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Coronary Artery Disease: HELP
Articles by Alun D. Hughes
Based on 6 articles published since 2010
(Why 6 articles?)

Between 2010 and 2020, Alun D. Hughes wrote the following 6 articles about Coronary Artery Disease.
+ Citations + Abstracts
1 Clinical Trial Attenuated systemic microvascular function in men with coronary artery disease is associated with angina but not explained by atherosclerosis. 2013

Strain, W David / Hughes, Alun D / Mayet, Jamil / Wright, Andrew R / Kooner, Jaspal / Chaturvedi, Nish / Shore, Angela C. ·Institute of Biomedical and Clinical Science, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, University of Exeter, Exeter, UK. ·Microcirculation · Pubmed #23682790.

ABSTRACT: INTRODUCTION: Refractory angina is the occurrence of clinical symptoms despite maximal therapy. We investigated associations between microvascular function, atherosclerotic burden, and clinical symptoms in subjects with CAD. METHODS: Skin microvascular response to heating and ischemia was assessed in 167 male volunteers by laser Doppler fluximetry; 82 with CAD on maximal therapy and 85 with no known CAD (noCAD). CAC scores, carotid IMT, and femoral IMT were measured and symptoms were scored using the Rose angina questionnaire. RESULTS: Patients with CAD had poorer microvascular response to heating (114[95% CI 106-122]au CAD vs. 143[134-153]au no CAD; p < 0.0001) and ischemia (42[38-46]au CAD vs. 53[78-58]au. noCAD; p = 0.001). Thirty-eight percent of the noCAD group had elevated CAC scores. There were no associations between markers of atherosclerosis and microvascular function. Forty-two percent of the CAD group had refractory angina. This was associated with impaired microvascular function compared to those with elevated CAC scores but no symptoms (109 [95-124]au vs. 131[122-140]au; p = 0.008). CONCLUSIONS: Men with symptomatic CAD have poorer microvascular function compared to individuals without CAD. Microvascular function does not correlate with atherosclerosis, but is impaired in individuals with refractory angina. Microvascular dysfunction may play a role in the symptomatology of angina.

2 Article Effectiveness and cost-effectiveness of a Yoga-based Cardiac Rehabilitation (Yoga-CaRe) program following acute myocardial infarction: Study rationale and design of a multi-center randomized controlled trial. 2019

Chandrasekaran, Ambalam M / Kinra, Sanjay / Ajay, Vamadevan S / Chattopadhyay, Kaushik / Singh, Kalpana / Singh, Kavita / Praveen, Pradeep A / Soni, Divya / Devarajan, Raji / Kondal, Dimple / Manchanda, Subhash C / Hughes, Alun D / Chaturvedi, Nishi / Roberts, Ian / Pocock, Stuart / Ebrahim, Shah / Reddy, Kolli S / Tandon, Nikhil / Prabhakaran, Dorairaj / Anonymous2431017. ·Centre for Chronic Disease Control, New Delhi, India. · London School of Hygiene and Tropical Medicine, London, UK. · Centre for Chronic Disease Control, New Delhi, India; Public Health Foundation of India, Gurgaon, India. · London School of Hygiene and Tropical Medicine, London, UK; The University of Nottingham, Nottingham, UK. · Centre for Chronic Disease Control, New Delhi, India; All India Institute of Medical Sciences, New Delhi, India. · Sir Ganga Ram Hospital, New Delhi, India. · University College London, London, UK; Imperial College London, London, UK. · All India Institute of Medical Sciences, New Delhi, India. · Centre for Chronic Disease Control, New Delhi, India; London School of Hygiene and Tropical Medicine, London, UK; Public Health Foundation of India, Gurgaon, India; Rollins School of Public Health, Emory University, Atlanta, GA, USA. Electronic address: dprabhakaran@ccdcindia.org. ·Int J Cardiol · Pubmed #30661847.

ABSTRACT: BACKGROUND: Cardiac rehabilitation (CR) is a standard treatment for secondary prevention of acute myocardial infarction (AMI) in high income countries (HICs), but it is inaccessible to most patients in India due to high costs and skills required for multidisciplinary CR teams. We developed a low-cost and scalable CR program based on culturally-acceptable practice of yoga (Yoga-CaRe). In this paper, we report the rationale and design for evaluation of its effectiveness and cost-effectiveness. METHODS: This is a multi-center, single-blind, two-arm parallel-group randomized controlled trial across 22 cardiac care hospitals in India. Four thousand patients aged 18-80 years with AMI will be recruited and randomized 1:1 to receive Yoga-CaRe program (13 sessions supervised by an instructor and encouragement to self-practice daily) or enhanced standard care (3 sessions of health education) delivered over a period of three months. Participants will be followed 3-monthly till the end of the trial. The co-primary outcomes are a) time to occurrence of first cardiovascular event (composite of all-cause mortality, non-fatal myocardial infarction, non-fatal stroke and emergency cardiovascular hospitalization), and b) quality of life (Euro-QoL-5L) at 12 weeks. Secondary outcomes include need for revascularization procedures, return to pre-infarct activities, tobacco cessation, medication adherence, and cost-effectiveness of the intervention. CONCLUSION: This trial will alone contribute >20% participants to existing meta-analyses of randomized trials of CR worldwide. If Yoga-CaRe is found to be effective, it has the potential to save millions of lives and transform care of AMI patients in India and other low and middle income country settings.

3 Article Application of the DILEMMA score to improve lesion selection for invasive physiological assessment. 2019

Michail, Michael / Dehbi, Hakim-Moulay / Nerlekar, Nitesh / Davies, Justin E / Sharp, Andrew S P / Talwar, Suneel / Cameron, James D / Brown, Adam J / Wong, Dennis T / Mathur, Anthony / Hughes, Alun D / Narayan, Om. ·Monash Cardiovascular Research Centre and MonashHeart, Melbourne, Australia. · Institute of Cardiovascular Science, University College London, London, United Kingdom. · Cancer Research UK & UCL Cancer Trials Centre, University College London, London, United Kingdom. · Imperial College London, London, United Kingdom. · Royal Devon and Exeter NHS Trust, Exeter, United Kingdom. · Royal Bournemouth and Christchurch NHS Trust, Bournemouth, United Kingdom. · Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom. ·Catheter Cardiovasc Interv · Pubmed #30604558.

ABSTRACT: OBJECTIVES: We sought to assess the validity of the DILEMMA score against instantaneous wave-free ratio (iFR) and evaluate its utility in rationalizing the number of patients referred for invasive physiological assessment. BACKGROUND: The DILEMMA score is a validated angiographic scoring tool incorporating minimal lumen diameter, lesion length and subtended myocardial area that has been shown to predict the functional significance of lesions as assessed by fractional flow reserve (FFR). METHODS: Patients in the DEFINE-FLAIR study who had coronary stenosis of intermediate severity were randomized to either FFR or iFR. DILEMMA score was calculated retrospectively on a subset of this cohort by operators blinded to FFR or iFR values. RESULTS: Three hundred and forty-six lesions (181 assessed by FFR; 165 by iFR) from 259 patients (mean age 66.0 years, 79% male) were included. A DILEMMA score ≤ 2 had a negative predictive value of 96.3% and 95.7% for identifying lesions with FFR >0.80 and iFR >0.89, respectively. A DILEMMA score ≥ 9 had a positive predictive value of 88.9% and 100% for identifying lesions with FFR ≤0.80 and iFR ≤0.89, respectively. The receiver operating characteristic area under the curve values for DILEMMA score to predict FFR ≤0.80 and iFR ≤0.89 were 0.83 (95% CI 0.77-0.90) and 0.82 (0.75-0.89) respectively. A DILEMMA score ≤ 2 or ≥9 occurred in 172 of the 346 lesions (49.7%). CONCLUSIONS: Using DILEMMA score in patients with coronary stenosis of intermediate severity may reduce the need for pressure wire use, offering potential cost-savings and minimizing the risks associated with invasive physiological lesion assessment.

4 Article Urinary proteomic biomarkers to predict cardiovascular events. 2015

Brown, Catriona E / McCarthy, Nina S / Hughes, Alun D / Sever, Peter / Stalmach, Angelique / Mullen, William / Dominiczak, Anna F / Sattar, Naveed / Mischak, Harald / Thom, Simon / Mayet, Jamil / Stanton, Alice V / Delles, Christian. ·Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK. · Royal College of Surgeons in Ireland, Dublin, Ireland. · University of Western Australia, Perth, Western Australia. · Imperial College London, London, UK. · Mosaiques Diagnostics, Hannover, Germany. ·Proteomics Clin Appl · Pubmed #25786980.

ABSTRACT: PURPOSE: We have previously demonstrated associations between the urinary proteome profile and coronary artery disease (CAD) in cross-sectional studies. Here, we evaluate the potential of a urinary proteomic panel as a predictor of CAD in the hypertensive atherosclerotic cardiovascular disease (HACVD) substudy population of the Anglo-Scandinavian Cardiac Outcomes Trial study. EXPERIMENTAL DESIGN: Thirty-seven cases with primary CAD endpoint were matched for sex and age to controls who had not reached a CAD endpoint during the study. Spot urine samples were analyzed using CE coupled to Micro-TOF MS. A previously developed 238-marker CE-MS model for diagnosis of CAD (CAD238 ) was assessed for its predictive potential. RESULTS: Sixty urine samples (32 cases; 28 controls; 88% male, mean age 64 ± 5 years) were analyzed. There was a trend toward healthier values in controls for the CAD model classifier (-0.432 ± 0.326 versus -0.587 ± 0.297, p = 0.170), and the CAD model showed statistical significance on Kaplan-Meier survival analysis p = 0.021. We found 190 individual markers out of 1501 urinary peptides that separated cases and controls (AUC >0.6). Of these, 25 peptides were also components of CAD238 . CONCLUSION AND CLINICAL RELEVANCE: A urinary proteome panel originally developed in a cross-sectional study predicts CAD endpoints independent of age and sex in a well-controlled prospective study.

5 Article Pre-angioplasty instantaneous wave-free ratio pullback provides virtual intervention and predicts hemodynamic outcome for serial lesions and diffuse coronary artery disease. 2014

Nijjer, Sukhjinder S / Sen, Sayan / Petraco, Ricardo / Escaned, Javier / Echavarria-Pinto, Mauro / Broyd, Christopher / Al-Lamee, Rasha / Foin, Nicolas / Foale, Rodney A / Malik, Iqbal S / Mikhail, Ghada W / Sethi, Amarjit S / Al-Bustami, Mahmud / Kaprielian, Raffi R / Khan, Masood A / Baker, Christopher S / Bellamy, Michael F / Hughes, Alun D / Mayet, Jamil / Francis, Darrel P / Di Mario, Carlo / Davies, Justin E R. ·Imperial College London, London, United Kingdom. · Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain. · Institute of Cardiovascular Science, University College London, London, United Kingdom. · National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Imperial College, London, United Kingdom. · Imperial College London, London, United Kingdom. Electronic address: justin.davies@imperial.ac.uk. ·JACC Cardiovasc Interv · Pubmed #25459526.

ABSTRACT: OBJECTIVES: The aim of this study was to perform hemodynamic mapping of the entire vessel using motorized pullback of a pressure guidewire with continuous instantaneous wave-free ratio (iFR) measurement. BACKGROUND: Serial stenoses or diffuse vessel narrowing hamper pressure wire-guided management of coronary stenoses. Characterization of functional relevance of individual stenoses or narrowed segments constitutes an unmet need in ischemia-driven percutaneous revascularization. METHODS: The study was performed in 32 coronary arteries with tandem and/or diffusely diseased vessels. An automated iFR physiological map, integrating pullback speed and physiological information, was built using dedicated software to calculate physiological stenosis severity, length, and intensity (ΔiFR/mm). This map was used to predict the best-case post-percutaneous coronary intervention (PCI) iFR (iFRexp) according to the stented location, and this was compared with the observed iFR post-PCI (iFRobs). RESULTS: After successful PCI, the mean difference between iFRexp and iFRobs was small (mean difference: 0.016 ± 0.004) with a strong relationship between ΔiFRexp and ΔiFRobs (r = 0.97, p < 0.001). By identifying differing iFR intensities, it was possible to identify functional stenosis length and quantify the contribution of each individual stenosis or narrowed segment to overall vessel stenotic burden. Physiological lesion length was shorter than anatomic length (12.6 ± 1.5 vs. 23.3 ± 1.3, p < 0.001), and targeting regions with the highest iFR intensity predicted significant improvement post-PCI (r = 0.86, p < 0.001). CONCLUSIONS: iFR measurements during continuous resting pressure wire pullback provide a physiological map of the entire coronary vessel. Before a PCI, the iFR pullback can predict the hemodynamic consequences of stenting specific stenoses and thereby may facilitate the intervention and stenting strategy.

6 Article The relationship between metabolic risk factors and incident cardiovascular disease in Europeans, South Asians, and African Caribbeans: SABRE (Southall and Brent Revisited) -- a prospective population-based study. 2013

Tillin, Therese / Hughes, Alun D / Mayet, Jamil / Whincup, Peter / Sattar, Naveed / Forouhi, Nita G / McKeigue, Paul M / Chaturvedi, Nish. ·International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom. t.tillin@imperial.ac.uk ·J Am Coll Cardiol · Pubmed #23500273.

ABSTRACT: OBJECTIVES: This study sought to determine whether ethnic differences in diabetes, dyslipidemia, and ectopic fat deposition account for ethnic differences in incident cardiovascular disease. BACKGROUND: Coronary heart disease risks are elevated in South Asians and are lower in African Caribbeans compared with Europeans. These ethnic differences map to lipid patterns and ectopic fat deposition. METHODS: Cardiovascular risk factors were assessed in 2,049 Europeans, 1,517 South Asians, and 630 African Caribbeans from 1988 through 1991 (mean age: 52.4 ± 6.9 years). Fatal and nonfatal events were captured over a median 20.5-year follow-up. Subhazard ratios (SHR) were calculated using competing risks regression. RESULTS: Baseline diabetes prevalence was more than 3 times greater in South Asians and African Caribbeans than in Europeans. South Asians were more and African Caribbeans were less centrally obese and dyslipidemic than Europeans. Compared with Europeans, coronary heart disease incidence was greater in South Asians and less in African Caribbeans. The age- and sex-adjusted South Asian versus European SHR was 1.70 (95% confidence interval [CI]: 1.52 to 1.91, p < 0.001) and remained significant (1.45, 95% CI: 1.28 to 1.64, p < 0.001) when adjusted for waist-to-hip ratio. The African Caribbean versus European age- and sex-adjusted SHR of 0.64 (95% CI: 0.52 to 0.79, p < 0.001) remained significant when adjusted for high-density lipoprotein and low-density lipoprotein cholesterol (0.74, 95% CI: 0.60 to 0.92, p = 0.008). Compared with Europeans, South Asians and African Caribbeans experienced more strokes (age- and sex-adjusted SHR: 1.45 [95% CI: 1.17 to 1.80, p = 0.001] and 1.50 [95% CI: 1.13 to 2.00, p = 0.005], respectively), and this differential was more marked in those with diabetes (age-adjusted SHR: 1.97 [95% CI: 1.16 to 3.35, p = 0.038 for interaction] and 2.21 [95% CI: 1.14 to 4.30, p = 0.019 for interaction]). CONCLUSIONS: Ethnic differences in measured metabolic risk factors did not explain differences in coronary heart disease incidence. The apparently greater association between diabetes and stroke risk in South Asians and African Caribbeans compared with Europeans merits further study.