Eduard Shantsila

University of Birmingham, Birmingham, England, United Kingdom

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Publications (164)838.39 Total impact

  • Christos Voukalis · Gregory Y.H. Lip · Eduard Shantsila
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    ABSTRACT: Ischaemic strokes resulting from atrial fibrillation (AF) constitute a devastating condition for patients and their carers with huge burden on health care systems. Prophylactic treatment against systemic embolization and ischaemic strokes is the cornerstone for the management of AF. Effective stroke prevention requires use of the vitamin K antagonists or non-vitamin K oral anticoagulants (NOACs). This article summarises the latest developments in the field of stroke prevention in AF and aims to assist physicians with the choice of oral anticoagulant for patients with non-valvular AF with different risk factor profile.
    No preview · Article · Jan 2016 · EBioMedicine
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    ABSTRACT: To identify novel cell ageing markers in order to gain insight into ageing mechanisms, we adopted membrane enrichment and comparison of the CD4(+) T cell membrane proteome (purified by cell surface labelling using Sulfo-NHS-SS-Biotin reagent) between healthy young (n=9, 20-25y) and older (n=10; 50-70y) male adults. Following two-dimensional gel electrophoresis (2DE) to separate pooled membrane proteins in triplicates, the identity of protein spots with age-dependent differences (p<0.05 and >1.4 fold difference) was determined using liquid chromatography-mass spectrometry (LC-MS/MS). Seventeen protein spot density differences (ten increased and seven decreased in the older adult group) were observed between young and older adults. From spot intensity analysis, CD4(+) T cell surface α-enolase was decreased in expression by 1.5 fold in the older age group; this was verified by flow cytometry (n=22) and qPCR with significantly lower expression of cellular α-enolase mRNA and protein compared to young adult CD4(+) T cells (p<0.05). In an independent age-matched case-control study, lower CD4(+) T cell surface α-enolase expression was observed in age-matched patients with cardiovascular disease (p<0.05). An immune-modulatory role has been proposed for surface α-enolase and our findings of decreased expression suggest that deficits in surface α-enolase merit investigation in the context of immune dysfunction during ageing and vascular disease.
    No preview · Article · Oct 2015 · Mechanisms of ageing and development
  • Mikhail Dzeshka · Eduard Shantsila · Gregory Lip
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    ABSTRACT: Background: Renal dysfunction is related to worse outcome in patients with AF. Although impairment of renal function in AF is often contributed by reduce cardiac output in the settings of reduced left ventricular (LV) contractility little data are available on association of kidney function and LV remodeling in AF patients with preserved LV systolic function. Aims: To evaluate relationship between left (LV) ventricular myocardial fibrosis and kidney function in patients with atrial fibrillation (AF). Methods: LV myocardial fibrosis was assessed non-invasively by echocardiography-based acoustic densitometry in 93 patients with AF (median age 71 [65-77] years, 61 [65.6%] males). All study patients had preserved LV systolic function defined as ejection fraction of 50% or more. Patients with low risk of stroke (according to the CHA2DS2-VASc score), severe valvular heart disease, recent (less than 6 months) thromboembolic or haemorrhagic event, known severe chronic kidney or hepatic dysfunction, respiratory failure, advanced malignancy or active inflammatory disorders were excluded from the study. The study was approved by West Midlands - South Birmingham Research Ethics Committee. Calibrated integrated backscatter (cIB) was established as difference between pericardial (reference tissue with high connective tissue content) and myocardial reflectivity on 2D echocardiography. LV cIB was calculated as an average of cIB obtained from interventricular septum and LV posterior wall. Estimated glomerular filtration rate (eGFR) was calculated with CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) formula. Data are presented as median and interquartile range. Linear regression analysis was used to test association between LV cIB and eGFR. Paroxysmal form of AF was present in 40 (43%) patients, persistent AF in 16 (17.2%) patients and permanent AF in 37 (39.8%) patients. Seventy (75.3%) patients also had hypertension, 36 (38.7%) coronary heart disease, 19 (20.4%) diabetes mellitus and 71 (76.3%) symptomatic heart failure. Results: The median cIB in the studied cohort was 23.4 (21.2-27.0) dB. The median eGFR was 73.5 (65.0-82.6) ml/min/1.73 m2. On univariate regression analysis eGFR was found to be associated with cIB (beta=0.22, p=0,013). eGFR remained a significant predictor of cIB after adjustment for presence of hypertension, coronary heart disease, heart failure, diabetes mellitus, and type of AF (beta=0.21, p=0.048). When stratified according to eGFR as follows: <60, 60 to 69, 70 to 79, 80 to 89, and ≥90 ml/min/1.73 m2; cIB was significantly different across the groups: 20.9 (19.2-22.4), 24.8 (21.2-28.3), 24.3 (22.8-27.0), 25.4 (19.5-27.8), and 24.0 (22.8-25.4) dB, p=0.024. The difference was driven by lower cIB in AF patients with eGFR <60 ml/min/1.73 m2 versus all other strata. Conclusion: More advanced LV myocardial fibrosis is independently associated with renal dysfunction in AF patients with preserved LV ejection fraction.
    No preview · Conference Paper · Oct 2015
  • Eduard Shantsila · Gregory Yh Lip
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    ABSTRACT: Despite major advances in stroke prevention in atrial fibrillation (AF), such complications are still not uncommon.(1) The study by Saliba et al. published in this issue of Journal of Thrombosis and Hemostasis shows a 3.17% overall annual rate of stroke despite oral anticoagulation use based on modern guideline recommendations and it suggests independent ling between high neutrophil-lymphocyte ratio (NLR) and the risk of stroke in AF.(2) Whilst potent oral anticoagulants could ameliorate the prothrombotic shift associated with AF, anticoagulation cannot modify all components of Virchow triad of thrombogenesis (thrombus formation). This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    No preview · Article · Aug 2015 · Journal of Thrombosis and Haemostasis
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    ABSTRACT: Atrial fibrillation (AF) is associated with structural, electrical, and contractile remodeling of the atria. Development and progression of atrial fibrosis is the hallmark of structural remodeling in AF and is considered the substrate for AF perpetuation. In contrast, experimental and clinical data on the effect of ventricular fibrotic processes in the pathogenesis of AF and its complications are controversial. Ventricular fibrosis seems to contribute to abnormalities in cardiac relaxation and contractility and to the development of heart failure, a common finding in AF. Given that AF and heart failure frequently coexist and that both conditions affect patient prognosis, a better understanding of the mutual effect of fibrosis in AF and heart failure is of particular interest. In this review paper, we provide an overview of the general mechanisms of cardiac fibrosis in AF, differences between fibrotic processes in atria and ventricles, and the clinical and prognostic significance of cardiac fibrosis in AF. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Aug 2015 · Journal of the American College of Cardiology
  • 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.
    No preview · Article · Jul 2015 · International Journal of Clinical Practice
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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.
    Full-text · Article · Jul 2015
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    Mikhail Dzeshka · Eduard Shantsila · Gregory Lip
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    ABSTRACT: Aims: To evaluate whether left ventricular (LV) myocardial fibrosis is associated with left atrial (LA) remodeling in patients with atrial fibrillation (AF). Methods: All study patients had preserved LV systolic function defined as ejection fraction of ≥50%. Patients with low risk of stroke (CHA2DS2-VASc score=0 (males) or 1 in females), severe valvular heart disease, recent (<6 months) thromboembolic or haemorrhagic event, severe chronic kidney or hepatic dysfunction, respiratory failure, advanced malignancy or active inflammatory disorders were excluded. LV myocardial fibrosis was assessed non-invasively by echocardiography-based acoustic densitometry. Calibrated integrated backscatter (cIB) was established as difference between pericardial (reference tissue with high connective tissue content) and myocardial reflectivity on 2D echocardiography. LV cIB was calculated as an average of cIB obtained from interventricular septum and LV posterior wall. Echocardiography was also used to measure LA volume index. Data are presented as median and interquartile range. Linear regression analysis was used to test association between LV cIB and LA volume index. Results: We studied 93 patients with AF (median age 71 (65-77) years, 66% male; 40% permanent AF). The median CHA2DS2-VASc score was 3.5 (2-5). Median LV cIB in the studied cohort was 23.8 (21.2-27) dB. The median LA volume index was 35.1 (30.0-47.3) ml/m². There was no significant difference in cIB among patients with different types of AF (i.e., permanent vs. paroxysmal vs. persistent, p>0.05). There was no significant association between cIB and AF duration (p>0.05). On univariate regression analysis, cIB was significantly associated with LA volume index (β=0.26, p=0.003). On multivariable analysis, cIB was significantly associated with LA volume index (β=0.18, p=0.014) after adjustment for gender, presence of hypertension, coronary heart disease and NYHA heart failure class. Significant predictors of LA remodeling on multivariable analysis apart from LV cIB were duration of AF history (β=0.18, p=0.03), progression from paroxysmal to persistent or permanent AF (β=0.40, p<0.001), and age (β=0.31, p<0.001). Conclusion: Atrial and ventricular remodeling are closely related in patients with AF and preserved LV ejection fraction, and predicted by associated comorbidities.
    Full-text · Conference Paper · Jun 2015
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    Mikhail Dzeshka · Eduard Shantsila · Gregory Lip
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    ABSTRACT: Aims: To evaluate relationship between left (LV) ventricular myocardial fibrosis and kidney function in patients with atrial fibrillation (AF). Methods: All AF patients had preserved LV systolic function defined as ejection fraction of ≥50%. Patients with low risk of stroke, severe valvular heart disease, recent (less than 6 months) thromboembolic or haemorrhagic event, known severe chronic kidney or hepatic dysfunction, malignancy or active inflammatory disorders were excluded. LV myocardial fibrosis was assessed non-invasively by echocardiography-based acoustic densitometry. Calibrated integrated backscatter (cIB) was established as difference between pericardial and myocardial reflectivity. Estimated glomerular filtration rate (eGFR) was calculated with CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) formula. Data are presented as median and interquartile range. Linear regression analysis was used to test associations between LV cIB and eGFR. Results: We studied 93 patients with AF (median age 71, 66% males, 40% permanent AF). Median cIB in the studied cohort was 23.4 (21.2-27.0) dB. Median eGFR was 73.5 (65.0-82.6) ml/min/1.73 m². When stratified according to eGFR as follows: <60, 60 to 69, 70 to 79, 80 to 89, and ≥90 ml/min/1.73 m²; cIB was significantly different across the groups (Figure). The main difference was driven by lower cIB in AF patients with eGFR <60 ml/min/1.73 m² versus all other strata. On multivariable analysis, eGFR remained a significant predictor of cIB (β=0.21, p<0.05) even after adjustment for presence of hypertension, coronary heart disease, heart failure, diabetes mellitus, and AF type. Conclusion: More advanced LV myocardial fibrosis is independently associated with kidney dysfunction in AF patients with preserved LV ejection fraction.
    Full-text · Conference Paper · Jun 2015
  • 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.
    No preview · Article · Jun 2015 · Age and Ageing
  • 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
    No preview · Article · Jun 2015 · Heart (British Cardiac Society)
  • Alena Shantsila · Paramjit S. Gill · Eduard Shantsila · Gregory YH Lip
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    ABSTRACT: 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. 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.
    No preview · Article · Jun 2015 · Heart (British Cardiac Society)
  • R.A. Brown · G Y H Lip · C Varma · E Shantsila

    No preview · Article · Mar 2015 · International journal of cardiology
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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.
    No preview · Article · Mar 2015 · Revista Espa de Cardiologia
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    ABSTRACT: Introduction and objectives: 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. Methods: 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. Results: 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). Conclusions: 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.
    No preview · Article · Mar 2015 · Revista Espanola de Cardiologia
  • 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.
    No preview · Article · Mar 2015 · International journal of cardiology
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    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.
    Preview · Article · Mar 2015 · International Journal of Clinical Practice
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    Deirdre A Lane · Andreas Wolff · Eduard Shantsila · Gregory Y H Lip

    Preview · Article · Mar 2015 · British Journal of General Practice
  • 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.
    No preview · Article · Mar 2015 · International Journal of Cardiology
  • 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.
    No preview · Article · Jan 2015 · British Journal of General Practice

Publication Stats

2k Citations
838.39 Total Impact Points

Institutions

  • 2009-2016
    • University of Birmingham
      • Centre for Cardiovascular Sciences
      Birmingham, England, United Kingdom
    • WWF United Kingdom
      Londinium, England, United Kingdom
    • Republican Science-Practical Center Cardiology
      Myenyesk, Minsk, Belarus
  • 2012-2015
    • Sandwell and West Birmingham Hospitals NHS Trust
      Birmingham, England, United Kingdom
    • Aston University
      Wheaton Aston, England, United Kingdom
  • 2006-2009
    • University Hospitals Birmingham NHS Foundation Trust
      • Department of Medicine
      Birmingham, England, United Kingdom