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Article ; Online: Coronary Artery Disease in Patients with Severe Mental Illness.

Tam To, Brian / Roy, Roman / Melikian, Narbeh / Gaughran, Fiona P / O'Gallagher, Kevin

Interventional cardiology (London, England)

2023 Volume 18, Page(s) e16

Abstract: Severe mental illnesses (SMI), such as schizophrenia and bipolar disorder, are associated with a decrease in life expectancy of up to two decades compared with the general population, with cardiovascular disease as the leading cause of death. SMI is ... ...

Abstract	Severe mental illnesses (SMI), such as schizophrenia and bipolar disorder, are associated with a decrease in life expectancy of up to two decades compared with the general population, with cardiovascular disease as the leading cause of death. SMI is associated with increased cardiovascular risk profile and early onset of incident cardiovascular disease. Following an acute coronary syndrome, patients with SMI have a worse prognosis, but are less likely to receive invasive treatment. In this narrative review, the management of coronary artery disease in patients with SMI is discussed, and avenues for future research are highlighted.
Language	English
Publishing date	2023-04-24
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2813989-6
ISSN	1756-1485 ; 1756-1485
ISSN (online)	1756-1485
ISSN	1756-1485
DOI	10.15420/icr.2022.31
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Article ; Online: Algorithm for Recognition of Left Atrial Appendage Boundaries in Echocardiographic Images

Hosein Ghayoumi Zadeh / Ali Fayazi / Narbeh Melikian / Mark J Monaghan / Mehdi Eskandari

Iranian Journal of Medical Physics, Vol 18, Iss 2, Pp 123-

2021 Volume 132

Abstract: Introduction: The left atrial appendage )LAA( occlusion using a purpose-built device is a growing procedure. This study aimed to develop a computer-aided diagnostic system for the recognition of the LAA in echocardiographic images. Material and Methods: ... ...

Abstract	Introduction: The left atrial appendage )LAA( occlusion using a purpose-built device is a growing procedure. This study aimed to develop a computer-aided diagnostic system for the recognition of the LAA in echocardiographic images. Material and Methods: The three-dimensional (3D) echocardiographic images of the LAA of 26 patients successfully treated with an LAA occluder were used in this study. A total of 208 3D derived two-dimensional images in the axial plane were derived from each 3D dataset. Then, 562 images in which the LAA boundaries were highly recognizable were selected for this study. The proposed convolutional neural network (CNN) in this study was based on open-source object identification and classification platform compiled under the You Only Look Once algorithm. Finally, 419 and 143 images were used for training and testing the algorithm, respectively. Results: Algorithm performance on the identification of the LAA region on a set of 143 images was compared to that reported for the traced regions on the same images by an expert in echocardiography using an intersection over the union (IOU) algorithm. The algorithm was able to correctly identify the LAA region in all 143 examined images with an average IOU of 90.7%. Conclusion: The proposed image-based CNN algorithm in this study showed high accuracy in the recognition of the LAA boundaries in the echocardiographic images. The method can be used in the development of algorithms for the automated analysis of the area of the LAA used for device sizing and procedural planning in the LAA occlusion procedures.
Keywords	artificial intelligence ; atrial fibrillation ; computer vision ; echocardiographic ; left atrial appendage ; Medical physics. Medical radiology. Nuclear medicine ; R895-920
Subject code	006
Language	English
Publishing date	2021-03-01T00:00:00Z
Publisher	Mashhad University of Medical Sciences
Document type	Article ; Online
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Article ; Online: Intravascular lithotripsy in the treatment of coronary artery calcification in a high-risk real world population.

Yeoh, Julian / Kanyal, Ritesh / Pareek, Nilesh / Macaya, Fernando / Cannata, Stefano / Tzalamouras, Vasileos / Webb, Ian / Dworakowski, Rafal / Melikian, Narbeh / Shah, Ajay M / MacCarthy, Philip / Hill, Jonathan / Byrne, Jonathan

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions

2023

Abstract: Background: The DISRUPT-CAD study series demonstrated feasibility and safety of intravascular lithotripsy (IVL) in selected patients, but applicability across a broad range of clinical scenarios remains unclear.: Aims: This study aims to evaluate the ...

Abstract	Background: The DISRUPT-CAD study series demonstrated feasibility and safety of intravascular lithotripsy (IVL) in selected patients, but applicability across a broad range of clinical scenarios remains unclear. Aims: This study aims to evaluate the procedural and clinical outcomes of IVL in a high-risk real-world cohort, compared to a regulatory approval cohort. Methods: Consecutive patients treated with IVL and percutaneous coronary intervention at our center from May 2016 to April 2020 were included. Comparison was made between those enrolled in the DISRUPT-CAD series of studies to those with calcified lesions but an exclusion criteria. Results: Among 177 patients treated with IVL, 142 were excluded from regulatory trials due to acute coronary syndrome presentation (47.2%), left ventricular ejection fraction <40% (22.5%), chronic renal failure (12.0%), or use of mechanical circulatory support (8.5%). This clinical cohort had a higher SYNTAX score (22.6 ± 12.1 vs. 17.4 ± 9.9, p = 0.019), and more treated ACC/AHA C lesions (56.3% vs. 37.1%, p = 0.042). Rates of device success (93.7% vs. 100.0%, p = 0.208), procedural success (96.5% vs. 100.0%, p = 0.585), and minimal lumen area gain (221.2 ± 93.7% vs. 198.6 ± 152.0%, p = 0.807) were similar in both groups. The DISRUPT-CAD cohort had no in-hospital mortality, 30-day major adverse cardiac events (MACE), or 30-day target vessel revascularization (TVR). The clinical cohort had an in-hospital mortality of 4.2%, 30-day MACE of 7.8%, and 30-day TVR of 1.5%. There was no difference in 12-month TVR (2.9% vs. 2.2%; p = 0.825). Twelve-month MACE was higher in the clinical cohort (21.1% vs. 8.6%, p = 0.03). Conclusion: IVL use remains associated with high clinical efficacy, procedural success, and low complication rates in a real-world population previously excluded from regulatory approving trials.
Language	English
Publishing date	2023-01-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	1459995-8
ISSN	1522-726X ; 1522-1946
ISSN (online)	1522-726X
ISSN	1522-1946
DOI	10.1002/ccd.30546
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Zs.A 1226: Show issues

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Article ; Online: Artificial intelligence methods for improved detection of undiagnosed heart failure with preserved ejection fraction.

European journal of heart failure

2024 Volume 26, Issue 2, Page(s) 302–310

Abstract: Aim: Heart failure with preserved ejection fraction (HFpEF) remains under-diagnosed in clinical practice despite accounting for nearly half of all heart failure (HF) cases. Accurate and timely diagnosis of HFpEF is crucial for proper patient management ... ...

Abstract	Aim: Heart failure with preserved ejection fraction (HFpEF) remains under-diagnosed in clinical practice despite accounting for nearly half of all heart failure (HF) cases. Accurate and timely diagnosis of HFpEF is crucial for proper patient management and treatment. In this study, we explored the potential of natural language processing (NLP) to improve the detection and diagnosis of HFpEF according to the European Society of Cardiology (ESC) diagnostic criteria. Methods and results: In a retrospective cohort study, we used an NLP pipeline applied to the electronic health record (EHR) to identify patients with a clinical diagnosis of HF between 2010 and 2022. We collected demographic, clinical, echocardiographic and outcome data from the EHR. Patients were categorized according to the left ventricular ejection fraction (LVEF). Those with LVEF ≥50% were further categorized based on whether they had a clinician-assigned diagnosis of HFpEF and if not, whether they met the ESC diagnostic criteria. Results were validated in a second, independent centre. We identified 8606 patients with HF. Of 3727 consecutive patients with HF and LVEF ≥50% on echocardiogram, only 8.3% had a clinician-assigned diagnosis of HFpEF, while 75.4% met ESC criteria but did not have a formal diagnosis of HFpEF. Patients with confirmed HFpEF were hospitalized more frequently; however the ESC criteria group had a higher 5-year mortality, despite being less comorbid and experiencing fewer acute cardiovascular events. Conclusions: This study demonstrates that patients with undiagnosed HFpEF are an at-risk group with high mortality. It is possible to use NLP methods to identify likely HFpEF patients from EHR data who would likely then benefit from expert clinical review and complement the use of diagnostic algorithms.
MeSH term(s)	Humans ; Heart Failure ; Stroke Volume ; Ventricular Function, Left ; Artificial Intelligence ; Retrospective Studies ; Prognosis
Language	English
Publishing date	2024-01-11
Publishing country	England
Document type	Journal Article
ZDB-ID	1483672-5
ISSN	1879-0844 ; 1388-9842
ISSN (online)	1879-0844
ISSN	1388-9842
DOI	10.1002/ejhf.3115
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Zs.A 5299: Show issues

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Article ; Online: The effect of ethnicity and socioeconomic status on outcomes after resuscitated out-of-hospital cardiac arrest - Findings from a tertiary centre in South London.

Roy, Roman / Kanyal, Ritesh / Abd Razak, Muhamad / To-Dang, Brian / Chotai, Shayna / Abu-Own, Huda / Cannata, Antonio / Dworakowski, Rafal / Webb, Ian / Pareek, Manish / Shah, Ajay M / MacCarthy, Philip / Byrne, Jonathan / Melikian, Narbeh / Pareek, Nilesh

Resuscitation plus

2023 Volume 14, Page(s) 100388

Abstract: Background: Out-of-hospital cardiac arrest is a common cause of morbidity and mortality, and ethnic variation in outcomes is recognised. We investigated ethnic and socioeconomic differences in arrest circumstances, rates of coronary artery disease, ... ...

Abstract	Background: Out-of-hospital cardiac arrest is a common cause of morbidity and mortality, and ethnic variation in outcomes is recognised. We investigated ethnic and socioeconomic differences in arrest circumstances, rates of coronary artery disease, treatment, and outcomes in resuscitated OOHCA. Methods: Patients with resuscitated OOHCA of suspected cardiac aetiology were included in the King's Out-of-Hospital Cardiac Arrest Registry between 1-May-2012 and 31-December-2020. Results: Of 526 patients (median age 62.0 years, IQR 21.1, 74.1% male), 414 patients (78.7%) were White, 35 (6.7%) were Asian, and 77 (14.6%) were Black. Black patients had more co-existent hypertension ( Conclusion: In this single-centre study, Black patients had higher mortality after resuscitated OOHCA than White/Asian patients. This may be in part due to differing underlying aetiology rather than differences in arrest circumstances or social deprivation.
Language	English
Publishing date	2023-04-15
Publishing country	Netherlands
Document type	Journal Article
ISSN	2666-5204
ISSN (online)	2666-5204
DOI	10.1016/j.resplu.2023.100388
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Article ; Online: The effect of ethnicity and socioeconomic status on outcomes after resuscitated out-of-hospital cardiac arrest – Findings from a tertiary centre in South London

Roman Roy / Ritesh Kanyal / Muhamad Abd Razak / Brian To-Dang / Shayna Chotai / Huda Abu-Own / Antonio Cannata / Rafal Dworakowski / Ian Webb / Manish Pareek / Ajay M Shah / Philip MacCarthy / Jonathan Byrne / Narbeh Melikian / Nilesh Pareek

Resuscitation Plus, Vol 14, Iss , Pp 100388- (2023)

2023

Abstract	Background: Out-of-hospital cardiac arrest is a common cause of morbidity and mortality, and ethnic variation in outcomes is recognised. We investigated ethnic and socioeconomic differences in arrest circumstances, rates of coronary artery disease, treatment, and outcomes in resuscitated OOHCA. Methods: Patients with resuscitated OOHCA of suspected cardiac aetiology were included in the King’s Out-of-Hospital Cardiac Arrest Registry between 1-May-2012 and 31-December-2020. Results: Of 526 patients (median age 62.0 years, IQR 21.1, 74.1% male), 414 patients (78.7%) were White, 35 (6.7%) were Asian, and 77 (14.6%) were Black. Black patients had more co-existent hypertension (p = 0.007) and cardiomyopathy (p = 0.003), but less prior coronary revascularisation (p = 0.026) compared with White/Asian patients. There were no ethnic differences in location, witnesses, or bystander CPR, but Black patients had more non-shockable rhythms (p < 0.001). Black patients received less immediate coronary angiography (p < 0.001) and percutaneous coronary intervention (p < 0.001) but had lower rates of CAD (p = 0.004) than White/Asian patients. All-cause mortality at 12 months was highest amongst Black patients, followed by Asian and then White patients (57.1% vs 48.6% vs 41.3%, p = 0.032). In Black patients, excess mortality was driven by higher rates of multi-organ dysfunction but lower cardiac death than White/Asian patients, with cardiac death highest amongst Asian patients (p = 0.009). Socioeconomic status had no effect on mortality, and in a multivariable logistic regression, age, location, witnesses, and Black compared to White ethnicity were independent predictors of mortality, whilst social deprivation was not. Conclusion: In this single-centre study, Black patients had higher mortality after resuscitated OOHCA than White/Asian patients. This may be in part due to differing underlying aetiology rather than differences in arrest circumstances or social deprivation.
Keywords	Out-of-hospital cardiac arrest ; Ethnicity ; Socioeconomic status ; Specialties of internal medicine ; RC581-951
Language	English
Publishing date	2023-06-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
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Article ; Online: A rare indication for surgery in acute myocardial infarction: spontaneous aortic thrombus causing left main stem occlusion.

Sirker, Alexander / Melikian, Narbeh / Kenny, Cliona / Deshpande, Ranjit

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

2014 Volume 45, Issue 5, Page(s) 948

MeSH term(s)	Coronary Occlusion/surgery ; Humans ; Male ; Middle Aged ; Myocardial Infarction/surgery ; Thrombosis/surgery
Language	English
Publishing date	2014-05
Publishing country	Germany
Document type	Case Reports ; Journal Article
ZDB-ID	639293-3
ISSN	1873-734X ; 1010-7940 ; 1567-4258
ISSN (online)	1873-734X
ISSN	1010-7940 ; 1567-4258
DOI	10.1093/ejcts/ezt441
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Zs.A 2303: Show issues

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Article ; Online: Direct cardiac versus systemic effects of inorganic nitrite on human left ventricular function.

O'Gallagher, Kevin / Cabaco, Ana R / Ryan, Matthew / Roomi, Ali / Gu, Haotian / Dancy, Luke / Melikian, Narbeh / Chowienczyk, Philip J / Webb, Andrew J / Shah, Ajay M

American journal of physiology. Heart and circulatory physiology

2021 Volume 321, Issue 1, Page(s) H175–H184

Abstract: Inorganic nitrite is a source of nitric oxide (NO) and is considered as a potential therapy in settings where endogenous NO bioactivity is reduced and left ventricular (LV) function impaired. However, the effects of nitrite on human cardiac contractile ... ...

Abstract	Inorganic nitrite is a source of nitric oxide (NO) and is considered as a potential therapy in settings where endogenous NO bioactivity is reduced and left ventricular (LV) function impaired. However, the effects of nitrite on human cardiac contractile function, and the extent to which these are direct or indirect, are unclear. We studied 40 patients undergoing diagnostic cardiac catheterization who had normal LV systolic function and were not found to have obstructive coronary disease. They received either an intracoronary sodium nitrite infusion (8.7-26 µmol/min,
MeSH term(s)	Aged ; Female ; Hemodynamics/drug effects ; Humans ; Male ; Middle Aged ; Myocardial Contraction/drug effects ; Sodium Nitrite/administration & dosage ; Stroke Volume/drug effects ; Systole/drug effects ; Ventricular Function, Left/drug effects
Chemical Substances	Sodium Nitrite (M0KG633D4F)
Language	English
Publishing date	2021-05-21
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	603838-4
ISSN	1522-1539 ; 0363-6135
ISSN (online)	1522-1539
ISSN	0363-6135
DOI	10.1152/ajpheart.00081.2021
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Article ; Online: Rare insight into the rapid evolution of a coronary aneurysm and fistula.

Sirker, Alexander A / Scott, Peter / Melikian, Narbeh

Journal of the American College of Cardiology

2013 Volume 62, Issue 21, Page(s) 2023

MeSH term(s)	Aged ; Coronary Aneurysm/diagnostic imaging ; Coronary Aneurysm/etiology ; Coronary Angiography ; Diagnosis, Differential ; Electrocardiography ; Fistula/diagnostic imaging ; Fistula/etiology ; Heart Atria ; Heart Diseases/diagnostic imaging ; Heart Diseases/etiology ; Humans ; Male ; Myocardial Infarction/complications ; Myocardial Infarction/diagnostic imaging
Language	English
Publishing date	2013-11-19
Publishing country	United States
Document type	Case Reports ; Journal Article ; Video-Audio Media
ZDB-ID	605507-2
ISSN	1558-3597 ; 0735-1097
ISSN (online)	1558-3597
ISSN	0735-1097
DOI	10.1016/j.jacc.2013.06.063
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Zs.A 1846: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Coronary Wave Intensity Analysis as an Invasive and Vessel-Specific Index of Myocardial Viability.

Ryan, Matthew / De Silva, Kalpa / Morgan, Holly / O'Gallagher, Kevin / Demir, Ozan M / Rahman, Haseeb / Ellis, Howard / Dancy, Luke / Sado, Daniel / Strange, Julian / Melikian, Narbeh / Marber, Michael / Shah, Ajay M / Chiribiri, Amedeo / Perera, Divaka

Circulation. Cardiovascular interventions

2022 Volume 15, Issue 12, Page(s) e012394

Abstract: Background: Coronary angiography and viability testing are the cornerstones of diagnosing and managing ischemic cardiomyopathy. At present, no single test serves both needs. Coronary wave intensity analysis interrogates both contractility and ... ...

Abstract	Background: Coronary angiography and viability testing are the cornerstones of diagnosing and managing ischemic cardiomyopathy. At present, no single test serves both needs. Coronary wave intensity analysis interrogates both contractility and microvascular physiology of the subtended myocardium and therefore has the potential to fulfil the goal of completely assessing coronary physiology and myocardial viability in a single procedure. We hypothesized that coronary wave intensity analysis measured during coronary angiography would predict viability with a similar accuracy to late-gadolinium-enhanced cardiac magnetic resonance imaging. Methods: Patients with a left ventricular ejection fraction ≤40% and extensive coronary disease were enrolled. Coronary wave intensity analysis was assessed during cardiac catheterization at rest, during adenosine-induced hyperemia, and during low-dose dobutamine stress using a dual pressure-Doppler sensing coronary guidewire. Scar burden was assessed with cardiac magnetic resonance imaging. Regional left ventricular function was assessed at baseline and 6-month follow-up after optimization of medical-therapy±revascularization, using transthoracic echocardiography. The primary outcome was myocardial viability, determined by the retrospective observation of functional recovery. Results: Forty participants underwent baseline physiology, cardiac magnetic resonance imaging, and echocardiography, and 30 had echocardiography at 6 months; 21/42 territories were viable on follow-up echocardiography. Resting backward compression wave energy was significantly greater in viable than in nonviable territories (-5240±3772 versus -1873±1605 W m Conclusions: Backward compression wave energy has accuracy similar to that of late-gadolinium-enhanced cardiac magnetic resonance imaging in the prediction of viability. Coronary wave intensity analysis has the potential to streamline the management of ischemic cardiomyopathy, in a manner analogous to the effect of fractional flow reserve on the management of stable angina.
MeSH term(s)	Humans ; Stroke Volume ; Retrospective Studies ; Gadolinium ; Fractional Flow Reserve, Myocardial ; Ventricular Function, Left ; Treatment Outcome ; Myocardium ; Myocardial Ischemia/diagnosis ; Cardiomyopathies/pathology ; Ventricular Dysfunction, Left
Chemical Substances	Gadolinium (AU0V1LM3JT)
Language	English
Publishing date	2022-12-20
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2450797-0
ISSN	1941-7632 ; 1941-7640
ISSN (online)	1941-7632
ISSN	1941-7640
DOI	10.1161/CIRCINTERVENTIONS.122.012394
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