Eduard Shantsila

Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, England, United Kingdom

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Publications (155)833.1 Total impact

  • R A Brown · E Shantsila · C Varma · G Y H Lip
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    ABSTRACT: As a result of increased cost and bleeding concerns, older patients receive abciximab during percutaneous coronary intervention (PCI) less often than younger patients. The aim of this was to evaluate the safety and efficacy of abciximab in older adults undergoing PCI. Retrospective, observational single centre cohort study. The British Cardiovascular Intervention Society (BCIS) database was used to establish the impact of abciximab in people with advanced age (≥ 75 years) on in-hospital bleeding and ischaemic events and all-cause mortality in 5727 consecutive patients undergoing PCI between January 2008 and June 2014. Older patients represented 23% of the study population (n = 1298). Abciximab was used in 198 (15%) older patients and 970 (22%) younger patients (p < 0.001). Unadjusted bleeding and mortality rates were 1.2% and 5.6%, respectively, vs. 0.4% and 1.7% in younger patients (p = 0.001 and p < 0.001 respectively). On multivariate analysis older subjects were at higher risk of bleeding [odds ratio (OR) 2.76, 95% confidence interval (CI) 1.26-6.04, p = 0.011] and had higher in-hospital mortality (OR 2.36, 95% CI 1.48-3.74, p < 0.001). The use of abciximab in older patients was not significantly associated with excess bleeding (adjusted OR 1.86, 95% CI 0.58-5.93, p = 0.3), ischaemic outcomes (adjusted OR, 95% CI, p = 0.12) or in-hospital mortality (adjusted OR, 95% CI, p = 0.11). Older patients having primary PCI had higher risk of bleeding irrespective of abciximab use (adjusted p = 0.042). Abciximab may not be associated with excess bleeding complications in older patients compared with younger individuals and may be safe to use in older people if indicated. © 2015 John Wiley & Sons Ltd.
    International Journal of Clinical Practice 07/2015; DOI:10.1111/ijcp.12702 · 2.54 Impact Factor
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    ABSTRACT: To investigate lipid metabolism and the relationship with monocyte expression of the fatty acid translocase CD36 in South Asians. An observational study of South Asians whom as an ethnic group have - a higher risk of developing diabetes. The susceptibility to diabetes is coupled with an earlier and more rapid progression of micro-, and macro-vascular complications. Twenty-nine healthy South Asian participants [mean age 34.6 (8.9) years, 76.2% male, mean body-mass index 25.0 (5.2) kg/m(2)] were recruited from an urban residential area of central Birmingham (United Kingdom). The main outcomes measured were post prandial (30 min) and post absorptive (120 min) changes from fasting (0 min) in circulating lipoproteins, lipds and hormones, and monocyte expression of CD36 post injection of a 75 g oral glucose challenge. The inducements of variations of monocyte CD36 expression were analysed. Our results showed evident changes in monocyte CD36 expression following the glucose challenge (P < 0.001). Non-esterified fatty acids (NEFA) levels decreased progressively during the challenge (P < 0.001), in contrast to increased cholesterol (but not triglyceride) concentrations within very low density lipoprotein (VLDL) and low density lipoprotein subfractions (P < 0.01). Levels of, glucose, serum triglycerides and high density lipoprotein cholesterol remained largely unchanged. Variations of monocyte CD36 were negatively (r = -0.47, P = 0.04) associated to fat from the diet and positively to carbohydrate from the diet (r = 0.65, P < 0.001). These data suggest that the initiation of VLDL genesis follows the consumption of glucose within this population, inferring that the sequestration of NEFA from these particles happens due to the increased availability of CD36 receptors. While these are preliminary results, it would appear that lifestyle exposures have a role in moderating the expression of CD36.
    07/2015; 6(7):983-989. DOI:10.4239/wjd.v6.i7.983
  • Andreas Wolff · Eduard Shantsila · Gregory Y H Lip · Deirdre A Lane
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    ABSTRACT: to examine the use of antithrombotic therapy and predictors of stroke and death in very elderly (≥85 years) atrial fibrillation (AF) patients in a general practice cohort from the UK. retrospective, observational cohort study; 12-month follow-up period. eleven general practices serving the town of Darlington, England representing a population of 105,000 patients. two thousand two hundred and fifty-nine patients with a history of AF, 561 (24.8%) aged ≥85 years. use of antithrombotic therapy by age group and predictors of stroke and death. five hundred and sixty-one (24.8%) AF patients aged ≥85 years (mean (SD) age 89 (4) years; 66% female) identified with a mean CHA2DS2-VASc score of 4.6 (SD 1.4). Thirty-six per cent received oral anticoagulation (OAC) compared with 57% in the 75-84 years age group. Forty-nine per cent of the very elderly received antiplatelet (AP) monotherapy; recorded OAC contraindications and declines were greatest among those aged ≥85 years. Stroke risk was highest among the very elderly (5.2% per annum), despite anticoagulation (3.9%). Multivariate analyses demonstrated an increased risk of stroke with AP monotherapy (odds ratio (OR) 2.45, 95% confidence intervals (CIs) 1.05-5.70) and a significant reduction in all-cause mortality with OAC therapy (OR 0.59, 95% CI 0.36-0.99). the majority of very elderly AF patients in general practice do not receive OAC despite their higher stroke risk; almost half received AP monotherapy. AP use independently increased the risk of stroke, signifying that effective stroke prevention requires OAC regardless of age, except where true contraindications exist. © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
    Age and Ageing 06/2015; DOI:10.1093/ageing/afv071 · 3.11 Impact Factor
  • Alena Shantsila · Paramjit S Gill · Eduard Shantsila · Gregory YH Lip
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    ABSTRACT: sec> Background Hypertension is a major course of diastolic dysfunction and heart failure with preserved ejection fraction. Cardiovascular morbidity is increased in South Asian (SA) and African-Caribbean (AC) ethnic groups. Scarce data are available on the contribution of ethnicity to diastolic dysfunction in hypertensive patients. We aimed to assess this it in an epidemiological screening study, Ethnic – Echocardiographic Heart of England Screening E-ECHOES. Methods A total of 1546 hypertensive participants in E-ECHOES with left ventricular ejection fraction > = 55% were included: 830 of SA origin and 716 of AC origin. People with history of ischaemic heart disease, cardiac valves pathology, peripheral artery disease, cancer, chronic obstructive pulmonary disease, and atrial fibrillation were excluded. Results AC subjects were older than SA patients (65+/-11 vs. 62+/-10 years, p < 0.001), had higher body mass index (30+/-6 vs. 29+/-5 kg/m2, p < 0.001) and mean systolic blood pressure (150+/-19 vs. 147+/-20 mmHg, p = 0.002). There was no statistical differencez in gender, ejection fraction, diastolic blood pressure and history of smoking (p = NS). SA patients had a higher prevalence of diabetes (47% vs. 35%, p < 0.001). Diastolic dysfunction was present in 73% of SA and 72% of AC patients. Increased left ventricular filling pressure (E/’e > = 13) was present in 14% of SA and 11% of AC patients. On stepwise forward multivariable logistic regression analysis, SA ethnicity was independently predictive of diastolic dysfunction and increased left ventricular filling pressure ( Table 1 ). SA origin was independently predictive of increase left ventricular filling pressure [Odds Ratio (OR) 0.48, 95% confidence interval (CI)] 0.34–0.69] for AC origin, along with age (OR 1.06, 95% CI 1.04–1.07 per 1 year), female gender (OR 2.48, 95% CI 1.73–3.56), higher left ventricular mass index (OR 1.01, 95% CI 1.00–1.01 per 1 g/m2) and higher systolic blood pressure (OR 1.02, 95% CI 1.01–1.03) per 1 mmHg), p < 0.001 for all. Abstract 124 Table 1 Independent predictors of diastolic dysfunction Predictor Odds ratio [95% confidence interval] p value Predictors of diastolic dysfunction Age, per 1 year 1.10 [1.08–1.12] <0.001 Female gender 1.72 [1.32–2.24] <0.001 Left ventricular mass index, per 1 g/m2 1.01 [1.00–1.01] <0.001 Diastolic blood pressure, per 1 mmHg 1.03 [1.02–1.04] <0.001 Heart rate, per 1 bpm 1.03 [1.02–1.04] <0.001 Waist circumference, per 1 cm 1.03 [1.02–1.04] <0.001 Aldosterone antagonist use 1.41 [1.01–1.97] 0.04 African-Caribbean origin 0.67 [0.51–0.87] 0.003 Conclusion SA ethnicity is independently associated with diastolic dysfunction and increased left ventricular filling pressure in subjects with arterial hypertension. Better understanding of mechanisms underlying this observation may help identify new therapeutic targets in hypertension. </sec
    Heart (British Cardiac Society) 06/2015; 101(Suppl 4):A71-A72. DOI:10.1136/heartjnl-2015-308066.124 · 6.02 Impact Factor
  • Richard Brown · Gregory Lip · Chetan Varma · Eduard Shantsila
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    ABSTRACT: sec> Background Monocytes play an integral role in the development of atherosclerosis. Specific monocyte subsets have been associated with excess cardiovascular events in different patient populations and highlighted as a potential therapeutic target. Objective To compare blood monocyte subsets in patients with focal coronary artery disease (CAD) and diffuse CAD. Methods Three monocyte subsets (CD14++CD16-CCR2+ [classical, Mon 1], CD14++CD16+CCR2+ [intermediate, Mon 2] and CD14+CD16++CCR2- [non-classical, Mon 3]) and their aggregates with platelets (monocyte-platelet aggregates, MPAs) were quantified by flow cytometry in 71 CAD patients (subdivided into a group with diffuse CAD [n = 50] and a group with focal CAD [n = 21] based on angiographic coronary artery morphology) and 39 age, sex and risk factor matched controls with normal coronary arteries assessed either invasively or non-invasively using computed tomography coronary angiography (CTCA). Results The clinical characteristics of each group are shown in Table 1 . Patients with diffuse CAD had a significantly higher proportion of Mon 2 than patients with focal disease (p = 0.02) or normal coronary arteries (p = 0.03) ( Table 2 ). MPA associated with Mon 2 was also significantly higher in the diffuse CAD group (p < 0.001). There was no difference in the levels of Mon 1 or Mon 3 between the groups (p = 0.84 and p = 0.51, respectively). There was no difference in MPA associated with Mon 1 between diffuse or focal CAD (p = 0.30) but these MPA were significantly higher in patients with diffuse CAD compared to normal controls (p = 0.02). There was no difference in MPA associated with Mon 3 between the groups (p = 0.17). Abstract 157 Table 1 Clinical characteristics Patient characteristic Diffuse CAD (n = 50) Focal CAD (n = 21) Normal (n = 39) P value Age mean (SD) 59 (8) 56 (11) 55 (7) 0.26 * Male n (%) 33 (66) 13 (62) 19 (49) 0.25 Diabetes n (%) 13 (26) 2 (10) 9 (23) 0.30 Hypertension n (%) 28 (56) 7 (33) 22 (56) 0.17 Hypercholesterolaemia n (%) 34 (68) 13 (62) 23 (59) 0.67 Current smoking n (%) 7 (14) 1 (5) 5 (13) 0.30 Premature family history n (%) 18 (36) 5 (24) 13 (33) 0.61 History of IHD n (%) 47 (94) 16 (76) 0 (0) <0.001 History of angina n (%) 12 (24) 7 (33) 5 (13) 0.16 * One-way analysis of variance (ANOVA), all other p values Chi Square, SD standard deviation, IHD ischaemic heart disease (defined as previous myocardial infarction, previous percutaneous coronary intervention and/or previous Aortocoronary bypass surgery) Abstract 157 Table 2 Monocyte subsets Monocyte subset and platelet adherence Diffuse CAD (n = 50) Focal CAD (n = 21) Normal (39) P value Mon 1/microlitre (SD) 396 (124) 377 (137) 377 (142) 0.84 * Mon 2/microlitre (IQR) 35 (23–59) 21 (12–36) 24 (18–42) 0.02 ** Mon 3/microlitre (IQR) 39 (25–50) 32 (21–47) 35 (23–48) 0.51 ** Total Mon/microlitre (SD) 481 (141) 442 (146) 450 (159) 0.56 * MPA 1/microlitre (IQR) 34 (29–48) 29 (22–49) 22 (13–46) 0.06 ** MPA 2/microlitre (IQR) 10 (4–15) 3.8 (1.6–7.3) 5.0 (3.0–7.7) <0.001 ** MPA 3/microlitre (IQR) 5.5 (4.0–9.0) 4.6 (2.6–6.9) 4.8 (2.3–6.8) 0.17 ** Total MPA/microlitre (IQR) 53 (41–65) 38 (30–59) 33 (22–67) 0.03 ** * One-way analysis of variance (ANOVA) ** Kruskall-Wallis, Mon monocyte, MPA monocyte platelet aggregate, SD standard deviation, IQR interquartile range Conclusion Patients with diffuse CAD have higher peripheral blood levels of Mon 2 and MPA associated with Mon 2 than patients with focal CAD. Our data support the notion that Mon 2 is related to worse CAD morphology. </sec
    Heart (British Cardiac Society) 06/2015; 101(Suppl 4):A90-A90. DOI:10.1136/heartjnl-2015-308066.157 · 6.02 Impact Factor
  • R.A. Brown · G Y H Lip · C Varma · E Shantsila
    International journal of cardiology 03/2015; 187:414-416. DOI:10.1016/j.ijcard.2015.03.371 · 6.18 Impact Factor
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    ABSTRACT: Microparticles are markers for cell activation and apoptosis and could provide valuable information that is not available from clinical data. This study assesses the clinical and biological relationship of small-sized microparticles in different forms of ischemic systolic heart failure and their relation to markers of inflammation and repair.
    Revista Espa de Cardiologia 03/2015; DOI:10.1016/j.recesp.2014.11.020 · 3.34 Impact Factor
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    ABSTRACT: Microparticles are markers for cell activation and apoptosis and could provide valuable information that is not available from clinical data. This study assesses the clinical and biological relationship of small-sized microparticles in different forms of ischemic systolic heart failure and their relation to markers of inflammation and repair. We compared 49 patients with acute heart failure, 39 with stable heart failure and 25 patients with stable coronary artery disease. Small-size microparticles counts were determined by high-resolution flow cytometry. Moreover, 3 different monocyte subpopulations and their expression of inflammatory and adhesive scavenger receptors were analyzed using a conventional flow cytometer. Endothelial CD144+ microparticle counts were decreased in heart failure groups (P=.008). Annexin V-binding microparticle counts were found increased in heart failure (P=.024) and in patients with lower functional class (P=.013). Platelet CD42b+ microparticle counts positively correlated with left ventricular ejection fraction (P=.006), and annexin V-binding microparticle counts with interleukin-6 levels in stable heart failure (P=.034). Annexin V-binding microparticle counts in the acute status strongly correlated with toll-like receptor-4 expression on all monocyte subsets (all P<.01). Three months after admission with acute heart failure, annexin V-binding microparticle counts were positively correlated with receptors for interleukin-6, CD163 and CD204 (all P<.05). Annexin V-binding microparticle counts constitute valuable hallmarks of acute decompensated state in systolic heart failure. The observed relationship between small-size annexin V-binding microparticles and scavenger receptors supports their involvement in the progression of the acute response to injury, and thus their contribution to the pathogenesis of acute decompensated heart failure. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.
    Revista Espanola de Cardiologia 03/2015; DOI:10.1016/j.rec.2014.11.016 · 3.34 Impact Factor
  • R.A. Brown · C Varma · D L Connolly · R Ahmad · E Shantsila · G Y H Lip
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    ABSTRACT: In 2009 activation of out of hours (OOH) primary percutaneous coronary intervention (PPCI) in our institution changed from separate telephone calls to a simultaneous computerised alert. We assessed the impact of this protocol change on door-to-balloon (DTB) time, in hospital and 1year mortality. Retrospective survey of our Myocardial Ischaemia National Audit Project (MINAP) database. OOH patients were categorised - pre- (Group 1) and post- (Group 2) introduction of the computerised alert protocol. OOH PPCI was performed for 793 patients (mean age 61, 73.4% male) - 295 in Group 1 and 498 in Group 2. Median DTB times were 92min (interquartile range [IQR] 75-111) for Group 1 and 76min (IQR 64-97) for Group 2 (p<0.0001). Forty-eight percent achieved DTB in ≤90min in Group 1 compared to 70% in Group 2 (p<0.0001). Computerised alert was associated with a shorter DTB time on multivariate analysis (beta coefficient -0.09, p=0.03 for linear regression and OR 2.8, 95% CI 1.6-5.0, p<0.0001 for logistic regression). In hospital mortality was 4.1% in Group 1 and 5% in Group 2 (p=0.60). All-cause mortality at 1year was 6.1% in Group 1 and 9.9% in Group 2 (p=0.09). Simultaneous computerised activation for OOH PPCI reduced DTB times, increased the number of patients achieving target DTB times but did not affect mortality. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    International journal of cardiology 03/2015; 186:226-230. DOI:10.1016/j.ijcard.2015.03.172 · 6.18 Impact Factor
  • E Shantsila · A Wolff · G Y H Lip · D A Lane
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    ABSTRACT: Women represent a large proportion of patients with atrial fibrillation (AF) and tend to have higher risk of stroke. This study examines gender differences in the utilisation of oral anticoagulation (OAC) and prognosis (i.e. stroke and death) in AF patients in UK general practice. Retrospective observational study. The Guidance on Risk Assessment and Stroke Prevention in Atrial Fibrillation (GRASP-AF) tool was employed to identify AF patients from 11 general practices in Darlington, England. Two thousand two hundred and fifty-nine AF patients (mean±SD age 76 ± 12 years; 46% female) were identified. Based on CHA2 DS2 -VASc score 95% of women and 90% of men were at moderate-high risk of stroke. Women with moderate-high risk of stroke were treated with OAC less frequently than men (47% vs. 52%, p = 0.006). Overall rates of stroke and all-cause mortality were higher among women than men (p = 0.02 and p < 0.001). However, there was no significant gender difference in these outcomes in patients receiving OAC (p = 0.52 for stroke, p = 0.18 for death). Among people not receiving OAC where indicated, female gender was associated with an increased risk of stroke before (p = 0.01), and after (p = 0.04), adjustment for stroke risk factors. Women not receiving OAC had a higher risk of death on univariate regression analysis (p = 0.002), but not after adjustment for stroke risk factors (p = 0.53). Women with AF are at higher risk of stroke than men without OAC. The gender-related differences in risk of stroke disappear if OAC is used. Despite this, women are more likely not to receive OAC. © 2015 John Wiley & Sons Ltd.
    International Journal of Clinical Practice 03/2015; DOI:10.1111/ijcp.12625 · 2.54 Impact Factor
  • Deirdre A Lane · Andreas Wolff · Eduard Shantsila · Gregory Y H Lip
    British Journal of General Practice 03/2015; 65(632):117. DOI:10.3399/bjgp15X683905 · 2.36 Impact Factor
  • Eduard Shantsila · Luke D. Tapp · Gregory Y.H. Lip
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    ABSTRACT: We assessed changes of serum combined free immunoglobulin light chains (cFLC) levels, which are associated with increased all-cause mortality, in ST-elevation myocardial infarction (STEMI) in relation to inflammation and renal function indices. cFLC were measured in 48 patients with STEMI on days 1, 3, 7 and 30 with assessment of their relationships with monocyte subsets, high sensitivity C-reactive protein (hsCRP), and cystatin C. Day 1 levels in STEMI patients were compared to 40 patients with stable coronary artery disease, and 37 healthy controls. There were no significant differences in cFLC levels between the study groups. In STEMI patients, cFLC values peaked on day 7 post-MI and remained elevated on day 30 (p<0.001 vs. day 1 for both). hsCRP concentrations peaked on day 3 of STEMI followed by their gradual reduction to the levels seen in the controls (p<0.001). In STEMI cFLC correlated with cystatin C (r=0.55, p<0.001), and negatively correlated with counts of CD14++CD16- monocytes (r=-0.55, p<0.001). On multivariate Cox regression analysis, cFLC concentrations were associated with increased need for future percutaneous coronary intervention (PCI) (p=0.019). cFLC levels increase during STEMI with peak values on day 7 after presentation and predict the need for future PCI. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    International Journal of Cardiology 03/2015; 185. DOI:10.1016/j.ijcard.2015.03.105 · 6.18 Impact Factor
  • Eduard Shantsila · Andreas Wolff · Gregory Y H Lip · Deirdre A Lane
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    ABSTRACT: Oral anticoagulation (OAC) is recommended for effective stroke prevention in the majority of atrial fibrillation patients but is often under-utilised. To use the Guidance on Risk Assessment and Stroke Prevention in the Atrial Fibrillation (GRASP-AF) tool to risk stratify patients, identify antithrombotic therapy received, and determine predictors of stroke and death in a UK general practice cohort. Retrospective-observational cohort study in 11 general practices in Darlington, England, with 105 000 patients. The study included patients with atrial fibrillation (AF) identified from GP databases using the GRASP-AF tool. Stroke risk was determined by CHADS2 and CHA2DS2-VASc scores. A total of 2259 (2.15%) patients with AF (mean age 76 years [SD 12]; 46% female) were identified. Use of CHA2DS2-VASc rather than CHADS2 increased the proportion eligible for OAC from 86.0% to 92.5%. Of those with CHA2DS2-VASc score of ≥2, 39.7% were not receiving appropriate OAC, and of those with CHADS2 score of ≥1, 39.5% were not receiving appropriate OAC. Antiplatelet monotherapy was utilised in 33-40% of patients at high risk of stroke. During 12-month follow-up, 67 (3.0%) patients experienced a stroke and 214 (9.5%) died. Use of OAC significantly reduced stroke risk (odds ratio [OR] 0.60, 95% confidence intervals [CI] = 0.45 to 0.81) and death (OR = 0.54, 95% CI = 0.38 to 0.75, P<0.001) among patients at moderate-high risk of stroke. Use of antiplatelet agents also independently predicted death (OR = 0.69, 95% CI = 0.50 to 0.94; P = 0.020). Most patients with AF in general practice are at high risk of stroke, but OAC is under-utilised in about 40%. Risk of stroke and death was significantly reduced by OAC, yet antiplatelet monotherapy was inappropriately used in approximately 25% of patients at risk of stroke. Optimal implementation of the CHA2DS2-VASc score in the GRASP-AF tool could help prevent more strokes annually. © British Journal of General Practice 2015.
    British Journal of General Practice 01/2015; 65(630):e16-23. DOI:10.3399/bjgp15X683113 · 2.36 Impact Factor
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    ABSTRACT: Increased combined free light chains (cFLC) are strongly prognostic of death in general populations and in patients with chronic kidney disease, but scarce data are available on cFLC in heart failure (HF). We aimed to assess the dynamics and prognostic significance of cFLC levels in patients following admission with acute heart failure (AHF). cFLC measurements were compared in 49 patients with AHF, 37 patients with stable HF, 43 patients with stable coronary artery disease and without HF (‘disease controls’), and 37 healthy controls. The association of cFLC with death and/or rehospitalisation was assessed. Patients with AHF had significantly elevated cFLC levels, compared to other groups (p<0.001). Patients with stable HF showed higher levels of cFLC than healthy controls. In AHF, cFLC levels correlated with cystatin C (Spearman r=0.63, p<0.001), and creatinine (Spearman r=0.47, p=0.002). During 3 months follow up brain natriuretic peptide (BNP) reduced significantly (p=0.017), but cFLC did not change significantly. In a multivariate Cox regression analysis, the higher quartiles of cFLC were significantly associated with death/readmission (hazard ratio (HR) 8.34 [95% CI 2.38-29.22] p=0.0009) after adjustment for age, gender, BNP and cystatin C levels. Higher quartiles of cFLC were prognostic for death alone (HR 14.0 [95% CI 1.72-113.8], p=0.014). In conclusion, raised serum cFLC concentrations in patients with AHF were independently associated with prognosis. In AHF, elevated cFLC levels persist long after clinical stabilisation, which may reflect immune disturbances and/or the reduced capacity of (perhaps functionally impaired) kidneys and the endothelium to eliminate them.
    The American Journal of Cardiology 10/2014; 114(8). DOI:10.1016/j.amjcard.2014.07.049 · 3.43 Impact Factor
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    ABSTRACT: Objectives Arterial and systolic elastance are important parameters determining effective functional interaction of heart and vessels. The aims of this study were to (i) compare arterial [arterial elastance index (EaI)] and ventricular [End-systolic elastance (Ees) and End-diastolic elastance (Eed)] elastance in subjects with obstructive sleep apnoea (OSA) and patients with treated ‘high-risk’ hypertension (HHT), and (ii) test whether these parameters in OSA patients can be improved by continuous positive airway pressure (CPAP) therapy. Methods Echocardiographic parameters of cardiac and vascular stiffness (EaI, Ees and Eed) were quantified in 28 patients with OSA (mean [SD] age 51 [11] years, 79% male) and 28 treated subjects with HHT (mean [SD] age 48 [12] years, 61% male). Twenty three OSA patients were treated with CPAP for median of 26 weeks. Ea was calculated from stroke volume and systolic BP and adjusted by body area (EaI). Both study groups had preserved and comparable left ventricle (LV) contractility. Results There was no significant differences in arterial elastance index (EaI, p=0.94), end-systolic elastance (Ees, p=0.5), end-diastolic elastance (Eed, p=0.63) and arterial-ventricular interaction (Ees/Ea, p=0.62) between OSA and HHT groups. After CPAP therapy, there was a significant reduction in arterial elastance index (EaI; paired t-test, p=0.013), and arterial-ventricular interaction (Ees/Ea; paired t-test, p=0.004). End-systolic elastance (Ees, p=0.17), end-diastolic elastance (Eed, p=0.66) parameters did not change significantly. Conclusions OSA patients and HHT patients have similar parameters of elastance and ventricular-arterial coupling. CPAP treatment in OSA patients significantly improved ventricular-arterial coupling.
    Journal of the American Society of Hypertension 09/2014; 8(9). DOI:10.1016/j.jash.2014.05.013 · 2.68 Impact Factor
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    ABSTRACT: "Lone" atrial fibrillation (AF) is generally used to refer to patients with AF in the absence of structural heart disease. When the decision for oral anticoagulation is discussed, "lone" AF refers to patients who do not have established stroke risk factors. Imaging is often used to rule out structural heart disease, e.g. coronary artery disease, peripheral vascular disease, mitral stenosis or left ventricular (LV) dysfunction. Imaging of the heart has a central role in establishing the "lone" aspect in patients with "lone"AF, similar to the measurement of blood glucose and blood pressure: Patients with structural heart disease, defined as e.g. reduced LV ejection fraction, clinical evidence for heart failure, or evidence for coronary artery disease, will not be considered as patients with "lone" AF. The search for these conditions requires some cardiac imaging, often done by echocardiography and non-invasive tests for coronary artery disease or ischemia. Increasingly, brain imaging is used to define the clinical diagnosis of a stroke, thus also contributing to the detection of stroke risk factors. Cerebral imaging in AF patients without competing causes for silent strokes or microbleeds ("lone" AF, rather used in the context of anticoagulation, i.e. clinical absence of structural heart disease) would allow to better understand the contribution of AF to these brain lesions. The assumption that silent strokes are likely drivers of cognitive dysfunction, and the fact that microbleeds put patients at risk for intracerebral hemorrhage, illustrates the need to collect information on brain imaging. In this review article, we summarize current data on heart and brain imaging in patients with "lone" AF and discuss their clinical implications for risk assessment and management of patients with "lone" AF.
    Current Pharmaceutical Design 08/2014; 21(5). DOI:10.2174/1381612820666140825131221 · 3.29 Impact Factor
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    ABSTRACT: Aim. To characterize blood monocyte subsets in patients with different degrees of carotid atherosclerosis and pathological carotid plaque neovascularization. Methods. Assessment of carotid plaque neovascularization using contrast ultrasonography and flow cytometric quantification of monocyte subsets and their receptors involved in inflammation, angiogenesis, and tissue repair was done in 40 patients with carotid stenosis ≥ 50% and CAD (CS > 50), 40 patients with carotid stenosis < 50% and documented CAD (CS < 50), 40 hypercholesterolaemic controls (HC group), and 40 normocholesterolaemic controls (NC). Results. CS > 50 and CS < 50 groups had increased counts of Mon1 ('classical' CD14++ CD16-CCR2 + cells) compared to HCs (P = 0.03, and P = 0.009). Mon3 ('non-classical' CD14 + CD16++ CCR2- cells) were only increased in CS < 50 compared with HCs (P < 0.01). Both CS>50 and CS < 50 groups showed increased expression of proinflammatory interleukin-6 receptor on Mon1 and Mon2 ('intermediate' CD14++ CD16 + CCR2+ cells); TLR4, proangiogenic Tie2 on all subsets (P < 0.01 for all). In multivariate regression analysis only high Mon1 count was a significant predictor of carotid stenosis (P = 0.04) and intima-media thickness (P = 0.02). In multivariate regression analysis only the Mon1 subset was significantly associated with severe, grade 2 neovascularization (P = 0.034). Conclusion. In this pilot study classical monocytes (Mon1) represent the only monocyte subset predictive of the severity of carotid and systemic atherosclerosis, such as carotid intima-media thickness, degree of carotid stenosis, and presence of carotid intraplaque neovascularization.
    Annals of Medicine 07/2014; 46(7):1-9. DOI:10.3109/07853890.2014.931101 · 4.73 Impact Factor
  • Gregory Yh Lip · Eduard Shantsila
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    ABSTRACT: Advances in pharmacological and devices therapy have greatly improved prognosis in patients with systolic heart failure. Despite this congestive heart failure still bears a very grim prognosis, particularly in patients with more advances stages of the disease that are so frequently seen on hospital wards. Which pathogenic pathways may need to be addressed to improve prognosis in heart failure? The current treatment of this condition is primarily focused on performance of the heart itself, and aims to inhibit unfavorable cardiac remodeling (e.g., amelioration of impact of activated catecholamine and renin-angiotensin-aldosterone systems), optimization of cardiac hemodynamics (e.g., cardiac resynchronization therapy) and prevention of life threatening arrhythmia (e.g., insertion of implantable defibrillators). However, accumulating evidence suggests that thrombotic complications may play a major role in morbidity and outcomes in heart failure patients, especially as the cardiac 'targets' (largely neurohuneral) are being better managed.
    Circulation 06/2014; 130(5). DOI:10.1161/CIRCULATIONAHA.114.011353 · 14.95 Impact Factor
  • Richard Brown · Eduard Shantsila · Chetan Varma · Gregory Lip
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    ABSTRACT: Studies have shown higher in-hospital mortality for female patients and ethnic minorities admitted to hospital with acute ST elevation myocardial infarction (STEMI). Pre-hospital delay is thought to be associated with increased in-hospital mortality. To assess the impact of gender and ethnicity on symptom-to-door time (STDT) in patients presenting with STEMI. Retrospective survey of consecutive patients receiving primary percutaneous coronary intervention (PPCI) between January 2008 and January 2013. A multivariate model was used to adjust for confounders. Influence of gender and ethnicity on STDT. We analysed 1020 patients (75% male, 263 South Asians, 38 Afro Caribbeans and 719 White Europeans.) There was a trend towards longer unadjusted median STDT in women compared to men (132 minutes vs 113 minutes p=0.07) which disappeared after correction for age and ethnicity (p=0.15). There was no gender difference in hospital mortality after correction for age (odds ratio [OR] 0.69, 95% confidence interval [CI] 0.40-1.18, p=0.17). On linear regression analysis South Asians showed a trend towards longer STDT than other ethnic groups (p=0.08) however after adjustment for diabetes there was no association between South Asian ethnicity and hospital mortality. Neither female gender nor ethnicity were shown to be associated with significant pre hospital delay. © The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
    Heart (British Cardiac Society) 06/2014; 100(Suppl 3):A18. DOI:10.1136/heartjnl-2014-306118.34 · 6.02 Impact Factor
  • Angie Ghattas · Eduard Shantsila · Helen Griffiths · G Lip
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    ABSTRACT: Monocytes, with 3 different subsets, are implicated in the initiation and progression of the atherosclerotic plaque contributing to plaque instability and rupture. Mon1 are the "classical" monocytes with inflammatory action, whilst Mon3 are considered reparative with fibroblast deposition ability. The function of the newly described Mon2 subset is yet to be fully described. In PCI era, fewer patients have globally reduced left ventricular ejection fraction post infarction, hence the importance of studying regional wall motion abnormalities and deformation at segmental levels using longitudinal strain. Little is known of the role for the 3 monocyte subpopulations in determining global strain in ST elevation myocardial infarction patients (STEMI).
    Heart (British Cardiac Society) 06/2014; 100(Suppl 3):A19-A20. DOI:10.1136/heartjnl-2014-306118.36 · 6.02 Impact Factor

Publication Stats

2k Citations
833.10 Total Impact Points

Institutions

  • 2012–2015
    • Sandwell and West Birmingham Hospitals NHS Trust
      Birmingham, England, United Kingdom
    • Aston University
      Wheaton Aston, England, United Kingdom
  • 2009–2015
    • University of Birmingham
      • Centre for Cardiovascular Sciences
      Birmingham, England, United Kingdom
    • Republican Science-Practical Center Cardiology
      Myenyesk, Minsk, Belarus
    • WWF United Kingdom
      Londinium, England, United Kingdom
  • 2006–2015
    • Birmingham City University
      Birmingham, England, United Kingdom
  • 2006–2012
    • University Hospitals Birmingham NHS Foundation Trust
      • Department of Medicine
      Birmingham, England, United Kingdom