Lana Jayne Dixon

Belfast Health and Social Care Trust | BHSCT · Cardiovascular Department

Anthracycline chemotherapy is used in approximately two thirds of the 35,000 European children diagnosed with cancer each year. Unfortunately 1 in 10 will develop symptomatic heart failure at 40 years after therapy. Emerging evidence suggests that anthracyclines exert a significant cardiovascular insult that expands beyond an impaired ejection frac...

Importance In the Revascularization for Ischemic Ventricular Dysfunction (REVIVED-BCIS2) trial, percutaneous coronary intervention (PCI) did not improve outcomes for patients with ischemic left ventricular dysfunction. Whether myocardial viability testing had prognostic utility for these patients or identified a subpopulation who may benefit from P...

Background: In Europe, more than 15 million people live with heart failure (HF). It imposes an enormous social, organizational and economic burden. As a reaction to impending impact on healthcare provision, different country-specific structures for HF-care have been established. The aim of this report is to provide an overview and compare the HF-c...

Background For patients with heart failure, reduced left ventricular ejection fraction and iron deficiency, intravenous ferric carboxymaltose administration improves quality of life and exercise capacity in the short-term and reduces hospital admissions for heart failure up to 1 year. We aimed to evaluate the longer-term effects of intravenous ferr...

Background Almost 60% of the 2,000 children diagnosed with cancer in the UK and Ireland every year are treated with anthracycline chemotherapy. Anthracyclines are WHO essential medicines, and 5-year childhood cancer survival rates are approaching 85%, but also carry a risk of cardiotoxicity, particularly for childhood cancer survivors (CCS) of whom...

Background: Whether revascularization by percutaneous coronary intervention (PCI) can improve event-free survival and left ventricular function in patients with severe ischemic left ventricular systolic dysfunction, as compared with optimal medical therapy (i.e., individually adjusted pharmacologic and device therapy for heart failure) alone, is u...

Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Northern Ireland Chest Heart & Stroke Background Cardiac cachexia is a multifactorial wasting syndrome, which is characterised by unintentional weight loss, a reduction in skeletal muscle mass, and reduced quality of life. There is a paucity of qualitative resear...

Background: Cardiac Cachexia is a wasting syndrome that has a significant impact on patient mortality and quality of life world-wide, although it is poorly understood in clinical practice. Aim: Identify the prevalence of cardiac cachexia in patients with advanced New York Heart Association (NYHA) functional class and explore its impact on patien...

Background: Recent landmark trials such as DAPA-HF and EMPEROR-Reduced have led to the approval and implementation of Sodium/glucose cotransporter 2 (SGLT2) inhibitors as a first line therapy for heart failure with reduced ejection fraction (HFreF). However, there is a paucity of data looking at real world outcomes in heart failure patients.AimWe s...

Cancer therapeutics related cardiac dysfunction (CTRCD) has emerged as a major cause of morbidity and mortality in cancer survivors. Effective clinical management of CTRCD is impeded by a lack of sensitive diagnostic and prognostic strategies. Circulating molecular markers could potentially address this need as they are often indicative of cardiac...

Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Northern Ireland Chest Heart and Stroke Background/Introduction: Cardiac cachexia (CC) is a multifactorial wasting syndrome, resulting in significant weight loss and reduction in muscle mass. This is reflected in a detrimental effect on the patients’ ph...

Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): INTERREG-NWE Background/Introduction Current heart failure (HF) healthcare provision is not sufficient. Due to demographic changes and subsequent increases in comorbidities, along with unequal distribution of medical care in rural areas, alternat...

Objective Heart failure is a growing challenge to healthcare systems worldwide. Technological solutions have the potential to improve the health of patients and help to reduce costs. Acceptability is a prerequisite for the use and a successful implementation of new disruptive technologies. This qualitative study aimed to explore determinants that i...

Background Current heart failure (HF) healthcare services are not sufficient to meet the needs of an aging population with increasing comorbidities and disease complexity together with the unequal distribution of medical care in rural and urban regions. These factors have created an imminent need to identify alternative healthcare approaches. eHeal...

Objective There is a paucity of studies investigating the impact of mid-range ejection fraction (mrEF) on clinical outcomes, including ventricular arrhythmias, in ST-segment-elevation myocardial infarction (STEMI). We sought to investigate the prognostic role of mrEF post STEMI and whether recommended medical therapy may modify future risk. Method...

As the number of implantable cardioverter defibrillators (ICDs) implanted continues to rise, there is a growing challenge to ensure patients and family members are adequately equipped for involvement in future end-of-life decisions concerning their device. Objective To explore patients’, family members’ and professionals’ attitudes and understandi...

Heart failure (HF) is one of the most complex chronic disorders with high prevalence, mainly due to the ageing population and better treatment of underlying diseases. Prevalence will continue to rise and is estimated to reach 3% of the population in Western countries by 2025. It is the most important cause of hospitalisation in subjects aged 65 yea...

Background: Cachexia is a complex and multifactorial syndrome defined as severe weight loss and muscle wasting which frequently goes unrecognised in clinical practice [1]. It is a debilitating syndrome, resulting in patients experiencing decreased quality of life and an increased risk of premature death; with cancer cachexia alone resulting in 2 m...

This Northern Ireland wide study reviewed all adult survivors of childhood cancer who received anthracycline based chemotherapy referred by paediatric oncology. We examined the demography and characteristics of this population, the therapies used, cardiovascular risk factors, symptoms, biomarkers, ECG, and echocardiography findings including GLS.

Introduction Current guidelines regarding investigation and treatment of stable ischaemic heart disease are conflicting. The recently updated NICE guidelines advise CTCA for investigation of chest pain and reserve non-invasive ischaemia tests for patients with known coronary artery disease (figure 1). The ESC guidelines advise non-invasive ischaemi...

Introduction Left ventricular ejection fraction (LVEF) is an important predictor of morbidity and mortality after ST elevation myocardial infarction (STEMI). In patients with left ventricular systolic dysfunction early after STEMI adverse ventricular remodelling can lead to a sustained reduction in LVEF, however, in some cases improvement may occur...

Background Cardiotoxicity is a recognised complication of anthracycline based chemotherapy. Although early toxicity is often reversible, late toxicity involves a cascade of injury that is significantly more difficult to treat. Subclinical myocardial cell injury is followed by asymptomatic and symptomatic heart failure and can potentially lead to an...

The great masquerader strikes again: cardiac sarcoid, an unusual cause of sudden cardiac arrest in a 37-year-old athlete. C McCune, O King, L Dixon. European Journal of Heart Failure (2019) 21 (Suppl. S1) 5-592. DOI 10.1002/ejhf.1488

Background: Clinicians face considerable challenges in identifying patients with advanced heart failure who experience significant symptom burden at the end of life. Often, these patients are cared for in the community by a loved one who has limited access to support from specialist services, including palliative care. Aim: The aims of this stud...

Background: Rate of implantable cardioverter defibrillator (ICD) implantations is increasing in patients with advanced heart failure. Despite clear guideline recommendations, discussions addressing deactivation occur infrequently. Aim: The aim of this article is to explore patient and professional factors that impact perceived likelihood and con...

Background: While studies have evaluated caregiver outcomes in heart failure, the burden and support needs when caring for someone with advanced heart failure at the end of life have yet to be outlined. Aim: To identify psychosocial factors associated with caregiver burden and evaluate the support needs of caregivers in advanced heart failure....

Introduction Trans-catheter aortic valve implantation (TAVI) is now an established treatment option for patients with severe symptomatic aortic stenosis who are at high or inoperable risk for surgical aortic valve replacement. Most of the established data are from studies of patients meeting strict inclusion and exclusion criteria. We present the c...

Purpose Previous research has identified that patients with a diagnosis of heart failure in the community frequently have not had previous heart failure specialist assessment. This study sought to determine the characteristics of patients with a label of heart failure in the community without a record of previous specialist assessment in two differ...

Background Identifying patients with ischaemic left ventricular dysfunction that would benefit from revascularisation is challenging. The aim of this study was to investigate the role of cardiovascular magnetic resonance (CMR) imaging in the decision making process in patients being considered for revascularisation. Methods All patients referred fo...

Background Viability assessment prior to revascularisation at our institution is largely requested for patients with severely impaired left ventricles (LV). This study however aims to review the outcomes of those patients with preserved or mildly impaired LV function who underwent cardiac magnetic resonance imaging (CMR) for assessment of viability...

The implantable cardioverter defibrillator (ICD) is a cornerstone in the treatment of life-threatening arrhythmias. As rates of device implantation continue to rise throughout Europe, European and International guidelines recommend professionals discuss deactivation with patients. In reality the appropriate therapeutic management of an ICD at the e...

Background: Individualised care at the end of life requires professional understanding of the patient's perception of implantable cardioverter defibrillator deactivation. Aim: The aim was to evaluate the evidence on patients' perception of implantable cardioverter defibrillator deactivation at end of life. Design: Systematic narrative review o...

Background: Cardiac magnetic resonance (CMR) is used in the diagnosis and risk stratification of hypertrophic cardiomyopathy (HCM) and can detect myocardial replacement fibrosis (anindependent predictor of adverse cardiac outcomes) using late gadolinium enhancement (LGE). Methods: We retrospectively analysed CMR studies carried out over a 2 year...

A 37-year-old Caucasian female with known rheumatic mitral stenosis was admitted for Balloon mitral valvuloplasty which was complicated with a laceration of anterior mitral leaflet (A2 scallop) resulting in severe mitral regurgitation. Intra-aortic balloon pump (IABP) was instituted and the patient was referred for emergency mitral surgery. During...

A 53-year-old man presented with a 12-month history of increasing shortness of breath, decreasing exercise tolerance, peripheral oedema, abdominal distension and paroxysmal nocturnal dyspnoea. He was a previously fit and well man with no co-morbidities. His only cardiac risk factor was of previous tobacco use. On examination, he had signs consist...

A 69-year-old female, with no previous history of cerebrovascular disease, presented with acute onset expressive and receptive dysphasia. Neurological examination revealed dysgraphia in addition to dysphasia with no other neurological deficit. The remainder of the clinical examination was unremarkable. Laboratory investigations revealed a normal fu...

A 66-year-old woman, admitted for day-case laser excision of a T1N0 laryngeal squamous cell carcinoma, suddenly became dyspnoeic while in the recovery ward ∼20 min after successful completion of an uneventful procedure. Arterial blood gas analysis confirmed acute type II respiratory failure which prompted emergency re-intubation, initiation of ven...

A 48-year-old housewife presented to hospital with acute central chest pain associated with dyspnoea at rest. The chest pain had awoken her from sleep 6 h previously, was non-pleuritic and radiated to her back. She had no past history of chest discomfort or angina however, she had been ‘worrying’ recently about a daughter who was ill. Of particular...

Reversible stress-induced cardiomyopathy, i.e., Takotsubo cardiomyopathy, rarely presents in preoperative patients. We provide the case reports of two patients who presented with Takotsubo cardiomyopathy, which we surmise was due to excess endogenous catecholamine production in response to acute pain. Electrocardiogram revealed T-wave inversion, wi...

We present the case of a post-menopausal female who, following a prolonged period of vomiting and diarrhoea, presented acutely with Wernicke's; encephalopathy, chest pain, ST-segment elevation and congestive cardiac failure associated with hypotension. Coronary angiography demonstrated no abnormality. Haemodynamics improved significantly in the sho...

Cardiac resynchronization therapy (CRT) is a recognised treatment option for a select group of patients with heart failure, i.e. those with New York Heart Association (NYHA) class III-IV symptoms, left ventricular ejection fraction 35% and either a QRS 150ms or a QRS 120 –149ms with echocardiographic evidence of mechanical dyssynchrony. Despite the...

We investigated the effects of omega-3 fatty acids administration on endothelium-dependent vasodilation in patients > or =65 years old who received treatment for chronic heart failure (CHF). Twenty patients (mean age 73 years; 15 men) with grade II and III CHF who were on maximal medical management were recruited. Patients were randomized in a doub...

Vascular NAD(P)H oxidase represents a major source for excessive superoxide production in hypertension. Angiotensin II (AngII) can activate NAD(P)H oxidase via the angiotensin II type 1 (AT1) receptor and protein kinase C (PKC). Platelets possess AT1 receptors and all the components of the NAD(P)H oxidase system. We employed this tissue model to ex...

Hypertension and diabetes are important independent risk factors for increased oxidative stress and increased cardiovascular risk. The combination of hypertension and diabetes results in a dramatic increase in cardiovascular risk. Enhanced oxidative stress in hypertension and diabetes is linked to decreased nitric oxide (NO) bioavailability because...

Impaired endothelium-dependent and independent vasodilator responses in chronic heart failure (CHF) have been well described. Previous studies involved younger patients and omitted medications prior to study. We explored if new therapeutic interventions would restore vasodilator responses in typical patients with chronic heart failure. 24 patients...

Frequent, lengthy hospital admissions for congestive cardiac failure (CCF) result in excessive health care costs. Cardiac resynchronisation therapy (CRT) is a novel treatment option for patients with CCF and associated cardiac conduction defects. We investigated whether CRT resulted in significant improvements in New York Heart Association (NYHA) s...

To evaluate the effects of the intravenous administration of the nitric oxide synthesis inhibitor N(g)nitro-L-arginine methyl ester (L-NAME) in healthy volunteers. L-NAME (0.25, 0.5 and 0.75 mg/kg over 8 min) was infused in 13 healthy male volunteers. Finally, subjects were infused with either L- or D-arginine. L-NAME resulted in dose-dependent fal...

Impaired endothelium-mediated vasodilatation (EMVD) in congestive cardiac failure (CCF) has been linked to decreased nitric oxide (NO) bioavailability because of its interaction with vascular superoxide (O2*-), derived predominantly from NAD(P)H-dependent oxidases. When uncoupled from essential cofactors, endothelial nitric oxide synthase (eNOS) pr...

The haemodynamic consequence of altered mechanical wall properties in diabetes can impair the compliance characteristics or pulsatile function of arteries before changes in calibre or peripheral resistance become evident. We studied the sensitivity of pulsatile and steady-state haemodynamic variables in identifying vascular abnormalities and assess...

The objective of this study was, using isolated platelets as a surrogate for vascular cells, to examine the effect of nonintermittent organic nitrate administration on 8-epi prostaglandin F(2alpha) (8-epi PGF(2alpha)) content and the effect of concurrent oral ascorbate administration. The long-term efficacy of organic nitrates is hampered by hemody...

The embryological development of the superior vena cava (SVC) is complex. If the left common cardinal vein fails to occlude it can, along with the left duct of Cuvier form a left SVC, which frequently drains into the coronary sinus. This may result in abnormalities in the anatomy of this structure. A persistent left SVC occurs in 0.5% of the normal...

The therapeutic benefits that accompany the continuous administration of organic nitrates are attenuated by the development of tolerance to the compounds. Altered superoxide production and NO bioavailability have been implicated in contributing to the development of tolerance, an effect that may be ameliorated by the administration of antioxidants....