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1. The Relationship Between Cardiac Troponin in People Hospitalised for Exacerbation of COPD and Major Adverse Cardiac Events (MACE) and COPD Readmissions

Author: Kallis C, Kaura A, Samuel NA, Mulla A, Glampson B, O'Gallagher K, Davies J, Papadimitriou D, Woods KJ, Shah AD, Williams B, Asselbergs FW, Mayer EK, Lee RW, Herbert C, Grant SW, Curzen N, Squire IB, Johnson T, Shah AM, Perera D, Kharbanda RK, Patel RS, Channon KM, Mayet J, and Quint JK
Subjects: copd, cvd, exacerbation, Diseases of the respiratory system, RC705-779
Abstract: Constantinos Kallis,1– 3 Amit Kaura,1,3 Nathan A Samuel,4 Abdulrahim Mulla,3 Ben Glampson,3 Kevin O’Gallagher,5 Jim Davies,4 Dimitri Papadimitriou,3 Kerrie J Woods,4 Anoop D Shah,6,7 Bryan Williams,6,7 Folkert W Asselbergs,6,7 Erik K Mayer,3,8 Richard W Lee,1,9 Christopher Herbert,10 Stuart W Grant,11 Nick Curzen,12 Iain B Squire,13 Thomas Johnson,14 Ajay M Shah,15 Divaka Perera,5 Rajesh K Kharbanda,4 Riyaz S Patel,6 Keith M Channon,4 Jamil Mayet,1,3 Jennifer K Quint1– 3 1National Heart and Lung Institute, Imperial College London, London, UK; 2School of Public Health, Imperial College London, London, UK; 3NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, UK; 4NIHR Oxford Biomedical Research Centre, University of Oxford and Oxford University Hospitals NHS Foundation Trust, Oxford, UK; 5NIHR King’s Biomedical Research Centre, King’s College London and King’s College Hospital NHS Foundation Trust, London, UK; 6NIHR University College London Biomedical Research Centre, University College London and University College London Hospitals NHS Foundation Trust, London, UK; 7Institute of Health Informatics, University College London, London, UK; 8Imperial Clinical Analytics, Research & Evaluation (iCARE) and Department of Surgery & Cancer, Imperial College London, London, UK; 9Early Diagnosis and Detection Centre, NIHR BRC at The Royal Marsden and Institute of Cancer Research, London, UK; 10NIHR Leeds Clinical Research Facility, Leeds Teaching Hospitals Trust and University of Leeds, Leeds, UK; 11NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust and the University of Manchester, Manchester, UK; 12NIHR Southampton Clinical Research Facility and Biomedical Research Centre, Faculty of Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK; 13NIHR Leicester Biomedical Research Centre, Glenfield Hospital, and Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; 14NIHR Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, UK; 15NIHR Guys & St Thomas’ Hospital Clinical Research Facility, King’s College Hospital, and King’s College London British Heart Foundation Centre of Excellence, London, UKCorrespondence: Jennifer K Quint, School of Public Health, Imperial College London, Floor 9, Sir Michael Uren Building, 86 Wood Ln, London, W12 0BZ, United Kingdom, Email j.quint@imperial.ac.ukBackground: No single biomarker currently risk stratifies chronic obstructive pulmonary disease (COPD) patients at the time of an exacerbation, though previous studies have suggested that patients with elevated troponin at exacerbation have worse outcomes. This study evaluated the relationship between peak cardiac troponin and subsequent major adverse cardiac events (MACE) including all-cause mortality and COPD hospital readmission, among patients admitted with COPD exacerbation.Methods: Data from five cross-regional hospitals in England were analysed using the National Institute of Health Research Health Informatics Collaborative (NIHR-HIC) acute coronary syndrome database (2008– 2017). People hospitalised with a COPD exacerbation were included, and peak troponin levels were standardised relative to the 99th percentile (upper limit of normal). We used Cox Proportional Hazard models adjusting for age, sex, laboratory results and clinical risk factors, and implemented logarithmic transformation (base-10 logarithm). The primary outcome was risk of MACE within 90 days from peak troponin measurement. Secondary outcome was risk of COPD readmission within 90 days from peak troponin measurement.Results: There were 2487 patients included. Of these, 377 (15.2%) patients had a MACE event and 203 (8.2%) were readmitted within 90 days from peak troponin measurement. A total of 1107 (44.5%) patients had an elevated troponin level. Of 1107 patients with elevated troponin at exacerbation, 256 (22.8%) had a MACE event and 101 (9.0%) a COPD readmission within 90 days from peak troponin measurement. Patients with troponin above the upper limit of normal had a higher risk of MACE (adjusted HR 2.20, 95% CI 1.75– 2.77) and COPD hospital readmission (adjusted HR 1.37, 95% CI 1.02– 1.83) when compared with patients without elevated troponin.Conclusion: An elevated troponin level at the time of COPD exacerbation may be a useful tool for predicting MACE in COPD patients. The relationship between degree of troponin elevation and risk of future events is complex and requires further investigation.Keywords: COPD, CVD, exacerbation
Published: 2023

2. Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study

Author: Evans, RA, Leavy, OC, Richardson, M, Elneima, O, McCauley, HJC, Shikotra, A, Singapuri, A, Sereno, M, Saunders, RM, Harris, VC, Houchen-Wolloff, L, Aul, R, Beirne, P, Bolton, CE, Brown, JS, Choudhury, G, Diar-Bakerly, N, Easom, N, Echevarria, C, Fuld, J, Hart, N, Hurst, J, Jones, MG, Parekh, D, Pfeffer, P, Rahman, NM, Rowland-Jones, SL, Shah, AM, Wootton, DG, Chalder, T, Davies, MJ, De Soyza, A, Geddes, JR, Greenhalf, W, Greening, NJ, Heaney, LG, Heller, S, Howard, LS, Jacob, J, Jenkins, RG, Lord, JM, Man, WD-C, McCann, GP, Neubauer, S, Openshaw, PJM, Porter, JC, Rowland, MJ, Scott, JT, Semple, MG, Singh, SJ, Thomas, DC, Toshner, M, Lewis, KE, Thwaites, RS, Briggs, A, Docherty, AB, Kerr, S, Lone, NI, Quint, J, Sheikh, A, Thorpe, M, Zheng, B, Chalmers, JD, Ho, LP, Horsley, A, Marks, M, Poinasamy, K, Raman, B, Harrison, EM, Wain, LV, Brightling, CE, Abel, K, Adamali, H, Adeloye, D, Adeyemi, O, Adrego, R, Jimenez, LAA, Ahmad, S, Haider, NA, Ahmed, R, Ahwireng, N, Ainsworth, M, Al-Sheklly, B, Alamoudi, A, Ali, M, Aljaroof, M, All, AM, Allan, L, Allen, RJ, Allerton, L, Allsop, L, Almeida, P, Altmann, D, Corral, MA, Amoils, S, Anderson, D, Antoniades, C, Arbane, G, Arias, A, Armour, C, Armstrong, L, Armstrong, N, Arnold, D, Arnold, H, Ashish, A, Ashworth, A, Ashworth, M, Aslani, S, Assefa-Kebede, H, Atkin, C, Atkin, P, Aung, H, Austin, L, Avram, C, Ayoub, A, Babores, M, Baggott, R, Bagshaw, J, Baguley, D, Bailey, L, Baillie, JK, Bain, S, Bakali, M, Bakau, M, Baldry, E, Baldwin, D, Ballard, C, Banerjee, A, Bang, B, Barker, RE, Barman, L, Barratt, S, Barrett, F, Basire, D, Basu, N, Bates, M, Bates, A, Batterham, R, Baxendale, H, Bayes, H, Beadsworth, M, Beckett, P, Beggs, M, Begum, M, Bell, D, Bell, R, Bennett, K, Beranova, E, Bermperi, A, Berridge, A, Berry, C, Betts, S, Bevan, E, Bhui, K, Bingham, M, Birchall, K, Bishop, L, Bisnauthsing, K, Blaikely, J, Bloss, A, Bolger, A, Bonnington, J, Botkai, A, Bourne, C, Bourne, M, Bramham, K, Brear, L, Breen, G, Breeze, J, Bright, E, Brill, S, Brindle, K, Broad, L, Broadley, A, Brookes, C, Broome, M, Brown, A, Brown, J, Brown, M, Brown, V, Brown, CW, Brugha, T, Brunskill, N, Buch, M, Buckley, P, Bularga, A, Bullmore, E, Burden, L, Burdett, T, Burn, D, Burns, G, Burns, A, Busby, J, Butcher, R, Butt, A, Byrne, S, Cairns, P, Calder, PC, Calvelo, E, Carborn, H, Card, B, Carr, C, Carr, L, Carson, G, Carter, P, Casey, A, Cassar, M, Cavanagh, J, Chablani, M, Chambers, RC, Chan, F, Channon, KM, Chapman, K, Charalambou, A, Chaudhuri, N, Checkley, A, Chen, J, Cheng, Y, Chetham, L, Childs, C, Chilvers, ER, Chinoy, H, Chiribiri, A, Chong-James, K, Choudhury, N, Chowienczyk, P, Christie, C, Chrystal, M, Clark, D, Clark, C, Clarke, J, Clohisey, S, Coakley, G, Coburn, Z, Coetzee, S, Cole, J, Coleman, C, Conneh, F, Connell, D, Connolly, B, Connor, L, Cook, A, Cooper, B, Cooper, J, Cooper, S, Copeland, D, Cosier, T, Coulding, M, Coupland, C, Cox, E, Craig, T, Crisp, P, Cristiano, D, Crooks, MG, Cross, A, Cruz, I, Cullinan, P, Cuthbertson, D, Daines, L, Dalton, M, Daly, P, Daniels, A, Dark, P, Dasgin, J, David, A, David, C, Davies, E, Davies, F, Davies, G, Davies, GA, Davies, K, Dawson, J, Daynes, E, Deakin, B, Deans, A, Deas, C, Deery, J, Defres, S, Dell, A, Dempsey, K, Denneny, E, Dennis, J, Dewar, A, Dharmagunawardena, R, Dickens, C, Dipper, A, Diver, S, Diwanji, SN, Dixon, M, Djukanovic, R, Dobson, H, Dobson, SL, Donaldson, A, Dong, T, Dormand, N, Dougherty, A, Dowling, R, Drain, S, Draxlbauer, K, Drury, K, Dulawan, P, Dunleavy, A, Dunn, S, Earley, J, Edwards, S, Edwardson, C, El-Taweel, H, Elliott, A, Elliott, K, Ellis, Y, Elmer, A, Evans, D, Evans, H, Evans, J, Evans, R, Evans, RI, Evans, T, Evenden, C, Evison, L, Fabbri, L, Fairbairn, S, Fairman, A, Fallon, K, Faluyi, D, Favager, C, Fayzan, T, Featherstone, J, Felton, T, Finch, J, Finney, S, Finnigan, J, Finnigan, L, Fisher, H, Fletcher, S, Flockton, R, Flynn, M, Foot, H, Foote, D, Ford, A, Forton, D, Fraile, E, Francis, C, Francis, R, Francis, S, Frankel, A, Fraser, E, Free, R, French, N, Fu, X, Furniss, J, Garner, L, Gautam, N, George, J, George, P, Gibbons, M, Gill, M, Gilmour, L, Gleeson, F, Glossop, J, Glover, S, Goodman, N, Goodwin, C, Gooptu, B, Gordon, H, Gorsuch, T, Greatorex, M, Greenhaff, PL, Greenhalgh, A, Greenwood, J, Gregory, H, Gregory, R, Grieve, D, Griffin, D, Griffiths, L, Guerdette, A-M, Guio, BG, Gummadi, M, Gupta, A, Gurram, S, Guthrie, E, Guy, Z, Henson, HH, Hadley, K, Haggar, A, Hainey, K, Hairsine, B, Haldar, P, Hall, I, Hall, L, Halling-Brown, M, Hamil, R, Hancock, A, Hancock, K, Hanley, NA, Haq, S, Hardwick, HE, Hardy, E, Hardy, T, Hargadon, B, Harrington, K, Harris, E, Harrison, P, Harvey, A, Harvey, M, Harvie, M, Haslam, L, Havinden-Williams, M, Hawkes, J, Hawkings, N, Haworth, J, Hayday, A, Haynes, M, Hazeldine, J, Hazelton, T, Heeley, C, Heeney, JL, Heightman, M, Henderson, M, Hesselden, L, Hewitt, M, Highett, V, Hillman, T, Hiwot, T, Hoare, A, Hoare, M, Hockridge, J, Hogarth, P, Holbourn, A, Holden, S, Holdsworth, L, Holgate, D, Holland, M, Holloway, L, Holmes, K, Holmes, M, Holroyd-Hind, B, Holt, L, Hormis, A, Hosseini, A, Hotopf, M, Howard, K, Howell, A, Hufton, E, Hughes, AD, Hughes, J, Hughes, R, Humphries, A, Huneke, N, Hurditch, E, Husain, M, Hussell, T, Hutchinson, J, Ibrahim, W, Ilyas, F, Ingham, J, Ingram, L, Ionita, D, Isaacs, K, Ismail, K, Jackson, T, James, WY, Jarman, C, Jarrold, I, Jarvis, H, Jastrub, R, Jayaraman, B, Jezzard, P, Jiwa, K, Johnson, C, Johnson, S, Johnston, D, Jolley, CJ, Jones, D, Jones, G, Jones, H, Jones, I, Jones, L, Jones, S, Jose, S, Kabir, T, Kaltsakas, G, Kamwa, V, Kanellakis, N, Kaprowska, S, Kausar, Z, Keenan, N, Kelly, S, Kemp, G, Kerslake, H, Key, AL, Khan, F, Khunti, K, Kilroy, S, King, B, King, C, Kingham, L, Kirk, J, Kitterick, P, Klenerman, P, Knibbs, L, Knight, S, Knighton, A, Kon, O, Kon, S, Kon, SS, Koprowska, S, Korszun, A, Koychev, I, Kurasz, C, Kurupati, P, Laing, C, Lamlum, H, Landers, G, Langenberg, C, Lasserson, D, Lavelle-Langham, L, Lawrie, A, Lawson, C, Layton, A, Lea, A, Lee, D, Lee, J-H, Lee, E, Leitch, K, Lenagh, R, Lewis, D, Lewis, J, Lewis, V, Lewis-Burke, N, Li, X, Light, T, Lightstone, L, Lilaonitkul, W, Lim, L, Linford, S, Lingford-Hughes, A, Lipman, M, Liyanage, K, Lloyd, A, Logan, S, Lomas, D, Loosley, R, Lota, H, Lovegrove, W, Lucey, A, Lukaschuk, E, Lye, A, Lynch, C, MacDonald, S, MacGowan, G, Macharia, I, Mackie, J, Macliver, L, Madathil, S, Madzamba, G, Magee, N, Magtoto, MM, Mairs, N, Majeed, N, Major, E, Malein, F, Malim, M, Mallison, G, Mandal, S, Mangion, K, Manisty, C, Manley, R, March, K, Marciniak, S, Marino, P, Mariveles, M, Marouzet, E, Marsh, S, Marshall, B, Marshall, M, Martin, J, Martineau, A, Martinez, LM, Maskell, N, Matila, D, Matimba-Mupaya, W, Matthews, L, Mbuyisa, A, McAdoo, S, McCall, JW, McAllister-Williams, H, McArdle, A, McArdle, P, McAulay, D, McCormick, J, McCormick, W, McCourt, P, McGarvey, L, McGee, C, Mcgee, K, McGinness, J, McGlynn, K, McGovern, A, McGuinness, H, McInnes, IB, McIntosh, J, McIvor, E, McIvor, K, McLeavey, L, McMahon, A, McMahon, MJ, McMorrow, L, Mcnally, T, McNarry, M, McNeill, J, McQueen, A, McShane, H, Mears, C, Megson, C, Megson, S, Mehta, P, Meiring, J, Melling, L, Mencias, M, Menzies, D, Morillas, MM, Michael, A, Milligan, L, Miller, C, Mills, C, Mills, NL, Milner, L, Misra, S, Mitchell, J, Mohamed, A, Mohamed, N, Mohammed, S, Molyneaux, PL, Monteiro, W, Moriera, S, Morley, A, Morrison, L, Morriss, R, Morrow, A, Moss, AJ, Moss, P, Motohashi, K, Msimanga, N, Mukaetova-Ladinska, E, Munawar, U, Murira, J, Nanda, U, Nassa, H, Nasseri, M, Neal, A, Needham, R, Neill, P, Newell, H, Newman, T, Newton-Cox, A, Nicholson, T, Nicoll, D, Nolan, CM, Noonan, MJ, Norman, C, Novotny, P, Nunag, J, Nwafor, L, Nwanguma, U, Nyaboko, J, O'Donnell, K, O'Brien, C, O'Brien, L, O'Regan, D, Odell, N, Ogg, G, Olaosebikan, O, Oliver, C, Omar, Z, Orriss-Dib, L, Osborne, L, Osbourne, R, Ostermann, M, Overton, C, Owen, J, Oxton, J, Pack, J, Pacpaco, E, Paddick, S, Painter, S, Pakzad, A, Palmer, S, Papineni, P, Paques, K, Paradowski, K, Pareek, M, Parfrey, H, Pariante, C, Parker, S, Parkes, M, Parmar, J, Patale, S, Patel, B, Patel, M, Patel, S, Pattenadk, D, Pavlides, M, Payne, S, Pearce, L, Pearl, JE, Peckham, D, Pendlebury, J, Peng, Y, Pennington, C, Peralta, I, Perkins, E, Peterkin, Z, Peto, T, Petousi, N, Petrie, J, Phipps, J, Pimm, J, Hanley, KP, Pius, R, Plant, H, Plein, S, Plekhanova, T, Plowright, M, Polgar, O, Poll, L, Porter, J, Portukhay, S, Powell, N, Prabhu, A, Pratt, J, Price, A, Price, C, Price, D, Price, L, Prickett, A, Propescu, J, Pugmire, S, Quaid, S, Quigley, J, Qureshi, H, Qureshi, IN, Radhakrishnan, K, Ralser, M, Ramos, A, Ramos, H, Rangeley, J, Rangelov, B, Ratcliffe, L, Ravencroft, P, Reddington, A, Reddy, R, Redfearn, H, Redwood, D, Reed, A, Rees, M, Rees, T, Regan, K, Reynolds, W, Ribeiro, C, Richards, A, Richardson, E, Rivera-Ortega, P, Roberts, K, Robertson, E, Robinson, E, Robinson, L, Roche, L, Roddis, C, Rodger, J, Ross, A, Ross, G, Rossdale, J, Rostron, A, Rowe, A, Rowland, A, Rowland, J, Roy, K, Roy, M, Rudan, I, Russell, R, Russell, E, Saalmink, G, Sabit, R, Sage, EK, Samakomva, T, Samani, N, Sampson, C, Samuel, K, Samuel, R, Sanderson, A, Sapey, E, Saralaya, D, Sargant, J, Sarginson, C, Sass, T, Sattar, N, Saunders, K, Saunders, P, Saunders, LC, Savill, H, Saxon, W, Sayer, A, Schronce, J, Schwaeble, W, Scott, K, Selby, N, Sewell, TA, Shah, K, Shah, P, Shankar-Hari, M, Sharma, M, Sharpe, C, Sharpe, M, Shashaa, S, Shaw, A, Shaw, K, Shaw, V, Shelton, S, Shenton, L, Shevket, K, Short, J, Siddique, S, Siddiqui, S, Sidebottom, J, Sigfrid, L, Simons, G, Simpson, J, Simpson, N, Singh, C, Singh, S, Sissons, D, Skeemer, J, Slack, K, Smith, A, Smith, D, Smith, S, Smith, J, Smith, L, Soares, M, Solano, TS, Solly, R, Solstice, AR, Soulsby, T, Southern, D, Sowter, D, Spears, M, Spencer, LG, Speranza, F, Stadon, L, Stanel, S, Steele, N, Steiner, M, Stensel, D, Stephens, G, Stephenson, L, Stern, M, Stewart, I, Stimpson, R, Stockdale, S, Stockley, J, Stoker, W, Stone, R, Storrar, W, Storrie, A, Storton, K, Stringer, E, Strong-Sheldrake, S, Stroud, N, Subbe, C, Sudlow, CL, Suleiman, Z, Summers, C, Summersgill, C, Sutherland, D, Sykes, DL, Sykes, R, Talbot, N, Tan, AL, Tarusan, L, Tavoukjian, V, Taylor, A, Taylor, C, Taylor, J, Te, A, Tedd, H, Tee, CJ, Teixeira, J, Tench, H, Terry, S, Thackray-Nocera, S, Thaivalappil, F, Thamu, B, Thickett, D, Thomas, C, Thomas, S, Thomas, AK, Thomas-Woods, T, Thompson, T, Thompson, AAR, Thornton, T, Tilley, J, Tinker, N, Tiongson, GF, Tobin, M, Tomlinson, J, Tong, C, Touyz, R, Tripp, KA, Tunnicliffe, E, Turnbull, A, Turner, E, Turner, S, Turner, V, Turner, K, Turney, S, Turtle, L, Turton, H, Ugoji, J, Ugwuoke, R, Upthegrove, R, Valabhji, J, Ventura, M, Vere, J, Vickers, C, Vinson, B, Wade, E, Wade, P, Wainwright, T, Wajero, LO, Walder, S, Walker, S, Wall, E, Wallis, T, Walmsley, S, Walsh, JA, Walsh, S, Warburton, L, Ward, TJC, Warwick, K, Wassall, H, Waterson, S, Watson, E, Watson, L, Watson, J, Welch, C, Welch, H, Welsh, B, Wessely, S, West, S, Weston, H, Wheeler, H, White, S, Whitehead, V, Whitney, J, Whittaker, S, Whittam, B, Whitworth, V, Wight, A, Wild, J, Wilkins, M, Wilkinson, D, Williams, N, Williams, J, Williams-Howard, SA, Willicombe, M, Willis, G, Willoughby, J, Wilson, A, Wilson, D, Wilson, I, Window, N, Witham, M, Wolf-Roberts, R, Wood, C, Woodhead, F, Woods, J, Wormleighton, J, Worsley, J, Wraith, D, Wright, C, Wright, L, Wright, S, Wyles, J, Wynter, I, Xu, M, Yasmin, N, Yasmin, S, Yates, T, Yip, KP, Young, B, Young, S, Young, A, Yousuf, AJ, Zawia, A, Zeidan, L, Zhao, B, Zongo, O, Group, The PHOSP-COVID Collaborative, National Institute for Health Research, and UKRI MRC COVID-19 Rapid Response Call
Subjects: Adult, Male, Pulmonary and Respiratory Medicine, Adolescent, PHOSP-COVID Collaborative Group, 1117 Public Health and Health Services, Post-Acute COVID-19 Syndrome, SDG 3 - Good Health and Well-being, Humans, Longitudinal Studies, Obesity, Prospective Studies, long COVID, Retrospective Studies, Inflammation, SARS-CoV-2, COVID-19, 1103 Clinical Sciences, Middle Aged, prospective observational study, United Kingdom, Hospitalization, Quality of Life, Female, 1199 Other Medical and Health Sciences
Abstract: Background No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. Methods The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. Findings 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7–9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46–0·99]), obesity (0·50 [0·34–0·74]) and invasive mechanical ventilation (0·42 [0·23–0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74–1·00]), at 5 months (0·74 [0·64–0·88]) to 1 year (0·75 [0·62–0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. Interpretation The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. Funding UK Research and Innovation and National Institute for Health Research.
Published: 2022

3. Quantification of the food-water-energy nexus in urban green and blue infrastructure: A synthesis of the literature

Author: Meng, F, Yuan, Q, Bellezoni, RA, de Oliveira, JAP, Cristiano, S, Shah, AM, Liu, G, Yang, Z, Seto, KC, Meng, F, Yuan, Q, Bellezoni, RA, de Oliveira, JAP, Cristiano, S, Shah, AM, Liu, G, Yang, Z, and Seto, KC
Abstract: Green and blue infrastructure (GBI) is an innovative strategy to tackle food-water-energy (FWE) nexus issues. GBI can provide the benefits of food production, energy saving and generation, waterlogging control, rainwater cleansing and harvesting. Significant efforts have been devoted to measuring the implications of GBI on FWE nexus. However, there is little research to simulate the multiple linkages between GBI and FWE nexus in urban areas, and the lack of a unified methodology framework also easily leads to an understanding bias of their connections and makes it challenging to compare the results. Focusing on the prior published literature, this study clarifies the interactions between GBI and FWE nexus and reviews the methods to quantify the implications of GBI on FWE nexus in cities, including FWE-related benefits, life cycle environmental impacts, and avoided upstream environmental footprints induced by FWE-related benefits. It is revealed that most studies focus on the FWE-related benefits or (and) life cycle environmental impacts of GBI from a silo perspective. Researchers pay little attention to the avoided trans-boundary environmental footprints by GBI, and carbon footprint is the greatest concern in the existing research. There is little evidence on comprehensive quantifications regarding multiple impacts of GBI on FWE nexus at the urban scale. The review outlines methods to simulate the linkages between GBI and FWE nexus and calls for a holistic methodological framework to apply at the urban scale. Such assessment practices would make sense for FWE-oriented resilience planning and governance for urban GBI implementation.
Published: 2023

4. Impact of Ocular Surface Temperature on Tear Characteristics: Current Insights

Author: Shah AM and Galor A
Subjects: dry eye, lcsh:Ophthalmology, lcsh:RE1-994, fungi, sense organs, ocular thermography, tear film, eye diseases
Abstract: Ankit M Shah,1 Anat Galor1,2 1Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA; 2Surgical Services, Miami Veterans Affairs (VA) Medical Center, Miami, FL, USACorrespondence: Anat GalorBascom Palmer Eye Institute, 900 NW 17th St, Miami, FL, 33136, USAEmail agalor@med.miami.eduAbstract: Infrared (IR) thermographic assessment of ocular surface temperature (OST) is gaining interest as an adjuvant method to evaluate the ocular surface. It is a quick, non-invasive test that causes minimal, if any, discomfort to patients. The purpose of this article was to summarize research on how OST relates to tear film parameters and dry eye disease (DED). PubMed, Google Scholar, and Scopus searches for specific terms were carried out and eligible articles reviewed. OST of the central cornea is ∼ 34-35°C when measured as a single time-point (typically right after a blink). Dynamically, OST values decrease over time at a rate of ∼ − 0.01 °C/s in healthy eyes. Single time-point OST values are impacted by temperature, with positive correlations noted with both ambient (1°C↓ results in ∼ 0.16°C↓ in OST) and body (1°C↑ results in ∼ 0.98°C↑ in OST) temperature. Single time-point OST values are also impacted by tear parameters, with negative correlations noted with tear break-up time (TBUT; r=− 0.61) and positive correlations with lipid layer thickness (∼r=0.50). Dynamically, the rate of OST cooling over the interblink period correlates with various tear parameters including Schirmer’s test scores (r=− 0.39), tear meniscus height (r=− 0.52) and the rate of tear film break-up (r=− 0.74). These data imply that OST decreases more rapidly in individuals with greater tear production, larger tear volumes, and shorter tear break-up times (faster rates of tear film break-up). There are discrepancies in relationships between OST and DED across studies, which is not surprising given that DED encompasses a number of different phenotypic presentations. However, most studies found that OST decreases at a more rapid rate in DED vs. control groups. As such, cooling rate may have utility as a screening tool in DED in combination with established point-of-care tests.Keywords: ocular thermography, tear film, dry eye
Published: 2021

5. Prognostic Significance of Ventricular Arrhythmias in 13 444 Patients With Acute Coronary Syndrome: A Retrospective Cohort Study Based on Routine Clinical Data (NIHR Health Informatics Collaborative VA‐ACS Study)

Author: Sau, A, Kaura, A, Ahmed, A, Patel, KHK, Li, X, Mulla, A, Glampson, B, Panoulas, V, Davies, J, Woods, K, Gautama, S, Shah, AD, Elliott, P, Hemingway, H, Williams, B, Asselbergs, FW, Melikian, N, Peters, NS, Shah, AM, Perera, D, Kharbanda, R, Patel, RS, Channon, KM, Mayet, J, Ng, FS, British Heart Foundation, Health Data Research Uk, and Imperial College Healthcare NHS Trust- BRC Funding
Subjects: ACUTE MYOCARDIAL-INFARCTION, OUTCOMES, Science & Technology, Cardiac & Cardiovascular Systems, IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR, Arrhythmias, Cardiac, cardiac arrest, Prognosis, State Medicine, EUROPEAN-SOCIETY, acute coronary syndrome, ST-SEGMENT-ELEVATION, Cardiovascular System & Cardiology, MANAGEMENT, Humans, FIBRILLATION, TACHYCARDIA, Cardiology and Cardiovascular Medicine, Life Sciences & Biomedicine, SUDDEN CARDIAC DEATH, 1102 Cardiorespiratory Medicine and Haematology, Medical Informatics, Retrospective Studies, ventricular arrhythmia, TASK-FORCE
Abstract: Background A minority of acute coronary syndrome (ACS) cases are associated with ventricular arrhythmias (VA) and/or cardiac arrest (CA). We investigated the effect of VA/CA at the time of ACS on long‐term outcomes. Methods and Results We analyzed routine clinical data from 5 National Health Service trusts in the United Kingdom, collected between 2010 and 2017 by the National Institute for Health Research Health Informatics Collaborative. A total of 13 444 patients with ACS, 376 (2.8%) of whom had concurrent VA, survived to hospital discharge and were followed up for a median of 3.42 years. Patients with VA or CA at index presentation had significantly increased risks of subsequent VA during follow‐up (VA group: adjusted hazard ratio [HR], 4.15 [95% CI, 2.42–7.09]; CA group: adjusted HR, 2.60 [95% CI, 1.23–5.48]). Patients who suffered a CA in the context of ACS and survived to discharge also had a 36% increase in long‐term mortality (adjusted HR, 1.36 [95% CI, 1.04–1.78]), although the concurrent diagnosis of VA alone during ACS did not affect all‐cause mortality (adjusted HR, 1.03 [95% CI, 0.80–1.33]). Conclusions Patients who develop VA or CA during ACS who survive to discharge have increased risks of subsequent VA, whereas those who have CA during ACS also have an increase in long‐term mortality. These individuals may represent a subgroup at greater risk of subsequent arrhythmic events as a result of intrinsically lower thresholds for developing VA.
Published: 2022

6. Endothelial NOX4 Oxidase Negatively Regulates Inflammation and Improves Morbidity During Influenza A Virus Lung Infection in Mice

Author: Hendricks, KS, To, EE, Luong, R, Liong, F, Erlich, JR, Shah, AM, Liong, S, O'Leary, JJ, Brooks, DA, Vlahos, R, Selemidis, S, Hendricks, KS, To, EE, Luong, R, Liong, F, Erlich, JR, Shah, AM, Liong, S, O'Leary, JJ, Brooks, DA, Vlahos, R, and Selemidis, S
Abstract: Endosomal NOX2 oxidase-dependent ROS production promotes influenza pathogenicity, but the role of NOX4 oxidase, which is highly expressed in the lung endothelium, is largely unknown. The aim of this study was to determine if endothelial NOX4 expression can influence viral pathology in vivo, using a mouse model of influenza infection. WT and transgenic endothelial NOX4 overexpressing mice (NOX4 TG) were infected intranasally with the Hong Kong H3N2 X-31 influenza A virus (104 PFU; HK x-31) or PBS control. Mice were culled at either 3 or 7 days post-infection to analyse: airway inflammation by bronchoalveolar lavage fluid (BALF) cell counts; NOX4, as well as inflammatory cytokine and chemokine gene expression by QPCR; and ROS production by an L-012-enhanced chemiluminescence assay. Influenza A virus infection of WT mice resulted in a significant reduction in lung NOX4 mRNA at day 3, which persisted until day 7, when compared to uninfected mice. Influenza A virus infection of NOX4 TG mice resulted in significantly less weight loss than that of WT mice at 3-days post infection. Viral titres were decreased in infected NOX4 TG mice compared to the infected WT mice, at both 3- and 7-days post infection and there was significantly less lung alveolitis, peri-bronchial inflammation and neutrophil infiltration. The oxidative burst from BALF inflammatory cells extracted from infected NOX4 TG mice was significantly less than that in the WT mice. Expression of macrophage and neutrophil chemoattractants CXCL10, CCL3, CXCL1 and CXCL2 in the lung tissue were significantly lower in NOX4 TG mice compared to the WT mice at 3-days post infection. We conclude that endothelial NOX4 oxidase is protective against influenza morbidity and is a potential target for limiting influenza A virus-induced lung inflammation.
Published: 2022

7. Mortality risk prediction of high-sensitivity C-reactive protein in suspected acute coronary syndrome: A cohort study

Author: Kaura, A, Hartley, A, Panoulas, V, Glampson, B, Shah, ASV, Davies, J, Mulla, A, Woods, K, Omigie, J, Shah, AD, Thursz, MR, Elliott, P, Hemmingway, H, Williams, B, Asselbergs, FW, O'Sullivan, M, Lord, GM, Trickey, A, Sterne, JA, Haskard, DO, Melikian, N, Francis, DP, Koenig, W, Shah, AM, Kharbanda, R, Perera, D, Patel, RS, Channon, KM, Mayet, J, Khamis, R, Kaura, Amit [0000-0002-6962-3199], Hartley, Adam [0000-0003-1431-2200], Panoulas, Vasileios [0000-0002-9894-9200], Glampson, Ben [0000-0002-5601-5581], Shah, Anoop SV [0000-0002-2825-3419], Davies, Jim [0000-0003-4664-6862], Mulla, Abdulrahim [0000-0002-5943-2348], Woods, Kerrie [0000-0001-8106-8290], Shah, Anoop D [0000-0002-8907-5724], Elliott, Paul [0000-0002-7511-5684], Hemmingway, Harry [0000-0003-2279-0624], Williams, Bryan [0000-0002-8094-1841], Asselbergs, Folkert W [0000-0002-1692-8669], Trickey, Adam [0000-0003-3462-2898], Francis, Darrel P [0000-0002-3410-0814], Koenig, Wolfgang [0000-0002-2064-9603], Shah, Ajay M [0000-0002-6547-0631], Kharbanda, Rajesh [0000-0002-5356-2395], Perera, Divaka [0000-0001-6362-1291], Mayet, Jamil [0000-0002-4665-6422], Khamis, Ramzi [0000-0003-4119-5193], and Apollo - University of Cambridge Repository
Subjects: Male, Cohort Studies, Predictive Value of Tests, Risk Factors, General & Internal Medicine, Humans, Longitudinal Studies, Acute Coronary Syndrome, Mortality, 11 Medical and Health Sciences, Aged, Retrospective Studies, Medicine and health sciences, Aged, 80 and over, Biology and life sciences, United Kingdom/epidemiology, C-Reactive Protein/metabolism, General Medicine, Middle Aged, Mortality/trends, United Kingdom, C-Reactive Protein, Acute Coronary Syndrome/blood, Female, Biomarkers/blood, Biomarkers, Research Article, Follow-Up Studies
Abstract: Funder: THIS Institute, BACKGROUND: There is limited evidence on the use of high-sensitivity C-reactive protein (hsCRP) as a biomarker for selecting patients for advanced cardiovascular (CV) therapies in the modern era. The prognostic value of mildly elevated hsCRP beyond troponin in a large real-world cohort of unselected patients presenting with suspected acute coronary syndrome (ACS) is unknown. We evaluated whether a mildly elevated hsCRP (up to 15 mg/L) was associated with mortality risk, beyond troponin level, in patients with suspected ACS. METHODS AND FINDINGS: We conducted a retrospective cohort study based on the National Institute for Health Research Health Informatics Collaborative data of 257,948 patients with suspected ACS who had a troponin measured at 5 cardiac centres in the United Kingdom between 2010 and 2017. Patients were divided into 4 hsCRP groups (15 mg/L makes it unlikely that sepsis was a major contributor. CONCLUSIONS: These multicentre, real-world data from a large cohort of patients with suspected ACS suggest that mildly elevated hsCRP (up to 15 mg/L) may be a clinically meaningful prognostic marker beyond troponin and point to its potential utility in selecting patients for novel treatments targeting inflammation. TRIAL REGISTRATION: ClinicalTrials.gov - NCT03507309.
Published: 2022

8. Study on the Major Genes Related with Fat Deposition in Liver and Abdominal Fat of Different Breeds of Chicken

Author: Kang, X, primary, Amevor, FK, additional, Zhang, L, additional, Shah, AM, additional, Zhu, Q, additional, Tian, Y, additional, Shu, G, additional, Wang, Y, additional, and Zhao, X, additional
Published: 2022
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9. Implications of elevated troponin on time-to-surgery in non-ST elevation myocardial infarction (NIHR Health Informatics Collaborative: TROP-CABG study)

Author: Benedetto, U, Sinha, S, Mulla, A, Glampson, B, Davies, J, Panoulas, V, Gautama, S, Papadimitriou, D, Woods, K, Elliott, P, Hemingway, H, Williams, B, Asselbergs, FW, Melikian, N, Krasopoulos, G, Sayeed, R, Wendler, O, Baig, K, Chukwuemeka, A, Angelini, GD, Sterne, JAC, Johnson, T, Shah, AM, Perera, D, Patel, RS, Kharbanda, R, Channon, KM, Mayet, J, and Kaura, A
Subjects: Aged, 80 and over, Male, Treatment Outcome, Myocardial Infarction, Humans, Female, Coronary Artery Bypass, Middle Aged, Cardiology and Cardiovascular Medicine, Non-ST Elevated Myocardial Infarction, Medical Informatics, Troponin, Aged
Abstract: Implications of elevated troponin on time-to-surgery in non-ST elevation myocardial infarction(NIHR Health Informatics Collaborative:TROP-CABG study). Benedetto et al. BACKGROUND: The optimal timing of coronary artery bypass grafting (CABG) in patients with non-ST elevation myocardial infarction (NSTEMI) and the utility of pre-operative troponin levels in decision-making remains unclear. We investigated (a) the association between peak pre-operative troponin and survival post-CABG in a large cohort of NSTEMI patients and (b) the interaction between troponin and time-to-surgery. METHODS AND RESULTS: Our cohort consisted of 1746 patients (1684 NSTEMI; 62 unstable angina) (mean age 69 ± 11 years,21% female) with recorded troponins that had CABG at five United Kingdom centers between 2010 and 2017. Time-segmented Cox regression was used to investigate the interaction of peak troponin and time-to-surgery on early (within 30 days) and late (beyond 30 days) survival. Average interval from peak troponin to surgery was 9 ± 15 days, with 1466 (84.0%) patients having CABG during the same admission. Sixty patients died within 30-days and another 211 died after a mean follow-up of 4 ± 2 years (30-day survival 0.97 ± 0.004 and 5-year survival 0.83 ± 0.01). Peak troponin was a strong predictor of early survival (adjusted P = 0.002) with a significant interaction with time-to-surgery (P interaction = 0.007). For peak troponin levels100 times the upper limit of normal, there was no improvement in early survival with longer time-to-surgery. However, in patients with higher troponins, early survival increased progressively with a longer time-to-surgery, till day 10. Peak troponin did not influence survival beyond 30 days (adjusted P = 0.64). CONCLUSIONS: Peak troponin in NSTEMI patients undergoing CABG was a significant predictor of early mortality, strongly influenced the time-to-surgery and may prove to be a clinically useful biomarker in the management of these patients.
Published: 2021

10. Club 35 Poster session 2: Thursday 4 December 2014, 08: 30–18: 00Location: Poster area

Author: Santos, M, Rivero, J, Mccullough, SD, Opotowsky, AR, Waxman, AB, Systrom, D, and Shah, AM
Published: 2014

11. Excess deaths in people with cardiovascular diseases during the COVID-19 pandemic

Author: Banerjee, A, Chen, S, Pasea, L, Lai, AG, Katsoulis, M, Denaxas, S, Nafilyan, V, Williams, B, Wong, WK, Bakhai, A, Khunti, K, Pillay, D, Noursadeghi, M, Wu, H, Pareek, N, Bromage, D, McDonagh, TA, Byrne, J, Teo, JTH, Shah, AM, Humberstone, B, Tang, L, Shah, AS, Rubboli, A, Guo, Y, Hu, Y, Sudlow, CLM, Lip, GYH, Hemingway, H, Banerjee, A, Chen, S, Pasea, L, Lai, AG, Katsoulis, M, Denaxas, S, Nafilyan, V, Williams, B, Wong, WK, Bakhai, A, Khunti, K, Pillay, D, Noursadeghi, M, Wu, H, Pareek, N, Bromage, D, McDonagh, TA, Byrne, J, Teo, JTH, Shah, AM, Humberstone, B, Tang, L, Shah, AS, Rubboli, A, Guo, Y, Hu, Y, Sudlow, CLM, Lip, GYH, and Hemingway, H
Abstract: AIMS: Cardiovascular diseases (CVDs) increase mortality risk from coronavirus infection (COVID-19). There are also concerns that the pandemic has affected supply and demand of acute cardiovascular care. We estimated excess mortality in specific CVDs, both 'direct', through infection, and 'indirect', through changes in healthcare. METHODS AND RESULTS: We used (i) national mortality data for England and Wales to investigate trends in non-COVID-19 and CVD excess deaths; (ii) routine data from hospitals in England (n = 2), Italy (n = 1), and China (n = 5) to assess indirect pandemic effects on referral, diagnosis, and treatment services for CVD; and (iii) population-based electronic health records from 3 862 012 individuals in England to investigate pre- and post-COVID-19 mortality for people with incident and prevalent CVD. We incorporated pre-COVID-19 risk (by age, sex, and comorbidities), estimated population COVID-19 prevalence, and estimated relative risk (RR) of mortality in those with CVD and COVID-19 compared with CVD and non-infected (RR: 1.2, 1.5, 2.0, and 3.0).Mortality data suggest indirect effects on CVD will be delayed rather than contemporaneous (peak RR 1.14). CVD service activity decreased by 60-100% compared with pre-pandemic levels in eight hospitals across China, Italy, and England. In China, activity remained below pre-COVID-19 levels for 2-3 months even after easing lockdown and is still reduced in Italy and England. For total CVD (incident and prevalent), at 10% COVID-19 prevalence, we estimated direct impact of 31 205 and 62 410 excess deaths in England (RR 1.5 and 2.0, respectively), and indirect effect of 49 932 to 99 865 deaths. CONCLUSION: Supply and demand for CVD services have dramatically reduced across countries with potential for substantial, but avoidable, excess mortality during and after the pandemic.
Published: 2021

12. Combining diastolic dysfunction and natriuretic peptides to risk stratify patients with heart failure with reduced ejection fraction

Author: Gori, M, Claggett, B, Senni, M, Shah, A, Goldenberg, I, Kutyifa, V, Knappe, D, Pouleur, A, Solomon, S, Gori M, Claggett B, Senni M, Shah AM, Goldenberg I, Kutyifa V, Knappe D, Pouleur AC, Solomon SD, Gori, M, Claggett, B, Senni, M, Shah, A, Goldenberg, I, Kutyifa, V, Knappe, D, Pouleur, A, Solomon, S, Gori M, Claggett B, Senni M, Shah AM, Goldenberg I, Kutyifa V, Knappe D, Pouleur AC, and Solomon SD
Abstract: Background: Diastolic dysfunction (DD) might help to risk stratify patients with heart failure (HF) with reduced ejection fraction (HFrEF). Nonetheless, HF guidelines/risk scores don't consider DD. We aimed to show the independent prognostic value of DD for nonfatal HF/death in patients with HFrEF on top of natriuretic peptides (NP). Methods: We analyzed 1155 baseline echocardiograms of the MADIT-CRT study (LVEF≤30%, QRS ≥ 130 ms, NYHA class I/II), classifying DD according to 2016 ASE/EACVI classification. Results: Patients were 64 ± 11 years-old, 24% females, LVEF was 24 ± 5%, 58% had abnormal BNP (≥100 pg/ml). While 45% had impaired relaxation, 33% had pseudonormal filling, 12% restrictive pattern, 6% indeterminate diastolic function, 4% were not classifiable due to missing data. During a follow-up of 2.1 ± 1.0 years, there were 233 HF/death. Compared to patients without pseudonormal/restrictive filling and with normal NP (23%), patients with pseudonormal/restrictive filling, alone (15%) or combined to elevated NP (30%), were at higher risk of events (respectively padj = 0.025 and padj < 0.001), as opposed to those with abnormal NP alone (22%; padj = 0.55). Adding DD to conventional markers of risk and NP improved prediction (C-statistic 0.733 versus 0.708, p = 0.024). DD was the first parameter to be considered to risk stratify MADIT-CRT population, according to Classification-And-Regression-Tree analysis. Conclusions: Among HFrEF patients with mild symptoms, pseudonormal/restrictive filling, either alone or combined with elevated NP, was associated with high risk of events, as opposed to isolated elevation of NP. DD provided incremental risk prediction for death/HF beyond commonly used markers. These data might suggest to integrate DD into HF guidelines/risk scores.
Published: 2021

13. P600Endothelial Nox2 is protective against sepsis-induced severe hypotension and systemic inflammatory response

Author: Trevelin, S C, Santos, CX, Zhang, M, Sag, C, Cunha, TM, Alves-Filho, JC, Lopes, LR, Cunha, FQ, Ivetic, A, and Shah, AM
Published: 2014
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14. P258Redox-state of pentraxin 3 as a novel biomarker for resolution of inflammation and survival in sepsis

Author: Cuello, F, Shankar-Hari, M, Mayr, U, Yin, X, Marshall, M, Willeit, P, Langley, SR, Terblanche, M, Shah, AM, and Mayr, M
Published: 2014
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15. Poster Session Saturday 14 December - AM: 14/12/2013, 08: 30–12: 30Location: Poster area

Author: Khan, SG, Mushemi-Blake, S, Jouhra, F, Dennes, W, Monaghan, M, Melikian, N, and Shah, AM
Published: 2013

16. Divergent effects of genetic and pharmacological inhibition of Nox2 NADPH oxidase on insulin resistance related vascular damage

Author: Maqbool, A, Watt, N, Haywood, N, Viswambharan, H, Skromna, A, Makava, N, Visnagri, A, Shawer, HM, Bridge, K, Muminov, SK, Griffin, K, Beech, DJ, Wheatcroft, SB, Porter, KE, Simmons, KJ, Sukumar, P, Shah, AM, Cubbon, RM, Kearney, MT, and Yuldasheva, NY
Subjects: urogenital system, cardiovascular system, hormones, hormone substitutes, and hormone antagonists, circulatory and respiratory physiology
Abstract: Insulin resistance leads to excessive endothelial cell (EC) superoxide generation and accelerated atherosclerosis. The principal source of superoxide from the insulin-resistant endothelium is the Nox2 isoform of NADPH oxidase. Here we examine the therapeutic potential of Nox2 inhibition on: superoxide generation in saphenous vein EC (SVEC) from patients with advanced atherosclerosis and type 2 diabetes; and on vascular function, vascular damage and lipid deposition in Apolipoprotein E deficient (ApoE-/-) mice with EC specific insulin resistance (ESMIRO). To examine the effect of genetic inhibition of Nox2, ESMIRO mice deficient in ApoE-/- and Nox2 (ESMIRO/ApoE-/-/Nox2-/y) were generated and compared to ESMIRO/ApoE-/-/Nox2+/y littermates. To examine the effect of pharmacological inhibition of Nox2 we administered gp91dstat or scrambled peptide to ESMIRO/ApoE-/- mice. SVEC from diabetic patients had increased expression of Nox2 protein with concomitant increase in superoxide generation which could be reduced by the Nox2 inhibitor gp91dstat. After 12 weeks western diet, ESMIRO/ApoE-/-/Nox2-/y mice had reduced EC superoxide generation and greater aortic relaxation to acetylcholine. ESMIRO/ApoE-/-/Nox2-/y mice developed more lipid deposition in the thoraco-abdominal aorta with multiple foci of elastin fragmentation at the level of the aortic sinus and greater expression of intercellular adhesion molecule-1 (ICAM-1). Gp91dstat reduced EC superoxide and lipid deposition in the thoraco-abdominal aorta of ESMIRO/ApoE-/- mice without causing elastin fragmentation or increased ICAM-1 expression. These results demonstrate that insulin resistance is characterized by increased Nox2-derived vascular superoxide. Complete deletion of Nox2 in mice with EC insulin resistance exacerbates, whereas partial pharmacological Nox2 inhibition protects against, insulin resistance-induced vascular damage.
Published: 2020

17. Biochemistry and physiology of cardiac muscle

Author: Layland, J and Shah, AM
Published: 2006
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18. Magnetic Resonance Perfusion or Fractional Flow Reserve in Coronary Disease

Author: Nagel, E, Greenwood, JP, McCann, GP, Bettencourt, N, Shah, AM, Hussain, ST, Perera, D, Plein, S, Bucciarelli-Ducci, C, Paul, M, Westwood, MA, Marber, M, Richter, W-S, Puntmann, VO, Schwenke, C, Schulz-Menger, J, Das, R, Wong, J, Hausenloy, DJ, Steen, H, Berry, C, and MR-INFORM Investigators
Subjects: Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Fractional flow reserve, Coronary Artery Disease, 030204 cardiovascular system & hematology, Coronary disease, Revascularization, Coronary Angiography, Magnetic resonance angiography, Angina, Magnetic resonance perfusion, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Humans, 030212 general & internal medicine, Angina, Stable, Aged, medicine.diagnostic_test, business.industry, Angina, Stable/complications, Magnetic resonance imaging, General Medicine, Middle Aged, medicine.disease, Fractional Flow Reserve, Myocardial, Cardiology, Female, business, Magnetic Resonance Angiography, Coronary Artery Disease/diagnostic imaging
Abstract: BACKGROUND: In patients with stable angina, two strategies are often used to guide revascularization: one involves myocardial-perfusion cardiovascular magnetic resonance imaging (MRI), and the other involves invasive angiography and measurement of fractional flow reserve (FFR). Whether a cardiovascular MRI-based strategy is noninferior to an FFR-based strategy with respect to major adverse cardiac events has not been established.METHODS: We performed an unblinded, multicenter, clinical-effectiveness trial by randomly assigning 918 patients with typical angina and either two or more cardiovascular risk factors or a positive exercise treadmill test to a cardiovascular MRI-based strategy or an FFR-based strategy. Revascularization was recommended for patients in the cardiovascular-MRI group with ischemia in at least 6% of the myocardium or in the FFR group with an FFR of 0.8 or less. The composite primary outcome was death, nonfatal myocardial infarction, or target-vessel revascularization within 1 year. The noninferiority margin was a risk difference of 6 percentage points.RESULTS: A total of 184 of 454 patients (40.5%) in the cardiovascular-MRI group and 213 of 464 patients (45.9%) in the FFR group met criteria to recommend revascularization (P = 0.11). Fewer patients in the cardiovascular-MRI group than in the FFR group underwent index revascularization (162 [35.7%] vs. 209 [45.0%], P = 0.005). The primary outcome occurred in 15 of 421 patients (3.6%) in the cardiovascular-MRI group and 16 of 430 patients (3.7%) in the FFR group (risk difference, -0.2 percentage points; 95% confidence interval, -2.7 to 2.4), findings that met the noninferiority threshold. The percentage of patients free from angina at 12 months did not differ significantly between the two groups (49.2% in the cardiovascular-MRI group and 43.8% in the FFR group, P = 0.21).CONCLUSIONS: Among patients with stable angina and risk factors for coronary artery disease, myocardial-perfusion cardiovascular MRI was associated with a lower incidence of coronary revascularization than FFR and was noninferior to FFR with respect to major adverse cardiac events. (Funded by the Guy's and St. Thomas' Biomedical Research Centre of the National Institute for Health Research and others; MR-INFORM ClinicalTrials.gov number, NCT01236807.).
Published: 2019

19. Effect of Iron Isomaltoside on Skeletal Muscle Energetics in Patients with Chronic Heart Failure and Iron Deficiency: The FERRIC-HF II Randomized Mechanistic Trial

Author: Kemp, GJ, Charles-Edwards, G, Amaral, N, Sleigh, A, Ayis, S, Catibog, N, McDonagh, T, Monaghan, N, Amin-Youssef, G, Shah, AM, and Okonko, DO
Published: 2019

20. WP1-6 The syndrome of the trephined

Author: Shah, AM, primary, Hayes, L, additional, Weston, P, additional, Lowe, A, additional, Liu, C, additional, Watkins, L, additional, and Greenwood, R, additional
Published: 2019
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21. Biochemistry and Physiology of Cardiac Muscle

Author: Layland, J and Shah, AM
Published: 2002
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22. A novel alpha-calcitonin gene-related peptide analogue protects against end-organ damage in experimental hypertension, cardiac hypertrophy, and heart failure

Author: Aubdool, AA, Thakore, P, Argunhan, F, Smillie, S-J, Schnelle, M, Srivastava, S, Alawi, KM, Wilde, E, Mitchell, J, Farrell-Dillon, K, Richards, DA, Maltese, G, Siow, RC, Nandi, M, Clark, JE, Shah, AM, Sams, A, and Brain, SD
Subjects: Male, Cardiac & Cardiovascular Systems, hypertension, Cardiotonic Agents, SMOOTH-MUSCLE-CELLS, Calcitonin Gene-Related Peptide, Multiple Organ Failure, heart failure, BLOOD-PRESSURE, Cardiomegaly, 1102 Cardiovascular Medicine And Haematology, Mice, oxidative stress, Animals, IN-VIVO, NEUROGENIC VASODILATATION, Science & Technology, II-INDUCED HYPERTENSION, 1103 Clinical Sciences, receptors, calcitonin gene-related peptide, Mice, Inbred C57BL, ANGIOTENSIN-II, Peripheral Vascular Disease, MYOCARDIAL-INFARCTION, 1117 Public Health And Health Services, Cardiovascular System & Hematology, inflammation, Cardiovascular System & Cardiology, MESSENGER-RNA, Life Sciences & Biomedicine, INDUCED RENAL DAMAGE, Blood Flow Velocity
Abstract: Background: Research into the therapeutic potential of α-calcitonin gene–related peptide (α-CGRP) has been limited because of its peptide nature and short half-life. Here, we evaluate whether a novel potent and long-lasting (t½ ≥7 hours) acylated α-CGRP analogue (αAnalogue) could alleviate and reverse cardiovascular disease in 2 distinct murine models of hypertension and heart failure in vivo. Methods: The ability of the αAnalogue to act selectively via the CGRP pathway was shown in skin by using a CGRP receptor antagonist. The effect of the αAnalogue on angiotensin II–induced hypertension was investigated over 14 days. Blood pressure was measured by radiotelemetry. The ability of the αAnalogue to modulate heart failure was studied in an abdominal aortic constriction model of murine cardiac hypertrophy and heart failure over 5 weeks. Extensive ex vivo analysis was performed via RNA analysis, Western blot, and histology. Results: The angiotensin II–induced hypertension was attenuated by cotreatment with the αAnalogue (50 nmol·kg–1·d–1, SC, at a dose selected for lack of long-term hypotensive effects at baseline). The αAnalogue protected against vascular, renal, and cardiac dysfunction, characterized by reduced hypertrophy and biomarkers of fibrosis, remodeling, inflammation, and oxidative stress. In a separate study, the αAnalogue reversed angiotensin II–induced hypertension and associated vascular and cardiac damage. The αAnalogue was effective over 5 weeks in a murine model of cardiac hypertrophy and heart failure. It preserved heart function, assessed by echocardiography, while protecting against adverse cardiac remodeling and apoptosis. Moreover, treatment with the αAnalogue was well tolerated with neither signs of desensitization nor behavioral changes. Conclusions: These findings, in 2 distinct models, provide the first evidence for the therapeutic potential of a stabilized αAnalogue, by mediating (1) antihypertensive effects, (2) attenuating cardiac remodeling, and (3) increasing angiogenesis and cell survival to protect against and limit damage associated with the progression of cardiovascular diseases. This indicates the therapeutic potential of the CGRP pathway and the possibility that this injectable CGRP analogue may be effective in cardiac disease.
Published: 2017

23. ROLE OF NEURONAL VS ENDOTHELIAL NITRIC OXIDE SYNTHASE IN THE CORONARY BLOOD FLOW RESPONSE TO PACING

Author: Shabeeh, H, Melikian, N, Dworakowski, R, Casadei, B, Chowienczyk, P, and Shah, AM
Published: 2016

24. NOX2 NADPH-OXIDASE A NOVEL TARGET TO PREVENT INSULIN RESISTANCE RELATED ENDOTHELIAL CELL DYSFUNCTION

Author: Sukumar, P, Viswambharan, H, Imrie, H, Cubbon, RM, Yuldasheva, N, Gage, M, Galloway, S, Skromna, A, Smith, J, Gatenby, K, Beech, DJ, Wheatcroft, SB, Channon, KM, Shah, AM, and Kearney, MT
Published: 2016

25. Nellix Endovascular Aneurysm Sealing System (EVAS): A New Concept in Endovascular Repair - What the Radiologist Needs to Know

Author: Touska P, Vlahos I, Weller A, Shah Am, Sayer C, and Seyed Ar
Subjects: medicine.medical_specialty, business.industry, Carotid arteries, medicine.medical_treatment, Stent, 030204 cardiovascular system & hematology, medicine.disease, Abdominal aortic aneurysm, Surgery, 03 medical and health sciences, 0302 clinical medicine, Aneurysm, medicine, 030212 general & internal medicine, Radiology, business
Abstract: The Nellix endovascular aneurysm sealing system (EVAS), licensed in Europe for treating infrarenal abdominal aortic aneurysms, has distinctive design comprising two balloon-expandable endoframes, each surrounded by a polymer-filled endobag. This review describes the current role of CT in both Nellix follow-up and pre-procedure planning, with reference to the inclusion criteria for Nellix insertion and the deployment technique. Knowledge of the expected evolution of CT features following Nellix insertion is important for recognizing potential complications. Examples of normal post-operative CT appearance, as well as complications seen to date are discussed.
Published: 2016

26. Seroprevalence of HIV, HBV, HCV & RPR among cornea donor in the regional institute of ophthalmology

Author: Patel, MH, primary, Patel, AM, additional, and Shah, AM, additional
Published: 2017
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27. Prognostic significance of anaemia in patients with heart failure with preserved and reduced ejection fraction: Results from the MAGGIC individual patient data meta-analysis

Author: Berry, C, Poppe, K, Gamble, G, Earle, N, Ezekowitz, J, Squire, I, Mcmurray, J, Mcalister, F, Komajda, M, Swedberg, K, Maggioni, A, Ahmed, A, Whalley, G, Doughty, R, Tarantini, L, Granger, C, Køber, L, Massie, B, Pocock, S, Somaratne, J, Andersson, B, Bayes-Genis, A, Cowie, M, Cubbon, R, Gonzalez-Juanatey, J, Gorini, M, Gotsman, I, Grigorian-Shamagian, L, Guazzi, M, Kearney, M, Di Lenarda, A, Lenzen, M, Lucci, D, Macín, S, Madsen, B, Martínez-Sellés, M, Oliva, F, Rich, M, Richards, M, Senni, M, Taffet, G, Tribouilloy, C, Troughton, R, Tsutsui, H, Ariti, C, Dobson, J, Hall, C, Lainchbury, J, Hogg, K, Norrie, J, Stevenson, K, Brett, M, Pfeffer, M, Held, P, Michelson, E, Olofsson, B, Östergren, J, Yusuf, S, Torp-Pedersen, C, Scholte op Reimer, W, Boersma, E, Vantrimpont, P, Follath, F, Cleland, J, Zwas, D, Planer, D, Azaz-Livshits, T, Admon, D, Lotan, C, Keren, A, Varela-Roman, A, Mazón-Ramos, P, Rigeiro-Veloso, P, Bandin-Dieguez, M, Myers, J, Arena, R, Armstrong, P, Cujec, B, Paterson, I, Wood, D, Coats, A, Thompson, S, Suresh, V, Poole-Wilson, P, Sutton, G, Robles, J, Prieto, L, Muñoa, M, Frades, E, Díaz-Castro, O, Almendral, J, Faggiano, P, Bertoli, D, Porcu, M, Opasich, C, Tavazzi, L, Kirk, V, Bay, M, Parner, J, Krogsgaard, K, Herzog, T, Boesgaard, S, Hassager, C, Nielsen, O, Aldershvile, J, Nielsen, H, Kober, L, Perna, E, Cimbaro Canella, J, Alvarenga, P, Pantich, R, Ríos, N, Farias, E, Badaracco, J, Hansen, J, Stokholm, K, Brons, J, Husum, D, Mortensen, L, Vazquez, R, Puig, T, Fernandez-Palomeque, C, Bardají, A, Pascual-Figal, D, Ordoñez-Llanos, J, Valdes, M, Gabarrus, A, Pavon, R, Pastor, L, Fiol, M, Nieto, V, Macaya, C, Cinca, J, Cygankiewitz, I, Bayes De Luna, A, Newton, J, Blackledge, H, Wright, S, Kerzner, R, Gage, B, Freedland, K, Huynh, B, Rovner, A, Carney, R, Teasdale, T, Bleyer, A, Kutka, N, Luchi, R, Rusinaru, D, Mahjoub, H, Soulière, V, Lévy, F, Peltier, M, Tsuchihashi, M, Takeshita, A, Maccarthy, P, Nolan, J, Lee, A, Prescott, R, Shah, A, Brooksby, W, Fox, K, Basante, P, Trillo, R, Garcia-Seara, J, Martinez-Sande, J, Gude, F, Berry C, Poppe KK, Gamble GD, Earle NJ, Ezekowitz JA, Squire IB, McMurray JJV, McAlister FA, Komajda M, Swedberg K, Maggioni AP, Ahmed A, Whalley GA, Doughty RN, Tarantini L, Granger C, Køber L, Massie B, Pocock S, Somaratne J, Andersson B, Bayes-Genis A, Cowie M, Cubbon R, Gonzalez-Juanatey J, Gorini M, Gotsman I, Grigorian-Shamagian L, Guazzi M, Kearney M, Di Lenarda A, Lenzen M, Lucci D, Macín S, Madsen B, Martínez-Sellés M, Oliva F, Rich M, Richards M, Senni M, Taffet G, Tribouilloy C, Troughton R, Tsutsui H, Ariti C, Dobson J, Hall C, Lainchbury J, Hogg K, Norrie J, Stevenson K, Brett M, Pfeffer MA, Held P, Michelson EL, Olofsson B, Östergren J, Yusuf S, Torp-Pedersen C, Scholte op Reimer W, Boersma E, Vantrimpont PJMJ, Follath F, Cleland J, Zwas D, Planer D, Azaz-Livshits T, Admon D, Lotan C, Keren A, Varela-Roman A, Mazón-Ramos P, Rigeiro-Veloso P, Bandin-Dieguez MA, Myers J, Arena R, Armstrong PW, Cujec B, Paterson I, Wood DA, Coats AJS, Thompson SG, Suresh V, Poole-Wilson PA, Sutton GC, Robles JAG, Prieto L, Muñoa MD, Frades E, Díaz-Castro O, Almendral J, Faggiano P, Bertoli D, Porcu M, Opasich C, Tavazzi L, Kirk V, Bay M, Parner J, Krogsgaard K, Herzog TM, Boesgaard S, Hassager C, Nielsen OW, Aldershvile J, Nielsen H, Kober L, Perna ER, Cimbaro Canella JP, Alvarenga P, Pantich R, Ríos N, Farias EF, Badaracco JR, Hansen JF, Stokholm KH, Brons J, Husum D, Mortensen LS, Vazquez R, Puig T, Fernandez-Palomeque C, Bardají A, Pascual-Figal D, Ordoñez-Llanos J, Valdes M, Gabarrus A, Pavon R, Pastor L, Fiol M, Nieto V, Macaya C, Cinca J, Cygankiewitz I, Bayes De Luna A, Newton JD, Blackledge HM, Wright SP, Kerzner R, Gage BF, Freedland KE, Huynh BC, Rovner A, Carney RM, Teasdale TA, Bleyer AJ, Kutka NJ, Luchi RJ, Rusinaru D, Mahjoub H, Soulière V, Lévy F, Peltier M, Tsuchihashi M, Takeshita A, MacCarthy PA, Nolan J, Lee AJ, Prescott RJ, Shah AM, Brooksby WP, Fox KAA, Basante P, Trillo R, Garcia-Seara J, Martinez-Sande JL, Gude F, Berry, C, Poppe, K, Gamble, G, Earle, N, Ezekowitz, J, Squire, I, Mcmurray, J, Mcalister, F, Komajda, M, Swedberg, K, Maggioni, A, Ahmed, A, Whalley, G, Doughty, R, Tarantini, L, Granger, C, Køber, L, Massie, B, Pocock, S, Somaratne, J, Andersson, B, Bayes-Genis, A, Cowie, M, Cubbon, R, Gonzalez-Juanatey, J, Gorini, M, Gotsman, I, Grigorian-Shamagian, L, Guazzi, M, Kearney, M, Di Lenarda, A, Lenzen, M, Lucci, D, Macín, S, Madsen, B, Martínez-Sellés, M, Oliva, F, Rich, M, Richards, M, Senni, M, Taffet, G, Tribouilloy, C, Troughton, R, Tsutsui, H, Ariti, C, Dobson, J, Hall, C, Lainchbury, J, Hogg, K, Norrie, J, Stevenson, K, Brett, M, Pfeffer, M, Held, P, Michelson, E, Olofsson, B, Östergren, J, Yusuf, S, Torp-Pedersen, C, Scholte op Reimer, W, Boersma, E, Vantrimpont, P, Follath, F, Cleland, J, Zwas, D, Planer, D, Azaz-Livshits, T, Admon, D, Lotan, C, Keren, A, Varela-Roman, A, Mazón-Ramos, P, Rigeiro-Veloso, P, Bandin-Dieguez, M, Myers, J, Arena, R, Armstrong, P, Cujec, B, Paterson, I, Wood, D, Coats, A, Thompson, S, Suresh, V, Poole-Wilson, P, Sutton, G, Robles, J, Prieto, L, Muñoa, M, Frades, E, Díaz-Castro, O, Almendral, J, Faggiano, P, Bertoli, D, Porcu, M, Opasich, C, Tavazzi, L, Kirk, V, Bay, M, Parner, J, Krogsgaard, K, Herzog, T, Boesgaard, S, Hassager, C, Nielsen, O, Aldershvile, J, Nielsen, H, Kober, L, Perna, E, Cimbaro Canella, J, Alvarenga, P, Pantich, R, Ríos, N, Farias, E, Badaracco, J, Hansen, J, Stokholm, K, Brons, J, Husum, D, Mortensen, L, Vazquez, R, Puig, T, Fernandez-Palomeque, C, Bardají, A, Pascual-Figal, D, Ordoñez-Llanos, J, Valdes, M, Gabarrus, A, Pavon, R, Pastor, L, Fiol, M, Nieto, V, Macaya, C, Cinca, J, Cygankiewitz, I, Bayes De Luna, A, Newton, J, Blackledge, H, Wright, S, Kerzner, R, Gage, B, Freedland, K, Huynh, B, Rovner, A, Carney, R, Teasdale, T, Bleyer, A, Kutka, N, Luchi, R, Rusinaru, D, Mahjoub, H, Soulière, V, Lévy, F, Peltier, M, Tsuchihashi, M, Takeshita, A, Maccarthy, P, Nolan, J, Lee, A, Prescott, R, Shah, A, Brooksby, W, Fox, K, Basante, P, Trillo, R, Garcia-Seara, J, Martinez-Sande, J, Gude, F, Berry C, Poppe KK, Gamble GD, Earle NJ, Ezekowitz JA, Squire IB, McMurray JJV, McAlister FA, Komajda M, Swedberg K, Maggioni AP, Ahmed A, Whalley GA, Doughty RN, Tarantini L, Granger C, Køber L, Massie B, Pocock S, Somaratne J, Andersson B, Bayes-Genis A, Cowie M, Cubbon R, Gonzalez-Juanatey J, Gorini M, Gotsman I, Grigorian-Shamagian L, Guazzi M, Kearney M, Di Lenarda A, Lenzen M, Lucci D, Macín S, Madsen B, Martínez-Sellés M, Oliva F, Rich M, Richards M, Senni M, Taffet G, Tribouilloy C, Troughton R, Tsutsui H, Ariti C, Dobson J, Hall C, Lainchbury J, Hogg K, Norrie J, Stevenson K, Brett M, Pfeffer MA, Held P, Michelson EL, Olofsson B, Östergren J, Yusuf S, Torp-Pedersen C, Scholte op Reimer W, Boersma E, Vantrimpont PJMJ, Follath F, Cleland J, Zwas D, Planer D, Azaz-Livshits T, Admon D, Lotan C, Keren A, Varela-Roman A, Mazón-Ramos P, Rigeiro-Veloso P, Bandin-Dieguez MA, Myers J, Arena R, Armstrong PW, Cujec B, Paterson I, Wood DA, Coats AJS, Thompson SG, Suresh V, Poole-Wilson PA, Sutton GC, Robles JAG, Prieto L, Muñoa MD, Frades E, Díaz-Castro O, Almendral J, Faggiano P, Bertoli D, Porcu M, Opasich C, Tavazzi L, Kirk V, Bay M, Parner J, Krogsgaard K, Herzog TM, Boesgaard S, Hassager C, Nielsen OW, Aldershvile J, Nielsen H, Kober L, Perna ER, Cimbaro Canella JP, Alvarenga P, Pantich R, Ríos N, Farias EF, Badaracco JR, Hansen JF, Stokholm KH, Brons J, Husum D, Mortensen LS, Vazquez R, Puig T, Fernandez-Palomeque C, Bardají A, Pascual-Figal D, Ordoñez-Llanos J, Valdes M, Gabarrus A, Pavon R, Pastor L, Fiol M, Nieto V, Macaya C, Cinca J, Cygankiewitz I, Bayes De Luna A, Newton JD, Blackledge HM, Wright SP, Kerzner R, Gage BF, Freedland KE, Huynh BC, Rovner A, Carney RM, Teasdale TA, Bleyer AJ, Kutka NJ, Luchi RJ, Rusinaru D, Mahjoub H, Soulière V, Lévy F, Peltier M, Tsuchihashi M, Takeshita A, MacCarthy PA, Nolan J, Lee AJ, Prescott RJ, Shah AM, Brooksby WP, Fox KAA, Basante P, Trillo R, Garcia-Seara J, Martinez-Sande JL, and Gude F
Abstract: Background: Anaemia is common among patients with heart failure (HF) and is an important prognostic marker. Aim: We sought to determine the prognostic importance of anaemia in a large multinational pooled dataset of prospectively enrolled HF patients, with the specific aim to determine the prognostic role of anaemia in HF with preserved and reduced ejection fraction (HF-PEF and HF-REF, respectively). Design: Individual person data meta-analysis. Methods: Patients with haemoglobin (Hb) data fromthe MAGGIC dataset were used. Anaemia was defined as Hb < 120 g/l in women and <130 g/l inmen. HF-PEF was defined as EF ≥ 50%; HF-REF was EF < 50%. Cox proportional hazardmodelling, with adjustment for clinically relevant variables, was undertaken to investigate factors associated with 3-year all-causemortality. Results: Thirteen thousand two hundred and ninety-five patients with HF from 19 studies (9887 with HF-REF and 3408 with HF-PEF). The prevalence of anaemia was similar among those with HF-REF and HF-PEF (42.8 and 41.6% respectively). Compared with patients with normal Hb values, those with anaemia were older, were more likely to have diabetes, ischaemic aetiology, New York Heart Association class IV symptoms, lower estimated glomerular filtration rate and were more likely to be taking diuretic and less likely to be taking a beta-blocker. Patients with anaemia had higher all-cause mortality (adjusted hazard ratio [aHR] 1.38, 95% confidence interval [CI] 1.25-1.51), independent of EF group: aHR 1.67 (1.39-1.99) in HFPEF and aHR 2.49 (2.13-2.90) in HF-REF. Conclusions: Anaemia is an adverse prognostic factor in HF irrespective of EF. The prognostic importance of anaemia was greatest in patients with HF-REF.
Published: 2016

28. Effect of Mineralocorticoid Receptor Antagonists on Cardiac Structure and Function in Patients With Diastolic Dysfunction and Heart Failure With Preserved Ejection Fraction: A Meta-Analysis and Systematic Review

Author: Pandey, A, Garg, S, Matulevicius, SA, Shah, AM, Garg, J, Drazner, MH, Amin, A, Berry, JD, Marwick, TH, Marso, SP, de Lemos, JA, Kumbhani, DJ, Pandey, A, Garg, S, Matulevicius, SA, Shah, AM, Garg, J, Drazner, MH, Amin, A, Berry, JD, Marwick, TH, Marso, SP, de Lemos, JA, and Kumbhani, DJ
Abstract: BACKGROUND: There has been an increasing interest in use of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure with preserved ejection fraction (HFPEF). However, a comprehensive evaluation of MRA effects on left ventricular (LV) structure and function in these patients is lacking. In this meta-analysis, we evaluated the effects of MRAs on LV structure and function among patients with diastolic dysfunction or HFPEF. METHODS & RESULTS: Randomized, controlled clinical trials evaluating the efficacy of MRAs in patients with diastolic dysfunction or HFPEF were included. The primary outcome was change in E/e', a specific measure of diastolic function. Secondary outcomes included changes in other measures of diastolic function, LV structure, surrogate markers for myocardial fibrosis (carboxy-terminal peptide of procollagen type I [PICP] and amino-terminal peptide of pro-collagen type-II [PIIINP]), blood pressure, and exercise tolerance. In the pooled analysis, MRA use was associated with significant reduction in E/e' (weighted mean difference [WMD] [95% confidence interval {CI}]: -1.68 [-2.03 to -1.33]; P<0.0001) and deceleration time (WMD [95% CI]: -12.0 ms [-23.3 to -0.7]; P=0.04) as compared with control, suggesting and improvement in diastolic function. Furthermore, blood pressure and levels of PIIINP and PICP were also significantly reduced with MRA therapy with no significant change in LV mass or dimensions. CONCLUSION: MRA therapy in patients with asymptomatic diastolic dysfunction or HFPEF is associated with significant improvement in diastolic function and markers of cardiac fibrosis without a significant change in LV mass or dimensions.
Published: 2015

29. Genetic analysis for high temperature tolerance in bread wheat

Author: Punia, SS, Shah, AM, and Ranwha, BR
Subjects: Heat tolerant, proline, Triticum aestivum
Abstract: Heat stress, characterised by a trend in average temperature increase during anthesis and grain filling, leads to forced maturity is one of the major constraints of wheat production in arid and, semiarid regions of the world. This study examined the nature and magnitude of gene action for yield and its contributing characters and some important heat tolerant parameters in bread wheat (Triticum aestivum l em. thell) to determine breeding strategies for future breeding programmes. Twelve lines and four testers were crossed in an L x T mating design. The 48 crosses and their parents were raised under normal (21, November 2002) and late sown (1, January 2003) seasons at the Experimental Farm of Rajasthan College of Agriculture, Udaipur in India. Lines K’sona, DWR 195, C 306 and K 9708 were found to be good combiners for different heat tolerant parameters along with grain yield. Combinations of Raj 3077 x Kailash under normal (E1) and late sown (E2), C 306 x PBN 51 (E1) and C 306 x HD 2189 (E2) for grain yield; had high sca effect. The crosses viz., K 9708 x PBN 51 for proline content and heat injury, DWR 195 with HD 2189, and C 306 with Kailash for heat injury had desirable significant sca effects. The other crosses, HD 2329 x Kailash for pollen viability, and Raj 3765 x Kailash for chlorophyll content, were the best specific combiners. Parents like C 306, K’sona, DWR 195, K 9708, Raj 3077, PBN 51 and Kailash could be utilised in multiple crossing programmes and further biparental matting for selection of high yielding progenies for heat tolerance.
Published: 2012

30. The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction: an individual patient data meta-analysis

Author: Granger, C, Massie, B, Somaratne, J, Ahmed, A, Cowie, M, Gonzalez-Juanatey, J, Gorini, M, Kearney, M, di Lenarda, A, Lenzen, M, Macin, S, Madsen, B, Maggioni, A, McAlister, F, Oliva, F, Rich, M, Richards, M, Squire, I, Taffet, G, Earle, N, Perera, K, Dobson, J, Pocock, S, Poppe, K, Whalley, G, Andersson, B, Hall, C, Richards, AM, Troughton, R, Lainchbury, J, Berry, C, Hogg, K, Norrie, J, Stevenson, K, Brett, M, McMurray, J, Pfeffer, MA, Granger, CB, Held, P, McMurray, JJV, Michelson, EL, Olofsson, B, Ostergren, J, Yusuf, S, Torp-Pedersen, C, Lenzen, MJ, Reimer, WJMS, Boersma, E, Vantrimpont, PJMJ, Follath, F, Swedberg, K, Cleland, J, Komajda, M, Gotsman, I, Zwas, D, Planer, D, Azaz-Livshits, T, Admon, D, Lotan, C, Keren, A, Grigorian-Shamagian, L, Mazon-Ramos, P, Rigeiro-Veloso, P, Bandin-Dieguez, MA, Guazzi, M, Myers, J, Arena, R, McAlister, FA, Ezekowitz, J, Armstrong, PW, Cujec, B, Paterson, I, Cowie, MR, Wood, DA, Coats, AJS, Thompson, SG, Suresh, V, Poole-Wilson, PA, Sutton, GC, Martinez-Selles, M, Robles, JAG, Prieto, L, Munoa, MD, Frades, E, Diaz-Castro, O, Tarantini, L, Faggiano, P, Senni, M, Lucci, D, Bertoli, D, Porcu, M, Opasich, C, Tavazzi, L, Maggioni, AP, Kirk, V, Bay, M, Parner, J, Krogsgaard, K, Herzog, TM, Boesgaard, S, Hassager, C, Nielsen, OW, Aldershvile, J, Nielsen, H, Kober, L, Macin, SM, Perna, ER, Canella, JPC, Alvarenga, P, Pantich, R, Rios, N, Farias, EF, Badaracco, JR, Madsen, BK, Hansen, JF, Stokholm, KH, Brons, J, Husum, D, Mortensen, LS, Bayes-Genis, A, Vazquez, R, Puig, T, Fernandez-Palomeque, C, Bardaji, A, Pascual-Figal, D, Ordonez-Llanos, J, Valdes, M, Gabarrus, A, Pavon, R, Pastor, L, Almendral, J, Fiol, M, Nieto, V, Macaya, C, Cinca, J, de Luna, AB, Newton, JD, Blackledge, HM, Squire, IB, Wright, SP, Whalley, GA, Doughty, RN, Kerzner, R, Gage, BF, Huynh, BC, Rovner, A, Freedland, KE, Carney, RM, Rich, MW, Taffet, GE, Teasdale, TA, Bleyer, AJ, Kutka, NJ, Luchi, RJ, Tribouilloy, C, Rusinaru, D, Mahjoub, H, Souliere, V, Levy, F, Peltier, M, Tsutsui, H, Tsuchihashi, M, Takeshita, A, MacCarthy, PA, Kearney, MT, Cubbon, R, Nolan, J, Lee, AJ, Prescott, RJ, Shah, AM, Brooksby, WP, Fox, KAA, Varela-Roman, A, Gonzalez-Juanatey, JR, Basante, P, Trillo, R, Garcia-Seara, J, Martinez-Sande, JL, and Gude, F
Subjects: Meta-analysis, Heart failure, Prognosis
Abstract: A substantial proportion of patients with heart failure have preserved left ventricular ejection fraction (HF-PEF). Previous studies have reported mixed results whether survival is similar to those patients with heart failure and reduced EF (HF-REF). We compared survival in patients with HF-PEF with that in patients with HF-REF in a meta-analysis using individual patient data. Preserved EF was defined as an EF epsilon 50. The 31 studies included 41 972 patients: 10 347 with HF-PEF and 31 625 with HF-REF. Compared with patients with HF-REF, those with HF-PEF were older (mean age 71 vs. 66 years), were more often women (50 vs. 28), and have a history of hypertension (51 vs. 41). Ischaemic aetiology was less common (43 vs. 59) in patients with HF-PEF. There were 121 [95 confidence interval (CI): 117, 126] deaths per 1000 patient-years in those with HF-PEF and 141 (95 CI: 138, 144) deaths per 1000 patient-years in those with HF-REF. Patients with HF-PEF had lower mortality than those with HF-REF (adjusted for age, gender, aetiology, and history of hypertension, diabetes, and atrial fibrillation); hazard ratio 0.68 (95 CI: 0.64, 0.71). The risk of death did not increase notably until EF fell below 40. Patients with HF-PEF have a lower risk of death than patients with HF-REF, and this difference is seen regardless of age, gender, and aetiology of HF. However, absolute mortality is still high in patients with HF-PEF highlighting the need for a treatment to improve prognosis.
Published: 2012

31. The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction: an individual patient data meta-analysis

Author: Berry C, Doughty RN, Granger C, Kober L, Massie B, McAlister F, McMurray J, Pocock S, Poppe K, Swedberg K, Somaratne J, Whalley GA, Ahmed A, Andersson B, Bayes-Genis A, Cowie M, Cubbon R, Ezekowitz J, Gonzalez-Juanatey J, Gorini M, Gotsman I, Grigorian-Shamagian L, Guazzi M, Kearney M, Komajda M, di Lenarda A, Lenzen M, Lucci D, Macin S, Madsen B, Maggioni A, Martinez-Selles M, Oliva F, Rich M, Richards M, Senni M, Squire I, Taffet G, Tarantini L, Tribouilloy C, Troughton R, Tsutsui H, Earle N, Perera K, Dobson J, Whalley G, Hall C, Richards AM, Lainchbury J, Hogg K, Norrie J, Stevenson K, Brett M, Pfeffer MA, Granger CB, Held P, McMurray JJV, Michelson EL, Olofsson B, Ostergren J, Yusuf S, Torp-Pedersen C, Lenzen MJ, Reimer WJMS, Boersma E, Vantrimpont PJMJ, Follath F, Cleland J, Zwas D, Planer D, Azaz-Livshits T, Admon D, Lotan C, Keren A, Varela-Roman A, Mazon-Ramos P, Rigeiro-Veloso P, Bandin-Dieguez MA, Gonzalez-Juanatey JR, Myers J, Arena R, McAlister FA, Armstrong PW, Cujec B, Paterson I, Cowie MR, Wood DA, Coats AJS, Thompson SG, Suresh V, Poole-Wilson PA, Sutton GC, Robles JAG, Prieto L, Munoa MD, Frades E, Diaz-Castro O, Almendral J, Faggiano P, Bertoli D, Porcu M, Opasich C, Tavazzi L, Maggioni AP, Kirk V, Bay M, Parner J, Krogsgaard K, Herzog TM, Boesgaard S, Hassager C, Nielsen OW, Aldershvile J, Nielsen H, Macin SM, Perna ER, Canella JPC, Alvarenga P, Pantich R, Rios N, Farias EF, Badaracco JR, Madsen BK, Hansen JF, Stokholm KH, Brons J, Husum D, Mortensen LS, Vazquez R, Puig T, Fernandez-Palomeque C, Bardaji A, Pascual-Figal D, Ordonez-Llanos J, Valdes M, Gabarrus A, Pavon R, Pastor L, Fiol M, Nieto V, Macaya C, Cinca J, de Luna AB, Newton JD, Blackledge HM, Squire IB, Wright SP, Kerzner R, Gage BF, Freedland KE, Rich MW, Huynh BC, Rovner A, Carney RM, Taffet GE, Teasdale TA, Bleyer AJ, Kutka NJ, Luchi RJ, Rusinaru D, Mahjoub H, Souliere V, Levy F, Peltier M, Tsuchihashi M, Takeshita A, MacCarthy PA, Kearney MT, Nolan J, Lee AJ, Prescott RJ, Shah AM, Brooksby WP, Fox KAA, Basante P, Trillo R, Garcia-Seara J, Martinez-Sande JL, Gude F, Berry, C, Doughty, R, Granger, C, Kober, L, Massie, B, Mcalister, F, Mcmurray, J, Pocock, S, Poppe, K, Swedberg, K, Somaratne, J, Whalley, G, Ahmed, A, Andersson, B, Bayes-Genis, A, Cowie, M, Cubbon, R, Ezekowitz, J, Gonzalez-Juanatey, J, Gorini, M, Gotsman, I, Grigorian-Shamagian, L, Guazzi, M, Kearney, M, Komajda, M, di Lenarda, A, Lenzen, M, Lucci, D, Macin, S, Madsen, B, Maggioni, A, Martinez-Selles, M, Oliva, F, Rich, M, Richards, M, Senni, M, Squire, I, Taffet, G, Tarantini, L, Tribouilloy, C, Troughton, R, Tsutsui, H, Earle, N, Perera, K, Dobson, J, Hall, C, Richards, A, Lainchbury, J, Hogg, K, Norrie, J, Stevenson, K, Brett, M, Pfeffer, M, Held, P, Michelson, E, Olofsson, B, Ostergren, J, Yusuf, S, Torp-Pedersen, C, Reimer, W, Boersma, E, Vantrimpont, P, Follath, F, Cleland, J, Zwas, D, Planer, D, Azaz-Livshits, T, Admon, D, Lotan, C, Keren, A, Varela-Roman, A, Mazon-Ramos, P, Rigeiro-Veloso, P, Bandin-Dieguez, M, Myers, J, Arena, R, Armstrong, P, Cujec, B, Paterson, I, Wood, D, Coats, A, Thompson, S, Suresh, V, Poole-Wilson, P, Sutton, G, Robles, J, Prieto, L, Munoa, M, Frades, E, Diaz-Castro, O, Almendral, J, Faggiano, P, Bertoli, D, Porcu, M, Opasich, C, Tavazzi, L, Kirk, V, Bay, M, Parner, J, Krogsgaard, K, Herzog, T, Boesgaard, S, Hassager, C, Nielsen, O, Aldershvile, J, Nielsen, H, Perna, E, Canella, J, Alvarenga, P, Pantich, R, Rios, N, Farias, E, Badaracco, J, Hansen, J, Stokholm, K, Brons, J, Husum, D, Mortensen, L, Vazquez, R, Puig, T, Fernandez-Palomeque, C, Bardaji, A, Pascual-Figal, D, Ordonez-Llanos, J, Valdes, M, Gabarrus, A, Pavon, R, Pastor, L, Fiol, M, Nieto, V, Macaya, C, Cinca, J, de Luna, A, Newton, J, Blackledge, H, Wright, S, Kerzner, R, Gage, B, Freedland, K, Huynh, B, Rovner, A, Carney, R, Teasdale, T, Bleyer, A, Kutka, N, Luchi, R, Rusinaru, D, Mahjoub, H, Souliere, V, Levy, F, Peltier, M, Tsuchihashi, M, Takeshita, A, Maccarthy, P, Nolan, J, Lee, A, Prescott, R, Shah, A, Brooksby, W, Fox, K, Basante, P, Trillo, R, Garcia-Seara, J, Martinez-Sande, J, and Gude, F
Subjects: Male, medicine.medical_specialty, Prognosi, Heart failure, Lower risk, Risk Factors, Cause of Death, Internal medicine, medicine, Humans, Meta-analysi, Aged, Randomized Controlled Trials as Topic, Ejection fraction, business.industry, Hazard ratio, Stroke Volume, Atrial fibrillation, medicine.disease, Confidence interval, Meta-analysis, Cardiology, Etiology, Female, Cardiology and Cardiovascular Medicine, business
Abstract: Aims A substantial proportion of patients with heart failure have preserved left ventricular ejection fraction (HF-PEF). Previous studies have reported mixed results whether survival is similar to those patients with heart failure and reduced EF (HF-REF). Methods and results We compared survival in patients with HF-PEF with that in patients with HF-REF in a meta-analysis using individual patient data. Preserved EF was defined as an EF ≥ 50%. The 31 studies included 41 972 patients: 10 347 with HF-PEF and 31 625 with HF-REF. Compared with patients with HF-REF, those with HF-PEF were older (mean age 71 vs. 66 years), were more often women (50 vs. 28%), and have a history of hypertension (51 vs. 41%). Ischaemic aetiology was less common (43 vs. 59%) in patients with HF-PEF. There were 121 [95% confidence interval (CI): 117, 126] deaths per 1000 patient-years in those with HF-PEF and 141 (95% CI: 138, 144) deaths per 1000 patient-years in those with HF-REF. Patients with HF-PEF had lower mortality than those with HF-REF (adjusted for age, gender, aetiology, and history of hypertension, diabetes, and atrial fibrillation); hazard ratio 0.68 (95% CI: 0.64, 0.71). The risk of death did not increase notably until EF fell below 40%. Conclusion Patients with HF-PEF have a lower risk of death than patients with HF-REF, and this difference is seen regardless of age, gender, and aetiology of HF. However, absolute mortality is still high in patients with HF-PEF highlighting the need for a treatment to improve prognosis.
Published: 2012

32. Association between renal function and cardiovascular structure and function in heart failure with preserved ejection fraction

Author: Gori, M, Senni, M, Gupta, D, Charytan, D, Kraigher-Krainer, E, Pieske, B, Claggett, B, Shah, A, Santos, A, Zile, M, Voors, A, Mcmurray, J, Packer, M, Bransford, T, Lefkowitz, M, Solomon, S, Gori M, Senni M, Gupta DK, Charytan DM, Kraigher-Krainer E, Pieske B, Claggett B, Shah AM, Santos ABS, Zile MR, Voors AA, McMurray JJV, Packer M, Bransford T, Lefkowitz M, Solomon SD, Gori, M, Senni, M, Gupta, D, Charytan, D, Kraigher-Krainer, E, Pieske, B, Claggett, B, Shah, A, Santos, A, Zile, M, Voors, A, Mcmurray, J, Packer, M, Bransford, T, Lefkowitz, M, Solomon, S, Gori M, Senni M, Gupta DK, Charytan DM, Kraigher-Krainer E, Pieske B, Claggett B, Shah AM, Santos ABS, Zile MR, Voors AA, McMurray JJV, Packer M, Bransford T, Lefkowitz M, and Solomon SD
Abstract: Aim Renal dysfunction is a common comorbidity in patients with heart failure and preserved ejection fraction (HFpEF). We sought to determine whether renal dysfunction was associated with measures of cardiovascular structure/function in patients with HFpEF. Methods We studied 217 participants from the PARAMOUNT study with HFpEF who had echocardiography and measures of kidney function. We evaluated the relationships between renal dysfunction [estimated glomerular filtration rate (eGFR) >30 and <60 mL/min/1.73 m2 and/or albuminuria] and cardiovascular structure/function. Results The mean age of the study population was 71 years, 55% were women, 94% hypertensive, and 40% diabetic. Impairment of at least one parameter of kidney function was present in 62% of patients (16% only albuminuria, 23% only low eGFR, 23% both). Renal dysfunction was associated with abnormal LV geometry (defined as concentric hypertrophy, or eccentric hypertrophy, or concentric remodelling) (adjusted P = 0.048), lower midwall fractional shortening (MWFS) (P = 0.009), and higher NT-proBNP (P = 0.006). Compared with patients without renal dysfunction, those with low eGFR and no albuminuria had a higher prevalence of abnormal LV geometry (P = 0.032) and lower MWFS (P < 0.01), as opposed to those with only albuminuria. Conversely, albuminuria alone was associated with greater LV dimensions (P < 0.05). Patients with combined renal impairment had mixed abnormalities (higher LV wall thicknesses, NT-proBNP; lower MWFS). Conclusion Renal dysfunction, as determined by both eGFR and albuminuria, is highly prevalent in HFpEF, and associated with cardiac remodelling and subtle systolic dysfunction. The observed differences in cardiac structure/function between each type of renal damage suggest that both parameters of kidney function might play a distinct role in HFpEF.
Published: 2014

33. The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction: an individual patient data meta-analysis

Author: Berry, C, Doughty, R, Granger, C, Kober, L, Massie, B, Mcalister, F, Mcmurray, J, Pocock, S, Poppe, K, Swedberg, K, Somaratne, J, Whalley, G, Ahmed, A, Andersson, B, Bayes-Genis, A, Cowie, M, Cubbon, R, Ezekowitz, J, Gonzalez-Juanatey, J, Gorini, M, Gotsman, I, Grigorian-Shamagian, L, Guazzi, M, Kearney, M, Komajda, M, di Lenarda, A, Lenzen, M, Lucci, D, Macin, S, Madsen, B, Maggioni, A, Martinez-Selles, M, Oliva, F, Rich, M, Richards, M, Senni, M, Squire, I, Taffet, G, Tarantini, L, Tribouilloy, C, Troughton, R, Tsutsui, H, Earle, N, Perera, K, Dobson, J, Hall, C, Richards, A, Lainchbury, J, Hogg, K, Norrie, J, Stevenson, K, Brett, M, Pfeffer, M, Held, P, Michelson, E, Olofsson, B, Ostergren, J, Yusuf, S, Torp-Pedersen, C, Reimer, W, Boersma, E, Vantrimpont, P, Follath, F, Cleland, J, Zwas, D, Planer, D, Azaz-Livshits, T, Admon, D, Lotan, C, Keren, A, Varela-Roman, A, Mazon-Ramos, P, Rigeiro-Veloso, P, Bandin-Dieguez, M, Myers, J, Arena, R, Armstrong, P, Cujec, B, Paterson, I, Wood, D, Coats, A, Thompson, S, Suresh, V, Poole-Wilson, P, Sutton, G, Robles, J, Prieto, L, Munoa, M, Frades, E, Diaz-Castro, O, Almendral, J, Faggiano, P, Bertoli, D, Porcu, M, Opasich, C, Tavazzi, L, Kirk, V, Bay, M, Parner, J, Krogsgaard, K, Herzog, T, Boesgaard, S, Hassager, C, Nielsen, O, Aldershvile, J, Nielsen, H, Perna, E, Canella, J, Alvarenga, P, Pantich, R, Rios, N, Farias, E, Badaracco, J, Hansen, J, Stokholm, K, Brons, J, Husum, D, Mortensen, L, Vazquez, R, Puig, T, Fernandez-Palomeque, C, Bardaji, A, Pascual-Figal, D, Ordonez-Llanos, J, Valdes, M, Gabarrus, A, Pavon, R, Pastor, L, Fiol, M, Nieto, V, Macaya, C, Cinca, J, de Luna, A, Newton, J, Blackledge, H, Wright, S, Kerzner, R, Gage, B, Freedland, K, Huynh, B, Rovner, A, Carney, R, Teasdale, T, Bleyer, A, Kutka, N, Luchi, R, Rusinaru, D, Mahjoub, H, Souliere, V, Levy, F, Peltier, M, Tsuchihashi, M, Takeshita, A, Maccarthy, P, Nolan, J, Lee, A, Prescott, R, Shah, A, Brooksby, W, Fox, K, Basante, P, Trillo, R, Garcia-Seara, J, Martinez-Sande, J, Gude, F, Berry C, Doughty RN, Granger C, Kober L, Massie B, McAlister F, McMurray J, Pocock S, Poppe K, Swedberg K, Somaratne J, Whalley GA, Ahmed A, Andersson B, Bayes-Genis A, Cowie M, Cubbon R, Ezekowitz J, Gonzalez-Juanatey J, Gorini M, Gotsman I, Grigorian-Shamagian L, Guazzi M, Kearney M, Komajda M, di Lenarda A, Lenzen M, Lucci D, Macin S, Madsen B, Maggioni A, Martinez-Selles M, Oliva F, Rich M, Richards M, Senni M, Squire I, Taffet G, Tarantini L, Tribouilloy C, Troughton R, Tsutsui H, Earle N, Perera K, Dobson J, Whalley G, Hall C, Richards AM, Lainchbury J, Hogg K, Norrie J, Stevenson K, Brett M, Pfeffer MA, Granger CB, Held P, McMurray JJV, Michelson EL, Olofsson B, Ostergren J, Yusuf S, Torp-Pedersen C, Lenzen MJ, Reimer WJMS, Boersma E, Vantrimpont PJMJ, Follath F, Cleland J, Zwas D, Planer D, Azaz-Livshits T, Admon D, Lotan C, Keren A, Varela-Roman A, Mazon-Ramos P, Rigeiro-Veloso P, Bandin-Dieguez MA, Gonzalez-Juanatey JR, Myers J, Arena R, McAlister FA, Armstrong PW, Cujec B, Paterson I, Cowie MR, Wood DA, Coats AJS, Thompson SG, Suresh V, Poole-Wilson PA, Sutton GC, Robles JAG, Prieto L, Munoa MD, Frades E, Diaz-Castro O, Almendral J, Faggiano P, Bertoli D, Porcu M, Opasich C, Tavazzi L, Maggioni AP, Kirk V, Bay M, Parner J, Krogsgaard K, Herzog TM, Boesgaard S, Hassager C, Nielsen OW, Aldershvile J, Nielsen H, Macin SM, Perna ER, Canella JPC, Alvarenga P, Pantich R, Rios N, Farias EF, Badaracco JR, Madsen BK, Hansen JF, Stokholm KH, Brons J, Husum D, Mortensen LS, Vazquez R, Puig T, Fernandez-Palomeque C, Bardaji A, Pascual-Figal D, Ordonez-Llanos J, Valdes M, Gabarrus A, Pavon R, Pastor L, Fiol M, Nieto V, Macaya C, Cinca J, de Luna AB, Newton JD, Blackledge HM, Squire IB, Wright SP, Kerzner R, Gage BF, Freedland KE, Rich MW, Huynh BC, Rovner A, Carney RM, Taffet GE, Teasdale TA, Bleyer AJ, Kutka NJ, Luchi RJ, Rusinaru D, Mahjoub H, Souliere V, Levy F, Peltier M, Tsuchihashi M, Takeshita A, MacCarthy PA, Kearney MT, Nolan J, Lee AJ, Prescott RJ, Shah AM, Brooksby WP, Fox KAA, Basante P, Trillo R, Garcia-Seara J, Martinez-Sande JL, Gude F, Berry, C, Doughty, R, Granger, C, Kober, L, Massie, B, Mcalister, F, Mcmurray, J, Pocock, S, Poppe, K, Swedberg, K, Somaratne, J, Whalley, G, Ahmed, A, Andersson, B, Bayes-Genis, A, Cowie, M, Cubbon, R, Ezekowitz, J, Gonzalez-Juanatey, J, Gorini, M, Gotsman, I, Grigorian-Shamagian, L, Guazzi, M, Kearney, M, Komajda, M, di Lenarda, A, Lenzen, M, Lucci, D, Macin, S, Madsen, B, Maggioni, A, Martinez-Selles, M, Oliva, F, Rich, M, Richards, M, Senni, M, Squire, I, Taffet, G, Tarantini, L, Tribouilloy, C, Troughton, R, Tsutsui, H, Earle, N, Perera, K, Dobson, J, Hall, C, Richards, A, Lainchbury, J, Hogg, K, Norrie, J, Stevenson, K, Brett, M, Pfeffer, M, Held, P, Michelson, E, Olofsson, B, Ostergren, J, Yusuf, S, Torp-Pedersen, C, Reimer, W, Boersma, E, Vantrimpont, P, Follath, F, Cleland, J, Zwas, D, Planer, D, Azaz-Livshits, T, Admon, D, Lotan, C, Keren, A, Varela-Roman, A, Mazon-Ramos, P, Rigeiro-Veloso, P, Bandin-Dieguez, M, Myers, J, Arena, R, Armstrong, P, Cujec, B, Paterson, I, Wood, D, Coats, A, Thompson, S, Suresh, V, Poole-Wilson, P, Sutton, G, Robles, J, Prieto, L, Munoa, M, Frades, E, Diaz-Castro, O, Almendral, J, Faggiano, P, Bertoli, D, Porcu, M, Opasich, C, Tavazzi, L, Kirk, V, Bay, M, Parner, J, Krogsgaard, K, Herzog, T, Boesgaard, S, Hassager, C, Nielsen, O, Aldershvile, J, Nielsen, H, Perna, E, Canella, J, Alvarenga, P, Pantich, R, Rios, N, Farias, E, Badaracco, J, Hansen, J, Stokholm, K, Brons, J, Husum, D, Mortensen, L, Vazquez, R, Puig, T, Fernandez-Palomeque, C, Bardaji, A, Pascual-Figal, D, Ordonez-Llanos, J, Valdes, M, Gabarrus, A, Pavon, R, Pastor, L, Fiol, M, Nieto, V, Macaya, C, Cinca, J, de Luna, A, Newton, J, Blackledge, H, Wright, S, Kerzner, R, Gage, B, Freedland, K, Huynh, B, Rovner, A, Carney, R, Teasdale, T, Bleyer, A, Kutka, N, Luchi, R, Rusinaru, D, Mahjoub, H, Souliere, V, Levy, F, Peltier, M, Tsuchihashi, M, Takeshita, A, Maccarthy, P, Nolan, J, Lee, A, Prescott, R, Shah, A, Brooksby, W, Fox, K, Basante, P, Trillo, R, Garcia-Seara, J, Martinez-Sande, J, Gude, F, Berry C, Doughty RN, Granger C, Kober L, Massie B, McAlister F, McMurray J, Pocock S, Poppe K, Swedberg K, Somaratne J, Whalley GA, Ahmed A, Andersson B, Bayes-Genis A, Cowie M, Cubbon R, Ezekowitz J, Gonzalez-Juanatey J, Gorini M, Gotsman I, Grigorian-Shamagian L, Guazzi M, Kearney M, Komajda M, di Lenarda A, Lenzen M, Lucci D, Macin S, Madsen B, Maggioni A, Martinez-Selles M, Oliva F, Rich M, Richards M, Senni M, Squire I, Taffet G, Tarantini L, Tribouilloy C, Troughton R, Tsutsui H, Earle N, Perera K, Dobson J, Whalley G, Hall C, Richards AM, Lainchbury J, Hogg K, Norrie J, Stevenson K, Brett M, Pfeffer MA, Granger CB, Held P, McMurray JJV, Michelson EL, Olofsson B, Ostergren J, Yusuf S, Torp-Pedersen C, Lenzen MJ, Reimer WJMS, Boersma E, Vantrimpont PJMJ, Follath F, Cleland J, Zwas D, Planer D, Azaz-Livshits T, Admon D, Lotan C, Keren A, Varela-Roman A, Mazon-Ramos P, Rigeiro-Veloso P, Bandin-Dieguez MA, Gonzalez-Juanatey JR, Myers J, Arena R, McAlister FA, Armstrong PW, Cujec B, Paterson I, Cowie MR, Wood DA, Coats AJS, Thompson SG, Suresh V, Poole-Wilson PA, Sutton GC, Robles JAG, Prieto L, Munoa MD, Frades E, Diaz-Castro O, Almendral J, Faggiano P, Bertoli D, Porcu M, Opasich C, Tavazzi L, Maggioni AP, Kirk V, Bay M, Parner J, Krogsgaard K, Herzog TM, Boesgaard S, Hassager C, Nielsen OW, Aldershvile J, Nielsen H, Macin SM, Perna ER, Canella JPC, Alvarenga P, Pantich R, Rios N, Farias EF, Badaracco JR, Madsen BK, Hansen JF, Stokholm KH, Brons J, Husum D, Mortensen LS, Vazquez R, Puig T, Fernandez-Palomeque C, Bardaji A, Pascual-Figal D, Ordonez-Llanos J, Valdes M, Gabarrus A, Pavon R, Pastor L, Fiol M, Nieto V, Macaya C, Cinca J, de Luna AB, Newton JD, Blackledge HM, Squire IB, Wright SP, Kerzner R, Gage BF, Freedland KE, Rich MW, Huynh BC, Rovner A, Carney RM, Taffet GE, Teasdale TA, Bleyer AJ, Kutka NJ, Luchi RJ, Rusinaru D, Mahjoub H, Souliere V, Levy F, Peltier M, Tsuchihashi M, Takeshita A, MacCarthy PA, Kearney MT, Nolan J, Lee AJ, Prescott RJ, Shah AM, Brooksby WP, Fox KAA, Basante P, Trillo R, Garcia-Seara J, Martinez-Sande JL, and Gude F
Abstract: Aims: A substantial proportion of patients with heart failure have preserved left ventricular ejection fraction (HF-PEF). Previous studies have reportedmixed resultswhether survival is similar to those patientswith heart failure and reduced EF (HF-REF). Methods and results: We compared survival in patients with HF-PEF with that in patients with HF-REF in a meta-analysis using individual patient data. Preserved EF was defined as an EF ≥ 50%. The 31 studies included 41 972 patients: 10 347 with HF-PEF and 31 625 with HF-REF. Compared with patients with HF-REF, those with HF-PEF were older (mean age 71 vs. 66 years), were more often women (50 vs. 28%), and have a history of hypertension (51 vs. 41%). Ischaemic aetiology was less common (43 vs. 59%) in patients with HF-PEF. There were 121 [95% confidence interval (CI): 117, 126] deaths per 1000 patient-years in those with HF-PEF and 141 (95% CI: 138, 144) deaths per 1000 patient-years in those with HF-REF. Patients with HF-PEF had lower mortality than those with HF-REF (adjusted for age, gender, aetiology, and history of hypertension, diabetes, and atrial fibrillation); hazard ratio 0.68 (95% CI: 0.64, 0.71). The risk of death did not increase notably until EF fell below 40%. Conclusion: Patients with HF-PEF have a lower risk of death than patients with HF-REF, and this difference is seen regardless of age, gender, and aetiology of HF. However, absolute mortality is still high in patients with HF-PEF highlighting the need for a treatment to improve prognosis.
Published: 2012

34. Post-Stroke Inhibition of Induced NADPH Oxidase Type 4 Prevents Oxidative Stress and Neurodegeneration

Author: McLeod, M, Kleinschnitz, C, Grund, H, Wingler, K, Armitage, ME, Jones, E, Mittal, M, Barit, D, Schwarz, T, Geis, C, Kraft, P, Barthel, K, Schuhmann, MK, Herrmann, AM, Meuth, SG, Stoll, G, Meurer, S, Schrewe, A, Becker, L, Gailus-Durner, V, Fuchs, H, Klopstock, T, de Angelis, MH, Jandeleit-Dahm, K, Shah, AM, Weissmann, N, Schmidt, HHHW, McLeod, M, Kleinschnitz, C, Grund, H, Wingler, K, Armitage, ME, Jones, E, Mittal, M, Barit, D, Schwarz, T, Geis, C, Kraft, P, Barthel, K, Schuhmann, MK, Herrmann, AM, Meuth, SG, Stoll, G, Meurer, S, Schrewe, A, Becker, L, Gailus-Durner, V, Fuchs, H, Klopstock, T, de Angelis, MH, Jandeleit-Dahm, K, Shah, AM, Weissmann, N, and Schmidt, HHHW
Abstract: Ischemic stroke is the second leading cause of death worldwide. Only one moderately effective therapy exists, albeit with contraindications that exclude 90% of the patients. This medical need contrasts with a high failure rate of more than 1,000 pre-clinical drug candidates for stroke therapies. Thus, there is a need for translatable mechanisms of neuroprotection and more rigid thresholds of relevance in pre-clinical stroke models. One such candidate mechanism is oxidative stress. However, antioxidant approaches have failed in clinical trials, and the significant sources of oxidative stress in stroke are unknown. We here identify NADPH oxidase type 4 (NOX4) as a major source of oxidative stress and an effective therapeutic target in acute stroke. Upon ischemia, NOX4 was induced in human and mouse brain. Mice deficient in NOX4 (Nox4(-/-)) of either sex, but not those deficient for NOX1 or NOX2, were largely protected from oxidative stress, blood-brain-barrier leakage, and neuronal apoptosis, after both transient and permanent cerebral ischemia. This effect was independent of age, as elderly mice were equally protected. Restoration of oxidative stress reversed the stroke-protective phenotype in Nox4(-/-) mice. Application of the only validated low-molecular-weight pharmacological NADPH oxidase inhibitor, VAS2870, several hours after ischemia was as protective as deleting NOX4. The extent of neuroprotection was exceptional, resulting in significantly improved long-term neurological functions and reduced mortality. NOX4 therefore represents a major source of oxidative stress and novel class of drug target for stroke therapy.
Published: 2010

35. Social Structure and Change: Development and Ethnicity

Author: Ramaswamy, EAR, Shah, AM, Baviskar, BS, and International Institute of Social Studies
Published: 1998

36. In vitro Anti-proliferative and Apoptotic Activities of Eurycoma longifolia Jack (Simaroubaceae) on HL-60 Cell Line

Author: Al-Salahi, OSA, additional, Zaki, A-H, additional, Chan, K-L, additional, Shah, AM, additional, Al-Hassan, F, additional, Abdullah, WZ, additional, and Yusoff, NM, additional
Published: 2013
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37. Abstract P2-01-14: circulating tumor cells in breast cancer exhibit dynamic changes in epithelial and mesenchymal cell composition

Author: Yu, M, primary, Bardia, A, additional, Wittner, BS, additional, Stott, SL, additional, Smas, ME, additional, Ting, DT, additional, Isakoff, SJ, additional, Ciciliano, JC, additional, Wells, MN, additional, Shah, AM, additional, Concannon, KF, additional, Sequist, LV, additional, Brachtel, E, additional, Sgroi, D, additional, Baselga, J, additional, Ramaswamy, S, additional, Toner, M, additional, Haber, DA, additional, and Maheswaran, S, additional
Published: 2012
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38. Retrospective Study of Various Histopathological Lesions in Prostate Biopsy

Author: Manek, Jaimin, Shah, Ami, and Goswami, Hansa M
Published: 2019
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39. Social Structure and Change: Women in Indian Society

Author: Ramaswamy, EAR, Shah, AM, Baviskar, BS, and International Institute of Social Studies
Published: 1996

40. Social Structure and Change: Complex Organizations and Urban Communities

Author: Ramaswamy, EAR, Shah, AM, Baviskar, BS, and International Institute of Social Studies
Published: 1996

41. Social Structure and Change: Theory and Method

Author: Ramaswamy, EAR, Shah, AM, Baviskar, BS, and International Institute of Social Studies
Published: 1996

42. The Resilience of Cardiac Care Through Virtualized Services During the COVID-19 Pandemic: Case Study of a Heart Function Clinic

Author: Shah, Amika, Guessi, Milena, Wali, Sahr, Ware, Patrick, McDonald, Michael, O'Sullivan, Mary, Posada, Juan Duero, Ross, Heather, and Seto, Emily
Subjects: Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: BackgroundVirtual care has historically faced barriers to widespread adoption. However, the COVID-19 pandemic has necessitated the rapid adoption and expansion of virtual care technologies. Although the intense and prolonged nature of the COVID-19 pandemic has renewed people’s interest in health systems resilience, which includes how services adapt or transform in response to shocks, evidence regarding the role of virtual care technologies in health systems resilience is scarce. ObjectiveAt Toronto General Hospital in Ontario, Canada, the rapid virtualization of cardiac care began on March 9, 2020, as a response to the pandemic. The objective of this study was to understand people’s experiences with and the barriers and facilitators of the rapid virtualization and expansion of cardiac care resulting from the pandemic. MethodsA single-case study was conducted with 3 embedded units of analysis. Patients, clinicians, and staff were recruited purposively from an existing mobile, phone-based telemonitoring program at a heart function clinic in Toronto, Canada. Individual, semistructured phone interviews were conducted by two researchers and transcribed verbatim. An inductive thematic analysis at the semantic level was used to analyze transcripts and develop themes. ResultsA total of 29 participants were interviewed, including patients (n=16), clinicians (n=9), and staff (n=4). The following five themes were identified: (1) patient safety as a catalyst for virtual care adoption; (2) piecemeal virtual care solutions; (3) confronting new roles and workloads; (4) missing pieces in virtual care; and (5) the inequity paradox. The motivation to protect patient safety and a piecemeal approach to virtual care adoption facilitated the absorptive and adaptive resilience of cardiac care during the COVID-19 pandemic. However, ad hoc changes to clinic roles and workflows, challenges in building relationships through remote methods, and widened inequities were barriers that threatened virtual care sustainment. ConclusionsWe contend that sustaining virtual care hinges upon transformative actions (rather than adaptive actions) that strengthen health systems so that they can face the dynamic and emergent challenges associated with COVID-19 and other shocks. Based on the barriers and facilitators we identified, we present the lessons we learned and recommend transformations for sustaining virtual care during and beyond the COVID-19 pandemic.
Published: 2021
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43. Expanding Telemonitoring in a Virtual World: A Case Study of the Expansion of a Heart Failure Telemonitoring Program During the COVID-19 Pandemic

Author: Wali, Sahr, Guessi Margarido, Milena, Shah, Amika, Ware, Patrick, McDonald, Michael, O'Sullivan, Mary, Duero Posada, Juan, Ross, Heather, and Seto, Emily
Subjects: Computer applications to medicine. Medical informatics, R858-859.7, Public aspects of medicine, RA1-1270
Abstract: BackgroundTo minimize the spread and risk of a COVID-19 outbreak, societal norms have been challenged with respect to how essential services are delivered. With pressures to reduce the number of in-person ambulatory visits, innovative models of telemonitoring have been used during the pandemic as a necessary alternative to support access to care for patients with chronic conditions. The pandemic has led health care organizations to consider the adoption of telemonitoring interventions for the first time, while others have seen existing programs rapidly expand. ObjectiveAt the Toronto General Hospital in Ontario, Canada, the rapid expansion of a telemonitoring program began on March 9, 2020, in response to COVID-19. The objective of this study was to understand the experiences related to the expanded role of a telemonitoring program under the changing conditions of the pandemic. MethodsA single-case qualitative study was conducted with 3 embedded units of analysis. Semistructured interviews probed the experiences of patients, clinicians, and program staff from the Medly telemonitoring program at a heart function clinic in Toronto, Canada. Data were analyzed using inductive thematic analysis as well as Eakin and Gladstone’s value-adding approach to enhance the analytic interpretation of the study findings. ResultsA total of 29 participants were interviewed, including patients (n=16), clinicians (n=9), and operational staff (n=4). Four themes were identified: (1) providing care continuity through telemonitoring; (2) adapting telemonitoring operations for a more virtual health care system; (3) confronting virtual workflow challenges; and (4) fostering a meaningful patient-provider relationship. Beyond supporting virtual visits, the program’s ability to provide a more comprehensive picture of the patient’s health was valued. However, issues relating to the lack of system integration and alert-driven interactions jeopardized the perceived sustainability of the program. ConclusionsWith the reduction of in-person visits during the pandemic, virtual services such as telemonitoring have demonstrated significant value. Based on our study findings, we offer recommendations to proactively adapt and scale telemonitoring programs under the changing conditions of an increasingly virtual health care system. These include revisiting the scope and expectations of telemedicine interventions, streamlining virtual patient onboarding processes, and personalizing the collection of patient information to build a stronger virtual relationship and a more holistic assessment of patient well-being.
Published: 2021
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44. Effects of Overexpression of Igf Binding Protein-1 on Vascular Function and Blood Pressure Homeostasis in Mice

Author: Wheatcroft, SB, primary, Williams, IL, additional, Shah, AM, additional, Crossey, PA, additional, and Kearney, MT, additional
Published: 2002
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45. Obesity, atherosclerosis and the vascular endothelium: mechanisms of reduced nitric oxide bioavailability in obese humans

Author: Williams, IL, primary, Wheatcroft, SB, additional, Shah, AM, additional, and Kearney, MT, additional
Published: 2002
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46. Tailored Web-Based Smoking Interventions and Reduced Attrition: Systematic Review and Meta-Analysis

Author: Shah, Amika, Chaiton, Michael, Baliunas, Dolly, and Schwartz, Robert
Subjects: Computer applications to medicine. Medical informatics, R858-859.7, Public aspects of medicine, RA1-1270
Abstract: BackgroundThe increasing number of internet users presents an opportunity to deliver health interventions to large populations. Despite their potential, many web-based interventions, including those for smoking cessation, face high rates of attrition. Further consideration of how intervention features impact attrition is needed. ObjectiveThe aim of this systematic review is to investigate whether tailored web-based smoking cessation interventions for smokers are associated with reduced rates of attrition compared with active or passive untailored web-based interventions. The outcomes of interest were dropout attrition at 1-, 3-, 6-, and 12-month follow-ups. MethodsLiterature searches were conducted in May 2018 and updated in May 2020 on MEDLINE (Medical Literature Analysis and Retrieval System Online), PsycINFO (Psychological Information), EMBASE (Excerpta Medica dataBASE), CINAHL (Cumulated Index to Nursing and Allied Health Literature), Scopus, and the Cochrane Tobacco Addiction Group Specialized Register with the following search terms: smoking cessation, tailored, or web- or internet-based. Included studies were published in English before or in May 2020 using a randomized controlled trial design. Studies were restricted to those with web-based delivery, a tailored intervention group, an untailored control group, and a reported outcome of smoking cessation. Studies were assessed for methodological quality using the Cochrane Risk of Bias tool. Two reviewers independently extracted the study characteristics and the number of participants lost to follow-up for each treatment group. ResultsA total of 13 studies were included in the systematic review, of which 11 (85%) were included in the meta-analysis. Tailoring had no statistically significant effect on dropout attrition at 1-month (risk ratio [RR]=1.02, 95% CI 0.95-1.09; P=.58; I2=78%), 3-month (RR=0.99, 95% CI 0.95-1.04; P=.80; I2=73%), 6-month (RR=1.00, 95% CI 0.95-1.05; P=.90; I2=43%), or 12-month (RR=0.97, 95% CI 0.92-1.02; P=.26; I2=28%) follow-ups. Subgroup analyses suggested that there was a statistically significant effect of tailoring between the active and passive subgroups at 1-month (P=.03), 3-month (P
Published: 2020
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47. Mobile Health for Perinatal Depression and Anxiety: Scoping Review

Author: Hussain-Shamsy, Neesha, Shah, Amika, Vigod, Simone N, Zaheer, Juveria, and Seto, Emily
Subjects: Computer applications to medicine. Medical informatics, R858-859.7, Public aspects of medicine, RA1-1270
Abstract: BackgroundThe perinatal period is a vulnerable time during which depression and anxiety commonly occur. If left untreated or undertreated, there may be significant adverse effects; therefore, access to rapid, effective treatment is essential. Treatments for mild-to-moderate symptoms according to a stepped-care approach involve psychoeducation, peer support, and psychological therapy, all of which have been shown to be efficaciously delivered through digital means. Women experience significant barriers to care because of system- and individual-level factors, such as cost, accessibility, and availability of childcare. The use of mobile phones is widespread in this population, and the delivery of mental health services via mobile phones has been suggested as a means of reducing barriers. ObjectiveThis study aimed to understand the extent, range, and nature of mobile health (mHealth) tools for prevention, screening, and treatment of perinatal depression and anxiety in order to identify gaps and inform opportunities for future work. MethodsUsing a scoping review framework, 4 databases were searched for terms related to mobile phones, perinatal period, and either depression or anxiety. A total of 477 unique records were retrieved, 81 of which were reviewed by full text. Peer-reviewed publications were included if they described the population as women pregnant or up to 1 year postpartum and a tool explicitly delivered via a mobile phone for preventing, screening, or treating depression or anxiety. Studies published in 2007 or earlier, not in English, or as case reports were excluded. ResultsA total of 26 publications describing 22 unique studies were included (77% published after 2017). mHealth apps were slightly more common than texting-based interventions (12/22, 54% vs 10/22, 45%). Most tools were for either depression (12/22, 54%) or anxiety and depression (9/22, 41%); 1 tool was for anxiety only (1/22, 4%). Interventions starting in pregnancy and continuing into the postpartum period were rare (2/22, 9%). Tools were for prevention (10/22, 45%), screening (6/22, 27%), and treatment (6/22, 27%). Interventions delivered included psychoeducation (16/22, 73%), peer support (4/22, 18%), and psychological therapy (4/22, 18%). Cost was measured in 14% (3/22) studies. ConclusionsFuture work in this growing area should incorporate active psychological treatment, address continuity of care across the perinatal period, and consider clinical sustainability to realize the potential of mHealth.
Published: 2020
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48. Endothelium-Derived Nitric Oxide Enhances Left Ventricular Relaxation

Author: Grocott-Mason, R, primary, Anning, P, additional, Lewis, MJ, additional, and Shah, AM, additional
Published: 1995
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49. Plug in Vehicles-A technology for the future

Author: Suresh, Srinidhi, Shah, Aman, Goswami, Prerna, and Kerawalla, M.A.K.
Published: 2017

50. Craniosynostosis with Marfan syndrome, hand and foot anomalies

Author: Karapurkar Ap, Kher A, Chattopadhyay A, Shah Am, and Burjor A. Bharucha
Subjects: musculoskeletal diseases, Marfan syndrome, Connective Tissue Disorder, business.industry, Connective tissue, General Medicine, Anatomy, medicine.disease, Pathology and Forensic Medicine, Craniosynostosis, medicine.anatomical_structure, Pediatrics, Perinatology and Child Health, medicine, business, Genetics (clinical), Foot (unit)
Abstract: We report a patient with various connective tissue abnormalities suggesting a distinctive connective tissue disorder combining some features of the Marfan syndrome with craniosynostosis and hand and feet anomalies.
Published: 1996

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