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1. Stroke and atrial fibrillation in hypertrophic cardiomyopathy

Author

Guttmann, O. P.

Abstract

Hypertrophic cardiomyopathy (HCM) is an inherited myocardial disease associated with atrial fibrillation (AF) and thromboembolism (TE), which are related to adverse clinical outcomes and reduced survival. Current ESC and ACCF/AHA guidelines recommend anticoagulation in all patients with HCM and atrial fibrillation but the absolute risk of thromboembolism in patients with and without documented AF is unclear. The primary aim of this study was to derive and validate a model for estimating the risk of TE in HCM. Analyses were performed to determine predictors of AF and TE. Exploratory analyses assessed the performance of the CHA2DS2-VASc score and outcome with vitamin K antagonists (VKA). A further aim was to investigate the effect of AF on mortality and the efficacy of antiarrhythmic therapy in the development of AF.

Published
2015

4. Acute Myocarditis Associated With Desmosomal Gene Variants

Author

Ammirati, E, Raimondi, F, Piriou, N, Sardo Infirri, L, Mohiddin, S, Mazzanti, A, Shenoy, C, Cavallari, U, Imazio, M, Aquaro, G, Olivotto, I, Pedrotti, P, Sekhri, N, Van de Heyning, C, Broeckx, G, Peretto, G, Guttmann, O, Dellegrottaglie, S, Scatteia, A, Gentile, P, Merlo, M, Goldberg, R, Reyentovich, A, Sciamanna, C, Klaassen, S, Poller, W, Trankle, C, Abbate, A, Keren, A, Horowitz-Cederboim, S, Cadrin-Tourigny, J, Tadros, R, Annoni, G, Bonoldi, E, Toquet, C, Marteau, L, Probst, V, Trochu, J, Kissopoulou, A, Grosu, A, Kukavica, D, Trancuccio, A, Gil, C, Tini, G, Pedrazzini, M, Torchio, M, Sinagra, G, Gimeno, J, Bernasconi, D, Valsecchi, M, Klingel, K, Adler, E, Camici, P, Cooper, L, Ammirati E., Raimondi F., Piriou N., Sardo Infirri L., Mohiddin S. A., Mazzanti A., Shenoy C., Cavallari U. A., Imazio M., Aquaro G. D., Olivotto I., Pedrotti P., Sekhri N., Van de Heyning C. M., Broeckx G., Peretto G., Guttmann O., Dellegrottaglie S., Scatteia A., Gentile P., Merlo M., Goldberg R. I., Reyentovich A., Sciamanna C., Klaassen S., Poller W., Trankle C. R., Abbate A., Keren A., Horowitz-Cederboim S., Cadrin-Tourigny J., Tadros R., Annoni G. A., Bonoldi E., Toquet C., Marteau L., Probst V., Trochu J. N., Kissopoulou A., Grosu A., Kukavica D., Trancuccio A., Gil C., Tini G., Pedrazzini M., Torchio M., Sinagra G., Gimeno J. R., Bernasconi D., Valsecchi M. G., Klingel K., Adler E. D., Camici P. G., Cooper L. T., Ammirati, E, Raimondi, F, Piriou, N, Sardo Infirri, L, Mohiddin, S, Mazzanti, A, Shenoy, C, Cavallari, U, Imazio, M, Aquaro, G, Olivotto, I, Pedrotti, P, Sekhri, N, Van de Heyning, C, Broeckx, G, Peretto, G, Guttmann, O, Dellegrottaglie, S, Scatteia, A, Gentile, P, Merlo, M, Goldberg, R, Reyentovich, A, Sciamanna, C, Klaassen, S, Poller, W, Trankle, C, Abbate, A, Keren, A, Horowitz-Cederboim, S, Cadrin-Tourigny, J, Tadros, R, Annoni, G, Bonoldi, E, Toquet, C, Marteau, L, Probst, V, Trochu, J, Kissopoulou, A, Grosu, A, Kukavica, D, Trancuccio, A, Gil, C, Tini, G, Pedrazzini, M, Torchio, M, Sinagra, G, Gimeno, J, Bernasconi, D, Valsecchi, M, Klingel, K, Adler, E, Camici, P, Cooper, L, Ammirati E., Raimondi F., Piriou N., Sardo Infirri L., Mohiddin S. A., Mazzanti A., Shenoy C., Cavallari U. A., Imazio M., Aquaro G. D., Olivotto I., Pedrotti P., Sekhri N., Van de Heyning C. M., Broeckx G., Peretto G., Guttmann O., Dellegrottaglie S., Scatteia A., Gentile P., Merlo M., Goldberg R. I., Reyentovich A., Sciamanna C., Klaassen S., Poller W., Trankle C. R., Abbate A., Keren A., Horowitz-Cederboim S., Cadrin-Tourigny J., Tadros R., Annoni G. A., Bonoldi E., Toquet C., Marteau L., Probst V., Trochu J. N., Kissopoulou A., Grosu A., Kukavica D., Trancuccio A., Gil C., Tini G., Pedrazzini M., Torchio M., Sinagra G., Gimeno J. R., Bernasconi D., Valsecchi M. G., Klingel K., Adler E. D., Camici P. G., and Cooper L. T.

Abstract

Background: The risk of adverse cardiovascular events in patients with acute myocarditis (AM) and desmosomal gene variants (DGV) remains unknown. Objectives: The purpose of this study was to ascertain the risk of death, ventricular arrhythmias, recurrent myocarditis, and heart failure (main endpoint) in patients with AM and pathogenic or likely pathogenetic DGV. Methods: In a retrospective international study from 23 hospitals, 97 patients were included: 36 with AM and DGV (DGV[+]), 25 with AM and negative gene testing (DGV[−]), and 36 with AM without genetics testing. All patients had troponin elevation plus findings consistent with AM on histology or at cardiac magnetic resonance (CMR). In 86 patients, CMR changes in function and structure were re-assessed at follow-up. Results: In the DGV(+) AM group (88.9% DSP variants), median age was 24 years, 91.7% presented with chest pain, and median left ventricular ejection fraction (LVEF) was 56% on CMR (P = NS vs the other 2 groups). Kaplan-Meier curves demonstrated a higher risk of the main endpoint in DGV(+) AM compared with DGV(−) and without genetics testing patients (62.3% vs 17.5% vs 5.3% at 5 years, respectively; P < 0.0001), driven by myocarditis recurrence and ventricular arrhythmias. At follow-up CMR, a higher number of late gadolinium enhanced segments was found in DGV(+) AM. Conclusions: Patients with AM and evidence of DGV have a higher incidence of adverse cardiovascular events compared with patients with AM without DGV. Further prospective studies are needed to ascertain if genetic testing might improve risk stratification of patients with AM who are considered at low risk.

Published
2022

6. Comparison of thrombus burden in patients with COVID-19 presenting with ST-segment elevation myocardial infarction across the three waves of outbreak in the United Kingdom

Author

Teoh, Z, primary, Rathod, K, additional, Tyrlis, A, additional, Choudry, F, additional, Comer, K, additional, Guttmann, O, additional, Jain, A, additional, Wragg, A, additional, Archbold, A, additional, Baumbach, A, additional, Mathur, A, additional, and Jones, D, additional

Published
2022
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8. 1174Characterization of disease hot-phases using 18f-fluorodeoxyglucose positron emission tomography in arrhythmogenic cardiomyopathy caused by desmosomal gene mutations

Author

Protonotarios, A, primary, Wicks, E C, additional, Guttmann, O, additional, Sekhri, N, additional, O'mahony, C, additional, Savvatis, K, additional, Lopes, L R, additional, Barnes, A, additional, Mohiddin, S A, additional, Syrris, P, additional, Menezes, L, additional, and Elliott, P M, additional

Published
2019
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11. P6426The use of direct oral anti-coagulations (DOACs) compared to vitamin k antagonist in patients with left ventricular thrombus after acute myocardial infarction

Author

Alizadeh, M, primary, Antoniou, S, additional, Fhadil, S, additional, Rathod, R, additional, Guttmann, O, additional, Knight, C, additional, Timmis, A, additional, Wragg, A, additional, Mathur, A, additional, Jones, D A, additional, Baumbach, A, additional, Weeraman, D, additional, and Beirne, A, additional

Published
2019
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13. P391Hot off the press; MRI at its best

Author

Abiodun, A T, primary, Tyebally, S, additional, Brown, J, additional, Moon, J, additional, Westwood, M, additional, Guttmann, O, additional, Mohiddin, S, additional, Treibel, T, additional, and Manisty, C, additional

Published
2019
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17. P1781An observational study assessing the value of computed tomography cardiac angiography (CTCA) in planning invasive angiographic procedures in patients with previous coronary artery bypass grafts (CABG)

Author

Castle, E V, primary, Rathod, K, additional, Treibel, T, additional, Davies, C, additional, Guttmann, O, additional, Curtis, M, additional, Knight, C, additional, Moon, J, additional, Smith, E, additional, Weerackody, R, additional, Bourantas, C, additional, Wragg, A, additional, Mathur, A, additional, Pugliese, F, additional, and Jones, D, additional

Published
2018
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27. DISCUSSION. THE SIMPLON TUNNEL.

Author

HUNTER, W, GUTTMANN, O, HODSON, C W, KENNEDY, SIR A B W, GALBRAITH, W R, BENEDICT, E, FOX, SIR D, HUDLESTON, F, BLOUNT, R, COATH, D D, COLSON, C H, FITZMAURICE, M, and FOX, F

Published
1907
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33. DISCUSSION ON GOLD-QUARTZ REDUCTION.

Author

JAMES, C, LOCK, C G W, JENKINS, H C, O DRISCOLL, F, GILES, A, COX, S H, CORNISH, J, CLARKSON, T, ARMER, J, COLLINS, G E, WOODHOUSE, A, VAUGHAN, W, HARRIS, H G, IMRAY, J, CURTIS, A H, AUSTEN, W C R, NEATE, P J, BROUGH, B H, GUTTMANN, O, and ROSE, T K

Published
1892
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36. P391 Hot off the press; MRI at its best.

Author

Abiodun, A T, Tyebally, S, Brown, J, Moon, J, Westwood, M, Guttmann, O, Mohiddin, S, Treibel, T, and Manisty, C

Subjects
CARDIAC hypertrophy, CONFERENCES & conventions, MAGNETIC resonance imaging, CORONARY angiography, DIAGNOSIS
Published
2019
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39. DISCUSSION ON GOLD-QUARTZ REDUCTION.

Author

CURTIS, A H, primary, WESTERN, C R, additional, O DRISCOLL, F, additional, IMRAY, J, additional, HARRIS, H G, additional, FOSTER, C L N, additional, CLARKSON, T, additional, GUTTMANN, O, additional, BROUGH, B H, additional, NEATE, P J, additional, COX, S H, additional, GILES, A, additional, AUSTEN, W C R, additional, JENKINS, H C, additional, WOODHOUSE, A, additional, COLLINS, G E, additional, ROSE, T K, additional, LOCK, C G W, additional, ARMER, J, additional, JAMES, C, additional, VAUGHAN, W, additional, OGLE, P J, additional, BEAUMONT, W, additional, CORNISH, J, additional, and SHELFORD, W, additional

Published
1892
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40. DISCUSSION. THE SIMPLON TUNNEL.

Author

KENNEDY, SIR A B W, primary, FOX, F, additional, HUDLESTON, F, additional, HODSON, C W, additional, FITZMAURICE, M, additional, BENEDICT, E, additional, GUTTMANN, O, additional, BLOUNT, R, additional, GALBRAITH, W R, additional, COLSON, C H, additional, FOX, SIR D, additional, HUNTER, W, additional, and COATH, D D, additional

Published
1907
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41. DISCUSSION. THE MANUFACTURE AND EFFICIENCY OF ARMOUR-PIERCING PROJECTILES.

Author

HAWKSHAW, J C, primary, BAINBRIDGE, E, additional, HADFIELD, R A, additional, DAWSON, A T, additional, BARLOW, H W W, additional, PARR, A A C, additional, WHINFIELD, J H R, additional, DOD, A H W, additional, GUTTMANN, O, additional, MINCHIN, F F, additional, JACK, A G M, additional, JORDAN, W L, additional, CARNEGIE, W, additional, HARDING, W J, additional, and CARNEGIE, D, additional

Published
1903
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42. Discussion. The Machinery used in the Manufacture of Cordite

Author

Barry, J W, primary, Anderson, E W, additional, Brackenbury, H, additional, Jenkin, C F, additional, Guttmann, O, additional, Ristori, E J, additional, Pollitt, R B, additional, Rigby, J, additional, Rigg, A, additional, Kraftmeier, E, additional, Perks, G W, additional, Thomson, J M, additional, Lloyd, R S, additional, Trench, G, additional, Melville, H, additional, and Anderson, W, additional

Published
1898
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45. Effectiveness of the 2014 European Society of Cardiology guideline on sudden cardiac death in hypertrophic cardiomyopathy. a systematic review and meta-analysis

Author

Aristides Anastasakis, Zacharias Anastasiou, Rumana Z Omar, Pieter A. Vriesendorp, Constantinos O'Mahony, Pablo García-Pavía, Elena Biagini, Claudio Rapezzi, Oliver P Guttmann, Perry M. Elliott, Adrián Fernández, Kevin M.W. Leong, Michelle Michels, Giuseppe Limongelli, Juan R. Gimeno, Lorenzo Monserrat, Damiano Magrì, Amanda Varnava, Juan Pablo Ochoa, Camillo Autore, Mohammed M Akhtar, O'Mahony, Constantino, Akhtar, Mohammed Majid, Anastasiou, Zacharia, Guttmann, Oliver P., Vriesendorp, Pieter A., Michels, Michelle, Magrì, Damiano, Autore, Camillo, Fernández, Adrián, Ochoa, Juan Pablo, Leong, Kevin M.W., Varnava, Amanda M., Monserrat, Lorenzo, Anastasakis, Aristide, Garcia-Pavia, Pablo, Rapezzi, Claudio, Biagini, Elena, Gimeno, Juan Ramon, Limongelli, Giuseppe, Omar, Rumana Z., Elliott, Perry M., O'Mahony, C., Akhtar, M. M., Anastasiou, Z., Guttmann, O. P., Vriesendorp, P. A., Michels, M., Magri, D., Autore, C., Fernandez, A., Ochoa, J. P., Leong, K. M. W., Varnava, A. M., Monserrat, L., Anastasakis, A., Garcia-Pavia, P., Rapezzi, C., Biagini, E., Gimeno, J. R., Limongelli, G., Omar, R. Z., Elliott, P. M., and Cardiology

Subjects
medicine.medical_specialty, MEDLINE, 030204 cardiovascular system & hematology, Risk Assessment, Sudden cardiac death, NO, 03 medical and health sciences, implanted cardiac defibrillator, 0302 clinical medicine, Internal medicine, medicine, Humans, 030212 general & internal medicine, cardiovascular diseases, implanted cardiac defibrillators, hypertrophic cardiomyopathy, ventricular fibrillation, Cardiology and Cardiovascular Medicine, business.industry, Hypertrophic cardiomyopathy, Guideline, Cardiomyopathy, Hypertrophic, medicine.disease, Data Accuracy, Europe, Primary Prevention, Death, Sudden, Cardiac, Meta-analysis, Ventricular fibrillation, Cohort, Practice Guidelines as Topic, Cardiology, Observational study, business, Human
Abstract

ObjectiveIn 2014, the European Society of Cardiology (ESC) recommended the use of a novel risk prediction model (HCM Risk-SCD) to guide use of implantable cardioverter defibrillators (ICD) for the primary prevention of sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM). We sought to determine the performance of HCM Risk-SCD by conducting a systematic review and meta-analysis of articles reporting on the prevalence of SCD within 5 years of evaluation in low, intermediate and high-risk patients as defined by the 2014 guidelines (predicted risk MethodsThe protocol was registered with PROSPERO (registration number: CRD42017064203). MEDLINE and manual searches for papers published from October 2014 to December 2017 were performed. Longitudinal, observational cohorts of unselected adult patients, without history of cardiac arrest were considered. The original HCM Risk-SCD development study was included a priori. Data were pooled using a random effects model.ResultsSix (0.9%) out of 653 independent publications identified by the initial search were included. The calculated 5-year risk of SCD was reported in 7291 individuals (70% low, 15% intermediate; 15% high risk) with 184 (2.5%) SCD endpoints within 5 years of baseline evaluation. Most SCD endpoints (68%) occurred in patients with an estimated 5-year risk of ≥4% who formed 30% of the total study cohort. Using the random effects method, the pooled prevalence of SCD endpoints was 1.01% (95% CI 0.52 to 1.61) in low-risk patients, 2.43% (95% CI 1.23 to 3.92) in intermediate and 8.4% (95% CI 6.68 to 10.25) in high-risk patients.ConclusionsThis meta-analysis demonstrates that HCM Risk-SCD provides accurate risk estimations that can be used to guide ICD therapy in accordance with the 2014 ESC guidelines.Registration numberPROSPERO CRD42017064203;Pre-results.

Published
2018

46. Thrombus Burden and Outcomes in Patients With COVID-19 Presenting With STEMI Across the Pandemic.

Author

Rathod KS, Teoh Z, Tyrlis A, Choudry FA, Hamshere SM, Comer K, Guttmann O, Jain AK, Ozkor MA, Wragg A, Archbold RA, Baumbach A, Mathur A, and Jones DA

Subjects
Humans, Pandemics, United Kingdom epidemiology, Treatment Outcome, COVID-19 epidemiology, ST Elevation Myocardial Infarction diagnosis, ST Elevation Myocardial Infarction epidemiology, ST Elevation Myocardial Infarction therapy, Thrombosis diagnostic imaging, Thrombosis epidemiology, Thrombosis etiology, Percutaneous Coronary Intervention adverse effects
Abstract

Background: It has been previously reported during the first COVID-19 outbreak that patients presenting with ST-segment elevation myocardial infarction (STEMI) and concurrent COVID-19 infection have increased thrombus burden and poorer outcomes. To date, there have been no reports comparing the outcomes of COVID-19-positive STEMI patients across all waves of the pandemic., Objectives: This study compared the baseline demographic, procedural, and angiographic characteristics alongside the clinical outcomes of patients presenting with STEMI and concurrent COVID-19 infection across the COVID-19 pandemic in the United Kingdom., Methods: This was a single-center, observational study of 1,269 consecutive patients admitted with confirmed STEMI treated with percutaneous coronary intervention (between January 3, 2020 and October 3, 2022). COVID-19-positive patients were split into 3 groups based upon the time course of the pandemic, and a comparison was made between waves., Results: A total of 154 COVID-19-positive patients with STEMI were included in the present analysis and were compared with 1,115 COVID-19-negative patients. Early during the pandemic (wave 1), STEMI patients presenting with concurrent COVID-19 infection had high rates of cardiac arrest, evidence of increased thrombus burden, bigger infarcts, and worse outcomes. However, by wave 3, no differences existed in outcomes between COVID-19-positive and -negative patients, with significant differences compared with earlier COVID-19-positive patients. Poor outcomes later in the study period were predominantly in unvaccinated individuals., Conclusions: Significant changes have occurred in the clinical characteristics, angiographic features, and outcomes of STEMI patients with COVID-19 infection treated by primary percutaneous coronary intervention during the course of the pandemic. Importantly, outcomes of recent waves and in vaccinated individuals are no different to a non-COVID-19 population., Competing Interests: Funding Support and Author Disclosures Dr Rathod has received funding from the National Institute for Health and Research (NIHR) in the form of an Academic Clinical Lectureship. Dr Jones has received funding from the Barts Charity. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Published
2023
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47. The safety of deferred coronary angiography in COVID-19 patients with acute coronary syndrome: the Barts COVID recovered pathway.

Author

Teoh Z, Rathod KS, Comer K, Tyrlis A, Choudry FA, Ozkor M, Archbold RA, Guttmann O, Wragg A, Baumbach A, Jain AK, Mathur A, and Jones DA

Abstract

Objective: To assess the safety and effectiveness of a novel pathway of deferrred invasive angiography in low-risk NSTEMI patients with concurrent COVID-19 infections; contrary to current UK guidelines recommending invasive coronary angiography in NSTEMI patients within 72 hours., Methods: This was a single-centre, observational study of all NSTEMI patients referred for inpatient coronary angiography at Barts Heart Centre, between March 2020 and June 2022. Demographic, procedural and outcome data were collected as part of a national cardiac audit., Results: 201 COVID positive NSTEMI patients were referred for angiography at Barts Heart Centre. 10 patients died from COVID related respiratory complications prior to angiography. Therefore, 191 patients underwent deferred angiography (median time 16 days from COVID diagnosis). The median GRACE score was 128 (IQR 86-153). Troponin levels were significantly elevated on initial COVID diagnosis compared to time of their procedure. 73% patients had a culprit lesion identified. 61.2% receiving PCI. Patients were followed-up for a median of 363 days (IQR 120-485 days) with MACE rates of 7.3%. This is comparable to the MACE event for NSTEMI patients (n=4529) without COVID at our institution treated during the same time-period (8.1%)., Conclusion: This study demonstrates the safety and effectiveness of deferred coronary angiography on a COVID-Recovered pathway after a period of medical management for patients presenting with NSTEMI and concurrent COVID-19 infection. There was no adverse signal associated with the wait for angiography with similar MACE rates to the non-deferred NSTEMI cohort without COVID-19., Competing Interests: None., (AJCD Copyright © 2023.)

Published
2023

48. An observational study assessing the use of Sirolimus-eluting balloons for side-branch treatment in the provisional stenting of coronary bifurcations.

Author

Jones J, Mouyis K, Tyrlis A, Rathod KS, Guttmann O, Wragg A, O'Mahony C, Mathur A, Baumbach A, and Jones DA

Abstract

Background: Drug eluting balloons (DEB) are a feasible method of rapid delivery of drug to a coronary vessel wall. Their efficacy has been established for the treatment of in-stent restenosis and small vessel disease but there is limited data for their use in bifurcation lesions., Objective: The aim of this study was to assess the effectiveness of provisional upfront side-branch DEB use in bifurcation lesions compared to a simple balloon (POBA) or upfront 2 stent bifurcation strategy., Methods: We conducted an observational study of 625 patients undergoing PCI to bifurcation lesions. All the patients had a DES deployed in the main vessel (MV). Decision on revascularization option for the side branch (SB) was made by the operator. The primary endpoint was target vessel failure. Secondary endpoints were target vessel myocardial infarction and all-cause mortality., Results: 311 patients had upfront DEB to the SB whilst the remaining were treated with either DES (188) or POBA (126). Baseline characteristics were similar aside from history of previous MI, which were higher in patients treated with DES or POBA, p = 0.009 whereas patients with previous CABG were likely to undergo DEB treatment (p = 0.004). TVF was more likely to occur in the POBA group (7.5 %) compared to the DEB (3.3 %) and DES (3.3 %) groups (p = 0.0019). There was no significant difference in TV-MI (p = 0.62) or death (p = 0.98) between the groups., Conclusion: This study suggests that provisional bifurcation stenting with upfront Sirolimus DEB use in the SB is an effective treatment for non-LMS bifurcation PCI., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Crown Copyright © 2023 Published by Elsevier Inc.)

Published
2023
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49. An exploration of the early discharge approach for low-risk STEMI patients following primary percutaneous coronary intervention.

Author

Broughton N, Comer K, Casey-Gillman O, Moore L, Antoniou S, Patel R, Fhadil S, Wright P, Ozkor M, Guttmann O, Baumbach A, Wragg A, Jain AJ, Choudry F, Mathur A, Rathod KS, and Jones DA

Abstract

Recently, there has been growing interest in the early discharge strategy for low-risk patients who have undergone primary percutaneous coronary intervention (PCI) to treat ST-segment elevation myocardial infarction (STEMI). So far findings have suggested there are multiple advantages of shorter hospital stays, including that it could be a safe way to be more cost- and resource-efficient, reduce cases of hospital-acquired infection and boost patient satisfaction. However, there are remaining concerns surrounding safety, patient education, adequate follow-up and the generalisability of the findings from current studies which are mostly small-scale. By assessing the current research, we describe the advantages, disadvantages and challenges of early hospital discharge for STEMI and discuss the factors that determine if a patient can be considered low risk. If it is feasible to safely employ a strategy like this, the implications for healthcare systems worldwide could be extremely beneficial, particularly in lower-income economies and when we consider the detrimental impacts of the recent COVID-19 pandemic on healthcare systems., Competing Interests: None., (AJCD Copyright © 2023.)

Published
2023

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