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Yang R, Yuan J, Chen X, Xie X, Ye Z, Qin C. Vessel wall magnetic resonance imaging of symptomatic middle cerebral artery atherosclerosis: A systematic review and meta-analysis. Clin Imaging 2022; 90:90-96. [DOI: 10.1016/j.clinimag.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/18/2022] [Accepted: 08/01/2022] [Indexed: 11/26/2022]
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Weir-McCall J, Bonnici-Mallia M, Ramkumar P, Nath A, Houston J. Whole-body magnetic resonance angiography. Clin Radiol 2019; 74:3-12. [DOI: 10.1016/j.crad.2018.05.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 04/10/2018] [Accepted: 05/29/2018] [Indexed: 01/01/2023]
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Lambert MA, Weir-McCall JR, Salsano M, Gandy SJ, Levin D, Cavin I, Littleford R, MacFarlane JA, Matthew SZ, Nicholas RS, Struthers AD, Sullivan F, Henderson SA, White RD, Belch JJF, Houston JG. Prevalence and Distribution of Atherosclerosis in a Low- to Intermediate-Risk Population: Assessment with Whole-Body MR Angiography. Radiology 2018; 287:795-804. [PMID: 29714681 PMCID: PMC5979784 DOI: 10.1148/radiol.2018171609] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To quantify the burden and distribution of asymptomatic atherosclerosis in a population with a low to intermediate risk of cardiovascular disease. Materials and Methods Between June 2008 and February 2013, 1528 participants with 10-year risk of cardiovascular disease less than 20% were prospectively enrolled. They underwent whole-body magnetic resonance (MR) angiography at 3.0 T by using a two-injection, four-station acquisition technique. Thirty-one arterial segments were scored according to maximum stenosis. Scores were summed and normalized for the number of assessable arterial segments to provide a standardized atheroma score (SAS). Multiple linear regression was performed to assess effects of risk factors on atheroma burden. Results A total of 1513 participants (577 [37.9%] men; median age, 53.5 years; range, 40-83 years) completed the study protocol. Among 46 903 potentially analyzable segments, 46 601 (99.4%) were interpretable. Among these, 2468 segments (5%) demonstrated stenoses, of which 1649 (3.5%) showed stenosis less than 50% and 484 (1.0%) showed stenosis greater than or equal to 50%. Vascular stenoses were distributed throughout the body with no localized distribution. Seven hundred forty-seven (49.4%) participants had at least one stenotic vessel, and 408 (27.0%) participants had multiple stenotic vessels. At multivariable linear regression, SAS correlated with age (B = 3.4; 95% confidence interval: 2.61, 4.20), heart rate (B = 1.23; 95% confidence interval: 0.51, 1.95), systolic blood pressure (B = 0.02; 95% confidence interval: 0.01, 0.03), smoking status (B = 0.79; 95% confidence interval: 0.44, 1.15), and socioeconomic status (B = -0.06; 95% confidence interval: -0.10, -0.02) (P < .01 for all). Conclusion Whole-body MR angiography identifies early vascular disease at a population level. Although disease prevalence is low on a per-vessel level, vascular disease is common on a per-participant level, even in this low- to intermediate-risk cohort. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
| | | | - Marco Salsano
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Stephen J. Gandy
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Daniel Levin
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Ian Cavin
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Roberta Littleford
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Jennifer A. MacFarlane
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Shona Z. Matthew
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Richard S. Nicholas
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Allan D. Struthers
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Frank Sullivan
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Shelley A. Henderson
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Richard D. White
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Jill J. F. Belch
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - J. Graeme Houston
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
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Zhang DF, Chen YC, Chen H, Zhang WD, Sun J, Mao CN, Su W, Wang P, Yin X. A High-Resolution MRI Study of Relationship between Remodeling Patterns and Ischemic Stroke in Patients with Atherosclerotic Middle Cerebral Artery Stenosis. Front Aging Neurosci 2017; 9:140. [PMID: 28536522 PMCID: PMC5422497 DOI: 10.3389/fnagi.2017.00140] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 04/26/2017] [Indexed: 11/13/2022] Open
Abstract
Purpose: Recently, high-resolution magnetic resonance imaging (HR-MRI) has been used to depict the wall characteristics of the intracranial arteries. The aim of this study was to explain the relationship between the remodeling patterns and acute ischemic stroke in patients with atherosclerotic middle cerebral artery (MCA) stenosis using HR-MRI. Materials and Methods: From August 2015 to May 2016, we prospectively screened 33 consecutive patients with unilateral MCA stenosis using time-to-flight MR angiography, including 15 patients with symptomatic MCA stenosis and 18 patients with asymptomatic MCA stenosis. Among them, 14 patients were diagnosed as positive remodeling (PR) and 19 as negative remodeling or non-remodeling. The cross-sectional images of the stenotic MCA wall on HR-MRI including T1WI, T2WI, and PDWI were compared between the symptomatic group and the asymptomatic group as well as the PR group and the non-PR group, based on the vessel area, lumen area, wall area, plaque area, degree of stenosis, remodeling index, and NIHSS score. Results: The symptomatic group had larger wall area (P = 0.040), plaque area (P<0.001), degree of stenosis (P = 0.038), remodeling index (P < 0.001), and NIHSS score (P = 0.003) as well as smaller lumen area (P = 0.001) than the asymptomatic group. In addition, more PR patients were observed in symptomatic group. The PR group had larger plaque area (P = 0.014) and NIHSS score (P = 0.037) than the non-PR group. Demographic and clinical characteristics between the symptomatic group and the asymptomatic group, the PR group and the non-PR group showed no statistical difference. Conclusion: The current study suggests that the HR-MRI has emerged as a promising tool to detect the characteristics of intracranial arteries wall and reveal the relationship between remodeling patterns and ischemic stroke. The PR is an unsafe remodeling way and is prone to cause acute ischemic stroke.
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Affiliation(s)
- Dan-Feng Zhang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical UniversityNanjing, China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical UniversityNanjing, China.,School of Medicine, Nanjing UniversityNanjing, China
| | - Huiyou Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical UniversityNanjing, China
| | - Wei-Dong Zhang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical UniversityNanjing, China
| | - Jun Sun
- Department of Radiology, Nanjing First Hospital, Nanjing Medical UniversityNanjing, China
| | - Cun-Nan Mao
- Department of Radiology, Nanjing First Hospital, Nanjing Medical UniversityNanjing, China
| | - Wen Su
- Department of Radiology, Nanjing First Hospital, Nanjing Medical UniversityNanjing, China
| | - Peng Wang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical UniversityNanjing, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical UniversityNanjing, China
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Weir-McCall JR, Cassidy DB, Belch JJF, Gandy SJ, Houston JG, Lambert MA, Littleford RC, Rowland J, Struthers AD, Khan F. Whole-body cardiovascular MRI for the comparison of atherosclerotic burden and cardiac remodelling in healthy South Asian and European adults. Br J Radiol 2016; 89:20160342. [PMID: 27351693 PMCID: PMC5124930 DOI: 10.1259/bjr.20160342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To determine the feasibility of using whole-body cardiovascular MRI (WB-CVMR) to compare South Asians (SAs)-a population known to have a higher risk of cardiovascular disease (CVD) but paradoxically lower prevalence of peripheral arterial disease-and Western Europeans (WEs). METHODS 19 SAs and 38 age-, gender- and body mass index-matched WEs were recruited. All were aged 40 years and over, free from CVD and with a 10-year risk of CVD <20% as assessed by the adult treatment panel (ATP) III risk score. WB-CVMR was performed, comprising a whole-body angiogram (WBA) and cardiac MR (CMR), on a 3-T MRI scanner (Magnetom(®) Trio; Siemens, Erlangen, Germany) following dual-phase injection of gadolinium-based contrast agent. A standardized atheroma score (SAS) was calculated from the WBA while indexed left ventricular mass and volumes were calculated from the CMR. RESULTS SAs exhibited a significantly lower iliofemoral atheroma burden (regional SAS 0.0 ± 0.0 vs 1.9 ± 6.9, p = 0.048) and a trend towards lower overall atheroma burden (whole-body SAS 0.7 ± 0.8 vs 1.8 ± 2.3, p = 0.1). They had significantly lower indexed left ventricular mass (46.9 ± 11.8 vs 56.9 ± 13.4 ml m(-2), p = 0.008), end diastolic volume (63.9 ± 10.4 vs 75.2 ± 11.4 ml m(-2), p=0.001), end systolic volume (20.5 ± 6.1 vs 24.6 ± 6.8 ml m(-2), p = 0.03) and stroke volume (43.4 ± 6.6 vs 50.6 ± 7.9 ml m(-2), p = 0.001), but with no significant difference in ejection fraction, mass-volume ratio or global functioning index. These differences persisted after accounting for CVD risk factors. CONCLUSION WB-CVMR can quantify cardiac and atheroma burden and can detect differences in these metrics between ethnic groups that, if validated, may suggest that the paradoxical high risk of CVD compared with PVD risk may be due to an adverse cardiac haemodynamic status incurred by the smaller heart rather than atherosclerosis. ADVANCES IN KNOWLEDGE WB-CVMR can be used to stratify and compare disease between ethnicities.
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Affiliation(s)
| | - Deirdre B Cassidy
- 1 Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital, Dundee, UK
| | - Jill J F Belch
- 1 Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital, Dundee, UK
| | - Stephen J Gandy
- 2 NHS Tayside Medical Physics, Ninewells Hospital, Dundee, UK
| | - J G Houston
- 1 Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital, Dundee, UK
| | - Matthew A Lambert
- 1 Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital, Dundee, UK
| | - Roberta C Littleford
- 1 Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital, Dundee, UK
| | - Janice Rowland
- 1 Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital, Dundee, UK
| | - Allan D Struthers
- 1 Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital, Dundee, UK
| | - Faisel Khan
- 1 Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital, Dundee, UK
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Dieleman N, Yang W, Abrigo JM, Chu WCW, van der Kolk AG, Siero JCW, Wong KS, Hendrikse J, Chen XY. Magnetic Resonance Imaging of Plaque Morphology, Burden, and Distribution in Patients With Symptomatic Middle Cerebral Artery Stenosis. Stroke 2016; 47:1797-802. [PMID: 27301944 PMCID: PMC4927221 DOI: 10.1161/strokeaha.116.013007] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 04/19/2016] [Indexed: 01/13/2023]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— Intracranial atherosclerosis is a major cause of ischemic stroke worldwide. Intracranial vessel wall imaging is an upcoming field of interest to assess intracranial atherosclerosis. In this study, we investigated total intracranial plaque burden in patients with symptomatic middle cerebral artery stenosis, assessed plaque morphological features, and compared features of symptomatic and asymptomatic lesions using a 3T vessel wall sequence. Methods— Nineteen consecutive Chinese patients with ischemic stroke and transient ischemic attack (mean age: 67 years; 7 females) with a middle cerebral artery stenosis were scanned at 3T magnetic resonance imaging; the protocol included a time-of-flight magnetic resonance angiography and the T1-weighted volumetric isotropically reconstructed turbo spin echo acquisition sequence before and after (83%) contrast administration. Chi-square tests were used to assess associations between different plaque features. Statistical significance was set at P<0.05. Results— Vessel wall lesions were identified in 18 patients (95%), totaling 57 lesions in 494 segments (12% of segments). Lesions were located primarily in the anterior circulation (82%). Eccentric lesions were associated with a focal thickening pattern and concentric lesions with a diffuse thickening pattern (P<0.001). When differentiating between asymptomatic and symptomatic lesions, an association (P<0.05) was found between eccentricity and asymptomatic lesions, but not for enhancement or a specific thickening pattern. Symptomatic lesions did not have any specific morphological features. Conclusions— Our results lead to a 2-fold conclusion: (1) The classification system of both thickening pattern and distribution of the lesion can be simplified by using distribution pattern only and (2) differentiation between symptomatic and asymptomatic atherosclerotic lesions was possible using intracranial vessel wall imaging.
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Affiliation(s)
- Nikki Dieleman
- From the Department of Radiology, University Medical Center Utrecht, The Netherlands (N.D., A.G.v.d.K., J.C.W.S., J.H.); and Department of Medicine (W.Y., K.S.W., X.Y.C.) and Department of Imaging and Interventional Radiology (J.M.A., W.C.W.C.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Wenjie Yang
- From the Department of Radiology, University Medical Center Utrecht, The Netherlands (N.D., A.G.v.d.K., J.C.W.S., J.H.); and Department of Medicine (W.Y., K.S.W., X.Y.C.) and Department of Imaging and Interventional Radiology (J.M.A., W.C.W.C.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jill M Abrigo
- From the Department of Radiology, University Medical Center Utrecht, The Netherlands (N.D., A.G.v.d.K., J.C.W.S., J.H.); and Department of Medicine (W.Y., K.S.W., X.Y.C.) and Department of Imaging and Interventional Radiology (J.M.A., W.C.W.C.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Winnie Chiu Wing Chu
- From the Department of Radiology, University Medical Center Utrecht, The Netherlands (N.D., A.G.v.d.K., J.C.W.S., J.H.); and Department of Medicine (W.Y., K.S.W., X.Y.C.) and Department of Imaging and Interventional Radiology (J.M.A., W.C.W.C.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Anja G van der Kolk
- From the Department of Radiology, University Medical Center Utrecht, The Netherlands (N.D., A.G.v.d.K., J.C.W.S., J.H.); and Department of Medicine (W.Y., K.S.W., X.Y.C.) and Department of Imaging and Interventional Radiology (J.M.A., W.C.W.C.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jeroen C W Siero
- From the Department of Radiology, University Medical Center Utrecht, The Netherlands (N.D., A.G.v.d.K., J.C.W.S., J.H.); and Department of Medicine (W.Y., K.S.W., X.Y.C.) and Department of Imaging and Interventional Radiology (J.M.A., W.C.W.C.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ka Sing Wong
- From the Department of Radiology, University Medical Center Utrecht, The Netherlands (N.D., A.G.v.d.K., J.C.W.S., J.H.); and Department of Medicine (W.Y., K.S.W., X.Y.C.) and Department of Imaging and Interventional Radiology (J.M.A., W.C.W.C.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jeroen Hendrikse
- From the Department of Radiology, University Medical Center Utrecht, The Netherlands (N.D., A.G.v.d.K., J.C.W.S., J.H.); and Department of Medicine (W.Y., K.S.W., X.Y.C.) and Department of Imaging and Interventional Radiology (J.M.A., W.C.W.C.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Xiang Yan Chen
- From the Department of Radiology, University Medical Center Utrecht, The Netherlands (N.D., A.G.v.d.K., J.C.W.S., J.H.); and Department of Medicine (W.Y., K.S.W., X.Y.C.) and Department of Imaging and Interventional Radiology (J.M.A., W.C.W.C.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
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7
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Weir-McCall JR, Duce SL, Gandy SJ, Matthew SZ, Martin P, Cassidy DB, McCormick L, Belch JJF, Struthers AD, Colhoun HM, Houston JG. Whole body cardiovascular magnetic resonance imaging to stratify symptomatic and asymptomatic atherosclerotic burden in patients with isolated cardiovascular disease. BMC Med Imaging 2016; 16:18. [PMID: 26923316 PMCID: PMC4770697 DOI: 10.1186/s12880-016-0121-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 02/16/2016] [Indexed: 12/25/2022] Open
Abstract
Background The aim of this study was to use whole body cardiovascular magnetic resonance imaging (WB CVMR) to assess the heart and arterial network in a single examination, so as to describe the burden of atherosclerosis and subclinical disease in participants with symptomatic single site vascular disease. Methods 64 patients with a history of symptomatic single site vascular disease (38 coronary artery disease (CAD), 9 cerebrovascular disease, 17 peripheral arterial disease (PAD)) underwent whole body angiogram and cardiac MR in a 3 T scanner. The arterial tree was subdivided into 31 segments and each scored according to the degree of stenosis. From this a standardised atheroma score (SAS) was calculated. Cine and late gadolinium enhancement images of the left ventricle were obtained. Results Asymptomatic atherosclerotic disease with greater than 50 % stenosis in arteries other than that responsible for their presenting complain was detected in 37 % of CAD, 33 % of cerebrovascular and 47 % of PAD patients. Unrecognised myocardial infarcts were observed in 29 % of PAD patients. SAS was significantly higher in PAD patients 24 (17.5-30.5) compared to CAD 4 (2–11.25) or cerebrovascular disease patients 6 (2-10) (ANCOVA p < 0.001). Standardised atheroma score positively correlated with age (β 0.36 p = 0.002), smoking status (β 0.34 p = 0.002), and LV mass (β -0.61 p = 0.001) on multiple linear regression. Conclusion WB CVMR is an effective method for the stratification of cardiovascular disease. The high prevalence of asymptomatic arterial disease, and silent myocardial infarctions, particularly in the peripheral arterial disease group, demonstrates the importance of a systematic approach to the assessment of cardiovascular disease.
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Affiliation(s)
- Jonathan R Weir-McCall
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, ᅟ, DD1 9SY, UK. .,NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, DD1 9SY, UK. .,Division of Cardiovascular and Diabetic Medicine, Level 7, Ninewells Hospital, Dundee, DD1 9SY, UK.
| | - Suzanne L Duce
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, ᅟ, DD1 9SY, UK
| | - Stephen J Gandy
- NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, DD1 9SY, UK.,NHS Tayside Medical Physics, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - Shona Z Matthew
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, ᅟ, DD1 9SY, UK
| | - Patricia Martin
- NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - Deirdre B Cassidy
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, ᅟ, DD1 9SY, UK
| | - Lynne McCormick
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, ᅟ, DD1 9SY, UK
| | - Jill J F Belch
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, ᅟ, DD1 9SY, UK
| | - Allan D Struthers
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, ᅟ, DD1 9SY, UK
| | - Helen M Colhoun
- Division of Population Health Sciences, Medical Research Institute, The Mackenzie Building, University of Dundee, ᅟ, DD2 4BF, UK
| | - J Graeme Houston
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, ᅟ, DD1 9SY, UK.,NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, DD1 9SY, UK
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Weir-McCall JR, White RD, Ramkumar PG, Gandy SJ, Khan F, Belch JJF, Struthers AD, Houston JG. Follow-up of atheroma burden with sequential whole body contrast enhanced MR angiography: a feasibility study. Int J Cardiovasc Imaging 2016; 32:825-32. [PMID: 26809611 PMCID: PMC4853465 DOI: 10.1007/s10554-016-0842-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 01/13/2016] [Indexed: 11/26/2022]
Abstract
Assess the feasibility of whole body magnetic resonance angiography (WB-MRA) for monitoring global atheroma burden in a population with peripheral arterial disease (PAD). 50 consecutive patients with symptomatic PAD referred for clinically indicated MRA were recruited. Whole body MRA (WB-MRA) was performed at baseline, 6 months and 3 years. The vasculature was split into 31 anatomical arterial segments. Each segment was scored according to degree of luminal narrowing: 0 = normal, 1 = <50 %, 2 = 50–70 %, 3 = 71–99 %, 4 = vessel occlusion. The score from all assessable segments was summed, and then normalised to the number of assessable vessels. This normalised score was divided by four (the maximum vessel score) and multiplied by 100 to give a final standardised atheroma score (SAS) with a score of 0–100. Progression was assessed with repeat measure ANOVA. 36 patients were scanned at 0 and 6 months, with 26 patients scanned at the 3 years follow up. Only those who completed all three visits were included in the final analysis. Baseline atherosclerotic burden was high with a mean SAS of 15.7 ± 10.3. No significant progression was present at 6 months (mean SAS 16.4 ± 10.5, p = 0.67), however there was significant disease progression at 3 years (mean SAS 17.7 ± 11.5, p = 0.01). Those with atheroma progression at follow-up were less likely to be on statin therapy (79 vs 100 %, p = 0.04), and had significantly higher baseline SAS (17.6 ± 11.2 vs 10.7 ± 5.1, p = 0.043). Follow up of atheroma burden is possible with WB-MRA, which can successfully quantify and monitor atherosclerosis progression at 3 years follow-up.
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Affiliation(s)
- Jonathan R. Weir-McCall
- />Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, DD1 9SY UK
| | - Richard D. White
- />Department of Clinical Radiology, University Hospital of Wales, Cardiff, CF14 4XW UK
| | - Prasad G. Ramkumar
- />NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, DD1 9SY UK
| | - Stephen J. Gandy
- />NHS Tayside Medical Physics, Ninewells Hospital, Dundee, DD1 9SY UK
| | - Faisel Khan
- />Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, DD1 9SY UK
| | - Jill J. F. Belch
- />Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, DD1 9SY UK
| | - Allan D. Struthers
- />Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, DD1 9SY UK
| | - J. Graeme Houston
- />Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, DD1 9SY UK
- />NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, DD1 9SY UK
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Gatidis S, Schlett CL, Notohamiprodjo M, Bamberg F. Imaging-based characterization of cardiometabolic phenotypes focusing on whole-body MRI--an approach to disease prevention and personalized treatment. Br J Radiol 2016; 89:20150829. [PMID: 26780657 DOI: 10.1259/bjr.20150829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Metabolic syndrome and cardiovascular disorders pose a challenge to global healthcare systems. Too often, patients with metabolic syndrome are diagnosed in advanced disease stages, where disease-associated damage is irreversible and treatment options are limited. Thus, prevention plays an increasingly important role in the management of cardiometabolic disorders. The main challenge of prevention is to identify patient groups who are at risk for developing overt disease and who might benefit from early therapeutic intervention. In this context, imaging-based phenotyping can add significant information to clinical evaluations, revealing anatomical and physiological changes that reflect intrinsic and extrinsic risk factors. The purpose of this review article was to provide an overview of the current state of imaging-based phenotyping of metabolic syndrome and cardiovascular disorders and to discuss current and potential developments in this field.
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Affiliation(s)
- Sergios Gatidis
- 1 Department of Radiology, Diagnostic and Interventional Radiology, University of Tuebingen, Tuebingen, Germany
| | - Christopher L Schlett
- 2 Department of Radiology, Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
| | - Mike Notohamiprodjo
- 1 Department of Radiology, Diagnostic and Interventional Radiology, University of Tuebingen, Tuebingen, Germany
| | - Fabian Bamberg
- 1 Department of Radiology, Diagnostic and Interventional Radiology, University of Tuebingen, Tuebingen, Germany
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Cohort comparison study of cardiac disease and atherosclerotic burden in type 2 diabetic adults using whole body cardiovascular magnetic resonance imaging. Cardiovasc Diabetol 2015; 14:122. [PMID: 26382729 PMCID: PMC4574534 DOI: 10.1186/s12933-015-0284-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whole body cardiovascular MR (WB CVMR) combines whole body angiography and cardiac MR assessment. It is accepted that there is a high disease burden in patients with diabetes, however the quantification of the whole body atheroma burden in both arterial and cardiac disease has not been previously reported. In this study we compare the quantified atheroma burden in those individuals with and without diabetes by clinical cardiovascular disease (CVD) status. METHODS 158 participants underwent WB CVMR, and were categorised into one of four groups: (1) type 2 diabetes mellitus (T2DM) with CVD; (2) T2DM without CVD; (3) CVD without T2DM; (4) healthy controls. The arterial tree was subdivided into 31 segments and each scored according to the degree of stenosis. From this a standardised atheroma score (SAS) was calculated. Cardiac MR and late gadolinium enhancement images of the left ventricle were obtained for assessment of mass, volume and myocardial scar assessment. RESULTS 148 participants completed the study protocol--61% male, with mean age of 64 ± 8.2 years. SAS was highest in those with cardiovascular disease without diabetes [10.1 (0-39.5)], followed by those with T2DM and CVD [4 (0-41.1)], then those with T2DM only [3.23 (0-19.4)] with healthy controls having the lowest atheroma score [2.4 (0-19.4)]. Both groups with a prior history of CVD had a higher SAS and left ventricular mass than those without (p < 0.001 for both). However after accounting for known cardiovascular risk factors, only the SAS in the group with CVD without T2DM remained significantly elevated. 6% of the T2DM group had evidence of silent myocardial infarct, with this subcohort having a higher SAS than the remainder of the T2DM group [7.7 (4-19) vs. 2.8 (0-17), p = 0.024]. CONCLUSIONS Global atheroma burden was significantly higher in those with known cardiovascular disease and without diabetes but not in those with diabetes and cardiovascular disease suggesting that cardiovascular events may occur at a lower atheroma burden in diabetes.
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Whole-Body MR Imaging Including Angiography: Predicting Recurrent Events in Diabetics. Eur Radiol 2015; 26:1420-30. [DOI: 10.1007/s00330-015-3936-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/02/2015] [Accepted: 07/20/2015] [Indexed: 01/15/2023]
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Technical assessment of whole body angiography and cardiac function within a single MRI examination. Clin Radiol 2015; 70:595-603. [PMID: 25791202 PMCID: PMC4728185 DOI: 10.1016/j.crad.2015.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 01/21/2015] [Accepted: 02/04/2015] [Indexed: 11/24/2022]
Abstract
AIM To evaluate a combined protocol for simultaneous cardiac MRI (CMR) and contrast-enhanced (CE) whole-body MR angiography (WB-MRA) techniques within a single examination. MATERIALS AND METHODS Asymptomatic volunteers (n = 48) with low-moderate risk of cardiovascular disease (CVD) were recruited. The protocol was divided into four sections: (1) CMR of left ventricle (LV) structure and function; (2) CE-MRA of the head, neck, and thorax followed by the distal lower limbs; (3) CMR LV "late gadolinium enhancement" assessment; and (4) CE-MRA of the abdomen and pelvis followed by the proximal lower limbs. Multiple observers undertook the image analysis. RESULTS For CMR, the mean ejection fraction (EF) was 67.3 ± 4.8% and mean left ventricular mass (LVM) was 100.3 ± 22.8 g. The intra-observer repeatability for EF ranged from 2.1-4.7% and from 9-12 g for LVM. Interobserver repeatability was 8.1% for EF and 19.1 g for LVM. No LV delayed myocardial enhancement was observed. For WB-MRA, some degree of luminal narrowing or stenosis was seen at 3.6% of the vessel segments (involving n = 29 of 48 volunteers) and interobserver radiological opinion was consistent in 96.7% of 1488 vessel segments assessed. CONCLUSION Combined assessment of WB-MRA and CMR can be undertaken within a single examination on a clinical MRI system. The associated analysis techniques are repeatable and may be suitable for larger-scale cardiovascular MRI studies.
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Weir-McCall JR, Khan F, Lambert MA, Adamson CL, Gardner M, Gandy SJ, Ramkumar PG, Belch JJF, Struthers AD, Rauchhaus P, Morris AD, Houston JG. Common carotid intima media thickness and ankle-brachial pressure index correlate with local but not global atheroma burden: a cross sectional study using whole body magnetic resonance angiography. PLoS One 2014; 9:e99190. [PMID: 24933122 PMCID: PMC4059661 DOI: 10.1371/journal.pone.0099190] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 05/12/2014] [Indexed: 11/18/2022] Open
Abstract
Background Common carotid intima media thickness (CIMT) and ankle brachial pressure index (ABPI) are used as surrogate marker of atherosclerosis, and have been shown to correlate with arterial stiffness, however their correlation with global atherosclerotic burden has not been previously assessed. We compare CIMT and ABPI with atheroma burden as measured by whole body magnetic resonance angiography (WB-MRA). Methods 50 patients with symptomatic peripheral arterial disease were recruited. CIMT was measured using ultrasound while rest and exercise ABPI were performed. WB-MRA was performed in a 1.5T MRI scanner using 4 volume acquisitions with a divided dose of intravenous gadolinium gadoterate meglumine (Dotarem, Guerbet, FR). The WB-MRA data was divided into 31 anatomical arterial segments with each scored according to degree of luminal narrowing: 0 = normal, 1 = <50%, 2 = 50–70%, 3 = 70–99%, 4 = vessel occlusion. The segment scores were summed and from this a standardized atheroma score was calculated. Results The atherosclerotic burden was high with a standardised atheroma score of 39.5±11. Common CIMT showed a positive correlation with the whole body atheroma score (β 0.32, p = 0.045), however this was due to its strong correlation with the neck and thoracic segments (β 0.42 p = 0.01) with no correlation with the rest of the body. ABPI correlated with the whole body atheroma score (β −0.39, p = 0.012), which was due to a strong correlation with the ilio-femoral vessels with no correlation with the thoracic or neck vessels. On multiple linear regression, no correlation between CIMT and global atheroma burden was present (β 0.13 p = 0.45), while the correlation between ABPI and atheroma burden persisted (β −0.45 p = 0.005). Conclusion ABPI but not CIMT correlates with global atheroma burden as measured by whole body contrast enhanced magnetic resonance angiography in a population with symptomatic peripheral arterial disease. However this is primarily due to a strong correlation with ilio-femoral atheroma burden.
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Affiliation(s)
- Jonathan R. Weir-McCall
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, United Kingdom
- NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom
- * E-mail:
| | - Faisel Khan
- Vascular & Inflammatory Diseases Research Unit, Medical Research Institute, University of Dundee, Dundee, United Kingdom
| | - Matthew A. Lambert
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, United Kingdom
| | - Carly L. Adamson
- University of Dundee, Ninewells Hospital & Medical School, Dundee, United Kingdom
| | - Michael Gardner
- University of Dundee, Ninewells Hospital & Medical School, Dundee, United Kingdom
| | - Stephen J. Gandy
- NHS Tayside Medical Physics, Ninewells Hospital, Dundee, United Kingdom
| | | | - Jill J. F. Belch
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, United Kingdom
| | - Allan D. Struthers
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, United Kingdom
| | - Petra Rauchhaus
- Dundee epidemiological and biostatistics unit, University of Dundee, Dundee, United Kingdom
| | - Andrew D. Morris
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, United Kingdom
| | - J. Graeme Houston
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, United Kingdom
- NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom
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Ovbiagele B, Goldstein LB, Amarenco P, Messig M, Sillesen H, Callahan A, Hennerici MG, Zivin J, Welch KMA. Prediction of major vascular events after stroke: the stroke prevention by aggressive reduction in cholesterol levels trial. J Stroke Cerebrovasc Dis 2014; 23:778-84. [PMID: 24582273 DOI: 10.1016/j.jstrokecerebrovasdis.2013.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 11/27/2013] [Accepted: 12/02/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Identifying patients with recent stroke or transient ischemic attack (TIA) at high risk of major vascular events (MVEs; stroke, myocardial infarction, or vascular death) may help optimize the intensity of secondary preventive interventions. We evaluated the relationships between the baseline Framingham Coronary Risk Score (FCRS) and a novel risk prediction model and with the occurrence of MVEs after stroke or TIA in subjects enrolled in the Stroke Prevention by Aggressive Reduction in Cholesterol Level (SPARCL) trial. METHODS Data from the 4731 subjects enrolled in the SPARCL study were analyzed. Hazard ratios (HRs) from Cox regression models were used to determine the risk of subsequent MVEs based on the FCRS predicting 20% or more 10-year coronary heart disease risk. The novel risk model was derived based on multivariable modeling with backward selection. Model discrimination (c-statistics) was assessed using the areas under the receiver operating characteristic curves. RESULTS Of 3969 subjects with complete data, 27% had a baseline FCRS of 20% or more. In multivariable analysis, an FCRS of 20% or more was associated with twice the risk of subsequent MVEs (HR = 1.92, 95% confidence interval [CI]: 1.63-2.27). The novel model based on a multivariable analysis included age (HR = 1.37, 95% CI: 1.25-1.51 per 10 years), diabetes (HR = 1.82, 95% CI: 1.51-2.18), male sex (HR = 1.35, 95% CI: 1.12-1.61), and an apolipoprotein (APO)-B/APO-A1 ratio (HR = 1.56, 95% CI: 1.16-2.11). The c-statistic was .58 (95% CI: .55-.60) for the FCRS of 20% or more and .65 (95% CI: .63-.67) for the novel model. CONCLUSIONS Both a baseline FCRS of 20% or more and a novel predictive model were associated with future MVEs in SPARCL trial subjects. The novel model needs to be validated, and the benefits of using either the FCRS or the novel model in clinical practice needs to be assessed.
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Affiliation(s)
- Bruce Ovbiagele
- Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina.
| | - Larry B Goldstein
- Department of Medicine, Division of Neurology, Duke University, Durham, North Carolina
| | - Pierre Amarenco
- Department of Neurology, Bichat-Claude Bernard University, Paris, France
| | | | - Henrik Sillesen
- Department of Vascular Surgery, University of Copenhagen, Denmark
| | - Alfred Callahan
- Department of Neurology, Vanderbilt University, Nashville, Tennessee
| | | | - Justin Zivin
- Department of Neurosciences, University of California, San Diego, California
| | - K Michael A Welch
- Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
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Salinas JJ, Abdelbary B, Wilson J, Hossain M, Fisher-Hoch S, McCormick J. Using the Framingham Risk Score to evaluate immigrant effect on cardiovascular disease risk in Mexican Americans. J Health Care Poor Underserved 2012; 23:666-77. [PMID: 22643615 DOI: 10.1353/hpu.2012.0058] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND This study uses the Framingham Risk Score (FRS) for 10-year cardiovascular disease (CVD) to evaluate differences between Mexican American immigrants and the U.S.-born population. METHODS AND RESULTS Data from the Cameron County Hispanic Cohort (N=1,559). Average total risk scores were generated by age group for each gender. Regression analysis was conducted adjusting for covariates and interaction effects. Both women and men in the CCHC sample who were long-term immigrant residents (mean FRS scores women 4.2 with p<.001 vs. men 4.0 with p<.001) or born in the U.S. (mean FRS scores women 4.6 with p<.001 vs. men 3.3 with p<.001) had significantly higher risk scores than immigrants who had only been in this country for less than 10 years. The interaction model indicates that differences between immigrant and native-born Mexican Americans are most greatly felt at lowest levels of socioeconomic status for men in the CCHC. CONCLUSIONS This study suggests that in terms of immigrant advantage in CVD risk, on whom, where, and how the comparisons are being made have important implications for the degree of difference observed.
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Affiliation(s)
- Jennifer J Salinas
- Division of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Brownsville Campus, Brownsville, TX 78520, USA.
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Chandesris MO, Azarine A, Ong KT, Taleb S, Boutouyrie P, Mousseaux E, Romain M, Bozec E, Laurent S, Boddaert N, Thumerelle C, Tillie-Leblond I, Hoarau C, Lebranchu Y, Aladjidi N, Tron F, Barlogis V, Body G, Munzer M, Jaussaud R, Suarez F, Clément O, Hermine O, Tedgui A, Lortholary O, Picard C, Mallat Z, Fischer A. Frequent and widespread vascular abnormalities in human signal transducer and activator of transcription 3 deficiency. ACTA ACUST UNITED AC 2011; 5:25-34. [PMID: 22084479 DOI: 10.1161/circgenetics.111.961235] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Signal transducer and activator of transcription 3 (STAT3) deficiency is responsible for autosomal dominant hyperimmunoglobulin E syndrome, characterized by recurrent bacterial and fungal infections, connective tissue abnormalities, hyperimmunoglobulin E, and Th17 lymphopenia. Although vascular abnormalities have been reported in some patients, the prevalence, characteristics, and etiology of these features have yet to be described. METHODS AND RESULTS We prospectively screened 21 adult STAT3-deficient patients [corrected] (median age, 26 years; range, 17-44 years) [corrected] for vascular abnormalities. We explored the entire arterial vasculature with whole-body magnetic resonance imaging angiography, coronary multislice computed tomography, and echo-tracking-based imaging specifically for the [corrected] carotid arteries. We also assayed for serum biomarkers of inflammation and endothelial dysfunction. Finally, we studied murine models of aortic aneurysm in the presence and absence of inhibitors of STAT3-dependent signaling. Ninety-five percent of patients showed brain abnormalities (white matter hyperintensities, lacunar lesions suggestive of ischemic infarcts, and atrophy). We reported peripheral and brain artery abnormalities in 84% of the patients and detected coronary artery abnormalities in 50% of the patients. The most frequent vascular abnormalities were ectasia and aneurysm. The carotid intima-media thickness was markedly decreased, with a substantial increase in circumferential wall stress, indicating the occurrence of hypotrophic arterial remodeling in this STAT3-deficient population. Systemic inflammatory biomarker levels correlated poorly with the vascular phenotype. In vivo inhibition of STAT3 signaling or blockade of IL-17A resulted in a marked increase in aneurysm severity and fatal rupture in mouse models. CONCLUSIONS Vascular abnormalities are highly prevalent in patients with STAT3 deficiency. This feature is consistent with the greater susceptibility to vascular aneurysm observed after inhibition of STAT3-dependent signaling in mouse models.
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Affiliation(s)
- Marie-Olivia Chandesris
- Hematology Department, Necker Children's Hospital, Assistance Publique Hôpitaux de Paris, 149 rue de Sèvres, Paris, France
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Pennell DJ, Firmin DN, Kilner PJ, Manning WJ, Mohiaddin RH, Prasad SK. Review of journal of cardiovascular magnetic resonance 2010. J Cardiovasc Magn Reson 2011; 13:48. [PMID: 21914185 PMCID: PMC3182946 DOI: 10.1186/1532-429x-13-48] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 09/13/2011] [Indexed: 12/15/2022] Open
Abstract
There were 75 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2010, which is a 34% increase in the number of articles since 2009. The quality of the submissions continues to increase, and the editors were delighted with the recent announcement of the JCMR Impact Factor of 4.33 which showed a 90% increase since last year. Our acceptance rate is approximately 30%, but has been falling as the number of articles being submitted has been increasing. In accordance with Open-Access publishing, the JCMR articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. Last year for the first time, the Editors summarized the papers for the readership into broad areas of interest or theme, which we felt would be useful to practitioners of cardiovascular magnetic resonance (CMR) so that you could review areas of interest from the previous year in a single article in relation to each other and other recent JCMR articles 1. This experiment proved very popular with a very high rate of downloading, and therefore we intend to continue this review annually. The papers are presented in themes and comparison is drawn with previously published JCMR papers to identify the continuity of thought and publication in the journal. We hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality manuscripts to JCMR for publication.
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Affiliation(s)
- Dudley J Pennell
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ, UK
| | - David N Firmin
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ, UK
| | - Philip J Kilner
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ, UK
| | - Warren J Manning
- Department of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215 USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
| | - Raad H Mohiaddin
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ, UK
| | - Sanjay K Prasad
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ, UK
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Findeisen HM, Weckbach S, Stark RG, Reiser MF, Schoenberg SO, Parhofer KG. Metabolic syndrome predicts vascular changes in whole body magnetic resonance imaging in patients with long standing diabetes mellitus. Cardiovasc Diabetol 2010; 9:44. [PMID: 20804545 PMCID: PMC2936364 DOI: 10.1186/1475-2840-9-44] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 08/30/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although diabetic patients have an increased rate of cardio-vascular events, there is considerable heterogeneity with respect to cardiovascular risk, requiring new approaches to individual cardiovascular risk factor assessment. In this study we used whole body-MR-angiography (WB-MRA) to assess the degree of atherosclerosis in patients with long-standing diabetes and to determine the association between metabolic syndrome (MetS) and atherosclerotic burden. METHODS Long standing (> or = 10 years) type 1 and type 2 diabetic patients (n = 59; 31 males; 63.3 +/- 1.7 years) were examined by WB-MRA. Based on the findings in each vessel, we developed an overall score representing the patient's vascular atherosclerotic burden (MRI-score). The score's association with components of the MetS was assessed. RESULTS The median MRI-score was 1.18 [range: 1.00-2.41] and MetS was present in 58% of the cohort (type 2 diabetics: 73%; type 1 diabetics: 26%). Age (p = 0.0002), HDL-cholesterol (p = 0.016), hypertension (p = 0.0008), nephropathy (p = 0.0093), CHD (p = 0.001) and MetS (p = 0.0011) were significantly associated with the score. Adjusted for age and sex, the score was significantly (p = 0.02) higher in diabetics with MetS (1.450 [1.328-1.572]) compared to those without MetS (1.108 [0.966-1.50]). The number of MetS components was associated with a linear increase in the MRI-score (increase in score: 0.09/MetS component; r2 = 0.24, p = 0.038). Finally, using an established risk algorithm, we found a significant association between MRI-score and 10-year risk for CHD, fatal CHD and stroke. CONCLUSION In this high-risk diabetic population, WB-MRA revealed large heterogeneity in the degree of systemic atherosclerosis. Presence and number of traits of the MetS are associated with the extent of atherosclerotic burden. These results support the perspective that diabetic patients are a heterogeneous population with increased but varying prevalence of atherosclerosis and risk.
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Affiliation(s)
- Hannes M Findeisen
- Department of Internal Medicine II, University Hospitals - Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
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Pennell DJ, Firmin DN, Kilner PJ, Manning WJ, Mohiaddin RH, Neubauer S, Prasad SK. Review of Journal of Cardiovascular Magnetic Resonance 2009. J Cardiovasc Magn Reson 2010; 12:15. [PMID: 20302618 PMCID: PMC2847562 DOI: 10.1186/1532-429x-12-15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 03/19/2010] [Indexed: 11/10/2022] Open
Abstract
There were 56 articles published in the Journal of Cardiovascular Magnetic Resonance in 2009. The editors were impressed with the high quality of the submissions, of which our acceptance rate was about 40%. In accordance with open-access publishing, the articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. We have therefore chosen to briefly summarise the papers in this article for quick reference for our readers in broad areas of interest, which we feel will be useful to practitioners of cardiovascular magnetic resonance (CMR). In some cases where it is considered useful, the articles are also put into the wider context with a short narrative and recent CMR references. It has been a privilege to serve as the Editor of the JCMR this past year. I hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality manuscripts to JCMR for publication.
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Affiliation(s)
- DJ Pennell
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP UK. National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ UK
| | - DN Firmin
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP UK. National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ UK
| | - PJ Kilner
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP UK. National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ UK
| | - WJ Manning
- Departments of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center 330 Brookline Avenue, Boston, MA 02215 USA. Harvard Medical School, 25 Shattuck Street Boston, MA 02115 USA
| | - RH Mohiaddin
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP UK. National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ UK
| | - S Neubauer
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - SK Prasad
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP UK. National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ UK
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