritised, whereas neurological outcomes including cerebrovascular and white matter lesions were dismissed as a primary or secondary outcome measure. Besides, there was a consensus regarding the importance of patient-related outcomes such as general quality of life, pain, and gastrointestinal symptoms. Also, unity about lysoGb3 and Gb3 tissue deposits as useful surrogate markers of the disease was obtained. The group recognised that cardiac T1 mapping still has potential but requires further development before its widespread introduction in clinical trials. Finally, patients with end-stage renal disease or renal transplant should be excluded unless a particular group for them is created inside the clinical trial. CONCLUSION This consensus will help to shape the future of clinical trials in FD. We note that the FDA has, coincidentally, recently published draft guidelines on clinical trials in FD and welcome this contribution.
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Affiliation(s)
- D Moreno-Martinez
- Lysosomal Storage Disorders Unit, Royal Free Hospital NHS Foundation Trust and University College London, London, UK
| | - P Aguiar
- Inborn Errors of Metabolism Reference Centre, North Lisbon Hospital Centre, Lisbon, Portugal
| | - C Auray-Blais
- Division of Medical Genetics, Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - M Beck
- Institute of Human Genetics, University Medical Centre, University of Mainz, Mainz, Germany
| | - D G Bichet
- Unité de Recherche Clinique, Centre de Recherche et Service de Néphrologie, Hôpital du Sacré-Coeur de Montreal, Montreal, Quebec, Canada
| | - A Burlina
- Neurological Unit, St. Bassiano Hospital, Bassano del Grappa, Italy
| | - D Cole
- Department of Medical Biochemistry and Immunology, University Hospital of Wales, Cardiff, Wales, UK
| | - P Elliott
- Barts Cardiac Centre, University College London, London, UK
| | - U Feldt-Rasmussen
- Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen, Denmark
| | - S Feriozzi
- Division of Nephrology, Belcolle Hospital, Viterbo, Italy
| | - J Fletcher
- Genetics and Molecular Pathology, SA Pathology Women's and Children's Hospital, North Adelaide, Australia
| | - R Giugliani
- Medical Genetics Service, HCPA, Department of Genetics, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - A Jovanovic
- Department of Endocrinology and Metabolic Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - C Kampmann
- Centre for Paediatric and Adolescent Medicine, University Medical Centre, University of Mainz, Mainz, Germany
| | - M Langeveld
- Department of Endocrinology and Metabolism, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - O Lidove
- Department of Internal Medicine, Université Paris 7, Hôpital Bichat Claude-Bernard, Paris, France
| | - A Linhart
- Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - M Mauer
- Department of Paediatrics, University of Minnesota, Minneapolis, MN, United States
| | - J C Moon
- Cardiac Imaging Department, Barts Heart Centre, London, UK
| | - A Muir
- Belfast Heart Centre, Royal Victoria Hospital, Belfast, UK
| | - A Nowak
- Department of Endocrinology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - J P Oliveira
- Service of Medical Genetics, São João University Hospital Centre, Alameda Hernãni Monteiro, Porto, Portugal
| | - A Ortiz
- Fundación Jiménez Díaz (IIS-FJD) Área de Patología Cardiovascular, Renal e Hipertensión, Madrid, Spain
| | - G Pintos-Morell
- Rare and Metabolic Diseases Unit, Vall Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Politei
- Fundation for the Study of Neurometabolic Diseases, FESEN, Argentina
| | - P Rozenfeld
- Departamento de Ciencias Biológicas, CONICET, Facultad de Ciencias Exactas, IIFP, Universidad Nacional de La Plata, La Plata, Argentina
| | - R Schiffmann
- Institute of Metabolic Disease, Baylor Research Institute, Dallas, TX, USA
| | - E Svarstad
- Department of Clinical Medicine, University of Bergen and Haukeland University Hospital, Bergen, Norway
| | - A S Talbot
- Department of Nephrology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - M Thomas
- Department of Nephrology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - C Tøndel
- Clinical Trials Unit, Haukeland University Hospital, Bergen, Norway
| | - D Warnock
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M L West
- Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - D A Hughes
- Lysosomal Storage Disorders Unit, Royal Free Hospital NHS Foundation Trust and University College London, London, UK.
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11
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Triantafyllou M, Monteiro R, Protonotarios A, Gossios T, Elliott P, Lloyd G, Savvatis K. Myocardial work analysis in screening of familial dilated cardiomyopathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Early detection of affected family relatives of patients with dilated cardiomyopathy (DCM) is essential in order to guide follow up, outcomes and initiate early treatment. Myocardial work analysis is a novel method which integrated strain imaging and blood pressure and has the potential to identify patients with subclinical disease.
Purpose
We analysed myocardial work in family relatives of DCM patients with positive genotype but negative phenotype in order to identify whether myocardial work can identify early changes.
Methods
Seventy-four family relatives of DCM patients attending for screening were examined. All individuals were asymptomatic with either positive (45/74, G+) or negative (29/74, G-) genotype and no echocardiographic evidence of left ventricular dilatation or systolic impairment. Non-invasive myocardial work analysis using two-dimensional (2D) speckle tracking echocardiography was analysed. Global longitudinal strain (GLS) was measured by the same vendor specific software used for myocardial work analysis. Left ventricular (LV) ejection fraction (EF) was measured with the Simpson's biplane method. The peak systolic arm cuff blood pressure (BP) measurement at the time of echocardiography was used for the myocardial work study.
Results
In total we included 74 individuals (37±15 years old, 50.7% women) with mean systolic and diastolic BP of 121.3±14 and 73.2±10 mmHg respectively, mean EF was 58±5% and mean GLS at 18.4±2.5%.
G+ individuals had pathogenic and very likely pathogenic mutations in 8 different genes (TTN, BAG3, DSP, FLNC, LMNA, DMD, RBM20, TPM1). There was no difference in age, systemic hypertension, diabetes or medical treatment between the 2 groups.
No significant difference was found among G+ and G- individuals in mean systolic and diastolic BP (121.2±14.7 vs 121.2±15.2 mmHg), mean EF (57.3±5 vs 59.1±4%), GLS (−18.2±1.5 vs −18.6±2.9%), mean global work index (1818±403 vs 1928±295 mmHg%) and global constructive work (2192±464 vs 2260±318 mmHg%).
However, we found significant reduction of the global work efficiency (GWE) with a GWE of 94.4±2.7% in the G+ versus 95.9±1.6% in the G- individuals (p 0.02). Moreover, the global wasted work (GWW) was increased in the G+ with a GWW of 111±58 mmHg% versus 82±41 mmHg% in the G- individuals (p 0.03).
Conclusion
DCM gene carriers show, early on, decreased myocardial work efficiency and increased wasted work compared to unaffected family members, which appears to be earlier than other parameters such as EF and GLS. Myocardial work analysis could potentially recognize individuals showing early cardiac involvement and guide closer follow up and early initiation of treatment.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Triantafyllou
- Halland's Hospital Halmstad, Cardiology Division, Halmstad, Sweden
| | - R Monteiro
- Barts Heart Centre, Inherited Cardiomyopathies Unit, London, United Kingdom
| | - A Protonotarios
- Barts Heart Centre, Inherited Cardiomyopathies Unit, London, United Kingdom
| | - T Gossios
- Guy's & St Thomas' NHS Foundation Trust, Department of Cardiology, London, United Kingdom
| | - P Elliott
- Barts Heart Centre, Inherited Cardiomyopathies Unit, London, United Kingdom
| | - G Lloyd
- Barts Heart Centre, Inherited Cardiomyopathies Unit, London, United Kingdom
| | - K Savvatis
- Barts Heart Centre, Inherited Cardiomyopathies Unit, London, United Kingdom
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12
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Abstract
Abstract
Background
The Tafamidis in Transthyretin Cardiomyopathy Clinical Trial (ATTR-ACT), demonstrated that tafamidis was an effective treatment for patients with transthyretin amyloid cardiomyopathy (ATTR-CM). Tafamidis, at an 80 mg daily dose, was subsequently approved in several countries for the treatment of ATTR-CM. Patients who completed ATTR-ACT were eligible to enroll in an ongoing long-term extension study (LTE) which provides additional data on the long-term efficacy of tafamidis.
Purpose
To assess the long-term benefit of tafamidis in patients with ATTR-CM and to determine median survival times with treatment.
Methods
Patients with ATTR-CM who completed ATTR-ACT (in which they were randomized to tafamidis meglumine 80 mg, 20 mg or placebo for 30 months) could enroll in the ongoing LTE in which patients continued to be treated with the same dose of tafamidis or, if previously treated with placebo, were randomized to tafamidis meglumine 80 mg or 20 mg. Tafamidis free acid 61 mg is a new formulation (bioequivalent to tafamidis meglumine 80 mg) developed for patient convenience and all patients in the LTE transitioned to tafamidis free acid 61 mg as of 1 Aug, 2018. All-cause mortality (with heart transplant or cardiac mechanical assist device [CMAD] implantation counted as death) was assessed using a Cox proportional hazards model (as of 1 Aug, 2019). Patients treated with tafamidis meglumine 80 mg in ATTR-ACT and the LTE who transitioned to tafamidis free acid 61 mg (tafamidis 80/61 mg) were compared with patients treated with placebo in ATTR-ACT who transitioned to tafamidis in the LTE (placebo/tafamidis).
Results
There were a total of 176 tafamidis 80/61 mg patients and 177 placebo/tafamidis patients. Median treatment duration was 51.9 months with tafamidis 80/61 mg and 51.4 months with placebo/tafamidis. With tafamidis 80/61 mg, there were 75 (42.6%) all-cause deaths; consisting of 67 (38.1%) deaths, 6 (3.4%) heart transplants, and 2 (1.1%) CMAD implantations. With placebo/tafamidis, there were 108 (61.0%) all-cause deaths; consisting of 102 (57.6%) deaths and 6 (3.4%) heart transplants. There was a significant reduction of 41.1% in the risk of all-cause mortality with tafamidis 80/61 mg compared with placebo/tafamidis (hazard ratio [95% CI], 0.5888 [0.4370, 0.7931]; P=0.0004). Median survival time with placebo/tafamidis was 35.8 months but was not reached with tafamidis 80/61 mg.
Conclusions
Treatment with tafamidis significantly improves long-term survival in patients with ATTR-CM. The comparatively poorer survival in patients treated with placebo in ATTR-ACT who transitioned to tafamidis in the LTE highlights the importance of early diagnosis and treatment.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): This study was sponsored by Pfizer.
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Affiliation(s)
- T Damy
- Henri Mondor University Hospital Chenevier APHP, French Referral Center for Cardiac Amyloidosis, Amyloidosis Mondor Network, GRC Amyloid Research Ins, Creteil, France
| | - P Elliott
- University College London, London, United Kingdom
| | | | - S See Tai
- Pfizer Inc, New York, United States of America
| | - M.B Sultan
- Pfizer Inc, New York, United States of America
| | - B.M Drachman
- University of Maryland, School of Medicine, Baltimore, United States of America
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13
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Dominguez F, Lopez-Sainz A, Rocha-Lopes L, Barriales-Villa R, Climent V, Tiron C, Marques N, Rasmussen T, Espinosa M, Quarta G, Arad M, Asselbergs F, Olivotto I, Elliott P, Garcia-Pavia P. Clinical characteristics and natural history of PRKAG2 syndrome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Purpose
Mutations in the PRKAG2 gene cause a syndrome characterized by hypertrophic cardiomyopathy, conduction disease and ventricular preexcitation. Only a small number of cases have been reported, and the natural history of the disease is poorly understood. The aim of this study is to describe phenotype and natural history of PRKAG2 mutation in a large multicenter international cohort.
Methods
We retrospectively studied clinical, electrocardiographic and echocardiographic data from 90 individuals with PRKAG2 mutations (53% males, 33±21 years) from 27 centers.
Results
At baseline evaluation, 93% of patients were in NYHA functional class I-II. Maximum left ventricular (LV) wall thickness was 18±8 mm and LV hypertrophy (LVH) was present in 60 (67%) subjects at baseline. LV ejection fraction was 61±12%. Seventeen pactients (19%) had a pacemaker (mean age at implantation 37±15and 16 (18%) had atrial fibrillation (AF) (mean age 41±23 years) and 33% had ventricular preexcitation or had undergone an accessory pathway ablation. After a median follow-up of 6 years (IQR:2.3–13.9), 71% of individuals had LVH, 29% had AF, 21% a de novo pacemaker (mean age at implantation 38±18 years), 14% required admission for heart failure (HF), 8% experienced sudden cardiac death or equivalent, 4% required a heart transplant and 13% died.
Conclusions
PRKAG2 syndrome is a severe, progressive cardiomyopathy characterized by high rates of AF, conduction disease, advanced HF and life-threatening arrhythmias. Outcome is not clearly related to the classical features of preexcitation and severe LVH, which are not always present.
Natural history of PRKAG2 syndrome
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Instituto de Salud Carlos III (ISCIII)
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Affiliation(s)
- F Dominguez
- University Hospital Puerta de Hierro Majadahonda, Department of Cardiology, Madrid, Spain
| | - A Lopez-Sainz
- University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
| | | | | | - V Climent
- General University Hospital of Alicante, Alicante, Spain
| | - C Tiron
- University Hospital de Girona Dr. Josep Trueta, Girona, Spain
| | - N Marques
- Algarve University Hospital Center, Faro, Portugal
| | | | - M.A Espinosa
- University Hospital Gregorio Maranon, Madrid, Spain
| | - G Quarta
- Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - M Arad
- Leviev Heart Center, Sheba Medical Center and The Sackler Faculty of Medicine, Tel Aviv, Israel
| | - F Asselbergs
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - I Olivotto
- Careggi University Hospital, Florence, Italy
| | - P Elliott
- St Bartholomew's Hospital, London, United Kingdom
| | - P Garcia-Pavia
- University Hospital Puerta de Hierro Majadahonda, Department of Cardiology, Madrid, Spain
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14
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Brownrigg J, Rose J, Low E, Richard S, Carr-White G, Elliott P. Clinical profiles and incident heart failure in cardiomyopathies: a population-based linked electronic health record cohort study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiomyopathies frequently cause heart failure (HF), however their prevalence in the general population and the natural history of incident HF across the spectrum of cardiomyopathy phenotypes is poorly understood. Improved understanding will help guide rational selection of diagnostic tests and accelerate the recognition of underlying causes of HF.
Purpose
To estimate the prevalence of cardiomyopathies using electronic health records; to compare clinical characteristics between patients with cardiomyopathy phenotypes; and to describe the temporal relationship between diagnosis of cardiomyopathy and incident HF.
Methods
A population-based cohort of patients with cardiomyopathy (n=4058) was provided by the UK Clinical Practice Research Datalink (CPRD) from a denominator sample of ∼9 million individuals. Patients were phenotyped into groups according to ESC criteria: hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), arrhythmogenic right ventricular cardiomyopathy (ARVC) and restrictive cardiomyopathy (RCM). An additional group of transthyretin amyloid cardiomyopathy (ATTR-CM) was reported separately. Point prevalence was estimated for each cardiomyopathy subtype and clinical characteristics defined. An index date at first diagnosis of HF was determined for each patient and the time from/to first diagnosis of cardiomyopathy calculated relative to the index date and presented graphically.
Results
DCM was the most common cardiomyopathy phenotype among women and men with 3.4 and 7.7 cases per 10,000 population, respectively. The 2-fold increase in prevalence among men was consistent across DCM, HCM and RCM; the reverse trend was observed for ARVC which was found in 2.3 per 10,000 women and 1.1 per 10,000 men. At the time of first diagnosis of cardiomyopathy, most patients with ATTR-CM (73.5%), DCM (71.0%) and RCM (71.3%) had pre-existing HF though this proportion fell to 41.0% in ARVC and 31.0% in HCM. In relation to incident HF, a diagnosis of HCM and DCM were recorded earliest at a mean −2.2 years (SE 0.2) and −0.6 years (SE 0.1), respectively. We observed a clustering of diagnoses of RCM (mean −0.2 years, SE 0.4) and ARVC (mean 0.1 years, SE 0.1) around the time of onset of heart failure, whereas a diagnosis of ATTR-CM was first recorded at a mean of 0.9 years (SE 0.2) following the onset of heart failure.
Conclusions
Most diagnoses of ATTR-CM, DCM and RCM were preceded by clinical expression of HF whereas most people with ARVC or HCM developed HF after their cardiomyopathy diagnosis. Our findings in ARVC and HCM suggest a more indolent course with respect to cardiac function or better recognition in an asymptomatic phase. The clustering of a diagnosis of heart failure around the time of diagnosis of cardiomyopathy highlights a need for greater awareness of specific aetiologies of heart failure in routine practice and suggests opportunities for presymptomatic or earlier diagnosis.
Temporality of HF in cardiomyopathies
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Pfizer
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Affiliation(s)
| | - J Rose
- Cardiomyopathy UK, Chesham, United Kingdom
| | - E Low
- Amyloidosis Research Consortium, Edinburgh, United Kingdom
| | - S Richard
- Amyloidosis Research Consortium, Edinburgh, United Kingdom
| | | | - P Elliott
- St Bartholomew's Hospital, Barts Heart Centre, London, United Kingdom
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15
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Cannie D, Protonotarios A, Lorenzini M, Akhtar M, Syrris P, Lopes L, Elliott P. The influence of age on the diagnostic yield of genetic testing in dilated cardiomyopathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2102] [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: 11/15/2022] Open
Abstract
Abstract
Background
Dilated cardiomyopathy (DCM) has an estimated population prevalence of 1/250 and is the underlying diagnosis in a third of heart failure patients. A substantial proportion of patients have familial disease caused by dominant mutations in one of more than 50 genes, but clinical practice guidelines recommend genetic testing in young patients with idiopathic DCM. There is an absence of robust data on the influence of age on the diagnostic yield of genetic testing.
Methods
The study cohort comprised 825 consecutive and unrelated patients (524 male (63.5%)) with DCM who underwent genetic testing from 2015 to 2019. Genetic variants were classified using American College of Medical Genetics (ACMG) criteria. Analyses were stratified by age and sex.
Results
173 (20.1%) patients had a positive genetic test (“pathogenic” or “likely pathogenic” variant); 292 (34.4%) had a variant of unknown significance. Mean age at genetic testing was 49.9±14.4 years. Mean age of patients with a positive test was 47.6±13.6 years. 99 (18.9%) men and 67 (22.3%) women had a positive test (p=0.246).
Mutations in the TTN gene, encoding for titin, accounted for 46.1% of positive results. 13.8% of mutations were in DSP, 8.4% in RBM20, 6% in FLNC, 4.2% in LMNA, 3.6% in BAG3 and 3.6% in MYH7.
There was a trend to declining yield with age (likelihood ratio chi-square p value = 0.047). The yield was 17.2% in the 56–65 year age group and 11.5% above 66 years of age (figure 1).
Conclusions
Approximately 1 in 5 patients with DCM had a positive genetic test. The yield declined in patients over 66 years but remained above 11%, suggesting that genetic testing should not be confined to younger patients with DCM.
Figure 1. Yield of Genetic Testing by Age
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- D.E Cannie
- University College London & Barts Heart Centre, London, United Kingdom
| | - A Protonotarios
- University College London & Barts Heart Centre, London, United Kingdom
| | - M Lorenzini
- University College London & Barts Heart Centre, London, United Kingdom
| | - M Akhtar
- University College London & Barts Heart Centre, London, United Kingdom
| | - P Syrris
- University College London & Barts Heart Centre, London, United Kingdom
| | - L Lopes
- University College London & Barts Heart Centre, London, United Kingdom
| | - P Elliott
- University College London & Barts Heart Centre, London, United Kingdom
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16
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Helio T, Elliott P, Koskenvuo J, Gimeno J, Tavazzi L, Tendera M, Kaski P, Maggioni A, Laroche C, Caforio A, Charron P. Genetic counselling and testing of adult patients with cardiomyopathies: insight from the EORP cardiomyopathy and myocarditis registry of the European Society of Cardiology. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Cardiomyopathies comprise a heterogeneous group of diseases, often of genetic origin.
Purpose
We assessed the current practice of genetic counselling and testing of adult cardiomyopathy patients in the prospective ESC EORP cardiomyopathy registry.
Methods
3 208 adult patients from sixty-nine centres in 18 countries were enrolled. Clinical data on genetic counselling and testing and on the presentation of cardiomyopathies were gathered.
Results
Genetic counselling was performed in 60.8% of all patients (75.4% in hypertrophic (HCM), 39.2% in dilated (DCM), 70.8% in arrhythmogenic right ventricular (ARVC) and 49.2% in restrictive cardiomyopathy (RCM), p<0.001). Comparing European geographical areas, genetic counselling was performed from 42.4% to 83.3% (p<0.001). It was provided by a cardiologist (85.3%), geneticist (15.1%), genetic counsellor (11.3%), or a nurse (7.5%), (p<0.001). Genetic testing was performed in 37.3% of all patients (48.8% in HCM, 18.6% in DCM, 55.6% % in ARVC and 43.6% in RCM, p<0.001). Index patients with genetic testing were younger at diagnosis, had more familial disease, family history of sudden cardiac death or implanted cardioverter defibrillators but less comorbidities than those not tested (p<0.001 for each comparison). At least 1 disease causing variant was found in 41.7% of index patients with genetic testing (43.3% in HCM, 33.3% in DCM, 51.4% in ARVC and 42.9% in RCM, p=0.13).
Conclusion
We report on the practice of genetic counselling and testing in cardiomyopathies in Europe. Genetic counselling and testing were performed in a substantial proportion of patients but less often than recommended by European guidelines, and much less in DCM than in HCM and ARVC, despite evidence for genetic background.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Helio
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - P Elliott
- University College London and St. Bartholomew's Hospital, London, United Kingdom
| | | | - J.G Gimeno
- Hospital Universitario Virgen Arrixaca, Murcia, Spain
| | - L Tavazzi
- Maria Cecilia Hospital, Cotignola, Italy
| | - M Tendera
- School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - P Kaski
- Great Ormond Street Hospital for Children, London, United Kingdom
| | | | - C Laroche
- European Society of Cardiology, EURObservational Research Programme, Sophia-Antipolis, France
| | - A.L.P Caforio
- University of Padova, Cardiology, Dept of Cardiological, Thoracic and Vascular Sciences and Public Health, Padova, Italy
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17
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Mizia-Stec K, Charron P, Blanes J, Elliott P, Kaski J, Maggioni A, Tavazzi L, Tendera M, Wybraniec M, Laroche C, Caforio A. Availability and applicability of cardiac magnetic resonance imaging in diagnosis in cardiomyopathies: the Cardiomyopathy/Myocarditis registry of the EURObservational Research Programme of the ESC. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac magnetic resonance (CMR) constitutes a gold standard in the diagnosis of cardiomyopathies. Regardless of CMR advantages, the method is time-consuming, high-cost, with limited availability in some European regions.
Purpose
To assess the availability and applicability of CMR for establishing the diagnosis in different populations of patients with cardiomyopathies.
Methods
Overall, 3208 adult patients with cardiomyopathy (1119 / 34.9% females; median age at diagnosis: 49.0 years): 1260 with dilated (DCM), 1739 with hypertrophic (HCM), 66 with restrictive (RCM) and 143 with arrhythmogenic right ventricular cardiomyopathy (ARVC) enrolled in EURObservational Research Programme (EORP) – Cardiomyopathy/Myocarditis Long-Term Registry were analysed.
Results
CMR scan was performed as a baseline diagnostic method in 29.4% of patients; CMR was a single diagnostic method in 0.9% of patients and in 28.6% of patients CMR was used along with transthoracic echocardiography (TTE). In 67.6% of patients TTE was at the baseline the single diagnostic imaging method. Prevalence of CMR use in different cardiomyopathies was as follows: 20.6% in DCM, 33.8% in HCM, 36.4% in RCM and 51.1% in ARVC (p<0.001). Range of CMR applicability in different European regions was diverse from 0% up to 63.2%.
The population with CMR use was younger, less symptomatic, with decreased prevalence of other cardiovascular risk factors and of associated cardiovascular diseases as compared to the population diagnosed without CMR scanning (p<0.001).
Abnormal CMR results were present in 93.4% of patients with the highest percentage in RCM (95.8%) and HCM (94.9%) followed by DCM (91.5%) and the lowest abnormal CMR scan ratio in ARVC (87.7%) (p=0.030). The majority of CMR examinations comprised the assessment of late gadolinium enhancement (LGE, 93.3% at baseline). Presence of CMR LGE was observed in 69.3% of all patients: 59.1% in DCM, 73.8% in HCM, in 63.9% in ARVC and with the highest prevalence in RCM (83.3%) (p<0.001).
Conclusion
The study reveals real-life data on the low availability and applicability of CMR in adult patients with cardiomyopathies. The analysis shows the advantages of CMR imaging but also identifies the gaps between recommendations and clinical practice. Improvement regarding access, training and reimbursement is necessary to offer CMR to cardiomyopathy patients in accordance with the ESC guidelines.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- K Mizia-Stec
- Medical University of Silesia, 1st Department of Cardiology, Katowice, Poland
| | - P Charron
- Sorbonne University, Inserm UMR1166, Paris, France
| | - J.R.G Blanes
- Hospital Universitario Virgen Arrixaca, Cardiac Department, Murcia, Spain
| | - P Elliott
- University College London, Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - J.P Kaski
- Great Ormond Street Hospital for Children, Centre for Inherited Cardiovascular Diseases, London, United Kingdom
| | - A.P Maggioni
- ANMCO Foundation For Your Heart, Florence, Italy
| | - L Tavazzi
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
| | - M Tendera
- School of Medicine in Katowice, Medical University of Silesia, Department of Cardiology and Structural Heart Disease, Katowice, Poland
| | - M Wybraniec
- Medical University of Silesia, 1st Department of Cardiology, Katowice, Poland
| | - C Laroche
- European Society of Cardiology, EURObservational Research Programme, Sophia-Antipolis, France
| | - A.L.P Caforio
- University of Padova, Division of Cardiology, Department of Cardiological Thoracic and Vascular Sciences, Padua, Italy
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18
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Graham NSN, Junghans C, Downes R, Sendall C, Lai H, McKirdy A, Elliott P, Howard R, Wingfield D, Priestman M, Ciechonska M, Cameron L, Storch M, Crone MA, Freemont PS, Randell P, McLaren R, Lang N, Ladhani S, Sanderson F, Sharp DJ. SARS-CoV-2 infection, clinical features and outcome of COVID-19 in United Kingdom nursing homes. J Infect 2020; 81:411-419. [PMID: 32504743 PMCID: PMC7836316 DOI: 10.1016/j.jinf.2020.05.073] [Citation(s) in RCA: 160] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/30/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To understand SARS-Co-V-2 infection and transmission in UK nursing homes in order to develop preventive strategies for protecting the frail elderly residents. METHODS An outbreak investigation involving 394 residents and 70 staff, was carried out in 4 nursing homes affected by COVID-19 outbreaks in central London. Two point-prevalence surveys were performed one week apart where residents underwent SARS-CoV-2 testing and had relevant symptoms documented. Asymptomatic staff from three of the four homes were also offered SARS-CoV-2 testing. RESULTS Overall, 26% (95% CI 22-31) of residents died over the two-month period. All-cause mortality increased by 203% (95% CI 70-336) compared with previous years. Systematic testing identified 40% (95% CI 35-46) of residents as positive for SARS-CoV-2, and of these 43% (95% CI 34-52) were asymptomatic and 18% (95% CI 11-24) had only atypical symptoms; 4% (95% CI -1 to 9) of asymptomatic staff also tested positive. CONCLUSIONS The SARS-CoV-2 outbreak in four UK nursing homes was associated with very high infection and mortality rates. Many residents developed either atypical or had no discernible symptoms. A number of asymptomatic staff members also tested positive, suggesting a role for regular screening of both residents and staff in mitigating future outbreaks.
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Affiliation(s)
- N S N Graham
- UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK; Department of Brain Sciences, Imperial College London, UK
| | - C Junghans
- Department of Primary Care and Public Health, Imperial College London, UK
| | - R Downes
- Department of Elderly Medicine, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
| | - C Sendall
- Department of Elderly Medicine, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
| | - H Lai
- UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK; Department of Brain Sciences, Imperial College London, UK
| | - A McKirdy
- North West London Health Protection Team, Public Health England, 61 Colindale Avenue, Colindale, London NW9 5EQ, UK
| | - P Elliott
- UK DRI Centre at Imperial, Imperial College London, UK; MRC Centre for Environment and Health, Imperial College London, UK; BHF Centre of Excellence, Imperial College London, UK; Imperial NIHR Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, UK
| | - R Howard
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London W1T 7NF, UK
| | - D Wingfield
- Department of Metabolism, Digestion and Reproduction, Imperial College London, UK; Department of Primary Care and Public Health, Imperial College London, UK
| | - M Priestman
- London Biofoundry, Imperial College Translation and Innovation Hub, White City Campus, 80 Wood Lane, London W12 0BZ, UK; Section of Structural and Synthetic Biology, Department of Infectious Disease, Imperial College London, London SW7 2AZ, UK; UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK
| | - M Ciechonska
- London Biofoundry, Imperial College Translation and Innovation Hub, White City Campus, 80 Wood Lane, London W12 0BZ, UK; Section of Structural and Synthetic Biology, Department of Infectious Disease, Imperial College London, London SW7 2AZ, UK; UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK
| | - L Cameron
- Section of Structural and Synthetic Biology, Department of Infectious Disease, Imperial College London, London SW7 2AZ, UK; UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK
| | - M Storch
- London Biofoundry, Imperial College Translation and Innovation Hub, White City Campus, 80 Wood Lane, London W12 0BZ, UK; Section of Structural and Synthetic Biology, Department of Infectious Disease, Imperial College London, London SW7 2AZ, UK; UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK
| | - M A Crone
- London Biofoundry, Imperial College Translation and Innovation Hub, White City Campus, 80 Wood Lane, London W12 0BZ, UK; Section of Structural and Synthetic Biology, Department of Infectious Disease, Imperial College London, London SW7 2AZ, UK; UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK
| | - P S Freemont
- London Biofoundry, Imperial College Translation and Innovation Hub, White City Campus, 80 Wood Lane, London W12 0BZ, UK; Section of Structural and Synthetic Biology, Department of Infectious Disease, Imperial College London, London SW7 2AZ, UK; UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK
| | - P Randell
- North West London Pathology, Charing Cross Hospital, London W6 8RF, UK; Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
| | - R McLaren
- Park Medical Centre, Hammersmith, London W6 0QG, UK
| | - N Lang
- Hammersmith and Fulham Council, 3 Shortlands, Hammersmith W6 8DA, UK
| | - S Ladhani
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - F Sanderson
- Department of Infection, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK.
| | - D J Sharp
- UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK; Department of Brain Sciences, Imperial College London, UK
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19
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Dewhurst JK, Willems F, Elliott P, Li QZ, Schmising CVK, Strüber C, Engel DW, Eisebitt S, Sharma S. Element Specificity of Transient Extreme Ultraviolet Magnetic Dichroism. Phys Rev Lett 2020; 124:077203. [PMID: 32142343 DOI: 10.1103/physrevlett.124.077203] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 01/22/2020] [Indexed: 06/10/2023]
Abstract
In this work we combine theory and experiment to study transient magnetic circular dichroism (TRMCD) in the extreme ultraviolet spectral range in bulk Co and CoPt. We use the ab initio method of real-time time-dependent density functional theory to simulate the magnetization dynamics in the presence of short laser pulses. From this we demonstrate how TRMCD may be calculated using an approximation to the excited-state linear response. We apply this approximation to Co and CoPt and show computationally that element-specific dynamics of the local spin moments can be extracted from the TRMCD in the extreme ultraviolet energy range, as is commonly assumed. We then compare our theoretical prediction for the TRMCD for CoPt with experimental measurement and find excellent agreement at many different frequencies including the M_{23} edge of Co and N_{67} and O_{23} edges of Pt.
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Affiliation(s)
- J K Dewhurst
- Max-Planck-Institut für Mikrostrukturphysik, Weinberg 2, D-06120 Halle, Germany
| | - F Willems
- Max-Born-Institut für Nichtlineare Optik und Kurzzeitspektroskopie, Max-Born-Strasse 2A, 12489 Berlin, Germany
| | - P Elliott
- Max-Born-Institut für Nichtlineare Optik und Kurzzeitspektroskopie, Max-Born-Strasse 2A, 12489 Berlin, Germany
| | - Q Z Li
- Max-Born-Institut für Nichtlineare Optik und Kurzzeitspektroskopie, Max-Born-Strasse 2A, 12489 Berlin, Germany
| | - C von Korff Schmising
- Max-Born-Institut für Nichtlineare Optik und Kurzzeitspektroskopie, Max-Born-Strasse 2A, 12489 Berlin, Germany
| | - C Strüber
- Max-Born-Institut für Nichtlineare Optik und Kurzzeitspektroskopie, Max-Born-Strasse 2A, 12489 Berlin, Germany
| | - D W Engel
- Max-Born-Institut für Nichtlineare Optik und Kurzzeitspektroskopie, Max-Born-Strasse 2A, 12489 Berlin, Germany
| | - S Eisebitt
- Max-Born-Institut für Nichtlineare Optik und Kurzzeitspektroskopie, Max-Born-Strasse 2A, 12489 Berlin, Germany
| | - S Sharma
- Max-Born-Institut für Nichtlineare Optik und Kurzzeitspektroskopie, Max-Born-Strasse 2A, 12489 Berlin, Germany
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20
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Kanagasabai T, Lee M, Carter E, Yan L, Guo D, Chan Q, Elliott P, Ezzati M, Wu Y, Baumgartner J. Exposure to air pollution is associated with lower sleep duration and higher odds of snoring and suspected osa in China. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.514] [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: 11/26/2022]
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Elliott P, Payne N. Environment and Health: Official knowledge and lay response. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Due to its history, Halton, United Kingdom, provides a natural experiment to investigate the divide between lay and official knowledge about environment and deprivation, and how these may influence health choices and outcomes. 55 semi-structured interviews were carried out to assess a cross-section of residents’ perceptions and experiences of health, environment and lifestyle, taking a life history approach to examine health over time, and how choices were constructed. These were analysed for themes using a structuration theory approach. Residents’ viewpoints were then presented to twenty local public organisation officials, with their own perceptions also discussed. The overall standpoints were very different to those expressed by residents, being based on quantifiable knowledge such as that gained by officially collected statistics. Residents were not only sceptical about the knowledge presented by public health organisations, but valued lay knowledge gained through observation and experience. Official knowledge was interpreted primarily via an analysis of why this knowledge was created rather than an assessment of the knowledge itself. The interpretation was formed by a perception amongst residents that lay fears about pollution were being, at best, downplayed or, at worst, discounted by ’the powers that be’ who, in turn, placed faith in checks carried out by other official bodies. Official knowledge represented an expression of vested interests, presented by superordinate and external agents. A feeling of disempowerment co-existed alongside a perception that there was access to a form of truth via observation and experience rather than empirical knowledge. Whereas scientific information was discredited, lay knowledge was seen to be a more reliable guide as it remained free from a perceived bias. A degree of agency could be exercised perhaps only in this perception of ’pure’, if unprovable, knowledge.
Key messages
Formulation of official knowledge and reception of issued messages by lay residents in an area of high deprivation and compromised environment. Factors influencing perception, and adoption, of health messages which may impact on health and well-being in a local population.
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Affiliation(s)
- P Elliott
- Research Office, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - N Payne
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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22
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Elliott P, Drachman BM, Gottlieb SS, Hoffman JE, Hummel SL, Lenihan DJ, Ebede B, Gundapaneni B, Schwartz JH, Sultan MB, Shah SJ. 1169Interim analysis of data from a long-term, extension trial of tafamidis meglumine in patients with transthyretin amyloid cardiomyopathy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Transthyretin amyloid cardiomyopathy (ATTR-CM), is an underdiagnosed, fatal disease caused by the deposition of transthyretin amyloid fibrils in the heart leading to heart failure. The Transthyretin Cardiomyopathy Clinical Trial (ATTR-ACT), an international, multi-center, double-blind, placebo-controlled, randomized study, demonstrated the efficacy and safety of tafamidis treatment for patients with ATTR-CM due to variant (ATTRm) or wild-type (ATTRwt) TTR.
Purpose
This is a pooled analysis of data from ATTR-ACT and interim data from the ongoing, long-term, extension study to evaluate longer term data on the efficacy of tafamidis in patients with ATTR-CM.
Methods
Patients who completed ATTR-ACT (which had a duration of 30 months) were eligible to be enrolled in a long-term, extension study in which patients either continued to receive tafamidis meglumine at the same dose (the tafamidis/tafamidis [T/T] group) or, for patients previously treated with placebo, were randomised (in a 1:2 ratio) to tafamidis meglumine 20 mg or 80 mg (the placebo/tafamidis [P/T] group) for up to 60 months. The primary efficacy outcome was all-cause mortality. This analysis combined data from the completed ATTR-ACT with interim data from the extension study (cut-off date: 15 Feb, 2018), and included patients treated with tafamidis meglumine across the two studies with a median follow up of 36 months.
Results
All-cause mortality was significantly lower in the T/T group (n=264; 88 events, 33.3%) compared with the P/T group (n=177; 88 events, 50.3%); hazard ratio (95% CI), 0.64 (0.47, 0.85); P=0.001. In the subgroup of ATTRwt patients, all-cause mortality was significantly reduced in the T/T group (55/201; 27.4%) compared with the P/T group (60/134; 44.8%); 0.64 (0.44, 0.92); P=0.002. In the 106 (24.0%) ATTRm patients, there was a trend towards a reduction in all-cause mortality in the T/T group (33/63; 52.4%) compared with the P/T group (29/43; 67.4%); 0.66 (0.39, 1.09); P=0.17. In patients who were NYHA Class I or II at baseline, all-cause mortality was significantly reduced in the T/T group (38/186; 20.4%) compared with the P/T group (45/114; 39.5%); 0.49 (0.32, 0.75); P=0.001. In those patients with more severe symptoms at baseline (NYHA Class III), there were fewer deaths in the T/T group (50/78; 64.1%) compared with the P/T group (44/63; 69.8%); 0.80 (0.53, 1.21), but this difference was not statistically significant (P=0.50).
Conclusions
In ATTR-ACT, tafamidis was shown to significantly improve survival, functional capacity, and quality of life in patients with ATTR-CM. This pooled analysis with data from the ongoing extension study further supports the efficacy of tafamidis in patients over a longer period of time and the importance of early diagnosis and treatment.
Acknowledgement/Funding
This study was sponsored by Pfizer.
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Affiliation(s)
- P Elliott
- University College London, London, United Kingdom
| | - B M Drachman
- Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia, United States of America
| | - S S Gottlieb
- University of Maryland, School of Medicine, Baltimore, United States of America
| | - J E Hoffman
- University of Miami, Miami, United States of America
| | - S L Hummel
- University of Michigan, Ann Arbor, United States of America
| | - D J Lenihan
- Washington University School of Medicine, St. Louis, United States of America
| | - B Ebede
- Pfizer Inc, Collegeville, United States of America
| | | | | | - M B Sultan
- Pfizer Inc, New York, United States of America
| | - S J Shah
- Northwestern University Feinberg School of Medicine, Division of Cardiology, Department of Medicine, Chicago, United States of America
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Pietrusz A, Scalco R, Pizzamiglio C, Savvatis K, Gkosios T, Elliott P, Godfrey R, Pattni J, Chatfield S, Patasin M, Quinlivan R. P.123Frequency of coronary artery disease in people with McArdle disease. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.179] [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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Quinlivan R, Pietrusz A, Pizzamiglio C, Pattni J, Mahroo O, Khan K, Elliott P, Patasin M, Chatfield S, Lucia A, Zugaza J, Llavero F, Godfrey R. McARDLE DISEASE. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.171] [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: 11/24/2022]
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25
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Wahbi K, Ben Yaou R, Gandjbakhch E, Anselme F, Gossios T, Lakdawala N, Stalens C, Sacher F, Babuty D, Charron P, Vigouroux C, Bonne G, Kumar S, Elliott P, Duboc D. 5164New risk prediction score for life-threatening ventricular tachyarrhythmias in laminopathies. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0049] [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
An accurate estimation of the risk of life-threatening (LT) ventricular tachyarrhythmia (VTA) in patients with LMNA mutations is crucial to select candidates for implantable cardioverter defibrillator (ICD) implantation.
Methods
We included 839 adult patients with LMNA mutations, including 660 from a French nationwide registry in the development sample, and 179 from other countries, referred to 5 tertiary centers for cardiomyopathies, in the validation sample. LTVTA was defined as a) sudden cardiac death or b) ICD-treated or hemodynamically unstable VTA. The prognostic model was derived using Fine-Gray's regression model. The net reclassification was compared with current clinical practice guidelines. The results are presented as means (standard deviation) or medians [interquartile range].
Results
We included 444 patients 40.6 (14.1) years of age in the derivation sample and 145 patients 38.2 (15.0) years in the validation sample, of whom 86 (19.3%) and 34 (23.4%) suffered LTVTA over 3.6 [1.0–7.2] and 5.1 [2.0–9.3] years of follow-up, respectively. Predictors of LTVTA in the derivation sample were: male sex, non-missense LMNA mutation, 1st degree and higher atrioventricular block, non-sustained ventricular tachycardia, and left ventricular ejection fraction. In the derivation sample, C-index (95% CI) of the model was 0.776 (0.711–0.842). In the external validation sample, the C-index was 0.800 (0.642–0.959) and calibration slope 1.082 (95% CI, 0.643–1.522). A 5-year estimated risk threshold ≥7% predicted 96.2% of LTVTA and net reclassified 28.8% of patients with LTVTA compared with the guidelines-based approach.
Conclusions
Compared to the current standard of care, this risk prediction model for LTVTA in laminopathies facilitated significantly the choice of ICD candidates.
Acknowledgement/Funding
AFM Téléthon
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Affiliation(s)
- K Wahbi
- Hospital Cochin, Paris, France
| | - R Ben Yaou
- AP-HP - Hospital Pitie-Salpetriere, Paris, France
| | | | - F Anselme
- Rouen University Medical School, Rouen, France
| | - T Gossios
- Barts Health NHS Trust, London, United Kingdom
| | - N Lakdawala
- Brigham and Womens Hospital, Boston, United States of America
| | | | - F Sacher
- Hospital Haut Leveque, Bordeaux-Pessac, France
| | - D Babuty
- University Hospital of Tours, Tours, France
| | - P Charron
- AP-HP - Hospital Pitie-Salpetriere, Paris, France
| | | | - G Bonne
- AP-HP - Hospital Pitie-Salpetriere, Paris, France
| | - S Kumar
- Westmead Hospital, Sydney, Australia
| | - P Elliott
- Barts Health NHS Trust, London, United Kingdom
| | - D Duboc
- Hospital Cochin, Paris, France
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26
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Yamauchi H, Kondo K, Tanaka S, Okuda N, Nakagawa H, Sakata K, Saitoh S, Okayama A, Yoshita K, Miura K, Chan Q, Masaki K, Elliott P, Stamler J, Ueshima H. P6234The relationship of alcohol consumption with risk factors of coronary heart disease and the intake of macro- and micro-nutrients in Japanese: the INTERLIPID study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Many studies have reported the J-shaped relationship between alcohol consumption and coronary heart disease (CHD) risk; therefore, light-drinkers is generally recognized to be associated with the lower risk of CHD. However, the mechanisms of lower risk for CHD in light-drinkers are still unclear. Alcohol drinking status is likely to be associated with not only CHD risk factors but also dietary intake. Nevertheless, few studies report these relationships in detail.
Purpose
The purpose of this study is to evaluate the relationships of alcohol drinking status with CHD classical risk factors and the intake of macro- and micro- nutrients in Japanese.
Methods
Study participants were 1,090 Japanese men and women aged 40–59 years from The INTERLIPID study excepted for 55 individuals who had missing data (n=26) and were past-drinkers (n=29). Alcohol consumption was assessed with two 7-day alcohol records, and average ethanol intake (per week) was calculated. Participants were classified into following 4 groups: non-drinkers (0g/week), light-drinkers (<100 g/week), moderate-drinkers (100–299 g/week), and heavy-drinkers (≥300 g/week). Serum LDL and HDL cholesterol, blood pressure (BP), the prevalence of hypertension and dyslipidemia, and smoking status were assessed as CHD risk factors. The intake of energy and macro- and micro-nutrients were evaluated from the four-timed in-depth 24-hr dietary recalls. Nutrient intake densities were calculated per total energy intake without alcohol. The analysis of variance and chi-squared test were used to evaluate the relations of alcohol status with CHD risk factors and nutrient intake.
Results
Serum HDL cholesterol levels increased and LDL cholesterol levels decreased with increasing alcohol consumption. Systolic and diastolic BP increased with increasing alcohol consumption. J-shaped relationships with alcohol consumption were observed for the proportion of current smoker, number of cigarettes, and the prevalence of hypertension; that is, light-drinkers was lowest among all groups. The prevalence of dyslipidemia was the highest in non-drinkers, and decreased with increasing alcohol consumption. In heavy-drinkers, total energy (kcal/day) was the highest, but energy intake without alcohol (kcal/day) was the lowest. For macronutrients, the intake of carbohydrate (%kcal) decreased, and the intakes of total and animal protein (%kcal) increased with increasing alcohol consumption. The intakes of total cholesterol (mg/1000kcal) and sodium (mg/1000kcal) increased, and total fiber (g/1000kcal) decreased with increasing alcohol consumption. These associations were similar in men and women.
Conclusions
Alcohol consumption was related with not only CHD classical risk factors but also the intake of macro- and micro-nutrients. Non-drinkers had a higher proportion of some CHD risk factors than light-drinkers. These results might influence on J-shaped relationship between alcohol consumption and CHD risk.
Acknowledgement/Funding
1: Ministry of Education, Science, Sports, and Culture of Japan, 2: National Institutes of Health, Bethesda, MD, USA
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Affiliation(s)
- H Yamauchi
- Shiga University of Medical Science, Center for Epidemiologic Research in Asia, Shiga, Japan
| | - K Kondo
- Shiga University of Medical Science, Department of Public Health, Shiga, Japan
| | - S Tanaka
- Shiga University of Medical Science, Department of Medical Statistics, Shiga, Japan
| | - N Okuda
- University of Human Arts and Sciences, Department of Health and Nutrition, Saitama, Japan
| | - H Nakagawa
- Kanazawa Medical University, Department of Epidemiology and Public Health, Kanazawa, Japan
| | - K Sakata
- Iwate Medical University, Department of Hygiene and Preventive Medicine, Iwate, Japan
| | - S Saitoh
- Sapporo Medical University, School of Health Sciences, School of Medicine, Sapporo, Japan
| | - A Okayama
- Research Institute of Strategy for Prevention, Tokyo, Japan
| | - K Yoshita
- Osaka City University, Department of Food Science and Nutrition, Osaka, Japan
| | - K Miura
- Shiga University of Medical Science, Department of Public Health, Shiga, Japan
| | - Q Chan
- Imperial College London, Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, London, United Kingdom
| | - K Masaki
- University of Hawaii and Kuakini Medical Center, Department of Geriatric Medicine, John A. Burns School of Medicine, Honolulu, United States of America
| | - P Elliott
- Imperial College London, Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, London, United Kingdom
| | - J Stamler
- Northwestern University, Department of Preventive Medicine, Feinberg School of Medicine, Chicago, United States of America
| | - H Ueshima
- Shiga University of Medical Science, Center for Epidemiologic Research in Asia, Shiga, Japan
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Nigenda G, Elliott P, Flores H, Aristizabal P, Martinez-Davalos A. Interprofessional training for the delivery of community health services in Mexico: the experience of Partners in Health. J Interprof Care 2019; 33:382-388. [PMID: 31429333 DOI: 10.1080/13561820.2019.1641475] [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] [Indexed: 10/26/2022]
Abstract
Interprofessional training in health is scarce in Mexico. Partners in Health (CES in Spanish), is the branch of an international civil society organization that provides health services to poor and rural populations. CES runs a set of ten health centers in Chiapas, Mexico, in partnership with the local Ministry of Health. A key component of the provision strategy is to train healthcare providers, mainly medical and nursing students in their final year of training, to create healthcare teams that work together while fostering their individual capacities. CES offers a diploma on Global Health and Social Medicine, where medical and nursing students -also called pasantes- interact to discuss jointly the effects of global and social determinants of health in local communities, as well as specific clinical topics. A qualitative study including interviews and nonparticipant observations was undertaken to identify initial achievements and challenges of the experience. CES has achieved important benefits related to teamwork as well as clinical capacities of individuals as healthcare providers. However, challenges have emerged: differences in social origin, personal development expectations, professional identity and institutional roles hinder team cohesion. Consequently, CES has introduced adjustments to reduce the negative impact of these differences. Although the training model needs further development, the possibility of transferring some of its good practices to non-CES scenarios should be seriously considered by health authorities.
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Affiliation(s)
- G Nigenda
- School of Nursing and Obstetrics, National University Autonomous of Mexico , Mexico
| | - P Elliott
- Partners in Health, Mexico and Brigham and Women's Hospital , Boston
| | - H Flores
- Partners in Health , Boston , Mexico
| | - P Aristizabal
- Iztacala School of Higher Studies, National University Autonomous of Mexico , Mexico
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Freni-Sterrantino A, Ghosh RE, Fecht D, Toledano MB, Elliott P, Hansell AL, Blangiardo M. Bayesian spatial modelling for quasi-experimental designs: An interrupted time series study of the opening of Municipal Waste Incinerators in relation to infant mortality and sex ratio. Environ Int 2019; 128:109-115. [PMID: 31039518 DOI: 10.1016/j.envint.2019.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND There is limited evidence on potential health risks from Municipal Waste Incinerators (MWIs), and previous studies on birth outcomes show inconsistent results. Here, we evaluate whether the opening of MWIs is associated with infant mortality and sex ratio in the surrounding areas, extending the Interrupted Time Series (ITS) methodological approach to account for spatial dependencies at the small area level. METHODS We specified a Bayesian hierarchical model to investigate the annual risks of infant mortality and sex-ratio (female relative to male) within 10 km of eight MWIs in England and Wales, during the period 1996-2012. We included comparative areas matched one-to-one of similar size and area characteristics. RESULTS During the study period, infant mortality rates decreased overall by 2.5% per year in England. The opening of an incinerator in the MWI area was associated with -8 deaths per 100,000 infants (95% CI -62, 40) and with a difference in sex ratio of -0.004 (95% CI -0.02, 0.01), comparing the period after opening with that before, corrected for before-after trends in the comparator areas. CONCLUSION Our method is suitable for the analysis of quasi-experimental time series studies in the presence of spatial structure and when there are global time trends in the outcome variable. Based on our approach, we do not find evidence of an association of MWI opening with changes in risks of infant mortality or sex ratio in comparison with control areas.
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Affiliation(s)
- A Freni-Sterrantino
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, W2 1PG, UK.
| | - R E Ghosh
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, W2 1PG, UK
| | - D Fecht
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, W2 1PG, UK
| | - M B Toledano
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK; National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Health Impact of Environmental Hazards, Dept Epidemiology and Biostatistics, Imperial College London, UK
| | - P Elliott
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, W2 1PG, UK; MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK; National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Health Impact of Environmental Hazards, Dept Epidemiology and Biostatistics, Imperial College London, UK
| | - A L Hansell
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, W2 1PG, UK; National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Health Impact of Environmental Hazards, Dept Epidemiology and Biostatistics, Imperial College London, UK; Directorate of Public Health and Primary Care, Imperial College Healthcare NHS Trust, London W2 1NY, UK; Centre for Environmental Health and Sustainability, George Davies Centre, Dept of Health Sciences, University of Leicester, UK
| | - M Blangiardo
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK
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Scully PR, Morris E, Patel K, Saberwal B, Chadalavada S, Testanera G, Subhani S, Ferreira S, Hartman N, Mullen M, Elliott P, Fontana M, Hawkins PN, Moon JC, Menezes LJ. 237SUV Quantification in DPD Scintigraphy. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez145.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P R Scully
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - E Morris
- St Bartholomew"s Hospital, Clinical Physics, London, United Kingdom of Great Britain & Northern Ireland
| | - K Patel
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - B Saberwal
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - S Chadalavada
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - G Testanera
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - S Subhani
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - S Ferreira
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - N Hartman
- Abertawe Bro Morgannwg University HB, Nuclear Medicine, Port Talbot, United Kingdom of Great Britain & Northern Ireland
| | - M Mullen
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - P Elliott
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - M Fontana
- University College London, National Amyloidosis Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - P N Hawkins
- University College London, National Amyloidosis Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - J C Moon
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - L J Menezes
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
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Wang CY, Elliott P, Sharma S, Dewhurst JK. Real time scissor correction in TD-DFT. J Phys Condens Matter 2019; 31:214002. [PMID: 30721894 DOI: 10.1088/1361-648x/ab048a] [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: 06/09/2023]
Abstract
We demonstrate how the scissor correction to the optical band gap, common in linear-response time-dependent density functional theory (TD-DFT), may be extended to the domain of real-time TD-DFT. This requires modifying both the eigenvalues and momentum matrix elements of the underlying basis set. It provides a simple and computationally economical approach for calculating accurate electron dynamics in solids. We demonstrate the importance of this correction for prototypical semiconductors, diamond and silicon, where the energy absorption in both the linear and non-linear regimes is examined. We also show that for a particular system, ZnSe, using the adiabatic local density approximation together with a scissor correction can be advantageous over other approximations, as the underlying quasi-particle band structure is more accurate.
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Affiliation(s)
- C-Y Wang
- Max Planck Institute of Microstructure Physics, Weinberg 2, D-06120 Halle, Germany
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31
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Chen J, Bovensiepen U, Eschenlohr A, Müller T, Elliott P, Gross EKU, Dewhurst JK, Sharma S. Competing Spin Transfer and Dissipation at Co/Cu(001) Interfaces on Femtosecond Timescales. Phys Rev Lett 2019; 122:067202. [PMID: 30822073 DOI: 10.1103/physrevlett.122.067202] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 11/28/2018] [Indexed: 05/23/2023]
Abstract
By combining interface-sensitive nonlinear magneto-optical experiments with femtosecond time resolution and ab initio time-dependent density functional theory, we show that optically excited spin dynamics at Co/Cu(001) interfaces proceeds via spin-dependent charge transfer and back transfer between Co and Cu. This ultrafast spin transfer competes with dissipation of spin angular momentum mediated by spin-orbit coupling already on sub 100 fs timescales. We thereby identify the fundamental microscopic processes during laser-induced spin transfer at a model interface for technologically relevant ferromagnetic heterostructures.
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Affiliation(s)
- J Chen
- Faculty of Physics and Center for Nanointegration (CENIDE), University of Duisburg-Essen, Lotharstraße 1, 47057 Duisburg, Germany
| | - U Bovensiepen
- Faculty of Physics and Center for Nanointegration (CENIDE), University of Duisburg-Essen, Lotharstraße 1, 47057 Duisburg, Germany
| | - A Eschenlohr
- Faculty of Physics and Center for Nanointegration (CENIDE), University of Duisburg-Essen, Lotharstraße 1, 47057 Duisburg, Germany
| | - T Müller
- Theory Department, Max Planck Institute of Microstructure Physics, Weinberg 2, 06120 Halle, Germany
| | - P Elliott
- Theory Department, Max Planck Institute of Microstructure Physics, Weinberg 2, 06120 Halle, Germany
| | - E K U Gross
- Theory Department, Max Planck Institute of Microstructure Physics, Weinberg 2, 06120 Halle, Germany
| | - J K Dewhurst
- Theory Department, Max Planck Institute of Microstructure Physics, Weinberg 2, 06120 Halle, Germany
| | - S Sharma
- Theory Department, Max Planck Institute of Microstructure Physics, Weinberg 2, 06120 Halle, Germany and Max Born Institute for Nonlinear Optics and Short Pulse Spectroscopy, Max-Born-Strasse 2A, 12489 Berlin, Germany
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Bugiardini E, Phadke R, Maas R, Pittman A, Kusters B, Morrow J, Parton M, Nunes A, Akhtar M, Syrris P, Lopes L, Fotelonga T, Houlden H, Elliott P, Hanna M, Raaphorst J, Burkin D, Matthews E. CONGENITAL MUSCULAR DYSTROPHIES. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.382] [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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Rominger AH, Gomez GAA, Elliott P. The implementation of a longitudinal POCUS curriculum for physicians working at rural outpatient clinics in Chiapas, Mexico. Crit Ultrasound J 2018; 10:19. [PMID: 30109455 PMCID: PMC6092270 DOI: 10.1186/s13089-018-0101-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 07/21/2018] [Indexed: 01/07/2023] Open
Abstract
Background Medical care in resource limited settings is challenging, particularly with limited access to diagnostic and imaging studies. The most portable and cost effective diagnostic imaging in these areas is ultrasound. Ultrasound is a very teachable skill with a short, single intensive training course and hands-on teaching; however, there are limited data on a longitudinal point-of-care ultrasound (POCUS) curriculum in resource limited settings. The goal of this intervention is to develop an effective longitudinal POCUS curriculum for local physicians working in rural clinics in the state of Chiapas, Mexico, and evaluate its effectiveness on patient care. Methods This is a 12-month longitudinal ultrasound educational curriculum for local supervising physicians working in rural clinics in Chiapas, Mexico. The 10 clinics are a collaboration of the Mexican government and Compañeros En Salud with limited access to any diagnostic imaging or laboratory studies. The investigators assisted in obtaining four portable ultrasound machines for use in the clinics. Next, they organized four point-of-care ultrasound (POCUS) teaching sessions over a year, each session focusing on several distinct concepts. The sessions included lectures and hands-on teaching with both healthy volunteers and with patients in the various communities. Over the 12 months, the POCUS were logged and the majority of images saved. The logs were analyzed to determine if POCUS affected the medical management of the patients. The primary investigator reviewed 35.2% of the total ultrasounds completed, which was 52.2% of the save images, for quality assurance and feedback. Results Over the 12 months, there were 584 ultrasound studies documented. The most common study was a transabdominal obstetric examination (45.5%) followed by abdomen/pelvis (26.6%) and musculoskeletal (5.7%) and skin and soft tissue (5.7%). The use of POCUS changed the patient diagnosis after 194 scans (34%) and changed the clinical management for the patient encounter in 171 (30%) scans. In the 194 scans in which POCUS changed the diagnosis, the clinical management was changed, as a direct result of the scan results, in 152 (78.4%) of those patient encounters. Conclusion A longitudinal POCUS educational curriculum is an effective way to equip local physicians in resource limited countries with a tool to improve their clinical management of patients.
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Affiliation(s)
- Annie Heffernan Rominger
- Department of Pediatrics, Division of Emergency Medicine, University of Louisville, 571 South Floyd Street, Suite 412, Louisville, KY, 40202, USA.
| | | | - Patrick Elliott
- Compañeros En Salud, Calle Primera Poniente Sur #25, 30370, Angel Albino Corzo (Jaltenango), Chiapas, Mexico
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Bicho Augusto JA, Eiros R, Treibel T, Captur G, Akhtar M, Protonotarios A, Gkosios T, Savvatis K, Mohiddin S, Moon J, Elliott P, Lopes L. P3431A comparison of phenotypes of left-dominant arrhythmogenic cardiomyopathy and dilated cardiomyopathy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - R Eiros
- Barts Health NHS Trust, Cardiac Imaging, London, United Kingdom
| | - T Treibel
- Barts Health NHS Trust, Cardiac Imaging, London, United Kingdom
| | - G Captur
- Barts Health NHS Trust, Cardiac Imaging, London, United Kingdom
| | - M Akhtar
- Barts Health NHS Trust, Cardiac Imaging, London, United Kingdom
| | - A Protonotarios
- Barts Health NHS Trust, Cardiac Imaging, London, United Kingdom
| | - T Gkosios
- Barts Health NHS Trust, Cardiac Imaging, London, United Kingdom
| | - K Savvatis
- Barts Health NHS Trust, Cardiac Imaging, London, United Kingdom
| | - S Mohiddin
- Barts Health NHS Trust, Cardiac Imaging, London, United Kingdom
| | - J Moon
- Barts Health NHS Trust, Cardiac Imaging, London, United Kingdom
| | - P Elliott
- Barts Health NHS Trust, Cardiac Imaging, London, United Kingdom
| | - L Lopes
- Barts Health NHS Trust, Cardiac Imaging, London, United Kingdom
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Dominguez Rodriguez F, Cuenca S, Bilinska Z, Toro R, Charron P, Barriales-Villa R, Asselbergs F, Akhtar M, Morris Hey T, Rangel-Sousa D, Limeres JM, Garcia-Pinilla JM, Ochoa JP, Elliott P, Garcia-Pavia P. P3169Clinical characteristics and natural history of dilated cardiomyopathy due to BAG3 mutations. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F Dominguez Rodriguez
- University Hospital Puerta de Hierro Majadahonda, Inherited Cardiac Disease Unit, CNIC, CIBERCV, Madrid, Spain
| | - S Cuenca
- University Hospital Gregorio Maranon, Madrid, Spain
| | - Z Bilinska
- The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland
| | - R Toro
- University Hospital Puerta del Mar, Cadiz, Spain
| | - P Charron
- Hospital Pitie-Salpetriere, Paris, France
| | | | - F Asselbergs
- University Medical Center Utrecht, Utrecht, Netherlands
| | - M Akhtar
- St Bartholomew's Hospital, London, United Kingdom
| | | | | | - J M Limeres
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - J M Garcia-Pinilla
- University Hospital Virgen de la Victoria, IBIMA, CIBERCV, Malaga, Spain
| | | | - P Elliott
- St Bartholomew's Hospital, London, United Kingdom
| | - P Garcia-Pavia
- University Hospital Puerta de Hierro Majadahonda, Inherited Cardiac Disease Unit, CNIC, CIBERCV, Madrid, Spain
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Abstract
SummaryBoth factor V Leiden and the C677T methylenetetrahydrofolate reductase (MTHFR) gene mutation are associated with premature vascular disease, and yet are found at surprisingly high allele frequencies in European populations, 2.7% and 35% respectively. We have investigated the prevalence of these mutations in 87 UK residents over the age of ninety, to look for any evidence of their association with premature death.Five factor V Leiden heterozygotes were found, giving an allele frequency of 2.9%, similar to that in the general UK population. The frequency of the thermolabile C677T MTHFR mutation was 36% with 11% homozygotes, again similar to that in the UK population; these genotypes are in Hardy-Weinberg equilibrium, suggesting that there is not strong selection against the homozygous state. One person was both heterozygous for factor V Leiden and homozygous for the C677T mutation. This study suggests that neither factor V Leiden nor thermolabile MTHFR are risk factors for premature death.
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Affiliation(s)
- D C Rees
- The MRC Molecular Haematology Unit, Institute of Molecular Medicine, The John Radcliffe, Headington, Oxford, UK
| | - Y T Liu
- The MRC Molecular Haematology Unit, Institute of Molecular Medicine, The John Radcliffe, Headington, Oxford, UK
| | - M J Cox
- The MRC Molecular Haematology Unit, Institute of Molecular Medicine, The John Radcliffe, Headington, Oxford, UK
| | - P Elliott
- Department of Haematology, The John Radcliffe, Headington, Oxford, UK
| | - J S Wainscoat
- Department of Haematology, The John Radcliffe, Headington, Oxford, UK
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Lavalle L, Thomas AS, Beaton B, Ebrahim H, Reed M, Ramaswami U, Elliott P, Mehta AB, Hughes DA. Phenotype and biochemical heterogeneity in late onset Fabry disease defined by N215S mutation. PLoS One 2018; 13:e0193550. [PMID: 29621274 PMCID: PMC5886405 DOI: 10.1371/journal.pone.0193550] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/13/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Fabry disease (FD) results from X-linked inheritance of a mutation in the GLA gene, encoding for alpha galactosidase A, and is characterized by heterogeneous clinical manifestations. Two phenotypes have been described "Classic" and "late onset" which cannot be predicted exclusively by genotype. The latter has been considered an attenuated form of the disease often affecting a single organ system commonly the heart. Recent studies have demonstrated that cardiac outcomes are similar in patients with classic and late onset mutations. In this study we investigate the relationship between clinical heterogeneity and plasma lyso-Gb3 in a large single centre cohort of N215S patients and compare this to patients with other mutations. METHODS In this single-centre, retrospective, cross-sectional study we analysed a cohort of 251 FD patients: 84 N215S mutation (37 males) and 167 non-N215S mutations (58 males). The Mainz severity score index (MSSI) was used as an index of overall disease severity. Cardiac function and morphology were assessed by electrocardiogram and echocardiogram. Left ventricular mass was calculated using the Devereux formula and the left ventricular mass index (LVMI) calculated to adjust for height (g/m2.7). The presence of white matter lesions was assessed by cerebral MRI or computed tomography (CT). GFR was measured by radio-isotope (chromium-EDTA) method and adjusted for patient height (ml/min/m2.7), and urinary protein quantification was undertaken by 24 hour urine collection. Plasma globotriaosylsphingosine (lyso-Gb3) was analysed prior to ERT in 84 patients. RESULTS N215S patients showed later symptom onset (males: p< 0.0001, females: p<0.03), later development of left ventricular hypertrophy (LVH) (median survival without LVH: 41 (non-N215S) vs. 64 (N215S) years, p< 0.0001), later development of proteinuria (median survival without proteinuria 43 (non-N215S) vs 71 years (N215S), p< 0.0001), later occurrence of cerebrovascular events (stroke/ Transient Ischaemic Attacks (TIA); median survival without stroke: 74 years (non-N215S) vs. not reached (N215S), p< 0.02), later decline in renal function to GFR <60 ml/min/1.73m2 (median survival: 56 (non-N215S) vs. 72 (N215S) years, p< 0.01), and greater overall survival (median survival 81 (N215S) vs. 66 (non-N215S) years, p< 0.0006). Lyso-Gb3 was found to be less elevated in N215S compared to non-N215S male and female patients. However, the N215S population eventually reached an overall severity measured by MSSI comparable to the non-N215S without equivalent elevation of lyso-Gb3 (means: 6.7 vs. 74.3 nmol/L, p < 0.001). In addition, N215S patients showed strong correlations between lyso-Gb3 levels and LVMI, GFR, and MSSI. These associations became stronger when we investigated individuals' life time exposure to lyso-Gb3 (calculated as [lyso-Gb3]*age): MSSI (r2 = 0.88, p< 0.0001), LVMI (r2 = 0.59, p< 0.005), and GFR (r2 = 0.75, p = 0.0001). CONCLUSION These results demonstrate that the N215S mutation results in a late onset phenotype involving the heart and other organs. Correlations between clinical manifestations and plasma lyso-Gb3 variations in this group suggest a Fabry-relevant disease mechanism for the heterogeneity observed in this group.
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Affiliation(s)
- L. Lavalle
- Lysosomal Storage Disorders Unit, Department of Haematology, Royal Free Hospital and University College Medical School, London, United Kingdom
| | - A. S. Thomas
- UCL Institute of Cardiovascular Science, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - B. Beaton
- Lysosomal Storage Disorders Unit, Department of Haematology, Royal Free Hospital and University College Medical School, London, United Kingdom
| | - H. Ebrahim
- Lysosomal Storage Disorders Unit, Department of Haematology, Royal Free Hospital and University College Medical School, London, United Kingdom
| | - M. Reed
- Lysosomal Storage Disorders Unit, Department of Haematology, Royal Free Hospital and University College Medical School, London, United Kingdom
| | - U. Ramaswami
- Lysosomal Storage Disorders Unit, Department of Haematology, Royal Free Hospital and University College Medical School, London, United Kingdom
| | - P. Elliott
- Haematology Department, St George’s Hospital NHS Foundation Trust, London, United Kingdom
| | - A. B. Mehta
- Lysosomal Storage Disorders Unit, Department of Haematology, Royal Free Hospital and University College Medical School, London, United Kingdom
| | - D. A. Hughes
- Lysosomal Storage Disorders Unit, Department of Haematology, Royal Free Hospital and University College Medical School, London, United Kingdom
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Newman PM, Franke MF, Arrieta J, Carrasco H, Elliott P, Flores H, Friedman A, Graham S, Martinez L, Palazuelos L, Savage K, Tymeson H, Palazuelos D. Community health workers improve disease control and medication adherence among patients with diabetes and/or hypertension in Chiapas, Mexico: an observational stepped-wedge study. BMJ Glob Health 2018. [PMID: 29527344 PMCID: PMC5841495 DOI: 10.1136/bmjgh-2017-000566] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Non-communicable diseases (NCDs) contribute greatly to morbidity and mortality in low-income and middle-income countries (LMICs). Community health workers (CHWs) may improve disease control and medication adherence among patients with NCDs in LMICs, but data are lacking. We assessed the impact of a CHW-led intervention on disease control and adherence among patients with diabetes and/or hypertension in Chiapas, Mexico. Methods We conducted a prospective observational study among adult patients with diabetes and/or hypertension, in the context of a stepped-wedge roll-out of a CHW-led intervention. We measured self-reported adherence to medications, blood pressure and haemoglobin A1c at baseline and every 3 months, timed just prior to expansion of the intervention to a new community. We conducted individual-level mixed effects analyses of study data, adjusting for time and clustering by patient and community. Findings We analysed 108 patients. The CHW-led intervention was associated with a twofold increase in the odds of disease control (OR 2.04, 95% CI 1.15 to 3.62). It was also associated with optimal adherence assessed by 30-day recall (OR 1.86; 95% CI 1.15 to 3.02) and a positive self-assessment of adherence behaviour (OR 2.29; 95% CI 1.26 to 4.15), but not by 5-day recall. Interpretation A CHW-led adherence intervention was associated with disease control and adherence among adults with diabetes and/or hypertension. This study supports a role of CHWs in supplementing comprehensive primary care for patients with NCDs in LMICs. Trial registration number NCT02549495.
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Affiliation(s)
- Patrick M Newman
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Molly F Franke
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Jafet Arrieta
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Hector Carrasco
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Patrick Elliott
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Hugo Flores
- Compañeros en Salud, Angel Albino Corzo, Chiapas, Mexico
| | - Alexandra Friedman
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | | | - Luis Martinez
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Kevin Savage
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Hayley Tymeson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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Rahman M, Maxwell E, Subramanian R, Elliott P. Relapsed intravascular lymphoma – A case report. Pathology 2018. [DOI: 10.1016/j.pathol.2017.12.301] [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: 11/24/2022]
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Shokeen V, Sanchez Piaia M, Bigot JY, Müller T, Elliott P, Dewhurst JK, Sharma S, Gross EKU. Spin Flips versus Spin Transport in Nonthermal Electrons Excited by Ultrashort Optical Pulses in Transition Metals. Phys Rev Lett 2017; 119:107203. [PMID: 28949167 DOI: 10.1103/physrevlett.119.107203] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Indexed: 05/23/2023]
Abstract
A joint theoretical and experimental investigation is performed to understand the underlying physics of laser-induced demagnetization in Ni and Co films with varying thicknesses excited by 10 fs optical pulses. Experimentally, the dynamics of spins is studied by determining the time-dependent amplitude of the Voigt vector, retrieved from a full set of magnetic and nonmagnetic quantities performed on both sides of films, with absolute time reference. Theoretically, ab initio calculations are performed using time-dependent density functional theory. Overall, we demonstrate that spin-orbit induced spin flips are the most significant contributors with superdiffusive spin transport, which assumes only that the transport of majority spins without spin flips induced by scattering does not apply in Ni. In Co it plays a significant role during the first ∼20 fs only. Our study highlights the material dependent nature of the demagnetization during the process of thermalization of nonequilibrium spins.
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Affiliation(s)
- V Shokeen
- Université de Strasbourg, CNRS, Institut de Physique et Chimie des Matériaux de Strasbourg, UMR 7504, 67034 Strasbourg, France
| | - M Sanchez Piaia
- Université de Strasbourg, CNRS, Institut de Physique et Chimie des Matériaux de Strasbourg, UMR 7504, 67034 Strasbourg, France
| | - J-Y Bigot
- Université de Strasbourg, CNRS, Institut de Physique et Chimie des Matériaux de Strasbourg, UMR 7504, 67034 Strasbourg, France
| | - T Müller
- Max-Planck Institut für Microstrukture Physics, Weinberg 2, D-06120 Halle, Germany
| | - P Elliott
- Max-Planck Institut für Microstrukture Physics, Weinberg 2, D-06120 Halle, Germany
| | - J K Dewhurst
- Max-Planck Institut für Microstrukture Physics, Weinberg 2, D-06120 Halle, Germany
| | - S Sharma
- Max-Planck Institut für Microstrukture Physics, Weinberg 2, D-06120 Halle, Germany
| | - E K U Gross
- Max-Planck Institut für Microstrukture Physics, Weinberg 2, D-06120 Halle, Germany
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Cardim N, Brito D, Rocha Lopes L, Freitas A, Araujo C, Belo A, Goncalves L, Mimoso J, Olivotto I, Elliott P, Madeira H. P2315The Portuguese registry of hypertrophic cardiomyopathy (PRO-HCM): global results. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - D. Brito
- University Hospital De Santa Maria, Lisbon, Portugal
| | - L. Rocha Lopes
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom
| | - A. Freitas
- Hospital Fernando Da Fonseca, Amadora-Sintra, Portugal
| | - C. Araujo
- Hospital of Vila Real, Vila Real, Portugal
| | - A. Belo
- Portuguese Society of Cardiology, Coimbra, Portugal
| | - L. Goncalves
- University Hospitals of Coimbra, Coimbra, Portugal
| | | | - I. Olivotto
- Careggi University Hospital (AOUC), Florence, Italy
| | - P. Elliott
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom
| | - H. Madeira
- University Hospital De Santa Maria, Lisbon, Portugal
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Krieger K, Elliott P, Müller T, Singh N, Dewhurst JK, Gross EKU, Sharma S. Ultrafast demagnetization in bulk versus thin films: an ab initio study. J Phys Condens Matter 2017; 29:224001. [PMID: 28441143 DOI: 10.1088/1361-648x/aa66f2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We report ab initio simulations of the quantum dynamics of electronic charge and spins when subjected to intense laser pulses. By performing these purely electron-dynamics calculations for a thin film and for the bulk of Ni, we conclude that formation of surfaces has a dramatic influence of amplifying the laser induced demagnetization. The reason for this amplification is enhanced spin-currents on the surface of the thin films. We show that the underlying physics of demagnetization for bulk is dominated by spin-flips induced by spin-orbit coupling. In the case of thin films, the dominant cause of demagnetization is a combination of the flow of spin-currents and spin-flips. Furthermore, a comparison of our results with experimental data shows that below ∼120 fs processes of demagnetization are entirely dominated by purely electronic processes followed by which dissipative effects like the Elliott-Yafet mechanism start to contribute significantly.
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Affiliation(s)
- K Krieger
- Max-Planck-Institut für Mikrostrukturphysik, Weinberg 2, D-06120 Halle, Germany
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McNeill S, Toner E, Caskey S, Marley AM, Guy S, Elliott P. First do no harm: changing culture surrounding ceilings of treatment in end-of-life care. Clin Med (Lond) 2017; 17:s29. [PMID: 30958790 PMCID: PMC6334129 DOI: 10.7861/clinmedicine.17-3-s29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- S McNeill
- Regional Adult Respiratory Centre, Belfast City Hospital
| | - E Toner
- Regional Adult Respiratory Centre, Belfast City Hospital
| | - S Caskey
- Regional Adult Respiratory Centre, Belfast City Hospital
| | | | - S Guy
- Mater Infirmorum Hospital, Belfast
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Al-Dabhani K, Tsilidis KK, Murphy N, Ward HA, Elliott P, Riboli E, Gunter M, Tzoulaki I. Prevalence of vitamin D deficiency and association with metabolic syndrome in a Qatari population. Nutr Diabetes 2017; 7:e263. [PMID: 28394362 PMCID: PMC5436094 DOI: 10.1038/nutd.2017.14] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/26/2017] [Accepted: 02/13/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Despite long hours of sunlight in Qatar and other regions of the Middle East, vitamin D deficiency has been rising. In parallel, the prevalence of metabolic syndrome has also been increasing in Qatar. Vitamin D levels have been associated with metabolic syndrome but the data are inconsistent and no studies have addressed these inter-relationships in a Middle Eastern population where the prevalence of these conditions is high. The objective is to investigate the prevalence of vitamin D deficiency and its association with metabolic syndrome and its components in the Qatar Biobank population. METHODS A cross-sectional study of 1205 participants (702 women and 503 men) from the Qatar Biobank, comprising Qataris and non-Qataris between the ages of 18 and 80 years, was used to perform multivariate linear regression analyses to examine the association between metabolic syndrome and prevalence of vitamin D deficiency (defined as <20 ng ml-1 serum vitamin D levels) adjusting for age, sex, ethnicity, season of blood collection, physical activity and education. Odds ratios and 95% confidence intervals were calculated for all analyses. RESULTS Approximately 64% of participants were vitamin D deficient (<20 ng ml-1) with more men being deficient (68.6%) than women (61.3%). Serum vitamin D was 8% lower in individuals with metabolic syndrome (RR: 0.92, 95%CI: 0.87-0.98, P-value: 0.01) compared to individuals without metabolic syndrome. Waist circumference and HDL as well as high triglyceride levels were also significantly positively associated with vitamin D deficiency. No association was found between the other components of metabolic syndrome or diabetes and the presence of vitamin D deficiency. CONCLUSIONS Vitamin D deficiency is prevalent in this Qatari population. Presence of metabolic syndrome was associated with presence of vitamin D deficiency. Future prospective studies need to be conducted to investigate the potential for causality.
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Affiliation(s)
- K Al-Dabhani
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
| | - K K Tsilidis
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - N Murphy
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
- Nutritional Epidemiology Group, International Agency for Research on Cancer
| | - H A Ward
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
| | - P Elliott
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - E Riboli
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
| | - M Gunter
- Nutritional Epidemiology Group, International Agency for Research on Cancer
| | - I Tzoulaki
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
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Schimek T, Molina R, Villar de Onis J, Palazuelos L, Palazuelos D, Elliott P, Flores H, Reyes Gutierrez A. Coordination and Partnership for Improved Maternal-Child Health in Rural
Chiapas, Mexico. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Arrieta J, Aguerrebere M, Raviola G, Flores H, Elliott P, Espinosa A, Reyes A, Ortiz-Panozo E, Rodriguez-Gutierrez EG, Mukherjee J, Palazuelos D, Franke MF. Validity and Utility of the Patient Health Questionnaire (PHQ)-2 and PHQ-9 for Screening and Diagnosis of Depression in Rural Chiapas, Mexico: A Cross-Sectional Study. J Clin Psychol 2017; 73:1076-1090. [PMID: 28195649 PMCID: PMC5573982 DOI: 10.1002/jclp.22390] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/19/2016] [Accepted: 08/31/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Depressive disorders are frequently under diagnosed in resource-limited settings because of lack of access to mental health care or the inability of healthcare providers to recognize them. The Patient Health Questionnaire (PHQ)-2 and the PHQ-9 have been widely used for screening and diagnosis of depression in primary care settings; however, the validity of their use in rural, Spanish-speaking populations is unknown. METHOD We used a cross-sectional design to assess the psychometric properties of the PHQ-9 for depression diagnosis and estimated the sensitivity and specificity of the PHQ-2 for depression screening. Data were collected from 223 adults in a rural community of Chiapas, Mexico, using the PHQ-2, the PHQ-9, and the World Health Organization Quality of Life BREF Scale (WHOQOL- BREF). RESULTS Confirmatory factor analysis suggested that the 1-factor structure fit reasonably well. The internal consistency of the PHQ-9 was good (Cronbach's alpha > = 0.8) overall and for subgroups defined by gender, literacy, and age. The PHQ-9 demonstrated good predictive validity: Participants with a PHQ-9 diagnosis of depression had lower quality of life scores on the overall WHOQOL-BREF Scale and each of its domains. Using the PHQ-9 results as a gold standard, the optimal PHQ-2 cutoff score for screening of depression was 3 (sensitivity 80.00%, specificity 86.88%, area under receiver operating characteristic curve = 0.89; 95% confidence interval [0.84, 0.94]). CONCLUSION The PHQ-2 and PHQ-9 demonstrated good psychometric properties, suggesting their potential benefit as tools for depression screening and diagnosis in rural, Spanish-speaking populations.
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Affiliation(s)
- Jafet Arrieta
- Harvard T.H. Chan School of Public Health.,Harvard Medical School.,Partners In Health/Compañeros En Salud
| | | | | | - Hugo Flores
- Harvard Medical School.,Partners In Health/Compañeros En Salud.,Brigham and Women's Hospital
| | - Patrick Elliott
- Harvard Medical School.,Partners In Health/Compañeros En Salud.,Brigham and Women's Hospital
| | | | | | | | | | - Joia Mukherjee
- Harvard Medical School.,Partners In Health/Compañeros En Salud.,Brigham and Women's Hospital
| | - Daniel Palazuelos
- Harvard Medical School.,Partners In Health/Compañeros En Salud.,Brigham and Women's Hospital
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Furniss G, Opel A, Hussein A, Pearman C, Grace A, Connelly D, Orlowski A, Banerjee A, McNicholas T, Providencia R, Montañes M, Providencia R, Panagopoulos D, Tomlinson D, Dalrymple-Hay M, Haywood G, Butler A, Ang R, Ullah W, Schwartz R, Fannon M, Finlay M, Hunter R, Schilling R, Das M, Asfour I, Morgan M, Ronayne C, Shaw M, Snowdon R, Gupta D, Todd D, King R, Hall M, Modi S, Mediratta N, Gupta D, Reddy V, Neuzil P, Willems S, Verma A, Heck P, Schilling R, Lambiase P, Hall M, Nicholl B, McQueenie R, Jani BD, McKeag N, Gallacher K, Mair F, Heaton D, Macdonald J, Burnell J, Ryan R, Marshall T, Sutton C, O'Callaghan S, Kenny R, Karim N, Srinivasan N, Ferreira M, Goncalves L, Lambiase P, Toledano M, Field E, Walsh H, Maguire K, Cervi E, Kaski J, Perez Tome M, Pantazis A, Elliott P, Lambiase P, Segal O. ORAL ABSTRACTS (3)EP & Ablation31LEFT ATRIAL POSTERIOR WALL ISOLATION (THE “BOX LESION PATTERN”) IN THE TREATMENT OF ATRIAL FIBRILLATION: A SINGLE CENTRE EXPERIENCE32DAY CASE CRYOBLATION (CRYO) FOR PAROXYSMAL ATRIAL FIBRILLATION (pAF) IN THE DISTRICT GENERAL HOSPITAL IS SAFE AND EFFECTIVE IF DONE IN HIGH VOLUME WITH EXPERIENCED OPERATORS33ABLATION INDEX-GUIDED PULMONARY VEIN ISOLATION FOR ATRIAL FIBRILLATION MAY IMPROVE CLINICAL OUTCOMES IN COMPARISON TO CONTACT FORCE-GUIDED ABLATION34THE PROCEDURAL COMPLICATION RATES AND SHORT-TERM SUCCESS RATES OF THORACOSCOPIC AF ABLATION DURING THE INSTITUTIONAL LEARNING CURVE35INITIAL PROCEDURAL RESULTS FROM DDRAMATIC-SVT STUDY: DD MECHANISM IDENTIFICATION AND LOCALISATION USING DIPOLE DENSITY MAPPING TO GUIDE ABLATION STRATEGY36MORBIDITY AND MORTALITY IN MIDDLE-AGED INDIVIDUALS WITH ATRIAL FIBRILLATION: UK BIOBANK DATAClinical EP37THE GM AHSN AF LANDSCAPE TOOL: A SHARED PUBLIC DATA PLATFORM TO PROMOTE QUALITY IMPROVEMENTS AND IDENTIFY OPPORTUNITIES TO PREVENT AF-RELATED STROKE IN THE DEVOLVED GREATER MANCHESTER HEALTH SYSTEM38REAL WORLD PERSISTENCE, ADHERENCE AND SWITCH-OVER ACROSS ANTICOAGULANTS IN ATRIAL FIBRILLATION-A NATIONAL POPULATION-BASED STUDY39ORTHOSTATIC HYPOTENSION AND ATRIAL FIBRILLATION40PREVALENCE OF SHORT QT AND CRITERIA OF SEVERITY IN A YOUNG ASYMPTOMATIC COHORT41SURFACE ELECTROCARDIOGRAPHIC FEATURES AND PREVALENCE OF ARRHYTHMIAS IN PAEDIATRIC FRIEDREICH'S ATAXIA42RISK STRATIFICATION OF TYPE 1 MYOTONIC DYSTROPHY: IS THE ECG ACCURATE ENOUGH TO SELECT PATIENTS AT RISK OF BRADYARRHYTHMIC EVENTS? Europace 2016. [DOI: 10.1093/europace/euw272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Philippsen T, Orini M, Martin C, Volkova E, Ormerod J, Sohaib S, Elamin N, Blake S, Sawhney V, Ahmad S, Waring O, Bowers R, Raiman L, Hazelwood T, Mills R, Corrado C, Honarbakhsh S, Von Maydell A, Norrish G, Chubb H, Chubb H, Chubb H, Toledano M, Ruiz A, van Zalen J, Foley P, Pearman C, Rehal O, Foley P, Wong L, Foley P, Pearman C, Brahmbhatt D, Khan H, Wardley J, Akbar S, Christensen L, Hansen M, Brandes A, Tinker A, Munroe P, Lambiase P, Honarbakhsh S, McLean A, Lambiase P, Schilling R, Lane J, Chow A, Earley M, Hunter R, Khan F, Lambiase P, Schilling R, Sporton S, Dhinoja M, Camm C, Xavier R, de Sousa M, Betts T, Shun-Shin M, Wright I, Lim E, Lim P, Koawing M, Lefroy D, Linton N, Davies D, Peters N, Kanagaratnam P, Francis D, Whinnett Z, Khan M, Bowes R, Sahu J, Sheridan P, Rogers D, Kyriacou A, Kelland N, Lewis N, Lee J, Segall E, Diab I, Breitenstein A, Ullah W, Sporton S, Earley M, Finlay M, Dhinoja M, Schilling R, Hunter R, Ahmed M, Petkar S, Davidson N, Stout M, Pearce KP, Leo M, Ginks M, Rajappan K, Bashir Y, Balasubramaniam R, Sopher S, Betts T, Paisey J, Cheong J, Roy D, Adhya S, Williams S, O'Neill M, Niederer S, Providencia R, Srinivasan N, Ahsan S, Lowe M, Segal O, Hunter R, Finlay M, Earley M, Schilling R, Lambiase P, Stella S, Cantwell C, Chowdhury R, Kim S, Linton N, Whinnett Z, Koa-Wing M, Lefroy D, Davies DW, Kanagaratnam P, Lim PB, Qureshi N, Peters N, Cantarutti N, Limongelli G, Elliott P, Kaski J, Williams S, Lal K, Harrison J, Whitaker J, Kiedrowicz R, Wright M, O'Neill M, Harrison J, Whitaker J, Williams S, Wright M, Schaeffter T, Razavi R, O'Neill M, Karim R, Williams S, Harrison J, Whitaker J, Wright M, Schaeffter T, Razavi R, O'Neill M, Montanes M, Ella Field E, Walsh H, Callaghan N, Till J, Mangat J, Lowe M, Kaski J, Ruiz Duthil A, Li A, Saba M, Patel N, Beale L, Brickley G, Lloyd G, French A, Khavandi A, McCrea W, Barnes E, Chandrasekaran B, Parry J, Garth L, Chapman J, Todd D, Hobbs J, Modi S, Waktare J, Hall M, Gupta D, Snowdon R, Papageorgiou N, Providência R, Falconer D, Sewart E, Ahsan S, Segal O, Ezzat V, Rowland E, Lowe M, Lambiase P, Chow A, Swift M, Charlton P, James J, Colling A, Barnes E, Starling L, Kontogeorgis A, Roses-Noguer F, Wong T, Jarman J, Clague J, Till J, Colling A, James J, Hawkins M, Burnell S, Chandrasekaran B, Coulson J, Smith L, Choudhury M, Oguguo E, Boyett M, Morris G, Flinn W, Chari A, Belham M, Pugh P, Somarakis K, Parasa R, Allata A, Hashim H, Mathew T, Kayasundar S, Venables P, Quinn J, Ivanova J, Brown S, Oliver R, Lyons M, Chuen M, Walsh J, Robinson T, Staniforth A, Ahsan A, Jamil-Copley S. POSTERS (2)96CONTINUOUS VERSUS INTERMITTENT MONITORING FOR DETECTION OF SUBCLINICAL ATRIAL FIBRILLATION IN HIGH-RISK PATIENTS97HIGH DAY-TO-DAY INTRA-INDIVIDUAL REPRODUCIBILITY OF THE HEART RATE RESPONSE TO EXERCISE IN THE UK BIOBANK DATA98USE OF NOVEL GLOBAL ULTRASOUND IMAGING AND CONTINUEOUS DIPOLE DENSITY MAPPING TO GUIDE ABLATION IN MACRO-REENTRANT TACHYCARDIAS99ANTICOAGULATION AND THE RISK OF COMPLICATIONS IN PATIENTS UNDERGOING VT AND PVC ABLATION100NON-SUSTAINED VENTRICULAR TACHYCARDIA FREQUENTLY PRECEDES CARDIAC ARREST IN PATIENTS WITH BRUGADA SYNDROME101USING HIGH PRECISION HAEMODYNAMIC MEASUREMENTS TO ASSESS DIFFERENCES IN AV OPTIMUM BETWEEN DIFFERENT LEFT VENTRICULAR LEAD POSITIONS IN BIVENTRICULAR PACING102CAN WE PREDICT MEDIUM TERM MORTALITY FROM TRANSVENOUS LEAD EXTRACTION PRE-OPERATIVELY?103PREVENTION OF UNECESSARY ADMISSIONS IN ATRIAL FIBRILLATION104EPICARDIAL CATHETER ABLATION FOR VENTRICULAR TACHYCARDIA ON UNINTERRUPTED WARFARIN: A SAFE APPROACH?105HOW WELL DOES THE NATIONAL INSTITUTE OF CLINICAL EXCELLENCE (NICE) GUIDENCE ON TRANSIENT LOSS OF CONSCIOUSNESS (T-LoC) WORK IN A REAL WORLD? AN AUDIT OF THE SECOND STAGE SPECIALIST CARDIOVASCULAT ASSESSMENT AND DIAGNOSIS106DETECTION OF ATRIAL FIBRILLATION IN COMMUNITY LOCATIONS USING NOVEL TECHNOLOGY'S AS A METHOD OF STROKE PREVENTION IN THE OVER 65'S ASYMPTOMATIC POPULATION - SHOULD IT BECOME STANDARD PRACTISE?107HIGH-DOSE ISOPRENALINE INFUSION AS A METHOD OF INDUCTION OF ATRIAL FIBRILLATION: A MULTI-CENTRE, PLACEBO CONTROLLED CLINICAL TRIAL IN PATIENTS WITH VARYING ARRHYTHMIC RISK108PACEMAKER COMPLICATIONS IN A DISTRICT GENERAL HOSPITAL109CARDIAC RESYNCHRONISATION THERAPY: A TRADE-OFF BETWEEN LEFT VENTRICULAR VOLTAGE OUTPUT AND EJECTION FRACTION?110RAPID DETERIORATION IN LEFT VENTRICULAR FUNCTION AND ACUTE HEART FAILURE AFTER DUAL CHAMBER PACEMAKER INSERTION WITH RESOLUTION FOLLOWING BIVENTRICULAR PACING111LOCALLY PERSONALISED ATRIAL ELECTROPHYSIOLOGY MODELS FROM PENTARAY CATHETER MEASUREMENTS112EVALUATION OF SUBCUTANEOUS ICD VERSUS TRANSVENOUS ICD- A PROPENSITY MATCHED COST-EFFICACY ANALYSIS OF COMPLICATIONS & OUTCOMES113LOCALISING DRIVERS USING ORGANISATIONAL INDEX IN CONTACT MAPPING OF HUMAN PERSISTENT ATRIAL FIBRILLATION114RISK FACTORS FOR SUDDEN CARDIAC DEATH IN PAEDIATRIC HYPERTROPHIC CARDIOMYOPATHY: A SYSTEMATIC REVIEW AND META-ANALYSIS115EFFECT OF CATHETER STABILITY AND CONTACT FORCE ON VISITAG DENSITY DURING PULMONARY VEIN ISOLATION116HEPATIC CAPSULE ENHANCEMENT IS COMMONLY SEEN DURING MR-GUIDED ABLATION OF ATRIAL FLUTTER: A MECHANISTIC INSIGHT INTO PROCEDURAL PAIN117DOES HIGHER CONTACT FORCE IMPAIR LESION FORMATION AT THE CAVOTRICUSPID ISTHMUS? INSIGHTS FROM MR-GUIDED ABLATION OF ATRIAL FLUTTER118CLINICAL CHARACTERISATION OF A MALIGNANT SCN5A MUTATION IN CHILDHOOD119RADIOFREQUENCY ASSOCIATED VENTRICULAR FIBRILLATION120CONTRACTILE RESERVE EXPRESSED AS SYSTOLIC VELOCITY DOES NOT PREDICT RESPONSE TO CRT121DAY-CASE DEVICES - A RETROSPECTIVE STUDY USING PATIENT CODING DATA122PATIENTS UNDERGOING SVT ABLATION HAVE A HIGH INCIDENCE OF SECONDARY ARRHYTHMIA ON FOLLOW UP: IMPLICATIONS FOR PRE-PROCEDURE COUNSELLING123PROGNOSTIC ROLE OF HAEMOGLOBINN AND RED BLOOD CELL DITRIBUTION WIDTH IN PATIENTS WITH HEART FAILURE UNDERGOING CARDIAC RESYNCHRONIZATION THERAPY124REMOTE MONITORING AND FOLLOW UP DEVICES125A 20-YEAR, SINGLE-CENTRE EXPERIENCE OF IMPLANTABLE CARDIOVERTER DEFIBRILLATORS (ICD) IN CHILDREN: TIME TO CONSIDER THE SUBCUTANEOUS ICD?126EXPERIENCE OF MAGNETIC REASONANCE IMAGING (MEI) IN PATIENTS WITH MRI CONDITIONAL DEVICES127THE SINUS BRADYCARDIA SEEN IN ATHLETES IS NOT CAUSED BY ENHANCED VAGAL TONE BUT INSTEAD REFLECTS INTRINSIC CHANGES IN THE SINUS NODE REVEALED BY
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(F) BLOCKADE128SUCCESSFUL DAY-CASE PACEMAKER IMPLANTATION - AN EIGHT YEAR SINGLE-CENTRE EXPERIENCE129LEFT VENTRICULAR INDEX MASS ASSOCIATED WITH ESC HYPERTROPHIC CARDIOMYOPATHY RISK SCORE IN PATIENTS WITH ICDs: A TERTIARY CENTRE HCM REGISTRY130A DGH EXPERIENCE OF DAY-CASE CARDIAC PACEMAKER IMPLANTATION131IS PRE-PROCEDURAL FASTING A NECESSITY FOR SAFE PACEMAKER IMPLANTATION? Europace 2016. [DOI: 10.1093/europace/euw274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Stott FH, Prescott R, Elliott P, Al’Atia MHJH. Assessment of the degradation of metals and alloys in air-2% chlorine at high temperature. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/02619180.1988.11753389] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Elliott P, Payne N. P130 “They must be looking through glass windows that’s stopping the pollution”: Key Results from a mixed Methods study examining the effects of deprivation and pollution in North West England. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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