Following completion of his PhD examining the role of metabolic manipulation with glucose-insulin-potassium in patients with left ventricular hypertrophy undergoing aortic valve surgery, Mr Howell is supervising a number of research fellows examining myocardial protection through novel myocardial metabolic modulators as part of the Birmingham Myocardial Metabolism Group. In addition to examining the clinical outcomes in such patients, he has been collaborating with Professor Viant to develop a method of analysing the change in the metabolome of the ventricle of these patients following a period of ischaemia-reperfusion using FT-ICR mass spectroscopy.
Clinical Outcomes research
He is also interested in clinical outcomes research, particularly examining the role of prosthesis selection in heart valve surgery, the influence of renal disease and diabetes on outcomes following surgery, and the results of contemporary coronary surgery.
He is also involved in analysing data from the Society for Cardiothoracic Surgery’s national database to develop procedure specific models for patients undergoing cardiac surgery. He continues to use these models to facilitate propensity matching to analyse the results of different surgical techniques
Howell NJ, Ashrafian H,Drury NE, Ranasinghe AM, Contractor H, Isackson H, Calvert M, Williams LK, Freemantle N, Quinn DW, Green DG, Frenneaux MP, Bonser RS, Mascaro J, Graham TR, Rooney SJ, Wilson IC, and Pagano D. Glucose-Insulin-Potassium Reduces the Incidence of Low Cardiac Output Episodes After Aortic Valve Replacement for Aortic Stenosis in Patients With Left Ventricular Hypertrophy. Circulation. 2011;123:170-177
Howell NJ, Keogh BE, Ray D, Bonser RS, Graham TR, Mascaro J, Rooney SJ, Wilson IC, Pagano D. Patient-Prosthesis Mismatch in patients with aortic stenosis undergoing isolated aortic valve replacement does not affect survival. Ann Thorac Surg 2010;89:60-64
Williams L, Howell NJ, Pagano D,Andreka P, Frenneaux MP, Granzier H. Titin Isoform expression in Aortic Stenosis. Clinic Science 2009;117
Ashrafian H, Howell NJ, Ormerod J, Hammer F, Drury N, Steeples V, Lygate C, Frenneaux MP, Pagano D and Watkins H. (2009) Aortic stenosis with impaired ventricular function manifests impaired cardiac metabolism: implications for prognosis and surgical intervention. Heart 2009:54;124
Pagano D, Freemantle N, Bridgewater B, Howell N, Ray D, Jackson M, Fabri BM, Au J, Keenan D, Kirkup B, Keogh BE. (2009) Social deprivation and prognostic benefits of cardiac surgery: observational study of 44,902 patients from 5 hospital over 10 years. BMJ 338:b902
Baker AR, Harte AL, Howell N, Pritlove DC, Ranasinghe AM, da Silva NF, Youssef EM, Khunti K, Davies MJ, Bonser RS, Kumar S, Pagano D, McTernan PG. (2008) Epicardial adipose tissue as a source of NFκβ and JNK mediated inflammation in patients with coronary disease. J Clin Endocrin Metab 4:2007
Howell NJ, Keogh BE, Bonser RS, Mascaro J, Graham TR, Rooney SJ, Wilson IC, Pagano D. (2008) Mild renal dysfunction predicts survival in-hospital and post-discharge survival following cardiac surgery. Eur J Cardiothorac Surg 34:390-395
Pagano D, Howell NJ, Freemantle N, Cunningham D, Bonser RS, Graham TR, Mascaro J, Rooney SJ, Wilson IC, Cramb R, Keogh BE. (2008) Bleeding in cardiac surgery: The use of aprotinin does not affect survival. J Thorac Cardiovasc Surg 135:495-50