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Featured researches published by L. Kearney.


European Journal of Echocardiography | 2012

Global longitudinal strain is a strong independent predictor of all-cause mortality in patients with aortic stenosis

L. Kearney; K. Lu; M. Ord; Sheila K. Patel; K. Profitis; George Matalanis; Louise M. Burrell; P. Srivastava

AIMS To assess the capacity of global longitudinal strain (GLS) in patients with aortic stenosis (AS) to (i) detect the subclinical left ventricular (LV) dysfunction [LV ejection fraction (LVEF) ≥50% patients]; (ii) predict all-cause mortality and major adverse cardiac events (MACE) (all patients), and (iii) provide incremental prognostic information over current risk markers. METHODS AND RESULTS Patients with AS (n = 146) and age-matched controls (n = 12) underwent baseline echocardiography to assess AS severity, conventional LV parameters and GLS via speckle tracking echocardiography. Baseline demographics, symptom severity class and comorbidities were recorded. Outcomes were identified via hospital record review and subject/physician interview. The mean age was 75 ± 11, 62% were male. The baseline aortic valve (AV) area was 1.0 ± 0.4 cm(2) and LVEF was 59 ± 11%. In patients with a normal LVEF (n = 122), the baseline GLS was controls -21 ± 2%, mild AS -18 ± 3%, moderate AS -17 ± 3% and severe AS -15 ± 3% (P< 0.001). GLS correlated with the LV mass index, LVEF, AS severity, and symptom class (P< 0.05). During a median follow-up of 2.1 (inter-quartile range: 1.8-2.4) years, there were 20 deaths and 101 MACE. Unadjusted hazard ratios (HRs) for GLS (per %) were all-cause mortality (HR: 1.42, P< 0.001) and MACE (HR: 1.09, P< 0.001). After adjustment for clinical and echocardiographic variables, GLS remained a strong independent predictor of all-cause mortality (HR: 1.38, P< 0.001). CONCLUSIONS GLS detects subclinical dysfunction and has incremental prognostic value over traditional risk markers including haemodynamic severity, symptom class, and LVEF in patients with AS. Incorporation of GLS into risk models may improve the identification of the optimal timing for AV replacement.


Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques | 2015

Right ventricular global longitudinal strain is an independent predictor of right ventricular function: a multimodality study of cardiac magnetic resonance imaging, real time three-dimensional echocardiography and speckle tracking echocardiography.

K. Lu; Janet X C Chen; Konstantinos Profitis; L. Kearney; Dimuth DeSilva; G. Smith; M. Ord; Susan Harberts; Paul Calafiore; E. Jones; P. Srivastava

Accurate assessment of right ventricular (RV) systolic function is important, as it is an established predictor of mortality in cardiac and respiratory diseases. We aimed to compare speckle tracking–derived longitudinal deformation measurements with traditional two‐dimensional (2D) echocardiographic parameters, as well as real time three‐dimensional echocardiography (RT3DE) and cardiac magnetic resonance imaging (CMR)‐derived RV volumes and ejection fraction (EF).


American Journal of Cardiology | 2012

Usefulness of the Charlson co-morbidity index to predict outcomes in patients >60 years old with aortic stenosis during 18 years of follow-up.

L. Kearney; M. Ord; Brian F. Buxton; George Matalanis; Sheila K. Patel; Louise M. Burrell; P. Srivastava

The present study assessed the effect of age and co-morbidity on the outcomes of mild, moderate, and severe aortic stenosis (AS) in patients aged >60 years during 18 years of follow-up. The outcomes evaluated were hemodynamic progression, a composite cardiac mortality or aortic valve replacement (AVR) end point, and all-cause mortality. Consecutive Department of Veterans Affairs patients (aged >60 years) with AS were prospectively enrolled from 1988 to 1994 and followed until 2008 (n = 239). The baseline demographic, co-morbidity, and echocardiographic parameters were recorded. At enrollment, the mean age was 74 ± 6 years, and 78% were men. The annualized mean aortic valve gradient progression was 4 ± 4, 6 ± 5, and 10 ± 8 mm Hg for mild, moderate, and severe AS, respectively (p <0.001). During a mean follow-up of 8 ± 5 years, 206 deaths (52% cardiac) and 91 AVRs were recorded. The AVR/cardiac mortality event rate at 1, 5, and 10 years was 2%, 26%, and 50% for mild AS, 13%, 63%, and 69% for moderate AS, and 66%, 95%, and 95% for severe AS (p <0.001). During the study period, 132 patients developed severe AS. The survival rate at 1, 5, and 10 years was 60 ± 7%, 14 ± 5%, and 5 ± 3% with conservative management and 98 ± 2%, 82 ± 4%, and 50 ± 5% after AVR, respectively (p <0.001). The independent predictors of all-cause mortality were the age-adjusted Charlson co-morbidity index (hazard ratio 1.24, p <0.001), AVR (hazard ratio 0.40, p <0.001), and grade of left ventricular dysfunction (hazard ratio 1.36, p = 0.01). In conclusion, the prognostic significance of AS is determined by the hemodynamic severity, left ventricular function, and the presence of symptoms, in the context of age and co-morbidities. The age-adjusted Charlson co-morbidity index provides crucial prognostic information to guide the surgical risk/benefit discussions for patients with severe AS.


International Journal of Cardiology | 2013

Age adjusted Charlson Co-morbidity Index is an independent predictor of mortality over long-term follow-up in infective endocarditis.

K. Lu; L. Kearney; M. Ord; E. Jones; Louise M. Burrell; P. Srivastava

BACKGROUND Infective endocarditis (IE) is associated with high morbidity and mortality. The epidemiology of IE is changing, affecting more elderly patients with increased medical comorbidities. We aimed to assess the ability of the age adjusted Charlson Co-morbidity Index (ACCI) to predict early and late outcomes. METHODS Between 1998 and 2010, adult patients with definite IE according to the modified Duke criteria were identified. The primary outcome was in-hospital and all-cause mortality. The secondary outcome was predictors of the primary outcome incorporating ACCI. RESULTS 148 patients with IE were followed up for a mean of 3.8 ± 3 years. The mean age was 57 ± 17 years and 66% were male. In-hospital mortality and all-cause mortality were 24 and 47% respectively. Comorbid conditions included diabetes mellitus (DM) (21%); ischaemic heart disease (16%); heart failure (HF) (14%); renal failure (eGFR <60 ml/min/1.73 m(2)) (19%); and anaemia (64%). The most common causative organism was Staphylococcus aureus (53%). ACCI was >3 in 59% of patients. Cardiac surgery was performed in 45% of patients. On Cox regression analysis, ACCI >3 (HR=3.0 [1.5-6.0], p<0.002), new onset HF (HR=2.2 [1.3-3.6], p<0.003), anaemia (HR=1.8 [1.1-3.2], p=0.04) and age-per decade (HR=1.4 [1.1-1.7]. p=0.004) were independently associated with all-cause mortality. ACCI >3 was the strongest predictor of in-hospital mortality (OR=8.4 [2.8-24], p<0.001). Of the individual ACCI components, prior HF, DM with complications and metastatic disease were independent predictors of all-cause mortality. CONCLUSION In-hospital and all-cause mortality of IE remain high. An ACCI >3 was a strong predictor of mortality, in addition to age, new HF and anaemia.


Cardiovascular Diabetology | 2012

Beta blocker use in subjects with type 2 diabetes mellitus and systolic heart failure does not worsen glycaemic control

Bryan Wai; L. Kearney; David L. Hare; M. Ord; Louise M. Burrell; P. Srivastava

BackgroundThe prognostic benefits of beta-blockers (BB) in patients with systolic heart failure (SHF) are known but despite this, in patients with diabetes they are underutilized. The aim of this study was to assess the effect of beta-blockers (BB) on glycaemic control in patients with Type 2 Diabetes (T2DM) and systolic heart failure (SHF) stratified to beta-1 selective (Bisoprolol) vs. nonselective BB (Carvedilol).MethodsThis observational, cohort study was conducted in patients with T2DM and SHF attending an Australian tertiary teaching hospitals heart failure services. The primary endpoint was glycaemic control measured by glycosylated haemoglobin (HbA1c) at initiation and top dose of BB. Secondary endpoints included microalbuminuria, changes in lipid profile and estimated glomerular filtration rate (eGFR).Results125 patients were assessed. Both groups were well matched for gender, NYHA class and use of guideline validated heart failure and diabetic medications. The mean treatment duration was 1.9 ± 1.1 years with carvedilol and 1.4 ± 1.0 years with bisoprolol (p = ns). The carvedilol group achieved a reduction in HbA1c (7.8 ± 0.21% to 7.3 ± 0.17%, p = 0.02) whereas the bisoprolol group showed no change in HbA1c (7.0 ± 0.20% to 6.9 ± 0.23%, p = 0.92). There was no significant difference in the change in HbA1c from baseline to peak BB dose in the carvedilol group compared to the bisoprolol group. There was a similar deterioration in eGFR, but no significant changes in lipid profile or microalbuminuria in both groups (p = ns).ConclusionBB use did not worsen glycaemic control, lipid profile or albuminuria status in subjects with SHF and T2DM. Carvedilol significantly improved glycemic control in subjects with SHF and T2DM and this improvement was non significantly better than that obtained with bisoprolol. BBs should not be withheld from patients with T2DM and SHF.


Europace | 2011

Validation of rapid automated tissue synchronization imaging for the assessment of cardiac dyssynchrony in sinus and non-sinus rhythm.

L. Kearney; Bryan Wai; M. Ord; Louise M. Burrell; David O'Donnell; P. Srivastava

AIMS Cardiac resynchronization therapy is showing benefits for an increasing number of indications but fails to predict response in up to 20-30% of subjects. Echocardiographically assessed dyssynchrony has been proposed as a potential stratifier but current methods are time-consuming and suffer poor reproducibility, thus limiting their clinical utility. This study compared the accuracy, time efficiency, and reproducibility of automated tissue synchronization imaging (Auto TSI) vs. established manual tissue velocity imaging (TVI) techniques for the assessment of intra-ventricular dyssynchrony in sinus and non-sinus rhythm. METHODS AND RESULTS Fifty consecutive stable systolic heart failure patients on optimal guideline-based medical therapy underwent intra-ventricular dyssynchrony assessment [time to peak velocity (Ts), septal to lateral delay (SLD), and dyssynchrony index (DI)] with TVI and Auto TSI techniques, enabling the assessment of agreement, time efficiency, and reproducibility. Statistical analyses included Pearsons correlation, Bland-Altmans statistics, and coefficient of reproducibility. There was excellent agreement between Auto TSI and TVI for the measurement of Ts [r=0.92, P<0.001, limits of agreement (LOA): -27.3 to 56.5 ms], SLD (r=0.94, P<0.001, LOA: -41 to 49 ms), and DI (r=0.89, P<0.001, LOA: -12.2 to 12.6 ms) which persisted irrespective of cardiac rhythm [Ts: sinus (n=32) r=0.93, P<0.001; non-sinus (n=18) r=0.91, P<0.001]. Automated TSI was more time efficient (3±1 vs. 14±2 min, P<0.001) and demonstrated superior reproducibility: intra-observer (5.5 vs. 9.6%) and inter-observer variability (9.5 vs. 13.4%). CONCLUSION Automated TSI enables rapid, reproducible intra-ventricular dyssynchrony assessment and overcomes some of the limitations of conventional techniques in sinus and non-sinus rhythm.


Heart Lung and Circulation | 2010

Thrombus entrapped in a patent foramen ovale: a potential source of pulmonary and systemic embolism.

L. Kearney; P. Srivastava

Patent foramen ovale (PFO) occurs in up to 30% of the population, making it the most common site for intra-cardiac shunting. The passage of thrombus across a PFO is typically transient, thus is rarely proven. We describe a rare case of a 79-year-old man with thrombus entrapped across a PFO providing a source for ongoing pulmonary and systemic thromboembolism, despite systemic anticoagulation. There is a paucity of literature to guide primary management of this condition. Management options include surgical thrombectomy with PFO closure, thrombolysis and systemic anticoagulation. The role of percutaneous PFO closure devices for secondary prevention of thromboembolic complications is currently under investigation.


Scientific Reports | 2018

Routine use of HbA1c amongst inpatients hospitalised with decompensated heart failure and the association of dysglycaemia with outcomes

Kaylyn Khoo; Jeremy Lew; P. Neef; L. Kearney; Leonid Churilov; Raymond Robbins; A. Tan; Mariam Hachem; L. Owen-Jones; Que T. Lam; Graeme Kevin Hart; A. Wilson; Priya Sumithran; Douglas H. Johnson; P. Srivastava; Omar Farouque; Louise M. Burrell; Jeffrey D. Zajac; Elif I. Ekinci

Diabetes is an independent risk factor for development of heart failure and has been associated with poor outcomes in these patients. The prevalence of diabetes continues to rise. Using routine HbA1c measurements on inpatients at a tertiary hospital, we aimed to investigate the prevalence of diabetes amongst patients hospitalised with decompensated heart failure and the association of dysglycaemia with hospital outcomes and mortality. 1191 heart failure admissions were identified and of these, 49% had diabetes (HbA1c ≥ 6.5%) and 34% had pre-diabetes (HbA1c 5.7–6.4%). Using a multivariable analysis adjusting for age, Charlson comorbidity score (excluding diabetes and age) and estimated glomerular filtration rate, diabetes was not associated with length of stay (LOS), Intensive Care Unit (ICU) admission or 28-day readmission. However, diabetes was associated with a lower risk of 6-month mortality. This finding was also supported using HbA1c as a continuous variable. The diabetes group were more likely to have diastolic dysfunction and to be on evidence-based cardiac medications. These observational data are hypothesis generating and possible explanations include that more diabetic patients were on medications that have proven mortality benefit or prevent cardiac remodelling, such as renin-angiotensin system antagonists, which may modulate the severity of heart failure and its consequences.


Heart Lung and Circulation | 2016

The Short-Term Effect of Right Ventricular Mid-septal Pacing on Right Ventricular Function

J. Ramchand; J. Chen; M. Yudi; L. Kearney; Paul Calafiore; D. O’donnell; K. Lu; P. Srivastava; E. Jones

Characterisation of soft tissue lesions is a common reason for paediatric patients to be referred to the ultrasound department. These lesions commonly occur in the head and neck and include haemangiomas, lymphatic and vascular malformations, thyroglossal duct cysts, brachial cleft cysts and ranulas. Soft tissue lesions may also occur on the body or limbs and can include lipomas, dermoid cysts and epidermal inclusion cysts. With the use of bmode, colour flow and spectral imaging it is possible to characterise these lesions and provide the most likely differential diagnosis. This e-poster demonstrates a simple approach to this type of examination, summarises the ultrasound features of these lesions and provides examples using high resolution images. The HeRO® Vascular Access Graft A Single Centre


The Journal of Thoracic and Cardiovascular Surgery | 2013

Cardiac magnetic resonance imaging for assessment of aortic valve morphology

Jasmin Grewal; L. Kearney; P. Srivastava

References 1. Redlin M, Habazettl H, Boettcher W, Kukucka M, Schoenfeld H, Hetzer R, et al. Effects of a comprehensive blood-sparing approach using body weight-adjusted miniaturized cardiopulmonary bypass circuits on transfusion requirements in pediatric cardiac surgery. J Thorac Cardiovasc Surg. 2012;144:493-9. 2. Redlin M, KukuckaM, BoettcherW, Schoenfeld H, HueblerM, Kuppe H, et al. Blood transfusion determines postoperative morbidity in pediatric cardiac surgery applying a comprehensive blood-sparing approach. J Thorac Cardiovasc Surg. Dec 7, 2012 [Epub ahead of print].

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M. Ord

University of Melbourne

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K. Lu

University of Melbourne

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Bryan Wai

University of Melbourne

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E. Jones

University of Melbourne

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J. Ramchand

University of Melbourne

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