Rosita Zakeri

King's College London | KCL · British Heart Foundation Centre of Excellence

Objective To evaluate the association between having concomitant chronic obstructive pulmonary disease (COPD) or asthma, and in-patient mortality and post-discharge management among patients hospitalised for acute heart failure (HF). Setting Data were obtained from patients enrolled in the National Heart Failure Audit. Participants 217 329 patien...

Aims: Despite the common occurrence of coronary artery disease (CAD) and heart failure (HF) with preserved ejection fraction (HFpEF), there is limited evidence to guide revascularization. Methods and results: We investigated the long-term outcomes of coronary artery bypass grafting (CABG) in patients with HF and significant CAD across the spectr...

Rationale: Differences in clinical presentation and outcomes between HF phenotypes in patients with COPD have not been assessed. Objectives: The aim of this study was to compare clinical outcomes and healthcare resource use (HRU) between patients with COPD and HF with preserved (HFpEF), mildly-reduced (HFmrEF), and reduced ejection fraction (HFr...

Aims: Heart failure with preserved ejection fraction (HFpEF) is thought to be highly prevalent yet remains underdiagnosed. We sought to develop a data-driven diagnostic model to predict from electronic health records (EHR) the likelihood of HFpEF among patients with unexplained dyspnea and preserved left ventricular EF. Methods & Results: The deriv...

Background: Registries show international variations in the characteristics and outcome of patients with heart failure (HF) but national samples are rarely large, and case-selection may be biased due to enrolment in academic centres. National administrative datasets provide large samples with a low risk of bias. In this study, we compared the char...

Background Patients with atrial fibrillation (AF) complicated by heart failure (HF) have a poor prognosis. We investigated whether long term loop-diuretic therapy in patients with AF and no known diagnosis of HF, as a potential surrogate marker of undiagnosed HF, is also associated with worse outcomes. Methods Adults with incident AF were identifi...

Background The relative association between cardiovascular (CV) risk factors, such as diabetes and hypertension, established CV disease (CVD), and susceptibility to CV complications or mortality in COVID-19 remains unclear. Methods We conducted a cohort study of consecutive adults hospitalised for severe COVID-19 between 1st March and 30th June 20...

This commentary refers to 'Association of beta-blocker use with survival and pulmonary function in patients with chronic obstructive pulmonary and cardiovascular disease: a systematic review and meta-analysis', by Y.L. Yang et al., doi:10.1093/eurheartj/ehaa793 and the discussion piece. 'Increasing the prescription rate of b-blockers is beneficial...

Background: Understanding the spectrum and course of biological responses to coronavirus disease 2019 (COVID-19) may have important therapeutic implications. We sought to characterise biological responses among patients hospitalised with severe COVID-19 based on serial, routinely collected, physiological and blood biomarker values. Methods and find...

Background Beta-blockers are associated with reduced mortality in patients with cardiovascular disease but are often under prescribed in those with concomitant COPD, due to concerns regarding respiratory side-effects. We investigated the effects of beta-blockers on outcomes in patients with COPD and explored within-class differences between differe...

Background Understanding the spectrum and course of biological responses to coronavirus disease 2019 (COVID-19) may have important therapeutic implications. We sought to characterise biological responses among patients hospitalised with severe COVID-19 based on serial, routinely collected, physiological and blood biomarker values. Methods and Find...

Background The National Early Warning Score (NEWS2) is currently recommended in the UK for the risk stratification of COVID-19 patients, but little is known about its ability to detect severe cases. We aimed to evaluate NEWS2 for the prediction of severe COVID-19 outcome and identify and validate a set of blood and physiological parameters routinel...

Background Comorbidities affect outcomes in heart failure (HF), but are not reflected in current HF classification. The aim of this study is to characterize HF groups that account for higher-order interactions between comorbidities and to investigate the association between comorbidity groups and outcomes. Methods Latent class analysis (LCA) was p...

Background The association between cardiovascular (CV) risk factors, such as hypertension and diabetes, established CV disease (CVD), and susceptibility to CV complications or mortality in COVID-19 remains unclear. Methods We conducted a cohort study of consecutive adults hospitalised for severe COVID-19 between 1 st March and 30 th June 2020. Pre...

The Lancet E-Clinical Medicine

Background. People of minority ethnic background may be disproportionately affected by severe COVID-19 for reasons that are unclear. We sought to examine the relationship between ethnic background and (1) hospital admission for severe COVID-19; (2) in-hospital mortality. Methods. We conducted a case-control study of 872 inner city adult residents a...

Aims The SARS‐Cov2 virus binds to the ACE2 receptor for cell entry. It has been suggested that ACE‐inhibitors (ACEi) and Angiotensin‐2 Blockers (ARB), which are commonly used in patients with hypertension or diabetes and may raise tissue ACE2 levels, could increase the risk of severe COVID19 infection. Methods and Results We evaluated this hypothe...

Importance: An early minimally symptomatic phase is often followed by deterioration in patients with COVID-19 infection. This study shows that the addition of age and a minimal set of common blood tests taken in patients on admission to hospital significantly improves the National Early Warning Score (NEWS2) for risk-stratification of severe COVID...

Background: The SARS-Cov2 virus binds to the ACE2 receptor for cell entry. It has been suggested that ACE-inhibitors, which are commonly used in patients with hypertension or diabetes and which raise ACE2 levels, may increase the risk of severe COVID-19 infection. Methods: We evaluated this hypothesis in an early cohort of 205 acute inpatients with...

Background: The SARS-Cov2 virus binds to the ACE2 receptor for cell entry. It has been suggested that ACE-inhibitors, which are commonly used in patients with hypertension or diabetes and which raise ACE2 levels, may increase the risk of severe COVID-19 infection. Methods: We evaluated this hypothesis in an early cohort of 205 acute inpatients with...

Background Cardiac implanted electronic devices (CIEDs) can detect short durations of previously unrecognised atrial fibrillation (AF). The prognostic significance of device-detected subclinical AF, in the context of contemporary heart failure (HF) therapy, is unclear. Methods Amongst patients enrolled in the Remote Monitoring in HF with implanted...

Objectives To characterise peak cardiac troponin levels, in patients presenting with acute myocardial infarction (AMI), according to their comorbid condition and determine the influence of peak cardiac troponin (cTn) levels on mortality. Methods We included patients with the first admission for AMI in the UK. We used linear regression to estimate...

Aims: Studies of remote monitoring (RM) in heart failure (HF) speculate that patients with atrial fibrillation (AF) derive the greatest benefit. We compared the impact of RM vs. usual care on clinical outcomes for patients with and without AF enrolled in the Remote Management of Heart Failure Using Implanted Electronic Devices (REM-HF) trial. Met...

Aims: Most reports estimating national incidence rates of coronary (CAD) and peripheral arterial disease (PAD) have focused on stable outpatients or acute or elective hospital admissions, but not on the overall burden of disease. In this study, we report the changing trends in the population-level incidence of CAD and PAD, respectively from 2006 t...

Background COPD is one of the most frequent comorbidties in HF and COPD exacerbations are a competing cause of hospitalisation in this patient group. We evaluated the causes and predictors of 30-day readmission in a large population of patients hospitalised for HF with comorbid COPD. Methods We identified 54,953 patients hospitalised for HF with a...

Background: Patients hospitalized for heart failure (HF) are at high risk of readmission. Chronic obstructive pulmonary disease (COPD) is one of the most prevalent comorbidities in this population. However, few data and only small studies describe the impact of COPD on the risk of readmission. Methods and results: Hospitalizations for HF were id...

Having comorbid chronic obstructive pulmonary disease (COPD) and heart failure (HF) (COPD-HF) may significantly impact a patient’s morbidity and mortality, though contemporary data are lacking. This study investigated HF incidence and mortality in a COPD population in UK primary care from 2006-2016.

Introduction and objectives Having comorbid chronic obstructive pulmonary disease (COPD) and heart failure (HF) (COPD-HF) may significantly impact a patient’s morbidity and mortality, though contemporary data are lacking. This study investigated HF incidence in a COPD population in UK primary care from 2006–2016. Methods Using UK primary care elec...

Abstract Introduction: Catheter ablation has been shown to improve symptoms, exercise performance and neurohormonal status, as compared to medical (rate-control) therapy in patients with co-existing atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF). Recent trials have suggested a reduction in early mortality associat...

Introduction Patients with chronic obstructive pulmonary disease (COPD) who have a clinical indication for beta-blocker therapy, are often not prescribed such medication, despite evidence suggesting that beta-blockers are not associated with adverse respiratory outcomes. The primary objective of this systematic review and meta-analysis is to examin...

Cardiovascular diseases (CVDs) are arguably the most important comorbidities in chronic obstructive pulmonary disease (COPD). CVDs are common in people with COPD, and their presence is associated with increased risk for hospitalization, longer length of stay and all-cause and CVD-related mortality. The economic burden associated with CVD in this po...

Heart failure with preserved ejection fraction (HFpEF) comprises almost half of the population burden of HF. Because HFpEF likely includes a range of cardiac and non-cardiac abnormalities, typically in elderly patients, obtaining an accurate diagnosis may be challenging, not least due to the existence of multiple HFpEF mimics and a newly identified...

Echocardiography for structural intervention is an exciting and rapidly progressive field. Developments in imaging technology, in particular real time three-dimensional echocardiography, have facilitated the growth of transcatheter interventions for structural heart disease, providing a solution for patients who are at prohibitive surgical risk. Ec...

Background: Daily physical activity assessed by accelerometers represents a novel method to assess the impact of interventions on heart failure (HF) patients' functional status. We hypothesized that daily activity varies by patient characteristics and correlates with established measures of HF severity in HF with preserved ejection fraction. Meth...

Atrial fibrillation (AF) is an age-related arrhythmia of enormous socio-economic significance. In recent years, our understanding of the basic mechanisms that initiate and perpetuate AF has evolved rapidly, catheter ablation of AF has progressed from concept to reality, and recent studies suggest lifestyle modification may help prevent AF recurrenc...

Background: Left atrial (LA) compliance and contractility influence left ventricular stroke volume. We hypothesized that diminished LA compliance and contractile function occur early during the development of heart failure with preserved ejection fraction (HFpEF) and impair overall cardiac performance. Methods and results: Cardiac magnetic reson...

Despite increasing recognition of the importance of right ventricular (RV) dysfunction (RVD) in the pathophysiology of left heart disease, our understanding of its epidemiology in heart failure (HF) with preserved ejection fraction (HFpEF) remains incomplete. In part, this is due to complex RV geometry and challenging and inconsistent assessment of...

Background Left atrial (LA) compliance and contractility are key determinants of left ventricular (LV) stroke volume. LA remodelling and dysfunction in heart failure with preserved ejection fraction (HFpEF) are considered to be late presenting features, secondary to hypertension-induced LV diastolic dysfunction and chronic LA pressure overload. How...

Heart failure is a leading cause of morbidity and mortality and cardiac gene delivery has the potential to provide novel therapeutic approaches. Adeno-associated virus serotype 9 (AAV9) transduces the rodent heart efficiently, but cardiotropism, immune tolerance and optimal delivery strategies in large animals are unclear. In this study, an AAV9 ve...

Phosphodiesterase-5 (PDE5) is highly expressed in the pulmonary vasculature, but its expression in the myocardium is controversial. Cyclic guanosine monophosphate (cGMP) activates protein kinase G (PKG), which has been hypothesized to blunt cardiac hypertrophy and negative remodeling in heart failure. Although PDE5 has been suggested to play a sign...

The prevalence of heart failure (HF) with preserved ejection fraction (HFpEF) is increasing.1 In patients with HFpEF, the burden of symptoms, functional decline, and mortality is high,2 and health-related quality of life is poor.3 Physicians caring for these patients currently have limited therapeutic options beyond diuresis and management of comor...

Background—Left atrial (LA) structure and function are altered in most heart failure (HF) patients, but there may be fundamental differences in LA properties between HF with preserved (HFpEF) and reduced ejection fraction (HFrEF). Methods and Results—198 HF patients (51% HFpEF, NYHA 3.1±0.7) and 40 HF-free controls underwent catheterization, echo...

The public health and economic burden of heart failure (HF) is staggering and the need for relevant pathophysiologic and clinical biomarkers to advance the field and improve HF therapy remains high. Renal dysfunction is common among HF patients and is associated with increased HF hospitalization and mortality. It is widely recognized that mechanism...

Introduction: Left atrial structure and function (LA) is affected by the presence of heart failure (HF), but the specific impact of HF subtype is poorly characterized. Hypothesis: HF-induced LA remodeling differs between patients with preserved (pEF) or reduced ejection fraction (rEF). Methods: 198 consecutive HF patients referred to Mayo Clinic (5...

Background: In heart failure with preserved ejection fraction (HFpEF), left ventricular (LV) systolic elastance (Ees) increases in tandem with increases in arterial elastance (Ea), which maintains ejection fraction but limits systolic reserve and precipitates volume sensitivity. The left atrium (LA) lies in series with the LV and contributes to LV...

Background: Reduced left atrial (LA) compliance (LAC) contributes to pulmonary venous hypertension in heart failure with preserved ejection fraction (HFpEF); however the underlying mechanisms are poorly defined. We hypothesized that microvascular inflammation with rarefaction and impaired nitric oxide (NO) signaling, LA titin hypophosphorylation an...

-Exercise intolerance is a hallmark of heart failure (HF), but factors associated with impaired exercise capacity in HF with preserved EF (HFpEF) are unclear. We hypothesized that in HFpEF, the severity of resting ventricular and vascular dysfunction are associated with impairment in exercise tolerance as assessed by peak oxygen consumption (pVO2)....

-Atrial fibrillation (AF) is common among patients with heart failure and preserved ejection fraction (HFpEF) but its clinical profile and impact on exercise capacity remains unclear. RELAX was a multicenter randomized trial testing the impact of sildenafil on peak VO2 in stable outpatients with chronic HFpEF. We sought to compare clinical features...

Purpose: C-type natriuretic peptide (CNP)-22, produced in the endothelium and kidney, is a potent antifibrotic factor functioning through the activation of guanylyl cyclase receptor B (GC-B) and its second messenger, cyclic GMP (cGMP).Evidence has suggested that CNP-22 serves as a cardiorenal protective peptide, activated by humoral mechanisms in t...

In patients with heart failure (HF) and preserved ejection fraction (HFpEF), atrial fibrillation (AF) may predate, concur with, or develop after HFpEF diagnosis. We sought to define the temporal relationship between AF and HFpEF, identify factors associated with AF, and determine the prognostic impact of prevalent and incident AF in HFpEF. From 198...

To determine whether urinary excretion of C-type natriuretic peptide (CNP) is elevated in acute decompensated heart failure (ADHF) and predicts adverse outcomes. Urinary CNP has been detected in heart failure patients but its clinical significance and prognostic utility in ADHF, compared to established kidney injury biomarkers, is unknown. We measu...

Chromosomal complement, including that provided by the sex chromosomes, influences expression of proteins and molecular signaling in every cell. However, less than 50% of the scientific studies published in 2009 using experimental animals reported sex as a biological variable. Because every cell has a sex, we conducted a literature review to determ...

Despite recent pharmacological advances in heart failure therapy, mortality from acute decompens