Papers by Oliver Guttmann
This study evaluated clinical outcome after multivessel stenting with sirolimus-eluting stents (S... more This study evaluated clinical outcome after multivessel stenting with sirolimus-eluting stents (SES) in unselected lesions. BACKGROUND Safety and effectiveness of multivessel SES implantation is currently unknown.
Heart (British Cardiac Society), Jan 15, 2015
A predictable relation between genotype and disease expression is needed in order to use genetic ... more A predictable relation between genotype and disease expression is needed in order to use genetic testing for clinical decision-making in hypertrophic cardiomyopathy (HCM). The primary aims of this study were to examine the phenotypes associated with sarcomere protein (SP) gene mutations and test the hypothesis that variation in non-sarcomere genes modifies the phenotype. Unrelated and consecutive patients were clinically evaluated and prospectively followed in a specialist clinic. High-throughput sequencing was used to analyse 41 genes implicated in inherited cardiac conditions. Variants in SP and non-SP genes were tested for associations with phenotype and survival. 874 patients (49.6±15.4 years, 67.8% men) were studied; likely disease-causing SP gene variants were detected in 383 (43.8%). Patients with SP variants were characterised by younger age and higher prevalence of family history of HCM, family history of sudden cardiac death, asymmetric septal hypertrophy, greater maximum ...
Postgraduate medical journal, 2006
Tako-tsubo cardiomyopathy is a cardiac syndrome precipitated by profound emotional stress and anx... more Tako-tsubo cardiomyopathy is a cardiac syndrome precipitated by profound emotional stress and anxiety, particularly in middle-aged women. It presents as a mimic of acute myocardial infarction, but coronary angiography shows normal coronary arteries and a characteristic left ventriculogram resembling an "octopus pot". The condition seems to have a favourable prognosis. Initially described in Japan, and with many names in the literature, it is being increasingly recognised in the West owing to early coronary angiography and primary coronary intervention, accounting for up to 1 in 30 primary cases of angioplasty in some institutions. A typical case is described, and the clinical features, pathophysiology and management reviewed.
Journal of the American College of Cardiology, 2012
Heart, 2014
Cardiomyopathies are myocardial disorders that are not explained by abnormal loading conditions a... more Cardiomyopathies are myocardial disorders that are not explained by abnormal loading conditions and coronary artery disease. They are classified into a number of morphological and functional phenotypes that can be caused by genetic and non-genetic mechanisms. The dominant themes in papers published in 2012-2013 are similar to those reported in Almanac 2011, namely, the use (and interpretation) of genetic testing, development and application of novel non-invasive imaging techniques and use of serum biomarkers for diagnosis and prognosis. An important innovation since the last Almanac is the development of more sophisticated models for predicting adverse clinical events.
Heart, 2014
HCM is commonly associated with AF. Current guidelines for AF management omit detailed advice for... more HCM is commonly associated with AF. Current guidelines for AF management omit detailed advice for HCM because of a lack of clinical prediction tools that estimate the risk of developing AF and an absence of adequately powered treatment studies. To critically review current literature on atrial fibrillation (AF) and thromboembolism in hypertrophic cardiomyopathy (HCM) and meta-analyse prevalence and incidence. PubMed and Web of Science. Studies investigating AF and stroke in HCM as primary or secondary endpoint. Two investigators independently reviewed and extracted data from the identified articles. A random effect meta-regression model and I(2) statistics were used for analysis. A population of 7381 patients (33 studies) revealed overall AF prevalence of 22.45% (95% CI 20.13% to 24.77%), I(2)=78.9% (p<0.001). Overall prevalence of thromboembolism in HCM patients with AF was 27.09% (95% CI 20.94% to 33.25%), I(2)=61.4% ( p<0.01). Overall AF incidence was 3.08% per 100 patients per year (95% CI 2.63% to 3.54%, I(2)=86.5%, p<0.001) and incidence of thromboembolism in HCM patients with AF was 3.75% per 100 patients per year (95% CI 2.88% to 4.61%), I(2)=37.9% (p=0.1). Left atrial (LA) dimension and age were common predictors for AF and thromboembolism. Meta-analysis revealed an LA diameter of 38.03 mm (95% CI 34.62% to 41.44%) in sinus rhythm and 45.37 mm (95% CI 41.64% to 49.04%) in AF. There were no randomised controlled trials of therapy; anticoagulation was associated with lower stroke incidence but data on other interventions were limited and contradictory. AF is common in HCM and associated with high thromboembolic risk. LA dimension and age are independently associated with AF but the literature is insufficient to create robust clinical tools to predict AF or thromboembolism. Most data suggest that AF patients should be anticoagulated.
Heart, 2012
Category: 4. Acute Coronary Syndromes: Therapy Background: Limited information exists regarding p... more Category: 4. Acute Coronary Syndromes: Therapy Background: Limited information exists regarding procedural success and outcomes of STEMI patients with prior CABG undergoing primary PCI. We sought to compare outcomes in STEMI patients undergoing primary PCI with or without prior CABG.
Heart, 2011
BackgroundRenal impairment is associated with increased cardiovascular mortality following acute ... more BackgroundRenal impairment is associated with increased cardiovascular mortality following acute coronary syndromes (ACS), however there is limited data assessing this relationship in the context of primary PCI and whether it exists with other major adverse cardiovascular events.MethodsClinical information was analysed from a prospective data base on 2310 STEMI patients who underwent primary PCI between January 2004 and May 2010 at a London centre. Information was entered at the time of procedure and outcome assessed by all-cause mortality information provided by the Office of National Statistics via the BCIS/CCAD national audit. Estimated glomerular filtration rate (eGFR) was calculated using the modified diet in renal disease equation and patients were divided into groups based on eGFR (60 ml/min/1.73 m2). 3-year composite of MACE (death, reinfarction, stroke and target vessel revascularisation) were compared between groups.ResultsThe average eGFR in all patients was 73.40±23.37 (95% CI 72.25 to 74.56) ml/min/1.73 m2. The prevalence of coexisting risk factors (hypertension, diabetes mellitus, hypercholesterolaemia), previous MI, previous CABG and cardiogenic shock were higher among patients with reduced eGFR. There was a progressive increase in MACE with declining eGFR (OR=4.84, 95% CI 2.94 to 7.96, for comparison between the highest and lowest eGFR groups). See Abstract 46 figure 1. After adjustment for baseline characteristics including age, diabetes and cardiogenic shock renal function based on the GFR at admission remained a strong independent predictor of outcome.All MACE after PCI for STEMI.ConclusionBaseline renal dysfunction in patients undergoing primary PCI is associated with an increased risk for combined death, re-infarction and recurrent angina. This risk increases linearly with declining eGFR.
Heart, 2011
IntroductionReperfusion therapy with primary PCI (PPCI) has reduced rates of recurrent ischaemia ... more IntroductionReperfusion therapy with primary PCI (PPCI) has reduced rates of recurrent ischaemia and arrhythmia following ST elevation myocardial infarction (STEMI), resulting in shorter hospital stays. Discharge at 72 h in selected patients has been suggested. We investigated the feasibility and safety of very early discharge (72 h, out to 5 years of follow-up.Results1079 patients (46.5%) were stratified to 48-h discharge,
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Papers by Oliver Guttmann