Peysh Patel

• MA (Hons)(Cantab) MB BChir MRCP (2011) PGD (Health Res) PhD PGC (Clin Ed) FHEA CCDS
• Consultant Cardiologist at Queen Elizabeth Hospital Birmingham

Arrhythmogenic cardiomyopathy (ACM) epitomises a genetic anomaly hallmarked by a relentless fibro-fatty transmogrification of cardiac myocytes. Initially typified as a right ventricular-centric disease, contemporary observations elucidate a frequent occurrence of biventricular and left-dominant presentations. The diagnostic labyrinth of ACM emerges...

Objective Heart failure with preserved ejection fraction (HFpEF) is a common heterogeneous syndrome that remains imprecisely defined and consequently has limited treatment options and poor outcomes. Methods The UK Heart Failure with Preserved Ejection Fraction Registry (UK HFpEF) is a prospective data-enabled cohort and platform study. The study w...

Introduction Sarcoidosis is a systemic inflammatory disorder associated with ventricular arrhythmias (VAs) and sudden death in the context of cardiac involvement. Established guidelines advocate implantable cardioverter-defibrillator (ICD) implantation in specific subcohorts, but there is a paucity of data on outcomes. Methods and Results We conduc...

We present the case of a patient with Alström syndrome who was found to have evidence of a prothrombotic state on autopsy after sudden cardiac death. To the best of our knowledge, this case of persistent prothrombotic milieu is the first described in a patient with Alström syndrome. (J Am Coll Cardiol Case Rep 2024;29:102215) © 2024 The Authors. Pu...

Objective To determine the diagnostic yield of a ‘high’ N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with suspected heart failure (HF) referred from primary to secondary care. Methods In this retrospective study, cardiac diagnoses were quantified in consecutive patients with an NT-proBNP>400 ng/L referred from primary care cent...

Aims: The past decade has seen an increased delivery of cardiac resynchronization therapy (CRT) for patients with heart failure (HF). We explored whether clinical outcomes after CRT have changed from the perspective of an entire public healthcare system. Methods and results: A national database covering the population of England (56.3 million in...

Background Natriuretic peptides (NPs) provide a reliable ‘rule-out’ test for the diagnosis of heart failure (HF). All cardiac conditions that lead to myocardial stretch lead to elevations in circulating NPs.OBJECTIVES To determine the diagnostic yield of a ‘high’ N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with suspected HF. M...

Funding Acknowledgements Type of funding sources: None. Introduction The pre-implant patient screening process (vector mapping) for subcutaneous defibrillators (S-ICD) seeks to determine eligibility for implantation. It broadly requires at least one of three available vectors (primary, secondary or alternate) to pass under all conditions to mitiga...

Aims The optimum timing of cardiac resynchronization therapy (CRT) implantation is unknown. We explored long-term outcomes after CRT in relation to the time interval from a first heart failure hospitalization (HFH) to device implantation. Methods and results A database covering the population of England (56.3 million in 2019) was used to quantify c...

Among primary prevention implantable cardioverter-defibrillator (ICD) recipients , 75% do not experience any appropriate ICD therapies during their lifetime, and nearly 25% have improvements in their left ventricular ejection fraction (LVEF) during the lifespan of their first generator. The practice guidelines concerning this subgroup's clinical ne...

Introduction: Sarcoidosis is a systemic inflammatory disorder associated with ventricular arrhythmias (VAs) and sudden death in the context of cardiac involvement. Guidelines advocate implantable cardioverter-defibrillator (ICD) implantation in specific subcohorts, but there is a paucity of data on outcomes. Methods and results: A systematic rev...

Introduction Sarcoidosis is a multi-systemic inflammatory disorder characterised by non-caseating granulomata. Cardiac sarcoidosis (CS) is typified by the presence of myocardial inflammation and confers adverse prognosis, as it can be associated with conduction abnormalities, congestive heart failure, ventricular arrhythmias (VA) and sudden cardiac...

Background: PRAETORIAN is the first randomized controlled trial that demonstrated the noninferiority of subcutaneous ICD (S-ICD) in comparison with transvenous ICD (TV-ICD). We retrospectively reviewed electronic records of patients with ICD implanted over the past 6 years, with the primary objective to compare our real-world single tertiary cente...

Stress echocardiography is historically well-validated for detection and risk stratification of stable coronary artery disease (CAD). The most recent NICE guidelines would suggest a diminished role for using exercise (ESE) as the stressor. Thus, this study assessed the utility of ESE alone in a contemporary, high-volume clinical setting. This singl...

Insulin resistance describes defective metabolic and signalling responses to insulin, which may manifest clinically as prediabetes or frank diabetes. The spectrum of insulin resistance is associated with accelerated development of cardiovascular disease, ranging from endothelial dysfunction to advanced atherosclerosis, and also impedes endogenous v...

Sudden cardiac death (SCD) is most commonly secondary to sustained ventricular arrhythmias (VAs). This review aimed to evaluate if left ventricular hypertrophy (LVH) secondary to systemic hypertension in humans is an isolated risk factor for ventricular arrhythmogenesis. Animal models of hypertensive LVH have shown changes in ion channel function a...

There has been a progressive evolution in the management of patients with chronic heart failure and reduced ejection fraction (HFrEF), including cardiac resynchronisation therapy (CRT) in those that fulfil pre-defined criteria. However, there exists a significant proportion with refractory symptoms in whom CRT devices are not clinically indicated o...

Observational studies investigating risk factors in coronavirus disease 2019 (COVID-19) have not considered the confounding effects of advanced care planning, such that a valid picture of risk for elderly, frail and multi-morbid patients is unknown. We aimed to report ceiling of care and cardiopulmonary resuscitation (CPR) decisions and their assoc...

Aims: We compared strategies in the treatment of decompensated severe aortic stenosis. The hypothesis was that undertaking urgent or emergency transcatheter aortic valve implantation (TAVI) directly in such patients is safer and more effective than urgent or emergency balloon aortic valvuloplasty (BAV) followed by elective TAVI or surgical aortic...

Background Observational studies investigating risk factors in coronavirus disease 2019 (COVID-19) have not considered the confounding effects of advanced care planning, such that a valid picture of risk for elderly, frail and multi-morbid patients is unknown. We aimed to report ceiling of care and cardiopulmonary resuscitation (CPR) decisions and...

Background Observational studies investigating risk factors in coronavirus disease 2019 (COVID-19) have not considered the confounding effects of advanced care planning, such that a valid picture of risk for elderly, frail and multi-morbid patients is unknown. We aimed to report ceiling of care and cardiopulmonary resuscitation (CPR) decisions and...

Background Observational studies investigating risk factors in coronavirus disease 2019 (COVID-19) have not considered the confounding effects of advanced care planning, such that a valid picture of risk for elderly, frail and multi-morbid patients is unknown. We aimed to report ceiling of care and cardiopulmonary resuscitation (CPR) decisions and...

Background Observational studies investigating risk factors in coronavirus disease 2019 (COVID-19) have not considered the confounding effects of advanced care planning, such that a valid picture of risk for elderly, frail and multi-morbid patients is unknown. We aimed to report ceiling of care and cardiopulmonary resuscitation (CPR) decisions and...

Background Cardiac resynchronisation therapy (CRT) confers symptomatic and survival benefits in chronic heart failure with reduced ejection fraction (HFrEF). There remains a paucity of data on long‐term performance of LV leads, particularly with newer quadripolar lead designs. Methods This single center study utilised an electronic, outpatient HFr...

Background European Society of Cardiology (ESC) guidelines on the management of stable coronary artery disease (CAD) advocate stress echocardiography (SE) as a first line assessment for functionally significant ischaemia. Pharmacological stressors such as dobutamine are typically utilised in most UK centres in view of practical benefits when compar...

Endocardial transvenous permanent pacemakers (TVPs) are a mainstay within cardiology and used to treat a range of bradyarrhythmias. However, their use is associated with potential complications both at the time of implantation and longer term. The concept of a leadless pacemaker, where a self-contained device is placed within the right ventricle, h...

Title Assessment of chest pain typicality stratifies likelihood of positive stress echocardiography and cardiovascular sequelae Background Stress echocardiography (SE) is a validated, non-invasive test for stable chest pain. Diagnostic assessment is only recommended in the context of typical or atypical symptoms. We assessed how typicality of ches...

Use of angiography for the assessment of coronary lesions is limited by its inability to provide information regarding the functional significance of stenoses. A number of studies have demonstrated the presence of ischaemia to be the most important determinant of the benefit associated with coronary revascularisation in stable coronary artery disea...

Introduction Insulin resistance is an independent risk factor for cardiovascular disease. We have previously shown that the insulin-like growth factor-1 receptor (IGF-1R) is a negative regulator of insulin receptor (IR) signalling, by sequestering IR subunits in insulin resistant IR:IGF1R ‘hybrid receptors’. By crossing IR haploinsufficient (IRKO)...

European Society of Cardiology (ESC) guidelines recommend treating patients presenting with suspected non-ST elevation myocardial infarction (NSTEMI) with aspirin, ticagrelor and fondaparinux in the absence of contraindications. 1 However, most admissions are via the emergency department (ED) or acute assessment unit (AAU) where the initial consult...

Hypertrophic cardiomyopathy (HCM) is a cardiovascular disorder with genetic predisposition. The number of treatment modalities has grown in the contemporary era, with use of pharmacotherapy, device therapy, and surgical intervention, though with the relative paucity of data derived from randomized trials. Its clinical course and prognosis are relat...

Data S1. Supplemental Methods Table S1. Imputation Model Specification for 20 Iterations and 50 Imputations Table S2. Multivariate Predictors of Sepsis Death in People With LVEF<40% Table S3. Multivariate Predictors of Sepsis Death Table S4. Multivariate Predictors of Progressive Heart Failure Death Table S5. Multivariate Predictors of Sudden...

Peripartum cardiomyopathy (PPCM) is characterised by cardiac failure secondary to left ventricular systolic dysfunction occurring in the last month of pregnancy or 6 months post-partum, in the absence of determinable heart disease. The pathophysiological basis of the condition remains incompletely understood, but a number of potential mechanisms ha...

Background The CASTLE‐AF (Catheter Ablation versus Standard Conventional Therapy in Patients With Left Ventricular Dysfunction and Atrial Fibrillation) trial recently reported that catheter ablation of atrial fibrillation (AF) improves survival in heart failure (HF) with reduced ejection fraction (HFrEF). However, established AF was not associated...

Background Noncardiovascular death is increasingly common in people with chronic heart failure (CHF), yet its causes remain poorly characterized. We aimed to define the prevalence of sepsis death in people with CHF and to ascertain its risk marker profile. Methods and Results We conducted a prospective cohort study of 1802 patients with CHF and le...

Dilated cardiomyopathy (DCM) is a myocardial disease characterised by impaired left ventricular systolic function in conjunction with enlargement of the cardiac chambers. A number of pathogenic pathways have been implicated, including genetic mutations in cytoskeletal components or autoimmune response to acute viral myocarditis. In a significant pr...

Background: Ivabradine is licensed as add-on therapy in patients with severe left ventricular systolic dysfunction (LVSD), normal sinus rhythm, and suboptimal heart rate (HR) control, but effects are not fully established. This study sought to assess the impact of ivabradine therapy on hemodynamic and functional outcome measures in all patients wi...

Reduced systemic insulin signaling promotes endothelial dysfunction and diminished endogenous vascular repair. We asked whether restoration of endothelial insulin receptor expression could rescue this phenotype. Insulin receptor haploinsufficient mice (IRKO) were crossed with mice expressing a human insulin receptor transgene in the endothelium (hI...

Diabetes mellitus (DM) is an established risk factor for the development and progression of macrovascular disease, and is associated with worse outcomes in the context of myocardial infarction and congestive heart failure. Despite the availability of a broad spectrum of pharmacotherapies for the management of DM, these do not appear to significantl...

The insulin-like growth factor (IGF) system consists of growth factors, receptors and binding proteins, and overlaps significantly with insulin signalling pathways. IGF-1 and IGF-2 are essential for growth and development and have also been shown to play a key role in insulin sensitivity, obesity, endothelial dysfunction, angiogenesis and tumorigen...

Diabetes mellitus (DM) is an established risk factor for the development and progression of macrovascular disease, and is associated with worse outcomes in the context of myocardial infarction and congestive heart failure. Despite the availability of a broad spectrum of pharmacotherapies for the management of DM, these do not appear to significantl...

Objective Refractory angina (RfA) is characterised by persistent anginal symptoms despite optimal medical therapy (OMT) and revascularization. A complex interplay between physical and psychological factors often necessitates multiple treatment modalities in the management of RfA. The aim of this study is to assess the effects of CSR implantation on...

Reduced systemic insulin signaling promotes endothelial dysfunction and diminished endogenous vascular repair. We asked whether restoration of endothelial insulin receptor expression could rescue this phenotype. Insulin receptor haploinsufficient mice (IRKO) were crossed with mice expressing a human insulin receptor transgene in the endothelium (hI...

Refractory angina (RA) is defined by intractable cardiac chest pain despite standard medical therapy and revascularisation. Symptoms are associated with significant morbidity and compromised quality of life (QoL). Various methods of interventional pain management can be considered for the complex care of these cohorts. This review explores postulat...

Refractory angina (RA) is characterised by persistent anginal symptoms despite optimal medical therapy and revascularisation. Enhanced external counterpulsation (EECP) is a technique that has shown promise in the treatment of this condition but is poorly utilised in the UK. The aim of this study is to assess the effect of EECP on anginal symptoms i...

Global ventricular impairment is a frequent presentation in clinical practice, but dissection of causative mechanisms from clinical associations is challenging. We present the case of a 19 year old gentleman who presented with dilated cardiomyopathy as the first presentation of coeliac disease. The manifestation of iron-deficiency anaemia prompted...

Heart Failure with Preserved Ejection Fraction (HF-PEF) describes patients with classic symptoms but without left ventricular systolic impairment (ejection fraction ≥ 50%). These cohorts have features of diastolic dysfunction which is considered a precursor and associated with poor outcomes. HF-PEF appears to be of increasing prevalence, which may...

Objective To characterise the association between socioeconomic deprivation and adverse outcomes in patients with chronic heart failure (CHF). Methods We prospectively observed 1802 patients with CHF and left ventricular ejection fraction (LVEF) ≤45%, recruited in four UK hospitals between 2006 and 2014. We assessed the association between depriva...

Interventional cardiology has been revolutionised by transcatheter aortic valve implantation (TAVI), which has become established as the benchmark treatment for severe aortic stenosis in patients at high risk for surgical aortic valve replacement (AVR). Increased procedural familiarity and progression in device technology has enabled improvements t...

Introduction: Insulin resistant type 2 diabetes mellitus (DM) causes accelerated vascular disease. Shc homology 2-containing inositol 5’ phosphatase-2 (SHIP2) is a lipid phosphatase that negatively regulates insulin signalling. This study assessed the effects of SHIP2 inactivation on metabolic and vascular homeostasis. Methods: Mice with global ta...

Objective. Diabetes mellitus increases mortality in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction. Studies have questioned the safety of β-adrenoceptor blockers (β-blockers) in some patients with diabetes and reduced left ventricular ejection fraction. We examined whether β-blockers and angiotensin convert...

Shc homology 2-containing inositol 5´ phosphatase-2 (SHIP2) is as lipid phosphatase which inhibits insulin signaling downstream of phosphoinositide-3-kinase (PI3K); its role in vascular function is poorly understood. To examine its role in endothelial cell (EC) biology, we generated mice with catalytic inactivation of one SHIP2 allele selectively i...

Coronary artery vasospasm is a mimic of coronary artery disease both in terms of clinical presentation and associated electrocardiogram changes. It is most strongly implicated in microvascular dysfunction, but in rarer instances it can provoke ST elevation myocardial infarction ventricular dysrhythmias, cardiogenic shock and death. However, in most...

Peripartum cardiomyopathy refl ects the presence of cardiac failure in the absence of determinable heart disease and occurs in late third trimester of pregnancy or up to 6 months postpartum. A full understanding of pathophysiological mechanisms is lacking, but excess prolactin levels, haemodynamic alterations, infl ammation and nutritional defi cie...

Regulation of the circulatory system to maintain a constant arterial pressure is critical in ensuring adequate perfusion to meet metabolic requirements of tissues. Blood pressure (BP) can be considered in the context of Ohm’s law, whereby BP (analogous to voltage) is directly proportional to the product of cardiac output (current) and total vascula...

An interactive case based module for medical trainees, covering causes, assessment, investigation, and initial emergency treatment of different types of blackout and collapse. Learning outcomes After completing this module you should be able to: Recall the causes for blackout (transient loss of consciousness) and collapse Take an appropriate hist...

Introduction: Insulin-resistant type 2 diabetes mellitus (DM) leads to premature death and disability, primarily as a consequence of accelerated vascular disease. Shc homology 2-containing inositol 5’ phosphatase-2 (SHIP2) is a lipid phosphatase that suppresses insulin signalling downstream of phosphoinositide-3-kinase (PI3K). Inhibition of SHIP2 h...

Introduction Insulin-resistant type 2 diabetes mellitus (DM) leads to premature death and disability, primarily as a consequence of accelerated vascular disease. Shc homology 2-containing inositol 5 phosphatase-2 (SHIP2) is a lipid phosphatase that suppresses insulin signalling downstream of phosphoinositide-3-kinase (PI3K). Inhibition of SHIP2 has...

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Atrial fibrillation is the most prevalent cardiac arrhythmia, affecting 10% of those aged over 80 years. Despite multiple treatment options, it remains an independent prognostic marker of mortality due to its association with clinical sequelae, particularly cerebrovascular events. Management can be broadly divided into treatment of the arrhythmia,...

Introduction Insulin resistance is an independent risk factor for cardiovascular disease. We have previously shown that the insulin-like growth factor-1 receptor (IGF-1R) is a negative regulator of insulin receptor (IR) signalling, by sequestering IR subunits in insulin resistant IR:IGF1R ‘hybrid receptors’. By crossing IR haploinsufficient (IRKO)...

Introduction Insulin resistance is an independent risk factor for cardiovascular disease. We have previously shown that the insulin-like growth factor-1 receptor (IGF-1R) is a negative regulator of insulin receptor (IR) signalling, by sequestering IR subunits in insulin resistant IR:IGF1R ‘hybrid receptors’. By crossing IR haploinsufficient (IRKO)...

Reducing insulin-like growth factor-1 receptor expression improves vascular repair and regeneration in whole body insulin resistance

Vascular repair and regeneration are improved with reduced expression of the insulin-like growth factor-1 receptor in whole body insulin resistance

Background: Diabetes mellitus is associated with an increased risk of death and hospitalisation in patients with chronic heart failure. Better understanding of potential underlying mechanisms may aid the development of diabetes mellitus–specific chronic heart failure therapeutic strategies. Methods: Prospective observational cohort study of 628 pat...

Background/Introduction Insulin resistance is independently associated with cardiovascular risk, and oxidative stress is recognised as a potential contributor to this relationship. We have previously shown that endothelium-specific insulin resistance causes endothelial dysfunction via increased vascular NADPH oxidase 2 (NOX2) derived reactive oxyge...

Introduction: Insulin resistance is independently linked to cardiovascular disease, and oxidative stress is recognised as a potential contributor to this relationship. We have previously shown that endothelium-specific insulin resistance promotes endothelial dysfunction, atherosclerosis, and increased vascular NADPH oxidase 2 (NOX2) derived reactiv...

Nox2 derived reactive oxygen species impede vascular repair in the context of endothelium-specific insulin resistance.

Vascular repair and regeneration are improved with reduced expression of the insulin-like growth factor-1 receptor in whole body insulin resistance