146 results on '"George Joy"'
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2. Persistent symptoms after COVID-19 are not associated with differential SARS-CoV-2 antibody or T cell immunity
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Daniel M. Altmann, Catherine J. Reynolds, George Joy, Ashley D. Otter, Joseph M. Gibbons, Corinna Pade, Leo Swadling, Mala K. Maini, Tim Brooks, Amanda Semper, Áine McKnight, Mahdad Noursadeghi, Charlotte Manisty, Thomas A. Treibel, James C. Moon, COVIDsortium investigators, and Rosemary J. Boyton
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Science - Abstract
Abstract Among the unknowns in decoding the pathogenesis of SARS-CoV-2 persistent symptoms in Long Covid is whether there is a contributory role of abnormal immunity during acute infection. It has been proposed that Long Covid is a consequence of either an excessive or inadequate initial immune response. Here, we analyze SARS-CoV-2 humoral and cellular immunity in 86 healthcare workers with laboratory confirmed mild or asymptomatic SARS-CoV-2 infection during the first wave. Symptom questionnaires allow stratification into those with persistent symptoms and those without for comparison. During the period up to 18-weeks post-infection, we observe no difference in antibody responses to spike RBD or nucleoprotein, virus neutralization, or T cell responses. Also, there is no difference in the profile of antibody waning. Analysis at 1-year, after two vaccine doses, comparing those with persistent symptoms to those without, again shows similar SARS-CoV-2 immunity. Thus, quantitative differences in these measured parameters of SARS-CoV-2 adaptive immunity following mild or asymptomatic acute infection are unlikely to have contributed to Long Covid causality. ClinicalTrials.gov (NCT04318314).
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- 2023
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3. AI Left Ventricular Segmentation Outperforms Humans for Prediction of All-cause Mortality in Known or Suspected Coronary Disease
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George Joy, MD, Kristopher Knott, PhD, Iain Pierce, PhD, Joao Augusto, MD, PhD, Andreas Seraphim, MD, Hunain Shiwani, MD, Thomas Treibel, MD, PhD, Charlotte H. Manisty, MD, PhD, Peter Kellman, PhD, James Moon, MD, and Rhodri Davies, MD, PhD
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2024
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4. Redefining Hypertrophic Cardiomyopathy Diagnosis: Validating the Impact of a Novel Age, Sex, and Body Size-specific Method Across International Centres
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Hunain Shiwani, MD, Rhodri Davies, MD, PhD, Constantin-Cristian Topriceanu, MD, Anjali Owens, MD, Betty Raman, MD, PhD, Raffaello Ditaranto, MD, Joao Augusto, MD, PhD, Camilla Torlasco, Matt Webber, Benjamin Dowsing, MD, Rebecca Hughes, Ines Miranda, MD, Walter Witschey, PhD, Luigi Lovato, MD, Alberto Ponziani, MD, Konstantinos Moschonas, MD, George Joy, Iain Pierce, PhD, Peter Kellman, PhD, Alun Hughes, MD, PhD, Elena Biagini, Saidi Mohiddin, Luis Lopes, MD, PhD, Harold Litt, MD, PhD, Victor A Ferrari, Gabriella Captur, MD, PhD, and James Moon, MD, PhD
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2024
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5. CMR Stress Aortic Flow in myofit46 – a Novel Approach Towards Dynamic Aortic Phenotyping
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Matt Webber, Aneesh Varma, George Joy, MD, Jonathan Bennett, Fiona Chan, Rebecca Hughes, Hunain Shiwani, Rhodri Davies, MD, PhD, Constantin-Cristian Topriceanu, Emma Martin, Andrew Wong, Alicja Rapala, Kenan Direk, Charlotte Manisty, MD, PhD, Nishi Chaturvedi, Thomas Treibel, MD, PhD, Michele Orini, Tim Evain, Iain Pierce, PhD, Peter Kellman, James Moon, MD, Alun Hughes, MD, PhD, Anish Bhuva, and Gabriella Captur, MD, PhD
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2024
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6. Pro-arrhythmic Electrophysiological Abnormalities in Subclinical and Overt Hypertrophic Cardiomyopathy; Insights from CMR-ECGI
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George Joy, MD, Matt Webber, Alessandra Ardissino, James Wilson, MD, Fiona Chan, Iain Pierce, PhD, Rebecca Hughes, Konstantinos Moschonas, Hunain Shiwani, Robert Jamieson, MSc, Paula Velazquez, MD, Ramya Vijayakumar, PhD, Erica Dall'Armellina, PhD, Peter MacFarlane, PhD, Charlotte H. Manisty, MD, PhD, Peter Kellman, PhD, Rhodri Davies, MD, PhD, Maite Tome, PhD, Vladan Koncar, Xuyuan Tao, Christoph Guger, Yoram Rudy, Alun Hughes, MD, PhD, Pier Lambiase, James Moon, MD, Luis Lopes, Michele Orini, and Gabriella Captur, MD, PhD
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2024
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7. The Four-dimensional Mechanical Phenotype of Lamin Mutation Carriers and Overt Lamin Heart Disease
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Constantin-Cristian Topriceanu, MD, Mashael Al-Farih, George Joy, MD, Fiona Chan, Matt Webber, Denis C. Ilie-Ablachim, Hunain Shiwani, MD, Stephen Pettit, Ben O’Brien, Alun Hughes, MD, PhD, Konstantinos Savvatis, Saidi Mohiddin, William Moody, Richard P Steeds, James Moon, MD, Paolo E Puddu, Andrea Barison, Paolo Piras, and Gabriella Captur, MD, PhD
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2024
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8. Advancing Subclinical Hypertrophic Cardiomyopathy Diagnosis: The Role of Cardiovascular Magnetic Resonance Based Radiomics and Machine Learning
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Liliana Szabo, MD, PhD, Esmeralda Ruiz Pujadas, PhD, Zahra Raisi-Estabragh, MBChB, PhD, Rebecca Hughes, George Joy, MD, PhD, James Moon, MD, Karim Lekadir, PhD, Luis Lopes, and Steffen Petersen, MBBS, DPhil
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2024
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9. Study protocol: MyoFit46—the cardiac sub-study of the MRC National Survey of Health and Development
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Matthew Webber, Debbie Falconer, Mashael AlFarih, George Joy, Fiona Chan, Clare Davie, Lee Hamill Howes, Andrew Wong, Alicja Rapala, Anish Bhuva, Rhodri H. Davies, Christopher Morton, Jazmin Aguado-Sierra, Mariano Vazquez, Xuyuan Tao, Gunther Krausz, Slobodan Tanackovic, Christoph Guger, Hui Xue, Peter Kellman, Iain Pierce, Jonathan Schott, Rebecca Hardy, Nishi Chaturvedi, Yoram Rudy, James C. Moon, Pier D. Lambiase, Michele Orini, Alun D. Hughes, and Gabriella Captur
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Subclinical myocardial dysfunction ,Cardiovascular health ,Life course risk factors ,Risk trajectories ,Cardiovascular magnetic resonance ,Electrocardiographic imaging ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background The life course accumulation of overt and subclinical myocardial dysfunction contributes to older age mortality, frailty, disability and loss of independence. The Medical Research Council National Survey of Health and Development (NSHD) is the world’s longest running continued surveillance birth cohort providing a unique opportunity to understand life course determinants of myocardial dysfunction as part of MyoFit46–the cardiac sub-study of the NSHD. Methods We aim to recruit 550 NSHD participants of approximately 75 years+ to undertake high-density surface electrocardiographic imaging (ECGI) and stress perfusion cardiovascular magnetic resonance (CMR). Through comprehensive myocardial tissue characterization and 4-dimensional flow we hope to better understand the burden of clinical and subclinical cardiovascular disease. Supercomputers will be used to combine the multi-scale ECGI and CMR datasets per participant. Rarely available, prospectively collected whole-of-life data on exposures, traditional risk factors and multimorbidity will be studied to identify risk trajectories, critical change periods, mediators and cumulative impacts on the myocardium. Discussion By combining well curated, prospectively acquired longitudinal data of the NSHD with novel CMR–ECGI data and sharing these results and associated pipelines with the CMR community, MyoFit46 seeks to transform our understanding of how early, mid and later-life risk factor trajectories interact to determine the state of cardiovascular health in older age. Trial registration: Prospectively registered on ClinicalTrials.gov with trial ID: 19/LO/1774 Multimorbidity Life-Course Approach to Myocardial Health- A Cardiac Sub-Study of the MCRC National Survey of Health and Development (NSHD).
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- 2022
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10. A Hybrid Architecture (CO-CONNECT) to Facilitate Rapid Discovery and Access to Data Across the United Kingdom in Response to the COVID-19 Pandemic: Development Study
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Emily Jefferson, Christian Cole, Shahzad Mumtaz, Samuel Cox, Thomas Charles Giles, Sam Adejumo, Esmond Urwin, Daniel Lea, Calum Macdonald, Joseph Best, Erum Masood, Gordon Milligan, Jenny Johnston, Scott Horban, Ipek Birced, Christopher Hall, Aaron S Jackson, Clare Collins, Sam Rising, Charlotte Dodsley, Jill Hampton, Andrew Hadfield, Roberto Santos, Simon Tarr, Vasiliki Panagi, Joseph Lavagna, Tracy Jackson, Antony Chuter, Jillian Beggs, Magdalena Martinez-Queipo, Helen Ward, Julie von Ziegenweidt, Frances Burns, Joanne Martin, Neil Sebire, Carole Morris, Declan Bradley, Rob Baxter, Anni Ahonen-Bishopp, Paul Smith, Amelia Shoemark, Ana M Valdes, Benjamin Ollivere, Charlotte Manisty, David Eyre, Stephanie Gallant, George Joy, Andrew McAuley, David Connell, Kate Northstone, Katie Jeffery, Emanuele Di Angelantonio, Amy McMahon, Mat Walker, Malcolm Gracie Semple, Jessica Mai Sims, Emma Lawrence, Bethan Davies, John Kenneth Baillie, Ming Tang, Gary Leeming, Linda Power, Thomas Breeze, Duncan Murray, Chris Orton, Iain Pierce, Ian Hall, Shamez Ladhani, Natalie Gillson, Matthew Whitaker, Laura Shallcross, David Seymour, Susheel Varma, Gerry Reilly, Andrew Morris, Susan Hopkins, Aziz Sheikh, and Philip Quinlan
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Computer applications to medicine. Medical informatics ,R858-859.7 ,Public aspects of medicine ,RA1-1270 - Abstract
BackgroundCOVID-19 data have been generated across the United Kingdom as a by-product of clinical care and public health provision, as well as numerous bespoke and repurposed research endeavors. Analysis of these data has underpinned the United Kingdom’s response to the pandemic, and informed public health policies and clinical guidelines. However, these data are held by different organizations, and this fragmented landscape has presented challenges for public health agencies and researchers as they struggle to find relevant data to access and interrogate the data they need to inform the pandemic response at pace. ObjectiveWe aimed to transform UK COVID-19 diagnostic data sets to be findable, accessible, interoperable, and reusable (FAIR). MethodsA federated infrastructure model (COVID - Curated and Open Analysis and Research Platform [CO-CONNECT]) was rapidly built to enable the automated and reproducible mapping of health data partners’ pseudonymized data to the Observational Medical Outcomes Partnership Common Data Model without the need for any data to leave the data controllers’ secure environments, and to support federated cohort discovery queries and meta-analysis. ResultsA total of 56 data sets from 19 organizations are being connected to the federated network. The data include research cohorts and COVID-19 data collected through routine health care provision linked to longitudinal health care records and demographics. The infrastructure is live, supporting aggregate-level querying of data across the United Kingdom. ConclusionsCO-CONNECT was developed by a multidisciplinary team. It enables rapid COVID-19 data discovery and instantaneous meta-analysis across data sources, and it is researching streamlined data extraction for use in a Trusted Research Environment for research and public health analysis. CO-CONNECT has the potential to make UK health data more interconnected and better able to answer national-level research questions while maintaining patient confidentiality and local governance procedures.
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- 2022
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11. Plasma proteomic signature predicts who will get persistent symptoms following SARS-CoV-2 infection
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Gabriella Captur, James C. Moon, Constantin-Cristian Topriceanu, George Joy, Leo Swadling, Jenny Hallqvist, Ivan Doykov, Nina Patel, Justyna Spiewak, Tomas Baldwin, Matt Hamblin, Katia Menacho, Marianna Fontana, Thomas A. Treibel, Charlotte Manisty, Ben O'Brien, Joseph M. Gibbons, Corrina Pade, Tim Brooks, Daniel M. Altmann, Rosemary J. Boyton, Áine McKnight, Mala K. Maini, Mahdad Noursadeghi, Kevin Mills, and Wendy E. Heywood
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COVID-19 ,Proteomics ,Post-acute sequelae of SARS-CoV-2 (PASC) ,Medicine ,Medicine (General) ,R5-920 - Abstract
Summary: Background: The majority of those infected by ancestral Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) during the UK first wave (starting March 2020) did not require hospitalisation. Most had a short-lived mild or asymptomatic infection, while others had symptoms that persisted for weeks or months. We hypothesized that the plasma proteome at the time of first infection would reflect differences in the inflammatory response that linked to symptom severity and duration. Methods: We performed a nested longitudinal case-control study and targeted analysis of the plasma proteome of 156 healthcare workers (HCW) with and without lab confirmed SARS-CoV-2 infection. Targeted proteomic multiple-reaction monitoring analysis of 91 pre-selected proteins was undertaken in uninfected healthcare workers at baseline, and in infected healthcare workers serially, from 1 week prior to 6 weeks after their first confirmed SARS-CoV-2 infection. Symptom severity and antibody responses were also tracked. Questionnaires at 6 and 12 months collected data on persistent symptoms. Findings: Within this cohort (median age 39 years, interquartile range 30–47 years), 54 healthcare workers (44% male) had PCR or antibody confirmed infection, with the remaining 102 (38% male) serving as uninfected controls. Following the first confirmed SARS-CoV-2 infection, perturbation of the plasma proteome persisted for up to 6 weeks, tracking symptom severity and antibody responses. Differentially abundant proteins were mostly coordinated around lipid, atherosclerosis and cholesterol metabolism pathways, complement and coagulation cascades, autophagy, and lysosomal function. The proteomic profile at the time of seroconversion associated with persistent symptoms out to 12 months. Data are available via ProteomeXchange with identifier PXD036590. Interpretation: Our findings show that non-severe SARS-CoV-2 infection perturbs the plasma proteome for at least 6 weeks. The plasma proteomic signature at the time of seroconversion has the potential to identify which individuals are more likely to suffer from persistent symptoms related to SARS-CoV-2 infection. Funding information: The COVIDsortium is supported by funding donated by individuals, charitable Trusts, and corporations including Goldman Sachs, Citadel and Citadel Securities, The Guy Foundation, GW Pharmaceuticals, Kusuma Trust, and Jagclif Charitable Trust, and enabled by Barts Charity with support from University College London Hospitals (UCLH) Charity. This work was additionally supported by the Translational Mass Spectrometry Research Group and the Biomedical Research Center (BRC) at Great Ormond Street Hospital.
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- 2022
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12. Quantitative, multiplexed, targeted proteomics for ascertaining variant specific SARS-CoV-2 antibody response
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Ivan Doykov, Tomas Baldwin, Justyna Spiewak, Kimberly C. Gilmour, Joseph M. Gibbons, Corinna Pade, Catherine J. Reynolds, Áine McKnight, Mahdad Noursadeghi, Mala K. Maini, Charlotte Manisty, Thomas Treibel, Gabriella Captur, Marianna Fontana, Rosemary J. Boyton, Daniel M. Altmann, Tim Brooks, Amanda Semper, James C. Moon, Kevin Mills, Wendy E. Heywood, Hakam Abbass, Aderonke Abiodun, Mashael Alfarih, Zoe Alldis, Oliver E. Amin, Mervyn Andiapen, Jessica Artico, João B. Augusto, Georgina L. Baca, Sasha N.L. Bailey, Anish N. Bhuva, Alex Boulter, Ruth Bowles, Olivia V. Bracken, Ben O’Brien, Natalie Bullock, David K. Butler, Olivia Carr, Nicola Champion, Carmen Chan, Aneesh Chandran, Tom Coleman, Jorge Couto de Sousa, Xose Couto-Parada, Eleanor Cross, Teresa Cutino-Moguel, Silvia D’Arcangelo, Rhodri H. Davies, Brooke Douglas, Cecilia Di Genova, Keenan Dieobi-Anene, Mariana O. Diniz, Anaya Ellis, Karen Feehan, Malcolm Finlay, Nasim Forooghi, Sasha Francis, David Gillespie, Derek Gilroy, Matt Hamblin, Gabrielle Harker, Georgia Hemingway, Jacqueline Hewson, Wendy Heywood, Lauren M. Hickling, Bethany Hicks, Aroon D. Hingorani, Lee Howes, Ivie Itua, Victor Jardim, Wing-Yiu Jason Lee, Melaniepetra Jensen, Jessica Jones, Meleri Jones, George Joy, Vikas Kapil, Caoimhe Kelly, Hibba Kurdi, Jonathan Lambourne, Kai-Min Lin, Siyi Liu, Aaron Lloyd, Sarah Louth, Vineela Mandadapu, Katia Menacho, Celina Mfuko, Sebastian Millward, Oliver Mitchelmore, Christopher Moon, James Moon, Diana Muñoz Sandoval, Sam M. Murray, Ashley Otter, Susana Palma, Ruth Parker, Kush Patel, Mihaela Pawarova, Steffen E. Petersen, Brian Piniera, Franziska P. Pieper, Lisa Rannigan, Alicja Rapala, Amy Richards, Matthew Robathan, Joshua Rosenheim, Cathy Rowe, Matthew Royds, Jane Sackville West, Genine Sambile, Nathalie M. Schmidt, Hannah Selman, Andreas Seraphim, Mihaela Simion, Angelique Smit, Michelle Sugimoto, Leo Swadling, Stephen Taylor, Nigel Temperton, Stephen Thomas, George D. Thornton, Thomas A. Treibel, Art Tucker, Ann Varghese, Jessry Veerapen, Mohit Vijayakumar, Tim Warner, Sophie Welch, Hannah White, Theresa Wodehouse, Lucinda Wynne, and Dan Zahedi
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complement: immunoglobulin ,SARS-CoV-2 ,vaccination ,proteomics ,COVID-19 ,variant of concern ,Biotechnology ,TP248.13-248.65 ,Biochemistry ,QD415-436 ,Science - Abstract
Summary: Determining the protection an individual has to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variants of concern (VoCs) is crucial for future immune surveillance, vaccine development, and understanding of the changing immune response. We devised an informative assay to current ELISA-based serology using multiplexed, baited, targeted proteomics for direct detection of multiple proteins in the SARS-CoV-2 anti-spike antibody immunocomplex. Serum from individuals collected after infection or first- and second-dose vaccination demonstrates this approach and shows concordance with existing serology and neutralization. Our assays show altered responses of both immunoglobulins and complement to the Alpha (B.1.1.7), Beta (B.1.351), and Delta (B.1.617.1) VoCs and a reduced response to Omicron (B1.1.1529). We were able to identify individuals who had prior infection, and observed that C1q is closely associated with IgG1 (r > 0.82) and may better reflect neutralization to VoCs. Analyzing additional immunoproteins beyond immunoglobulin (Ig) G, provides important information about our understanding of the response to infection and vaccination. Motivation: Assays for measuring serum antibody responses are typically limited to measurement of a total or single immunoglobulin isotype. The antibody response is far more complex, with multiple immunoglobulin classes, isotypes, and complement factors involved. This is a potential wealth of information that is typically understudied and missed by existing tests. The global COVID-19 pandemic has highlighted the need to understand better the immune response in respect to vaccine development and emerging new severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variants. Using the ability of tandem mass spectrometry to multiplex and directly and accurately measure the antibody complex, we devised an alternative assay to capture this valuable information.
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- 2022
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13. Use of quantitative cardiovascular magnetic resonance myocardial perfusion mapping for characterization of ischemia in patients with left internal mammary coronary artery bypass grafts
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Andreas Seraphim, Kristopher D. Knott, Anne-Marie Beirne, Joao B. Augusto, Katia Menacho, Jessica Artico, George Joy, Rebecca Hughes, Anish N. Bhuva, Ryo Torii, Hui Xue, Thomas A. Treibel, Rhodri Davies, James C. Moon, Daniel A. Jones, Peter Kellman, and Charlotte Manisty
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Perfusion ,Coronary artery bypass ,Grafts ,Cardiovascular magnetic resonance ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Quantitative myocardial perfusion mapping using cardiovascular magnetic resonance (CMR) is validated for myocardial blood flow (MBF) estimation in native vessel coronary artery disease (CAD). Following coronary artery bypass graft (CABG) surgery, perfusion defects are often detected in territories supplied by the left internal mammary artery (LIMA) graft, but their interpretation and subsequent clinical management is variable. Methods We assessed myocardial perfusion using quantitative CMR perfusion mapping in 38 patients with prior CABG surgery, all with angiographically-proven patent LIMA grafts to the left anterior descending coronary artery (LAD) and no prior infarction in the LAD territory. Factors potentially determining MBF in the LIMA–LAD myocardial territory, including the impact of delayed contrast arrival through the LIMA graft were evaluated. Results Perfusion defects were reported on blinded visual analysis in the LIMA–LAD territory in 27 (71%) cases, despite LIMA graft patency and no LAD infarction. Native LAD chronic total occlusion (CTO) was a strong independent predictor of stress MBF (B = − 0.41, p = 0.014) and myocardial perfusion reserve (MPR) (B = − 0.56, p = 0.005), and was associated with reduced stress MBF in the basal (1.47 vs 2.07 ml/g/min; p = 0.002) but not the apical myocardial segments (1.52 vs 1.87 ml/g/min; p = 0.057). Extending the maximum arterial time delay incorporated in the quantitative perfusion algorithm, resulted only in a small increase (3.4%) of estimated stress MBF. Conclusions Perfusion defects are frequently detected in LIMA–LAD subtended territories post CABG despite LIMA patency. Although delayed contrast arrival through LIMA grafts causes a small underestimation of MBF, perfusion defects are likely to reflect true reductions in myocardial blood flow, largely due to proximal native LAD disease.
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- 2021
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14. Myocardial Perfusion Defects in Hypertrophic Cardiomyopathy Mutation Carriers
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Rebecca K. Hughes, Claudia Camaioni, João B. Augusto, Kristopher Knott, Ellie Quinn, Gabriella Captur, Andreas Seraphim, George Joy, Petros Syrris, Perry M. Elliott, Saidi Mohiddin, Peter Kellman, Hui Xue, Luis R. Lopes, and James C. Moon
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genetics ,hypertrophic cardiomyopathy ,quantitative perfusion mapping ,sarcomere mutations carriers without hypertrophy ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Impaired myocardial blood flow (MBF) in the absence of epicardial coronary disease is a feature of hypertrophic cardiomyopathy (HCM). Although most evident in hypertrophied or scarred segments, reduced MBF can occur in apparently normal segments. We hypothesized that impaired MBF and myocardial perfusion reserve, quantified using perfusion mapping cardiac magnetic resonance, might occur in the absence of overt left ventricular hypertrophy (LVH) and late gadolinium enhancement, in mutation carriers without LVH criteria for HCM (genotype‐positive, left ventricular hypertrophy‐negative). Methods and Results A single center, case‐control study investigated MBF and myocardial perfusion reserve (the ratio of MBF at stress:rest), along with other pre‐phenotypic features of HCM. Individuals with genotype‐positive, left ventricular hypertrophy‐negative (n=50) with likely pathogenic/pathogenic variants and no evidence of LVH, and matched controls (n=28) underwent cardiac magnetic resonance. Cardiac magnetic resonance identified LVH‐fulfilling criteria for HCM in 5 patients who were excluded. Individuals with genotype‐positive, left ventricular hypertrophy‐negative had longer indexed anterior mitral valve leaflet length (12.52±2.1 versus 11.55±1.6 mm/m2, P=0.03), lower left ventricular end‐systolic volume (21.0±6.9 versus 26.7±6.2 mm/m2, P≤0.005) and higher left ventricular ejection fraction (71.9±5.5 versus 65.8±4.4%, P≤0.005). Maximum wall thickness was not significantly different (9.03±1.95 versus 8.37±1.2 mm, P=0.075), and no subject had significant late gadolinium enhancement (minor right ventricle‒insertion point late gadolinium enhancement only). Perfusion mapping demonstrated visual perfusion defects in 9 (20%) carriers versus 0 controls (P=0.011). These were almost all septal or near right ventricle insertion points. Globally, myocardial perfusion reserve was lower in carriers (2.77±0.83 versus 3.24±0.63, P=0.009), with a subendocardial:subepicardial myocardial perfusion reserve gradient (2.55±0.75 versus 3.2±0.65, P=
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- 2021
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15. Time series analysis and mechanistic modelling of heterogeneity and sero-reversion in antibody responses to mild SARS‑CoV-2 infection
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Charlotte Manisty, Thomas Alexander Treibel, Melanie Jensen, Amanda Semper, George Joy, Rishi K Gupta, Teresa Cutino-Moguel, Mervyn Andiapen, Jessica Jones, Stephen Taylor, Ashley Otter, Corrina Pade, Joseph Gibbons, Jason Lee, Joanna Bacon, Steve Thomas, Chris Moon, Meleri Jones, Dylan Williams, Jonathan Lambourne, Marianna Fontana, Daniel M Altmann, Rosemary Boyton, Mala Maini, Aine McKnight, Benjamin Chain, Mahdad Noursadeghi, and James C Moon
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SARS-CoV-2, Serology, Mathematical modelling, Sero-reversion ,Medicine ,Medicine (General) ,R5-920 - Abstract
Background: SARS-CoV-2 serology is used to identify prior infection at individual and at population level. Extended longitudinal studies with multi-timepoint sampling to evaluate dynamic changes in antibody levels are required to identify the time horizon in which these applications of serology are valid, and to explore the longevity of protective humoral immunity. Methods: Healthcare workers were recruited to a prospective cohort study from the first SARS-CoV-2 epidemic peak in London, undergoing weekly symptom screen, viral PCR and blood sampling over 16–21 weeks. Serological analysis (n =12,990) was performed using semi-quantitative Euroimmun IgG to viral spike S1 domain and Roche total antibody to viral nucleocapsid protein (NP) assays. Comparisons were made to pseudovirus neutralizing antibody measurements. Findings: A total of 157/729 (21.5%) participants developed positive SARS-CoV-2 serology by one or other assay, of whom 31.0% were asymptomatic and there were no deaths. Peak Euroimmun anti-S1 and Roche anti-NP measurements correlated (r = 0.57, p
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- 2021
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16. Do EXCEL and NOBLE translate into real world? A 5-year observational study of left main stem outcomes
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George Joy and Hany Eissa
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Aims We aimed to uncover the 5-year real world outcomes of patients with significant left mainstem (LMS) disease managed with percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG) or medical management.Methods We identified patients with LMS disease in 2012 and analysed baseline characteristics and outcomes in the following 5 years.Results 119 patients were identified, 62% (74) received CABG and 12% (14) received PCI and 26% (31) were medically managed. In PCI versus CABG, there was no significant difference in age and Synergy between PCI with Taxus and Cardiac Surgery score but there were significantly higher rates of pretreatment heart failure (ejection fraction 42%±10 vs 52%±13p=0.01). Overall major adverse cardiovascular event (MACE) being a composite of stroke, myocardial infarction (MI), target vessel revascularisation and all-cause mortality were not statistically different but numerically higher in the PCI group (36% (5) vs 23% (17) p=0.12). Medically managed patients were significantly older than those that were revascularised (PCI or CABG n=88; 75±11 vs 69±9 years p=0.01). They also had higher MACE (74% (23) vs 25% (22) p=0.000002) driven by MI (19% (6) vs 2% (1) p=0.01) and all-cause mortality (52% (16) vs 19% (17) p=0.01) compared with those with revascularisation.Conclusions The bleak outcomes of medical management in LMS disease are reflective findings from studies performed from several decades ago. Our findings show that there is still a role for PCI in the management of LMS disease in selected patients.
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- 2020
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17. Healthcare Workers Bioresource: Study outline and baseline characteristics of a prospective healthcare worker cohort to study immune protection and pathogenesis in COVID-19 [version 2; peer review: 1 approved, 2 approved with reservations]
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João B Augusto, Katia Menacho, Mervyn Andiapen, Ruth Bowles, Maudrian Burton, Sophie Welch, Anish N Bhuva, Andreas Seraphim, Corinna Pade, George Joy, Melanie Jensen, Rhodri H Davies, Gabriella Captur, Marianna Fontana, Hugh Montgomery, Ben O’Brien, Aroon D Hingorani, Teresa Cutino-Moguel, Áine McKnight, Hakam Abbass, Mashael Alfarih, Zoe Alldis, Georgina L Baca, Alex Boulter, Olivia V Bracken, Natalie Bullock, Nicola Champion, Carmen Chan, Xose Couto-Parada, Keenan Dieobi-Anene, Karen Feehan, Gemma Figtree, Melanie C Figtree, Malcolm Finlay, Nasim Forooghi, Joseph M Gibbons, Peter Griffiths, Matt Hamblin, Lee Howes, Ivie Itua, Meleri Jones, Victor Jardim, Vikas Kapil, Wing-Yiu Jason Lee, Vineela Mandadapu, Celina Mfuko, Oliver Mitchelmore, Susana Palma, Kush Patel, Steffen E Petersen, Brian Piniera, Rosalind Raine, Alicja Rapala, Amy Richards, Genine Sambile, Jorge Couto de Sousa, Michelle Sugimoto, George D Thornton, Jessica Artico, Dan Zahedi, Ruth Parker, Mathew Robathan, Lauren M Hickling, Ntobeko Ntusi, Amanda Semper, Tim Brooks, Jessica Jones, Art Tucker, Jessry Veerapen, Mohit Vijayakumar, Theresa Wodehouse, Lucinda Wynne, Thomas A Treibel, Mahdad Noursadeghi, Charlotte Manisty, and James C Moon
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Medicine ,Science - Abstract
Background: Most biomedical research has focused on sampling COVID-19 patients presenting to hospital with advanced disease, with less focus on the asymptomatic or paucisymptomatic. We established a bioresource with serial sampling of health care workers (HCWs) designed to obtain samples before and during mainly mild disease, with follow-up sampling to evaluate the quality and duration of immune memory. Methods: We conducted a prospective study on HCWs from three hospital sites in London, initially at a single centre (recruited just prior to first peak community transmission in London), but then extended to multiple sites 3 weeks later (recruitment still ongoing, target n=1,000). Asymptomatic participants attending work complete a health questionnaire, and provide a nasal swab (for SARS-CoV-2 RNA by RT-PCR tests) and blood samples (mononuclear cells, serum, plasma, RNA and DNA are biobanked) at 16 weekly study visits, and at 6 and 12 months. Results: Preliminary baseline results for the first 731 HCWs (400 single-centre, 331 multicentre extension) are presented. Mean age was 38±11 years; 67% are female, 31% nurses, 20% doctors, and 19% work in intensive care units. COVID-19-associated risk factors were: 37% black, Asian or minority ethnicities; 18% smokers; 13% obesity; 11% asthma; 7% hypertension and 2% diabetes mellitus. At baseline, 41% reported symptoms in the preceding 2 weeks. Preliminary test results from the initial cohort (n=400) are available: PCR at baseline for SARS-CoV-2 was positive in 28 of 396 (7.1%, 95% CI 4.9-10.0%) and 15 of 385 (3.9%, 2.4-6.3%) had circulating IgG antibodies. Conclusions: This COVID-19 bioresource established just before the peak of infections in the UK will provide longitudinal assessments of incident infection and immune responses in HCWs through the natural time course of disease and convalescence. The samples and data from this bioresource are available to academic collaborators by application https://covid-consortium.com/application-for-samples/.
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- 2020
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18. Spontaneous Coronary Artery Dissection in a Patient with a Family History of Fatal Ascending Aortic Dissection: Case Report and Discussion of Diseases Causing Both Presentations
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George Joy and Hany Eissa
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background. Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS). Aortic dissection and SCAD share common aetiologies such as a fibromuscular dysplasia (FMD), Marfan, Ehlers Danlos, and more rarely systemic lupus erythematosus and Loeys-Dietz; however, SCAD has never been known to have a familial association with aortic dissection. Case Summary. This case report describes a 48-year-old woman suffering from SCAD who had a mother who died from ascending aortic dissection in her 50s. Discussion. This is the first case report to our knowledge of a patient with SCAD with a first-degree relative with aortic dissection. Our case is interesting in that it shows that if predisposition to arterial dissection was inherited from mother to daughter, one of them suffered an extremely rare manifestation of their underlying disease. It also shows that a high index of suspicion is needed for SCAD in the presence of a patient with ACS and a family history of dissection elsewhere in the arterial tree.
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- 2019
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19. Accelerated full-thickness skin wound tissue regeneration by self-crosslinked chitosan hydrogel films reinforced by oxidized CNC-AgNPs stabilized Pickering emulsion for quercetin delivery
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Sharma, Garima, George Joy, Jomon, Sharma, Ashish Ranjan, and Kim, Jin-Chul
- Published
- 2024
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20. Tailoring polymeric nanocarriers for hypoxia-specific drug release: Insights into design and applications in clinics
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George Joy, Jomon, Sharma, Garima, and Kim, Jin-Chul
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- 2024
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21. Glucose-responsive soluble microneedle prepared with “Gelatin - hydroxyethylcellulose ethoxylate complex coacervate” for the transdermal drug delivery
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George Joy, Jomon, Son, Hyeon Ki, Lee, Seung- Jun, and Kim, Jin-Chul
- Published
- 2024
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22. Faecal contamination and prevalence of pathogenic E. coli in shellfish growing areas along south-west coast of India
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Antony, Ally C., Silvester, Reshma, P.S., Divya, P.A., Aneesa, Francis, Bini, C., Ajith Joseph, Hussain, Midhun Shah, B.T., Umesh, George, Joy, and Abdulla, Mohamed Hatha
- Published
- 2021
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23. Human Resource Development and Service Delivery in Rivers State Ministry of Education, Nigeria
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Prince-George, Joy Nkeiru, primary
- Published
- 2024
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24. Chitosan and (Phenylthio) acetic acid-based ion pair self assembled for temperature and oxidation-responsive drug release
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George Joy, Jomon, primary and Kim, Jin-Chul, additional
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- 2024
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25. ThermOxshield ion pair self assembly unleashing suppressed release.
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Guo, Yuyuan, George Joy, Jomon, and Kim, Jin-Chul
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- *
ION pairs , *PHASE transitions , *STAINS & staining (Microscopy) , *TRANSITION temperature , *CRITICAL temperature , *THERMORESPONSIVE polymers - Abstract
Poly (acrylic acid) (PAA), an anionic polymer was used to prepare ion pair self-assembly (IPSAM) with 4-(methylthio)aniline (MTA), a hydrophobic counter ion, which is responsive to temperature and oxidation. The IPSAM was formed when the carboxylic to amino group molar ratio was 7/3-5/5. The structure of the IPSAM nanoparticle was spherical whose diameter was 30-40 nm on the TEM images. The PAA/MTA ion pair showed the upper critical solution temperature (UCST) that hiked with increasing MTA content. When the MTA of the ion pair was oxidized by H2O2, the UCST was also increased. The amphiphilic property of the ion pair was responsible for interface activity which declined upon the oxidation of the MTA. The surface tension was low for the ratio of PAA/MTA (5/5), which made the 5/5 ratio suitable for further studies. The interaction between PAA and MTA, which was ionic, and the oxidation of MTA was confirmed by FT-IR spectroscopy. The release of payload (i.e. Nile red) in IPSAM was restrained below the UCST but it was triggered above the phase transition temperature possibly due to the disintegration of the IPSAM whereas on MTA oxidation the release was shielded due to more hydrophobicity. The release was found to be higher in tumor environment temperature which could be controlled with the input concentration of H2O2 giving a stable IPSAM. The cell viability results showed that IPSAM has no significant cytotoxicity and can serve as a drug carrier for stimulus-response. [ABSTRACT FROM AUTHOR]
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- 2024
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26. 16 Impaired strain precedes fibrosis in lamin heart disease
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Constantin-Cristian Topriceanu, Mashael Al-Farih, Denis C Ilie-Ablachim, Matt Webber, George Joy, Stephen Pettit, Ben O’Brien, Alun D Hughes, Konstantinos Savvatis, Saidi Mohiddin, William Moody, Rick Steeds, Paolo E Puddu, Paolo Piras, James C Moon, Andrea Barison, and Gabriella Captur
- Published
- 2023
27. Prospective Case-Control Study of Cardiovascular Abnormalities 6 Months Following Mild COVID-19 in Healthcare Workers
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Rishi K Patel, Thomas A. Treibel, George Joy, Erik B. Schelbert, Charlotte Manisty, Mahdad Noursadeghi, Katia Menacho, Áine McKnight, Hunain Shiwani, Andreas Seraphim, Hibba Kurdi, Jessica Artico, Gabriella Captur, Timothée Evain, Nikoo Aziminia, Marianna Fontana, Iain Pierce, Robert Adam, John P Greenwood, James T Brown, Liza Chacko, Marta Fontes Oliveira, George Thornton, Rhodri H. Davies, COVIDsortium Investigators, Peter Kellman, João B Augusto, James C. Moon, Mervyn Andiapen, Clement Lau, and Anish N Bhuva
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Male ,Contrast Media ,Gadolinium ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,030218 nuclear medicine & medical imaging ,0302 clinical medicine ,Natriuretic peptide ,Prospective Studies ,Prospective cohort study ,Original Research ,Ejection fraction ,COVID-19, coronavirus disease-2019 ,LGE, late gadolinium enhancement ,troponin ,SARS-CoV-2, severe acute respiratory syndrome-coronavirus-2 ,Middle Aged ,late gadolinium enhancement ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Adult ,medicine.medical_specialty ,Myocarditis ,Adolescent ,medicine.drug_class ,Health Personnel ,Cardiovascular Abnormalities ,CMR, cardiovascular magnetic resonance ,Magnetic Resonance Imaging, Cine ,Asymptomatic ,Young Adult ,cardiovascular magnetic resonance ,03 medical and health sciences ,Artificial Intelligence ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Seroconversion ,LV, left ventricular ,SARS-CoV-2 ,Vascular disease ,business.industry ,Myocardium ,hsTnT, high-sensitivity troponin T ,Case-control study ,COVID-19 ,medicine.disease ,Case-Control Studies ,myocardial edema ,NT-proBNP, N-terminal pro–B-type natriuretic peptide ,myocarditis ,business - Abstract
Objectives The purpose of this study was to detect cardiovascular changes after mild severe acute respiratory syndrome coronavirus 2 infection. Background Concern exists that mild coronavirus disease 2019 may cause myocardial and vascular disease. Methods Participants were recruited from COVIDsortium, a 3-hospital prospective study of 731 health care workers who underwent first-wave weekly symptom, polymerase chain reaction, and serology assessment over 4 months, with seroconversion in 21.5% (n = 157). At 6 months post-infection, 74 seropositive and 75 age-, sex-, and ethnicity-matched seronegative control subjects were recruited for cardiovascular phenotyping (comprehensive phantom-calibrated cardiovascular magnetic resonance and blood biomarkers). Analysis was blinded, using objective artificial intelligence analytics where available. Results A total of 149 subjects (mean age 37 years, range 18 to 63 years, 58% women) were recruited. Seropositive infections had been mild with case definition, noncase definition, and asymptomatic disease in 45 (61%), 18 (24%), and 11 (15%), respectively, with 1 person hospitalized (for 2 days). Between seropositive and seronegative groups, there were no differences in cardiac structure (left ventricular volumes, mass, atrial area), function (ejection fraction, global longitudinal shortening, aortic distensibility), tissue characterization (T1, T2, extracellular volume fraction mapping, late gadolinium enhancement) or biomarkers (troponin, N-terminal pro–B-type natriuretic peptide). With abnormal defined by the 75 seronegatives (2 SDs from mean, e.g., ejection fraction 1,072 ms, septal T2 >52.4 ms), individuals had abnormalities including reduced ejection fraction (n = 2, minimum 50%), T1 elevation (n = 6), T2 elevation (n = 9), late gadolinium enhancement (n = 13, median 1%, max 5% of myocardium), biomarker elevation (borderline troponin elevation in 4; all N-terminal pro–B-type natriuretic peptide normal). These were distributed equally between seropositive and seronegative individuals. Conclusions Cardiovascular abnormalities are no more common in seropositive versus seronegative otherwise healthy, workforce representative individuals 6 months post–mild severe acute respiratory syndrome coronavirus 2 infection., Central Illustration
- Published
- 2021
28. Persistent symptoms after COVID-19 during the first wave are not associated with differential immunity to SARS-CoV-2
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Daniel Altmann, Catherine Reynolds, George Joy, Ashley Otter, Joseph Gibbons, Corinna Pade, Leo Swadling, Mala Maini, Tim Brooks, Amanda Semper, Aine McKnight, Mahdad Noursadeghi, Charlotte Manisty, Thomas Treibel, James Moon, and Rosemary Boyton
- Abstract
Among the unknowns in decoding the pathogenesis of SARS-CoV-2 persistent symptoms in Long Covid is whether there is a contributory role of abnormal immunity during acute infection - some have proposed that Long Covid may be a consequence of either an excessive or inadequate initial response. We analysed SARS-CoV-2 humoral and cellular immunity in healthcare workers infected during the first wave. Symptom questionnaires allowed stratification into those with persistent symptoms and those without for comparison. During the period up to 18-weeks post-infection, we observed no difference in antibody responses to spike, RBD or nucleoprotein, virus neutralisation, or T cell responses. Also, there was no difference in the profile of antibody waning. Analysis at 1-year, after two vaccine doses, comparing those with persistent symptoms to those without, again showed similar SARS-CoV-2 immunity. Thus, quantitative differences in SARS-CoV-2 adaptive immunity during acute infection are unlikely to contribute to Long Covid causality.
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- 2022
29. Detection of subclinical hypertrophic cardiomyopathy
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George Joy, James C. Moon, and Luis R. Lopes
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Cardiology and Cardiovascular Medicine - Published
- 2023
30. Immune boosting by B.1.1.529
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Catherine J, Reynolds, Corinna, Pade, Joseph M, Gibbons, Ashley D, Otter, Kai-Min, Lin, Diana, Muñoz Sandoval, Franziska P, Pieper, David K, Butler, Siyi, Liu, George, Joy, Nasim, Forooghi, Thomas A, Treibel, Charlotte, Manisty, James C, Moon, Amanda, Semper, Tim, Brooks, Áine, McKnight, Daniel M, Altmann, Rosemary J, Boyton, Hakam, Abbass, Aderonke, Abiodun, Mashael, Alfarih, Zoe, Alldis, Oliver E, Amin, Mervyn, Andiapen, Jessica, Artico, João B, Augusto, Georgina L, Baca, Sasha N L, Bailey, Anish N, Bhuva, Alex, Boulter, Ruth, Bowles, Olivia V, Bracken, Ben, O'Brien, Natalie, Bullock, Gabriella, Captur, Olivia, Carr, Nicola, Champion, Carmen, Chan, Aneesh, Chandran, Tom, Coleman, Jorge, Couto de Sousa, Xose, Couto-Parada, Eleanor, Cross, Teresa, Cutino-Moguel, Silvia, D'Arcangelo, Rhodri H, Davies, Brooke, Douglas, Cecilia, Di Genova, Keenan, Dieobi-Anene, Mariana O, Diniz, Anaya, Ellis, Karen, Feehan, Malcolm, Finlay, Marianna, Fontana, Sasha, Francis, David, Gillespie, Derek, Gilroy, Matt, Hamblin, Gabrielle, Harker, Georgia, Hemingway, Jacqueline, Hewson, Wendy, Heywood, Lauren M, Hickling, Bethany, Hicks, Aroon D, Hingorani, Lee, Howes, Ivie, Itua, Victor, Jardim, Wing-Yiu Jason, Lee, Melaniepetra, Jensen, Jessica, Jones, Meleri, Jones, Vikas, Kapil, Caoimhe, Kelly, Hibba, Kurdi, Jonathan, Lambourne, Aaron, Lloyd, Sarah, Louth, Mala K, Maini, Vineela, Mandadapu, Katia, Menacho, Celina, Mfuko, Kevin, Mills, Sebastian, Millward, Oliver, Mitchelmore, Christopher, Moon, James, Moon, Sam M, Murray, Mahdad, Noursadeghi, Ashley, Otter, Susana, Palma, Ruth, Parker, Kush, Patel, Mihaela, Pawarova, Steffen E, Petersen, Brian, Piniera, Lisa, Rannigan, Alicja, Rapala, Amy, Richards, Matthew, Robathan, Joshua, Rosenheim, Cathy, Rowe, Matthew, Royds, Jane, Sackville West, Genine, Sambile, Nathalie M, Schmidt, Hannah, Selman, Andreas, Seraphim, Mihaela, Simion, Angelique, Smit, Michelle, Sugimoto, Leo, Swadling, Stephen, Taylor, Nigel, Temperton, Stephen, Thomas, George D, Thornton, Art, Tucker, Ann, Varghese, Jessry, Veerapen, Mohit, Vijayakumar, Tim, Warner, Sophie, Welch, Hannah, White, Theresa, Wodehouse, Lucinda, Wynne, Dan, Zahedi, and Benjamin, Chain
- Subjects
B-Lymphocytes ,Mice ,SARS-CoV-2 ,T-Lymphocytes ,Spike Glycoprotein, Coronavirus ,Immunization, Secondary ,Animals ,COVID-19 ,Humans ,Cross Reactions ,Antibodies, Viral ,Antibodies, Neutralizing ,BNT162 Vaccine - Abstract
The Omicron, or Pango lineage B.1.1.529, variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) carries multiple spike mutations with high transmissibility and partial neutralizing antibody (nAb) escape. Vaccinated individuals show protection against severe disease, often attributed to primed cellular immunity. We investigated T and B cell immunity against B.1.1.529 in triple BioNTech BNT162b2 messenger RNA-vaccinated health care workers (HCWs) with different SARS-CoV-2 infection histories. B and T cell immunity against previous variants of concern was enhanced in triple-vaccinated individuals, but the magnitude of T and B cell responses against B.1.1.529 spike protein was reduced. Immune imprinting by infection with the earlier B.1.1.7 (Alpha) variant resulted in less durable binding antibody against B.1.1.529. Previously infection-naïve HCWs who became infected during the B.1.1.529 wave showed enhanced immunity against earlier variants but reduced nAb potency and T cell responses against B.1.1.529 itself. Previous Wuhan Hu-1 infection abrogated T cell recognition and any enhanced cross-reactive neutralizing immunity on infection with B.1.1.529.
- Published
- 2022
31. CO-CONNECT: A hybrid architecture to facilitate rapid discovery and access to UK wide data in the response to the COVID-19 pandemic (Preprint)
- Author
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Emily Jefferson, Christian Cole, Shahzad Mumtaz, Sam Cox, Tom Giles, Samuel Adejumo, Esmond Urwin, Daniel Lea, Calum McDonald, Joseph Best, Erum Masood, Gordon Milligan, Jenny Johnston, Scott Horban, Ipek Birced, Christopher Hall, Aaron Jackson, Clare Collins, Sam Rising, Charlotte Dodsley, Jill Hampton, Andrew Hadfield, Roberto Santos, Simon Tarr, Vasiliki Panagi, Joseph Lavagna, Tracy Jackson, Antony Chuter, Jillian Beggs, Magdalena Martinez-Queipo, Helen Ward, Julie von Ziegenweidt, Frances Burns, Jo Martin, Neil Sebire, Carole Morris, Declan Bradley, Rob Baxter, Anni Ahonen-Bishop, Amelia Shoemark, Ana Valdes, Benjamin J Ollivere, Charlotte Manisty, David William Eyre, Stephanie Gallant, George Joy, Andrew McAuley, David W Connell, Kate Northstone, Katie JM Jeffery, Emanuele Di Angelantonio, Amy McMahon, Matthew Walker, Malcolm Gracie Semple, Jessica Mai Sims, Emma Lawrence, Bethan Davies, J Kenneth Baillie, Ming Tang, Gary Leeming, Linda Power, Thomas Breeze, Natalie Gilson, Duncan J Murray, Chris Orton, Iain Pierce, Ian Hall, Shamez Ladhani, Matthew Whitaker, Laura Shallcross, David Seymour, Susheel Varma, Gerry Reilly, Andrew Morris, Susan Hopkins, Aziz Sheikh, and Philip Quinlan
- Abstract
BACKGROUND COVID-19 data have been generated across the UK as a by-product of clinical care and public health provision, and numerous bespoke and repurposed research endeavours. Analysis of these data has underpinned the UK’s response to the pandemic and informed public health policies and clinical guidelines. However, these data are held by different organisations and this fragmented landscape has presented challenges for public health agencies and researchers as they struggle to find, navigate permissions to access and interrogate the data they need to inform the pandemic response at pace. OBJECTIVE To transform UK COVID-19 diagnostic datasets to be Findable, Accessible, Interoperable and Reusable (FAIR). METHODS A federated infrastructure model was rapidly built to enable the automated and reproducible mapping of health Data Partners’ pseudonymised data to the OMOP common data model without the need for any data to leave the data controllers’ secure environments and to support federated cohort discovery queries and meta-analysis. RESULTS 56 datasets from 19 organisations are being connected to the federated network. The data includes research cohorts and COVID-19 data collected through routine health care provision linked to longitudinal healthcare records and demographics. The infrastructure is live, supporting aggregate level querying of data across the UK. CONCLUSIONS CO-CONNECT was developed by a multidisciplinary team enabling rapid COVID-19 data discovery, instantaneous meta-analysis across data sources, and is researching streamlined data extraction for egress into a Trusted Research Environment (TRE) for research and public health analysis. CO-CONNECT has the potential to make UK health data more interconnected and better able to answer national-level research questions whilst maintaining patient confidentiality and local governance procedures. CLINICALTRIAL
- Published
- 2022
32. Prognostic Value of Pulmonary Transit Time and Pulmonary Blood Volume Estimation Using Myocardial Perfusion CMR
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Charlotte Manisty, Kristopher D. Knott, Katia Menacho, Steffen E. Petersen, Hui Xue, Anish N Bhuva, Andreas Seraphim, Peter Kellman, João B Augusto, Rhodri H. Davies, Marianna Fontana, Thomas A. Treibel, Alun D. Hughes, Iain Pierce, George Joy, James C. Moon, and Jackie A. Cooper
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Male ,Magnetic Resonance Spectroscopy ,Cardiac index ,Blood volume ,030204 cardiovascular system & hematology ,outcomes ,Ventricular Function, Left ,030218 nuclear medicine & medical imaging ,0302 clinical medicine ,Risk Factors ,Interquartile range ,PTTn, pulmonary transit time normalized for heart rate ,Original Research ,PTT, pulmonary transit time ,Blood Volume ,Ejection fraction ,Hazard ratio ,Atrial fibrillation ,Middle Aged ,Prognosis ,ICD, implantable cardioverter-defibrillator ,Perfusion ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,MPR, myocardial perfusion reserve ,medicine.medical_specialty ,Magnetic Resonance Imaging, Cine ,MBF, myocardial blood flow ,PBV, pulmonary blood volume ,pulmonary blood volume ,03 medical and health sciences ,Artificial Intelligence ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,IQR, interquartile range ,Retrospective Studies ,Heart Failure ,business.industry ,first pass perfusion ,Hemodynamics ,Stroke Volume ,medicine.disease ,Confidence interval ,CI, confidence interval ,business ,AIF, arterial input function ,Mace - Abstract
Objectives The purpose of this study was to explore the prognostic significance of PTT and PBVi using an automated, inline method of estimation using CMR. Background Pulmonary transit time (PTT) and pulmonary blood volume index (PBVi) (the product of PTT and cardiac index), are quantitative biomarkers of cardiopulmonary status. The development of cardiovascular magnetic resonance (CMR) quantitative perfusion mapping permits their automated derivation, facilitating clinical adoption. Methods In this retrospective 2-center study of patients referred for clinical myocardial perfusion assessment using CMR, analysis of right and left ventricular cavity arterial input function curves from first pass perfusion was performed automatically (incorporating artificial intelligence techniques), allowing estimation of PTT and subsequent derivation of PBVi. Association with major adverse cardiovascular events (MACE) and all-cause mortality were evaluated using Cox proportional hazard models, after adjusting for comorbidities and CMR parameters. Results A total of 985 patients (67% men, median age 62 years [interquartile range (IQR): 52 to 71 years]) were included, with median left ventricular ejection fraction (LVEF) of 62% (IQR: 54% to 69%). PTT increased with age, male sex, atrial fibrillation, and left atrial area, and reduced with LVEF, heart rate, diabetes, and hypertension (model r2 = 0.57). Over a median follow-up period of 28.6 months (IQR: 22.6 to 35.7 months), MACE occurred in 61 (6.2%) patients. After adjusting for prognostic factors, both PTT and PBVi independently predicted MACE, but not all-cause mortality. There was no association between cardiac index and MACE. For every 1 × SD (2.39-s) increase in PTT, the adjusted hazard ratio for MACE was 1.43 (95% confidence interval [CI]: 1.10 to 1.85; p = 0.007). The adjusted hazard ratio for 1 × SD (118 ml/m2) increase in PBVi was 1.42 (95% CI: 1.13 to 1.78; p = 0.002). Conclusions Pulmonary transit time (and its derived parameter pulmonary blood volume index), measured automatically without user interaction as part of CMR perfusion mapping, independently predicted adverse cardiovascular outcomes. These biomarkers may offer additional insights into cardiopulmonary function beyond conventional predictors including ejection fraction., Central Illustration
- Published
- 2021
33. Abstract 11481: Non-Invasive Electrocardiographic Mapping of the Human Heart Through a Novel 'Cardiac Magnetic Resonance-Electrocardiographic Imaging' Solution for High Throughput Use
- Author
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Matthew Webber, George Joy, Debbie falconer, Xuyuan Tao, Iain Pierce, James Moon, Alun Hughes, Pier Lambiase, Yoram Rudy, Michele Orini, and Gabriella Captur
- Subjects
Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Background: Electrocardiographic imaging (ECGI) non-invasively maps the heart’s electrical activity through multiple leads on the body surface. Cardiologists need a safe, quick, affordable and re-usable ECGI method to apply to patients undergoing cardiovascular magnetic resonance (CMR), but current solutions are not suitable for high-throughput use. We developed a CMR-ECGI vest for high-throughput use and report the first in vivo results. Methods: We designed and fabricated the CMR-ECGI vest from cotton, containing 256 square (2x2cm) dry textile electrodes each tagged with a localisation marker ( Fig 1 ). Body surface potentials were recorded and co-registered with heart-torso geometries obtained from CMR ( Fig 2 ). Epicardial unipolar potentials were reconstructed using state-of-the-art ECGI algorithms (YR Lab) and local activation and repolarization times were computed using standard methods. Results: Ten healthy volunteers with normal resting ECGs were recruited (34±10years; 60% male). A recumbent 5-minute ECGI recording was performed (preparation time ~15 minutes for montage and doffing). 3 Tesla CMR provided baseline parameters (left ventricular ejection fraction [LVEF] 75±5%, right ventricular [RV] EF 57±5%, native T1 1275±23ms, T2 42±1ms) and showed no clinically significant late gadolinium enhancement. ECGI showed that the sites of earliest and latest activation were the basal RV ( Fig 3A ) and basal-lateral LV respectively ( Fig 3B ). Total duration of epicardial activation and repolarization was 73.3±8.9ms and 195±35.2ms, respectively. These epicardial activation patterns in health are in line with previously described ECGI data. Conclusions: We have developed a re-usable and high-throughput CMR-ECGI solution that is safe and well-tolerated in vivo . This technology is now available for large-scale clinical research use to provide deeper insights into the pathophysiology of arrhythmogenesis, through seamless integration with CMR.
- Published
- 2021
34. 12 Myocardial inflammation and diffuse fibrosis underpin the electrophysiological derangements of the ageing human heart–A CMR-ECGI study
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Pier D. Lambiase, Gabriella Captur, Iain Pierce, James C. Moon, Michele Orini, Alun D. Hughes, George Joy, Xuyuan Tao, Matthew Webber, Yoram Rudy, and Debbie Falconer
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Electrophysiology ,medicine.medical_specialty ,Ageing ,business.industry ,Diffuse fibrosis ,Internal medicine ,Myocardial inflammation ,Cardiology ,Medicine ,Human heart ,business - Published
- 2021
35. 20 Apical ischaemia is ubiquitous in apical hypertrophic cardiomyopathy and occurs before overt hypertrophy
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Rebecca K. Hughes, Saidi A Mohiddin, Gabriella Captur, Andreas Seraphim, Kristopher D Knott, James C. Moon, Peter Kellman, George Joy, João B Augusto, and Luis R. Lopes
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medicine.medical_specialty ,business.industry ,Internal medicine ,Ischemia ,medicine ,Cardiology ,Hypertrophic cardiomyopathy ,medicine.disease ,business ,Muscle hypertrophy - Published
- 2021
36. Myocardial Perfusion Defects in Hypertrophic Cardiomyopathy Mutation Carriers
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Gabriella Captur, Kristopher D Knott, João B Augusto, Saidi A. Mohiddin, Petros Syrris, Hui Xue, Claudia Camaioni, Rebecca K. Hughes, Perry M. Elliott, James C. Moon, Peter Kellman, Ellie Quinn, Andreas Seraphim, George Joy, and Luis R. Lopes
- Subjects
Adult ,Male ,Sarcomeres ,Heterozygote ,medicine.medical_specialty ,Cardiomyopathy ,Heart Ventricles ,Magnetic Resonance Imaging (MRI) ,Magnetic Resonance Imaging, Cine ,sarcomere mutations carriers without hypertrophy ,030204 cardiovascular system & hematology ,Coronary disease ,Imaging ,030218 nuclear medicine & medical imaging ,Electrocardiography ,03 medical and health sciences ,0302 clinical medicine ,Coronary Circulation ,Internal medicine ,Cardiomyopathy, Hypertrophic, Familial ,Humans ,Medicine ,genetics ,cardiovascular diseases ,Genetic Testing ,quantitative perfusion mapping ,Original Research ,business.industry ,Microcirculation ,Myocardial Perfusion Imaging ,Hypertrophic cardiomyopathy ,Blood flow ,hypertrophic cardiomyopathy ,medicine.disease ,Feature (computer vision) ,Mutation ,Mutation (genetic algorithm) ,Cardiology ,Female ,Hypertrophy, Left Ventricular ,Cardiology and Cardiovascular Medicine ,business ,Cardiac Myosins ,Perfusion ,Magnetic Resonance Angiography - Abstract
Background Impaired myocardial blood flow (MBF) in the absence of epicardial coronary disease is a feature of hypertrophic cardiomyopathy (HCM). Although most evident in hypertrophied or scarred segments, reduced MBF can occur in apparently normal segments. We hypothesized that impaired MBF and myocardial perfusion reserve, quantified using perfusion mapping cardiac magnetic resonance, might occur in the absence of overt left ventricular hypertrophy (LVH) and late gadolinium enhancement, in mutation carriers without LVH criteria for HCM (genotype‐positive, left ventricular hypertrophy‐negative). Methods and Results A single center, case‐control study investigated MBF and myocardial perfusion reserve (the ratio of MBF at stress:rest), along with other pre‐phenotypic features of HCM. Individuals with genotype‐positive, left ventricular hypertrophy‐negative (n=50) with likely pathogenic/pathogenic variants and no evidence of LVH, and matched controls (n=28) underwent cardiac magnetic resonance. Cardiac magnetic resonance identified LVH‐fulfilling criteria for HCM in 5 patients who were excluded. Individuals with genotype‐positive, left ventricular hypertrophy‐negative had longer indexed anterior mitral valve leaflet length (12.52±2.1 versus 11.55±1.6 mm/m 2 , P =0.03), lower left ventricular end‐systolic volume (21.0±6.9 versus 26.7±6.2 mm/m 2 , P ≤0.005) and higher left ventricular ejection fraction (71.9±5.5 versus 65.8±4.4%, P≤ 0.005). Maximum wall thickness was not significantly different (9.03±1.95 versus 8.37±1.2 mm, P =0.075), and no subject had significant late gadolinium enhancement (minor right ventricle‒insertion point late gadolinium enhancement only). Perfusion mapping demonstrated visual perfusion defects in 9 (20%) carriers versus 0 controls ( P =0.011). These were almost all septal or near right ventricle insertion points. Globally, myocardial perfusion reserve was lower in carriers (2.77±0.83 versus 3.24±0.63, P =0.009), with a subendocardial:subepicardial myocardial perfusion reserve gradient (2.55±0.75 versus 3.2±0.65, P =P =0.026) but equivalent MBF (2.75±0.82 versus 2.65±0.69 mL/g per min, P =0.826). Conclusions Regional and global impaired myocardial perfusion can occur in HCM mutation carriers, in the absence of significant hypertrophy or scarring.
- Published
- 2021
37. Impact of afterload and infiltration on coexisting aortic stenosis and transthyretin amyloidosis
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Simon Kennon, Nikant Sabharwal, James C. Moon, Julia Mascherbauer, George Thornton, Gabriella Captur, Leon Menezes, James D. Newton, Andreas A. Kammerlander, Guy Lloyd, George Joy, Therese Tillin, Rebecca K. Hughes, Francesca Pugliese, Paul Scully, Philip N. Hawkins, Mick Ozkor, Christian Nitsche, Andrew Kelion, Alun D. Hughes, Liza Chacko, Thomas A. Treibel, Michael P. Mullen, Julian D. Gillmore, Suzanne Williams, Kush Patel, and Marianna Fontana
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medicine.medical_specialty ,Amyloid Neuropathies, Familial ,biology ,business.industry ,Amyloidosis ,Cardiomyopathy ,Aortic Valve Stenosis ,medicine.disease ,Brain natriuretic peptide ,Transcatheter Aortic Valve Replacement ,Stenosis ,Transthyretin ,Cardiac amyloidosis ,Afterload ,Internal medicine ,Aortic valve stenosis ,medicine ,biology.protein ,Cardiology ,Humans ,Cardiology and Cardiovascular Medicine ,business ,Radionuclide Imaging - Abstract
ObjectiveThe coexistence of wild-type transthyretin cardiac amyloidosis (ATTR) is common in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). However, the impact of ATTR and AS on the resultant AS-ATTR is unclear and poses diagnostic and management challenges. We therefore used a multicohort approach to evaluate myocardial structure, function, stress and damage by assessing age-related, afterload-related and amyloid-related remodelling on the resultant AS-ATTR phenotype.MethodsWe compared four samples (n=583): 359 patients with AS, 107 with ATTR (97% Perugini grade 2), 36 with AS-ATTR (92% Perugini grade 2) and 81 age-matched and ethnicity-matched controls. 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) scintigraphy was used to diagnose amyloidosis (Perugini grade 1 was excluded). The primary end-point was NT-pro Brain Natriuretic Peptide (BNP) and secondary end-points related to myocardial structure, function and damage.ResultsCompared with older age controls, the three disease cohorts had greater cardiac remodelling, worse function and elevated NT-proBNP/high-sensitivity Troponin-T (hsTnT). NT-proBNP was higher in AS-ATTR (2844 (1745, 4635) ng/dL) compared with AS (1294 (1077, 1554)ng/dL; p=0.002) and not significantly different to ATTR (3272 (2552, 4197) ng/dL; p=0.63). Diastology, hsTnT and prevalence of carpal tunnel syndrome were statistically similar between AS-ATTR and ATTR and higher than AS. The left ventricular mass indexed in AS-ATTR was lower than ATTR (139 (112, 167) vs 180 (167, 194) g; p=0.013) and non-significantly different to AS (120 (109, 130) g; p=0.179).ConclusionsThe AS-ATTR phenotype likely reflects an early stage of amyloid infiltration, but the combined insult resembles ATTR. Even after treatment of AS, ATTR-specific therapy is therefore likely to be beneficial.
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- 2021
38. Pre-existing polymerase-specific T cells expand in abortive seronegative SARS-CoV-2 infection
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Christine Y.L. Tham, Laura E. McCoy, Corinna Pade, Lucy van Dorp, Áine McKnight, Francois Balloux, Antonio Bertoletti, Joseph M Gibbons, Gloryanne Aidoo-Micah, Ana M. Valdes, Cedric C.S. Tan, Emily Shaw, Joshua Rosenheim, Daniel M. Altmann, Leo Swadling, Rosemary J. Boyton, Stephanie Kucyowicz, Mariana O. Diniz, Mala K. Maini, George Joy, Aneesh Chandran, Melanie P. Jensen, Jessica Davies, Thomas A. Treibel, James C. Moon, Charlotte Manisty, COVIDsortium Investigators, Anthony T. Tan, Oliver E. Amin, Mahdad Noursadeghi, Nathalie M. Schmidt, and Nina Le Bert
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Biology ,biology.organism_classification ,medicine.disease_cause ,Virology ,Neutralization ,medicine.anatomical_structure ,In vivo ,Cohort ,biology.protein ,medicine ,Coronaviridae ,Antibody ,Seroconversion ,Memory T cell ,Coronavirus - Abstract
Individuals with likely exposure to the highly infectious SARS-CoV-2 do not necessarily develop PCR or antibody positivity, suggesting some may clear sub-clinical infection before seroconversion. T cells can contribute to the rapid clearance of SARS-CoV-2 and other coronavirus infections1–5. We hypothesised that pre-existing memory T cell responses, with cross-protective potential against SARS-CoV-26–12, would expand in vivo to mediate rapid viral control, potentially aborting infection. We studied T cells against the replication transcription complex (RTC) of SARS-CoV-2 since this is transcribed first in the viral life cycle13–15and should be highly conserved. We measured SARS-CoV-2-reactive T cells in a cohort of intensively monitored healthcare workers (HCW) who remained repeatedly negative by PCR, antibody binding, and neutralisation for SARS-CoV-2 (exposed seronegative, ES). 16-weeks post-recruitment, ES had memory T cells that were stronger and more multispecific than an unexposed pre-pandemic cohort, and more frequently directed against the RTC than the structural protein-dominated responses seen post-detectable infection (matched concurrent cohort). The postulate that HCW with the strongest RTC-specific T cells had an abortive infection was supported by a low-level increase in IFI27 transcript, a robust early innate signature of SARS-CoV-2 infection16. We showed that the RNA-polymerase within RTC was the largest region of high sequence conservation across human seasonal coronaviruses (HCoV) and was preferentially targeted by T cells from UK and Singapore pre-pandemic cohorts and from ES. RTC epitope-specific T cells capable of cross-recognising HCoV variants were identified in ES. Longitudinal samples from ES and an additional validation cohort, showed pre-existing RNA-polymerase-specific T cells expanded in vivo following SARS-CoV-2 exposure, becoming enriched in the memory response of those with abortive compared to overt infection. In summary, we provide evidence of abortive seronegative SARS-CoV-2 infection with expansion of cross-reactive RTC-specific T cells, highlighting these highly conserved proteins as targets for future vaccines against endemic and emerging Coronaviridae.
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- 2021
39. Blood transcriptional biomarkers of acute viral infection for detection of pre-symptomatic SARS-CoV-2 infection: a nested, case-control diagnostic accuracy study
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Rishi K Gupta, Joshua Rosenheim, Lucy C Bell, Aneesh Chandran, Jose A Guerra-Assuncao, Gabriele Pollara, Matthew Whelan, Jessica Artico, George Joy, Hibba Kurdi, Daniel M Altmann, Rosemary J Boyton, Mala K Maini, Aine McKnight, Jonathan Lambourne, Teresa Cutino-Moguel, Charlotte Manisty, Thomas A Treibel, James C Moon, Benjamin M Chain, Mahdad Noursadeghi, Hakam Abbass, Aderonke Abiodun, Mashael Alfarih, Zoe Alldis, Oliver E Amin, Mervyn Andiapen, João B Augusto, Georgiana L Baca, Sasha NL Bailey, Anish N Bhuva, Alex Boulter, Ruth Bowles, Olivia V Bracken, Ben O'Brien, Tim Brooks, Natalie Bullock, David K Butler, Gabriella Captur, Nicola Champion, Carmen Chan, David Collier, Jorge Couto de Sousa, Xose Couto-Parada, Rhodri H Davies, Brooke Douglas, Cecilia Di Genova, Keenan Dieobi-Anene, Mariana O Diniz, Anaya Ellis, Karen Feehan, Malcolm Finlay, Marianna Fontana, Nasim Forooghi, Celia Gaier, Joseph M Gibbons, Derek Gilroy, Matt Hamblin, Gabrielle Harker, Jacqueline Hewson, Lauren M Hickling, Aroon D Hingorani, Lee Howes, Alun Hughes, Gemma Hughes, Rebecca Hughes, Ivie Itua, Victor Jardim, Wing-Yiu Jason Lee, Melaniepetra Jensen, Jessica Jones, Meleri Jones, Vikas Kapil, Kai-Min Lin, Sarah Louth, Vineela Mandadapu, Áine McKnight, Katia Menacho, Celina Mfuko, Oliver Mitchelmore, Christopher Moon, Diana Munoz Sandoval, Sam M Murray, Ashley Otter, Corinna Pade, Susana Palma, Ruth Parker, Kush Patel, Babita Pawarova, Steffen E Petersen, Brian Piniera, Franziska P Pieper, Daniel Pope, Maria Prossora, Lisa Rannigan, Alicja Rapala, Catherine J Reynolds, Amy Richards, Matthew Robathan, Genine Sambile, Nathalie M Schmidt, Amanda Semper, Andreas Seraphim, Mihaela Simion, Angelique Smit, Michelle Sugimoto, Leo Swadling, Stephen Taylor, Nigel Temperton, Stephen Thomas, George D Thornton, Art Tucker, Jessry Veerapen, Mohit Vijayakumar, Sophie Welch, Theresa Wodehouse, Lucinda Wynne, Dan Zahedi, Medical Research Council (MRC), and UKRI
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Adult ,Male ,Microbiology (medical) ,medicine.medical_specialty ,Adolescent ,Standard score ,Sensitivity and Specificity ,Corrections ,Microbiology ,Virology ,Internal medicine ,Humans ,Medicine ,Prospective Studies ,Prospective cohort study ,COVIDsortium Investigators ,QR355 ,Receiver operating characteristic ,SARS-CoV-2 ,business.industry ,Risk of infection ,COVID-19 ,Gold standard (test) ,Articles ,Middle Aged ,Infectious Diseases ,Case-Control Studies ,Nested case-control study ,Biomarker (medicine) ,Female ,business ,Viral load ,Biomarkers - Abstract
Summary Background We hypothesised that host-response biomarkers of viral infections might contribute to early identification of individuals infected with SARS-CoV-2, which is critical to breaking the chains of transmission. We aimed to evaluate the diagnostic accuracy of existing candidate whole-blood transcriptomic signatures for viral infection to predict positivity of nasopharyngeal SARS-CoV-2 PCR testing. Methods We did a nested case-control diagnostic accuracy study among a prospective cohort of health-care workers (aged ≥18 years) at St Bartholomew's Hospital (London, UK) undergoing weekly blood and nasopharyngeal swab sampling for whole-blood RNA sequencing and SARS-CoV-2 PCR testing, when fit to attend work. We identified candidate blood transcriptomic signatures for viral infection through a systematic literature search. We searched MEDLINE for articles published between database inception and Oct 12, 2020, using comprehensive MeSH and keyword terms for "viral infection", "transcriptome", "biomarker", and "blood". We reconstructed signature scores in blood RNA sequencing data and evaluated their diagnostic accuracy for contemporaneous SARS-CoV-2 infection, compared with the gold standard of SARS-CoV-2 PCR testing, by quantifying the area under the receiver operating characteristic curve (AUROC), sensitivities, and specificities at a standardised Z score of at least 2 based on the distribution of signature scores in test-negative controls. We used pairwise DeLong tests compared with the most discriminating signature to identify the subset of best performing biomarkers. We evaluated associations between signature expression, viral load (using PCR cycle thresholds), and symptom status visually and using Spearman rank correlation. The primary outcome was the AUROC for discriminating between samples from participants who tested negative throughout the study (test-negative controls) and samples from participants with PCR-confirmed SARS-CoV-2 infection (test-positive participants) during their first week of PCR positivity. Findings We identified 20 candidate blood transcriptomic signatures of viral infection from 18 studies and evaluated their accuracy among 169 blood RNA samples from 96 participants over 24 weeks. Participants were recruited between March 23 and March 31, 2020. 114 samples were from 41 participants with SARS-CoV-2 infection, and 55 samples were from 55 test-negative controls. The median age of participants was 36 years (IQR 27–47) and 69 (72%) of 96 were women. Signatures had little overlap of component genes, but were mostly correlated as components of type I interferon responses. A single blood transcript for IFI27 provided the highest accuracy for discriminating between test-negative controls and test-positive individuals at the time of their first positive SARS-CoV-2 PCR result, with AUROC of 0·95 (95% CI 0·91–0·99), sensitivity 0·84 (0·70–0·93), and specificity 0·95 (0·85–0·98) at a predefined threshold (Z score >2). The transcript performed equally well in individuals with and without symptoms. Three other candidate signatures (including two to 48 transcripts) had statistically equivalent discrimination to IFI27 (AUROCs 0·91–0·95). Interpretation Our findings support further urgent evaluation and development of blood IFI27 transcripts as a biomarker for early phase SARS-CoV-2 infection for screening individuals at high risk of infection, such as contacts of index cases, to facilitate early case isolation and early use of antiviral treatments as they emerge. Funding Barts Charity, Wellcome Trust, and National Institute of Health Research.
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- 2021
40. Prospective case-control study of cardiovascular abnormalities six months following mild COVID-19 in healthcare workers
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Jessica Artico, Gabriella Captur, Thomas A. Treibel, Clement Lau, Robert Adam, Rhodri H Davies, Charlotte Manisty, Katia Menacho, Eric B. Schelbert, James C. Moon, Peter Kellman, I Pierce, George Joy, Hibba Kurdi, and Marianna Fontana
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medicine.medical_specialty ,Ejection fraction ,Myocarditis ,Myocardial Disease ,biology ,business.industry ,Convalescence ,media_common.quotation_subject ,General Medicine ,medicine.disease ,Troponin ,Asymptomatic ,Linear gingival erythema ,Internal medicine ,biology.protein ,medicine ,Radiology, Nuclear Medicine and imaging ,AcademicSubjects/MED00200 ,Seroconversion ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Prospective cohort study ,business ,media_common - Abstract
Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Barts Charity UCLH Charity OnBehalf COVIDsortium Background Recent CMR studies have reported cardiac abnormalities after COVID-19 are common, even after mild, non-hospitalised illness with evidence of ongoing myocardial inflammation. Such a prevalence of chronic myocarditis after mild disease has prompted societal concerns in diverse domains, and suggests that screening should be considered post COVID-19, even in asymptomatic individuals. Cardiovascular magnetic resonance (CMR) has proven utility for diagnosis in patients with COVID-19 infection and elevated troponin from unclear causes by measuring cardiac structure, function, myocardial scar (late gadolinium enhancement) and oedema (T1 and T2 mapping). Objectives We aimed to determine the prevalence and extent of late cardiac and cardiovascular sequelae after mild non-hospitalised SARS-CoV-2 infection. Methods Participants were recruited from COVIDsortium, a three-hospital prospective study of 731 healthcare workers who underwent first wave weekly symptom, PCR and serology assessment over 4 months, with seroconversion in 21.5% (n = 157). At 6 months post infection, 74 seropositive and 75 age-, sex-, ethnicity-matched seronegative controls were recruited for cardiovascular phenotyping (comprehensive phantom-calibrated Cardiovascular Magnetic Resonance and blood biomarkers). Analysis was blinded, using objective AI analytics where available. Results 149 subjects (mean age 37 years, range 18-63, 58% female) were recruited. Seropositive infections had been mild with case definition/non-case definition/asymptomatic disease in 45(61%), 18(24%) and 11(15%) with one person hospitalised (for 2 days). Between seropositive and seronegative groups, there were no differences in cardiac structure (left ventricular volumes, mass; atrial area), function (ejection fraction, global longitudinal shortening, aortic distensibility), tissue characterisation (T1, T2, ECV mapping, late gadolinium enhancement) or biomarkers (troponin, NT-proBNP). With abnormal defined by the 75 seronegatives (2 standard deviations from mean, e.g. EF 1072ms, septal T2 > 52.4ms), individuals had abnormalities including reduced EF (n = 2, minimum 50%), T1 elevation (n = 6), T2 elevation (n = 9), LGE (n = 13, median 1%, max 5% of myocardium), biomarker elevation (borderline troponin elevation in 4; all NT-proBNP normal). These were distributed equally between seropositive and seronegative individuals. Conclusions Cardiovascular abnormalities are no more common in seropositive vs seronegative otherwise healthy, workforce representative individuals 6 months post mild SARS-CoV-2 infection. Our study provides societal reassurance for the cardiovascular health of working-aged individuals with convalescence from mild SARS-CoV-2. Screening asymptomatic individuals following mild diseases is not indicated.
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- 2021
41. Phenotyping hypertrophic cardiomyopathy using cardiac diffusion magnetic resonance imaging: the relationship between microvascular dysfunction and microstructural changes
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Nicholas Jex, Amrit Chowdhary, Christopher Nguyen, Erica Dall’Armellina, James C. Moon, Rhodri H. Davies, Peter Kellman, Luis R. Lopes, Christopher Kelly, Irvin Teh, Peter P Swoboda, Jürgen E. Schneider, Arka Das, Noor Sharrack, John P Greenwood, Sharmaine Thirunavukarasu, Sven Plein, George Joy, Louise A.E. Brown, and Miroslawa Gorecka
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medicine.medical_specialty ,Magnetic Resonance Spectroscopy ,Contrast Media ,Magnetic Resonance Imaging, Cine ,Gadolinium ,Internal medicine ,Fractional anisotropy ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Systole ,Endocardium ,medicine.diagnostic_test ,business.industry ,Myocardium ,Hypertrophic cardiomyopathy ,Magnetic resonance imaging ,General Medicine ,Blood flow ,Cardiomyopathy, Hypertrophic ,medicine.disease ,Magnetic Resonance Imaging ,Diffusion Tensor Imaging ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Perfusion ,Diffusion MRI - Abstract
Aims Microvascular dysfunction in hypertrophic cardiomyopathy (HCM) is predictive of clinical decline, however underlying mechanisms remain unclear. Cardiac diffusion tensor imaging (cDTI) allows in vivo characterization of myocardial microstructure by quantifying mean diffusivity (MD), fractional anisotropy (FA) of diffusion, and secondary eigenvector angle (E2A). In this cardiac magnetic resonance (CMR) study, we examine associations between perfusion and cDTI parameters to understand the sequence of pathophysiology and the interrelation between vascular function and underlying microstructure. Methods and results Twenty HCM patients underwent 3.0T CMR which included: spin-echo cDTI, adenosine stress and rest perfusion mapping, cine-imaging, and late gadolinium enhancement (LGE). Ten controls underwent cDTI. Myocardial perfusion reserve (MPR), MD, FA, E2A, and wall thickness were calculated per segment and further divided into subendocardial (inner 50%) and subepicardial (outer 50%) regions. Segments with wall thickness ≤11 mm, MPR ≥2.2, and no visual LGE were classified as ‘normal’. Compared to controls, ‘normal’ HCM segments had increased MD (1.61 ± 0.09 vs. 1.46 ± 0.07 × 10−3 mm2/s, P = 0.02), increased E2A (60 ± 9° vs. 38 ± 12°, P Conclusion In HCM patients, even in segments with normal wall thickness, normal perfusion, and no scar, diffusion is more isotropic than in controls, suggesting the presence of underlying cardiomyocyte disarray. Increased E2A suggests the myocardial sheetlets adopt hypercontracted angulation in systole. Increased MD, most notably in the subendocardium, is suggestive of regional remodelling which may explain the reduced subendocardial blood flow.
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- 2021
42. Comparison of the prognostic value of stress and rest pulmonary transit time estimation using myocardial perfusion CMR
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Charlotte Manisty, Katia Menacho, Marianna Fontana, Thomas A. Treibel, X Hui, James C. Moon, Jacqueline A. Cooper, Peter Kellman, J Augusto, Kristopher D Knott, George Joy, Rhodri H Davies, Alun D. Hughes, Andreas Seraphim, and Steffen E. Petersen
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Tachycardia ,medicine.medical_specialty ,Ejection fraction ,Lung ,business.industry ,Transit time ,General Medicine ,medicine.disease ,medicine.anatomical_structure ,Internal medicine ,Heart failure ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,Myocardial infarction ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Perfusion ,Rest (music) - Abstract
Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Clinical Research Training Fellowship Background Pulmonary transit time (PTT) is a quantitative biomarker of cardiopulmonary status. Rest PTT was previously shown to predict outcomes in specific disease models, but clinical adoption is hindered but challenges in data acquisition. Whether evaluation of PTT during stress encodes incremental prognostic information has not been previously investigated as scale. Objectives To compare the prognostic value of stress and rest PTT derived from a fully automated, in-line method of estimation using perfusion CMR, in a large patient cohort. Methods A retrospective two-center study of patients referred clinically for adenosine stress myocardial perfusion assessment using CMR. Analysis of right and left ventricular cavity arterial input function curves from first pass perfusion was performed automatically, allowing the in-line estimation of both rest and stress PTT. Association with major adverse cardiovascular events (MACE) was evaluated. MACE was defined as a composite outcome of myocardial infarction, stroke, heart failure admission and ventricular tachycardia or appropriate ICD treatment (including ICD shock and/or anti-tachycardia pacing). Results 985 patients (67% male, median age 62 years (IQR 52,71)) were included, with median left ventricular ejection fraction (LVEF) of 62% (IQR 54-69). Median stress PTT was shorter than rest PTT 6.2 (IQR 5.1, 7.7) seconds versus 7.7 (IQR, 6.4, 9.2) seconds. Stress and rest PTT were highly correlated (r = 0.69; p Conclusions In this 2-center study of 985 patients, we deploy a fully automated method of PTT estimation using perfusion mapping with CMR and show that both stress and rest PTT are independently associated with adverse cardiovascular outcomes. In this patient cohort, there is no clear incremental prognostic value of stress PTT, over its evaluation during rest. Figure 1. Stress and Rest Pulmonary Transit Time estimation using myocardial perfusion CMR Figure 2. Event-free survival curves for major adverse cardiovascular events (Heart failure hospitalization, myocardial infarction, stroke and ventricular tachycardia/ICD treatment) according to mean rest PTT (8.05seconds) and mean stress PTT (6.7seconds). Log-rank for both p
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- 2021
43. Fluorouracil-induced Takotsubo cardiomyopathy causing cardiogenic shock: a case report of clinical and acute cardiac magnetic resonance imaging features
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Steven K White, Riyad Al Karoudi, George Joy, and Hany Eissa
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Flourouracil ,Inotrope ,medicine.medical_specialty ,Cardiomyopathy ,Case Reports ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,FOLFOX ,Cardiac magnetic resonance imaging ,Internal medicine ,Case report ,medicine ,Cardiac MRI ,Cardiotoxicity ,medicine.diagnostic_test ,business.industry ,Cardiogenic shock ,medicine.disease ,Chemotherapy regimen ,030220 oncology & carcinogenesis ,Cardiology ,Takotsubo cardiomyopathy ,Cardiology and Cardiovascular Medicine ,Complication ,business ,medicine.drug - Abstract
Background Takotsubo cardiomyopathy (TTS) is an extremely rare complication of fluorouracil containing chemotherapy regimes such as FOLFOX used for colorectal cancer, occurring in only five previous case reports. Due to its potentially fatal outcomes, yet infrequent presence in the literature, it is worthwhile reviewing the clinical features and outcomes of this phenomenon. Case summary A 54-year-old lady was admitted with cardiogenic shock. A cardiac magnetic resonance imaging (CMR) showed mid-ventricle to apical hypokinesis and confirmed TTS. She was managed with inotropes and non-invasive ventilation after which she recovered fully both clinically and in her CMR features 6 weeks following discharge. Discussion This is the first case showing the acute CMR features of this complication and highlights the need for awareness of this rarely occurring cardiotoxicity. It also shows the potentially fatal phenomenon can be fully reversible when diagnosed and managed promptly even in patients with metastatic cancer and critical illness.
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- 2019
44. Blood transcriptional biomarkers of acute viral infection for detection of pre-symptomatic SARS-CoV-2 infection
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Hibba Kurdi, Matthew Whelan, Gabriele Pollara, Jonathan Lambourne, James C. Moon, Rosemary J. Boyton, José Afonso Guerra-Assunção, Jessica Artico, Joshua Rosenheim, Daniel M. Altmann, Mahdad Noursadeghi, Teresa Cutino-Moguel, Thomas A. Treibel, Aneesh Chandran, Charlotte Manisty, Mala K. Maini, Lucy C K Bell, George Joy, Rishi K Gupta, Áine McKnight, and Benjamin M. Chain
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Receiver operating characteristic ,business.industry ,Transmission (medicine) ,Convalescence ,media_common.quotation_subject ,Confidence interval ,Virus ,Immunology ,Biomarker (medicine) ,Medicine ,Prospective cohort study ,business ,Viral load ,media_common - Abstract
We hypothesised that host-response biomarkers of viral infections may contribute to early identification of SARS-CoV-2 infected individuals, critical to breaking chains of transmission. We identified 20 candidate blood transcriptomic signatures of viral infection by systematic review and evaluated their ability to detect SARS-CoV-2 infection, compared to the gold-standard of virus PCR tests, among a prospective cohort of 400 hospital staff subjected to weekly testing when fit to attend work. The transcriptional signatures had limited overlap, but were mostly co-correlated as components of type 1 interferon responses. We reconstructed each signature score in blood RNA sequencing data from 41 individuals over sequential weeks spanning a first positive SARS-CoV-2 PCR, and after 6-month convalescence. A single blood transcript for IFI27 provided the highest accuracy for discriminating individuals at the time of their first positive viral PCR result from uninfected controls, with area under the receiver operating characteristic curve (AUROC) of 0.95 (95% confidence interval 0.91–0.99), sensitivity 0.84 (0.7–0.93) and specificity 0.95 (0.85–0.98) at a predefined test threshold. The test performed equally well in individuals with and without symptoms, correlated with viral load, and identified incident infections one week before the first positive viral PCR with sensitivity 0.4 (0.17–0.69) and specificity 0.95 (0.85–0.98). Our findings strongly support further urgent evaluation and development of blood IFI27 transcripts as a biomarker for early phase SARS-CoV-2 infection, for screening individuals such as contacts of index cases, in order to facilitate early case isolation and early antiviral treatments as they emerge.
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- 2021
45. Use of quantitative myocardial perfusion mapping by CMR for characterisation of ischaemia in patients post coronary artery bypass graft surgery
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Peter Kellman, João B Augusto, Andreas Seraphim, Anish N Bhuva, Hui Xue, Anne-Marie Beirne, James C. Moon, Charlotte Manisty, Kristopher D Knott, Katia Menacho, T Triebel, Daniel A. Jones, Ryo Torii, George Joy, and Jessica Artico
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medicine.medical_specialty ,Ejection fraction ,business.industry ,Ischemia ,Infarction ,General Medicine ,Internal thoracic artery ,medicine.disease ,Coronary artery bypass surgery ,medicine.anatomical_structure ,Coronary occlusion ,Internal medicine ,medicine.artery ,cardiovascular system ,Cardiology ,Medicine ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business ,Perfusion ,circulatory and respiratory physiology ,Artery - Abstract
Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Background Quantitative myocardial perfusion mapping using Cardiac Magnetic Resonance (CMR) imaging is used for evaluation of ischaemia in the context of native vessel coronary disease, but its diagnostic performance in patients with grafts is not well established. Perfusion defects are often detected in these patients, but whether these are a consequence of a technical limitation (delayed contrast arrival from graft conduits) or a true reflection of reduced myocardial blood flow is unclear. Methods 39 patients undergoing stress perfusion CMR with previous coronary artery bypass graft (CABG) surgery, unobstructed left internal mammary artery (LIMA) grafts to the left anterior descending (LAD) artery on coronary angiography and no CMR evidence of prior LAD infarction were included. Myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) were evaluated with quantitative perfusion mapping and the factors determining MBF in the LIMA-LAD territory (AHA segments 1,2,7,8,13,14), including the impact of delayed contrast arrival through the LIMA graft were evaluated. Results In 28 out of 39 cases a myocardial perfusion defect was reported on visual assessment in LIMA-LAD myocardial territory, despite the presence of unobstructed LIMA graft and no LAD infarction. Chronic total occlusion (CTO) of the native LAD was an independent predictor of stress MBF (B=-0.36, p =0.027) and the strongest predictor of MPR (B=-0.55, p 0.005) within the LIMA-LAD myocardial territory after adjusting for age, left ventricular (LV) ejection fraction, and presence of diabetes. CTO of the native LAD was associated with a reduction in stress MBF in the basal myocardial segments (-0.57ml/g/min, p = 0.002) but had no effect on the MBF of apical segments (-0.31ml/g/min, p = 0.084). Increasing the maximum value for allowable arterial delay (TA) of contrast in the quantitative mapping algorithm resulted in a small increase in myocardial blood flow in the LIMA-LAD territory both at stress (0.07 ± 0.08ml/g/min, p Conclusions Perfusion defects detected in LIMA-LAD subtended territories are common despite graft patency. These defects are likely to represent genuine reduction in MBF, resulting from native LAD coronary occlusion. Prolonged contrast transit time associated with LIMA grafts results in small underestimation of MBF as measured by quantitative CMR perfusion mapping, but does not account for the degree of MBF reduction seen in these patients. Figure 1. Study patient with unobstructed LIMA to LAD graft and evidence of inducible perfusion defect in LIMA-LAD territories. (A): First pass perfusion CMR imaging. (B): Perfusion mapping showing reduced stress MBF in mid antero-septum (0.85ml/g/min) compared to the apical septum (1.65ml/g/min). (C): Late gadolinium enhancement showing no evidence of previous infarction. (D,E): Coronary angiography demonstrating unobstructed LIMA graft (D) and anastomosis site (E). Abstract Figure 1.
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- 2021
46. Influences on myocardial perfusion in non-obstructive coronary disease: an observational quantitative perfusion mapping study
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Claudia Camaioni, J Augusto, Peter Kellman, Tushar Kotecha, Charlotte Manisty, Lae Brown, Hui Xue, James C. Moon, Kristopher D Knott, Sven Plein, George Joy, Andreas Seraphim, Anish N Bhuva, Joyce Wong, and M Fontana
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medicine.medical_specialty ,business.industry ,General Medicine ,Coronary disease ,Quantitative perfusion ,Internal medicine ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,Observational study ,Cardiology and Cardiovascular Medicine ,business ,Perfusion ,Mapping study - Abstract
Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This study was supported by a Clinical Training Research Fellowship (K. Knott) from the British Heart Foundation and directly and indirectly from the Biomedical Research Centre at University College London Hospitals and Barts Heart Centre. Background Cardiovascular magnetic resonance (CMR) with automated inline perfusion mapping permits rapid fully automated non-invasive myocardial blood flow (MBF, ml/g/min). Understanding the microvascular component of MBF would help optimize epicardial coronary artery disease detection and potentially serve as an independent diagnostic / therapeutic target. Purpose To explore MBF influences at stress and rest in patients with unobstructed epicardial coronary arteries. Methods 242 participants (mean age 56.9 years) from 5 European centers with unobstructed epicardial coronary arteries and no myocardial scar underwent adenosine vasodilator perfusion mapping at stress and rest. The factors influencing MBF were determined using univariate and multivariate linear regression analyses. Results Mean rest perfusion was 0.91+/-0.24ml/g/min. Rest perfusion was higher in females (0.97+/-0.22ml/g/min vs 0.83 +/- 0.24ml/g/min) and lower in patients on beta blockers. Mean stress MBF was 2.53+/-0.82ml/g/min. Factors independently associated with reduced stress MBF were increasing age, diabetes, increasing left ventricular mass (LVMi) and the use of beta blockers. The predicted stress MBF can be obtained from the equation MBF = 2.66–0.015(age-60)–0.013(LVMi-57)-0.405(diabetes)–0.365(beta blocker). This means stress MBF falls 10% over 19 years and that diabetes drops the MBF by the equivalent of being 27 years older. These changes are large: for example, a 70-year-old diabetic would have 30% lower stress MBF than a 35 year-old non-diabetic. Conclusions In the absence of obstructive epicardial coronary disease, stress MBF falls with age, diabetes, increased LV mass and beta-blockers. These data may help develop normal reference ranges, input to other modelling (eg CT FFR), and they advance perfusion mapping as a measure of microvascular function. Abstract Figure. Summary of the determinants of perfusion
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- 2021
47. Microvascular and mechanical improvements following bariatric surgery in the obese; mechanistic insights from advanced & automated quantitative perfusion cardiac MRI
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Hui Xue, Charlotte Manisty, George Joy, JD Crane, BM Mcgowan, J Augusto, Peter Kellman, Anish N Bhuva, James C. Moon, Clement Lau, JK Cruickshank, and Andreas Seraphim
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medicine.medical_specialty ,Ejection fraction ,business.industry ,Diastole ,General Medicine ,Stroke volume ,medicine.disease ,Quantitative perfusion ,Internal medicine ,Heart failure ,medicine ,Cardiology ,End-diastolic volume ,Radiology, Nuclear Medicine and imaging ,Systole ,Cardiology and Cardiovascular Medicine ,business ,Perfusion - Abstract
Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Guy"s and St Thomas" Charity University College London Hospital Biomedical Research Centre Background In people with obesity, bariatric surgery reduces mortality, heart failure and coronary disease, improving metabolic (blood sugar, lipid profile, inflammation) and cardiovascular (diastolic/systolic function, filling pressure, cardiac remodelling) parameters. Myocardial microvascular function is a candidate causal link of metabolic to structural cardiac abnormalities. Purpose We hypothesised that bariatric surgery could improve myocardial microvascular and mechanical function in both those with and without diabetes. Methods Before and six months after bariatric surgery, 24 subjects with obesity were assessed with haematology, biochemistry and advanced CMR (cines, vasodilator adenosine stress and rest fully-automated quantitative perfusion mapping, tissue-tracking (CVI42, post processing). Results. Mean age was 49± 12 years, 35%(8) were male, 63%(15), had hypertension, 17 (71%) had diabetes. Surgery resulted in decreases in BMI (44 ± 7 to 34 ± 6 kg/m2 p = 0.0001) and HbA1c (57 ± 16 to 42 ± 9mmol/mol p = 0.0001). EF% and absolute LV end-diastolic volumes remained unchanged, but mass regressed and myocardial contraction fraction (ratio of stroke volume and LV volume) increased (see Table). There were also strain improvements (radial 35 ± 8.8 to 37.3 ± 8.7 %p = 0.029) (circumferential -19.8 ± 2.3 vs -20.7 ± 3% p = 0.017), although longitudinal did not improve (-16.3 ± 3.2 to -15.9 ± 3% p = 0.25). Myocardial perfusion significantly improved (stress myocardial blood flow, MBF 2.35 ± 0.71 to 2.80 ± 0.98 ml/g/min p = 0.008; myocardial perfusion reserve MPR 2.47 ± 0.78 to 2.97 ± 0.95 p = 0.005). Improvement in stress MBF and MPR from pre-operative to post-operative was higher in the non-diabetics (n = 7 (29%)) than the diabetics (n = 17 (71%)) (stress MBF: 1.15 ± 1.00 vs 0.16 ± 0.39ml/g/min p = 0.002) MPR: (1.09 ± 0.73 vs 0.25 ± 0.66 p = 0.011). Conclusion At 6 months, bariatric surgery results in beneficial myocardial remodelling and substantial improvements in myocardial microvascular function. These improvements occur most in those without diabetes suggesting that there may be reversible and irreversible components to microvascular dysfunction. Perfusion and strain variables Variable Pre-op (n = 24) Post-op (n = 24) p-value LVEDV (ml) 163 ± 28 161 ± 29 0.64 EF (%) 70 ± 8 70 ± 7 0.78 Stroke volume (ml) 113 ± 19 111 ± 21 0.6 LV Mass (g) 117 ± 25 103 ± 21 0.001 Myocardial contraction fraction 94 ± 14 105 ± 14 0.001 LVEDV - left ventricular end-diastolic volume, EF - ejection fraction Abstract Figure.
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- 2021
48. Impact of obesity on myocardial microvasculature assessed using fully-automated inline myocardial perfusion mapping CMR
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Hui Xue, Amrit Chowdhary, James C. Moon, Peter Kellman, Tushar Kotecha, Charlotte Manisty, Clement Lau, J Augusto, JK Cruickshank, Sven Plein, M Fontana, Lae Brown, George Joy, JD Crane, and BM Mcgowan
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medicine.medical_specialty ,Ejection fraction ,business.industry ,Diastole ,General Medicine ,Microvascular Network ,Fully automated ,Metabolic disturbance ,Internal medicine ,medicine ,Cardiology ,End-diastolic volume ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business ,Perfusion ,Endocardium - Abstract
Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Guy"s and St Thomas" Charity University College London Hospitals Biomedical Research Centre Background Obesity and cardiovascular disease are associated, but the relationship is poorly understood. Myocardial perfusion, metabolic derangement and lipotoxicity appear adversely associated in many scenarios (myocardial injury, diastolic dysfunction, diabetes). Altered perfusion (by PET) predicts outcome, and it is hypothesised that perfusion derangement is part of causality for cardiac disease and adverse outcomes. Purpose To assess the presence and pattern of myocardial microvascular dysfunction in patients with obesity (scheduled for bariatric surgery) using stress quantitative perfusion mapping. Methods 38 subjects with obesity planned to undergo bariatric surgery and 38 age and sex matched healthy volunteers (no diabetes, no hypertension) underwent anthropometry, biochemistry and CMR at 1.5T (Siemens) with cine imaging, stress (adenosine 140-210 mcg/kg/min) and rest fully-automated quantitative perfusion mapping. Results Bariatric patients had a higher BMI (44 ± 6.4 vs 26.5 ± 4kg/m2 p = 0.001); 58%(22) were diabetic and 58%(22) had hypertension. Bariatric patients had higher absolute but lower indexed end-diastolic volumes, and overall higher ejection fractions (+5%) (see Table). Rest myocardial blood flow (MBF) in bariatric patients was the same (1.00 ± 0.3 vs 0.88 ± 0.24 p = 0.052), but stress perfusion results were significantly lower both for stress MBF (2.35 ± 0.69 vs 2.93 ± 0.76ml/g/min p = 0.001) and myocardial perfusion reserve (MPR 2.48 ± 0.82 vs 3.4 ± 0.81ml/g/min p = 0.0001). Although this was transmural, the endocardial stress MBF was particularly negatively affected in the bariatric cohort compared to controls (endocardial MBF 2.16 ± 0.65 vs 2.82 ± 0.73ml/g/min, p = 0.0001 vs epicardial MBF: 2.52 ± 0.76 vs 3.06 ± 0.79 p = 0.003), meaning there was an increased endo-epicardial stress MBF gradient in bariatric patients (0.87 ± 0.12 vs 0.92 ± 0.07 p = 0.03). Conclusion Compared to healthy controls, patients with obesity have abnormal myocardial stress perfusion with reduced global perfusion, perfusion reserve and an increased transmyocardial perfusion gradient. Table - myocardial perfusion parameters Category Bariatric patients n = 38 Controls n = 38 p value Age (years) 48 ± 11 45 ± 13 0.25 n male (%) 12 (32%) 10 (36%) 0.32 LVEDV (ml) 168 ± 37 149 ± 31 0.017 LVEDVi (ml/m2) 70.4 ± 12.3 78.8 ± 12.1 0.004 LV Mass (g) 116 ± 31 99 ± 28 0.019 EF (%) 70 ± 8 65 ± 5 0.002 LVEDV - left ventricular end-diastolic volume, EF - ejection fraction
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- 2021
49. Acute coronary syndrome caused by extrinsic coronary compression from an aortic root abscess in a patient with mechanical aortic valve endocarditis: a case report and literature review
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George Joy, Stephen Furniss, and Michael Lewis
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Acute coronary syndrome ,medicine.medical_specialty ,medicine.medical_treatment ,Aortic root abscess ,Case Report ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Coronary compression ,Internal medicine ,medicine ,Endocarditis ,AcademicSubjects/MED00200 ,030212 general & internal medicine ,Myocardial infarction ,Abscess ,business.industry ,Cardiogenic shock ,Percutaneous coronary intervention ,Mechanical Aortic Valve ,medicine.disease ,Infective endocarditis ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Extrinsic coronary compression is an extremely rare complication of aortic root abscess formation and can manifest as an acute coronary syndrome in infective endocarditis. Optimal management strategies are unknown and therefore illustrative case reports may be informative. Case summary We describe a 63-year-old man with a background history of a mechanical aortic valve who developed sepsis due to Escherichia coli bacteraemia from a presumed urinary source. He suddenly deteriorated with cardiogenic shock and anterior ST-segment elevation myocardial infarction on Day 16 and received emergency percutaneous coronary intervention for severe stenoses of left anterior descending and diagonal arteries. A transoesophageal echocardiogram 2 days later demonstrated a large aortic root abscess. He was transferred for emergency surgery which revealed a large aortic abscess surrounding the left main stem confirming extrinsic coronary compression. He received a redo tissue aortic valve replacement and repair of his abscess cavity. Discussion We describe a case where percutaneous coronary intervention and emergency surgery was used to treat extrinsic compression from an aortic root abscess; a complication that is associated with a high mortality. This is also a rare case of E. coli causing prosthetic valve endocarditis. We also explore the findings of 11 previous cases of extrinsic coronary compression from aortic root abscess.
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- 2020
50. Time series analysis and mechanistic modelling of heterogeneity and sero-reversion in antibody responses to mild SARS‑CoV-2 infection
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Teresa Cutino-Moguel, James C. Moon, Ashley Otter, Stephen Taylor, Marianna Fontana, Benjamin M. Chain, Christopher William Moon, Mervyn Andiapen, Jonathan Lambourne, Dylan M. Williams, Daniel M. Altmann, Amanda Semper, Steve Thomas, Melanie Jensen, Mala K. Maini, George Joy, Rishi K Gupta, Mahdad Noursadeghi, Jason J. Lee, Rosemary J. Boyton, Thomas A. Treibel, Meleri Jones, Joseph M Gibbons, Corrina Pade, Joanna Bacon, Jessica Jones, Charlotte Manisty, Áine McKnight, and Medical Research Council (MRC)
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0301 basic medicine ,Health Personnel ,lcsh:Medicine ,Antibodies, Viral ,Asymptomatic ,General Biochemistry, Genetics and Molecular Biology ,Serology ,1117 Public Health and Health Services ,03 medical and health sciences ,0302 clinical medicine ,Protein Domains ,medicine ,Coronavirus Nucleocapsid Proteins ,Humans ,Prospective cohort study ,Neutralizing antibody ,lcsh:R5-920 ,biology ,business.industry ,SARS-CoV-2 ,lcsh:R ,Viral nucleocapsid ,COVID-19 ,1103 Clinical Sciences ,General Medicine ,Phosphoproteins ,Antibodies, Neutralizing ,Immunoglobulin A ,030104 developmental biology ,030220 oncology & carcinogenesis ,SARS-CoV-2, Serology, Mathematical modelling, Sero-reversion ,Immunoglobulin G ,Humoral immunity ,Immunology ,Spike Glycoprotein, Coronavirus ,biology.protein ,Antibody ,medicine.symptom ,business ,lcsh:Medicine (General) ,Blood sampling ,Research Paper - Abstract
BACKGROUND: SARS-CoV-2 serology is used to identify prior infection at individual and at population level. Extended longitudinal studies with multi-timepoint sampling to evaluate dynamic changes in antibody levels are required to identify the time horizon in which these applications of serology are valid, and to explore the longevity of protective humoral immunity. METHODS: Healthcare workers were recruited to a prospective cohort study from the first SARS-CoV-2 epidemic peak in London, undergoing weekly symptom screen, viral PCR and blood sampling over 16-21 weeks. Serological analysis (n =12,990) was performed using semi-quantitative Euroimmun IgG to viral spike S1 domain and Roche total antibody to viral nucleocapsid protein (NP) assays. Comparisons were made to pseudovirus neutralizing antibody measurements. FINDINGS: A total of 157/729 (21.5%) participants developed positive SARS-CoV-2 serology by one or other assay, of whom 31.0% were asymptomatic and there were no deaths. Peak Euroimmun anti-S1 and Roche anti-NP measurements correlated (r = 0.57, p
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- 2020
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