ORCID Profile
0000-0003-0760-6382
Current Organisations
Cardiac Society of Australia and New Zealand
,
Lyell McEwin Hospital
,
Royal Australasian College of Physicians
,
University of Adelaide
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Publications
Cardiologists are more willing to prescribe β-blockers than respiratory physicians: an Australasian clinical scenario survey.
Publisher: Wiley
Date: 05-2013
DOI: 10.1111/IMJ.12035
Providing a simple and consistent solution for the definition of in- versus out-of-hospital cardiac arrest
Publisher: Elsevier BV
Date: 11-2020
Pregnancy Outcomes in Women After Arterial Switch Operation for Transposition of the Great Arteries: Results From ROPAC (Registry of Pregnancy and Cardiac Disease) of the European Society of Cardiolog
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-01-2021
Abstract: In the past 3 decades, the arterial switch procedure has replaced the atrial switch procedure as treatment of choice for transposition of the great arteries. Although survival is superior after the arterial switch procedure, data on pregnancy outcomes are scarce and transposition of the great arteries after arterial switch is not yet included in the modified World Health Organization classification of maternal cardiovascular risk. The ROPAC (Registry of Pregnancy and Cardiac disease) is an international prospective registry of pregnant women with cardiac disease, part of the European Society of Cardiology EURObservational Research Programme. Pregnancy outcomes in all women after an arterial switch procedure for transposition of the great arteries are described. The primary end point was a major adverse cardiovascular event, defined as combined end point of maternal death, supraventricular or ventricular arrhythmias requiring treatment, heart failure, aortic dissection, endocarditis, ischemic coronary events, and thromboembolic events. Altogether, 41 pregnant women (mean age, 26.7±3.9 years) were included, and there was no maternal mortality. A major adverse cardiovascular event occurred in 2 women (4.9%): heart failure in one (2.4%) and ventricular tachycardia in another (2.4%). One woman experienced fetal loss, whereas no neonatal mortality was observed. Women after an arterial switch procedure for transposition of the great arteries tolerate pregnancy well, with a favorable maternal and fetal outcome. During counseling, most women should be reassured that the risk of pregnancy is low. Classification as modified World Health Organization risk class II seems appropriate.
Aetiology of resuscitated out-of-hospital cardiac arrest treated at hospital
Publisher: Elsevier BV
Date: 2022
Study design of embracing high-sensitivity troponin effectively: the value of more information: a randomized comparison.
Publisher: Elsevier BV
Date: 11-2014
GARFIELD-AF: risk profiles, treatment patterns and 2-year outcomes in patients with atrial fibrillation in Germany, Austria and Switzerland (DACH) compared to 32 countries in other regions worldwide
Publisher: Springer Science and Business Media LLC
Date: 12-09-2023
The association between guidelines adherence and clinical outcomes during pregnancy in a cohort of women with cardiac co-morbidities
Publisher: Public Library of Science (PLoS)
Date: 23-07-2021
DOI: 10.1371/JOURNAL.PONE.0255070
Abstract: Maternal and infant morbidities associated with pregnant women with cardiac conditions are a global issue contingent upon appropriate care. This study aimed to describe the clinical variables and their association with the adherence scores to perinatal guidelines for pregnant women with cardiac conditions. The clinical variables included cardiac, perinatal, and neonatal outcomes and complications. Using a retrospective cross-sectional medical record audit, data were abstracted and categorised as cardiac, obstetric, and neonatal predictors. Linear regression modelling was used to find the mean difference (MD) in adherence scores for each predictor, including a 95% confidence interval (CI) and a significance value for all the three categories’ clinical outcomes. This maternal cohort’s (n = 261) cardiac complications were primarily arrhythmias requiring treatment (29.9%), particularly SVT (28%), a new diagnosis of valvular heart disease and congenital heart disease (24%) and decompensated heart failure (HF) (16%). Women with HF had associated increased adherence scores (MD = 3.546, 95% CI: 1.689, 5.403) compared to those without HF. Elective LSCS mode of delivery was associated with a higher adherence score (MD = 5.197, 95% CI: 3.584, 6.811) than non-elective LSCS subgroups. Babies admitted to intensive /special care had greater adherence to the guidelines (MD = 3.581, 95% CI: 1.822, 5.340) than those not requiring the same care. Some pregnancy associated complications and morbidities were associated with higher adherence scores, reflecting that a diagnosis, identification of morbidities or risk factors, initiation of appropriate multidisciplinary involvement and adherence to guidelines were associated. Conversely, potentially avoidable major complications such as sepsis were associated with a low adherence score. ACTRN12617000417381 .
Do Chest Pain Characteristics in Patients with Acute Myocardial Infarction Differ between Those with and without Obstructive Coronary Artery Disease?
Publisher: MDPI AG
Date: 10-07-2023
DOI: 10.3390/JCM12144595
Abstract: The universal definition of acute myocardial infarction (MI) requires both evidence of myocardial injury and myocardial ischaemia. In MINOCA (MI with non-obstructive coronary arteries), patients must fulfil this MI criteria, but is their chest pain similar to those who have MI with obstructive CAD (MICAD)? This study compares prospectively collected chest pain features between patients with MINOCA and MICAD. Utilising the Coronary Angiogram Database of South Australia (CADOSA), consecutive MI patients were categorized as MINOCA or MICAD based on angiographic findings. Chest pain data were collected via direct patient interviews by trained staff members. Of 6811 consecutive patients fulfilling a clinical MI diagnosis, 411 (6.0%) were MINOCA, and 5948 MICAD. The MINOCA patients were younger, more often female and had less cardiovascular risk factors than those with MICAD. There were no significant differences in chest pain characteristics between the MINOCA and MICAD cohorts in relation to pain location, quality, associated symptoms, or duration. In conclusion, MINOCA patients have chest pain characteristics that are indistinguishable from MICAD patients, suggesting that their pain is ischaemic in nature. Thus, in the presence of positive myocardial injury markers, ischaemic chest pain fulfils the universal criteria for MI, despite the absence of obstructive coronary artery disease.
Management and 1‐Year Outcomes of Patients With Newly Diagnosed Atrial Fibrillation and Chronic Kidney Disease: Results From the Prospective GARFIELD‐AF Registry
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-02-2019
Abstract: Using data from the GARFIELD ‐ AF (Global Anticoagulant Registry in the FIELD –Atrial Fibrillation), we evaluated the impact of chronic kidney disease ( CKD ) stage on clinical outcomes in patients with newly diagnosed atrial fibrillation ( AF ). GARFIELD ‐ AF is a prospective registry of patients from 35 countries, including patients from Asia (China, India, Japan, Singapore, South Korea, and Thailand). Consecutive patients enrolled (2013–2016) were classified with no, mild, or moderate‐to‐severe CKD , based on the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative guidelines. Data on CKD status and outcomes were available for 33 024 of 34 854 patients (including 9491 patients from Asia) 10.9% (n=3613) had moderate‐to‐severe CKD , 16.9% (n=5595) mild CKD , and 72.1% (n=23 816) no CKD . The use of oral anticoagulants was influenced by stroke risk (ie, post hoc assessment of CHA 2 DS 2 ‐ VAS c score), but not by CKD stage. The quality of anticoagulant control with vitamin K antagonists did not differ with CKD stage. After adjusting for baseline characteristics and antithrombotic use, both mild and moderate‐to‐severe CKD were independent risk factors for all‐cause mortality. Moderate‐to‐severe CKD was independently associated with a higher risk of stroke/systemic embolism, major bleeding, new‐onset acute coronary syndrome, and new or worsening heart failure. The impact of moderate‐to‐severe CKD on mortality was significantly greater in patients from Asia than the rest of the world ( P =0.001). In GARFIELD ‐ AF , moderate‐to‐severe CKD was independently associated with stroke/systemic embolism, major bleeding, and mortality. The effect of moderate‐to‐severe CKD on mortality was even greater in patients from Asia than the rest of the world. URL : www.clinicaltrials.gov . Unique identifier: NCT 01090362.
In vivo anthelmintic activity of Azadirachta indica A. Juss seeds against gastrointestinal nematodes of sheep.
Publisher: Elsevier BV
Date: 03-2010
DOI: 10.1016/J.VETPAR.2009.11.005
Abstract: This paper describes the in vivo anthelmintic activity of Azadirachta indica seeds to justify their use in South-Asia by traditional animal healers. Seeds of A. indica were administered as crude powder (CP), crude aqueous (CAE) and crude methanolic extracts (CME) at the doses of 1 and 3g/kg of body weight to sheep naturally infected with mixed species of gastrointestinal nematodes. The study design also included untreated as well as treated controls. Faecal egg count reduction and larval counts from coprocultures were performed pre- and post-treatments to assess the anthelmintic activity. Crude powder and CME did not show significant activity (P>0.05) at the lower dose used but were found effective at 3g/kg and the maximum anthelmintic effect was observed at the 15 days post-treatment with both crude powder and CME (P<0.01) with a maximum reduction of 29.3% and 40.2%, respectively in eggs per gram of faeces. Haemonchus contortus and Trichostrongylus species were found susceptible (P<0.01) to higher doses of CP and CME of A. indica. However, CAE did not exhibit any considerable reduction in EPG as well as larval counts. Levamisole (7.5mg/kg), a standard anthelmintic agent, exhibited 99.2% reduction in EPG (P<0.001). Though of low efficacy compared with levamisole, the use of A. indica seeds against gastrointestinal nematodes may be justified in some situations, depending on the nature and intensity of the helminth infections.
Education and imaging. Hepatobiliary and pancreatic: hepatic arteriovenous malformations in hereditary hemorrhagic telangiectasia.
Publisher: Wiley
Date: 15-08-2007
Predictors of Obstructive Sleep Apnoea (OSA) Population in the Coronary Angiogram Database of South Australia (CADOSA)
Publisher: Elsevier BV
Date: 06-2022
Cost effectiveness of high-sensitivity troponin compared to conventional troponin among patients presenting with undifferentiated chest pain: A trial based analysis
Publisher: Elsevier BV
Date: 07-2017
Physicians' guideline adherence is associated with long‐term heart failure mortality in outpatients with heart failure with reduced ejection fraction: the QUALIFY international registry
Publisher: Wiley
Date: 04-2019
DOI: 10.1002/EJHF.1459
Abstract: Physicians' adherence to guideline-recommended therapy is associated with short-term clinical outcomes in heart failure (HF) with reduced ejection fraction (HFrEF). However, its impact on longer-term outcomes is poorly documented. Here, we present results from the 18-month follow-up of the QUALIFY registry. Data at 18 months were available for 6118 ambulatory HFrEF patients from this international prospective observational survey. Adherence was measured as a continuous variable, ranging from 0 to 1, and was assessed for five classes of recommended HF medications and dosages. Most deaths were cardiovascular (CV) (228/394) and HF-related (191/394) and the same was true for unplanned hospitalizations (1175 CV and 861 HF-related hospitalizations, out of a total of 1541). According to univariable analysis, CV and HF deaths were significantly associated with physician adherence to guidelines. In multivariable analysis, HF death was associated with adherence level [subdistribution hazard ratio (SHR) 0.93, 95% confidence interval (CI) 0.87-0.99 per 0.1 unit adherence level increase P = 0.034] as was composite of HF hospitalization or CV death (SHR 0.97, 95% CI 0.94-0.99 per 0.1 unit adherence level increase P = 0.043), whereas unplanned all-cause, CV or HF hospitalizations were not (all-cause: SHR 0.99, 95% CI 0.9-1.02 CV: SHR 0.98, 95% CI 0.96-1.01 and HF: SHR 0.99, 95% CI 0.96-1.02 per 0.1 unit change in adherence score P = 0.52, P = 0.2, and P = 0.4, respectively). These results suggest that physicians' adherence to guideline-recommended HF therapies is associated with improved outcomes in HFrEF. Practical strategies should be established to improve physicians' adherence to guidelines.
Adherence to clinical practice guidelines for South Australian pregnant women with cardiac conditions between 2003 and 2013
Publisher: Public Library of Science (PLoS)
Date: 17-03-2020
Mechanisms linking exposure to preeclampsia in utero and the risk for cardiovascular disease
Publisher: Cambridge University Press (CUP)
Date: 19-02-2020
DOI: 10.1017/S2040174420000094
Abstract: Preecl sia (PE) is now recognised as a cardiovascular risk factor for women. Emerging evidence suggests that children exposed to PE in utero may also be at increased risk of cardiovascular disease (CVD) in later life. In iduals exposed to PE in utero have higher systolic and diastolic blood pressure and higher body mass index (BMI) compared to those not exposed to PE in utero . The aim of this review is to discuss the potential mechanisms driving the relationship between PE and offspring CVD. Exposure to an adverse intrauterine environment as a consequence of the pathophysiological changes that occur during a pregnancy complicated by PE is proposed as one mechanism that programs the fetus for future CVD risk. Consistent with this hypothesis, animal models of PE where progeny have been studied demonstrate causality for programming of offspring cardiovascular health by the preecl tic environment. Shared alleles between mother and offspring, and shared lifestyle factors between mother and offspring provide alternate pathways explaining associations between PE and offspring CVD risk. In addition, adverse lifestyle habits can also act as second hits for those programmed for increased CVD risk. PE and CVD are both multifactorial diseases and, hence, identifying the relative contribution of PE to offspring risk for CVD is a very complex task. However, considering the emerging strong association between PE and CVD, those exposed to PE in utero may benefit from targeted primary CVD preventive strategies.
Association between metabolic syndrome and gestational diabetes mellitus in women and their children: a systematic review and meta-analysis
Publisher: Springer Science and Business Media LLC
Date: 15-09-2021
Evaluation of gender differences in Door-to-Balloon time in ST-elevation myocardial infarction.
Publisher: Elsevier BV
Date: 10-2013
Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry
Publisher: Elsevier BV
Date: 11-2018
Streptokinase-induced transient aggravation of myocardial injury
Publisher: Elsevier BV
Date: 06-1995
A prospective registry analysis of psychosocial and metabolic health between women with and without metabolic syndrome after a complicated pregnancy
Publisher: Springer Science and Business Media LLC
Date: 21-11-2022
DOI: 10.1186/S12905-022-02035-Y
Abstract: Pregnancy complications affect over one quarter of Australian pregnancies, and this group of mothers is vulnerable and more likely to experience adverse cardiometabolic health outcomes in the postpartum period. Metabolic syndrome is common in this population and may be associated with postpartum mental health issues. However, this relationship remains poorly understood. To compare the differences in psychosocial parameters and mental health outcomes between women with metabolic syndrome and women without metabolic syndrome 6 months after a complicated pregnancy. This study is prospective registry analysis of women attending a postpartum healthy lifestyle clinic 6 months following a complicated pregnancy. Mental health measures included 9-item Patient Health Questionnaire (PHQ-9), 7-item Generalised Anxiety Disorder questionnaire (GAD-7), self-reported diagnosed history of depression, anxiety and/or other psychiatric condition, and current psychotropic medication use. Women with metabolic syndrome reported significantly more subjective mental health concerns, were more likely to have a history of depression and other psychiatric diagnoses and were more likely prescribed psychotropic medications. However, there were no significant differences in PHQ-9 and GAD-7 scores. Amongst new mothers who experienced complications of pregnancy, those with metabolic syndrome represent a particularly vulnerable group with regards to psychosocial disadvantage and mental health outcomes. These vulnerabilities may not be apparent when using common standardised cross-sectional mental health screening tools such as PHQ-9 and GAD-7.
Hypertensive disorders of pregnancy and later cardiovascular disease risk in mothers and children
Publisher: Cambridge University Press (CUP)
Date: 15-10-2021
DOI: 10.1017/S2040174420000896
Abstract: Preecl sia (PE) and gestational hypertension (GH) are pregnancy-specific diseases that occur in around 10% of pregnancies worldwide. Increasing evidence suggests that women whose pregnancies were complicated by PE or GH, and their offspring, are at increased risk of cardiovascular disease (CVD) later in life. We hypothesised that PE and GH would associate with CVD risk factors 8–10 years after the first pregnancy in the mother and child and that differences in cardiovascular risk profile would be seen between 8- and 10-year-old male and female children. This is a follow-up study of the Adelaide SCOPE pregnancy cohort where 1164 nulliparous women and their babies were recruited between 2005 and 2008. Haemodynamic function was assessed using non-invasive USCOMBP+ and USCOM1A devices. Microvascular function was assessed by post-occlusive reactive hyperaemia. Of the 273 mother–child pairs followed up, 38 women had PE and 20 had GH during pregnancy. Augmentation index (Aix) and suprasystolic pulse pressure (ssPP) were increased, whereas measures of microvascular function were decreased in children who were born to PE compared to uncomplicated pregnancies. Female children had decreased Aix and ssPP compared to male children after in utero exposure to PE. Women who developed GH during their first pregnancy had increased systolic, diastolic and mean arterial pressures compared to women who had uncomplicated pregnancy. Our data suggest that GH is associated with increased cardiovascular risk in women 8–10 years after first pregnancy and PE is associated with increased offspring risk at 8–10 years of age, highlighting differences between these two hypertensive disorders of pregnancy.
Silent ischemia after uncomplicated myocardial infarction: lack of incremental clinical significance.
Publisher: Elsevier BV
Date: 06-1994
In-hospital mode of death after out-of-hospital cardiac arrest
Publisher: Elsevier BV
Date: 06-2022
Pregnancy complications and cardiovascular disease risk perception: A qualitative study
Publisher: Public Library of Science (PLoS)
Date: 21-07-2022
DOI: 10.1371/JOURNAL.PONE.0271722
Abstract: We aimed to assess women’s perceptions on the long-term risks for cardiovascular disease (CVD) after major pregnancy complications. Women who experienced major pregnancy complications and those who experienced uncomplicated pregnancies were invited to participate in a qualitative study. Focus group discussions (FGDs) and self-administered questionnaires were used to explore: The knowledge of long-term sequelae after experiencing a major pregnancy complication Importance of education on heart health The practicality of referral to a clinic after pregnancy complications Willingness for regular postpartum clinic visits after pregnancy complications. A thematic qualitative analysis was undertaken. 26 women participated in four FGDs. The majority of women did not know of the association between major pregnancy complications and CVD. The main views expressed were: Women who experience pregnancy complications should receive education on improving heart health An appointment for the first CVD risk screening visit needs to be made prior to discharge from the delivery suite Women will benefit by having the option to select between a hospital and a general-practitioner based model of follow up. These views are important in developing postpartum strategies to reduce CVD risk among women who experience pregnancy complications.
Asymmetric dimethylarginine and gestational diabetes mellitus: a systematic review and meta-analysis
Publisher: Springer Science and Business Media LLC
Date: 30-11-2023
Endothelial dysfunction and glycocalyx shedding in heart failure: insights from patients receiving cardiac resynchronisation therapy
Publisher: Springer Science and Business Media LLC
Date: 27-08-2020
The Keeping on Track Study: Exploring the Activity Levels and Utilization of Healthcare Services of Acute Coronary Syndrome (ACS) Patients in the First 30-Days after Discharge from Hospital
Publisher: MDPI AG
Date: 19-04-2019
Abstract: The aim of this study was to investigate the impact of bedside discharge education on activity levels and healthcare utilization for patients with acute coronary syndrome (ACS) in the first 30 days post-discharge. Knowledge recall and objective activity and location data were collected by global positioning systems (GPS). Participants were asked to carry the tracking applications (apps) for 30–90 days. Eighteen participants were recruited (6 metropolitan 12 rural) 61% ST elevation myocardial infarction (STEMI), mean age 55 years, 83% male. Recall of discharge education included knowledge of diagnosis (recall = 100%), procedures (e.g., angiogram = 40%), and comorbidities (e.g., hypertension = 60%, diabetes = 100%). In the first 30 days post-discharge, median steps per day was 2506 (standard deviation (SD) ± 369) steps (one participant completed 10,000 steps), 62% visited a general practitioner (GP) 16% attended cardiac rehabilitation, 16% visited a cardiologist, 72% a pharmacist, 27% visited the emergency department for cardiac event, and 61% a pathology service (blood tests). Adherence to using the activity tracking apps was 87%. Managing Big Data from the GPS and physical activity tracking apps was a challenge with over 300,000 lines of raw data cleaned to 90,000 data points for analysis. This study was an ex le of the application of objective data from the real world to help understand post-ACS discharge patient activity. Rates of access to services in the first 30 days continue to be of concern.
Muscarinic cholinergic regulation of cardiac myocyte ICa-L is absent in mice with targeted disruption of endothelial nitric oxide synthase
Publisher: Proceedings of the National Academy of Sciences
Date: 26-05-1998
Abstract: Cardiac myocytes have been shown to express constitutively endothelial nitric oxide synthase (eNOS) (nitric oxide synthase 3), the activation of which has been implicated in the regulation of myocyte L-type voltage-sensitive calcium channel current (I Ca-L ) and myocyte contractile responsiveness to parasympathetic nervous system signaling, although this implication remains controversial. Therefore, we examined the effect of the muscarinic cholinergic agonist carbachol (CCh) on I Ca-L and contractile litude in isoproterenol (ISO)-prestimulated ventricular myocytes isolated from adult mice, designated eNOS null mice, with targeted disruption of the eNOS gene. Although both eNOS null and wild-type (WT) ventricular myocytes exhibited similar increases in I Ca-L in response to ISO, there was no measurable suppression of I Ca-L by CCh in cells from eNOS null mice, in contrast to cells from WT mice. These results were reflected in the absence of an effect of CCh on the positive inotropic effect of ISO in eNOS null myocytes. Also, unlike myocytes from WT animals, eNOS null myocytes failed to exhibit an increase in cGMP content in response to CCh. Nevertheless, the pharmacologic nitric oxide donors 3-morpholino-sydnonimine and S-nitroso-acetyl-cystein increased cGMP generation and suppressed ISO-augmented I Ca-L in eNOS null cells, suggesting that the signal transduction pathway(s) downstream of eNOS remained intact. Of importance, activation of the acetylcholine-activated K + channel by CCh was unaffected in atrial and ventricular eNOS null myocytes. These results confirm the obligatory role of eNOS in coupling muscarinic receptor activation to cGMP-dependent control of I Ca-L in cardiac myocytes.
Agreement of aneroid and oscillometric blood pressure devices used in pregnancy
Publisher: Elsevier BV
Date: 07-2019
Incidence of adverse events during treatment with verapamil for suspected acute myocardial infarction.
Publisher: Elsevier BV
Date: 12-1992
Human ventricular myocytes in vitro exhibit both early and delayed preconditioning responses to simulated ischemia.
Publisher: Elsevier BV
Date: 05-1998
Abstract: Myocardial tissue has been demonstrated to exhibit, in response to brief periods of ischemia, both an immediate period of cytoprotection [i.e. early or "first window" preconditioning response (EPR)], and a later period of cytoprotection [i.e. delayed or "second window" preconditioning response (DPR)], when exposed to a subsequent prolonged hypoxic insult. EPR has been documented in vitro in isolated cardiac myocytes, as well as in situ in intact hearts or trabeculae, for a number of vertebrate species, including humans. However, there are no reports to date of DPR in human cardiac myocytes. To address this question, human ventricular myocytes (HVM) primary isolates were prepared from fetal ventricular muscle, grown to confluency, and studied in primary culture in serum-free medium (> 90%) ventricular myocytes as determined by immunohistochemical analysis with an anti-myosin chain antibody). Using cell viability as determined by trypan blue exclusion, an EPR response could readily be detected following 15, 30, or 60 min of simulated ischemia (SI) in a hypoxic (< 1 tau pO2) buffer containing 11 mmol/l 2-deoxyglucose, followed by a prolonged (c. 17 h) SI challenge. In addition, HVM exposed to 60 min of SI, followed after 24 h by a period of SI, also exhibited a "second window" DPR (80 +/- 10% compared to 71 +/- 11% survival, in preconditioned and non-preconditioned cultures P < 0.05 n = 18 independent experiments). Thus, in response to short periods of SI, human ventricular myocytes in vitro exhibit both "first window" and "second window" cytoprotective responses to subsequent, prolonged ischemic stress.
Gender differences in patients with stable angina attending primary care practices.
Publisher: Elsevier BV
Date: 07-2011
Reversible S-nitrosation of creatine kinase by nitric oxide in adult rat ventricular myocytes.
Publisher: Elsevier BV
Date: 05-1998
Complications of Pregnancy and Future Cardiovascular Risk
Publisher: Elsevier
Date: 2017
N-acetylcysteine in combination with nitroglycerin and streptokinase for the treatment of evolving acute myocardial infarction. Safety and biochemical effects.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-11-1995
DOI: 10.1161/01.CIR.92.10.2855
Abstract: Background N -acetylcysteine (NAC) has been shown to potentiate the effects of nitroglycerin (NTG) and to have antioxidant activity. This is the first study to assess the safety and effect of NAC in the treatment of evolving acute myocardial infarction (AMI). Methods and Results Patients with AMI received either 15 g NAC infused over 24 hours (n=20) or no NAC (n=7), combined with intravenous NTG and streptokinase. Peripheral venous plasma malondialdehyde (MDA), reduced (GSH) and oxidized (GSSG) glutathione concentrations, and rate of reperfusion (using continuous ST-segment analysis) were measured. Cardiac catheterization was performed between days 2 and 5. No significant adverse events occurred. Less oxidative stress occurred in patients treated with NAC than in patients not receiving NAC (GSH to GSSG ratio 44±25 versus 19±13 at 4 hours, P .05). NAC concentration (mean 172±79 μmol/L at 4 hours) was correlated to GSH concentration ( P =.006). MDA concentrations were lower ( P =.001) over the first 8 hours of treatment with NAC. There was a trend toward more rapid reperfusion (median 58 minutes, 95% confidence interval [CI] 48 to 98 minutes versus median 95 minutes, 95% CI 59 to 106 minutes P =.17) and better preservation of left ventricular function (cardiac index 3.4±0.8 versus 2.6±0.27 L · min · m 2 , P =.009) with NAC treatment. Conclusions NAC in combination with NTG and streptokinase appeared to be safe for the treatment of evolving AMI and was associated with significantly less oxidative stress, a trend toward more rapid reperfusion, and better preservation of left ventricular function.
Cardiovascular risk factors in women with previous gestational diabetes mellitus: A systematic review and meta-analysis
Publisher: Springer Science and Business Media LLC
Date: 27-10-2021
The impact of maternal asthma during pregnancy on offspring retinal microvascular structure and its relationship to placental growth factor production in utero
Publisher: Wiley
Date: 14-05-2020
DOI: 10.1111/MICC.12622
Women's awareness of cardiovascular disease risk after complications of pregnancy
Publisher: Elsevier BV
Date: 05-2023
The role of nitric oxide in heart failure
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 1999
A Protocol for Nurse-Practitioner Led Cardiovascular Follow-Up After Pregnancy Complications in a Socioeconomically Disadvantaged Population
Publisher: Frontiers Media SA
Date: 08-01-2020
Daunorubicin-induced apoptosis in rat cardiac myocytes is inhibited by dexrazoxane.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 19-02-1999
Abstract: Abstract —The clinical efficacy of anthracycline antineoplastic agents is limited by a high incidence of severe and usually irreversible cardiac toxicity, the cause of which remains controversial. In primary cultures of neonatal and adult rat ventricular myocytes, we found that daunorubicin, at concentrations ≤1 μmol/L, induced myocyte programmed cell death within 24 hours, as defined by several complementary techniques. In contrast, daunorubicin concentrations ≥10 μmol/L induced necrotic cell death within 24 hours, with no changes characteristic of apoptosis. To determine whether reactive oxygen species play a role in daunorubicin-mediated apoptosis, we monitored the generation of hydrogen peroxide with dichlorofluorescein (DCF). However, daunorubicin (1 μmol/L) did not increase DCF fluorescence, nor were the antioxidants N -acetylcysteine or the combination of α-tocopherol and ascorbic acid able to prevent apoptosis. In contrast, dexrazoxane (10 μmol/L), known clinically to limit anthracycline cardiac toxicity, prevented daunorubicin-induced myocyte apoptosis, but not necrosis induced by higher anthracycline concentrations (≥10 μmol/L). The antiapoptotic action of dexrazoxane was mimicked by the superoxide-dismutase mimetic porphyrin manganese(II/III)tetrakis(1-methyl-4-peridyl)porphyrin (50 μmol/L). The recognition that anthracycline-induced cardiac myocyte apoptosis, perhaps mediated by superoxide anion generation, occurs at concentrations well below those that result in myocyte necrosis, may aid in the design of new therapeutic strategies to limit the toxicity of these drugs.
The existence of upper common pathway: Evidence from concomitant atrioventricular nodal reentrant tachycardia and atrial fibrillation
Publisher: Elsevier BV
Date: 2021
Cardiac failure with bevacizumab: An oversight.
Publisher: Wiley
Date: 02-08-2013
DOI: 10.1111/AJCO.12092
Clinical determinants of acetylcholine-induced coronary artery spasm in Australian patients
Publisher: Elsevier BV
Date: 08-2015
Does cardiac resynchronization therapy restore peripheral circulatory homeostasis?
Publisher: Wiley
Date: 13-10-2018
DOI: 10.1002/EHF2.12211
The Association of Obstructive Sleep Apnea in Ischemia with No Obstructive Coronary Artery Disease – A Pilot Study
Publisher: Elsevier BV
Date: 05-2023
Overcoming challenges of establishing a hospital-based out-of-hospital cardiac arrest registry: accuracy of case identification using administrative data and clinical registries
Publisher: Elsevier BV
Date: 06-2021
Risk Factors for Premature Coronary Heart Disease in Women Compared to Men: Systematic Review and Meta-Analysis
Publisher: Mary Ann Liebert Inc
Date: 09-2023
The association of breast feeding for at least six months with hemodynamic and metabolic health of women and their children aged three years: an observational cohort study
Publisher: Springer Science and Business Media LLC
Date: 19-07-2023
DOI: 10.1186/S13006-023-00571-3
Abstract: Breastfeeding is important for both mother and child in reducing risk of future cardiovascular disease. Therefore, it may be an effective method to improve cardio-metabolic health, particularly those who are exposed to pregnancy complications which increase later CVD risk for both mother and child. The aim of this study is to assess differences in cardiometabolic health at three years postpartum in mothers who breastfed for at least six months and their children compared to those who did not. Women and children from the Screening Tests to Predict Poor Outcomes of Pregnancy (STOP) study (2015–2017) were invited to attend a health check-up at three years postpartum. Women’s breastfeeding status at least six months postpartum was ascertained through their child health record. Anthropometric and hemodynamic measurements were taken from women and their children. A fasting blood s le was taken from women to measure blood glucose and lipids. A total of 160 woman-child dyads were assessed in this study. Women who breastfed for at least six months had significantly lower maternal BMI, systolic blood pressure, diastolic blood pressure, mean arterial pressure, central systolic blood pressure, and central diastolic blood pressure than those who did not and this did not change after adjusting for BMI and socioeconomic index in early pregnancy, prenatal smoking and maternal age in early pregnancy. Subgroup analysis on women who had one or more pregnancy complications during the index pregnancy (i.e. preecl sia, gestational hypertension, delivery of a small for gestational age infant, delivery of a preterm infant, and/or gestational diabetes mellitus) demonstrated that women who breastfed for at least six months had significantly lower maternal systolic and diastolic blood pressures, serum insulin and triglycerides, and higher HDL cholesterol. There were no differences in child anthropometric or hemodynamic variables at three years of age between those children who had been breastfed for at least six months and those who had not. Breastfeeding for at least six months may reduce some maternal cardiovascular risk factors in women at three years postpartum, in particular, in those who have experienced a complication of pregnancy. ACTRN12614000985684 (12/09/2014).
Risk factors for premature coronary artery disease (PCAD) in adults: A systematic review protocol
Publisher: F1000 Research Ltd
Date: 02-12-2021
DOI: 10.12688/F1000RESEARCH.74926.1
Abstract: PCAD possesses a public health challenge resulting in years of productive life lost and an escalating burden on health systems. Objective of this review is to compare modifiable and non-modifiable risk factors for PCAD compared to those without PCAD. This review will include all comparative observational studies conducted in adults aged 18 years with confirmed diagnosis of PCAD (on angiography) compared to those without PCAD. Databases to be searched include PubMed, CINAHL, Embase, Web of Science, and grey literature (Google Scholar). All identified studies will be screened for title and abstract and full-text against the inclusion criteria on Covidence software. Data relevant to exposures and outcomes will be extracted from all included studies. All studies selected for data extraction will be critically appraised for methodological quality. Meta-analysis using random-effects model will be performed using Review Manager 5.3. Effect sizes for categorical risk factors will be expressed as odds ratios with 95% confidence intervals. For risk factors measured in continuous form, mean difference (if units are consistent) otherwise standardized mean difference (if units are different across studies) will be reported. Heterogeneity between studies will be assessed using I 2 test statistics. GRADE will be used to assess the certainty of the findings. Systematic review registration number: PROSPERO Registration # CRD42020173216
Is there still a role for treatment with beta-adrenoceptor antagonists in post-myocardial infarction patients with well-preserved left ventricular systolic function?
Publisher: Informa UK Limited
Date: 2008
Early pregnancy cardio metabolic risk factors and the prevalence of metabolic syndrome 10 years after the first pregnancy
Publisher: Public Library of Science (PLoS)
Date: 20-01-2023
DOI: 10.1371/JOURNAL.PONE.0280451
Abstract: We aimed to compare risk factors for CVD 10 years postpartum among women who had ≥ 1 compared to no cardio metabolic risk factor in early first pregnancy. Women of the SCOPE (Screening fOr Pregnancy Endpoints) study from Adelaide, South Australia were invited to participate in a cardiovascular risk assessment 10 years after the delivery of the first child. Data from 141 women who completed all the assessments are included in the analyses. Compared to women who did not have any cardio metabolic risk factor at 15 ± 1 weeks’ gestation during the first pregnancy, those who had ≥ 1 risk factor were 5.5 times more likely to have metabolic syndrome 10 years postpartum (aOR = 5.5, 95% CI 1.8–17.3, p = 0.004). Women who had ≥ 1cardio metabolic risk factor during the first pregnancy were more likely to be obese (p = 0.001), have high total cholesterol levels (p .001) or have increased insulin resistance (p .001) 10 years later compared to women who had no risk factor during the first pregnancy. 63.5% of the women with no cardio metabolic risk factor compared to 39% of women who had ≥ 1 risk factor in first pregnancy, had neither a complicated first pregnancy nor was diagnosed with MetS 10 years postpartum (p = 0.023). Cardio metabolic risk factors at the booking visit in the first pregnancy may be useful in identifying young women at risk of future CVD.
Protective Influence of Breastfeeding on Cardiovascular Risk Factors in Women With Previous Gestational Diabetes Mellitus and Their Children: A Systematic Review and Meta-Analysis
Publisher: SAGE Publications
Date: 05-10-2022
DOI: 10.1177/08903344211034779
Abstract: There is evidence that breastfeeding may provide protection against cardiovascular risk factors in mothers with a history of gestational diabetes mellitus and their children who were exposed in utero. To perform a systematic review and meta-analysis of observational studies to ascertain the effects of breastfeeding on cardiovascular risk factors in women with previous gestational diabetes mellitus and their children exposed in utero. Studies assessing conventional cardiovascular risk factors in women with previous gestational diabetes mellitus and children exposed in utero stratified by breastfeeding/no breastfeeding or breastfed/not breastfed were included. Gestational diabetes mellitus was defined based on the International Association of Diabetes in Pregnancy Study Group definition or previous accepted definitions. Breastfeeding was defined as reported in each study. The literature search yielded 260 titles, of which 17 studies were selected to be in the review. Women with previous gestational diabetes mellitus who did not breastfeed had higher blood glucose ( SMD: 0.32, 95% CI [0.12, 0.53]) and a greater risk of developing Type 2 diabetes mellitus ( RR: 2.08 95% CI [1.44, 3.00]) compared to women with no history. There were not enough studies to conduct a meta-analysis on the effects of breastfeeding on risk factors for cardiovascular disease among children exposed to gestational diabetes mellitus in utero. Breastfeeding appears to be protective against cardiovascular risk factors among women who experience gestational diabetes mellitus.
Effects of alirocumab on cardiovascular and metabolic outcomes after acute coronary syndrome in patients with or without diabetes: a prespecified analysis of the ODYSSEY OUTCOMES randomised controlled trial
Publisher: Elsevier BV
Date: 08-2019
Cardiologists appropriately exclude resuscitated out-of-hospital cardiac arrests from emergency coronary angiography
Publisher: Wiley
Date: 20-10-2020
DOI: 10.1002/EMP2.12276
Silent myocardial ischaemia is uncommon after uncomplicated acute myocardial infarction.
Publisher: Wiley
Date: 02-1993
Role of nitric oxide in ventricular dysfunction.
Publisher: Elsevier BV
Date: 09-1998
Meta-Analysis of admission hyperglycaemia in acutemyocardial infarction patients treated with primary angioplasty: A cause or a marker of mortality?
Publisher: Oxford University Press (OUP)
Date: 29-04-2015
A South Australian registry of biphasic cardioversions of atrial arrhythmias: efficacy and predictors of success.
Publisher: Elsevier BV
Date: 04-2015
Cardiac hemodynamics in men versus women during acute ST-segment elevation myocardial infarction.
Publisher: Elsevier BV
Date: 07-2013
Inducible nitric oxide synthase and tumor necrosis factor in animal models of myocardial necrosis induced by coronary artery ligation or isoproterenol injection.
Publisher: Elsevier BV
Date: 09-1999
Speckle Tracking Derived Contractile Reserve and Microvascular Functions in Ischaemia with No Obstructive Coronary Artery Disease – A Pilot Study.
Publisher: Research Square Platform LLC
Date: 30-03-2022
DOI: 10.21203/RS.3.RS-1300678/V1
Abstract: Background Microvascular angina (MVA) is increasingly recognized as an endotype of ischaemia with no obstructive coronary artery disease (INOCA), but assessment remains difficult while validated diagnostic investigation is invasive. This pilot study assessed the correlation between left ventricular contractile reserve (CR), measured via speckle-tracking imaging on low dose dobutamine stress echocardiography (DSE) and the invasive coronary microvascular function in patients with INOCA. Methods Forty-two patients with INOCA and abnormal coronary vasomotor dysfunction were prospectively screened at a single tertiary centre covering the Northern metropolitan area of South Australia, from February 2018 to December 2020 (ACTRN12618000149268). Forty patients were invited into to the DSE study after coronary angiography demonstrated NOCAD and abnormal coronary epicardial and microvascular function (n = 40). Results: Of the 40 participants undergoing DSE study, 30 were suitable to be included in the final analysis. Average age of 54.8 ± 10.8 years old and more female (76.2%) than male recruited. 92.1% of patients were of Caucasian ethnicity. 65.8% were considered obese. The study cohort demonstrating a degree of angina burden, with 73.7% experiencing once angina in a week. Weak positive association between CR with hyperaemic microvascular resistance (HMR) at 5mcg/kg/min, CR(absolute) (r=0.427, p-value=0.019) between 5 and 10 mcg/kg/min, CR(absolute) (r = 0.481, p-value = 0.007). The relationship between CR and HMR showed a trend of increase in CR at a DSE of 5mcg/kg/min, but a blunted response at the higher doses of 10 and 20mcg/kg/min (p=0.400). Weak positive association between CR with coronary flow reserve (CFR) at 5mcg/kg/min, CR(absolute) (r = 0.442, p-value = 0.015). The relationship between CR and CFR showed a trend of increase in CR at a DSE of 5mcg/kg/min, but a blunted response at the higher doses of 10 and 20mcg/kg/min (p=0.393). Conclusion: This pilot study has provided the possible utility of speckle tracking technique in assessment of INOCA with a MVA endotype.
Analysis of Pathogenic Variants Correctable with CRISPR Base Editing among Patients with Recessive Inherited Retinal Degeneration
Publisher: American Medical Association (AMA)
Date: 03-2021
Lipoprotein(a) and Benefit of PCSK9 Inhibition in Patients With Nominally Controlled LDL Cholesterol
Publisher: Elsevier BV
Date: 08-2021
Modulation of the endothelial nitric-oxide synthase-caveolin interaction in cardiac myocytes. Implications for the autonomic regulation of heart rate.
Publisher: Elsevier BV
Date: 11-1998
Randomized comparison of high-sensitivity troponin reporting in undifferentiated chest pain assessment
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2016
DOI: 10.1161/CIRCOUTCOMES.115.002488
Abstract: High-sensitivity troponin T (hs-TnT) assays promise greater discrimination of evolving myocardial infarction, but the impact of unguided implementation on the effectiveness of care is uncertain. We evaluated the impact of hs-TnT reporting on care and outcome among chest pain patients presenting to 5 emergency departments within a multicenter randomized trial. Patients were allocated to hs-TnT reporting (hs-report) or standard reporting (std-report Roche Elecys). The primary end point was death and new or recurrent acute coronary syndrome by 12 months. A total of 1937 patients without ST-segment elevation were enrolled between July 2011 and March 2013. The median age was 61 (interquartile range, 48–74) years, and 46.3% were women. During the index hospitalization, 1466 patients (75.7%) had maximal troponin ng/L within 24 hours. Randomization to hs-report format did not alter the admission rate (hs-report: 57.7% versus std-report: 58.0% P =0.069). There was no difference in angiography (hs-report: 11.9% versus std-report: 10.9% P =0.479). The hs-reporting did not reduce 12-month death or new/recurrent acute coronary syndrome in the overall population (hs-report: 9.7% versus std-report: 7.2% [hazard ratio, 0.83 (0.57–1.22) P =0.362]). However, among those with troponin levels ng/L, a modest reduction in the primary end point was observed (hs-report: 2.6% versus std-report: 4.4%, [hazard ratio, 0.58 95% confidence interval, 0.34–0.1.00 P =0.050). High-sensitivity troponin reporting alone is associated with only modest changes in practice. Clinical effectiveness in the adoption of high-sensitivity troponin may require close coupling with protocols that guide interpretation and care. URL: www.ANZCTR.org.au . Unique identifier: ACTRN12611000879965.
Cytokine-mediated apoptosis in cardiac myocytes: the role of inducible nitric oxide synthase induction and peroxynitrite generation.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 29-10-1999
Abstract: Abstract —Increased production of nitric oxide (NO) after induction of the cytokine-inducible isoform of nitric oxide synthase (iNOS or NOS2) in cardiac myocytes and other parenchymal cells within the heart may in addition to contributing to myocyte contractile dysfunction also contribute to the induction of programmed cell death (apoptosis). To investigate the mechanism(s) by which increased NO production leads to apoptosis, we examined the role of NO in primary cultures of neonatal rat ventricular myocytes (NRVMs) after induction by the cytokines interleukin-1β (IL-1β) and interferon γ (IFNγ) or exposure to the exogenous NO donor S -nitroso- N -acetylcysteine (SNAC) or peroxynitrite (ONOO − ). Both SNAC (1 mmol/L) and ONOO − (100 μmol/L), but not their respective controls (ie, N -acetylcysteine and pH-inactivated ONOO − ), induced apoptosis in confluent, serum-starved NRVMs at 48 hours. Similarly, incubation of NRVMs with IL-1β and IFNγ for 48 hours resulted in an increase in iNOS expression, nitrite production, and programmed cell death. Both the cytokine-induced nitrite accumulation and myocyte apoptosis could be completely prevented by the nonselective NOS inhibitor l -nitroarginine (3 mmol/L) or the specific iNOS inhibitor 2-amino-5,6-dihydro-6-methyl-4 H -1,3-thiazine (AMT, 100 μmol/L). NO-mediated myocyte apoptosis was not attenuated by the inhibition of soluble guanylyl cyclase with ODQ, nor could apoptosis be induced by the incubation of NRVMs with 1 mmol/L 8-bromo-cGMP, a cell-permeant cGMP analogue. However, NO-mediated apoptosis was significantly attenuated by the superoxide dismutase mimetic and ONOO − scavenger Mn(III)tetrakis (4-benzoic acid) porphyrin (MnTBAP, 100 μmol/L). NO/ONOO − -mediated apoptosis was associated with increased expression of Bax with no change in Bcl-2 mRNA abundance. Furthermore, apoptotic cell death was also confirmed in adult rat ventricular myocytes (ARVMs) when grown in heteroculture with IL-1β– and IFNγ-treated rat cardiac microvascular endothelial cells. Therefore, cytokine-induced apoptosis in NRVMs and ARVMs is mediated by iNOS induction, ONOO − , and associated with an increase in Bax levels.
The prevalence of ST-segment depression on ambulatory electrocardiographic monitoring during daily life in high-risk asymptomatic police officers
Publisher: Oxford University Press (OUP)
Date: 08-1994
Heart failure in minority populations - Impediments to optimal treatment in Australian aborigines
Publisher: Bentham Science Publishers Ltd.
Date: 15-07-2016
Anxiety and Depression in Early Gestation and the Association with Subsequent Gestational Diabetes Mellitus in a Disadvantaged Population
Publisher: Springer Science and Business Media LLC
Date: 12-10-2023
Effectiveness of a nurse practitioner-led cardiovascular prevention clinic at reduction of metabolic syndrome following maternal complications of pregnancy: a preliminary analysis
Publisher: Springer Science and Business Media LLC
Date: 06-10-2022
DOI: 10.1186/S13098-022-00916-8
Abstract: Maternal complications of pregnancy, including hypertensive disorders of pregnancy, gestational diabetes mellitus, intrauterine growth restriction, preterm labour, and placental abruption, are associated with increased risk of future cardiometabolic disease. Lifestyle interventions that focus on preventative strategies for this young, high-risk population of women may assist in cardiometabolic disease risk reduction. The aim of this preliminary registry analysis was to observe the change in maternal metabolic syndrome status after receiving a nurse practitioner-led lifestyle intervention delivered soon after a complicated pregnancy. This preliminary analysis included 64 eligible women who had attended both baseline (approximately 6 months postpartum) and review (approximately eighteen months postpartum) appointments at the postpartum lifestyle clinic after an index pregnancy complicated by at least one maternal complication of pregnancy. Metabolic syndrome status at both appointments was assessed. At the baseline appointment, 22 (34.4%) women met the criteria for metabolic syndrome. This number reduced at the review appointment to 19 (29.7%). This difference was not statistically significant. There were some modest improvements in the in idual cardiometabolic risk factors, as well as marked improvements in the women who had recovered from metabolic syndrome over twelve months. There was a high percentage of metabolic syndrome present early in the postpartum period. The results of this preliminary analysis highlight the importance of continuing preventative care and ongoing research for this group of high-risk women.
Nitric oxide inhibits creatine kinase and regulates rat heart contractile reserve.
Publisher: Proceedings of the National Academy of Sciences
Date: 28-05-1996
Abstract: Cardiac myocytes express both constitutive and cytokine-inducible nitric oxide syntheses (NOS). NO and its congeners have been implicated in the regulation of cardiac contractile function. To determine whether NO could affect myocardial energetics, 31P NMR spectroscopy was used to evaluate high-energy phosphate metabolism in isolated rat hearts perfused with the NO donor S-nitrosoacetylcysteine (SNAC). All hearts were exposed to an initial high Ca2+ (3.5 mM) challenge followed by a recovery period, and then, either in the presence or absence of SNAC, to a second high Ca2+ challenge. This protocol allowed us to monitor simultaneously the effect of SNAC infusion on both contractile reserve (i.e., baseline versus high workload contractile function) and high-energy phosphate metabolism. The initial high Ca2+ challenge caused the rate-pressure product to increase by 74 +/- 5% in all hearts. As expected, ATP was maintained as phosphocreatine (PCr) content briefly dropped and then returned to baseline during the subsequent recovery period. Control hearts responded similarLy to the second high Ca2+ challenge, but SNAC-treated hearts did not demonstrate the expected increase in rate-pressure product. In these hearts, ATP declined significantly during the second high Ca2+ challenge, whereas phosphocreatine did not differ from controls, suggesting that phosphoryl transfer by creatine kinase (CK) was inhibited. CK activity, measured biochemically, was decreased by 61 +/- 13% in SNAC-treated hearts compared to controls. Purified CK in solution was also inhibited by SNAC, and reversal could be accomplished with DTT, a sulfhydryl reducing agent. Thus, NO can regulate contractile reserve, possibly by reversible nitrosothiol modification of CK.
Prevalence of Metabolic Syndrome in Women After Maternal Complications of Pregnancy: An Observational Cohort Analysis
Publisher: Frontiers Media SA
Date: 14-03-2022
Abstract: Certain complications of pregnancy, including hypertensive disorders of pregnancy, gestational diabetes mellitus, intrauterine growth restriction, spontaneous preterm birth, and placental abruption, are established independent risk factors for premature cardiovascular disease in women. Metabolic syndrome, which is associated with an increased risk of cardiovascular disease, may be a suitable alternative to traditional cardiovascular risk calculators that underestimate risk in young women. This study aimed to investigate the prevalence of metabolic syndrome in women who experienced a complicated pregnancy 6 months earlier. This observational study investigated the prevalence of metabolic syndrome as defined by the International Diabetes Federation in all eligible participants ( n = 247) attending a postpartum lifestyle intervention clinic from August 2018 to June 2021 at the Lyell McEwin Hospital in Adelaide, South Australia. A total of 89 (36%) participants met the criteria for metabolic syndrome at a mean follow up time of 7 months postpartum. Almost 90% of the cohort were abdominally obese, and over two thirds of the total cohort met at least two of the criteria for metabolic syndrome. Women with a prior history of one of the common major pregnancy complications are at high risk of future cardiovascular and metabolic disease, with many showing either metabolic syndrome or multiple risk factors at only 7 months postpartum. The results indicate that follow-up within 1 year postpartum is an appropriate time to commence preventative strategies, as many women are already showing early signs of disease.
South Australian prospective cohort study evaluating outcomes of maternal kidney and cardiac disease in pregnancy: A protocol
Publisher: BMJ
Date: 02-2022
DOI: 10.1136/BMJOPEN-2021-059160
Abstract: Chronic kidney disease (CKD) and cardiac disease are two significant health conditions that can impact a women’s pregnancy however, little is known about their prevalence and health impact within the population. These pregnancies are associated with significant risks of morbidity and mortality and propose a challenge to clinicians. The aim of this longitudinal cohort study is to prospectively record the incidence, prevalence, aetiology, outcomes and follow-up of maternal CKD and cardiac disease in the obstetric population of South Australia. This study is a state-wide multicentre prospective cohort study in South Australia that will begin recruitment in 2022 and is planned for at least 5 years. Pregnant women with chronic or acquired kidney or cardiac disease will be enrolled across the state’s major public obstetric hospitals. The data collected will focus on the chronic disease aetiology, peripartum interventions, delivery, obstetric and neonatal outcomes, progression of underlying disease and patient-related outcome measures. Women will have data collected each trimester during pregnancy and then at follow-up 6 weeks, 6 months and 12 months post partum. Clear inclusion and exclusion criteria have been developed which importantly includes new diagnosis of chronic disease in pregnancy. Approval was obtained from the local Health Network Human Research Ethics Committee. Summary data will be reviewed and reported in accordance with Strengthening the Reporting of Observational Studies in Epidemiology criteria 6 monthly and results will be published in peer-reviewed journals and presented at conferences. Findings will be presented to relevant local clinicians and hospitals at regular intervals. Consumer versions of research outputs will be developed in conjunction with the consumer reference group.
Sex Differences in Incidence and Outcome of Out-of-Hospital Cardiac Arrest Within a Local Health Network
Publisher: Frontiers Media SA
Date: 08-04-2022
Abstract: Sex and gender differences in presentation and characteristics of out-of-hospital cardiac arrest (OHCA) are established in cohorts with presumed cardiac aetiology but not non-cardiac etiology. This study investigated the effect of sex on incidence and outcome of OHCA according to presumed and adjudicated aetiology within a local health network. Population-based observational cohort study of emergency medical services (EMS) attended OHCAs within an Australian local health network. Cases identified from an EMS registry between 2012-2016 were linked to a hospital registry. Age-standardised incidence and baseline characteristics were stratified by sex for EMS-treated OHCA, non-EMS witnessed presumed cardiac and obvious non-cardiac sub-cohorts, and hospitalised cases. Logistic regression was used to explore the primary outcome of survival to hospital discharge. We identified 2,024 EMS-attended and 780 EMS-treated OHCAs. The non-EMS witnessed sub-cohorts comprised 504 presumed cardiac and 168 obvious non-cardiac OHCAs. Adjudicated aetiology was recorded in 123 hospitalised cases. Age-standardised incidence for women was almost half that of men across all groups. Across cohorts, women were generally older and arrested with a non-shockable initial rhythm in an area of low socioeconomic status. There was no sex difference in the primary outcome for the main EMS-treated cohort or in the non-cardiac sub-cohorts. The sex difference in outcome in the presumed cardiac sub-cohort was not present after multivariable adjustment. There are sex differences in incidence and outcome of EMS-treated OHCA that appear to be driven by differences in susceptibility to cardiac arrhythmias and underlying etiology, rather than treatment delays or disparities.
Gaps in Cardiac Rehabilitation Referral A Universal Problem
Publisher: Elsevier BV
Date: 12-2015
Effect of lorcaserin on prevention and remission of type 2 diabetes in overweight and obese patients (CAMELLIA-TIMI 61): a randomised, placebo-controlled trial
Publisher: Elsevier BV
Date: 11-2018
Gestational diabetes mellitus and cardio-metabolic risk factors in women and children at 3 years postpartum
Publisher: Springer Science and Business Media LLC
Date: 11-07-2022
DOI: 10.1007/S00592-022-01914-Y
Abstract: Gestational diabetes mellitus (GDM) is thought to be associated with cardio-metabolic risk factor development in women and their children during the early postpartum period and early childhood. We hypothesized that these women and their children would exhibit increased abnormal cardio-metabolic risk factors three years after pregnancy. Women from the Screening Tests to Predict Poor Outcomes of Pregnancy study were invited to attend a follow-up with the child from their index pregnancy at 3 years postpartum. Women and children were assessed for anthropometric measures and haemodynamic function. Fasting blood s les were obtained from women to assess lipid and glucose status. A total of 281 woman-child dyads participated in the 3-year follow-up, with 40 women developing GDM during their index pregnancy. Fasting serum insulin was higher in women with GDM in index pregnancy compared to those with an uncomplicated pregnancy. However, this association was mediated by early pregnancy BMI and socioeconomic index (SEI). The rate of metabolic syndrome was higher in the GDM group than the uncomplicated pregnancy group. Maternal GDM was associated with elevated maternal fasting serum triglycerides at 3 years after adjustment for early pregnancy BMI and SEI. Children exposed to GDM in utero had higher waist circumference compared to children born after an uncomplicated pregnancy, but this is mediated the above covariates. Exposure to GDM is associated with elevated serum triglycerides in women at 3 years postpartum but other cardiometabolic outcomes in women and children appear to be mediated by early pregnancy BMI and SEI.
F5. Skin microvascular dysfunction in preeclampsia persists to the postpartum period
Publisher: Informa UK Limited
Date: 12-08-2016
Impact of Young Age and Gender on Outcomes of Transradial Versus Transfemoral Access Coronary Angiography
Publisher: SAGE Publications
Date: 24-09-2021
Abstract: The differential impact of young age and female gender on transradial access (TRA) outcomes remains to be confirmed. The primary objective was to assess the impact of young age and female gender on in-hospital net adverse cardiovascular events (NACE). Among 12 346 patients from the Coronary Angiogram Database of South Australia (CADOSA) Registry, the impact of gender men (transfemoral access [TFA] 1995, TRA 6168) and women (TFA 1249, TRA 2934), and a median split of age, ≤63 years (TFA 1617, TRA 4727) and years (TFA 1627, TRA 4375) were analyzed on in-hospital outcomes by creating 5 separate propensity-matched cohorts (entire cohort, men, women, ≤63 and 63 years). Net adverse cardiovascular event reduction with TRA was limited to the years old cohort (odds ratio [OR] = 0.56, 95% CI: 0.34-0.93, P = .02) and women (OR = 0.37, 95% CI: 0.18-0.76, P = .007). In both the age groups and genders, TRA was associated with a lower risk of bleeding and all-cause mortality. On multivariate logistic regression, TRA was associated with a significant reduction in NACE, major bleeding, and mortality in the overall cohort. In conclusion, a reduction in bleeding and mortality was noted with TRA in all the subgroups in this observational study.
Sotalol-induced torsade de pointes: management with magnesium infusion.
Publisher: Oxford University Press (OUP)
Date: 04-1992
Abstract: A 69 year old woman was treated with sotalol (320 mg daily) for intermittent atrial fibrillation. Sotalol was initially well tolerated and reversion to sinus rhythm with sinus bradycardia occurred 4 weeks after initiation of therapy. Shortly thereafter, the patient developed recurrent syncope due to torsade de pointes. This was treated successfully with intravenous magnesium infusion and withdrawal of sotalol. Subsequently, the atrial fibrillation was adequately managed using amiodarone, with no recurrence of torsade de pointes. Development of bradycardia associated with reversion to sinus rhythm represents a potential cause of 'late' pro-arrhythmic effects of sotalol.
Prevalence and real-world management of NSTEMI with multivessel disease
Publisher: AME Publishing Company
Date: 02-2022
DOI: 10.21037/CDT-21-518
Related Organisations
Cardiac Society Of Australia And New Zealand
Location: No location found
Related Funding Activities
No related grants have been discovered for Margaret Arstall.