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Opotowsky AR, Khairy P, Diller G, Kasparian NA, Brophy J, Jenkins K, Lopez KN, McCoy A, Moons P, Ollberding NJ, Rathod RH, Rychik J, Thanassoulis G, Vasan RS, Marelli A. Clinical Risk Assessment and Prediction in Congenital Heart Disease Across the Lifespan: JACC Scientific Statement. J Am Coll Cardiol 2024; 83:2092-2111. [PMID: 38777512 DOI: 10.1016/j.jacc.2024.02.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/12/2024] [Accepted: 02/22/2024] [Indexed: 05/25/2024]
Abstract
Congenital heart disease (CHD) comprises a range of structural anomalies, each with a unique natural history, evolving treatment strategies, and distinct long-term consequences. Current prediction models are challenged by generalizability, limited validation, and questionable application to extended follow-up periods. In this JACC Scientific Statement, we tackle the difficulty of risk measurement across the lifespan. We appraise current and future risk measurement frameworks and describe domains of risk specific to CHD. Risk of adverse outcomes varies with age, sex, genetics, era, socioeconomic status, behavior, and comorbidities as they evolve through the lifespan and across care settings. Emerging technologies and approaches promise to improve risk assessment, but there is also need for large, longitudinal, representative, prospective CHD cohorts with multidimensional data and consensus-driven methodologies to provide insight into time-varying risk. Communication of risk, particularly with patients and their families, poses a separate and equally important challenge, and best practices are reviewed.
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Affiliation(s)
- Alexander R Opotowsky
- Adult Congenital Heart Disease Program, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
| | - Paul Khairy
- Adult Congenital Heart Centre, Montreal Heart Institute, Montréal, Quebec, Canada
| | - Gerhard Diller
- Department of Cardiology III, University Hospital Münster, Münster, Germany
| | - Nadine A Kasparian
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Heart and Mind Wellbeing Center, Cincinnati, Ohio, USA; Heart Institute and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - James Brophy
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
| | - Kathy Jenkins
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Keila N Lopez
- Department of Pediatrics, Section of Cardiology, Texas Children's Hospital & Baylor College of Medicine, Houston, Texas, USA
| | - Alison McCoy
- Vanderbilt Clinical Informatics Core, Department of Biomedical Informatics, Vanderbilt University Medical Center and Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Nicholas J Ollberding
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Rahul H Rathod
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jack Rychik
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - George Thanassoulis
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
| | - Ramachandran S Vasan
- School of Public Health, University of Texas, San Antonio, Texas, USA; Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ariane Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence, McGill University, Montreal, Quebec, Canada.
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2
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Campolo J, Annoni G, Vignati G, Peretti A, Papa M, Colombo PE, Muti G, Parolini M, Borghini A, Giaccardi M, Ait-Alì L, Picano E, Andreassi MG. The burden of radiation exposure in congenital heart disease: the Italian cohort profile and bioresource collection in HARMONIC project. Ital J Pediatr 2024; 50:100. [PMID: 38760836 PMCID: PMC11102118 DOI: 10.1186/s13052-024-01663-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/28/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND The European-funded Health Effects of Cardiac Fluoroscopy and Modern Radiotherapy in Pediatrics (HARMONIC) project aims to improve knowledge on the effects of medical exposure to ionizing radiation (IR) received during childhood. One of its objectives is to build a consolidated European cohort of pediatric patients who have undergone cardiac catheterization (Cath) procedures, with the goal of enhancing the assessment of long-term radiation-associated cancer risk. The purpose of our study is to provide a detailed description of the Italian cohort contributing to the HARMONIC project, including an analysis of cumulative IR exposure, reduction trend over the years and an overview of the prospective collection of biological samples for research in this vulnerable population. METHODS In a single-center retrospective cohort study, a total of 584 patients (323 males) with a median age of 6 (2-13) years, referred at the Pediatric Cardiology in Niguarda Hospital from January 2015 to October 2023, were included. Biological specimens from a subset of 60 patients were prospectively collected for biobanking at baseline, immediately post-procedure and after 12 months. RESULTS Two hundred fifty-nine (44%) patients were under 1 year old at their first procedure. The median KAP/weight was 0.09 Gy·cm2/kg (IQR: 0.03-0.20), and the median fluoroscopy time was 8.10 min (IQR: 4.00-16.25). KAP/weight ratio showed a positive correlation with the fluoroscopy time (Spearman's rho = 0.679, p < 0.001). Significant dose reduction was observed either after implementation of an upgraded technology system and a radiation training among staff. The Italian cohort includes 1858 different types of specimens for Harmonic biobank, including blood, plasma, serum, clot, cell pellet/lymphocytes, saliva. CONCLUSIONS In the Italian Harmonic cohort, radiation dose in cardiac catheterization varies by age and procedure type. An institution's radiological protection strategy has contributed to a reduction in radiation dose over time. Biological samples provide a valuable resource for future research, offering an opportunity to identify potential early biomarkers for health surveillance and personalized risk assessment.
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Affiliation(s)
- Jonica Campolo
- CNR Institute of Clinical Physiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
| | - Giuseppe Annoni
- Pediatric Cardiology, Regina Margherita Children's Hospital, Turin, Italy
| | - Gabriele Vignati
- Pediatric Cardiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessio Peretti
- Pediatric Cardiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Papa
- Pediatric Cardiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Gaia Muti
- Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marina Parolini
- CNR Institute of Clinical Physiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | | | - Marzia Giaccardi
- Department of Internal Medicine, Electrophysiology Unit, Santa Maria Annunziata Hospital, Florence, Italy
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3
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Cheong D, Alloah Q, Fishbein JS, Rajagopal HG. Comparison and Agreement between Cardiovascular Computed Tomography-Derived Mid-Diastolic and End-Diastolic Ventricular Volume in Patients with Congenital Heart Disease. Pediatr Cardiol 2024:10.1007/s00246-024-03504-x. [PMID: 38689021 DOI: 10.1007/s00246-024-03504-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/19/2024] [Indexed: 05/02/2024]
Abstract
Prospective electrocardiogram (ECG)-triggered cardiovascular computed tomography (CCT) is primarily utilized for anatomical information in congenital heart disease (CHD) and has not been utilized for calculation of the end-diastolic volume (EDV); however, the mid-diastolic volume (MDV) may be measured. The objective of this study was to evaluate the feasibility and agreement between ventricular EDV and MDV. 31 retrospectively ECG-gated CCT were analyzed for the study of the 450 consecutive CCT. CCT images were processed using syngo.via with automatic contouring followed by manual adjustment of the endocardial borders of the left ventricles (LV) and right ventricles (RV) at end-diastolic and mid-diastolic phase (measured at 70% of cardiac cycle). The correlation and agreements between EDV and MDV were demonstrated using Spearman rank coefficient and intraclass correlation coefficient (ICC), respectively. Mean age ± SD was 28.8 ± 12.5 years, 19 were male (61.3%) and tetralogy of Fallot (TOF) was the most common diagnosis (58.1%), 35% (11/31) patients with a pacemaker, ICD or other such contraindication for a CMRI, 23% (7/31) with claustrophobia, and 6.5% (2/31) with developmental delay with refusal for sedation did not have a previous CMRI. The mean ± SD indexed LV EDV and LV MDV were 91.1 ± 24.5 and 84.8 ± 22.3 ml/m2, respectively. The mean ± SD indexed RV EDV and RV MDV were 136.8 ± 41 and 130.2 ± 41.5 ml/m2, respectively. EDV and MDV had a strong positive correlation and good agreement (ICC 0.92 for LV and 0.95 for RV). This agreement was preserved in a subset of patients (21) with dilated RV (indexed RV EDV z-score > 2). Intra-observer reliability (0.97 and 0.98 for LV and RV MDV, respectively) and inter-observer reliability (0.96 and 0.90 for LV and RV MDV, respectively) were excellent. In a select group of patients with CHD, measuring MDV by CCT is feasible and these values have good agreements with EDV. This may be used to derive functional data from prospectively ECG-triggered CCT studies. Further large-scale analysis is needed to determine accuracy and clinical correlation.
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Affiliation(s)
- Daniel Cheong
- Pediatric Cardiology, Cohen Children's Medical Center, Northwell Health, 2000 Marcus Ave, Suite 300, New Hyde Park, NY, 11042-1069, USA.
| | - Qais Alloah
- Pediatric Cardiology, Cohen Children's Medical Center, Northwell Health, 2000 Marcus Ave, Suite 300, New Hyde Park, NY, 11042-1069, USA
| | - Joanna S Fishbein
- Biostatistics Unit, Office of Academic Affairs, Northwell Health, New Hyde Park, USA
| | - Hari G Rajagopal
- Pediatric Cardiology, Cohen Children's Medical Center, Northwell Health, 2000 Marcus Ave, Suite 300, New Hyde Park, NY, 11042-1069, USA
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Picano E, Vano E. Updated Estimates of Radiation Risk for Cancer and Cardiovascular Disease: Implications for Cardiology Practice. J Clin Med 2024; 13:2066. [PMID: 38610831 PMCID: PMC11012972 DOI: 10.3390/jcm13072066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
This review aims to furnish an updated assessment of the societal healthcare load, including cancer and cardiovascular disease resulting from diagnostic radiologic operations. The previously projected additional cancer risk of 0.9% in a United States 2004 study referred to radiological conditions in 1996 with an X-ray exposure of 0.50 millisievert (mSv) per capita annually. Radiological exposure (radiology + nuclear medicine) has escalated to 2.29 mSv (2016) per capita per year. Low-dose exposures were previously assumed to have a lower biological impact, since they allow the DNA repair system to mitigate molecular damage. However, epidemiological data matured and disproved this assumption, as shown by updated cancer risk assessments derived from the World Health Organization 2013 and the German Institute of Radioprotection 2014 data. The risk of cardiovascular disease aligns within the same order of magnitude as cancer risk and compounds it, as shown by a comprehensive meta-analysis of 93 studies. The collective societal burden arising from the augmented risks of cancer and cardiovascular disease attributable to diagnostic radiology and nuclear medicine is higher than previously thought.
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Affiliation(s)
- Eugenio Picano
- Cardiology Clinic, University Center Serbia, Medical School, University of Belgrade, 11000 Belgrade, Serbia
| | - Eliseo Vano
- Cardiology Department, Medical Faculty, Complutense University, 28040 Madrid, Spain;
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Harrison DJ, Prada F, Nokoff NJ, Iwamoto SJ, Pastor T, Jacobsen RM, Yeung E. Considerations for Gender-Affirming Hormonal and Surgical Care Among Transgender and Gender Diverse Adolescents and Adults With Congenital Heart Disease. J Am Heart Assoc 2024; 13:e031004. [PMID: 38293963 PMCID: PMC11056179 DOI: 10.1161/jaha.123.031004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 12/05/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Transgender and gender diverse (TGD) individuals and long-term survivors with adult congenital heart disease (ACHD) are both growing populations with specialized needs. No studies assess temporal trends or evaluate the care of TGD individuals with ACHD. METHODS AND RESULTS Meetings between congenital cardiology and gender-affirming care specialists identified unique considerations in TGD individuals with ACHD. A retrospective chart review was then performed to describe patient factors and outpatient trends in those with an ACHD diagnosis undergoing gender-affirming hormonal or surgical care (GAHT/S) at 1 adult and 1 pediatric tertiary care center. Thirty-three TGD individuals with ACHD were identified, 21 with a history of GAHT/S. Fourteen (66%) had moderate or complex ACHD, 8 (38%) identified as transgender male, 9 (43%) transgender female, and 4 (19%) other gender identities. Three had undergone gender-affirming surgery. There were zero occurrences of the composite end point of unplanned hospitalization or thrombotic event over 71.1 person-years of gender-affirming care. Median age at first gender-affirming appointment was 16.8 years [interquartile range 14.8-21.5]. The most common treatment modification was changing estradiol administration from oral to transdermal to reduce thrombotic risk (n=3). An increasing trend was observed from zero TGD patients with ACHD attending a gender diversity appointment in 2012 to 14 patients in 2022. CONCLUSIONS There is a growing population of TGD patients with ACHD and unique medical and psychosocial needs. Future studies must fully evaluate the reassuring safety profile observed in this small cohort. We share 10 actionable care considerations for providers with a goal of overseeing a safe and fulfilling gender transition across all TGD patients with ACHD.
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Affiliation(s)
- David J. Harrison
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) ProgramUniversity of Colorado School of Medicine, UCHealth Hospital System and Children’s Hospital ColoradoAuroraCOUSA
| | - Francisco Prada
- Division of Adolescent MedicineChildren’s Hospital ColoradoAuroraCOUSA
| | | | - Sean J. Iwamoto
- UCHealth Integrated Transgender Program, Division of Endocrinology, Metabolism and DiabetesUniversity of Colorado School of Medicine, Rocky Mountain Regional VA Medical CenterAuroraCOUSA
| | - Tony Pastor
- Division of Cardiology, Yale New Haven HospitalNew HavenCTUSA
| | - Roni M. Jacobsen
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) ProgramUniversity of Colorado School of Medicine, UCHealth Hospital System and Children’s Hospital ColoradoAuroraCOUSA
| | - Elizabeth Yeung
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) ProgramUniversity of Colorado School of Medicine, UCHealth Hospital System and Children’s Hospital ColoradoAuroraCOUSA
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6
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Nappi F. In-Depth Genomic Analysis: The New Challenge in Congenital Heart Disease. Int J Mol Sci 2024; 25:1734. [PMID: 38339013 PMCID: PMC10855915 DOI: 10.3390/ijms25031734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/25/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024] Open
Abstract
The use of next-generation sequencing has provided new insights into the causes and mechanisms of congenital heart disease (CHD). Examinations of the whole exome sequence have detected detrimental gene variations modifying single or contiguous nucleotides, which are characterised as pathogenic based on statistical assessments of families and correlations with congenital heart disease, elevated expression during heart development, and reductions in harmful protein-coding mutations in the general population. Patients with CHD and extracardiac abnormalities are enriched for gene classes meeting these criteria, supporting a common set of pathways in the organogenesis of CHDs. Single-cell transcriptomics data have revealed the expression of genes associated with CHD in specific cell types, and emerging evidence suggests that genetic mutations disrupt multicellular genes essential for cardiogenesis. Metrics and units are being tracked in whole-genome sequencing studies.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France
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Hasan MS, Ganni E, Liu A, Guo L, Mackie AS, Kaufman JS, Marelli AJ. CanCHD Study of Hematopoietic Cancers in Children With and Without Genetic Syndromes. J Am Heart Assoc 2024; 13:e026604. [PMID: 38156460 PMCID: PMC10863797 DOI: 10.1161/jaha.122.026604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/23/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Individuals with genetic syndromes can manifest both congenital heart disease (CHD) and cancer attributable to possible common underlying pathways. To date, reliable risk estimates of hematopoietic cancer (HC) among children with CHD based on large population-based data remain scant. This study sought to quantify the risk of HC by the presence of genetic syndrome among children with CHD. METHODS AND RESULTS Data sources were the Canadian CHD database, a nationwide database on CHD (1999-2017), and the CCR (Canadian Cancer Registry). Standardized incidence ratios were calculated for comparing HC incidences in children with CHD with the general pediatric population. A modified Kaplan-Meier curve was used to estimate the cumulative incidence of HC with death as a competing risk. A total of 143 794 children (aged 0-17 years) with CHD were followed up from birth to age 18 years for 1 314 603 person-years. Of them, 8.6% had genetic syndromes, and 898 HC cases were observed. Children with known syndromes had a substantially higher risk of incident HC than the general pediatric population (standardized incidence ratio, 13.4 [95% CI, 11.7-15.1]). The cumulative incidence of HC was 2.44% (95% CI, 2.11-2.76) among children with a syndrome and 0.79% (95% CI, 0.72-0.87) among children without a syndrome. Acute myeloid leukemia had a higher cumulative incidence during early childhood than acute lymphoblastic leukemia. CONCLUSIONS This is the first large population-based analysis documenting that known genetic syndromes in children with CHD are a significant predictor of HC. The finding could be essential in informing risk-stratified policy recommendations for cancer surveillance in children with CHD.
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Affiliation(s)
- Mohammad Sazzad Hasan
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealQuebecCanada
| | - Elie Ganni
- McGill Adult Unit for Congenital Heart Disease ExcellenceMcGill University Health CentreMontrealQuebecCanada
| | - Aihua Liu
- McGill Adult Unit for Congenital Heart Disease ExcellenceMcGill University Health CentreMontrealQuebecCanada
| | - Liming Guo
- McGill Adult Unit for Congenital Heart Disease ExcellenceMcGill University Health CentreMontrealQuebecCanada
| | - Andrew S. Mackie
- Division of Cardiology, Stollery Children’s Hospital and Department of PediatricsUniversity of AlbertaEdmontonAlbertaCanada
| | - Jay S. Kaufman
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealQuebecCanada
| | - Ariane J. Marelli
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealQuebecCanada
- McGill Adult Unit for Congenital Heart Disease ExcellenceMcGill University Health CentreMontrealQuebecCanada
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8
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Barak-Corren Y, Herz C, Lasso A, Dori Y, Tang J, Smith CL, Callahan R, Rome JJ, Gillespie MJ, Jolley MA, O’Byrne ML. Calculating Relative Lung Perfusion Using Fluoroscopic Sequences and Image Analysis: The Fluoroscopic Flow Calculator. Circ Cardiovasc Interv 2024; 17:e013204. [PMID: 38152881 PMCID: PMC10872906 DOI: 10.1161/circinterventions.123.013204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/03/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Maldistribution of pulmonary blood flow in patients with congenital heart disease impacts exertional performance and pulmonary artery growth. Currently, measurement of relative pulmonary perfusion can only be performed outside the catheterization laboratory. We sought to develop a tool for measuring relative lung perfusion using readily available fluoroscopy sequences. METHODS A retrospective cohort study was conducted on patients with conotruncal anomalies who underwent lung perfusion scans and subsequent cardiac catheterizations between 2011 and 2022. Inclusion criteria were nonselective angiogram of pulmonary vasculature, oblique angulation ≤20°, and an adequate view of both lung fields. A method was developed and implemented in 3D Slicer's SlicerHeart extension to calculate the amount of contrast that entered each lung field from the start of contrast injection and until the onset of levophase. The predicted perfusion distribution was compared with the measured distribution of pulmonary blood flow and evaluated for correlation, accuracy, and bias. RESULTS In total, 32% (79/249) of screened studies met the inclusion criteria. A strong correlation between the predicted flow split and the measured flow split was found (R2=0.83; P<0.001). The median absolute error was 6%, and 72% of predictions were within 10% of the true value. Bias was not systematically worse at either extreme of the flow distribution. The prediction was found to be more accurate for either smaller and younger patients (age 0-2 years), for right ventricle injections, or when less cranial angulations were used (≤20°). In these cases (n=40), the prediction achieved R2=0.87, median absolute error of 5.5%, and 78% of predictions were within 10% of the true flow. CONCLUSIONS The current study demonstrates the feasibility of a novel method for measuring relative lung perfusion using conventional angiograms. Real-time measurement of lung perfusion at the catheterization laboratory has the potential to reduce unnecessary testing, associated costs, and radiation exposure. Further optimization and validation is warranted.
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Affiliation(s)
- Yuval Barak-Corren
- Division of Cardiology, The Children’s Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Christian Herz
- Division of Pediatric Cardiac Anesthesia, The Children’s Hospital of Philadelphia and Department of Anesthesia and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Andras Lasso
- Laboratory for Percutaneous Surgery, Queen’s University, Kingston, ON
| | | | - Jessica Tang
- Division of Cardiology, The Children’s Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Christopher L Smith
- Division of Cardiology, The Children’s Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Ryan Callahan
- Division of Cardiology, The Children’s Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Jonathan J Rome
- Division of Cardiology, The Children’s Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Matthew J Gillespie
- Division of Cardiology, The Children’s Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Matthew A Jolley
- Division of Cardiology, The Children’s Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Division of Pediatric Cardiac Anesthesia, The Children’s Hospital of Philadelphia and Department of Anesthesia and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Michael L O’Byrne
- Division of Cardiology, The Children’s Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Clinical Futures, The Children’s Hospital of Philadelphia, Pennsylvania, Philadelphia, PA
- Leonard Davis Institute and Center for Cardiovascular Outcomes, Quality, and Evaluative Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA
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Caryl NE, June C, Culbert MH, Hellinger RD, Hoyer AW, Klewer SE, Seckeler MD. Incidence of Radiation-Associated Cancer in Patients With Congenital Heart Disease. Am J Cardiol 2024; 210:65-68. [PMID: 37844721 DOI: 10.1016/j.amjcard.2023.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/02/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023]
Affiliation(s)
- Natalie E Caryl
- College of Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - Ciara June
- College of Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - M Hunter Culbert
- College of Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - Riley D Hellinger
- College of Medicine, University of Arizona College of Medicine, Tucson, Arizona; Medical Scientist Training Program, University of Arizona College of Medicine, Tucson, Arizona
| | - Andrew W Hoyer
- Department of Pediatrics (Cardiology), University of Arizona, Tucson, Arizona
| | - Scott E Klewer
- Department of Pediatrics (Cardiology), University of Arizona, Tucson, Arizona
| | - Michael D Seckeler
- Department of Pediatrics (Cardiology), University of Arizona, Tucson, Arizona.
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10
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Tournoy TK, Moons P, Daelman B, De Backer J. Biological Age in Congenital Heart Disease-Exploring the Ticking Clock. J Cardiovasc Dev Dis 2023; 10:492. [PMID: 38132660 PMCID: PMC10743752 DOI: 10.3390/jcdd10120492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/08/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
Over the past 50 years, there has been a major shift in age distribution of patients with congenital heart disease (CHD) thanks to significant advancements in medical and surgical treatment. Patients with CHD are, however, never cured and face unique challenges throughout their lives. In this review, we discuss the growing data suggesting accelerated aging in this population. Adults with CHD are more often and at a younger age confronted with age-related cardiovascular complications such as heart failure, arrhythmia, and coronary artery disease. These can be related to the original birth defect, complications of correction, or any residual defects. In addition, and less deductively, more systemic age-related complications are seen earlier, such as renal dysfunction, lung disease, dementia, stroke, and cancer. The occurrence of these complications at a younger age makes it imperative to further map out the aging process in patients across the spectrum of CHD. We review potential feasible markers to determine biological age and provide an overview of the current data. We provide evidence for an unmet need to further examine the aging paradigm as this stresses the higher need for care and follow-up in this unique, newly aging population. We end by exploring potential approaches to improve lifespan care.
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Affiliation(s)
- Tijs K. Tournoy
- Department of Cardiology, Ghent University Hospital, 9000 Ghent, Belgium;
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, University of Leuven, 3000 Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, 405 30 Gothenburg, Sweden
- Department of Pediatrics and Child Health, University of Cape Town, Cape Town 7700, South Africa
| | - Bo Daelman
- KU Leuven Department of Public Health and Primary Care, University of Leuven, 3000 Leuven, Belgium
| | - Julie De Backer
- Department of Cardiology, Ghent University Hospital, 9000 Ghent, Belgium;
- Center for Medical Genetics, Ghent University Hospital, 9000 Ghent, Belgium
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Shetty G, Zouki J, Lee G, Patukale A, Betts KS, Justo RN, Marathe SP, Venugopal P, Alphonso N. Utility of routine chest radiographs after chest drain removal in paediatric cardiac surgical patients-a retrospective analysis of 1076 patients. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad159. [PMID: 37756693 PMCID: PMC10560101 DOI: 10.1093/icvts/ivad159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/05/2023] [Accepted: 09/25/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVES Chest drains are routinely placed in children following cardiac surgery. The purpose of this study was to determine the incidence of a clinically relevant pneumothorax and/or pleural effusion after drain removal and to ascertain if a chest radiograph can be safely avoided following chest drain removal. METHODS This single-centre retrospective cohort study included all patients under 18 years of age who underwent cardiac surgery between January 2015 and December 2019 with the insertion of mediastinal and/or pleural drains. Exclusion criteria were chest drain/s in situ ≥14 days and mortality prior to removal of chest drain/s. A drain removal episode was defined as the removal of ≥1 drains during the same episode of analgesia ± sedation. All chest drains were removed using a standard protocol. Chest radiographs following chest drain removal were reviewed by 2 investigators. RESULTS In all, 1076 patients were identified (median age: 292 days, median weight: 7.8 kg). There were 1587 drain removal episodes involving 2365 drains [mediastinal (n = 1347), right pleural (n = 598), left pleural (n = 420)]. Chest radiographs were performed after 1301 drain removal episodes [mediastinal (n = 1062); right pleural (n = 597); left pleural (n = 420)]. Chest radiographs were abnormal after 152 (12%) drain removal episodes [pneumothorax (n = 43), pleural effusion (n = 98), hydropneumothorax (n = 11)]. Symptoms/signs were present in 30 (2.3%) patients. Eleven (<1%) required medical management. One required reintubation and 2 required chest drain reinsertion. CONCLUSIONS The incidence of clinically significant pneumothorax/pleural effusion following chest drain removal after paediatric cardiac surgery is low (<1%). Most patients did not require reinsertion of a chest drain. It is reasonable not to perform routine chest radiographs following chest drain removal in most paediatric cardiac surgical patients.
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Affiliation(s)
- Gautham Shetty
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children's Hospital, Brisbane, QLD, Australia
- School of Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, QLD, Australia
- Queensland Paediatric Cardiac Research, Children's Health Queensland, Brisbane, QLD, Australia
| | - Jason Zouki
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Geraldine Lee
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Aditya Patukale
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children's Hospital, Brisbane, QLD, Australia
- School of Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, QLD, Australia
- Queensland Paediatric Cardiac Research, Children's Health Queensland, Brisbane, QLD, Australia
| | - Kim S Betts
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Robert N Justo
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children's Hospital, Brisbane, QLD, Australia
- School of Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, QLD, Australia
- Queensland Paediatric Cardiac Research, Children's Health Queensland, Brisbane, QLD, Australia
| | - Supreet P Marathe
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children's Hospital, Brisbane, QLD, Australia
- School of Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, QLD, Australia
- Queensland Paediatric Cardiac Research, Children's Health Queensland, Brisbane, QLD, Australia
| | - Prem Venugopal
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children's Hospital, Brisbane, QLD, Australia
- School of Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, QLD, Australia
- Queensland Paediatric Cardiac Research, Children's Health Queensland, Brisbane, QLD, Australia
| | - Nelson Alphonso
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children's Hospital, Brisbane, QLD, Australia
- School of Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, QLD, Australia
- Queensland Paediatric Cardiac Research, Children's Health Queensland, Brisbane, QLD, Australia
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12
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Karsenty C, Alattar Y, Mousseaux E, Marcilhacy G, Gencer U, Craiem D, Iserin L, Ladouceur M, Legendre A, Laredo M, Bonnet D, Malekzadeh-Milani S, Soulat G. 4D flow magnetic resonance imaging to assess right ventricular outflow tract in patients undergoing transcatheter pulmonary valve replacement. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:793-802. [PMID: 36921915 DOI: 10.1016/j.rec.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/22/2023] [Indexed: 03/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES Magnetic resonance imaging (MRI) including 4D flow is used before percutaneous pulmonary valve implantation (PPVI). As PPVI is limited by the size of the right ventricular outflow tract (RVOT), accurate sizing is needed to plan the intervention. The aim of this study was to compare different MRI modalities and invasive angiography to balloon sizing of RVOT. METHODS Single-center prospective study of patients who underwent PPVI for isolated pulmonary regurgitation assessed by 4D flow MRI, 3D steady-state free precession/gradient echo (3D SSFP/GRE) and contrast magnetic resonance angiography. Balloon sizing was considered as the reference. RESULTS A total of 23 adults were included (mean age, 38.4±12.5 years). Eighteen patients underwent successful primary PPVI. The average of the narrowest RVOT diameter was 25.4±4.3 mm by balloon sizing. Compared to balloon sizing, RVOT diameters were better correlated when estimated by systolic 4D flow MRI (r=0.89, P<.001) than by diastolic 4D flow MRI (r=0.71, P <.001), 3D contrast magnetic resonance angiography (r=0.73; P <.001) and 3D SSFP/GRE (r=0.50; P=.04) and was not significantly correlated when estimated by 2D in diastole and systole. The mean difference between systolic 4D flow MRI and balloon sizing was 0.2 mm (95%CI, -3.5 to 3.9 mm), whereas it was wider with other techniques. CONCLUSIONS Beyond the quantification of pulmonary valve regurgitation, 4D flow allows accurate estimation of RVOT diameters, especially in systole, which is fundamental before planning PPVI.
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Affiliation(s)
- Clément Karsenty
- Adult Congenital Cardiology Department, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Pediatric and Congenital Cardiology, Children's Hospital, CHU Toulouse, Toulouse, France; Institut des Maladies Métaboliques et Cardiovasculaires, Université de Toulouse, Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Toulouse, France; Adult Congenital Cardiology Department, Clinique Pasteur, Toulouse, France.
| | - Yousef Alattar
- Adult Congenital Cardiology Department, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Elie Mousseaux
- Adult Congenital Cardiology Department, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Paris Centre de Recherche Cardiovasculaire (PARCC), Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM) Paris, France
| | - Gabrielle Marcilhacy
- Adult Congenital Cardiology Department, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Umit Gencer
- Paris Centre de Recherche Cardiovasculaire (PARCC), Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM) Paris, France
| | - Damian Craiem
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, Buenos Aires, Argentina
| | - Laurence Iserin
- Adult Congenital Cardiology Department, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Magalie Ladouceur
- Adult Congenital Cardiology Department, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Paris Centre de Recherche Cardiovasculaire (PARCC), Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM) Paris, France
| | - Antoine Legendre
- Adult Congenital Cardiology Department, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Mikael Laredo
- Adult Congenital Cardiology Department, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Institut de Cardiologie, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Damien Bonnet
- Pediatric and Congenital Department, M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Paris, France; Institut IMAGINE, Université de Paris, Paris, France
| | - Sophie Malekzadeh-Milani
- Adult Congenital Cardiology Department, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Pediatric and Congenital Department, M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Paris, France
| | - Gilles Soulat
- Adult Congenital Cardiology Department, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Paris Centre de Recherche Cardiovasculaire (PARCC), Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM) Paris, France
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13
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Liu J, Chen S, Zhou Y, Zheng X, Meng R, Tan N, Liu Y. Effect of cumulative radiation exposure from Coronary catheterization on lung cancer mortality. BMC Cancer 2023; 23:757. [PMID: 37582730 PMCID: PMC10426196 DOI: 10.1186/s12885-023-11231-4] [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: 04/20/2023] [Accepted: 07/26/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Coronary catheterization (CC) procedure inevitably exposes patients with cardiovascular disease (CVD) to radiation, while cumulative radiation exposure may lead to higher risk of cancer. METHODS This multi-center, retrospective study was based on the CC procedure in Cardiorenal ImprovemeNt II cohort (CIN-II, NCT05050877) among five regional central tertiary teaching hospitals in China between 2007 and 2020. Patients without known cancer were stratified according to the times they received CC procedure. Baseline information from their last CC procedure was analyzed. Cox regression and Fine-Gray competing risk models were used to assess the relationship between cumulative radiation exposure from CC procedures and cancer-specific, all-cause and cardiovascular mortality. RESULTS Of 136,495 hospitalized survivors without cancer at baseline (mean age: 62.3 ± 11.1 years, 30.9% female), 116,992 patients (85.7%) underwent CC procedure once, 15,184 patients (11.1%) on twice, and 4,319 patients (3.2%) underwent CC procedure more than three times. During the median follow-up of 4.7 years (IQR: 2.5 to 7.4), totally 18,656 patients (13.7%) died after discharge, of which 617 (0.5%) died of lung cancer. Compared with the patients who underwent CC procedure once, the risk of lung cancer mortality increased significantly with the increase of the number of CC procedure (CC 2 times vs. 1 time: HR 1.42, 95% CI 1.13 to 1.78, P < 0.001; CC ≥ 3 times vs. 1 time: HR 1.64, 95%CI 1.13 to 2.39, P < 0.05). Similar results were observed in all-cause mortality and cardiovascular mortality, but not in other cancer-specific mortality. CONCLUSIONS Our data suggest that substantial proportion of CVD patients are exposed to multiple high levels of low-dose ionizing radiation from CC procedure, which is associated with an increased risk of cancer mortality in this population. TRIAL REGISTRATION ClinicalTrials.gov: NCT05050877; URL: http://www. CLINICALTRIALS gov ; 21/09/2021.
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Affiliation(s)
- Jin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shiqun Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Yang Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xueyan Zheng
- Institute of Control and Prevention for Chronic Non-Infective Disease, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Ruilin Meng
- Institute of Control and Prevention for Chronic Non-Infective Disease, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China.
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
- School of Medicine, Guangdong Provincial People's Hospital, South China University of Technology, Guangzhou, China.
| | - Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
- School of Medicine, Guangdong Provincial People's Hospital, South China University of Technology, Guangzhou, China.
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14
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Cimci M, Batar B, Bostanci M, Durmaz E, Karayel B, Raimoglou D, Guven M, Karadag B. The Long-Term Impact of Ionizing Radiation on DNA Damage in Patients Undergoing Multiple Cardiac Catheterizations. Cardiovasc Toxicol 2023; 23:278-283. [PMID: 37458898 DOI: 10.1007/s12012-023-09801-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 07/08/2023] [Indexed: 08/18/2023]
Abstract
Ionizing radiation (IR) exposures have increased exponentially in recent years due to the rise in diagnostic and therapeutic interventions. A number of small-scale studies investigated the long-term effect of IR on health workers or immediate effects of IR on patients undergoing catheterization procedures; however, the long-term impact of multiple cardiac catheterizations on DNA damage on a patient population is not known. In this study, the effects of IR on DNA damage, based on micronuclei (MN) frequency and 8-hydroxy-2'-deoxyguanosine (8-OHdG) as markers in peripheral lymphocytes, were evaluated in patients who previously underwent multiple cardiac catheterization procedures. Moreover, genetic polymorphisms in genes PARP1 Val762Ala, OGG1 Ser326Cys, and APE1 Asn148Glu as a measure of sensitivity to radiation exposure were also investigated in the same patient population. The patients who underwent ≥ 3 cardiac catheterization procedures revealed higher DNA injury in comparison to the patients who underwent ≤ 2 procedures, documented with the presence of higher level of MN frequency (6.4 ± 4.8 vs. 9.1 ± 4.3, p = 0.002) and elevated serum 8-OHdG levels (33.7 ± 3.8 ng/mL vs. 17.4 ± 1.9 ng/mL, p = 0.001). Besides, OGG1 Ser326Cys and APE1 Asn148Glu heterozygous and homozygous polymorphic types, which are related with DNA repair mechanisms, were significantly associated with MN frequency levels (p = 0.006 for heterozygous and p = 0.001 for homozygous with respect to OGG1 Ser326Cys, p = 0.007 for heterozygous and p = 0.001 for homozygous with respect to APE1 Asn148Glu). There was no significant difference in terms of PARP1 Val762Ala gene polymorphism between two groups.
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Affiliation(s)
- Murat Cimci
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Bahadir Batar
- Department of Medical Biology, Tekirdag Namik Kemal University School of Medicine, Tekirdaǧ, Turkey
| | - Merve Bostanci
- Department of Medical Biology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Eser Durmaz
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Bahadir Karayel
- Department of Internal Medicine, Health Science University, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Damla Raimoglou
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mehmet Guven
- Department of Medical Biology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Bilgehan Karadag
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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15
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Guan F, Gass M, Berger F, Akdis D, Duru F, Wolber T. Transseptal Puncture Guided by Three-Dimensional Electroanatomical Mapping: Early Experience Using a Simplified Approach in Adults with Congenital Heart Disease. J Clin Med 2023; 12:4491. [PMID: 37445531 DOI: 10.3390/jcm12134491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
AIMS The widespread use of three-dimensional (3D) mapping systems and echocardiography in the field of cardiac electrophysiology has made it possible to perform transseptal punctures (TSP) with low or no fluoroscopy. However, such attempts in adults with congenital heart disease (ACHD) who have previously undergone surgical or interventional treatment are limited. Therefore, we sought to explore the feasibility and safety of an approach to perform zero- or low-fluoroscopy TSP in ACHD patients undergoing left atrial cardiac ablation procedures. METHODS AND RESULTS This study included 45 ACHD patients who underwent TSP for ablation of left-sided tachycardias (left atrium or pulmonary venous atrium). Computed tomography (CT) of the heart was performed in all patients prior to ablation. 3D mapping of the right-sided heart chambers before TSP was used to superimpose the registered anatomy, which was subsequently used for the mapping-guided TSP technique. TSP was performed with zero-fluoroscopy in 27 patients, and the remaining 18 patients had a mean fluoroscopy exposure of 315.88 ± 598.43 μGy.m2 and a mean fluoroscopy duration of 1.9 ± 5.4 min. No patient in this cohort experienced TSP-related complications. CONCLUSION Our study describes a fluoroscopy-free or low-dose fluoroscopy approach for TSP in ACHD patients undergoing catheter ablation of left-sided tachyarrhythmias who had been previously treated surgically or interventionally due to congenital heart defects. By superimposing 3D electroanatomic mapping with cardiac CT anatomy, this protocol proved to be highly effective, feasible and safe.
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Affiliation(s)
- Fu Guan
- Department of Cardiology, Arrhythmia and Electrophysiology Division, University Heart Center Zurich, 8091 Zurich, Switzerland
| | - Matthias Gass
- Children's Research Center, Zurich University Children's Hospital, 8032 Zurich, Switzerland
| | - Florian Berger
- Children's Research Center, Zurich University Children's Hospital, 8032 Zurich, Switzerland
| | - Deniz Akdis
- Department of Cardiology, Arrhythmia and Electrophysiology Division, University Heart Center Zurich, 8091 Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, Arrhythmia and Electrophysiology Division, University Heart Center Zurich, 8091 Zurich, Switzerland
- Center for Integrative Human Physiology, University of Zurich, 8091 Zurich, Switzerland
| | - Thomas Wolber
- Department of Cardiology, Arrhythmia and Electrophysiology Division, University Heart Center Zurich, 8091 Zurich, Switzerland
- Center for Integrative Human Physiology, University of Zurich, 8091 Zurich, Switzerland
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16
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Mahendra M, Chu P, Amin EK, Nawaytou H, Duncan JR, Fineman JR, Smith‐Bindman R. Associated radiation exposure from medical imaging and excess lifetime risk of developing cancer in pediatric patients with pulmonary hypertension. Pulm Circ 2023; 13:e12282. [PMID: 37614831 PMCID: PMC10442605 DOI: 10.1002/pul2.12282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/02/2023] [Accepted: 08/13/2023] [Indexed: 08/25/2023] Open
Abstract
Pediatric patients with pulmonary hypertension (PH) receive imaging studies that use ionizing radiation (radiation) such as computed tomography (CT) and cardiac catheterization to guide clinical care. Radiation exposure is associated with increased cancer risk. It is unknown how much radiation pediatric PH patients receive. The objective of this study is to quantify radiation received from imaging and compute associated lifetime cancer risks for pediatric patients with PH. Electronic health records between 2012 and 2022 were reviewed and radiation dose data were extracted. Organ doses were estimated using Monte Carlo modeling. Cancer risks for each patient were calculated from accumulated exposures using National Cancer Institute tools. Two hundred and forty-nine patients with PH comprised the study cohort; 97% of patients had pulmonary arterial hypertension, PH due to left heart disease, or PH due to chronic lung disease. Mean age at the time of the first imaging study was 2.5 years (standard deviation [SD] = 4.9 years). Patients underwent a mean of 12 studies per patient per year, SD = 32. Most (90%) exams were done in children <5 years of age. Radiation from CT and cardiac catheterization accounted for 88% of the total radiation dose received. Cumulative mean effective dose was 19 mSv per patient (SD = 30). Radiation dose exposure resulted in a mean increased estimated lifetime cancer risk of 7.6% (90% uncertainty interval 3.0%-14.2%) in females and 2.8% (1.2%-5.3%) in males. Careful consideration for the need of radiation-based imaging studies is warranted, especially in the youngest of children.
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Affiliation(s)
- Malini Mahendra
- Department of Pediatrics, Division of Pediatric Critical Care, UCSF Benioff Children's HospitalUniversity of California at San FranciscoSan FranciscoCaliforniaUSA
- Philip R. Lee Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Philip Chu
- Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Elena K. Amin
- Department of Pediatrics, Division of Pediatric Cardiology, UCSF Benioff Children's HospitalUniversity of California at San FranciscoSan FranciscoCaliforniaUSA
| | - Hythem Nawaytou
- Department of Pediatrics, Division of Pediatric Cardiology, UCSF Benioff Children's HospitalUniversity of California at San FranciscoSan FranciscoCaliforniaUSA
| | - James R. Duncan
- Interventional Radiology Section, Mallinckrodt Institute of RadiologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Jeffrey R. Fineman
- Department of Pediatrics, Division of Pediatric Critical Care, UCSF Benioff Children's HospitalUniversity of California at San FranciscoSan FranciscoCaliforniaUSA
- Cardiovascular Research InstituteUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Rebecca Smith‐Bindman
- Philip R. Lee Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of CaliforniaSan FranciscoCaliforniaUSA
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17
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Abalo KD, Malekzadeh-Milani S, Hascoët S, Dreuil S, Feuillet T, Damon C, Bouvaist H, Bouzguenda I, Cohen S, Dauphin C, Di Filippo S, Douchin S, Godart F, Guérin P, Helms P, Karsenty C, Lefort B, Mauran P, Ovaert C, Piéchaud JF, Thambo JB, Lee C, Little MP, Bonnet D, Bernier MO, Rage E. Lympho-hematopoietic malignancies risk after exposure to low dose ionizing radiation during cardiac catheterization in childhood. Eur J Epidemiol 2023:10.1007/s10654-023-01010-7. [PMID: 37191831 DOI: 10.1007/s10654-023-01010-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 04/16/2023] [Indexed: 05/17/2023]
Abstract
Pediatric patients with congenital heart disease (CHD) often undergo low dose ionizing radiation (LDIR) from cardiac catheterization (CC) for the diagnosis and/or treatment of their disease. Although radiation doses from a single CC are usually low, less is known about the long-term radiation associated cancer risks. We aimed to assess the risk of lympho-hematopoietic malignancies in pediatric CHD patients diagnosed or treated with CC. A French cohort of 17,104 children free of cancer who had undergone a first CC from 01/01/2000 to 31/12/2013, before the age of 16 was set up. The follow-up started at the date of the first recorded CC until the exit date, i.e., the date of death, the date of first cancer diagnosis, the date of the 18th birthday, or the 31/12/2015, whichever occurred first. Poisson regression was used to estimate the LDIR associated cancer risk. The median follow-up was 5.9 years, with 110,335 person-years. There were 22,227 CC procedures, yielding an individual active bone marrow (ABM) mean cumulative dose of 3.0 milligray (mGy). Thirty-eight incident lympho-hematopoietic malignancies were observed. When adjusting for attained age, gender and predisposing factors to cancer status, no increased risk was observed for lympho-hematopoietic malignancies RR/mGy = 1.00 (95% CI: 0.88; 1.10). In summary, the risk of lympho-hematopoietic malignancies and lymphoma was not associated to LDIR in pediatric patients with CHD who undergo CC. Further epidemiological studies with greater statistical power are needed to improve the assessment of the dose-risk relationship.
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Affiliation(s)
- Kossi D Abalo
- Institute for Radiological Protection and Nuclear Safety (IRSN), PSE-SANTE/SESANE/Laboratory of Epidemiology, BP 17, Fontenay-aux-Roses, 92262, France
| | - Sophie Malekzadeh-Milani
- M3C-Necker, Hôpital universitaire Necker-Enfants malades, Université de Paris Cité, Paris, France
| | - Sébastien Hascoët
- Cardiology department, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Serge Dreuil
- Institute for Radiological Protection and Nuclear Safety, (IRSN), PSE-SANTE/SER/UEM, BP 17, Fontenay-aux-Roses, 92262, France
| | | | - Cecilia Damon
- Institute for Radiological Protection and Nuclear Safety, (IRSN), DTR/D3NSI/SVDDA/CVD, BP 17, Fontenay-aux-Roses, 92262, France
| | - Hélène Bouvaist
- Cardiopédiatrie, hôpital couple enfant, CHU Grenoble Alpes, Grenoble cedex 9, 38043, France
| | - Ivan Bouzguenda
- Pediatric and congenital cardiology, Interventional cardiology, INTERCARD Clinique La Louvière, Lille, France
| | - Sarah Cohen
- Cardiology department, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Claire Dauphin
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Sylvie Di Filippo
- Paediatric and Congential Cardiology Department, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Stéphanie Douchin
- Cardiopédiatrie, hôpital couple enfant, CHU Grenoble Alpes, Grenoble cedex 9, 38043, France
| | - François Godart
- Service de Cardiologie Infantile et Congénitale, Institut Coeur Poumon, Lille Cedex, 59037, France
| | - Patrice Guérin
- CHU Nantes, INSERM, Nantes Université, Clinique Cardiologique et des Maladies Vasculaires, Institut du Thorax, Nantes, 1413, CIC, France
| | - Pauline Helms
- Unit of Cardiopediatrics, University Hospital of Strasbourg, Strasbourg, France
| | - Clément Karsenty
- Pediatric and Congenital Cardiology, Institut des Maladies Métaboliques et Cardiovasculaires, Children's Hospital, INSERM U1048, Université de Toulouse, Toulouse, I2MC, France
| | - Bruno Lefort
- Institut des Cardiopathies Congénitales, CHRU Tours, 49 boulevard Béranger, Tours, 37000, France
| | - Pierre Mauran
- Unité de cardiologie pédiatrique et congénitale, American Memorial Hospital, CHU de Reims, 47 rue Cognacq-Jay, Reims Cedex, 51092, France
| | - Caroline Ovaert
- Cardiologie pédiatrique et congénitale, AP-HM et INSERM 1251, Aix-Marseille Université, Timone enfants, Marseille, France
| | | | - Jean-Benoît Thambo
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Pessac, 33600, France
| | - Choonsik Lee
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Mark P Little
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Damien Bonnet
- M3C-Necker, Hôpital universitaire Necker-Enfants malades, Université de Paris Cité, Paris, France
| | - Marie-Odile Bernier
- Institute for Radiological Protection and Nuclear Safety (IRSN), PSE-SANTE/SESANE/Laboratory of Epidemiology, BP 17, Fontenay-aux-Roses, 92262, France
| | - Estelle Rage
- Institute for Radiological Protection and Nuclear Safety (IRSN), PSE-SANTE/SESANE/Laboratory of Epidemiology, BP 17, Fontenay-aux-Roses, 92262, France.
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Andreassi MG, Haddy N, Harms-Ringdahl M, Campolo J, Borghini A, Chevalier F, Schwenk JM, Fresneau B, Bolle S, Fuentes M, Haghdoost S. A Longitudinal Study of Individual Radiation Responses in Pediatric Patients Treated with Proton and Photon Radiotherapy, and Interventional Cardiology: Rationale and Research Protocol of the HARMONIC Project. Int J Mol Sci 2023; 24:ijms24098416. [PMID: 37176123 PMCID: PMC10178896 DOI: 10.3390/ijms24098416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
The Health Effects of Cardiac Fluoroscopy and Modern Radiotherapy (photon and proton) in Pediatrics (HARMONIC) is a five-year project funded by the European Commission that aimed to improve the understanding of the long-term ionizing radiation (IR) risks for pediatric patients. In this paper, we provide a detailed overview of the rationale, design, and methods for the biological aspect of the project with objectives to provide a mechanistic understanding of the molecular pathways involved in the IR response and to identify potential predictive biomarkers of individual response involved in long-term health risks. Biological samples will be collected at three time points: before the first exposure, at the end of the exposure, and one year after the exposure. The average whole-body dose, the dose to the target organ, and the dose to some important out-of-field organs will be estimated. State-of-the-art analytical methods will be used to assess the levels of a set of known biomarkers and also explore high-resolution approaches of proteomics and miRNA transcriptomes to provide an integrated assessment. By using bioinformatics and systems biology, biological pathways and novel pathways involved in the response to IR exposure will be deciphered.
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Affiliation(s)
| | - Nadia Haddy
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | - Mats Harms-Ringdahl
- Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, 10691 Stockholm, Sweden
| | - Jonica Campolo
- CNR National Research Council Institute of Clinical Physiology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Andrea Borghini
- CNR National Research Council Institute of Clinical Physiology, 56125 Pisa, Italy
| | - François Chevalier
- UMR6252 CIMAP, CEA-CNRS-ENSICAEN-University of Caen Normandy, 14000 Caen, France
- Advanced Resource Center for HADrontherapy in Europe (ARCHADE), 14000 Caen, France
| | - Jochen M Schwenk
- Affinity Proteomics, SciLifeLab, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH-Royal Institute of Technology, 10044 Stockholm, Sweden
| | - Brice Fresneau
- Department of Children and Adolescents Oncology, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | - Stephanie Bolle
- Department of Radiation Therapy, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | - Manuel Fuentes
- Deparment of Medicine and General Service of Cytometry, Proteomics Unit, Cancer Research Centre-IBMCC, CSIC-USAL, IBSAL, Campus Miguel de Unamuno s/n, University of Salamanca-CSIC, 37007 Salamanca, Spain
| | - Siamak Haghdoost
- Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, 10691 Stockholm, Sweden
- UMR6252 CIMAP, CEA-CNRS-ENSICAEN-University of Caen Normandy, 14000 Caen, France
- Advanced Resource Center for HADrontherapy in Europe (ARCHADE), 14000 Caen, France
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19
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Borghini A, Campolo J, Annoni G, Giuli V, Sicari R, Peretti A, Mercuri A, Picano E, Andreassi MG. Cancer Risk in Patients With Congenital Heart Disease Exposed to Radiation From Cardiac Procedures. J Am Coll Cardiol 2023; 81:1133-1134. [PMID: 36922096 DOI: 10.1016/j.jacc.2022.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 12/09/2022] [Accepted: 12/30/2022] [Indexed: 03/18/2023]
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20
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Panayiotou HR, Mills LK, Broadbent DA, Shelley D, Scheffczik J, Olaru AM, Jin N, Greenwood JP, Michael H, Plein S, Bissell MM. Comprehensive Neonatal Cardiac, Feed and Wrap, Non-contrast, Non-sedated, Free-breathing Compressed Sensing 4D Flow MRI Assessment. J Magn Reson Imaging 2023; 57:789-799. [PMID: 35792484 DOI: 10.1002/jmri.28325] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/05/2022] [Accepted: 06/06/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Cardiac MRI is an important imaging tool in congenital cardiac disease, but its use has been limited in the neonatal population as general anesthesia has been needed for breath-holding. Technological advances in four-dimensional (4D) flow MRI have now made nonsedated free-breathing acquisition protocols a viable clinical option, but the method requires prospective validation in neonates. PURPOSE To test the feasibility of compressed sensing (CS) 4D flow MRI in the neonatal population and to compare with standard previously validated two-dimensional (2D) phase-contrast (PC) flow MRI. STUDY TYPE Prospective, cohort, image quality. POPULATION A total of 14 healthy neonates (median [range] age: 2.5 [0-80] days; 8 male). FIELD STRENGTH AND SEQUENCE Noncontrast 2D cine gradient echo sequence with through-plane velocity encoding (PC) sequence and compressed sensing (CS) three-dimensional (3D), time-resolved, cine phase-contrast MRI with 3D velocity-encoding (4D flow MRI) at 3 T. ASSESSMENT Aortic 2D PC, and aortic, pulmonary trunk and superior vena cava CS 4D flow MRI were acquired using the feed and wrap technique (nonsedated) and quantified using commercially available software. Aortic flow and peak velocity were compared between methods. Internal consistency of 4D flow MRI was determined by comparing mean forward flow of the main pulmonary artery (MPA) vs. the sum of left and right pulmonary artery flows (LPA and RPA) and by comparing mean ascending aorta forward flow (AAo) vs. the sum of superior vena cava (SVC) and descending aorta flows (DAo). STATISTICAL TESTS Flow and peak-velocity comparisons were assessed using paired t-tests, with P < 0.05 considered significant, and Bland-Altman analysis. Interobserver and intraobserver agreement and internal consistency were analyzed by intraclass correlation co-efficient (ICC). RESULTS There was no statistically significant difference between ascending aortic forward flow between 2D PC and CS 4D Flow MRI (P = 0.26) with a bias of 0.11 mL (-0.59 to 0.82 mL) nor peak velocity (P = 0.11), with a bias of -5 cm/sec and (-26 to 16 cm/sec). There was excellent interobserver and intraobserver agreement for each vessel (interobserver ICC: AAo 1.00; DAo 0.94, SVC 0.90, MPA 0.99, RPA 0.98, LPA 0.96; intraobserver ICC: AAo 1.00; DAo 0.99, SVC 0.98, MPA 1.00, RPA 1.00, LPA 0.99). Internal consistency measures showed excellent agreement for both mean forward flow of main pulmonary artery vs. the sum of left and right pulmonary arteries (ICC: 0.95) and mean ascending aorta forward flow vs. the sum of superior vena cava and descending aorta flows (ICC: 1.00). CONCLUSION Sedation-free neonatal feed and wrap MRI is well tolerated and feasible. CS 4D flow MRI quantification is similar to validated 2D PC free-breathing imaging with excellent interobserver and intraobserver agreement. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
| | - Lily K Mills
- Biomedical Imaging Sciences Department, University of Leeds, Leeds, UK
| | - David A Broadbent
- Biomedical Imaging Sciences Department, University of Leeds, Leeds, UK.,Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - David Shelley
- Biomedical Imaging Sciences Department, University of Leeds, Leeds, UK
| | - Jutta Scheffczik
- Department of Anaesthesiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Ning Jin
- Siemens Medical Solutions USA, Inc., Chicago, Illinois, USA
| | - John P Greenwood
- Biomedical Imaging Sciences Department, University of Leeds, Leeds, UK
| | - Helen Michael
- Department of Paediatric Cardiology, Leeds Teaching Hospitals NHS Trust, UK
| | - Sven Plein
- Biomedical Imaging Sciences Department, University of Leeds, Leeds, UK
| | - Malenka M Bissell
- Biomedical Imaging Sciences Department, University of Leeds, Leeds, UK.,Department of Paediatric Cardiology, Leeds Teaching Hospitals NHS Trust, UK
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21
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Olivieri F, Prattichizzo F, Lattanzio F, Bonfigli AR, Spazzafumo L. Antifragility and antiinflammaging: Can they play a role for a healthy longevity? Ageing Res Rev 2023; 84:101836. [PMID: 36574863 DOI: 10.1016/j.arr.2022.101836] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/14/2022] [Accepted: 12/21/2022] [Indexed: 12/25/2022]
Abstract
One of the most exciting challenges of the research on aging is to explain how the environmental factors interact with the genetic background to modulate the chances to reach the extreme limit of human life in healthy conditions. The complex epigenetic mechanisms can explain both the interaction between DNA and environmental factors, and the long-distance persistence of lifestyle effects, due to the so called "epigenetic memory". One of the most extensively investigated theories on aging focuses on the inflammatory responses, suggesting that the age-related progression of low-grade and therefore for long time subclinical, chronic, systemic, inflammatory process, named "inflammaging", could be the most relevant risk factor for the development and progression of the most common age-related diseases and ultimately of death. The results of many studies on long-lived people, especially on centenarians, suggested that healthy old people can cope with inflammaging upregulating the antiinflammaging responses. Overall, a genetic make-up coding for a strong antiinflammaging response and an age-related ability to remodel key metabolic pathways to cope with a plethora of antigens and stressors seem to be the best ways for reach the extreme limit of human lifespan in health status. In this scenario, we wondered if the antifragility concept, recently developed in the framework of business and risk analysis, could add some information to disentangle the heterogeneous nature of the aging process in human. The antifragility is the property of the complex systems to increase their performances because of high stress. Based on this theory we were wondering if some subjects could be able to modulate faster than others their epigenome to cope with a plethora of stressors during life, probably modulating the inflammatory and anti-inflammatory responses. In this framework, antifragility could share some common mechanisms with anti-inflammaging, modulating the ability to restrain the inflammatory responses, so that antifragility and antiinflammaging could be viewed as different pieces of the same puzzle, both impinging upon the chances to travel along the healthy aging trajectory.
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Affiliation(s)
- Fabiola Olivieri
- Department of Clinical and Molecular Sciences, DISCLIMO, Università Politecnica Delle Marche, Ancona, Italy; Clinica di Medicina di Laboratorio e di Precisione, IRCCS INRCA, Ancona, Italy.
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22
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Changing epidemiology of congenital heart disease: effect on outcomes and quality of care in adults. Nat Rev Cardiol 2023; 20:126-137. [PMID: 36045220 DOI: 10.1038/s41569-022-00749-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 01/21/2023]
Abstract
The epidemiology of congenital heart disease (CHD) has changed in the past 50 years as a result of an increase in the prevalence and survival rate of CHD. In particular, mortality in patients with CHD has changed dramatically since the latter half of the twentieth century as a result of more timely diagnosis and the development of interventions for CHD that have prolonged life. As patients with CHD age, the disease burden shifts away from the heart and towards acquired cardiovascular and systemic complications. The societal costs of CHD are high, not just in terms of health-care utilization but also with regards to quality of life. Lifespan disease trajectories for populations with a high disease burden that is measured over prolonged time periods are becoming increasingly important to define long-term outcomes that can be improved. Quality improvement initiatives, including advanced physician training for adult CHD in the past 10 years, have begun to improve disease outcomes. As we seek to transform lifespan into healthspan, research efforts need to incorporate big data to allow high-value, patient-centred and artificial intelligence-enabled delivery of care. Such efforts will facilitate improved access to health care in remote areas and inform the horizontal integration of services needed to manage CHD for the prolonged duration of survival among adult patients.
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23
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Lakshmanan S, Gimelli A. Cancer risk in adult congenital heart disease. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2023. [DOI: 10.1016/j.ijcchd.2023.100441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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24
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Cao CF, Ma KL, Shan H, Liu TF, Zhao SQ, Wan Y, Jun-Zhang, Wang HQ. CT Scans and Cancer Risks: A Systematic Review and Dose-response Meta-analysis. BMC Cancer 2022; 22:1238. [PMID: 36451138 PMCID: PMC9710150 DOI: 10.1186/s12885-022-10310-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/10/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There is still uncertainty on whether ionizing radiation from CT scans can increase the risks of cancer. This study aimed to identify the association of cumulative ionizing radiation from CT scans with pertaining cancer risks in adults. METHODS Five databases were searched from their inception to November 15, 2020. Observational studies reporting cancer risks from CT scans in adults were included. The main outcome included quantified cancer risks as cancer case numbers in exposed/unexposed adult participants with unified converted measures to odds ratio (OR) for relative risk, hazard ratio. Global background radiation (2.4 mSv per year) was used as control for lifetime attribution risk (LAR), with the same period from incubation after exposure until survival to 100 years. RESULTS 25 studies were included with a sum of 111,649,943 participants (mean age: 45.37 years, 83.4% women), comprising 2,049,943 actual participants from 6 studies with an average follow-up period as 30.1 years (range, 5 to 80 years); 109,600,000 participants from 19 studies using LAR. The cancer risks for adults following CT scans were inordinately increased (LAR adults, OR, 10.00 [95% CI, 5.87 to 17.05]; actual adults, OR, 1.17 [95%CI, 0.89 to 1.55]; combined, OR, 5.89 [95%CI, 3.46 to 10.35]). Moreover, cancer risks elevated with increase of radiation dose (OR, 33.31 [95% CI, 21.33 to 52.02]), and multiple CT scan sites (OR, 14.08 [95% CI, 6.60 to 30.05]). The risk of solid malignancy was higher than leukemia. Notably, there were no significant differences for age, gender, country, continent, study quality and studying time phrases. CONCLUSIONS Based on 111.6 million adult participants from 3 continents (Asia, Europe and America), this meta-analysis identifies an inordinately increase in cancer risks from CT scans for adults. Moreover, the cancer risks were positively correlated with radiation dose and CT sites. The meta-analysis highlights the awareness of potential cancer risks of CT scans as well as more reasonable methodology to quantify cancer risks in terms of life expectancy as 100 years for LAR. PROSPERO TRIAL REGISTRATION NUMBER CRD42019133487.
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Affiliation(s)
- Chun-Feng Cao
- grid.203458.80000 0000 8653 0555Department of Orthopedics, Yongchuan Hospital of Chongqing Medical University, Hua Road, No. 439, Yongchuan, 402160 Chongqing, People’s Republic of China
| | - Kun-Long Ma
- grid.203458.80000 0000 8653 0555Department of Orthopedics, Yongchuan Hospital of Chongqing Medical University, Hua Road, No. 439, Yongchuan, 402160 Chongqing, People’s Republic of China
| | - Hua Shan
- grid.449637.b0000 0004 0646 966XInstitute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xixian Avenue, Xixian District, Xi’an, 712046 Shaanxi Province People’s Republic of China
| | - Tang-Fen Liu
- grid.449637.b0000 0004 0646 966XInstitute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xixian Avenue, Xixian District, Xi’an, 712046 Shaanxi Province People’s Republic of China
| | - Si-Qiao Zhao
- grid.412262.10000 0004 1761 5538Department of Orthopedics, No.1 Hospital of Xi’an City, Northwestern University, Xi’an, 710002 Shaanxi Province People’s Republic of China
| | - Yi Wan
- grid.233520.50000 0004 1761 4404Department of Health Services, Fourth Military Medical University, Xi’an, 710032 No.169 West Changle Road, Shaanxi Province People’s Republic of China
| | - Jun-Zhang
- grid.489934.bBaoji Central Hospital, 8 Jiangtan Road, Baoji, 721008 Shaanxi Province People’s Republic of China ,grid.43169.390000 0001 0599 1243School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, 710061 Shaanxi Province People’s Republic of China
| | - Hai-Qiang Wang
- grid.449637.b0000 0004 0646 966XInstitute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xixian Avenue, Xixian District, Xi’an, 712046 Shaanxi Province People’s Republic of China
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25
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Venkatesh P, Yan KL, Bravo-Jaimes K, Yang EH, Lluri G. Outcomes of malignancy in adults with congenital heart disease: a single center experience. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2022; 8:20. [PMID: 36419184 PMCID: PMC9685873 DOI: 10.1186/s40959-022-00144-z] [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: 09/27/2022] [Accepted: 10/17/2022] [Indexed: 11/27/2022]
Abstract
Background Malignancy is known to be a major cause of death in adult congenital heart disease (ACHD). However, data regarding cardiovascular and cancer-related outcomes in ACHD are lacking. Methods We conducted a retrospective single-center cohort study comprising patients with ACHD and malignancy. The primary outcome was all-cause mortality. Key secondary outcomes included major adverse cardiovascular and cerebrovascular events (MACCE), cardiotoxicity events and consequent cancer therapy modifications. Results Sixty-eight patients with ACHD and a history of cancer were included in the study. 82% of patients had moderate or great ACHD anatomic complexity. Over a median follow-up of 5 years after cancer diagnosis, 16 (24%) patients died, with 69% of deaths being due to cancer. Univariate predictors of mortality were baseline arrhythmia (OR 3.82, 95% CI 1.15-12.67, p = 0.028), baseline diuretic therapy (OR 3.54, 95% CI 1.04-12.04, p = 0.044) and advanced cancer stage at diagnosis (OR 2.37, 95% CI 1.32-4.25, p = 0.004). MACCE occurred in 40 (59%) patients and was independently predicted by baseline diuretic requirement (OR 9.91, 95% CI 1.12-87.85, p = 0.039). A 14% incidence of cardiotoxicity was seen; 3 patients needed modification and 1 patient needed temporary interruption of cancer therapy for 2 weeks. Conclusions Considerable mortality occurred in this cohort of patients with ACHD and cancer; most deaths were cancer-related. A high rate of MACCE was observed, yet rates of obligatory modification of cancer therapy due to cardiotoxicity were low. Supplementary Information The online version contains supplementary material available at 10.1186/s40959-022-00144-z.
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Affiliation(s)
- Prashanth Venkatesh
- grid.50956.3f0000 0001 2152 9905Guerin Congenital Heart Program, Department of Cardiology, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd, Suite A3600, Los Angeles, CA 90048 USA
| | - Kimberly L. Yan
- grid.266102.10000 0001 2297 6811Department of Medicine, University of California, San Francisco, San Francisco, CA USA
| | - Katia Bravo-Jaimes
- grid.417467.70000 0004 0443 9942Division of Cardiology, Department of Medicine, Mayo Clinic Florida, Jacksonville, FL USA
| | - Eric H. Yang
- grid.19006.3e0000 0000 9632 6718UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA USA
| | - Gentian Lluri
- grid.19006.3e0000 0000 9632 6718UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718Ahmanson/UCLA Adult Congenital Heart Disease Center, Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA USA
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Prescription medication use after congenital heart surgery. Cardiol Young 2022; 32:1786-1793. [PMID: 34986916 DOI: 10.1017/s1047951121005060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Improvements in mortality after congenital heart surgery have necessitated a shift in focus to postoperative morbidity as an outcome measure. We examined late morbidity after congenital heart surgery based on prescription medication use. METHODS Between 1953 and 2009, 10,635 patients underwent congenital heart surgery at <15 years of age in Finland. We obtained 4 age-, sex-, birth-time, and hospital district-matched controls per patient. The Social Insurance Institution of Finland provided data on all prescription medications obtained between 1999 and 2012 by patients and controls. Patients were assigned one diagnosis based on a hierarchical list of cardiac defects and dichotomised into simple and severe groups. Medications were divided into short- and long-term based on indication. Follow-up started at the first operation and ended at death, emigration, or 31 December, 2012. RESULTS Totally, 8623 patients met inclusion criteria. Follow-up was 99.9%. In total, 8126 (94%) patients required prescription medications. Systemic anti-bacterials were the most common short-term prescriptions among patients (93%) and controls (88%). Patients required betablockers (simple hazard ratio 1.9, 95% confidence interval 1.7-2.1; severe hazard ratio 6.5, 95% confidence interval 5.3-8.1) and diuretics (simple hazard ratio 3.2, 95% CI 2.8-3.7; severe hazard ratio 38.8, 95% CI 27.5-54.7) more often than the general population. Both simple and severe defects required medication for cardiovascular, gastrointestinal, psychiatric, neurologic, metabolic, autoimmune, and infectious diseases more often than the general population. CONCLUSIONS The significant risk for postoperative cardiovascular and non-cardiovascular disease warrants close long-term follow-up after congenital heart surgery for all defects.
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27
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Dodeja AK, Tan Y, Ackley T, Russell J, Kertesz N, Daniels CJ, Kamp A. PentaRay® Multielectrode Mapping Catheter for Atrial Tachyarrhythmia in Adults With Congenital Heart Disease. Tex Heart Inst J 2022; 49:e207535. [PMID: 36269883 PMCID: PMC9632387 DOI: 10.14503/thij-20-7535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
BACKGROUND Ablation of atrial tachyarrhythmia in adults with congenital heart disease (ACHD) is challenging because of complex anatomy and high scar burden. We proposed that the addition of high-density mapping with the PentaRay® (Biosense Webster, Inc) mapping catheter (EAM+P) to 3-dimensional electroanatomic mapping (EAM) allows for rapid acquisition of high-resolution maps and shorter procedure times. METHODS In this single-center, retrospective cohort study of patients with ACHD who underwent atrial arrhythmia ablation, patients were divided those who underwent ablation with EAM and those who underwent ablation with EAM+P. RESULTS Fifteen ablations were performed in 13 patients using standard EAM, and 11 ablations were performed in 10 patients using EAM+P. There was no difference in mean age or complexity of congenital heart disease. The procedure duration was 1.5 times longer in the EAM than in the EAM+P group (P = .015). The dose area product was 12 times higher in the EAM than in the EAM+P group (P = .001). A higher number of venous access sites were used for EAM cases than for EAM+P cases (P = .008). Acute success rates of ablation and recurrence rates at 1 year were similar in the 2 groups. There were no procedure-related complications in either group. CONCLUSION This is the first study to evaluate the use of the PentaRay® high-density mapping catheter for ablation of atrial tachyarrhythmia in patients with ACHD. The use of the PentaRay® high-density mapping catheter results in shorter procedure time, decreased radiation exposure, and fewer venous access sites.
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Affiliation(s)
- Anudeep K. Dodeja
- Department of Pediatrics, Division of Cardiovascular Medicine, Nationwide Children's Hospital, Columbus, Ohio
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Yubo Tan
- Department of Pediatrics, Division of Cardiovascular Medicine, Nationwide Children's Hospital, Columbus, Ohio
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Tamara Ackley
- Department of Pediatrics, Division of Cardiovascular Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Jennifer Russell
- Department of Pediatrics, Division of Cardiovascular Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Naomi Kertesz
- Department of Pediatrics, Division of Cardiovascular Medicine, Nationwide Children's Hospital, Columbus, Ohio
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Curt J. Daniels
- Department of Pediatrics, Division of Cardiovascular Medicine, Nationwide Children's Hospital, Columbus, Ohio
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Anna Kamp
- Department of Pediatrics, Division of Cardiovascular Medicine, Nationwide Children's Hospital, Columbus, Ohio
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Congenital Heart Disease and the Risk of Cancer: An Update on the Genetic Etiology, Radiation Exposure Damage, and Future Research Strategies. J Cardiovasc Dev Dis 2022; 9:jcdd9080245. [PMID: 36005409 PMCID: PMC9409914 DOI: 10.3390/jcdd9080245] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 01/27/2023] Open
Abstract
Epidemiological studies have shown an increased prevalence of cancer in patients with congenital heart disease (CHD) as compared with the general population. The underlying risk factors for the acquired cancer risk remain poorly understood, and shared genetic anomalies and cumulative radiation exposure from repeated imaging and catheterization procedures may be contributing factors. In the present review, we provide an update on the most recent literature regarding the associations between CHD and cancer, with a particular focus on genetic etiology and radiation exposure from medical procedures. The current evidence indicates that children with CHD may be a high-risk population, already having the first genetic “hit”, and, consequently, may have increased sensitivity to ionizing radiation from birth or earlier. Future research strategies integrating biological and molecular measures are also discussed in this article.
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Mejia EJ, Rossano JW. Congenital heart disease and the risk of cancer: The importance of understanding associated comorbidities. Lancet Reg Health Eur 2022; 18:100415. [PMID: 35663364 PMCID: PMC9160338 DOI: 10.1016/j.lanepe.2022.100415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Erika J. Mejia
- Corresponding author at: 3401 Civic Center Boulevard, Philadelphia, PA 19104.
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Karazisi C, Dellborg M, Mellgren K, Giang KW, Skoglund K, Eriksson P, Mandalenakis Z. Risk of cancer in young and older patients with congenital heart disease and the excess risk of cancer by syndromes, organ transplantation and cardiac surgery: Swedish health registry study (1930-2017). THE LANCET REGIONAL HEALTH. EUROPE 2022; 18:100407. [PMID: 35663362 PMCID: PMC9156800 DOI: 10.1016/j.lanepe.2022.100407] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Increasing survival of patients with congenital heart disease (CHD) will result in an increased risk of age-dependent acquired diseases later in life. We aimed to investigate the risk of cancer in young and older patients with CHD and to evaluate the excess risk of cancer by syndromes, organ transplantation and cardiac surgery. Methods Patients with CHD born between 1930 and 2017 were identified using Swedish Health Registers. Each patient with CHD (n = 89,542) was matched by sex and birth year with ten controls without CHD (n = 890,472) from the Swedish Total Population Register. Findings 4012 patients with CHD (4·5%) and 35,218 controls (4·0%) developed cancer. The median follow-up time was 58·8 (IQR 42·4-69·0) years. The overall cancer risk was 1·23 times higher (95% confidence interval (CI) 1·19-1·27) in patients with CHD compared with matched controls, and remained significant when patients with syndromes and organ transplant recipients were excluded. The risk of cancer was higher in all CHD age groups, and in patients that underwent cardiac surgery during the first year after birth (Hazard Ratio 1·83; 95% CI 1·32-2·54). The highest risk was found in children (0-17 years), HR 3·21 (95% CI 2·90-3·56). Interpretation The cancer risk in patients with CHD was 23% higher than in matched controls without CHD. The highest risk was found in children and in the latest birth cohort (1990-2017). Funding Funding by the Swedish state (Grant Number: 236611), the Swedish Research Council (Grant Number: 2019-00193), the Swedish Childhood Cancer Fund (Grant Number: SP2017-0012) and the Swedish Heart-Lung Foundation (Grant Number: 20190724).
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Affiliation(s)
- Christina Karazisi
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Diagnosvägen 11, Gothenburg SE-416 50, Sweden
| | - Mikael Dellborg
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Diagnosvägen 11, Gothenburg SE-416 50, Sweden
- Adult Congenital Heart Disease Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karin Mellgren
- Department of Pediatric Oncology, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kok Wai Giang
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Diagnosvägen 11, Gothenburg SE-416 50, Sweden
| | - Kristofer Skoglund
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Peter Eriksson
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Diagnosvägen 11, Gothenburg SE-416 50, Sweden
- Adult Congenital Heart Disease Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Zacharias Mandalenakis
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Diagnosvägen 11, Gothenburg SE-416 50, Sweden
- Adult Congenital Heart Disease Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
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Yet Kwong Horman J, Schultz M. An Unexpected Occurrence of Malignancy in a Patient After a Fontan Operation. Cureus 2022; 14:e26160. [PMID: 35891831 PMCID: PMC9302605 DOI: 10.7759/cureus.26160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/05/2022] Open
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Iacobazzi D, Alvino VV, Caputo M, Madeddu P. Accelerated Cardiac Aging in Patients With Congenital Heart Disease. Front Cardiovasc Med 2022; 9:892861. [PMID: 35694664 PMCID: PMC9177956 DOI: 10.3389/fcvm.2022.892861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/11/2022] [Indexed: 01/03/2023] Open
Abstract
An increasing number of patients with congenital heart disease (CHD) survive into adulthood but develop long-term complications including heart failure (HF). Cellular senescence, classically defined as stable cell cycle arrest, is implicated in biological processes such as embryogenesis, wound healing, and aging. Senescent cells have a complex senescence-associated secretory phenotype (SASP), involving a range of pro-inflammatory factors with important paracrine and autocrine effects on cell and tissue biology. While senescence has been mainly considered as a cause of diseases in the adulthood, it may be also implicated in some of the poor outcomes seen in patients with complex CHD. We propose that patients with CHD suffer from multiple repeated stress from an early stage of the life, which wear out homeostatic mechanisms and cause premature cardiac aging, with this term referring to the time-related irreversible deterioration of the organ physiological functions and integrity. In this review article, we gathered evidence from the literature indicating that growing up with CHD leads to abnormal inflammatory response, loss of proteostasis, and precocious age in cardiac cells. Novel research on this topic may inspire new therapies preventing HF in adult CHD patients.
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Affiliation(s)
| | | | | | - Paolo Madeddu
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
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Romans RA, Lu JC, Balasubramanian S, Whiteside W, Yu S, Aldoss OT, Armstrong AK, Boe BA, Balzer DT, Christensen JT, Jones TK, Keeshan B, McLennan D, Nicholson GT, Patel N, Salavitabar A, Shahanavaz S, Sullivan PM, Turner ME, Zampi JD. Cardiac Magnetic Resonance to Predict Coronary Artery Compression in Transcatheter Pulmonary Valve Implantation Into Conduits. JACC Cardiovasc Interv 2022; 15:979-988. [PMID: 35512922 DOI: 10.1016/j.jcin.2022.02.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the accuracy of cardiac magnetic resonance (CMR) in predicting coronary artery (CA) compression during transcatheter pulmonary valve implantation (TPVi). BACKGROUND TPVi is a widely available option to treat dysfunctional right ventricle (RV)-to-pulmonary artery (PA) conduits, but CA compression is an absolute contraindication. CMR can evaluate coronary anatomy, but its utility in predicting CA compression is not well established. METHODS After Institutional Review Board approval was obtained, all patients at 9 centers with attempted TPVi in RV-PA conduits and recent CMR (≤12 months) were analyzed. A core laboratory reviewed all CMR studies for the shortest orthogonal distance from a CA to the conduit, the shortest distance from a CA to the most stenotic area of the conduit, and subjective assessment of CA compression risk. RESULTS Among 231 patients, TPVi was successful in 198 (86%); in 24 (10%), balloon testing precluded implantation (documented CA compression or high risk). Distance to the RV-PA conduit ≤2.1 mm (area under the curve [AUC]: 0.70) and distance to most stenotic area ≤13.1 mm (AUC: 0.69) predicted CA compression. Subjective assessment had the highest AUC (0.78), with 96% negative predictive value. Both distances and qualitative assessment remained independently associated with CA compression when controlling for abnormal coronary anatomy or degree of conduit calcification. CONCLUSIONS CMR can help predict the risk for CA compression during TPVi in RV-PA conduits but cannot completely exclude CA compression. CMR may assist in patient selection and counseling families prior to TPVi, although balloon testing remains essential.
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Affiliation(s)
- Ryan A Romans
- Ward Family Heart Center, Children's Mercy Kansas City, Kansas City, Missouri, USA.
| | - Jimmy C Lu
- Division of Cardiology, Department of Pediatrics, C.S. Mott Children's Hospital and University of Michigan Congenital Heart Center, Ann Arbor, Michigan, USA
| | - Sowmya Balasubramanian
- Division of Cardiology, Department of Pediatrics, C.S. Mott Children's Hospital and University of Michigan Congenital Heart Center, Ann Arbor, Michigan, USA
| | - Wendy Whiteside
- Division of Cardiology, Department of Pediatrics, C.S. Mott Children's Hospital and University of Michigan Congenital Heart Center, Ann Arbor, Michigan, USA
| | - Sunkyung Yu
- Division of Cardiology, Department of Pediatrics, C.S. Mott Children's Hospital and University of Michigan Congenital Heart Center, Ann Arbor, Michigan, USA
| | - Osamah T Aldoss
- Division of Pediatric Cardiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Aimee K Armstrong
- The Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Brian A Boe
- The Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - David T Balzer
- Division of Cardiology, Department of Pediatrics, St. Louis Children's Hospital, St. Louis, Missouri, USA
| | - Jason T Christensen
- Division of Cardiology, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska, USA
| | - Thomas K Jones
- Division of Cardiology, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Britton Keeshan
- Division of Cardiology, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Daniel McLennan
- Division of Cardiology, Herma Heart Institute at Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - George T Nicholson
- Division of Cardiology, Department of Pediatrics, Monroe Carrell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Neil Patel
- Department of Cardiology, Children's Hospital Los Angeles and The Heart Institute, Los Angeles, California, USA
| | - Arash Salavitabar
- The Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Shabana Shahanavaz
- Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Patrick M Sullivan
- Department of Cardiology, Children's Hospital Los Angeles and The Heart Institute, Los Angeles, California, USA
| | - Mariel E Turner
- Department of Pediatrics, Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Jeffrey D Zampi
- Division of Cardiology, Department of Pediatrics, C.S. Mott Children's Hospital and University of Michigan Congenital Heart Center, Ann Arbor, Michigan, USA
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Arar Y, Divekar A, Clark S, Hussain T, Sebastian R, Hoda M, King J, Zellers TM, Reddy SRV. Role of Cross-Sectional Imaging in Pediatric Interventional Cardiac Catheterization. CHILDREN 2022; 9:children9030300. [PMID: 35327672 PMCID: PMC8947056 DOI: 10.3390/children9030300] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 11/16/2022]
Abstract
Management of congenital heart disease (CHD) has recently increased utilization of cross-sectional imaging to plan percutaneous interventions. Cardiac computed tomography (CT) and cardiac magnetic resonance (CMR) imaging have become indispensable tools for pre-procedural planning prior to intervention in the pediatric cardiac catheterization lab. In this article, we review several common indications for referral and the impact of cross-sectional imaging on procedural planning, success, and patient surveillance.
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Affiliation(s)
- Yousef Arar
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA; (A.D.); (S.C.); (T.H.); (R.S.); (M.H.); (T.M.Z.); (S.R.V.R.)
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Dr, Dallas, TX 75235, USA;
- Correspondence:
| | - Abhay Divekar
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA; (A.D.); (S.C.); (T.H.); (R.S.); (M.H.); (T.M.Z.); (S.R.V.R.)
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Dr, Dallas, TX 75235, USA;
| | - Stephen Clark
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA; (A.D.); (S.C.); (T.H.); (R.S.); (M.H.); (T.M.Z.); (S.R.V.R.)
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Dr, Dallas, TX 75235, USA;
| | - Tarique Hussain
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA; (A.D.); (S.C.); (T.H.); (R.S.); (M.H.); (T.M.Z.); (S.R.V.R.)
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Dr, Dallas, TX 75235, USA;
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Roby Sebastian
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA; (A.D.); (S.C.); (T.H.); (R.S.); (M.H.); (T.M.Z.); (S.R.V.R.)
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Dr, Dallas, TX 75235, USA;
- Department of Anesthesia and Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Mehar Hoda
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA; (A.D.); (S.C.); (T.H.); (R.S.); (M.H.); (T.M.Z.); (S.R.V.R.)
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Dr, Dallas, TX 75235, USA;
| | - Jamie King
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Dr, Dallas, TX 75235, USA;
| | - Thomas M. Zellers
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA; (A.D.); (S.C.); (T.H.); (R.S.); (M.H.); (T.M.Z.); (S.R.V.R.)
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Dr, Dallas, TX 75235, USA;
| | - Surendranath R. Veeram Reddy
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA; (A.D.); (S.C.); (T.H.); (R.S.); (M.H.); (T.M.Z.); (S.R.V.R.)
- Pediatric Cardiology, Children’s Medical Center, 1935 Medical District Dr, Dallas, TX 75235, USA;
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Kampitsi CE, Mogensen H, Feychting M, Tettamanti G. The relationship between congenital heart disease and cancer in Swedish children: A population-based cohort study. PLoS Med 2022; 19:e1003903. [PMID: 35213531 PMCID: PMC8880823 DOI: 10.1371/journal.pmed.1003903] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 01/05/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Birth defects have been consistently associated with elevated childhood cancer risks; however, the relationship between congenital heart disease (CHD) and childhood cancer remains conflicting. Considering the increasing patient population with CHD after improvements in their life expectancies, insights into this relationship are particularly compelling. Thus, we aimed to determine the relationship between CHD and cancer in Swedish children. METHODS AND FINDINGS All individuals registered in the Swedish Medical Birth Register (MBR) between 1973 and 2014 were included in this population-based cohort study (n = 4,178,722). Individuals with CHD (n = 66,892) were identified from the MBR and National Patient Register, whereas cancer diagnoses were retrieved from the Swedish Cancer Register. The relationship between CHD and childhood cancer (<20 years at diagnosis) was evaluated using Cox proportional hazards regression models. We observed increased risks of cancer overall, leukemia, lymphoma, and hepatoblastoma in children with CHD, but after adjustment for Down syndrome, only the increased lymphoma (hazard ratio (HR) = 1.64, 95% confidence interval (CI) 1.11 to 2.44) and hepatoblastoma (HR = 3.94, 95% CI 1.83 to 8.47) risk remained. However, when restricting to CHD diagnoses from the MBR only, i.e., those diagnosed around birth, the risk for childhood cancer overall (HR = 1.45, 95% CI 1.23 to 1.71) and leukemia (HR = 1.41, 95% CI 1.08 to 1.84) was more pronounced, even after controlling for Down syndrome. Finally, a substantially elevated lymphoma risk (HR = 8.13, 95% CI 4.06 to 16.30) was observed in children with complex CHD. Limitations of the study include the National Patient Register not being nationwide until 1987, in addition to the rareness of the conditions under study providing limited power for analyses on the rarer cancer subtypes. CONCLUSIONS We found associations between CHD and childhood lymphomas and hepatoblastomas not explained by a diagnosis of Down syndrome. Stronger associations were observed in complex CHD.
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Affiliation(s)
- Christina-Evmorfia Kampitsi
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Giorgio Tettamanti
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Saef JM, Burke BJ, Tchou PJ, Aziz PF. Early Experience with High-density Electroanatomical Mapping Using the Rhythmia™ Mapping System in Congenital and Pediatric Heart Disease. J Innov Card Rhythm Manag 2021; 12:4657-4669. [PMID: 34595049 PMCID: PMC8476094 DOI: 10.19102/icrm.2021.120901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/18/2021] [Indexed: 11/23/2022] Open
Abstract
The Rhythmia™ system (Boston Scientific, Natick, MA, USA) facilitates the rapid acquisition of high-resolution electroanatomical and activation maps. However, there are limited data on its efficacy and safety in pediatric and adult congenital heart disease (CHD) patients. In a retrospective, observational cohort study, adult CHD and pediatric patients followed by pediatric cardiology underwent electrophysiologic study using the Rhythmia™ electroanatomic mapping system. Variables examined included the number of electroanatomical maps required, acquisition time, procedure time, fluoroscopy time, radiation dosage, and rate of recurrent arrhythmia. Twelve consecutive patients, including six male patients (50%), were included with an average age of 27.7 years (range: 11–64 years). Seven (58%) of these patients had a diagnosis of CHD [moderate complexity in two (17%) and great complexity in five patients (42%)] and 10 (83%) patients underwent ablation. A total of 37 high-density maps were created in 12 procedures, with a median of 8,140 mapping points, taking a median of 631 seconds. The median procedure time was 189.5 minutes. The median fluoroscopy time was 0.9 minutes, with eight (67%) patients receiving no fluoroscopy at all. Recurrence occurred in one patient (8%) over a median follow-up duration of 16 months (interquartile range: 12.8–17.3 months). No adverse periprocedural events were recorded. This study suggests the use of high-density electroanatomic mapping in adult CHD patients showed potential for rapid acquisition of highly detailed maps with minimal fluoroscopy time or risk of periprocedural events in the studied population.
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Affiliation(s)
- Joshua M Saef
- Department of Cardiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Brendan J Burke
- Department of Pediatrics, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Patrick J Tchou
- Department of Cardiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Peter F Aziz
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, OH, USA
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Boyd A, Byrne S, Middleton RJ, Banati RB, Liu GJ. Control of Neuroinflammation through Radiation-Induced Microglial Changes. Cells 2021; 10:2381. [PMID: 34572030 PMCID: PMC8468704 DOI: 10.3390/cells10092381] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/02/2021] [Accepted: 09/02/2021] [Indexed: 12/15/2022] Open
Abstract
Microglia, the innate immune cells of the central nervous system, play a pivotal role in the modulation of neuroinflammation. Neuroinflammation has been implicated in many diseases of the CNS, including Alzheimer's disease and Parkinson's disease. It is well documented that microglial activation, initiated by a variety of stressors, can trigger a potentially destructive neuroinflammatory response via the release of pro-inflammatory molecules, and reactive oxygen and nitrogen species. However, the potential anti-inflammatory and neuroprotective effects that microglia are also thought to exhibit have been under-investigated. The application of ionising radiation at different doses and dose schedules may reveal novel methods for the control of microglial response to stressors, potentially highlighting avenues for treatment of neuroinflammation associated CNS disorders, such as Alzheimer's disease and Parkinson's disease. There remains a need to characterise the response of microglia to radiation, particularly low dose ionising radiation.
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Affiliation(s)
- Alexandra Boyd
- Australian Nuclear Science and Technology Organisation, Sydney, NSW 2234, Australia; (A.B.); (S.B.); (R.J.M.); (R.B.B.)
| | - Sarah Byrne
- Australian Nuclear Science and Technology Organisation, Sydney, NSW 2234, Australia; (A.B.); (S.B.); (R.J.M.); (R.B.B.)
| | - Ryan J. Middleton
- Australian Nuclear Science and Technology Organisation, Sydney, NSW 2234, Australia; (A.B.); (S.B.); (R.J.M.); (R.B.B.)
| | - Richard B. Banati
- Australian Nuclear Science and Technology Organisation, Sydney, NSW 2234, Australia; (A.B.); (S.B.); (R.J.M.); (R.B.B.)
- Discipline of Medical Imaging & Radiation Sciences, Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, NSW 2050, Australia
| | - Guo-Jun Liu
- Australian Nuclear Science and Technology Organisation, Sydney, NSW 2234, Australia; (A.B.); (S.B.); (R.J.M.); (R.B.B.)
- Discipline of Medical Imaging & Radiation Sciences, Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, NSW 2050, Australia
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Association of occupational direct radiation exposure to the hands with longitudinal melanonychia and hand eczema in spine surgeons: a survey by the society for minimally invasive spinal treatment (MIST). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:3702-3708. [PMID: 34427761 DOI: 10.1007/s00586-021-06973-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 05/19/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the association between occupational direct radiation exposure to the hands and longitudinal melanonychia (LM) and hand eczema in spine surgeons. METHODS A web-based questionnaire survey of the Society for Minimally Invasive Spinal Treatment (MIST) in Japan was conducted. The proportion of LM and hand eczema in hands with high and low-radiation exposure was compared using Fisher's exact test. The odds ratios (ORs) and their 95% confidence intervals (CIs) for the prevalence of LM and hand eczema in the high-radiation exposure hands were calculated using generalized estimating equations for logistic regression as control for the correlation of observations among the same individuals and possible confounders. RESULTS Among 324 members of the society, responses were received from 229 members (70.7%). A total of 454 hands from 227 participants were analysed. The prevalence of LM and hand eczema was 43% and 29%, respectively. In a hand-by-hand comparison, more hands had LM in the high-radiation exposure group than the low-radiation exposure group (90 [40%] vs. 39 [17%], respectively, p < 0.001). A similar trend was observed for hand eczema (63 [28%] vs. 33 [15%], respectively, p = 0.001). The adjusted OR for high-radiation exposure hands was 3.18 (95% CI: 2.24-4.52). Consistent results were obtained for hand eczema, with an adjusted OR of 2.26 (95% CI: 1.67-3.06). CONCLUSION The present study suggests that direct radiation exposure to physician's hands is associated with LM and hand eczema. Those with LM and radially biased hand eczema may have had high direct radiation exposure.
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Stress Echo 2030: The Novel ABCDE-(FGLPR) Protocol to Define the Future of Imaging. J Clin Med 2021; 10:jcm10163641. [PMID: 34441937 PMCID: PMC8397117 DOI: 10.3390/jcm10163641] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 02/06/2023] Open
Abstract
With stress echo (SE) 2020 study, a new standard of practice in stress imaging was developed and disseminated: the ABCDE protocol for functional testing within and beyond CAD. ABCDE protocol was the fruit of SE 2020, and is the seed of SE 2030, which is articulated in 12 projects: 1-SE in coronary artery disease (SECAD); 2-SE in diastolic heart failure (SEDIA); 3-SE in hypertrophic cardiomyopathy (SEHCA); 4-SE post-chest radiotherapy and chemotherapy (SERA); 5-Artificial intelligence SE evaluation (AI-SEE); 6-Environmental stress echocardiography and air pollution (ESTER); 7-SE in repaired Tetralogy of Fallot (SETOF); 8-SE in post-COVID-19 (SECOV); 9: Recovery by stress echo of conventionally unfit donor good hearts (RESURGE); 10-SE for mitral ischemic regurgitation (SEMIR); 11-SE in valvular heart disease (SEVA); 12-SE for coronary vasospasm (SESPASM). The study aims to recruit in the next 5 years (2021–2025) ≥10,000 patients followed for ≥5 years (up to 2030) from ≥20 quality-controlled laboratories from ≥10 countries. In this COVID-19 era of sustainable health care delivery, SE2030 will provide the evidence to finally recommend SE as the optimal and versatile imaging modality for functional testing anywhere, any time, and in any patient.
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Abalo KD, Malekzadeh-Milani S, Hascoët S, Dreuil S, Feuillet T, Cohen S, Dauphin C, Filippo SD, Douchin S, Godart F, Guérin P, Helms P, Karsenty C, Lefort B, Mauran P, Ovaert C, Piéchaud JF, Thambo JB, Leuraud K, Bonnet D, Bernier MO, Rage E. Exposure to low-dose ionising radiation from cardiac catheterisation and risk of cancer: the COCCINELLE study cohort profile. BMJ Open 2021; 11:e048576. [PMID: 34344681 PMCID: PMC8336117 DOI: 10.1136/bmjopen-2020-048576] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The COCCINELLE study is a nationwide retrospective French cohort set up to evaluate the risk of cancer in patients who undergone cardiac catheterisation (CC) procedures for diagnosis or treatment of congenital heart disease during childhood. PARTICIPANTS Children who undergone CC procedures from 1 January 2000 to 31 December 2013, before the age of 16 in one of the 15 paediatric cardiology departments which perform paediatric CC in mainland France were included. The follow-up started at the date of the first recorded CC procedure until the exit date, that is, the date of death, the date of first cancer diagnosis, the date of the 18th birthday or the 31 December 2015, whichever occurred first. The cohort was linked to the National Childhood Cancer Registry to identify patients diagnosed with cancer and with the French National Directory for the Identification of Natural Persons to retrieve the patients' vital status. FINDINGS TO DATE A total of 17 104 children were included in the cohort and followed for 110 335 person-years, with 22 227 CC procedures collected. Among the patients, 81.6% received only one procedure. Fifty-nine cancer cases were observed in the cohort. Standardised incidence ratios (SIRs) were increased for all-cancer (SIR=3.8, 95% CI: 2.9 to 4.9), leukaemia (SIR=3.3, 95% CI: 2.0 to 5.4), lymphoma (SIR=14.9, 95% CI: 9.9 to 22.5) and solid cancers excluding central nervous system (CNS) tumours (SIR=3.3, 95% CI: 2.0 to 5.5) compared with the general population. FUTURE PLANS Dose reconstruction is currently underway to estimate individual cumulative doses absorbed to relevant organs, including red bone marrow and brain for respectively haematologic disorders and CNS tumours risk estimation. A dose-response analysis will be conducted with consideration to confounding factors such as age at exposure, gender, predisposing factors to cancer and other sources of medical diagnostic low-dose ionising radiation.
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Affiliation(s)
- Kossi Dovene Abalo
- PSE-SANTE/SESANE/Laboratory of Epidemiology, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, Île-de-France, France
| | - Sophie Malekzadeh-Milani
- Department of Congenital and Pediatric Cardiology, Necker-Sick Children University Hospital, M3C-Necker, Université de Paris, Paris, France
| | - Sébastien Hascoët
- Paediatric and Congenital Cardiac Surgery Department, M3C Marie-Lannelongue Hospital, National Reference Centre, Groupe Hospitalier Saint-Joseph, Paris Saclay University, Plessis-Robinson, France
| | - Serge Dreuil
- PSE-SANTE/SER/UEM, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, Île-de-France, France
| | | | - Sarah Cohen
- Paediatric and Congenital Cardiac Surgery Department, M3C Marie-Lannelongue Hospital, National Reference Centre, Groupe Hospitalier Saint-Joseph, Paris Saclay University, Plessis-Robinson, France
| | - Claire Dauphin
- Cardiology and Vascular Department, Hopital Gabriel Montpied, Clermont-Ferrand, France
| | - Sylvie Di Filippo
- Paediatric and Congential Cardiology Department, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Stéphanie Douchin
- Cardiopédiatrie, Hôpital couple enfant, CHU Grenoble Alpes, Grenoble cedex 9, France, Grenoble, France
| | - François Godart
- Service de Cardiologie Infantile et Congénitale, Institut Cœur Poumon, Lille Cedex, Lille, France
| | - Patrice Guérin
- Clinique Cardiologique et des Maladies Vasculaires, CIC 1413, Institut du Thorax, Cardiopédiatrie, CHU Nantes, INSERM, Nantes Université, Nantes, France
| | - Pauline Helms
- Unit of Cardiopediatrics, University Hospital of Strasbourg, Strasbourg, France
| | - Clement Karsenty
- Pediatric and Congenital Cardiology, Children's Hospital and INSERM U1048, I2MC, Institut des Maladies Métaboliques et Cardiovasculaires, Université de Toulouse, Toulouse, France
| | - Bruno Lefort
- Institut des Cardiopathies Congénitales, CHRU Tours, Tours, France
| | - Pierre Mauran
- Unité de cardiologie pédiatrique et congénitale, American Memorial Hospital, CHU de Reims, 47 rue Cognacq-Jay, Reims Cedex, Reims, France
| | - Caroline Ovaert
- Cardiologie pédiatrique et congénitale, Timone enfants, AP-HM et INSERM 1251, Aix-Marseille Université, Marseille, France
| | - Jean-François Piéchaud
- Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques-Cartier, Massy, France
| | - Jean-Benoît Thambo
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Bordeaux, France
| | - Klervi Leuraud
- PSE-SANTE/SESANE/Laboratory of Epidemiology, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, Île-de-France, France
| | - Damien Bonnet
- Department of Congenital and Pediatric Cardiology, Necker-Sick Children University Hospital, M3C-Necker, Université de Paris, Paris, France
| | - Marie-Odile Bernier
- PSE-SANTE/SESANE/Laboratory of Epidemiology, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, Île-de-France, France
| | - Estelle Rage
- PSE-SANTE/SESANE/Laboratory of Epidemiology, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, Île-de-France, France
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Kosik P, Durdik M, Skorvaga M, Klimova D, Kochanova D, Cerna Z, Kubes M, Holop M, Belyaev I. Induction of AML Preleukemic Fusion Genes in HSPCs and DNA Damage Response in Preleukemic Fusion Gene Positive Samples. Antioxidants (Basel) 2021; 10:antiox10030481. [PMID: 33803739 PMCID: PMC8003332 DOI: 10.3390/antiox10030481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 11/27/2022] Open
Abstract
Preleukemic fusion genes (PFGs) occurring after DNA damage in hematopoietic stem progenitor cells (HSPCs) in utero often represent the initial event in the development of childhood leukemia. While the incidence of PFGs characteristic for acute lymphoblastic leukemia (ALL) was relatively well examined by several research groups and estimated to be 1–5% in umbilical cord blood (UCB) of healthy newborns, PFGs that are relevant to acute myeloid leukemia (AML) were poorly investigated. Therefore, this study is focused on the estimation of the incidence of the most frequent AML PFGs in newborns. For the first time, this study considered the inducibility of AML PFGs in different subsets of UCB HSPCs by low-dose γ-rays and also compared endogenous DNA damage, apoptosis, and reactive oxygen species (ROS) level between UCB samples containing or lacking AML PFGs. We found that: (i) the incidence of AML PFGs in UCB was 3.19% for RUNX1-RUNX1T1, 3.19% for PML-RARα, and 1.17% for KMT2A-MLLT3, (ii) 50 cGy of γ-rays did not induce RUNX1-RUNX1T1, PML-RARα, or KMT2A-MLLT3 PFGs in different subsets of sorted and expanded HSPCs, and (iii) the AML PFG+ samples accumulated the same level of endogenous DNA damage, as measured by the γH2AX/53BP1 focus formation, and also the same ROS level, and apoptosis as compared to PFG− controls. Our study provides critical insights into the prevalence of AML PFGs in UCB of newborns, without the evidence of a specific HSPC population more susceptible for PFG formation after irradiation to low-dose γ-rays or increased amount of ROS, apoptosis and DNA damage.
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Affiliation(s)
- Pavol Kosik
- Department of Radiobiology, Cancer Research Institute, Biomedical Research Center, Slovak Academy of Sciences, 845 05 Bratislava, Slovakia; (M.D.); (M.S.); (D.K.); (D.K.); (Z.C.); (I.B.)
- Correspondence: ; Tel.: +421-2-32295-118
| | - Matus Durdik
- Department of Radiobiology, Cancer Research Institute, Biomedical Research Center, Slovak Academy of Sciences, 845 05 Bratislava, Slovakia; (M.D.); (M.S.); (D.K.); (D.K.); (Z.C.); (I.B.)
| | - Milan Skorvaga
- Department of Radiobiology, Cancer Research Institute, Biomedical Research Center, Slovak Academy of Sciences, 845 05 Bratislava, Slovakia; (M.D.); (M.S.); (D.K.); (D.K.); (Z.C.); (I.B.)
| | - Daniela Klimova
- Department of Radiobiology, Cancer Research Institute, Biomedical Research Center, Slovak Academy of Sciences, 845 05 Bratislava, Slovakia; (M.D.); (M.S.); (D.K.); (D.K.); (Z.C.); (I.B.)
- Institute of Medical Biology, Genetics and Clinical Genetics, Comenius University in Bratislava, 811 08 Bratislava, Slovakia
| | - Dominika Kochanova
- Department of Radiobiology, Cancer Research Institute, Biomedical Research Center, Slovak Academy of Sciences, 845 05 Bratislava, Slovakia; (M.D.); (M.S.); (D.K.); (D.K.); (Z.C.); (I.B.)
| | - Zlatica Cerna
- Department of Radiobiology, Cancer Research Institute, Biomedical Research Center, Slovak Academy of Sciences, 845 05 Bratislava, Slovakia; (M.D.); (M.S.); (D.K.); (D.K.); (Z.C.); (I.B.)
| | - Miroslav Kubes
- Stem Cell Lab, BIOM-R, Ltd., 841 05 Bratislava, Slovakia; (M.K.); (M.H.)
| | - Marek Holop
- Stem Cell Lab, BIOM-R, Ltd., 841 05 Bratislava, Slovakia; (M.K.); (M.H.)
| | - Igor Belyaev
- Department of Radiobiology, Cancer Research Institute, Biomedical Research Center, Slovak Academy of Sciences, 845 05 Bratislava, Slovakia; (M.D.); (M.S.); (D.K.); (D.K.); (Z.C.); (I.B.)
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Zhang X, Chen X, Wang L, He C, Shi Z, Fu Q, Xu W, Zhang S, Hu S. Review of the Efficacy and Mechanisms of Traditional Chinese Medicines as a Therapeutic Option for Ionizing Radiation Induced Damage. Front Pharmacol 2021; 12:617559. [PMID: 33658941 PMCID: PMC7917257 DOI: 10.3389/fphar.2021.617559] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/11/2021] [Indexed: 12/16/2022] Open
Abstract
Ionizing radiation damage refers to acute, delayed, or chronic tissue damage associated with ionizing radiation. Specific or effective therapeutic options for systemic injuries induced by ionizing radiation have not been developed. Studies have shown that Chinese herbal Medicine or Chinese Herbal Prescription exhibit preventive properties against radiation damage. These medicines inhibit tissue injuries and promote repair with very minimal side effects. This study reviews traditional Chinese herbal medicines and prescriptions with radiation protective effects as well as their mechanisms of action. The information obtained will guide the development of alternative radioprotectants.
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Affiliation(s)
- Xiaomeng Zhang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoying Chen
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Lei Wang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Changhao He
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Zhongyu Shi
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Qian Fu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Wenhui Xu
- Beijing Academy of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Shujing Zhang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Sumin Hu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
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Haddad RN, Rizk C, Saliba Z, Farah J. Percutaneous closure of ventricular septal defects in children: key parameters affecting patient radiation exposure. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2021; 11:65-72. [PMID: 33815921 PMCID: PMC8012278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 01/11/2021] [Indexed: 09/28/2022]
Abstract
BACKGROUND Ventricular septal defect (VSD) transcatheter closure is gaining worldwide popularity despite its complexity. Reports on key factors affecting radiation exposure in children are scarce. AIMS This clinical study is the first to comprehensively analyze the impact of all relevant parameters on children's radiation exposure during VSD interventional closures. METHODS Between March 2016 and August 2019, all pediatric VSD cases percutaneously treated at a reference center for interventional congenital cardiology and equipped with a single-plane Innova 2100 X-ray unit were retrospectively reviewed. Multiple linear regression was performed to investigate the impact of clinical, technical, and procedural parameters on patients' radiation exposure assessed using total air kerma area product (PKA,T). RESULTS A total of 85 patients were included in this study and 82.4% had perimembranous defects. Device implantation was successful in 96.5% of cases. The procedure lasted for a median of 60 min with a median PKA,T of 19.6 Gy.cm2 (range, 1.1 to 244.8 Gy.cm2). Patients' weight (B = 1.679, P = 0.01), number of operators (B = 1.561, P = 0.02), device positioning complexity (B = 2.381, P = 0.002), and procedural incidents (B = 2.096, P = 0.008) significantly increased PKA,T. Patients' age (B = 1.053, P = 0.784), device design (B = -1.216, P = 0.780) and approach of delivery (B = -1.119, P = 0.511) did not significantly affect PKA,T. CONCLUSIONS Radiation exposure in children undergoing VSD percutaneous closure was highly variable. A higher patient's weight, numbers of operators, complexity in device positioning, and procedural incidents, were identified as key factors increasing patient dose for this kind of intervention.
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Affiliation(s)
- Raymond N Haddad
- Hotel Dieu de France University Medical Center, Department of Pediatrics, Saint Joseph UniversityBeirut, Lebanon
| | - Chadia Rizk
- Lebanese Atomic Energy Commission, National Council for Scientific Research11-8281 Beirut, Lebanon
| | - Zakhia Saliba
- Hotel Dieu de France University Medical Center, Department of Pediatric Cardiology, Saint Joseph UniversityBeirut, Lebanon
| | - Jad Farah
- Bicêtre Hospital, Department of Radiology and Nuclear Medicine, Paris-Sud University Hospitals94270 Le Kremlin-Bicêtre, Paris, France
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Abstract
BACKGROUND There is limited data describing the characteristics of paediatric post-operative cardiac surgery patients who develop pneumothoraces after chest tube removal. Patient management after chest tube removal is not standardised across paediatric cardiac surgery programmes. The purposes of this study were to describe the frequency of pneumothorax after chest tube removal in paediatric post-operative cardiac surgical patients and to describe the patient and clinical characteristics of those patients who developed a clinically significant pneumothorax requiring intervention. METHODS A single-institution retrospective descriptive study (1 January, 2010-31 December, 2018) was utilised to review 11,651 paediatric post-operative cardiac surgical patients from newborn to 18 years old. RESULTS Twenty-five patients were diagnosed with a pneumothorax by chest radiograph following chest tube removal (0.2%). Of these 25 patients, 15 (1.6%) had a clinically significant pneumothorax and 8 (53%) did not demonstrate a change in baseline clinical status or require an increase in supplemental oxygen, 14 (93%) required an intervention, 9 (60%) were <1 year of age, 4 (27%) had single-ventricle physiology, and 5 (33%) had other non-cardiac anomalies/genetic syndromes. CONCLUSIONS In our cohort of patients, we confirmed the incidence of pneumothorax after chest tube removal is low in paediatric post-operative cardiac surgery patients. This population does not always exhibit changes in clinical status despite having clinically significant pneumothoraces. We suggest the development of criteria, based on clinical characteristics, for patients who are at increased risk of developing a pneumothorax and would require a routine chest radiograph following chest tube removal.
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Early life ionizing radiation exposure and cancer risks: systematic review and meta-analysis. Pediatr Radiol 2021; 51:45-56. [PMID: 32910229 DOI: 10.1007/s00247-020-04803-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 06/12/2020] [Accepted: 08/05/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Ionizing radiation use for medical diagnostic purposes has substantially increased over the last three decades. Moderate to high doses of radiation are well established causes of cancer, especially for exposure at young ages. However, cancer risk from low-dose medical imaging is debated. OBJECTIVE To review the literature on cancer risks associated with prenatal and postnatal medical diagnostic ionizing radiation exposure among children and to assess this risk through a meta-analysis. MATERIALS AND METHODS A literature search of five electronic databases supplemented by a hand search was performed to retrieve relevant epidemiological studies published from 2000 to 2019, including patients younger than 22 years of age exposed to medical imaging ionizing radiation. Pooled odds ratio (ORpooled) and pooled excess relative risk (ERRpooled) representing the excess of risk per unit of organ dose were estimated with a random effect model. RESULTS Twenty-four studies were included. For prenatal exposure (radiographs or CT), no significant increased risk was reported for all cancers, leukemia and brain tumors. For postnatal exposure, increased risk was observed only for CT, mostly for leukemia (ERRpooled=26.9 Gy-1; 95% confidence interval [CI]: 2.7-57.1) and brain tumors (ERRpooled=9.1 Gy-1; 95% CI: 5.2-13.1). CONCLUSION CT exposure in childhood appears to be associated with increased risk of cancer while no significant association was observed with diagnostic radiographs.
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46
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Low bone mineral density in adults with complex congenital heart disease. Int J Cardiol 2020; 319:62-66. [DOI: 10.1016/j.ijcard.2020.06.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/31/2020] [Accepted: 06/26/2020] [Indexed: 11/18/2022]
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Transcatheter Closure of Patent Ductus Arteriosus under Echocardiography Guidance: A Randomized Controlled Noninferiority Trial. J Interv Cardiol 2020; 2020:4357017. [PMID: 33093816 PMCID: PMC7556051 DOI: 10.1155/2020/4357017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 09/21/2020] [Indexed: 11/18/2022] Open
Abstract
Background Percutaneous occlusion under fluoroscopy guidance has become the preferred method for the treatment of patent ductus arteriosus (PDA). To avoid radiation exposure and contrast agent use, PDA occlusion under transthoracic echocardiography (TTE) guidance was conducted. Objectives We assessed the hypothesis that the success rate of percutaneous PDA occlusion under TTE was noninferior to that under fluoroscopy guidance. Methods In this single-center trial, 100 patients were randomly assigned in a 1 : 1 ratio to the TTE group (n = 50) or to the fluoroscopy group (n = 50). The primary endpoint was the success rate of occlusion, with the noninferiority margin set at 8% for the between-group difference in intention-to-treat analysis. Secondary endpoints were hospitalization duration, cost, procedure time, and rate of adverse events including occluder migration, hemolysis, peripheral vascular complications, and residual shunt at 1-month and 12-month follow-up. Results Patient, defect, and device characteristics were similarly distributed between groups. The success rate of occlusion was 98% for the TTE group and 100% for the fluoroscopy group (absolute difference: -2%; 95% confidence interval: -5.9% to 1.9%). Cost and procedure duration were significantly lower in the TTE group, without adverse events in either group at a median of 12.0 months (range, 10.0-15.5 months) of follow-up. Conclusion Percutaneous PDA occlusion can be performed via TTE guidance safely and effectively, and the success rate of the TTE-guided procedure was noninferior to that under fluoroscopy guidance, with reduced cost and procedure time. The trial is registered with http://www.chictr.org.cn (ChiCTR-ICR-15006334).
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UÇAR M, AKKOÇ A, TOPCUOĞLU M, ÖZTÜRK SA, DEMİR M. İyonlaştırıcı Radyasyona Maruz Kalan Sağlık Çalışanlarında Radyasyon Maruziyeti ve Farkındalığının Değerlendirilmesi. ACTA MEDICA ALANYA 2020. [DOI: 10.30565/medalanya.804454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
Our understanding of the development of congenital heart disease (CHD) across the lifespan has evolved. These include the evidence for the change in demographics of CHD, the observations that lifelong complications of CHD result in CHD as a lifespan disease, and the concept of long windows of exposure to risk that start in foetal life and magnify the expression of risk in adulthood. These observations set the stage for trajectories as an emerging construct to target health-service interventions. The lifelong cardiovascular and systemic complications of CHD make the long-term care of these patients challenging for cardiologists and internists alike. A life-course approach is thus required to facilitate our understanding of the natural history and to orient our clinical efforts. Three specific examples are illustrated: neurocognition; cancer resulting from exposure to low-dose ionizing radiation; and cardiovascular disease acquired in ageing adults. As patients grow, they do not just want to live longer, they want to live well. With the need to move beyond the mortality outcome, a shift in paradigm is needed. A life-course health development framework is developed for CHD. Trajectories are used as a complex construct to illustrate the patient's healthcare journey. There is a need to define disease trajectories, wellness trajectories and ageing trajectories in this population. Disease trajectories for repaired tetralogy of Fallot, transposition of the great arteries and the Fontan operation are hypothetically constructed. For clinicians, the life-course horizon helps to frame the patient's history and plan for the future. For researchers, life-course epidemiology offers a framework that will help increase the relevance of clinical enquiry and improve study design and analyses. A health-service policy framework is proposed for a growing number of conditions that start in the before birth and extend as long as contemporary survival now permits. Ultimately, the goal is the precision delivery of health services that enables lifelong health management, organization of developmental health services, and integration of vertical and horizontal health-service delivery.
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Affiliation(s)
- A Marelli
- McGill University Health Centre, RVH/Glen Site, Cardiology, McGill University Health Centre, Montreal, Québec, Canada
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Ma I, El Arid JM, Neville P, Soule N, Dion F, Poinsot J, Chantepie A, Lefort B. Long-term evolution of stents implanted in branch pulmonary arteries. Arch Cardiovasc Dis 2020; 114:33-40. [PMID: 32917562 DOI: 10.1016/j.acvd.2020.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 05/17/2020] [Accepted: 05/27/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Branch pulmonary artery stenosis complicates the management of congenital heart diseases. Surgical branch pulmonary artery angioplasty is associated with a high reintervention rate. As an alternative, percutaneous or intraoperative branch pulmonary artery stents have been implanted to improve efficiency, but long-term evaluations are limited. AIM To describe the long-term evolution of branch pulmonary artery stents. METHODS We conducted a retrospective cohort study at Tours University Hospital. All stents implanted by surgery or catheterization in branch pulmonary arteries with a minimum follow-up of 12 months and at least one catheterization control were included. The primary endpoint combined cardiovascular mortality, surgical or percutaneous reintervention for stent complication or new stent implantation. RESULTS Between 2007 and 2017, 76 stents in 51 patients were included (62 stents implanted by surgery, 14 by catheterization). At implantation, the patients' mean age and weight were 4.7years (interquartile range 4.2years) and 17.3kg (interquartile range 11.0kg), respectively. Mean branch pulmonary artery minimum diameter was 4.1±2.1mm (mean Z-score-4.9±2.9), and mean initial stent diameter was 9.1±3.1mm. During a follow-up of 5.3years (range 0-11.2 years), freedom from primary endpoint was 86.8% (95% confidence interval 79.6-94.8%) at 1 year, 71.5% (95% confidence interval 61.9-82.7%) at 5years and 69.6% (95% confidence interval 59.6-81.2%) at 10 years. We did not identify any factors associated with major adverse cardiovascular events. Among stents without major adverse cardiovascular events, the mean branch pulmonary artery diameter Z-score at last evaluation had increased by +4.8±3.2 compared with the initial diameter (P<0.001). After stent implantation, a median of 2 re-expansions were performed for each stent (range 0-7). CONCLUSIONS Stent implantation should offer a good long-term solution for branch pulmonary artery stenosis, although iterative re-expansions are required.
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Affiliation(s)
- Iris Ma
- Institut des Cardiopathies Congénitales de Tours, Centre Hospitalier Universitaire de Tours, 37044 Tours, France; Université François Rabelais, 37000 Tours, France
| | - Jean-Marc El Arid
- Institut des Cardiopathies Congénitales de Tours, Centre Hospitalier Universitaire de Tours, 37044 Tours, France
| | - Paul Neville
- Institut des Cardiopathies Congénitales de Tours, Centre Hospitalier Universitaire de Tours, 37044 Tours, France
| | - Nathalie Soule
- Institut des Cardiopathies Congénitales de Tours, Centre Hospitalier Universitaire de Tours, 37044 Tours, France
| | - Fanny Dion
- Institut des Cardiopathies Congénitales de Tours, Centre Hospitalier Universitaire de Tours, 37044 Tours, France
| | - Jacques Poinsot
- Institut des Cardiopathies Congénitales de Tours, Centre Hospitalier Universitaire de Tours, 37044 Tours, France
| | - Alain Chantepie
- Institut des Cardiopathies Congénitales de Tours, Centre Hospitalier Universitaire de Tours, 37044 Tours, France; Université François Rabelais, 37000 Tours, France
| | - Bruno Lefort
- Institut des Cardiopathies Congénitales de Tours, Centre Hospitalier Universitaire de Tours, 37044 Tours, France; Université François Rabelais, 37000 Tours, France; Inserm UMR 1069 (Nutrition, Croissance et Cancer), 37032 Tours, France.
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