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1. Report from the Annual Conference of the British Society of Echocardiography, November 2016, Queen Elizabeth II Conference Centre, London

Author: Richard P. Steeds, Martin R. Cowie, Bushra S. Rana, John B. Chambers, Simon Ray, Janaki Srinivasan, Konstantin Schwarz, Christopher J. Neil, Caroline Scally, John D. Horowitz, Michael P. Frenneaux, Cristina Pislaru, Dana K. Dawson, Oliver J. Rothwell, Keith George, John D. Somauroo, Rachel Lord, Mike Stembridge, Rob Shave, Martin Hoffman, Euan A. Ashley, Francois Haddad, Thijs M. H. Eijsvogels, David Oxborough, Reinette Hampson, Chris D. Kinsey, Sothinathan Gurunathan, Anastasia Vamvakidou, Nikolaos Karogiannis, Roxy Senior, Shahram Ahmadvazir, Benoy N. Shah, Konstantinos Zacharias, Dan Bowen, Shaun Robinson, Ugochukwu Ihekwaba, Karen Parker, James Boyd, Cameron G. Densem, Charlotte Atkinson, Jonathan Hinton, Edmund B. Gaisie, Dhrubo J. Rakhit, Arthur M. Yue, Paul R. Roberts, Dean Thomas, Pat Phen, Jonathan Sibley, Sarah Fergey, and Paul Russhard
Subjects: Diseases of the circulatory (Cardiovascular) system, RC666-701
Published: 2017
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2. Low Transvalvular Flow Rate Predicts Mortality in Patients With Low-Gradient Aortic Stenosis Following Aortic Valve Intervention

Author: Wenying Jin, Rajdeep S. Khattar, Roxy Senior, Anastasia Vamvakidou, Navtej S. Chahal, and Oleksandr Danylenko
Subjects: Male, Aortic valve, Time Factors, Cardiac & Cardiovascular Systems, low-gradient aortic stenosis, IMPACT, Left Ventricular Ejection Time, Ventricular Function, Left, stroke volume index, Risk Factors, Cause of Death, 1102 Cardiorespiratory Medicine and Haematology, Aged, 80 and over, Heart Valve Prosthesis Implantation, Radiology, Nuclear Medicine & Medical Imaging, Stroke volume, Middle Aged, REPLACEMENT, Treatment Outcome, medicine.anatomical_structure, PRESERVED EJECTION FRACTION, Aortic Valve, Cardiology, Female, transvalvular flow rate, Cardiology and Cardiovascular Medicine, Life Sciences & Biomedicine, Balloon Valvuloplasty, PARADOXICAL LOW-FLOW, medicine.medical_specialty, Risk Assessment, Transcatheter Aortic Valve Replacement, Afterload, Internal medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, In patient, Low gradient, Aged, Retrospective Studies, Science & Technology, business.industry, AREA, Hemodynamics, Stroke Volume, 1103 Clinical Sciences, Mean age, Aortic Valve Stenosis, medicine.disease, AFTERLOAD, Stenosis, SEVERITY, Cardiovascular System & Hematology, Cardiovascular System & Cardiology, business
Abstract: OBJECTIVES: This study aimed to assess the value of low transvalvular flow rate (FR) for the prediction of mortality compared with low stroke volume index (SVi) in patients with low-gradient (mean gradient
Published: 2019
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3. Clinical effectiveness of a sonographer-led, cardiologist-interpreted stress echocardiography service in the rapid access stable chest pain clinic

Author: Bablu Singh, Anastasia Vamvakidou, Roxy Senior, Reinette Hampson, and Christopher Kinsey
Subjects: Male, Chest Pain, medicine.medical_specialty, Clinical effectiveness, Coronary Artery Disease, 030204 cardiovascular system & hematology, Coronary Angiography, Chest pain, Coronary artery disease, 03 medical and health sciences, Cardiologists, 0302 clinical medicine, Internal medicine, Rapid access, medicine, Stress Echocardiography, Humans, Prospective Studies, 030212 general & internal medicine, Adverse effect, Technology, Radiologic, Aged, Retrospective Studies, business.industry, Middle Aged, medicine.disease, Log-rank test, Treatment Outcome, Sonographer, Cardiology, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Echocardiography, Stress, Follow-Up Studies
Abstract: Aims To assess the clinical effectiveness of a sonographer-led, cardiologist-interpreted stress echocardiography (SE) service in a rapid access stable chest pain clinic (RACPC) setting. Methods and results Baseline data was collected prospectively on 768 consecutive patients, referred from the RACPC, who underwent SE between May 2014 and May 2015. Retrospective analysis was performed on follow-up data for outcomes. Among 768 patients (mean age 58 years, 57.8% males) with a mean pre-test probability of coronary artery disease (CAD) of 31%, 675 (88%) underwent SE on the same day as the RACPC consultation. Diagnostic tests were obtained in 749 (97.5%) cases with 62 (8.1%) demonstrating inducible ischemia. Coronary angiography was performed in 61 patients of whom 54 demonstrated flow-limiting CAD (positive predictive value: 88.5%). There was no occurrence of serious adverse events. During a mean follow-up period of 2.5 years, 20 first cardiac events were recorded, of which annualised events in the normal SE group were 0.64% versus 5.8% in patients with an abnormal SE (log rank p Conclusion Sonographer-led SE interpreted by a cardiologist is feasible, safe and efficacious. It impacted on the management of patients with appropriate outcomes and may be a cost-efficient and safer alternative to other non-invasive imaging modalities in the RACPC setting.
Published: 2019
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4. Health status after invasive or conservative care in coronary and advanced kidney disease

Author: Spertus J. A., Jones P. G., Maron D. J., Mark D. B., O'Brien S. M., Fleg J. L., Reynolds H. R., Stone G. W., Sidhu M. S., Chaitman B. R., Chertow G. M., Hochman J. S., Bangalore S, ISCHEMIA-CKD Research Group: Abdallah M Abdallah, Abel E Moreyra, Abhay A Laddu, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Adedayo Adeboye, Agne Juceviciene, Agne Urboniene, Agnieszka Szramowska, Ahmed Abdel-Latif, Ahmed Ayoub, Ahmed Elghamaz, Ahmed Kamal, Ahmed Talaat, Ajay Sharma, Ajit Singh Narula, Akshay Bagai, Akvile Smigelskaite, Alain Raymond, Alain Rheault, Alaine Melanie Loehr, Albert Varga, Aldo P Maggioni, Alec Moorman, Alejandro Chevaile Ramos, Alejandro Gisbert, Aleksandra Fratczak, Aleksandras Laucevicius, Alexander M Chernyavskiy, Alexander Sergeevich Borisov, Alexandra Craft, Alexandra Hunter, Alexandre Ciappina Hueb, Alexandre Schaan de Quadros, Alice Manica Muller, Aline Peixoto Deiro, Allegra Stone, Almudena Castro, Amar Uxa, Amaryllis Van Craenenbroeck, Ambuj Roy, Amit Kakkar, Amy Flowers, Amy Iskandrian, Ana D Djordjevic-Dikic, Ana Gomes Almeida, Ana Rita Francisco, Ana S Mladenovic, Ana Santana, Anandaroop Lahiri, Anastasia M Kuzmina-Krutetskaya, Anastasia Vamvakidou, Andras Vertes, Andre Gabriel, Andrea Bartykowszki, Andrea Lorimer, Andrea Pascual, Andreia Coelho, Andreia Rocha, Andrés García-Rincón, Andrew Starovoytov, Andrzej Łabyk, Anelise Kawakami, Angela Hoye, Angelo Nobre, Anjali Acharya, Anjali Anand, Anjana Rishmawi, Ann Banfield, Ann Luyten, Anna Cichocka-Radwan, Anna Fojt, Anna Plachcinska, Anna Teresinska, Anne Marie Webb, Anne Heath, Anoop Mathew, Antonia Vega, Antonio Carvalho, Antonio Colombo, Antonio Fiarresga, Anu Tharini, Anupama Rao, Aquiles Valdespino-Estrada, Ariel Diaz, Arif Asif, Arnold H Seto, Arturo S Campos-Santaolalla, Asim N Cheema, Asker Ahmed, Atul Mathur, Audrey W Leong, Axel Åkerblom, Axelle Fuentes, Aynun Naher, Badhma Valaiyapathi, Balaji Srinivasan, Baljeet Kaur, Balram Bhargava, Bandula Guruge, Barbara Wicklund, Bartosz Czarniak, Bebek Singh, Begoña Igual, Bela Merkely, Benoy N Shah, Bernard de Bruyne, Beth Abramson, Beth Stefanchik, Bethany Harvey, Bharati Shivalkar, Bilal Malik, Binoy Mannekkattukudy Kurian, Bougrida Hammouche, Branko D Beleslin, Bruce Ferguson, Bruce McManus, Bruna Maria Ascoli, Bryn Smith, Byron J Allen, C Michael Gibson, C Noel Bairey Merz, Calin Pop, Carl-Éric Gagné, Carly Ohmart, Carol M Kartje, Caroline Alsweiler, Caroline Rodgers, Caroline Spindler, Carolyn J Gruber, Catherine Albert, Catherine Bone, Catherine Lemay, Cezary Kepka, Chandini Suvarna, Chantale Mercure, Charlene Wiyarand, Chetan Patel, Chiara Attanasio, Chi-Ming Chow, Ching Min Er, Ching-Ching Ong, Cholenahally Nanjappa Manjunath, Chris Buller, Christel Vassaliere, Christiaan Vrints, Christian Witzke, Christie Ballantyne, Christina Björklund, Christine Roraff, Christophe Laure, Christophe Thuaire, Christopher Chan, Christopher Fordyce, Christopher Kinsey, Chunli Xia, Cidney Schultz, Claes Held, Claudia Cortés, Claudia Escobar, Cláudia Freixo, Clemens T Kadalie, Corine Thobois, Courtney Page, Cristina Bare, Dalisa Espinosa, Dan Gao, Dana Rizk, Daniela Puzhevsky, Data Analyst, David M Charytan, David O Williams, David Booth, David Charytan, David Cohen, David DeMets, David Foo, David Goldfarb, David Schlichting, David Sisson, David Taggart, David Waters, David Wheeler, David Williams, Davis Vo, Dawid Teodorczyk, Dawn D Shelstad, Dean Kereiakes, Deborah Yip, Deepa Ramaswamy, Deirdre Mattina, Deirdre Murphy, Dengke Jiang, Derek Cyr, Diana Cukali, Diane Camara, Dimitrios Stournaras, Dipti Patel, Dongze Li, Donna Exley, Doreen Reimann, Doron Schwartz, Duarte Cacela, Dwayne S G Conway, Eapen Punnoose, Edgar L Tay, Edgar Karanjah, Eduardo Gomes Lima, Eduardo Hernandez-Rangel, Edward D Nicol, Edyta Kaczmarska, Elena Refoyo Salicio, Eli Feen, Elihú Durán-Cortés, Elisabeth M Janzen, Elise van Dongen, Elissa Restelli Piloto, Elizabeta Srbinovska Kostovska, Elizabeth Capasso-Gulve, Elizaveta V Zbyshevskaya, Ellie Fridell, Ellis W Lader, Elvira Gosmanova, Emilie Tachot, Emma Howard, Emmanuel Sorbets, Encarnación Alonso-Álvarez, Eric Daugas, Erick Alexánderson Rosas, Estelle Montpetit, Eugene Passamani, Evgeny Shutov, Ewa Szczerba, Ewelina Wojtala, Expedito Eustáquio Ribeiro Silva, Fabio Fimiani, Fadi Hage, Fahim Haider Jafary, Fang Feng, Fatima Ranjbaran, Fausto J Pinto, Fernando Caeiro, Fernando Nolasco, Filipa Silva, Filippo Ottani, Firas Al Solaiman, Flávia Egydio, Florina Chereches, Francesca De Micco, Francesca Bianchini, Francesca Pietrucci, Francesco Orso, Francesco Pisano, Francisca Patuleia Figueiras, François Madore, Frank Harrell, Frank Rockhold, Frans Van de Werf, Franziska Guenther, Fred Mohr, G Karthikeyan, Gabriel Galeote, Gabriel Grossmann, Gabriel Steg, Gabriela Guzman, Gabriele Gabrielli, Gang Chen, Gautam Sharma, Gaylin Petty, Gelmina Mikolaitiene, Gennie Yee, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Girish Mishra, Gonzalo Barge-Caballero, Grace M Young, Graciela Scaro, Graham Wong, Gregg Pressman, Gregor Simonis, Gudrun Steinmaurer, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillermo Garcia-Garcia, Guoqin Wang, Gurpreet S Wander, Gurpreet Gulati, Haibo Zhang, Halina Marciniak, Hao Dai, Haojian Dong, Harold Franch, Harvey White, Hatem Elabd, Hayley Pomeroy, Heather Golden, Heidi Wilson, Helene Abergel, Hemalata Siddaram, Hemant Shakhar Mahapatra, Henry C Stokes, Hermine Osseni, Herwig Schuchlenz, Hicham Skali, Holly Mattix-Kramer, Hong Cheng, Hossam Mahrous, Hristo Pejkov, Hugo Marques, Hui Zhong, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ikraam Hassan, Ileana L Pina, Ilona Tamasauskiene, Inês Zimbarra Cabrita, Ines Rodrigues, Inga Soveri, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Isabelle Roy, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona Niedzwiecka, Jacek Kusmierek, Jackie Chow, Jaekyeong Heo, Jakub Maksym, James E Davies, James J Jang, James Hirsch, James Tatoulis, Jan Henzel, Janaina Oliveira, Janani Rangaswami, Jane Eckstein, Janitha Raj, Jaqueline Pozzibon, Jaroslaw Drozdz, Jason Loh Kwok Kong, Jason T Call, Jason Linefsky, Javier J Garcia, Jay Meisner, Jayne Scales, Jean Michel Juliard, Jean Diodati, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeff Leimberger, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Stojkovic, Jenne M Jose, Jennifer L Stanford, Jennifer Hogan, Jennifer Horst, Jennifer Isaacs, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jerry Yee, Jessica Berg, Jesus Peteiro, Jesús Peteiro, Jia Li, Jiamin Liu, Jianxin Zhang, Jill Marcus, Jim Blankenship, Jing Dong, Jiyan Chen, Jo Evans, Joaquín V Peñafiel, Joe Sabik, Johann Christopher, John B Kostis, John Joseph Graham, John Doan, John Jose, John Kotter, John Lehman, John Middleton, John Pownall, Jonathan M Gleadle, Jonathan S Chavez-Iñiguez, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Lebowitz, Jonean Thorsen, Jorge Carrillo Calvillo, Jorge Escobedo, José A Ortega-Ramírez, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Costa Vieira, José M Flores-Palacios, Jose Fragata, Jose Lopes, Jose Lopez-Sendon, José Lopez-Sendon, Jose Rueda, Joseph B Selvanayagam, Joseph Sacco, Joshua P Loh, Joy Burkhardt, Juan Manuel López Quijano, Juan Gaztanaga, Judit Sebo, Judith Wright, Juergen Stumpf, Julia de Aveiro Morata, Julio César Figal, Julio Hernandez Jaras, Junqing Yang, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Karen Calfas, Karen Petrosyan, Karen Servilla, Karen Swan, Karin Ploetze, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Katharina Knaut, Katherine Martin, Kathleen Claes, Kathryn Mason, Ken Mahaffey, Kenneth Gin, Kerry Lee, Kerstin Bonin, Kerstin Mikes, Kevin R Bainey, Kevin T Harley, Kevin Marzo, Kevin McMahon, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khrystyna Kushniriuk, Kian-Keong Poh, Kim Holland, Kimberly E Halverson, Kinnari Murphy, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kreton Mavromatis, Krishnakumar Hongalgi, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristine Arges, Kristine Teoh, Krzysztof Drzymalski, Lalathaksha Kumbar, Laszlone Matics, LaTonya J Hickson, Laura Keinaite, Laura Sarti, Laura True, Lawrence M Phillips, Lawrence Friedman, Leandro C Maranan, Leda Lotaif, Lekshmi Dharmarajan, Leo A Bockeria, Leonardo Pizzol Caetano, Leonardo Bridi, Leonid L Bershtein, Li Hai Yan, Li Li, Lidia Sousa, Lihong Xu, Lihua Zhang, Lili Zhang, Lilian Mazza Barbosa, Liljana Tozija, Linda Arcand, Lino Patricio, Liping Zhang, Lisa Hatch, Lixin Jiang, Liz Low, Loay Salman, Lorena Lopez, Lori Pritchard, Luis Bernanrdes, Luis Guzman, Lynette L Teo, M Sowjanya Reddy, Maarten Simoons, Maayan Konigstein, Mafalda Selas, Magdalena Madero, Magdalena Miller, Magdalena Misztal-Teodorczyk, Magdy Abdelhamid, Magid Fahim, Mahevamma Mylarappa, Majo X Joseph, Malgorzata Frach, Manjula Rani, Marcello Galvani, Marcin Demkow, Marcin Szkopiak, Marco De Fabritis, Marco Magnoni, Marco Marini, Marco Sicuro, Marek Roik, Maria A Alfonso, Maria Antonieta Pereira de Moraes, María Dolores Martínez-Ruíz, Maria Eugenia Canziani, Maria Eugenia Martin, Maria Inês Caetano, Maria P Corral, Maria Pérez García, Maria Andreasson, Maria Posada, Marianna D A Dracoulakis, Mariano Rubio, Marija T Petrovic, Marina Vieira, Mario J Garcia, Mario D'arezzo, Maris Orgera, Marius Miglinas, Mark Garand, Mark Peterson, Mark Xavier, Marlowe Mosley, Marta Capinha, Marta Swiderek, Martha Meyer, Martina Ceseri, Martinia Tricoli, Mary Wiilliams, Mary Ann Champagne, Mary Streif, Massoud Leesar, Matei Claudia, Mateusz Solecki, Matías Nicolás Mungo, Matthew Shinseki, Matthew Weir, Maura Carina Nédio, Max-Paul Winter, Mayil S Krishnam, Meenakshi Mishra, Mei Hwang, Melemadathil Srilatha, Melissa LeFevre, Mengistu Simegn, Michael A Gibson, Michael B Rubens, Michael D Shapiro, Michael Chobanian, Michael Davidson, Michael Farkouh, Michael Mack, Michal Wlodarczyk, Michel G Khouri, Michelle Crowder, Michelle Ratliff, Miguel Borges Santos, Miguel Nobre Menezes, Miguel Perez Fontan, Miguel Barrero, Mihaly Tapolyai, Mikhail T Torosoff, Milan R Dobric, Milind Avdhoot Gadkari, Min Tun Kyaw, Miri Revivo, Mitchel B Lustre, Mohamed Adel, Mohamed Hassan, Mohammad El-Hajjar, Mohammed Hussain, Mohammed Saleem, Moisés Blanco-Calvo, Moisés Jiménez-Santos, Monika Laukyte, Muhamed Saric, Myrthes Emy Takiuti, Nadia Asif, Nagaraja Moorthy, Naima L Ogletree, Nana O Katamadze, Nandita Nataraj, Naomi Uchida, Nasrul Ismail, Natalia S Oliveira, Natalia de Carvalho Maffei, Nathalie Brosens, Naved Aslam, Naveed Akhtar, Neamat Mowafy, Neeraj Pandit, Neeraj Parakh, Neesh Pannu, Neill Duncan, Nevena Garcevic, Ngaire Meadows, Nicholas Danchin, Nicole Deming, Nikola N Boskovic, Nikolaos Karogiannis, Ning Zhang, Nirmal Kumar, Niruta Sharma, Nitika Chadha, Nitish Naik, Noelle M Durfee, Nora M Cosgrove, Norbert Urbanski, Norma Hogg, Olga Walesiak, Olga Zdończyk, Olga Zhdanova, Olivia Anaya, Olugbenga Bello, Omar Almousalli, Omar Thompson, Orit Kliuk, Oscar Méndiz, Óscar Prada-Delgado, Oz Shapira, Pablo Raffaele, Page Salanger, Pal Maurovich-Horvat, Pallav Garg, Paloma Moraga, Pam Singh, Pamela Ouyang, Pamela Woodard, Paola Emanuela Poggio Smanio, Paola Smanio, Paolo Calabro, Patricia K Nguyen, Patricia Alarie, Patricia Carrilho, Patricia Endsley, Patricia Pellikka, Patrycja Lebioda, Paul Der Mesropian, Paul Hauptman, Paula García-González, Paula Wilson, Paulo Cury Rezende, Paulo Novis Rocha, Pedro Canas Silva, Pedro Farto E Abreu, Pedro Píccaro de Oliveira, Pedro Carvalho, Pedro Modas, Pedro Rio, Peiyu He, Peter A McCullough, Peter H Stone, Peter Douglass, Peter Sizeland, Peter Voros, Philippe Gabriel Steg, Philippe Genereux, Philippe Généreux, Philippe Menasche, Philippe Rheault, Piero Tassinario, Pierre Gervais, Pilar Calvillo, Ping Chai, Piotr Jakubowski, Piotr Pruszczyk, Poay-Huan Loh, Pouneh Samadi, Prakash Deedwania, Pranav M Patel, Praneeth Polamuri, Pratiksha Sharma, Preeti Kamath, Prince Thomas, Priyadarshani Arambam, Puneet Sodhi, Pushpa Naik, Qi Zhong, Qian Zhao, Qianqian Yuan, Qiulan Xie, Rachel Murphy, Radmila Lyubarova, Radmilar Lyubarova, Raewyn Fisher, Rafael Diaz, Rafael Maldonado, Rafael Selgas, Raffaele Bugiardini, Rafia Chaudhry, Raisa Kavalakkat, Rajalekshmi Vs, Rajesh Gopalan Nair, Rajiv Narang, Rakesh Yadav, Ramiro Carvalho, Ramon de Jesús-Pérez, Ran Leng, Ranjan Kachru, Raquel Sanchez, Raven R Dwyer, Raven Lee, Ray Wyman, Raymond C Wong, Reinette Hampson, Renato Abdala Karam Kalil, Renato D Lopes, Renato George Eick, Renato Lopes, Reshma Ravindran, Reto Andreas Gamma, Ricardo Costa, Richa Bhatt, Richard H J Trimlett, Risha Patel, Rita Coram, Robert K Riezebos, Robert M Donnino, Robert Guyton, Robert Harrington, Robert Malecki, Roberto René Favaloro, Robyn Elliott, Rodolfo G S D Lima, Rohit Tandon, Rolf Doerr, Roma Tewari, Ron Wald, Rongrong Hu, Rory Collins, Roxana Mehran, Roxy Senior, Rubén Baleón-Espinosa, Ruben Ramos, Rui Ferreira, Ruth Kirby, Ruth Pérez-Fernández, S Ramakrishnan, S K Dwivedi, Sadath Lubna, Sadiq Ahmed, Sajeev Chakanalil Govindan, Salamah Alfalahi, Salvador Cruz-Flores, Salvatore P Costa, Sampoornima Setty, Samuel Nwosu, Sandeep Mahajan, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandy Carr, Sanja Simic Ogrizovic, Sanja Ogrizovic, Sanjeev Gulati, Sanjeev Sharma, Sara Fernandez, Sarah Williams, Sarju Ralhan, Sasko Kedev, Satinder Singh, Satish Sankaranarayanan, Satvic Cholenahally Manjunath, Sau Lee, Schawana Thaxton, Sean M O'Brien, Sebastian Sobczak, Seema Nour, Sergey A Sayganov, Sérgio Bravo Baptista, Sergio Draibe, Seth Sokol, Sharad Chandra, Shari Mackedanz, Shaun Goodman, Shayan Shirazian, Sheetal Rupesh Karwa, Sheri Ussery, Sheromani Bajaj, Shirin Heydari, Shiv Kumar Choudhary, Shivali Patel, Shruti Pandey, Shuyang Zhang, Siddharth Gadage, Sik-Yin V Tan, Sílvia Zottis Poletti, Silvia Valbuena, Simone Savaris, Solomon Yakubov, Songlin Zhu, Sonika Gupta, Sorin Brener, Sothinathan Gurunathan, Soundarya Nayak, Sowjanya Reddy, Stanley E Cobos, Stefan Weikl, Stephanie M Lane, Stephanie Ferket, Stephanie Mavromichalis, Stephen Fremes, Steven A Fein, Steven P Sedlis, Steven Giovannone, Steven Weitz, Subhash Banerjee, Sudhanva S Hegde, Suellen Hosino, Sulagna Mookherjee, Suman Singh, Sumith Abeygunasekara, Sundeep Mishra, Sunil Kumar Verma, Suresh Kumar, Suryaprakash Narayanappa, Susan K Milbrandt, Susana Silva, Susanna Stevens, Suvarna Kolhe, Suzana Tavares, Suzanne Welsh, T A Kishore, Tamara Colaiácovo Soares, Tapan Umesh Pillay, Tarek Rashid, Tarun K Mittal, Tauane Bello Duarte, Téodora Dutoiu, Teresa Delgadillo, Terrance Chua, Terrance Welch, Theodoros Kofidis, Thierry Lefevre, Tiago Silva, Timea Boros, Titus Lau, Tiziana Formisano, Tomasz Ciurus, Tomasz Tarchalski, Tracy Tan, Umesh Lingaraj, V K Bahl, V S Narain, Valentina Pellu, Valentine Lobo, Valerie Robesyn, Vandana Yadav, Veerabhadra Gupta, Verghese Mathew, Vicente Miro, Victoria Gumerova, Victoria Hernandez, Vijay Kher, Vijay Kumar, Vikas Makkar, Vikranth Reddy, Viktoria Bulkley, Vinoi George David, Virendra Misra, Virginia Fernández-Figares, Vladimir Ryasniansky, Vojislav L Giga, Wael A Almahmeed, Wan Xian Chan, Wanda C Marfori, Wanda Parker, Wayne Pennachi, Wei Ling Lau, Weibing Xing, Weijing Bian, Wendy L Stewart, Wendy Drewes, Whady Hueb, William Weintraub, Winnie C Sia, Xacobe Flores-Ríos, Xiang Ma, Xiangqiong Gu, Xiaomei Li, Xiaoyi Xu, Xin Fu, Xuemei Li, Xutong Wang, Yanek Pépin-Dubois, Yaron Arbel, Yechen Han, Yiming Lit, Ying Tung Sia, Ying Wang, Yining Yang, Yitong Ma, Yolayfi Peralta, Yves Smets, Yvonne Taul, Zalina Kudzoeva, Zeljko Z Markovic, Zhangsuo Liu, Zhenyu Liu, Zhiming Ye, Zixiang Yu, Zoltan Davidovits, Zvezdana Petronijevic, Spertus J.A., Jones P.G., Maron D.J., Mark D.B., O'Brien S.M., Fleg J.L., Reynolds H.R., Stone G.W., Sidhu M.S., Chaitman B.R., Chertow G.M., Hochman J.S., Bangalore S, and ISCHEMIA-CKD Research Group: Abdallah M Abdallah, Abel E Moreyra, Abhay A Laddu, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Adedayo Adeboye, Agne Juceviciene, Agne Urboniene, Agnieszka Szramowska, Ahmed Abdel-Latif, Ahmed Ayoub, Ahmed Elghamaz, Ahmed Kamal, Ahmed Talaat, Ajay Sharma, Ajit Singh Narula, Akshay Bagai, Akvile Smigelskaite, Alain Raymond, Alain Rheault, Alaine Melanie Loehr, Albert Varga, Aldo P Maggioni, Alec Moorman, Alejandro Chevaile Ramos, Alejandro Gisbert, Aleksandra Fratczak, Aleksandras Laucevicius, Alexander M Chernyavskiy, Alexander Sergeevich Borisov, Alexandra Craft, Alexandra Hunter, Alexandre Ciappina Hueb, Alexandre Schaan de Quadros, Alice Manica Muller, Aline Peixoto Deiro, Allegra Stone, Almudena Castro, Amar Uxa, Amaryllis Van Craenenbroeck, Ambuj Roy, Amit Kakkar, Amy Flowers, Amy Iskandrian, Ana D Djordjevic-Dikic, Ana Gomes Almeida, Ana Rita Francisco, Ana S Mladenovic, Ana Santana, Anandaroop Lahiri, Anastasia M Kuzmina-Krutetskaya, Anastasia Vamvakidou, Andras Vertes, Andre Gabriel, Andrea Bartykowszki, Andrea Lorimer, Andrea Pascual, Andreia Coelho, Andreia Rocha, Andrés García-Rincón, Andrew Starovoytov, Andrzej Łabyk, Anelise Kawakami, Angela Hoye, Angelo Nobre, Anjali Acharya, Anjali Anand, Anjana Rishmawi, Ann Banfield, Ann Luyten, Anna Cichocka-Radwan, Anna Fojt, Anna Plachcinska, Anna Teresinska, Anne Marie Webb, Anne Heath, Anoop Mathew, Antonia Vega, Antonio Carvalho, Antonio Colombo, Antonio Fiarresga, Anu Tharini, Anupama Rao, Aquiles Valdespino-Estrada, Ariel Diaz, Arif Asif, Arnold H Seto, Arturo S Campos-Santaolalla, Asim N Cheema, Asker Ahmed, Atul Mathur, Audrey W Leong, Axel Åkerblom, Axelle Fuentes, Aynun Naher, Badhma Valaiyapathi, Balaji Srinivasan, Baljeet Kaur, Balram Bhargava, Bandula Guruge, Barbara Wicklund, Bartosz Czarniak, Bebek Singh, Begoña Igual, Bela Merkely, Benoy N Shah, Bernard de Bruyne, Beth Abramson, Beth Stefanchik, Bethany Harvey, Bharati Shivalkar, Bilal Malik, Binoy Mannekkattukudy Kurian, Bougrida Hammouche, Branko D Beleslin, Bruce Ferguson, Bruce McManus, Bruna Maria Ascoli, Bryn Smith, Byron J Allen, C Michael Gibson, C Noel Bairey Merz, Calin Pop, Carl-Éric Gagné, Carly Ohmart, Carol M Kartje, Caroline Alsweiler, Caroline Rodgers, Caroline Spindler, Carolyn J Gruber, Catherine Albert, Catherine Bone, Catherine Lemay, Cezary Kepka, Chandini Suvarna, Chantale Mercure, Charlene Wiyarand, Chetan Patel, Chiara Attanasio, Chi-Ming Chow, Ching Min Er, Ching-Ching Ong, Cholenahally Nanjappa Manjunath, Chris Buller, Christel Vassaliere, Christiaan Vrints, Christian Witzke, Christie Ballantyne, Christina Björklund, Christine Roraff, Christophe Laure, Christophe Thuaire, Christopher Chan, Christopher Fordyce, Christopher Kinsey, Chunli Xia, Cidney Schultz, Claes Held, Claudia Cortés, Claudia Escobar, Cláudia Freixo, Clemens T Kadalie, Corine Thobois, Courtney Page, Cristina Bare, Dalisa Espinosa, Dan Gao, Dana Rizk, Daniela Puzhevsky, Data Analyst, David M Charytan, David O Williams, David Booth, David Charytan, David Cohen, David DeMets, David Foo, David Goldfarb, David Schlichting, David Sisson, David Taggart, David Waters, David Wheeler, David Williams, Davis Vo, Dawid Teodorczyk, Dawn D Shelstad, Dean Kereiakes, Deborah Yip, Deepa Ramaswamy, Deirdre Mattina, Deirdre Murphy, Dengke Jiang, Derek Cyr, Diana Cukali, Diane Camara, Dimitrios Stournaras, Dipti Patel, Dongze Li, Donna Exley, Doreen Reimann, Doron Schwartz, Duarte Cacela, Dwayne S G Conway, Eapen Punnoose, Edgar L Tay, Edgar Karanjah, Eduardo Gomes Lima, Eduardo Hernandez-Rangel, Edward D Nicol, Edyta Kaczmarska, Elena Refoyo Salicio, Eli Feen, Elihú Durán-Cortés, Elisabeth M Janzen, Elise van Dongen, Elissa Restelli Piloto, Elizabeta Srbinovska Kostovska, Elizabeth Capasso-Gulve, Elizaveta V Zbyshevskaya, Ellie Fridell, Ellis W Lader, Elvira Gosmanova, Emilie Tachot, Emma Howard, Emmanuel Sorbets, Encarnación Alonso-Álvarez, Eric Daugas, Erick Alexánderson Rosas, Estelle Montpetit, Eugene Passamani, Evgeny Shutov, Ewa Szczerba, Ewelina Wojtala, Expedito Eustáquio Ribeiro Silva, Fabio Fimiani, Fadi Hage, Fahim Haider Jafary, Fang Feng, Fatima Ranjbaran, Fausto J Pinto, Fernando Caeiro, Fernando Nolasco, Filipa Silva, Filippo Ottani, Firas Al Solaiman, Flávia Egydio, Florina Chereches, Francesca De Micco, Francesca Bianchini, Francesca Pietrucci, Francesco Orso, Francesco Pisano, Francisca Patuleia Figueiras, François Madore, Frank Harrell, Frank Rockhold, Frans Van de Werf, Franziska Guenther, Fred Mohr, G Karthikeyan, Gabriel Galeote, Gabriel Grossmann, Gabriel Steg, Gabriela Guzman, Gabriele Gabrielli, Gang Chen, Gautam Sharma, Gaylin Petty, Gelmina Mikolaitiene, Gennie Yee, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Girish Mishra, Gonzalo Barge-Caballero, Grace M Young, Graciela Scaro, Graham Wong, Gregg Pressman, Gregor Simonis, Gudrun Steinmaurer, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillermo Garcia-Garcia, Guoqin Wang, Gurpreet S Wander, Gurpreet Gulati, Haibo Zhang, Halina Marciniak, Hao Dai, Haojian Dong, Harold Franch, Harvey White, Hatem Elabd, Hayley Pomeroy, Heather Golden, Heidi Wilson, Helene Abergel, Hemalata Siddaram, Hemant Shakhar Mahapatra, Henry C Stokes, Hermine Osseni, Herwig Schuchlenz, Hicham Skali, Holly Mattix-Kramer, Hong Cheng, Hossam Mahrous, Hristo Pejkov, Hugo Marques, Hui Zhong, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ikraam Hassan, Ileana L Pina, Ilona Tamasauskiene, Inês Zimbarra Cabrita, Ines Rodrigues, Inga Soveri, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Isabelle Roy, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona Niedzwiecka, Jacek Kusmierek, Jackie Chow, Jaekyeong Heo, Jakub Maksym, James E Davies, James J Jang, James Hirsch, James Tatoulis, Jan Henzel, Janaina Oliveira, Janani Rangaswami, Jane Eckstein, Janitha Raj, Jaqueline Pozzibon, Jaroslaw Drozdz, Jason Loh Kwok Kong, Jason T Call, Jason Linefsky, Javier J Garcia, Jay Meisner, Jayne Scales, Jean Michel Juliard, Jean Diodati, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeff Leimberger, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Stojkovic, Jenne M Jose, Jennifer L Stanford, Jennifer Hogan, Jennifer Horst, Jennifer Isaacs, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jerry Yee, Jessica Berg, Jesus Peteiro, Jesús Peteiro, Jia Li, Jiamin Liu, Jianxin Zhang, Jill Marcus, Jim Blankenship, Jing Dong, Jiyan Chen, Jo Evans, Joaquín V Peñafiel, Joe Sabik, Johann Christopher, John B Kostis, John Joseph Graham, John Doan, John Jose, John Kotter, John Lehman, John Middleton, John Pownall, Jonathan M Gleadle, Jonathan S Chavez-Iñiguez, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Lebowitz, Jonean Thorsen, Jorge Carrillo Calvillo, Jorge Escobedo, José A Ortega-Ramírez, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Costa Vieira, José M Flores-Palacios, Jose Fragata, Jose Lopes, Jose Lopez-Sendon, José Lopez-Sendon, Jose Rueda, Joseph B Selvanayagam, Joseph Sacco, Joshua P Loh, Joy Burkhardt, Juan Manuel López Quijano, Juan Gaztanaga, Judit Sebo, Judith Wright, Juergen Stumpf, Julia de Aveiro Morata, Julio César Figal, Julio Hernandez Jaras, Junqing Yang, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Karen Calfas, Karen Petrosyan, Karen Servilla, Karen Swan, Karin Ploetze, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Katharina Knaut, Katherine Martin, Kathleen Claes, Kathryn Mason, Ken Mahaffey, Kenneth Gin, Kerry Lee, Kerstin Bonin, Kerstin Mikes, Kevin R Bainey, Kevin T Harley, Kevin Marzo, Kevin McMahon, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khrystyna Kushniriuk, Kian-Keong Poh, Kim Holland, Kimberly E Halverson, Kinnari Murphy, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kreton Mavromatis, Krishnakumar Hongalgi, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristine Arges, Kristine Teoh, Krzysztof Drzymalski, Lalathaksha Kumbar, Laszlone Matics, LaTonya J Hickson, Laura Keinaite, Laura Sarti, Laura True, Lawrence M Phillips, Lawrence Friedman, Leandro C Maranan, Leda Lotaif, Lekshmi Dharmarajan, Leo A Bockeria, Leonardo Pizzol Caetano, Leonardo Bridi, Leonid L Bershtein, Li Hai Yan, Li Li, Lidia Sousa, Lihong Xu, Lihua Zhang, Lili Zhang, Lilian Mazza Barbosa, Liljana Tozija, Linda Arcand, Lino Patricio, Liping Zhang, Lisa Hatch, Lixin Jiang, Liz Low, Loay Salman, Lorena Lopez, Lori Pritchard, Luis Bernanrdes, Luis Guzman, Lynette L Teo, M Sowjanya Reddy, Maarten Simoons, Maayan Konigstein, Mafalda Selas, Magdalena Madero, Magdalena Miller, Magdalena Misztal-Teodorczyk, Magdy Abdelhamid, Magid Fahim, Mahevamma Mylarappa, Majo X Joseph, Malgorzata Frach, Manjula Rani, Marcello Galvani, Marcin Demkow, Marcin Szkopiak, Marco De Fabritis, Marco Magnoni, Marco Marini, Marco Sicuro, Marek Roik, Maria A Alfonso, Maria Antonieta Pereira de Moraes, María Dolores Martínez-Ruíz, Maria Eugenia Canziani, Maria Eugenia Martin, Maria Inês Caetano, Maria P Corral, Maria Pérez García, Maria Andreasson, Maria Posada, Marianna D A Dracoulakis, Mariano Rubio, Marija T Petrovic, Marina Vieira, Mario J Garcia, Mario D'arezzo, Maris Orgera, Marius Miglinas, Mark Garand, Mark Peterson, Mark Xavier, Marlowe Mosley, Marta Capinha, Marta Swiderek, Martha Meyer, Martina Ceseri, Martinia Tricoli, Mary Wiilliams, Mary Ann Champagne, Mary Streif, Massoud Leesar, Matei Claudia, Mateusz Solecki, Matías Nicolás Mungo, Matthew Shinseki, Matthew Weir, Maura Carina Nédio, Max-Paul Winter, Mayil S Krishnam, Meenakshi Mishra, Mei Hwang, Melemadathil Srilatha, Melissa LeFevre, Mengistu Simegn, Michael A Gibson, Michael B Rubens, Michael D Shapiro, Michael Chobanian, Michael Davidson, Michael Farkouh, Michael Mack, Michal Wlodarczyk, Michel G Khouri, Michelle Crowder, Michelle Ratliff, Miguel Borges Santos, Miguel Nobre Menezes, Miguel Perez Fontan, Miguel Barrero, Mihaly Tapolyai, Mikhail T Torosoff, Milan R Dobric, Milind Avdhoot Gadkari, Min Tun Kyaw, Miri Revivo, Mitchel B Lustre, Mohamed Adel, Mohamed Hassan, Mohammad El-Hajjar, Mohammed Hussain, Mohammed Saleem, Moisés Blanco-Calvo, Moisés Jiménez-Santos, Monika Laukyte, Muhamed Saric, Myrthes Emy Takiuti, Nadia Asif, Nagaraja Moorthy, Naima L Ogletree, Nana O Katamadze, Nandita Nataraj, Naomi Uchida, Nasrul Ismail, Natalia S Oliveira, Natalia de Carvalho Maffei, Nathalie Brosens, Naved Aslam, Naveed Akhtar, Neamat Mowafy, Neeraj Pandit, Neeraj Parakh, Neesh Pannu, Neill Duncan, Nevena Garcevic, Ngaire Meadows, Nicholas Danchin, Nicole Deming, Nikola N Boskovic, Nikolaos Karogiannis, Ning Zhang, Nirmal Kumar, Niruta Sharma, Nitika Chadha, Nitish Naik, Noelle M Durfee, Nora M Cosgrove, Norbert Urbanski, Norma Hogg, Olga Walesiak, Olga Zdończyk, Olga Zhdanova, Olivia Anaya, Olugbenga Bello, Omar Almousalli, Omar Thompson, Orit Kliuk, Oscar Méndiz, Óscar Prada-Delgado, Oz Shapira, Pablo Raffaele, Page Salanger, Pal Maurovich-Horvat, Pallav Garg, Paloma Moraga, Pam Singh, Pamela Ouyang, Pamela Woodard, Paola Emanuela Poggio Smanio, Paola Smanio, Paolo Calabro, Patricia K Nguyen, Patricia Alarie, Patricia Carrilho, Patricia Endsley, Patricia Pellikka, Patrycja Lebioda, Paul Der Mesropian, Paul Hauptman, Paula García-González, Paula Wilson, Paulo Cury Rezende, Paulo Novis Rocha, Pedro Canas Silva, Pedro Farto E Abreu, Pedro Píccaro de Oliveira, Pedro Carvalho, Pedro Modas, Pedro Rio, Peiyu He, Peter A McCullough, Peter H Stone, Peter Douglass, Peter Sizeland, Peter Voros, Philippe Gabriel Steg, Philippe Genereux, Philippe Généreux, Philippe Menasche, Philippe Rheault, Piero Tassinario, Pierre Gervais, Pilar Calvillo, Ping Chai, Piotr Jakubowski, Piotr Pruszczyk, Poay-Huan Loh, Pouneh Samadi, Prakash Deedwania, Pranav M Patel, Praneeth Polamuri, Pratiksha Sharma, Preeti Kamath, Prince Thomas, Priyadarshani Arambam, Puneet Sodhi, Pushpa Naik, Qi Zhong, Qian Zhao, Qianqian Yuan, Qiulan Xie, Rachel Murphy, Radmila Lyubarova, Radmilar Lyubarova, Raewyn Fisher, Rafael Diaz, Rafael Maldonado, Rafael Selgas, Raffaele Bugiardini, Rafia Chaudhry, Raisa Kavalakkat, Rajalekshmi Vs, Rajesh Gopalan Nair, Rajiv Narang, Rakesh Yadav, Ramiro Carvalho, Ramon de Jesús-Pérez, Ran Leng, Ranjan Kachru, Raquel Sanchez, Raven R Dwyer, Raven Lee, Ray Wyman, Raymond C Wong, Reinette Hampson, Renato Abdala Karam Kalil, Renato D Lopes, Renato George Eick, Renato Lopes, Reshma Ravindran, Reto Andreas Gamma, Ricardo Costa, Richa Bhatt, Richard H J Trimlett, Risha Patel, Rita Coram, Robert K Riezebos, Robert M Donnino, Robert Guyton, Robert Harrington, Robert Malecki, Roberto René Favaloro, Robyn Elliott, Rodolfo G S D Lima, Rohit Tandon, Rolf Doerr, Roma Tewari, Ron Wald, Rongrong Hu, Rory Collins, Roxana Mehran, Roxy Senior, Rubén Baleón-Espinosa, Ruben Ramos, Rui Ferreira, Ruth Kirby, Ruth Pérez-Fernández, S Ramakrishnan, S K Dwivedi, Sadath Lubna, Sadiq Ahmed, Sajeev Chakanalil Govindan, Salamah Alfalahi, Salvador Cruz-Flores, Salvatore P Costa, Sampoornima Setty, Samuel Nwosu, Sandeep Mahajan, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandy Carr, Sanja Simic Ogrizovic, Sanja Ogrizovic, Sanjeev Gulati, Sanjeev Sharma, Sara Fernandez, Sarah Williams, Sarju Ralhan, Sasko Kedev, Satinder Singh, Satish Sankaranarayanan, Satvic Cholenahally Manjunath, Sau Lee, Schawana Thaxton, Sean M O'Brien, Sebastian Sobczak, Seema Nour, Sergey A Sayganov, Sérgio Bravo Baptista, Sergio Draibe, Seth Sokol, Sharad Chandra, Shari Mackedanz, Shaun Goodman, Shayan Shirazian, Sheetal Rupesh Karwa, Sheri Ussery, Sheromani Bajaj, Shirin Heydari, Shiv Kumar Choudhary, Shivali Patel, Shruti Pandey, Shuyang Zhang, Siddharth Gadage, Sik-Yin V Tan, Sílvia Zottis Poletti, Silvia Valbuena, Simone Savaris, Solomon Yakubov, Songlin Zhu, Sonika Gupta, Sorin Brener, Sothinathan Gurunathan, Soundarya Nayak, Sowjanya Reddy, Stanley E Cobos, Stefan Weikl, Stephanie M Lane, Stephanie Ferket, Stephanie Mavromichalis, Stephen Fremes, Steven A Fein, Steven P Sedlis, Steven Giovannone, Steven Weitz, Subhash Banerjee, Sudhanva S Hegde, Suellen Hosino, Sulagna Mookherjee, Suman Singh, Sumith Abeygunasekara, Sundeep Mishra, Sunil Kumar Verma, Suresh Kumar, Suryaprakash Narayanappa, Susan K Milbrandt, Susana Silva, Susanna Stevens, Suvarna Kolhe, Suzana Tavares, Suzanne Welsh, T A Kishore, Tamara Colaiácovo Soares, Tapan Umesh Pillay, Tarek Rashid, Tarun K Mittal, Tauane Bello Duarte, Téodora Dutoiu, Teresa Delgadillo, Terrance Chua, Terrance Welch, Theodoros Kofidis, Thierry Lefevre, Tiago Silva, Timea Boros, Titus Lau, Tiziana Formisano, Tomasz Ciurus, Tomasz Tarchalski, Tracy Tan, Umesh Lingaraj, V K Bahl, V S Narain, Valentina Pellu, Valentine Lobo, Valerie Robesyn, Vandana Yadav, Veerabhadra Gupta, Verghese Mathew, Vicente Miro, Victoria Gumerova, Victoria Hernandez, Vijay Kher, Vijay Kumar, Vikas Makkar, Vikranth Reddy, Viktoria Bulkley, Vinoi George David, Virendra Misra, Virginia Fernández-Figares, Vladimir Ryasniansky, Vojislav L Giga, Wael A Almahmeed, Wan Xian Chan, Wanda C Marfori, Wanda Parker, Wayne Pennachi, Wei Ling Lau, Weibing Xing, Weijing Bian, Wendy L Stewart, Wendy Drewes, Whady Hueb, William Weintraub, Winnie C Sia, Xacobe Flores-Ríos, Xiang Ma, Xiangqiong Gu, Xiaomei Li, Xiaoyi Xu, Xin Fu, Xuemei Li, Xutong Wang, Yanek Pépin-Dubois, Yaron Arbel, Yechen Han, Yiming Lit, Ying Tung Sia, Ying Wang, Yining Yang, Yitong Ma, Yolayfi Peralta, Yves Smets, Yvonne Taul, Zalina Kudzoeva, Zeljko Z Markovic, Zhangsuo Liu, Zhenyu Liu, Zhiming Ye, Zixiang Yu, Zoltan Davidovits, Zvezdana Petronijevic
Subjects: Male, Intention to Treat Analysi, medicine.medical_treatment, Health Status, Myocardial Ischemia, 030204 cardiovascular system & hematology, Coronary Angiography, law.invention, Health Statu, 0302 clinical medicine, Randomized controlled trial, law, Surveys and Questionnaires, Odds Ratio, Surveys and Questionnaire, 030212 general & internal medicine, Myocardial infarction, Coronary Artery Bypass, medicine.diagnostic_test, General Medicine, Middle Aged, Intention to Treat Analysis, Cardiology, Female, Human, medicine.medical_specialty, Revascularization, Follow-Up Studie, 03 medical and health sciences, Percutaneous Coronary Intervention, Internal medicine, medicine, Humans, cardiovascular diseases, Healthy Lifestyle, Renal Insufficiency, Chronic, Proportional Hazards Models, Aged, Intention-to-treat analysis, business.industry, Coronary Artery Bypa, Percutaneous coronary intervention, Odds ratio, medicine.disease, Angiography, Exercise Test, Proportional Hazards Model, business, Kidney disease, Follow-Up Studies
Abstract: BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of
Published: 2020

5. Relative clinical value of coronary computed tomography and stress echocardiography-guided management of stable chest pain patients: a propensity-matched analysis

Author: Anastasia Vamvakidou, Roxy Senior, Amarjit Sethi, Oleksandr Danylenko, Timothy Jones, Jiwan Pradhan, David Whiteside, and Mihir Kelshiker
Subjects: medicine.medical_specialty, medicine.medical_treatment, Population, 030204 cardiovascular system & hematology, Chest pain, Revascularization, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, Internal medicine, medicine, Stress Echocardiography, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Myocardial infarction, education, education.field_of_study, business.industry, General Medicine, medicine.disease, Stenosis, Cardiology, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract: Aims The European Society of Cardiology recommends coronary computed tomography (CCT) for the assessment of low-risk patients with suspected stable angina. We aimed to assess in a real-life setting the relative clinical value of stress echocardiography (SE)- and CCT-guided management in this population. Methods and results Patients with stable chest pain and no prior history of coronary artery disease (CAD) who underwent CCT or SE as the initial investigative strategy were propensity-matched (990 patients each group-age: 59 ± 13.2 years, males: 47.9%) to account for baseline differences in cardiovascular risk factors. Inconclusive tests were 6% vs. 3% (P Conclusion Initial SE-guided management was similar for the detection of obstructive CAD, demonstrated better resource utilization, but was associated with reduced prescription of statins although with no difference in medium-term outcome compared to CCT in this very low-risk population. However, a randomized study with longer follow-up is needed to confirm the clinical value of our findings.
Published: 2020
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6. Sex differences in transaortic flow rate and association with all-cause mortality in patients with severe aortic stenosis

Author: George Papasozomenos, Spyridon Zidros, Vegard Lysne, Sahrai Saeed, Anastasia Vamvakidou, Roxy Senior, and Rajdeep S. Khattar
Subjects: Aortic valve, Male, medicine.medical_specialty, 030204 cardiovascular system & hematology, Severity of Illness Index, Ventricular Function, Left, 03 medical and health sciences, 0302 clinical medicine, Aortic valve replacement, Risk Factors, Internal medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Aged, Retrospective Studies, Aged, 80 and over, Heart Valve Prosthesis Implantation, Sex Characteristics, Ejection fraction, business.industry, Proportional hazards model, Mortality rate, Hazard ratio, Stroke Volume, General Medicine, Aortic Valve Stenosis, Middle Aged, medicine.disease, Stenosis, medicine.anatomical_structure, Aortic valve stenosis, Aortic Valve, Cardiology, Female, Cardiology and Cardiovascular Medicine, business
Abstract: Aims It is not known whether transaortic flow rate (FR) in aortic stenosis (AS) differs between men and women, and whether the commonly used cut-off of 200 mL/s is prognostic in females. We aimed to explore sex differences in the determinants of FR, and determine the best sex-specific cut-offs for prediction of all-cause mortality. Methods and results Between 2010 and 2017, a total of 1564 symptomatic patients (mean age 76 ± 13 years, 51% men) with severe AS were prospectively included. Mean follow-up was 35 ± 22 months. The prevalence of cardiovascular disease was significantly higher in men than women (63% vs. 42%, P Conclusion Transaortic FR was lower in women than men. In the group undergoing AVI, lower FR was associated with increased risk of all-cause mortality, and the optimal cut-off for prediction of all-cause mortality was lower in women than men.
Published: 2020

7. 120 Coronary computed tomography versus stress echocardiography-guided management of stable chest pain patients: a propensity-matched analysis

Author: Anastasia Vamvakidou, Mihir Kelshiker, Roxy Senior, Amarjit Sethi, Jiwan Pradhan, David Whiteside, Timothy Jones, and Oleksandr Danylenko
Subjects: medicine.medical_specialty, education.field_of_study, business.industry, medicine.medical_treatment, Population, medicine.disease, Chest pain, Revascularization, Coronary artery disease, Stenosis, Internal medicine, Propensity score matching, Cardiology, Stress Echocardiography, Medicine, Myocardial infarction, medicine.symptom, business, education
Abstract: Introduction Recent recommendations by national and international societies advocate the use of coronary computed tomography (CCT) as the first-line test for the assessment of low-risk patients with suspected stable angina. However limited real-life data exist regarding its relative clinical value versus stress echocardiography (SE)-guided management. We aimed to assess in a real-life setting the clinical value of stress echocardiography (SE)-guided versus CCT-guided management in patients presenting with stable chest pain and no prior history of coronary artery disease (CAD). Methods We compared the relative feasibility, efficacy and the proportion of patients undergoing downstream testing including revascularisation and their impact on outcome (mortality and myocardial infarction) when CCT versus SE were used as the first line test for the assessment of stable chest pain. Of the patients who underwent CCT (N=2192) or SE (N=2081) between October 2013 and October 2014 only those with suspected stable angina and without previous CAD were selected. The population was propensity-matched (total 1980 patients-990 patients each group) to account for differences in the baseline cardiovascular risk factors (Figure 1). Results The baseline characteristics of the propensity-matched population are shown in Table 1. The mean age of the population was 59±13.2 years and 949 (47.9%) patients were male. Inconclusive tests were 6% versus 3% (p 70%) luminal stenosis on CCT and inducible ischemia on SE detected obstructive CAD by invasive coronary angiography in 63% versus 57% patients (p=0.33). Over the entire follow-up period (median 717 (IQR 93-1069) days) significantly more patients underwent invasive coronary angiography (21.5% versus 7.3%, p Conclusions SE when used for the assessment of patients with stable angina and no prior CAD resulted in more conclusive tests, similar detection of obstructive CAD, less overall invasive coronary angiography and revascularization and less subsequent functional tests compared with CCT. These findings suggest that SE may be considered an equally appropriate test compared to CCT in the assessment of low-risk patients with chest pain and no prior CAD. Conflict of Interest None
Published: 2020
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8. Cost-effectiveness of a management strategy based on exercise echocardiography versus exercise electrocardiography in patients presenting with suspected angina during long term follow up: A randomized study

Author: Kostas Zacharias, Vishal Mehta, Raj Khattar, Anastasia Vamvakidou, Roxy Senior, Sothinathan Gurunathan, Nikos Karogiannis, Mohammed Akhtar, and Asrar Ahmed
Subjects: Male, Cardiac & Cardiovascular Systems, PREDICTION, Cost effectiveness, Cost-Benefit Analysis, 030204 cardiovascular system & hematology, Chest pain, ECONOMIC-IMPACT, law.invention, Angina, Coronary artery disease, Electrocardiography, 0302 clinical medicine, Randomized controlled trial, law, Clinical endpoint, 030212 general & internal medicine, Myocardial infarction, WOMEN, Disease Management, Middle Aged, Pre- and post-test probability, Cardiology, CORONARY-ARTERY-DISEASE, TRIAL, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, Life Sciences & Biomedicine, Healthcare outcomes, Echocardiography, Stress, Adult, medicine.medical_specialty, DIAGNOSIS, 1102 Cardiovascular Medicine And Haematology, Angina Pectoris, 03 medical and health sciences, Internal medicine, medicine, Humans, cardiovascular diseases, Aged, Science & Technology, business.industry, CARDIAC EVENTS, medicine.disease, Economic evaluation, Stress echocardiography, Exercise ECG, Cardiovascular System & Hematology, Cardiovascular System & Cardiology, Exercise Test, business, Follow-Up Studies
Abstract: Introduction Exercise ECG (Ex-ECG) is advocated by guidelines for patients with low - intermediate probability of coronary artery disease (CAD). However, there are no randomized studies comparing Ex-ECG with exercise stress echocardiography (ESE) evaluating long term cost-effectiveness of each management strategy. Methods Accordingly, 385 patients with no prior CAD and low-intermediate probability of CAD (mean pre-test probability 34%), were randomized to undergo either Ex-ECG (194 patients) or ESE (191 patients). The primary endpoint was clinical effectiveness defined as the positive predictive value (PPV) for the detection of CAD of each test. Cost-effectiveness was derived using the cumulative costs incurred by each diagnostic strategy during a mean of follow up of 3.0 years. Results The PPV of ESE and Ex-ECG were 100% and 64% (p = 0.04) respectively for the detection of CAD. There were fewer clinic (31 vs 59, p 20% reduction in cost with an ESE strategy with no difference in the combined end-point of death, myocardial infarction, unplanned revascularization and hospitalization for chest pain between ESE and Ex-ECG (3.2% vs 3.7%, p = 0.38). Conclusion In patients with low to intermediate pretest probability of CAD and suspected angina, an ESE management strategy is cost-effective when compared with Ex-ECG during long term follow up.
Published: 2018
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9. Report from the Annual Conference of the British Society of Echocardiography, November 2016, Queen Elizabeth II Conference Centre, LondonForewordNational Invited Lecture 2016Echo Research and Practice sessionAbstract 1: Left ventricular mechano-temporal alterations during the apparent recovery of acute stress-induced (Tako-tsubo) cardiomyopathyAbstract 2: Right ventricular structure and function in veteran ultrarunners: is there evidence for chronic maladaptation?Abstract 3: Feasibility, efficacy and safety of physiologist-led stress echocardiography in a rapid access chest pain settingAbstract 4: Prognostic value of simultaneous stress echocardiography and carotid ultrasound in patients with suspected coronary artery diseaseAbstract 5: Long-term echocardiographic follow-up in transcatheter aortic valve implantationAbstract 6: The CHA2DS2VASc risk score appropriately risk stratifies patients prior to atrial fibrillation ablation and reduces the requirement for trans-esophageal echocardiographyAbstract 7: The role of speckle tracking strain imaging in assessing left ventricular response to cardiac resynchronization therapy in responders and non-responders

Author: Dean Thomas, Charlotte Atkinson, Dan Bowen, Shahram Ahmadvazir, Reinette Hampson, Oliver J Rothwell, Janaki Srinivasan, Bushra S Rana, Martin R Cowie, Richard P Steeds, John B Chambers, Simon Ray, Konstantin Schwarz, Christopher J Neil, Caroline Scally, John D Horowitz, Michael P Frenneaux, Cristina Pislaru, Dana K Dawson, Keith George, John D Somauroo, Rachel Lord, Mike Stembridge, Rob Shave, Martin Hoffman, Euan A Ashley, Francois Haddad, Thijs M H Eijsvogels, David Oxborough, Chris D Kinsey, Sothinathan Gurunathan, Anastasia Vamvakidou, Nikolaos Karogiannis, Roxy Senior, Benoy N Shah, Konstantinos Zacharias, Shaun Robinson, Ugochukwu Ihekwaba, Karen Parker, James Boyd, Cameron G Densem, Jonathan Hinton, Edmund B Gaisie, Dhrubo J Rakhit, Arthur M Yue, Paul R Roberts, Pat Phen, Jonathan Sibley, Sarah Fergey, and Paul Russhard
Subjects: Advanced and Specialized Nursing, Radiological and Ultrasound Technology, business.industry, Medicine, Art history, Radiology, Nuclear Medicine and imaging, business, Queen (playing card)
Published: 2017
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10. 128 The impact of aortic valve replacement on survival in patients with normal flow low gradient severe aortic stenosis: a propensity-matched comparison

Author: Rajdeep S. Khattar, Sahrai Saeed, Wei Li, Roxy Senior, and Anastasia Vamvakidou
Subjects: medicine.medical_specialty, Medical treatment, business.industry, Retrospective cohort study, Stroke volume, medicine.disease, Normal flow, Stenosis, Aortic valve replacement, Internal medicine, Cardiology, Medicine, In patient, Low gradient, business
Abstract: Introduction To assess the survival benefit of aortic valve replacement (AVR) in patients with normal flow low gradient severe aortic stenosis (AS). Methods A retrospective study of prospectively collected data of 276 patients (mean age 75±15 years, 51% male) with normal transaortic flow (flow rate [FR] ≥200 ml/s or stroke volume index [SVi] ≥35 ml/m2) and severe AS (aortic valve area [AVA] Results Of the 276 patients, 55% (n=151) were medically treated while 45% (n=125) underwent an AVR. Over a mean follow-up of 3.2±1.8 years (range 0–6.9 years) a total of 96 (34.8%) deaths occurred: 17 (13.6%) in AVR group versus 79 (52.3%) in those medically treated, when transaortic flow was defined by FR (p Conclusion In patients with normal flow low gradient severe AS, AVR was associated with a significantly improved survival compared to those who received standard medical treatment. Conflict of Interest No
Published: 2019
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11. The impact of aortic valve replacement on survival in patients with normal flow low gradient severe aortic stenosis: a propensity-matched comparison

Author: Rajdeep S. Khattar, Roxy Senior, Sahrai Saeed, Reinhard Seifert, Wei Li, and Anastasia Vamvakidou
Subjects: Male, medicine.medical_specialty, Comorbidity, 030204 cardiovascular system & hematology, Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Aortic valve replacement, Risk Factors, Internal medicine, London, medicine, Humans, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Propensity Score, Aged, Retrospective Studies, Body surface area, Heart Valve Prosthesis Implantation, Ejection fraction, business.industry, Hazard ratio, Atrial fibrillation, General Medicine, Stroke volume, Aortic Valve Stenosis, medicine.disease, Echocardiography, Doppler, Survival Rate, Stenosis, Aortic valve stenosis, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Blood Flow Velocity
Abstract: Aims To assess the survival benefit of aortic valve replacement (AVR) in patients with normal flow low gradient severe aortic stenosis (AS). Methods and results A retrospective study of prospectively collected data of 276 patients (mean age 75 ± 15 years, 51% male) with normal transaortic flow [flow rate (FR) ≥200 mL/s or stroke volume index (SVi) ≥35 mL/m2] and severe AS (aortic valve area Conclusion In patients with normal flow low gradient severe AS, AVR was associated with a significantly improved survival compared with those who received standard medical treatment.
Published: 2019

12. Contrast echocardiography

Author: Anastasia Vamvakidou and Roxy Senior
Abstract: The major requirement for optimal echocardiographic image interpretation, reproducibility, and diagnostic accuracy is image quality. Despite the use of harmonics, a significant proportion of patients have challenging images, which has an impact on diagnosis and management. The ultrasound contrast agents (UCAs), which are administered intravenously, have been a significant development in image quality optimization and have proved to be an important aid in the assessment of structural abnormalities, detection of regional wall motion abnormalities, and calculation of left ventricular ejection fraction. The use of UCAs is also of critical importance for the detection of ischaemia and the assessment of significant coronary artery disease through detection of inducible regional wall motion abnormalities during stress echocardiography. UCAs can also assess myocardial perfusion, which improves assessment of myocardial ischaemia during stress echocardiography. Similarly the simultaneous assessment of wall motion and perfusion improves assessment of viable myocardium in patients with left ventricular dysfunction. As the use of UCAs results in increased feasibility, reproducibility, and diagnostic and prognostic accuracy of echocardiography including cost-efficiency, both European and American guidelines endorse its use in clinical cardiology.
Published: 2018
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13. Impact of Pre-Intervention Transaortic Flow Rate Versus Stroke Volume Index on Mortality Across the Hemodynamic Spectrum of Severe Aortic Stenosis: Implications for a New Hemodynamic Classification of Aortic Stenosis

Author: Anastasia, Vamvakidou, Wenying, Jin, Oleksandr, Danylenko, Jiwan, Pradhan, Wei, Li, Cathy, West, Rajdeep, Khattar, and Roxy, Senior
Subjects: Aged, 80 and over, Heart Valve Prosthesis Implantation, Male, Heart Ventricles, Stroke Volume, Aortic Valve Stenosis, Middle Aged, Risk Assessment, Severity of Illness Index, Ventricular Function, Left, Ventricular Dysfunction, Left, Treatment Outcome, Echocardiography, Predictive Value of Tests, Risk Factors, Aortic Valve, Humans, Female, Aged
Published: 2018

14. Novel techniques in stress echocardiography: a focus on the advantages and disadvantages

Author: Roxy Senior, Anastasia Vamvakidou, and Sothinathan Gurunathan
Subjects: medicine.medical_specialty, Heart Valve Diseases, Cardiomyopathy, CAD, Coronary Artery Disease, 030204 cardiovascular system & hematology, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Valvular disease, Internal medicine, Internal Medicine, Stress Echocardiography, Humans, Medicine, 030212 general & internal medicine, business.industry, Reproducibility of Results, Coronary flow reserve, Strain imaging, General Medicine, medicine.disease, Fractional Flow Reserve, Myocardial, Dimensional Measurement Accuracy, Contrast echocardiography, Cardiology, Radiology, Cardiomyopathies, Cardiology and Cardiovascular Medicine, business, Echocardiography, Stress
Abstract: Stress echocardiography (SE) is an established tool not only for the assessment of coronary artery disease (CAD), but also for the evaluation of valvular disease and cardiomyopathy. New techniques, namely contrast echocardiography for function and perfusion including assessment of coronary flow reserve, strain imaging, 3-dimensional echocardiography, Doppler-derived coronary flow reserve and multimodality echocardiography, have been incorporated into stress protocols for improving assessment of cardiac disease. In this review, the advantages and disadvantages of these novel SE techniques are examined in terms of feasibility, accuracy, reproducibility and applications.
Published: 2016
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15. Can severity of aortic stenosis be determined despite absent contractile reserve in low-flow low-gradient aortic stenosis?

Author: Benoy N. Shah, Roxy Senior, and Anastasia Vamvakidou
Subjects: medicine.medical_specialty, business.industry, Dobutamine stress echocardiography, Increasing breathlessness, Stroke volume, Dobutamine stress, 030204 cardiovascular system & hematology, medicine.disease, 03 medical and health sciences, Stenosis, 0302 clinical medicine, Internal medicine, cardiovascular system, medicine, Ventricular pressure, Cardiology, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Low gradient, Cardiology and Cardiovascular Medicine, business, Severe left ventricular systolic dysfunction
Abstract: A 79-year-old man presented with increasing breathlessness and his echocardiogram revealed severe left ventricular systolic dysfunction and low-flow low-gradient aortic stenosis. Low-dose dobutamine stress echocardiography revealed the absence of contractile reserve (increase of stroke volume by ≥20% did not occur). The test would have therefore been inconclusive. However, the attainment of normal flow (FR≥200 mL/s) during dobutamine stress enabled the diagnosis of true severe aortic stenosis.
Published: 2016
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16. Left Ventricle, Right Ventricle and Cardiomyopathy

Author: Ghazwan Elias, JR Chahwala, Ahmed Elkaryoni, Mahmoud Elsayed, Mohammed J. Arisha, Kunal Bhagatwala, LG Adarna, Nermina Alagic, Anastasia Vamvakidou, Serkan Bulur, Navin C. Nanda, Begum Uygur, Nsn Turaga, Roxy Senior, and Ramdas Pai
Subjects: medicine.medical_specialty, medicine.anatomical_structure, Ventricle, business.industry, Internal medicine, medicine, Cardiomyopathy, Cardiology, medicine.disease, business
Published: 2018
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17. Diagnostic Concordance and Clinical Outcomes in Patients Undergoing Fractional Flow Reserve and Stress Echocardiography for the Assessment of Coronary Stenosis of Intermediate Severity

Author: Ihab S. Ramzy, Sothinathan Gurunathan, Aamir Ali, Grace Young, Spiros Zidros, Roxy Senior, Ahmed Elghamaz, Anastasia Vamvakidou, Asrar Ahmed, Gothandaraman Balaji, Nikos Karogiannis, and Mohammed Akhtar
Subjects: Male, medicine.medical_specialty, Cardiac & Cardiovascular Systems, Coronary flow reserve, CFR, Concordance, Fractional flow reserve, 030204 cardiovascular system & hematology, Coronary Angiography, Severity of Illness Index, ANGIOGRAPHY, FFR, 1102 Cardiovascular Medicine And Haematology, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Internal medicine, Stress Echocardiography, Medicine, Humans, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Myocardial infarction, Aged, Retrospective Studies, Ejection fraction, Science & Technology, business.industry, Hazard ratio, Coronary Stenosis, medicine.disease, Coronary Vessels, DISCORDANCE, Fractional Flow Reserve, Myocardial, PROGNOSTIC VALUE, Stress echocardiography, Cardiovascular System & Hematology, Cardiology, Cardiovascular System & Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Life Sciences & Biomedicine, Echocardiography, Stress, Follow-Up Studies
Abstract: Background The ischemic consequences of coronary artery stenosis can be assessed by invasive fractional flow reserve (FFR) or by noninvasive imaging. We sought to determine (1) the concordance between wall thickening assessment during clinically indicated stress echocardiography (SE) and FFR measurements and (2) the factors associated with hard events in these patients. Methods Two hundred twenty-three consecutive patients who underwent SE and invasive FFR measurements in close succession were analyzed retrospectively for diagnostic concordance and clinical outcomes. Results At the vessel level, the sensitivity, specificity, positive predictive value, and negative predictive value of SE for identifying significant disease as assessed by FFR was 68%, 75%, 43%, and 89%, respectively. The greatest discordance was seen in patients with wall thickening abnormalities (WTAs) and negative FFR. During a follow-up of 3.6 ± 2.2 years, there were 23 cardiovascular (CV) events (death and nonfatal myocardial infarction). The number of wall segments with inducible WTAs emerged as the strongest factor associated with CV events (hazard ratio, 1.18 [1.05-1.34]; P = .008). FFR was not associated with outcome. There was a significant increase in event rate in patients with WTA/negative FFR versus no WTA/negative FFR ( P = .01), but no significant difference versus WTA/positive FFR ( P = .85). Conclusions In a patient population with significant CV risk factors, a normal SE had a high negative predictive value for excluding abnormal FFR. WTAs were associated with outcomes regardless of FFR value, suggesting that this is a superior marker of ischemia to FFR.
Published: 2017

18. Long-Term Association of Dipyridamole Stress Myocardial Contrast Echocardiography versus Single-Photon Emission Computed Tomography with Clinical Outcomes in Patients with Known or Suspected Coronary Artery Disease

Author: Grace Young, Sothinathan Gurunathan, Anastasia Vamvakidou, Jatinder Pabla, Nikolaos Karogiannis, and Roxy Senior
Subjects: Male, Technetium Tc 99m Sestamibi, medicine.medical_specialty, Iron, Contrast Media, Coronary Artery Disease, 030204 cardiovascular system & hematology, Single-photon emission computed tomography, Ferric Compounds, Sensitivity and Specificity, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Cause of Death, medicine, Humans, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Myocardial infarction, Tomography, Emission-Computed, Single-Photon, Univariate analysis, medicine.diagnostic_test, business.industry, Hazard ratio, Oxides, Dipyridamole, Middle Aged, medicine.disease, Cardiology, Female, Radiopharmaceuticals, Cardiology and Cardiovascular Medicine, business, Perfusion, Emission computed tomography, medicine.drug, Echocardiography, Stress
Abstract: Background Single-photon emission computed tomography (SPECT) is a well-established method to evaluate patients with coronary artery disease. Myocardial contrast echocardiography (MCE) is an imaging technique that allows the assessment of myocardial perfusion in real time. Previous research has shown that vasodilator MCE is superior to SPECT for the prediction of hard events. The aim of this study was to investigate the long-term association of SPECT and MCE with clinical outcomes in patients with known or suspected coronary artery disease. Methods Accordingly, 258 patients who underwent MCE and SPECT as part of multicenter studies performed prospectively were followed up for hard events (all-cause mortality and nonfatal myocardial infarction). The mean age was 63.4 ± 5.5 years, 186 (72.1%) were men, and 32 (12.4%) had left ventricular systolic dysfunction. We calculated the ratio of the number of abnormal segments (at rest and/or stress) to the total number of segments expressed as MCE and SPECT indices. Results Over a mean follow-up period of 80.4 ± 6.1 months, 46 patients had hard events. MCE and SPECT indices were associated with all-cause mortality on univariate analysis ( P = .008 and P = .035, respectively) but only MCE index was independently associated with hard events (hazard ratio, 4.24; 95% CI, 1.27–14.15; P = .019), beyond clinical data and left ventricular function, and independently associated with hard cardiac events (hazard ratio, 4.78; 95% CI, 1.06–21.59; P = .042). Conclusions MCE but not SPECT showed a long-term association with outcome. These results thus favor the routine use of MCE in the long-term assessment of patients with known or suspected coronary artery disease.
Published: 2017

19. Report from the Annual Conference of the British Society of Echocardiography, November 2016, Queen Elizabeth II Conference Centre, London

Author: Richard P, Steeds, Martin R, Cowie, Bushra S, Rana, John B, Chambers, Simon, Ray, Janaki, Srinivasan, Konstantin, Schwarz, Christopher J, Neil, Caroline, Scally, John D, Horowitz, Michael P, Frenneaux, Cristina, Pislaru, Dana K, Dawson, Oliver J, Rothwell, Keith, George, John D, Somauroo, Rachel, Lord, Mike, Stembridge, Rob, Shave, Martin, Hoffman, Euan A, Ashley, Francois, Haddad, Thijs M H, Eijsvogels, David, Oxborough, Reinette, Hampson, Chris D, Kinsey, Sothinathan, Gurunathan, Anastasia, Vamvakidou, Nikolaos, Karogiannis, Roxy, Senior, Shahram, Ahmadvazir, Benoy N, Shah, Konstantinos, Zacharias, Dan, Bowen, Shaun, Robinson, Ugochukwu, Ihekwaba, Karen, Parker, James, Boyd, Cameron G, Densem, Charlotte, Atkinson, Jonathan, Hinton, Edmund B, Gaisie, Dhrubo J, Rakhit, Arthur M, Yue, Paul R, Roberts, Dean, Thomas, Pat, Phen, Jonathan, Sibley, Sarah, Fergey, and Paul, Russhard
Subjects: Science & Technology, Cardiac & Cardiovascular Systems, Cardiovascular System & Cardiology, Meeting Report, Life Sciences & Biomedicine
Published: 2017

20. Impact of Pre-Intervention Transaortic Flow Rate Versus Stroke Volume Index on Mortality Across the Hemodynamic Spectrum of Severe Aortic Stenosis

Author: Jiwan Pradhan, Wei Li, Oleksandr Danylenko, Rajdeep S. Khattar, Wenying Jin, Roxy Senior, Cathy West, and Anastasia Vamvakidou
Subjects: medicine.medical_specialty, business.industry, Left Ventricular Ejection Time, Hemodynamics, Stroke volume, 030204 cardiovascular system & hematology, medicine.disease, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Stenosis, Pre-intervention, 0302 clinical medicine, Internal medicine, Predictive value of tests, Severity of illness, medicine, Cardiology, Radiology, Nuclear Medicine and imaging, In patient, cardiovascular diseases, Cardiology and Cardiovascular Medicine, business
Abstract: Transvalvular flow rate (FR), which is stroke volume divided by left ventricular ejection time (in milliliters per second), is physiologically likely to be a better marker of transvalvular flow in patients with severe aortic stenosis (AS) compared with stroke volume index (SVi), a traditional marker
Published: 2019
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21. Dobutamine stress echo for suspected paradoxical low-flow low-gradient severe aortic stenosis: Value of left ventricular wall thickening assessment

Author: Roxy Senior, Ihab S. Ramzy, and Anastasia Vamvakidou
Subjects: medicine.medical_specialty, business.industry, Dobutamine stress, medicine.disease, Stenosis, Internal medicine, Cardiology, Medicine, Low gradient, Thickening, Radiology, Cardiology and Cardiovascular Medicine, business, Left ventricular wall
Published: 2015
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22. Giant lymphomatous cardiac mass: In vivo imaging and histological findings

Author: Gurunathan, Sothinathan, Ahmed, Asrar, Nayef, Aqel, Anastasia, Vamvakidou, Karogiannis, Nikolaos, and Senior, Roxy
Published: 2016
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23. 115 Diagnostic concordance and clinical outcomes in patients undergoing fractional flow reserve and stress echocardiography for the assessment of coronary stenosis of intermediate severity

Author: Sothinathan Gurunathan, Ahmed Elghamaz, Asrar Ahmed, Grace Young, Anastasia Vamvakidou, Nikos Karogiannis, Ihab Ramzy, and Roxy Senior
Subjects: Cardiology and Cardiovascular Medicine
Published: 2017
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24. 124 Stroke volume determined flow reserve does not predict the true severity of low-flow low-gradient aortic stenosis and is not a robust marker of contractile reserve in patients undergoing low-dose dobutamine echocardiography

Author: Anastasia Vamvakidou, Wei Li, Rajdeep S. Khattar, Navtej S. Chahal, Roxy Senior, Reinette Hampson, Ann Banfield, Nikos Karogiannis, and Sothinathan Gurunathan
Subjects: Chronotropic, Aortic valve, medicine.medical_specialty, Ejection fraction, business.industry, Stroke volume, medicine.disease, Stenosis, medicine.anatomical_structure, Internal medicine, Cardiology, medicine, Dobutamine, In patient, Low gradient, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract: Background During low-dose dobutamine stress echocardiography (LDDSE) in low-flow low-gradient aortic stenosis (LFLGAS), both the aortic stenosis (AS) severity and the presence of contractile reserve (CR) are conventionally assessed based on stroke volume flow reserve (SVFR), which is defined as stroke volume [SV] increase 20%. However frequent exaggerated chronotropic response to dobutamine with shortening left ventricular time result in SV drop. On the contrary, transvalvular flow rate (FR) (SV/ejection time) and left ventricular ejection fraction (LVEF) may increase. We aimed to assess the value of FR 200 ml/s (normal FR) and LVEF change in the identification of true severe AS (TSAS) and the assessment of CR respectively. Methods Accordingly 74 consecutive patients (mean age 78 years) with LFLGAS referred for LDDSE for determination of AS severity and CR underwent retrospective assessment of SV, FR, LVEF and standard echocardiographic parameters of AS severity (Table 1). The outcome assessed was all-cause mortality censored for aortic valve intervention. Results SVFR was present in 30 (40.5%) of the 74 patients whereas FR 200 ml/s was achieved in 60 (81.1%) (p Conclusions During LDDSE in LFLGAS normalised FR, not SVFR, is a better determinant of TSAS, whereas assessment of LVEF change instead of SVFR determines CR.
Published: 2017
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25. 107 The long term prognostic value of dipyridamole stress myocardial contrast echocardiography in comparison with single photon emission tomography in patients with known or suspected coronary artery disease

Author: Sothinathan Gurunathan, Grace Young, Anastasia Vamvakidou, Nikos Karogiannis, Jatinder Pabla, and Roxy Senior
Subjects: medicine.medical_specialty, Univariate analysis, education.field_of_study, medicine.diagnostic_test, business.industry, Population, Single-photon emission computed tomography, medicine.disease, Dipyridamole, Coronary artery disease, Angina, Internal medicine, medicine, Cardiology, Radiology, Myocardial infarction, Cardiology and Cardiovascular Medicine, education, business, Kidney disease, medicine.drug
Abstract: Background Single photon emission computed tomography (SPECT) is a well-established method to evaluate patients with coronary artery disease (CAD). Myocardial contrast echocardiography (MCE) is an imaging technique that allows assessment of myocardial perfusion in a real-time setting. Very short term prognostic study has shown that vasodilator MCE is superior to SPECT for the prediction of hard events. We sought to investigate the long term prognostic value of SPECT and MCE in the assessment of patients with known or suspected CAD. Methods We retrospectively followed-up patients with suspected or known CAD who were scheduled for coronary angiography and who also underwent MCE and SPECT at our institute, as part of multicentre studies performed between January 2002 and December 2009. Rest and vasodilator SPECT was performed after injection of 99mTc-sestamibi using the standard technique on separate days. Coronary Angiography (CA) was performed within thirty days of stress imaging. We calculated the ratio of the number of abnormal segments (at rest and/or stress) to the total number of segments expressed as% for both MCE and SPECT in order to obtain a uniform assessment of the total ischaemic and scar burden (MCE and SPECT indexes). This population was followed up in 2016 to obtain a long term prognostic value of MCE and SPECT for hard events, all-cause mortality and non-fatal myocardial infarction (NFMI). Results Of the 277 patients who were analysed, 262 followed up and 15 were lost to follow up (5.4%). The mean age was 63.4 years and 186 (71.8%) patients were male, 82 (31.7%) had diabetes, 180 (69.5%) hypertension, 189 (73%) dyslipidaemia, 26 (10%) family history of CAD (FHCAD) and 64 (24.7%) were smokers. Prior CAD (angina, known acute myocardial infarction (AMI) or coronary revascularisation) was present in 178 (68.7%) patients, left ventricular systolic dysfunction in 32 (12.4%) and chronic kidney disease in 16 (6.2%). Over a mean follow-up period of 80 months(6.6 years)±6 months, 18 patients suffered NFMI and 29 died (18% hard events, annualised hard events 2.7%). Both MCE and SPECT indexes were significant predictors on univariate analysis for all-cause mortality (p=0.008 and p=0.035 respectively), but MCE index was the only independent predictor for hard events (HR 3.711, 95% CI(1.13–12.14), p=0.03). Figure 1 demonstrates the Kaplan-Meier curve for the long-term prognostic value in all-cause mortality and NFMI of abnormal versus normal MCE. The annualised event rate for the abnormal MCE is 3.8% versus 1.0% for the normal MCE. Conclusion This is the first study to our knowledge that investigated the long-term prognostic value of SPECT and MCE in patients with suspected or known CAD. MCE was the only independent predictor of hard events. These results further support the routine use of MCE and not SPECT for the long-term prognostication of patients with known or suspected CAD.
Published: 2017
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26. FLOW RATE NOT STROKE VOLUME IS A SUPERIOR PROGNOSTIC MARKER OF TRANSORTIC FLOW AND FLOW RESERVE IN PATIENTS WITH LOW-FLOW LOW-GRADIENT AORTIC STENOSIS UNDERGOING LOW-DOSE DOBUTAMINE ECHOCARDIOGRAPHY

Author: George Papasozomenos, Oleksandr Danylenko, Anastasia Vamvakidou, Rajdeep S. Khattar, Roxy Senior, Wenying Jin, and Navtej S. Chahal
Subjects: medicine.medical_specialty, business.industry, Low dose dobutamine, Stroke volume, medicine.disease, Volumetric flow rate, Stenosis, Aortic valve area, Flow (mathematics), Internal medicine, medicine, Cardiology, In patient, Low gradient, Cardiology and Cardiovascular Medicine, business
Abstract: The objectives of low-dose dobutamine stress echocardiography (LDDSE) in low-flow low-gradient aortic stenosis (LFLG AS) are both to normalise transvalvular flow, at which juncture the aortic valve area informs the true AS severity, and to assess flow reserve. Conventionally, these assessments are
Published: 2018
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27. Lack of Stroke Volume Determined Flow Reserve Does Not Always Preclude Assessment of Severity of Aortic Stenosis in Low-Flow Low-Gradient State During Dobutamine Echocardiography

Author: Anastasia Vamvakidou, Navtej S. Chahal, and Roxy Senior
Subjects: Aortic valve, Male, medicine.medical_specialty, 030204 cardiovascular system & hematology, Doppler echocardiography, Severity of Illness Index, Ventricular Function, Left, 03 medical and health sciences, 0302 clinical medicine, Heart Rate, Predictive Value of Tests, Internal medicine, Dobutamine, Severity of illness, medicine, Humans, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Stroke, Aged, Retrospective Studies, medicine.diagnostic_test, business.industry, Reproducibility of Results, Stroke Volume, Stroke volume, Aortic Valve Stenosis, medicine.disease, Echocardiography, Doppler, Stenosis, medicine.anatomical_structure, Adrenergic beta-1 Receptor Agonists, Aortic valve stenosis, Aortic Valve, Cardiology, Radiology, Cardiology and Cardiovascular Medicine, business, medicine.drug, Echocardiography, Stress
Abstract: The severity of low-flow low-gradient (LFLG) aortic stenosis (AS) during low-dose dobutamine stress echocardiography (LDDSE) is deemed assessable only when stroke volume–determined flow reserve (SVFR) (stroke volume [SV] increase ≥20%) is present. However, due to typically frequently
Published: 2016

28. A 56-year-old man with exercise-induced chest pains

Author: Roxy Senior, Anastasia Vamvakidou, and Sothinathan Gurunathan
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Coronary Artery Disease, 030204 cardiovascular system & hematology, Chest pain, Coronary Angiography, Angina Pectoris, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Internal medicine, Stress Echocardiography, Medicine, Humans, Family history, Exercise, Morning, Myocardial Stunning, Interventional cardiology, business.industry, Percutaneous coronary intervention, 030229 sport sciences, Middle Aged, medicine.disease, Echocardiography, Anesthesia, Cardiology, Presentation (obstetrics), medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract: A 56-year-old man presented to our chest pain clinic with chest pain predominantly on exercise, but also at rest. He actually declared chest pain 1 h before presentation, precipitated by walking to the hospital, lasting for 2–3 min. He had a strong family history of ischaemic heart disease. His ECG was normal. The probability of significant coronary artery disease was intermediate, and he was referred for stress echocardiography (SE) on the same morning. The SE was not performed (only rest pictures acquired), and he was admitted to hospital (see figure 1 and online supplementary video S1 and S2). Figure 1 (1A and …
Published: 2015

29. Exercise echocardiography in asymptomatic severe aortic stenosis

Author: Roxy Senior, Ahmed Elghamaz, Anastasia Vamvakidou, Nikos Karogiannis, and Ihab S. Ramzy
Subjects: Aortic valve, medicine.medical_specialty, Doppler echocardiography, Asymptomatic, Severity of Illness Index, Coronary artery disease, Predictive Value of Tests, Internal medicine, Stress Echocardiography, medicine, Humans, Radiology, Nuclear Medicine and imaging, Asymptomatic Diseases, Aged, medicine.diagnostic_test, business.industry, Hemodynamics, Aortic Valve Stenosis, medicine.disease, Echocardiography, Doppler, Stenosis, medicine.anatomical_structure, Aortic valve stenosis, Aortic Valve, Cardiology, Exercise Test, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Echocardiography, Stress
Published: 2015

30. 132 Diagnostic Accuracy of Stress Echocardiography Compared with Invasive Coronary Angiography with Fractional Flow Reserve for The Diagnosis of Haemodynamically Significant Cad in Patients with Known or Suspected CAD

Author: Grace Young, Anastasia Vamvakidou, Guy Parsons, Roxy Senior, Ahmed Elghamaz, Nikos Karogiannis, and Sothinathan Gurunathan
Subjects: Acute coronary syndrome, medicine.medical_specialty, Population, Fractional flow reserve, Coronary artery disease, 03 medical and health sciences, Coronary artery bypass surgery, 0302 clinical medicine, medicine.artery, Internal medicine, medicine, 030212 general & internal medicine, education, education.field_of_study, medicine.diagnostic_test, business.industry, 030503 health policy & services, medicine.disease, Stenosis, Right coronary artery, Angiography, Cardiology, Radiology, 0305 other medical science, Cardiology and Cardiovascular Medicine, business
Abstract: Introduction Haemodynamically significant coronary artery disease (CAD) is an important indication for revascularisation. Wall motion analysis during stress echocardiography (SE) is a noninvasive alternative to invasive fractional flow reserve (FFR) for evaluating hemodynamically significant CAD. We sought to determine the diagnostic accuracy of SE compared with invasive coronary angiography with FFR for the diagnosis of hemodynamically significant CAD. Methods and Results Between January 2008 and April 2015, all patients that underwent clinically indicated FFR measurements during invasive angiography and SE in close succession were analysed. Patients were excluded if tests were not done within 6 months of each other, or an intervening percutaneous coronary procedure or acute coronary syndrome occurred. 184 patients (mean age 66.5yrs, 59 (32%) female) were identified. The majority of patients underwent coronary angiography following SE. The prevalence of known CAD, diabetes and chronic kidney disease were 46%, 43% and 13% respectively, and 14 (8%) patients had previous coronary artery bypass surgery. Exercise SE was performed in 84 (46%) patients and Dobutamine SE in 100 (54%) patients. Contrast was used in 158 patients (86%). In 108 patients (59%), the SE was positive for inducible ischaemia. From 217 vessels analysed, the Left Anterior Descending Artery, Right Coronary Artery, Left Circumflex Artery and Left Main Coronary artery were involved in 120 (55%), 47 (22%), 30 (14%), 18 (8%) respectively, with 2 vessels being grafts. 46 FFR measurements were positive (21%) and 171 were negative (79%), using a cut off of≤ 0.80. At the vessel level, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of SE for identifying significant disease as assessed by FFR was 70%, 77%, 45% and 90% respectively. In 73 patients, there was single vessel disease on angiography. At the vessel level, the sensitivity, specificity, PPV and NPV were 85%, 68%, 37% and 95%. Conclusion To date this is the largest study comparing SE and FFR for the assessment of the physiological significance of a coronary lesion, and reflects real world experience. SE demonstrates good diagnostic accuracy and excellent NPV for excluding flow-limiting disease. The low PPV is likely to represent the commencement of medical therapy following a positive SE, as well as referral bias (since only patients with positive SE underwent angiography) as well as the low prevalence of positive FFR measurements in this population. The presence of a haemodynamically significant stenosis can be accurately ruled out with SE.
Published: 2016
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31. 108 Clinical outcome and cost-effectiveness of performing cardiac investigations in a very low likehood of coronary artery disease population according to nice and esc risk prediction models

Author: Sothinathan Gurunathan, Roxy Senior, Nikos Karogiannis, Anastasia Vamvakidou, and Konstantinos Zacharias
Subjects: medicine.medical_specialty, education.field_of_study, Cost effectiveness, business.industry, Population, Nice, Chest pain, medicine.disease, Surgery, Pre- and post-test probability, Coronary artery disease, Internal medicine, medicine, Myocardial infarction, medicine.symptom, Family history, Cardiology and Cardiovascular Medicine, education, business, computer, computer.programming_language
Abstract: Background The NICE (National Institute for Health and Care Excellence) guidance for the management of recent-onset chest pain in 2010, recommended no routine cardiac investigations for patients with risk of coronary artery disease (CAD) less than 10%. The ESC (European Society of Cardiology) guidelines for stable angina in 2013, proposed no further testing in patients with a pretest probability below 15%. The management of patients with very low risk for CAD can be challenging, particularly when there is high clinical suspicion, family history of premature CAD (FHCAD) or ethnicity background with high prevalence of CAD. We sought to evaluate the clinical and economic impact of performing tests to diagnose CAD in this population. Methods We retrospectively analysed patients with very low risk for CAD who attended rapid access chest pain clinic (RACPC) due to recent onset chest pain. The likelihood of CAD was estimated by the NICE modified Diamond-Forrester formula and the ESC pretest probability formula and it was below 10% and 15% respectively. According to the guidelines, no further investigations are recommended for this group. Patients underwent exercise ECG (ExECG) or/and stress echocardiography (SE) mainly due to increased clinical suspicion. Coronary Angiography (CA) was subsequently performed, if it was clinically indicated. This population was followed-up for all-cause mortality, myocardial infarction (MI) and revascularisation. Cost-analysis was also performed. Results Over a period of 12 months, 279 patients underwent ExECG [171 (61,3%) negative, 13 (4,6%) positive and 56 (20%) inconclusive] or/and SE [72 (25,8%) negative and 5 (1.7%) positive]. Coronary angiography performed in 26 patients (9.3%) and significant CAD was identified in one patient (0.3%). Regarding risk factors, 88 (31.5%) patients had FHCAD, 66 (23.6%) hypertension, 30 (10.7%) dyslipidaemia, 17 (6.1%) diabetes and 10 (3.5%) were smokers. The ethnicity distribution predominantly consisted of South Asians (49.8%). Over 55 months (4.5 years)±5 months of follow up, two patients were diagnosed with myocardial infarction (0.7%) but only one had significant CAD and subsequent revascularisation (0.3%). Both patients had ExECG initially which was negative. Also, two patients died (0.7%) both from non-cardiovascular cause. A total cost of £69,060 was spent in these tests with a mean cost of £247 per patient. Conclusion The above findings support the rationale of avoiding further cardiac investigations in patients who are at very low risk of CAD as it is recommended by NICE and ESC guidelines. The cost-effectiveness of this strategy is well-depicted in previous studies and our findings are consistent with these results. Current guidance for the management of these patients seems that it is reassuringly applicable in ethnicities with high prevalence of CAD.
Published: 2017
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32. STROKE VOLUME DETERMINED FLOW RESERVE DOES NOT PREDICT THE TRUE SEVERITY OF LOW-FLOW LOW-GRADIENT AORTIC STENOSIS AND IS NOT A ROBUST MARKER OF CONTRACTILE RESERVE IN PATIENTS UNDERGOING LOW-DOSE DOBUTAMINE ECHOCARDIOGRAPHY

Author: Wei Li, Navtej S. Chahal, Reinette Hampson, Rajdeep S. Khattar, Nikolaos Karogiannis, Roxy Senior, and Anastasia Vamvakidou
Subjects: medicine.medical_specialty, business.industry, Dobutamine stress echocardiography, Low dose dobutamine, Stroke volume, medicine.disease, Stenosis, Internal medicine, Cardiology, Medicine, In patient, Low gradient, Cardiology and Cardiovascular Medicine, business
Abstract: Background: During low-dose dobutamine stress echocardiography in low-flow low-gradient aortic stenosis (LFLGAS), both the aortic stenosis severity and the presence of contractile reserve are conventionally assessed based on stroke volume flow reserve (SVFR) (stroke volume increase ≥20%). However
Published: 2017
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33. Prognostic usefulness of contemporary stress echocardiography in patients with left bundle branch block and impact of contrast use in improving prediction of outcome

Author: Nikos Karogiannis, Sothinathan Gurunathan, Guy Parsons, Grace Young, Anastasia Vamvakidou, Roxy Senior, and Vasilis Tzalamouras
Subjects: Male, medicine.medical_specialty, Prognostic variable, Bundle-Branch Block, Myocardial Infarction, Cardiomyopathy, Contrast Media, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Coronary Angiography, Risk Assessment, Severity of Illness Index, Cohort Studies, Coronary artery disease, Electrocardiography, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Internal medicine, medicine, Stress Echocardiography, Humans, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Myocardial infarction, Aged, Retrospective Studies, Aged, 80 and over, Analysis of Variance, Left bundle branch block, business.industry, Confounding, Stroke Volume, General Medicine, Middle Aged, Prognosis, medicine.disease, United Kingdom, Survival Rate, Logistic Models, Concomitant, Multivariate Analysis, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Echocardiography, Stress
Abstract: Aims Patients with symptomatic left bundle branch block (LBBB) may have myocardial ischaemia due to both coronary artery disease and/or cardiomyopathy (microcirculatory abnormalities) and may have concomitant left ventricular (LV) dysfunction. We aimed to assess the feasibility and prognostic value of contemporary stress echocardiography (SE), which can uncover both pathophysiologies in LBBB patients in routine clinical practice, and also aimed to assess the additive value of contrast SE. Methods and results Accordingly, 190 consecutive patients (age 70.5 ± 11.3 years, LV ejection fraction = 50.1 ± 10%) with symptomatic LBBB who underwent SE over 6 years were assessed, of which 142 (75%) underwent contrast SE and 176 (92.6%) had diagnostic SE. Inducible ischaemia was present in 25 (14.2%) patients. During follow-up (35.4 ± 20.2 months) there were 32 deaths (18%) and 18 (10.2%) first cardiovascular (CV) events (acute myocardial infarction/mortality) in the 176 patients with diagnostic studies. Wall thickening score index at peak stress (WTSIpeak), which measures combined LV function and inducible ischaemia, was an independent predictor of mortality (HR = 3.78, 95% CI = 1.39–10.31, P = 0.01) and CV events (HR = 3.96, 95% CI = 1.1–14.3, P = 0.036). An abnormal SE (myocardial ischaemia and/or abnormal LV function) predicted an almost three-fold increase in all-cause mortality and CV events compared with normal SE. Amongst the confounders affecting assessment of wall thickening in LBBB and conventional prognostic variables, use of contrast was an independent predictor ( P = 0.034) of WTSI1.16 (optimal predictor of mortality/CV outcome). Conclusion SE in patients with LBBB demonstrated high feasibility and the combination of LV systolic function and myocardial ischaemia provided important prognostic information. Contrast-enhanced SE improved the prediction of outcome.
Published: 2016
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34. HOW CAN SIMPLE THOUGHTS LEAD TO A COMPLEX DIAGNOSIS

Author: Anastasia Vamvakidou and Dimitris Konstantinou
Subjects: Lead (geology), business.industry, Internal Medicine, Calculus, Medicine, business, Simple (philosophy)
Published: 2011
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35. THE ROLE OF THE GENERAL INTERNIST IN MODERN MEDICINE THROUGH AN UNCOMMON CASE-KIKUCHI LYMPHADENOPATHY

Author: Dimitris Konstantinou and Anastasia Vamvakidou
Subjects: Modern medicine, medicine.medical_specialty, business.industry, General surgery, Internal medicine, Internal Medicine, medicine, business
Published: 2011
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35 results on '"Anastasia Vamvakidou"'

1. Report from the Annual Conference of the British Society of Echocardiography, November 2016, Queen Elizabeth II Conference Centre, London

2. Low Transvalvular Flow Rate Predicts Mortality in Patients With Low-Gradient Aortic Stenosis Following Aortic Valve Intervention

3. Clinical effectiveness of a sonographer-led, cardiologist-interpreted stress echocardiography service in the rapid access stable chest pain clinic

4. Health status after invasive or conservative care in coronary and advanced kidney disease

5. Relative clinical value of coronary computed tomography and stress echocardiography-guided management of stable chest pain patients: a propensity-matched analysis

6. Sex differences in transaortic flow rate and association with all-cause mortality in patients with severe aortic stenosis

7. 120 Coronary computed tomography versus stress echocardiography-guided management of stable chest pain patients: a propensity-matched analysis

8. Cost-effectiveness of a management strategy based on exercise echocardiography versus exercise electrocardiography in patients presenting with suspected angina during long term follow up: A randomized study

10. 128 The impact of aortic valve replacement on survival in patients with normal flow low gradient severe aortic stenosis: a propensity-matched comparison

11. The impact of aortic valve replacement on survival in patients with normal flow low gradient severe aortic stenosis: a propensity-matched comparison

12. Contrast echocardiography

13. Impact of Pre-Intervention Transaortic Flow Rate Versus Stroke Volume Index on Mortality Across the Hemodynamic Spectrum of Severe Aortic Stenosis: Implications for a New Hemodynamic Classification of Aortic Stenosis

14. Novel techniques in stress echocardiography: a focus on the advantages and disadvantages

15. Can severity of aortic stenosis be determined despite absent contractile reserve in low-flow low-gradient aortic stenosis?

16. Left Ventricle, Right Ventricle and Cardiomyopathy

17. Diagnostic Concordance and Clinical Outcomes in Patients Undergoing Fractional Flow Reserve and Stress Echocardiography for the Assessment of Coronary Stenosis of Intermediate Severity

18. Long-Term Association of Dipyridamole Stress Myocardial Contrast Echocardiography versus Single-Photon Emission Computed Tomography with Clinical Outcomes in Patients with Known or Suspected Coronary Artery Disease

19. Report from the Annual Conference of the British Society of Echocardiography, November 2016, Queen Elizabeth II Conference Centre, London

20. Impact of Pre-Intervention Transaortic Flow Rate Versus Stroke Volume Index on Mortality Across the Hemodynamic Spectrum of Severe Aortic Stenosis

21. Dobutamine stress echo for suspected paradoxical low-flow low-gradient severe aortic stenosis: Value of left ventricular wall thickening assessment

22. Giant lymphomatous cardiac mass: In vivo imaging and histological findings

23. 115 Diagnostic concordance and clinical outcomes in patients undergoing fractional flow reserve and stress echocardiography for the assessment of coronary stenosis of intermediate severity

24. 124 Stroke volume determined flow reserve does not predict the true severity of low-flow low-gradient aortic stenosis and is not a robust marker of contractile reserve in patients undergoing low-dose dobutamine echocardiography

25. 107 The long term prognostic value of dipyridamole stress myocardial contrast echocardiography in comparison with single photon emission tomography in patients with known or suspected coronary artery disease

26. FLOW RATE NOT STROKE VOLUME IS A SUPERIOR PROGNOSTIC MARKER OF TRANSORTIC FLOW AND FLOW RESERVE IN PATIENTS WITH LOW-FLOW LOW-GRADIENT AORTIC STENOSIS UNDERGOING LOW-DOSE DOBUTAMINE ECHOCARDIOGRAPHY

27. Lack of Stroke Volume Determined Flow Reserve Does Not Always Preclude Assessment of Severity of Aortic Stenosis in Low-Flow Low-Gradient State During Dobutamine Echocardiography

28. A 56-year-old man with exercise-induced chest pains

29. Exercise echocardiography in asymptomatic severe aortic stenosis

30. 132 Diagnostic Accuracy of Stress Echocardiography Compared with Invasive Coronary Angiography with Fractional Flow Reserve for The Diagnosis of Haemodynamically Significant Cad in Patients with Known or Suspected CAD

31. 108 Clinical outcome and cost-effectiveness of performing cardiac investigations in a very low likehood of coronary artery disease population according to nice and esc risk prediction models

32. STROKE VOLUME DETERMINED FLOW RESERVE DOES NOT PREDICT THE TRUE SEVERITY OF LOW-FLOW LOW-GRADIENT AORTIC STENOSIS AND IS NOT A ROBUST MARKER OF CONTRACTILE RESERVE IN PATIENTS UNDERGOING LOW-DOSE DOBUTAMINE ECHOCARDIOGRAPHY

33. Prognostic usefulness of contemporary stress echocardiography in patients with left bundle branch block and impact of contrast use in improving prediction of outcome

34. HOW CAN SIMPLE THOUGHTS LEAD TO A COMPLEX DIAGNOSIS

35. THE ROLE OF THE GENERAL INTERNIST IN MODERN MEDICINE THROUGH AN UNCOMMON CASE-KIKUCHI LYMPHADENOPATHY

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