A5003999199- Cardiac Valve Diseases and Treatments
- Infective Endocarditis Diagnosis and Management
- Congenital Heart Disease Studies
- Aortic Disease and Treatment Approaches
- Cardiac Imaging and Diagnostics
- Cardiovascular Function and Risk Factors
- Cardiovascular and Diving-Related Complications
- Cardiovascular Health and Disease Prevention
- Cardiac Arrhythmias and Treatments
- Amyloidosis: Diagnosis, Treatment, Outcomes
- Cardiac pacing and defibrillation studies
- Connective tissue disorders research
- Coronary Interventions and Diagnostics
- Pulmonary Hypertension Research and Treatments
- Blood Pressure and Hypertension Studies
- Cardiac Structural Anomalies and Repair
- Cerebrovascular and Carotid Artery Diseases
- Nitric Oxide and Endothelin Effects
- Cardiac and Coronary Surgery Techniques
- Cardiac, Anesthesia and Surgical Outcomes
- Reservoir Engineering and Simulation Methods
- Traumatic Brain Injury and Neurovascular Disturbances
- Atrial Fibrillation Management and Outcomes
- Cardiomyopathy and Myosin Studies
- Hydraulic Fracturing and Reservoir Analysis
St Bartholomew's Hospital
2007-2025
Barts Health NHS Trust
2016-2024
British Heart Foundation
2016-2024
University College London
2013-2023
John Wiley & Sons (United States)
2023
Art Research Centre of the Slovak Academy of Sciences
2018-2021
University of Kentucky
2011-2021
Queen Mary University of London
2019-2021
William Harvey Research Institute
2021
University College Hospital at Westmoreland Street
2005-2018
Background —Patients with chronic heart failure (CHF) have a continuing high mortality. Autonomic dysfunction may play an important role in the pathophysiology of cardiac death CHF. UK-HEART examined value rate variability (HRV) measures as independent predictors Methods and Results —In prospective study powered for mortality, we recruited 433 outpatients 62±9.6 years old CHF (NYHA functional class I to III; mean ejection fraction, 0.41±0.17). Time-domain HRV indices conventional prognostic...
The objective was to define the characteristics of a real-world patient population treated with transcatheter aortic valve implantation (TAVI), regardless technology or access route, and evaluate their clinical outcome over mid long term. Although substantial body data exists in relation early outcomes after TAVI, there are few on beyond 1 year any notable number patients. U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry established report all procedures performed...
Background— Although some patients with adult congenital heart disease (ACHD) report limitations in exercise capacity, we hypothesized that depressed capacity may be more widespread than superficially evident during clinical consultation and could a means of assessing risk. Methods Results— Cardiopulmonary testing was performed 335 consecutive ACHD (age, 33±13 years), 40 non–congenital failure 58±15 11 young 29±5 years) 12 older 59±9 healthy subjects. Peak oxygen consumption (peak V̇ o 2 )...
Background —Mental stress has been linked to increased morbidity and mortality in coronary artery disease atherosclerosis progression. Experimental studies have suggested that damage the endothelium may be an important mechanism. Methods Results —Endothelial function was studied 10 healthy men (aged 50.4±9.6 years) 8 non–insulin-dependent diabetic 52.0±7.2 years). Brachial flow-mediated dilation (FMD, dependent) response 50 μg of sublingual glyceryl trinitrate (GTN, independent) were...
Background —We tested the hypothesis that endothelial dysfunction underlies association between an acute inflammatory episode and transiently increased risk of a cardiovascular event by examining effects experimental stimulus on endothelium-dependent vasodilation. Methods Results — Salmonella typhi vaccine was used to generate systemic response in healthy volunteers. In 12 subjects, dilatation brachial artery flow sublingual nitroglycerin (NTG) recorded (conduit vessel response), 6 venous...
Patent foramen ovale (PFO) is prevalent in patients with migraine aura. Observational studies show that PFO closure resulted cessation or improvement approximately 80% of such patients. We investigated the effects for a randomized, double-blind, sham-controlled trial.Patients who suffered from aura, experienced frequent attacks, had previously failed > = 2 classes prophylactic treatments, and moderate large right-to-left shunts consistent presence were randomized to transcatheter STARFlex...
Abstract —Flow-mediated dilatation (FMD) of conduit arteries is dependent on an intact endothelium, although the mechanisms are not fully understood. Using high-resolution ultrasound, we examined role endothelial mediators in radial artery response to transient (short period reactive hyperemia) and sustained (prolonged hyperemia, hand warming, or incremental infusion acetylcholine into distal artery) hyperemia. After short episodes FMD was abolished by local nitric oxide synthesis inhibitor...
Permanent pacemaker (PPM) requirement is a recognized complication of transcatheter aortic valve implantation. We assessed the UK incidence permanent pacing within 30 days CoreValve implantation and formulated an anatomic electrophysiological model.Data from 270 patients at 10 centers in United Kingdom were examined. Twenty-five (8%) had preexisting PPMs; 2 incomplete data. The remaining 243 81.3±6.7 years age; 50.6% male. QRS duration increased 105±23 to 135±29 milliseconds (P<0.01). Left...
Older patients with severe aortic stenosis (AS) are increasingly identified as having cardiac amyloidosis (CA). It is unknown whether concomitant AS-CA has worse outcomes or results in futility of transcatheter valve replacement (TAVR).This study clinical characteristics and compared lone AS.Patients who were referred for TAVR at 3 international sites underwent blinded research core laboratory 99mtechnetium-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) bone scintigraphy (Perugini grade...
Cardiac amyloidosis is common in elderly patients with aortic stenosis (AS) referred for transcatheter valve implantation (TAVI). We hypothesized that dual and cardiac amyloid pathology (AS-amyloid) would have different baseline characteristics, periprocedural mortality outcomes.Patients aged ≥75 severe AS TAVI at two sites underwent blinded bone scintigraphy prior to intervention (Perugini Grade 0 negative, 1-3 increasingly positive). Baseline assessment included echocardiography,...
Background —Endothelial dysfunction leading to neutrophil infiltration of tissues has been implicated in tissue injury caused by ischemia-reperfusion (IR). Tissue during IR can be reduced prior ischemic preconditioning (IPC). In humans, it is unclear whether endothelial occurs or IPC offers protection against and inflammatory cell activation. We studied the effects experimental on function human forearm vivo examined afforded IPC. Method Results —The was made for 20 minutes inflating a blood...
Paravalvular leak (PVL) occurs in 5% to 17% of patients following surgical valve replacement. Percutaneous device closure represents an alternative repeat surgery.All UK and Ireland centers undertaking percutaneous PVL submitted data the Registry. Data were analyzed for association with death major adverse cardiovascular events (MACE) at follow-up.Three hundred eight procedures attempted 259 20 (2004-2015). Patient age was 67±13 years; 28% female. The main indications heart failure (80%)...
Irbesartan, a long acting selective angiotensin-1 receptor inhibitor, in Marfan syndrome might reduce aortic dilatation, which is associated with dissection and rupture. We aimed to determine the effects of irbesartan on rate dilatation children adults syndrome.We did placebo-controlled, double-blind randomised trial at 22 centres UK. Individuals aged 6-40 years clinically confirmed were eligible for inclusion. Study participants all given 75 mg open label once daily, then randomly assigned...
Postinfarction ventricular septal defect carries a grim prognosis. Surgical repair offers reasonable outcomes in patients who survive healing phase. Percutaneous device implantation represents potentially attractive early alternative.Postinfarction closure was attempted 53 from 11 centers (1997-2012; aged 72±11 years; 42% female). Nineteen percent had previous surgical closure. Myocardial infarction anterior (66%) or inferior (34%). Time myocardial to procedure 13 (first and third quartiles,...
In a previous study, 0.3 and 0.45 mg/kg of intravenous recombinant tissue plasminogen activator (rt-PA) were safe when combined with eptifibatide 75 mcg/kg bolus 2-hour infusion (0.75 per minute). The Combined Approach to Lysis Utilizing Eptifibatide rt-PA in Acute Ischemic Stroke-Enhanced Regimen (CLEAR-ER) trial sought determine the safety higher-dose regimen establish evidence for phase III trial.CLEAR-ER was multicenter, double-blind, randomized study. stroke patients 0.6 plus (135 at...
The purpose of this study was to validate computed tomography measured ECV (ECVCT) as part routine evaluation for the detection cardiac amyloid in patients with aortic stenosis (AS)-amyloid. AS-amyloid affects 1 7 elderly referred transcatheter valve replacement (TAVR). Bone scintigraphy exclusion a plasma cell dyscrasia can diagnose transthyretin-related noninvasively, which novel treatments are emerging. Amyloid interstitial expansion increases myocardial extracellular volume (ECV)....