Dr Seshasayee Narasimhan
Conjoint Senior Lecturer
School of Medicine and Public Health
Career Summary
Biography
Dr. Seshasayee Narasimhan is the current Chair of Manning Hospital Medical Staff Council and the Director of Medicine at Manning Base Hospital. Besides HNEAH in NSW, he is a Visiting Interventional cardiologist at The Gold Coast University Hospital in QLD. He is a Conjoint Senior Lecturer at University of Newcastle and an Adjunct Senior Lecturer at the School of Rural Medicine, UNE. He teaches year 4 & 5 medical students clinical skills and contributes to the Joint Medical Program. In addition to his commitments to students, he is actively involved in training registrars for the FRACP examinations and is a visiting instructor in Interventional Cardiology with the Jillin University in China.
Dr. Narasimhan completed his General Cardiology training at John Hunter Hospital. During his training period, he wrote the orientation manual for the cardiology-advanced training. He consolidated his Rural Cardiology experience at Tamworth Hospital where he helped establish the inpatient Transthoracic Echocardiography Services, Cardiac Rehabilitation and Heart Failure Outreach Clinics. Further to this, he has completed 2 years of invasive cardiology fellowships in both the USA and Canada and has settled with his family in the Taree area. Whilst having a broad interest in general cardiology, Dr. Narasimhan's area of expertise is invasive cardiology which includes complex coronary angioplasty of ischemic heart disease, percutaneous management of adult congenital and structural disease including ASD/PFO closures, assessment and management of valvular heart disease, pulmonary hypertension assessment and management, cardiac transplant work up including right heart catheterization and basic diagnostic and interventional vascular medicine.He lives with his wife Katrina and their children, Zeke and Matilda in Taree.
Qualifications
- Bachelor of Medicine, Bachelor of Surgery, University of Madras
Professional Experience
Professional appointment
Dates | Title | Organisation / Department |
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21/10/2012 - | Cardiologist | Hunter New England Health Internal Medicine Australia |
1/10/2012 - |
Director of Medicine |
Hunter New England Health Internal Medicine Australia |
Teaching appointment
Dates | Title | Organisation / Department |
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21/10/2012 - | Conjoint Senior Lecturer | Hunter New England Health Internal Medicine Australia |
Publications
For publications that are currently unpublished or in-press, details are shown in italics.
Journal article (47 outputs)
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2024 |
Vega LS, Sommerville C, Williams E, Narasimhan S, 'Adult ADHD Therapy Related Dilated
Cardiomyopathy and Thromboembolic
Phenomenon', Open Journal of Cardiology & Heart Disease, 4 (2024)
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2022 |
Porwal KH, Porwal MH, Ibrahim MM, Ramaswamykanive H, Gupta K, Mathur M, Narasimhan S, 'Atypical Presentation of Acute Mitral Regurgitation Secondary to Papillary Muscle Rupture', CUREUS JOURNAL OF MEDICAL SCIENCE, 14 (2022)
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2020 |
Bhatt HV, Schuessler ME, Torregrossa G, Fitzgerald MM, Evans AS, Narasimhan S, Ramakrishna H, 'Robotic Cardiac Surgery Part II: Anesthetic Considerations for Robotic Coronary Artery Bypass Grafting', Journal of Cardiothoracic and Vascular Anesthesia, 34 2484-2491 (2020) [C1] Coronary artery bypass grafting represents one of the most commonly performed cardiac surgeries worldwide. Recently, interest has increased in providing patients with a less invas... [more] Coronary artery bypass grafting represents one of the most commonly performed cardiac surgeries worldwide. Recently, interest has increased in providing patients with a less invasive approach to cardiac surgery, such as thoracotomy and endoscopic techniques using robotic technology as an alternative to traditional sternotomy. As the population gets older, the need for additional methods to provide care for sick patients will continue to expand. These advancements will further allow physicians to provide cardiac surgical procedures with less pain and faster recovery for patients.
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2019 |
Cormican D, Jayaraman AL, Sheu R, Peterson C, Narasimhan S, Shaefi S, et al., 'Coronary Artery Bypass Grafting Versus Percutaneous Transcatheter Coronary Interventions: Analysis of Outcomes in Myocardial Revascularization.', Journal of cardiothoracic and vascular anesthesia, 33 2569-2588 (2019) [C1]
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2018 |
Connolly SJ, Eikelboom JW, Bosch J, Dagenais G, Dyal L, Lanas F, et al., 'Rivaroxaban with or without aspirin in patients with stable coronary artery disease: an international, randomised, double-blind, placebo-controlled trial', The Lancet, 391 205-218 (2018) Background: Coronary artery disease is a major cause of morbidity and mortality worldwide, and is a consequence of acute thrombotic events involving activation of platelets and co... [more] Background: Coronary artery disease is a major cause of morbidity and mortality worldwide, and is a consequence of acute thrombotic events involving activation of platelets and coagulation proteins. Factor Xa inhibitors and aspirin each reduce thrombotic events but have not yet been tested in combination or against each other in patients with stable coronary artery disease. Methods: In this multicentre, double-blind, randomised, placebo-controlled, outpatient trial, patients with stable coronary artery disease or peripheral artery disease were recruited at 602 hospitals, clinics, or community centres in 33 countries. This paper reports on patients with coronary artery disease. Eligible patients with coronary artery disease had to have had a myocardial infarction in the past 20 years, multi-vessel coronary artery disease, history of stable or unstable angina, previous multi-vessel percutaneous coronary intervention, or previous multi-vessel coronary artery bypass graft surgery. After a 30-day run in period, patients were randomly assigned (1:1:1) to receive rivaroxaban (2·5 mg orally twice a day) plus aspirin (100 mg once a day), rivaroxaban alone (5 mg orally twice a day), or aspirin alone (100 mg orally once a day). Randomisation was computer generated. Each treatment group was double dummy, and the patients, investigators, and central study staff were masked to treatment allocation. The primary outcome of the COMPASS trial was the occurrence of myocardial infarction, stroke, or cardiovascular death. This trial is registered with ClinicalTrials.gov, number NCT01776424, and is closed to new participants. Findings: Between March 12, 2013, and May 10, 2016, 27 395 patients were enrolled to the COMPASS trial, of whom 24 824 patients had stable coronary artery disease from 558 centres. The combination of rivaroxaban plus aspirin reduced the primary outcome more than aspirin alone (347 [4%] of 8313 vs 460 [6%] of 8261; hazard ratio [HR] 0·74, 95% CI 0·65¿0·86, p<0·0001). By comparison, treatment with rivaroxaban alone did not significantly improve the primary outcome when compared with treatment with aspirin alone (411 [5%] of 8250 vs 460 [6%] of 8261; HR 0·89, 95% CI 0·78¿1·02, p=0·094). Combined rivaroxaban plus aspirin treatment resulted in more major bleeds than treatment with aspirin alone (263 [3%] of 8313 vs 158 [2%] of 8261; HR 1·66, 95% CI 1·37¿2·03, p<0·0001), and similarly, more bleeds were seen in the rivaroxaban alone group than in the aspirin alone group (236 [3%] of 8250 vs 158 [2%] of 8261; HR 1·51, 95% CI 1·23¿1·84, p<0·0001). The most common site of major bleeding was gastrointestinal, occurring in 130 [2%] patients who received combined rivaroxaban plus aspirin, in 84 [1%] patients who received rivaroxaban alone, and in 61 [1%] patients who received aspirin alone. Rivaroxaban plus aspirin reduced mortality when compared with aspirin alone (262 [3%] of 8313 vs 339 [4%] of 8261; HR 0·77, 95% CI 0·65¿0·90, p=0·0012). Interpretation: In patients with stable coronary artery disease, addition of rivaroxaban to aspirin lowered major vascular events, but increased major bleeding. There was no significant increase in intracranial bleeding or other critical organ bleeding. There was also a significant net benefit in favour of rivaroxaban plus aspirin and deaths were reduced by 23%. Thus, addition of rivaroxaban to aspirin has the potential to substantially reduce morbidity and mortality from coronary artery disease worldwide. Funding: Bayer AG.
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2018 |
Anand SS, Bosch J, Eikelboom JW, Connolly SJ, Diaz R, Widimsky P, et al., 'Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial', The Lancet, 391 219-229 (2018) Background: Patients with peripheral artery disease have an increased risk of cardiovascular morbidity and mortality. Antiplatelet agents are widely used to reduce these complicat... [more] Background: Patients with peripheral artery disease have an increased risk of cardiovascular morbidity and mortality. Antiplatelet agents are widely used to reduce these complications. Methods: This was a multicentre, double-blind, randomised placebo-controlled trial for which patients were recruited at 602 hospitals, clinics, or community practices from 33 countries across six continents. Eligible patients had a history of peripheral artery disease of the lower extremities (previous peripheral bypass surgery or angioplasty, limb or foot amputation, intermittent claudication with objective evidence of peripheral artery disease), of the carotid arteries (previous carotid artery revascularisation or asymptomatic carotid artery stenosis of at least 50%), or coronary artery disease with an ankle¿brachial index of less than 0·90. After a 30-day run-in period, patients were randomly assigned (1:1:1) to receive oral rivaroxaban (2·5 mg twice a day) plus aspirin (100 mg once a day), rivaroxaban twice a day (5 mg with aspirin placebo once a day), or to aspirin once a day (100 mg and rivaroxaban placebo twice a day). Randomisation was computer generated. Each treatment group was double dummy, and the patient, investigators, and central study staff were masked to treatment allocation. The primary outcome was cardiovascular death, myocardial infarction or stroke; the primary peripheral artery disease outcome was major adverse limb events including major amputation. This trial is registered with ClinicalTrials.gov, number NCT01776424, and is closed to new participants. Findings: Between March 12, 2013, and May 10, 2016, we enrolled 7470 patients with peripheral artery disease from 558 centres. The combination of rivaroxaban plus aspirin compared with aspirin alone reduced the composite endpoint of cardiovascular death, myocardial infarction, or stroke (126 [5%] of 2492 vs 174 [7%] of 2504; hazard ratio [HR] 0·72, 95% CI 0·57¿0·90, p=0·0047), and major adverse limb events including major amputation (32 [1%] vs 60 [2%]; HR 0·54 95% CI 0·35¿0·82, p=0·0037). Rivaroxaban 5 mg twice a day compared with aspirin alone did not significantly reduce the composite endpoint (149 [6%] of 2474 vs 174 [7%] of 2504; HR 0·86, 95% CI 0·69¿1·08, p=0·19), but reduced major adverse limb events including major amputation (40 [2%] vs 60 [2%]; HR 0·67, 95% CI 0·45¿1·00, p=0·05). The median duration of treatment was 21 months. The use of the rivaroxaban plus aspirin combination increased major bleeding compared with the aspirin alone group (77 [3%] of 2492 vs 48 [2%] of 2504; HR 1·61, 95% CI 1·12¿2·31, p=0·0089), which was mainly gastrointestinal. Similarly, major bleeding occurred in 79 (3%) of 2474 patients with rivaroxaban 5 mg, and in 48 (2%) of 2504 in the aspirin alone group (HR 1·68, 95% CI 1·17¿2·40; p=0·0043). Interpretation: Low-dose rivaroxaban taken twice a day plus aspirin once a day reduced major adverse cardiovascular and limb events when compared with aspirin alone. Although major bleeding was increased, fatal or critical organ bleeding was not. This combination therapy represents an important advance in the management of patients with peripheral artery disease. Rivaroxaban alone did not significantly reduce major adverse cardiovascular events compared with asprin alone, but reduced major adverse limb events and increased major bleeding. Funding: Bayer AG.
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2018 |
Stawiarski K, Kataria R, Bravo CA, Villablanca P, Mohananey D, Narasimhan S, Ramakrishna H, 'Dual Antiplatelet Therapy Guidelines and Implications for Perioperative Management', Journal of Cardiothoracic and Vascular Anesthesia, 32 1072-1080 (2018) [C1]
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2017 |
Eikelboom JW, Connolly SJ, Bosch J, Dagenais GR, Hart RG, Shestakovska O, et al., 'Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease', NEW ENGLAND JOURNAL OF MEDICINE, 377 1319-1330 (2017)
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2016 |
Baker D, Wilsmore B, Narasimhan S, 'Adoption of direct oral anticoagulants for stroke prevention in atrial fibrillation', Internal Medicine Journal, 46 792-797 (2016) [C1] Background: Direct oral anticoagulants (DOAC) are being increasingly utilised for stroke prevention in atrial fibrillation (AF) and atrial flutter. Aims: To analyse the adoption a... [more] Background: Direct oral anticoagulants (DOAC) are being increasingly utilised for stroke prevention in atrial fibrillation (AF) and atrial flutter. Aims: To analyse the adoption and application of these drugs in a regional hospital inpatient cohort and compare with national prescribing data. Methods: Digital medical records identified prescribed anticoagulants for patients admitted with AF and atrial flutter during 2013¿2014. Analysis of patient demographics and stroke risk identified trends in prescribing DOAC versus warfarin. For broader comparison, data from the Pharmaceuticals Benefits Scheme were sourced to determine the nation-wide adoption of DOAC. Result: Of the 615 patients identified, 505 (255 in 2013, 250 in 2014) had sufficient records to include in the study. From 2013 to 2014, DOAC prescriptions increased from 9 to 28% (P < 0.001), warfarin and aspirin remained comparatively stable (38¿34%, 22¿20%), and those prescribed no medication declined (17¿8%, P < 0.001). DOAC were prescribed to patients with lower CHA2DS2VASc scores than warfarin (3.6 vs 4.4; P = 0.005), lower HAS-BLED scores (1.7 vs 2.3; P < 0.01), higher glomerular filtration rates; 70 vs 63 ml/min; P = 0.002) and younger age (74 vs 77 years; P = 0.006). Nationally, warfarin prescriptions are higher in total numbers but increasing at a slower rate than DOAC, which increased 10-fold (101 158 in 2013, 1 095 985 in 2014). Conclusion: DOAC prescribing grew rapidly from 2013 to 2014, regionally and nationally. Warfarin prescriptions have remained stable, indicating that more patients are being appropriately anticoagulated for AF who previously were not. DOAC were found to be prescribed to patients with lower CHA2DS2VASc and HAS-BLED scores, younger age and higher glomerular filtration rates. Aspirin therapy remains over utilised in AF.
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2014 |
Sebastianski M, Narasimhan S, Graham MM, Toleva O, Shavadia J, Abualnaja S, et al., 'Usefulness of the ankle-brachial index to predict high coronary syntax scores, myocardium at risk, and incomplete coronary revascularization', American Journal of Cardiology, 114 1745-1749 (2014) Peripheral artery disease (PAD) is strongly associated with coronary artery disease and poor outcomes after coronary revascularization. The aim of this study was to test the hypot... [more] Peripheral artery disease (PAD) is strongly associated with coronary artery disease and poor outcomes after coronary revascularization. The aim of this study was to test the hypothesis that patients with PAD diagnosed by a low ankle-brachial index (ABI; =0.90) have more complex coronary artery disease and more myocardium at risk than patients with normal ABIs (1.00 to 1.40) and that subsequent coronary revascularization is less complete. Adults referred for coronary angiography underwent ABI measurement using a standard Doppler ultrasound technique. Blinded reviewers calculated SYNTAX scores and Duke jeopardy scores at baseline and 3 months after angiography. Of 814 patients, 8% had PAD (ABI =;0.90), 9% had borderline PAD (ABI 0.91 to 0.99), 77% were normal (ABI 1.00 to 1.40), and 7% had vascular calcification artifact (ABI >1.40). Patients with PAD were more likely to have high SYNTAX scores (=33), with an odds ratio of 4.3 (95% confidence interval 1.2 to 14.9), compared with those with normal ABIs after adjustment for traditional cardiovascular risk factors. Similarly, there was a positive association between baseline high Duke jeopardy score (=8) and PAD (adjusted odds ratio 3.5, 95% confidence interval 1.7 to 7.1). Postrevascularization high Duke jeopardy scores (=5) were also positively associated with PAD (adjusted odds ratio 3.0, 95% confidence interval 1.1 to 8.8). In conclusion, PAD is associated with higher SYNTAX scores, more myocardium at risk, and less complete coronary revascularization than in patients with normal ABIs. More complex coronary artery disease and incomplete revascularization may contribute to worse cardiovascular outcomes in patients with PAD.
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2014 |
Jayasinghe R, Narasimhan S, Tran TH, Paskaranandavadivel A, 'Rapid rule out of myocardial infarction with the use of copeptin as a biomarker for cardiac injury', Internal Medicine Journal, 44 921-924 (2014) Copeptin is a non-specific marker of an endogenous stress response. A dual biomarker marker approach involving the simultaneous use of troponin and copeptin assays may assist earl... [more] Copeptin is a non-specific marker of an endogenous stress response. A dual biomarker marker approach involving the simultaneous use of troponin and copeptin assays may assist early exclusion of acute coronary syndrome in Australian emergency departments. The utility and limitations of this approach are discussed.
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2010 |
Hiew C, Williams T, Hatton R, Narasimhan S, O'Connor S, Baker F, et al., 'Influence of age on long-term outcome after emergent percutaneous coronary intervention for ST-elevation myocardial infarction', Journal of Invasive Cardiology, 22 273-277 (2010) [C1]
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2009 |
Narasimhan S, McKay K, Attia JR, 'Staff perspectives of a cardiac short stay unit', Australian Journal of Advanced Nursing, 26 23-28 (2009) [C1]
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Show 44 more journal articles |
Conference (4 outputs)
Year | Citation | Altmetrics | Link | ||
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2016 |
Lim J, Sarwar G, Narasimhan S, 'Characterising Heart Failure with Reduced Ejection Fraction and its Management in Regional New South Wales', Heart, Lung and Circulation (2016)
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2013 | McMurtry MS, Sebastianski M, Narasimhan S, Toleva O, Shavadia J, Abdualnaja S, et al., 'Low ABI predicts higher coronary syntax scores and myocardium at risk, but not incomplete coronary revascularization', VASCULAR MEDICINE (2013) | ||||
2011 | Gabriel PP, Aggarwal V, Narasimhan S, Krim N, Srinivas VS, Scheuer J, 'Mean Platelet Volume and Neutrophil-to-Lymphocyte Ratio on Admission as a Predictor of Impaired Reperfusion in Patients Presenting with ST-Segment Elevation Myocardial Infarction', CIRCULATION (2011) | ||||
Show 1 more conference |
Dr Seshasayee Narasimhan
Position
Conjoint Senior Lecturer
School of Medicine and Public Health
College of Health, Medicine and Wellbeing
Contact Details
seshasayee.narasimhan@newcastle.edu.au |