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Armenian SH, Chao C. Burden of Morbidity and Mortality in Adolescent and Young Adult Cancer Survivors. J Clin Oncol 2024; 42:735-742. [PMID: 37983585 DOI: 10.1200/jco.23.01751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 08/29/2023] [Accepted: 09/28/2023] [Indexed: 11/22/2023] Open
Abstract
There are an estimated 650,00 survivors of adolescent and young adult (AYA) cancers in the United States, a number that is expected to markedly increase in the coming decades. The recognition of the potential for some cancer treatments to affect the health of patients for many years after the initial diagnosis has prompted investigators to examine the evolving burden of late morbidity and mortality in AYAs with cancer after treatment completion. Studies in large international cohorts of AYA cancer survivors have now shown that the burden of late effects in survivors treated during the past four decades is substantial, affecting the health and well-being of the survivor, health systems' preparedness to meet their health care needs in the future, and societal economic costs that are largely affected by loss of productivity. We highlight the unique considerations for AYA cancer survivors, identify gaps in knowledge for future research, and provide an overview of emerging efforts to mitigate late effects in these survivors. Ongoing multidisciplinary bench-to-bedside collaborations are critical to understanding the biology of late effects in AYA cancer survivors and to developing personalized interventions to mitigate them. The growing population of AYA cancer survivors makes it imperative that these efforts extend across the cancer care continuum, which will allow survivors to ultimately live to their fullest potential.
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Affiliation(s)
- Saro H Armenian
- Department of Pediatrics, City of Hope, Duarte, CA
- Division of Outcomes Research, Department of Population Science, City of Hope, Duarte, CA
| | - Chun Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
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2
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Alavi R, Wang Q, Gorji H, Pahlevan NM. A machine learning approach for computation of cardiovascular intrinsic frequencies. PLoS One 2023; 18:e0285228. [PMID: 37883430 PMCID: PMC10602266 DOI: 10.1371/journal.pone.0285228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/17/2023] [Indexed: 10/28/2023] Open
Abstract
Analysis of cardiovascular waveforms provides valuable clinical information about the state of health and disease. The intrinsic frequency (IF) method is a recently introduced framework that uses a single arterial pressure waveform to extract physiologically relevant information about the cardiovascular system. The clinical usefulness and physiological accuracy of the IF method have been well-established via several preclinical and clinical studies. However, the computational complexity of the current L2 optimization solver for IF calculations remains a bottleneck for practical deployment of the IF method in real-time settings. In this paper, we propose a machine learning (ML)-based methodology for determination of IF parameters from a single carotid waveform. We use a sequentially-reduced Feedforward Neural Network (FNN) model for mapping carotid waveforms to the output parameters of the IF method, thereby avoiding the non-convex L2 minimization problem arising from the conventional IF approach. Our methodology also includes procedures for data pre-processing, model training, and model evaluation. In our model development, we used both clinical and synthetic waveforms. Our clinical database is composed of carotid waveforms from two different sources: the Huntington Medical Research Institutes (HMRI) iPhone Heart Study and the Framingham Heart Study (FHS). In the HMRI and FHS clinical studies, various device platforms such as piezoelectric tonometry, optical tonometry (Vivio), and an iPhone camera were used to measure arterial waveforms. Our blind clinical test shows very strong correlations between IF parameters computed from the FNN-based method and those computed from the standard L2 optimization-based method (i.e., R≥0.93 and P-value ≤0.005 for each IF parameter). Our results also demonstrate that the performance of the FNN-based IF model introduced in this work is independent of measurement apparatus and of device sampling rate.
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Affiliation(s)
- Rashid Alavi
- Department of Aerospace and Mechanical Engineering, University of Southern California, Los Angeles, California, United States of America
| | - Qian Wang
- Beijing Computational Science Research Center, Beijing, China
| | - Hossein Gorji
- Swiss Federal Laboratories for Materials Science and Technology (EMPA), Dubendorf, Switzerland
| | - Niema M. Pahlevan
- Department of Aerospace and Mechanical Engineering, University of Southern California, Los Angeles, California, United States of America
- Cardiovascular Research Institute, Huntington Medical Research Institutes, Pasadena, CA, United States of America
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
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3
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Alavi R, Dai W, Matthews RV, Kloner RA, Pahlevan NM. Instantaneous detection of acute myocardial infarction and ischaemia from a single carotid pressure waveform in rats. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead099. [PMID: 37849787 PMCID: PMC10578505 DOI: 10.1093/ehjopen/oead099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/17/2023] [Accepted: 09/25/2023] [Indexed: 10/19/2023]
Abstract
Aims Myocardial infarction (MI) is one of the leading causes of death worldwide. It is well accepted that early diagnosis followed by early reperfusion therapy significantly increases the MI survival. Diagnosis of acute MI is traditionally based on the presence of chest pain and electrocardiogram (ECG) criteria. However, around 50% of the MIs are without chest pain, and ECG is neither completely specific nor definitive. Therefore, there is an unmet need for methods that allow detection of acute MI or ischaemia without using ECG. Our hypothesis is that a hybrid physics-based machine learning (ML) method can detect the occurrence of acute MI or ischaemia from a single carotid pressure waveform. Methods and results We used a standard occlusion/reperfusion rat model. Physics-based ML classifiers were developed using intrinsic frequency parameters extracted from carotid pressure waveforms. ML models were trained, validated, and generalized using data from 32 rats. The final ML models were tested on an external stratified blind dataset from additional 13 rats. When tested on blind data, the best ML model showed specificity = 0.92 and sensitivity = 0.92 for detecting acute MI. The best model's specificity and sensitivity for ischaemia detection were 0.85 and 0.92, respectively. Conclusion We demonstrated that a hybrid physics-based ML approach can detect the occurrence of acute MI and ischaemia from carotid pressure waveform in rats. Since carotid pressure waveforms can be measured non-invasively, this proof-of-concept pre-clinical study can potentially be expanded in future studies for non-invasive detection of MI or myocardial ischaemia.
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Affiliation(s)
- Rashid Alavi
- Department of Aerospace and Mechanical Engineering, University of Southern California, 3650 McClintock Ave. Room 400, Los Angeles, CA 90089, USA
| | - Wangde Dai
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA 90033, USA
- Cardiovascular Research Institute, Huntington Medical Research Institutes, 686 S Fair Oaks Ave., Pasadena, CA 91105, USA
| | - Ray V Matthews
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA 90033, USA
- Cardiac and Vascular Institute, University of Southern California, 1975 Zonal Ave., Los Angeles, CA 90033, USA
| | - Robert A Kloner
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA 90033, USA
- Cardiovascular Research Institute, Huntington Medical Research Institutes, 686 S Fair Oaks Ave., Pasadena, CA 91105, USA
| | - Niema M Pahlevan
- Department of Aerospace and Mechanical Engineering, University of Southern California, 3650 McClintock Ave. Room 400, Los Angeles, CA 90089, USA
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA 90033, USA
- Cardiovascular Research Institute, Huntington Medical Research Institutes, 686 S Fair Oaks Ave., Pasadena, CA 91105, USA
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4
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Cheng AL, Liu J, Bravo S, Miller JC, Pahlevan NM. Screening left ventricular systolic dysfunction in children using intrinsic frequencies of carotid pressure waveforms measured by a novel smartphone-based device. Physiol Meas 2023; 44:10.1088/1361-6579/acba7b. [PMID: 36753767 PMCID: PMC11073485 DOI: 10.1088/1361-6579/acba7b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/08/2023] [Indexed: 02/10/2023]
Abstract
Objective.Children with heart failure have higher rates of emergency department utilization, health care expenditure, and hospitalization. Therefore, a need exists for a simple, non-invasive, and inexpensive method of screening for left ventricular (LV) dysfunction. We recently demonstrated the practicality and reliability of a wireless smartphone-based handheld device in capturing carotid pressure waveforms and deriving cardiovascular intrinsic frequencies (IFs) in children with normal LV function. Our goal in this study was to demonstrate that an IF-based machine learning method (IF-ML) applied to noninvasive carotid pressure waveforms can distinguish between normal and abnormal LV ejection fraction (LVEF) in pediatric patients.Approach. Fifty patients ages 0 to 21 years underwent LVEF measurement by echocardiogram or cardiac magnetic resonance imaging. On the same day, patients had carotid waveforms recorded using Vivio. The exclusion criterion was known vascular disease that would interfere with obtaining a carotid artery pulse. We adopted a hybrid IF- Machine Learning (IF-ML) method by applying physiologically relevant IF parameters as inputs to Decision Tree classifiers. The threshold for low LVEF was chosen as <50%.Main results.The proposed IF-ML method was able to detect an abnormal LVEF with an accuracy of 92% (sensitivity = 100%, specificity = 89%, area under the curve (AUC) = 0.95). Consistent with previous clinical studies, the IF parameterω1was elevated among patients with reduced LVEF.Significance.A hybrid IF-ML method applied on a carotid waveform recorded by a hand-held smartphone-based device can differentiate between normal and abnormal LV systolic function in children with normal cardiac anatomy.
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Affiliation(s)
- Andrew L Cheng
- Division of Pediatric Cardiology, Children’s Hospital Los Angeles, Los Angeles, CA, United States of America
| | - Jing Liu
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Stephen Bravo
- Division of Pediatric Cardiology, Children’s Hospital Los Angeles, Los Angeles, CA, United States of America
| | - Jennifer C Miller
- Division of Pediatric Cardiology, Children’s Hospital Los Angeles, Los Angeles, CA, United States of America
| | - Niema M Pahlevan
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
- Department of Aerospace and Mechanical Engineering, University of Southern California, Los Angeles, CA, United States of America
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Liu J, Pahlevan NM. The underlying mechanism of intersite discrepancies in ejection time measurements from arterial waveforms and its validation in the Framingham Heart Study. Am J Physiol Heart Circ Physiol 2021; 321:H135-H148. [PMID: 34018849 DOI: 10.1152/ajpheart.00096.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Radial applanation tonometry is a well-established method for clinical hemodynamic assessment and is also becoming popular in wrist-worn fitness trackers. The time difference between the foot and the dicrotic notch of the arterial pressure waveform is a well-accepted approximation for the left ventricular ejection time (ET). However, several clinical studies have shown that ET measured from the radial pressure waveform deviates from that measured centrally. In this work, we consider the systolic wave and the dicrotic wave as two independent traveling waves and hypothesize that their wave speed difference leads to the intersite differences of measured ET (ΔET). Accordingly, we derived a mathematical dicrotic wave decomposition model and identified the most influential factors on ΔET via global sensitivity analysis. In our clinical validation on a heterogeneous cohort (N = 5,742) from the Framingham Heart Study (FHS), the local sensitivity analysis results resembled the sensitivity variation patterns of ΔET from model simulations. A regression analysis on FHS data, using morphological features of radial pressure waveforms to estimate the carotid ET, produced a root mean square error of 3.76 ms and R2 of 0.91. The proposed dicrotic wave decomposition model can explain the intersite ET measurement discrepancies observed in the clinical data of FHS and can facilitate the precise identification of ET with radial pressure waveforms. Therefore, the proposed model will improve various physics-based pulse wave analysis methods as well as prospective artificial intelligence methods for tackling the subsequent big data produced from widespread wearable radial pressure monitoring.NEW & NOTEWORTHY Based on a new understanding of pressure wave propagation, we propose a novel dicrotic wave decomposition model considering the dicrotic wave as an independent traveling component. The proposed model can explain the mechanism underlying the intersite discrepancies in ejection time measurement from arterial waveforms and then, in principle, enhance the accuracy of both classical physics-based as well as more contemporary artificial intelligence-based pulse wave analysis methods in clinical and wearable radial blood pressure monitoring applications.
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Affiliation(s)
- Jing Liu
- Department of Aerospace and Mechanical Engineering, University of Southern California, Los Angeles, California
| | - Niema M Pahlevan
- Department of Aerospace and Mechanical Engineering, University of Southern California, Los Angeles, California.,Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
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6
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Asymptomatic systolic dysfunction on contemporary echocardiography in anthracycline-treated long-term childhood cancer survivors: a systematic review. J Cancer Surviv 2021; 16:338-352. [PMID: 33772445 PMCID: PMC8964593 DOI: 10.1007/s11764-021-01028-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/15/2021] [Indexed: 11/24/2022]
Abstract
Purpose Echocardiographic surveillance for asymptomatic left ventricular systolic dysfunction (ALVSD) is advised in childhood cancer survivors (CCS), because of their risk of heart failure after anthracycline treatment. ALVSD can be assessed with different echocardiographic parameters. We systematically reviewed the prevalence and risk factors of late ALVSD, as defined by contemporary and more traditional echocardiographic parameters. Methods We searched databases from 2001 to 2020 for studies on ≥ 100 asymptomatic 5-year CCS treated with anthracyclines, with or without radiotherapy involving the heart region. Outcomes of interest were prevalence of ALVSD—measured with volumetric methods (ejection fraction; LVEF), myocardial strain, or linear methods (fractional shortening; FS)—and its risk factors from multivariable analyses. Results Eleven included studies represented 3840 CCS. All studies had methodological limitations. An LVEF < 50% was observed in three studies in 1–6% of CCS, and reduced global longitudinal strain (GLS) was reported in three studies in 9–30% of CCS, both after a median follow-up of 9 to 23 years. GLS was abnormal in 20–28% of subjects with normal LVEF. Abnormal FS was reported in six studies in 0.3–30% of CCS, defined with various cut-off values (< 25 to < 30%), at a median follow-up of 10 to 18 years. Across echocardiographic parameters, reported risk factors were cumulative anthracycline dose and radiotherapy involving the heart region, with no ‘safe’ dose for ALVSD. Conclusions GLS identifies higher prevalence of ALVSD in anthracycline-treated CCS, than LVEF. Implications for Cancer Survivors The diagnostic and prognostic value of GLS should be evaluated within large cohorts. Protocol registration PROSPERO CRD42019126588 Supplementary Information The online version contains supplementary material available at 10.1007/s11764-021-01028-4.
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7
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Chang EK, Chanson D, Teh JB, Iukuridze A, Peng K, Forman SJ, Nakamura R, Wong FL, Cai L, Armenian SH. Atrial Fibrillation in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation. J Clin Oncol 2021; 39:902-910. [PMID: 33417479 PMCID: PMC8078261 DOI: 10.1200/jco.20.02401] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
To examine the incidence and risk factors for de novo atrial fibrillation (AF) after allogeneic hematopoietic cell transplantation (HCT) and to describe the impact of AF on HCT-related outcomes.
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Affiliation(s)
- Ellen K Chang
- Division of Hematology/Oncology, Children's Hospital Los Angeles; Los Angeles, CA
| | - Dayana Chanson
- Department of Population Sciences, City of Hope; Duarte, CA
| | | | | | - Kelly Peng
- Department of Population Sciences, City of Hope; Duarte, CA
| | - Stephen J Forman
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Ryotaro Nakamura
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - F Lennie Wong
- Department of Population Sciences, City of Hope; Duarte, CA
| | - LiYing Cai
- Division of Cardiology, Department of Medicine, City of Hope, Duarte, CA
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8
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Mogadam E, Shavelle DM, Giesler GM, Economides C, Lidia SP, Duquette S, Matthews RV, Pahlevan NM. Intrinsic frequency method for instantaneous assessment of left ventricular-arterial coupling after transcatheter aortic valve replacement. Physiol Meas 2020; 41:085002. [DOI: 10.1088/1361-6579/aba67f] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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9
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Leerink JM, de Baat EC, Feijen EA, Bellersen L, van Dalen EC, Grotenhuis HB, Kapusta L, Kok WE, Loonen J, van der Pal HJ, Pluijm SM, Teske AJ, Mavinkurve-Groothuis AM, Merkx R, Kremer LC. Cardiac Disease in Childhood Cancer Survivors: Risk Prediction, Prevention, and Surveillance: JACC CardioOncology State-of-the-Art Review. JACC CardioOncol 2020; 2:363-378. [PMID: 34396245 PMCID: PMC8352294 DOI: 10.1016/j.jaccao.2020.08.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 02/06/2023] Open
Abstract
Cardiac diseases in the growing population of childhood cancer survivors are of major concern. Cardiotoxicity as a consequence of anthracyclines and chest radiotherapy continues to be relevant in the modern treatment era. Mitoxantrone has emerged as an important treatment-related risk factor and evidence on traditional cardiovascular risk factors in childhood cancer survivors is accumulating. International surveillance guidelines have been developed with the aim to detect and manage cardiac diseases early and prevent symptomatic disease. There is growing interest in risk prediction models to individualize prevention and surveillance. This State-of-the-Art Review summarizes literature from a systematic PubMed search focused on cardiac diseases after treatment for childhood cancer. Here, we discuss the prevalence, risk factors, prevention, risk prediction, and surveillance of cardiac diseases in survivors of childhood cancer.
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Key Words
- CAD, coronary artery disease
- CCS, childhood cancer survivors
- ECG, electrocardiogram
- FS, fractional shortening
- GLS, global longitudinal strain
- IGHG, International Late Effects of Childhood Cancer Guideline Harmonization Group
- LV, left ventricle
- LVEF, left ventricular ejection fraction
- RCT, randomized controlled trial
- cardiotoxicity
- cardiovascular risk factors
- chest RT, chest-directed radiotherapy
- childhood cancer survivors
- prevention
- risk prediction
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Affiliation(s)
- Jan M. Leerink
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Esmée C. de Baat
- Department of Pediatric Oncology, Princess Máxima Center, Utrecht, the Netherlands
| | | | - Louise Bellersen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Elvira C. van Dalen
- Department of Pediatric Oncology, Princess Máxima Center, Utrecht, the Netherlands
| | - Heynric B. Grotenhuis
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University of Utrecht, Utrecht, the Netherlands
| | - Livia Kapusta
- Department of Pediatric Cardiology, Radboud University Medical Center, Amalia Children’s Hospital, Nijmegen, the Netherlands
- Department of Pediatrics, Tel Aviv University, Sackler School of Medicine, Tel Aviv Sourasky Medical Center, Pediatric Cardiology Unit, Tel Aviv, Israel
| | - Wouter E.M. Kok
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Jacqueline Loonen
- Department of Pediatric Hematology and Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Saskia M.F. Pluijm
- Department of Pediatric Oncology, Princess Máxima Center, Utrecht, the Netherlands
| | - Arco J. Teske
- Department of Cardiology, Utrecht University Medical Center, Utrecht, the Netherlands
| | | | - Remy Merkx
- Department of Medical Imaging, Radboud University Medical Center, Medical UltraSound Imaging Center, Nijmegen, the Netherlands
| | - Leontien C.M. Kremer
- Department of Pediatric Oncology, Princess Máxima Center, Utrecht, the Netherlands
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Narayan HK, Xu R, Forsch N, Govil S, Iukuridze D, Lindenfeld L, Adler E, Hegde S, Tremoulet A, Ky B, Armenian S, Omens J, McCulloch AD. Atlas-based measures of left ventricular shape may improve characterization of adverse remodeling in anthracycline-exposed childhood cancer survivors: a cross-sectional imaging study. CARDIO-ONCOLOGY 2020; 6:13. [PMID: 32782827 PMCID: PMC7414730 DOI: 10.1186/s40959-020-00069-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/31/2020] [Indexed: 11/28/2022]
Abstract
Background Adverse cardiac remodeling is an important precursor to anthracycline-related cardiac dysfunction, however conventional remodeling indices are limited. We sought to examine the utility of statistical atlas-derived measures of ventricular shape to improve the identification of adverse anthracycline-related remodeling in childhood cancer survivors. Methods We analyzed cardiac magnetic resonance imaging from a cross-sectional cohort of 20 childhood cancer survivors who were treated with low (< 250 mg/m2 [N = 10]) or high (≥250 mg/m2 [N = 10]) dose anthracyclines, matched 1:1 by sex and age between dose groups. We reconstructed 3D computational models of left ventricular end-diastolic shape for each subject and assessed the ability of conventional remodeling indices (volume, mass, and mass to volume ratio) vs. shape modes derived from a statistical shape atlas of an asymptomatic reference population to stratify anthracycline-related remodeling. We compared conventional parameters and five atlas-based shape modes: 1) between survivors and the reference population (N = 1991) using multivariable linear regression, and 2) within survivors by anthracycline dose (low versus high) using two-sided T-tests, multivariable logistic regression, and receiver operating characteristic curves. Results Compared with the reference population, survivors had differences in conventional measures (lower volume and mass) and shape modes (corresponding to lower overall size and lower sphericity; all p < 0.001). Among survivors, differences in a shape mode corresponding to increased basal cavity size and altered mitral annular orientation in the high-dose group were observed (p = 0.039). Collectively, atlas-based shape modes in conjunction with conventional measures discriminated survivors who received low vs. high anthracycline dosage (area under the curve [AUC] 0.930, 95% confidence interval 0.816, 1.00) significantly better than conventional measures alone (AUC 0.710, 95% confidence interval 0.473, 0.947; AUC comparison p = 0.0498). Conclusions Compared with a reference population, heart size is smaller in anthracycline-exposed childhood cancer survivors. Atlas-based measures of left ventricular shape may improve the detection of anthracycline dose-related remodeling differences.
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Affiliation(s)
- Hari K Narayan
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive #0831, La Jolla, CA 92093-0831 USA
| | - Ronghui Xu
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive #0628, La Jolla, CA 92093-0628 USA.,Department of Mathematics, University of California San Diego, 9500 Gilman Drive #0112, La Jolla, CA 92093-0112 USA
| | - Nickolas Forsch
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive #0412, La Jolla, CA 92093-0412 USA
| | - Sachin Govil
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive #0412, La Jolla, CA 92093-0412 USA
| | - David Iukuridze
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive #0831, La Jolla, CA 92093-0831 USA
| | - Lanie Lindenfeld
- Department of Population Sciences, City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010 USA
| | - Eric Adler
- Department of Medicine, University of California San Diego, 9500 Gilman Drive #8811, La Jolla, CA 92093-8811 USA
| | - Sanjeet Hegde
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive #0831, La Jolla, CA 92093-0831 USA
| | - Adriana Tremoulet
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive #0831, La Jolla, CA 92093-0831 USA
| | - Bonnie Ky
- Department of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 USA
| | - Saro Armenian
- Department of Population Sciences, City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010 USA
| | - Jeffrey Omens
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive #0412, La Jolla, CA 92093-0412 USA.,Department of Medicine, University of California San Diego, 9500 Gilman Drive #8811, La Jolla, CA 92093-8811 USA
| | - Andrew D McCulloch
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive #0412, La Jolla, CA 92093-0412 USA.,Department of Medicine, University of California San Diego, 9500 Gilman Drive #8811, La Jolla, CA 92093-8811 USA
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11
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Rinderknecht D, De Balasy JM, Pahlevan NM. A wireless optical handheld device for carotid waveform measurement and its validation in a clinical study. Physiol Meas 2020; 41:055008. [DOI: 10.1088/1361-6579/ab7b3f] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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12
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Zou MX, Zheng BW, Liu FS, Wang XB, Hu JR, Huang W, Dai ZH, Zhang QS, Liu FB, Zhong H, Jiang Y, She XL, Li XB, Lv GH, Li J. The Relationship Between Tumor-Stroma Ratio, the Immune Microenvironment, and Survival in Patients With Spinal Chordoma. Neurosurgery 2020; 85:E1095-E1110. [PMID: 31501892 DOI: 10.1093/neuros/nyz333] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 05/23/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Currently, little is known about the clinical relevance of tumor-stroma ratio (TSR) in chordoma and data discussing the relationship between TSR and immune status of chordoma are lacking. OBJECTIVE To characterize TSR distribution in spinal chordoma, and investigated its correlation with clinicopathologic or immunological features of patients and outcome. METHODS TSR was assessed visually on hematoxylin and eosin-stained sections from 54 tumor specimens by 2 independent pathologists. Multiplex immunofluorescence was used to quantify the expression levels of microvessel density, Ki-67, Brachyury, and tumor as well as stromal PD-L1. Tumor immunity status including the Immunoscore and densities of tumor-infiltrating lymphocytes (TILs) subtypes were obtained from our published data and reanalyzed. RESULTS Bland-Altman plot showed no difference between mean TSR derived from the two observers. TSR was positively associated with stromal PD-L1 expression, the Immunoscore and CD3+ as well as CD4+ TILs density, but negatively correlated with tumor microvessel density, Ki-67 index, surrounding muscle invasion by tumor and number of Foxp3+ and PD-1+ TILs. Low TSR independently predicted poor local recurrence-free survival and overall survival. Moreover, patients with low TSR and low Immunoscore chordoma phenotype were associated with the worst survival. More importantly, combined TSR and Immunoscore accurately reflected prognosis and enhanced the ability of TSR or Immunoscore alone for outcome prediction. CONCLUSION These data reveal the significant impact of TSR on tumor progression and immunological response of patients. Subsequent use of agents targeting the stroma compartment may be an effective strategy to treat chordoma especially in combination with immune-based drugs.
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Affiliation(s)
- Ming-Xiang Zou
- Department of Spine Surgery, The Second Xiangya Hospital, Central South, University, Changsha, China
| | - Bo-Wen Zheng
- Department of Spine Surgery, The Second Xiangya Hospital, Central South, University, Changsha, China
| | - Fu-Sheng Liu
- Department of Spine Surgery, The Second Xiangya Hospital, Central South, University, Changsha, China
| | - Xiao-Bin Wang
- Department of Spine Surgery, The Second Xiangya Hospital, Central South, University, Changsha, China
| | - Jia-Rui Hu
- Department of Spine Surgery, The Second Xiangya Hospital, Central South, University, Changsha, China
| | - Wei Huang
- Institute of Precision Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Zhe-Hao Dai
- Department of Spine Surgery, The Second Xiangya Hospital, Central South, University, Changsha, China
| | - Qian-Shi Zhang
- Department of Spine Surgery, The Second Xiangya Hospital, Central South, University, Changsha, China
| | - Fu-Bing Liu
- Department of Spine Surgery, The Second Xiangya Hospital, Central South, University, Changsha, China
| | - Hua Zhong
- Department of Orthopedics Surgery, Central Hospital of Yi Yang, Yiyang, China
| | - Yi Jiang
- Department of Pathology, The Second Xiangya Hospital, Central South, University, Changsha, China
| | - Xiao-Ling She
- Department of Pathology, The Second Xiangya Hospital, Central South, University, Changsha, China
| | - Xiao-Bing Li
- Department of Spine Surgery, The Second Xiangya Hospital, Central South, University, Changsha, China
| | - Guo-Hua Lv
- Department of Spine Surgery, The Second Xiangya Hospital, Central South, University, Changsha, China
| | - Jing Li
- Department of Spine Surgery, The Second Xiangya Hospital, Central South, University, Changsha, China
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Pahlevan NM, Mazandarani SP. Estimation of Wave Condition Number From Pressure Waveform Alone and Its Changes With Advancing Age in Healthy Women and Men. Front Physiol 2020; 11:313. [PMID: 32328003 PMCID: PMC7161432 DOI: 10.3389/fphys.2020.00313] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/19/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction The wave condition number (WCN) is a non-dimensional number that determines the state of arterial wave reflections. WCN is equal to HR × Leff/PWV where HR, Leff, and PWV are the heart rate, effective length, and pulse wave velocity, respectively. It has been shown that a value of WCN = 0.1 indicates the optimum state of arterial wave reflection in which left ventricle workload is minimized. The pressure wave, flow wave, and PWV are all required to compute WCN, which may limit the potential clinical utility of WCN. The aims of this study are as follows: (1) to assess the feasibility of approximating WCN from the pressure waveform alone (WCNPinf), and (2) to provide the proof-of-concept that WCNPinf can capture age related differences in arterial wave reflection among healthy women and men. Methods Previously published retrospective data composed of seventeen patients (age 19–54 years; 34.3 ± 9.6) were used to assess the accuracy of WCNPinf. The exact value of WCN was computed from PWV (measured by foot-to-foot method), HR, and Leff. A quarter wavelength relationship with minimum impedance modulus were used to compute Leff. WCNPinf was calculated using HR and the reflected wave arrival time. Previously published analyses from a healthy subset of the Anglo-Cardiff Collaborative Trial (ACCT) study population were used to investigate if non-invasive WCNPinf captures age related differences in arterial wave reflection among healthy women and men. Results A strong correlation (r = 0.83, p-value <0.0001) between WCNPinf and WCN was observed. The accuracy of WCNPinf was independent from relevant physiological parameters such as PWV, pulse pressure (PP), and HR. Similar changes in WCNPinf with advancing age were observed in both healthy men and healthy women. In young, healthy individuals (women and men) the WCNPinf was around 0.1 (the optimum value), and reduced with aging. Conclusion WCN can be approximated from a single pressure waveform and can capture age related arterial wave reflection alteration. These results are clinically significant since WCN can be extracted from a single non-invasive pressure waveform. Future studies will focus on investigating if WCN is associated with risk for onset of cardiovascular disease events.
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Affiliation(s)
- Niema M Pahlevan
- Department of Aerospace Mechanical Engineering, University of Southern California, Los Angeles, CA, United States.,Division of Cardiovascular Medicine, Department of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Sohrab P Mazandarani
- Department of Economics, Geography, and Political Science, Division of Language, Humanity, and Social Science, Riverside City College, Riverside, CA, United States
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Abstract
Advances in cancer therapies have significantly improved patient outcomes. However, with improvements in survival, the toxicities associated with cancer therapy have become of paramount importance and oncologists are faced with the challenge of establishing therapeutic efficacy while minimizing toxicity. Cardiovascular disease represents a significant risk to survivors of childhood cancer and is a major cause of morbidity and mortality. This article outlines the current state of knowledge regarding cardiotoxicity in children undergoing cancer therapies, including the impact of specific oncologic therapies, recommendations for cardiovascular screening, the management of established cardiac disease, and the evolving field of pediatric cardio-oncology.
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Affiliation(s)
- Thomas D Ryan
- Department of Pediatrics, Division of Pediatric Cardiology, Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 2003, Cincinnati, OH 45229, USA.
| | - Rajaram Nagarajan
- Department of Pediatrics, Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 7018, Cincinnati, OH 45229, USA
| | - Justin Godown
- Department of Pediatrics, Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 5230 DOT, Nashville, TN 37232, USA
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Proof-of-concept for a non-invasive, portable, and wireless device for cardiovascular monitoring in pediatric patients. PLoS One 2020; 15:e0227145. [PMID: 31899768 PMCID: PMC6941801 DOI: 10.1371/journal.pone.0227145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/11/2019] [Indexed: 11/19/2022] Open
Abstract
Measurement of cardiac function is vital for the health of pediatric patients with heart disease. Standard tools to measure function including echocardiogram and magnetic residence imaging are time intensive, costly, and have limited accessibility. The Vivio is a novel, non-invasive, handheld device that screens for cardiac dysfunction by analyzing intrinsic frequencies (IF) ω1 and ω2 of carotid artery waveforms. Prior studies demonstrated that left ventricular ejection fraction can be derived from IFs in adults. This study 1) studies whether the Vivio can capture carotid arterial pulse waveform data in children ages 0–19 years old; 2) tests the performance of two sensor head geometries, one larger and smaller than the standard size used in adults, designed for the pediatric population; 3) compares the IFs between pediatric age groups and adults with normal function. The Vivio successfully measured a carotid artery waveform in all children over 5 years old and 28% of children under the age of five. The small head did not accurately measure a waveform in any age group. One-way analysis of variance (ANOVA) demonstrated a difference in the IF ω1 between the adult and pediatric cohorts (F = 7.3, Prob>F = 0.0001). Post host analysis demonstrated a difference between the adult cohort (ω1 = 99 +/- 5 bpm) and the cohorts ages 0–4 (ω1 = 111 +/- 2 bpm; p = 0.0006) and 15–19 years old (ω1 = 105 +/-5 bpm; p = 0.02). One-way ANOVA demonstrated a difference in the IF ω2 between the adult and pediatric cohorts (F = 4.8, Prob>F = 0.003), specifically between the adult (ω2 = 81 +/- 13 bpm) and age 0–4 cohorts (ω2 = 48 +/- 8 bpm; p = 0.002). These results suggest that the Vivio can be used to capture carotid pulse waveform data in pediatric populations and that the data produced can be used to measure intrinsic frequencies.
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Bhat S, Gahungu N, Thavendiranathan P, Dwivedi G. The Role of Echocardiography in Cardio-oncology Patients: Contemporary Indications and Future Directions. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9519-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Cardiac Triangle Mapping: A New Systems Approach for Noninvasive Evaluation of Left Ventricular End Diastolic Pressure. FLUIDS 2019. [DOI: 10.3390/fluids4010016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Noninvasive and practical assessment of hemodynamics is a critical unmet need in the treatment of both chronic and acute cardiovascular diseases. Particularly, the ability to monitor left ventricular end-diastolic pressure (LVEDP) noninvasively offers enormous benefit for managing patients with chronic congestive heart failure. Recently, we provided proof of concept that a new cardiac metric, intrinsic frequency (IF), derived from mathematical analysis of non-invasively captured arterial waveforms, can be used to accurately compute cardiovascular hemodynamic measures, such as left ventricle ejection fraction (LVEF), by using a smartphone. In this manuscript, we propose a new systems-based method called cardiac triangle mapping (CTM) for hemodynamics evaluation of the left ventricle. This method is based on intrinsic frequency (IF) and systolic time interval (STI) methods that allows computation of LVEDP from noninvasive measurements. Since the CTM method only requires arterial waveform and electrocardiogram (ECG), it can eventually be adopted as a simple smartphone-based device, an inexpensive hand-held device, or perhaps (with future design modifications) a wearable sensor. Such devices, combined with this method, would allow for remote monitoring of heart failure patients.
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