Mark Ainslie | The University of Manchester (original) (raw)

Papers by Mark Ainslie

Research paper thumbnail of Three-year outcomes and reconnection patterns after initial contact force guided pulmonary vein isolation for paroxysmal atrial fibrillation

Journal of Cardiovascular Electrophysiology, Sep 1, 2017

Background and Objective Contact force (CF) sensing is a novel technology used for catheter ablat... more Background and Objective Contact force (CF) sensing is a novel technology used for catheter ablation of atrial fibrillation (AF). We compared the single procedure success of CF-guided pulmonary vein isolation (PVI) with that of non-CF guided PVI during a three-year (1095 days) follow up period and analyzed the pattern of pulmonary vein (PV) reconnection. Methods A cohort of 167 subjects (68 CF vs. 99 Non-CF) with paroxysmal AF were included in the study. Atrial arrhythmia (AA) recurrence was defined as documented AF, atrial flutter, or atrial tachycardia lasting > 30 seconds and occurring after 90 days. Results Subjects in the CF group showed a statistically non-significant improvement in atrial arrhythmia free survival compared to those in the non-CF group (66.2% vs. 51.5%; P value-0.06). A greater propensity for reconnection was noted around the right-sided PVs compared to left-sided PVs related in both catheter ablation groups. For example, in the CF group 36% of right-sided segments reconnected compared to 16% of left-sided segments (P value <0.01). Conclusions A greater propensity for reconnection was noted around the right sided PV segments in both the CF and non-CF groups. The explanation for this finding was related to greater catheter instability around the right sided veins. Further research is needed to explore the utility of a 'real-time' composite indicator that includes RF energy, CF and catheter stability in predicting transmural lesion formation during catheter ablation. CF Reconnection Patterns and 3-Y FU Nair GM et al.

Research paper thumbnail of Multiparametric Cardiovascular Magnetic Resonance Assessment of Pacemaker-Induced Alterations in Ventricular Activation and Function

Research paper thumbnail of Decompensated heart failure secondary to hypocalcaemia post coronary artery bypass grafting

BMJ case reports, Jan 15, 2011

A man presented with an exacerbation of heart failure following coronary artery bypass grafting. ... more A man presented with an exacerbation of heart failure following coronary artery bypass grafting. He was found to be severely hypocalcaemic secondary to a combination of decreased parathyroid reserve and severe vitamin D deficiency. On treatment of his hypocalcaemia, all symptoms resolved. This case highlights the importance of recognising that metabolic derangement can affect cardiac function.

Research paper thumbnail of Voxel-wise quantification of myocardial blood flow with cardiovascular magnetic resonance: effect of variations in methodology and validation with positron emission tomography

Journal of Cardiovascular Magnetic Resonance, 2014

Research paper thumbnail of A Pilot Study

cardiovascular magnetic f acute cardiac significant ACAR. Significant ACAR was associated with a ... more cardiovascular magnetic f acute cardiac significant ACAR. Significant ACAR was associated with a reduction in circumferential strain (−12.7 ± 2.5 % vs.-13.7 ± 3.6%, p = 0.047) but there was considerable overlap between groups. Whilst trends were observed between ACAR and Miller et al. Journal of Cardiovascular Magnetic Resonance 2014, 16:52

Research paper thumbnail of Multiparametric assessment of apical versus septal pacing study using Cardiac Magnetic Imaging

Evaluation of left ventricular torsion using cardiac MRI. Validation of feature tracking. Ainslie... more Evaluation of left ventricular torsion using cardiac MRI. Validation of feature tracking. Ainslie MP, Reid A, Miller C, Clark D, Francis L, Schmitt M. Journal of cardiovascular magnetic resonance. 2015. 17 (suppl 1): O47. MAPS; acute safety data of the St Jude accenttendril IPG system during prolonged max power CMR scanning. Ainslie M, Reid A, Miller C, Clark D, Brown B, Fox D, Davidson N, Trafford A, Schmitt M. Journal of cardiovascular magnetic resonance. 2015. 17 (Suppl 1): M6. Multiparametric CMR Assessment of RV apical versus septal pacing study (MAPS)Preliminary acute hemodynamic findings. Ainslie M, Miller C, Brown B, Fox D, Davidson N, Trafford A, Schmitt M. Heart 2013; 99: suppl 2 A50. Multiparametric CMR assessment of RV apical versus septal Pacing Study (MAPS) preliminary acute hemodynamic findings. Ainslie M, Miller CA, Brown B, Davidson N, Fox DJ, Schmitt M. Journal of Cardiovascular Magnetic Resonance. 2013; 15(suppl 1):O85.

Research paper thumbnail of A pain in the leg following angiography

This case illustrates a complication following deployment of the Angioseal® vascular closure devi... more This case illustrates a complication following deployment of the Angioseal® vascular closure device after routine angiography. The AngioSeal device is a percutaneous, bioabsorbable, collagen-based hemostatic plug deployed to seal the arterial puncture. We describe a 69-year-old gentleman who presented with unilateral leg cramps 1 week post-procedure. When seen in the cardiology clinic, a magnetic resonance imaging angiogram was requested, which showed a filling defect in the right popliteal artery. The collagen seal had embolized and was subsequently removed by the vascular surgeons.

Research paper thumbnail of The MindfulBreather: Motion Guided Mindfulness

Frontiers in human neuroscience, 2017

For millennia, humans have focused their attention on the breath to develop mindfulness, but find... more For millennia, humans have focused their attention on the breath to develop mindfulness, but finding a scientific way to harness mindful breathing has proven elusive. Existing attempts to objectively measure and feedback on mindfulness have relied on specialist external hardware including electroencephalograms or respirometers that have been impractical for the majority of people learning to meditate. Consequently, training in the key skill of breath-awareness has lacked practical objective measures and guidance to enhance training. Here, we provide a brief technology report on an invention, The MindfulBreather® that addresses these issues. The technology is available to download embedded in a smartphone app that targets, measures and feedbacks on mindfulness of breathing in realtime to enhance training. The current article outlines only the technological concept with future studies quantifying efficacy, validity and reliability to be reported elsewhere. The MindfulBreather works by...

Research paper thumbnail of The effect of 1.5 T cardiac magnetic resonance on human circulating leucocytes

European heart journal, Jan 18, 2017

Investigators have proposed that cardiovascular magnetic resonance (CMR) should have restrictions... more Investigators have proposed that cardiovascular magnetic resonance (CMR) should have restrictions similar to those of ionizing imaging techniques. We aimed to investigate the acute effect of 1.5 T CMR on leucocyte DNA integrity, cell counts, and function in vitro, and in a large cohort of patients in vivo. In vitro study: peripheral blood mononuclear cells (PBMCs) were isolated from healthy volunteers, and histone H2AX phosphorylation (γ-H2AX) expression, leucocyte counts, and functional parameters were quantified using flow cytometry under the following conditions: (i) immediately following PBMC isolation, (ii) after standing on the benchside as a temperature and time control, (iii) after a standard CMR scan. In vivo study: blood samples were taken from 64 consecutive consenting patients immediately before and after a standard clinical scan. Samples were analysed for γ-H2AX expression and leucocyte counts. CMR was not associated with a significant change in γ-H2AX expression in vit...

Research paper thumbnail of Multiparametric CMR assessment of RV apical versus septal Pacing Study (MAPS) - preliminary acute hemodynamic findings

Journal of Cardiovascular Magnetic Resonance

Research paper thumbnail of Effect of contrast dose, post-contrast acquisition time, myocardial regionality, cardiac cycle and gender on dynamic-equilibrium CMR measurement of myocardial extracellular volume

Journal of Cardiovascular Magnetic Resonance

Values are mean ± standard deviation. Age range is also given in brackets. BP indicates blood pre... more Values are mean ± standard deviation. Age range is also given in brackets. BP indicates blood pressure, eGFR estimated glomerular filtration rate, EDV end diastolic volume; ESV end-systolic volume; EF ejection fraction. 'Indexed' refers to indexed to body surface area.

Research paper thumbnail of Evaluation of left ventricular torsion using cardiac MRI. Validation of feature tracking

Journal of Cardiovascular Magnetic Resonance, 2015

Research paper thumbnail of 118 Multiparametric Cardiovascular Magnetic Resonance Surveillance of Acute Cardiac Allograft Rejection and Characterisation of Transplantation-associated Myocardial Injury

Heart, 2014

Background: Serial surveillance endomyocardial biopsies are performed in patients who have recent... more Background: Serial surveillance endomyocardial biopsies are performed in patients who have recently undergone heart transplantation in order to detect acute cardiac allograft rejection (ACAR) before symptoms occur, however the biopsy process is associated with a number of limitations. This study aimed to prospectively and longitudinally evaluate the performance of multiparametric cardiovascular magnetic resonance (CMR) for detecting and monitoring ACAR in the early phase post-transplant, and characterize graft recovery following transplantation. Methods: All patients receiving a heart transplant at a single UK centre over a period of 25 months were approached within one month of transplantation. Multiparametric CMR was prospectively performed on the same day as biopsy on four separate occasions (6 weeks, 10 weeks, 15 weeks and 20 weeks post-transplant). CMR included assessment of global and regional ventricular function, myocardial tissue characterization (T1 mapping, T2 mapping, extracellular volume, LGE) and pixel-wise absolute myocardial blood flow quantification. CMR parameters were compared with biopsy findings. As is standard, grade 2R or higher ACAR was considered significant. Results: 88 CMR-matched biopsies were performed in 22 patients. Eight (9%) biopsies in 5 patients demonstrated significant ACAR. Significant ACAR was associated with a reduction in circumferential strain (−12.7 ± 2.5% vs.-13.7 ± 3.6%, p = 0.047) but there was considerable overlap between groups. Whilst trends were observed between ACAR and proposed CMR markers of oedema, particularly after adjusting for primary graft dysfunction, differences were not significant. Significant improvements were seen in markers of graft structure and contractility, oedema and microvascular function over the period studied, although few parameters normalised. Conclusions: This study provides novel insight into the myocardial injury associated with transplantation, and its recovery, however multiparametric CMR was not able to accurately detect ACAR during the early phase post-transplantation.

Research paper thumbnail of MAPS; acute safety data of the St Jude accent - tendril IPG system during prolonged max power CMR scanning

Journal of Cardiovascular Magnetic Resonance, 2015

Background Until recently, the use of MRI in patients with PPM's was prohibited. The lifetime pro... more Background Until recently, the use of MRI in patients with PPM's was prohibited. The lifetime probability of a patient with a cardiac device requiring an MRI is 50-75%. Serious adverse events occurring during MRI of patients with cardiac devices are rare, but include asystole, VF and death. There is a clinical need to develop knowledge of MR safe devices and safe scanning protocols.

Research paper thumbnail of A pain in the leg following angiography

The Journal of invasive cardiology, 2011

This case illustrates a complication following deployment of the Angioseal® vascular closure devi... more This case illustrates a complication following deployment of the Angioseal® vascular closure device after routine angiography. The AngioSeal device is a percutaneous, bioabsorbable, collagen-based hemostatic plug deployed to seal the arterial puncture. We describe a 69-year-old gentleman who presented with unilateral leg cramps 1 week post-procedure. When seen in the cardiology clinic, a magnetic resonance imaging angiogram was requested, which showed a filling defect in the right popliteal artery. The collagen seal had embolized and was subsequently removed by the vascular surgeons.

Research paper thumbnail of Aneurysm of a coronary vein graft

BMJ case reports, Jan 15, 2011

Research paper thumbnail of Republished: Cardiac MRI of patients with implanted electrical cardiac devices

Postgraduate medical journal, 2014

Implantable pulse generators and defibrillators have traditionally been considered contraindicati... more Implantable pulse generators and defibrillators have traditionally been considered contraindications to MRI. However, recent data have challenged this paradigm and demonstrated that patients with newer generation devices can safely undergo MRI, including cardiac MRI, provided basic precautions are taken. Indeed, the introduction of MRI conditional systems has led to a conceptual shift in clinical decision making-'can this patient undergo MRI safely?' is being superseded by 'should this patient be implanted with an MRI conditional device?'. This review outlines the risks associated with MRI in patients with implanted cardiac devices, and discusses practical measures to minimise risks and facilitate safe and diagnostic scanning.

Research paper thumbnail of Shortness of breath in a CF patient: not always the chest

Case Reports, 2011

BACKGROUND I think this case illustrates that when patients have a chronic condition, it is often... more BACKGROUND I think this case illustrates that when patients have a chronic condition, it is often easy to focus on that as the cause of a clinical presentation. In most cases, this may be the case but if things do not seem to fi t then you most always think of differentials. CASE PRESENTATION This is the case of a middle aged patient with cystic fi brosis (CF) with co-existing diabetes, pancreatic insuffi ciency, asthma and vocal cord dysfunction. She was admitted to the CF unit with a 1 week history of cough productive of thicker sputum, increased shortness of breath on exertion (with increased use of her home oxygen), and chest discomfort that she put down to sputum retention. Her abdomen was also distended, and with her previous history of distal intestinal obstruction syndrome, she had commenced gastrograffi n at home. No fevers were reported. These symptoms were typical of her infective exacerbations of CF and she was commenced on intravenous antibiotics and had intensive physiotherapy. Blood tests revealed: C reactive protein 1, white cell count 8.1, neutrophils 4.11, haemoglobin 12.5, Na 136, K 5.1, Ur 2.8, Cr 59 Chest x-ray (CXR) (fi gure 1) showed apical fi brocystic changes unchanged from previous x-rays. Abdominal x-ray showed no dilated bowel loops. Over the next 2 days, her symptoms started to resolve and she felt much better. She did think that her ankles had become more swollen and she had some pitting oedema to both ankles. She was given a day leave, but returned later that day very unwell. She was profoundly short of breath, with severe paroxysms of coughing and oxygen saturations of 69% on air. She complained of no chest pain.

Research paper thumbnail of Acute hepatic failure following intravenous amiodarone

Case Reports, 2012

A 73-year-old gentleman presented to the hospital after an episode of loss of consciousness. He h... more A 73-year-old gentleman presented to the hospital after an episode of loss of consciousness. He had a defibrillator in situ, which on interrogation was found to have fired for an episode of ventricular fibrillation. As an inpatient he developed frequent episodes of self-terminating ventricular tachycardia, treated initially with oral amiodarone. A 24 h amiodarone infusion was started on day 3 of admission, following which the patient developed hyperventilation. Investigations revealed that this was secondary to acute hepatic and renal failure, requiring haemofiltration on the intensive care unit. Cessation of amiodarone was associated with normalisation of liver function over 48 h. The patient had normal blood and jugular venous pressures throughout days 1-4 of admission. We discuss the role of amiodarone as the predominant factor in the deterioration of this patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s liver function, versus the differential diagnosis of ischaemia-induced hepatotoxicity, citing recent research regarding this subject.

Research paper thumbnail of Characterisation of adhesion receptors mediating lymphocyte adhesion to bronchial endothelium provides evidence for a distinct lung homing pathway

Thorax, 2002

Background: The lung is an important tertiary lymphoid organ and many lung diseases are associate... more Background: The lung is an important tertiary lymphoid organ and many lung diseases are associated with disordered lung immunity. Unlike the gut (α4β7 binding to MAdCAM-1) and skin (CLA+ve T cells binding to E-selectin) where the adhesion receptors involved in organ specific homing of T cells have been identified, the molecular pathways controlling lymphocyte migration to the lung are unclear. Using a modified version of the Stamper-Woodruff assay we have investigated the receptors mediating adhesion of peripheral blood lymphocytes to airway endothelium. Methods: Longitudinal frozen sections of bronchus (8 µm) obtained from lung resection specimens were incubated with T cell enriched peripheral blood mononuclear cells for 30 minutes under shaking conditions in the presence of a fluorescently labelled polyclonal anti-von Willebrand antibody to identify blood vessels. After fixation the percentage of blood vessels supporting adhesion was measured. Blocking monoclonal antibodies were used to determine the role of individual adhesion receptors in lymphocyte binding. Results: Specific cation dependent binding of lymphocytes to bronchial endothelium was observed which was significantly inhibited by antibodies against P-selectin, PSGL-1, L-selectin, LFA-1, ICAM-1 and ICAM-2 but not E-selectin, VLA-4, VCAM-1 or Mac-1. This was consistent with the pattern of endothelial expression of these receptors with strong expression of P-selectin and ICAM-1, but negligible expression of E-selectin on bronchial endothelium. Conclusion: This study suggests an important role for PSGL-1/P-selectin in T cell migration into the bronchi and provides further evidence for a pattern of recirculation for respiratory tract homing T cells distinct from the gut and skin.

Research paper thumbnail of Three-year outcomes and reconnection patterns after initial contact force guided pulmonary vein isolation for paroxysmal atrial fibrillation

Journal of Cardiovascular Electrophysiology, Sep 1, 2017

Background and Objective Contact force (CF) sensing is a novel technology used for catheter ablat... more Background and Objective Contact force (CF) sensing is a novel technology used for catheter ablation of atrial fibrillation (AF). We compared the single procedure success of CF-guided pulmonary vein isolation (PVI) with that of non-CF guided PVI during a three-year (1095 days) follow up period and analyzed the pattern of pulmonary vein (PV) reconnection. Methods A cohort of 167 subjects (68 CF vs. 99 Non-CF) with paroxysmal AF were included in the study. Atrial arrhythmia (AA) recurrence was defined as documented AF, atrial flutter, or atrial tachycardia lasting > 30 seconds and occurring after 90 days. Results Subjects in the CF group showed a statistically non-significant improvement in atrial arrhythmia free survival compared to those in the non-CF group (66.2% vs. 51.5%; P value-0.06). A greater propensity for reconnection was noted around the right-sided PVs compared to left-sided PVs related in both catheter ablation groups. For example, in the CF group 36% of right-sided segments reconnected compared to 16% of left-sided segments (P value <0.01). Conclusions A greater propensity for reconnection was noted around the right sided PV segments in both the CF and non-CF groups. The explanation for this finding was related to greater catheter instability around the right sided veins. Further research is needed to explore the utility of a 'real-time' composite indicator that includes RF energy, CF and catheter stability in predicting transmural lesion formation during catheter ablation. CF Reconnection Patterns and 3-Y FU Nair GM et al.

Research paper thumbnail of Multiparametric Cardiovascular Magnetic Resonance Assessment of Pacemaker-Induced Alterations in Ventricular Activation and Function

Research paper thumbnail of Decompensated heart failure secondary to hypocalcaemia post coronary artery bypass grafting

BMJ case reports, Jan 15, 2011

A man presented with an exacerbation of heart failure following coronary artery bypass grafting. ... more A man presented with an exacerbation of heart failure following coronary artery bypass grafting. He was found to be severely hypocalcaemic secondary to a combination of decreased parathyroid reserve and severe vitamin D deficiency. On treatment of his hypocalcaemia, all symptoms resolved. This case highlights the importance of recognising that metabolic derangement can affect cardiac function.

Research paper thumbnail of Voxel-wise quantification of myocardial blood flow with cardiovascular magnetic resonance: effect of variations in methodology and validation with positron emission tomography

Journal of Cardiovascular Magnetic Resonance, 2014

Research paper thumbnail of A Pilot Study

cardiovascular magnetic f acute cardiac significant ACAR. Significant ACAR was associated with a ... more cardiovascular magnetic f acute cardiac significant ACAR. Significant ACAR was associated with a reduction in circumferential strain (−12.7 ± 2.5 % vs.-13.7 ± 3.6%, p = 0.047) but there was considerable overlap between groups. Whilst trends were observed between ACAR and Miller et al. Journal of Cardiovascular Magnetic Resonance 2014, 16:52

Research paper thumbnail of Multiparametric assessment of apical versus septal pacing study using Cardiac Magnetic Imaging

Evaluation of left ventricular torsion using cardiac MRI. Validation of feature tracking. Ainslie... more Evaluation of left ventricular torsion using cardiac MRI. Validation of feature tracking. Ainslie MP, Reid A, Miller C, Clark D, Francis L, Schmitt M. Journal of cardiovascular magnetic resonance. 2015. 17 (suppl 1): O47. MAPS; acute safety data of the St Jude accenttendril IPG system during prolonged max power CMR scanning. Ainslie M, Reid A, Miller C, Clark D, Brown B, Fox D, Davidson N, Trafford A, Schmitt M. Journal of cardiovascular magnetic resonance. 2015. 17 (Suppl 1): M6. Multiparametric CMR Assessment of RV apical versus septal pacing study (MAPS)Preliminary acute hemodynamic findings. Ainslie M, Miller C, Brown B, Fox D, Davidson N, Trafford A, Schmitt M. Heart 2013; 99: suppl 2 A50. Multiparametric CMR assessment of RV apical versus septal Pacing Study (MAPS) preliminary acute hemodynamic findings. Ainslie M, Miller CA, Brown B, Davidson N, Fox DJ, Schmitt M. Journal of Cardiovascular Magnetic Resonance. 2013; 15(suppl 1):O85.

Research paper thumbnail of A pain in the leg following angiography

This case illustrates a complication following deployment of the Angioseal® vascular closure devi... more This case illustrates a complication following deployment of the Angioseal® vascular closure device after routine angiography. The AngioSeal device is a percutaneous, bioabsorbable, collagen-based hemostatic plug deployed to seal the arterial puncture. We describe a 69-year-old gentleman who presented with unilateral leg cramps 1 week post-procedure. When seen in the cardiology clinic, a magnetic resonance imaging angiogram was requested, which showed a filling defect in the right popliteal artery. The collagen seal had embolized and was subsequently removed by the vascular surgeons.

Research paper thumbnail of The MindfulBreather: Motion Guided Mindfulness

Frontiers in human neuroscience, 2017

For millennia, humans have focused their attention on the breath to develop mindfulness, but find... more For millennia, humans have focused their attention on the breath to develop mindfulness, but finding a scientific way to harness mindful breathing has proven elusive. Existing attempts to objectively measure and feedback on mindfulness have relied on specialist external hardware including electroencephalograms or respirometers that have been impractical for the majority of people learning to meditate. Consequently, training in the key skill of breath-awareness has lacked practical objective measures and guidance to enhance training. Here, we provide a brief technology report on an invention, The MindfulBreather® that addresses these issues. The technology is available to download embedded in a smartphone app that targets, measures and feedbacks on mindfulness of breathing in realtime to enhance training. The current article outlines only the technological concept with future studies quantifying efficacy, validity and reliability to be reported elsewhere. The MindfulBreather works by...

Research paper thumbnail of The effect of 1.5 T cardiac magnetic resonance on human circulating leucocytes

European heart journal, Jan 18, 2017

Investigators have proposed that cardiovascular magnetic resonance (CMR) should have restrictions... more Investigators have proposed that cardiovascular magnetic resonance (CMR) should have restrictions similar to those of ionizing imaging techniques. We aimed to investigate the acute effect of 1.5 T CMR on leucocyte DNA integrity, cell counts, and function in vitro, and in a large cohort of patients in vivo. In vitro study: peripheral blood mononuclear cells (PBMCs) were isolated from healthy volunteers, and histone H2AX phosphorylation (γ-H2AX) expression, leucocyte counts, and functional parameters were quantified using flow cytometry under the following conditions: (i) immediately following PBMC isolation, (ii) after standing on the benchside as a temperature and time control, (iii) after a standard CMR scan. In vivo study: blood samples were taken from 64 consecutive consenting patients immediately before and after a standard clinical scan. Samples were analysed for γ-H2AX expression and leucocyte counts. CMR was not associated with a significant change in γ-H2AX expression in vit...

Research paper thumbnail of Multiparametric CMR assessment of RV apical versus septal Pacing Study (MAPS) - preliminary acute hemodynamic findings

Journal of Cardiovascular Magnetic Resonance

Research paper thumbnail of Effect of contrast dose, post-contrast acquisition time, myocardial regionality, cardiac cycle and gender on dynamic-equilibrium CMR measurement of myocardial extracellular volume

Journal of Cardiovascular Magnetic Resonance

Values are mean ± standard deviation. Age range is also given in brackets. BP indicates blood pre... more Values are mean ± standard deviation. Age range is also given in brackets. BP indicates blood pressure, eGFR estimated glomerular filtration rate, EDV end diastolic volume; ESV end-systolic volume; EF ejection fraction. 'Indexed' refers to indexed to body surface area.

Research paper thumbnail of Evaluation of left ventricular torsion using cardiac MRI. Validation of feature tracking

Journal of Cardiovascular Magnetic Resonance, 2015

Research paper thumbnail of 118 Multiparametric Cardiovascular Magnetic Resonance Surveillance of Acute Cardiac Allograft Rejection and Characterisation of Transplantation-associated Myocardial Injury

Heart, 2014

Background: Serial surveillance endomyocardial biopsies are performed in patients who have recent... more Background: Serial surveillance endomyocardial biopsies are performed in patients who have recently undergone heart transplantation in order to detect acute cardiac allograft rejection (ACAR) before symptoms occur, however the biopsy process is associated with a number of limitations. This study aimed to prospectively and longitudinally evaluate the performance of multiparametric cardiovascular magnetic resonance (CMR) for detecting and monitoring ACAR in the early phase post-transplant, and characterize graft recovery following transplantation. Methods: All patients receiving a heart transplant at a single UK centre over a period of 25 months were approached within one month of transplantation. Multiparametric CMR was prospectively performed on the same day as biopsy on four separate occasions (6 weeks, 10 weeks, 15 weeks and 20 weeks post-transplant). CMR included assessment of global and regional ventricular function, myocardial tissue characterization (T1 mapping, T2 mapping, extracellular volume, LGE) and pixel-wise absolute myocardial blood flow quantification. CMR parameters were compared with biopsy findings. As is standard, grade 2R or higher ACAR was considered significant. Results: 88 CMR-matched biopsies were performed in 22 patients. Eight (9%) biopsies in 5 patients demonstrated significant ACAR. Significant ACAR was associated with a reduction in circumferential strain (−12.7 ± 2.5% vs.-13.7 ± 3.6%, p = 0.047) but there was considerable overlap between groups. Whilst trends were observed between ACAR and proposed CMR markers of oedema, particularly after adjusting for primary graft dysfunction, differences were not significant. Significant improvements were seen in markers of graft structure and contractility, oedema and microvascular function over the period studied, although few parameters normalised. Conclusions: This study provides novel insight into the myocardial injury associated with transplantation, and its recovery, however multiparametric CMR was not able to accurately detect ACAR during the early phase post-transplantation.

Research paper thumbnail of MAPS; acute safety data of the St Jude accent - tendril IPG system during prolonged max power CMR scanning

Journal of Cardiovascular Magnetic Resonance, 2015

Background Until recently, the use of MRI in patients with PPM's was prohibited. The lifetime pro... more Background Until recently, the use of MRI in patients with PPM's was prohibited. The lifetime probability of a patient with a cardiac device requiring an MRI is 50-75%. Serious adverse events occurring during MRI of patients with cardiac devices are rare, but include asystole, VF and death. There is a clinical need to develop knowledge of MR safe devices and safe scanning protocols.

Research paper thumbnail of A pain in the leg following angiography

The Journal of invasive cardiology, 2011

This case illustrates a complication following deployment of the Angioseal® vascular closure devi... more This case illustrates a complication following deployment of the Angioseal® vascular closure device after routine angiography. The AngioSeal device is a percutaneous, bioabsorbable, collagen-based hemostatic plug deployed to seal the arterial puncture. We describe a 69-year-old gentleman who presented with unilateral leg cramps 1 week post-procedure. When seen in the cardiology clinic, a magnetic resonance imaging angiogram was requested, which showed a filling defect in the right popliteal artery. The collagen seal had embolized and was subsequently removed by the vascular surgeons.

Research paper thumbnail of Aneurysm of a coronary vein graft

BMJ case reports, Jan 15, 2011

Research paper thumbnail of Republished: Cardiac MRI of patients with implanted electrical cardiac devices

Postgraduate medical journal, 2014

Implantable pulse generators and defibrillators have traditionally been considered contraindicati... more Implantable pulse generators and defibrillators have traditionally been considered contraindications to MRI. However, recent data have challenged this paradigm and demonstrated that patients with newer generation devices can safely undergo MRI, including cardiac MRI, provided basic precautions are taken. Indeed, the introduction of MRI conditional systems has led to a conceptual shift in clinical decision making-'can this patient undergo MRI safely?' is being superseded by 'should this patient be implanted with an MRI conditional device?'. This review outlines the risks associated with MRI in patients with implanted cardiac devices, and discusses practical measures to minimise risks and facilitate safe and diagnostic scanning.

Research paper thumbnail of Shortness of breath in a CF patient: not always the chest

Case Reports, 2011

BACKGROUND I think this case illustrates that when patients have a chronic condition, it is often... more BACKGROUND I think this case illustrates that when patients have a chronic condition, it is often easy to focus on that as the cause of a clinical presentation. In most cases, this may be the case but if things do not seem to fi t then you most always think of differentials. CASE PRESENTATION This is the case of a middle aged patient with cystic fi brosis (CF) with co-existing diabetes, pancreatic insuffi ciency, asthma and vocal cord dysfunction. She was admitted to the CF unit with a 1 week history of cough productive of thicker sputum, increased shortness of breath on exertion (with increased use of her home oxygen), and chest discomfort that she put down to sputum retention. Her abdomen was also distended, and with her previous history of distal intestinal obstruction syndrome, she had commenced gastrograffi n at home. No fevers were reported. These symptoms were typical of her infective exacerbations of CF and she was commenced on intravenous antibiotics and had intensive physiotherapy. Blood tests revealed: C reactive protein 1, white cell count 8.1, neutrophils 4.11, haemoglobin 12.5, Na 136, K 5.1, Ur 2.8, Cr 59 Chest x-ray (CXR) (fi gure 1) showed apical fi brocystic changes unchanged from previous x-rays. Abdominal x-ray showed no dilated bowel loops. Over the next 2 days, her symptoms started to resolve and she felt much better. She did think that her ankles had become more swollen and she had some pitting oedema to both ankles. She was given a day leave, but returned later that day very unwell. She was profoundly short of breath, with severe paroxysms of coughing and oxygen saturations of 69% on air. She complained of no chest pain.

Research paper thumbnail of Acute hepatic failure following intravenous amiodarone

Case Reports, 2012

A 73-year-old gentleman presented to the hospital after an episode of loss of consciousness. He h... more A 73-year-old gentleman presented to the hospital after an episode of loss of consciousness. He had a defibrillator in situ, which on interrogation was found to have fired for an episode of ventricular fibrillation. As an inpatient he developed frequent episodes of self-terminating ventricular tachycardia, treated initially with oral amiodarone. A 24 h amiodarone infusion was started on day 3 of admission, following which the patient developed hyperventilation. Investigations revealed that this was secondary to acute hepatic and renal failure, requiring haemofiltration on the intensive care unit. Cessation of amiodarone was associated with normalisation of liver function over 48 h. The patient had normal blood and jugular venous pressures throughout days 1-4 of admission. We discuss the role of amiodarone as the predominant factor in the deterioration of this patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s liver function, versus the differential diagnosis of ischaemia-induced hepatotoxicity, citing recent research regarding this subject.

Research paper thumbnail of Characterisation of adhesion receptors mediating lymphocyte adhesion to bronchial endothelium provides evidence for a distinct lung homing pathway

Thorax, 2002

Background: The lung is an important tertiary lymphoid organ and many lung diseases are associate... more Background: The lung is an important tertiary lymphoid organ and many lung diseases are associated with disordered lung immunity. Unlike the gut (α4β7 binding to MAdCAM-1) and skin (CLA+ve T cells binding to E-selectin) where the adhesion receptors involved in organ specific homing of T cells have been identified, the molecular pathways controlling lymphocyte migration to the lung are unclear. Using a modified version of the Stamper-Woodruff assay we have investigated the receptors mediating adhesion of peripheral blood lymphocytes to airway endothelium. Methods: Longitudinal frozen sections of bronchus (8 µm) obtained from lung resection specimens were incubated with T cell enriched peripheral blood mononuclear cells for 30 minutes under shaking conditions in the presence of a fluorescently labelled polyclonal anti-von Willebrand antibody to identify blood vessels. After fixation the percentage of blood vessels supporting adhesion was measured. Blocking monoclonal antibodies were used to determine the role of individual adhesion receptors in lymphocyte binding. Results: Specific cation dependent binding of lymphocytes to bronchial endothelium was observed which was significantly inhibited by antibodies against P-selectin, PSGL-1, L-selectin, LFA-1, ICAM-1 and ICAM-2 but not E-selectin, VLA-4, VCAM-1 or Mac-1. This was consistent with the pattern of endothelial expression of these receptors with strong expression of P-selectin and ICAM-1, but negligible expression of E-selectin on bronchial endothelium. Conclusion: This study suggests an important role for PSGL-1/P-selectin in T cell migration into the bronchi and provides further evidence for a pattern of recirculation for respiratory tract homing T cells distinct from the gut and skin.