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Belmonte M, Gallinoro E, Pijls NHJ, Bertolone DT, Keulards DCJ, Viscusi MM, Storozhenko T, Mizukami T, Mahendiran T, Seki R, Fournier S, de Vos A, Adjedj J, Barbato E, Sonck J, Damman P, Keeble T, Fawaz S, Gutiérrez-Barrios A, Paradies V, Bouisset F, Kern MJ, Fearon WF, Collet C, De Bruyne B. Measuring Absolute Coronary Flow and Microvascular Resistance by Thermodilution: JACC Review Topic of the Week. J Am Coll Cardiol 2024; 83:699-709. [PMID: 38325996 DOI: 10.1016/j.jacc.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/01/2023] [Indexed: 02/09/2024]
Abstract
Diagnosing coronary microvascular dysfunction remains challenging, primarily due to the lack of direct measurements of absolute coronary blood flow (Q) and microvascular resistance (Rμ). However, there has been recent progress with the development and validation of continuous intracoronary thermodilution, which offers a simplified and validated approach for clinical use. This technique enables direct quantification of Q and Rμ, leading to precise and accurate evaluation of the coronary microcirculation. To ensure consistent and reliable results, it is crucial to follow a standardized protocol when performing continuous intracoronary thermodilution measurements. This document aims to summarize the principles of thermodilution-derived absolute coronary flow measurements and propose a standardized method for conducting these assessments. The proposed standardization serves as a guide to ensure the best practice of the method, enhancing the clinical assessment of the coronary microcirculation.
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Affiliation(s)
- Marta Belmonte
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Cardiology Department, Galeazzi-Sant'Ambrogio Hospital, Milan, Italy
| | - Nico H J Pijls
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands.
| | | | - Danielle C J Keulards
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Michele Mattia Viscusi
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | | | - Thabo Mahendiran
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Ruiko Seki
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Annemiek de Vos
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Julien Adjedj
- Department of Cardiology, Institut Arnault Tzanck, Saint-Laurent-du-Var, France
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Peter Damman
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Thomas Keeble
- Essex Cardiothoracic Centre, Mid South Essex NHS Foundation Trust, Basildon, Essex, United Kingdom; Medical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom
| | - Samer Fawaz
- Essex Cardiothoracic Centre, Mid South Essex NHS Foundation Trust, Basildon, Essex, United Kingdom; Medical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom
| | - Alejandro Gutiérrez-Barrios
- Cardiology Department, Hospital Puerta del Mar, Cádiz, Spain; Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, Cádiz, Spain
| | - Valeria Paradies
- Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Morton J Kern
- Veteran's Administration Long Beach Health Care System, Long Beach, California, USA
| | - William F Fearon
- Department of Medicine, Division of Cardiology, Stanford Medical Center Palo Alto, Palo Alto, California, USA; VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.
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Khan S, Alsanjari O, Keulards D, Vlaar PJ, Zhang J, Konstantinou K, Fawaz S, Simpson R, Clesham G, Kelly P, Tang K, Cook C, Cockburn J, Pijls N, Hildick-Smith D, Teeuwen K, Keeble T, Karamasis G, Davies J. TCT-129 Symptom and Physiological Changes After Successful Chronic Total Occlusion Percutaneous Coronary Intervention. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.151] [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: 10/14/2022]
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Moseby-Knappe M, Levin H, Blennow K, Ullén S, Zetterberg H, Lilja G, Dankiewicz J, Jakobsen JC, Lagebrant A, Friberg H, Nichol A, Ainschough K, Eastwood GM, Wise MP, Thomas M, Keeble T, Cariou A, Leithner C, Rylander C, Düring J, Bělohlávek J, Grejs A, Borgquist O, Undén J, Simon M, Rolny V, Piehler A, Cronberg T, Nielsen N. Biomarkers of brain injury after cardiac arrest; a statistical analysis plan from the TTM2 trial biobank investigators. Resusc Plus 2022; 10:100258. [PMID: 35677835 PMCID: PMC9168690 DOI: 10.1016/j.resplu.2022.100258] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 01/27/2023] Open
Abstract
Background Several biochemical markers in blood correlate with the magnitude of brain injury and may be used to predict neurological outcome after cardiac arrest. We present a protocol for the evaluation of prognostic accuracy of brain injury markers after cardiac arrest. The aim is to define the best predictive marker and to establish clinically useful cut-off levels for routine implementation. Methods Prospective international multicenter trial within the Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial in collaboration with Roche Diagnostics International AG. Samples were collected 0, 24, 48, and 72 hours after randomisation (serum) and 0 and 48 hours after randomisation (plasma), and pre-analytically processed at each site before storage in a central biobank. Routine markers neuron-specific enolase (NSE) and S100B, and neurofilament light, total-tau and glial fibrillary acidic protein will be batch analysed using novel Elecsys® electrochemiluminescence immunoassays on a Cobas e601 instrument. Results Statistical analysis will be reported according to the Standards for Reporting Diagnostic accuracy studies (STARD) and will include comparisons for prediction of good versus poor functional outcome at six months post-arrest, by modified Rankin Scale (0-3 vs. 4-6), using logistic regression models and receiver operating characteristics curves, evaluation of mortality at six months according to biomarker levels and establishment of cut-off values for prediction of poor neurological outcome at 95-100% specificities. Conclusions This prospective trial may establish a standard methodology and clinically appropriate cut-off levels for the optimal biomarker of brain injury which predicts poor neurological outcome after cardiac arrest.
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Affiliation(s)
- Marion Moseby-Knappe
- Department of Clinical Sciences Lund, Neurology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Helena Levin
- Department of Clinical Sciences Lund, Anaesthesiology and Intensive Care, Research and Education, Lund University, Skåne University Hospital, Lund, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Susann Ullén
- Clinical Studies Sweden - Forum South, Skåne University Hospital, Lund, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, United Kingdom
- UK Dementia Research Institute at UCL, London, United Kingdom
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
| | - Gisela Lilja
- Department of Clinical Sciences Lund, Neurology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Josef Dankiewicz
- Department of Clinical Sciences Lund, Cardiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Janus Christian Jakobsen
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Denmark
| | - Alice Lagebrant
- Department of Clinical Sciences Lund, Neurology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Hans Friberg
- Department of Clinical Sciences Lund, Anaesthesia and Intensive Care, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Alistair Nichol
- University College Dublin, Clinical Research Centre, St Vincent's University Hospital Dublin, Ireland
- The Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne. Australia
- Intensive Care Unit, Alfred Hospital, Melbourne, Australia
| | - Kate Ainschough
- University College Dublin, Clinical Research Centre, St Vincent's University Hospital Dublin, Ireland
| | - Glenn M Eastwood
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Matt P Wise
- Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom
| | - Matthew Thomas
- Intensive Care Unit, University Hospitals, Bristol and Weston, England, United Kingdom
| | - Thomas Keeble
- Essex Cardiothoracic Centre, MSE, Basildon, Essex, United Kingdom
- MTRC, Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom
| | - Alain Cariou
- Medical Intensive Care Unit, AP-HP, Cochin Hospital, Paris, France, Paris Cité University, Paris, France
| | - Christoph Leithner
- AG Emergency and Critical Care Neurology, Campus Virchow Klinikum, Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Rylander
- Anaesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Joachim Düring
- Department of Clinical Sciences Lund, Anaesthesia and Intensive Care, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Jan Bělohlávek
- Second Department of Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Anders Grejs
- Department of Anaesthesiology and Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ola Borgquist
- Department of Clinical Sciences Lund, Anaesthesia and Intensive Care, Lund University, Department of Cardiothoracic Surgery, Skåne University Hospital, Lund, Sweden
| | - Johan Undén
- Department of Clinical Sciences Malmö, Dept. Operation and Intensive Care, Lund University, Hallands Hospital Halmstad, Halmstad, Sweden
| | - Maryline Simon
- Clinical Development Department, Roche Diagnostics International AG, Rotkreuz, Switzerland
| | - Vinzent Rolny
- Biostatistical Department, Roche Diagnostics International AG, Rotkreuz, Switzerland
| | - Alex Piehler
- Biostatistical Department, Roche Diagnostics International AG, Rotkreuz, Switzerland
| | - Tobias Cronberg
- Department of Clinical Sciences Lund, Neurology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Niklas Nielsen
- Department of Clinical Sciences Lund, Anaesthesia and Intensive Care, Lund University, Helsingborg Hospital, Lund, Sweden
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Mion M, Magee N, Davis J, Farrell K, Nikolopoulou E, Jessup D, Davies J, Karamasis G, Keeble T. Exploring cognitive impairment in the early stages of an out-of-hospital cardiac arrest - a consecutive case series study. Neuropsychol Rehabil 2022; 33:927-944. [PMID: 35343857 DOI: 10.1080/09602011.2022.2052325] [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: 10/18/2022]
Abstract
Cognitive deficits are common, although often mild, in out-of-hospital cardiac arrest patients. Prevalence and severity of cognitive deficits on discharge from acute hospital, however, are not systematically assessed in clinical practice, and not frequently reported in scientific literature, potentially hindering the development of appropriate follow-up care pathways for these patients. We hereby present data from a consecutive case series of 75 out-of-hospital cardiac arrest patients discharged from our hospital over a period of 16 months; for 46 of them we were able to obtain a cognitive profile around the time of discharge from hospital, with 37 of them experiencing cognitive deficits, ranging from mild to severe. Memory, verbal fluency and cognitive flexibility were the areas more frequently impaired. The patients we were able to assess did not differ for age, cerebral performance category score and time to return of spontaneous circulation from those we were unable to assess. Cognitive deficits were not associated with duration of "no blood flow" during cardiac arrest or with age. Our results suggest that cognitive deficits in the immediate aftermath of out-of-hospital cardiac arrest are common; however, these may be missed due to lack of systematic assessment and use of poorly sensitive cognitive tests.
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Affiliation(s)
- Marco Mion
- Essex Cardio Thoracic CentreBasildon and Thurrock University Hospitals, Basildon, UK.,Anglia Ruskin University Faculty of Health Education Medicine & Social Care, Chelmsford
| | - Neil Magee
- Essex Cardio Thoracic CentreBasildon and Thurrock University Hospitals, Basildon, UK
| | - Jean Davis
- Essex Cardio Thoracic CentreBasildon and Thurrock University Hospitals, Basildon, UK
| | - Kelly Farrell
- Essex Cardio Thoracic CentreBasildon and Thurrock University Hospitals, Basildon, UK
| | - Eleni Nikolopoulou
- Essex Cardio Thoracic CentreBasildon and Thurrock University Hospitals, Basildon, UK
| | - Donna Jessup
- Essex Cardio Thoracic CentreBasildon and Thurrock University Hospitals, Basildon, UK
| | - John Davies
- Essex Cardio Thoracic CentreBasildon and Thurrock University Hospitals, Basildon, UK.,Anglia Ruskin University Faculty of Health Education Medicine & Social Care, Chelmsford
| | - Grigoris Karamasis
- Essex Cardio Thoracic CentreBasildon and Thurrock University Hospitals, Basildon, UK.,Anglia Ruskin University Faculty of Health Education Medicine & Social Care, Chelmsford
| | - Thomas Keeble
- Essex Cardio Thoracic CentreBasildon and Thurrock University Hospitals, Basildon, UK.,Anglia Ruskin University Faculty of Health Education Medicine & Social Care, Chelmsford
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Hildick-Smith D, Briceno N, Alsanjari O, Clesham GJ, Keeble T, Hill A, Gomes A, Cockburn J. Amplatzer Post-Infarction Ventricular Septal Defect Closure via Retrograde Transarterial Access: Easier and Better. Structural Heart 2021. [DOI: 10.1080/24748706.2021.1894371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Blennow Nordström E, Lilja G, Vestberg S, Ullén S, Friberg H, Nielsen N, Heimburg K, Evald L, Mion M, Segerström M, Grejs AM, Keeble T, Kirkegaard H, Ljung H, Rose S, Wise MP, Rylander C, Undén J, Cronberg T. Neuropsychological outcome after cardiac arrest: a prospective case control sub-study of the Targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest trial (TTM2). BMC Cardiovasc Disord 2020; 20:439. [PMID: 33028221 PMCID: PMC7542852 DOI: 10.1186/s12872-020-01721-9] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 09/30/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND This study is designed to provide detailed knowledge on cognitive impairment after out-of-hospital cardiac arrest (OHCA) and its relation to associated factors, and to validate the neurocognitive screening of the Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest trial (TTM2-trial), assessing effectiveness of targeted temperature management after OHCA. METHODS This longitudinal multi-center clinical study is a sub-study of the TTM2-trial, in which a comprehensive neuropsychological examination is performed in addition to the main TTM2-trial neurocognitive screening. Approximately 7 and 24 months after OHCA, survivors at selected study sites are invited to a standardized assessment, including performance-based tests of cognition and questionnaires of emotional problems, fatigue, executive function and insomnia. At 1:1 ratio, a matched control group from a cohort of acute myocardial infarction (MI) patients is recruited to perform the same assessment. We aim to include 100 patients per group. Potential differences between the OHCA patients and the MI controls at 7 and 24 months will be analyzed with a linear regression, using composite z-scores per cognitive domain (verbal, visual/constructive, working memory, episodic memory, processing speed, executive functions) as primary outcome measures. Results from OHCA survivors on the main TTM2-trial neurocognitive screening battery will be compared with neuropsychological test results at 7 months, using sensitivity and specificity analyses. DISCUSSION In this study we collect detailed information on cognitive impairment after OHCA and compare this to a control group of patients with acute MI. The validation of the TTM2 neurocognitive screening battery could justify its inclusion in routine follow-up. Our results may have a potential to impact on the design of future follow-up strategies and interventions after OHCA. TRIAL REGISTRATION ClinicalTrials.gov, NCT03543371 . Registered 1 June 2018.
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Affiliation(s)
- Erik Blennow Nordström
- Lund University, Skane University Hospital, Center for Cardiac Arrest at Lund University, Neurology Research Unit, Department of Clinical Sciences Lund, Neurology, Remissgatan 4, 221 85, Lund, Sweden.
| | - Gisela Lilja
- Lund University, Skane University Hospital, Center for Cardiac Arrest at Lund University, Neurology Research Unit, Department of Clinical Sciences Lund, Neurology, Remissgatan 4, 221 85, Lund, Sweden
| | | | - Susann Ullén
- Skane University Hospital, Clinical Studies Sweden - Forum South, Lund, Sweden
| | - Hans Friberg
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Intensive and Perioperative Care, Malmö, Sweden
| | - Niklas Nielsen
- Lund University, Helsingborg Hospital, Department of Clinical Sciences Lund, Anesthesiology and Intensive Care, Lund, Sweden
| | - Katarina Heimburg
- Lund University, Skane University Hospital, Center for Cardiac Arrest at Lund University, Neurology Research Unit, Department of Clinical Sciences Lund, Neurology, Remissgatan 4, 221 85, Lund, Sweden
| | - Lars Evald
- Hammel Neurorehabilitation and Research Centre, Hammel, Denmark
| | - Marco Mion
- Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals, Basildon, UK
| | - Magnus Segerström
- Sahlgrenska University Hospital, Department of Neurology and Department of Cardiology, Gothenburg, Sweden
| | - Anders M Grejs
- Aarhus University Hospital and Aarhus University, Research Centre for Emergency Medicine, Emergency Department and Department of Clinical Medicine, Aarhus, Denmark
| | - Thomas Keeble
- Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals, Basildon, UK
- Department of Allied Health and Medicine, Anglia Ruskin School of Medicine, Chelmsford, UK
| | - Hans Kirkegaard
- Aarhus University Hospital and Aarhus University, Research Centre for Emergency Medicine, Emergency Department and Department of Clinical Medicine, Aarhus, Denmark
| | - Hanna Ljung
- Lund University, Skane University Hospital, Center for Cardiac Arrest at Lund University, Neurology Research Unit, Department of Clinical Sciences Lund, Neurology, Remissgatan 4, 221 85, Lund, Sweden
| | - Sofia Rose
- Clinical Psychology, Cardiff and Vale University Health Board, NHS Wales, Cardiff, UK
| | | | - Christian Rylander
- Sahlgrenska Academy, University of Gothenburg, Institute of Clinical Sciences, Department of Anaesthesiology and Intensive Care Medicine, Gothenburg, Sweden
| | - Johan Undén
- Lund University, Skane University Hospital, Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care Medicine, Lund, Sweden
| | - Tobias Cronberg
- Lund University, Skane University Hospital, Center for Cardiac Arrest at Lund University, Neurology Research Unit, Department of Clinical Sciences Lund, Neurology, Remissgatan 4, 221 85, Lund, Sweden
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Rajkumar C, Shun-Shin M, Seligman H, Ahmad Y, Warisawa T, Cook C, Howard J, Amarin L, Nowbar A, Foley M, Assomull R, Keenan N, Sehmi J, Keeble T, Davies J, Tang K, Gerber R, Cole G, O'Kane P, Sharp A, Khamis R, Kanaganayagam G, Petraco R, Ruparelia N, Malik I, Nijjer S, Sen S, Francis D, Al-Lamee R. TCT CONNECT-385 Placebo-Controlled Efficacy of Percutaneous Coronary Intervention for Focal and Diffuse Patterns of Stable Coronary Artery Disease: A Secondary Analysis From ORBITA. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.407] [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: 11/15/2022]
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Mion M, Swindell P, Nikolopoulou E, Davis J, Farrell K, Gudde E, Magee N, Karamasis G, Davies J, Keeble T. The incidence and severity of cognitive deficits measured in out-of-hospital cardiac arrest survivors at hospital discharge – A consecutive case series study. Resuscitation 2020. [DOI: 10.1016/j.resuscitation.2020.08.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Karamasis G, Napp LC, Dogan G, Ruhparwar A, Schmack B, Reitan O, Zundorf I, Giering T, Walker T, Keeble T. TCT CONNECT-179 In Vivo Safety of the 10-F Reitan Catheter Temporary Percutaneous Mechanical Circulatory Support (pMCS) Device. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.192] [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: 12/01/2022]
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Alsanjari O, Karamasis G, Keulards D, Kelly P, Tang K, Konstantinou K, Cockburn J, Hildick-Smith D, Teeuwen K, Keeble T, Davies J. TCT CONNECT-235 Coronary Collateral Function Post Successful CTO PCI Using Contemporary Method. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.251] [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: 11/24/2022]
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Alsanjari O, Karamasis G, Keulards D, Kelly P, Tang K, Konstantinou K, Cockburn J, Hildick-Smith D, Teeuwen K, Keeble T, Davies J. TCT CONNECT-403 Serial Measurements of Absolute Coronary Blood Flow Post-CTO PCI and Predictors of Its Recovery. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Toor IS, Rückerl D, Mair I, Ainsworth R, Meloni M, Spiroski AM, Benezech C, Felton JM, Thomson A, Caporali A, Keeble T, Tang KH, Rossi AG, Newby DE, Allen JE, Gray GA. Eosinophil Deficiency Promotes Aberrant Repair and Adverse Remodeling Following Acute Myocardial Infarction. JACC Basic Transl Sci 2020; 5:665-681. [PMID: 32760855 PMCID: PMC7393409 DOI: 10.1016/j.jacbts.2020.05.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 01/24/2023]
Abstract
In ST-segment elevation myocardial infarction of both patients and mice, there was a decline in blood eosinophil count, with activated eosinophils recruited to the infarct zone. Eosinophil deficiency resulted in attenuated anti-inflammatory macrophage polarization, enhanced myocardial inflammation, increased scar size, and deterioration of myocardial structure and function. Adverse cardiac remodeling in the setting of eosinophil deficiency was prevented by interleukin-4 therapy.
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Affiliation(s)
- Iqbal S. Toor
- British Heart Foundation/University Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Dominik Rückerl
- Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Iris Mair
- MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Rob Ainsworth
- Division of Pathology, Deanery of Molecular, Genetic and Population Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Marco Meloni
- British Heart Foundation/University Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Ana-Mishel Spiroski
- British Heart Foundation/University Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Cecile Benezech
- British Heart Foundation/University Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Jennifer M. Felton
- MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Adrian Thomson
- British Heart Foundation/University Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Andrea Caporali
- British Heart Foundation/University Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Thomas Keeble
- Essex Cardiothoracic Centre, Basildon and Thurrock Hospitals NHS Foundation Trust, Essex, United Kingdom
- School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
| | - Kare H. Tang
- Essex Cardiothoracic Centre, Basildon and Thurrock Hospitals NHS Foundation Trust, Essex, United Kingdom
| | - Adriano G. Rossi
- MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - David E. Newby
- British Heart Foundation/University Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Judith E. Allen
- Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Gillian A. Gray
- British Heart Foundation/University Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
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Al-Lamee RK, Shun-Shin MJ, Howard JP, Nowbar AN, Rajkumar C, Thompson D, Sen S, Nijjer S, Petraco R, Davies J, Keeble T, Tang K, Malik I, Bual N, Cook C, Ahmad Y, Seligman H, Sharp AS, Gerber R, Talwar S, Assomull R, Cole G, Keenan NG, Kanaganayagam G, Sehmi J, Wensel R, Harrell FE, Mayet J, Thom S, Davies JE, Francis DP. Dobutamine Stress Echocardiography Ischemia as a Predictor of the Placebo-Controlled Efficacy of Percutaneous Coronary Intervention in Stable Coronary Artery Disease: The Stress Echocardiography-Stratified Analysis of ORBITA. Circulation 2019; 140:1971-1980. [PMID: 31707827 PMCID: PMC6903430 DOI: 10.1161/circulationaha.119.042918] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Dobutamine stress echocardiography is widely used to test for ischemia in patients with stable coronary artery disease. In this analysis, we studied the ability of the prerandomization stress echocardiography score to predict the placebo-controlled efficacy of percutaneous coronary intervention (PCI) within the ORBITA trial (Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina). METHODS One hundred eighty-three patients underwent dobutamine stress echocardiography before randomization. The stress echocardiography score is broadly the number of segments abnormal at peak stress, with akinetic segments counting double and dyskinetic segments counting triple. The ability of prerandomization stress echocardiography to predict the placebo-controlled effect of PCI on response variables was tested by using regression modeling. RESULTS At prerandomization, the stress echocardiography score was 1.56±1.77 in the PCI arm (n=98) and 1.61±1.73 in the placebo arm (n=85). There was a detectable interaction between prerandomization stress echocardiography score and the effect of PCI on angina frequency score with a larger placebo-controlled effect in patients with the highest stress echocardiography score (Pinteraction=0.031). With our sample size, we were unable to detect an interaction between stress echocardiography score and any other patient-reported response variables: freedom from angina (Pinteraction=0.116), physical limitation (Pinteraction=0.461), quality of life (Pinteraction=0.689), EuroQOL 5 quality-of-life score (Pinteraction=0.789), or between stress echocardiography score and physician-assessed Canadian Cardiovascular Society angina class (Pinteraction=0.693), and treadmill exercise time (Pinteraction=0.426). CONCLUSIONS The degree of ischemia assessed by dobutamine stress echocardiography predicts the placebo-controlled efficacy of PCI on patient-reported angina frequency. The greater the downstream stress echocardiography abnormality caused by a stenosis, the greater the reduction in symptoms from PCI. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02062593.
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Affiliation(s)
- Rasha K. Al-Lamee
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Matthew J. Shun-Shin
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - James P. Howard
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Alexandra N. Nowbar
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Christopher Rajkumar
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - David Thompson
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.)
| | - Sayan Sen
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Sukhjinder Nijjer
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Ricardo Petraco
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - John Davies
- Essex Cardiothoracic Centre, Basildon, UK (J.D., T.K., K.T.).,Anglia Ruskin University, Chelmsford, UK (J.D., T.K.)
| | - Thomas Keeble
- Essex Cardiothoracic Centre, Basildon, UK (J.D., T.K., K.T.).,Anglia Ruskin University, Chelmsford, UK (J.D., T.K.)
| | - Kare Tang
- Essex Cardiothoracic Centre, Basildon, UK (J.D., T.K., K.T.)
| | - Iqbal Malik
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | | | - Christopher Cook
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Yousif Ahmad
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Henry Seligman
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | | | - Robert Gerber
- East Sussex Healthcare NHS Trust, Hastings, UK (R.G.)
| | - Suneel Talwar
- Royal Bournemouth and Christchurch NHS Trust, UK (S. Talwar)
| | - Ravi Assomull
- Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Graham Cole
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Niall G. Keenan
- West Hertfordshire Hospitals NHS Trust, Watford, UK (N.G.K., J.S.)
| | - Gajen Kanaganayagam
- Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Joban Sehmi
- West Hertfordshire Hospitals NHS Trust, Watford, UK (N.G.K., J.S.)
| | - Roland Wensel
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.)
| | - Frank E. Harrell
- Vanderbilt University School of Medicine, Department of Biostatistics, Nashville, TN (F.E.H.)
| | - Jamil Mayet
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Simon Thom
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.)
| | - Justin E. Davies
- Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Darrel P. Francis
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
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Al-Lamee R, Howard JP, Shun-Shin MJ, Thompson D, Dehbi HM, Sen S, Nijjer S, Petraco R, Davies J, Keeble T, Tang K, Malik IS, Cook C, Ahmad Y, Sharp ASP, Gerber R, Baker C, Kaprielian R, Talwar S, Assomull R, Cole G, Keenan NG, Kanaganayagam G, Sehmi J, Wensel R, Harrell FE, Mayet J, Thom SA, Davies JE, Francis DP. Fractional Flow Reserve and Instantaneous Wave-Free Ratio as Predictors of the Placebo-Controlled Response to Percutaneous Coronary Intervention in Stable Single-Vessel Coronary Artery Disease. Circulation 2019; 138:1780-1792. [PMID: 29789302 DOI: 10.1161/circulationaha.118.033801] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND There are no data on how fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are associated with the placebo-controlled efficacy of percutaneous coronary intervention (PCI) in stable single-vessel coronary artery disease. METHODS We report the association between prerandomization invasive physiology within ORBITA (Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina), a placebo-controlled trial of patients who have stable angina with angiographically severe single-vessel coronary disease clinically eligible for PCI. Patients underwent prerandomization research FFR and iFR assessment. The operator was blinded to these values. Assessment of response variables, treadmill exercise time, stress echocardiography score, symptom frequency, and angina severity were performed at prerandomization and blinded follow-up. Effects were calculated by analysis of covariance. The ability of FFR and iFR to predict placebo-controlled changes in response variables was tested by using regression modeling. RESULTS Invasive physiology data were available in 196 patients (103 PCI and 93 placebo). At prerandomization, the majority had Canadian Cardiovascular Society class II or III symptoms (150/196, 76.5%). Mean FFR and iFR were 0.69±0.16 and 0.76±0.22, respectively; 97% had ≥1 positive ischemia tests. The estimated effect of PCI on between-arm prerandomization-adjusted total exercise time was 20.7 s (95% confidence interval [CI], -4.0 to 45.5; P=0.100) with no interaction of FFR ( Pinteraction=0.318) or iFR ( Pinteraction=0.523). PCI improved stress echocardiography score more than placebo (1.07 segment units; 95% CI, 0.70-1.44; P<0.00001). The placebo-controlled effect of PCI on stress echocardiography score increased progressively with decreasing FFR ( Pinteraction<0.00001) and decreasing iFR ( Pinteraction<0.00001). PCI did not improve angina frequency score significantly more than placebo (odds ratio, 1.64; 95% CI, 0.96-2.80; P=0.072) with no detectable evidence of interaction with FFR ( Pinteraction=0.849) or iFR ( Pinteraction=0.783). However, PCI resulted in more patient-reported freedom from angina than placebo (49.5% versus 31.5%; odds ratio, 2.47; 95% CI, 1.30-4.72; P=0.006) but neither FFR ( Pinteraction=0.693) nor iFR ( Pinteraction=0.761) modified this effect. CONCLUSIONS In patients with stable angina and severe single-vessel disease, the blinded effect of PCI was more clearly seen by stress echocardiography score and freedom from angina than change in treadmill exercise time. Moreover, the lower the FFR or iFR, the greater the magnitude of stress echocardiographic improvement caused by PCI. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT02062593.
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Affiliation(s)
- Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - James P Howard
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Matthew J Shun-Shin
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - David Thompson
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.)
| | - Hakim-Moulay Dehbi
- Cancer Research UK and UCL Cancer Trials Centre, University College London (H.-M.D.)
| | - Sayan Sen
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Sukhjinder Nijjer
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Ricardo Petraco
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - John Davies
- Essex Cardiothoracic Centre, Basildon, United Kingdom (J.D., T.K., K.T.).,Anglia Ruskin University, Chelmsford, United Kingdom (J.D., T.K.)
| | - Thomas Keeble
- Essex Cardiothoracic Centre, Basildon, United Kingdom (J.D., T.K., K.T.).,Anglia Ruskin University, Chelmsford, United Kingdom (J.D., T.K.)
| | - Kare Tang
- Essex Cardiothoracic Centre, Basildon, United Kingdom (J.D., T.K., K.T.)
| | - Iqbal S Malik
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Christopher Cook
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Yousif Ahmad
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | | | - Robert Gerber
- East Sussex Healthcare NHS Trust, Hastings, United Kingdom (R.G.)
| | - Christopher Baker
- Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | | | - Suneel Talwar
- Royal Bournemouth and Christchurch NHS Trust, United Kingdom (S.T.)
| | | | - Graham Cole
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Niall G Keenan
- West Hertfordshire Hospitals NHS Trust, Watford, United Kingdom (N.G.K.)
| | - Gajen Kanaganayagam
- Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | | | - Roland Wensel
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.)
| | - Frank E Harrell
- Vanderbilt University School of Medicine, Department of Biostatistics, Nashville, TN (F.E.H.)
| | - Jamil Mayet
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Simon A Thom
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.)
| | - Justin E Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Darrel P Francis
- National Heart and Lung Institute, Imperial College London, United Kingdom (R.A-L., J.H., M.S.-S., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., G.C., R.W., J.M., S.A.T., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (R.A.-L., J.H., M.S.-S., S.S., SN., R.P., I.M.,K C.C., Y.A., C.B., G.C., G.K., J.M., J.E.D., D.P.F.)
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Potter M, Watson N, Damian M, Magee N, Maccaroni M, Karamasis G, Al-Janabi F, Davies J, Keeble T. Setting up a neurological prognostication service in a tertiary cardiac centre with no neurophysiological support on-site. Clin Med (Lond) 2019. [DOI: 10.7861/clinmedicine.19-2-s97] [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: 11/27/2022]
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Mion M, Magee N, Watson N, Davies J, Islam S, Al-Janabi F, Karamasis G, Balasubramanian R, Keeble T. Neuropsychological care after out-of-hospital cardiac arrest - the CARE clinic model. Future Healthc J 2019; 6:51. [PMID: 31363575 PMCID: PMC6616680 DOI: 10.7861/futurehosp.6-1-s51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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)
- Marco Mion
- Basildon and Thurrock Hospitals NHS Foundation Trust - Essex Cardiothoracic Centre
| | - Neil Magee
- Basildon and Thurrock Hospitals NHS Foundation Trust - Essex Cardiothoracic Centre
| | - Noel Watson
- Basildon and Thurrock Hospitals NHS Foundation Trust - Essex Cardiothoracic Centre
| | - John Davies
- Basildon and Thurrock Hospitals NHS Foundation Trust - Essex Cardiothoracic Centre
| | - Shahed Islam
- Basildon and Thurrock Hospitals NHS Foundation Trust - Essex Cardiothoracic Centre
| | - Firas Al-Janabi
- Basildon and Thurrock Hospitals NHS Foundation Trust - Essex Cardiothoracic Centre
| | - Grigoris Karamasis
- Basildon and Thurrock Hospitals NHS Foundation Trust - Essex Cardiothoracic Centre
| | | | - Thomas Keeble
- Basildon and Thurrock Hospitals NHS Foundation Trust - Essex Cardiothoracic Centre
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17
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Karamasis G, Kalogeropoulos A, Marco V, Al-Janabi F, Toor I, Cook C, Jagathesan R, Kabir A, Sayer J, Robinson N, Aggarwal R, Clesham G, Gamma R, Kelly P, Tang K, Prati F, Keeble T, Davies J. TCT-66 The effects of stent post-dilatation during primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI): Insights from optical coherence tomography (OCT) and coronary physiology. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cook C, Ahmad Y, Howard J, Shun-Shin M, Sethi A, Clesham G, Tang K, Nijjer S, Kelly P, Davies J, Malik I, Kaprielian R, Mikhail G, Petraco R, Warisawa T, Al-Janabi F, Karamasis G, Gamma R, Al-Lamee R, Keeble T, Mayet J, Sen S, Francis D, Davies J. TCT-96 Predicting angina-limited exercise capacity using coronary physiology. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1193] [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: 01/09/2023]
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Watson ND, Potter M, Karamasis G, Damian M, Clesham G, Gamma R, Kelly P, Aggarwal R, Maccaroni M, Kadayam R, Nalgirkar R, Caruso V, Noc M, Davies J, Keeble T. P839Therapeutic hypothermia and early waking (THAW): is it safe and feasible to wake OHCA patients receiving therapeutic hypothermia at 12 hours to enable early neuro-prognostication and extubation? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p839] [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)
- N D Watson
- Basildon and Thurrock University Hospital NHS FT & Anglia Ruskin University School of Medicine, Essex, United Kingdom
| | - M Potter
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - G Karamasis
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - M Damian
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - G Clesham
- Basildon and Thurrock University Hospital NHS FT & Anglia Ruskin University School of Medicine, Essex, United Kingdom
| | - R Gamma
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - P Kelly
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - R Aggarwal
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - M Maccaroni
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - R Kadayam
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - R Nalgirkar
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - V Caruso
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - M Noc
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - J Davies
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - T Keeble
- Basildon and Thurrock University Hospital NHS FT & Anglia Ruskin University School of Medicine, Essex, United Kingdom
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Kikuta Y, Cook CM, Sharp ASP, Salinas P, Kawase Y, Shiono Y, Giavarini A, Nakayama M, De Rosa S, Sen S, Nijjer SS, Al-Lamee R, Petraco R, Malik IS, Mikhail GW, Kaprielian RR, Wijntjens GWM, Mori S, Hagikura A, Mates M, Mizuno A, Hellig F, Lee K, Janssens L, Horie K, Mohdnazri S, Herrera R, Krackhardt F, Yamawaki M, Davies J, Takebayashi H, Keeble T, Haruta S, Ribichini F, Indolfi C, Mayet J, Francis DP, Piek JJ, Di Mario C, Escaned J, Matsuo H, Davies JE. Pre-Angioplasty Instantaneous Wave-Free Ratio Pullback Predicts Hemodynamic Outcome In Humans With Coronary Artery Disease: Primary Results of the International Multicenter iFR GRADIENT Registry. JACC Cardiovasc Interv 2018; 11:757-767. [PMID: 29673507 DOI: 10.1016/j.jcin.2018.03.005] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 03/01/2018] [Accepted: 03/06/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The authors sought to evaluate the accuracy of instantaneous wave-Free Ratio (iFR) pullback measurements to predict post-percutaneous coronary intervention (PCI) physiological outcomes, and to quantify how often iFR pullback alters PCI strategy in real-world clinical settings. BACKGROUND In tandem and diffuse disease, offline analysis of continuous iFR pullback measurement has previously been demonstrated to accurately predict the physiological outcome of revascularization. However, the accuracy of the online analysis approach (iFR pullback) remains untested. METHODS Angiographically intermediate tandem and/or diffuse lesions were entered into the international, multicenter iFR GRADIENT (Single instantaneous wave-Free Ratio Pullback Pre-Angioplasty Predicts Hemodynamic Outcome Without Wedge Pressure in Human Coronary Artery Disease) registry. Operators were asked to submit their procedural strategy after angiography alone and then after iFR-pullback measurement incorporating virtual PCI and post-PCI iFR prediction. PCI was performed according to standard clinical practice. Following PCI, repeat iFR assessment was performed and the actual versus predicted post-PCI iFR values compared. RESULTS Mean age was 67 ± 12 years (81% male). Paired pre- and post-PCI iFR were measured in 128 patients (134 vessels). The predicted post-PCI iFR calculated online was 0.93 ± 0.05; observed actual iFR was 0.92 ± 0.06. iFR pullback predicted the post-PCI iFR outcome with 1.4 ± 0.5% error. In comparison to angiography-based decision making, after iFR pullback, decision making was changed in 52 (31%) of vessels; with a reduction in lesion number (-0.18 ± 0.05 lesion/vessel; p = 0.0001) and length (-4.4 ± 1.0 mm/vessel; p < 0.0001). CONCLUSIONS In tandem and diffuse coronary disease, iFR pullback predicted the physiological outcome of PCI with a high degree of accuracy. Compared with angiography alone, availability of iFR pullback altered revascularization procedural planning in nearly one-third of patients.
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Affiliation(s)
- Yuetsu Kikuta
- Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom; Fukuyama Cardiovascular Hospital, Fukuyama, Japan
| | - Christopher M Cook
- Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom
| | - Andrew S P Sharp
- Royal Devon and Exeter Hospital and University of Exeter, Exeter, United Kingdom
| | - Pablo Salinas
- Hospital Clínico San Carlos, Faculty of Medicine, Complutense University, Madrid, Spain
| | | | - Yasutsugu Shiono
- Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom
| | | | | | | | - Sayan Sen
- Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom
| | - Sukhjinder S Nijjer
- Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom
| | - Rasha Al-Lamee
- Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom
| | - Ricardo Petraco
- Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom
| | - Iqbal S Malik
- Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom
| | - Ghada W Mikhail
- Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom
| | - Raffi R Kaprielian
- Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom
| | | | - Shinsuke Mori
- Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | | | | | | | - Farrel Hellig
- Sunninghill Hospital, Johannesburg, University of Cape Town, South Africa
| | - Kelvin Lee
- United Lincolnshire Hospital, Lincoln, United Kingdom
| | | | | | - Shah Mohdnazri
- Essex Cardiothoracic Centre, Basildon and Anglia Ruskin University, Chelmsford, Essex, United Kingdom
| | - Raul Herrera
- Hospital Clínico San Carlos, Faculty of Medicine, Complutense University, Madrid, Spain
| | | | | | - John Davies
- Essex Cardiothoracic Centre, Basildon and Anglia Ruskin University, Chelmsford, Essex, United Kingdom
| | | | - Thomas Keeble
- Essex Cardiothoracic Centre, Basildon and Anglia Ruskin University, Chelmsford, Essex, United Kingdom
| | | | | | - Ciro Indolfi
- Universita degli Studi Magna Græcia di Catanzaro, Catanzaro, Italy
| | - Jamil Mayet
- Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom
| | - Darrel P Francis
- Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom
| | - Jan J Piek
- Academic Medical Centre, Amsterdam, the Netherlands
| | - Carlo Di Mario
- Royal Brompton Hospital and Harefield Trust, London, United Kingdom
| | - Javier Escaned
- Hospital Clínico San Carlos, Faculty of Medicine, Complutense University, Madrid, Spain
| | | | - Justin E Davies
- Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom.
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Affiliation(s)
- Kees Polderman
- 1 Department of Critical Care, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Darren Malinoski
- 2 Department of Surgery, Oregon Health & Science University , Portland, Oregon
| | - Sergio Timerman
- 3 Medicine and Health Sciences, Laureate International Universities , Sao Paulo, Brazil
| | - Thomas Keeble
- 4 Essex Cardiothoracic Centre, Anglia Ruskin University , Cambridge, United Kingdom
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Al-Lamee R, Thompson D, Dehbi HM, Sen S, Tang K, Davies J, Keeble T, Mielewczik M, Kaprielian R, Malik IS, Nijjer SS, Petraco R, Cook C, Ahmad Y, Howard J, Baker C, Sharp A, Gerber R, Talwar S, Assomull R, Mayet J, Wensel R, Collier D, Shun-Shin M, Thom SA, Davies JE, Francis DP. Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial. Lancet 2018; 391:31-40. [PMID: 29103656 DOI: 10.1016/s0140-6736(17)32714-9] [Citation(s) in RCA: 627] [Impact Index Per Article: 104.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 10/11/2017] [Accepted: 10/12/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Symptomatic relief is the primary goal of percutaneous coronary intervention (PCI) in stable angina and is commonly observed clinically. However, there is no evidence from blinded, placebo-controlled randomised trials to show its efficacy. METHODS ORBITA is a blinded, multicentre randomised trial of PCI versus a placebo procedure for angina relief that was done at five study sites in the UK. We enrolled patients with severe (≥70%) single-vessel stenoses. After enrolment, patients received 6 weeks of medication optimisation. Patients then had pre-randomisation assessments with cardiopulmonary exercise testing, symptom questionnaires, and dobutamine stress echocardiography. Patients were randomised 1:1 to undergo PCI or a placebo procedure by use of an automated online randomisation tool. After 6 weeks of follow-up, the assessments done before randomisation were repeated at the final assessment. The primary endpoint was difference in exercise time increment between groups. All analyses were based on the intention-to-treat principle and the study population contained all participants who underwent randomisation. This study is registered with ClinicalTrials.gov, number NCT02062593. FINDINGS ORBITA enrolled 230 patients with ischaemic symptoms. After the medication optimisation phase and between Jan 6, 2014, and Aug 11, 2017, 200 patients underwent randomisation, with 105 patients assigned PCI and 95 assigned the placebo procedure. Lesions had mean area stenosis of 84·4% (SD 10·2), fractional flow reserve of 0·69 (0·16), and instantaneous wave-free ratio of 0·76 (0·22). There was no significant difference in the primary endpoint of exercise time increment between groups (PCI minus placebo 16·6 s, 95% CI -8·9 to 42·0, p=0·200). There were no deaths. Serious adverse events included four pressure-wire related complications in the placebo group, which required PCI, and five major bleeding events, including two in the PCI group and three in the placebo group. INTERPRETATION In patients with medically treated angina and severe coronary stenosis, PCI did not increase exercise time by more than the effect of a placebo procedure. The efficacy of invasive procedures can be assessed with a placebo control, as is standard for pharmacotherapy. FUNDING NIHR Imperial Biomedical Research Centre, Foundation for Circulatory Health, Imperial College Healthcare Charity, Philips Volcano, NIHR Barts Biomedical Research Centre.
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Affiliation(s)
- Rasha Al-Lamee
- Imperial College London, London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - David Thompson
- Imperial College London, London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - Hakim-Moulay Dehbi
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | - Sayan Sen
- Imperial College London, London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - Kare Tang
- Essex Cardiothoracic Centre, Basildon, UK
| | | | | | | | | | | | | | - Ricardo Petraco
- Imperial College London, London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - Christopher Cook
- Imperial College London, London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - Yousif Ahmad
- Imperial College London, London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - James Howard
- Imperial College London, London, UK; Imperial College Healthcare NHS Trust, London, UK
| | | | | | | | - Suneel Talwar
- Royal Bournemouth and Christchurch NHS Trust, Bournemouth, UK
| | | | - Jamil Mayet
- Imperial College London, London, UK; Imperial College Healthcare NHS Trust, London, UK
| | | | - David Collier
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Matthew Shun-Shin
- Imperial College London, London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - Simon A Thom
- Imperial College London, London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - Justin E Davies
- Imperial College London, London, UK; Imperial College Healthcare NHS Trust, London, UK.
| | - Darrel P Francis
- Imperial College London, London, UK; Imperial College Healthcare NHS Trust, London, UK
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Karamasis G, Mohdnazri S, Al-Janabi F, Kalogeropoulos A, Jagathesan R, Clesham G, Tang K, Kelly P, Davies J, Keeble T. TCT-255 Impact of right atrial pressure on fractional flow reserve calculation in the presence of a chronic total occlusion. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.329] [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: 10/18/2022]
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Ghani S, Karamasis G, Al Janabi F, Griffiths EB, Keeble T, Davies J, Tang K, Kelly P. GW28-e0700 Percutaneous coronary intervention for unprotected left main stem: outcomes from a single tertiary centre experience in UK. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.07.404] [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: 10/18/2022]
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Noc M, Erlinge D, Neskovic A, Kafedzic S, Merkely B, Zima E, Fister M, Petrović M, Čanković M, Veress G, Laanmets P, Pern T, Vukcevic V, Dedovic V, Średniawa B, Świątkowski A, Keeble T, Davies J, Warenits AM, Olivecrona G, Peruga J, Ciszewski M, Horvath I, Edes I, Nagy G, Aradi D, Holzer M. COOL AMI EU pilot trial: a multicentre, prospective, randomised controlled trial to assess cooling as an adjunctive therapy to percutaneous intervention in patients with acute myocardial infarction. EUROINTERVENTION 2017; 13:e531-e539. [DOI: 10.4244/eij-d-17-00279] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Karamasis GV, Hampton-Till J, Al-Janabi F, Mohdnazri S, Parker M, Ioannou A, Jagathesan R, Kabir A, Sayer JW, Robinson NM, Aggarwal RK, Clesham GJ, Gamma RA, Kelly PA, Tang KH, Davies JR, Keeble T. Impact of point-of-care pre-procedure creatinine and eGFR testing in patients with ST segment elevation myocardial infarction undergoing primary PCI: The pilot STATCREAT study. Int J Cardiol 2017; 240:8-13. [DOI: 10.1016/j.ijcard.2017.03.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/23/2017] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
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Al-Janabi F, Magee N, Islam S, Watson N, Mion M, Davies J, Karamasis G, Potter M, Keeble T. P3431Care after resuscitation - an early psychological support service for out of hospital cardiac arrest survivors. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3431] [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: 11/12/2022] Open
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Cook C, Kikuta Y, Sharp A, Salinas P, Nakayama M, Wijntjens G, Sen S, da Cunha RP, Al-Lamee R, Nijjer S, Mizuno A, Mates M, Janssens L, Hellig F, Horie K, Davies J, Yamawaki M, Keeble T, Ribichini F, Indotfi C, Piek J, Di Mario C, Escaned J, Matsuo H, Davies J. INSTANTANEOUS WAVE-FREE RATIO SCOUT PULLBACK (IFR SCOUT) PRE-ANGIOPLASTY PREDICTS HEMODYNAMIC OUTCOME IN HUMANS WITH CORONARY ARTERY DISEASE: PRIMARY RESULTS OF INTERNATIONAL MULTICENTRE IFR GRADIENT REGISTRY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34439-x] [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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Hammersley D, Podd S, Gomes A, Thomson C, Keeble T, Dooley M, Hildick-Smith D. Feasibility of Left Atrial Appendage Occlusion Without Preprocedural Transesophageal Echocardiography or CT Scanning. J Invasive Cardiol 2015; 27:E297-E301. [PMID: 26477044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To assess the success rate and safety outcomes of left atrial appendage occlusion (LAAO) procedures in a cohort of patients who had not undergone preprocedural imaging. BACKGROUND LAAO patients usually undergo imaging with either transesophageal echocardiography (TEE) or computed tomography (CT) prior to the procedure itself. This preprocedural imaging may not be necessary. METHODS The procedural success and major complication rates were assessed in a cohort of 52 patients who underwent LAAO without preprocedural imaging. RESULTS Mean patient age was 75 ± 8 years. Median CHA2DS2-VASc score was 4 and median HASBLED score was 3. The LAAO procedure was successful in 51/52 cases (98.1%). In 1 case, the LAAO procedure did not proceed because the LAA was too large for the available occlusion devices. No patient had left atrial appendage thrombus, despite the fact that only 4 patients were taking oral anticoagulation therapy at the time. Major complications occurred in 2/52 cases (3.8%), both due to vascular injuries causing pseudoaneurysm formation. CONCLUSION LAAO in this series was not adversely affected by lack of preprocedural imaging. Omitting preprocedural imaging reduces risk attributable to the modality, reduces patient inconvenience and discomfort, reduces cost, and does not appear to significantly reduce the proportion of patients who can undergo a successful procedure. Further larger studies are warranted.
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Affiliation(s)
| | | | | | | | | | | | - David Hildick-Smith
- Royal Sussex Cardiac Centre, Brighton Department of Cardiology, Brighton, BN2 5BE, United Kingdom.
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Islam S, Keeble T, Davies J, Magee N, Balasubramanian R, Watson N. 25 Care after Resuscitation: An Innovative Early Psychological Support Service Proven to Improve the Quality of Life, Cognitive Function, and Ability to Return to Work – An Early Intervention for Cardiac Arrest Survivors and their Caregivers. Heart 2015. [DOI: 10.1136/heartjnl-2015-308066.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Affiliation(s)
- Carmelo Graffagnino
- Department of Neurology and Medicine, Duke University Medical Center, Durham, North Carolina
| | - David Erlinge
- Department of Cardiology, Lund University, Lund, Sweden
| | - Thomas Keeble
- Department of Cardiology, Essex Cardiothoracic Centre, London, United Kingdom
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Keeble T, Smith E, Ferrari M, Hullin R, Fredrik S, Reitan O, Rothman M. TCT-378 Interim analysis of the Reitan Catheter Pump (RCP) heart failure efficacy study: RCP improves cardiovascular and renal function in acute decompensated heart failure (ADHF). J Am Coll Cardiol 2012. [DOI: 10.1016/j.jacc.2012.08.406] [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: 10/27/2022]
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Hernandez L, Roux KJ, Wong ESM, Mounkes LC, Mutalif R, Navasankari R, Rai B, Cool S, Jeong JW, Wang H, Lee HS, Kozlov S, Grunert M, Keeble T, Jones CM, Meta MD, Young SG, Daar IO, Burke B, Perantoni AO, Stewart CL. Functional coupling between the extracellular matrix and nuclear lamina by Wnt signaling in progeria. Dev Cell 2010; 19:413-25. [PMID: 20833363 PMCID: PMC2953243 DOI: 10.1016/j.devcel.2010.08.013] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Revised: 07/07/2010] [Accepted: 08/23/2010] [Indexed: 12/14/2022]
Abstract
The segmental premature aging disease Hutchinson-Gilford Progeria (HGPS) is caused by a truncated and farnesylated form of Lamin A. In a mouse model for HGPS, a similar Lamin A variant causes the proliferative arrest and death of postnatal, but not embryonic, fibroblasts. Arrest is due to an inability to produce a functional extracellular matrix (ECM), because growth on normal ECM rescues proliferation. The defects are associated with inhibition of canonical Wnt signaling, due to reduced nuclear localization and transcriptional activity of Lef1, but not Tcf4, in both mouse and human progeric cells. Defective Wnt signaling, affecting ECM synthesis, may be critical to the etiology of HGPS because mice exhibit skeletal defects and apoptosis in major blood vessels proximal to the heart. These results establish a functional link between the nuclear envelope/lamina and the cell surface/ECM and may provide insights into the role of Wnt signaling and the ECM in aging.
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Affiliation(s)
- Lidia Hernandez
- Cancer and Developmental Biology Laboratory, NCI, Frederick, MD 21702
- Molecular Signaling Section, Medical Oncology Branch, Center for Cancer Research NCI, Bethesda, MD 20892
| | - Kyle J. Roux
- Dept. of Anatomy and Cell Biology, University of Florida College of Medicine, Gainesville, FL 32606
| | | | - Leslie C. Mounkes
- Cancer and Developmental Biology Laboratory, NCI, Frederick, MD 21702
| | - Rafidah Mutalif
- Institute of Medical Biology, Immunos, 8A Biomedical Grove, Singapore 138648
| | - Raju Navasankari
- Institute of Medical Biology, Immunos, 8A Biomedical Grove, Singapore 138648
| | - Bina Rai
- Institute of Medical Biology, Immunos, 8A Biomedical Grove, Singapore 138648
| | - Simon Cool
- Institute of Medical Biology, Immunos, 8A Biomedical Grove, Singapore 138648
| | - Jae-Wook Jeong
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX 77030
| | - Honghe Wang
- Cancer and Developmental Biology Laboratory, NCI, Frederick, MD 21702
| | - Hyun-Shik Lee
- Laboratory of Cell and Developmental Signaling, NCI, Frederick, MD 21702
| | - Serguei Kozlov
- Cancer and Developmental Biology Laboratory, NCI, Frederick, MD 21702
| | - Martin Grunert
- Institute of Medical Biology, Immunos, 8A Biomedical Grove, Singapore 138648
| | - Thomas Keeble
- Institute of Medical Biology, Immunos, 8A Biomedical Grove, Singapore 138648
| | - C. Michael Jones
- Institute of Medical Biology, Immunos, 8A Biomedical Grove, Singapore 138648
| | - Margarita D. Meta
- Dept. of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA90095
| | - Stephen G. Young
- Dept. of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA90095
| | - Ira O. Daar
- Laboratory of Cell and Developmental Signaling, NCI, Frederick, MD 21702
| | - Brian Burke
- Dept. of Anatomy and Cell Biology, University of Florida College of Medicine, Gainesville, FL 32606
| | - Alan O. Perantoni
- Cancer and Developmental Biology Laboratory, NCI, Frederick, MD 21702
| | - Colin L. Stewart
- Cancer and Developmental Biology Laboratory, NCI, Frederick, MD 21702
- Institute of Medical Biology, Immunos, 8A Biomedical Grove, Singapore 138648
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Smith EJ, Reitan O, Keeble T, Dixon K, Rothman MT. A first-in-man study of the reitan catheter pump for circulatory support in patients undergoing high-risk percutaneous coronary intervention. Catheter Cardiovasc Interv 2009; 73:859-65. [DOI: 10.1002/ccd.21865] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Cable GG, Keeble T, Wilson G. Pulmonary cyst and cerebral arterial gas embolism in a hypobaric chamber: a case report. Aviat Space Environ Med 2000; 71:172-6. [PMID: 10685592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
This is a report of an aircrew member who suffered a serious physiological incident in the form of pulmonary barotrauma and cerebral arterial gas embolism during hypobaric chamber training, and who subsequently was shown to have a cyst in the upper lobe of the left lung. The likely origin of the cyst is discussed, as well as the aeromedical disposition following thoracotomy and apical segmentectomy to remove the cyst.
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Affiliation(s)
- G G Cable
- Royal Australian Air Force Institute of Aviation Medicine, RAAF Base Edinburgh, South Australia
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McColl AJ, Keeble T, Hadjinikolaou L, Cohen A, Aitkenhead H, Glenville B, Richmond W. Plasma antioxidants: evidence for a protective role against reactive oxygen species following cardiac surgery. Ann Clin Biochem 1998; 35 ( Pt 5):616-23. [PMID: 9768327 DOI: 10.1177/000456329803500504] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Total plasma antioxidant status (TPAS), lipid peroxide concentration (LPX) and cardiac troponin T (cTnT) were measured in 24 patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). Samples were obtained preoperatively and at 1.5 h, 6 h, 24 h and 72 h after CPB. The absolute TPAS values were significantly lower at 1.5 h, 6 h, 24 h and 72 h after CPB than were preoperative values (P < 0.05). The LPX concentration was significantly elevated at 1.5 h after CPB (P < 0.05). Cardiac troponin T concentrations were significantly elevated at all time points postoperatively (P < 0.05). Preoperative TPAS values were significantly correlated with the magnitude of fall in TPAS at 1.5 h (P < 0.05). The greater the fall in TPAS between 0 and 1.5 h, the less LPX was formed between 0 and 1.5 h. The LPX at 1.5 h displayed a significant correlation with cTnT release from myocardial myocytes (P < 0.05). These data provide evidence for the first time that the consumption of antioxidants during CABG surgery with CPB protects against the production of reactive oxygen species and subsequent myocyte necrosis. Furthermore, the availability of protective antioxidants is dependent upon preoperative TPAS.
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Affiliation(s)
- A J McColl
- Unit of Metabolic Medicine, Imperial College School of Medicine at St Mary's, London, UK
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Abstract
Nineteen of 25 patients (14 female) with advanced malignant disease completed a randomized controlled trial of a new high-dose (200 mg) tablet formulation of controlled-release morphine. Compared with the currently available 100-mg tablets there were no differences in pain severity or adverse effects with the new formulation. In four patients, full 12-hr plasma morphine concentration profiles at steady state were obtained and showed no significant differences between the same dose provided as 100-mg and 200-mg tablets in Cmax, tmax, or other pharmacokinetic indices.
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Affiliation(s)
- G W Hanks
- Royal Marsden Hospital, London, United Kingdom
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