Liverpool Heart and Chest Hospital

Liverpool, United Kingdom

Liverpool Heart and Chest Hospital

Liverpool, United Kingdom
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LONDRES--(BUSINESS WIRE)--Le NICE (National Institute for Health and Care Excellence) a publié aujourd'hui des directives relatives à l'utilisation de la solution HeartFlow® FFRct Analysis pour aider à déterminer la cause de la douleur thoracique stable chez les patients. Conçue par HeartFlow, Inc., la solution HeartFlow FFRct Analysis est la première technologie non invasive à fournir des renseignements à la fois sur l'étendue de la maladie coronarienne et sur l'impact de ladite maladie sur la circulation sanguine vers le cœur, permettant aux cliniciens de choisir le traitement approprié. Le NICE recommande l'utilisation de la solution HeartFlow FFRct Analysis pour les patients souffrant d'une douleur thoracique stable récemment diagnostiquée. Sur la base des données de preuve, l'Institut a conclu que la technologie était sûre, qu'elle présentait un haut niveau de précision diagnostique et qu'elle était susceptible d'éviter le recours à une coronarographie invasive. Le comité a en outre conclu que l'utilisation de la solution HeartFlow FFRct Analysis, en comparaison avec tous les autres tests, était susceptible de faire économiser au NHS environ 214 GBP par patient (soit l'équivalent de 9,1 millions GBP/an rien que pour le NHS anglais) en évitant le recours à des tests et à des traitements invasifs non nécessaires. Le processus de HeartFlow débute avec des données issues d'une coronarographie par TDM non invasive standard.  Tirant parti de connaissances approfondies et d'une forme avancée d'intelligence artificielle, HeartFlow crée un modèle 3D personnalisé de chaque artère du patient.  De puissants algorithmes informatiques résolvent ensuite des millions d'équations complexes, afin de simuler la circulation sanguine et d'évaluer l'impact des blocages dans les artères. Grâce à ces informations exploitables, les médecins peuvent déterminer la marche à suivre adaptée pour chaque patient. « La solution HeartFlow FFRct Analysis fournit une compréhension définitive à la fois des résultats anatomiques et fonctionnels, sans aucun test ou risque supplémentaire pour les patients », a déclaré le Dr Joseph Mills du Liverpool Heart and Chest Hospital. « L'application de la solution HeartFlow FFRct Analysis devrait transformer la qualité des soins que nous offrons aux patients, en garantissant le diagnostic le plus précis et le meilleur plan de traitement, tout en réduisant la nécessité de recourir à une coronarographie invasive – une procédure qui n'est pas sans risques. » Présentant des douleurs thoraciques et des difficultés croissantes à l'effort, John Roberts, 50 ans, de Southport, a participé à la mise à l'essai de cette technologie. « Je suis extrêmement chanceux d'avoir eu accès à la solution non invasive HeartFlow FFRct Analysis. Elle m'a offert une véritable seconde chance. Elle a permis de montrer à mon médecin que j'avais besoin d'un stent pour résoudre un blocage et d'empêcher une crise cardiaque.  Je suis extrêmement reconnaissant  d'avoir pu bénéficier d'un traitement qui s'est avéré idéal et opportun - la solution a véritablement changé ma vie et déjà j'arrive à courir à nouveau 10 kilomètres.  » « Les directives du NICE viennent renforcer la valeur de la solution HeartFlow Analysis, et confirment que cette technologie peut améliorer la manière dont la maladie coronarienne est diagnostiquée et traitée », a confié pour sa part John H. Stevens, docteur en médecine, président et chef de la direction de HeartFlow. « Nous nous félicitons de l'analyse approfondie menée par le NICE autour de la technologie de HeartFlow, et pensons que son évaluation détaillée constituera une ressource précieuse pour les prestataires et les payeurs souhaitant améliorer les soins aux patients. » La maladie coronarienne, également appelée coronaropathie, constitue la principale cause de décès chez les femmes et les hommes à travers le monde. La maladie coronarienne se développe lorsque les artères menant au cœur se rétrécissent, souvent en raison de la formation de plaque sur la paroi vasculaire. Le rétrécissement des artères peut réduire la circulation sanguine vers le cœur, entraînant des douleurs thoraciques, des crises cardiaques, voire un décès. La maladie coronarienne est également l'un des troubles médicaux les plus coûteux au monde aujourd'hui. HeartFlow, Inc. est une société technologique de médecine personnalisée qui a pour vocation de transformer la manière dont les maladies cardiovasculaires sont diagnostiquées et traitées. La solution HeartFlow FFRct Analysis de la société est la première solution non invasive disponible permettant aux médecins de déterminer de manière plus précise si un patient présente une maladie coronarienne (MC) importante à partir de données anatomiques et physiologiques. Cette solution, qui tire parti de connaissances approfondies permettant de créer un modèle 3D personnalisé des artères du patient, se positionne de manière idéale pour devenir partie intégrante du traitement recommandé chez les patients présentant un risque de MC, grâce à sa capacité potentielle d'améliorer les résultats cliniques, d'optimiser l'expérience des patients et de réduire le coût des soins. La solution HeartFlow FFRct Analysis est disponible aux États-Unis, au Canada, en Europe et au Japon. Pour en savoir plus, rendez-vous sur heartflow.com/uk.


Poullis M.,Liverpool Heart and Chest Hospital
Journal of Extra-Corporeal Technology | Year: 2012

Aortic root and valve clots are rare but well described in patients on maximal left ventricular assist device (LVAD) support. We performed a theoretical analysis using computational fluid dynamic analyses in two dimensions to try and ascertain if inflow cannula design/orientation/placement affect aortic root flow dynamics. Two-dimensional computational fluid dynamics using easy CFD-G was performed. The effect of a curved inflow cannula, a straight cannula, and one with a hole in the outer curve was analyzed. In addition, the effect of inflow conduit angulation on the ascending aorta was studied. Computational fluid dynamic (CFD) analysis predicts that stagnant blood exists in the aortic root when little or no cardiac ejection is taking place. Coronary flow is too small to affect the root flow streamlines. A hole on the root side of a curved inflow aortic cannula increases the flow in the aortic root and may decrease the incidence of root and valve thrombosis. The angle of the inflow conduit attachment to the ascending aorta was also found to be crucial with regard to aortic root blood stasis. In addition, a baffle at the tip of the inflow cannula may prove to be beneficial. Theoretical analysis using the technique of CFD predicts that inflow cannula position and design may affect the incidence of aortic root thrombosis during LVAD support when minimal cardiac ejection is occurring.


Poullis M.,Liverpool Heart and Chest Hospital
Interactive Cardiovascular and Thoracic Surgery | Year: 2014

OBJECTIVESTo determine the optimal computed tomography (CT) scanning interval for the detection of a new primary lung cancer and recurrent disease, utilizing the known mathematical formula for tumour doubling.METHODS where: Ti interval time, Diinitial diameter and D ofinal diameter. Three doubling times were utilized for demonstration of the principle, 30, 80 and 100 days.RESULTSA worst-case scenario for a doubling time of 30 days indicates that a 2-mm tumour will need 210 days (7 months) to reach 10 mm in diameter and 300 days (10 months) to reach 20 mm in diameter. Over a 5-year (60 months) follow-up period, this indicates that eight CT scans will be required if a threshold of 10 mm is desired or six if a threshold of 20 mm is desired. For an 80-day doubling time over a 5-year (60 months) follow-up period, three CT scans will be required if a threshold of 10 mm is desired or two if a threshold of 20 mm is desired and for a 100-day doubling time. Assuming complete histological clearance of the primary lung cancer and that recurrence occurs from a microscopic focus, a time period of 1700 days (56 months) is required to reach 10 mm in diameter.CONCLUSIONSThe exact timing of interval CT scanning to detect recurrence and new primary tumour depends on philosophy; however, three monthly CT scanning is probably inappropriate, and scanning every 7 months is probably the shortest interval that is clinically useful, particularly for small-cell lung cancer in the first year after treatment. We recommend, based on mathematical modelling, a scanning interval post-potentially curative resection surgery for primary lung cancer of 18 months, which is different from the current guidelines on surveillance, for non-small-cell lung cancer. © 2013 The Author.


Fothergill J.L.,University of Liverpool | Walshaw M.J.,Liverpool Heart and Chest Hospital | Winstanley C.,University of Liverpool
European Respiratory Journal | Year: 2012

Pseudomonas aeruginosa chronic lung infections are the major cause of morbidity and mortality associated with cystic fibrosis. For many years, the consensus was that cystic fibrosis patients acquire P. aeruginosa from the environment, and hence harbour their own individual clones. However, in the past 15 yrs the emergence of transmissible strains, in some cases associated with greater morbidity and increased antimicrobial resistance, has changed the way that many clinics treat their patients. Here we provide a summary of reported transmissible strains in the UK, other parts of Europe, Australia and North America. In particular, we discuss the prevalence, epidemiology, unusual genotypic and phenotypic features, and virulence of the most intensively studied transmissible strain, the Liverpool epidemic strain. We also discuss the clinical impact of transmissible strains, in particular the diagnostic and infection control approaches adopted to counter their spread. Genomic analysis carried out so far has provided little evidence that transmissibility is due to shared genetic characteristics between different strains. Previous experiences with transmissible strains should help us to learn lessons for the future. In particular, there is a clear need for strain surveillance if emerging problem strains are to be detected before they are widely transmitted. Copyright©ERS 2012.


Hawkins N.M.,Liverpool Heart and Chest Hospital | Jhund P.S.,University of Glasgow | McMurray J.J.V.,University of Glasgow | Capewell S.,University of Liverpool
European Journal of Heart Failure | Year: 2012

Aims Socioeconomic status (SES) is a powerful predictor of incident coronary disease and adverse cardiovascular outcomes. Understanding the impact of SES on heart failure (HF) development and subsequent outcomes may help to develop effective and equitable prevention, detection, and treatment strategies Methods and Results A systematic literature review of electronic databases including PubMed, EMBASE, CINAHL, and the Cochrane Library, restricted to human subjects, was carried out. The principal outcomes were incidence, prevalence, hospitalizations, mortality, and treatment of HF. Socioeconomic measures included education, occupation, employment relations, social class, income, housing characteristics, and composite and area level indicators. Additional studies were identified from bibliographies of relevant articles and reviews. Twenty-eight studies were identified. Lower SES was associated with increased incidence of HF, either in the community or presenting to hospital. The adjusted risk of developing HF was increased by ∼3050 in most reports. Readmission rates following hospitalization were likewise greater in more deprived patients. Although fewer studies examined mortality, lower SES was associated with poorer survival. Evidence defining the equity of medical treatment of patients with HF was scarce and conflicting. Conclusions Socioeconomic deprivation is a powerful independent predictor of HF development and adverse outcomes. However, the precise mechanisms accounting for this risk remain elusive. Heart failure represents the endpoint of numerous different pathophysiological processes and 'chains of events', each modifiable throughout the disease trajectories. The interaction between SES and HF is accordingly complex. Disentangling the many and varied life course processes is challenging. A better understanding of these issues may help attenuate the health inequalities so clearly evident among patients with HF. © 2011 The Author.


Poullis M.,Liverpool Heart and Chest Hospital
Interactive Cardiovascular and Thoracic Surgery | Year: 2012

Thromboendarterectomy remains a high-risk procedure. The use of circulatory arrest as a technique to allow pulmonary artery visualization is associated with cerebral and organ damage secondary to the ischaemic insult. Application of techniques learned from thoracic aortic stenting and minimal invasive valvular surgery may mean that circulatory arrest becomes an uncommon accompaniment to thromboendarterectomy. © The Author 2012.


Campbell R.T.,University of Glasgow | Jhund P.S.,University of Glasgow | Castagno D.,University of Turin | Hawkins N.M.,Liverpool Heart and Chest Hospital | And 2 more authors.
Journal of the American College of Cardiology | Year: 2012

Examination of patients with reduced and preserved ejection fraction in the DIG (Digitalis Investigation Group) trials and the CHARM (Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity) trials provides comparisons of outcomes in each of these types of heart failure. Comparison of the patients in these trials, along with the I-PRESERVE (Irbesartan in Heart Failure with Preserved Systolic Function Trial), with patients of similar age, sex distribution, and comorbidity in trials of hypertension, diabetes mellitus, angina pectoris, and atrial fibrillation provides even more interesting insights into the relation between phenotype and rates of death and heart failure hospitalization. The poor clinical outcomes in patients with heart failure and preserved ejection fraction do not seem easily explained on the basis of age, sex, comorbidity, blood pressure, or left ventricular structural remodeling but do seem to be explained by the presence of the syndrome of heart failure. © 2012 American College of Cardiology Foundation.


Poullis M.,Liverpool Heart and Chest Hospital
Interactive cardiovascular and thoracic surgery | Year: 2014

OBJECTIVES: EuroSCORE II, despite improving on the original EuroSCORE system, has not solved all the calibration and predictability issues. Recursive, non-linear and mixed recursive and non-linear regression analysis were assessed with regard to sensitivity, specificity and predictability of the original EuroSCORE and EuroSCORE II systems.METHODS: The original logistic EuroSCORE, EuroSCORE II and recursive, non-linear and mixed recursive and non-linear regression analyses of these risk models were assessed via receiver operator characteristic curves (ROC) and Hosmer-Lemeshow statistic analysis with regard to the accuracy of predicting in-hospital mortality. Analysis was performed for isolated coronary artery bypass grafts (CABGs) (n = 2913), aortic valve replacement (AVR) (n = 814), mitral valve surgery (n = 340), combined AVR and CABG (n = 517), aortic (n = 350), miscellaneous cases (n = 642), and combinations of the above cases (n = 5576).RESULTS: The original EuroSCORE had an ROC below 0.7 for isolated AVR and combined AVR and CABG. None of the methods described increased the ROC above 0.7. The EuroSCORE II risk model had an ROC below 0.7 for isolated AVR only. Recursive regression, non-linear regression, and mixed recursive and non-linear regression all increased the ROC above 0.7 for isolated AVR. The original EuroSCORE had a Hosmer-Lemeshow statistic that was above 0.05 for all patients and the subgroups analysed. All of the techniques markedly increased the Hosmer-Lemeshow statistic. The EuroSCORE II risk model had a Hosmer-Lemeshow statistic that was significant for all patients (P < 0.0001), and very close to significant for isolated CABG (P = 0.05) and for isolated AVR (P = 0.06). Non-linear regression failed to improve on the original Hosmer-Lemeshow statistic. The mixed recursive and non-linear regression using the EuroSCORE II risk model was the only model that produced an ROC of 0.7 or above for all patients and procedures and had a Hosmer-Lemeshow statistic that was highly non-significant.CONCLUSIONS: The original EuroSCORE and the EuroSCORE II risk models do not have adequate ROC and Hosmer-Lemeshow statistics to allow accurate assessment of cardiac surgeons in the modern era. A mixed recursive and non-linear regression model utilizing the EuroSCORE II risk model improves both the ROC and Hosmer-Lemeshow statistics. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.


Kirmani B.H.,Liverpool Heart and Chest Hospital | Holmes M.V.,University of Oxford | Muir A.D.,Liverpool Heart and Chest Hospital
Circulation | Year: 2016

Background: The long-term outcomes of off-pump coronary artery bypass grafting (CABG) are the subject of speculation. Our institution has >15 years of experience performing CABG both off-pump (OPCAB) and on cardiopulmonary bypass (CPB). Our null hypothesis was that there would be no difference in a long-term composite of death and revascularisation between the 2 methods. Methods: We performed a retrospective cohort study of all isolated CABG at our institution from 2001 to 2015. We used an intention-to-treat analysis, performing risk adjustment with adjustment for and matching to propensity score. In total, 13 226 patients had CABG: 5882 had OPCAB and 7344 had CPB, with a median follow-up of 6.2 years. Results: Of the 5882 OPCAB, 76 (1.3%) converted to CPB. One-, 5-, and 10-year survivals in each group were similar (OPCAB vs CPB: 96.7%, 87.9%, 72.1% vs 96.2%, 87.4%, 72.8%). No difference was found in long-term survival (adjusted hazards ratio [HR] 1.03; 95% confidence interval [CI]: 0.94-1.11 for OPCAB vs CPB; P=0.56) or freedom from death and reintervention (HR 0.98; 95% CI: 0.92-1.06 for OPCAB vs CPB; P=0.23). Patients receiving OPCAB had higher EuroSCOREs (median [quartiles]: 2.81 [1.53-5.57] vs 2.73 [1.51-5.22]; P=0.01), fewer grafts (mean±SD: 3.0±0.9 vs 3.3±0.9; P<0.001), but more total arterial grafting (45.9% vs 8.4%; P<0.001). OPCAB also had more trainee first operators (15.3% vs 12.5%), lower cardiac enzyme rise, shorter length of stay, and fewer complications (such as myocardial infarction). Conclusions: OPCAB is associated with similar long-term outcomes to CABG performed on CPB in our institution. Our low conversion rate to CPB, while training junior surgeons, demonstrates that OPCAB can be taught safely. The number of grafts performed between the 2 approaches is clinically comparable, if statistically different, and appears to provide equal benefits to survival and freedom from reintervention as on-pump CABG. © 2016 American Heart Association, Inc.


Poullis M.,Liverpool Heart and Chest Hospital
Interactive Cardiovascular and Thoracic Surgery | Year: 2014

OBJECTIVES: To determine the effect of differing modes of left ventricular assist device (LVAD) operation: synchronous, independent (asynchronous or pseudosynchronous) or counter pulsation (antisynchronous), on left atrial pressure, pulmonary artery pressure, pulmonary blood flow and right ventricular work load, utilizing a previously published electrical analogy of the systemic and pulmonary circulation and the heart. METHODS: A previously published electrical analogy of the systemic and pulmonary circulation was utilized. The Simulation Package with Integrated Circuit Emphasis (LTSPICE IV) was utilized. Three LVAD operation mode scenarios were analysed: synchronous, counter pulsation and independent pulsatile. The root mean square of the pulmonary artery pressure (PAP), left atrial pressure (LAP) and pulmonary blood flow (PBF) were calculated, as was the right ventricular work load. RESULTS: Counter pulsation LVAD operation resulted in the lowest LAP, PAP, right ventricular work load and the highest pulmonary blood flow. Independent pulsation resulted in the highest LAP, PAP and the lowest pulmonary blood flow. This technique actually increased RV work load. CONCLUSIONS: If an LVAD is to be operated in a pulsatile mode, the counter pulsation mode reduces pulmonary artery and left atrial pressure and increases pulmonary blood flow and thus cardiac output. This is in addition to the reduced right ventricular energetic requirement, a finding previously described. Clinical validation of our findings is necessary. © 2014 The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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