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Reavette RM, Sherwin SJ, Tang MX, Weinberg PD. Wave Intensity Analysis Combined With Machine Learning can Detect Impaired Stroke Volume in Simulations of Heart Failure. Front Bioeng Biotechnol 2022; 9:737055. [PMID: 35004634 PMCID: PMC8740183 DOI: 10.3389/fbioe.2021.737055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/26/2021] [Indexed: 11/13/2022] Open
Abstract
Heart failure is treatable, but in the United Kingdom, the 1-, 5- and 10-year mortality rates are 24.1, 54.5 and 75.5%, respectively. The poor prognosis reflects, in part, the lack of specific, simple and affordable diagnostic techniques; the disease is often advanced by the time a diagnosis is made. Previous studies have demonstrated that certain metrics derived from pressure-velocity-based wave intensity analysis are significantly altered in the presence of impaired heart performance when averaged over groups, but to date, no study has examined the diagnostic potential of wave intensity on an individual basis, and, additionally, the pressure waveform can only be obtained accurately using invasive methods, which has inhibited clinical adoption. Here, we investigate whether a new form of wave intensity based on noninvasive measurements of arterial diameter and velocity can detect impaired heart performance in an individual. To do so, we have generated a virtual population of two-thousand elderly subjects, modelling half as healthy controls and half with an impaired stroke volume. All metrics derived from the diameter-velocity-based wave intensity waveforms in the carotid, brachial and radial arteries showed significant crossover between groups-no one metric in any artery could reliably indicate whether a subject's stroke volume was normal or impaired. However, after applying machine learning to the metrics, we found that a support vector classifier could simultaneously achieve up to 99% recall and 95% precision. We conclude that noninvasive wave intensity analysis has significant potential to improve heart failure screening and diagnosis.
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Affiliation(s)
- Ryan M Reavette
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Spencer J Sherwin
- Department of Aeronautics, Imperial College London, London, United Kingdom
| | - Meng-Xing Tang
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Peter D Weinberg
- Department of Bioengineering, Imperial College London, London, United Kingdom
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2
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Bhuva AN, D'Silva A, Torlasco C, Nadarajan N, Jones S, Boubertakh R, Van Zalen J, Scully P, Knott K, Benedetti G, Augusto JB, Bastiaenen R, Lloyd G, Sharma S, Moon JC, Parker KH, Manisty CH, Hughes AD. Non-invasive assessment of ventriculo-arterial coupling using aortic wave intensity analysis combining central blood pressure and phase-contrast cardiovascular magnetic resonance. Eur Heart J Cardiovasc Imaging 2021; 21:805-813. [PMID: 31501858 DOI: 10.1093/ehjci/jez227] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/01/2019] [Accepted: 08/20/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Wave intensity analysis (WIA) in the aorta offers important clinical and mechanistic insight into ventriculo-arterial coupling, but is difficult to measure non-invasively. We performed WIA by combining standard cardiovascular magnetic resonance (CMR) flow-velocity and non-invasive central blood pressure (cBP) waveforms. METHODS AND RESULTS Two hundred and six healthy volunteers (age range 21-73 years, 47% male) underwent sequential phase contrast CMR (Siemens Aera 1.5 T, 1.97 × 1.77 mm2, 9.2 ms temporal resolution) and supra-systolic oscillometric cBP measurement (200 Hz). Velocity (U) and central pressure (P) waveforms were aligned using the waveform foot, and local wave speed was calculated both from the PU-loop (c) and the sum of squares method (cSS). These were compared with CMR transit time derived aortic arch pulse wave velocity (PWVtt). Associations were examined using multivariable regression. The peak intensity of the initial compression wave, backward compression wave, and forward decompression wave were 69.5 ± 28, -6.6 ± 4.2, and 6.2 ± 2.5 × 104 W/m2/cycle2, respectively; reflection index was 0.10 ± 0.06. PWVtt correlated with c or cSS (r = 0.60 and 0.68, respectively, P < 0.01 for both). Increasing age decade and female sex were independently associated with decreased forward compression wave (-8.6 and -20.7 W/m2/cycle2, respectively, P < 0.01) and greater wave reflection index (0.02 and 0.03, respectively, P < 0.001). CONCLUSION This novel non-invasive technique permits straightforward measurement of wave intensity at scale. Local wave speed showed good agreement with PWVtt, and correlation was stronger using the cSS than the PU-loop. Ageing and female sex were associated with poorer ventriculo-arterial coupling in healthy individuals.
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Affiliation(s)
- Anish N Bhuva
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.,Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - A D'Silva
- Cardiovascular Sciences Research Centre, St. George's University of London, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - C Torlasco
- IRCCS, Istituto Auxologico Italiano, Via Ludovico Ariosto 13, 20145 Milan, Italy, Italy
| | - N Nadarajan
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK
| | - S Jones
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK
| | - R Boubertakh
- Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - J Van Zalen
- Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - P Scully
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.,Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - K Knott
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.,Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - G Benedetti
- Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - J B Augusto
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.,Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - Rachel Bastiaenen
- Cardiovascular Sciences Research Centre, St. George's University of London, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - G Lloyd
- Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - S Sharma
- Cardiovascular Sciences Research Centre, St. George's University of London, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - J C Moon
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.,Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - K H Parker
- Department of Bioengineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - C H Manisty
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.,Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.,MRC Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London WC1E 7HB, UK
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3
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Li Y, Hickson SS, McEniery CM, Wilkinson IB, Khir AW. Stiffening and ventricular-arterial interaction in the ascending aorta using MRI: ageing effects in healthy humans. J Hypertens 2020; 37:347-355. [PMID: 30645209 PMCID: PMC6365245 DOI: 10.1097/hjh.0000000000001886] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Supplemental Digital Content is available in the text Objectives: The aim of this study was to investigate the effect of age and sex on nPWV and ndI in the ascending aorta of healthy humans. Background: Local pulse wave velocity (nPWV) and wave intensity (ndI) in the human ascending aorta have not been studied adequately, because of the need for invasive pressure measurements. However, a recently developed technique made the noninvasive determination of nPWV and ndI possible using measurements of flow velocity and arterial diameter. Methods: Diameter and flow velocity were measured at the level of the ascending aorta in 144 healthy participants (aged 20–77 years, 66 men), using MRI. nPWV, ndI parameters; forward (FCW); backward (BCW) compression waves, forward decompression wave (FDW), local aortic distensibility (nDs) and reflection index (nRI) were calculated. Results: nPWV increased significantly with age from 4.7 ± 0.3 m/s for those 20–30 years to 6.4 ± 0.2 m/s for those 70–80 years (P < 0.001) and did not differ between sexes. nDs decreased with age (5.3 ± 0.5 vs. 2.6 ± 0.2 10−5 1/Pa, P < 0.001) and nRI increased with age (0.17 ± 0.03 vs. 0.39 ± 0.06, P < 0.01) for those 20–30 and 70–80 years, respectively. FCW, BCW and FDW decreased significantly with age by 86.3, 71.3 and 74.2%, respectively (P < 0.001), all compared to the lowest age-band. Conclusion: In healthy humans, ageing results in stiffer ascending aorta, with increase in nPWV and decrease in nDs. A decrease in FCW and FDW indicates decline in left ventricular early and late systolic functions with age in healthy humans with no differences between sexes. nRI is more sensitive than BCW in establishing the effects of ageing on reflected waves measured in the ascending aorta.
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Affiliation(s)
- Ye Li
- King's College London, British Heart Foundation Centre, London.,Brunel Institute for Bioengineering, Brunel University, Uxbridge, Middlesex, UK
| | - Stacey S Hickson
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge
| | - Carmel M McEniery
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge
| | - Ian B Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge
| | - Ashraf W Khir
- Brunel Institute for Bioengineering, Brunel University, Uxbridge, Middlesex, UK
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Negoita M, Hughes AD, Parker KH, Khir AW. A method for determining local pulse wave velocity in human ascending aorta from sequential ultrasound measurements of diameter and velocity. Physiol Meas 2018; 39:114009. [PMID: 30475745 PMCID: PMC6254752 DOI: 10.1088/1361-6579/aae8a0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/11/2018] [Accepted: 10/16/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Pulse wave velocity (PWV) is an indicator of arterial stiffness, and predicts cardiovascular events independently of blood pressure. Currently, PWV is commonly measured by the foot-to-foot technique thus giving a global estimate of large arterial stiffness. However, and despite its importance, methods to measure the stiffness of the ascending aorta are limited. OBJECTIVE To introduce a method for calculating local PWV in the human ascending aorta using non-invasive ultrasound measurements of its diameter (D) and flow velocity (U). APPROACH Ten participants (four females) were recruited from Brunel University students. Ascending aortic diameter and velocity were recorded with a GE Vivid E95 equipped with a 1.5-4.5 MHz phased array transducer using M-mode in the parasternal long axis view and pulse wave Doppler in the apical five chamber view respectively. Groups of six consecutive heartbeats were selected from each 20 s run based on the most similar cycle length resulting in three groups for D and three for U each with six waveforms. Each D waveform was paired with each U waveform to calculate PWV using ln(D)U-loop method. MAIN RESULTS The diastolic portions of the diameters or velocities waveforms were truncated to allow the pairs to have equal length and were used to construct ln(D)U-loops. The trimmed average, excluding 10% of extreme values, resulting from the 324 loops was considered representative for each participant. Overall mean local PWV for all participants was 4.1(SD = 0.9) m s-1. SIGNIFICANCE Local PWV can be measured non-invasively in the ascending aorta using ultrasound measurements of diameter and flow velocity This should facilitate more widespread assessment of ascending aortic stiffness in larger studies.
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Affiliation(s)
- Madalina Negoita
- Brunel Institute of Bioengineering, Brunel University London, London, United Kingdom
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, London, United Kingdom
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
| | - Kim H Parker
- Department of Bioengineering, Imperial College, London, United Kingdom
| | - Ashraf W Khir
- Brunel Institute of Bioengineering, Brunel University London, London, United Kingdom
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Neumann S, Sophocleous F, Kobetic MD, Hart EC, Nightingale AK, Parker KH, Hamilton MK, Biglino G. Wave intensity analysis in the internal carotid artery of hypertensive subjects using phase-contrast MR angiography and preliminary assessment of the effect of vessel morphology on wave dynamics. Physiol Meas 2018; 39:104003. [PMID: 30192235 PMCID: PMC6372132 DOI: 10.1088/1361-6579/aadfc5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: Hypertension is associated with reduced cerebral blood flow, but it is not known how this impacts on wave dynamics or potentially relates to arterial morphology. Given the location of the internal carotid artery (ICA) and risks associated with invasive measurements, wave dynamics in this artery have not been extensively assessed in vivo. This study explores the feasibility of studying wave dynamics in the internal carotid artery non-invasively. Approach: Normotensive, uncontrolled and controlled hypertensive participants were recruited (daytime ambulatory blood pressure <135/85 mmHg and >135/85 mmHg, respectively; n = 38). Wave intensity, reservoir pressure and statistical shape analyses were performed on the right ICA and ascending aorta high-resolution phase-contrast magnetic resonance angiography data. Main results: Wave speed in the aorta was significantly lower in normotensive compared to hypertensive participants (6.7 ± 1.8 versus 11.2 ± 6.2 m s−1 for uncontrolled and 11.8 ± 4.6 m s−1 for controlled hypertensives, p = 0.02), whilst there were no differences in wave speed in the ICA. There were no significant differences between the groups for the wave intensity or reservoir pressure. Interestingly, a significant association between the anatomy of the ICA and wave energy (FCW and size, r2 = 0.12, p = 0.04) was found. Significance: This study shows it is feasible to study wave dynamics in the ICA non-invasively. Whilst changes in aortic wave speed confirmed an expected increase in arterial stiffness, this was not observed in the ICA. This might suggest a protective mechanism in the cerebral circulation, in conjunction with the effect of vessel tortuosity. Furthermore, it was observed that ICA shape correlated with wave energy but not wave speed.
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Affiliation(s)
- S Neumann
- University of Bristol, Bristol, United Kingdom
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Quail MA, Knight DS, Steeden JA, Taelman L, Moledina S, Taylor AM, Segers P, Coghlan GJ, Muthurangu V. Noninvasive pulmonary artery wave intensity analysis in pulmonary hypertension. Am J Physiol Heart Circ Physiol 2015; 308:H1603-11. [PMID: 25659483 PMCID: PMC4469876 DOI: 10.1152/ajpheart.00480.2014] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 02/02/2015] [Indexed: 01/09/2023]
Abstract
Pulmonary wave reflections are a potential hemodynamic biomarker for pulmonary hypertension (PH) and can be analyzed using wave intensity analysis (WIA). In this study we used pulmonary vessel area and flow obtained using cardiac magnetic resonance (CMR) to implement WIA noninvasively. We hypothesized that this method could detect differences in reflections in PH patients compared with healthy controls and could also differentiate certain PH subtypes. Twenty patients with PH (35% CTEPH and 75% female) and 10 healthy controls (60% female) were recruited. Right and left pulmonary artery (LPA and RPA) flow and area curves were acquired using self-gated golden-angle, spiral, phase-contrast CMR with a 10.5-ms temporal resolution. These data were used to perform WIA on patients and controls. The presence of a proximal clot in CTEPH patients was determined from contemporaneous computed tomography/angiographic data. A backwards-traveling compression wave (BCW) was present in both LPA and RPA of all PH patients but was absent in all controls (P = 6e−8). The area under the BCW was associated with a sensitivity of 100% [95% confidence interval (CI) 63–100%] and specificity of 91% (95% CI 75–98%) for the presence of a clot in the proximal PAs of patients with CTEPH. In conclusion, WIA metrics were significantly different between patients and controls; in particular, the presence of an early BCW was specifically associated with PH. The magnitude of the area under the BCW showed discriminatory capacity for the presence of proximal PA clot in patients with CTEPH. We believe that these results demonstrate that WIA could be used in the noninvasive assessment of PH.
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Affiliation(s)
- Michael A Quail
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Daniel S Knight
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom; Department of Cardiology, Royal Free London National Health Services Foundation Trust, London, United Kingdom; and
| | - Jennifer A Steeden
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Liesbeth Taelman
- IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium
| | - Shahin Moledina
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Patrick Segers
- IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium
| | - Gerry J Coghlan
- Department of Cardiology, Royal Free London National Health Services Foundation Trust, London, United Kingdom; and
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom;
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Biglino G, Steeden JA, Baker C, Schievano S, Taylor AM, Parker KH, Muthurangu V. A non-invasive clinical application of wave intensity analysis based on ultrahigh temporal resolution phase-contrast cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2012; 14:57. [PMID: 22876747 PMCID: PMC3472227 DOI: 10.1186/1532-429x-14-57] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 07/19/2012] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Wave intensity analysis, traditionally derived from pressure and velocity data, can be formulated using velocity and area. Flow-velocity and area can both be derived from high-resolution phase-contrast cardiovascular magnetic resonance (PC-CMR). In this study, very high temporal resolution PC-CMR data is processed using an integrated and semi-automatic technique to derive wave intensity. METHODS Wave intensity was derived in terms of area and velocity changes. These data were directly derived from PC-CMR using a breath-hold spiral sequence accelerated with sensitivity encoding (SENSE). Image processing was integrated in a plug-in for the DICOM viewer OsiriX, including calculations of wave speed and wave intensity. Ascending and descending aortic data from 15 healthy volunteers (30 ± 6 years) data were used to test the method for feasibility, and intra- and inter-observer variability. Ascending aortic data were also compared with results from 15 patients with coronary heart disease (61 ± 13 years) to assess the clinical usefulness of the method. RESULTS Rapid image acquisition (11 s breath-hold) and image processing was feasible in all volunteers. Wave speed was physiological (5.8 ± 1.3 m/s ascending aorta, 5.0 ± 0.7 m/s descending aorta) and the wave intensity pattern was consistent with traditionally formulated wave intensity. Wave speed, peak forward compression wave in early systole and peak forward expansion wave in late systole at both locations exhibited overall good intra- and inter-observer variability. Patients with coronary heart disease had higher wave speed (p <0.0001), and lower forward compression wave (p <0.0001) and forward expansion wave (p <0.0005) peaks. This difference is likely related to the older age of the patients' cohort, indicating stiffer aortas, as well as compromised ventricular function due to their underlying condition. CONCLUSION A non-invasive, semi-automated and reproducible method for performing wave intensity analysis is presented. Its application is facilitated by the use of a very high temporal resolution spiral sequence. A formulation of wave intensity based on area change has also been proposed, involving no assumptions about the cross-sectional shape of the vessel.
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Affiliation(s)
- Giovanni Biglino
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, and Great Ormond Street Hospital for Children, NHS Trust, London, UK
| | - Jennifer A Steeden
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, and Great Ormond Street Hospital for Children, NHS Trust, London, UK
| | - Catriona Baker
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, and Great Ormond Street Hospital for Children, NHS Trust, London, UK
| | - Silvia Schievano
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, and Great Ormond Street Hospital for Children, NHS Trust, London, UK
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, and Great Ormond Street Hospital for Children, NHS Trust, London, UK
| | - Kim H Parker
- Department of Bioengineering, Imperial College London, London, UK
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, and Great Ormond Street Hospital for Children, NHS Trust, London, UK
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, 30 Guildford Street, London, WC1N 1EH, UK
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