E A Shinebourne

Bio: E A Shinebourne is an academic researcher from Imperial College London. The author has contributed to research in topics: Blood pressure & Great arteries. The author has an hindex of 24, co-authored 49 publications receiving 2278 citations.

Fetal, Infant, and Childhood Growth and Adult Blood Pressure A Longitudinal Study From Birth to 22 Years of Age

Abstract: Background— People who are small at birth tend to have higher blood pressure in later life. However, it is not clear whether it is fetal growth restriction or the accelerated postnatal growth that often follows it that leads to higher blood pressure. Methods and Results— We studied blood pressure in 346 British men and women aged 22 years whose size had been measured at birth and for the first 10 years of life. Their childhood growth was characterized using a conditional method that, free from the effect of regression to the mean, estimated catch-up growth. People who had been small at birth but who gained weight rapidly during early childhood (1 to 5 years) had the highest adult blood pressures. Systolic pressure increased by 1.3 mm Hg (95% CI, 0.3 to 2.3) for every standard deviation score decrease in birth weight and, independently, increased by 1.6 mm Hg (95% CI, 0.6 to 2.7) for every standard deviation score increase in early childhood weight gain. Adjustment for adult body mass index attenuated the ...

Changes in the pressure-volume relation of the right ventricle when its loading conditions are modified.

Abstract: Ventricular pressure-volume diagrams were obtained from the right ventricle in patients before and after relief of right ventricular pressure load, in patients with volume loaded right ventricles, and from the left ventricle in patients after the Mustard procedure for transposition of the great arteries. The patterns of ejection during pressure development and decline were similar in patients after relief of pressure load and in those with isolated volume load. A right ventricular pressure load, however, reduced ejection during the two "isovolumic" periods, and the overall shape of the pressure-volume loop resembled that of the normal left ventricle. Pressure-volume diagrams obtained from the left ventricle after the Mustard procedure were indistinguishable from the normal right ventricle, which accords with the hypothesis that the normal right ventricular contraction pattern is a consequence of loading conditions rather than a reflection of an intrinsic property of the myocardium.

24-hour electrocardiographic study of heart rate and rhythm patterns in population of healthy children

Abstract: Twenty-four hour electrocardiographic recordings were made on 104 randomly selected, healthy 7 to 11-year-old children. Ninety-two were technically adequate and suitable for analysis. The mean highest heart rate measured by direct electrocardiographic analysis over nine beats was 164 +/- 17. The mean lowest heart rates were 49 +/- 6 over three beats', and 56 +/- 6 over nine beats' duration. The maximum duration of heart rates less than 55/minute was 40 minutes. At their lowest heart rates 41 children (45 per cent) had junctional escape rhythms, the maximum duration of which was 25 minutes. Nine children showed PR intervals greater than or equal to 0.20 s and included three with Mobitz type I second degree atrioventricular block. Nineteen (21%) had isolated supraventricular or ventricular premature beats (less than 1/hour). Sixty subjects (65%) had sinus pauses that could not be distinguished on the surface electrocardiogram from those previously described as sinuatrial exit block or sinus arrest. The maximum duration of sinus pause measured over 24 hours on each child was 1.36 +/- 0.23 seconds. Thus apparently healthy children show variations in heart rate and rhythm over 24 hours hitherto considered to be abnormal.

A new technique for the assessment of pulmonary regurgitation and its application to the assessment of right ventricular function before and after repair of tetralogy of Fallot.

Abstract: Biplane right ventriculograms with simultaneous high fidelity pressure recordings were obtained in 24 patients with tetralogy of Fallot. Twelve patients were studied before repair and 12 were studied 67 (42) months after radical surgical repair without the use of a transannular patch. In the patients who had repair right ventricular end diastolic and end systolic volume indices were higher, and the ejection fraction was lower. Time to peak ventricular filling and the peak rate of ventricular fillings were also lower in this group and there was a significant relation between peak filling rate and ejection fraction. Postoperative pressure-volume loops from nine patients showed an increase in cavity volume during the decline in right ventricular pressure, which indicated pulmonary regurgitation. The mean regurgitant volume for the group correlated with end diastolic volume index, stroke volume index, and peak filling rate, but not with ejection fraction. These data show that both systolic and diastolic abnormalities of right ventricular function are detected in most patients after radical repair of tetralogy of Fallot. The reduction of ejection fraction previously reported in these patients is unrelated to the degree of pulmonary regurgitation and primarily reflects an impairment of contractile function that presumably is related to intraoperative events.

Sequential 22-hour profiles of breathing patterns and heart rate in 110 full-term infants during their first 6 months of life.

Abstract: Sequential recordings (total number 365, mean duration 22 hours) of ECG and abdominal wall movement were obtained from 110 full-term infants up to 6 months of age. The longest pause in breathing movement per recording (maximum 21.6 seconds) decreased in duration over the first 2 weeks of life (P less than .005). Pauses greater than 18.0 seconds were not detected after seven days. The spread of values for pauses greater than or equal to 3.6 seconds duration was widest during the first 2 weeks, and their number decreased with age (P less than .001). Periodic breathing, detected in 69% to 80% of infants in all age groups, showed decreasing trends with age in total duration and maximum length of episode (P less than .005 for both). The spread of values was widest during the first 2 weeks (range for total duration 0 to 4.7 hours) and decreased with age. The mean respiratory rate during regular breathing decreased after 4 weeks (P less than .001). The spread of values was widest during the first 2 weeks and decreased with age. Birth weight was positively correlated with mean respiratory rate during the first three days of life (r = +.64, P less than .001). The mean heart rate during regular breathing increased during the first 15 days (P less than .001) and then decreased after 4 weeks (P less than .001). Higher mean heart rates were found in male infants (P less than .01).

2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC)

Abstract: ACC : American College of Cardiology ACE : angiotensin-converting enzyme ACS : acute coronary syndrome AF : atrial fibrillation AGNES : Arrhythmia Genetics in the Netherlands AHA : American Heart Association AMIOVIRT : AMIOdarone Versus Implantable cardioverter-defibrillator:

ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

Abstract: It is important that the medical profession plays a significant role in critically evaluating the use of diagnostic procedures and therapies as they are introduced and tested in the detection, management, or prevention of disease states. Rigorous and expert analysis of the available data documenting absolute and relative benefits and risks of those procedures and therapies can produce helpful guidelines that improve the effectiveness of care, optimize patient outcomes, and favorably affect the overall cost of care by focusing resources on the most effective strategies. The American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) have jointly engaged in the production of such guidelines in the area of cardiovascular disease since 1980. The ACC/AHA Task Force on Practice Guidelines, whose charge is to develop, update, or revise practice guidelines for important cardiovascular diseases and procedures, directs this effort. The Task Force is pleased to have this guideline developed in conjunction with the European Society of Cardiology (ESC). Writing committees are charged with the task of performing an assessment of the evidence and acting as an independent group of authors to develop or update written recommendations for clinical practice. Experts in the subject under consideration have been selected from all 3 organizations to examine subject-specific data and write guidelines. The process includes additional representatives from other medical practitioner and specialty groups when appropriate. Writing committees are specifically charged to perform a formal literature review, weigh the strength of evidence for or against a particular treatment or procedure, and include estimates of expected health outcomes where data exist. Patient-specific modifiers, comorbidities, and issues of patient preference that might influence the choice of particular tests or therapies are considered as well as frequency of follow-up and cost effectiveness. When available, information from studies on cost will be considered; however, review …

2015 ESC Guidelines for the Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death.

Abstract: 2015 ESC Guidelines for the Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review

Abstract: The last systematic review on the health consequences of child and adolescent obesity found little evidence on consequences for adult health. The present study aimed to summarize evidence on the long-term impact of child and adolescent obesity for premature mortality and physical morbidity in adulthood. Systematic review with evidence searched from January 2002 to June 2010. Studies were included if they contained a measure of overweight and/or obesity between birth and 18 years (exposure measure) and premature mortality and physical morbidity (outcome) in adulthood. Five eligible studies examined associations between overweight and/or obesity, and premature mortality: 4/5 found significantly increased risk of premature mortality with child and adolescent overweight or obesity. All 11 studies with cardiometabolic morbidity as outcomes reported that overweight and obesity were associated with significantly increased risk of later cardiometabolic morbidity (diabetes, hypertension, ischaemic heart disease, and stroke) in adult life, with hazard ratios ranging from 1.1–5.1. Nine studies examined associations of child or adolescent overweight and obesity with other adult morbidity: studies of cancer morbidity were inconsistent; child and adolescent overweight and obesity were associated with significantly increased risk of later disability pension, asthma, and polycystic ovary syndrome symptoms. A relatively large and fairly consistent body of evidence now demonstrates that overweight and obesity in childhood and adolescence have adverse consequences on premature mortality and physical morbidity in adulthood.