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Article ; Online: Cardiotoxicity in Oncology Guidelines: Discrepancies Do Matter.

Tan, Sean / Kader, Zainel / Day, Daphne / Chen, Daniel / Nicholls, Stephen J / Ramkumar, Satish

2024

Language	English
Publishing date	2024-03-06
Publishing country	Australia
Document type	Editorial
ZDB-ID	2020980-0
ISSN	1444-2892 ; 1443-9506
ISSN (online)	1444-2892
ISSN	1443-9506
DOI	10.1016/j.hlc.2024.02.007
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Article ; Online: Atrial fibrillation in cancer survivors - a systematic review and meta-analysis.

Bao, Yueyang / Lee, John / Thakur, Udit / Ramkumar, Satish / Marwick, Thomas H

Cardio-oncology (London, England)

2023 Volume 9, Issue 1, Page(s) 29

Abstract: Background: Atrial fibrillation (AF) is a common cardiac complication during cancer treatment. It is unclear if cancer survivors have increased AF risk when compared to the population. AF screening is now recommended in patients ≥65 years, however there ...

Abstract	Background: Atrial fibrillation (AF) is a common cardiac complication during cancer treatment. It is unclear if cancer survivors have increased AF risk when compared to the population. AF screening is now recommended in patients ≥65 years, however there are no specific recommendations in the oncology population. We sought to compare the AF detection rate of cancer survivors compared to the general population. Methods: We searched the Pubmed, Embase and Web of Science databases using search terms related to AF and cancer mapped to subject headings. We included English language studies, limited to adults > 18 years who were > 12 months post completion of cancer treatment. Using a random-effects model we calculated the overall AF detection rate. Meta-regression analysis was performed to assess for potential causes for study heterogeneity. Results: Sixteen studies were included in the study. The combined AF detection rate amongst all the studies was 4.7% (95% C.I 4.0-5.4%), which equated to a combined annualised AF rate of 0.7% (95% C.I 0.1-0.98%). There was significant heterogeneity between studies (I Conclusion: Whilst the results should be interpreted with caution due to study heterogeneity, AF rates in patients with cancer survival >12 months were not significantly increased compared to the general population. Study registration: Open Science Framework - DOI: https://doi.org/10.17605/OSF.IO/APSYG .
Language	English
Publishing date	2023-06-17
Publishing country	England
Document type	Journal Article
ISSN	2057-3804
ISSN (online)	2057-3804
DOI	10.1186/s40959-023-00180-3
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Pyopneumopericarditis from a gastropericardial fistula: a case report.

Lee, John / Ramkumar, Satish / Ha, Phil / Raghunath, Ajay / Dundon, Benjamin

European heart journal. Case reports

2021 Volume 5, Issue 11, Page(s) ytab408

Abstract: Background: Pyopneumopericarditis is a very rare diagnosis that requires prompt recognition and urgent treatment. It denotes the presence of pus and air in the pericardium with associated inflammation of the fibrous pericardial sac.: Case summary: A ... ...

Abstract	Background: Pyopneumopericarditis is a very rare diagnosis that requires prompt recognition and urgent treatment. It denotes the presence of pus and air in the pericardium with associated inflammation of the fibrous pericardial sac. Case summary: A 49-year-old gentleman was admitted with pyopneumoperciarditis on a background of a previous uncomplicated Roux-en-Y gastric bypass surgery performed 7 years prior. He underwent emergency surgery for an omental patch repair of an ulcer perforation involving the diaphragm and pericardium. His inpatient stay was complicated by persistent seropurulent output from the pericardial drain, loculated pleural effusion, and deconditioning. Discussion: Management is extrapolated from the literature regarding purulent pericarditis. This condition albeit rare, requires swift recognition as without treatment mortality approaches 100%. Colchicine is an important adjunctive therapy postoperatively to prevent constrictive physiology.
Language	English
Publishing date	2021-11-15
Publishing country	England
Document type	Case Reports
ISSN	2514-2119
ISSN (online)	2514-2119
DOI	10.1093/ehjcr/ytab408
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Cost-effectiveness of screening for paroxysmal atrial fibrillation in patients undergoing echocardiography.

Ramkumar, Satish / Kawakami, Hiroshi / Wong, Edmond / Nolan, Mark / Marwick, Thomas H

Internal medicine journal

2022 Volume 53, Issue 5, Page(s) 760–772

Abstract: Background: Screening for atrial fibrillation is recommended for patients > 65 years on current guidelines. Targeted screening may be more efficient, however the appropriate location for screening programs has not been well defined. Our aim was to ... ...

Abstract	Background: Screening for atrial fibrillation is recommended for patients > 65 years on current guidelines. Targeted screening may be more efficient, however the appropriate location for screening programs has not been well defined. Our aim was to compare the cost-effectiveness of unselected electrocardiographic (ECG) screening for atrial fibrillation (AF), and selective screening based on an abnormal echocardiogram. Methods: Two strategies of portable ECG screening for AF were compared in the base case of a hypothetical asymptomatic 65-year-old man (CHA Results: ImagingScreen dominated AgeScreen, with a lower cost ($54 823 vs $57842) and better outcome (11.56 vs 11.52 QALY over 20 years). Monte Carlo simulation demonstrated that 61% of observations were more efficacious with ImagingScreen, with cost below willingness to pay. The main cost determinants were annual costs of stroke or heart failure and AF detection rates. ImagingScreen was more cost-effective for AF detection rates up to 14%, and more cost-effective across a range of annual stroke ($24 000-$102 000) and heart failure ($4000-$12 000) costs. Conclusion: In patients with a previous echocardiogram, AF screening of those with baseline clinical and imaging risk parameters is more cost-effective than age-based screening.
MeSH term(s)	Male ; Humans ; Aged ; Atrial Fibrillation/diagnosis ; Cost-Benefit Analysis ; Echocardiography/methods ; Stroke/etiology ; Heart Failure
Language	English
Publishing date	2022-09-04
Publishing country	Australia
Document type	Case Reports ; Journal Article
ZDB-ID	2045436-3
ISSN	1445-5994 ; 1444-0903
ISSN (online)	1445-5994
ISSN	1444-0903
DOI	10.1111/imj.15769
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Zs.A 792: 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: Associations of subclinical heart failure and atrial fibrillation with mild cognitive impairment: a cross-sectional study in a subclinical heart failure screening programme.

Potter, Elizabeth L / Ramkumar, Satish / Wright, Leah / Marwick, Thomas H

BMJ open

2021 Volume 11, Issue 7, Page(s) e045896

Abstract: Objectives: Effective identification and management of subclinical left ventricular (LV) dysfunction (LVD) and subclinical atrial fibrillation (AF) by screening elderly populations might be compromised by mild cognitive impairment (MCI). We sought to ... ...

Abstract	Objectives: Effective identification and management of subclinical left ventricular (LV) dysfunction (LVD) and subclinical atrial fibrillation (AF) by screening elderly populations might be compromised by mild cognitive impairment (MCI). We sought to characterise the prevalence and profile of MCI and evaluate associations with LV and left atrial (LA) dysfunction and AF, in a trial of screening for subclinical LVD and AF. Design: Cross-sectional. Setting: Australian, community-based intervention trial. Participants: Adults aged ≥65 years with ≥1 LVD risk factors without ischaemic heart disease (n=337). Outcome measures: The Montreal cognitive assessment (MoCA) was obtained. Subclinical LVD was defined as echocardiographic global longitudinal strain ≤16%, diastolic dysfunction or LV hypertrophy; abnormal LA reservoir strain (LARS) was defined as <24%. Subclinical AF was detected using a single-lead portable electrocardiographic device in those without pre-existing AF who gave consent (n=293). Results: Subclinical LVD was found in 155 (46%), abnormal LARS in 9 (3.6%) and subclinical AF in 11 (3.8%). MoCA score consistent with MCI (<26) was found in 101 (30%); executive function (69%) and delayed recall (93%), were the most frequently abnormal domains. Compared with normal cognition, MCI was associated with non-adherence to AF screening (25% vs 40%, p=0.01). In multivariable logistic regression modelling, educational achievement, systolic blood pressure, body mass index and waist-to-hip ratio were independently associated with MCI. However, neither subclinical AF nor any measure of cardiac dysfunction, were associated with MCI. Conclusions: The 30% prevalence of MCI among elderly subjects with risk factors for subclinical LVD and AF has important implications for screening strategies and management. However, MCI is not associated with subclinical myocardial dysfunction nor subclinical AF. Trial registration number: Australian New Zealand Clinical Trials Registry (ACTRN12617000116325).
MeSH term(s)	Aged ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/epidemiology ; Australia/epidemiology ; Cognitive Dysfunction/diagnosis ; Cognitive Dysfunction/epidemiology ; Cross-Sectional Studies ; Heart Failure ; Humans
Language	English
Publishing date	2021-07-05
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2020-045896
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Article ; Online: Associations of subclinical heart failure and atrial fibrillation with mild cognitive impairment

Thomas H Marwick / Satish Ramkumar / Elizabeth L Potter / Leah Wright

BMJ Open, Vol 11, Iss

a cross-sectional study in a subclinical heart failure screening programme

2021 Volume 7

Abstract: Objectives Effective identification and management of subclinical left ventricular (LV) dysfunction (LVD) and subclinical atrial fibrillation (AF) by screening elderly populations might be compromised by mild cognitive impairment (MCI). We sought to ... ...

Abstract	Objectives Effective identification and management of subclinical left ventricular (LV) dysfunction (LVD) and subclinical atrial fibrillation (AF) by screening elderly populations might be compromised by mild cognitive impairment (MCI). We sought to characterise the prevalence and profile of MCI and evaluate associations with LV and left atrial (LA) dysfunction and AF, in a trial of screening for subclinical LVD and AF.Design Cross-sectional.Setting Australian, community-based intervention trial.Participants Adults aged ≥65 years with ≥1 LVD risk factors without ischaemic heart disease (n=337).Outcome measures The Montreal cognitive assessment (MoCA) was obtained. Subclinical LVD was defined as echocardiographic global longitudinal strain ≤16%, diastolic dysfunction or LV hypertrophy; abnormal LA reservoir strain (LARS) was defined as <24%. Subclinical AF was detected using a single-lead portable electrocardiographic device in those without pre-existing AF who gave consent (n=293).Results Subclinical LVD was found in 155 (46%), abnormal LARS in 9 (3.6%) and subclinical AF in 11 (3.8%). MoCA score consistent with MCI (<26) was found in 101 (30%); executive function (69%) and delayed recall (93%), were the most frequently abnormal domains. Compared with normal cognition, MCI was associated with non-adherence to AF screening (25% vs 40%, p=0.01). In multivariable logistic regression modelling, educational achievement, systolic blood pressure, body mass index and waist-to-hip ratio were independently associated with MCI. However, neither subclinical AF nor any measure of cardiac dysfunction, were associated with MCI.Conclusions The 30% prevalence of MCI among elderly subjects with risk factors for subclinical LVD and AF has important implications for screening strategies and management. However, MCI is not associated with subclinical myocardial dysfunction nor subclinical AF.Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN12617000116325).
Keywords	Medicine ; R
Subject code	610
Language	English
Publishing date	2021-07-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Coronary artery ectasia presenting with ST-elevation myocardial infarction in a young indigenous man: a case report.

Lee, John / Ramkumar, Satish / Khav, Nancy / Dundon, Benjamin K

European heart journal. Case reports

2020 Volume 4, Issue 5, Page(s) 1–5

Abstract: Background: Coronary artery ectasia (CAE) is often an incidental finding on angiography, however, patients can present with acute coronary syndrome due to a large thrombus burden requiring treatment with percutaneous coronary intervention or with ... ...

Abstract	Background: Coronary artery ectasia (CAE) is often an incidental finding on angiography, however, patients can present with acute coronary syndrome due to a large thrombus burden requiring treatment with percutaneous coronary intervention or with emergency surgery. Case summary: A 26-year-old Indigenous Australian male was admitted with anterior ST-elevation myocardial infarction associated with an out of hospital ventricular fibrillation arrest. Coronary angiography demonstrated thrombotic occlusion of the proximal left anterior descending (LAD) artery with heavy thrombus burden and prominent vascular ectasia of all three coronary arteries. He was managed with surgical thrombectomy and coronary artery bypass graft of his LAD. Discussion: This is the first case of triple CAE in an Indigenous Australian. The case highlights the lack of consensus approach in the management of CAE due to paucity of prospective studies.
Language	English
Publishing date	2020-08-25
Publishing country	England
Document type	Case Reports
ISSN	2514-2119
ISSN (online)	2514-2119
DOI	10.1093/ehjcr/ytaa253
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: NOACs Now Mainstream for the Use of Anticoagulation in Non-Valvular Atrial Fibrillation in Australia.

Pol, Derk / Curtis, Claire / Ramkumar, Satish / Bittinger, Logan

Heart, lung & circulation

2018 Volume 28, Issue 4, Page(s) e40–e42

Abstract: The management of stroke risk in patients with non-valvular atrial fibrillation has changed over the past few years. This change has occurred due to the introduction of novel oral anticoagulants (NOACs) such as apixaban, rivaroxaban and dabigatran for ... ...

Abstract	The management of stroke risk in patients with non-valvular atrial fibrillation has changed over the past few years. This change has occurred due to the introduction of novel oral anticoagulants (NOACs) such as apixaban, rivaroxaban and dabigatran for the management of non-valvular atrial fibrillation. These agents have shown comparable stroke risk reduction to warfarin in large international multicentre trials [1-3]. This has changed the clinical practice of many treating physicians since their introduction from 2011 to 2013. The purpose of this review was to highlight the now mainstream use of NOAC administration in preference to warfarin, by comparing the trends in the number of prescriptions filled since all three forms of oral anti-coagulant became available in 2013. These agents are being increasingly prescribed due to their ease of use compared to warfarin, which not only requires ongoing monitoring due to narrow therapeutic range but also has many drug and food interactions. Since November 2015, NOACs have become the mainstream choice for anticoagulation in atrial fibrillation likely given their ease of use compared to warfarin. The use of each anticoagulant remains divergent with the use of warfarin continuing to decrease.
MeSH term(s)	Administration, Oral ; Anticoagulants/administration & dosage ; Atrial Fibrillation/complications ; Atrial Fibrillation/drug therapy ; Dabigatran/administration & dosage ; Follow-Up Studies ; Humans ; Incidence ; Pyrazoles/administration & dosage ; Pyridones/administration & dosage ; Retrospective Studies ; Risk Factors ; Rivaroxaban/administration & dosage ; Stroke/epidemiology ; Stroke/prevention & control ; Thrombolytic Therapy/methods ; Treatment Outcome ; Victoria/epidemiology ; Warfarin/administration & dosage
Chemical Substances	Anticoagulants ; Pyrazoles ; Pyridones ; apixaban (3Z9Y7UWC1J) ; Warfarin (5Q7ZVV76EI) ; Rivaroxaban (9NDF7JZ4M3) ; Dabigatran (I0VM4M70GC)
Language	English
Publishing date	2018-03-22
Publishing country	Australia
Document type	Journal Article ; Multicenter Study
ZDB-ID	2020980-0
ISSN	1444-2892 ; 1443-9506
ISSN (online)	1444-2892
ISSN	1443-9506
DOI	10.1016/j.hlc.2018.03.010
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Zs.A 4988: Show issues

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Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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Jg. 1995 - 2021: Lesesall (2.OG)
ab Jg. 2022: Lesesaal (EG)

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Article ; Online: Left Atrial Strain Performance and its Application in Clinical Practice.

Haji, Kawa / Wong, Chiew / Wright, Leah / Ramkumar, Satish / Marwick, Thomas H

JACC. Cardiovascular imaging

2019 Volume 12, Issue 6, Page(s) 1093–1101

MeSH term(s)	Atrial Function, Left ; Biomechanical Phenomena ; Echocardiography ; Heart Atria/diagnostic imaging ; Heart Atria/physiopathology ; Heart Diseases/diagnostic imaging ; Heart Diseases/physiopathology ; Humans ; Image Interpretation, Computer-Assisted ; Myocardial Contraction ; Predictive Value of Tests ; Reproducibility of Results ; Stress, Mechanical
Language	English
Publishing date	2019-01-16
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Video-Audio Media
ZDB-ID	2491503-8
ISSN	1876-7591 ; 1936-878X
ISSN (online)	1876-7591
ISSN	1936-878X
DOI	10.1016/j.jcmg.2018.11.009
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Zs.A 6846: Show issues

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Article ; Online: The importance of calibration method in determining the association between central blood pressure with left ventricular and left atrial strain.

Ramkumar, Satish / Yang, Hong / Nolan, Mark / Negishi, Tomoko / Sharman, James E / Marwick, Thomas H / Negishi, Kazuaki

The international journal of cardiovascular imaging

2021 Volume 38, Issue 3, Page(s) 589–600

Abstract: Afterload is an important determinant of left ventricular (LV) and atrial (LA) function, including myocardial strain. Central blood pressure (CBP) is the major component of cardiac afterload and independently associated with cardiovascular risk. However, ...

Abstract	Afterload is an important determinant of left ventricular (LV) and atrial (LA) function, including myocardial strain. Central blood pressure (CBP) is the major component of cardiac afterload and independently associated with cardiovascular risk. However, the optimal means of calibrating CBP is unclear-standard CBP assessment uses systolic (SBP) and diastolic blood pressure (DBP) from brachial waveforms, but calibration with mean pressure (MAP) and DBP purports to be more accurate. Therefore, we sought to determine which CBP is best associated with LA and LV strain. CBP was measured using both standard and MAP based calibration methods in 546 participants (age 70.7 ± 4.7 years, 45% male) with risk factors for heart failure. Echocardiography was performed in all patients and strain analysis conducted to assess LA/LV function. The associations of CBP with LA and LV strain were assessed using linear regression. MAP-derived CSBP (150 ± 20 mmHg) was higher than standard CSBP (128 ± 15 mmHg) and brachial SBP (140 ± 17 mmHg, p < 0.001), whereas DBPs were similar (84 ± 10, 83 ± 10, and 82 ± 10 mmHg). MAP-derived CSBP was not independently associated with LV strain (p > 0.05), however was independently associated with LA reservoir strain (p < 0.05). Brachial and central DBP were more strongly associated with LA reservoir/conduit and LV strain than brachial and central SBP. LA pump strain was not independently associated with any SBP or DBP parameter (p > 0.05). MAP-derived CBP was more accurate in identifying patients with abnormal LA and LV strain than brachial SBP and standard CBP calibration. In conclusion, CBP calibrated using MAP and DBP may be more accurate in identifying patients with abnormal LA and LV function than standard brachial calibration methods.
MeSH term(s)	Aged ; Blood Pressure/physiology ; Calibration ; Echocardiography/methods ; Female ; Heart Atria/diagnostic imaging ; Humans ; Male ; Predictive Value of Tests
Language	English
Publishing date	2021-10-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2055311-0
ISSN	1875-8312 ; 1573-0743 ; 1569-5794 ; 0167-9899
ISSN (online)	1875-8312 ; 1573-0743
ISSN	1569-5794 ; 0167-9899
DOI	10.1007/s10554-021-02444-4
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