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  • 1
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    OR17-05 Hypospadias Is a Predictor of Adverse Cardiometabolic Risk in Adulthood - a Case-Control Study
    The Endocrine Society ; 2020
    In:  Journal of the Endocrine Society Vol. 4, No. Supplement_1 ( 2020-05-08)
    Details
    In: Journal of the Endocrine Society, The Endocrine Society, Vol. 4, No. Supplement_1 ( 2020-05-08)
    Abstract: Introduction: Abnormal development of the genital tract during the first trimester can lead to hypospadias. This stage coincides with the programming window during which androgens are required for normal masculinisation of the genital tract. Since fetal development may also be associated with long-term effects on cardiometabolic outcome and testosterone is itself an important vascular hormone, we questioned whether adults with a history of hypospadias are at increased risk of long-term cardiovascular and metabolic disease. Aim: This retrospective study determined if hypospadias is associated with increased risk of cardiometabolic disease later in life. Methods: Cardiovascular and diabetes admissions data were extracted through record linkage for all males with a history of hypospadias (ICD10 Q54) from 1981 to 2019 through the NHS Scotland Information Services Division after ethics approval. Controls were matched for age, birthweight, gestation and deprivation index. Incident admissions for angina, arrhythmia, diabetes, heart failure, ischaemic heart disease, myocardial infarction, peripheral arterial disease, renal failure and stroke were obtained for each individual. Case control analysis was performed using Chi square test using R. Results: Admission data on 13,481 men with hypospadias and 9,615 matched controls were reviewed. Men with hypospadias had a 10- fold higher risk of diabetes (9.7 [8.4-11.2] , p & lt;0.0001); 9- fold higher risk of ischaemic heart disease (OR [95% CI] 9.1[8.1-10.2] , p & lt;0.0001); 8- fold higher risk of renal failure (7.9 [6.9-9.1], p & lt;0.0001); 6- fold higher risk of stroke (6.2 [5.2-7.2], p & lt;0.0001); 6- fold higher risk of myocardial infarction (6.4 [5.6-7.3], p & lt;0.0001); 6-fold higher risk of angina (5.9 [5.3;6.8], p & lt;0.0001); 5-fold higher risk of arrhythmia (4.8 [4.2-5.4], p & lt;0.0001) 5- fold higher risk of peripheral arterial disease (4.8 [3.7-6.1], p & lt;0.0001) and 4- fold higher risk of heart failure (3.6 [3.1-4.1], p & lt;0.0001). Conclusions: Men with a history of hypospadias are at significantly increased risk of admission for treatment for cardiovascular and metabolic conditions, especially ischaemic heart disease, diabetes and renal failure. The mechanisms underlying this observed increase are unclear and merit further evaluation.
    Type of Medium: Online Resource
    ISSN: 2472-1972
    URL: Article
    DOI: 10.1210/jendso/bvaa046.1246
    Language: English
    Publisher: The Endocrine Society
    Publication Date: 2020
    detail.hit.zdb_id: 2881023-5
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  • 2
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    A 20-year population study of peripartum cardiomyopathy
    Oxford University Press (OUP) ; 2023
    In:  European Heart Journal ( 2023-10-07)
    Details
    In: European Heart Journal, Oxford University Press (OUP), ( 2023-10-07)
    Abstract: The epidemiology of peripartum cardiomyopathy (PPCM) in Europe is poorly understood and data on long-term outcomes are lacking. A retrospective, observational, population-level study of validated cases of PPCM in Scotland from 1998 to 2017 was conducted. Methods Women hospitalized with presumed de novo left ventricular systolic dysfunction around the time of pregnancy and no clear alternative cause were included. Each case was matched to 10 controls. Incidence and risk factors were identified. Morbidity and mortality were examined in mothers and children. Results The incidence of PPCM was 1 in 4950 deliveries. Among 225 women with PPCM, obesity, gestational hypertensive disorders, and multi-gestation were found to be associated with having the condition. Over a median of 8.3 years (9.7 years for echocardiographic outcomes), 8% of women with PPCM died and 75% were rehospitalized for any cause at least once. Mortality and rehospitalization rates in women with PPCM were ∼12- and ∼3-times that of controls, respectively. The composite of all-cause death, mechanical circulatory support, or cardiac transplantation occurred in 14%. LV recovery occurred in 76% and, of those who recovered, 13% went on to have a decline in LV systolic function despite initial recovery. The mortality rate for children born to women with PPCM was ∼5-times that of children born to controls and they had an ∼3-times greater incidence of cardiovascular disease over a median of 8.8 years. Conclusions PPCM affected 1 in 4950 women around the time of pregnancy. The condition is associated with considerable morbidity and mortality for the mother and child. There should be a low threshold for investigating at-risk women. Long term follow-up, despite apparent recovery, should be considered.
    Type of Medium: Online Resource
    ISSN: 0195-668X , 1522-9645
    URL: Article
    DOI: 10.1093/eurheartj/ehad626
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2001908-7
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  • 3
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    Correction to: Health-related qualify of life, angina type and coronary artery disease in patients with stable chest pain
    Springer Science and Business Media LLC ; 2020
    In:  Health and Quality of Life Outcomes Vol. 18, No. 1 ( 2020-12)
    Details
    In: Health and Quality of Life Outcomes, Springer Science and Business Media LLC, Vol. 18, No. 1 ( 2020-12)
    Abstract: An amendment to this paper has been published and can be accessed via the original article.
    Type of Medium: Online Resource
    ISSN: 1477-7525
    URL: Article
    DOI: 10.1186/s12955-020-01443-8
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2098765-1
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  • 4
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    Effects of Sex Hormones on Vascular Reactivity in Boys With Hypospadias
    The Endocrine Society ; 2023
    In:  The Journal of Clinical Endocrinology & Metabolism ( 2023-09-06)
    Details
    In: The Journal of Clinical Endocrinology & Metabolism, The Endocrine Society, ( 2023-09-06)
    Abstract: Arteries from boys with hypospadias demonstrate hypercontractility and impaired vasorelaxation. The role of sex hormones in these responses in unclear. Aims We compared effects of sex steroids on vascular reactivity in healthy boys and boys with hypospadias. Methods Excess foreskin tissue was obtained from 11 boys undergoing hypospadias repair (cases) and 12 undergoing routine circumcision (controls) (median age [range], 1.5 [1.2-2.7] years) and small resistance arteries were isolated. Vessels were mounted on wire myographs and vascular reactivity was assessed in the absence/presence of 17β-estradiol, dihydrotestosterone (DHT), and testosterone. Results In controls, testosterone and 17β-estradiol increased contraction (percent of maximum contraction [Emax]: 83.74 basal vs 125.4 after testosterone, P & lt; .0002; and 83.74 vs 110.2 after estradiol, P = .02). 17β-estradiol reduced vasorelaxation in arteries from controls (Emax: 10.6 vs 15.6 to acetylcholine, P & lt; .0001; and Emax: 14.6 vs 20.5 to sodium nitroprusside, P & lt; .0001). In hypospadias, testosterone (Emax: 137.9 vs 107.2, P = .01) and 17β-estradiol (Emax: 156.9 vs 23.6, P & lt; .0001) reduced contraction. Androgens, but not 17β-estradiol, increased endothelium-dependent and endothelium-independent vasorelaxation in cases (Emax: 77.3 vs 51.7 with testosterone, P = .02; and vs 48.2 with DHT to acetylcholine, P = .0001; Emax: 43.0 vs 39.5 with testosterone, P = .02; and 39.6 vs 37.5 with DHT to sodium nitroprusside, P = .04). Conclusion In healthy boys, testosterone and 17β-estradiol promote a vasoconstrictor phenotype, whereas in boys with hypospadias, these sex hormones reduce vasoconstriction, with androgens promoting vasorelaxation. Differences in baseline artery function may therefore be sex hormone-independent and the impact of early-life variations in androgen exposure on vascular function needs further study.
    Type of Medium: Online Resource
    ISSN: 0021-972X , 1945-7197
    URL: Article
    DOI: 10.1210/clinem/dgad525
    RVK:
    XA 10000
    Language: English
    Publisher: The Endocrine Society
    Publication Date: 2023
    detail.hit.zdb_id: 2026217-6
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  • 5
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    Effect of Empagliflozin on Left Ventricular Volumes in Patients With Type 2 Diabetes, or Prediabetes, and Heart Failure With Reduced Ejection Fraction (SUGAR-DM-HF)
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 143, No. 6 ( 2021-02-09), p. 516-525
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 143, No. 6 ( 2021-02-09), p. 516-525
    Abstract: Sodium-glucose cotransporter 2 inhibitors reduce the risk of heart failure hospitalization and cardiovascular death in patients with heart failure and reduced ejection fraction (HFrEF). However, their effects on cardiac structure and function in HFrEF are uncertain. Methods: We designed a multicenter, randomized, double-blind, placebo-controlled trial (the SUGAR-DM-HF trial [Studies of Empagliflozin and Its Cardiovascular, Renal and Metabolic Effects in Patients With Diabetes Mellitus, or Prediabetes, and Heart Failure]) to investigate the cardiac effects of empagliflozin in patients in New York Heart Association functional class II to IV with a left ventricular (LV) ejection fraction ≤40% and type 2 diabetes or prediabetes. Patients were randomly assigned 1:1 to empagliflozin 10 mg once daily or placebo, stratified by age ( 〈 65 and ≥65 years) and glycemic status (diabetes or prediabetes). The coprimary outcomes were change from baseline to 36 weeks in LV end-systolic volume indexed to body surface area and LV global longitudinal strain both measured using cardiovascular magnetic resonance. Secondary efficacy outcomes included other cardiovascular magnetic resonance measures (LV end-diastolic volume index, LV ejection fraction), diuretic intensification, symptoms (Kansas City Cardiomyopathy Questionnaire Total Symptom Score, 6-minute walk distance, B-lines on lung ultrasound, and biomarkers (including N-terminal pro-B-type natriuretic peptide). Results: From April 2018 to August 2019, 105 patients were randomly assigned: mean age 68.7 (SD, 11.1) years, 77 (73.3%) male, 82 (78.1%) diabetes and 23 (21.9%) prediabetes, mean LV ejection fraction 32.5% (9.8%), and 81 (77.1%) New York Heart Association II and 24 (22.9%) New York Heart Association III. Patients received standard treatment for HFrEF. In comparison with placebo, empagliflozin reduced LV end-systolic volume index by 6.0 (95% CI, –10.8 to –1.2) mL/m 2 ( P =0.015). There was no difference in LV global longitudinal strain. Empagliflozin reduced LV end-diastolic volume index by 8.2 (95% CI, –13.7 to –2.6) mL/m 2 ( P =0.0042) and reduced N-terminal pro-B-type natriuretic peptide by 28% (2%–47%), P =0.038. There were no between-group differences in other cardiovascular magnetic resonance measures, diuretic intensification, Kansas City Cardiomyopathy Questionnaire Total Symptom Score, 6-minute walk distance, or B-lines. Conclusions: The sodium-glucose cotransporter 2 inhibitor empagliflozin reduced LV volumes in patients with HFrEF and type 2 diabetes or prediabetes. Favorable reverse LV remodeling may be a mechanism by which sodium-glucose cotransporter 2 inhibitors reduce heart failure hospitalization and mortality in HFrEF. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03485092.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/CIRCULATIONAHA.120.052186
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1466401-X
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  • 6
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    Discussing Weight Management With Type 2 Diabetes Patients in Primary Care Using the Small Talk Big Difference Intervention: Protocol for a Randomized Controlled Trial
    JMIR Publications Inc. ; 2019
    In:  JMIR Research Protocols Vol. 8, No. 2 ( 2019-02-15), p. e12162-
    Details
    In: JMIR Research Protocols, JMIR Publications Inc., Vol. 8, No. 2 ( 2019-02-15), p. e12162-
    Type of Medium: Online Resource
    ISSN: 1929-0748
    URL: Article
    DOI: 10.2196/12162
    Language: English
    Publisher: JMIR Publications Inc.
    Publication Date: 2019
    detail.hit.zdb_id: 2719222-2
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  • 7
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    Diagnostic accuracy of the Thessaly test, standardised clinical history and other clinical examination tests (Apley’s, McMurray’s and joint line tenderness) for meniscal tears in comparison with magnetic resonance imaging diagnosis
    National Institute for Health and Care Research ; 2015
    In:  Health Technology Assessment Vol. 19, No. 62 ( 2015-08), p. 1-62
    Details
    In: Health Technology Assessment, National Institute for Health and Care Research, Vol. 19, No. 62 ( 2015-08), p. 1-62
    Abstract: Reliable non-invasive diagnosis of meniscal tears is difficult. Magnetic resonance imaging (MRI) is often used but is expensive and incidental findings are problematic. There are a number of physical examination tests for the diagnosis of meniscal tears that are simple, cheap and non-invasive. Objectives To determine the diagnostic accuracy of the Thessaly test and to determine if the Thessaly test (alone or in combination with other physical tests) can obviate the need for further investigation by MRI or arthroscopy for patients with a suspected meniscal tear. Design Single-centre prospective diagnostic accuracy study. Setting Although the study was performed in a secondary care setting, it was designed to replicate the results that would have been achieved in a primary care setting. Participants Two cohorts of patients were recruited: patients with knee pathology ( n  = 292) and a control cohort with no knee pathology ( n  = 75). Main outcome measures Sensitivity, specificity and diagnostic accuracy of the Thessaly test in determining the presence of meniscal tears. Methods Participants were assessed by both a primary care clinician and a musculoskeletal clinician. Both clinicians performed the Thessaly test, McMurray’s test, Apley’s test, joint line tenderness test and took a standardised clinical history from the patient. Results The Thessaly test had a sensitivity of 0.66, a specificity of 0.39 and a diagnostic accuracy of 54% when utilised by primary care clinicians. This compared with a sensitivity of 0.62, a specificity of 0.55 and diagnostic accuracy of 59% when used by musculoskeletal clinicians. The diagnostics accuracy of the other tests when used by primary care clinicians was 54% for McMurray’s test, 53% for Apley’s test, 54% for the joint line tenderness test and 55% for clinical history. For primary care clinicians, age and past history of osteoarthritis were both significant predictors of MRI diagnosis of meniscal tears. For musculoskeletal clinicians age and a positive diagnosis of meniscal tears on clinical history taking were significant predictors of MRI diagnosis. No physical tests were significant predictors of MRI diagnosis in our multivariate models. The specificity of MRI diagnosis was tested in subgroup of patients who went on to have a knee arthroscopy and was found to be low [0.53 (95% confidence interval 0.28 to 0.77)], although the sensitivity was 1.0. Conclusions The Thessaly test was no better at diagnosing meniscal tears than other established physical tests. The sensitivity, specificity and diagnostic accuracy of all physical tests was too low to be of routine clinical value as an alternative to MRI. Caution needs to be exercised in the indiscriminate use of MRI scanning in the identification of meniscal tears in the diagnosis of the painful knee, due to the low specificity seen in the presence of concomitant knee pathology. Further research is required to determine the true diagnostic accuracy and cost-effectiveness of MRI for the detection of meniscal tears. Trial registration Current Controlled Trial ISRCTN43527822. Funding The National Institute for Health Research Health Technology Assessment programme.
    Type of Medium: Online Resource
    ISSN: 1366-5278 , 2046-4924
    URL: Article
    DOI: 10.3310/hta19620
    Language: English
    Publisher: National Institute for Health and Care Research
    Publication Date: 2015
    detail.hit.zdb_id: 2059206-1
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  • 8
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    Rationale and design of the Coronary Microvascular Angina Cardiac Magnetic Resonance Imaging (CorCMR) diagnostic study: the CorMicA CMR sub-study
    BMJ ; 2018
    In:  Open Heart Vol. 5, No. 2 ( 2018-12), p. e000924-
    Details
    In: Open Heart, BMJ, Vol. 5, No. 2 ( 2018-12), p. e000924-
    Abstract: Angina with no obstructive coronary artery disease (ANOCA) is a common syndrome with unmet clinical needs. Microvascular and vasospastic angina are relevant but may not be diagnosed without measuring coronary vascular function. The relationship between cardiovascular magnetic resonance (CMR)-derived myocardial blood flow (MBF) and reference invasive coronary function tests is uncertain. We hypothesise that multiparametric CMR assessment will be clinically useful in the ANOCA diagnostic pathway. Methods/analysis The Stratified Medical Therapy Using Invasive Coronary Function Testing In Angina (CorMicA) trial is a prospective, blinded, randomised, sham-controlled study comparing two management approaches in patients with ANOCA. We aim to recruit consecutive patients with stable angina undergoing elective invasive coronary angiography. Eligible patients with ANOCA (n=150) will be randomised to invasive coronary artery function-guided diagnosis and treatment (intervention group) or not (control group). Based on these test results, patients will be stratified into disease endotypes: microvascular angina, vasospastic angina, mixed microvascular/vasospastic angina, obstructive epicardial coronary artery disease and non-cardiac chest pain. After randomisation in CorMicA, subjects will be invited to participate in the Coronary Microvascular Angina Cardiac Magnetic Resonance Imaging (CorCMR) substudy. Patients will undergo multiparametric CMR and have assessments of MBF (using a novel pixel-wise fully quantitative method), left ventricular function and mass, and tissue characterisation (T1 mapping and late gadolinium enhancement imaging). Abnormalities of myocardial perfusion and associations between MBF and invasive coronary artery function tests will be assessed. The CorCMR substudy represents the largest cohort of ANOCA patients with paired multiparametric CMR and comprehensive invasive coronary vascular function tests. Ethics/dissemination The CorMicA trial and CorCMR substudy have UK REC approval (ref.16/WS/0192). Trial registration number NCT03193294 .
    Type of Medium: Online Resource
    ISSN: 2053-3624
    URL: Article
    DOI: 10.1136/openhrt-2018-000924
    Language: English
    Publisher: BMJ
    Publication Date: 2018
    detail.hit.zdb_id: 2747269-3
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  • 9
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    Vitamin K for kidney transplant organ recipients: investigating vessel stiffness (ViKTORIES): study rationale and protocol of a randomised controlled trial
    BMJ ; 2020
    In:  Open Heart Vol. 7, No. 2 ( 2020-07), p. e001070-
    Details
    In: Open Heart, BMJ, Vol. 7, No. 2 ( 2020-07), p. e001070-
    Abstract: Renal transplant recipients (RTRs) exhibit increased vascular stiffness and calcification; these parameters are associated with increased cardiovascular risk. Activity of endogenous calcification inhibitors such as matrix gla protein (MGP) is dependent on vitamin K. RTRs commonly have subclinical vitamin K deficiency. The Vitamin K in kidney Transplant Organ Recipients: Investigating vEssel Stiffness (ViKTORIES) study assesses whether vitamin K supplementation reduces vascular stiffness and calcification in a diverse population of RTR. Methods and analysis ViKTORIES ( ISRCTN22012044 ) is a single-centre, phase II, parallel-group, randomised, double-blind, placebo-controlled trial of the effect of vitamin K supplementation in 90 prevalent RTR. Participants are eligible if they have a functioning renal transplant for 〉 1 year. Those on warfarin, with atrial fibrillation, estimated glomerular filtration rate 〈 15 mL/min/1.73 m 2 or contraindications to MRI are excluded. Treatment is with vitamin K (menadiol diphosphate) 5 mg three times per week for 1 year or matching placebo. All participants have primary and secondary endpoint measures at 0 and 12 months. The primary endpoint is ascending aortic distensibility on cardiac MR imaging. Secondary endpoints include vascular calcification (coronary artery calcium score by CT), cardiac structure and function on MR, carotid-femoral pulse wave velocity, serum uncarboxylated MGP, transplant function, proteinuria and quality of life. The study is powered to detect 1.0×10 –3 mm Hg -1 improvement in ascending aortic distensibility in the vitamin K group relative to placebo at 12 months. Analyses will be conducted as between-group differences at 12 months by intention to treat. Discussion This trial may identify a novel, inexpensive and low-risk treatment to improve surrogate markers of cardiovascular risk in RTR.
    Type of Medium: Online Resource
    ISSN: 2053-3624
    URL: Article
    DOI: 10.1136/openhrt-2019-001070
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2747269-3
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  • 10
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    ASSESSMENT OF THE REPRODUCIBILITY OF SEMI-AUTOMATED FLOW MEDIATED DILATION MEASUREMENTS PERFORMED ON SEPARATE DAYS
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Journal of Hypertension Vol. 39, No. Supplement 1 ( 2021-04), p. e228-
    Details
    In: Journal of Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 39, No. Supplement 1 ( 2021-04), p. e228-
    Type of Medium: Online Resource
    ISSN: 0263-6352 , 1473-5598
    URL: Article
    DOI: 10.1097/01.hjh.0000747028.12809.e1
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2017684-3
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