John M Elliott

Publications (6)10.78 Total impact

• Article: A case of recurrent earthquake stress cardiomyopathy with a differing wall motion abnormality.

  Paul G Bridgman, Christina W Chan, John M Elliott
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  ABSTRACT: We present the case of a Caucasian woman who survived two major earthquakes, presenting on each occasion with stress cardiomyopathy, but with a different pattern of regional wall motion abnormality on the second occasion. The first Christchurch earthquake struck on September 4, 2010. At 7.1 on the Richter scale, it was larger than the major Haiti quake, but miraculously there were no direct fatalities. In the week following, eight women meeting modified Mayo criteria for stress cardiomyopathy presented to Christchurch Hospital. The second Christchurch earthquake was on February 22, 2011. It measured 6.4 on the Richter scale and caused 180 direct fatalities. In the week following this earthquake, 24 women were admitted with stress cardiomyopathy. One patient presented after both earthquakes. This 76-year-old woman first presented on September 4 with 10 hours of chest pain. Electrocardiogram showed inferolateral deep T-wave inversion and QT prolongation. TnI peaked at 0.81 μg/L. Coronary angiography demonstrated diffuse atheroma with a moderate mid LAD lesion that was stented at the time. Echocardiography showed a classic takotsubo pattern. Her follow-up echocardiogram on September 28 was normal and she was completely well at that point. However, during the second earthquake of February 22, she again developed chest pain and shortness of breath. TnI peaked at 1.3 μg/L. Echocardiogram showed a midwall variant takotsubo with apical sparing. She was discharged from hospital on the 25th, planning to leave Christchurch for a new home in another city, but returned for follow-up echocardiogram on July 27. This was normal.
  Echocardiography 11/2011; 29(2):E26-7. · 1.24 Impact Factor
• Article: Risk stratification in the setting of non-ST elevation acute coronary syndromes 1999-2007.

  Isuru Ranasinghe, Bernadette Alprandi-Costa, Vincent Chow, John M Elliott, Jonathon Waites, John T Counsell, Jose Lopéz-Sendón, Alvaro Avezum, Shaun G Goodman, Christopher B Granger, David Brieger
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  ABSTRACT: It is unclear if clinician risk stratification has changed with time. The aim of this study was to assess the temporal change in the concordance between patient presenting risk and the intensity of evidence-based therapies received for non-ST-segment elevation acute coronary syndromes over a 9-year period. Data from 3,562 patients with non-ST-segment elevation acute coronary syndromes enrolled in the Australian and New Zealand population of the Global Registry of Acute Coronary Events (GRACE) from 1999 to 2007 were analyzed. Patients were stratified to risk groups on the basis of the GRACE risk score for in-hospital mortality. Main outcome measures included in-hospital use of widely accepted evidence-based medications, investigations, and procedures. Invasive management was consistently higher in low-risk patients than in intermediate- or high-risk patients (coronary angiography 66.7% vs 63.5% vs 35.3%, p <0.001; percutaneous coronary intervention 31.1% vs 22.0% vs 12.9%, p <0.001). Absolute rates of angiography and percutaneous coronary intervention in the high-risk group remained 24% and 15% lower compared to the low-risk group in the most recent time period (2005 to 2007). In-hospital use of thienopyridine, low-molecular weight heparin, and glycoprotein IIb/IIIa inhibitors showed a similar inverse relation with risk. Prescription of aspirin, β blockers, statins, and angiotensin receptor blockers was inversely related to risk before 2004, although this inverse relation was no longer present in the most recent time period (2005 to 2007). Only in-hospital use of unfractionated heparin showed use concordant with patient risk status. In conclusion, despite an overall increase in the uptake of evidence-based therapies, most investigations and treatments are not targeted on the basis of patient risk. Clinician risk stratification remains suboptimal compared to objective measures of patient risk.
  The American journal of cardiology 06/2011; 108(5):617-24. · 3.58 Impact Factor
• Article: Factors influencing local and systemic levels of plasma myeloperoxidase in ST-segment elevation acute myocardial infarction.

  Catriona J Marshall, Mark Nallaratnam, Tessa Mocatta, David Smyth, Mark Richards, John M Elliott, James Blake, Christine C Winterbourn, Anthony J Kettle, Dougal R McClean
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  ABSTRACT: Myeloperoxidase (MPO) is associated with risk in acute coronary syndromes. However, the precise role it plays in ST-elevation myocardial infarction (STEMI) remains unclear. In this study we tested the hypothesis that levels of MPO in plasma after a myocardial infarction are affected by its ability to bind to the endothelium and there is local release of the enzyme at the culprit lesion. We measured plasma MPO in systemic circulation and throughout the coronary circulation in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). MPO levels at the femoral artery were higher (p <0.001) in patients with STEMI (n = 67, median 45 ng/ml, interquartile range 34 to 83) compared to control patients (n = 12, 25 ng/ml, 19 to 30) with chronic stable angina undergoing elective PCI. After administration of the anticoagulant bivalirudin in 13 patients with STEMI, plasma MPO was increased only at the culprit coronary artery lesion before PCI (178 ng/ml, 91 to 245) versus all other sites (femoral artery 86 ng/ml, 54 to 139, p = 0.019). Administration of heparin caused a marked increase of plasma MPO. Even so, it was still possible to detect an increase of plasma MPO at culprit lesion in patients with STEMI (n = 54, 171 ng/ml, 122 to 230) versus controls (n = 12, 136 ng/ml, 109 to 151, p <0.05) after heparin and before PCI. MPO levels were higher at the culprit lesion in patients with STEMI who presented early and in those with restricted flow (p <0.05). In conclusion, our results demonstrate that, in addition to a systemic increase of MPO in patients presenting early with STEMI, levels of this leukocyte enzyme are increased at the culprit coronary lesion before PCI.
  The American journal of cardiology 08/2010; 106(3):316-22. · 3.58 Impact Factor
• Article: CT coronary angiography to guide intervention for acute myocardial ischaemia in a patient with an anomalous single coronary ostium.

  W Y Wandy Chan, Dougal R McClean, John M Elliott, Sharyn MacDonald
  Heart Lung &amp Circulation 12/2009; 18(6):408-9. · 1.20 Impact Factor
• Article: Proficiency in coronary angiography: local experience and college requirements.

  Richard James Hillock, David W Smyth, John M Elliott
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  ABSTRACT: Proficiency in coronary angiography is a necessary skill for all cardiology trainees and is a requirement of training for the Royal Australasian College of Physicians. The purpose of this study was to compare the local experience of advanced trainees with the College guidelines. A retrospective analysis of fluoroscopy time and radiation exposure of the first 150 cases of three trainees between 1997 and 2001. These data were also compared to those from three experienced cardiologists. Advanced trainees are significantly slower than senior colleagues when starting (p<0.01) and improvements are made after 150 cases. Not all trainees improved by the same degree over the study period and most remained slower than consultants after 150 cases. Radiation doses were higher in general although there was significant individual variation between the trainee and the effect of time was diverse. The performance of 150 coronary angiograms as a primary operator should be considered an arbitrary number. While improvements are seen in any task when performed repeatedly, the question of when an individual is proficient is less clear. Some individualization of assessment and monitoring would seem appropriate to ensure that trainees gain proficiency in performing coronary angiography during their advanced training period.
  Heart Lung &amp Circulation 06/2006; 15(3):163-7. · 1.20 Impact Factor
• Article: Correlation of CYP2D6 genotype with perhexiline phenotypic metabolizer status.

  Murray L Barclay, Steven M Sawyers, Evan J Begg, Mei Zhang, Rebecca L Roberts, Martin A Kennedy, John M Elliott
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  ABSTRACT: Perhexiline is metabolized by CYP2D6 and has concentration-related hepatoxicity and peripheral neuropathy. The risk of toxicity is reduced using therapeutic drug monitoring. CYP2D6 genotyping before therapy may allow earlier appropriate dosing. This study aimed to determine whether assessment of CYP2D6 genotype in patients on perhexiline could predict accurately metabolizer status as determined by the perhexiline metabolic ratio (MR). Blood samples from patients stabilized on perhexiline were analysed for CYP2D6 genotype and for concentrations of perhexiline and its hydroxy metabolite. The MR was determined. Of 74 patients, five were poor metabolizers (PM) defined by a MR<0.4, and the remainder were extensive metabolizers (EM). The genotypes were: *1/*1 (n=21), *1/*4 (n=18), *1/*2 (n=12), *1/*3 (n=2), *1/*5 (n=1), *1/*9 (n=2), *1/*10 (n=2), *2/*4 (n=4), *2/*2 (n=3), *4/*41 (n=3), *2/*41 (n=1), *41/*41 (n=1), *4/*9 (n=1), *4/*5 (n=1), *5/*6 (n=1) and *4/*6 (n=1). Allele frequencies were consistent with those reported in population studies. The 3 PMs with the lowest MR were predicted by genotype (*4/*5, *5/*6, *4/*6). The other 2 PMs had intermediate metabolizer genotypes and were on CYP2D6 inhibiting drugs. Amongst the EMs, the highest MR was associated with *1 and *2 allele combinations and the MR was progressively lower with the presence of alleles with intermediate function (*9, *10, *41) followed by alleles with no functional product (*3, *4, *5, *6). Thus, a gene-dose effect was observed. Genotype predicted PM phenotype and also intermediate metabolizers. Determination of CYP2D6 genotype before therapy with perhexiline may help predict perhexiline dose requirements and reduce the risk of perhexiline concentration-related toxicity.
  Pharmacogenetics 10/2003; 13(10):627-32.