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Vimalesvaran K, Zaman S, Howard JP, Aziminia N, Giannoudi M, Procter H, Varela M, Uslu F, Ariff B, Linton N, Levelt E, Bharath AA, Cole GD. Aortic stenosis assessment from the 3-chamber cine: Ratio of balanced steady-state-free-precession (bSSFP) blood signal between the aorta and left ventricle predicts severity. J Cardiovasc Magn Reson 2024; 26:100005. [PMID: 38211656 DOI: 10.1016/j.jocmr.2023.100005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/10/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) imaging is an important tool for evaluating the severity of aortic stenosis (AS), co-existing aortic disease, and concurrent myocardial abnormalities. Acquiring this additional information requires protocol adaptations and additional scanner time, but is not necessary for the majority of patients who do not have AS. We observed that the relative signal intensity of blood in the ascending aorta on a balanced steady state free precession (bSSFP) 3-chamber cine was often reduced in those with significant aortic stenosis. We investigated whether this effect could be quantified and used to predict AS severity in comparison to existing gold-standard measurements. METHODS Multi-centre, multi-vendor retrospective analysis of patients with AS undergoing CMR and transthoracic echocardiography (TTE). Blood signal intensity was measured in a ∼1 cm2 region of interest (ROI) in the aorta and left ventricle (LV) in the 3-chamber bSSFP cine. Because signal intensity varied across patients and scanner vendors, a ratio of the mean signal intensity in the aorta ROI to the LV ROI (Ao:LV) was used. This ratio was compared using Pearson correlations against TTE parameters of AS severity: aortic valve peak velocity, mean pressure gradient and the dimensionless index. The study also assessed whether field strength (1.5 T vs. 3 T) and patient characteristics (presence of bicuspid aortic valves (BAV), dilated aortic root and low flow states) altered this signal relationship. RESULTS 314 patients (median age 69 [IQR 57-77], 64% male) who had undergone both CMR and TTE were studied; 84 had severe AS, 78 had moderate AS, 66 had mild AS and 86 without AS were studied as a comparator group. The median time between CMR and TTE was 12 weeks (IQR 4-26). The Ao:LV ratio at 1.5 T strongly correlated with peak velocity (r = -0.796, p = 0.001), peak gradient (r = -0.772, p = 0.001) and dimensionless index (r = 0.743, p = 0.001). An Ao:LV ratio of < 0.86 was 84% sensitive and 82% specific for detecting AS of any severity and a ratio of 0.58 was 83% sensitive and 92% specific for severe AS. The ability of Ao:LV ratio to predict AS severity remained for patients with bicuspid aortic valves, dilated aortic root or low indexed stroke volume. The relationship between Ao:LV ratio and AS severity was weaker at 3 T. CONCLUSIONS The Ao:LV ratio, derived from bSSFP 3-chamber cine images, shows a good correlation with existing measures of AS severity. It demonstrates utility at 1.5 T and offers an easily calculable metric that can be used at the time of scanning or automated to identify on an adaptive basis which patients benefit from dedicated imaging to assess which patients should have additional sequences to assess AS.
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Affiliation(s)
- Kavitha Vimalesvaran
- A1 for Healthcare Centre for Doctoral Training, Imperial College London, SW7 2AZ, United Kingdom; National Heart and Lung Institute, Imperial College London, SW7 2AZ, United Kingdom; Imperial College Healthcare NHS Trust, London W12 0HS, United Kingdom.
| | - Sameer Zaman
- National Heart and Lung Institute, Imperial College London, SW7 2AZ, United Kingdom; Imperial College Healthcare NHS Trust, London W12 0HS, United Kingdom.
| | - James P Howard
- National Heart and Lung Institute, Imperial College London, SW7 2AZ, United Kingdom; Imperial College Healthcare NHS Trust, London W12 0HS, United Kingdom.
| | - Nikoo Aziminia
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, United Kingdom.
| | - Marilena Giannoudi
- Multidisciplinary Cardiovascular Research Centre & Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, United Kingdom.
| | - Henry Procter
- Multidisciplinary Cardiovascular Research Centre & Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, United Kingdom.
| | - Marta Varela
- National Heart and Lung Institute, Imperial College London, SW7 2AZ, United Kingdom.
| | - Fatmatulzehra Uslu
- Department of Electric-Electronic Engineering, Bursa Technical University, Bursa, Turkiye.
| | - Ben Ariff
- Imperial College Healthcare NHS Trust, London W12 0HS, United Kingdom.
| | - Nick Linton
- Imperial College Healthcare NHS Trust, London W12 0HS, United Kingdom; Department of Bioengineering, Imperial College London, SW7 2AZ, United Kingdom.
| | - Eylem Levelt
- Multidisciplinary Cardiovascular Research Centre & Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, United Kingdom.
| | - Anil A Bharath
- Imperial College Healthcare NHS Trust, London W12 0HS, United Kingdom; Department of Bioengineering, Imperial College London, SW7 2AZ, United Kingdom.
| | - Graham D Cole
- National Heart and Lung Institute, Imperial College London, SW7 2AZ, United Kingdom; Imperial College Healthcare NHS Trust, London W12 0HS, United Kingdom.
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Foley MJ, Hall K, Howard JP, Ahmad Y, Gandhi M, Mahboobani S, Okafor J, Rahman H, Hadjiloizou N, Ruparelia N, Mikhail G, Malik I, Kanaganayagam G, Sutaria N, Rana B, Ariff B, Barden E, Anderson J, Afoke J, Petraco R, Al-Lamee RK, Sen S. CRT-700.27 Aortic Valve Calcium Score Is Associated With Acute Stroke in Transcatheter Aortic Valve Replacement Patients. JACC Cardiovasc Interv 2023. [DOI: 10.1016/j.jcin.2023.01.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Gopalan D, Riley J, Leong K, Alsanjari S, Ariff B, Auger W, Lindholm P. Biatrial Volumetric Assessment by Non-ECG-Gated CT Pulmonary Angiography Correlated with Transthoracic Echocardiography in Patients with Normal Diastology. Tomography 2022; 8:2761-2771. [PMID: 36412689 PMCID: PMC9680340 DOI: 10.3390/tomography8060230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2022] Open
Abstract
Atrial size is a predictor of cardiovascular mortality. Non-ECG-gated computed tomography pulmonary angiography (CTPA) is a common test for cardiopulmonary evaluation but normative values for biatrial volumes are lacking. We derived normal CT biatrial volumes using manual and semiautomated segmentation with contemporaneous transthoracic echocardiography (TTE) to confirm normal diastology. Thirty-five consecutive cases in sinus rhythm with no history of cardio-vascular, renal, or pulmonary disease and normal diastolic function were selected. Planimetric CTPA measurements were compared to TTE volumes measured using area length method. TTE and CTPA derived normal LAVi and RAVi were 27 + 5 and 20 + 6 mL/m2, and 30 + 8 and 29 + 9 mL/m2, respectively. Bland-Altman analysis revealed an underestimation of biatrial volumes by TTE. TTE-CT mean biases for LAV and RAV were -5.7 + 12.0 mL and -16.2 + 14.8 mL, respectively. The CT intraclass correlation coefficients (ICC 95% CI) for LA and RA volumes were 0.99 (0.96-1.00) and 0.96 (0.76-0.99), respectively. There was excellent correlation (p < 0.001) between the semiautomated and manual measurements for LA (r 0.99, 95% CI 0.98-0.99) and RA (r 0.99, 95% CI 0.99-1.00). Atrial volumetric assessment on CTPA is easy and reproducible and can provide additional metric in cardiopulmonary assessment.
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Affiliation(s)
- Deepa Gopalan
- Department of Physiology & Pharmacology, Karolinska Institute, 17177 Stockholm, Sweden
- Department of Radiology, Imperial College Healthcare, London W12 0HS, UK
- Correspondence:
| | - Jan Riley
- Department of Radiology, Monash Health, Melbourne 3168, Australia
| | - Kai’En Leong
- Department of Cardiology, Royal Melbourne Hospital, Melbourne 3052, Australia
| | - Senan Alsanjari
- Department of Radiology, Imperial College Healthcare, London W12 0HS, UK
| | - Ben Ariff
- Department of Radiology, Imperial College Healthcare, London W12 0HS, UK
| | - Willam Auger
- Department of Pulmonary Medicine, University of California, San Diego, CA 92037, USA
| | - Peter Lindholm
- Department of Physiology & Pharmacology, Karolinska Institute, 17177 Stockholm, Sweden
- Department of Emergency Medicine, University of California, San Diego, CA 92103, USA
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4
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Foley M, Hall K, Howard JP, Ahmad Y, Gandhi M, Mahboobani S, Okafor J, Rahman H, Hadjiloizou N, Ruparelia N, Mikhail G, Malik I, Kanaganayagam G, Sutaria N, Rana B, Ariff B, Barden E, Anderson J, Afoke J, Petraco R, Al-Lamee R, Sen S. Aortic Valve Calcium Score Is Associated With Acute Stroke in Transcatheter Aortic Valve Replacement Patients. J Soc Cardiovasc Angiogr Interv 2022; 1:100349. [PMID: 35992189 PMCID: PMC9337994 DOI: 10.1016/j.jscai.2022.100349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/04/2022] [Accepted: 04/18/2022] [Indexed: 01/09/2023]
Abstract
Background Transcatheter aortic valve replacement (TAVR) is the treatment of choice for patients with severe aortic stenosis who are at a moderate or higher surgical risk. Stroke is a recognised and serious complication of TAVR, and it is important to identify patients at higher stroke risk. This study aims to discover if aortic valve calcium score calculated from pre-TAVR computed tomography is associated with acute stroke in TAVR patients. Methods We conducted a retrospective, observational cohort study of 433 consecutive patients undergoing TAVR between January 2017 and December 2019 at the Hammersmith Hospital. Results This cohort had a median age of 83 years (interquartile range, 78-87), and 52.7% were male. Fifty-two patients (12.0%) had a history of previous stroke or transient ischemic attack. Median aortic valve calcium score was 2145 (interquartile range, 1427-3247) Agatston units. Twenty-two patients had a stroke up to the time of discharge (5.1%). In a logistic regression model, aortic valve calcium score was significantly associated with acute stroke (odds ratio [OR], 1.26; 95% confidence interval [CI], 1.01-1.53; P = .02). Acute stroke was also significantly associated with peripheral arterial disease (OR, 4.32; 95% CI, 1.65-10.65; P = .0018) and a longer procedure time (OR, 1.01; 95% CI, 1.00-1.02; P = .0006). Conclusions Aortic valve calcium score from pre-TAVR computed tomography is an independent risk factor for acute stroke in the TAVR population. This is an additional clinical value of the pre-TAVR aortic valve calcium score and should be considered when discussing periprocedural stroke risk.
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Affiliation(s)
- Michael Foley
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Kerry Hall
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - James P. Howard
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Yousif Ahmad
- Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Manisha Gandhi
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Samir Mahboobani
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Joseph Okafor
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Haseeb Rahman
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nearchos Hadjiloizou
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Neil Ruparelia
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ghada Mikhail
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Iqbal Malik
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Gajen Kanaganayagam
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nilesh Sutaria
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Bushra Rana
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ben Ariff
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Edward Barden
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Jonathan Anderson
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Jonathan Afoke
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ricardo Petraco
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Sayan Sen
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
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Wall C, Huang Y, Le EPV, Ćorović A, Uy CP, Gopalan D, Ma C, Manavaki R, Fryer TD, Aloj L, Graves MJ, Tombetti E, Ariff B, Bambrough P, Hoole SP, Rusk RA, Jayne DR, Dweck MR, Newby D, Fayad ZA, Bennett MR, Peters JE, Slomka P, Dey D, Mason JC, Rudd JHF, Tarkin JM. Pericoronary and periaortic adipose tissue density are associated with inflammatory disease activity in Takayasu arteritis and atherosclerosis. Eur Heart J Open 2021; 1:oeab019. [PMID: 34661196 PMCID: PMC8508012 DOI: 10.1093/ehjopen/oeab019] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/26/2021] [Accepted: 08/04/2021] [Indexed: 12/20/2022]
Abstract
AIMS To examine pericoronary adipose tissue (PCAT) and periaortic adipose tissue (PAAT) density on coronary computed tomography angiography for assessing arterial inflammation in Takayasu arteritis (TAK) and atherosclerosis. METHODS AND RESULTS PCAT and PAAT density was measured in coronary (n = 1016) and aortic (n = 108) segments from 108 subjects [TAK + coronary artery disease (CAD), n = 36; TAK, n = 18; atherosclerotic CAD, n = 32; matched controls, n = 22]. Median PCAT and PAAT densities varied between groups (mPCAT: P < 0.0001; PAAT: P = 0.0002). PCAT density was 7.01 ± standard error of the mean (SEM) 1.78 Hounsfield Unit (HU) higher in coronary segments from TAK + CAD patients than stable CAD patients (P = 0.0002), and 8.20 ± SEM 2.04 HU higher in TAK patients without CAD than controls (P = 0.0001). mPCAT density was correlated with Indian Takayasu Clinical Activity Score (r = 0.43, P = 0.001) and C-reactive protein (r = 0.41, P < 0.0001) and was higher in active vs. inactive TAK (P = 0.002). mPCAT density above -74 HU had 100% sensitivity and 95% specificity for differentiating active TAK from controls [area under the curve = 0.99 (95% confidence interval 0.97-1)]. The association of PCAT density and coronary arterial inflammation measured by 68Ga-DOTATATE positron emission tomography (PET) equated to an increase of 2.44 ± SEM 0.77 HU in PCAT density for each unit increase in 68Ga-DOTATATE maximum tissue-to-blood ratio (P = 0.002). These findings remained in multivariable sensitivity analyses adjusted for potential confounders. CONCLUSIONS PCAT and PAAT density are higher in TAK than atherosclerotic CAD or controls and are associated with clinical, biochemical, and PET markers of inflammation. Owing to excellent diagnostic accuracy, PCAT density could be useful as a clinical adjunct for assessing disease activity in TAK.
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Affiliation(s)
- Christopher Wall
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Yuan Huang
- EPSRC Centre for Mathematical Imaging in Healthcare, University of Cambridge, Cambridge, UK
| | - Elizabeth P V Le
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Andrej Ćorović
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Christopher P Uy
- Vascular Sciences, National Heart & Lung Institute, Faculty of Medicine, Imperial College London, Hammersmith Campus, DuCane Road, London, W12 0HS, UK
| | - Deepa Gopalan
- Department of Radiology, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 2QQ, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, W12 0HS, UK
| | - Chuoxin Ma
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Roido Manavaki
- Department of Radiology, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Tim D Fryer
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Luigi Aloj
- Department of Radiology, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Martin J Graves
- Department of Radiology, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Enrico Tombetti
- Department of biomedical Sciences L. Sacco, Università degli Studi di Milano, Milan, Italy
| | - Ben Ariff
- Department of Radiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, W12 0HS, UK
| | - Paul Bambrough
- Department of Cardiology, Royal Papworth Hospital, Cambridge, UK CB2 0AY, UK
| | - Stephen P Hoole
- Department of Cardiology, Royal Papworth Hospital, Cambridge, UK CB2 0AY, UK
| | - Rosemary A Rusk
- Department of Cardiology, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 2QQ, UK
| | - David R Jayne
- Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - David Newby
- Centre for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Zahi A Fayad
- BioMedical Engineering & Imaging Institute, Icahn School of Medicine at Mt Sinai, Gustave L. Levy Place, New York, NY 10029-5674, USA
| | - Martin R Bennett
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - James E Peters
- Centre for Inflammatory Diseases, Imperial College London, London, UK
| | - Piotr Slomka
- Department of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Blvd, Los Angeles, CA, 90048, USA
| | - Justin C Mason
- Vascular Sciences, National Heart & Lung Institute, Faculty of Medicine, Imperial College London, Hammersmith Campus, DuCane Road, London, W12 0HS, UK
| | - James H F Rudd
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Jason M Tarkin
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK
- Vascular Sciences, National Heart & Lung Institute, Faculty of Medicine, Imperial College London, Hammersmith Campus, DuCane Road, London, W12 0HS, UK
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Riley JYJ, Leong K, Mortensen KH, Ariff B, Gopalan D. Native aorto-ostial coronary lesions on CT coronary angiogram. Br J Radiol 2021; 94:20210211. [PMID: 33989055 PMCID: PMC8248224 DOI: 10.1259/bjr.20210211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aorto-ostial coronary lesions (AOLs) are important to detect due to the high risk of catastrophic consequences. Unfortunately, due to the complexities of these lesions, they may be missed on invasive coronary angiography. Computed tomography coronary angiogram (CTCA) is highly sensitive and specific in detecting AOLs, and has the additional advantage of demonstrating the surrounding anatomy. CTCA is particularly useful when assessing for AOL aetiologies in addition to atherosclerotic disease, e.g.Congenital anomalies, extrinsic Compression, Iatrogenic, Arteritis and Other, such as Thrombus, Embolism, Dissection and Spasm. This gives rise to “CIAO (TEDS)” as a proposed aide-mémoire and will form the structure of this pictorial review.
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Affiliation(s)
- Jan Y J Riley
- Department of Radiology, Hammersmith Hospital, Imperial College Healthcare NHS trust, London, United Kingdom.,Department of Diagnostic Imaging, Monash Health, Melbourne, Australia
| | - Kai'En Leong
- Department of Radiology, Hammersmith Hospital, Imperial College Healthcare NHS trust, London, United Kingdom
| | - Kristian H Mortensen
- Cardiorespiratory Unit, Great Ormond Street Hospital, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Ben Ariff
- Department of Radiology, Hammersmith Hospital, Imperial College Healthcare NHS trust, London, United Kingdom
| | - Deepa Gopalan
- Department of Radiology, Hammersmith Hospital, Imperial College Healthcare NHS trust, London, United Kingdom.,Department of Radiology, Cambridge University Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Kotecha T, Knight DS, Razvi Y, Kumar K, Vimalesvaran K, Thornton G, Patel R, Chacko L, Brown JT, Coyle C, Leith D, Shetye A, Ariff B, Bell R, Captur G, Coleman M, Goldring J, Gopalan D, Heightman M, Hillman T, Howard L, Jacobs M, Jeetley PS, Kanagaratnam P, Kon OM, Lamb LE, Manisty CH, Mathurdas P, Mayet J, Negus R, Patel N, Pierce I, Russell G, Wolff A, Xue H, Kellman P, Moon JC, Treibel TA, Cole GD, Fontana M. Patterns of myocardial injury in recovered troponin-positive COVID-19 patients assessed by cardiovascular magnetic resonance. Eur Heart J 2021; 42:1866-1878. [PMID: 33596594 PMCID: PMC7928984 DOI: 10.1093/eurheartj/ehab075] [Citation(s) in RCA: 236] [Impact Index Per Article: 78.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/14/2020] [Accepted: 02/03/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Troponin elevation is common in hospitalized COVID-19 patients, but underlying aetiologies are ill-defined. We used multi-parametric cardiovascular magnetic resonance (CMR) to assess myocardial injury in recovered COVID-19 patients. METHODS AND RESULTS One hundred and forty-eight patients (64 ± 12 years, 70% male) with severe COVID-19 infection [all requiring hospital admission, 48 (32%) requiring ventilatory support] and troponin elevation discharged from six hospitals underwent convalescent CMR (including adenosine stress perfusion if indicated) at median 68 days. Left ventricular (LV) function was normal in 89% (ejection fraction 67% ± 11%). Late gadolinium enhancement and/or ischaemia was found in 54% (80/148). This comprised myocarditis-like scar in 26% (39/148), infarction and/or ischaemia in 22% (32/148) and dual pathology in 6% (9/148). Myocarditis-like injury was limited to three or less myocardial segments in 88% (35/40) of cases with no associated LV dysfunction; of these, 30% had active myocarditis. Myocardial infarction was found in 19% (28/148) and inducible ischaemia in 26% (20/76) of those undergoing stress perfusion (including 7 with both infarction and ischaemia). Of patients with ischaemic injury pattern, 66% (27/41) had no past history of coronary disease. There was no evidence of diffuse fibrosis or oedema in the remote myocardium (T1: COVID-19 patients 1033 ± 41 ms vs. matched controls 1028 ± 35 ms; T2: COVID-19 46 ± 3 ms vs. matched controls 47 ± 3 ms). CONCLUSIONS During convalescence after severe COVID-19 infection with troponin elevation, myocarditis-like injury can be encountered, with limited extent and minimal functional consequence. In a proportion of patients, there is evidence of possible ongoing localized inflammation. A quarter of patients had ischaemic heart disease, of which two-thirds had no previous history. Whether these observed findings represent pre-existing clinically silent disease or de novo COVID-19-related changes remain undetermined. Diffuse oedema or fibrosis was not detected.
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Affiliation(s)
- Tushar Kotecha
- Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- Institute of Cardiovascular Science, University College London, UK
| | - Daniel S Knight
- Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- Institute of Cardiovascular Science, University College London, UK
| | - Yousuf Razvi
- Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
| | - Kartik Kumar
- Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
| | | | - George Thornton
- Institute of Cardiovascular Science, University College London, UK
- Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK
| | - Rishi Patel
- Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK
| | - Liza Chacko
- Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK
| | - James T Brown
- Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- Institute of Cardiovascular Science, University College London, UK
| | - Clare Coyle
- Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
- National Heart and Lung Institute, Imperial College London, UK
| | - Donald Leith
- Institute of Cardiovascular Science, University College London, UK
- Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK
| | - Abhishek Shetye
- Institute of Cardiovascular Science, University College London, UK
- Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK
- University College London Hospitals NHS Trust, London, UK
| | - Ben Ariff
- Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
| | - Robert Bell
- Institute of Cardiovascular Science, University College London, UK
- University College London Hospitals NHS Trust, London, UK
| | - Gabriella Captur
- Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- Institute of Cardiovascular Science, University College London, UK
| | - Meg Coleman
- Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
| | - James Goldring
- Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
| | - Deepa Gopalan
- Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
| | | | - Toby Hillman
- University College London Hospitals NHS Trust, London, UK
| | - Luke Howard
- Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
- National Heart and Lung Institute, Imperial College London, UK
| | - Michael Jacobs
- Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
| | | | - Prapa Kanagaratnam
- Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
- National Heart and Lung Institute, Imperial College London, UK
| | - Onn Min Kon
- Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
- National Heart and Lung Institute, Imperial College London, UK
| | - Lucy E Lamb
- Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- Academic Department of Defence Medicine, Royal Centre for Defence Medicine, Edgbaston, Birmingham, UK
| | - Charlotte H Manisty
- Institute of Cardiovascular Science, University College London, UK
- Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK
| | | | - Jamil Mayet
- Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
- National Heart and Lung Institute, Imperial College London, UK
| | - Rupert Negus
- Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
| | - Niket Patel
- Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- Institute of Cardiovascular Science, University College London, UK
| | - Iain Pierce
- Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK
| | - Georgina Russell
- Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
- National Heart and Lung Institute, Imperial College London, UK
| | - Anthony Wolff
- Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
| | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institute of Health, Bethesda, MD, USA
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institute of Health, Bethesda, MD, USA
| | - James C Moon
- Institute of Cardiovascular Science, University College London, UK
- Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK
| | - Thomas A Treibel
- Institute of Cardiovascular Science, University College London, UK
- Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK
| | - Graham D Cole
- Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK
- National Heart and Lung Institute, Imperial College London, UK
| | - Marianna Fontana
- Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- National Amyloidosis Centre, Division of Medicine, University College London, UK
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8
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Abstract
Heart failure affects 1-2% of the adult population and one of the main contributors to its development is cardiomyopathy. Assessing a patient's risk for adverse events in heart failure is challenging and made more difficult by the heterogenous phenotypic expression of the disease. Cardiac MRI has long been a gold standard measure of myocardial function and anatomy due to its high spatial and temporal resolution. More recently, it has been posited to play a more critical role in the diagnosis and prognosis of cardiomyopathy-related heart failure. Given the limitations of more commonly used imaging modalities, increasing the clinical use of cardiac magnetic resonance imaging could potentially improve the prognosis of specific subgroups of patients at risk of adverse cardiac events.
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Affiliation(s)
- Nishant Lahoti
- Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Richard J Jabbour
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK.,Imperial College Healthcare Trust, Hammersmith Hospital, London, UK
| | - Ben Ariff
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK.,Imperial College Healthcare Trust, Hammersmith Hospital, London, UK
| | - Brian Xiangzhi Wang
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
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9
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Jabbour RJ, Rana B, Sutaria N, Frame A, Seligman H, Gopalan D, Ariff B, Mirsadraee S, Barden E, Ruparelia N, Malik IS. Percutaneous devices for the treatment of complex native valve mitral leaflet and aortomitral continuity defects: Review and case series. Cardiovasc Revasc Med 2021; 36:153-163. [PMID: 34366296 DOI: 10.1016/j.carrev.2021.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 04/17/2021] [Indexed: 11/03/2022]
Abstract
Percutaneous closure of paravalvar leaks (PVLs) was once only performed in extreme or non-surgical risk cases not suitable for redo-surgery with tissue or mechanical valves. This technique is now the treatment of choice with long term outcomes that are better than redo operations.123 As interventionalists become more familiar with using PVL devices, more off label device use has been reported in non-surgical cases involving complex native mitral valve regurgitation (NVMR). In this review, we appraise the literature regarding percutaneous treatment of paravalvar leaks and more recently esoteric off label use. We also describe two recent challenging cases where percutaneous devices were used to treat severe leaks that developed as a sequela of previous infective endocarditis. We also provide specific recommendations regarding periprocedural strategy and focus on the importance of device choice to provide an optimal outcome.
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Affiliation(s)
- Richard J Jabbour
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Bushra Rana
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Nilesh Sutaria
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Angela Frame
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Henry Seligman
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Deepa Gopalan
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Ben Ariff
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Saeed Mirsadraee
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Edward Barden
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Neil Ruparelia
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Iqbal S Malik
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
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10
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Wall C, Huang Y, Uy C, Le E, Tombetti E, Gopalan D, Manavaki R, Dweck M, Ariff B, Bennett M, Slomka P, Dey D, Mason J, Rudd J, Tarkin J. Pericoronary adipose tissue density is associated with clinical disease activity in Takayasu arteritis and coronary arterial inflammation measured by 68Ga-DOTATATE PET in atherosclerosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Coronary artery disease (CAD) is an under-recognized complication of intense arterial inflammation in Takayasu arteritis (TAK). While pericoronary adipose tissue (PCAT) density is associated with arterial inflammation in CAD patients, this relationship has not previously been studied in TAK patients, nor directly compared with coronary arterial inflammation measured by 68Ga-DOTATATE positron emission tomography (PET).
Purpose
To compare PCAT density with clinical, biochemical and molecular imaging markers of inflammation in TAK and CAD patients.
Methods
PCAT density was quantified from computed tomography coronary angiography (CTCA) around each of the 17 coronary segments in patients with: (1) TAK and CAD, (2) atherosclerotic CAD, and (3) age and gender-matched healthy controls, using semi-automated software (Autoplaque). In TAK patients, PCAT density was compared to the Indian Takayasu Clinical Activity Score (ITAS) and high-sensitivity C-reactive protein (CRP). In CAD patients, PCAT density was compared to local arterial inflammation measured by coronary motion-frozen 68Ga-DOTATATE PET using image registration software (FusionQuant), and systemic (aortic) inflammation using 18F-fluorodeoxyglucose (FDG) PET. Data was acquired either during routine clinical care or prior research that established 68Ga-DOTATATE as an experimental marker of arterial inflammation that binds macrophage somatostatin receptor-2 in atherosclerotic plaques (NCT02021188).
Results
60 patients were included (TAK, n=20; CAD, n=20; healthy, n=20). Non-calcified plaque burden (TAK: 95.2%; CAD: 90.4%, p<0.0001) and CRP (TAK: 25.2 ±SD 16.1 mg/L; CAD: 2.5 ±SD 1.7 mg/L, p=0.04) were greater in TAK than CAD patients.
PCAT density varied significantly among the three groups (median [IQR] TAK: −72.9 [−81.2 to -66.1] Hounsfield unit [HU]; CAD: −79.9 [−88.0 to −72.2]; healthy: −83.8 [−90.1 to −75.8] HU, p<0.0001). Figure: box-plot showing the distribution of PCAT values by group, with corresponding representative multiplanar reconstructed and cross-sectional CTCA images with surrounding PCAT density displayed by color table in left anterior descending arteries.
PCAT density was significantly associated with ITAS (r=0.61, p=0.004) and CRP (r=0.43, p=0.03) in TAK patients, and coronary 68Ga-DOTATATE maximum tissue-to-blood ratio (r=0.31, p<0.001) in CAD patients. PCAT density was not associated with aortic 18F-FDG uptake in CAD patients, nor subcutaneous (pre-sternal) adipose tissue density in either disease group. No significant patient-level confounders were identified using linear mixed-effects regression modelling.
Conclusion
PCAT density measured by CTCA is greater in TAK than CAD patients, and is associated with clinical and biochemical markers of disease activity in TAK, and coronary arterial inflammation measured by 68Ga-DOTATATE PET in CAD. PCAT could be a useful, easy to measure marker of coronary inflammation and disease activity in both TAK and CAD.
PCAT density is greater in TAK than CAD
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Wellcome Trust
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Affiliation(s)
- C Wall
- University of Cambridge, Cambridge, United Kingdom
| | - Y Huang
- University of Cambridge, Cambridge, United Kingdom
| | - C Uy
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - E Le
- University of Cambridge, Cambridge, United Kingdom
| | - E Tombetti
- University Vita-Salute San Raffaele, Milan, Italy
| | - D Gopalan
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - R Manavaki
- University of Cambridge, Cambridge, United Kingdom
| | - M Dweck
- University of Edinburgh, Edinburgh, United Kingdom
| | - B Ariff
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - M Bennett
- University of Cambridge, Cambridge, United Kingdom
| | - P Slomka
- Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - D Dey
- Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - J Mason
- Imperial College London, London, United Kingdom
| | - J Rudd
- University of Cambridge, Cambridge, United Kingdom
| | - J Tarkin
- University of Cambridge, Cambridge, United Kingdom
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11
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Jabbour RJ, Cook C, Seligman H, Rajkumar C, Hadjiloizou N, Sen S, Ruparelia N, Ariff B, Mikhail GW, Malik IS. Balloon-Assisted Tracking (BAT) of an Uncrossable Aortic Valve During Transcatheter Aortic Valve Implantation. Cardiovasc Revasc Med 2020; 21:33-35. [PMID: 32487482 DOI: 10.1016/j.carrev.2020.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 02/19/2020] [Accepted: 03/17/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Richard J Jabbour
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Christopter Cook
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Henry Seligman
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | | | | | - Sayan Sen
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Neil Ruparelia
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Ben Ariff
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Ghada W Mikhail
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Iqbal S Malik
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
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12
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Naik M, McNamara C, Jabbour RJ, Gopalan D, Mikhail GW, Mirsadraee S, Ariff B. Imaging of transcatheter aortic valve replacement complications. Clin Radiol 2020; 76:27-37. [PMID: 31964536 DOI: 10.1016/j.crad.2019.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/11/2019] [Indexed: 01/05/2023]
Abstract
Aortic stenosis is increasing in incidence and is now commonly managed with transcatheter aortic valve replacement (TAVR) in intermediate and high-risk patients. Radiologists are likely to encounter patients undergoing this procedure both pre- and postoperatively, and therefore, an understanding of procedural complications is essential. Complications may relate to the access site or approach, or the valve itself. This article will review the most common complications described in literature and focuses on the role of multidetector computed tomography (CT) in their evaluation either exclusively, or complementary to other imaging methods.
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Affiliation(s)
- M Naik
- Department of Radiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - C McNamara
- Department of Radiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - R J Jabbour
- Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - D Gopalan
- Department of Radiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - G W Mikhail
- Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - S Mirsadraee
- Department of Radiology, Harefield Hospital, Hill End Road, Uxbridge, UB9 6JH, UK
| | - B Ariff
- Department of Radiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK.
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13
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Annio G, Torii R, Ariff B, O'Regan DP, Muthurangu V, Ducci A, Tsang V, Burriesci G. Enhancing Magnetic Resonance Imaging With Computational Fluid Dynamics. ACTA ACUST UNITED AC 2019. [DOI: 10.1115/1.4045493] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Abstract
The analysis of the blood flow in the great thoracic arteries does provide valuable information about the cardiac function and can diagnose the potential development of vascular diseases. Flow-sensitive four-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR) is often used to characterize patients' blood flow in the clinical environment. Nevertheless, limited spatial and temporal resolution hinders a detailed assessment of the hemodynamics. Computational fluid dynamics (CFD) could expand this information and, integrated with experimental velocity field, enable to derive the pressure maps. However, the limited resolution of the 4D flow CMR and the simplifications of CFD modeling compromise the accuracy of the computed flow parameters. In this article, a novel approach is proposed, where 4D flow CMR and CFD velocity fields are integrated synergistically to obtain an enhanced MR imaging (EMRI). The approach was first tested on a two-dimensional (2D) portion of a pipe, to understand the behavior of the parameters of the model in this novel framework, and afterwards in vivo, to apply it to the analysis of blood flow in a patient-specific human aorta. The outcomes of EMRI are assessed by comparing the computed velocities with the experimental one. The results demonstrate that EMRI preserves flow structures while correcting for experimental noise. Therefore, it can provide better insights into the hemodynamics of cardiovascular problems, overcoming the limitations of MRI and CFD, even when considering a small region of interest. EMRI confirmed its potential to provide more accurate noninvasive estimation of major cardiovascular risk predictors (e.g., flow patterns, endothelial shear stress) and become a novel diagnostic tool.
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Affiliation(s)
- Giacomo Annio
- Department Medical Physics and Bioengineering, University College London, Torrington Place, London WC1E 7JE, UK
| | - Ryo Torii
- UCL Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
| | - Ben Ariff
- MRC London Institute of Medical Sciences, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Declan P. O'Regan
- MRC London Institute of Medical Sciences, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Vivek Muthurangu
- UCL Institute of Cardiovascular Science, Centre for Cardiovascular Imaging, University College London, 62 Huntley Street, Fitzrovia, London WC1E 6DD, UK; Great Ormond Street Hospital for Children, Great Ormond Street, Holborn, London WC1N 3JH, UK
| | - Andrea Ducci
- UCL Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
| | - Victor Tsang
- Cardiothoracic Surgery Unit, Great Ormond Street Hospital for Children, Great Ormond Street, Holborn, London WC1N 3JH, UK
| | - Gaetano Burriesci
- UCL Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK; Ri.MED Foundation, Via Bandiera, 11, Palermo 90133, Italy
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14
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Ahmad Y, Vendrik J, Eftekhari A, Howard JP, Cook C, Rajkumar C, Malik I, Mikhail G, Ruparelia N, Hadjiloizou N, Nijjer S, Al-Lamee R, Petraco R, Warisawa T, Wijntjens GWM, Koch KT, van de Hoef T, de Waard G, Echavarria-Pinto M, Frame A, Sutaria N, Kanaganayagam G, Ariff B, Anderson J, Chukwuemeka A, Fertleman M, Koul S, Iglesias JF, Francis D, Mayet J, Serruys P, Davies J, Escaned J, van Royen N, Götberg M, Juhl Terkelsen C, Høj Christiansen E, Piek JJ, Baan J, Sen S. Determining the Predominant Lesion in Patients With Severe Aortic Stenosis and Coronary Stenoses: A Multicenter Study Using Intracoronary Pressure and Flow. Circ Cardiovasc Interv 2019; 12:e008263. [PMID: 31752515 PMCID: PMC6924937 DOI: 10.1161/circinterventions.119.008263] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Patients with severe aortic stenosis (AS) often have coronary artery disease. Both the aortic valve and the coronary disease influence the blood flow to the myocardium and its ability to respond to stress; leading to exertional symptoms. In this study, we aim to quantify the effect of severe AS on the coronary microcirculation and determine if this is influenced by any concomitant coronary disease. We then compare this to the effect of coronary stenoses on the coronary microcirculation.
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Affiliation(s)
- Yousif Ahmad
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Jeroen Vendrik
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, the Netherlands (J.V., K.T.K., T.v.d.H., J.J.P., J.B.)
| | - Ashkan Eftekhari
- Aarhus University Hospital Skejby, Denmark (A.E., C.J.T., E.H.C.)
| | - James P Howard
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Christopher Cook
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Christopher Rajkumar
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Iqbal Malik
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Ghada Mikhail
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Neil Ruparelia
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Nearchos Hadjiloizou
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Sukhjinder Nijjer
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Rasha Al-Lamee
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Ricardo Petraco
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Takayuki Warisawa
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | | | - Karel T Koch
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, the Netherlands (J.V., K.T.K., T.v.d.H., J.J.P., J.B.)
| | - Tim van de Hoef
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, the Netherlands (J.V., K.T.K., T.v.d.H., J.J.P., J.B.)
| | - Guus de Waard
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands (G.d.W., N.v.R.)
| | | | - Angela Frame
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Nilesh Sutaria
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Gajen Kanaganayagam
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Ben Ariff
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Jon Anderson
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Andrew Chukwuemeka
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Michael Fertleman
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Sweden (S.K., M.G.)
| | - Juan F Iglesias
- Cardiology Department, Lausanne University Hospital, Switzerland (J.F.I.)
| | - Darrel Francis
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Jamil Mayet
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Patrick Serruys
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Justin Davies
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Javier Escaned
- Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.)
| | - Niels van Royen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands (G.d.W., N.v.R.)
| | - Matthias Götberg
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Sweden (S.K., M.G.)
| | | | | | - Jan J Piek
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, the Netherlands (J.V., K.T.K., T.v.d.H., J.J.P., J.B.)
| | - Jan Baan
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, the Netherlands (J.V., K.T.K., T.v.d.H., J.J.P., J.B.)
| | - Sayan Sen
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
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Ahmad Y, Götberg M, Cook C, Howard JP, Malik I, Mikhail G, Frame A, Petraco R, Rajkumar C, Demir O, Iglesias JF, Bhindi R, Koul S, Hadjiloizou N, Gerber R, Ramrakha P, Ruparelia N, Sutaria N, Kanaganayagam G, Ariff B, Fertleman M, Anderson J, Chukwuemeka A, Francis D, Mayet J, Serruys P, Davies J, Sen S. Coronary Hemodynamics in Patients With Severe Aortic Stenosis and Coronary Artery Disease Undergoing Transcatheter Aortic Valve Replacement: Implications for Clinical Indices of Coronary Stenosis Severity. JACC Cardiovasc Interv 2018; 11:2019-2031. [PMID: 30154062 PMCID: PMC6197079 DOI: 10.1016/j.jcin.2018.07.019] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/10/2018] [Accepted: 07/17/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVES In this study, a systematic analysis was conducted of phasic intracoronary pressure and flow velocity in patients with severe aortic stenosis (AS) and coronary artery disease, undergoing transcatheter aortic valve replacement (TAVR), to determine how AS affects: 1) phasic coronary flow; 2) hyperemic coronary flow; and 3) the most common clinically used indices of coronary stenosis severity, instantaneous wave-free ratio and fractional flow reserve. BACKGROUND A significant proportion of patients with severe aortic stenosis (AS) have concomitant coronary artery disease. The effect of the valve on coronary pressure, flow, and the established invasive clinical indices of stenosis severity have not been studied. METHODS Twenty-eight patients (30 lesions, 50.0% men, mean age 82.1 ± 6.5 years) with severe AS and coronary artery disease were included. Intracoronary pressure and flow assessments were performed at rest and during hyperemia immediately before and after TAVR. RESULTS Flow during the wave-free period of diastole did not change post-TAVR (29.78 ± 14.9 cm/s vs. 30.81 ± 19.6 cm/s; p = 0.64). Whole-cycle hyperemic flow increased significantly post-TAVR (33.44 ± 13.4 cm/s pre-TAVR vs. 40.33 ± 17.4 cm/s post-TAVR; p = 0.006); this was secondary to significant increases in systolic hyperemic flow post-TAVR (27.67 ± 12.1 cm/s pre-TAVR vs. 34.15 ± 17.5 cm/s post-TAVR; p = 0.02). Instantaneous wave-free ratio values did not change post-TAVR (0.88 ± 0.09 pre-TAVR vs. 0.88 ± 0.09 post-TAVR; p = 0.73), whereas fractional flow reserve decreased significantly post-TAVR (0.87 ± 0.08 pre-TAVR vs. 0.85 ± 0.09 post-TAVR; p = 0.001). CONCLUSIONS Systolic and hyperemic coronary flow increased significantly post-TAVR; consequently, hyperemic indices that include systole underestimated coronary stenosis severity in patients with severe AS. Flow during the wave-free period of diastole did not change post-TAVR, suggesting that indices calculated during this period are not vulnerable to the confounding effect of the stenotic aortic valve.
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Affiliation(s)
- Yousif Ahmad
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Matthias Götberg
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Sweden
| | - Christopher Cook
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - James P Howard
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Iqbal Malik
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ghada Mikhail
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Angela Frame
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ricardo Petraco
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Christopher Rajkumar
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Ozan Demir
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Juan F Iglesias
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Sweden
| | - Nearchos Hadjiloizou
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Robert Gerber
- Department of Cardiology, Conquest Hospital, St. Leonards-on-Sea, United Kingdom
| | - Punit Ramrakha
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Neil Ruparelia
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nilesh Sutaria
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Gajen Kanaganayagam
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ben Ariff
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Michael Fertleman
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Jon Anderson
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Andrew Chukwuemeka
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Darrel Francis
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Jamil Mayet
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Patrick Serruys
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Justin Davies
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Sayan Sen
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom.
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Ahmad Y, Demir O, Rajkumar C, Howard JP, Shun-Shin M, Cook C, Petraco R, Jabbour R, Arnold A, Frame A, Sutaria N, Ariff B, Kanaganayagam G, Francis D, Mayet J, Mikhail G, Malik I, Sen S. Optimal antiplatelet strategy after transcatheter aortic valve implantation: a meta-analysis. Open Heart 2018; 5:e000748. [PMID: 29387433 PMCID: PMC5786926 DOI: 10.1136/openhrt-2017-000748] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/13/2017] [Accepted: 12/29/2017] [Indexed: 01/09/2023] Open
Abstract
Objective International guidelines recommend the use of dual antiplatelet therapy (DAPT) after transcatheter aortic valve implantation (TAVI). The recommended duration of DAPT varies between guidelines. In this two-part study, we (1) performed a structured survey of 45 TAVI centres from around the world to determine if there is consensus among clinicians regarding antiplatelet therapy after TAVI; and then (2) performed a systematic review of all suitable studies (randomised controlled trials (RCTs) and registries) to determine if aspirin monotherapy can be used instead of DAPT. Methods A structured electronic survey regarding antiplatelet use after TAVI was completed by 45 TAVI centres across Europe, Australasia and the USA. A systematic review of TAVI RCTs and registries was then performed comparing DAPT duration and incidence of stroke, bleeding and death. A variance weighted least squared metaregression was then performed to determine the relationship of antiplatelet therapy and adverse events. Results 82.2% of centres routinely used DAPT after TAVI. Median duration was 3 months. 13.3% based their practice on guidelines. 11 781 patients (26 studies) were eligible for the metaregression. There was no benefit of DAPT over aspirin monotherapy for stroke (P=0.49), death (P=0.72) or bleeding (P=0.91). Discussion Aspirin monotherapy appears to be as safe and effective as DAPT after TAVI.
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Affiliation(s)
- Yousif Ahmad
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Ozan Demir
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Christopher Rajkumar
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - James P Howard
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Matthew Shun-Shin
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Christopher Cook
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Ricardo Petraco
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Richard Jabbour
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Ahran Arnold
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Angela Frame
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Nilesh Sutaria
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Ben Ariff
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Gajen Kanaganayagam
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Darrel Francis
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Jamil Mayet
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Ghada Mikhail
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Iqbal Malik
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Sayan Sen
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
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Lam MC, Kanaganayagam G, Ahmad Y, Fertleman M, Ariff B. Acute myocardial infarction and stroke secondary to valve thrombosis following transcatheter aortic valve replacement-what can happen when antiplatelet agents are stopped. Quant Imaging Med Surg 2017; 7:605-607. [PMID: 29184771 DOI: 10.21037/qims.2017.10.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Mau Chu Lam
- Department of Diagnostic Radiology, Princess Margaret Hospital, Kwai Chung, Hong Kong, China
| | | | - Yousif Ahmad
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Ben Ariff
- Imaging Department, Imperial College Healthcare NHS Trust, London, UK
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Ahmad Y, Demir O, Howard J, Shun-Shin M, Cook C, Petraco R, Al-Lamee R, Jabbour R, Sutaria N, Ariff B, Kanaganayagam G, Chukwuemeka A, Anderson J, Francis D, Mayet J, Davies J, Mikhail G, Malik I, Sen S. TCT-120 Aspirin is equivalent to dual antiplatelet therapy after transcatheter aortic valve replacement: a meta-analysis of 11,781 patients. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Mittal TK, Pottle A, Nicol E, Barbir M, Ariff B, Mirsadraee S, Dubowitz M, Gorog DA, Clifford P, Firoozan S, Smith R, Dubrey S, Chana H, Shah J, Stephens N, Travill C, Kelion A, Pakkal M, Timmis A. Prevalence of obstructive coronary artery disease and prognosis in patients with stable symptoms and a zero-coronary calcium score. Eur Heart J Cardiovasc Imaging 2017; 18:922-929. [PMID: 28379388 PMCID: PMC5837484 DOI: 10.1093/ehjci/jex037] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 02/15/2017] [Accepted: 02/16/2017] [Indexed: 11/26/2022] Open
Abstract
AIMS CT calcium scoring (CTCS) and CT cardiac angiography (CTCA) are widely used in patients with stable chest pain to exclude significant coronary artery disease (CAD). We aimed to resolve uncertainty about the prevalence of obstructive coronary artery disease and long-term outcomes in patients with a zero-calcium score (ZCS). METHODS AND RESULTS Consecutive patients with stable cardiac symptoms referred for CTCS or CTCS and CTCA from chest pain clinics to a tertiary cardiothoracic centre were prospectively enrolled. In those with a ZCS, the prevalence of obstructive CAD on CTCA was determined. A follow-up for all-cause mortality was obtained from the NHS tracer service. A total of 3914 patients underwent CTCS of whom 2730 (69.7%) also had a CTCA. Half of the patients were men (50.3%) with a mean age of 56.9 years. Among patients who had both procedures, a ZCS was present in 52.2%, with a negative predictive value of 99.5% for excluding ≥70% stenosis on CTCA. During a mean follow-up of 5.2 years, the annual event rate was 0.3% for those with ZCS compared with 1.2% for CS ≥1. The presence of non-calcified atheroma on CTCA in patients with ZCS did not affect the prognostic value (P = 0.98). CONCLUSION In patients with stable symptoms and a ZCS, obstructive CAD is rare, and prognosis over the long-term is excellent, regardless of whether non-calcified atheroma is identified. A ZCS could reliably be used as a 'gatekeeper' in this patient cohort, obviating the need for further more expensive tests.
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Affiliation(s)
- Tarun K. Mittal
- Department of Cardiology and Imaging, Royal Brompton and Harefield NHS Foundation Trust, London UB9 6JH, UK
- Imperial College London, National Heart and Lung Institute, London SW7 2AZ, UK
| | - Alison Pottle
- Department of Cardiology and Imaging, Royal Brompton and Harefield NHS Foundation Trust, London UB9 6JH, UK
| | - Ed Nicol
- Department of Cardiology and Imaging, Royal Brompton and Harefield NHS Foundation Trust, London UB9 6JH, UK
- Imperial College London, National Heart and Lung Institute, London SW7 2AZ, UK
| | - Mahmoud Barbir
- Department of Cardiology and Imaging, Royal Brompton and Harefield NHS Foundation Trust, London UB9 6JH, UK
- Imperial College London, National Heart and Lung Institute, London SW7 2AZ, UK
| | - Ben Ariff
- Imperial College London, National Heart and Lung Institute, London SW7 2AZ, UK
- Imperial College NHS Healthcare Trust, London W2 1NY, UK
| | - Saeed Mirsadraee
- Department of Cardiology and Imaging, Royal Brompton and Harefield NHS Foundation Trust, London UB9 6JH, UK
- Imperial College London, National Heart and Lung Institute, London SW7 2AZ, UK
| | - Michael Dubowitz
- Department of Cardiology, East and North Hertfordshire NHS Trust, Stevenage SG1 4AB, UK
| | - Diana A. Gorog
- Imperial College London, National Heart and Lung Institute, London SW7 2AZ, UK
- Department of Cardiology, East and North Hertfordshire NHS Trust, Stevenage SG1 4AB, UK
| | - Piers Clifford
- Department of Cardiology, Buckinghamshire Healthcare NHS Trust, Amersham HP7 0JD, UK
| | - Soroosh Firoozan
- Department of Cardiology, Buckinghamshire Healthcare NHS Trust, Amersham HP7 0JD, UK
| | - Robert Smith
- Department of Cardiology and Imaging, Royal Brompton and Harefield NHS Foundation Trust, London UB9 6JH, UK
- Department of Cardiology, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge UB8 3NN, UK
| | - Simon Dubrey
- Department of Cardiology, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge UB8 3NN, UK
| | - Harmeet Chana
- Department of Cardiology, London North West Healthcare NHS Trust, Harrow HA1 3UJ, UK
| | - Jaymin Shah
- Department of Cardiology, London North West Healthcare NHS Trust, Harrow HA1 3UJ, UK
| | - Nigel Stephens
- Department of Cardiology, London North West Healthcare NHS Trust, Harrow HA1 3UJ, UK
| | - Christopher Travill
- Department of Cardiology, Luton and Dunstable University Hospital, Luton LU4 0DZ, UK
| | - Andrew Kelion
- Department of Cardiology, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Mini Pakkal
- Joint Department of Medical Imaging, University Hospital Network, Toronto, Canada
| | - Adam Timmis
- NIHR Cardiovascular Biomedical Research Unit, Bart’s Heart Centre, London EC1A 7BE, UK
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Panoulas VF, Ruparelia N, Franks R, Sen S, Ariff B, Sutaria N, Frame A, Nihoyannopoulos P, Malik IS, Mikhail GW. The Impact of Gender on Outcomes Following Transcatheter Aortic Valve Implantation: True Effect or Bias? J Heart Valve Dis 2016; 25:552-556. [PMID: 28238236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is currently the treatment of choice for patients with severe aortic stenosis (AS) who are unsuitable for surgical aortic valve replacement (SAVR), and is an acceptable alternative for those at high and intermediate surgical risk. In published TAVI registries and meta-analyses, whilst women are significantly older they present with fewer comorbidities compared to men (including coronary artery disease, peripheral vascular disease, diabetes and chronic obstructive pulmonary disease). In response to chronic pressure overload from AS, women have been shown to develop greater levels of left ventricular hypertrophy than men, as well as having a greater preservation of LV ejection fraction (LVEF) and less fibrosis. Following aortic valve replacement, women have been shown to have a faster regression of myocardial hypertrophy, with a significant improvement in LVEF. Following TAVI, female gender seems to be associated with a significantly lower one-year mortality. In the current viewpoint, it is discussed whether these findings reflect a true differential treatment response to TAVI among women, or simply the higher comorbidity burden among males undergoing TAVI.
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Affiliation(s)
- Vasileios F Panoulas
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK
- Cardiology Department, National Heart and Lung Institute, Imperial College London, London, UK. Electronic correspondence:
| | - Neil Ruparelia
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK
- Cardiology Department, National Heart and Lung Institute, Imperial College London, London, UK
| | - Russel Franks
- Cardiology Department, National Heart and Lung Institute, Imperial College London, London, UK
| | - Sayan Sen
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK
- Cardiology Department, National Heart and Lung Institute, Imperial College London, London, UK
| | - Ben Ariff
- Radiology Department, National Heart and Lung Institute, Imperial College London, London, UK
| | - Nilesh Sutaria
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK
- Cardiology Department, National Heart and Lung Institute, Imperial College London, London, UK
| | - Angela Frame
- Cardiology Department, National Heart and Lung Institute, Imperial College London, London, UK
| | - Petros Nihoyannopoulos
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK
- Cardiology Department, National Heart and Lung Institute, Imperial College London, London, UK
| | - Iqbal S Malik
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK
- Cardiology Department, National Heart and Lung Institute, Imperial College London, London, UK
| | - Ghada W Mikhail
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK
- Cardiology Department, National Heart and Lung Institute, Imperial College London, London, UK
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Ruparelia N, Panoulas VF, Frame A, Ariff B, Sutaria N, Fertleman M, Cousins J, Anderson J, Bicknell C, Chukwuemeka A, Sen S, Malik IS, Colombo A, Mikhail GW. Impact of clinical and procedural factors upon C reactive protein dynamics following transcatheter aortic valve implantation. World J Cardiol 2016; 8:425-431. [PMID: 27468335 PMCID: PMC4958693 DOI: 10.4330/wjc.v8.i7.425] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 04/24/2016] [Accepted: 05/27/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the effect of procedural and clinical factors upon C reactive protein (CRP) dynamics following transcatheter aortic valve implantation (TAVI).
METHODS: Two hundred and eight consecutive patients that underwent transfemoral TAVI at two hospitals (Imperial, College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom and San Raffaele Scientific Institute, Milan, Italy) were included. Daily venous plasma CRP levels were measured for up to 7 d following the procedure (or up to discharge). Procedural factors and 30-d safety outcomes according to the Valve Academic Research Consortium 2 definition were collected.
RESULTS: Following TAVI, CRP significantly increased reaching a peak on day 3 of 87.6 ± 5.5 mg/dL, P < 0.001. Patients who developed clinical signs and symptoms of sepsis had significantly increased levels of CRP (P < 0.001). The presence of diabetes mellitus was associated with a significantly higher peak CRP level at day 3 (78.4 ± 3.2 vs 92.2 ± 4.4, P < 0.001). There was no difference in peak CRP release following balloon-expandable or self-expandable TAVI implantation (94.8 ± 9.1 vs 81.9 ± 6.9, P = 0.34) or if post-dilatation was required (86.9 ± 6.3 vs 96.6 ± 5.3, P = 0.42), however, when pre-TAVI balloon aortic valvuloplasty was performed this resulted in a significant increase in the peak CRP (110.1 ± 8.9 vs 51.6 ± 3.7, P < 0.001). The development of a major vascular complication did result in a significantly increased maximal CRP release (153.7 ± 11.9 vs 83.3 ± 7.4, P = 0.02) and there was a trend toward a higher peak CRP following major/life-threatening bleeding (113.2 ± 9.3 vs 82.7 ± 7.5, P = 0.12) although this did not reach statistical significance. CRP was not found to be a predictor of 30-d mortality on univariate analysis.
CONCLUSION: Careful attention should be paid to baseline clinical characteristics and procedural factors when interpreting CRP following TAVI to determine their future management.
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Ruparelia N, Panoulas VF, Frame A, Nathan AW, Ariff B, Jaffer U, Sutaria N, Chukwuemeka A, Mikhail GW, Malik IS. Transfemoral Valve-in-Valve Transcatheter Aortic Valve Implantation (TAVI) in a Patient With Previous Endovascular Aortic Repair (EVAR). J Invasive Cardiol 2016; 28:E69-E70. [PMID: 27342209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 90-year-old man presented with increasing exertional breathlessness. He had previous implantation of a Perimount bioprosthetic aortic valve (Edwards Lifesciences) and coronary artery bypass graft surgery. Due to severe transvalvular bioprosthetic regurgitation with preserved left ventricular dimensions and ejection fraction, the heart team decided on valve-in- valve transcatheter aortic valve implantation via the transfemoral route in view of the patient's prohibitively high surgical and anesthetic risk. The patient had an uncomplicated recovery and was symptomatically much improved at 3-month follow-up.
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Affiliation(s)
- Neil Ruparelia
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, United Kingdom.
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Mittal TK, Reichmuth L, Ariff B, Rao PPG, Baltabaeva A, Rahman-Haley S, Kabir T, Wong J, Dalby M. Imaging diagnoses and outcome in patients presenting for primary angioplasty but no obstructive coronary artery disease. Heart 2016; 102:1728-1734. [PMID: 27368743 PMCID: PMC5099205 DOI: 10.1136/heartjnl-2015-309039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 05/16/2016] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE A proportion of patients with suspected ST-elevation myocardial infarction (STEMI) presenting for primary percutaneous coronary intervention (PPCI) do not have obstructive coronary disease and other conditions may be responsible for their symptoms and ECG changes. In this study, we set out to determine the prevalence and aetiology of alternative diagnoses in a large PPCI cohort as determined with multimodality imaging and their outcome. METHODS From 2009 to 2012, 5238 patients with suspected STEMI were referred for consideration of PPCI. Patients who underwent angiography but had no culprit artery for revascularisation and no previous history of coronary artery disease were included in the study. Troponin values, imaging findings and all-cause mortality were obtained from hospital and national databases. RESULTS A total of 575 (13.0%) patients with a mean age of 58±15 years (69% men) fulfilled the inclusion criteria. A specific diagnosis based on imaging was made in 237 patients (41.2%) including cardiomyopathies (n=104, 18%), myopericarditis (n=48, 8.4%), myocardial infarction/other coronary abnormality (n=27, 4.9%) and severe valve disease (n=23, 4%). Pulmonary embolism and type A aortic dissection were identified in seven (1.2%) and four (0.7%) cases respectively. A total of 40 (7.0%) patients died over a mean follow-up of 42.6 months. CONCLUSIONS A variety of cardiac and non-cardiac conditions are prevalent in patients presenting with suspected STEMI but culprit-free angiogram, some of which may have adverse outcomes. Further imaging of such patients could thus be useful to help in appropriate management and follow-up.
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Affiliation(s)
- Tarun K Mittal
- Department of Cardiology & Cardiac Imaging, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Luise Reichmuth
- Department of Imaging, Mater Dei University Hospital, Malta, Malta
| | - Ben Ariff
- Department of Imaging, Imperial College NHS Healthcare Trust, London, UK
| | - Praveen P G Rao
- Department of Imaging, Glenfield Hospital, University Hospital of Leicester, Leicester, UK
| | - Aigul Baltabaeva
- Department of Cardiology & Cardiac Imaging, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Shelley Rahman-Haley
- Department of Cardiology & Cardiac Imaging, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Tito Kabir
- Department of Cardiology & Cardiac Imaging, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Joyce Wong
- Department of Cardiology & Cardiac Imaging, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Miles Dalby
- Department of Cardiology & Cardiac Imaging, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, UK
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Ng FS, Ariff B, Punjabi PP, Hanna GB, Cousins J, Peters NS, Kanagaratnam P, Lim PB. Pyopneumopericardium Secondary to Pericardioesophageal Fistula After Radiofrequency Ablation of Atrial Fibrillation. JACC Clin Electrophysiol 2016; 2:397-399. [DOI: 10.1016/j.jacep.2015.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/10/2015] [Indexed: 10/22/2022]
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Ruparelia N, Panoulas VF, Frame A, Sutaria N, Ariff B, Gopalan D, Chukwuemeka A, Mikhail GW, Malik IS. Successful Treatment of Very Early Thrombosis of SAPIEN 3 Valve with Direct Oral Anticoagulant Therapy. J Heart Valve Dis 2016; 25:211-213. [PMID: 27989069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Thrombosis of transcatheter aortic valve implantation (TAVI) is an uncommon complication that commonly occurs weeks to months following the procedure. Herein are described the details of a patient who presented with a recurrence of symptoms days after intervention with a bioprosthesis thrombosis that was successfully treated with direct oral anticoagulant (DOAC) therapy and resulted in hemodynamic improvement and resolution of symptoms. Whilst a previous trial of DOAC therapy with mechanical valves was stopped due to elevated events in comparison to warfarin, a TAVI valve may be different, and the rapid onset of action and reduced bleeding risk may be beneficial in this patient group.
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Affiliation(s)
- Neil Ruparelia
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | | | - Angela Frame
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Nilesh Sutaria
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Ben Ariff
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Deepa Gopalan
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | | | - Ghada W Mikhail
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Iqbal S Malik
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
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Jaijee SK, Ariff B, Howard L, O'Regan DP, Gin-Sing W, Davies R, Gibbs JSR. Left main bronchus compression due to main pulmonary artery dilatation in pulmonary hypertension: two case reports. Pulm Circ 2015; 5:723-5. [PMID: 26697180 DOI: 10.1086/683687] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Pulmonary arterial dilatation associated with pulmonary hypertension may result in significant compression of local structures. Left main coronary artery and left recurrent laryngeal nerve compression have been described. Tracheobronchial compression from pulmonary arterial dilatation is rare in adults, and there are no reports in the literature of its occurrence in idiopathic pulmonary arterial hypertension. Compression in infants with congenital heart disease has been well described. We report 2 cases of tracheobronchial compression: first, an adult patient with idiopathic pulmonary arterial hypertension who presents with symptomatic left main bronchus compression, and second, an adult patient with Eisenmenger ventricular septal defect and right-sided aortic arch, with progressive intermedius and right middle lobe bronchi compression in association with enlarged pulmonary arteries.
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Affiliation(s)
- Shareen K Jaijee
- University of Sydney, Camperdown, New South Wales, Australia ; MRC Clinical Sciences Centre, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom
| | - Ben Ariff
- Department of Imaging, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Luke Howard
- Pulmonary Hypertension Service, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Declan P O'Regan
- MRC Clinical Sciences Centre, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom
| | - Wendy Gin-Sing
- Pulmonary Hypertension Service, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Rachel Davies
- Pulmonary Hypertension Service, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - J Simon R Gibbs
- Pulmonary Hypertension Service, Imperial College London, Hammersmith Hospital, London, United Kingdom
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Panoulas VF, Sen S, Frame A, Ariff B, Gopalan D, Mikhail GW, Malik IS. Tackling the bends in transcatheter aortic valve implantation. Int J Cardiol 2015; 201:55-7. [PMID: 26288329 DOI: 10.1016/j.ijcard.2015.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 08/01/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Vasileios F Panoulas
- Cardiovascular Sciences, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK; Cardiology department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
| | - Sayan Sen
- Cardiovascular Sciences, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK; Cardiology department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Angela Frame
- Cardiology department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Ben Ariff
- Radiology department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Deepa Gopalan
- Radiology department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Ghada W Mikhail
- Cardiovascular Sciences, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK; Cardiology department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Iqbal S Malik
- Cardiovascular Sciences, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK; Cardiology department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
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Kim MY, Ng FS, Ariff B, Hanna GB, Whinnett Z, Kanagaratnam P, Tanner M, Lim PB. Extensive Intramural Esophageal Hematoma After Transesophageal Echocardiography During Atrial Fibrillation Ablation. Circulation 2015; 132:1847-9. [PMID: 26553715 DOI: 10.1161/circulationaha.115.016674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Min-young Kim
- From Imperial College Healthcare NHS Trust, London, UK
| | - Fu Siong Ng
- From Imperial College Healthcare NHS Trust, London, UK
| | - Ben Ariff
- From Imperial College Healthcare NHS Trust, London, UK
| | | | | | | | - Mark Tanner
- From Imperial College Healthcare NHS Trust, London, UK
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Tombetti E, Khamis R, Gopalan D, Kiprianos A, Ariff B, Mason J. FRI0250 Coronary CT-Angiography Reveals the Extent of Coronary Artery Disease in Takayasu Arteritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Tombetti E, Zia A, Gopalan D, Kiprianos A, Bechmam K, Ariff B, Mason J. FRI0258 A Novel MRI-Based Longitudinal Scoring System for Arterial Involvement in Large-Vessel Vasculitis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Costopoulos C, Sutaria N, Ariff B, Fertleman M, Malik I, Mikhail GW. Balloon aortic valvuloplasty as a treatment option in the era of transcatheter aortic valve implantation. Expert Rev Cardiovasc Ther 2015; 13:457-60. [PMID: 25865236 DOI: 10.1586/14779072.2015.1036742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Aortic valve stenosis is the commonest encountered valvular pathology and a frequent cause of morbidity and mortality in cases of severe stenosis. Definitive treatment has traditionally been offered in the form of surgical aortic valve replacement in patients with an acceptable surgical risk and more recently with the less invasive transcatheter aortic valve implantation (TAVI) in those where surgery is not a viable option. Prior to the introduction of TAVI, inoperable patients were treated medically and where appropriate with balloon aortic valvuloplasty, a procedure which although effective only provided short-term relief and was associated with high complication rates especially during its infancy. Here we discuss whether balloon aortic valvuloplasty continues to have a role in contemporary clinical practice in an era where significant advances have been achieved in the fields of surgical aortic valve replacement, TAVI and postoperative care.
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Affiliation(s)
- Charis Costopoulos
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
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Koa-Wing M, Jamil-Copley S, Ariff B, Kojodjojo P, Lim PB, Whinnett Z, Rajakulendran S, Malhotra P, Lefroy D, Peters NS, Davies DW, Kanagaratnam P. Haemorrhagic cerebral air embolism from an atrio-oesophageal fistula following atrial fibrillation ablation. Perfusion 2014; 30:484-6. [PMID: 25475690 DOI: 10.1177/0267659114562102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report the case of a man found unconscious three weeks following atrial fibrillation (AF) ablation. Cranial and thoracic imaging demonstrated multiple areas of pneumo-embolic infarction secondary to an atrio-oesophageal fistula (AEF). AEF is a recognised, but rare, complication of AF ablation.(1-8) Early recognition is critical as the mortality is 100% without surgical intervention. We consider the postulated mechanisms of AEF formation, the spectrum of clinical presentation, investigations and treatment.
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Affiliation(s)
- M Koa-Wing
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - S Jamil-Copley
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - B Ariff
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - P Kojodjojo
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - P B Lim
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Z Whinnett
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - S Rajakulendran
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - P Malhotra
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - D Lefroy
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - N S Peters
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - D W Davies
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - P Kanagaratnam
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
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Kanaganayagam GS, Ngo AT, Alsafi A, Kamanahalli R, Sutaria N, Mittal T, Ariff B. CT coronary angiography in the investigation of chest pain — Beyond coronary artery atherosclerosis; A pictorial review. Int J Cardiol 2014; 176:618-29. [DOI: 10.1016/j.ijcard.2014.08.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 07/13/2014] [Accepted: 08/05/2014] [Indexed: 12/26/2022]
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Costopoulos C, Frame A, Mikhail G, Sutaria N, Ariff B, Anderson J, Chukwuemeka A, Malik IS. TCT-747 Cost of transcatheter aortic valve implantation in the real-world: a single-center experience. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Konstantinou K, Pabari P, Sutaria N, O’Regan D, Bhattacharyya S, Keenan N, Chapman N, Ariff B. 123 Comprehensive Cardiovascular MRI for the non-invasive Assessment of Patients with Systemic Hypertension. Heart 2014. [DOI: 10.1136/heartjnl-2014-306118.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Al-Lamee R, Broyd C, Parker J, Davies JE, Mayet J, Sutaria N, Ariff B, Unsworth B, Cousins J, Bicknell C, Anderson J, Malik IS, Chukwuemeka A, Blackman DJ, Moat N, Ludman PF, Francis DP, Mikhail GW. Influence of gender on clinical outcomes following transcatheter aortic valve implantation from the UK transcatheter aortic valve implantation registry and the National Institute for Cardiovascular Outcomes Research. Am J Cardiol 2014; 113:522-8. [PMID: 24326271 DOI: 10.1016/j.amjcard.2013.10.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 10/15/2013] [Accepted: 10/15/2013] [Indexed: 01/09/2023]
Abstract
Gender differences exist in outcomes after percutaneous coronary intervention and coronary artery bypass graft surgery but have yet to be fully explored after transcatheter aortic valve implantation. We aimed to investigate gender differences after transcatheter aortic valve implantation in the UK National Institute for Cardiovascular Outcomes Research registry. A retrospective analysis was performed of Medtronic CoreValve and Edwards SAPIEN implantation in 1,627 patients (756 women) from January 2007 to December 2010. Men had more risk factors: poor left ventricular systolic function (11.9% vs 5.5%, p <0.001), 3-vessel disease (19.4% vs 9.2%, p <0.001), previous myocardial infarction (29.5% vs 13.0%, p <0.001), peripheral vascular disease (32.4% vs 23.3%, p <0.001), and higher logistic EuroSCORE (21.8 ± 14.2% vs 21.0 ± 13.4%, p = 0.046). Thirty-day mortality was 6.3% (confidence interval 4.3% to 7.9%) in women and 7.4% (5.6% to 9.2%) in men and at 1 year, 21.9% (18.7% to 25.1%) and 22.4% (19.4% to 25.4%), respectively. There was no mortality difference: p = 0.331 by log-rank test; hazard ratio for women 0.91 (0.75 to 1.10). Procedural success (96.6% in women vs 96.4% in men, p = 0.889) and 30-day cerebrovascular event rates (3.8% vs 3.7%, p = 0.962) did not differ. Women had more major vascular complications (7.5% vs 4.2%, p = 0.004) and less moderate or severe postprocedural aortic regurgitation (7.5% vs 12.5%, p = 0.001). In conclusion, despite a higher risk profile in men, there was no gender-related mortality difference; however, women had more major vascular complications and less postprocedural moderate or severe aortic regurgitation.
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Pabari P, Konstantinou K, Sutaria N, O'Regan DP, Bhattacharyya S, Keenan NG, Chapman N, Ariff B. Comprehensive cardiovascular MRI in hypertension: a UK single centre experience. J Cardiovasc Magn Reson 2014. [PMCID: PMC4044237 DOI: 10.1186/1532-429x-16-s1-p236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Lee G, Hunter R, Lovell M, Finlay M, Sawhney V, Ullah W, Diab I, Dhinoja M, Earley M, Sporton S, Schilling RJ, Williams SE, Linton NWF, Harrison J, Wright M, O'Neill M, Jamil-Copley S, Linton N, Koa-Wing M, Lim PB, Hayat S, Qureshi N, Whinnett Z, Davies W, Peters N, Francis D, Kanagaratnam P, Jamil-Copley S, Ryan B, Kojodjojo P, Qureshi N, Koa-Wing M, Hayat S, Kyriacou A, Sandler B, Sohaib A, Wright I, Davies W, Peters N, Whinnett Z, Kanagaratnam P, Lim PB, Qureshi NA, Bai W, Ariff B, Williams A, Monro C, Kim S, Jamil-Copley S, Hayat S, Kao-Wing M, Kyriacou A, Sandler B, Fu NS, Kanagaratnam P, Whinnett Z, Davies DW, Lefroy D, Peters NS, Lim PB, Ryan MJ, Ezzat VA, O'Leary J, Bull C, Chow A, Lambiase P, Lowe MD, Anwar AS, Collitt S, Iddon P, Rice N, Dodd M, Dunsdale A, Petkar S, Mudd J, Linker N, Fitzpatrick AP, Fraser S, Choo WK, Padfield G, Rushworth G, Bloe C, Forsyth P, Cross SJ, Leslie SJ, Phan TT, Dewhurst M, Lee D, Williams D, James S, Thornley A, de Belder M, Linker N, Turley A, Campbell NG, Cantor E, Sawhney V, Duncan ER, Demartini C, Baker V, Diab IG, Dhinoja M, Earley MJ, Sporton S, Davies LC, Schilling RJ, Pettit SJ, Randles DA, Shaw M, Hawkins NM, Wright DJ, Lambiase PD, Barr C, Knops R, Neuzil P, Theuns D, Johansen JB, Hood M, Pederson S, Reeve HL, Boersma L. ABSTRACTS FOR ORAL PRESENTATION, SESSION 3, HRC 2013. Europace 2013. [DOI: 10.1093/europace/eut316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fabritz L, Fortmuller L, Vloumidi E, Yue TY, Syeda F, Kirchhof P, Leube R, Krusche C, Chin SH, Winter J, Brack KE, Ng GA, Ng FS, Holzem KM, Koppel AC, Janks D, Wit AL, Peters NS, Efimov IR, Chowdhury RA, El-Harasis MA, Dupont E, Terracciano CMN, Peters NS, Mellor GJ, Raju H, de Noronha SV, Papadakis M, Sharma S, Behr ER, Sheppard MN, Jamil-Copley S, Bai W, Ariff B, Lim PB, Koa-Wing M, Kyriacou A, Hayat S, Sohaib A, Qureshi N, Sandler B, O'Regan D, Whinnett Z, Davies W, Rueckert D, Kanagaratnam P, Peters N, Lambiase PD, Chow AW, Lowe MD, Segal OR, Ahsan S, de Bono J, Dhaliwal M, Mfuko C, Ng A, Sandilands A, Paisey J, Roberts P, Morgan JM, McCready J, Yue A, Ullah W, Hunter R, Lovell M, Dhinoja M, Sporton S, Earley M, Schilling R, Ghosh J, Martin A, Keech A, Chan KH, Gomes S, Singarayar S, McGuire M, Lee G, Hunter R, Berriman T, Diab I, Kamdar R, Richmond L, Baker V, Goromonzi F, Sawhney V, Duncan E, Unsworth B, Mayet J, Abrams D, Dhinoja M, Sporton S, Earley M, Schilling RJ, Bowers RW, Mulholland V, Balasubramaniam RN, Paisey JR, Sopher SM, Chu GS, Chin SH, Winter J, Armstrong S, Masca N, Almeida TP, Brown PD, Sandilands AJ, Schlindwein FS, Ng GA. ABSTRACTS FOR ORAL PRESENTATION, SESSION 2, HRC 2013. Europace 2013. [DOI: 10.1093/europace/eut315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Malcolme-Lawes LC, Juli C, Karim R, Bai W, Quest R, Lim PB, Jamil-Copley S, Kojodjojo P, Ariff B, Davies DW, Rueckert D, Francis DP, Hunter R, Jones D, Boubertakh R, Petersen SE, Schilling R, Kanagaratnam P, Peters NS. Automated analysis of atrial late gadolinium enhancement imaging that correlates with endocardial voltage and clinical outcomes: a 2-center study. Heart Rhythm 2013; 10:1184-91. [PMID: 23685170 PMCID: PMC3734347 DOI: 10.1016/j.hrthm.2013.04.030] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND For late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) assessment of atrial scar to guide management and targeting of ablation in atrial fibrillation (AF), an objective, reproducible method of identifying atrial scar is required. OBJECTIVE To describe an automated method for operator-independent quantification of LGE that correlates with colocated endocardial voltage and clinical outcomes. METHODS LGE CMR imaging was performed at 2 centers, before and 3 months after pulmonary vein isolation for paroxysmal AF (n = 50). A left atrial (LA) surface scar map was constructed by using automated software, expressing intensity as multiples of standard deviation (SD) above blood pool mean. Twenty-one patients underwent endocardial voltage mapping at the time of pulmonary vein isolation (11 were redo procedures). Scar maps and voltage maps were spatially registered to the same magnetic resonance angiography (MRA) segmentation. RESULTS The LGE levels of 3, 4, and 5SDs above blood pool mean were associated with progressively lower bipolar voltages compared to the preceding enhancement level (0.85 ± 0.33, 0.50 ± 0.22, and 0.38 ± 0.28 mV; P = .002, P < .001, and P = .048, respectively). The proportion of atrial surface area classified as scar (ie, >3 SD above blood pool mean) on preablation scans was greater in patients with postablation AF recurrence than those without recurrence (6.6% ± 6.7% vs 3.5% ± 3.0%, P = .032). The LA volume >102 mL was associated with a significantly greater proportion of LA scar (6.4% ± 5.9% vs 3.4% ± 2.2%; P = .007). CONCLUSIONS LA scar quantified automatically by a simple objective method correlates with colocated endocardial voltage. Greater preablation scar is associated with LA dilatation and AF recurrence.
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Affiliation(s)
- L C Malcolme-Lawes
- Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
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Al-Lamee R, Broyd C, Parker J, Davies J, Mayet J, Sutaria N, Ariff B, Unsworth B, Cousins J, Bicknell C, Anderson J, Malik I, Chukwuemeka A, Moat N, Ludman P, Francis D, Mikhail G. TCT-96 Influence Of Gender On Clinical Outcomes Following Transcatheter Aortic Valve Implantation: Results From The UK TAVI Registry On Behalf Of The UK TAVI Steering Group And The National Institute For Cardiovascular Outcomes Research. J Am Coll Cardiol 2012. [DOI: 10.1016/j.jacc.2012.08.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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O’Regan DP, Shi W, Ariff B, Baksi AJ, Durighel G, Rueckert D, Cook SA. Remodeling after acute myocardial infarction: mapping ventricular dilatation using three dimensional CMR image registration. J Cardiovasc Magn Reson 2012; 14:41. [PMID: 22720881 PMCID: PMC3411469 DOI: 10.1186/1532-429x-14-41] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 06/21/2012] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Progressive heart failure due to remodeling is a major cause of morbidity and mortality following myocardial infarction. Conventional clinical imaging measures global volume changes, and currently there is no means of assessing regional myocardial dilatation in relation to ischemic burden. Here we use 3D co-registration of Cardiovascular Magnetic Resonance (CMR) images to assess the long-term effects of ischemia-reperfusion injury on left ventricular structure after acute ST-elevation myocardial infarction (STEMI). METHODS Forty six patients (age range 33-77 years) underwent CMR imaging within 7 days following primary percutaneous coronary intervention (PPCI) for acute STEMI with follow-up at one year. Functional cine imaging and Late Gadolinium Enhancement (LGE) were segmented and co-registered. Local left ventricular wall dilatation was assessed by using intensity-based similarities to track the structural changes in the heart between baseline and follow-up. Results are expressed as means, standard errors and 95% confidence interval (CI) of the difference. RESULTS Local left ventricular remodeling within infarcted myocardium was greater than in non-infarcted myocardium (1.6%±1.0 vs 0.3%±0.9, 95% CI: -2.4% - -0.2%, P=0.02). One-way ANOVA revealed that transmural infarct thickness had a significant effect on the degree of local remodeling at one year (P<0.0001) with greatest wall dilatation observed when infarct transmurality exceeded 50%. Infarct remodeling was more severe when microvascular obstruction (MVO) was present (3.8%±1.3 vs -1.6%±1.4, 95% CI: -9.1% - -1.5%, P=0.007) and when end-diastolic volume had increased by >20% (4.8%±1.4 vs -0.15%±1.2, 95% CI: -8.9% - -0.9%, P=0.017). CONCLUSIONS The severity of ischemic injury has a significant effect on local ventricular wall remodeling with only modest dilatation observed within non-ischemic myocardium. Limitation of chronic remodeling may therefore depend on therapies directed at modulating ischemia-reperfusion injury. CMR co-registration has potential for assessing dynamic changes in ventricular structure in relation to therapeutic interventions.
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Affiliation(s)
- Declan P O’Regan
- Robert Steiner MRI Unit, MRC Clinical Sciences Centre, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Wenzhe Shi
- Department of Computing, Imperial College London, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK
| | - Ben Ariff
- Department of Imaging, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - A John Baksi
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Giuliana Durighel
- Robert Steiner MRI Unit, MRC Clinical Sciences Centre, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Daniel Rueckert
- Department of Computing, Imperial College London, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK
| | - Stuart A Cook
- Robert Steiner MRI Unit, MRC Clinical Sciences Centre, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
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Zerizer I, Al-Nahhas A, Towey D, Tait P, Ariff B, Wasan H, Hatice G, Habib N, Barwick T. The role of early ¹⁸F-FDG PET/CT in prediction of progression-free survival after ⁹⁰Y radioembolization: comparison with RECIST and tumour density criteria. Eur J Nucl Med Mol Imaging 2012; 39:1391-9. [PMID: 22644713 DOI: 10.1007/s00259-012-2149-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 04/30/2012] [Indexed: 01/09/2023]
Abstract
PURPOSE This study evaluated the ability of (18)F-FDG PET/CT imaging to predict early response to (90)Y-radioembolization in comparison with contrast-enhanced CT (CECT) using RECIST and lesion density (Choi) criteria. Progression-free survival (PFS) in patients with liver metastases at 2 years and decline in tumour markers were the primary end-points of the study. METHODS A total of 121 liver lesions were evaluated in 25 patients (14 men, 11 women) with liver-dominant metastatic colorectal cancer who underwent (18)F-FDG PET/CT and CECT before and 6-8 weeks after treatment. Changes in SUV(max), tumour density measured in terms of Hounsfield units and the sum of the longest diameters (LD) were calculated for the target liver lesions in each patient. The patient responses to treatment were categorized using EORTC PET criteria, tumour density criteria (Hounsfield units) and RECIST, and were correlated with the responses of tumour markers and 2-year PFS using Kaplan-Meier plots and the log-rank test for comparison. Multivariate proportional hazards (Cox) regression analysis was performed to assess the effect of relevant prognostic factors on PFS. RESULTS Using (18)F-FDG PET/CT response criteria, 15 patients had a partial response (PR) and 10 patients had stable disease (SD), while using RECIST only 2 patients had a PR and 23 had SD. Two patients had a PR, 21 SD and 2 progressive disease using tumour density criteria. The mean changes in SUV(max), sum of the LDs and tumour density after treatment were 2.9 ± 2.6, 7.3 ± 14.4 mm and 1.9 ± 13.18 HU, respectively. Patients who had a PR on (18)F-FDG PET/CT had a mean decrease of 44.5 % in SUV(max) compared to those with SD who had a decrease of only 10.3 %. The decreases in SUV(max) and sum of the LDs were significant (p < 0.0001, p < 0.05, respectively) while the decrease in tumour density was not (p > 0.1065). The responses on the (18)F-FDG PET/CT studies were highly correlated with the responses of tumour markers (p < 0.0001 for LDH, p = 0.01 for CEA and p = 0.02 for Ca19-9), while the responses on the CECT studies using both RECIST and tumour density criteria were not significantly correlated with the responses of tumour markers. The responses on (18)F-FDG PET/CT studies also significantly predicted PFS (the median PFS in those with a PR was 12.0 months and in those with SD was 5 months, p < 0.0001), while RECIST and tumour density did not significantly predict PFS. Multivariate analysis demonstrated that responses on (18)F-FDG PET/CT studies and decreases in SUV(max) of ≤ 2.0 were the strongest predictors of PFS. CONCLUSION Early response assessment to (90)Y-radioembolization using (18)F-FDG PET/CT is superior to RECIST and tumour density, demonstrating a correlation with tumour markers and significantly predicting PFS in patients with liver metastases. This could enable early response-adapted treatment strategies to be employed.
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Affiliation(s)
- I Zerizer
- Department of Radiology/Nuclear Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK.
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Malcolme-Lawes L, Juli C, Karim R, Bai W, Quest R, Lim PB, Jamil-Copley S, Kojodjojo P, Ariff B, Davies DW, Rueckert D, Hunter R, Boubertakh R, Petersen S, Schilling R, Kanagaratnam P, Peters NS. 050 Automated analysis of atrial delayed enhancement cardiac MRI correlates with voltage, AF recurrence post-ablation, and high stroke risk. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Leong T, Wong J, Rice A, Zidan M, Hamilton A, Ariff B, Chester R, Rahman Haley SL, Kelion A, Burke MM, Mitchell AG, Banner N, Mittal TK. Giant cell myocarditis in the CMR era. J Cardiovasc Magn Reson 2012. [PMCID: PMC3304887 DOI: 10.1186/1532-429x-14-s1-m2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Laurence I, Ariff B, Quest RA, Moser S, Glover A, Taube D, Gishen P, Papalois V, Juli C. Is there a role for free breathing non-contrast steady-state free precession renal MRA imaging for assessing live donors? A preliminary study. Br J Radiol 2012; 85:e448-54. [PMID: 22253354 DOI: 10.1259/bjr/16270927] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Accurate pre-operative evaluation of renal vascular anatomy is essential for successful renal harvest in live donor transplantation. Non-contrast renal MR angiographic (MRA) techniques are potentially well suited to the screening of donors; however, their restricted imaging field of view (FOV) has previously been an important limitation. We sought to assess whether the addition of a large FOV balanced fast field echo (BFFE) steady-state free precession (SSFP) sequence to non-contrast SSFP MRA could overcome this problem. Comparison with contrast-enhanced MRA (CE MRA) and findings at surgery were performed. METHODS 22 potential renal donors each underwent SSFP and CE MRA. 11 out of 22 potential donors subsequently underwent a donor nephrectomy. RESULTS All images were diagnostic. Both SSFP MRA and CE MRA identified an equal number of arteries. Surgery confirmed two accessory renal arteries, both demonstrated with both imaging techniques. A third accessory vessel was identified with both techniques on a kidney contralateral to the donated organ. 6 out of 11 procured kidneys demonstrated early branch arteries at surgery, 5 out of 6 of which had been depicted on both SSFP and CE MRA. The median grading of image quality for main renal arteries was slightly better for CE MRA (p=0.048), but for accessory vessels it was better for SSFP MRA. CONCLUSION This pilot study indicates that by combining free-breathing SSFP MRA with large-FOV bFFE images, an accurate depiction of renal vascular anatomy without the need for intravenous contrast administration can be obtained, as compared with surgical findings and CE MRA.
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Affiliation(s)
- I Laurence
- Radiology Department, Royal United Hospital, Bath, UK.
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O'Regan DP, Ariff B, Neuwirth C, Tan Y, Durighel G, Cook SA. The ischemic area-at-risk on T2-weighted MRI shows recovery of systolic strain at 1 year. J Cardiovasc Magn Reson 2011. [PMCID: PMC3106717 DOI: 10.1186/1532-429x-13-s1-p90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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O'Regan DP, Ariff B, Neuwirth C, Tan Y, Durighel G, Cook SA. Assessment of severe reperfusion injury with T2* cardiac MRI in patients with acute myocardial infarction. Heart 2010; 96:1885-91. [PMID: 20965977 DOI: 10.1136/hrt.2010.200634] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In patients with acute myocardial infarction, restoration of coronary flow by primary coronary intervention (PCI) can lead to profound ischaemia-reperfusion injury with detrimental effects on myocardial salvage. Non-invasive assessment of interstitial myocardial haemorrhage by T2* cardiac MRI (T2*-CMR) provides a novel and specific biomarker of severe reperfusion injury which may be of prognostic value. OBJECTIVE To characterise the determinants of acute ischaemia-reperfusion injury following ST elevation myocardial infarction (STEMI) using CMR. METHODS AND RESULTS Fifty patients with acute STEMI who had been successfully treated by PCI were studied. T2*-CMR was used to identify the presence of reperfusion haemorrhage and contrast enhancement was used to measure microvascular obstruction (MVO) and infarct size. Haemorrhagic ischaemia-reperfusion injury was present in 29 patients (58%) following PCI and occurred despite rapid revascularisation (mean 4.2±3.3 h). Haemorrhage was only present when the infarct involved at least 80% (mean±SD 91±5.3%) of the left ventricular wall thickness. There was a strong association between the extent of MVO and reperfusion haemorrhage (r(2)=0.87, p<0.001). Transmural infarcts (n=43) showed significantly impaired systolic wall thickening at the infarct mid point when reperfusion haemorrhage was present (21.5±16.7% vs 3.7±12.9%), p<0.0001) compared with non-haemorrhagic infarcts. CONCLUSIONS Severe reperfusion injury may occur when there is near-transmural myocardial necrosis despite early and successful revascularisation. Reperfusion haemorrhage is closely associated with the development of MVO. These findings indicate that, once advanced necrosis has developed, the potential for severe myocardial reperfusion injury is significantly enhanced.
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Affiliation(s)
- Declan P O'Regan
- MRC Clinical Sciences Centre, Robert Steiner MRI Unit, Faculty of Medicine, Imperial College, Hammersmith Hospital Campus, Du Cane Road, London, UK.
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Abstract
Improvements in imaging technology allow exploitation of the dual blood supply of the liver to aid in the identification and characterisation of both malignant and benign liver lesions. Imaging techniques available include contrast enhanced ultrasound, computed tomography and magnetic resonance imaging. This review discusses the application of several imaging techniques in the diagnosis and staging of both hepatocellular carcinoma and cholangiocarcinoma and outlines certain characteristics of benign liver lesions. The advantages of each imaging technique are highlighted, while underscoring the potential pitfalls and limitations of each imaging modality.
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Ariff B, Glor F, Crowe L, Xu Y, Vennart W, Firmin D, Thom S, Hughes A. P4.03 SUB-ACUTE EFFECTS OF BLOOD PRESSURE LOWERING WITH AMLODIPINE OR LISINOPRIL ON LOCAL CAROTID ARTERY HAEMODYNAMICS. Artery Res 2009. [DOI: 10.1016/j.artres.2009.10.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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