Author: "Niket Patel" / Language: undetermined - Searchworks@Jio Institute Digital Library Search Results

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63 results on '"Niket Patel"'

1. Evaluation of nurse- and anaesthetist-led sedation for selected transcatheter aortic valve implantation procedures

Author: Suzy Browne, David Smith, Daniel Adams, Sumesh Thiruthalil, Alison Pottle, Mark Bowers, Ian McGovern, Simon Mattison, Robert Smith, Vasileios Panoulas, Tito Kabir, Simson Davies, Joanne Shannon, Ee Ling Heng, Hazim Rahbi, Navin Chandra, Niket Patel, Winston Banya, Utam Seehra, Alexander Tindale, Rebecca Lane, Thomas Luescher, and Miles Dalby
Subjects: General Earth and Planetary Sciences, General Environmental Science
Abstract: Background/Aims Most transcatheter aortic valve implantation procedures are now performed under conscious sedation, rather than general anaesthetic. This study evaluated nurse-led conscious sedation, compared with anaesthetist-led sedation, to determine the feasibility of the former. Methods Consecutive patients undergoing transcatheter aortic valve implantation under either nurse-led or anaesthetist-led sedation between July 2018 and September 2021 were reviewed. Assessed outcomes were analysed and compared, including 30-day mortality rate, major vascular access site bleeding, moderate or severe aortic regurgitation, stroke, new pacemaker implantation, duration of procedure and length of stay. Results A total of 212 patients who underwent nurse-led sedation and 412 who underwent anaesthetist-led sedation were identified. There were no significant differences in risk scores between the two groups. In both groups, incidence of conversion to general anaesthetic was low, with nurse sedatitionists seeking anaesthetist support in 13 (6.2%) cases. Cases with nurse-led sedation had a significantly lower average duration of the procedure (90 minutes vs 111 minutes; P=0.001) and length of stay (2 days vs 3 days, P=0.0002). Conclusions Nurse-led sedation can be safely incorporated into transcatheter aortic valve implantation practice. Nurse-led sedation delivered similar outcomes to anaesthetist-led sedation, but with shorter procedural times and legnth of stay. This could allow more flexible scheduling, increased capacity and improved access for patients.
Published: 2022

2. Midterm Outcomes in Patients With Aortic Stenosis Treated With Contemporary Balloon‐Expandable and Self‐Expanding Valves: Does Valve Size Have an Impact on Outcome?

Author: Konstantinos Kalogeras, Richard J. Jabbour, Radoslaw Pracon, Tito Kabir, Joanne Shannon, Alison Duncan, Cesare Quarto, Ee‐Ling Heng, Hazim Rahbi, Evangelos Oikonomou, Efstratios Katsianos, Niket Patel, Navin Chandra, Michael‐Andrew Vavuranakis, Suzane Cadiz, Maria Bougiakli, Robert D. Smith, Gerasimos Siasos, Manolis Vavuranakis, Simon Davies, Miles Dalby, and Vasileios Panoulas
Subjects: Cardiology and Cardiovascular Medicine
Abstract: Background No data currently exist comparing the contemporary iterations of balloon‐expandable (BE) Edwards SAPIEN 3/Ultra and the self‐expanding (SE) Medtronic Evolut PRO/R34 valves. The aim of the study was the comparison of these transcatheter heart valves with emphasis on patients with small aortic annulus. Methods and Results In this retrospective registry, periprocedural outcomes and midterm all‐cause mortality were analyzed. A total of 1673 patients (917 SE versus 756 BE) were followed up for a median of 15 months. A total of 194 patients died (11.6%) during follow‐up. SE and BE groups showed similar survival at 1 (92.6% versus 90.6%) and 3 (80.3% versus 85.2%) years ( P log‐rank =0.136). Compared with the BE group, patients treated with the SE device had lower peak (16.3±8 mm Hg SE versus 21.9±8 mm Hg BE) and mean (8.8±5 mm Hg SE versus 11.5±5 mm Hg BE) gradients at discharge. Conversely, the BE group demonstrated lower rates of at least moderate paravalvular regurgitation postoperatively (5.6% versus 0.7% for SE and BE valves, respectively; P P log‐rank =0.042). In propensity‐matched patients treated with small transcatheter heart valve, there remained a trend for higher survival among the SE group at both 1 (97% SE versus 92.3% BE) and 3 years (91.8% SE versus 78.7% BE), P log‐rank =0.096). Conclusions Real‐world comparison of the latest‐generation SE and BE devices demonstrated similar survival up to 3 years’ follow‐up. In patients with small transcatheter heart valves, there may be a trend for improved survival among those treated with SE valves.
Published: 2023

3. Birth of a healthy infant after bone marrow-derived cell therapy

Author: Molina N Patel, Nayana H Patel, Harmi R Thakkar, Piyush N Chudasama, Niket Patel, Harsha K Bhadarka, and Yuvraj D Jadeja
Subjects: medicine.medical_specialty, medicine.medical_treatment, Case Report, Asherman's syndrome, Endometrium, medicine, music, reproductive and urinary physiology, Gynecology, Asherman’s syndrome, Stem cell therapy, music.instrument, In vitro fertilisation, urogenital system, business.industry, Hormone replacement therapy (menopause), medicine.disease, female genital diseases and pregnancy complications, medicine.anatomical_structure, Reproductive Medicine, Regenerative medicine, Asherman Syndrome, Lower segment caesarean section, Endometrial atrophy, Amenorrhea, medicine.symptom, Live birth, business, Bone marrow-derived cell therapy
Abstract: Bone marrow-derived cell (BMDC) therapy has numerous applications as potential biological cells for use in regenerative medicine. Here, we present an original case of endometrial atrophy associated with genital tuberculosis in a woman who achieved a live birth with BMDC. This 27-year-old woman came to our center with endometrial atrophy and primary infertility. She had a past history of genital tuberculosis and amenorrhea. Her husband’s semen quality was normal. The patient was counseled for hysteroscopy due to thin endometrium and advised in vitro fertilization (IVF) with donor eggs in lieu of poor ovarian reserve. Several attempts of IVF with hormone replacement therapy (HRT) were made, but the desired thickness of the endometrium was not achieved. Uterine artery injection of BMDC through interventional radiology was given, followed by HRT for three months, which resulted in improved endometrium. This was subsequently followed by IVF with donor egg. The treatment resulted in the conception and delivery of a 3.1-kg baby boy through lower segment caesarean section with no antenatal, intranatal or postnatal complications. Recently, there has been massive interest in stem cells as a novel treatment method for regenerative medicine, and more specifically for the regeneration of human endometrium disorders like Asherman syndrome and thin endometrium, which was the reason behind using this strategy for treatment.
Published: 2021

4. Prolonged Use of Tirofiban Infusion Without Percutaneous Coronary Intervention To Achieve Optimal Results in a COVID-19 Positive Patient With Inferior ST Segment Elevated Myocardial Infarction (STEMI) Secondary to Thromboembolism: A Case Report

Author: Zahid Khan and Niket Patel
Subjects: General Engineering
Published: 2022

5. Atypical Carcinoid Syndrome in a Patient Presenting With Pericarditis and Supraventricular Tachycardia: A Case Report

Author: Zahid Khan, George Besis, and Niket Patel
Subjects: General Engineering
Published: 2022

6. Initial Invasive or Conservative Strategy for Stable Coronary Disease

Author: Maron D. J., Hochman J. S., Reynolds H. R., Bangalore S., O'Brien S. M., Boden W. E., Chaitman B. R., Senior R., Lopez-Sendon J., Alexander K. P., Lopes R. D., Shaw L. J., Berger J. S., Newman J. D., Sidhu M. S., Goodman S. G., Ruzyllo W., Gosselin G., Maggioni A. P., White H. D., Bhargava B., Min J. K., John Mancini G. B., Berman D. S., Picard M. H., Kwong R. Y., Ali Z. A., Mark D. B., Spertus J. A., Krishnan M. N., Elghamaz A., Moorthy N., Hueb W. A., Demkow M., Mavromatis K., Bockeria O., Peteiro J., Miller T. D., Szwed H., Doerr R., Keltai M., Selvanayagam J. B., Gabriel Steg P., Held C., Kohsaka S., Mavromichalis S., Kirby R., Jeffries N. O., Harrell F. E., Rockhold F. W., Broderick S., Bruce Ferguson T., Williams D. O., Harrington R. A., Stone G. W., Rosenberg Y, ISCHEMIA Research Group: Joseph Ricci, A Tello Montoliu, A I Robero Aniorte, Abbey Mulder, Abhay A Laddu, Abhinav Goyal, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Abraham Oomman, Adam J Jaskowiak, Adam Kolodziej, Adam Witkowski, Adnan Hameed, Adriana Anesini, Afshan Hussain, Agne Juceviciene, Agne Urboniene, Agnes Jakal, Agnieszka Szramowska, Ahmad Khairuddin, Ahmed Abdel-Latif, Ahmed Adel, Ahmed Aljzeeri, Ahmed Kamal, Ahmed Talaat, Aimee Mann, Aira Contreras, Ajit Kumar, V K Kumar, Akemi Furukawa, Akshay Bagai, Akvile Smigelskaite, Alain Furber, Alain Rheault, Alaine Melanie Loehr, Alan Rosen, Albert Varga, Albertina Qelaj, Alberto Barioli, Aldo Russo, Alec Moorman, Alejandro Gisbert, Aleksandra Fratczak, Aleksandras Laucevicius, Alena Kuleshova, Alessandro Sionis, Alexander A Sirker, Alexander M Chernyavskiy, Alexandra Craft, Alexandra Vazquez, Alexandre Ciappina Hueb, Alexandre S Colafranseschi, Alexandre Schaan de Quadros, Alexandre Tognon, Ali Alghamdi, Alice Manica Muller, Aline Nogueira Rabaça, Aline Peixoto Deiro, Alison Hallam, Allegra Stone, Allison Schley, Almudena Castro, Alvaro Rabelo Ales, Amanda Germann, Amanda O'Malley, Amar Uxa, Amarachi Ojajuni, Amarino C Oliveira Jr, Amber B Hull, Ambuj Roy, Amer Zarka, Amir Janmohamed, Ammani Brown, Ammy Malinay, Amparo Martinez Monzonis, Amy J Richards, Amy Iskandrian, Amy Ollinger, Ana D Djordjevic-Dikic, Ana Fernández Martínez, Ana Gomes Almeida, Ana Paula Batista, Ana Rita Francisco, Ana S Mladenovic, Ana Santana, Anam Siddiqui, Anastasia M Kuzmina-Krutetskaya, Andras Vertes, Andre S Sousa, Andre Gabriel, André Schmidt, Andrea M Lundeen, Andrea Bartykowszki, Andrea Lorimer, Andrea Mortara, Andrea Pascual, Andreia Coelho, Andreia Rocha, Andrés García-Rincón, Andrew G Howarth, Andrew J Moriarty, Andrew Docherty, Andrew Starovoytov, Andrew Zurick, Andrzej Łabyk, Andrzej Swiatkowski, Andy Lam, Anelise Kawakami, Angela Hoye, Angela Kim, Angelique Smit, Angelo Nobre, Anil V Shah, Anja Ljubez, Anjali Anand, Ankush Sachdeva, Ann Greenberg, Ann Luyten, Ann Ostrander, Anna Di Donato, Anna Cichocka-Radwan, Anna Fojt, Anna Plachcinska, Anna Proietti, Anna Teresinska, Anne Marie Webb, Anne Cartwright, Anne Heath, Anne Mackin, Anong Amaritakomol, Anong Chaiyasri, Anoop Chauhan, Anoop Mathew, Anthony Gemignani, Anto Luigi Andres, Antonia Vega, Antonietta Hansen, Antonino Ginel Iglesias, Antonio Carlos Carvalho, Antonio Di Chiara, Antonio Serra Peñaranda, Antonio Carvalho, Antonio Colombo, Antonio Fiarresga, Anupama Rao, Aquiles Valdespino-Estrada, Araceli Boan, Areef Ishani, Ariel Diaz, Arijit Ghosh, Arintaya Prommintikul, Arline Roberts, Arnold H Seto, Arnold P Good, Arshed Quyyumi, Arthur J Labovitz, Arthur Kerner, Arturo S Campos-Santaolalla, Arunima Misra, Ashok Mukherjee, Ashok Seth, Ashraf Seedhom, Asim N Cheema, Asker Ahmed, Atul Mathur, Atul Verma, Audrey W Leong, Axel Åkerblom, Axelle Fuentes, Aynun Naher, Badhma Valaiyapathi, Baljeet Kaur, Bandula Guruge, Barbara Brzezińska, Barbara Nardi, Bartosz Czarniak, Bebek Singh, Begoña Igual, Bela Merkely, Belen Cid Alvarez, Benjamin J Spooner, Benjamin J W Chow, Benjamin Cheong, Benoy N Shah, Bernard de Bruyne, Bernardas Valecka, Bernhard Jäger, Beth A Archer, Beth Abramson, Beth Jorgenson, Bethany Harvey, Betsy O'Neal, Bev Atkinson, Bev Bozek, Bevin Lang, Bijulal Sasidharan, Bin Yang, Bin Zhang, Binoy Mannekkattukudy Kurian, Bjoern Goebel, Bob Hu, Bogdan A Popescu, Bogdan Crnokrak, Bolin Zhu, Bonnie J Kirby, Brandi D Zimbelman, Brandy Starks, Branko D Beleslin, Brenda Hart, Brian P Shapiro, Brian McCandless, Brianna Wisniewski, Brigham R Smith, Brooks Mirrer, Bruce McManus, Bruce Rutkin, Bruna Edilena Paulino, Bruna Maria Ascoli, Bryn Smith, Byron J Allen, C Michael Gibson, C Noel Bairey Merz, Calin Pop, Cameron Hague, Camila Thais de Ormundo, Candace Gopaul, Candice P Edillo, Carísi A Polanczyk, Carita Krannila, Carla Vicente, Carl-Éric Gagné, Carlo Briguori, Carlos Peña Gil, Carlos Alvarez, Carly Ohmart, Carmen C Beladan, Carmen Ginghina, Carol M Kartje, Caroline Alsweiler, Caroline Brown, Caroline Callison, Caroline Pinheiro, Caroline Rodgers, Caroline Spindler, Carolyn Corbett, Carrie Drum, Casey Riedberger, Catherine Bone, Catherine Fleming, Catherine Gordon, Catherine Jahrsdorfer, Catherine Lemay, Catherine Weick, Cathrine Patten, Cecilia Goletto, Cezary Kepka, Chandini Suvarna, Chang Xu, Chantale Mercure, Charle A Viljoen, Charlene Wiyarand, Charles Jia-Yin Hou, Charles Y Lui, Charles Cannan, Charles Cornet, Charlotte Pirro, Chataroon Rimsukcharoenchai, Chen Wang, Cheng-Ting Tsai, Chen-Yen Chien, Cheryl A Allardyce, Chester M Hedgepeth, Chetan Patel, Chiara Attanasio, Chih-Hsuan Yen, Chi-Ming Chow, Ching Min Er, Ching-Ching Ong, Cholenahally Nanjappa Manjunath, Chris Beck, Chris Buller, Christel Vassaliere, Christian Hamm, Christiano Caldeira, Christie Ballantyne, Christina Björklund, Christine R Hinton, Christine Bergeron, Christine Masson, Christine Roraff, Christine Shelley, Christophe Laure, Christophe Thuaire, Christopher Kinsey, Christopher McFarren, Christopher Spizzieri, Christopher Travill, Chun-Chieh Liu, Chung-Lieh Hung, Chunguang Li, Chun-Ho Yun, Chunli Xia, Ciarra Heard, Cidney Schultz, Clare Venn-Edmonds, Claudia P Hochberg, Claudia Wegmayr, Claudia Cortés, Claudia Escobar, Cláudia Freixo, Claudio T Mesquita, Clemens T Kadalie, Colin Berry, Constance Philander, Corine Thobois, Costantino Costantini, Courtney Page, Craig Atkinson, Craig Barr, Craig Paterson, Cristina Bare, Cynthia Baumann, Cynthia Burman, Dalisa Espinosa, Damien Collison, Dan Deleanu, Dan Elian, Dan Gao, Dana Oliver, Daniel P Vezina, Daniel O'Rourke, Daniele Komar, Danielle Schade, Darrel P Francis, Dastan Malaev, David A Bull, David E Winchester, David P Faxon, David Booth, David Cohen, David DeMets, David Foo, David Schlichting, David Taggart, David Waters, David Wohns, Davis Vo, Dawid Teodorczyk, Dawn Shelstad, Dawn Turnbull, Dayuan Li, Dean Kereiakes, Deborah O'Neill, Deborah Yip, Debra K Johnson, Debra Dees, Deepak L Bhatt, Deepika Gopal, Deepti Kumar, Deirdre Mattina, Deirdre Murphy, Delano R Small, Delsa K Rose, Dengke Jiang, Denis Carl Phaneuf, Denise Braganza, Denise Fine, Derek Cyr, Desiree Tobin, Diana Cukali, Diana Parra, Diane Camara, Diane Minshall Liu, Diego Adrián Vences, Diego Franca de Cunha, Dimitrios Stournaras, Dipti Patel, Dongze Li, Donna Exley, Dorit Grahl, Dragana Stanojevic, Duarte Cacela, Dwayne S G Conway, E Pinar Bermudez, Eapen Punnoose, Edgar L Tay, Edgar Karanjah, Edoardo Verna, Eduardo Hernandez-Rangel, Edward D Nicol, Edward O McFalls, Edward T Martin, Edyta Kaczmarska, Ekaterina I Lubinskaya, Elena A Demchenko, Elena Refoyo Salicio, Eli Feen, Elihú Durán-Cortés, Elisabeth M Janzen, Elise L Hannemann, Elise van Dongen, Elissa Restelli Piloto, Eliza Kaplan, Elizabeta Srbinovska Kostovska, Elizabeth Capasso-Gulve, Elizabeth Congdon, Elizabeth Ferguson, Elizaveta V Zbyshevskaya, Ellen Magedanz, Ellie Fridell, Ellis W Lader, Elvin Kedhi, Emanuela Racca, Emilie Tachot, Emily DeRosa, Encarnación Alonso-Álvarez, Eric Nicollet, Eric Peterson, Erick Alexánderson Rosas, Erick Donato Morales, Erin Orvis, Ermina Moga, Estelle Montpetit, Estevao Figueiredo, Eugene Passamani, Eugenia Nikolsky, Eunice Yeoh, Evgeniy I Kretov, Ewa Szczerba, Ewelina Wojtala, Expedito Eustáquio Ribeiro Silva, F Marin Ortuño, Fabio R Farias, Fabio Fimiani, Fabrizio Rolfo, Fa-Chang Yu, Fadi Hage, Fadi Matar, Fahim Haider Jafary, Fang Feng, Fang Liu, Fatima Ranjbaran, Fatima Rodriguez, Fausto J Pinto, Fauzia Rashid, Federica Ramani, Fei Wang, Fernanda Igansi, Filipa Silva, Filippo Ottani, Fiona Haines, Firas Al Solaiman, Flávia Egydio, Flavio Lyra, Florian Egger, Fran Farquharson, Frances Laube, Francesc Carreras Costa, Francesca de Micco, Francesca Bianchini, Francesca Pezzetta, Francesca Pietrucci, Francesco Orso, Francesco Pisano, Francis Burt, Francisca Patuleia Figueiras, Francisco Fernandez-Aviles, Francois Pierre Mongeon, Frans Van de Werf, Franziska Guenther, Fraser N Witherow, Fred Mohr, Frederico Dall'Orto, Fumiyuki Otsuka, G De La Morena, G Karthikeyan, Gabor Dekany, Gabor Kerecsen, Gabriel Galeote, Gabriel Grossmann, Gabriel Vorobiof, Gabriela Sanchez de Souza, Gabriela Guzman, Gabriela Zeballos, Gabriele Gabrielli, Gabriele Jakl-Kotauschek, Gail A Shammas, Gail Brandt, Gang Chen, Gary E Lane, Gary J Luckasen, Gautam Sharma, Gelmina Mikolaitiene, Gennie Yee, Georg Nickenig, George E Revtyak, George J Juang, Gerald Fletcher, Gerald Leonard, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Geza Fontos, Ghada Mikhail, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Giles Roditi, Gilles Barone-Rochette, Girish Mishra, Giuseppe Tarantini, Glenda Wong, Glenn S Hamroff, Glenn Rayos, Gong Cheng, Gonzalo Barge-Caballero, Goran Davidović, Goran Stankovic, Gordana Stevanovic, Grace Jingyan Wang, Grace M Young, Graceanne Wayser, Graciela Scaro, Graham S Hillis, Graham Wong, Grazyna Anna Szulczyk, Gregor Simonis, Gregory Kumkumian, Gretchen Ann Peichel, Grzegorz Gajos, Gudrun Steinmaurer, Guilherme G Rucatti, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillem Pons Lladó, Gunnar Frostfelt, Gurpreet S Wander, Gurpreet Gulati, Gustavo Pucci, Hafidz Abd Hadi, Haibo Zhang, Haitao Wang, Halina Marciniak, Han Chen, Hanan Kerr, Hani Najm, Hanna Douglas, Hannah Phillips, Hao Dai, Haojian Dong, Haqeel Jamil, Harikrishnan Sivadasanpillai, Harry Suryapranata, Hassan Reda, Hayley Pomeroy, Heather Barrentine, Heather Golden, Heather Hurlburt, Heidi Wilson, Helen C Tucker, Helene Abergel, Hemalata Siddaram, Hermine Osseni, Herwig Schuchlenz, Hesong Zeng, Hicham Skali, Hilda Solomon, Hollie Horton, Holly Hetrick, Holly Little, Holly Park, Hongjie Chi, Hossam Mahrous, Howard A Levite, Hristo Pejkov, Huajun Li, Hugo Bloise-Adames, Hugo Marques, Hui Zhong, Hui-Min Zhang, Humayrah Hashim, Hung-I Yeh, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ihab Hamzeh, Ikraam Hassan, Ikuko Ueda, Ileana L Pina, Ilona Tamasauskiene, Ilse Bouwhuis, Imran Arif, Ina Wenzelburger, Inês Zimbarra Cabrita, Ines Rodrigues, Inga H Robbins, Inga Soveri, Ingela Schnittger, Iqbal Karimullah, Ira M Dauber, Iram Rehman, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Irni Yusnida, Isabel Estela Carvajal, Isabella C Palazzo, Isabelle Hogan, Isabelle Roy, Ishba Syed, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona Niedzwiecka, J David Knight, Jacek Kusmierek, Jackie M White, Jackie Chow, Jacob Udell, Jacqueline E Tamis-Holland, Jacqueline Fannon, Jacquelyn A Quin, Jacquelyn Do, Jaekyeong Heo, Jakub Maksym, James E Davies, James H O'Keefe Jr, James J Jang, James Cha, James Harrison, James Hirsch, James Stafford, James Tatoulis, Jamie Rankin, Jan Henzel, Jan Orga, Jana Tancredi, Janaina Oliveira, Jane Burton, Jane Eckstein, Jane Marucci, Janet P Knight, Janet Blount, Janet Halliday, Janetta Kourzenkova, Janitha Raj, Jan-Malte Sinning, Jaqueline Pozzibon, Jaroslaw Drozdz, Jaroslaw Karwowski, Jason D Glover, Jason Loh Kwok, Jason T Call, Jason Linefsky, Jassira Gomes, Jati Anumpa, Javier J Garcia, Javier Courtis, Jay Meisner, K Jayakumar, Jayne Scales, Jean E Denaro, Jean Michel Juliard, Jean Ho, Jeanette K Stansborough, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeet Thambyrajah, Jeff Leimberger, Jeffery A Breall, Jeffrey A Kohn, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Blume, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Djokic, Jelena Stojkovic, Jenne M Jose, Jenne Manchery, Jennifer A Mull, Jennifer H Czerniak, Jennifer L Stanford, Jennifer Gillis, Jennifer Horst, Jennifer Isaacs, Jennifer Langdon, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jen-Yuan Kuo, Jeremy Rautureau, Jerome Fleg, Jessica Berg, Jessica Rodriguez, Jessica Waldron, Jhina Patro, Jia Li, Jiajia Mao, Jiamin Liu, Jian'an Wang, Jianhua Li, Jianxin Zhang, Jie Qi, Jihyun Lyo, Jill Marcus, Jim Blankenship, Jing Zhang, Jingjing Liu, Jing-Yao Fan, Jiun-Yi Li, Jiwan Pradhan, Jiyan Chen, J M Rivera Caravaca, Jo Evans, Joan Garcia Picart, Joan Hecht, Joanna Jaroch, Joanna Zalewska, Joanne Kelly, Joanne Taaffe, João Reynaldo Abbud, João V Vitola, Joaquín V Peñafiel, Jocelyne Benatar, Jody Bindeman, Joe Sabik, Joel Klitch, Johann Christopher, Johannes Aspberg, John D Friedman, John F Beltrame, John F Heitner, John Joseph Graham, John R Davies, John Doan, John Kotter, John Kurian, John Mukai, John Pownall, Jolanta Sobolewska, Jon Kobashigawa, Jonathan L Goldberg, Jonathan W Bazeley, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Leipsic, Jonean Thorsen, Jorge F Trejo Gutierrez, Jorge Escobedo, Jorik Timmer, José A Ortega-Ramírez, José Antonio Marin-Neto, Jose D Salas, Jose Enrique Castillo, Jose Francisco Saraiva, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Vieira, José M Flores-Palacios, Jose Ramon Gonzalez, Jose Seijas Amigo, Jose Fragata, Josep Maria Padró, Josheph F X McGarvey Jr, Joseph Hannan, Joseph Sacco, Joseph Sweeny, Joseph Wiesel, Josephine D Abraham, Joshua P Loh, Joy Burkhardt, Joyce R White, Joyce Riestenberg-Smith, Judit Sebo, Judith L Meadows, Judith Wright, Judy Mae Foltz, Judy Hung, Judy Otis, Juergen Stumpf, Jui-Peng Tsai, Julia S Dionne, Julia de Aveiro Morata, Julie Bunke, Julie Morrow, Julio César Figal, Jun Fujita, Jun Jiang, Junhua Li, Junqing Yang, Juntima Euathrongchit, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Kai Eggers, Kamalakar Surineni, Kanae Hirase, T R Kapilamoorthy, Karen Calfas, Karen Gratrix, Karen Hallett, Karen Hultberg, Karen Nugent, Karen Petrosyan, Karen Swan, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karsten Lenk, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Kate Pointon, Kate Robb, Katherine Martin, Kathleen Claes, Kathryn Carruthers, Kathy E Siegel, Katia Drouin, Katie Fowler-Lehman, Kavita Rawat, Kay Rowe, Keiichi Fukuda, Keith A A Fox, Ken Mahaffey, Kendra Unterbrink, Kenneth Giedd, Kerrie Van Loo, Kerry Lee, Kerstin Bonin, Kevin R Bainey, Kevin T Harley, Kevin Anstrom, Kevin Chan, Kevin Croce, Kevin Landolfo, Kevin Marzo, Keyur Patel, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khaled Ziada, Khaula Baloch, Khrystyna Kushniriuk, Kian-Keong Poh, Kim F Ireland, Kim Holland, Kimberly Ann Byrne, Kimberly E Halverson, Kimberly Elmore, Kimberly Miller-Cox, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kotiboinna Preethi, Kozhaya Sokhon, Krissada Meemuk, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristina Wippler, Kristine Arges, Kristine Teoh, Krystal Etherington, Krystyna Łoboz-Grudzień, Krzysztof W Reczuch, Krzysztof Bury, Krzysztof Drzymalski, Krzysztof Kukuła, Kuo-Tzu Sung, Kurt Huber, Ladda Douangvila, Lance Sullenberger, Larissa Miranda Trama, Laszlone Matics, Laura Drew, Laura Flint, Laura Keinaite, Laura Sarti, Laurel Kolakaluri, Lawrence M Phillips, Lawrence Friedman, Lawrence Phillips, Lazar Velicki, Leah Howell, Leandro C Maranan, Leanne Cox, Ledjalem Daba, Lei Zhang, Lekshmi Dharmarajan, Leo Bockeria, Leonardo Pizzol Caetano, Leonardo Bridi, Leonid L Bershtein, Leszek Sokalski, Li Hai Yan, Li Li, Lia Nijmeijer, Lidia Sousa, Lihong Xu, Lihua Zhang, Lili Zhang, Lilia Schiavi, Lilian Mazza Barbosa, Lillian L Khor, Lina Felix-Stern, Linda L Hall, Linda M Hollenweger, Linda Arcand, Linda Davidson-Ray, Linda Schwarz, Lindsey N Sikora, Lingping Chi, Lino Patricio, Liping Zhang, Lisa Chaytor, Lisa Hatch, Lisa McCloy, Lisa Wong, Liselotte Persson, Lixin Jiang, Liz Low, Ljiljana Pupic, Loïc Bière, Lorenzo Monti, Lori Christensen, Lori Pritchard, Loriane Black, Lori-Ann Desimone, Lori-Ann Larmand, Lorraine McGregor, Louise Morby, Louise Thomson, Luc Harvey, Luciana de Pádua Baptista, Lucilla Garcia, Ludivine Eliahou, Ludmila Helmer, Luis F Smidt, Luis Bernanrdes, Luis Guzman, Luiz A Carvalho, Luyang Xiong, Lynette L Teo, Lynn M Neeson, Lynne Winstanley, M Barbara Srichai-Parsia, M Quintana Giner, M Sowjanya Reddy, M Valdés Chávarri, M Grazia Rossi, Maarten Simoons, Maayan Konigstein, Maciej Lesiak, Maciej Olsowka, Mafalda Selas, Magalie Corfias, Magdalena Madero Rovalo, Magdalena Łanocha, Magdalena Miller, Magdalena Misztal-Teodorczyk, Magdalena Rantinella, Magdy Abdelhamid, Magnolia Jimenez, Mahboob Alam, Mahevamma Mylarappa, Mahfouz El Shahawy, Mahmoud Mohamed, Mahmud Al-Bustami, Majo X Joseph, Malgorzata Frach, Małgorzta Celińska-Spodar, Malte Helm, Manas Chacko, Mandy Murphy, Manitha Vinod, Manjula Rani, Manu Dhawan, Manuela Mombelli, Marcel Weber, Marcello Galvani, Marcelo Jamus Rodrigues, Marcia F Dubin, Marcia F Werner Bayer, Marcin Szkopiak, Marco Antonio Monsalve, Marco Bizzaro Santos, Marco Magnoni, Marco Marini, Marco Sicuro, Marco Zenati, Marcos Valério Coimbra Resende, Marek Roik, Margalit Bentzvi, Margaret Gilsenan, Margaret Iraola, Margot C 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George J Juang, Gerald Fletcher, Gerald Leonard, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Geza Fontos, Ghada Mikhail, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Giles Roditi, Gilles Barone-Rochette, Girish Mishra, Giuseppe Tarantini, Glenda Wong, Glenn S Hamroff, Glenn Rayos, Gong Cheng, Gonzalo Barge-Caballero, Goran Davidović, Goran Stankovic, Gordana Stevanovic, Grace Jingyan Wang, Grace M Young, Graceanne Wayser, Graciela Scaro, Graham S Hillis, Graham Wong, Grazyna Anna Szulczyk, Gregor Simonis, Gregory Kumkumian, Gretchen Ann Peichel, Grzegorz Gajos, Gudrun Steinmaurer, Guilherme G Rucatti, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillem Pons Lladó, Gunnar Frostfelt, Gurpreet S Wander, Gurpreet Gulati, Gustavo Pucci, Hafidz Abd Hadi, Haibo Zhang, Haitao Wang, Halina Marciniak, Han Chen, Hanan Kerr, Hani Najm, Hanna Douglas, Hannah Phillips, Hao Dai, Haojian Dong, Haqeel Jamil, Harikrishnan Sivadasanpillai, Harry Suryapranata, Hassan Reda, Hayley Pomeroy, Heather Barrentine, Heather Golden, Heather Hurlburt, Heidi Wilson, Helen C Tucker, Helene Abergel, Hemalata Siddaram, Hermine Osseni, Herwig Schuchlenz, Hesong Zeng, Hicham Skali, Hilda Solomon, Hollie Horton, Holly Hetrick, Holly Little, Holly Park, Hongjie Chi, Hossam Mahrous, Howard A Levite, Hristo Pejkov, Huajun Li, Hugo Bloise-Adames, Hugo Marques, Hui Zhong, Hui-Min Zhang, Humayrah Hashim, Hung-I Yeh, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ihab Hamzeh, Ikraam Hassan, Ikuko Ueda, Ileana L Pina, Ilona Tamasauskiene, Ilse Bouwhuis, Imran Arif, Ina Wenzelburger, Inês Zimbarra Cabrita, Ines Rodrigues, Inga H Robbins, Inga Soveri, Ingela Schnittger, Iqbal Karimullah, Ira M Dauber, Iram Rehman, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Irni Yusnida, Isabel Estela Carvajal, Isabella C Palazzo, Isabelle Hogan, Isabelle Roy, Ishba Syed, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona Niedzwiecka, J David Knight, Jacek Kusmierek, Jackie M White, Jackie Chow, Jacob Udell, Jacqueline E Tamis-Holland, Jacqueline Fannon, Jacquelyn A Quin, Jacquelyn Do, Jaekyeong Heo, Jakub Maksym, James E Davies, James H O'Keefe Jr, James J Jang, James Cha, James Harrison, James Hirsch, James Stafford, James Tatoulis, Jamie Rankin, Jan Henzel, Jan Orga, Jana Tancredi, Janaina Oliveira, Jane Burton, Jane Eckstein, Jane Marucci, Janet P Knight, Janet Blount, Janet Halliday, Janetta Kourzenkova, Janitha Raj, Jan-Malte Sinning, Jaqueline Pozzibon, Jaroslaw Drozdz, Jaroslaw Karwowski, Jason D Glover, Jason Loh Kwok, Jason T Call, Jason Linefsky, Jassira Gomes, Jati Anumpa, Javier J Garcia, Javier Courtis, Jay Meisner, K Jayakumar, Jayne Scales, Jean E Denaro, Jean Michel Juliard, Jean Ho, Jeanette K Stansborough, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeet Thambyrajah, Jeff Leimberger, Jeffery A Breall, Jeffrey A Kohn, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Blume, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Djokic, Jelena Stojkovic, Jenne M Jose, Jenne Manchery, Jennifer A Mull, Jennifer H Czerniak, Jennifer L Stanford, Jennifer Gillis, Jennifer Horst, Jennifer Isaacs, Jennifer Langdon, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jen-Yuan Kuo, Jeremy Rautureau, Jerome Fleg, Jessica Berg, Jessica Rodriguez, Jessica Waldron, Jhina Patro, Jia Li, Jiajia Mao, Jiamin Liu, Jian'an Wang, Jianhua Li, Jianxin Zhang, Jie Qi, Jihyun Lyo, Jill Marcus, Jim Blankenship, Jing Zhang, Jingjing Liu, Jing-Yao Fan, Jiun-Yi Li, Jiwan Pradhan, Jiyan Chen, J M Rivera Caravaca, Jo Evans, Joan Garcia Picart, Joan Hecht, Joanna Jaroch, Joanna Zalewska, Joanne Kelly, Joanne Taaffe, João Reynaldo Abbud, João V Vitola, Joaquín V Peñafiel, Jocelyne Benatar, Jody Bindeman, Joe Sabik, Joel Klitch, Johann Christopher, Johannes Aspberg, John D Friedman, John F Beltrame, John F Heitner, John Joseph Graham, John R Davies, John Doan, John Kotter, John Kurian, John Mukai, John Pownall, Jolanta Sobolewska, Jon Kobashigawa, Jonathan L Goldberg, Jonathan W Bazeley, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Leipsic, Jonean Thorsen, Jorge F Trejo Gutierrez, Jorge Escobedo, Jorik Timmer, José A Ortega-Ramírez, José Antonio Marin-Neto, Jose D Salas, Jose Enrique Castillo, Jose Francisco Saraiva, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Vieira, José M Flores-Palacios, Jose Ramon Gonzalez, Jose Seijas Amigo, Jose Fragata, Josep Maria Padró, Josheph F X McGarvey Jr, Joseph Hannan, Joseph Sacco, Joseph Sweeny, Joseph Wiesel, Josephine D Abraham, Joshua P Loh, Joy Burkhardt, Joyce R White, Joyce Riestenberg-Smith, Judit Sebo, Judith L Meadows, Judith Wright, Judy Mae Foltz, Judy Hung, Judy Otis, Juergen Stumpf, Jui-Peng Tsai, Julia S Dionne, Julia de Aveiro Morata, Julie Bunke, Julie Morrow, Julio César Figal, Jun Fujita, Jun Jiang, Junhua Li, Junqing Yang, Juntima Euathrongchit, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Kai Eggers, Kamalakar Surineni, Kanae Hirase, T R Kapilamoorthy, Karen Calfas, Karen Gratrix, Karen Hallett, Karen Hultberg, Karen Nugent, Karen Petrosyan, Karen Swan, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karsten Lenk, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Kate Pointon, Kate Robb, Katherine Martin, Kathleen Claes, Kathryn Carruthers, Kathy E Siegel, Katia Drouin, Katie Fowler-Lehman, Kavita Rawat, Kay Rowe, Keiichi Fukuda, Keith A A Fox, Ken Mahaffey, Kendra Unterbrink, Kenneth Giedd, Kerrie Van Loo, Kerry Lee, Kerstin Bonin, Kevin R Bainey, Kevin T Harley, Kevin Anstrom, Kevin Chan, Kevin Croce, Kevin Landolfo, Kevin Marzo, Keyur Patel, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khaled Ziada, Khaula Baloch, Khrystyna Kushniriuk, Kian-Keong Poh, Kim F Ireland, Kim Holland, Kimberly Ann Byrne, Kimberly E Halverson, Kimberly Elmore, Kimberly Miller-Cox, Kiran 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Mohamed, Mahmud Al-Bustami, Majo X Joseph, Malgorzata Frach, Małgorzta Celińska-Spodar, Malte Helm, Manas Chacko, Mandy Murphy, Manitha Vinod, Manjula Rani, Manu Dhawan, Manuela Mombelli, Marcel Weber, Marcello Galvani, Marcelo Jamus Rodrigues, Marcia F Dubin, Marcia F Werner Bayer, Marcin Szkopiak, Marco Antonio Monsalve, Marco Bizzaro Santos, Marco Magnoni, Marco Marini, Marco Sicuro, Marco Zenati, Marcos Valério Coimbra Resende, Marek Roik, Margalit Bentzvi, Margaret Gilsenan, Margaret Iraola, Margot C Quinn, Maria A Alfonso, Maria Antonieta Pereira Moraes, María Dolores Martínez-Ruíz, María Fernanda Canales, Maria Inês Caetano, Maria P Corral, Maria Pérez García, Maria Victoria Actis, Maria Aguirre, Maria Andreasson, Maria Aprile, Maria Colton, Maria Eugenia Martin, Maria Lasala, Maria Lorenzo, Maria Posada, Maria Shier, Maria Thottam, Mariana V Furtado, Mariana Yumi Okada, Marianna D A Dracoulakis, Marianne De Andrade, Mariano Rubio, Marie Essermark, Marielle Scherrer-Crosbie, Marija T Petrovic, Marija Zdravkovic, Marilyn Black, Marina Garcia, Mario J Garcia, Mariola Szulik, Marisa Orgera, Mark A de Belder, Mark Harbinson, Mark Hyun, Mark Peterson, Mark Xavier, Marlowe Mosley, Marta Capinha, Marta Marcinkiewicz-Siemion, Marta Swiderek, Martha Meyer, Martina Ceseri, Martina Tricoli, Marvin Kronenberg, Mary Williams, Mary Ann Champagne, Mary Colleen Rogge, Mary R Soltau, Mary Streif, Massimo Villella, Massoud Leesar, Matei Claudia, Mateusz Solecki, Matías Nicolás Mungo, Matthew Wall Jr, Matthew Budoff, Matthew Jezior, Matthew Luckie, Matthias Friedrich, Mauren P Haeffner, Maximilian Tscharre, Max-Paul Winter, Mayana Almeida, Mayil S Krishnam, Mayuri Patel, Meenakshi Mishra, Megan Manocchia, Meghana Kakade, Melanie J Munro, Melissa D Chaplin, Melissa LeFevre, Mervyn Andiapen, Michael A Gibson, Michael B Rubens, Michael C Turner, Michael D Shapiro, Michael W Lee, Michael Berlowitz, Michael Davidson, Michael Mack, Michael McDaniel, Michael Mumma, Michal Wlodarczyk, Michel G Khouri, Michel S Slama, Michele Rawlins, Michelle M Bonner, Michelle M Seib, Michelle Chang, Michelle Crowder, Michelle Dixon, Michelle Mayon, Michelle McEvoy, Michelle Yee, Miguel M Fernandes, Miguel Nobre Menezes, Miguel Souto Bayarri, Miguel Barrero, Mikhail T Torosoff, Milan R Dobric, Milan Dobric, Milica Nikola Dekleva, Milind Avdhoot Gadkari, Millie Gomez, Min Tun Kyaw, Miriam Brooks, Miroslav Stevo Martinovic, Mitchel B Lustre, Mohammad Tariq Vakani, Mohammad El-Hajjar, Mohammed Al-Amoodi, Mohammed Hussain, Mohammed Saleem, Moisés Blanco-Calvo, Moisés Jiménez-Santos, Mona Bhatia, Monica Rosca, Monika Laukyte, Montserrat Gracida Blanca, Montserrat Vila Perales, Mouaz H Al-Mallah, Moysés de Oliveira Filho, Mpiko Ntsekhe, Muhamed Saric, Mulei Chen, Myriam Brousseau, Myrthes Emy Takiuti, Nada Cemerlic-Adjic, Nadia Asif, Nadia Gakou, Nafisa Hussain, Nana O Katamadze, Nancy L Clapp, Nancy Aedy, Nandita Nataraj, Nanette K Wenger, Naomi Uchida, Nasrul Ismail, Natalia S Oliveira, Natalia de Carvalho Maffei, Natalie Spitzer, Natasha C Putnam, Naved Aslam, Neamat Mowafy, Neeraj Pandit, Neeraj Parakh, Nevena Garcevic, Ngaire Meadows, Nhi N Tran, Nicholas Danchin, Nicki Lakeman, Nicola Johnston, Nicolas W Shammas, Nicole Saint Vrestil, Nicole Deming, Nier Zhong, Niket Patel, Nikola N Boskovic, Nikolaos Karogiannis, Nikos Werner, Nina Johnston, Ning Zhang, Ning Zhou, Niree Hindoyan, Nirmal Kumar, Nitika Chadha, Nitish Naik, Nodira Aripova, Noloyiso Mtana, Nona A Eskelson, Noor Syamira Mokhtar, Noppon Taksaudom, Nor Asiah Basri, Nora Marchelletta, Norma Hogg, Nungshi Jungla, Nuno Ferreira, Oksana A Lubyanaya, Olga B Nikolaeva, Olga Cañavate, Olga Sobrino, Olga Walesiak, Olga Walter, Olga Zdończyk, Olivia J Lim, Olivia Anaya, Olivia Mancilla, Olivier Dubourg, Olugbenga Bello, Omar Almousalli, Omar Thompson, Oni Olurinde, Or Harel, Osama Raheem, Oscar Méndiz, Óscar Prada-Delgado, Oz Shapira, P Christian Schulze, Pachara Panpunuan, Pal Maurovich-Horvat, Pallav Garg, Paloma Moraga, Pam Singh, Pamela Julian, Pamela Ouyang, Pamela Sigel, Pamela Woodard, Panpan Zhou, Paola Emanuela Poggio, Paola Smanio, Paolo Calabro, Paramjit Jeetley, Pascal Goube, Patricia K Nguyen, Patricia Alarie, Patricia Arakelian, Patricia Arsenault, Patricia Blaise, Patricia Brito, Patricia Cowper, Patricia Endsley, Patricia Mieses, Patrick B Alexander, Patrick Donnelly, Patrick Wilmot, Patrycja Lebioda, Paul C Gordon, Paul Der Mesropian, Paul Galiwango, Paul Hauptman, Paul Kennedy, Paula Beardsley, Paula García-González, Paulo Cury Rezende, Paulo Ricardo Caramori, Pavel S Kozlov, Pedro Canas Silva, Pedro Gabriel Melo Barros E Silva, Pedro Píccaro de Oliveira, Pedro Carvalho, Pedro Modas, Pedro Rio, Peeyush Jain, Peiyu He, Peter A McCullough, Peter H Stone, Peter M Pollak, Peter Douglass, Peter Henriksen, Peter OKane, Peter Ong, Philip Jones, Philip Rogal, Philippe Généreux, Philippe Menasche, Philippe Rheault, Phoebe Goold, Pierre Gervais, Pierre Michaud, Pilar Calvillo, Ping Chai, Piotr Jakubowski, Piotr Pruszczyk, Piotr Slomka, Piyamitr Sritara, Poay-Huan Loh, Poonam Sonawane, Pouneh Samadi, Pragnesh P Parikh, Prakash Deedwania, Pranav M Patel, Praneeth Polamuri, Pratiksha Sharma, Precilia Vasquez, Preeti Kamath, Prince Thomas, Priyadarshani Arambam, Puja K Mehta, Purvez Grant, Pushpa Naik, Qi Zhong, Qian Zhao, Qiang Zhou, Qianqian Yuan, Qin Yu, Qingxian Li, Qiulan Xie, Qiutang Zeng, R J Vindhya, R James Gerlach, Rachel King, Rada Vučić, Radmila Lyubarova, Radoslaw Pracon, Raewyn Fisher, Rafael Beyar, Rafael Diaz, Rafael Selgas, Raffaele Bugiardini, Raffaele Fanelli, Raisa Kavalakkat, V S Rajalekshmi, Rajat S Barua, Rajeev Menon, Rajesh Gopalan Nair, Rajesh Francis, Rajiv Narang, Rakesh Yadav, Ralph Alan Huston, T Ramakrishnan, Ramesh de Silva, Rami El Mahmoud, Ramiro Carvalho, Ramon de Jesús-Pérez, Ramona Stevens, Ran Leng, Ranjan Kachru, Ranjit Kumar Nath, Raquel Sanchez, Raven R Dwyer, Raven Lee, Ray Wyman, Raymond C Wong, Raymond W Little, Raymundo Ocaranza Sanchez, Rebecca J Wimmer, Rebecca Bariciano, Rebecca Otis, Rebekah R Herrmann, Reem Yunis, Reinette Hampson, Renato Abdala Karam, Renee C Hessian, Renee Kaneshiro, Reshma Ravindran, Reto Andreas Gamma, Reyna Bhandari, Reza Arsanjani, Ricardo L Lopes, Ricardo Mendes Oliveira, Ricardo Costa, Richa Bhatt, Richard F Davies, Richard H J Trimlett, Richard Goldweit, Rik Hermanides, Rine Nakanishi, Rinu R Sidh, Risha Patel, Rita Coram, Rizwan A Siddiqui, Rob S Beanlands, Robert J Hamburger, Robert K Riezebos, Robert M Donnino, Robert Bojar, Robert Chilton, Robert Guyton, Robert Henderson, Robert Kornberg, Robert Leber, Robert Mao, Robert Stenberg, Roberta P Santos, Roberto René Favaloro, Roberto Amati, Rodolfo G S D Lima, Rodrigo J Cerci, Rogerio Tumelero, Rohit Tandon, Roma Tewari, Romalisa Miranda-Peats, Ron Wald, Ronald A Mastouri, Ronald G Morford, Ronald G Schwartz, Ronald P Pedalino, Rongrong Hu, Ronnell A Hansen, Ronny A Cohen, Rory Hachamovitch, Rosa Homem, Rosa Sandonato, Rosane Laimer, Rosann Gans, Roxanne Yost, Roy Mathew, Rubén Baleón-Espinosa, Ruben Ramos, Rubine Gevorgyan, Rui Ferreira, Rui Jing, Ruth Pérez-Fernández, S K Dwivedi, S Ramakrishnan, Saadat Khan, Sabahat Bokhari, Sabu Thomas, Sadath Lubna, Sajeeda Parveen Khan, Sajeev Chakanalil Govindan, Saket Girotra, Saleem Kassam, Sallie Canada, Salvador Cruz-Flores, Samaa Mohamed, Samantha Ly, Sameh El Kaffas, Samia Massalha, Sampoornima Setty, Samuel Nwosu, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandra M Rivest, Sandra S Zier, Sandra Ahoud, Sandy Carr, Sanjay Ganapathi, Sanjay Shetty, Sanjeev Sharma, Santa Jimenez, Santhosh Satheesh, Santiago A Garcia, Sara Fernandez, Sara Karlsson, Sara Salkind, Sara Temiyasathit, Sarah Medina Rodriguez, Sarah Beaudry, Sarah Hadjih, Sarah Williams, Sarah Zahrani, Sarju Ralhan, Sasa Hinic, Sasko Kedev, Satinder Singh, Satoshi Yasuda, Satvic Cholenahally Manjunath, Sau Lee, Scott M Kaczkowski, Scott Kinlay, Sean W Hayes, Sebastian Sobczak, Senait Asier, Sergey A Sayganov, Seth I Sokol, Shaheen Pandie, Shaiful Azmi Yahaya, Shamir Mehta, Shao-Ping Nie, Sharad Chandra, Sharder Islam, Sharon Tai, Sheetal Rupesh Karwa, Sheri Ussery, Sheromani Bajaj, Sherron C Crook, Shigeyuki Nishimura, Shintaro Nakano, Shirin Heydari, Shiv Kumar Choudhary, Shivali Patel, Shobana Ganesan, Shruti Pandey, Shuyang Zhang, Shweta Hande, Siddharth Gadage, Sik-Yin V Tan, Silvia Zottis Poletti, Silvia Riera, Silvia Valbuena, Simon Walsh, Simona Maspoli, Simone Savaris, Si-Ting Feng, So Yang Cho, Solomon Yakubov, Songlin Zhu, Songtao Wang, Sonia Guerrero, Sonika Gupta, Sonja Salinger Martinovic, Sonya Brons, Sorin Brener, Sothinathan Gurunathan, Souheil Saba, Soundarya Nayak, Sowjanya Reddy, Srinivasa Potluri, Sriram Sudarshan, Srun Kuanprasert, Stacie Van Oosterhout, Stamatios Lerakis, Stanley E Cobos, Stefan C Bertog, Stefan M Simović, Stefan Weikl, Stefano Di Marco, Stefano Provasoli, Stephanie A Tirado, Stephanie C Boer, Stephanie M Lane, Stephanie Ferket, Stephanie Kelly, Stephanie Wasmiller, Stephen H McKellar, Stephen P Hoole, Stephen Fremes, Stephen Preston, Steve Leung, Steven A Fein, Steven J Lindsay, Steven P Sedlis, Steven Giovannone, Steven Michael, Steven Weitz, Stijn van Vugt, Subhash Banerjee, Sudhir Naik, Suellen Hosino, Sukie Desire, Sukit Yamwong, Suku T Thambar, Sulagna Mookherjee, Suman Singh, Sundeep Mishra, Sunil Kumar Verma, Supap Kulthawong, Supatchara Khwakhong, Surendra Naik, Suresh Babu, Surin Woragidpoonpol, Suryaprakash Narayanappa, Susan Derbyshire, Susan Gent, Susan Mathus, Susan Milbrandt, Susan Moore, Susan Regan, Susan Stinson, Susan Webber, Susana Silva, Susanna Stevens, Susanne Gruensfelder, Suthara Aramcharoen, Suvarna Kolhe, Suzana Tavares, Suzanne Arnold, Suzanne Welsh, Svetlana Apostolovic, Swapna Kunhunny, Ta-Chuan Hung, Taissa Zappernick, Tali Sharir, Talita Silva, Tamara Colaiácovo Soares, Tapan Umesh Pillay, Tarun K Mittal, Tatiana Trifonova, Tauane Bello Duarte, Tauqir Huk, Téodora Dutoiu, Terrance Chua, Terry Weyand, Thabitha Charles, Theodoros Kofidis, Theresa McCreary, Thierry Lefevre, Thippeekaa Arumairajah, Thitipong Tepsuwan, Thomas J Mulhearn, Thomas M Meyer, Thomas P Rocco, Thomas R Downes, Thomas Crain, Thomas Haldis, Thomas Mathew, Thomas Redick, Thounaojam Indira Devi, Thuraia Nageh, Tia Cauthren, Tiago Silva, Tiffany Little, Tijana Andric, Tina Harding, Titus Lau, Tiziana Formisano, Tiziano Moccetti, Tomasz Ciurus, Tomasz Mazurek, Tomasz Tarchalski, Toshiyuki Nagai, Tri Tran, Tricia Youn, Trish Tucker, Trudie Milner, Tuhina Bose, Tushar Kotecha, Udo Sechtem, Uma S Valeti, Umberto Cucchini, Umesh Badami, Upendra Kaul, V K Bahl, V S Narain, Valentina Casali, Valeria Godoy, Valerie Robesyn, Vamshi P Priya, Vandana Yadav, Vera McKinney, Veronica De Lenges, Veronica Tinnirello, Vicente Miro, Victor Navarro, Victoria Gumerova, Victoria Hernandez, Vidya Seeratan, Vijay Kumar, Vikentiy Y Kozulin, Viktoria Bulkley, Vilmar Veiga Jr, Vincent Setang, C P Vineeth, Virginai Pubull Nuñez, Virginia Fernández-Figares, Vitor Gomes, Viviana Gabriel, Viviane Dos Santos, Viviane Almeida, Vlad A Iliescu, Vladan Mudrenovic, Vladimir Dzavik, Vojislav L Giga, Walter Enrique Mogrovejo, Wan Xian Chan, Wanda C Marfori, Wanda Parker, Warangkana Mekara, Wassim Nona, Wayne Old, Wayne Pennachi, Weerachai Nawarawong, Wei Chen, Wei Su, Weibing Xing, Wei-Ren Lan, Wenda Crawford, Wendy L Stewart, Wendy Drewes, Wenhua Lin, William B Abernethy, William D Salerno, William F Fearon, William Vergoni, William Weintraub, Winnie C Sia, Wlodzimierz J Musial, Xacobe Flores-Ríos, Xavier Garcia-Moll Marimon, Xi Su, Xiang Ma, Xiangqiong Gu, Xiao Wang, Xiaomei Li, Xiaowei Yao, Xin Fu, Xin Su, Xin Zeng, Xinchun Yang, Xiuhong Li, Xuehua Fang, Xutong Wang, Yaming Geng, Yan Yan, Yanek Pépin-Dubois, Yanfu Wang, Yang Wang, Yanmeng Tian, Yaping Huang, Yechen Han, Yesenia Zambrano, Yi-Hsuan Yang, Ying Tung Sia, Yining Yang, Yitong Ma, Yolayfi Peralta, Yongjian Wu, Yu Kunwu, Yu Zhao, Yudong Peng, Yueh-Hung Lin, Yulan Zhao, Yumei Dong, Yunhai Zhao, Yutthaphan Wannasopha, Yvonne Taul, Zakir Sahul, Zalina Kudzoeva, Zbigniew Kalarus, Zeljko Z Markovic, Zhen Huang, Zheng Ji, Zhenyu Liu, Zhou Yue, Zhulin Zhang, Zhuxi Li, Zile Singh Meharwal, Ziliang Bai, Zixiang Yu, Zohra Huda, Zoltan Davidovits
Subjects: Male, Cardiac Catheterization, Computed Tomography Angiography, medicine.medical_treatment, Myocardial Ischemia, Coronary Disease, Coronary Artery Disease, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Coronary Angiography, ISCHEMIA Research Group, law.invention, Angina, Coronary artery disease, 0302 clinical medicine, Randomized controlled trial, law, Cardiovascular Disease, Myocardial Revascularization, 030212 general & internal medicine, Coronary Artery Bypass, 11 Medical and Health Sciences, Cardiac catheterization, General Medicine, Middle Aged, humanities, Cardiovascular Diseases, Cardiology, Female, Human, medicine.medical_specialty, Ischemia, Article, 03 medical and health sciences, Geriatric cardiology, Percutaneous Coronary Intervention, General & Internal Medicine, Internal medicine, medicine, Humans, Angina, Unstable, Aged, business.industry, Coronary Artery Bypa, Percutaneous coronary intervention, Bayes Theorem, medicine.disease, Heart failure, Quality of Life, business
Abstract: BACKGROUND: Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS: We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS: Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage points; 95% CI, -4.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS: Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, NCT01471522.).
Published: 2020

7. A Decision Support Tool for Optimized Personalized Drug Dosage Profiles for Superovulation in In-Vitro Fertilization with Early Clinical Trial Results

Author: Urmila Diwekar, Nayana Patel, Niket Patel, Molina Patel, Harsha Bhadarka, Paresh Ghoghari, Harmi Thakkar, Richa Ainani, and Sanjay Joag
Published: 2022

8. 75 Nurse-led sedation is safe and effective, shortening procedure times, and improving access for selected transcatheter aortic valve implantation (tavi) patients

Author: Suzannah Browne, David Smith, Daniel Adams, Sumesh Thiruthalil, Ian McGovern, Simon Mattison, Vasileios Panoulas, Tito Kabir, Simon Davies, Jo Shannon, Ee Ling Heng, Hazim Rahbi, Navin Chandra, Niket Patel, Winston Banya, Alex Tindale, Robert Smith, Rebecca Lane, and Miles Dalby
Published: 2022

9. Patterns of myocardial injury in recovered troponin-positive COVID-19 patients assessed by cardiovascular magnetic resonance

Author: James C. Moon, Peter Kellman, Robert G. Bell, George Thornton, Yousuf Razvi, Thomas A. Treibel, Paramjit S. Jeetley, Gabriella Captur, Clare Coyle, Liza Chacko, Luke Howard, Abhishek Shetye, Anthony Wolff, Michael Jacobs, Toby Hillman, Rupert Negus, Hui Xue, Onn Min Kon, Meg Coleman, Daniel S Knight, Tushar Kotecha, Jamil Mayet, Melissa Heightman, Georgina Russell, Kavitha Vimalesvaran, Ben Ariff, Palmira Mathurdas, Niket Patel, Marianna Fontana, Donald Leith, James T Brown, Lucy E Lamb, Deepa Gopalan, Charlotte Manisty, Graham D. Cole, Iain Pierce, J. G. Goldring, Prapa Kanagaratnam, Rishi K Patel, and Kartik Kumar
Subjects: medicine.medical_specialty, Ejection fraction, Myocarditis, biology, business.industry, Convalescence, media_common.quotation_subject, Ischemia, Infarction, 030204 cardiovascular system & hematology, medicine.disease, Troponin, 030218 nuclear medicine & medical imaging, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Cardiology, biology.protein, Myocardial infarction, Cardiology and Cardiovascular Medicine, business, media_common
Abstract: Background Troponin elevation is common in hospitalized COVID-19 patients, but underlying aetiologies are ill-defined. We used multi-parametric cardiovascular magnetic resonance (CMR) to assess myocardial injury in recovered COVID-19 patients. Methods and results One hundred and forty-eight patients (64 ± 12 years, 70% male) with severe COVID-19 infection [all requiring hospital admission, 48 (32%) requiring ventilatory support] and troponin elevation discharged from six hospitals underwent convalescent CMR (including adenosine stress perfusion if indicated) at median 68 days. Left ventricular (LV) function was normal in 89% (ejection fraction 67% ± 11%). Late gadolinium enhancement and/or ischaemia was found in 54% (80/148). This comprised myocarditis-like scar in 26% (39/148), infarction and/or ischaemia in 22% (32/148) and dual pathology in 6% (9/148). Myocarditis-like injury was limited to three or less myocardial segments in 88% (35/40) of cases with no associated LV dysfunction; of these, 30% had active myocarditis. Myocardial infarction was found in 19% (28/148) and inducible ischaemia in 26% (20/76) of those undergoing stress perfusion (including 7 with both infarction and ischaemia). Of patients with ischaemic injury pattern, 66% (27/41) had no past history of coronary disease. There was no evidence of diffuse fibrosis or oedema in the remote myocardium (T1: COVID-19 patients 1033 ± 41 ms vs. matched controls 1028 ± 35 ms; T2: COVID-19 46 ± 3 ms vs. matched controls 47 ± 3 ms). Conclusions During convalescence after severe COVID-19 infection with troponin elevation, myocarditis-like injury can be encountered, with limited extent and minimal functional consequence. In a proportion of patients, there is evidence of possible ongoing localized inflammation. A quarter of patients had ischaemic heart disease, of which two-thirds had no previous history. Whether these observed findings represent pre-existing clinically silent disease or de novo COVID-19-related changes remain undetermined. Diffuse oedema or fibrosis was not detected.
Published: 2021

10. Quantitative cardiovascular magnetic resonance myocardial perfusion mapping to assess hyperaemic response to adenosine stress

Author: James Brown, Liza Chacko, Philip N. Hawkins, Roby Rakhit, Ana Martinez-Naharro, Tim Lockie, Sven Plein, James C. Moon, Marianna Fontana, Peter Kellman, Hui Xue, Niket Patel, Tushar Kotecha, Daniel R. Knight, Juan Manuel Monteagudo, and Kristopher D Knott
Subjects: medicine.medical_specialty, Adenosine, Magnetic Resonance Spectroscopy, Vasodilator Agents, Magnetic Resonance Imaging, Cine, Hyperemia, Coronary Artery Disease, 030204 cardiovascular system & hematology, 030218 nuclear medicine & medical imaging, Coronary artery disease, 03 medical and health sciences, Hyperaemia, 0302 clinical medicine, Predictive Value of Tests, Coronary Circulation, Internal medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, Volunteer, medicine.diagnostic_test, business.industry, Myocardium, Myocardial Perfusion Imaging, Magnetic resonance imaging, General Medicine, Blood flow, medicine.disease, Perfusion, Blood pressure, Cohort, Cardiology, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract: Aims Assessment of hyperaemia during adenosine stress cardiovascular magnetic resonance (CMR) remains a clinical challenge with lack of a gold-standard non-invasive clinical marker to confirm hyperaemic response. This study aimed to validate maximum stress myocardial blood flow (SMBF) measured using quantitative perfusion mapping for assessment of hyperaemic response and compare this to current clinical markers of adenosine stress. Methods and results Two hundred and eighteen subjects underwent adenosine stress CMR. A derivation cohort (22 volunteers) was used to identify a SMBF threshold value for hyperaemia. This was tested in a validation cohort (37 patients with suspected coronary artery disease) who underwent invasive coronary physiology assessment on the same day as CMR. A clinical cohort (159 patients) was used to compare SMBF to other physiological markers of hyperaemia [splenic switch-off (SSO), heart rate response (HRR), and blood pressure (BP) fall]. A minimum SMBF threshold of 1.43 mL/g/min was derived from volunteer scans. All patients in the coronary physiology cohort demonstrated regional maximum SMBF (SMBFmax) >1.43 mL/g/min and invasive evidence of hyperaemia. Of the clinical cohort, 93% had hyperaemia defined by perfusion mapping compared to 71% using SSO and 81% using HRR. There was no difference in SMBFmax in those with or without SSO (2.58 ± 0.89 vs. 2.54 ± 1.04 mL/g/min, P = 0.84) but those with HRR had significantly higher SMBFmax (2.66 1.86 mL/g/min, P 15 bpm was superior to SSO in predicting adequate increase in SMBF (AUC 0.87 vs. 0.62, P Conclusion Adenosine-induced increase in myocardial blood flow is accurate for confirmation of hyperaemia during stress CMR studies and is superior to traditional, clinically used markers of adequate stress such as SSO and BP response.
Published: 2020

11. Comparison of Doppler Flow Velocity and Thermodilution Derived Indexes of Coronary Physiology

Author: Ozan M. Demir, Coen K.M. Boerhout, Guus A. de Waard, Tim P. van de Hoef, Niket Patel, Marcel A.M. Beijk, Rupert Williams, Haseeb Rahman, Henk Everaars, Rajesh K. Kharbanda, Paul Knaapen, Niels van Royen, Jan J. Piek, Divaka Perera, Cardiology, ACS - Heart failure & arrhythmias, ACS - Atherosclerosis & ischemic syndromes, Graduate School, ACS - Microcirculation, and ACS - Amsterdam Cardiovascular Sciences
Subjects: coronary flow reserve, microvascular dysfunction, Microcirculation, Thermodilution, Vascular damage Radboud Institute for Molecular Life Sciences [Radboudumc 16], Hyperemia, Coronary Vessels, Treatment Outcome, Coronary Circulation, Humans, index of microvascular resistance, hyperemic microvascular resistance, Cardiology and Cardiovascular Medicine, Blood Flow Velocity
Abstract: Objectives: The aim of this study was to compare Doppler flow velocity and thermodilution-derived indexes and to determine the optimal thermodilution-based diagnostic thresholds for coronary flow reserve (CFR). Background: The majority of clinical data and diagnostic thresholds for flow-based indexes are derived from Doppler measurements, and correspondence with thermodilution-derived indices remain unclear. Methods: An international multicenter registry was conducted among patients who had coronary flow measurements using both Doppler and thermodilution techniques in the same vessel and during the same procedure. Results: Physiological data from 250 vessels (in 149 patients) were included in the study. A modest correlation was found between thermodilution-derived CFR (CFR thermo) and Doppler-derived CFR (CFR Doppler) (r 2 = 0.36; P < 0.0001). CFR thermo overestimated CFR Doppler (mean 2.59 ± 1.46 vs 2.05 ± 0.89; P < 0.0001; mean bias 0.59 ± 1.24 by Bland-Altman analysis), the relationship being described by the equation CFR thermo = 1.04 × CFR Doppler + 0.50. The commonly used dichotomous CFR thermo threshold of 2.0 had poor sensitivity at predicting a CFR Doppler value thermo threshold was 2.5 (sensitivity 75.54%, specificity 81.25%). There was only a weak correlation between hyperemic microvascular resistance and index of microvascular resistance (r 2 = 0.19; P < 0.0001), due largely to variation in the measurement of flow by each modality. Forty-four percent of patients were discordantly classified as having abnormal microvascular resistance by hyperemic microvascular resistance (≥2.5 mm Hg · cm −1 · s) and index of microvascular resistance (≥25). Conclusions: CFR calculated by thermodilution overestimates Doppler-derived CFR, while both parameters show modest correlation. The commonly used CFR thermo threshold of 2.0 has poor sensitivity for identifying vessels with diminished CFR, but using the same binary diagnostic threshold as for Doppler (
Published: 2021

12. TCT-461 Improved Mid-term Survival in Aortic Stenosis Patients Treated With Small Self-Expanding vs Balloon-Expandable Transcatheter Heart Valves

Author: Richard Jabbour, Radoslaw Pracon, Tito Kabir, Joanne Shannon, Alison Duncan, Ee Ling Heng, Evangelos Oikonomou, Efstratios Katsianos, Niket Patel, Navin Chandra, Robert Smith, Manolis Vavouranakis, Miles Dalby, Vasileios Panoulas, and Kostas Kalogeras
Subjects: Cardiology and Cardiovascular Medicine
Published: 2022

13. Automated Pixel-Wise Quantitative Myocardial Perfusion Mapping by CMR to Detect Obstructive Coronary Artery Disease and Coronary Microvascular Dysfunction

Author: Tim Lockie, Hui Xue, Roby Rakhit, Ana Martinez-Naharro, Sven Plein, Deven Patel, Sundeep Kalra, Gerry Coghlan, Daniel R. Knight, Niket Patel, James C. Moon, Tushar Kotecha, Peter Kellman, Philip N. Hawkins, Marianna Fontana, and Michele Boldrini
Subjects: medicine.medical_specialty, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, Blood flow, Fractional flow reserve, 030204 cardiovascular system & hematology, medicine.disease, 030218 nuclear medicine & medical imaging, Coronary arteries, Coronary artery disease, 03 medical and health sciences, Stenosis, 0302 clinical medicine, medicine.anatomical_structure, Internal medicine, Angiography, medicine, Cardiology, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Cardiology and Cardiovascular Medicine, business, Perfusion
Abstract: Objectives This study sought to assess the performance of cardiovascular magnetic resonance (CMR) myocardial perfusion mapping against invasive coronary physiology reference standards for detecting coronary artery disease (CAD, defined by fractional flow reserve [FFR] ≤0.80), microvascular dysfunction (MVD) (defined by index of microcirculatory resistance [IMR] ≥25) and the ability to differentiate between the two. Background Differentiation of epicardial (CAD) and MVD in patients with stable angina remains challenging. Automated in-line CMR perfusion mapping enables quantification of myocardial blood flow (MBF) to be performed rapidly within a clinical workflow. Methods Fifty patients with stable angina and 15 healthy volunteers underwent adenosine stress CMR at 1.5T with quantification of MBF and myocardial perfusion reserve (MPR). FFR and IMR were measured in 101 coronary arteries during subsequent angiography. Results Twenty-seven patients had obstructive CAD and 23 had nonobstructed arteries (7 normal IMR, 16 abnormal IMR). FFR positive (epicardial stenosis) areas had significantly lower stress MBF (1.47 ± 0.48 ml/g/min) and MPR (1.75 ± 0.60) than FFR-negative IMR-positive (MVD) areas (stress MBF: 2.10 ± 0.35 ml/g/min; MPR: 2.41 ± 0.79) and normal areas (stress MBF: 2.47 ± 0.50 ml/g/min; MPR: 2.94 ± 0.81). Stress MBF ≤1.94 ml/g/min accurately detected obstructive CAD on a regional basis (area under the curve: 0.90; p Conclusions This novel automated pixel-wise perfusion mapping technique can be used to detect physiologically significant CAD defined by FFR, MVD defined by IMR, and to differentiate MVD from multivessel coronary disease. A CMR-based diagnostic algorithm using perfusion mapping for detection of epicardial disease and MVD warrants further clinical validation.
Published: 2019

14. Distinct gut and vaginal microbiota profile in women with Recurrent Implantation Failure and Unexplained Infertility

Author: Nayna Patel, Nidhi Patel, Sejal Pal, Neelam Nathani, Ramesh Pandit, Molina Patel, Niket Patel, Chaitanya Joshi, and Bhavin Parekh
Subjects: Reproductive Medicine, Microbiota, RNA, Ribosomal, 16S, Vagina, Obstetrics and Gynecology, Dysbiosis, Humans, Female, General Medicine, Infertility, Female
Abstract: BackgroundImplantation failure limits the success rate of natural and in vitro fertilization (IVF)-assisted conceptions. Evidence suggests dysbiosis in the female reproductive tract impacts implantation failure. However, whether gut dysbiosis influences implantation failure and whether it accompanies reproductive tract dysbiosis remains unexplored.MethodWe recruited 11fertile women as the controls, and a cohort of 20 women diagnosed with implantation-failure associated infertility, which included 10 women diagnosed with recurrent implantation failure (RIF), and 10 women diagnosed with unexplained infertility (UE). Using next-generation amplicon sequencing, we compared the diversity, structure, and composition of fecal and vaginal bacteria of the controls with that of the infertile cohort. While we sequenced fecal samples of all the participants (n=31), we could only sequence 8 vaginal samples in each group (n=24).ResultsCompared with the controls, α-diversity of the gut bacteria, analysed by Chao 1 and Shannon indices, among the infertile groups declined (p□p□Firmicutes, in the RIF group. In contrast, Gram-negative bacteria were relatively more abundant in the UE group. Additionally, mucus-producing bacteria genera such as Prevotella and Sutterella declined in the infertile cohort (p□p□Hungatella, associated with trimethylamine N-oxide (TMAO) production, occurred in the infertile cohort. Vaginal microbiota was dominated by L. iners across the groups, with the UE group showing the highest levels. Of the three groups, the RIF group had the least diverse vaginal microbiota. Taxa analysis showed higher levels of anaerobic bacteria such as Leptotrichia, Snethia, and Prevotella in the controls.ConclusionWe posit that in the setting of the compromised gut mucosal barrier, the phyla Firmicutes generates TNF-α-driven systemic inflammation, leading to RIF, whereas an overload of Gram-negative bacteria induces IL-6-driven systemic inflammation, leading to UE. Additionally, Hungatella-induced elevation of TMAO levels causes platelet hypercoagulability, synergistically contributing to implantation failure. Finally, vaginal dysbiosis does not appear to co-occur with gut dysbiosis.
Published: 2021

15. Abstract 15710: Myocardial Ischaemia in Cardiac Amyloidosis, Changing Perspectives

Author: Janet A. Gilbertson, Arantxa González, Claudio Rapezzi, James C. Moon, Marianna Fontana, Tushar Kotecha, Ana Martinez-Naharro, Peter Kellman, Julian D. Gillmore, Daniel R. Knight, Hui Xue, Kristopher D Knott, Tamer Rezk, James Brown, Niket Patel, Ornella Leone, Philip N. Hawkins, and Liza Chacko
Subjects: medicine.medical_specialty, Myocardial ischaemia, medicine.diagnostic_test, Amyloid, business.industry, Cardiomyopathy, Magnetic resonance imaging, Blood flow, medicine.disease, Adenosine, Systemic amyloidosis, Cardiac amyloidosis, Physiology (medical), Internal medicine, medicine, Cardiology, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract: Introduction: Cardiac involvement determines outcome in systemic amyloidosis, but the relationship between amyloid deposits and outcomes is poorly understood. Many clinical observations are not explained by the simple concept of physical, mechanical replacement of the interstitium by amyloid material. Hypothesis: Preliminary studies in patients with cardiac amyloidosis (CA) support the hypothesis that myocardial ischaemia contributes to cell damage. This study assesses the presence and mechanisms of myocardial ischaemia using CMR with multiparametric mapping and histopathological assessment. Methods: 92 patients with CA (41 AL, 51 ATTR) and 73 without CA (26 with unobstructed coronary arteries; 47 with 3VD) underwent CMR with T1, T2, Extracellular volume (ECV) mapping and adenosine stress with myocardial blood flow (MBF) mapping. 25 cardiac biopsies and 3 explanted hearts with CA were analysed histopathologically. Results: CA patients had severe reductions in stress MBF and myocardial perfusion reserve (MPR)- (1.03ml/g/min±0.50;1.54±0.59 ) compared to patients with unobstructed coronary arteries (2.82 ml/g/min±0.53; 2.94±0.59, p Conclusion: CA is associated with severe myocardial ischaemia demonstrable by histology and CMR perfusion mapping. Histological evaluation indicates a complex pathophysiology, where direct disruption of the vessels by amyloid deposits and reduction in epicardial flow contribute to myocardial ischaemia.
Published: 2020

16. COVID-19: Myocardial Injury in Survivors

Author: Anthony Wolff, Michael Jacobs, Liza Chacko, Yousuf Razvi, Daniel S Knight, Paramjit S. Jeetley, James C. Moon, Peter Kellman, Marianna Fontana, Rupert Negus, James T Brown, Lucy E Lamb, Tushar Kotecha, J. G. Goldring, Niket Patel, and Hui Xue
Subjects: Male, Adenosine, Contrast Media, Gadolinium, 030204 cardiovascular system & hematology, 0302 clinical medicine, Edema, 030212 general & internal medicine, Survivors, Lung, media_common, medicine.diagnostic_test, biology, Troponin T, Convalescence, Myocardial Perfusion Imaging, Heart, Middle Aged, Myocarditis, medicine.anatomical_structure, Cardiology, Female, Cardiology and Cardiovascular Medicine, Cardiomyopathies, Coronavirus Infections, 2019-20 coronavirus outbreak, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), media_common.quotation_subject, Pneumonia, Viral, Magnetic Resonance Imaging, Cine, macromolecular substances, Article, 03 medical and health sciences, Myocardial perfusion imaging, Betacoronavirus, Physiology (medical), Internal medicine, medicine, Humans, Pandemics, Aged, business.industry, SARS-CoV-2, Myocardium, COVID-19, medicine.disease, Troponin, Cross-Sectional Studies, biology.protein, business, Biomarkers
Abstract: Background: Hospitalised COVID-19 patients frequently have acute myocardial injury with elevated troponin levels Underlying aetiologies are ill-defined We use
Published: 2020

17. A novel chemotherapeutic protocol for peritoneal metastasis and inhibition of relapse in drug resistant ovarian cancer

Author: Arash Hatefi, Niket Patel, Alireza Nomani, Obeid M. Malekshah, and Siddik Sarkar
Subjects: cancer stem cells, 0301 basic medicine, Cancer Research, medicine.medical_treatment, Mice, chemistry.chemical_compound, 0302 clinical medicine, Tumor Cells, Cultured, Peritoneal Neoplasms, Original Research, tumorsphere, Ovarian Neoplasms, combination chemotherapy, Combination chemotherapy, 3. Good health, ovarian cancer, Treatment Outcome, Oncology, Paclitaxel, peritoneal metastasis, 030220 oncology & carcinogenesis, Neoplastic Stem Cells, Drug Therapy, Combination, Female, Oligopeptides, medicine.drug, recurrence, Combination therapy, Antineoplastic Agents, Irinotecan, 03 medical and health sciences, Cancer stem cell, Cell Line, Tumor, Spheroids, Cellular, medicine, Animals, Humans, Radiology, Nuclear Medicine and imaging, Cisplatin, Chemotherapy, Dose-Response Relationship, Drug, business.industry, Clinical Cancer Research, Cancer, medicine.disease, Xenograft Model Antitumor Assays, Disease Models, Animal, 030104 developmental biology, chemistry, Cancer research, Ovarian cancer, business
Abstract: The majority of ovarian cancer patients are diagnosed in late stages of the disease, in which the tumor cells have leaked into the peritoneum and are present as tumorspheres. These tumorspheres are rich in cancer stem‐like cells (CSCs), which are resistant to therapy and are a major source of relapse. The purpose of this research was to identify a safe therapeutic approach that could eradicate the peritoneal CSC‐rich tumorspheres and inhibit relapse. Highly metastatic ascitic cells (OVASC‐1) that are resistant to standard‐of‐care chemotherapy due to upregulation of MDR1 gene were obtained from a patient with ovarian carcinoma and recurrent disease. CSC‐rich tumorspheres were generated, characterized, and treated with different chemotherapeutics. The most effective drug combination that could eradicate tumorspheres at nanomolar levels despite upregulation of MDR1 gene was identified. Luciferase‐expressing OVASC‐1 cells were implanted in the peritoneum of nude mice and treated with the identified drug combination. The progression of disease, response to therapy and recurrence were studied by quantitative imaging. Toxicity to abdominal tissues was studied by histopathology. Mice implanted with intraperitoneal (IP) OVASC‐1 xenografts showed limited response to combination therapy with cisplatin/paclitaxel at the maximum tolerated dose. Despite overexpression of MDR1 on OVASC‐1 cells, mice treated with our combination IP low‐dose MMAE and SN‐38 chemotherapy showed complete response without relapse. No signs of toxicity to abdominal tissues were observed. While MMAE and SN‐38 are not administered as free drugs due to their high potency and potential for systemic toxicity, our low‐dose localized therapy approach effectively restricted the cytotoxic effects to the tumor cells in the peritoneum. Consequently, maximum efficacy with minimal adverse effects was achieved. These remarkable results with IP low‐dose combination chemotherapy encourage investigation into its potential clinical application as either first‐line therapy or in cases of acquired resistance to cisplatin and paclitaxel.
Published: 2018

18. Bioengineering a non-genotoxic vector for genetic modification of mesenchymal stem cells

Author: Niket Patel, Xuguang Chen, Arash Hatefi, Faranak Salman Nouri, and Alireza Nomani
Subjects: 0301 basic medicine, Receptor, ErbB-2, Surface Properties, Somatic cell, Cellular differentiation, Biophysics, Bioengineering, Cell-Penetrating Peptides, Biology, Stem cell marker, Peptides, Cyclic, Article, Viral vector, Biomaterials, 03 medical and health sciences, Escherichia coli, Humans, Vector (molecular biology), Particle Size, Cells, Cultured, Cell Proliferation, Vascular Endothelial Growth Factor Receptor-1, Mesenchymal stem cell, Gene Transfer Techniques, Cell Differentiation, Mesenchymal Stem Cells, Transfection, Molecular biology, Cell biology, 030104 developmental biology, Adipose Tissue, Mechanics of Materials, Ceramics and Composites, Nanoparticles, Stem cell
Abstract: Vectors used for stem cell transfection must be non-genotoxic, in addition to possessing high efficiency, because they could potentially transform normal stem cells into cancer-initiating cells. The objective of this research was to bioengineer an efficient vector that can be used for genetic modification of stem cells without any negative somatic or genetic impact. Two types of multifunctional vectors, namely targeted and non-targeted were genetically engineered and purified from E. coli. The targeted vectors were designed to enter stem cells via overexpressed receptors. The non-targeted vectors were equipped with MPG and Pep1 cell penetrating peptides. A series of commercial synthetic non-viral vectors and an adenoviral vector were used as controls. All vectors were evaluated for their efficiency and impact on metabolic activity, cell membrane integrity, chromosomal aberrations (micronuclei formation), gene dysregulation, and differentiation ability of stem cells. The results of this study showed that the bioengineered vector utilizing VEGFR-1 receptors for cellular entry could transfect mesenchymal stem cells with high efficiency without inducing genotoxicity, negative impact on gene function, or ability to differentiate. Overall, the vectors that utilized receptors as ports for cellular entry (viral and non-viral) showed considerably better somato- and genosafety profiles in comparison to those that entered through electrostatic interaction with cellular membrane. The genetically engineered vector in this study demonstrated that it can be safely and efficiently used to genetically modify stem cells with potential applications in tissue engineering and cancer therapy.
Published: 2018

19. Assessing the left main stem in the cardiac catheterization laboratory. What is 'significant'? Function, imaging or both?

Author: Peter Scott, Niket Patel, Rajesh K. Kharbanda, Tushar Raina, Giovanni Luigi De Maria, Adrian P. Banning, and George Kassimis
Subjects: Cardiac Catheterization, medicine.medical_specialty, medicine.medical_treatment, Clinical Decision-Making, Coronary Artery Disease, Fractional flow reserve, 030204 cardiovascular system & hematology, Coronary Angiography, Revascularization, Severity of Illness Index, Coronary artery disease, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Predictive Value of Tests, Internal medicine, Severity of illness, Intravascular ultrasound, medicine, Humans, 030212 general & internal medicine, Coronary Artery Bypass, Ultrasonography, Interventional, Cardiac catheterization, medicine.diagnostic_test, business.industry, Patient Selection, Coronary Stenosis, Reproducibility of Results, Percutaneous coronary intervention, General Medicine, Prognosis, medicine.disease, Coronary Vessels, Fractional Flow Reserve, Myocardial, Stenosis, Cardiology, Radiology, Cardiology and Cardiovascular Medicine, business
Abstract: Revascularization of significant Left Main Stem (LMS) disease improves clinical outcomes. This can be achieved through either Coronary Artery Bypass Grafting or Percutaneous coronary intervention. Defining a significant stenosis of the LMS can be challenging and debatable, as most data have been derived using angiographic assessment alone, with a threshold of 50% luminal stenosis used as a marker of functional significance. The use of adjunctive technologies like Intravascular Ultrasound and Fractional Flow Reserve has improved our ability to accurately assess the anatomical severity and physiological significance of coronary artery stenoses, much more so, than can be achieved through conventional angiography alone. An improved assessment of LMS disease through these adjunctive techniques offers procedural and clinical benefits. Rather than focus on the preferred methods of revascularisation, this article aims to highlight the common pitfalls and misconceptions in the assessment of LMS stenoses. We also propose a simple algorithm for the assessment of LMS disease to help guide revascularisation decisions.
Published: 2018

20. Obstructive left main stem coronary disease: is it time to recommend coronary stenting?

Author: Adrian P. Banning, Niket Patel, and Giovanni Luigi De Maria
Subjects: medicine.medical_specialty, medicine.medical_treatment, Clinical Decision-Making, Coronary Artery Disease, Disease, 030204 cardiovascular system & hematology, Coronary Angiography, Coronary artery disease, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Internal medicine, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Clinical Trials as Topic, business.industry, Standard treatment, Coronary stenting, Percutaneous coronary intervention, Prognosis, medicine.disease, Coronary Vessels, Patient Care Management, Surgery, Cardiac surgery, surgical procedures, operative, Atheroma, Coronary Occlusion, Conventional PCI, Cardiology, Stents, Cardiology and Cardiovascular Medicine, business
Abstract: Learning objectives Obstructive atheroma of the left main stem (LMS) is relatively unusual as it is present in only 4% of diagnostic coronary angiograms.1 Historically, disease of the LMS has been treated with particular respect as the LMS provides blood supply to at least two-thirds of the left ventricle,2 since prognosis after diagnosis of LMS obstruction is poor without treatment and because percutaneous coronary intervention (PCI) to the LMS usually involves a major bifurcation with higher calcific and fibrotic components than atherosclerosis elsewhere in the coronary tree.3 4 These historical data and technical challenges resulted in coronary bypass grafting (CABG) being the standard treatment of LMS narrowing especially because of the excellent results achieved using the left internal mammary artery graft to the left anterior descending artery.5 Encouraging outcomes when treating the LMS with PCI in patients unsuitable for surgery and technical advances in the predictability of PCI outcome have generated interest and reconsideration of the relative merits of PCI and CABG. Four small preliminary studies6–9 were performed, but provocative data from the randomised Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial substudy9 provided sufficient circumstantial evidence for the initiation of two international multicentre randomised comparative trials of surgery versus PCI for LMS disease: Evaluation of Xience Versus CABG for Effectiveness of Left Main …
Published: 2017

21. Study of Morphokinetics in Day 3 Embryo with Implantation Potential and Effect of Sperm Cryopreservation on Embryogenesis

Author: Darshan H. Patel, Kruti B Patel, Niket Patel, Jagdish Suresh Patel, Atul V Patel, Molina N Patel, Harsha K Bhadarka, Yuvraj D Jadeja, Nayana H Patel, and Nilofar R Sodagar
Subjects: 0301 basic medicine, 030219 obstetrics & reproductive medicine, business.industry, Embryogenesis, Sperm cryopreservation, Embryo, Andrology, 03 medical and health sciences, 030104 developmental biology, 0302 clinical medicine, Reproductive Medicine, Embryo cryopreservation, Medicine, business
Abstract: AimIn recent past, many studies had come up with the combination of time-lapse (TL) imaging of embryo morphokinetics as a noninvasive means for improving embryo selection andin vitrofertilization (IVF) success. The primary objective of the study was to find out if there is significant variation in morphokinetics of embryos with different implantation potential and also to study the effect of sperm freezing on time points of embryogenesis events in embryos with implantation potential.Materials and methodsKinetic data and cycle outcomes were analyzed retrospectively in 142 patients who had undergone IVF/intracytoplasmic sperm injection (ICSI) cycles using semen with normal parameters and embryo transfer (ET) on day 3. For the surety of specificity of morphokinetics, only cases with single ET cycles were included in the study. Timing of specific events, from the point of ICSI, was determined using TL imaging. Kinetic markers like time to syngamy (t-pnf), t2, time to two cells (c), 3c (t3), 4c (t4), 5c (t5), 8c (t8), tMor, CC2, CC3, t5–t2, t5–t4, s1, s2, and s3 were calculated. The cleavage synchronicity from the 2–8 cell stage (CS2–8), from 4 to 8 cell stage (CS4–8), and from 2 to 4 cell stage (CS2–4) were calculated as defined elsewhere. Deoxyribonucleic acid replication time ratio (DR) was also included in the comparison. Analysis of variance test was used for comparison of the mean timing of cell division and cell cycle intervals.ResultsMorphokinetics t-pnf, t2, t8, CC2, S2, S3, CS2–8, CS4–8, and CS2–4 differed significantly between embryos with and without implantation potential, when embryos were developed using fresh semen, while t3, t4, t5, CC2, S2, t5–t2, CS2–4, and DR differed significantly between the embryos with and without implantation potential when frozen semen was used. No significant difference was found in mean value of any of the above-stated parameters when comparison was done between implanted embryos fertilized by either fresh or cryopreserved sperm.ConclusionMany morphokinetics parameters of embryogenesis vary significantly between embryos with different ability to implant; therefore, the criteria developed in our IVF lab can be useful for selection of suitable embryo even at day 3 of development with more chances of implantation.Clinical significanceStudy indicates necessity of development of individualized selection model based on morphokinetics for every IVF lab and also confirms freezing as an important tool for fertility preservation of males as it does not affect events of embryogenesis.How to cite this articleBhadarka HK, Patel NH, Patel KB, Sodagar NR, Jadeja YD, Patel NH, Patel MN, Patel AV, Patel DH, Patel JS. Study of Morphokinetics in Day 3 Embryo with Implantation Potential and Effect of Sperm Cryopreservation on Embryogenesis. Int J Infertil Fetal Med 2017;8(2):61-67.
Published: 2017

22. The influence of coronary plaque morphology assessed by optical coherence tomography on final microvascular function after stenting in patients with ST-elevation myocardial infarction

Author: Keith M. Channon, George Kassimis, Mathias Wolfrum, J C Forfar, Robin P. Choudhury, Giovanni Luigi De Maria, Hector M. Garcia-Garcia, Sam Dawkins, Italo Porto, Bernard Prendergast, Niket Patel, Rajesh K. Kharbanda, Adrian P. Banning, and Gregor Fahrni
Subjects: Male, Cardiac Catheterization, Time Factors, medicine.medical_treatment, Myocardial Infarction, 030204 cardiovascular system & hematology, Coronary Angiography, Electrocardiography, 0302 clinical medicine, Prospective Studies, 030212 general & internal medicine, Myocardial infarction, Angioplasty, Balloon, Coronary, Cardiac catheterization, medicine.diagnostic_test, General Medicine, Middle Aged, Coronary Vessels, Plaque, Atherosclerotic, Treatment Outcome, surgical procedures, operative, medicine.anatomical_structure, Cardiology, Female, Stents, Radiology, Cardiology and Cardiovascular Medicine, Tomography, Optical Coherence, Artery, medicine.medical_specialty, Culprit, Article, 03 medical and health sciences, Coronary circulation, Percutaneous Coronary Intervention, Predictive Value of Tests, Coronary Circulation, Angioplasty, Internal medicine, medicine, Humans, cardiovascular diseases, Anterior Wall Myocardial Infarction, Aged, business.industry, Microcirculation, medicine.disease, Vascular resistance, ST Elevation Myocardial Infarction, Vascular Resistance, business
Abstract: Objectives The index of microcirculatory resistance (IMR) provides a reproducible assessment of the status of coronary microvasculature in patients with ST-elevation myocardial infarction (STEMI). Frequency-domain optical coherence tomography (FD-OCT) enables detailed assessment of the morphology of coronary plaque.We sought to determine the influence of the initial culprit coronary plaque anatomy within the infarct-related artery on IMR after stenting in STEMI. Patients and methods In 25 STEMI patients IMR was measured immediately before and after stent implantation. FD-OCT imaging was performed at the same time points and atherothrombotic volume (ATV) before stenting, prolapsed+floating ATV after stenting and ΔATV was measured using three different strategies. Results There were no relationships between preprocedural IMR and FD-OCT parameters. Prestenting IMR was related only to pain to wire time (P: 0.02). Irrespective of the method adopted, the final IMR was related to prestenting ATV (ρ: 0.44, P: 0.03 for method I, ρ: 0.48, P: 0.02 for method II and ρ: 0.30, P: 0.06 for method III) and ΔATV (ρ: 0.41, P: 0.04 for method II and ρ: 0.44, P: 0.03 for method III). Conclusion IMR measured before stenting is independent of the appearances of the culprit coronary plaque within the infarct-related artery. IMR after stenting, and more importantly, the change in IMR after stenting, reflect the degree of distal embolization during stent implantation.
Published: 2017

23. RAHI–SATHI Indo-U.S. Collaboration: The Evolution of a Trainee-Led Twinning Model in Global Health Into a Multidisciplinary Collaborative Program

Author: Melissa A. Fischer, Nisha Fahey, Michael Chin, Apurv Soni, Harshil Patel, Heena P. Santry, Dipen Patel, Jasmine A. Khubchandani, Shyamsundar Raithatha, Brittany Novak, David D. McManus, Allison Earon, Utpala N Kharod, Patricia A. McQuilkin, Anna Handorf, John Bostrom, Tiffany A. Moore Simas, Michaela Tracey, Sunil Thanvi, Nitin Raithatha, Milagros C. Rosal, Jagdish Vankar, Kandarp Talati, Soaham Desai, Dharti Rajesh Patel, Eileen O'Keefe, Nancy Byatt, Hannah Rosenfield, Shirish Srivastava, Niket Patel, Abraham Jaffe, Anindita Deb, Himanshu Pandya, Archana S. Nimbalkar, Jeroan J. Allison, Somashekhar Nimbalkar, Ajay G Phatak, Haley Newman, and Anusha Prabhakaran
Subjects: Program evaluation, Medical education, education.field_of_study, Economic growth, 020205 medical informatics, Cost effectiveness, 4. Education, Population, Capacity building, 02 engineering and technology, General Medicine, 3. Good health, Student Article–Doctoral, 03 medical and health sciences, 0302 clinical medicine, Mentorship, Seed money, General partnership, 0202 electrical engineering, electronic engineering, information engineering, 030212 general & internal medicine, Psychology, education, Health policy
Abstract: RAHI–SATHI presents an innovative twinning model of global health academic partnership, resulting in a number of successful research activities, that features trainees or students as the driving force, complemented by strategic institutional support from both sides of the partnership. Others can promote similar student-led initiatives by: (1) accepting an expanded role for trainees in global health programs, (2) creating structured research and program opportunities for trainees, (3) developing a network of faculty and trainees interested in global health, (4) sharing extramural global health funding opportunities with faculty and trainees, and (5) offering seed funding., Background: In recent years there has been a surge in the number of global health programs operated by academic institutions. However, most of the existing programs describe partnerships that are primarily faculty-driven and supported by extramural funding. Program Description: Research and Advocacy for Health in India (RAHI, or “pathfinder” in Hindi) and Support and Action Towards Health-Equity in India (SATHI, or “partnership” in Hindi) are 2 interconnected, collaborative efforts between the University of Massachusetts Medical School (UMMS) and Charutar Arogya Mandal (CAM), a medical college and a tertiary care center in rural western India. The RAHI–SATHI program is the culmination of a series of student/trainee-led research and capacity strengthening initiatives that received institutional support in the form of faculty mentorship and seed funding. RAHI–SATHI's trainee-led twinning approach overcomes traditional barriers faced by global health programs. Trainees help mitigate geographical barriers by acting as a bridge between members from different institutions, garner cultural insight through their ability to immerse themselves in a community, and overcome expertise limitations through pre-planned structured mentorship from faculty of both institutions. Trainees play a central role in cultivating trust among the team members and, in the process, they acquire personal leadership skills that may benefit them in their future careers. Conclusion: This paradigm of trainee-led twinning partnership promotes sustainability in an uncertain funding climate and provides a roadmap for conducting foundational work that is essential for the development of a broad, university-wide global health program.
Published: 2017

24. Assessment of Multivessel Coronary Artery Disease Using Cardiovascular Magnetic Resonance Pixelwise Quantitative Perfusion Mapping

Author: James Brown, Niket Patel, Philip N. Hawkins, Hui Xue, Omar Chehab, Kristopher D Knott, Liza Chacko, James C. Moon, Peter Kellman, Daniel R. Knight, Roby Rakhit, Ana Martinez-Naharro, Sven Plein, Tushar Kotecha, Jonathan Lazari, Marianna Fontana, Vivek Muthurangu, and Nanci O’Reilly
Subjects: medicine.medical_specialty, Adenosine, Magnetic Resonance Spectroscopy, Ischemia, Coronary Artery Disease, 030204 cardiovascular system & hematology, Coronary Angiography, Severity of Illness Index, 030218 nuclear medicine & medical imaging, Quantitative perfusion, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, Predictive Value of Tests, Internal medicine, Coronary Circulation, medicine, Humans, Radiology, Nuclear Medicine and imaging, medicine.diagnostic_test, business.industry, Myocardial Perfusion Imaging, Magnetic resonance imaging, Blood flow, medicine.disease, Magnetic Resonance Imaging, Fractional Flow Reserve, Myocardial, Perfusion, Cardiology, Cardiology and Cardiovascular Medicine, business, Coronary physiology
Abstract: The authors sought to compare the diagnostic accuracy of quantitative perfusion maps to visual assessment (VA) of first-pass perfusion images for the detection of multivessel coronary artery disease (MVCAD).VA of first-pass stress perfusion cardiac magnetic resonance (CMR) may underestimate ischemia in MVCAD. Pixelwise perfusion mapping allows quantitative measurement of regional myocardial blood flow, which may improve ischemia detection in MVCAD.One hundred fifty-one subjects recruited at 2 centers underwent stress perfusion CMR with myocardial perfusion mapping, and invasive coronary angiography with coronary physiology assessment. Ischemic burden was assessed by VA of first-pass images and by quantitative measurement of stress myocardial blood flow using perfusion maps.In patients with MVCAD (2-vessel [2VD] or 3-vessel disease [3VD]; n = 95), perfusion mapping identified significantly more segments with perfusion defects (median segments per patient 12 [interquartile range (IQR): 9 to 16] by mapping vs. 8 [IQR: 5 to 9.5] by VA; p 0.001). Ischemic burden (IB) measured using mapping was higher in MVCAD compared with IB measured using VA (3VD mapping 100 % (75% to 100%) vs. first-pass 56% (38% to 81%) ; 2VD mapping 63% (50% to 75%) vs. first-pass 41% (31% to 50%); both p 0.001), but there was no difference in single-vessel disease (mapping 25% (13% to 44%) vs. 25% (13% to 31%). Perfusion mapping was superior to VA for the correct identification of extent of coronary disease (78% vs. 58%; p 0.001) due to better identification of 3VD (87% vs. 40%) and 2VD (71% vs. 48%).VA of first-pass stress perfusion underestimates ischemic burden in MVCAD. Pixelwise quantitative perfusion mapping increases the accuracy of CMR in correctly identifying extent of coronary disease. This has important implications for assessment of ischemia and therapeutic decision-making.
Published: 2019

25. 302Redefining assessment of adenosine stress response using CMR perfusion mapping: An alternative to splenic switch off

Author: Roby Rakhit, Ana Martinez-Naharro, Niket Patel, J M Brown, Daniel S Knight, Marianna Fontana, Tim Lockie, Callum Little, J M Moon, Hui Xue, J M Monteagudo, Peter Kellman, Philip N. Hawkins, Tushar Kotecha, and L I Z A Chacko
Subjects: medicine.medical_specialty, business.industry, Adenosine stress, Spleen, General Medicine, Adenosine, Fight-or-flight response, medicine.anatomical_structure, Internal medicine, Cardiology, medicine, Radiology, Nuclear Medicine and imaging, Cardiology and Cardiovascular Medicine, business, Perfusion, medicine.drug
Published: 2019

26. 303Quantitative CMR perfusion mapping to detect microvascular dysfunction in patients without obstructive coronary disease

Author: J M Moon, Tim Lockie, Hui Xue, Roby Rakhit, Ana Martinez-Naharro, Peter Kellman, Callum Little, Philip N. Hawkins, Daniel S Knight, Niket Patel, Marianna Fontana, Tushar Kotecha, J M Brown, Gavin Manmathan, and L I Z A Chacko
Subjects: medicine.medical_specialty, business.industry, Internal medicine, Cardiology, Medicine, Radiology, Nuclear Medicine and imaging, In patient, General Medicine, Coronary disease, Cardiology and Cardiovascular Medicine, business, Perfusion
Published: 2019

27. Bioengineered adipose-derived stem cells for targeted enzyme-prodrug therapy of ovarian cancer intraperitoneal metastasis

Author: Arash Hatefi, Marianne Polunas, Niket Patel, Pedro Louro, Alireza Nomani, Obeid M. Malekshah, Siddik Sarkar, Michael Goedken, and Parisa Javidian
Subjects: Paclitaxel, medicine.medical_treatment, Pharmaceutical Science, Enzyme Therapy, Mice, Nude, Antineoplastic Agents, Bioengineering, 02 engineering and technology, Irinotecan, Article, Targeted therapy, Metastasis, Carboxylesterase, 03 medical and health sciences, Cell Line, Tumor, medicine, Animals, Prodrugs, Molecular Targeted Therapy, Peritoneal Neoplasms, 030304 developmental biology, Cisplatin, Ovarian Neoplasms, 0303 health sciences, business.industry, Stem Cells, Cancer, Suicide gene, 021001 nanoscience & nanotechnology, medicine.disease, Adipose Tissue, Drug Resistance, Neoplasm, Cancer cell, Cancer research, Female, Stem cell, 0210 nano-technology, Ovarian cancer, business, medicine.drug
Abstract: The objective of this study was to develop a stem cell-based system for targeted suicide gene therapy of recurrent, metastatic, and unresectable ovarian cancer. Malignant cells were obtained from the ascites of a patient with advanced recurrent epithelial ovarian cancer (named OVASC-1). Cancer cells were characterized to determine the percentages of drug-resistant ALDH+ cells, MDR-1/ABCG2 overexpressing cells, and cancer stem-like cells. The sensitivity and resistance of the OVASC-1 cells and spheroids to the metabolites of three different enzyme/prodrug systems were assessed, and the most effective one was selected. Adipose-derived stem cells (ASCs) were genetically engineered to express recombinant secretory human carboxylesterase-2 and nanoluciferase genes for simultaneous disease therapy and quantitative imaging. Bioluminescent imaging, magnetic resonance imaging and immuno/histochemistry results show that the engineered ASCs actively targeted and localized at both tumor stroma and necrotic regions. This created the unique opportunity to deliver drugs to not only tumor supporting cells in the stroma, but also to cancer stem-like cells in necrotic/hypoxic regions. The statistical analysis of intraperitoneal OVASC-1 tumor burden and survival rates in mice shows that the administration of the bioengineered ASCs in combination with irinotecan prodrug in the designed sequence and timeline eradicated all intraperitoneal tumors and provided survival benefits. In contrast, treatment of the drug-resistant OVASC-1 tumors with cisplatin/paclitaxel (standard-of-care) did not have any statistically significant benefit. The histopathology and hematology results do not show any toxicity to major peritoneal organs. Our toxicity data in combination with efficacy outcomes delineate a nonsurgical and targeted stem cell-based approach to overcoming drug resistance in recurrent metastatic ovarian cancer.
Published: 2019

28. 65 Nurse led radial access for coronary angiography

Author: Roby Rakhit, Gerry Coghlan, Dorota Wojcik, Tim Lockie, Luciano Candilio, Gavin Manmathan, Niket Patel, Mahmood Ahmad, and Deven Patel
Subjects: Coronary angiography, medicine.diagnostic_test, business.industry, Procedure training, medicine.disease, Catheter, Nurse led, Patient satisfaction, Angiography, medicine, Medical emergency, Training program, business, Patient comfort
Abstract: Introduction NHS England announced a new nurse angiographer role with the purpose of reducing hospital waiting lists for elective angiography. Methods Development of a standardised operating procedure for training in Radial Arterial Access (RAA), guidance on how to minimise the risk and recognise complications and post procedural limb management. Obtaining approval at the new procedures committee. Training program 50 consultant supervised nurse led procedures for (RAA), establishing expertise in 100 further procedures, followed by roll out of the program to other nursing staff. Results During training (RAA) cannulation was successful on 1st attempt in 42 out of 50 (success rate allowing for two attempts 84%), with no complications recorded. Successful access by a more experienced operator N = 7, failed (RAA) N = 1. The following 100 were performed independently on unselected patients (success rate 81%; (1st pass 70)), with no complications, need for alternate access routes, N = 1. The following table details the success rate and patient comfort score recorded during 104 procedures performed by a nurse specialist and trainee registrars. Conclusion Nurse-led (RAA) is safe and feasible and has the potential to improve catheter laboratory efficiency, patient satisfaction, standardise procedure training and improve staff retention. Our next steps will be to train more nurses in radial access and progress to nurse led angiography. Conflict of Interest None
Published: 2019

29. 19 Myocardial perfusion mapping in cardiac amyloidosis- unearthing the spectrum from infiltration to ischaemia

Author: Callum Little, Roby Rakhit, Ana Martinez-Naharro, Niket Patel, Daniel R. Knight, Julian D. Gillmore, Alexandros Steriotis, James C. Moon, Hui Xue, Peter Kellman, James Brown, Philip N. Hawkins, Marianna Fontana, and Tushar Kotecha
Subjects: medicine.medical_specialty, business.industry, Ischemia, Fractional flow reserve, Blood flow, 030204 cardiovascular system & hematology, medicine.disease, Pathophysiology, 03 medical and health sciences, 0302 clinical medicine, Cardiac amyloidosis, Internal medicine, Extracellular fluid, cardiovascular system, Cardiology, Medicine, 030212 general & internal medicine, business, Infiltration (medical), Perfusion
Abstract: Background Cardiac involvement is the main driver of outcome in systemic amyloidosis, but the relationship between amyloid deposits and outcomes is not well understood. The simple explanation of physical, mechanical replacement of the interstitium by amyloid seems insufficient. Preliminary studies support the hypothesis that myocardial ischaemia could contribute to cell damage. Purpose (1) To assess myocardial ischaemia in cardiac amyloidosis. (2) To compare patients with cardiac amyloidosis to patients assessed on invasive coronary angiography (ICA) to have normal coronary physiology (NCP), microvascular dysfunction (MVD) and triple vessel coronary disease (3VD). (3) To assess correlation of perfusion mapping to markers of disease severity and prognosis. Methods 86 patients and 20 healthy volunteers (HV) underwent CMR at 1.5T (Siemens) with standard cine, PSIR-LGE, T1,T2,Extracellular Volume (ECV) mapping and adenosine stress with myocardial blood flow (MBF) mapping. Thirty-eight patients also underwent ICA with 3 vessel assessment of Index of Microcirculatory Resistance and Fractional Flow Reserve: 7 had cardiac amyloidosis, 8 had NCP, 15 had MVD and 8 had 3VD. Results Cardiac amyloidosis patients had severe reduction in stress MBF and myocardial perfusion reserve (MPR) (1.22 ml/g/min±0.70 and 1.62±0.63) compared to HV (3.21 ml/g/min±0.64,p Conclusion Myocardial ischaemia is common in cardiac amyloidosis – with stress MBF and MPR similar to that of patients with 3VD. The reduction correlates with the degree of amyloid infiltration and markers of adverse prognosis, highlighting the potential role of myocardial ischaemia as a key mechanism in the pathophysiology of cardiac amyloidosis.
Published: 2019

30. 18 Quantitative CMR myocardial perfusion mapping to assess hyperaemic response to adenosine stress: a new reference standard?

Author: Tushar Kotecha, Juan Manuel Monteagudo, Tim Lockie, James W. Brown, Roby Rakhit, Ana Martinez-Naharro, Niket Patel, Liza Chacko, Hui Xue, Peter Kellman, Philip Hawkins, Daniel S Knight, Marianna Fontana, and Callum Little
Subjects: medicine.medical_specialty, business.industry, Adenosine stress, Gold standard (test), Blood flow, Hyperaemia, Blood pressure, Internal medicine, medicine, Cardiology, Physiological markers, medicine.symptom, business, Perfusion, Reference standards, circulatory and respiratory physiology
Abstract: Background Assessment of hyperaemia during adenosine stress CMR remains a clinical challenge with lack of a gold standard marker of adequate stress. Multiple parameters including the splenic switch off (SSO) sign, heart rate response (HRR) and blood pressure response (BPR) are used in clinical practice. Perfusion mapping provides a pixelwise representation of myocardial blood flow (MBF), allowing for measurement of MBF at a regional level. This may provide an alternative tool for assessment of hyperaemia. Objectives To validate the use of stress MBF for assessment of hyperaemic response and compare this to currently used clinical markers. Methods In total, 216 subjects were recruited. This included 3 cohorts: 1) Derivation cohort (22 healthy volunteers) to identify a stress MBF threshold value representative of the normal minimum response to adenosine; 2) Validation cohort (37 patients with suspected coronary disease) who underwent stress CMR and invasive coronary physiological assessment on the same day, to validate the stress MBF threshold value against invasive markers of hyperaemia; 3) Clinical cohort (159 patients undergoing clinically-indicated adenosine stress CMR) to assess the presence of stress MBF-defined hyperaemia and other physiological markers of hyperaemia (SSO, HHR and BPR). Results From the derivation cohort, maximum stress MBF (SMBFmax) >1.43 ml/g/min was derived as the threshold value of hyperaemia (defined as 1.96 standard deviations below the sample mean of lowest stress MBF values). This threshold was tested in the validation cohort: 100% of patients with invasive evidence of hyperaemia demonstrated SMBFmax >1.43 ml/g/min, 81% had SSO and 81% had HRR >10 bpm. Of the clinical cohort, 93% had hyperaemia defined by SMBFmax compared to 71% using SSO and 81% using HRR. SMBFmax was no different in those with or without SSO (2.58±0.89 ml/g/min vs 2.54±1.04 ml/g/min, p=0.84) but those with HRR had significantly higher SMBFmax (2.69 ml/g/min vs 1.95 ml/g/min, p HRR >16 bpm was able to predict SMBFmax >1.43 ml/g/min with sensitivity 63% and specificity 91% (AUC 0.87, p Conclusion Adenosine-induced increase in MBF measured using perfusion mapping is accurate for the confirmation of hyperaemia during stress CMR studies and is superior to traditional, clinically used markers of adequate stress.
Published: 2019

31. Surrogacy in Assisted Reproductive Technology

Author: Niket Patel, Nayana H Patel, Harsha K Bhadarka, Yuvraj D Jadeja, Nilofar R Sodagar, and Molina Patel
Subjects: Assisted reproductive technology, medicine.medical_treatment, medicine, Engineering ethics, Biology
Published: 2019

32. Insight into Different Aspects of Surrogacy Practices

Author: Nayana H Patel, Niket Patel, Harsha K Bhadarka, Nilofar R Sodagar, Yuvraj D Jadeja, and Molina N Patel
Subjects: Service (business), gestational carrier, 030219 obstetrics & reproductive medicine, Assisted reproductive technology, surrogacy, medicine.medical_treatment, Assisted reproduction, surrogate mother, Review Article, Surrogate mothers, lcsh:Gynecology and obstetrics, 03 medical and health sciences, Gestational carrier, 0302 clinical medicine, Reproductive Medicine, restrict, Political science, Law, medicine, 030212 general & internal medicine, intended parent, international scenario on surrogacy, lcsh:RG1-991
Abstract: Surrogacy is an important method of assisted reproductive technology wherein a woman carries pregnancy for another couple. Number of couples around the world require surrogacy services for various reasons. Although this arrangement seems to be beneficial for all parties concerned, there are complex social, ethical, moral, and legal issues associated with it. It is these complexities that have made this practice unpopular in many parts of the world. Surrogacy in India has had its own journey from India becoming popular as a surrogacy center since 2002 to the Surrogacy (Regulation) Bill, 2016, which would restrict the option of surrogacy for many. Surrogacy is an important medical service for all those couples who would otherwise not have been able to produce a child. Surrogacy would be practiced harmoniously if delicate issues associated with surrogacy will be addressed properly through appropriately framed laws which would protect the rights of surrogate mothers, intended parents, and child born through surrogacy.
Published: 2018

33. Fertility preservation in non-seminomatous germ cell tumor: a case report

Author: Harmi R Thakkar, Nayana H Patel, Molina Patel, Niket Patel, Harsha K Bhadarka, and Yuvraj D Jadeja
Subjects: endocrine system, medicine.anatomical_structure, business.industry, Cancer research, Medicine, Fertility preservation, business, Germ cell
Abstract: Testicular germ cell tumors (TGCTs) are the most common malignancy in young men in their peak fertility years. It can intrinsically and permanently affect fertility potential of an individual. Clinicians are advised to offer Fertility Preservation before initiating the treatment. We present one such case of presence of Neoplasm in testis, where semen was cryopreserved before operating it for fertility preservation and biological pregnancy was achieved. On further investigations, presence of neoplasm on left testis was diagnosed. However, neoplasms of the testes are unique in that way they affect men at a young age and also have a high survival rates. Cryopreservation of ejaculated or surgically retrieved sperm is currently the only established method of fertility preservation for post-pubertal man. The incidence as well as rates for testicular cancers have remained relatively low and if presented early on, can be cured and has good survival rates. Fertility awareness must be raised amongst the oncologist, gynecologist and patients.
Published: 2021

34. Hyperaemic microvascular resistance predicts clinical outcome and microvascular injury after myocardial infarction

Author: Guus A. de Waard, Divaka Perera, Rupert Williams, Douwe de Wit, Paul Knaapen, Paul F. Teunissen, Hironori Kitabata, Niket Patel, Takashi Akasaka, Sabahattin Umman, Niels van Royen, Gregor Fahrni, Peter M. van de Ven, Rajesh K. Kharbanda, Murat Sezer, Cardiology, APH - Methodology, ACS - Heart failure & arrhythmias, Epidemiology and Data Science, and ACS - Atherosclerosis & ischemic syndromes
Subjects: medicine.medical_specialty, business.industry, medicine.medical_treatment, Vascular damage Radboud Institute for Molecular Life Sciences [Radboudumc 16], Percutaneous coronary intervention, Coronary flow reserve, 030204 cardiovascular system & hematology, medicine.disease, Microcirculation, 03 medical and health sciences, Coronary circulation, All institutes and research themes of the Radboud University Medical Center, 0302 clinical medicine, medicine.anatomical_structure, Internal medicine, Heart failure, Predictive value of tests, Adjunctive treatment, medicine, Cardiology, 030212 general & internal medicine, Myocardial infarction, Cardiology and Cardiovascular Medicine, business
Abstract: ObjectivesEarly detection of microvascular dysfunction after acute myocardial infarction (AMI) could identify patients at high risk of adverse clinical outcome, who may benefit from adjunctive treatment. Our objective was to compare invasively measured coronary flow reserve (CFR) and hyperaemic microvascular resistance (HMR) for their predictive power of long-term clinical outcome and cardiac magnetic resonance (CMR)-defined microvascular injury (MVI).MethodsSimultaneous intracoronary Doppler flow velocity and pressure measurements acquired immediately after revascularisation for AMI from five centres were pooled. Clinical follow-up was completed for 176 patients (mean age 60±10 years; 140(80%) male; ST-elevation myocardial infarction (STEMI) 130(74%) and non-ST-segment elevation myocardial infarction 46(26%)) with median follow-up time of 3.2 years. In 110 patients with STEMI, additional CMR was performed.ResultsThe composite end point of death and hospitalisation for heart failure occurred in 17 patients (10%). Optimal cut-off values to predict the composite end point were 1.5 for CFR and 3.0 mm Hg cm−1•s for HMR. CFR −1 s was predictive for the composite end point (HR 7.0;95% CI 1.5 to 33.7) as well as both individual components. HMR had significantly greater area under the receiver operating characteristic curve for MVI than CFR. HMR remained an independent predictor of adverse clinical outcome and MVI, whereas CFR did not.ConclusionsHMR measured immediately following percutaneous coronary intervention for AMI with a cut-off value of 3.0 mm Hg cm−1 s, identifies patients with MVI who are at high risk of adverse clinical outcome. For this purpose, HMR is superior to CFR.
Published: 2018

35. Improved Coronary Sinus Blood Sampling for Cardiac Research

Author: Jeremy P. Langrish, Niket Patel, Robin P. Choudhury, George Kassimis, Keith M. Channon, Mohammad Alkhalil, Giovanni Luigi De Maria, Adrian P. Banning, Gregor Fahrni, Rajesh K. Kharbanda, Regent Lee, Sam Dawkins, Colin Forfar, and Andrew J. Lucking
Subjects: business.industry, Antecubital Fossa, Sampling (statistics), 030204 cardiovascular system & hematology, medicine.disease, 03 medical and health sciences, Catheter, 0302 clinical medicine, medicine.anatomical_structure, Medicine, 030212 general & internal medicine, Myocardial infarction, Cardiology and Cardiovascular Medicine, Nuclear medicine, business, Vein, Coronary sinus, Blood drawing, Blood sampling
Abstract: Background: Coronary sinus (CS) blood sampling is important for measuring metabolites and biomarkers in cardiovascular research, but can be technically challenging. Here we demonstrate the use of the antecubital fossa for CS blood sampling as an alternative to femoral access, and a simple technique of paired venous and CS blood gas analysis for confirmation of valid CS sampling. We also demonstrate improvement in sampling accuracy by using a coronary guide wire to stabilize the sampling catheter in the CS. Methods: Paired blood samples from CS and peripheral vein were collected from patients at the time of primary PCI for acute myocardial infarction. Venous access for CS sampling was via the antecubital vein. Blood gas analysis was used to confirm a true CS sample (pO2[CS]
Published: 2018

36. Index of Microcirculatory Resistance at the Time of Primary Percutaneous Coronary Intervention Predicts Early Cardiac Complications: Insights From the OxAMI (Oxford Study in Acute Myocardial Infarction) Cohort

Author: Florim Cuculi, Keith M. Channon, Mohammad Alkhalil, Niket Patel, Adrian P. Banning, Gregor Fahrni, Robin P. Choudhury, Sam Dawkins, Mathias Wolfrum, Rajesh K. Kharbanda, J C Forfar, Giovanni Luigi De Maria, and Bernard Prendergast
Subjects: Male, medicine.medical_treatment, clinical outcome, 030204 cardiovascular system & hematology, Coronary Angiography, Electrocardiography, Postoperative Complications, 0302 clinical medicine, Risk Factors, Prospective Studies, 030212 general & internal medicine, Myocardial infarction, Prospective cohort study, Original Research, Quality and Outcomes, medicine.diagnostic_test, Incidence, Middle Aged, Coronary Vessels, Interventional Cardiology, Survival Rate, Treatment Outcome, myocardial infarction, medicine.anatomical_structure, Cohort, Cardiology, Female, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, microcirculation, Diagnostic Testing, Risk Assessment, 03 medical and health sciences, Coronary circulation, Percutaneous Coronary Intervention, Coronary Circulation, Internal medicine, medicine, Humans, Survival rate, business.industry, Percutaneous coronary intervention, medicine.disease, United Kingdom, ROC Curve, Vascular resistance, ST Elevation Myocardial Infarction, Vascular Resistance, business, Acute Coronary Syndromes
Abstract: Background Early risk stratification after primary percutaneous coronary intervention ( PPCI ) for ST ‐segment–elevation myocardial infarction is currently challenging. Identification of a low‐risk group may improve triage of patients to alternative clinical pathways and support early hospital discharge. Our aim was to assess whether the index of microcirculatory resistance ( IMR ) at the time of PPCI can identify patients at low risk of early major cardiac complications and to compare its performance against guideline‐recommended risk scores. Methods and Results IMR was measured using a pressure–temperature sensor wire. Cardiac complications were defined as the composite of cardiac death, cardiogenic shock, pulmonary edema, malignant arrhythmias, cardiac rupture, and presence of left ventricular thrombus either before hospital discharge or within 30‐day follow‐up. In total, 261 patients undergoing PPCI who were eligible for coronary physiology assessment were prospectively enrolled. Twenty‐two major cardiac complications were reported. Receiver operating characteristic curve analysis confirmed the utility of IMR in predicting complications and showed significantly better performance than coronary flow reserve, the Primary Angioplasty in Myocardial Infarction II (PAMI‐II), and Zwolle score ( P ≤0.006). Low microvascular resistance ( IMR ≤40) was measured in 159 patients (61%) of the study population and identified all patients who were free of major cardiac complications (sensitivity: 100%; 95% CI , 80.5–100%). Conclusions IMR immediately at the end of PPCI for ST ‐segment–elevation myocardial infarction reliably predicts early major cardiac complications and performed significantly better than recommended risk scores. These novel data have implications for early risk stratification after PPCI .
Published: 2017

37. Flow patterns in externally stented saphenous vein grafts and development of intimal hyperplasia

Author: David P. Taggart, Eyal Orion, Carlo Di Mario, Carolyn M. Webb, Yanai Ben Gal, Tomer Meirson, Niket Patel, and Keith M. Channon
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Intimal hyperplasia, medicine.medical_treatment, Hemodynamics, coronary artery bypass graft surgery, saphenous vein graft, Internal medicine, Intravascular ultrasound, medicine, Humans, Saphenous Vein, Coronary Artery Bypass, flow pattern, Hyperplasia, medicine.diagnostic_test, business.industry, Vascular disease, Stent, Tunica intima, medicine.disease, Biomechanical Phenomena, external stent, medicine.anatomical_structure, Angiography, Cardiology, Stents, Surgery, Radiology, Tunica Intima, Cardiology and Cardiovascular Medicine, business, intimal hyperplasia, Artery
Abstract: Low and oscillatory wall shear stress promotes endothelial dysfunction and vascular disease. The aim of the study was to investigate the impact of an external stent on hemodynamic flow parameters in saphenous vein grafts (SVGs) and their correlation with the development of intimal hyperplasia.We performed post hoc computational fluid dynamics analysis of the randomized Venous External Support Trial, in which angiography and intravascular ultrasound data were available for 29 patients, 1 year after coronary artery bypass grafting. Each patient received 1 external stent, to either the right or left coronary territories; ≥ 1 patients with nonstented SVGs served as control(s). Diffuse flow patterns were assessed using mean values of various hemodynamic parameters, including time-averaged wall shear stress and oscillatory shear index (OSI). Focal flow disturbances were characterized using percentile analysis of each parameter.Angiography and intravascular ultrasound data were available for 53 and 43 SVGs, respectively. The stented versus nonstented SVG failure rates were significantly lower in the left territory (17.6% vs 27.5%; P = .02), and significantly higher in the right territory (46.2% vs 13.4%; P = .01). In both diffuse and focal flow-pattern analyses, OSI was significantly lower in the stented versus nonstented SVG group (P = .009 and P.003, respectively), whereas no significant differences were observed in time-averaged wall shear stress values. High OSI values were correlated with the development of intimal hyperplasia (P = .01).External stenting affects SVG's hemodynamics 1 year after coronary artery bypass grafting and may mitigate the progression of intimal hyperplasia by reducing oscillatory shear stress.
Published: 2015

38. Zero-Flow Pressure Measured Immediately After Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction Provides the Best Invasive Index for Predicting the Extent of Myocardial Infarction at 6 Months

Author: Adrian P. Banning, Justin E. Davies, Niket Patel, Ricardo Petraco, J C Forfar, Keith M. Channon, Giovanni Luigi De Maria, George Kassimis, Rajesh K. Kharbanda, Regent Lee, Sam Dawkins, Erica Dall'Armellina, Bernard Prendergast, and Robin P. Choudhury
Subjects: medicine.medical_specialty, medicine.medical_treatment, Infarction, microcirculation, 030204 cardiovascular system & hematology, Doppler echocardiography, 03 medical and health sciences, Coronary circulation, 0302 clinical medicine, Internal medicine, medicine, magnetic resonance imaging, 030212 general & internal medicine, Myocardial infarction, Ejection fraction, medicine.diagnostic_test, biology, business.industry, Electrocardiography in myocardial infarction, Percutaneous coronary intervention, angioplasty, medicine.disease, Troponin, medicine.anatomical_structure, myocardial infarction, physiology, Cardiology, biology.protein, business, Cardiology and Cardiovascular Medicine
Abstract: ObjectivesThe aim of this study was to define which measure of microvascular best predicts the extent of left ventricular (LV) infarction.BackgroundMicrovascular injury after ST-segment elevation myocardial infarction (STEMI) is an important determinant of outcome. Several invasive measures of the microcirculation at primary percutaneous coronary intervention (PPCI) have been described. One such measure is zero-flow pressure (Pzf), the calculated pressure at which coronary flow would cease.MethodsIn 34 STEMI patients, Pzf, hyperemic microvascular resistance (hMR), and index of microcirculatory resistance (IMR) were derived using thermodilution flow/pressure and Doppler flow/pressure wire assessment of the infarct-related artery following PPCI. The extent of infarction was determined by blinded late gadolinium enhancement on cardiac magnetic resonance at 6 months post-PPCI. Infarction of ≥24% total LV mass was used as a categorical cutoff in receiver-operating characteristic curve analysis.ResultsPzf was superior to both hMR and IMR for predicting ≥24% infarction area under the curve: 0.94 for Pzf versus 0.74 for hMR (p = 0.04) and 0.54 for IMR (p = 0.003). Pzf ≥42 mm Hg was the optimal cutoff value, offering 100% sensitivity and 73% specificity. Patients with Pzf ≥42 mm Hg also had a lower salvage index (61.3 ± 8.1 vs. 44.4 ± 16.8, p = 0.006) and 6-month ejection fraction (62.4 ± 3.6 vs. 49.9 ± 9.6, p = 0.002). In addition, there were significant direct relationships between Pzf and troponin area under the curve (rho = 0.55, p = 0.002), final infarct mass (rho = 0.75, p < 0.0001), percentage of LV infarction and percent transmurality of infarction (rho = 0.77 and 0.74, respectively, p < 0.0001), and inverse relationships with myocardial salvage index (rho = −0.53, p = 0.01) and 6-month ejection fraction (rho = −0.73, p = 0.0001).ConclusionsPzf measured at the time of PPCI is a better predictor of the extent of myocardial infarction than hMR or IMR. Pzf may provide important prognostic information at the time of PPCI and merits further investigation in clinical studies with relevant outcome measures.
Published: 2015
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39. A Randomized Trial of External Stenting for Saphenous Vein Grafts in Coronary Artery Bypass Grafting

Author: Anthony DeSouza, Carlo Di Mario, Fabio De Robertis, Carolyn M. Webb, Adrian P. Banning, Yanai Ben Gal, Eyal Orion, Niket Patel, Miles Dalby, Keith M. Channon, David P. Taggart, Syed M. Rehman, Rashmi Yadav, and Belinda Lees
Subjects: Male, Cardiac & Cardiovascular Systems, Intimal hyperplasia, FLOW, medicine.medical_treatment, Respiratory System, Coronary Artery Disease, Coronary Angiography, DISEASE, FAILURE, Prospective Studies, Coronary Artery Bypass, medicine.diagnostic_test, Graft Occlusion, Vascular, Coronary Vessels, Treatment Outcome, surgical procedures, operative, medicine.anatomical_structure, SURVIVAL, Cardiology, Female, Stents, Cardiology and Cardiovascular Medicine, Life Sciences & Biomedicine, Artery, Reoperation, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Lumen (anatomy), 1102 Cardiovascular Medicine And Haematology, Internal medicine, Ectasia, PATENCY, INTRAVASCULAR ULTRASOUND, medicine, Humans, Vascular Patency, Saphenous Vein, Mammary Arteries, Ultrasonography, Interventional, Aged, Science & Technology, business.industry, Stent, 1103 Clinical Sciences, Vascular surgery, medicine.disease, PREVENTION, Surgery, Angiography, Cardiovascular System & Cardiology, FOLLOW-UP, business, Follow-Up Studies
Abstract: Background External stents inhibit saphenous vein graft (SVG) intimal hyperplasia in animal studies. We investigated whether external stenting inhibits SVG diffuse intimal hyperplasia 1 year after coronary artery bypass graft surgery. Methods Thirty patients with multivessel disease undergoing coronary artery bypass graft surgery were enrolled. In addition to an internal mammary artery graft, each patient received one external stent to a single SVG randomly allocated to either the right or left coronary territories; and one or more nonstented SVG served as the control. Graft patency was confirmed at the end of surgery in all patients. The primary endpoint was SVG intimal hyperplasia (mean area) assessed by intravascular ultrasonography at 1 year. Secondary endpoints were SVG failure, ectasia (>50% initial diameter), and overall uniformity as judged by Fitzgibbon classification. Results One-year follow-up angiography was completed in 29 patients (96.6%). All internal mammary artery grafts were patent. Overall SVG failure rates did not differ significantly between the two groups (30% stented versus 28.2% nonstented SVG, p = 0.55). The SVG mean intimal hyperplasia area, assessed in 43 SVGs, was significantly reduced in the stented group (4.37 ± 1.40 mm 2 ) versus nonstented group (5.12 ± 1.35 mm 2 , p = 0.04). In addition, stented SVGs demonstrated marginally significant improvement in lumen uniformity ( p = 0.08) and less ectasia (6.7% versus 28.2%, p = 0.05). There was some evidence that ligation of side branches with metallic clips increased SVG failure in the stented group. Conclusions External stenting has the potential to improve SVG lumen uniformity and reduce diffuse intimal hyperplasia 1 year after coronary artery bypass graft surgery.
Published: 2015

40. Percutaneous Circulatory Assist Devices for High-Risk Coronary Intervention

Author: Adrian P. Banning, Deepak L. Bhatt, Shana Tehrani, Simon Redwood, Aung Myat, and Niket Patel
Subjects: medicine.medical_specialty, Percutaneous, medicine.medical_treatment, Extracorporeal, law.invention, Extracorporeal Membrane Oxygenation, Percutaneous Coronary Intervention, Randomized controlled trial, Risk Factors, law, Counterpulsation, Internal medicine, Extracorporeal membrane oxygenation, Humans, Medicine, Assisted Circulation, high-risk PCI, Angioplasty, Balloon, Coronary, Impella, Intra-aortic balloon pump, mechanical circulatory support, Intra-Aortic Balloon Pumping, business.industry, Hemodynamics, Percutaneous coronary intervention, intra-aortic balloon pump, Cardiovascular Diseases, Conventional PCI, Cardiology, diastolic augmentation, Heart-Assist Devices, business, Cardiology and Cardiovascular Medicine
Abstract: A unifying definition of what constitutes high-risk percutaneous coronary intervention remains elusive. This reflects the existence of several recognized patient, anatomic, and procedural characteristics that, when combined, can contribute to elevating risk. The relative inability to withstand the adverse hemodynamic sequelae of dysrhythmia, transient episodes of ischemia-reperfusion injury, or distal embolization of atherogenic material associated with coronary intervention serve as a common thread to tie this patient cohort together. This enhanced susceptibility to catastrophic hemodynamic collapse has triggered the development of percutaneous cardiac assist devices such as the intra-aortic balloon pump, Impella (Abiomed Inc., Danvers, Massachusetts), TandemHeart (CardiacAssist, Inc., Pittsburgh, Pennsylvania), and extracorporeal membranous oxygenation to provide adjunctive mechanical circulatory support. In this state-of-the-art review, we discuss the physiology underpinning their application. Thereafter, we examine the results of several randomized multicenter trials investigating their use in high-risk coronary intervention to determine which patients would benefit most from their implantation and whether there is a signal to delineate whether they should be used in an elective pre-procedure, standby, rescue, or routine post-procedure fashion.
Published: 2015
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41. High-speed rotational atherectomy using the radial artery approach and a sheathless guide: a single-centre comparison with the 'conventional' femoral approach

Author: Keith M. Channon, Niket Patel, Rajesh K. Kharbanda, George Kassimis, and Adrian P. Banning
Subjects: Atherectomy, Coronary, Male, Catheters, medicine.medical_treatment, Femoral artery, Atherectomy, Percutaneous Coronary Intervention, medicine.artery, medicine, Humans, Radial artery, High speed rotational atherectomy, Aged, Retrospective Studies, business.industry, Percutaneous coronary intervention, Length of Stay, Femoral Artery, Single centre, Radial Artery, Conventional PCI, Guiding catheter, Female, Cardiology and Cardiovascular Medicine, Nuclear medicine, business
Abstract: AIMS: This study retrospectively compares the in-hospital outcomes for patients undergoing high-speed rotational atherectomy (HSRA) facilitated percutaneous coronary intervention (PCI) using either the radial or the femoral artery approach. From September 2008 to February 2013, 135 consecutive patients (75 femoral, 60 radial) underwent HSRA in our centre. A comparison of in-hospital outcomes was performed. For the radial approach, a 7.5 Fr sheathless guiding catheter (SGC) was used. The sizing of the burrs deployed was similar (1.75 [0.75-2.00] vs. 1.75 [1.25-2.5] mm, p=0.68) with no difference in screening time (15.5 [12.2-19.5] vs. 19 [14-26] min, p=0.068), major access-site bleeding complications (0.0% vs. 1.3%, p>0.99) and procedural success (100% vs. 91%, p=0.22) in the radial and the femoral group, respectively. However, in-hospital stay [1 (0-5) vs. 1 (0-20) days, p=0.04] was slightly higher following the femoral approach. A temporary wire was placed in 10% of femoral patients. No in-hospital death was observed. This study shows that the radial artery approach with the 7.5 Fr SGC is at least as safe and effective as the conventional femoral approach for performing HSRA-facilitated PCI.
Published: 2014

42. Outcomes After Emergency Percutaneous Coronary Intervention in Patients With Unprotected Left Main Stem Occlusion

Author: Adrian P. Banning, Giovanni Luigi De Maria, Derrick A Bennett, George Kassimis, Peter Ludman, Kazem Rahimi, and Niket Patel
Subjects: medicine.medical_specialty, business.industry, medicine.medical_treatment, Percutaneous coronary intervention, Infarction, Thrombolysis, medicine.disease, Surgery, Coronary thrombosis, Coronary occlusion, Emergency medicine, Conventional PCI, medicine, Myocardial infarction, Cardiology and Cardiovascular Medicine, business, TIMI
Abstract: Objectives This study sought to evaluate in-hospital outcomes and 3-year mortality of patients presenting with unprotected left main stem occlusion (ULMSO) treated with primary percutaneous coronary intervention (PPCI). Background Limited data exists about management and outcome following presentation with ULMSO. Methods From January 1, 2007 to December 21, 2012, 446,257 PCI cases were recorded in the British Cardiovascular Intervention Society database of all PCI cases in England and Wales. Of those, 568 were patients having emergency PCI for ST-segment elevation infarction (0.6% of all PPCI) who presented with ULMSO (TIMI [Thrombolysis In Myocardial Infarction] flow grade 0/1 and stenosis >75%), and they were compared with 1,045 emergency patients treated with nonocclusive LMS disease. Follow-up was obtained through linkage with the Office of National Statistics. Results Presentation with ULMSO, compared with nonocclusive LMS disease, was associated with a doubling in the likelihood of periprocedural shock (57.9% vs. 27.9%; p Conclusions In patients undergoing PPCI for ULMSO, acute outcomes are poor and additional therapies are required to improve outcome. However, long-term outcomes for survivors of ULMSO are encouraging.
Published: 2014

43. Two rings too tight: Sequential emergency PCI for hemodynamic and arrhythmic complications of mitral and tricuspid valve repair

Author: Florim Cuculi, Niket Patel, and Adrian P. Banning
Subjects: Mitral regurgitation, medicine.medical_specialty, business.industry, Postoperative complication, General Medicine, Cardiac surgery, Surgery, Coronary arteries, medicine.anatomical_structure, Mitral valve annuloplasty, Internal medicine, Right coronary artery, medicine.artery, Conventional PCI, cardiovascular system, Cardiology, Medicine, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Circumflex, Cardiology and Cardiovascular Medicine, business
Abstract: New intra-operative mitral regurgitation is an unusual complication of tricuspid annuloplasty and maybe ischemic in etiology as a consequence of right coronary artery distortion. We report the case of a woman in whom this was treated by mitral valve annuloplasty with ensuing hemodynamic instability and ventricular arrhythmia secondary to a new left circumflex occlusion. Injury/distortion to either of the coronary arteries running in the atrio-ventricular groove is rare, and described only several times. To our knowledge, concurrent right coronary artery and circumflex artery injury/distortion has not been reported previously.
Published: 2013

44. Left internal mammary artery graft stenosis and post-angioplasty restenosis: follow-up through multi-slice cardiac computed tomography angiography

Author: George, Kassimis, Nikant, Sabharwal, Niket, Patel, and Adrian P, Banning
Subjects: Aged, 80 and over, Coronary Restenosis, Male, Coronary Stenosis, Myocardial Revascularization, Humans, Coronary Angiography, Tomography, X-Ray Computed
Published: 2016

45. The prognostic significance of incomplete revascularization and untreated coronary anatomy following percutaneous coronary intervention: An analysis of 6,755 patients with multivessel disease

Author: Robert Smith, Miles Dalby, Wala Mattar, Charles Ilsley, Mark Mason, Tito Kabir, Vasileios F. Panoulas, M. Bilal Iqbal, Richard Grocott-Mason, Niket Patel, and Rebecca Lane
Subjects: Male, medicine.medical_specialty, Acute coronary syndrome, Time Factors, medicine.medical_treatment, Disease, Coronary Artery Disease, 030204 cardiovascular system & hematology, Revascularization, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Risk Factors, Internal medicine, Medicine, Humans, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Aged, Retrospective Studies, business.industry, Mortality rate, Confounding, Coronary Stenosis, Percutaneous coronary intervention, General Medicine, Middle Aged, medicine.disease, Stenosis, Treatment Outcome, England, Conventional PCI, Cardiology, Female, Cardiology and Cardiovascular Medicine, business
Abstract: Background More than half of the patients undergoing percutaneous coronary intervention (PCI) have multivessel disease. Whether complete revascularization impacts long-term mortality or whether selected patients or those with specific coronary anatomy benefit from complete revascularization is unclear. Methods A total of 14,452 patients underwent PCI between 2004 and 2015 at Harefield Hospital, UK. Of these, 7,076 patients had multivessel disease. We excluded 321 patients with left main-stem stenosis ≥50%, with 6,755 patients included in the analysis (936 patients had complete revascularization). Results The unadjusted 3-year mortality rates were lower with complete revascularization (10.8% vs 13.1%, P = 0.047). However, multivariable-adjusted analyses indicated that complete revascularization was not independently associated with mortality (HR = 1.01, 95% CI: 0.78–1.31, P = 0.939). These findings were unchanged when addressing measured confounding using propensity-matched analyses (HR = 1.16, 95% CI: 0.81–1.65, P = 0.417) and inverse probability treatment weighted analyses (HR = 1.01, 95% CI: 0.77–1.33, P = 0.950); and unmeasured confounding using instrumental variable analyses (Δ = 0.9%, 95% CI: −2.5%, 4.3%, P = 0.958). There was no association with mortality and untreated LAD disease (HR = 0.92, 95% CI: 0.72–1.17, P = 0.482) and LCx disease (HR = 0.90, 95% CI: 0.74–1.10, P = 0.999). However, untreated proximal LAD disease (HR = 1.23, 95% CI: 1.06–1.51, P = 0.045) and RCA disease (HR = 1.36, 95% CI: 1.08–1.65, P = 0.007) was associated with increased mortality, particularly in patients with ST-elevation acute coronary syndrome (STEACS). Conclusions In this study of unselected patients undergoing PCI, complete revascularization did not confer a mortality benefit. However, the presence of untreated proximal LAD and RCA disease was prognostic in patients with STEACS. Thus, complete revascularization may be considered in select patient groups with anatomical subsets of coronary disease.
Published: 2016

46. TCT-165 Hyperemic microvascular resistance is a predictor of clinical outcome after revascularization for acute myocardial infarction: A patient-level pooled analysis

Author: Niels van Royen, Paul F. Teunissen, Divaka Perera, Douwe de Wit, Guus A. de Waard, Paul Knaapen, Niket Patel, Murat Sezer, Takashi Akasaka, Hironori Kitabata, Rajesh K. Kharbanda, Gregor Fahrni, and Rupert Williams
Subjects: medicine.medical_specialty, Microvascular resistance, Pooled analysis, business.industry, Internal medicine, medicine.medical_treatment, medicine, Cardiology, Myocardial infarction, Cardiology and Cardiovascular Medicine, Revascularization, business, medicine.disease
Published: 2016

47. Effect of coronary artery bypass surgery on myocardial function as assessed by tissue Doppler echocardiography

Author: Gerhard-Paul Diller, Andreas Kyriacou, Roberto Casula, Balvinder S. Wasan, Niket Patel, Thanos Athanasiou, Darrel P. Francis, and Jamil Mayet
Subjects: Male, Pulmonary and Respiratory Medicine, Cardiac function curve, medicine.medical_specialty, Ventricular Dysfunction, Right, Coronary Artery Bypass, Off-Pump, Coronary Artery Disease, Ventricular Function, Left, law.invention, Coronary artery bypass surgery, Tissue Doppler echocardiography, Diastole, law, Internal medicine, Cardiopulmonary bypass, medicine, Humans, Prospective Studies, cardiovascular diseases, Coronary Artery Bypass, Systole, Aged, Myocardial stunning, business.industry, Stroke Volume, General Medicine, Middle Aged, medicine.disease, Echocardiography, Doppler, Cardiac surgery, Treatment Outcome, medicine.anatomical_structure, Ventricular Function, Right, cardiovascular system, Cardiology, Female, Surgery, Cardiology and Cardiovascular Medicine, business, Artery
Abstract: Objective: Coronary artery bypass graft (CABG) surgery may induce myocardial stunning and thereby affect cardiac function. We aimed to assess whether myocardial function is affected by CABG in patients with preserved preoperative systolic function. Methods: Myocardial tissue peak velocities were recorded at the lateral and septal angle of the mitral annulus as well as at the lateral tricuspid annulus by pulsed wave tissue Doppler echocardiography before cardiac surgery, and then at 5 days, 6 weeks and 18 months after surgery. Results: Thirty-two consecutive patients with preserved systolic left ventricular function (31 male, 63 � 10 years) undergoing CABG (9 with cardiopulmonary bypass on-pump, 23 beating heart off-pump) were included. Peak systolic velocity on tissue Doppler echocardiography was unchanged after surgery. In contrast, peak early diastolic velocities (E 0 ) improved significantly 5 days and 6 weeks after surgery in the septal area (6.2 � 2.3 to 7.4 � 2.6 and 7.6 � 2.6 cm/s, respectively; p < 0.05) and at the left ventricular lateral wall (9.1 � 3.0 to 10.1 � 3.0 and 11.3 � 2.9 cm/s, respectively; p < 0.05), and then declined slowly to preoperative values after 18 months. In contrast, right ventricular E0 decreased significantly immediately after surgery (9.8 � 2.7 preoperatively to 7.7 � 1.7 cm/s at 5 days, p = 0.005) with only incomplete recovery over time. This was similar in both the conventional and the off-pump CABG cohort. Conclusions: Left ventricular function did not deteriorate after CABG in patients with preserved preoperative systolic function. On the contrary, diastolic function improved immediately after CABG. Right ventricular function, in contrast, appeared to be damagedby surgery, to similar degrees regardless of whether patients underwent off-pump or on-pump surgery. Hypothermia and immune-inflammatory activation are, therefore, not plausible explanations for this decline in right ventricular function. # 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
Published: 2008

48. Reply: Is Coronary Wedge Pressure a Technique to Identify High-Risk Patients Who May Benefit From Alternative Treatment in Acute Myocardial Infarction?: Is This The Next Step?

Author: Niket, Patel, Adrian P, Banning, and Rajesh K, Kharbanda
Subjects: Male, Percutaneous Coronary Intervention, Coronary Circulation, Microcirculation, Myocardium, Myocardial Infarction, Humans, Female, Coronary Vessels
Published: 2015

49. Adenosine as an Adjunct Therapy in ST Elevation Myocardial Infarction Patients: Myth or Truth?

Author: Athanasios J. Manolis, Adrian P. Banning, Dimitrios Alexopoulos, Manolis S. Kallistratos, Gianluigi De Maria, Niket Patel, George Kassimis, Periklis Davlouros, and Rajesh K. Kharbanda
Subjects: medicine.medical_specialty, Weakness, Adenosine, Cardiotonic Agents, Ischemia, Myocardial Infarction, Myocardial Reperfusion Injury, law.invention, Reperfusion therapy, Percutaneous Coronary Intervention, Randomized controlled trial, law, Internal medicine, medicine, Humans, Infusions, Intra-Arterial, Pharmacology (medical), Myocardial infarction, Infusions, Intravenous, Pharmacology, business.industry, General Medicine, medicine.disease, Clinical trial, Cardiology, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Reperfusion injury, medicine.drug
Abstract: Early reperfusion represents the key strategy in ST elevation myocardial infarction. However, reperfusion may induce myocardial damage due to the reperfusion myocardial injury, compromising the full potential of reperfusion therapy and accounting for unfavourable results in high risk patients. Adenosine seems to attenuate ischemia reperfusion injury, and thus represents a promising therapeutic option for treating such patients. However, previous randomized clinical trials have collectively failed to demonstrate whether adenosine can effectively reduce measures of myocardial injury and improve clinical outcome, despite its good basic evidence. The failure of such trials to show a real beneficial action may be in part related to specific factors other than adenosine’s clinical efficacy. The purpose of this review is to explain the rationale for the use of adenosine as an adjunctive pharmacological cardio-protective agent following reperfusion of the ischemic myocardium, to address the weakness of previous trials and to summarize the current state of knowledge regarding the effect of adenosine administration on reperfusion myocardial injury in patients with myocardial infarction. Although some preclinical and clinical studies point towards the beneficial role of adenosine in the prevention and treatment of no-reflow phenomenon in myocardial infarction, many unanswered questions still remain, including the optimal clinical indication, mode, dosage, duration and timing of application, and the exact mechanisms leading to potential benefits. Clarifying these issues will depend on further properly designed, adequately powered and well conducted clinical trials, which will probably provide us with the definite answers.
Published: 2015

50. Reply

Author: Adrian P. Banning, Niket Patel, and Rajesh K. Kharbanda
Subjects: medicine.medical_specialty, business.industry, medicine.medical_treatment, Percutaneous coronary intervention, Context (language use), Disease, Coronary microcirculation, 030204 cardiovascular system & hematology, medicine.disease, Microcirculation, Surgery, 03 medical and health sciences, Coronary circulation, 0302 clinical medicine, medicine.anatomical_structure, Internal medicine, Cardiology, Medicine, 030212 general & internal medicine, Myocardial infarction, Cardiology and Cardiovascular Medicine, business, Ischemic heart
Abstract: We would like to thank Dr. Lozano and colleagues for their comments regarding our study [(1)][1]. It is clear that our understanding of the coronary microcirculation remains incomplete. In our study, we undertook a detailed assessment of the microcirculation in the context of ST-segment elevation
Published: 2016

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