Mark Abela

Mark Abela
Mater Dei Hospital · Department of Cardiology

MD (Melit) MRCP (UK) MRCP (London) MSc (Edinburgh) MSc Sports Cardiology (London)
Designated Cardiologist for the Malta Football Association, Malta Olympic Committee, Aquatic Sport Association of Malta

About

66
Publications
10,985
Reads
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55
Citations
Citations since 2017
35 Research Items
54 Citations
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Introduction
Interested in Sports Cardiology, Sudden Cardiac Death, Cardiovascular Screening and Cardiac Rehabilitation. Currently a PhD student at the University of Malta. Recently elected on the Sports Cardiology and Exercise EAPC Nucleus.
Additional affiliations
May 2019 - present
St George's, University of London
Position
  • Fellow
December 2015 - January 2020
Mater Dei Hospital
Position
  • Higher Specialist Trainee
June 2012 - December 2015
Mater Dei Hospital
Position
  • Basic Medical Specialist Trainee
Education
September 2016 - September 2019
St George's, University of London
Field of study
  • Sports Cardiology
September 2012 - September 2015
The University of Edinburgh
Field of study
  • Internal Medicine
September 2002 - September 2007
University of Malta
Field of study
  • Doctor of Medicine and Surgery

Publications

Publications (66)
Article
Aim Cardiac arrest prevention in schools has recently gained momentum. The survival benefit in schools who have access to defibrillators is clear, with far better survival outcomes in children or adults who sustain a cardiac arrest on school grounds. The main objectives of this study were to assess sudden cardiac arrest prevention in Maltese school...
Article
Background Anterior T wave inversion (TWI) is frequent in healthy adolescent individuals (juvenile ECG pattern), normalising after puberty. Its clinical implications are uncertain. Aim This study assessed a) national prevalence of anterior TWI, b) ST segment morphology, c) proportion of individuals with a juvenile ECG pattern whose ECG normalises a...
Article
Full-text available
Cardiac Magnetic Resonance (CMR) is increasingly being used for diagnosing various cardiac conditions. Parametric mapping enables quantitative myocardial characterization by directly measuring myocardial T1 and T2 values. However, reference values of parametric mapping are not standardized across different vendors and scanners, causing drawbacks fo...
Technical Report
Full-text available
Cardiovascular disease prevention in clinical practice: implementation report A recent EAPC report has been published on the implementation of ESC Guidelines on cardiovascular disease prevention in clinical practice across 13 European countries, highlighting changes between 2011 and 2021. The report discusses remaining and newly perceived issues...
Article
Full-text available
The esports industry has grown exponentially and is expected to flourish rapidly in the coming years. Awareness about the cardiovascular sequalae in elite esport athletes has gained considerable momentum. Evidence supporting systematic screening in esport athletes is however lacking. In this narrative review, we discuss potential negative health ef...
Preprint
Full-text available
Background Cardiac Magnetic Resonance (CMR) is increasingly being used for diagnosing various cardiac conditions. Parametric mapping enables quantitative myocardial characterization by directly measuring myocardial T1 and T2 values. However, reference values of parametric mapping are not standardized across different vendors and scanners, causing d...
Preprint
Background Cardiac Magnetic Resonance (CMR) is increasingly being used for diagnosing various cardiac conditions. Parametric mapping enables quantitative myocardial characterization by directly measuring myocardial T1 and T2 values. However, reference values of parametric mapping are not standardized across different vendors and scanners, causing d...
Article
Full-text available
Funding Acknowledgements Type of funding sources: None. Introduction Sudden cardiac arrest is the leading cause of premature death. Effective cardiopulmonary resuscitation (CPR) and early defibrillation substantially improve survival rates. This has also been replicated in schools, with excellent outcome data in schools who advocated CPR certifica...
Article
Full-text available
Funding Acknowledgements Type of funding sources: None. Introduction The global COVID19 pandemic has led to significant morbidity and mortality to millions of cardiac patients across the globe. Inferior clinical standards, modified clinical pathways and limited hospital resources has unfortunately translated to significant premature cardiac deaths...
Article
Full-text available
Funding Acknowledgements Type of funding sources: None. Introduction Most international bodies now recommend cardiac screening for all individuals undertaking high intensity physical activity. The sensitivity and specificity of the ECG in cardiac screening is undisputed. Study Objective Two major national institutions (Police Force and the Armed F...
Article
Full-text available
Background Athletes presenting with 1st degree atrio-ventricular block on 12-lead ECG may present a diagnostic conundrum, especially when significantly prolonged and associated with higher degrees of block. A pragmatic stepwise approach to evaluation of these patients is therefore crucial. Case Summary A 19 year old waterpolo player was referred f...
Preprint
Full-text available
AimCardiac arrest prevention in schools has recently gained momentum. The survival benefit in schools who have access to defibrillators is clear, with far better survival outcomes in children or adults who sustain a cardiac arrest on school grounds. The main objectives of this study were to assess sudden cardiac arrest (SCA) prevention in Maltese s...
Preprint
Full-text available
Aim Cardiac arrest prevention in schools has recently gained momentum. The survival benefit in schools who have access to defibrillators is clear, with far better survival outcomes in children or adults who sustain a cardiac arrest on school grounds. The main objectives of this study were to assess sudden cardiac arrest (SCA) prevention in Maltese...
Conference Paper
Full-text available
Introduction: Cascade family screening in inherited heart disease is often reserved for probands with a clinical diagnosis. This study assessed the yield of family screening in a national cardiac screening program, comparing a clinical and a clinical/genetic screening algorithm. Methods: 2708 teens (14-16 years) participated in a national cardiac...
Article
Participation in regular exercise of moderate intensity is associated with a plethora of systemic benefits, including a reduction in risk factors for coronary atherosclerosis; however, intensive exercise may paradoxically culminate in sudden cardiac arrest among individuals harboring arrhythmogenic substrates. The precise mechanism for arrhythmogen...
Article
Full-text available
Introduction Cascade family screening in patients with confirmed or suspected inherited cardiac disorders is now well established. This may refute or confirm a familial clinical diagnosis and is particularly relevant in young adolescent individuals as it may be too early to manifest a distinct phenotype. Objectives A large cohort of 2708 adolescen...
Article
Full-text available
Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Malta Heart Foundation and Beating Hearts Background Little is known about the prevalence and clinical relevance of an isolated short PR interval in young individuals. Objectives To explore the PR interval in adolescent athletes and non-...
Conference Paper
Full-text available
ackground Little is known about the prevalence and clinical relevance of an isolated short PR interval in young individuals. Objectives To explore the PR interval in adolescent athletes and non-athletes and determine possible association with sex, age, ethnicity, athletic ability and sporting discipline. Methods Between 2017-2018, school child...
Article
Full-text available
Improved cardiovascular care of patients with congenital heart disease has led to a significantly improved survival in this previously high-risk population. More patients are keen to engage in regular physical activity, some even opting for competitive sports. The beneficial effects of exercise are well known, though balancing this benefit with the...
Chapter
Exercise-related sudden death from a previously quiescent cardiac disorder is a highly visible event, particularly when a high-profile athlete is affected. A comprehensive assessment to identify the diverse spectrum of potential causes is cost-prohibitive, given the rarity of such catastrophes. The 12-lead ECG, which is among the simplest of cardia...
Article
Participation in regular exercise of moderate intensity is associated with a plethora of systemic benefits, including a reduction in risk factors for coronary atherosclerosis; however, intensive exercise may paradoxically culminate in sudden cardiac arrest among individuals harboring arrhythmogenic substrates. The precise mechanism for arrhythmogen...
Chapter
Exercise-related sudden death from a previously quiescent cardiac disorder is a highly visible event, particularly when a high-profile athlete is affected. A comprehensive assessment to identify the diverse spectrum of potential causes is cost-prohibitive, given the rarity of such catastrophes. The 12-lead ECG, which is among the simplest of cardia...
Article
Full-text available
Introduction: Cardiac screening in competitive athletes is now recommended by most scientific and sporting organisations. Screening non­athletic young individuals has been challenged. Absence of a definite phenotype can falsely reassure those screened. Genetics may possibly help identify those with a pre­-clinical state. Objectives: To explore th...
Conference Paper
Full-text available
Introduction The electrocardiogram (ECG) has a central role in cardiac screening for the prevention of sudden cardiac death. T-wave inversion (TWI) is a common finding in cardiomyopathies and warrants further investigation. Cardiac Magnetic Resonance (CMR) has gained momentum for imaging of individuals with TWI as it provides incremental yield. Pu...
Conference Paper
Background: N-terminal pro-Brain Natriuretic peptide (NT-proBNP) appears to be the most powerful neurohumoral predictor of left-ventricular function and prognosis. NT-pro BNP has a longer half-life and therefore has become a more attractive assay than BNP, both for study design and clinical management. Objectives: To determine whether NT-proBNP le...
Conference Paper
Full-text available
Background: T wave inversion (TWI) in the right precordial leads is a common finding in adolescent individuals. In the absence of symptoms or significant family history, TWI in 2 contiguous chest leads is regarded as a normal variant (Juvenile ECG pattern). Objectives: The first is to assess the prevalence of TWI beyond V1 in a large cohort of ind...
Article
Full-text available
Purpose of review: Pre-participation cardiovascular evaluation with electrocardiography is normal practice for most sporting bodies. Awareness about sudden cardiac death in athletes and recognizing how screening can help identify vulnerable athletes have empowered different sporting disciplines to invest in the wellbeing of their athletes. Recent...
Article
Introduction Evidence supporting a multi-disciplinary approach in the management of heart failure [HF] patients is substantial. Exercise training [ET] sessions for HF patients are now available locally as of 2018. This study aimed to look at patient satisfaction in those referred to the program, whilst also looking at a number of health outcomes....
Article
Introduction: Screening for conditions predisposing to Sudden Cardiac Death (SCD) in athletes is recommended by a number of scientific and sporting organisations. The ethics of limiting screening to athletes has been challenged as identifying high-risk individuals early on may allow life-saving interventions, irrespective of athletic ability. Obje...
Article
Full-text available
Purpose of review Excessive trabeculation attracting a diagnosis of left ventricular noncompaction cardiomyopathy (LVNC) has been reported in ostensibly healthy athletes. This review aims to explain why this occurs and whether this represents a spectrum of athletic physiological remodelling or unmasking of occult cardiomyopathy. Recent findings Ge...
Article
Full-text available
Exercise training (ET) in heart failure (HF) has long been established as an important part of HF care. ET is known to improve quality of life and functional capacity in a number of ways. Despite its proposed benefits, evidence supporting its routine inclusion in standard rehabilitation programme is at times conflicting, partly because of the signi...
Article
Full-text available
A 62-year-old, previously healthy man presented with dyspnoea. His examination findings were in keeping with congestive cardiac failure secondary to severe aortic regurgitation, which was confirmed on echocardiography. A comprehensive assessment was carried out to identify the aetiology of his aortic regurgitation, and in view of his sexual history...
Article
Exercise is known to have a vast array of health benefits. It may however confer delirious effects on most body systems, with the cardiovascular system taking particular prominence. Athletes in particular are known to be at a higher risk for sudden cardiac death as a result of several cardiac adaptations which take place. Myocardial damage as a res...
Article
Full-text available
Participation is comparable if not better to international data (55% completed the program). Only smoking history was a predictor for better participation (p=0.013). Age and gender which are notoriously related to poor CR participation in international data, were not significant in this particular cohort (p=0.649 and p=0.931 respectively). Patients...
Article
Introduction Inherited cardiac diseases are common causes of sudden cardiac death (SCD) and the family must not only contend with the grief of their loss, but also with the possibility that SCD may strike the family again. There is at present no epidemiological data regarding the aetiology of SCD in the young pertaining to the Maltese population....
Article
Introduction: Intermittent hypoxia (IH) in obstructive sleep apnoea (OSA) confers cardioprotection by enhancing coronary collateral circulation (CCC) development, thereby decreasing myocardium vulnerability to hypoxia and ischaemia. The exact mechanism is as yet unclear. By better understanding of the physiology, one may attempt to replicate these...
Conference Paper
Full-text available
Introduction Intermittent hypoxia (IH) in obstructive sleep apnoea (OSA) confers cardioprotection by enhancing coronary collateral circulation (CCC) development, decreasing myocardium vulnerability to hypoxia and ischaemia. The main objective was to assess whether hypoxia inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) pl...
Conference Paper
Full-text available
Non-bacterial thrombotic endocarditis (NBTE) and infective endocarditis (IE) are two distinct clinical and pathological entities which are often very difficult to distinguish. We present a case of IE in a chronically damaged mitral valve (MV) in a 38 year old with systemic lupus erythematosus (SLE). The patient initially presented with dyspnoea and...
Conference Paper
Full-text available
C1 esterase inhibitor (C1-INH) is a serine protease inhibitor that acts on a number of proteins that play a role in the complement, coagulation and kinin-kallikrein cascades. By adhering to specific factors (C1, Factor XIIa, MASP-1, MASP-2, Kallikrein), it helps maintain a balance between thrombin generation and fibrinolysis. Deficient patients how...
Conference Paper
Full-text available
The Malta BioBank (BBMRI.mt) forms part of the new inter-faculty Centre for Molecular Medicine and BioBanking at the University of Malta. The clinical catalogue holds a number of disease collections including: the Globin Bank; Parkinson’s Disease (PD); Diabetes; Multiple Sclerosis; renal disorders; various cancers and rare diseases. The Globin Bank...
Article
Full-text available
Iron deficiency (ID) is one of the most prevalent conditions in chronic heart failure (CHF) patients. Similar to the pathophysiology of anaemia of chronic disease in chronic inflammatory diseases, the inflammatory status in such patients as evidenced by increasing levels of inflammatory cytokines with worsening CHF, impairs functional mobilisation...
Conference Paper
Full-text available
Introduction Iron deficiency (ID) is an important intracellular metabolically active element, leading to mitotic arrest and apoptosis in deficient individuals. With new evidence suggesting that patients in heart failure (HF) are prone to develop an active inflammatory state, numerous studies have identified ID as an important prognostic predictor (...
Article
Full-text available
Heart failure is one of the commonest diagnoses presenting to physicians in the community or hospital care. Symptoms are often subjective, with clinicians having to rely on clinical assessment and radiological imaging to manage these patients. Treatment is often symptomatic with no clear therapeutic goals as yet identified. To date, there are no ob...
Conference Paper
Full-text available
AIMS This study aimed to identify the 30-day readmission rate following percutaneous coronary interventions (PCI) in Malta, to determine the predictors that lead to readmission following PCI, as well as the underlying reasons for readmissions. This study has already been performed in New York State; a comparison of the readmission rate would thus b...
Article
Full-text available
Background The aim of this audit was to evaluate the safety and efficiency of the methods by which doctors on call are made aware of investigation results that are issued during on-call hours; and how these are acknowledged as seen. Method Using the pathology department’s Laboratory Information System, a set of results issued during 5 consecuti...
Conference Paper
Full-text available
Introduction In order to improve efficiency with the use of continuous cardiac monitoring, an audit was set up to compare local practice with American Heart Association (AHA) recommendations (Class I – monitor indicated, Class II – monitoring may be of benefit, Class III – not indicated). Method All medical admissions and all in-patients who were...
Conference Paper
Full-text available
Low Molecular Weight Heparin (LMWH) has been recently introduced in the Catheterisation Suite at Mater Dei Hospital (MDH) for Urgent Percutaneous Coronary Interventions (PCI). Due to its infancy locally, this audit was set up, so as to assess how LMWH was administered, comparing results to the European Society of Cardiology (ESC) recommendations an...
Conference Paper
Full-text available
To assess the clerking performed during the acute medical take, and compare the results to a previous audit carried out before the medical admission proforma was introduced.
Conference Paper
Full-text available
Low Molecular Weight Heparin (LMWH) has been recently introduced in the Catheterisation Suite at Mater Dei Hospital (MDH) for Urgent Percutaneous Coronary Interventions (PCI). Due to its infancy locally, this audit was set up, so as to assess how LMWH was administered, comparing results to the European Society of Cardiology (ESC) recommendations an...
Conference Paper
Full-text available
To assess whether acute medical admissions are receiving the appropriate level of inpatient monitoring, parameter charting, senior involvement and selection of admitting ward based on a validated Modified Early Warning Score.
Conference Paper
Full-text available
In Malta, an audit on VTE prophylaxis in 2009 demonstrated a very low prescription rate amongst acute medical admissions at Mater Dei Hospital (6% prescription rates). A second audit was performed in 2010, following a series of educational events in the hope of improving on current practise; however results failed to demonstrate any improvement (3%...
Conference Paper
Full-text available
Ever since the introduction of Low Molecular Weight Heparin in the catheterisation suite at Mater Dei Hospital, numerous cases of in-stent thrombosis prompted the set up of this audit to look at the local use of LMWH (available locally as Enoxaparin) in patients presenting with STEMI-ACS, NSTEMI-ACS and Unstable Angina, needing Percutaneous Coronar...
Conference Paper
Full-text available
Introduction: Ivabridine (Procorlan) is a newly approved anti-ischaemic drug, recently included in new European Society of Cardiology (ESC) Heart Failure after evidence showed it decreased the risk of Heart Failure Hospitalisation, left ventricular systolic function and quality of life. Audit Objection: One can assume that local Heart Failure Clin...
Conference Paper
Full-text available
Oral Presentation discussing a case of mitral endocarditis post-transcatheter aortic valve implantation (TAVI)
Article
Medical Undergraduates are often too focused on their studies and disregard the importance of Medical Research and Audit both for their own personal development and also for the benefit of the general medical community. This is probably due to the lack of exposure and understanding of what being involved in such projects truly entails. Some view it...
Conference Paper
Full-text available
TAVI - an initial local experience
Article
Full-text available
This study is aimed to assess the influence of body shape on Body Mass Index (BMI) estimations by determining the Sitting Height to Standing height ratio. The study population included 291 non-pregnant premenopausal Maltese women aged 20-54 years. These women were assessed using the following anthropometric measurements: Body weight (Kg), standing...
Article
Full-text available
Aim Pulmonary Thromboembolism is a relatively common emergency condition. Despite this, current investigations (including D-Dimer, Spiral Computer Tomography, pro-Brain Natriuretic Peptide, and Cardiac Troponin) and treatment (including Low Molecular Weight Heparin, Computer Tomography Pulmonary Angiography, Surgical Embolectomy or Catheter Based L...

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Projects (2)
Archived project
Project
Looking into the feasibility of a school based on-site screening program with a questionnaire and ECG. By identifying high risk individuals for sudden cardiac death, treatment can be initiated earlier, whilst also being able to risk stratify individuals accordingly, together with lifestyle advice.